Who is intersex? What are the types of intersex? Is intersexuality natural? What concerns are shared by LGBT people and intersex people? Learn why you should care about intersex people!

1. INTERSEX PEOPLE: What You Should Know and Why You Should Care Presented By Veronica Drantz, PhD And Intersex Spokespersons Alex & Mugsie Prepared for H.E.R. Day at the Center on Halsted June 11, 2011

5. 23 Pairs Human Chromosomes XX (Female), XY (Male) Figure 25-2 Karyotype of chromosomes from a normal male. The chromosomes have been stained with Giemsa's stain, which produces a characteristic banding pattern.

12. Sexual Differentiation of Internal Genitalia Figure 25-4 Embryonic differentiation of male and female internal genitalia (genital ducts) from wolffian (male) and müllerian (female) primordia.

13. Sexual Differentiation of External Genitalia Figure 25-5 Differentiation of male and female external genitalia from indifferent primordial structures in the embryo.

14. Sexual Development in Mammals Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT, Dihydrotestosterone

15. Androgen Hormones Are Made in Adrenal Glands and Gonads http://www.carolguze.com/text/442-6-sexual_differentiation.shtml 17  -HSD =17-beta hydroxysteroid dehydrogenase

16. Male Testosterone Levels Figure 25-8 Plasma testosterone levels at various ages in human males.

17. Mechanism of Steroid Hormone Action Brain Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).

18. Puberty = “Activation” Alteration in typical women Female Secondary Sex Characteristic Cause Genitalia Enlargement of breasts, uterus, vagina Estrogen Voice larynx retains prepubertal proportions; high-pitched voice Lack of testicular androgens Hair less body hair, more scalp hair, flat-topped pubic hair pattern Lack of testicular androgens Pubic and axillary hair Androgen Mental Interest in sex Androgen Body Conformation Narrow shoulders, broad hips, thighs that converge, arms that diverge (wide carrying angle), female distribution of fat in breasts & buttocks Lack of testicular androgens Skin Sebaceous glands more fluid (inhibit acne) Estrogen

28. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)

30. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)

32. Intersex People Curtis Hinkle - Founder Organization Intersex International

44. CAIS People Feel Like Women! Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons, 1987. Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)

49. Five Degrees of Virilization Affecting the Urogenital Sinus and External Genitalia in Females Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81 (2004)

50. Congenital Adrenal Hyperplasia (CAH) Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987) Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)

52. CAH (Adrenogenital Syndrome) Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987)

58. Sexual Behavior and Gonadal Function Controlled by Different Regions of Hypothalamus in Mammals Figure 25-28 Loci where implantations of estrogen in the hypothalamus affect ovarian weight and sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area), whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral hypothalamus (red). MB, mamillary body

76. Medical Profession’s Treatment of LGBT People Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990 1952 (DSM-I) Sociopathic Personality Disorders 1968 (DSM-II) Sexual Deviation 1970 Gay rights activists storm APA annual convention 1972 APA annual meeting –first-ever panel of non-patient homosexuals” and Dr. Anonymous 1973 (DSM-II Revision) Deletion of Homosexuality Substitution of Sexual Orientation Disturbance (Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is an illness) 1980 (DSM-III) Gender Identity Disorder (GID) Ego-dystonic Homosexuality (formerly SOD) 1987 (DSM-III Revision) Homosexuality omitted entirely (Ego-dystonic homosexuality/SOD removed. It’s normal to not want to be persecuted & empirical data to support diagnosis is lacking) )-> 2000 (APA Position Statement) Ethical psychiatrists should stop conversion or “reparative therapies”

82. Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004) NEW STANDARDS OF CARE FOR INTERSEX PATIENTS American Academy Pediatricians year 2000 British Association Pediatric Surgeons year 2001 #1. General moratorium on sex assignment cosmetic surgery No surgical moratorium (In1999, AAP decided that surgical moratorium was “unrealistic” because it was hypothesized that parents would not accept it) No surgical moratorium #2. Moratorium should not be lifted unless and until studies show outcomes are positive Recognized need for more research and greater candor and honesty Recognized need for more research and greater candor and honesty #3. Efforts should be made to undo effects of past physician deception and secrecy No call back to families or individuals that had previous treatment No call back to families or individuals that had previous treatment Response to intersex birth “ Social emergency” Informed consent includes “possibility of non-operative management” Gender assignment All virilized females (CAH or maternal androgen) should be girls (because of retained fertility) Gender assignment on individual basis; may include cultural considerations Clitoral surgery Infants raised as girls “will usually require clitoral reduction” “ There is a strong case for no clitoral surgery in lesser degrees of clitoromegaly” Penile surgery PAIS infants “in whom a very small phallus mandates a female sex of rearing” should have testes removed The risk of malignant testicular changes in AIS is small

94. Basic Human Right: To Be Who We Are!