According to Greek mythology, humanity comprises three genders: male, female, and androgynous. As a punishment for provoking the god Zeus, humanity was split into two halves: either male or female. This separation led humans to constantly search for their other half, giving rise to what we call love.
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Statue of Hermaphrodite |
The legend of individuals with ambiguous gender has existed since ancient times. The gods Hermes and Aphrodite combined their names to name their son: Hermaphrodite. Another goddess fell in love with Hermaphrodite but was rejected, leading her to wish for their bodies to merge into one. This wish was granted, resulting in a being that was both male and female, depicted as having both breasts and a penis. Greek mythology also mentions Tiresias, who, according to legend, alternated between being a man and a woman.
In biology, the natural state of being both male and female can be observed in some species, such as certain snails that can be male or female throughout their lives. In ancient times, children born with “ambiguous gender” were seen as carrying the wrath of the gods and were often killed immediately. This behavior persisted in some cultures until recently. However, in certain contexts, ambiguous gender is viewed as a manifestation of the convergence of opposing elements, embodying mystical and religious powers linked to each individual possessing both genders. In such cases, individuals are granted the powers of both genders through various ritualistic practices, particularly through changes in clothing.
Historically, the population with ambiguous gender has often been referred to as hermaphrodites. If this occurred in a family, it caused significant anxiety and even horror. There are many reasons for concern: parents of children with ambiguous gender must consider how to raise and educate them without damaging their psychological development and social roles; doctors need to determine the right time for intervention to align with the child’s wishes; and what the future holds for children with ambiguous gender if no interventions are made… Additionally, there are many other questions that need answers, and only understanding can improve the quality of life for this population.
The term hermaphrodite is now rarely used as it is considered inappropriate. The medical community suggests using alternative terms such as intersex, ambiguous gender, or ambiguous androgynous. Previously, doctors believed that the gonads were the primary indicator for assigning an individual to a specific gender. As a result, they created a series of classifications not based on genetic, hormonal, or embryological understanding, categorizing individuals with indeterminate gender into types such as “pseudohermaphrodite male“, “pseudohermaphrodite female“, or “true hermaphrodite“.
Only when both gonads (both testicles and ovaries) exist in an individual can they be labeled as true hermaphrodites, which is exceedingly rare and typically results from genetic anomalies. These individuals may lead normal lives but cannot reproduce and have limited sexual function since male hormones can suppress the effects of female hormones and vice versa.
Many pathological conditions can cause children to be born with reproductive organs that do not fit the definitions of male or female. For instance, a child may appear female but have predominantly male anatomical structures internally. Conversely, some children may be born with external genitalia that are unclear in terms of male or female: for example, a girl born with an enlarged clitoris or without a vaginal opening; or a boy born with a noticeably small penis or with a bifid scrotum resembling two labia majora. Some children may be born with a mosaic genetic structure, meaning some cells possess XX chromosomes while others have XY chromosomes.
Ambiguous gender can arise from chromosomal or hormonal disorders, presenting in various physical manifestations. Although it is a congenital condition, it does not always become apparent at birth. Sometimes, ambiguous anatomical conditions are only discovered during puberty or adulthood when reproduction is not observed. In some cases, individuals may live their entire lives with ambiguous gender without anyone knowing (not even themselves).
Not all individuals with ambiguous gender have genitalia that are difficult to identify as male or female. The answer is no; external genitalia may be ambiguous but can also be distinctly male or female. For example, a girl born with XY chromosomes and androgen insensitivity syndrome may have completely female external genitalia. Conversely, some children born with XX chromosomes but with congenital adrenal hyperplasia may exhibit entirely male external genitalia. As they grow up, children will naturally notice differences and will decide which gender they identify with based on their gender identity. Modern medicine and psychology play crucial roles in ensuring the rights of individuals with ambiguous gender and gender identity disorders.
What is the personality of individuals with ambiguous gender like? It varies based on the underlying causes; severe abnormalities may lead to psychological complexes and cognitive delays. There is substantial evidence that children with ambiguous gender, even without surgical intervention, can grow up normally. Medical literature has documented cases of women who grew up with enlarged clitorises; even boys with small penises can develop normally if not subjected to surgical interventions and are raised and educated properly.
Can a child with ambiguous gender be assigned as male or female without surgical intervention? Generally, to designate a child with ambiguous gender as male or female, certain hormone, genetic, radiological investigations are needed, along with consulting medical professionals regarding the probable gender the child will identify with in adulthood. For example, the vast majority of children with complete androgen insensitivity syndrome grow up identifying as female, while many children with enlarged clitorises and XY chromosomes will identify as male. The Intersex Society of North America (ISNA) advocates for assigning a gender to newborns with ambiguous gender, but this is only a preliminary step; later, the child may feel they were misassigned and wish to transition to a different gender.
Children with ambiguous gender expressions have a significantly higher rate of gender transition compared to the general population. This is the primary reason why early surgical intervention should be avoided without their consent. Genitalia shaped from a young age can be very difficult to revise, if not impossible. Therefore, surgical interventions to correct genitalia should be postponed until the age when children can recognize their gender identity and make their own decisions.
