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Review: Between XX and XY by Gerald Callahan

May 18, 2010

Title: Between XX and XY: Intersexuality and the Myth of Two Genders
Author: Callahan, Gerald N.
Length: 195 pages
Genre: Non-Fiction, Gender
Publisher / Year: Chicago Review Press / 2009
Source: Charis Books, Atlanta, Georgia (LOVE this store!)
Rating: 5/5
Why I Read It: It looked interesting, and I had zero knowledge on the subject.
Date Read: 15/05/10

Warning – this is a long one. I just couldn’t stop!

When I read the blurb on the back cover I thought wow, I know nothing about this, I need to read this book! And am I ever glad I did. Here is what the blurb says:

Every year in the United States, more than two thousand children are born with an intersex condition of disorder of sex development. What makes someone a boy or a girl? Is it external genitalia, chromosomes, DNA, environment, or some combination of these factors? Not even doctors or scientists are entirely clear. What is clear is that sex is not an either-or proposition: not girl/boy or XX/XY, switching between two poles like an on-off switch on a radio. Rather, sex is like the bass and tremble knobs on the radio.

Between XX and XY provides a fascinating look at the science of sex and what makes people male of female. There are many people born XXY, XXXY, or XXXXY, or with any number of variations in X or Y chromosomes, yet those who do not fit into society’s preconceived notions about sex often face a difficult path in life.

I had to copy in that whole section because I don’t feel I will be able to convey the total relevance of this book, but I think that everyone should read it. There is a good chance that you had never heard of this condition, I know I hadn’t. I had heard of hermaphrodites, but not of any of the other conditions mentioned, including the chromosome differences. And with between 1 in 500 and 1 in 1000 living with some type of disorder of sex development, that is a huge segment of the population and a huge disorder that we completely ignore. Not only that – you may have been born intersex and the doctors may have hidden the knowledge from you and simply performed surgeries! Scary stuff.

In the introduction Callahan says:

… we try to keep sex simple. Men and women come in two, and only two, opposite forms: male and female, men and women, boys and girls. Black and white simplicity, no gray. We understand that gender – the ways that society molds us into proper girls or boys, men or women – is complicated. Gender depends on a lot of things – upbringing, culture, the stories fed to us by television and movies, hormones, and power struggles. Throughout it all, sex remains inviolate to us – boy/girl, black/white.

But that point of view doesn’t fit very well with the world around us.

He starts by giving us some real life examples of people living with these issues. He talks about the way these people feel, how they are raised, and how common it is. Because in our culture we demand to know, boy or girl, doctors often had to make the decision. And doctors make the decision based on what they see. It turns out that a surprising number of children are born with indeterminate sex features (surprising given how little attention the fact gets). If doctors weren’t sure, they just make a decision. Sometimes the family was involved, sometimes not. He says on page 7:

Surprisingly, until very recently, standard practice usually excluded the child and the parents from the decision-making process. The physicians made the choice of boy or girl and did what they could do to ensure that the child would walk that path for the rest of his or her life. Physicians believed that they knew best and that the input of others was unnecessary.

How crazy is that? Some children were raised never knowing the truth, some happily, some always feeling that they were ‘in the wrong body’. In one story by Kalana Sidrandi Alaniz, she says the following (on page 74), which I thought was so powerful:

Truthfully, I think the most important thing I would like people to understand about me is that I am a person, I have a right to my own body. It is mine after all , I am the one that has to live with it, and no one else has a right to make decisions for me. I really hope people come to understand that each of us has that same right. There isn’t a person on this planet who should be forced to live as something they aren’t. While doctors still continue to spread the belief that assigning a child as a girl or a boy is extremely crucial to their well-being, for those of us who they chose [the] wrong [sex for], our lives are just tortured. And for [those of us for whom the doctors] chose correctly, there are still huge emotional conflicts and emotional issues that are continually being ignored because of the medical standards in practice for intersexed people.

And then we have Nicky Phillips. She was born with Androgen Insensitivity Syndrome, which makes male babies look very similar to girl babies. The sex chromosomes say boy, but the appearance says girl. She says, on page 108:

I have AIS, which is passed down through the X chromosome. If it were color blindness, which is passed the same way, no one would think it was a big deal. Because it is tied in with issues of sexuality and gender, it becomes something to be laughed about or discussed with discomfort.

So Callahan gives us personal accounts, and he also talks about the history of intersex. He talks about how these people were viewed and how we viewed gender in various cultures. He also discusses the different conditions, how they come about, the process by which a fetus develops, and what chromosomes and other bits and pieces make us into who we are. The discussion gets a little bit technical by times but he did keep it fairly ‘dumbed down’ so that I never found myself too lost. While I couldn’t list the various differences and what causes each, I will definitely be keeping the book as a reference.

Based on studies and anecdotal evidence Callahan says, on page 158:

… under the right circumstances, ambiguous genitalia are no impediment to becoming a boy or a girl. It seems that left to his or her own devices, an intersex child may find his or her own gender identity as easily as any other child.

The issue though, is that many doctors still say a sex needs to be chosen at birth. Their reasoning?

We don’t have any social system for accepting as human somebody who doesn’t have a gender assignment as male or female as a child. There are some adults who manage and struggle with having no gender, or having a third gender, or having two genders, but there is no social system at all for a child like that. I think it would be incredibly cruel and incredibly damaging to try to raise a child without a gender.

My idea? After reading this book, I would say don’t mess with something when you don’t know the consequences. The solution isn’t to ‘modify’ children’s bodies, the solution should be to change our thinking. These people exist, they make up a large part of our society, it’s time we recognize them. Obviously male/female one or the other does not work, we need to have a third option, or multiple options, or simply the right to not specify. I am human, isn’t that enough?

I will leave you with the following quote from the conclusion, on page 163:

Sex isn’t a switch we can easily flip between two poles. Between those two imaginary poles lies an infinite number of possibilities. Somewhere within that infinity is where you will find each of us. Intersex people have shown us that. We should be grateful. Because they are not bound by the traditional ropes of our traditions, they have shown us that we can untie the knots that bind us to our own preconceptions and begin to live freer lives.

Did you know about intersexuality? I didn’t realize it was as huge an issue as it is until I read this book. I now feel I have a general overview, though still want to read more. Any book suggestions?

34 Comments leave one →
  1. May 18, 2010 8:57 am

    You know, I actually studied the multiple-X-plus-one-Y genetic disorder in my sophomore year of high school. I had to do research and write a whole paper on it. It was a very interesting subject and if I hadn’t I probably never would have heard about the XXXY etcs that you mention.

    This sounds like a good read. I worry about it because I really am not good at reading nonfiction, but I might make an exception in this case!

    • May 18, 2010 11:11 am

      How cool! I didn’t know schools offered courses on that, especially in Texas! (Or did you do high school somewhere else?)

      The thing that kept popping into my head while thinking about the book afterwards is – how can people be against gay marriage if they know that gender is such a fuzzy concept? What if I was born intersex, who can I marry? If assigned a female gender, transition to male, who can I marry? Maybe that is part of the reason there is so much silence on the issue, it really forces us to realize how silly some of societies ideas are.

      The book is a fairly easy read though there are some really technical parts. If you have some background in one disorder though you might know more about that stuff and it might not be as over your head as it was for me. The whole process of sex development in fetuses was quite complex. But I was able to get the broad overview at least! And the rest of the book was easier.

  2. May 18, 2010 11:23 am

    I didn’t know much about intersexuality until I read Middlesex by Jeffrey Eugenides. If you haven’t read it, it’s a fictional story about an intersex person struggling with his/her gender identity. It’s a really good book.

    This one sounds good too. I’m always fascinated by the complexity of the human body and how it’s never as black/white as it seems.

    • May 18, 2010 11:31 am

      Yes, Middlesex is actually mentioned in this book as well and I’m definitely wanting to read it more now. I am also fascinated by it. It’s crazy the things we still don’t know.

  3. May 18, 2010 12:59 pm

    this sounds like a really interesting read. I had never heard of any of these issues before, and always just assumed that the only thing that could be a gender issuue like this would be hermaphroditism (if that’s even a word!) I would be greatly interested in reading more about this and will be looking for this book. Thanks for the excellent review!

    • May 18, 2010 1:19 pm

      I’m glad to know that I’m not the only one who was completely in the dark, Zibilee. I always assumed the same, and was surprised to learn that they are the minority. I hope you can find this book, and that you learn lots 🙂

  4. winstonsdad permalink
    May 18, 2010 1:04 pm

    my connecrtion with this is working years ago with someone with fagile x syndrone ,a highly interesting subject and little spoken about ,all the best stu

    • May 18, 2010 1:20 pm

      Yes Stu I believe that was one of the conditions talked about in the book. So many different possibilities, so much that we do not know.

  5. May 18, 2010 1:45 pm

    I’d heard of some of these… I’m not sure what word to use, condition sounds negative somehow… I guess sexualities will do, before, mainly through different discussions on websites such as metafilter but don’t really know a lot about it. The book sounds fascinating.

    I’ve always believed that people are people before they are whatever gender you are. That’s why I really hate and despise those self-help books that state women like this. Men like that. I just think that they are so unhelpful because they can create all sorts of expectations and then when they aren’t met, can lead to even great conflicts. But that is off the point 🙂

    • May 18, 2010 3:10 pm

      Thanks for stopping by Fence. It is hard to determine what term to use, you are right. The author said a change is being made toward disorders of sex development. Throughout the book he used such positive references that were wonderful. He was always talking about the the wonderful, amazing, incredible, remarkable differences. It could have been written in a negative way I’m sure, but Callahan always kept it positive and made you understand the awe and respect toward our bodies and the differences we each have.

      And I completely agree. We don’t need more divisiveness or imagined extremes, we need to work together and let everyone be whoever they want to be. Great point.

  6. May 18, 2010 2:15 pm

    How fascinating! I know that intersexuality exists, but I never knew that doctors could just choose a gender for someone! Eek, that is really… well, it seems bizarre, but I guess in a way it is even worse to have the parents choose? I mean, what if you and your husband both answered impulsively and chose different genders? And then you had to pick one, but there might be suspicion all the way through like that the other person wanted the opposite gender. I actually think it may be better to just let the doctor pick…

    • May 18, 2010 3:16 pm

      Thanks Aarti. Good point about the marriage issues that could crop up 😉 What some (especially those born with the condition) are recommending is that doctors start leaving kids as they are for now and letting them have input when they are old enough to have an idea of what they want or how they feel. That way they don’t have to go through unnecessary surgeries with unknown effects without having a say in the decision. The only reason anything is decided immediately is because we don’t have any kind of acceptance toward those children who have indeterminate sex development.

  7. May 18, 2010 4:27 pm

    I LOVE that quote by Kalana Sidrandi Alaniz – so powerful, and so very, very true. I think it’s appalling that doctors would assign a gender without even TELLING the person what they’ve done, and their reasoning doesn’t convince me at all. If the world has no support system for a child with no clearly identifiable gender, then let’s create one. It might not be easy, but it’s surely better than permanently damaging a human being’s life.

    • May 18, 2010 6:18 pm

      Thank you Nymeth, isn’t it incredible? I also was in complete shock over the fact that doctors didn’t always tell the children (or even the parents). Some of the first hand accounts were people that were STILL trying to get information from their doctors about what had been done to them, but they were unable to get the truth. Gross.

      And hear, hear! Changing people’s opinions on gender one person at a time 🙂 So much better than damaging people’s lives. Why are we humans so closed-minded?

  8. May 18, 2010 4:39 pm

    Wonderful review Amy. I’ve known about this issue for a while and I agree with you, it’s society that needs changing. It blows most people’s minds that sex and gender are two different concepts and that both are fluid. The most recent public example of this is the South African runner whose gender was questioned and investigated after the last Olympics. In sports, the implications are huge and far-reaching. I would love to read this book. You really do a good job educating us on great non-fiction books. Thank you.

    • May 18, 2010 6:21 pm

      I have to admit Kinna, it definitely blew my mind. Well, maybe not blew my mind, but certainly opened my eyes. I think it is something that needs a lot more coverage to bring it to the attention of the general public. And yes, I had completely forgotten about the SA runner, how true. So many things that we really have to think about – obviously these people can’t be barred from playing sports, so rather than hide the issue, we need to come up with a way to fit them in to society as they are without ‘gender tests’ and the like.

      And thank you, I’ve been on a non-fiction kick lately it seems 🙂

  9. May 18, 2010 4:54 pm

    I didn´t know intersexuality was such a huge issue, either. I suppose it´s so taboo that it´s not mentioned often or really discussed.

    It´s very interesting for me to read your review because I´m currently writing a short paper on the sex-gender-system.

    There should really much more information available on this topic. You´re definitely right that we need to change our thinking and adjust our categorization. I do think though that letting a child grow up between two genders, not choosing one, has to be unbelievably hard for it.

    • May 18, 2010 6:23 pm

      What good timing Bina! Best of luck on your paper 🙂 It sounds quite interesting (to me anyway).

      And agreed. There may be a lot of information available but I don’t think so, as it isn’t something that seems to be very well known. I hope that this book, and hopefully others, will change that. And yes, that it must be so difficult… I can’t even imagine.

      • May 20, 2010 4:50 pm

        Thanks! Haha, I also find the topic interesting but it´s a very short paper (3 pages max). I´m doing the Judith Butler angle on the topic 🙂

  10. May 18, 2010 10:43 pm

    This book looks great, I can’t wait to try it! My only suggestion would be a book I know you already have, Sexing the Body.

    I second your opinion that what we, as a society, should work to change is our narrow notions of sex and gender, and not other people’s bodies. I do know (a pretty basic amount) about intersexuality, but I also have a particular interest in sex/sexuality/gender stuff and have for a while. I also think it’s important to allow children to grow into their own gender identity, which they pretty much inevitably do at a very early age just like all other children, before performing such a serious and altering non-consensual surgery on them.

    Thanks for writing about this book!

    • May 19, 2010 9:19 am

      Great advice Emily Jane – I can’t wait to get started on Sexing the Body. I am so happy to have found this book. I really hope that medical opinion changes to allow kids the option to wait for any surgery. Each open mind generates more, so hopefully at some point parents will know about it and simply demand that option.

  11. May 19, 2010 4:45 am

    I had heard about this, but only a little. It is a very interesting subject, because I think it shows more than anything how socially programmed we are to think in two sexes.

    • May 19, 2010 9:20 am

      Agreed Iris – it was scary for me to learn how much I was programmed to think of two genders when there is so much that shows we can’t simply say boy/girl so easily. I hope that as the information gets out we can break that.

  12. May 19, 2010 4:46 am

    Great review of an interesting book. I agree with what Nymeth said. We need to stop thinking of gender in terms of the complementing opposites of male and female, and recognise the plurality of existing sexualities.

    • May 19, 2010 9:21 am

      Thank you Violet. I hope that more people agree with us and that general opinion changes!

  13. May 19, 2010 6:19 am

    I just loved your reason for reading this book: “It looked interesting, and I had zero knowledge on the subject.” Exactly! THAT’S what books are for! And it sounds fascinating. Thanks for pointing it up.

    • May 19, 2010 9:22 am

      Thanks for stopping by Katherine. I completely agree, I love picking up books just because they sound new (to me) and interesting. And I almost always end up loving such books, and learning so much.


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