@notagermannoun
Is there a reason why males with Mboma's condition (androgen sensitive XY DSDs) are raised as girls?
Obviously in many cases in the developing world, the child is observed as 'female' at birth and regarded and socialised as female for many years, but what of children where the condition is identified very early in infancy? Are parents given the choice, or advised to raise the child as a girl? In other words, why is a boy with lower testosterone production and no external male genitalia best considered a girl?
The various conditions lead to underdevelopment of the external genitalia. For example in 5 alpha reductase deficiency which affects Semenya, the enzyme deficiency means there is a lack of dihydrotestoserone which is the hormone responsible for full development of the male external genitalia. As a result there is an external appearance that may appear female. But it isn’t. It’s not a vulva or a vagina, it’s a failed fully formed penis. There is no uterus. There is no lack of or lower testosterone, which is why they still benefit from male puberty. It’s likely this external genitalia appearance leads them to be raised as girls, but it would depend on the circumstances. In many places a proper examination may make it clear that it isn’t female external genitalia, leading to further investigations of a newborn infant. An ultrasound is pretty standard, with chromosomes, and testes would be found. In some circumstances, no sex would be assigned - the true meaning of the word
- because of the difficulties in determining how a child might develop with such anatomy and physiology. It
used to be the case that parents were told - not counselled - what sex to raise their child, by doctors and surgeons who thought they knew what was best, but it raised a number of ethical concerns when these children reached adulthood and felt “not right” or that they hadn’t been given a choice about surgical management etc. Quite rightly now there is no rush.
This is why the term the term “assigned at birth” for trans people is incorrect - there is never doubt as to their sex and it isn’t assigned - and the rush to medicalise children who are trans is antithetical to people with DSDs who are used as part of that debate, who have campaigned for years to let children reach adulthood before making permanent decisions about their bodies and sexual function.
In most situations around the world, if these athletes were anywhere else they would have been investigated for primary amenorrhoea at the age of 16. No one would have attributed it to them being athletes alone; it’s not actually that common for athletes to be amenorrhoeic and a diagnosis of primary amenorrhoea secondary to relative energy deficiency is a diagnosis of exclusion. So if these athletes were in the UK, Australia, USA etc they would have had a battery of tests to determine why and been found to be XY.
That these athletes only found out - apparently - that they were XY when World Athletics got involved suggests a few possibilities;l:
a) no one cared about them enough to be bothered by the fact they had never had a period. Even if you were sure they were female, starting periods and oestrogen is vital for bone health. They were medically neglected.
b) someone did think it wasn’t right, but there was no access to appropriate health care to look into it. I doubt this option.
c) people knew, but conveniently didn’t bother to check because they knew they had potential star athletes on their hands.
d) they were tested but Namibian authorities decided to cover it up and see if they could get away with it.
I doubt we will know the truth any time soon.