R i g h t a r d i a: A person's sex is not always so clear cut

Sunday, August 23, 2009

A person's sex is not always so clear cut

Is South African runner Caster Semenya a boy or girl? The runner is undergoing gender testing required by the International Association of Athletics Federations (IAAF), and some say it's only because she's black and from a Third World country.

It's the first question any parent asks after the birth of their child: is it a girl or a boy? In some rare cases, the doctor may not know.

There are babies born who, left to grow up without medical intervention, will be intersex. They have been called hermaphrodites, pseudohermaphrodites and intersex children.

Some doctors now prefer to speak of sex development disorders, because they believe such a disorder can often be put right.

However, many doctors suggest that it is best to let the child's sexuality emerge naturally in adolescence. The doctor may make the wrong decision and perform inappropriate surgery or provide the wrong hormone treatment.

In the past such babies were sometimes subjected to early interventional surgery. Others will never have been detected or will have chosen to go through life without seeking medical help with little chance of ever having a child themselves.

Some, may have athletic potential because of their unusual strength. At the Atlanta Olympics in 1996 eight female athletes failed sex tests but were cleared on appeal and seven of them were found to have physically developed as neither fully female nor male.

The IAAF is going to muster a host of experts to decide whether Caster Semenya is a man or a woman. According to Professor Wiebke Arlt, professor of medicine at Birmingham University, the question of which is the most appropriate sex when a child is born is a relatively straightforward one.

Other doctors would disagree and suggest the brain has to do more with sexuality than appearances and that Caster Semenya's sex will be difficult to determine.

Aside from very rare exceptions, all of us have 46 chromosomes, plus the pair which, in most cases, decides our sex either the X or Y chromosome. Sometimes there is a mismatch between the body's male and female hormones and those key chromosomes. There are women who are born with both and X and and Y (XY) chromosomes rather than the typical two X chromosomes (XX).

One of the more common disorders but which only occurs in one in 15,000 births, women who technically were born male. There has also been unsubstantiated speculation that some famous lesbian and bi-sexual actresses had this disorder. There are also women born with extra X and Y chromosomes (XXX) and (XXY).

Their chromosomes are 46,XY and they have male hormones, but those hormones cannot act because of a mutation in the protein to which they are supposed to bind. "They would look and behave like a girl," said Arlt. "Many models and film stars have this disorder. These women are very tall, slender and beautiful.

"They usually find out because their period doesn't start. They do not have a uterus . . . They have testicles in the abdomen which must be removed or they can become cancerous. Apart from the fact that they can't bear children, these women are completely female. If sex testing were limited to chromosomes, they would be declared male," said Arlt.

At the other end of the spectrum are those who are 46,XX and should be female, but have too much action from male hormones, because of a deficiency of the stress hormone, cortisol.

Newsy.com looks at the controversy surrounding Caster Semenya.