Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and (...) biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles. (shrink)

In April 2018, the International Association of Athletics Federations released new regulations placing a ceiling on women athletes’ natural testosterone levels to “ensure fair and meaningful competition.” The regulations revise previous ones with the same intent. They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of “restricted” events to lower their testosterone levels to below a designated threshold. If they do not lower their testosterone, women may compete in the male category, in (...) an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone, or quit sport. Irrespective of IAAF’s stated aims, the options forced by the new regulations are impossible choices. They violate dignity, threaten privacy, and mete out both suspicion and judgement on the sex and gender identity of the athletes regulated. (shrink)

Once described as hermaphrodites and later as intersex people, individuals born with intersex variations are routinely subject to so-called “normalizing” medical interventions, often in childhood. Opposition to such practices has been met by attempts to discredit critics and reasserted clinical authority over the bodies of women and men with “disorders of sex development.” However, claims of clinical consensus have been selectively constructed and applied and lack evidence. Limited transparency and lack of access to justice have helped to perpetuate forced interventions. (...) At the same time, associated with the diffusion of distinct concepts of sex and gender, intersex has been constructed as a third legal sex classification, accompanied by pious hopes and unwarranted expectations of consequences. The existence of intersex has also been instrumentalized for the benefit of other, intersecting, populations. The creation of gender categories associated with intersex bodies has created profound risks: a paradoxically narrowed and normative gender binary, maintenance of medical authority over the bodies of “disordered” females and males, and claims that transgressions of social roles ascribed to a third gender are deceptive. Claims that medicalization saves intersex people from “othering,” or that legal othering saves intersex people from medicalization, are contradictory and empty rhetoric. In practice, intersex bodies remain “normalized” or eliminated by medicine, while society and the law “others” intersex identities. That is, medicine constructs intersex bodies as either female or male, while law and society construct intersex identities as neither female nor male. Australian attempts at reforms to recognize the rights of intersex people have either failed to adequately comprehend the population affected or lacked implementation. An emerging human rights consensus demands an end to social prejudice, stigma, and forced medical interventions, focusing on the right to bodily integrity and principles of self-determination. (shrink)

Endosex, in contrast to intersex, refers to innate physical sex characteristics judged to fall within the broad range of what is considered normative or typical for ‘binary’ female or male bodies by the medical field, or to persons with such characteristics1 (p. 437). In this short contribution, we explain the origins and increasing use of this little-known term and discuss its practical and ethical relevance to medicine as well as to scholarship from a range of disciplines concerned with individuals’ sexed (...) embodiment. There is growing awareness in many quarters of the term intersex— used within some discourses to refer to clusters of bodily attributes (as in ‘intersex traits’, also termed differences of sex development or variations of sex characteristics)1 or more broadly to persons (as in ‘intersex persons’) whose bodily attributes differ from the dominant clinical, biological, or legal paradigms that categorise and differentiate female and male bodies. Intersex traits have historically been stigmatised as monstrous, morbid or tragic, justifying surgical and hormonal ‘fixing’.2 Persons born with the attributes named with these terms, even if physically healthy, therefore risk unnecessary pathologisation and medicalisation, prompting interventions, often non-voluntary, into their bodies to make them appear or function in ways that are deemed more typically female or male. In addition, some legal and social systems automatically associate persons with these traits with third categories of sex—neither female nor male—which may or may not align with their sex designation at birth, sex of rearing, personal experience or self-conception (see Coda). Being seen as intersex or being judged to have …. (shrink)

In his paper, Loland1 offers conditional support for 2019 World Athletics ‘differences of sex development’ regulations,2 upheld that year by the Court of Arbitration for Sport 3 in the case of Caster Semenya. He states this is conditional due to the ‘systemic and psycho-somatic’ impact of hormonal treatment. Loland also calls for ‘further analysis of the nature of athlete classification’ and identifies some welcome options for reducing the significance of sex classifications in sport. While Loland identifies ‘essentialist and reductionist definitions (...) of gender’ as problematic, he finds this inescapable, affirming the case as a ‘dilemma of rights’ where excluding Semenya is ‘protecting the integrity of women’s sport’.1 The idea that Semenya’s participation presents a dilemma necessarily presumes that she is not a woman. Loland’s conclusions support a convenience-based approach to classification of sex where choices about the status of people with intersex variations are made by others according to their interests at that time, inter alia, a woman in situation A if no-one complains, a woman in situation B when subjected to medical intervention, a man in situation C and non-binary in D. While a majority decision by CAS adjudicators denied consideration of the ‘wider impact’ of their decision outside sport, …. (shrink)