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Sex and gender blind spots and biases in health research
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
Avni Amin, Lavanya Vijayasingham, Jacqui Stevenson
Sex and gender are distinct concepts and should be applied precisely. The use of these two terms interchangeably perpetuates confusion and leads to incorrect analyses. Sex is widely defined and understood as the biological and physiological characteristics that distinguish males and females. And sex is thought to have independent and cumulative effects on disease pathology, progression, health outcomes, and inequities through genetic, cellular, and physiological pathways. Sex is usually understood in binary terms—as genetic differences between females and males based on the former carrying two X chromosomes and the latter carrying an X and a Y chromosome. There is an increasing recognition that sex is not an absolute binary category and includes intersex individuals with variations in sex chromosomes, genes, internal reproductive organs, and hormones and secondary sex characteristics such as external genitalia. Intersex persons have been estimated to make up 1–2% of the population. The estimations can depend on the diagnostic criteria and cultural stigma, which can prevent disclosure (Carpenter 2016; Fausto-Sterling 2000; Jones 2018).
LGBTQIA+ and Co-occurring Disorders
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Intersex: An individual born with a mix of traditionally male and female anatomy without any medical intervention. In some instances, the outer anatomy will not be consistent with the inner anatomy traditionally associated with the individual’s interpreted sex. In some cases, the individual may have cells that have XX chromosomes and other cells that have XY chromosomes.
Effects on Human Males of In Utero Exposure to Exogenous Sex Hormones
Published in Takao Mori, Hiroshi Nagasawa, Toxicity of Hormones in Perinatal Life, 2020
Other cases of ambiguous genitalia following exposure to DES in utero have been reported. Cleveland and Chang28 reported a problem of intersex with an XX karyotype, but no uterus or Fallopian tubes, and with glands only being in scrotal folds and containing aplastic testicular tissue. Hoefnagel29 reported prenatal DES exposure and “typical clinical and laboratory findings of hypogonadotropic hypogonadism with anosmia’ ‘. (Histologic description of the gonads was not given.) Beral and Col well30 reported a case of hermaphroditism and a case of “underdeveloped external genitalia” following in utero exposure to DES and ethisterone.
University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students
Published in Journal of American College Health, 2023
Abigail T. Heller, Sergey S. Berg, J. Roxanne Prichard
Gender identity is defined as the feelings and behaviors a given culture associates with a person’s sex, which includes a diverse spectrum of expression, style, and appearances.8,9 Gender identity typically falls into one of two categories: cisgender, when one’s gender identity is the same as the biological sex they were assigned at birth, or gender diverse, when one’s gender identity does not match their sex assigned at birth, as in the case of transgender and genderqueer individuals.9,10 Transgender identities are when one’s biological sex assignment of male or female is incongruent with their gender as a man or woman; genderqueer identities do not fit purely into a masculine or feminine binary and may be fluid over time.9,10 Additionally, intersex individuals, who comprise 1–2% of the population, are persons whose biological markers (chromosomes, gonads, sex hormones, or genitals) do not fit clearly within a male or female binary, and approximately 15% of intersex individuals identify as transgender or gender diverse.11
Ageing in obscurity: a critical literature review regarding older intersex people
Published in Sexual and Reproductive Health Matters, 2022
Intersex is an umbrella term used to describe a variety of sex characteristics that fall outside accepted binary notions of male and female bodies. Some traits are visible at birth while others are not apparent until puberty.1 In the mid-1950s, Dr John Money theorised that children born with ambiguous genitalia could be successfully raised in whatever gender they were assigned.2 Money’s theory, embraced by medical professionals, led to procedures being performed to enforce sex binaries on intersex infants worldwide. This went largely unchallenged until the 1990s.3 As intersex conditions are generally associated with and considered only in relation to paediatric care, little is understood about the needs of the intersex person throughout the remainder of their life into old age.4,5 The paucity of literature relating to older intersex people3 illustrates how intersex variations are often relegated to paediatric urology and endocrinology and then seemingly forgotten about. Existing literature often includes only a handful of intersex participants.6–8 The oldest of the children operated on under the guidelines of Dr John Money are in their mid-sixties today.
The Nashville Statement’s Undoing? Grappling with Evangelical Christianity’s Ontology of Sex
Published in Journal of Homosexuality, 2021
An even more substantial reason to pause for thought about a focus on intersex people in a statement only marginally about intersex people centers on the important differences between intersex and trans people. Susannah Cornwall’s (2015a, p. 667) explanation of the difference, through the lens of experiences with surgery, is worth quoting at length: An important difference between transgender and intersex experiences of surgery is that, in most cases, sex reassignment surgery for transgender people does not take place until they are over 18 and have lived publicly for a year in their acquired gender. Some transgender people report difficulty in accessing surgical intervention, especially where such surgery is very experience and transgender people must pay for it themselves or convince ‘gatekeeper’ doctors or insurance companies that it is medically necessary. By contrast, most initial surgery for intersex takes place on babies and young children, and many need repeat operations throughout their lives.6 Whilst surgery and other medical intervention for transgender people might endorse their agency and capacity to make decisions about their bodies, surgery for intersex people is likely–especially if it occurred when they were very young, or without their consent–to be understood as invading or compromising their agency.