Passage One

1．Let us see how these terms and concepts might involve a developing child．A mother of an 8-year-old chromosomal XY male^[16]with ambiguous genitalia said to me:

2．“My child has questions on her gender．Oddly enough，we have raised her as a complete female child，to date．．．she does not know of her condition．We thought best to wait，as a young child would never understand．．．．Increasingly over the years she has said things like I'm not a girl．．．I'm a boy．．．．clothing desired is neutral．．．teachers' complaints(they are unaware)is that she is very tomboyish．．．．All her friends are boys．At home it is her brothers she hangs out with．And her strength．．．Wow!”

3．The mother，at the child's birth，had been advised by her physician to raise the child as a girl due to its lack of a penis．This was a standard recommendation until just several years ago．The child's sex is male but it had an imposed gender^[17]of girl．It had been raised since birth as a girl．Obviously here is a case where sex and gender are not in agreement．4．The child knows it is being raised as a girl and encouraged by its parents and physicians to live as one．The child recognizes it is being seen and reacted to as a social girl．It is，thus，aware of its(social) gender identity．Yet，although raised as a girl，the child manifests gender roles more typical of a boy．Further，despite its rearing and ignorance of its biology，the child has developed the(inner)sexual identity of a boy; i．e．the child feels at his core that he is a boy or should be a boy．This realization comes about by comparing his feelings，interests，attitudes and preferences with those of male and female peers and judging that his living as a boy is a better“fit”with the reality he sees and comes to know．

5．The child has male chromosomes(is an intersexed male pseudohermaphrodite^[18])with the imposed gender of a girl．When the child matures and becomes more aware of his history I predict he will likely come to live as a man or as close to a neuter gender as possible．He will come to recognize that he is intersexed and might or might not openly identify as such．

6．The mother asked if I thought it would be better to allow the child to switch to live as a boy or proceed with the prepubertal^[19]feminizing hormone administration advised by her physicians．My advice was to allow the child to live as a boy and foster typical male development．Despite the genital ambiguity such management would allow gender and sex to be better matched than is presently so．Genital reconstruction can occur later if desired．

7．An intersexed individual is one born with physical characteristics that are both male and female．For instance an individual can be XX in chromosomal configuration but have a male-like phallus;another individual might be XY in chromosomal make-up and not have a penis but have a vagina instead．The intersex person might have genitals that are ambiguous in character or they might appear typical．

8．Intersexed men and women might identify as female，male or intersexed and they might live ostensibly as women or men or in some sort of neuter manner．Intersexed children，while not aware of their condition，might nevertheless manifest this neuter status in choice of dress，hairstyle and comportment．

9．The variety of intersex conditions is so large that only broad generalizations can be made as to how any single individual's sexual identity and gender identity might compare．While some intersexed individuals can easily meld their biological incongruities with the way they are raised and with the life they lead，others find great difficulty in reconciling the disparities they see and feel with the social input that is thrust upon them．Even within a single category of intersex there is a great variation．It is for this reason that I believe it best that the child itself，particularly after puberty，has the final say in how he or she is allowed to live．

10．Before leaving this topic let me emphasize that at issue here is not whether a person，male for example，thinks he is masculine looking“enough”or macho behaving“enough”to satisfy his ego or some social stereotype．Most men wish that they could increase some aspect of their male selves．And the same can be said similarly for females．Most women would relish the ability to enhance some aspect of their feminine looks and modify some aspect of their behavior．But for the typical person there is little doubt of his or her basic male or female self and sexual identity despite any lack in wished for socially preferred gender feature．(Rewritten from Milton Diamond，“Sexual Identity and Gender Identity are Different”．)

Questions for Understanding

1．Why did the physician advise the mother to raise the child as a girl despite the fact that the child has XY chromosome?

2．In what ways does the child manifest his gender role as a boy?

3．How do the suggestions given by the physician and by the writer of this essay differ concerning the future raising and development of the child?

4．How does the writer of the essay define“an intersex”?Do intersexed individuals share the same features?

5．According to the writer，what element plays the key role in a person's gender identity?