Intersex

I don’t think anyone here would disagree that early diagnosis and sympathetic medical intervention (delayed until the child can consent wherever practical, eg surgical intervention that is cosmetic rather than necessary for continence) along with appropriate psychological support should be made available to all children born with DSDs, and that where sex has been recorded erroneously paperwork amendments should be a simple process, free of charge.

Paediatric MtF transitioners tend to be tall and thin (similar effect happens in prematurely castrated mammals). Quite a few former MtF ‘trans kids’ are catwalk models.

The same increased height was noted in castrati singers - boys castrated before puberty to preserve their high-pitched singing voices.

Haven’t rtft but DSDs often need to be taken on a case by case basis imho. Some XY people (a small percentage) will have female bodies except for internal organs. Chimeras can have cells some of which are XX and some XY. These are very rare so need to assess individually.
Other DSDs are more commonplace, eg Kleinfelters XXY, so easier to make a grouping as male (though they can still affect people somewhat differently).

from the NHS: average height for XXY men (Klinefelter Syndrome) is 6ft 2 (average height for UK men is 5ft 9 to 5ft 10, depending on the year they were born)

www.mangen.co.uk/wp-content/uploads/2018/07/Klinefelter-Syndrome.pdf

Yes, and even if the birth paperwork mistake wasn’t noted until the child was 4-5 or 12-13 families in developed countries are more likely to have had the paperwork annotated/revised than families in poorer countries.

Unscrupulous sports scouts specifically need 5ARD boys who have never had their paperwork corrected.

Boys and girls have different height and weight charts from birth, not just from puberty, so while hormonal intervention may alter the expected growth trajectory it won’t change nearly as much as trans people like to assume it does.

Paediatric MtF transitioners tend to be tall and thin (similar effect happens in prematurely castrated mammals). Quite a few former MtF ‘trans kids’ are catwalk models.

CAIS individuals (male genotype, female-seeming phenotype) are also taller than biological females. It’s because one of the genes for male height is on the Y chromosome and doesn’t need testosterone to activate it (and conversely, giving testosterone to female teenagers does not give them male height because they don’t have that Y chromosome gene).

XXY men tend to be tall even by male standards.

There is a reason athletic scouts looked for 5-ARD cases in specific countries because in countries with good obstetric care these boys are identified shortly after birth and their sex recorded correctly,

@BonfireLady

Biological males on oestrogen won't get wider pelvis bones (they'll get fat distribution on their hips) or start ovulating. Biological females on testosterone won't get a wider larynx (they'll get longer vocal chords in the same sized space, hence the distinctive "rasp") or start producing sperm.

Whilst it's true that cross-sex gamete production is impossible, I understood that skeletal feminisation is possible if the exposure is started at a young-enough age.

But there's the rub. Changing a child, who knows nothing of what they are choosing, into a different person. How can anyone think it's ethical?

Ps my sympathy drops of a cliff for any boxer (or runner, or footballer) who knows that they are obfuscating the truth when competing in women's sports.

FWIW, I agree with Caster that nobody should be forced into taking testosterone suppressants in order to compete. However, Caster and I are on opposite pages regarding which sex category biological males with 5-ARD should compete in.

Thank you for coming on here to share your perspective. I do not like the fact that congenital conditions are used to defend positions related to identity.

We need to learn how to talk like everyone is listening. I think your thread showed us, that we never know who is talking - until we ask them.

Social media platforms like this one, have presented us with a myriad of opinions, augmented and echoed so that we feel the need to shout back so our voices and opinions are not dismissed.

Much disinformation that is shared and we are invited to learn more, but it seems, the more we learn, the less it is understood. We need to learn to communicate with people who hold different opinions to ours... this is the only way forward.

Children with 5-ard who develop a strong female identity are offered gonadectomy/œstrogen/vaginoplasty. Whilst, for me, this is right on the edge of acceptability, it does fit with my rough and ready paradigm of "DSDs can choose: the rest of us should lump it".

In principal, I kind of agree that it's right up against the line on the right side of acceptability. The BBC article that I linked upthread mentions that there will be a small number of children (biological males) who will make a decision to take female hormones, have their testicles and penis removed and an approximation of a vagina created. However, for me it's still a no ethically. The child's sense of who they are is based on pre-puberty. When the testosterone surge kicks in at puberty, this will all change. Their body shape, their aggression and libido levels etc. Left without intervention, their body will catch up as a natural adult male. Although obviously it would be very difficult emotionally, they deserve to go through puberty for the benefit of their future health. Removing their testicles will remove this possibility. (If someone has CAIS or Swyer that's different as puberty is not possible anyway). It's a case of First Do No Harm. The endocrine system is going to balance itself much better without intervention.

Unfortunately the conflation with gender identity kicks in here, as does lots of misinformation. For example many people seem to think it's possible to go through the puberty of the opposite sex. It's not. There's either puberty or no puberty. Cross sex hormones will just create a mimicry of opposite-sex puberty. Biological males on oestrogen won't get wider pelvis bones (they'll get fat distribution on their hips) or start ovulating. Biological females on testosterone won't get a wider larynx (they'll get longer vocal chords in the same sized space, hence the distinctive "rasp") or start producing sperm.

Also biological males with 5-ARD are at risk of coercion by people who want to use them. For example there may be someone who is talent-spotted for women's boxing, who parades around with male coaches in a way that wouldn't normally be seen in a Muslim society (women don't normally ride around on the shoulders of men, for example), who then goes on to talk about facial feminisation surgery. It's difficult to see whether this person might have been pressured into this pathway or is fully complicit. Obviously such a person doesn't belong in women's boxing but the boundary between victim and perpetrator isn't necessarily clear, depending on how it all unfolded and how young the boxer was when it did.

Yes, an extension of the Guthrie test would be great.

But in the interim it feels like there is an opportunity to use existing protocols (with a tweak to training) for early indication of some of the more complex conditions. 5-ARD could also be picked up at this stage as it would flag as an absence of uterus and of penis/scrotum too.

Maybe sonographers are already doing this at the 20 week scan in some countries?

You’re right.

Such a predictable plot twist

Your genetics are part of your biology.

Handy graph -

XY: in other words, biologically male.

I would say genetically male and that ‘biolgically male’ would be the individual’s biology -Anatomy, hormones etc.

@Wonderi there is literally no overlap between male and female testosterone levels. If you're seeing an athlete on tv who is being asked to reduce his testosterone levels then it's because he's male.

From the Telegraph newspaper:
"The irony is that a controversy smouldering for two years could be resolved in roughly 20 seconds. That is the length of time it would take to undertake the simple cheek swab to establish beyond doubt whether Banda is genetically XX or XY. This is a vital determination when you study the Caster Semenya precedent. For a decade the South African athlete, the world and Olympic champion over 800 metres, was widely depicted, without a hint of curiosity, as female...
But then, 10 years later, came the Court of Arbitration for Sport ruling that changed everything: Semenya, it said, had a difference of sexual development known as 46 XY 5-alpha reductase deficiency. Note the two crucial letters, XY: in other words, biologically male.
The same situation has unfolded, in nearly every detail, with Imane Khelif. First the International Boxing Association bans Khelif from the World Championships on the basis of test results declaring that the athlete’s DNA is “that of a male, consisting of XY chromosomes”

Karyotyping is a way of visualising the whole genome including the structure of the chromosomes which is important when looking for large imbalances/balanced rearrangements of the genome.

Molecular karyotyping techniques are becoming more developed but tend to focus their utility in individuals with haemato-oncologies.

You will be able to achieve a degree of ‘karyotyping’ through the WGS techniques used in the newborn screening pilot, but there are limitations for this including time and cost. It is a very involved test and throws up many issues compared to a conventional G-banded karyotype for sex chromosome disruption.

Karyotyping was cheaper but won’t necessarily continue to be so, especially if genotyping becomes more routine to test for other genetic conditions.

I don't know quite what was intended by the PP I responded to, but:

Karyotyping is simpler than genotyping, and

If the idea is to reflect the whole genotype, including the genes that make an XY individual into someone with SS, you then have to decide if they are 'really' female or not, which is ultimately arbitrary.

Although appealing in its purity, how useful would this be? OP is somatically female and could potentially carry an implanted embryo to term, but would have a male sex marker.

Not if they looked at genotype rather than karyotype.

Although appealing in its purity, how useful would this be? OP is somatically female and could potentially carry an implanted embryo to term, but would have a male sex marker.

Children with 5-ard who develop a strong female identity are offered gonadectomy/œstrogen/vaginoplasty. Whilst, for me, this is right on the edge of acceptability, it does fit with my rough and ready paradigm of "DSDs can choose: the rest of us should lump it".

If we want a sex marker that's both medically and socially useful, maybe there should be more of them eg M, F, SS, CAIS, 5-ARD etc. Intrusive, yes. But your proposal would also advertise to the world the presence of a DSD, and to less useful effect.