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Between The Sexes (Intersex Children)
Time Magazine ^ | 02.27.04 | Christine Gorman and Wendy Cole

Posted on 02/27/2004 11:12:18 AM PST by Cathryn Crawford

In 1993 Debbie Hartman was sure she was hearing things in her hospital room. She had just undergone a caesarean section, and the doctors were saying the baby was healthy but they weren't sure whether it was a boy or a girl. "I thought the drugs were making me hallucinate," she recalls. In fact, she was hearing just fine. But nothing about her child's biology — from the chromosomes to the reproductive tissue — conformed to the standard demarcations we have come to expect between the male and female sexes. In the language of developmental biologists, the baby was "intersexual."

Careful examination showed that the infant had one testis, what looked like a small penis and no uterus or vagina. Genetic tests did not make things any clearer: some of the child's cells contained the XX chromosome pairing typically seen in girls, others contained the XY pattern seen in boys, and some had but a single X chromosome, commonly seen in girls with a condition called Turner syndrome.

Technically speaking, the Hartman baby was a true hermaphrodite. Scientists don't know how this happens, but one possible explanation is that two eggs are fertilized in the womb — one XX and the other XY — but rather than developing separately into twins, the zygotes merge to become one embryo. At any rate, "hermaphrodite" is not one of the options available on a birth certificate, so the Hartmans' doctors struggled to figure out which sex was more appropriate for the child. Meanwhile, Debbie's sister and mother told relatives and friends not to send anything pink or blue. "They said yellow or green," Hartman recalls. "Or better yet, just send a card."

After two weeks, the doctors decided the baby was a boy. Debbie and her husband — they have since divorced — named their son Kyle and took him home. Debbie quickly dubbed her little guy Mr. Man and Slugger. When Kyle was 11 weeks old, however, he developed a hernia that required surgery. Midway through the operation, four doctors came to the waiting room, and one of them told Kyle's parents that "your child is in fact a girl." The surgical team had found rudimentary ovarian and Fallopian-tube tissue in Kyle's body.

In some ways, this latest turn of events was even more upsetting and confusing than the birth. But the physician's recommendation was clear: the vestigial ovarian and Fallopian-tube tissue and the testis should be removed at once, while the child was still under anesthesia. Otherwise the tissue could become cancerous. "All I could hear was cancer, cancer, cancer," Debbie says. So she and her husband consented to the operation. (The phallus, which doctors eventually renamed a clitoris, was surgically reduced two years later.) The next day the Hartmans took home their recovering infant, whom they quickly renamed Kelli. The family held a second baby shower, and boyish clothing was replaced with lacy pink dresses and other feminine attire.

Kelli went on to have three more surgeries to construct female-looking genitalia. But the matter wasn't settled. At the age of 4, she started asking, "Mommy, am I a boy or a girl?" When she was 6, she questioned her mother about all her surgical scars, and when Kelli was 8, her mother told her the whole story.

The truth came as a relief, although Kelli, now 10, is still grappling with the significance of gender in her life. A stocky, surefooted kid whose interests range from gardening and landscaping to marble collecting and woodworking, Kelli suffers from attention-deficit/hyperactivity disorder, which, she says, actually makes her feel more self-conscious than being intersexual. When asked what she wants to be when she grows up, she replies, "A carpenter. Maybe I'll be a male carpenter." Why a male carpenter? "Because I'd be taken more seriously."

True hermaphrodites like Kelli are thought to be quite rare. But less extreme cases of intersexuality occur more often than you might think. One estimate from a scientific review published in 2000 is that they represent 0.2% to 2% of live births. About 30 genetic and hormonal conditions can give rise to intersexuality, leading, in some folks, to an obvious mixture of male and female sex traits. In others the variation is far less noticeable, producing, for example, the premature development of body hair. Indeed, many intersexuals probably live their whole lives as men or women without ever suspecting the complexity of their nature.

For years doctors believed that the best treatment for an obviously intersexual newborn was a swift one. The reproductive system and genitalia were surgically refashioned to conform to one sex or the other. (In practice, this often meant deciding that the child should be a girl because, in the indelicate phrasing of the surgical world, "it's easier to make a hole than build a pole.") The goal was to minimize the amount of time the child spent with a nonstandard body in the hope that he or she would find it easier to develop a conventional sense of gender. As in Kelli's case, there was also concern that "extraneous" reproductive tissues might be more likely to become malignant.

In recent years, however, the need for swift and irreversible intervention has been called into question. Adult intersexuals are stepping from the shadows to talk about their experiences, including the harmful effects they attribute to extensive childhood surgery. Some complain that they were assigned the wrong sex at birth. Others are more upset about the secrecy and shame their condition often elicited from their family. There is growing evidence that such surgery can interfere with the ability to achieve sexual gratification, that it can cause chronic incontinence and that the cancer risk may be exaggerated.

As these issues have emerged, the American Academy of Pediatrics (A.A.P.) has begun to reconsider its policy of endorsing early surgery for intersexuals. Dr. Ian Aaronson, a professor of urology and pediatrics at the Medical University of South Carolina, who helped write the A.A.P. guidelines, is coordinating what he hopes will be the largest-ever follow-up study of intersexuals to see what effects, good or bad, surgery has had on their emotional, psychological and sexual well-being.

Nobody is arguing that babies should be raised without a gender identity, says Dr. Bruce Wilson, a pediatric endocrinologist at DeVos Children's Hospital in Grand Rapids, Mich. "Those decisions should be made reasonably quickly, within a few days," he believes. But in his view and that of a growing number of other doctors, surgery can often be postponed until closer to puberty or even later, when the child can more effectively participate in the decision and help ensure that the surgically fashioned gender fits the child's subjective sense of self.

There is a larger social issue to consider. Despite the many changes in gender roles in recent decades, our society is still fixed on the idea that there are just two separate sexes. Is the rush to early surgery a matter of medical necessity, or is it a matter of social bias that leaves doctors and parents uncomfortable with nonstandard genitalia? It's a question that more intersexuals are raising. "Doctors have found a medical solution to what is essentially a social problem," insists Thea Hillman, board member of the advocacy group Intersex Society of North America www.isna.org). "The problem has to do with differences and people's fear of differences."

Yet postponing surgery would carry its own burdens. "When children become aware of their body image at age 2 or 3 and compare their anatomy with others', questions are raised about the potential for psychological harm through their childhood," Aaronson says.

Either way, the decision to operate soon after birth isn't easy. In retrospect, Kelli's mom thinks she might have waited. "Parents can help their kids live with genitals that are different," she says. On the other hand, she acknowledges, postponing surgery might have been difficult too. "If we had left Kyle as Kyle, I'm convinced he would have felt feminine at times."

Part of what makes the decision so complex is that even when the chromosomes present a clear message on gender, anatomy may contradict it. Consider Sherri, a 45-year-old tax attorney from San Diego. Although her sex chromosomes are unambiguously XY, there is no doubt that she is a woman. Sherri has androgen-insensitivity syndrome (AIS), a condition that affects prenatal development. All embryos start out with the rudiments of male and female reproductive systems. A sort of developmental tug-of-war ensues until, generally speaking, the male reproductive system predominates in XY fetuses and the female in XX fetuses. The external male genitalia will not take shape in an XY fetus, however, until after the embryonic testes form and begin to produce testosterone.

AIS occurs when a gene on the X chromosome prevents the fetus from responding to that prenatal testosterone. Because the genitalia cannot be masculinized, they assume a more female structure. But that's not all. In the complete form of AIS, the body cannot respond to testosterone at all and the baby develops as a female, although without a functioning reproductive system. When Sherri was 11, she was told that she could never bear children because she had been born with "twisted ovaries" that had to be removed when she was a baby. In fact, the "ovaries" were her testes. "No one ever explained to me what my medical condition was," Sherri says.

The secrecy that surrounds intersexuality may be the most damaging thing about it. Julanne Tutty, a 35-year-old assistant deli manager in a Boston supermarket, didn't learn she was intersexual until she was 31. During a routine visit to her doctor's office, she became curious about her voluminous medical records and decided to sneak a peek. They indicated her chromosomes are all XY, yet she was born with an internal vagina, two testes and a "flattened stump" for a penis. "I was stunned," she says. Eventually Tutty got a copy of her medical records. "It was like getting the missing piece of a jigsaw puzzle."

Tutty's parents never told her she had undergone surgery as an infant to make her more female in appearance. Looking back, she thinks they made the right decision but wishes they had been more forthcoming. Since discovering her intersexuality, Tutty has decided to stop dating men. "I had this fear that if the truth about me came out, things could get ugly," she says. For nearly a year, she has been happily involved with a woman. "Things have turned out well for me," Tutty says. "A lot of intersex people never feel O.K. in relationships or even find partners."

Relationships are one thing, but even everyday paperwork can be a problem. Elijah Hobbs, 26, was raised as a girl in Cicero, Ind. At puberty, his body developed both feminine and masculine features — breasts but broad shoulders and a deep voice. It became more difficult to pass as a girl, and Hobbs eventually came to think of himself as male. At 24, he legally changed his sex to male, and in January he underwent surgery to have his breasts and ovaries removed. To get medical coverage, he told his insurance company he was a woman. After all, what guy would require these operations?

Elijah, Julanne and Sherri all would have found life easier if less embarrassment and secrecy were associated with their condition. That's a goal the Intersex Society is working toward. Meanwhile, scientists hope that more sophisticated testing will eventually help doctors and families make more informed choices about how to treat intersexuals. New research on the genetics of sexual development shows, for example, that several of the genes that influence sex are not even located on the X or Y chromosomes. What it all boils down to, says Dr. Eric Vilain, a professor of human genetics, pediatrics and urology at UCLA, is that the roots of gender identity are much more complex than anyone thought. But Kelli could have told them that.


TOPICS: Culture/Society; Front Page News
KEYWORDS: biologicalmistake; genetics; hermaphrodites; homosexualagenda; intersexual
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1 posted on 02/27/2004 11:12:18 AM PST by Cathryn Crawford
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To: Cathryn Crawford
I say this is using biologically-unique individuals for the trans-sexual agenda. Sickening...
2 posted on 02/27/2004 11:17:27 AM PST by Pyro7480 ("We are all born ignorant, but one must work hard to remain stupid" - Benjamin Franklin)
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To: Cathryn Crawford
Jeffrey Eugenides' Pulitzer Prize winning novel "Middlesex" dealt with this issue. It was about Calliope Stephanides, who appeared to be a girl, but at puberty, started developing masculine features. Eventually, she decided to live as a man. (This doesn't ruin the book. It's all at the start. What's interesting is why it happened and how he/she discovered it.) It's an excellent read.
3 posted on 02/27/2004 11:20:36 AM PST by TedsGarage
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To: Cathryn Crawford
Holy Intersexual experiences! This is confusing and sickening.
4 posted on 02/27/2004 11:20:39 AM PST by writer33 (The U.S. Constitution defines a Conservative)
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To: Cathryn Crawford
Although her sex chromosomes are unambiguously XY, there is no doubt that she is a woman.

I doubt it. She is a disfigured man.

5 posted on 02/27/2004 11:23:30 AM PST by Sloth (We cannot defeat foreign enemies of the Constitution if we yield to the domestic ones.)
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To: Cathryn Crawford
At the age of 4, she started asking, "Mommy, am I a boy or a girl?"

This line is so sad. Poor kid :<
6 posted on 02/27/2004 11:27:16 AM PST by KantianBurke (Principles, not blind loyalty)
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To: Sloth
It's not quite that simple. I read a medical journal recently about a XY mosaic woman who gave birth to a healthy baby.
7 posted on 02/27/2004 11:29:11 AM PST by ahayes
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To: Sloth
Have trouble reading? Your quote refers to an entirely different person that the one featured in the article.
8 posted on 02/27/2004 11:30:29 AM PST by js1138
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To: Cathryn Crawford
May God bless that unfortunate child and all who care for her.
9 posted on 02/27/2004 11:33:11 AM PST by Ronaldus Magnus
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To: js1138
Did you read the entire article?
10 posted on 02/27/2004 11:33:41 AM PST by Sloth (We cannot defeat foreign enemies of the Constitution if we yield to the domestic ones.)
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To: Pyro7480
I say this is using biologically-unique individuals for the trans-sexual agenda. Sickening...

No, anyone who takes graduate level biochemistry or medical courses is quite familiar with this phenomenon.
11 posted on 02/27/2004 11:35:31 AM PST by aruanan
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To: John O
About 30 genetic and hormonal conditions can give rise to intersexuality, leading, in some folks, to an obvious mixture of male and female sex traits.

Ping, this is some of what I was trying to tell you in my posts to you.

12 posted on 02/27/2004 11:35:34 AM PST by Paul C. Jesup
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To: Cathryn Crawford
What it all boils down to, says Dr. Eric Vilain, a professor of human genetics, pediatrics and urology at UCLA, is that the roots of gender identity are much more complex than anyone thought.

No it's not. These are examples of birth defects. Are we to believe that "human identity is much more complex than anyone thought" because some are born without a limb, with spina bifida, or dwarfism? Of course not.

It's wrong and insulting to use exceptions to push a political agenda.

13 posted on 02/27/2004 11:37:14 AM PST by anniegetyourgun
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To: ahayes
Interesting, that is really rare. What medical journal did you read that out of?
14 posted on 02/27/2004 11:37:30 AM PST by Paul C. Jesup
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To: KantianBurke
:-(
15 posted on 02/27/2004 11:38:58 AM PST by Huck (OK. I'm over it.)
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To: anniegetyourgun
(sarcasm) Do you also believe the feminist dogma that there is no difference between the brains of men and women.
16 posted on 02/27/2004 11:39:18 AM PST by Paul C. Jesup
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To: KantianBurke
I was once vaguely acquainted with a 40+ year old college student who was born a hermaphrodite. Her father wanted a son and insisted she be raised as a boy. Her mother didn't dare raise any objections to the domineering dad's decrees, but the then-child definitely felt like a girl and wanted to be one. Dad forced medical treatments aimed at making him/her a him, which made the final result she achieved as a her much less normal looking than would originally have been possible. In high school, she left home every day dressed as a boy since dad insisted, and a sympathetic school counselor met her a couple of blocks away in a car, where the boy/girl changed clothes in order to arrive at school as a girl. It took her a long long time to get her head together, but in early forties she was finally in college and amazingly well-adjusted. All things considered, I found it rather miraculous that she didn't grow up to be serial killer.
17 posted on 02/27/2004 11:41:51 AM PST by GovernmentShrinker
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To: Paul C. Jesup
(No sarcasm) Having read brain and NLP studies, I know better.
18 posted on 02/27/2004 11:42:07 AM PST by anniegetyourgun
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To: Sloth
I find your use of the term "disfigured" to be offensive and medically innaccurate. Genderis usually determined by chrosomes, but it can be altered in the fetus by hormones, and sometimes by other chemicals. People affected by this are not disfigured.
19 posted on 02/27/2004 11:43:39 AM PST by js1138
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To: KantianBurke
Sounds like a really, really smart and alert child.
20 posted on 02/27/2004 11:43:59 AM PST by krb (the statement on the other side of this tagline is false)
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To: anniegetyourgun
Check out the BSTc region study on brains.
21 posted on 02/27/2004 11:44:01 AM PST by Paul C. Jesup
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To: Pyro7480
Bullseye. While we can feel sorry for the unfortunate people in the article, it is no excuse for perversion. Separate issues.
22 posted on 02/27/2004 11:44:53 AM PST by watchin
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To: ahayes
And then there was the mosaic woman who gave birth to a baby who was genetically her sister's offspring. Seems her fraternal twin sister had merged with her in utero, and most of the absorbed sister had turned into the surviving sister's ovaries.
23 posted on 02/27/2004 11:45:39 AM PST by GovernmentShrinker
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To: Paul C. Jesup
thanks for the ping.
24 posted on 02/27/2004 11:45:53 AM PST by John O (God Save America (Please))
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To: John O
Your welcome.
25 posted on 02/27/2004 11:46:30 AM PST by Paul C. Jesup
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To: aruanan
Yeah, I am familiar with this too. It was in a textbook that I saw in the college bookstore that I worked in. Given the publication that this was published in, I think this is political.
26 posted on 02/27/2004 11:48:31 AM PST by Pyro7480 ("We are all born ignorant, but one must work hard to remain stupid" - Benjamin Franklin)
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To: Cathryn Crawford

Carolyn Cossey: Started life as a "boy," later appeared nude in Playboy....

27 posted on 02/27/2004 11:48:46 AM PST by r9etb
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To: Cathryn Crawford
Evolution's diversity at work.

An article that demonstrates the difficulty in life of dealing with what is within a construct of what ought and questioning why on both counts.

The more you learn, the less you know.

28 posted on 02/27/2004 11:52:49 AM PST by optimistically_conservative (If consistency is the hobgoblin of small minds, John F. Kerry’s mind must be freaking enormous. T.B.)
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To: Paul C. Jesup
sad birth defects. Eventually we'll find a way to prevent them. Of course dealing with those who suffer with these conditions now is a tricky problem. No easy answer I'd suppose.
29 posted on 02/27/2004 11:53:11 AM PST by John O (God Save America (Please))
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To: John O
sad birth defects. Eventually we'll find a way to prevent them. Of course dealing with those who suffer with these conditions now is a tricky problem. No easy answer I'd suppose.

Not as cut and dry as you originally thought.

30 posted on 02/27/2004 11:54:26 AM PST by Paul C. Jesup
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To: js1138
>>People affected by this are not disfigured

Are they reproductively viable without medical intervention?

What is the net effect of reproductive fitness on groups containing a high incidence of this mutation?
31 posted on 02/27/2004 11:55:13 AM PST by VxH (This species has amused itself to death.)
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To: TedsGarage
I read "Middlesex" as well and became very sympathetic towards the people who aren't either a girl or boy. It's an aweful way to live. At birth, a doctor chooses what the sex is, and in turn takes away the "feeling" down there....many aren't able to feel any sexual stimulation because it's been surgically removed. They grow up in a society that categorizes if you are a girl or a boy but what if you have the hormones for both? How confusing that would be. Although I have very conservative views, I couldn't help but put myself in the person's place. They were born with a physical deformity and the consequences of that are devastating. Everyone should read "Middlesex".
32 posted on 02/27/2004 11:56:03 AM PST by sonserae
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To: Paul C. Jesup
Not as cut and dry as you originally thought.

No. my original contention is still cut and dried. Gender is determined by Chromosomes. However, just like the previously mentioned spina bifida et al birth defects happen and need to be dealt with. Marriage is between a woman (XX) and a man (XY).

33 posted on 02/27/2004 11:59:18 AM PST by John O (God Save America (Please))
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To: John O
I took lots of endocrinology and physio-psych back in the day. Such conditions are rare, though not outrageously so, and must be heartbreaking to parents. We're talking about a fundamental characteristic of identity, and it's ambiguous. And I don't think anyone could comprehend what goes through the mind of an individual who lives with such ambiguity.
34 posted on 02/27/2004 12:06:53 PM PST by Mr. Bird
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To: Paul C. Jesup
Well, I haven't found that original article yet, but I found two other cases:

"Chimerism in a woman with a 46,XY karyotype and female phenotype," Human Reproduction, 2001, 16, 56-58.

"Demonstration of spontaneous XX/XY chimerism by DNA fingerprinting," Human Genetics, 1989, 82, 197-198.

I didn't read the second article (published too early to be online) but the first involves a woman with a normal reproductive system but some of her tissues have XX cells and some XY. She had a baby at 17 and was seeing the doctor because of infertility (unrelated). This article references the other case and says that in that case the woman had XY cells identical genetically to her twin brother's. They don't say if she had children, but said she was phenotypically normal.

The article I'm looking for is even more interesting because the woman had one normal ovary and the other had a mixture of XX ovarian and XY testicular tissue.

35 posted on 02/27/2004 12:07:31 PM PST by ahayes
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To: VxH
I don't think this is a mutation in the usual sense of the word, although I would defer to the biologists on this one. I do know from my background in special education that people with anomalous chrosomes are usually, but not always, sterile.

Sex is not always fixed in animals. The clownfish father in "Finding Nemo" would, in real life, have turned into a female upon the death of his mate.
36 posted on 02/27/2004 12:07:42 PM PST by js1138
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To: John O
What part of "hormonal conditions" did not understand.
37 posted on 02/27/2004 12:08:07 PM PST by Paul C. Jesup
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To: John O
What part of "hormonal conditions" did you not understand.
38 posted on 02/27/2004 12:08:16 PM PST by Paul C. Jesup
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To: ahayes
Yea, I heard about that a couple of months ago. Thanks
39 posted on 02/27/2004 12:09:11 PM PST by Paul C. Jesup
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To: VxH
Are they reproductively viable without medical intervention?

Many who have these conditions have what is called "streaked" gonads; meaning they are not functional. The androgen insensitivity syndrome will cause this, as will it's converse, fetal androgen syndrome, which is when female embryos are affected by testosterone from a fraternal (boy) twin.

The short answer to your question is that the truly complex cases are not able to reproduce, with or without medical intervention.

40 posted on 02/27/2004 12:11:20 PM PST by Mr. Bird
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To: KantianBurke
"Mommy, am I a boy or a girl?"

Typical two-party system reasoning. Always X or Y, never Z.

41 posted on 02/27/2004 12:14:03 PM PST by Sender ("This is the most important election in the history of the world." -DU)
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To: VxH
If you know any cattle farmers, ask them about freemartins. It's the cow equivalent to this discussion.
42 posted on 02/27/2004 12:15:17 PM PST by Mr. Bird
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To: Paul C. Jesup
Found it!

"Pregnancy in a Woman with a Y Chromosome after Removal of an Ovarian Dysgerminoma," Gynecologic Oncology, 79, 519-521 (2000).

The woman developed a tumor in one ovary (common in woman with chimeric ovaries) and it was removed and she received chemotherapy. They found a mixture of ovarian and testicular tissue in the cancerous ovary. The other ovary appeared normal. They did a karyotype and found she had a 20% 46,XX/80% 46,XY genotype. They suggested she have her other ovary removed, but she wanted to keep it in spite of possible future cancer. Nine months after surgery she got pregnant and gave birth to a normal baby boy.

43 posted on 02/27/2004 12:25:26 PM PST by ahayes
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To: js1138; VxH
I recall reading years ago about a case (in Russia, I think) of an intersexed person who had both fathered a child, and given birth to one.
44 posted on 02/27/2004 12:27:28 PM PST by GovernmentShrinker
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To: js1138
>>I don't think this is a mutation in the usual sense of the word,

All genetic traits are mutations.
45 posted on 02/27/2004 12:28:18 PM PST by VxH (This species has amused itself to death.)
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To: VxH
All genetic traits are mutations.

What can I say to that?

46 posted on 02/27/2004 12:31:20 PM PST by js1138
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To: Cathryn Crawford
I thought a true hermaphrodite.....basically only urban legand....was where someone had a functioning penis and vagina and uterus/fallopians/ovaries.

The poor child in question here seems to me to have been a biologically compromised male.
47 posted on 02/27/2004 12:32:05 PM PST by wardaddy (A man better believe in something or he'll fall for anything.)
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To: Paul C. Jesup
What part of "hormonal conditions" did you not understand.

And what causes hormnonal conditions? XX and XY. Of course sometimes they go awry but the blueprints for biology are always the genes. (The testicles develop because they are programmed to develop in the genes. then they produce testosterone. Hormones always follow genes)

48 posted on 02/27/2004 12:36:30 PM PST by John O (God Save America (Please))
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To: Sender
>>Typical two-party system reasoning. Always X or Y, never Z.


Typical Socialist reasoning: Steal reproductive resources from X and Y so that deviant Z can reproduce.
49 posted on 02/27/2004 12:38:43 PM PST by VxH (This species has amused itself to death.)
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To: Mr. Bird
>> the truly complex cases are not able to reproduce, with or without medical intervention.

Let's take the "less" complex examples which ~are able to reproduce with medical intervention.

Should members of society who do not have this genetic mutation be forced to expend reproductive resources so that the mutant genome can reproduce?

50 posted on 02/27/2004 12:46:06 PM PST by VxH (This species has amused itself to death.)
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