Intersex* and transgender activism: grounds for cooperation

The article is published in the language of the original

Based on a lecture on intersexuality delivered for the Russian-speaking “LGBTQI+ community” of New York by Alexander Beryozkin and Yana Sitnikova.

The inclusion of intersexuality in the acronym “LGBTQI+” raises serious questions; nevertheless, of all these “letters” it is transgender issues that have the most in common with intersex ones. For this reason, in some contexts intersex* activism is even regarded as part of trans* activism — something I cannot agree with at all, since I prefer to see them as two distinct, fully fledged movements that should cooperate as equals rather than bend one under the other. I will try to outline the main themes of such cooperation.

1. The social construction of the body. In today’s mainstream culture, people’s bodies are constructed in relation to two norms: the “female” one and the “male” one. Or, to be more precise, in relation to a single norm — the “male” one — while everything else may be considered a “deviation” from it to a greater or lesser degree. The accepted binary model holds that (1) at every level covered by the concepts of “sex” and “gender” there are only two options — “female” and “male”; and that (2) the options at all levels must “correspond” to one another. In the first case, such a model excludes intersex* people (when we speak of “sex”) and gender non-binary people (when we speak of “gender”); in the second, transgender people (if we take the common definition). A particular case of the demand for “correspondence” is the tying of “gender roles” to “sex,” and here we get exactly what feminism is fighting against. To this we can add the idea of the complementarity of “sex”/”gender” — and there we have heteronormativity.

All of this is tangled together into a single knot, especially if we take into account that the division between “gender” and (biological) “sex” is highly conventional. Idealized notions of the body include at least two further aspects: ableism (discrimination on the basis of disability) and racism.

2. Depathologization. The inclusion of both gender and sex variance in the ICD is based on a desire to preserve the model described above. In both cases, alongside “normalizing” arguments, the struggle is complicated by the need of intersex* and trans* people for medical care. In both cases, the communities concerned hold a whole range of different opinions about the need for depathologization and about its models. I assume that since the reasons for pathologization are similar, the fight against it should be waged as a united front. Unfortunately, it seems to me that depathologizing intersex* conditions will be harder to achieve, because it concerns bodily matters that lend themselves to more precise measurement and surgical “correction” (unlike psychiatry, with its not always objective criteria and its diagnostics that rely on what the patient says).
3. Medical care. In the case of intersexuality as well as of transgender identity, it is necessary to secure the medical care that is needed and to fight the care that is not.

• First, about the care that is not needed. Intersex* children are subjected to surgeries meant to bring their bodies into line with the model described in point 1. Transgender people are forced to undergo hormonal “treatment” and surgeries in order to achieve conformity with the same model and to gain the possibility of obtaining documents with a different passport gender.
• Now about the care that is needed. The surgeries performed on intersex* children produce unsatisfactory results in most cases. Sutures come apart and the operations have to be redone. Because gonads that do not fit the model in point 1 are removed, many intersex* people are forced to take hormones for the rest of their lives. In some countries, intersex* people also have to pay for these medical services themselves — services that are essentially an attempt to repair the harm done to them. At the same time, it should be borne in mind that some intersex* people may need medical care even if no unwanted surgeries were performed on them. As for transgender people, some of them do wish to change their bodies through hormones and surgeries, and they too must have access to these procedures.

4. Changing documents. Some intersex* people go through a “transgender” transition. This may happen because they disagree with the “sex” and “gender” assigned to them, or because their hormone levels change over the course of their lives against their will. In this case we can speak of an intersection of intersexuality and transgender identity (and, possibly, of intersectionality). It is curious that legal systems treat the “transitions” of intersex* and dyadic (i.e. non-intersex*) people differently:

• In a number of legal systems (including those of the former USSR), changing one’s documents is permitted exclusively for intersex* people, and in that case it is understood as correcting an error in the gender assigned at birth. In some cases the law specifically spells out a ban on changing gender for those whose genitals match the stereotypical model.
• In other legal systems (Ukraine’s, for example), intersex* people are in theory supposed to go through the same procedure as transgender people. That is, to obtain the diagnosis of “Transsexualism,” whose criteria are not designed for intersex* people at all. Sex variations may also, in themselves, be a contraindication for issuing the diagnosis, without which documents are not changed.

The conclusion is obvious: such legal systems must be fought together. The question of what exactly to demand is far more complicated, and this is where misunderstandings sometimes arise between intersex* and trans* activists (see below).

5. Reproductive rights. The surgeries that transgender people are compelled to undergo lead to sterilization (where it is not specifically required, as it is in some European countries). The reproductive rights of intersex* people are a topic I am only planning to look into so far, but I assume that common ground will be found here as well. This concerns not only doing away with unwanted surgeries that result in sterility, but also access to assisted reproductive technologies for transgender and intersex* people.

The intersex* problematization of the trans* movement

Having looked at what unites us, we should not lapse into idealism, and it remains to discuss what divides us. Since the trans* movement is in a certain sense more privileged, let us begin with criticism addressed to it.

6. Just as the concept of sexual orientation was created without regard for transgender identity, so the concept of transgender identity fails to take the existence of intersex* people into account. The common definition of transgender identity as “a mismatch between biological sex and gender identity” presupposes that the “mismatch” is measured against two diametrically opposed options at the level of biology. My own definition of transgender identity as “a transition within the gender-sex space” likewise does not make it possible to say whether intersex* people are transgender in cases where the “transition” was carried out without their knowledge or wish. The terms “MtF” and “FtM,” which many trans* people still use to this day (and which, incidentally, came out of medicalizing discourse), also rest on a binary notion of “sex.”
7. This criticism applies rather to the queer movement, but since it overlaps heavily with the trans* movement, I will mention it too. We regularly see queer activists instrumentalize intersex* people in order to dismantle sex and gender binarity. Yet those same activists do not actually work on the problems intersex* people face, and the voices of intersex* people are not heard there.

The trans* problematization of the intersex* movement

There are grievances in the other direction too. Intersex* people are very often tied to biology; in particular, they define the concepts of “woman” and “man” through biological “sex.” This contradicts the position of most trans* people, who view these terms through the prism of gender identity. Some intersex* activists also advocate for the option of recording a “third sex” as the civil sex of intersex* people. In doing so, they tie civil sex to biological characteristics and therefore advocate an approach opposite to the one trans* activists are fighting for.

Yana Sitnikova