11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).key

A Biblical ,Medical ,Scientific and Historical View
-Antonio Bernard

THE LGBT MOVEMENT
Part 11

Ambiguous Genitalia
INTERSEX HERMAPHRODITES
DISORDERS OF SEX
DEVELOPMENT (DSD)

Are there only two sexes?

A generation ago, this might have seemed like a silly question. But given the rise of
gender theory, transgenderism, intersexuality, and all of their related phenomena,
the question now appears to be both complex and pressing. . .
- Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes"
JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/


What differentiates human males from human females? Is it the number of sex chromosomes?
Is it the possession of the appropriate sex organs? Is it the amount of testosterone or estrogen?
The difficulty is that none of these standards always works: some individuals are born with
extra chromosomes, such as XXYY or XYY. Some individuals are born with both pairs of
sex organs. Some females have higher testosterone levels than many men.

“GENETIC DISORDERS”
“Chromosomal and hormonal pathologies may
disrupt normal development, though in fact these
abnormalities have essentially nothing to do with
transgender ideology—except insofar as activists want
to relabel such abnormalities as mere “differences,” in
an effort to normalize disorders.”


Biologically, intersex individuals seem to exist, as do people with other non-binary
sex conditions. Hermaphrodites have male and female sexual organs. Some
individuals with male organs have XX chromosomes. Some genetically male
individuals have incomplete female sexual organs. What non-arbitrary but
universal standard can there possibly be for determining sex?

“Suppose we met a race of creatures—fairly clearly non-rational animals—that was very different from us:
on Mars, say. And the question arises: are these creatures sexed? and if so, can we distinguish male and
female? We need to think now how we would go about ﬁnding out these answers. We would not do it by
investigating their psyches, nor even merely by just looking at (or cutting up) individuals. We would try to
ﬁnd out how they reproduced and what was the role of the different organs of the different individuals
involved in reproduction. Thus, sex is a biological and teleological notion. Anything else which is called
sexual is so called ultimately because it has some relation to this process, to these organs.”
What Determines Sex?

- “Lawrence S. Mayer, M.B., M.S., Ph.D., and Paul R. McHugh, M.D., “Sexuality and Gender Findings from the
Biological, Psychological, and Social Sciences,” Special Report, New Atlantis 50 (Fall 2016): 89.”
“The underlying basis of maleness and femaleness is the distinction between the reproductive
roles of the sexes; in mammals such as humans, the female gestates offspring and the male
impregnates the female. More universally, the male of the species fertilizes the egg cells provided
by the female of the species. This conceptual basis for sex roles is binary and stable, and allows
us to distinguish males from females on the grounds of their reproductive systems, even when
these individuals exhibit behaviors that are not typical of males or females.”

- “Sherif Girgis, “Windsor: Lochnerizing on Marriage?” Case Western Reserve Law Review 64 (2014): 988.”
“…What differentiates them are not just different anatomical or
genetic features, but—at a deeper level of explanation—their joint
(basic) physical potential for a biological task: reproduction. And
this task, its social value, and its link to sexual composition are
certainly not mere social inventions”

“In biology, an organism is male or female if it is structured to
perform one of the respective roles in reproduction. This deﬁnition
does not require any arbitrary measurable or quantiﬁable physical
characteristics or behaviors; it requires understanding the
reproductive system and the reproduction process.”

“Different animals have different reproductive systems, but sexual
reproduction occurs when the sex cells from the male and female of the
species come together to form newly fertilized embryos. It is these
reproductive roles that provide the conceptual basis for the differentiation
of animals into the biological categories of male and female. There is no
other widely accepted biological classiﬁcation for the sexes.”

-Excerpt From: Ryan T. Anderson. “When Harry Became Sally”. Apple Books. ”
“Males are organized to engage in sexual acts that donate genetic
material, while females are organized to engage in sexual acts that
receive genetic material and then gestate the resulting offspring.
This fundamental difference in organization is what allows
scientists to distinguish male from female.”

-“Expert Rebuttal Declaration of Lawrence S. Mayer, M.D., M.S., Ph.D., U.S. District Court,
Middle District of North Carolina, Case 1:16-cv-00425-TDS-JEP.”
When Dr. Deanna Adkins called this “an extremely outdated view of biological
sex” in her declaration to a federal court in North Carolina, Dr. Mayer responded
in his rebuttal declaration: “This statement is stunning. I have searched dozens
of references in biology, medicine and genetics—even Wiki!—and can find no
alternative scientific definition. In fact the only references to a more fluid
definition of biological sex are in the social policy literature.”

“Sex is understood this way across species. No one ﬁnds it
particularly difﬁcult—let alone controversial—to identify male
and female members of the bovine species or the canine
species. Farmers and breeders rely on this easy
distinction for their livelihoods.”

“Our sex—male or female—is determined by our basic capacity to engage in sexually reproductive
acts. If we observe that the members of a species reproduce asexually, then we rightly conclude that
neither male nor female exist in that species. But if we observe that two are required for reproduction to
occur, we rightly conclude that the species reproduces sexually by the union of the two. We name
these two types differently—as male and female—based upon the roles they play in reproduction.”

“There, thus, can only be two biological sexes for human beings. In syllogistic form, what I am arguing is this:
(A) Biological sex is deﬁned in relation to the roles played in sexual reproduction.
(B) Sexual reproduction involves only two, namely, male and female.
(C) Thus, biological sex is only two, namely, male or female.

Defects occur in nature, but defects imply a norm from which they deﬂect. A castrated man is still a
male; a female with a mastectomy is still a female. The fact that one is born with ambiguous genitalia
does not do away with one’s true sex. That it is hard to identify someone as male or female does not
mean one is neither. Identical twins are hard to distinguish, but they are still distinct persons.
Epistemological problems need not entail ontological ones.”

“Consider the case of plants that reproduce sexually. When we discover a plant missing
parts of its sexual organs, we do not thereby conclude that we have discovered a third sex.
Rather biologists rightly concur that what you have found is a defective plant. Likewise, in
human beings, when one has an extra chromosome, or defective genitalia, you have just
that: a sexual defect at the physical level. Such people often are wonderful, loving, and
morally upright persons, but physically something has gone wrong. ”

“Hermaphrodites are individuals with both pairs of sex organs. While in very rare cases
some human beings have both pairs of genitalia, in no case whatsoever has it ever been
observed that both pairs are fully functioning. True human hermaphrodites with both male
and female sexual organs that fully function don’t exist. Such is why no cases of self-
fertilization have ever been recorded in human beings. ”

“Hermaphroditism, rather than disproving the traditional binary
distinction, actually reinforces it. We would not even know
hermaphrodites existed, let alone be able to speak of them,
unless we knew of the male-female binary. ”

-“Gender Ideology Harms Children” , The American College of Pediatricians -
https://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children/
“Human sexuality is an objective biological binary trait: “XY”
and “XX” are genetic markers of male and female, respectively
– not genetic markers of a disorder. The norm for human
design is to be conceived either male or female.”

“Human sexuality is binary by design with the obvious
purpose being the reproduction and ﬂourishing of our
species. This principle is self-evident. The exceedingly rare
disorders of sex development (DSDs),…”

“…including but not limited to testicular feminization and
congenital adrenal hyperplasia, are all medically identiﬁable
deviations from the sexual binary norm, and are rightly
recognized as disorders of human design. Individuals with DSDs
(also referred to as “intersex”) do not constitute a third sex.”

“How we fundamentally distinguish male and female then is based upon the two
biological roles in reproduction. A human individual that has the basic capacity to
reproduce with the female is biologically and truly a male. A human individual that has
the basic capacity to reproduce with a male is biologically and truly a female. Male and
female are deﬁned in reference to each other, which is why they are correlative terms.”
Differentiating Potencies

“Males are still males even when they are not actively reproducing with a female, or if they are unable to
reproduce due to sterility, castration, or a genetic or physical defect. A mechanic that doesn’t have the
proper tools is still “capable” of ﬁxing your car, but not in the same way in which a mechanic with the proper
tools is “capable” to ﬁx your car in the here and now. A male is the type of organism that is capable to
impregnate the female. In other words, he could impregnate her, given that he has the appropriate
functioning organs. A female, however, cannot impregnate another female.”

“Given that human beings reproduce sexually, they are biologically either only
male or female. Men are men, and women are women. True hermaphrodites with
fully functioning sexual organs do not exist in human beings.”

* Declaration of Quentin L. Van Meter, M.D., U.S. District Court, Middle District
of North Carolina, Case 1:16-cv-00425-TDS-JEP, Exhibit I.
As the pediatric endocrinologist Quentin L. Van Meter writes, “The exceedingly rare
DSDs are all medically identiﬁable deviations from the sexual binary norm. The 2006
consensus statement of the Intersex Society of North America and the 2015 revision of
the statement does not endorse DSD as a third sex.” * After all, biological sex is
grounded in the organism’s organization for reproduction. There is no third gonad.
With DSDs, what can develop are dysfunctional ovaries and testes.
No Third Gender/Gonad

6,500 genetic
differences between men
and women
Sex Chromosome only account
for some of those genes.
Other Cells and Organs contain
the rest of these genes.

“ Biological sex is not assigned. Sex is determined at conception by our DNA and is
stamped into every cell of our bodies. Human sexuality is binary. You either have a
normal Y chromosome, and develop into a male, or you don’t, and you will develop
into a female. There are at least 6,500 genetic differences between men and
women. Hormones and surgery cannot change this.”
 
-Michelle Cretella, M.D., is president of the American College of Pediatricians, a national organization of
pediatricians and other health care professionals dedicated to the health and well-being of children.

“Every cell has a sex. And what it means is
that men and women are different down to
the cellular and molecular levels.”

Dr. Paula Johnson , TEDWomen 2013 : His and hers ... health care
Dr. Paula A. Johnson is executive director of the Connors Center for Women’s Health at Brigham
and Women’s Hospital and a professor of medicine at Harvard Medical School.
EVERY CELL HAS A SEX

“It means that we're different across all of
our organs. From our brains to our

hearts, our lungs, our joints.”

Dr. Paula Johnson , TEDWomen 2013 : His and hers ... health care
Dr. Paula A. Johnson is executive director of the Connors Center for Women’s Health at Brigham
and Women’s Hospital and a professor of medicine at Harvard Medical School.
EVERY CELL HAS A SEX

“The result is that male and female bodies differ
not only in their sex chromosomes (XX and XY)
and in their organization for reproduction, but
also, on average, in size, shape, bone length and
density, fat distribution, musculature, and
various organs including the brain.”

Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books.

“These secondary sex differences are not what
define us as male or female; organization for
reproduction does that. But this organization
leads to other bodily differences.”

“There are organizational differences and
organism-wide differences in organs and
tissues, as well as differences at the cellular and
molecular levels. These differences affect not
just our physiology, but also our minds.”

“Indeed, after the reproductive
organs, the brain is possibly the most
“sexed” organ in a human being.”

“This is not to say that there are male brains and female
brains, but that on average there are differences in the brains
of males and females that tend to make a difference in how
men and women experience emotion and pain, how they see
and hear, and how they remember and navigate.”

LARRY CAHILL .PHD. NEUROBIOLOGIST

Larry Cahill, a neurobiologist at the University of
California, Irvine, reviewed the literature for Scientific
American in 2012 and reported: “a surge of findings
that highlight the influence of sex on many areas of
cognition and behavior, including memory, emotion,
vision, hearing, the processing of faces and the
brain’s response to stress hormones.”
-.Larry Cahill, “His Brain, Her Brain,” Scientific
American, October 1, 2012.


There are differences in the size of various
regions and structures in the brain, as well
as differences at the cellular level..
In addition to Cahill, see Amber N. V. Ruigrok et al., “A meta-analysis
of sex differences in human brain structure,” Neuroscience &
Biobehavioral Reviews 39 (2014): 34–50.


Larry Cahill, writing in the journal Cerebrum, grants
that human brains are in some sense “mosaics,” but
he emphatically rejects the argument that males and
females share an essentially “intersex” brain.
“Evolution,” he writes, “has produced in men and
women bodies that are ﬁlled with similarities and
differences, including in the heart, liver, lungs,
immune system, and even knees.”
-Cahill, “Equal ≠ Same: Sex Differences in the Human Brain.”


“To insist that somehow— magically—
evolution did not produce biologically based
sex differences of all sizes and sorts in the
human brain...is tantamount to denying that
evolution applies to the human brain.”
-Cahill, “Equal ≠ Same: Sex Differences in the Human Brain.”


While male and female brains are similar in many
ways, researchers have found “an astonishing
array of structural, chemical and functional
variations” between them. This is not to suggest
that either men or women are smarter, and “no
one has uncovered any evidence that anatomical
disparities might render women incapable of
achieving academic distinction in
math, physics or engineering,”
-Cahill, “His Brain, Her Brain.”

“Babies that are born with both male and female sexual organs, or
characteristics of both organs, are called hermaphrodites or intersex. A child
who is in an intersexual state is classified in one of three categories: (1) true
hermaphrodite – an infant born with both ovaries and testicles and has both
male and female sex organs. (2) female pseudohermaphrodite – a genetic
female with male external sex organs. (3) male pseudohermaphrodite – a
genetic male with external sex organs that fail to develop properly,
resulting in female or male/female physical characteristics.”

“In times past, doctors would perform surgeries without first testing
the infant to find out its true sex, and the child would sometimes grow
up very obviously a man, with female genitalia. Now, specialists can
perform an ultrasound, blood test, chromosome analysis, and even
do exploratory surgery to find out the baby's true sex.”

Overview
Ambiguous genitalia is a rare condition in which an infant's external genitals don't appear to be clearly
either male or female. In a baby with ambiguous genitalia, the genitals may be incompletely developed or the
baby may have characteristics of both sexes. The external sex organs may not match the internal sex organs
or genetic sex.
Ambiguous genitalia isn't a disease, it's a disorder of sex development. Usually, ambiguous genitalia is
obvious at or shortly after birth, and it can be very distressing for families. Your medical team will look for the
cause of ambiguous genitalia and provide information and counseling that can help guide decisions about
your baby's gender and any necessary treatment.

Symptoms
Your medical team will likely be the first to recognize ambiguous genitalia soon after your baby is born.
Occasionally, ambiguous genitalia may be suspected before birth (prenatally). Characteristics can vary in
severity, depending on when during genital development the problem occurred and the cause of the disorder.
Babies who are genetically female (with two X chromosomes) may have:
An enlarged clitoris, which may resemble a penis
Closed labia, or labia that include folds and resemble a scrotum
Lumps that feel like testes in the fused labia

Symptoms
Babies who are genetically male (with one X and one Y chromosome) may have:
A condition in which the narrow tube that carries urine and semen
(urethra) doesn't fully extend to the tip of the penis (hypospadias)
An abnormally small penis with the urethral opening closer to the scrotum
The absence of one or both testicles in what appears to be the scrotum
Undescended testicles and an empty scrotum that has the appearance of
a labia with or without a micropenis

Causes
Ambiguous genitalia primarily occurs when hormone abnormalities during pregnancy interrupt or
disturb the fetus's developing sex organs.
How sex organs form in the womb
A baby's genetic sex is established at conception, based on the sex chromosomes. The mother's egg
contains an X chromosome, and the father's sperm contains either an X or a Y chromosome. A baby
who inherits the X chromosome from the father is a genetic female (two X chromosomes). A baby who
inherits the Y chromosome from the father is a genetic male (one X and one Y chromosome).

Causes
Male and female sex organs develop from the same tissue. Whether this tissue becomes male
organs or female organs depends on the chromosomes and the presence or absence of male
hormones.
• In males, a region on the Y chromosome triggers the development of testicles, which
produce male hormones. Male genitals develop in response to male hormones from the fetal
testicles.
• In a fetus without a Y chromosome — without the effects of male hormones — the genitals
develop as female.
Occasionally, a chromosomal abnormality may make determination of genetic sex complex.

Causes
How ambiguous genitalia occurs
A disruption of the steps that determine sex can result in a mismatch between the appearance of the
external genitals and the internal sex organs or the genetic sex (XX or XY).
• A lack or deﬁciency of male hormones in a genetic male fetus can cause ambiguous genitalia, while
exposure to male hormones during development results in ambiguous genitalia in a genetic female.
• Mutations in certain genes can inﬂuence fetal sex development and cause ambiguous genitalia.
• Chromosomal abnormalities, such as a missing sex chromosome or an extra one, also can cause
ambiguous genitalia.
• In some cases, the cause of ambiguous genitalia may not be determined.

Possible causes in genetic females
Causes of ambiguous genitalia in a genetic female may include:
• Congenital adrenal hyperplasia. Certain forms of this genetic condition cause the adrenal
glands to make excess male hormones (androgens).
• Prenatal exposure to male hormones. Certain drugs that contain male hormones or that
stimulate production of male hormones in a pregnant woman can cause developing female
genitals to become more masculine. A developing baby also may be exposed to excess male
hormones if the mother has a disease or condition that causes hormone imbalance.
• Tumors. Rarely, a tumor in the mother can produce male hormones.

Possible causes in genetic males
Causes of ambiguous genitalia in a genetic male may include:
• Impaired testicle development. This may be due to genetic abnormalities or unknown causes.
• Androgen insensitivity syndrome. In this condition, developing genital tissues don't respond normally to
male hormones made by the testes.
• Abnormalities with testes or testosterone. Various abnormalities can interfere with the testes' activity. This
may include structural problems with the testes, problems with production of the male hormone testosterone or
problems with cellular receptors that respond to testosterone.
• 5a-reductase deﬁciency. This enzyme defect impairs normal male hormone production.
Ambiguous genitalia can also be a feature of certain rare, complex syndromes that affect many organ systems.

DISORDER OF SEXUAL DEVELOPMENT CAUSES
Male Female
People with disorders of sexual development are grouped into three
general categories: those with an XY set of chromosomes who develop
female characteristics, referred to as XY DSD; those with an XX set of
chromosomes who develop male characteristics, referred to as XX DSD.
and those with more than one set of chromosomes
who develop both ovarian and testicular cell lines and
genitals—what used to be called true hermaphroditism,
now referred to as ovo-testicular DSD. There are
dozens of specific types of DSDs that fall into these
three categories. We will look at a few of them to
illustrate the phenomena.

Male
Female
People with disorders of sexual development are grouped into
three general categories: those with an XY set of chromosomes
who develop female characteristics, referred to as XY DSD;
those with an XX set of chromosomes who develop male
characteristics, referred to as XX DSD.
and those with more than one set of chromosomes who
develop both ovarian and testicular cell lines and genitals—
what used to be called true hermaphroditism, now referred
to as ovo-testicular DSD. There are dozens of specific types
of DSDs that fall into these three categories. We will look at
a few of them to illustrate the phenomena.

To take this last example first, sometimes a
chromosomal disorder at conception results in more
than 46 chromosomes or fewer, leading to a
disorder in sexual development.
Male Female
Disorders of sexual development can have a variety of
causes. They can arise from genetic mutations, hormonal
influences, the formation of a chimera or mosaic as an early
embryo, or chromosomal abnormalities at fertilization.

KLINEFELTER & TURNER SYNDROME
Male Female
People with Klinefelter syndrome have 47 chromosomes and are
XXY. They develop as males, but tend to have abnormal body
proportions, with enlarged breasts, and they frequently suffer
from sexual and reproductive problems including infertility.
People with Turner syndrome have only 45
chromosomes, with a single X chromosome rather
than XX or XY. They develop as women but are
infertile, because two X chromosomes are necessary
for normal development of the ovaries.
-Moore and Persaud, The Developing Human, 307.

XY DSD
Consider two examples of XY DSD. As The Developing Human reminds
us, “If a normal Y chromosome is present, the embryo develops as a
male. If no Y chromosome is present, or the testis-determining region of
the Y chromosome is absent, female development occurs.”
-Moore and Persaud, The Developing Human, 307.
SRY, is the gene that commences the formation of
male gonads. The testes then produce testosterone,
which influences the subsequent development of male
reproductive organs and external genitalia. This is
when development follows the typical pattern.
Male Female

XY DSD & SRY MISSING
But some XY people lack the SRY gene or have a severe mutation in it.
As a result, the testes never form and the body never masculinizes;
these individuals develop as females who are infertile
(because they lack a second X chromosome)”
Other XY people have a functional SRY gene but develop
as females because they suffer from complete androgen
insensitivity syndrome (CAIS). These individuals have a
mutation in the gene that contains the androgen receptor
protein, so they cannot be influenced by testosterone.
Male Female
-Bonnie McCann-Crosby and V. Reid Sutton, “Disorders of Sexual Development,”
Clinics in Perinatology 42 (June 2015): 403.
-Bonnie McCann-Crosby and V. Reid Sutton, “Disorders of Sexual Development,”
Clinics in Perinatology 42 (June 2015): 406.

THE SRY GENE PURPOSE
Though they are XY chromosomally, they develop
as females in appearance: “People with androgen
insensitivity syndrome develop as normal-appearing
but sterile women, lacking a uterus and oviducts
and having internal testes in the abdomen.”
Male Female-Gilbert, Developmental Biology, 531.
The SRY instructs them to develop testes and their testes produce
testosterone, but it makes no difference in their development because
their bodies do not respond to it. Thus they never develop a penis.

Male
Female
Now consider some examples of XX DSDs. Some people with XX
chromosomes develop as males because one of their X chromosomes
contains the SRY gene (which is normally on the Y chromosome).
Typically this results from “a translocation of SRY from the
paternal Y to the paternal X chromosome.”
While ordinary cells divide and reproduce identical copies by a process
called mitosis (as you may recall from high school biology), the sex
cells form by meiosis, in which a 46-chromosome cell produces four 23-
chromosome sex cells, either sperm or ova. As sperm are produced
by this process in a male, the SRY gene can be translocated
from a Y to an X in what’s known as meiotic crossover.
-Adriana A. Carrillo, Middey Damian, and Gary Berkovitz, “Disorders of Sexual Differentiation,” Chapter
15 in Pediatric Endocrinology, 5th ed., ed. Fima Lifshitz (New York: Informa Healthcare, 2009), 2:374.
-McCann-Crosby and Sutton, “Disorders of Sexual Development,” 402.
XX DSD

XX DSD
Male Female
Because what matters most for male development is the presence of the
SRY gene, individuals with SRY on an X chromosome develop for the most
part as normal males except for being infertile, since they lack other
important genetic material that is located on the Y chromosome.
-McCann-Crosby and Sutton, “Disorders of Sexual Development,” 402.
Other people with XX DSDs develop for the most part as women,
though they may also develop some male genitalia in a process
known as virilization. For example, some XX people have
congenital adrenal hyperplasia (CAH), a disorder that prevents the
normal production of cortisol. This results in the overproduction of
androgen, the male sex hormone, which in turn can lead to the
virilization of the female external genitalia. But internally
these individuals develop and function as women.

XX DSD
Male Female
Now Let’s now consider the parallels between XY
DSDs and XX DSDs. An XY without SRY will develop
as a female, while an XX with SRY will develop as a
male. An XY with SRY but without the ability to
respond to androgen (CAIS) will develop as a female,
while an XX without SRY but with too much androgen
(CAH) will develop as a female with virilized external
genitalia. These are just a couple of the ways in which
minor genetic or hormonal abnormalities can lead to
disorders of sexual development.

Male Female
In the third general classification of DSDs, the
individuals possess cells with both XX and XY
genotypes, resulting in a mixture of male and female
characteristics. One common cause of this condition
is the presence of two sets of DNA in the same
person, and therefore two sets of sex chromosomes:
XX and XY, or a single X and an XY.
DISORDER OF SEXUAL DEVELOPMENT
-See Alexandre Serra et al., “Uniparental Disomy in Somatic Mosaicism 45, X/46, XY/46,
XX Associated with Ambiguous Genitalia,” Sexual Development 9 (June 2015): 136–43;
and Marion S. Verp et al., “Chimerism as the etiology of a 46, XX/46, XY fertile true
hermaphrodite,” Fertility and Sterility 57 (February 1992): 346–49.

Male Female
When genetic mutations in the developing embryo
result in two or more different genotypes in the same
person, it’s called a “mosaic.” When two different
embryos combine early in a pregnancy to form one,
it’s called a “chimera.” In both cases, the result is two
different sets of DNA, with some of the body’s cells
being XX (or a single X) and some being XY, and
these cells can direct the growth and development of
different parts of the same person.
-Carrillo et al., “Disorders of Sexual Differentiation,” 373–74.

Male Female
As noted above, DSDs occur in approximately one
out of every 5,000 live births, but specific types vary
in frequency and in severity. For example, complete
androgen insensitivity syndrome (CAIS) occurs in one
out of every 20,000 to 64,000 births.53 The most
common form of congenital adrenal hyperplasia
(CAH) occurs in one out of every 14,000 to 15,000
births.54

Male Female
Ovo-testicular DSD occurs in one out of every
100,000 births. The examples of DSDs described
here are the more easily understandable varieties.
Others have a more complicated etiology and are less
well understood. They can result in a more
ambiguous body formation, including external
genitalia.

Risk factors
Family history may play a role in the development of ambiguous genitalia, because many disorders of sex
development result from genetic abnormalities that can be inherited. Possible risk factors for ambiguous
genitalia include a family history of:
• Unexplained deaths in early infancy
• Infertility, absent menstrual periods or excess facial hair in females
• Genital abnormalities
• Abnormal physical development during puberty
• Congenital adrenal hyperplasia, a group of inherited genetic disorders that affect the adrenal glands
If your family has a history of these risk factors, consider seeking medical advice before trying to conceive.
You may also beneﬁt from genetic counseling.

Complications
Complications of ambiguous genitalia may include:
• Infertility. Whether people with ambiguous genitalia can have children depends on
the speciﬁc diagnosis. For example, genetic females with congenital adrenal
hyperplasia usually can get pregnant if they so choose.
• Increased risk of certain cancers. Some disorders of sex development are
associated with an increased risk of certain types of cancer.

Diagnosis
Ambiguous genitalia is usually diagnosed at birth or shortly after. Doctors and nurses who
help with delivery may notice the signs of ambiguous genitalia in your newborn.
Determining the cause
If your baby is born with ambiguous genitalia, the doctors will work to determine the
underlying cause. The cause helps guide treatment and decisions about your baby's gender.
Your doctor will likely begin by asking questions about your family and medical history. He or
she will do a physical exam to check for testes and evaluate your baby's genitalia.

Your medical team will likely recommend these tests:
• Blood tests to measure hormone levels
• Blood tests to analyze chromosomes and determine the genetic sex (XX or XY) or tests for
single gene disorders
• Ultrasound of the pelvis and abdomen to check for undescended testes, uterus or vagina
• X-ray studies using a contrast dye to help clarify anatomy
In certain cases, minimally invasive surgery may be necessary to collect a tissue sample
of your newborn's reproductive organs.

Determining the gender
The standard treatment for people with DSDs—for example, a newborn baby
with ambiguous genitalia—begins with trying to discern the causes of the
disorder, which may shed light on the underlying sex of the child.

Pediatric Endocrinology, a standard desk reference, says that after an “assessment of the
anatomy of the sex organs,” the decisions regarding a course of treatment should rest “on the
likely cosmetic appearance of the reconstructed genitalia, on the potential for normal sex steroid
secretion at puberty, on the potential for normal sexual intercourse, and on the potential for
fertility.”56

Using the information gathered from these tests, your doctor may suggest a gender for your
baby. The suggestion will be based on the cause, genetic sex, anatomy, future reproductive
and sexual potential, probable adult gender identity, and discussion with you.

In some cases, a family may make a decision within a few days after the birth. However, it's
important that the family wait until test results are completed. Sometimes gender assignment can
be complex and the long-term impact can be difficult to predict. Parents should be aware that as the
child grows up, he or she may make a different decision about gender identification.

These children do not constitute a third sex; they are either male or female, but with a
disorder in their development. The sound medical response is to identify the predominant
underlying sex and then take measures to provide health and functioning, as far as possible,
through hormones and possibly surgery.”

Treatment
Once you and your doctor have chosen a gender for your baby, you may choose to begin
treatment for ambiguous genitalia. The goal of treatment is long-term psychological and
social well-being, as well as to enable sexual function and fertility to the greatest extent
possible. When to begin treatment depends on your child's specific situation.

“Ambiguous genitalia is uncommon and complex, and it may require a team
of experts. The team might include a pediatrician, neonatologist, pediatric
urologist, pediatric general surgeon, endocrinologist, geneticist, and
psychologist or social worker.”

Medications
Hormone medications may help correct or compensate for the
hormonal imbalance. For example, in a genetic female with a
slightly enlarged clitoris caused by a minor to moderate case of
congenital adrenal hyperplasia, proper levels of hormones may
reduce the size of the tissue. Other children may take hormones
around the time they would normally experience puberty.

Surgery
In children with ambiguous genitalia, surgery may be used to:
• Preserve normal sexual function
• Create genitals that appear more typical
The timing of surgery will depend on your child's specific situation. Some doctors prefer
to postpone surgery done solely for cosmetic reasons until the person with ambiguous
genitalia is mature enough to participate in the decision about gender assignment.

"For girls with ambiguous genitalia, the sex
organs may work normally despite the ambiguous
outward appearance. If a girl's vagina is hidden
under her skin, surgery in childhood can help
with sexual function later."

"For boys, surgery to reconstruct an incomplete
penis may normalize appearance and make
erections possible. Surgery to reposition the
testes into the scrotum may be required."

“Results of surgery are often satisfying, but repeat surgeries may be needed
later. Risks include a disappointing cosmetic result or sexual dysfunction, such
as an impaired ability to achieve orgasm. Children with ambiguous genitalia
require ongoing medical care and monitoring for complications, such as
cancer screenings, into adulthood.”

If your baby is diagnosed with ambiguous genitalia, you may worry about your child's
future. Mental health professionals can help you deal with this difficult and unexpected
challenge. Ask your child's doctor for a referral to a mental health professional who has
experience helping people in your situation. In addition to ongoing counseling for your
family and your child, you may benefit from a support group, either in person or
online. Your child can benefit from ongoing counseling by mental health professionals
and participation in support groups into adulthood.
Coping and support:

Not knowing the gender of your newborn immediately can turn a hoped-for celebration
into a stressful crisis. Your medical team will provide you with updates and information as
quickly as possible to help settle any questions about your child's health. Consider delaying
a formal announcement of the birth until testing is complete and you've developed a plan
with advice from your medical team. Give yourself some time to learn and think about the
issue before answering difficult questions from family and friends.
Coping and support:

Ask if there's anything you need to do in advance to prepare your infant for tests and
procedures. Discuss family history with your relatives and bring key
personal information, including family history of genetic diseases or conditions,
such as ambiguous genitalia. Consider taking a family member or friend along.
Sometimes it can be difficult to remember all the information provided during an
appointment. Someone who accompanies you may remember something that you
missed or forgot. Make a list of questions to ask your doctor.
What you can do, Before your appointment:

"Disease has been transmitted from parents to children, from generation to generation.
Infants in their cradle are miserably afﬂicted because of the sins of their parents, which
have lessened their vital force. Their wrong habits of eating and dressing, and their
general dissipation, are transmitted, as an inheritance to their children. Many are
born insane, deformed, blind, deaf, and a very large class deﬁcient in intellect."
-The Health Reformer, September, November 1, 1872.

"The strange absence of principle which characterizes this generation, in
disregarding the laws of life and health, is astonishing. Ignorance prevails upon
this subject, while light is shining all around them. With the majority, their principal
anxiety is, What shall I eat? What shall I drink? and wherewithal shall I be clothed?
Notwithstanding all that is said and written with regard to how we should treat our
bodies, appetite is the great law which governs men and women generally."
-The Health Reformer, September, November 1, 1872.

"The moral powers are beclouded, because men and women will not live in obedience to
the laws of health, and make this great subject a personal duty. Parents bequeath to
their offspring their own perverted habits, and loathsome diseases corrupt the blood and
enervate the brain. The majority of men and women remain in ignorance of the laws of their
being, and indulge appetite and passion at the expense of intellect and morals, and seem
willing to remain in ignorance of the result of their violation of nature’s laws.”
-The Health Reformer, September November 1, 1872.

"They indulge the depraved appetite in the use of slow poisons which corrupt the blood and
undermine the nervous forces, and in consequence bring upon themselves sickness and death.
Their friends call the result of their own course the dispensation of Providence. In this, they insult
Heaven. They rebelled against the laws of nature, and suffered the penalty. Suffering and mortality
now prevail everywhere, especially among the children. How great is the contrast between this
generation and those who lived during the ﬁrst two thousand years!”
-The Health Reformer, September November 1, 1872.

“God Himself appeared to the wife of Manoah
and told her that she should have a son, and
that he should be a great man and should
deliver Israel. Then He gave her special
instructions regarding her diet. . . . Let us
regard this as instruction given to
every mother in our world.”
{Conflict and Courage 130.2}
Teach us what we shall do unto the child

that shall be born Judges 13:8.

“Let us regard this as instruction
given to every mother in our world.
If you want your children to have
well-balanced minds, you must be
temperate yourselves. Keep your
own heart and affections sound and
healthful, that you may impart to
your offspring a healthful
mind and body.”

“Every mother may understand her duty.
She may know that the character of her
children will depend vastly more upon her
habits before their birth and her personal
efforts after their birth, than upon external
advantages or disadvantages.”

The child will be affected for good or for evil
by the habits of the mother. She must herself
be controlled by principle, and must practice
temperance and self-denial, if she would seek
the welfare of her child. If before the birth of
her child she is unstable, if she is selfish,
peevish, and exacting, the disposition of her
child will bear the marks of her wrong
course. . . . But if she unswervingly adheres
to the right, if she is kind, gentle, and
unselfish, she will give her child these traits
of character. {The Faith I Live By 262.4}
Before the Baby Comes

" The well-being of the child will be
affected by the habits of the mother. Her
appetites and passions are to be controlled
by principle. There is something for her to
shun, something for her to work against, if
she fulfills God's purpose for her in giving
her a child.”
{Ministry of Healing Chap 31 The Mother
Temperance and Self Control pg 156}

“If before the birth of her child she is self-
indulgent, if she is selfish, impatient, and exacting,
these traits will be reflected in the disposition of the
child. Thus many children have received as a
birthright almost unconquerable tendencies to evil.
But if the mother unswervingly adheres to right
principles, if she is temperate and self-denying, if
she is kind, gentle, and unselfish, she may give her
child these same precious traits of character.”
{Ministry of Healing Chap 31 The Mother
Temperance and Self Control pg 156

“Thus many children have received as a birthright
almost unconquerable tendencies to evil. But if the
mother unswervingly adheres to right principles, if
she is temperate and self-denying, if she is kind,
gentle, and unselfish, she may give her child these
same precious traits of character.”
-Ministry of Healing Chap 31 The Mother Temperance
and Self Control pg 156

“Very many children are born with
their blood tainted with scrofula
(Infection of Tuberculosis) through
the wrong habits of the mother in
her eating and dressing. . . . These
fashionably dressed women cannot
transmit good constitutions to their
children.”
{ Healthful Living 58.5}

“. . . Wasp waists may have been
transmitted to them from their mothers, as
the result of their sinful practice of tight
lacing, and in consequence of imperfect
breathing. Poor children born of these
miserable slaves of fashion have diminished
vitality, and are predisposed to disease. . . .
The impurities retained in the system in
consequence of improper breathing are
transmitted to their offspring.”
{ Healthful Living 58.5}

“From their babyhood train your children for God. If in these earlier
years the foundations of a righteous character are laid, their lives,
as they grow into manhood and womanhood, will develop into
beautiful temples for the Lord.” {18MR 119.3}

“If this kind of education had been given to our children, we should
today see far less selfishness, far less envy and jealousy; we should
have more manly young men and womanly young women.”
{RH, December 9, 1890 par. 9}

“The position of a parent is one of the most responsible on earth, yet it is far too
lightly regarded by the majority of the world. The things which are perishable
receive their time, labor, and money, while the work which will be enduring as
eternity is made a secondary matter. The future of the rising generation is in
the hands of parents; for, in a great measure, they hold within their control
the destiny of their children both for time and for eternity.”
(Signs of the Times, December 19, 1878.)

“The salvation of the young depends almost wholly upon the training they receive
in childhood. Christian parents, who believe the sacred truth of God, are required
to regulate their own conduct by the sanctifying influence of that truth, and, by
precept and example, impress lessons of morality and religion upon their children.
Line upon line, precept upon precept they should be taught concerning the
precious love of Jesus for man, and the virtue of his atonement. That
love should be blended with all their studies and duties.”
(Signs of the Times, December 19, 1878.)

https://www.dropbox.com/sh/mc08vpdjz1gzke0/
AAAQ517HZnf5ntn9jVX4dxxua?dl=0
REFERENCES BELOW
Part 11
-Antonio Bernard , dindinbernard1@hotmail.com

11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).key

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