Because of that millions of people have come to know

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Unformatted text preview: o early surgery, and waiting until the child is old enough to have meaningful input is often a better way to go. He also argues that from the very start it is essential to have a multidisciplinary team—including pediatricians, surgeons, endocrinologists, ethicists, psychologists, geneticists, genetic counselors, and social workers—involved in the process. That is the best way to optimize the likelihood that the child will develop into a healthy and perhaps happy adult. But even with all of that expertise, people, especially parents, must realize that the initial gender assignment may still be wrong. Dreger says, “I always say to clinicians: ‘You’ve got to get parents to realize that for many types of intersex conditions, the odds of us getting the gender assignment wrong at birth is higher than that for the general population.” In other words, “For most people with intersex, they’ll never change their gender assignment. . . . But for some intersex conditions, like 5-alpha reductase deficiency, and like intersex conditions involving ovotestes, there’s a higher rate of what I’ll call gender unpredictability—that people either change gender later or don’t quite feel the gender they were assigned.”6 That would seem to be among the best arguments for not performing irreversible surgeries while the child is still too young to have any role in the decision-making process—that and Alice Dreger and Melissa Cull’s observations that a lot of people out there are unhappy about what was done to them surgically as children. Are Our Attitudes and Our Medicine Changing? Yes and no. Dr. Frader observes, “I think it’s highly unlikely there’s been a complete revolution in practice. I think there are still a lot of places that have pediatric endocrine leadership . . . who are still very much in the mode of, ‘We make paternalistic decisions. Here’s what we think should happen,’ including counseling families to maintain secrets. But, I think that’s becoming less and less acceptable.” 160 Between XX and XY In fact, it seems that many physicians’ thoughts about management of intersex children have undergone major changes very much like those suggested by Dr. Frader—more parental involvement and input from pediatricians, surgeons, endocrinologists, ethicists, psychologists, geneticists, genetic counselors, and social workers. And changes in our vocabulary. Curiously, though, it isn’t clear that physicians’ changes in attitude are translating to changes in practice. According to Dr. Dreger, that sort of change will take time. The general public, though, is a bit faster to respond. Some parents and children may yet find themselves working with physicians who insist on surgery and who may choose not to involve too many others in their decision-making process. General changes in medical practice can be glacial in their progress. According to Dr. Dreger, “The lay audiences are much more receptive to this message. I think there are a couple reasons for that. One is what I call the Will and Grace effect, and I really do mean Will and Grace. That TV show and similar ones that have put gay and lesbian life out in the public eye [have] made an enormous difference toward people accepting people who are gender nonconforming. People with intersex are often gender conforming, but they’re sex nonconforming. So it all gets sort of mashed together. So the effect of the gay and lesbian population rights movement has made a huge, huge difference in terms of humanizing people with intersex.” She also attributes some significant changes in attitude to Jeffrey Eugenides’s book Middlesex, a remarkable novel that describes the difficulties a boy experiences as he grows up with 5-alpha reductase deficiency. “It’s so funny. I meet little old ladies who—when they find out what I do—say, ‘Oh, we read about that in my book club. I totally understand what you’re talking about.’ And they do. That book made a difference.” 7 In 2007 Oprah Winfrey chose Middlesex for her book club. Because of that, millions of people have come to know more about intersex and the people it affects. We are moving forward one step at a time. Epilogue: Untying the Knot When we divide the world into two groups, male and female, we tend to see all males as being similar and all females as being similar, and the two categories of “male” and “female” as being very different from each other. In real life, the characteristics of women and men tend to overlap. Unfortunately, however, gender polarization often creates an artificial gap between women and men. —from a publication of the National Honor Society in Psychology1 We still see a gap where none exists, a mirage that shimmers over the hot land of sex. And that mirage haunts us all, cleaves our lives in two. Real men are all man, and real women are all woman—Mars and Venus, Budweiser and Virginia Slims. In truth, all of us fall somewhere in between our masculine and feminine ideals. Graphically the human race might look something like this: Woman • • • • • ...
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This document was uploaded on 02/04/2014.

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