Back when I was very active on Twitter, I spent a lot of time talking to some people with DSDs like 5ARD and PAIS and some of them are very distressed to be told they are simply “male and no argument”.
It’s my understanding that, in some places, people with DSDs are allowed legally to choose which sex they identify with, which has made life much easier for them.
DSDs vary a lot - it's a broad classification. I do recall Exulansic going off on one insisting that CAIS XY individuals are men, when that really doesn't make a lot of sense for almost any purpose, except maybe some gene-based therapy or reproductive assistance. There's definitely an argument there, and I'd say "it depends why you're asking about their sex". They're not phenotypically male, and would not be read as such by anyone. It makes more sense socially to classify them as female and women, due to the end result of their development. Their body on the whole develops much closer to the female form, despite no chance of actual female reproduction. (And I've not seen any evidence of male behaviour patterns, or sexuality. Anyone got any evidence either way?)
There is some scope for leeway in treatment in CAIS, and maybe PAIS in social circumstances. Those conditions are so rare, I think "let them choose" is not unreasonable. Society can't tolerate self-ID, and it's increasingly clear we shouldn't have tolerated "gender dysphoria" ID. But maybe it could tolerate "self-ID" for a subset of DSDs.
World Athletics has drawn the line saying CAIS is permitted into female sports, but not PAIS. CAIS does have a sporting advantage over XX females, enough to show up as clear overrepresentation in the field, but apparently not enough to be anything like the unbeatable male advantage, and they definitely would have no more hope in a male field than any woman.
But 5-ARD is really not like those at all. It's a far milder condition, where the developmental differences are far more localised. It is more a disorder of genital development specifically, than affecting the overall sexual phenotype of the body. There's really no ambiguity once you get past a cursory genital check at birth - as is clear when you see Semenya.
There would not be any reason for anyone third-party to suppose Semenya as an adult is female, apart from the presence in female sport and the continued lies from the press. Without the context, you'd assume "zero-effort transwoman" - male claiming to be female with no attempt to pass by any mannerisms or presentation, Alex Drummond or Danielle Muscato style. (Although actually that is the other place 5-ARD has an effect - reduced body hair and no baldness, so Semenya avoids two of the male secondary markers they have. But not being bald and not having a bushy beard is not sufficient to be female!)
And there's no sports disadvantage compared to other men, as far as I know. That's why the scouts were scouting for 5-ARD, not CAIS/PAIS! They were looking for men who had a strong chance to beat elite women. They knew all they needed to do is find someone with 5-ARD at "club runner" level, and they had a shot at the women's Olympics.
Now, it seems historically 5-ARD individuals have been some of those most mistreated in handlings of DSDs. It appears lack of properly developed male genitalia was sufficient to push them into a "not man" category and thus attempt to treat them as female. Which in turn would then require fighting nature - from Wikipedia:
"Female sex of rearing in 5αR2D individuals involves surgical procedures such as childhood gonadectomy (to prevent virilization at puberty) and vaginoplasty. Life-long hormonal treatments as also required for the development and maintenance of female secondary sex characteristics."
In other words - exactly the same as transing any male child, and without consent. And:
"later reports show that over half of patients who underwent virilizing puberty adopted a male gender identity thus challenging historical practices".
Yes, like other "trans children", if you leave them alone, they'll likely become accustomed to their actual sex.
"Male sex of rearing avoids lifelong hormonal treatments and allow for the potential of fertility."
Yes! As for any males! The assignment of female to a 5-ARD male is one of the most clearly wrong that could occur. It's purely on the basis of superficial initial genital appearance, and everything else in the body is going to be pushing the other way.
There are 4 very different cases:
- The mistreated 5-ARD individual who was actually "assigned female at birth". Effectively Jazz Jennings, but with even less consent. Infertile due to mistreatment.
- A 5-ARD individual who was told they were female as a child, but now looks in the mirror and sees a man, and will have had to come to terms with that. They would have figured it out by puberty. Underdeveloped genitals, but probably fertile with assistance.
- A 5-ARD individual who was correctly identified as male as a child, so has always known they were male, and has only to come to terms with their underdeveloped genitalia.
- A CAIS individual who has always believed they were female, and looks in the mirror and sees a woman, with no clear outward signs of anything unusual, but knows they're infertile due to their genetics, and has to put up with some people insisting they're a man.
Semenya is either 2 or 3, but it doesn't matter which, because they knew exactly what they were doing by the time they were entering women's sport. The exact nature of their back story is irrelevant. 2 gives them more "sympathy points" but you don't get to spend sympathy points on unfairness to women.