Thursday, May 22, 2008

Klinefelter's, Turner's, and Pregnant Men

Are you a girl or a boy? Are you a boy or a girl? --Le Tigre, "On Guard"
OK, let's say from the beginning that I'm going to be as careful and sensitive as I can be, and that I'm still probably going to misstep and say something wrong. But, in light of the recent spate of publicity for the pregnant man who appeared on Oprah, I thought it might be a good idea to talk about sex/gender from both a medical and a feminist studies perspective--because I really wish those two perspectives were cozier, anyway. Yes, I'm talking to you, male pediatrician who told me when I was 11 that my debilitating made-me-vomit cramps were 'in my head' and that PMS has been collectively imagined by whiny women since the dawn of time. So I'm going to try to be careful with the pronouns and definitions, and if I say something totally out of line feel free to take me to school in the comments, but give me a little slack.

OK. Gender and sex, as anyone who's taken a women's studies class can tell you, aren't the same. Gender is largely socially constructed--how men and women are supposed to act, dress, talk, and so on. Sex is thought of as biological--male or female rather than man or woman--but of course since biology is a 'constructed' discipline, you can't really get to PURE biology, as evidenced by the intransigent (nice word, huh?) difficulty in answering what "should" be a very simple question: How do we define sex, biologically? Well, here are some of the answers--and some of the problems with those answers:
1. According to chromosomes--two Xs make a female, and XY means you're a guy. OK, I guess, but what about people with Turner's syndrome? They have only one X chromosome, no other X or Y. Their genitals are externally "female," and most have uteruses, but ovaries are underdeveloped and since estrogen isn't produced in quantity, secondary sexual characteristics (breasts, menstruation, etc) don't happen. A person with an XXY karyotype (a 50 dollar word for what chromosomes someone has), or Klinefelter's syndrome, should be female too then, right? No, that person 'looks' male--the only tip-offs to the chromosomal hanky-panky are "michroorchidism," ie small testicles, low testosterone, and sterility. Crap. And then there's androgen insensitivity syndrome, where someone has XY chromosomes but, because their cells aren't sensitive to male hormones, they develop into what we'd call "females" at birth. Nothing much happens at puberty--in part because they have testes rather than ovaries or a uterus in the pelvic cavity (the testes should usually be removed, because hanging out inside the body increases the risk of testicular cancer), and in part because the cells aren't sensitive to androgens, and those are the hormones that get the party started (with body hair especially) at puberty. Hmmm.
2. Ok, not chromosomes--what about just using the body? The whole "girls have vaginas..." thing we learned in kindergarten? Yeah, about that. Aside from the exceptions listed above, there's such a thing as being "intersexed," or born with "ambiguous genitalia"--not clearly fish or fowl, you might say. According to the Intersex Society of North America, about 1% of people are intersexed to some degree. A lot of times these people are 'sexually assigned' shortly after birth--a baby with an 'enlarged' clitoris has it cut to 'normal size' (which of course does away with the ability to orgasm a lot of times--gee, thanks, Doc), or a small penis is refashioned into a clitoris. Needless to say, the sex these people are assigned, since they're not doing the assigning, doesn't always line up with what they feel later in life. There's a lot a mental anguish associated with this, not to mention dealing with the fact that your genitals were carved up when you were a kid. Seriously, go to ISNA's website and find out more about it; it's a silent outrage that surgeons are wielding their knives this way. Even though the rationale is often to save the patient "the pain of being different," it's misplaced and often harmful treatment.
3. OK, fine--chromosomes don't always do it and neither do bodies/genitals...what about hormone levels? Well, Klinefelter's and Turner's patients have levels of hormones that often don't fall clearly into male or female territory...not to mention the fact that postmenopausal females and preadolescents have very different hormone levels from reproductive aged men and women. So is a postmenopausal female not female because she doesn't make as much estrogen as she used to? Does picking up a Premarin prescription suddenly make her a chick again? If my friend Steve starts popping estrogen like Mentos, does that make him female?

Clearly this is a complicated question, one that no single factor accounts for and that no one person can answer definitively. Sex, perhaps just as much as gender, depends on a lot of factors--not least the way the person identifies him or herself. Which is why, if that guy in Cali says he's a pregnant man, I believe him. Biology may have a lot of say, but biology is still not destiny.


Anonymous said...

Very interesting. Why can't we let people be what they say they are? Why do we have to be in somebody's business?

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AtYourCervix said...

Interesting thoughts. My sister had Turner's syndrome. (now deceased from a car accident)