Sunday, November 16, 2008

OII's Statement of Dissent

OII is working to end NON-CONSENSUAL normalisation treatments of intersex children and adults without consultation with the individual intersexed person.

We oppose all consensus statements, especially those without representation of intersex people as equal stakeholders in the consensus.

We have no desire for any consensus statement because intersex people do not agree on:

  • the exact definition of intersex
  • what treatments are appropriate for all intersex people
  • what gender assignment, if any, is appropriate for all the different intersex variations
  • pathological definitions of our bodies and identities

OII is working in favour of human rights for individuals affected by intersex variations and therefore is opposed to all attempts to impose definitions, treatments and terminology on all people with bodies which do not meet the current standards for male or female.

Consensus statements imply that there is consent. We dissent!

This is on OII's website:

Click here

Sunday, October 19, 2008

A Queer feminist perspective

A queer feminist perspective on intersex activism based on my experience of sexist and racist separatist movements
One thing I think is essential is that everyone be able to express their own opinions openly and honestly and that each intersexed person be free to work for human rights from the perspective that best fits with their own personal experience and understanding of who they are. I want to share my own perspective and it is only my perspective.
I do not find identity politics and defining people by particular reductionist and essentialist definitions as the best way politically to work toward human rights and this is the reason that I have been a queer feminist and resisted both sexism and racism. I find that the way identity movements are constructed that they are essentially sexist and encourage separatism.
I have issues with separatist movements. This essay is not a critique of the LGBT movement per se but of the white separatist movement that I experienced in the region of the United States where I spent a lot of my childhood, Louisiana. This state has a long history of white separatism and in order to entrench this separatism into Louisiana's state laws, there had to be a definition of what a white person was and what a black person was. The solution was to define anyone who was not able to prove they were totally white as:
quadroons, octoroons and even quintroons. This was true until the 80's and all legal documentation had to reflect this. All quadroons, octoroons and quintroons had to have Black on their legal documentation
It can prove quite difficult to take a large population, regardless of the characteristic chosen to separate them, and come up with workable definitions that do not stigmatize people or which can actually divide all people into the categories proposed, especially if there are only two categories.
To me as an intersex person, I understand the sexual apartheid system with male/female legal categories as an equivalent to the racial apartheid system and the underlying political reasons for such a legal separation as somewhat analogous.
I think most people would agree that the system I just described in Louisiana is racist.
My questions are:
Are the separatist divisions posited as good within the LGBT identity movement not sexist?
Are there ethical reasons for perpetuating sexism?
As an example, what does it really mean when a parent of an intersex child is told to raise the child as a girl? To me that is sexist because the notion of "girl" carries stereotypical connotations not essentially derived just from her body which in this case was not a typically female body to begin with.
My family is biracial. If a doctor told us to raise a child as black or white, I would personally interpret that as racist.
Are racism and sexism ethically justified in some cases and if so, when and for what reasons?
I have yet to find ethical justifications for perpetuating racism and sexism as particularly helpful for human rights for all people. Someone will always be excluded and categorized as the "other" as a result of such imposed boundaries.
Now, concerning the separatism within the LGBT movement, I feel that that all separatist movements are another way that oppressed groups perpetuate oppression and divert energy, which is through the policing function necessary to make sure that the borders of "us" and "them" remain clearly bounded. It is the people who fall into the borders/liminal spaces who become the new oppressed minority within such separatist groups. And, as seems endemic, as the definitions of the identity change in response to political changes within the group, and as individuals change and grow in the fluidity of an examined life, membership in the group requires a scramble to prove one still qualifies. Policing and proving membership come to replace activism as the focus of the group. This is what I feel has happened within the intersex community. Policing and defining became the actual focus and we ended up with a intersex being redefined as a genetic defect – DSD or Disorder of Sex Development.
The enforcement of static identity is why I believe that separatisms seem to do more harm than good, particularly around an inherently fluid aspect of life such as sexuality, but even "race" is fluid and culture-dependent for its definition, and policing of racial borders has certainly been an aspect of racial separatist groups with whose histories I am acquainted. Through this insistence on a static allegiance to a particular identity, human growth is curtailed.

Friday, October 17, 2008

Intersex Solidarity Day - November 8

Intersex Solidarity Day - November 8
Herculine Barbin’s Birthday

The Organisation Intersex International would like to invite others to join us each year by commemorating November 8 as Intersex Solidarity Day. All human rights organizations, feminist allies, academics and gender specialists, as well as other groups and individuals interested in intersex human rights, are invited to show their solidarity by organizing workshops, lectures, discussions and other activities which deal with any or all of the following topics:
  • the life of Herculine Barbin
  • intersex normalisation treatments without consent
  • the violence of the binary sex and gender system
  • the sexism implicit within the binary construct of sex and gender
Please show your solidarity with the intersex community. Intersex rights are humans rights. Also, please sign our petition:

If you would like to announce your activity on our website, please contact us.
You can contact us at:

Sunday, September 28, 2008


We in OII firmly reject the idea that our sex is a disorder and we therefore reject the pathological definition of our sex as a “disorder of sex development” or DSD. The real danger and disorders are the racism and sexism which are developing eugenic ideologies and technologies to deal with what are social problems. Instead of empowering and valuing people born with sex variations, the solution is to eliminate us.

Open discussions about the abuse of power by those who control the definitions is one important way to confront the real problem - eugenics, Euro-centric racism and male patriarchal models of power which are at risk of collapse if the current binary male/female dichotomies are not firmly held as sacrosanct.

We in OII do not accept the current male/female binary categories imposed on all people in most countries as sacrosanct and hope that others will help us confront the political agenda of those who would eliminate us.

For more information: Click here

Monday, August 18, 2008

Ambiguous Medicine and Sexist Genetics

Ambiguous Medicine and Sexist Genetics: A Critique of the DSD Nomenclature
By M. Italiano, M.B.B.S. (A.M.) and Curtis E. Hinkle
© Aug. 8, 2008

Many intersex persons around the world and their allies are concerned about the new nomenclature, DSD or “Disorders of Sex Development”, which has been endorsed by the Chicago Consensus (1) to replace the term “intersex”. We believe that the categories proposed are not only demeaning, but also scientifically flawed.

The age of chromosomes

The DSD nomenclature uses chromosomes, instead of gonads, as the most important classifier of an individual's sex, such as “46,XY DSD” and “46,XX DSD”. This is no more helpful than using male pseudohermaphroditism or female pseudohermaphroditism which was based on gonads. (2) Instead of male pseudohermaphroditism and female pseudohermaphroditism, the new DSD nomenclature proposes “46, XY DSD” and “46, XX DSD” as replacements for the former taxonomy.

Furthermore, what was called true hermaphroditism is now dichotomized to fit more neatly within the binary. True hermaphroditism used to be called “true” because it meant that an individual had both ovarian and testicular tissue and gonads (ovaries and testicles) were considered to be the “true” determiner of one’s sex. Of course the word "true" was problematic because it suggested that all other forms of “hermaphroditism" were not legitimate, only “pseudo conditions”. Also, using the term “hermaphrodite” as a word to describe a person with an intersex variation has often been criticized as insulting and inaccurate. However, by replacing true hermaphroditism with "ovotesticular DSD", we still have another problem. The DSD nomenclature now wishes to divide "ovotesticular DSD" (formerly true hermaphroditism) into “46, XY ovotesticular DSD”, “46, XX ovotesticular DSD”, or “chromosomal DSD” (of “46,XX/46,XY” chimerism or “45, X/46,XY” mosaic types). In effect, it gives an individual in the latter case two types of DSD, an “ovotesticular DSD”, and a “chromosomal DSD”. Also, we see the division based on chromosomes, which again exposes the preeminence of chromosomes as the “true” markers of an individual’s sex. Further, by combining “ovostesticular DSD” with a chimeric or mosaic karyotype, as it does, it also fails to provide a clear classification of so-called “ovotesticular DSD” which has 3 or more cell line types, isochromosomes, inversions, or ring chromosomes in the karyotype.

For individuals who have both 46,XX in some cells and 46,XY in other cells, and who are referred to as having a "chromosomal DSD" of "46,XX/46,XY(chimerism)" type, it is not uncommon for them to have male anatomy only (3) or female anatomy only (4) and they may also be fertile. In this new nomenclature they would be “diagnosed” as having a "chromosomal DSD" despite any practical relevance for them. Furthermore, although the DSD nomenclature is intended to be representative of congenital conditions, there are individuals who have become 46,XX/46,XY because their twin’s cells make up part of their own karyotype (5), or because an individual who is 46,XX received a bone marrow donation from someone who is 46,XY, as well as by many other means (6). In fact, a pregnancy may also lead to "false positives" for a DSD since fetal cells end up in a woman’s bloodstream. (5)

Likewise, individuals with a 45,X/46,XY karyotype are listed as having a “chromosomal DSD”, but with a parenthetical “mixed gonadal dysgenesis” or “ovotesticular” DSD. This is also confusing since many 45,X/46,XY individuals do NOT have mixed gonadal dysgenesis or ovotesticular tissue. Again, some have only typical male or female anatomy (some being fertile as such), and the XO cells are known to disappear during various stages of development. (7) Thus, predicting this type of “chromosomal DSD” in prenatal screening has been demonstrated to be hampered by a high rate of erroneous results, has provided unnecessary cause for alarm (by projecting birth defects which do not exist), has led to unwanted elective abortion, and is considered a serious problem in clinical genetics. (8)

Another problem is that the DSD proponents have misunderstood basic genetics (or intentionally distorted the information) and have assumed that XY chromosomes indicate that testicular tissue is expected. This assumption leads to another error in the new taxonomy because when gonadal dysgenesis is classified as a “46,XY DSD”, (see Table 2 in reference 1) DSD proponents refer to it (parenthetically) as "testicular dysgenesis". This is misleading and ambiguous because many individuals with 46,XY gonadal dysgenesis actually have OVARIAN dysgenesis. (9) It has been known for over 30 years now that in the presence of an unaltered Y chromosome, but in the absence of substances which would cause testicular differentiation and development, that ovaries start to form, not testicles. (reviewed in ref. 9). It is therefore deceptive to classify 46,XY gonadal dysgenesis as 46,XY testicular dysgenesis because testicular dysgenesis is the result on some occasions but at other times the result is ovarian dysgenesis. The type of treatment indications for dysgenetic testicular tissue may differ from that of dysgenetic ovarian tissue, and thus may unnecessarily confuse clinicians. Furthermore, the preeminence of chromosomes in this taxonomy is apparent and the idea that XY chromosomes somehow are the real “male” sex marker is the result of sexist genetics which produces more ambiguous medicine.

A basic problem with the DSD nomenclature is that it divides all the “disorders” into groups based on what are erroneously known as “sex chromosomes”. (10) This sexist interpretation of genetics, typical throughout this new nomenclature, leads to ambiguous medicine because there are individuals who have male anatomy only but have what appears to be XX chromosomes and are diagnosed as having a "46,XX DSD". Likewise, there are individuals who have female anatomy with what appears to be XY chromosomes and are diagnosed as having a "46,XY DSD". If these apparent XY individuals have a piece of the Y chromosome missing, (such as would include the SRY testis determining gene) they are still referred to as having a “46,XY DSD”, which is factually impossible since they are not XY, but X plus only part of the Y. Likewise, someone who is called XY (but in reality has an extra copy of an X chromosomal gene called DAX1) is also put in the category of having a "46,XY DSD", even though this is impossible, since they are not XY, but are instead X (PLUS another piece of an X)+Y. Likewise, individuals who appear to be XX, but are actually XX (PLUS the Y chromosome-specific SRY gene) are listed as having a "46,XX DSD" and a disorder of gonadal (ovarian) development, both of which are technically inaccurate. The fact that the DSD proponents (1) have put a note next to some conditions which indicates whether a deletion or addition of some X or Y chromosomal material exists, further demonstrates the inconsistency of their listing these conditions in the binary categories of “46,XY DSD” or “46, XX DSD” and not that of “chromosomal DSD.” In these regards, the DSD terminology is in violation of the principles and accepted diagnostic nomenclature used by clinical and molecular cytogeneticists. (11) Why didn't the DSD proponents put these in the "chromosomal DSD category"? One apparently needs an entire extra "sex chromosome" or to be lacking one, in order NOT to be put in the binary "EITHER XX or XY" category.

The DSD nomenclature is ambiguous and sexist in its understanding of genetics and it appears that this is necessary in order to preserve an "artificial binary". People who have portions of the X or Y chromosome missing or added are neither XX nor XY. The DSD system again here is flawed. Technically, CAIS individuals do not have a so-called "46,XY DSD" (even though the proponents state that they do) because the androgen receptor gene on the X chromosome is altered so that, in fact, they are only "X"Y. The androgen receptor is certainly involved in sex development. Thus if it is not there or is altered, it is ambiguous and misleading to call these individuals XY. It is equally ambiguous and misleading to call CAIS individuals “genetic males”. Yes, they have the SRY gene and a typical Y chromosome, but the X linked gene sequences for androgen "action" are not something that they "have". The same is true for an XY individual who has a female anatomy only, unaltered X and Y chromosomes, but an alteration on one of the many genes on one of the so-called "non sex chromosomes" (autosomes) which are certainly sex determining.

Sophia Siedlberg, Genetics Advisor to the Organisation Intersex International, came up with a polygenic model which explained the role of genes, not chromosomes, in sex determination. (12) This model has been misappropriated by others who don't know how to interpret it correctly. We can be quite sure, that barring an environmental cause (such as a teratogen), if we have an XY individual who does not appear to be a male, but instead appears female or intersex, that this person CANNOT be a “genetic male”, “chromosomally a male”, “genetically a male” and vice versa for individuals who have XX chromosomes. How do we know this? By the simple rule of basic genetics, that

GENES (+ environment) = PHENOTYPE (observable trait)

Thus, the DSD model based on "sex chromosomal" divisions has failed. By using the umbrella term “development”, it has also misapplied the knowledge base from the field of (sex) “differentiation” and conflated it with that of “development”. (13) It is ambiguous and sexist (in that it prescribes what sex one should be and not what sex one is and it perpetuates gender and sexist stereotypes based on chromosomes). It promotes confusion and oppression. It is NOT scientific. It simply uses scientific terminology in such a way that is confuses those who have little knowledge of genetics and biology. In so doing, it victimizes intersex people while offering “unlimited immunity" to medical and psychological professionals who continue FORCED sex assignments, FORCED sex reassignments, and FORCED gender expression expectations.

DSD makes the central health issue one’s sex

A second big problem with the DSD Consensus is that it largely ignores the health issues of intersexed individuals. With its emphasis on “sex” divisions based on chromosomes, they have persons with non-intersexed conditions like labial adhesions, cloacal exstrophy of the bladder and absent penis in an otherwise typical male, (or absence of a vagina in an otherwise typical female), mixed in with endocrine conditions, such as congenital adrenal hyperplasia, or mixed in with other organ system conditions, such as Smith-Lemli-Opitz Syndrome, and Turner's syndrome. These are then categorized as "sex development disorders", thus taking this "distant commonality" of one symptom, i.e., sex, and placing all of these disparate conditions as a disorder of one’s sex, while the predominant health issues become categorically "secondary" and likely to be ignored by clinicians.

DSD lacks clinical relevance

Even without considering the fact that the DSD Consensus largely ignores health issues, its taxonomy is in many cases irrelevant for the purposes of clinicians, especially those with subspecialties. An XX male with testes, a penis, and no female reproductive organs, who finds out at the age of 30 that his chromosomes are atypical after an infertility check, is in the same category as an otherwise typical female with ovaries and a uterus who has vaginal atresia. Both have a “46,XX DSD”. The same holds true for a male, typical in every way but with isolated hypospadias (classified as having a “46,XY DSD”), whose clinician finds that they have given their prior patient, an XY female with streak ovaries, uterus, and vagina who has given birth after embryo donation the same diagnostic classification of “46,XY DSD”. Again, ambiguous diagnoses lead to ambiguous treatment implications and vice versa. This is ambiguous medicine.

Gender conformity based on sexist genetics

With disorders of sex development, which sounds like “sexual development” (and can be confused with psychosexual development or psychosexual disorders), we now see a pathologizing of gender, gender identity, gender role, sexual orientation, and its ties to (re)assignment. People with a so-called DSD, especially in the binary XX or XY categories, are expected to conform in the above categories according to a binary gender expression, as indicated by the expectations of the DSD category, as well as the whim of the person who enforces the assignment or re-assignment. Those who reject such enforcement can be labeled mentally disordered, and treatment can be instituted or re-instituted at the whim of professionals, and this can be enforced legally.

DSD is about ambiguous medicine, sexist genetics, body control, and mind control. It certainly is not a client centered consensus statement. The fact that almost no intersex people had input into this consensus is glaringly evident.

In effect, we have moved from the “age of gonads” to the “age of chromosomes” even though it has been established that "sex chromosomes" as portrayed do not determine one’s sex. (10) This is based on prescriptive notions about genetics, not a descriptive understanding of the role of chromosomes in sex determination. Genes, not "sex chromosomes", determine sex, and most of the genes involved are not on the X and Y chromosomes. They are on the autosomes.

It appears to the authors of this article that the DSD nomenclature misinterprets genetics based on a sexist, binary male/female model and in so doing, it has erroneously pathologized and stigmatized intersex people in order to try to preserve the heterosexist male/female hierarchies that justify the oppression of many classes of people, not just those who are intersexed.


1) Hughes, I.A. et al. Consensus statement on management of intersex disorders. J. Ped. Urol., 2006, 3:148-162.

3) Gencik, A. et al. Chimerism 46,XX/46,XY in a phenotypic female. Hum. Genet., 1980, 55: 407-408.

4) Sudik, R. et al. Chimerism in a fertile woman with a 46,XY karyotype and female phenotype: Case Report. Hum. Rep., 2001, 16: 56-58.

5) Schoenle, E. et al. 46,XX/46,XY Chimerism in a Phenotypically Normal Man. Hum. Genet., 1983, 64: 86-89.

6) Ford, C.E. Mosaics and Chimaeras. British Med. Bull, 1969, 25:104-109.

7) Chang, H.J. et al. The phenotype of 45,X/46,XY mosaicism: an analysis of 92 prenatally diagnosed cases. Amer. J. Hum. Genet., 1990, 46: 156-167.

8) Robinson, A. et al. Prognosis of prenatally diagnosed children with sex chromosome aneuploidy. Am J. Med. Genet., 1992, 44: 365-368.

9) Wachtel S.S. & Simpson J.L. Sex Reversal in the Human. In Wachtel S.S. (Ed.) Molecular Genetics of Sex Determination., 1994, 287-309. Academic Press, Inc.

10) Italiano, M The Scientific Abuse of Genetics and Sex Classifications. Manuscript published July 17, 2008 © Organisation Intersex International.

11) Schaffer, L.G. & Tommerup, N. ISCN 2005: An International System for Human Cytogenetic Nomenclature (2005): Recommendations of the International Standing Committee on Human Cytogenetic Nomenclature., 2005. Karger, S.C. Publ.

12) Siedlberg, S. The Gender Genital Gene Genie. Manuscript published 2001.

13) Italiano, M. Some problems with the new terminology for intersex. Manuscript published July 13, 2008 © Organisation Intersex International.

Wednesday, May 21, 2008

A message to the linguistically challenged

I usually don't talk about my professional background. However, at times, when others who have degrees want to give advice, it is important that we who are intersex and/or trans, also speak with professional clarity and expect the same professional respect that non-trans/non-intersex professionals give to their peers. This is something that many of us have faced and those who are not intersex and/or trans often have no idea how they come across and they often have no idea how we often are devalued and deemed unworthy of any professional respect despite our own degrees and accomplishments. This is offensive and needs to stop.

I am a linguist with a degree in linguistics from the Université de Monptellier, France. As a linguist, I am concerned that Marshall Forstein, M.D., of Harvard Medical School pointed out in his e-mail that, contrary to claims made in petitions and frantic emails, "sexual orientation is NOT even an issue for the DSM committee to consider." What about the words "homosexuality" or "sexual orientation" does Dr. Forstein not understand? The people named to the board in question (Blanchard and Zucker) have used the word "homosexuality" repeatedly in referring to transsexuality. They are going to have input into the definitions concerning GID. Has Dr. Forstein taken the time to read what Blanchard and Zucker have written about homosexuality as part of the differential diagnosis for "GID"? If one reads their articles, it is plausible to conclude that Blanchard and Zucker would most likely try to introduce homosexuality into the DSM as part of the taxonomy for transsexuality because it is not based on GENDER at all, it is based on SEXUAL ORIENTATION.

This is what is disturbing to many people who read the rants of uninformed experts such as Dreger and it makes many of us very wary of their ability to discuss this topic with intelligence in order to make informed decisions considering the matter at hand: Zucker and Blanchard having control of the definitions of gender variance in the DSM, since they are on record as not really accepting gender as a valid construct for defining transsexuality.

Quotes from Blanchard:

"In my terminology, which follows the individual's chromosomal sex, these groups are homosexual and heterosexual transsexuals, respectively." (Blanchard, Deconstructing the Feminine Essence Narrative, Archives of Sexual Behavior, Arch Sex Behav

DOI 10.1007/s10508-008-9328-y)

We have the rudimentary terms used in this proposed taxonomy in the short sentence above: "chromosomal sex", "homosexual", and "heterosexual".

"There are two distinct types of cross-gender identity. The feminine gender identity that develops in homosexual males is different from the feminine gender identity that develops in heterosexual males. In other words, homosexual and heterosexual men cannot ''catch'' the same gender identity disorder in the way that homosexual and heterosexual men can both ''catch'' the identical strain of influenza virus. Each class of men is susceptible to its own type of gender identity disorder and only its own type of gender identity disorder." (Blanchard, Deconstructing the Feminine Essence Narrative, Archives of Sexual Behavior, Arch Sex Behav DOI 10.1007/s10508-008-9328-y)

"Homosexual and heterosexual men"? Very revealing use of the term "men" here. So there we see how Blanchard is referring to M to F transsexuals. In this case, he is referring to them as "men" and he uses the word "men" several times in that short paragraph.

If we read further in this same article, it is clear why Blanchard would refer to M to F transsexuals as "men":

"I have not seen any new research studies that present compelling evidence for a third, distinct type of male-to-female transsexualism. It is quite difficult, however, to achieve complete certainty in taxonomic work. I made this point in a lecture on the parallels between gender identity disorder (GID) and body integrity identity disorder (BIID), a condition characterized by the feeling that one's proper phenotype is that of an amputee, together with the desire for surgery to achieve this. Most, but not all, persons with BIID report some history of erotic arousal in association with thoughts of being an amputee (apotemnophilia). ." (Blanchard, Deconstructing the Feminine Essence Narrative, Archives of Sexual Behavior, Arch Sex Behav DOI 10.1007/s10508-008-9328-y)

What are the parallels between GID and BIID? As a linguist reading this rather short article, the semantic field that Blanchard has ascribed to the term GID is very problematic because he is using the term GID in a way which is inconsistent with the DSM itself.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders has five criteria that must be met before a diagnosis of gender identity disorder (302.85) can be given:[2]
1. There must be evidence of a strong and persistent cross-gender identification.
2. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
3. There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.
4. The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
5. There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

There is no mention of sexual orientation as a factor for diagnosing GID.
There is no mention of body image problems and desire for castration, etc. That is covered in another part of the manual: GIDNOS.
The emphasis is on IDENTIFICATION and inappropriateness of GENDER ROLE. Blanchard is not talking about GID at all as it is currently defined in the DSM. He is talking about something unrelated to this diagnosis.

He is talking about homosexuality, sexual paraphilias, body integrity issues and that is clear if one takes the time to read his work. I would not say that his findings are all wrong. I would simply point out that he is not talking about GID and that is clear from all discursive analyses I have made of his texts.

So, I would hope that professionals in the field of psychiatry would take the time to examine how Blanchard is using language, how he is using the terms which would have a great impact on future revisions of the DSM.

Now, who is the one talking about homosexuality? Blanchard himself. And he calls the people he is talking about HOMOSEXUAL MEN.
As a linguist, I am not going to take Dr. Forstein's advice because it is based on ignorance. Dr. Forstein and Dreger would be better advised to scrutinize Blanchard's use of language and terms before giving advice to those of us in the intersex/trans community about speaking about "sexual orientation" and homosexuality.

Curtis E. Hinkle
Founder, OII

Tuesday, May 20, 2008

Fact Checking Alice Dreger

Please visit OII's NOT A DISORDER blog:

A fact check to the fact checker

Response to:
(Italics are quotes from Alice Dreger's blog)

Well, I see Alice Dreger is up to her usual: distorting the facts and creating a smokescreen so that those with power who are not being accountable for their unethical behavior appear to be justified in further victimizing marginalized communities. As usual, she is telling us what to do and being deceptive as she talks down to us – vintage Dreger – while deflecting the attention away from those who are harming people and making it look like those harmed are the real problem.

I’ve been watching the same sort of thing happen over the debate regarding Zucker and the DSM. Lots of errors about basic facts.

She should know about errors about basic facts. Her recent article in defense of J. Michael Bailey was full of errors. Click here

Some of these errors have been noted in an open letter from Marshall Forstein, M.D., of Harvard Medical School. Forstein pointed out that in his letter that, contrary to claims made in petitions and frantic emails, “sexual orientation is NOT even an issue for the DSM committee to consider.”

Once again. This appears accurate but it is not factually correct to accuse those of us who are discussing SEXUAL ORIENTATION as having our facts wrong. We are discussing sexual orientation, and she understands why because she wrote an article about this same topic herself defending J. Michael Bailey, because the people named to the DSM committee are discussing homosexuality. That is the issue and it is deceptive to put this on her blog and mischaracterize why we are discussing sexual orientation. The problem is not with the intersex or trans community. It is with Blanchard, Zucker, and Dreger. They have been writing papers and elaborating theories which conflate sexual orientation with transsexuality. So, let’s be accurate and check our facts, Alice Dreger. We are talking about this because they, the proposed members of the DSM committee write many articles about homosexuality and see it as one of only two causes of transsexuality.

And the DSM “is a guide to diagnosis and NOT to treatment.”

Once again, we know that. It is inaccurate to act as if we do not. The fact that one or two people might not know that is not necessarily the case for most of us. Why didn’t Dreger write to the people who don’t know this if she really wants to help out instead of making all of us look like uniformed troublemakers? Well, she has an agenda – to protect Zucker, Blanchard and Bailey. That’s why.

The tone of Forstein’s letter reminded me of my own tone as I lectured my well-meaning neighbors on my porch yesterday. Basically: “Geez, people! You don’t have the most basic facts right! How do you expect to gain and keep allies if you can’t get the facts straight?!”

Once again, she paints all of us with one stroke (pretending that she is addressing her neighbors but this is not written to her neighbors, is it?). This is outright propaganda. Many of us are quite informed, articulate people capable of exposing the facts. She would be well advised to get informed and stop generalizing about a whole community.

The errors Forstein chronicled are important, but arguably not as important as the erroneous claims that Zucker does “conversion therapy,” i.e., that he tries to change children’s sexual orientation from gay to straight, and that he thinks a patient turning out to be transsexual represents a “bad outcome.”

Fact check. I thought that Alice Dreger had read J. Michael Bailey’s book. In his “Queen” book, Bailey wrote:

“….Zucker believes that most boys who play with girls’ things often enough to earn a diagnosis of GID would become girls if they could. Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers a bad outcome.” (Page 31 in book)

“Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual. His experience has convinced him that if a boy with GID becomes an adolescent with GID, the chances that he will become an adult with GID and seek a sex change are much higher. And he thinks the kind of therapy he practices helps reduce this risk” (Page 30 in book)

“…Zucker’s therapy seems kinder and more consistent, and thus more likely to be effective. Zucker believes that it is, although he is the first to ackowledge that no scientific studies currently support the effectiveness of what he does.” (Page 34 in book).

Now. One final fact check. Here is why Zucker and Blanchard are talking about homosexuality. Let’s get that fact straight. And therefore we who are opposed to their being part of the DSM committee are discussing this same topic because:

The DSM controls the definitions not the treatments

The DSM is concerned with diagnoses, not treatments per se. We know that, Alice Dreger. However, that is why people that are ideologically motivated with very little, if any, empirical data to support their theories (and Bailey himself admitted that) should not be placed in charge of the definitions or diagnoses. Here is the problem. Drucker will have input into the DIAGNOSES, not the treatments but the treatments are not the issue for Zucker and many of these people that have been influenced by him. In my opinion, they want NO TREATMENTS. I am convinced that the motivation is to tie the hands of those who would desire to provide treatments and they might be able to do that by controlling the definitions, i.e. the diagnoses. In other words, if the members of this committee, some of which I know have been influenced by the views of Zucker which are that gender identity, as opposed to gender role, is extremely malleable, even more malleable than sexual orientation, then reassignment may eventually become almost impossible, if not outright impossible in the years to come.

The theory that Blanchard et al. are expounding has two key elements which will have enormous impact on redefining transsexuality in such a way that

1) it is NOT really a GENDER identity disorder at all and

2) with ONLY TWO categories possible for all people with "gender confusion" which appears to be the word that is becoming more and more common.

Now, if GID is not about gender but SEX, and there are only two diagnoses, one of which is based on HOMOSEXUALITY, what treatments can be ethically justified by therapists if homosexuality is NOT also reintroduced as a TREATABLE disorder? If you include autogynephilia, then you have to include homosexuality because the theory that Blanchard and others are propagating posits that there must also be "trans" people motivated by homosexual orientation (and ONLY those two categories). This erases intersex and trans experience and the essential definitions that we often use to give meaning to our own sense of being – our own definitions of ourselves and if we are not allowed to define ourselves within the system to the best of our ability, then I don't see anyway to improve our well-being within that system – only further marginalization and stigma.

If Zucker is treating homosexuality in childhood and he admits that these boys grow up to be homosexuals and according to Bailey he is treating them in the hopes of preventing transsexuality, then why not treat homosexuality in adulthood to prevent transsexuality? That is why we are discussing this issue.

Professionals? It is time to act – PROFESSIONALLY

Writing to a whole community instead of addressing the people whose behavior Alice Dreger and others associated with her are denouncing is not professional. When I write about Dreger, for example, I don't generalize and characterize her behavior, writings and ideology as characteristic of the whole intersex community. Why does she include me and thousands of others who have nothing to do with the non-factual allegations she is writing about?

This is political spin. This is part of the ongoing assault against the intersex and trans communities. I and hundreds of others in the IS and Trans communities have NEVER written anything similar to this deceptive blog entry by Alice Dreger.

The documentation about Alice Dreger that I have published is based on verifiable sources, not generalizations, not innuendo, not rumors, which is more characteristic of her writings lately.

I have not claimed anything to be true about these people that I cannot back up with reliable sources. It would be advisable that she and other "experts" defending Zucker and Blanchard make the same effort when speaking about us in generalized terms. Don't include me in those generalizations without informed opinions that are reality-based, not agenda-driven spin. It is very offensive to include my work in these generalizations about the trans and intersex communities.

I would never write a blog that gave the impression that all mental health professionals were acting the same way as Zucker, Dreger and Blanchard are because I know otherwise.

What advice like this does is discredit all the well researched articles that many of us in the trans and intersex communities have written about this topic.

It is time that some of the professionals act responsibly (notably those in charge of the APA and those who are enabling Zucker and Blanchard) and inform themselves and stop giving advice until they do know the facts. It is time to demand accountability of those who provide care and who speak as ethicists about our care. The professionals in this debate have much more responsibility. Part of being a professional is that one takes the time to inform oneself of the facts. Many of us have. These factual articles are published. Read them.

Sunday, May 04, 2008

Penetrating the stone wall of narcissism

Narcissistic rage within the medical and academic communities
Available on OII's webstie at:

Narcissistic personality disorder is a major social problem and medical experts and others in the academic community are more prone to this severe mental illness than the population in general. [1] NPD (Narcissistic personality disorder) is defined as a pattern of grandiosity and a need for admiration or adulation which usually begins by early adulthood. Five or more of the following criteria must be met: [2]

• Feelings of grandiosity
• Obsessed with fantasies of success, power, fame and brilliance
• Firm conviction that they are unique and should associate only with those of special status
• Requires excessive admiration
• Feelings of entitlement
• Exploitative and manipulative behavior of others
• Devoid of empathy
• Envious of others
• Arrogant behavior coupled with rage when frustrated, contradicted or confronted.

"Medical narcissism is a term coined by John Banja in his book Medical Errors and Medical Narcissism. He uses the psychological concept of narcissism to explain the culture by which many medical practitioners downplay medical errors and often avoid taking personal responsibility. He claims this is part of the dehumanization of the patients from the practitioner's perspective. John Banja provided evidence that there is a higher incidence of practitioners in the medical profession with narcissistic personality disorder than the general population, and that there is a resultant general narcissistic culture in the medical profession of self-righteousness, arrogance, and denial." [3]

Medical narcissists as well as others who suffer from NPD invariably exhibit symptoms of narcissistic rage when reacting to what they perceive as the slightest injury (narcissistic injury). Narcissistic injury is any real or imagined threat to the narcissist's grandiosity and self-perception as entitled to special treatment and recognition, regardless of his actual accomplishments, if any. [4]

After years of intersex activism, some influential academics and medical researchers, Alice Dreger, Anne Lawrence and Eric Vilain et al., have all exhibited the symptoms of a violent narcissistic rage against the intersex community and have caused great damage to a vulnerable group of people who were just emerging into the collective consciousness.

Their own narcissism has been perpetuated by their own grandiosity as the gatekeepers of all sex variations with their own image as a man or woman as the standard which should be imposed on all people, especially the intersexed. Defining a person by a checklist of sex markers and arbitrarily assigning the individual as male or female without permission or any input from the child is dehumanizing and one of the most blatant forms of medical narcissism. These doctors and academics are pretending to be omniscient and in possession of some profound knowledge which is unknowable to anyone – the "true" sex of a child whose sex cannot be defined as male or female to begin with. Then, they assume that this omniscience gives them the right to surgically and/or hormonally alter the child's body long before the child has developed any awareness of their own individuality and autonomy.

The current terminology used to stigmatize and justify such medical (mal)practice, DSD or Disorders of Sex Development, originated from the narcissistic rage of the academic and medical community against the intersex community which had started to question these practices and demand accountability and respect for intersex children.

Typical of the schoolyard bully, these academics and doctors reacted with an attitude of "how dare they question our authority". The victims of their abuse, by daring to denounce it, had to be further bullied and silenced because the narcissist will not entertain the slightest criticism without flying into a rage that is totally disproportional to the points being made by the victim. The narcissist cannot admit to an error and intersex treatments are particularly prone to what would be serious medical errors if designed for treating almost any other group of people. Lack of informed consent, surgical and hormonal manipulation of an individual's body and labeling the individual as mentally ill for refusing the medical abuse which assigned the person a wrong sex: all these present serious ethical issues which the medical community should take seriously.

Instead of taking the criticisms of the intersex community seriously, their pathological narcissism has only become more impenetrable as they scramble to protect themselves against lawsuits and a loss of their self-perceived grandiosity.

The deepest wound that many intersex people live with is the lie that we are all either a male or a female. This violence against many intersexed people is so profound and brutally denied that intersex activism has almost been crushed by replacing the term “intersex” with “disorders of sex development” without any real consultation with those directly affected – intersexed people themselves.

Many of the same people are reacting the same way to the trans community. Some of them who have falsely accused some transsexuals of responding with narcissistic rage, have misinterpreted the condition, based upon narrow reading (Kohut) and thus have failed to find in themselves more severe narcissistic pathologies, including "borderline" ideology. For a more balanced approach to this, we suggest they and others read Kernberg's critiques of Kohut. Kernberg, saw a far more fragmented self, which is more descriptive of the traits exhibited by certain writers who have written recently about narcissistic rage in transsexuals than the transsexuals these writers were describing.

For such reading on the misunderstanding of narcissistic rage and its misinterpretation and displacement upon others (transsexuals), see Kernberg's criticisms of the limitations of Kohut's view of narcissism.

For more on borderline disorders in physicians, see

For more on how such conditions can cause a physician to sexually abuse others, see

Some OII members clearly see that certain "professionals" studying transsexualism and intersex do indeed have more severe narcissistic disorders which lead to borderline personality expression. (We realize that BPD is a "controversial diagnosis". However, it certainly is no more controversial than the "diagnosis" of autogynephilia, which although not listed in the DSM, is believed by a few not-overly-suspicious OII members, to be "nominated" for its inclusion in the DSM).


Disturbances suffered by those with borderline personality disorder are wide-ranging. The general profile of the disorder typically includes a pervasive instability in mood, extreme "black and white" thinking, or "splitting", chaotic and unstable interpersonal relationships, self-image, identity, and behavior, as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. These disturbances have a pervasive negative impact on many or all of the psychosocial facets of life. This includes the ability to maintain relationships in work, home, and social settings.

For those persons who see in black and white and who quickly change from over-valuing and then to de-valuing those with whom they disagree, and whom they criticize even more stringently without merit, and without re-examining themselves, it is suggested that they seek modern psychoanalysis.

This is the treatment which caused analysts since Freud’s time to wonder: "can the stone wall of narcissism be penetrated?" And Spotnitz has responded with a resounding yes to that question. Although we doubt that those who pathologize transsexual and intersexed persons will be amongst Spotnitz's successes (in that their own stone wall of narcissistic defense surrounding their narcissistic rage and borderline symptoms will be penetrated), we still say to these hacademics: "Please give it the old college try".


Further reading:

For a review and critique on understanding of pathological narcissism of Heinz Kohut, see the following and the writings of Otto Kernberg.

A Day in Neverland

The Neverland Essence Narrative and latent homosexuality

by Curtis E. Hinkle
Available on OII's website:

Blanchard, Bailey and Dreger have attempted to deconstruct what they call the “feminine essence narrative”. Their articles and analysis are replete with internal contradictions and lack of empirical data. Some of the illogical fallacies included are: 1) In comparing male to female transsexuals to natal women, lesbians are not even considered as a possible control group for male to female transsexuals who are attracted to women. Instead, Blanchard suggests that homosexual transsexuals (those who are attracted to men) are the proper control group for autogynephiles. 2) Bailey pretends that he doesn’t even know what a gender identity is. However, he has a clear gender identity because he states in the very book in which he questions the validity of a gender identity that he is a heterosexual man. 3) According to Bailey, all males are gay or straight. Bisexuals are simply gay men in denial. On the other hand, he puts bisexual males who transition to female into the autogynephilic category, instead of the homosexual transsexual category. If males who say they are bisexual are really gay men, how can they fit into any other of his two transsexual categories than homosexual transsexual? 4) Women are basically bisexual according to Bailey. If so, are most natal women in denial? Wouldn’t natal women, make a perfect control group for male-to-female transsexuals as both are said to be in denial? Wouldn’t feminine lesbians, in particular, and not so-called “homosexual transsexuals”, make a perfect control group for so called autogynephilic transsexuals, since each claim NOT to be male oriented?

Recently, I read a few articles written by Blanchard, Dreger and Bailey. Everything I read was full of contradictions, illogical assumptions and binary sex categories that left me feeling I had spent a day on Neverland, the fantasy island in Peter Pan where children never grow up. The simplistic, often contradictory binary logic with overwhelming focus on male sexuality reminded me of the locker room fantasies of adolescent boys stranded on Neverland who have absolutely no idea of female sexuality whatsoever.

One of the articles I read was entitled Deconstructing the Feminine Essence Narrative by Blanchard. In this article he is writing about his proposed theory of transsexualism based on the sexual orientation of the individual and not the person's gender identity (or feminine essence narrative). First of all, I want to be clear that I am convinced that Blanchard's observations of certain behaviors in "men" seeking sex reassignment are correct and that there are those who would fall into the category he has proposed. That is not what seems so illogical and basically "Neverland" about the theory. What is conspicuous is that female sexuality is totally banned from this Neverland adventure into male-to-female transsexualism. This is very problematic because there is no possibility of deconstructing the feminine essence narrative, the alleged purpose of the essay by Blanchard, without a thorough understanding and description of female sexuality since Blanchard's theory is based on sexual orientation, not gender identity, per se.

Blanchard wrote in his article:

The notion that typical natal females are erotically aroused by—and sometimes even masturbate to—the thought or image of themselves as women might seem feasible if one considers only conventional, generic fantasies of being a beautiful, alluring woman in the act of attracting a handsome, desirable man.

This tells me more about Blanchard than the autogynephiles (who are transwomen attracted to other women) he is writing about. How could he possibly compare autogynephiles with heterosexual natal women as the control group? Why would Blanchard assume that typical natal females would necessarily be interested in attracting a handsome, desirable man? Many are interested in attracting a beautiful, desirable woman, just like the autogynephiles he is supposedly describing. Would it have to do with the constant focus on the male phallus? It certainly appears the case and is symptomatic of what I call the Neverland Essence Narrative – (phallo-centric sexual ideation generalized as a description of the only "real" sexuality that counts). Has this man never heard of femme lesbians? Wouldn't this be a more promising control group to consider? What is striking is that lesbianism is not even part of the discourse when talking about natal women, much less femme lesbians.

In the same article, Blanchard wrote:

Proponents of the feminine essence theory could argue that it is an empirical question whether heterosexual male-to-female transsexuals manifest a higher prevalence of autogynephilia than do natal females. My view, in contrast, is that the correct control group for such (necessarily survey) research is not natal females but rather homosexual male-to-female transsexuals, and that the results of such research have already shown that autogynephilia is characteristic of heterosexual transsexuals (Blanchard, 1989a).

Once again Blanchard exhibits the same logical fallacy. Instead of considering natal females as a control group, he posits that the best control group for understanding autogynephiles is made up of male to female transsexuals who are attracted to men. How odd! If the basic categories of his theory of transsexualism are defined by sexual orientation, why use a control group with an orientation towards men? Well, it seems clear. In the previous paragraph, he did not even consider the fact that there are women who have no desire for male partners. It was almost a given in his characterization of women that desiring male sex partners was the primary definition for "woman". Although he knows that lesbians exist, his text and his discourse on female sexuality (which is almost invisible) are so phallocentric that either consciously or unconsciously, there is no real representation of the wide range of diversity characteristic of female sexuality in the text even though he is supposedly talking about natal females. Very typical of the Neverland Essence Narrative. Even when talking about natal females and female sexuality, it is all based on MALE sexual orientation. It has nothing whatsoever to do with female sexuality, femininity and eroticism in femme lesbians, the female body or sensuality.

In this article, Blanchard was defending both J. Michael Bailey and Dreger who is a great fan of Bailey's. In an article by Dreger in defense of her colleague at Northwestern University, she quotes Bailey:

"gender identity… what the hell does that mean?" p 50 of his his book, The Man who would be Queen.

Who is Bailey trying to fool? I would like for Bailey to spend just one day with many of the intersexed people in the Organisation Intersex International if he really would like to meet a group of people who in fact do wonder what the hell a gender identity is because to many of us there is no defined gender identity (or feminine essence narrative or masculine essence narrative) which can be PRESCRIBED by the gatekeepers which fit with our own sense of self which can be very fluid and undefined within a binary gender identity construct. OII has many intersexed people who have an undefined gender identity and who really do question the validity of any of the "essence narratives" as valid in prescribing a gender identity for them at birth. However, when one reads Bailey's book and his articles, his question seems artificial, almost hypocritical because elsewhere in the same book, he makes it clear he identifies as a heterosexual MAN.

Quote from the "Queen" book by Bailey:

Bailey confirms this opinion when he describes his own sexual response (only) to homosexual transsexuals: "It is difficult to avoid viewing Kim from two perspectives: as a researcher but also as a single, heterosexual man" (p. 141).

Bailey knows quite well what a gender identity is and he is very explicit in informing us that he is not only a man but a heterosexual man. This is interesting because the particular woman he is sexually aroused by is described by Bailey himself as a "male". Very interesting indeed.

In another article by Bailey, who supposedly supports Blanchard's taxonomy of all male-to-female transsexuals as either homosexual transsexuals (those who are attracted to men) and autogynephilic (including those who are asexual and those who are attracted to women or who are bisexual), I was surprised that Bailey insists that bisexuality does not exist in males. How contradictory! There was an article in the New York Times which analyzed Bailey's research which allegedly proves that all males are gay or straight or lying. In other words, males who say they are bisexual are really gay men in denial.

Let's follow the logical fallacy here which is characteristic of the fundamental empirical flaw of Blanchard and Bailey's theories – anyone who does not agree with their definition of them is in denial or a liar. However, when you compare Bailey's research on bisexuality with his research on autogynephilia, it is clear who is in denial of empirical data: Blanchard and Bailey themselves.

On the one hand, their theory and taxonomy for male to female transsexualism does include bisexuality as a real orientation for m to f transsexuals. However, they both put bisexual m to f transsexuals, who transition to female, in the autogynephilic category. But wait. Bailey has concluded that bisexuality does not exist in males. They are all gay men in denial. So how can Bailey put someone who by their definition, is a gay male, in the autogynephilic category, which EXCLUDES male to female transsexuals, who are attracted exclusively to males and whom they call “homosexual transsexuals”? Wouldn't bisexual male to female transsexuals also fit their definition of gay men in denial? Wouldn't they have to be categorized according to their taxonomy instead, as “homosexual transsexuals”? The problem with this "research" is that it is not based on empirical evidence which can be falsified. It is based on Blanchard's and Bailey's own Neverland Essence Narrative projected on to all the subjects of their research. And typical of this lack of empirical methods, Bailey concluded that all females are basically bisexual – once again, female sexuality was dismissed and phallocentric arousal remains the only important criteria for categorizing all people. Neverland at its worst.

The fundamental flaw of Blanchard's, Bailey's and Dreger's attempt to deconstruct the feminine essence narrative, is their inability to see anything beyond male/female, and to conceive of a world which is not based on what makes a male's penis erect. I prefer the real world which is full of diversity where a whole spectrum of sex variations exist with some people who have no defined gender identity and for whom NO prescribed gender within the binary will ever categorize them. I prefer to conceptualize a world, where female sexuality exists, where feminine lesbians and their sensuality exist, and where the whole world does not revolve around what makes a penis erect. Neverland is especially well-suited for those who have a monochromatic vision disorder (no real rainbows on this island) with only shades of black and white where the only attraction is the ebb and flow of the inhabitants' own phallocentric erection fantasies.

In conclusion, what did I learn from this foray into Neverland? Not much really. But I did learn something about the people who pretend to be deconstructing the feminine essence narrative and questioning the very concept of gender identity as a valid construct for describing transsexuality. Bailey, Blanchard and Dreger have done absolutely nothing to deconstruct gender identity as a binary or gender identity itself. They have simply prescribed a "masculine essence narrative" on all the subjects of their discourse (male to female transsexuals) with focus on the phallus and what makes it erect in coming up with a new taxonomy for transsexualism. This is about gender policing, not science. There is nothing in the Neverland Essence Narrative that can even fathom the undefined gender identity of many intersexed people who know that NO prescribed gender (feminine or masculine) applies to them.

Now, back to reality which is a lot more interesting, complex and diverse. I will leave Neverland to those who want to perpetuate narcissistic visions of their own budding masculine essence narrative and who never developed any concept that women and intersex people really do exist. Bye-bye Neverland.