"Male and female He created them" .. and sometimes intersex

I learned something new on Facebook after posting this article to group for science friendly Christians. I knew that mix-ups in sexual expression sometimes happen but I had no idea how often. Apparently it is as common as being born with red hair, about 1.5% of the time. In fact there are many ways sex can be expressed in ways not clearly female or clearly male. Some will say that everyone is born either male or female and that there is a simple criteria for determining which one they “really” are, but that doesn’t turn out to be true either as made clear here.

The science alone is fascinating and surprising to me at least. But there seems to be a problem here for many Christians. I don’t think there is any deep theological problem anymore than there is for accepting evolution. But many Christians seem not to want to acknowledge this biological messiness perhaps because it reflects poorly on the perfection of creation. But to my mind, and I assume to most or many here, this is no bigger hurdle for Christianity than is the “red in tooth and claw” element of creation. The real problem, as I see it, is that too many Christians are essentially blaming the victims of biology’s mix-ups rather than supporting and respecting them. If only these petty human biases were as easy to address as the science.


I think there is also widespread conflation of intersex conditions with gender dysphoria (equally important topic, but not really the same thing), and having a same sex sexual orientation.

I’m working this week on editing the INTEGRATE unit we are putting out that deals with the topic. It is definitely an area of science Christians need to be educated in before they start telling people how the Bible relates to an individual’s situation.


Fantastic. Got to go do something now but I want to look over that unit when I get back. I only hope BioLogos becomes more widely valued by more Christians.


Actually, it stresses the perfection of creation and the designer of our genes, that after thousands of years of sin and mutations, the vast majority of people still have healthy baby boys and girls. That is a miracle.

The problem here is that I doubt any of the people wanting sex change treatments are victims of any of the DSD’s, most of which are so rare that you or I or anyone on this forum will likely never know one or anyone who knows one. Those who are real victims are under doctors’ care and not seeking public approval.

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Many reviewers are not aware that this figure includes conditions which most clinicians do not recognize as intersex, such as Klinefelter syndrome, Turner syndrome, and late-onset adrenal hyperplasia. If the term intersex is to retain any meaning, the term should be restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female. Applying this more precise definition, the true prevalence of intersex is seen to be about 0.018%, almost 100 times lower than Fausto-Sterling s estimate of 1.7%.

To get this ~1.7% number, apparently they needed to include conditions that no reasonable observer would have ever thought about classifying as “intersex.” such as a late onset disease that overproduces testosterone or other androgens in unambiguously biological women, or other obvious gender-specific birth defects in unambiguously male or female children.

for instance, also apparently included in “intersex” conditions to disingenuously beef up this number is a congenital birth defect (hypospadias) in unambiguously male babies where the urethra opens on another location along the penis than its normal location. Even wikipedia describes it as…

"Hypospadias is among the most common birth defects in the world and is said to be the second-most common birth defect in the male reproductive system, occurring once in every 250 males.

Recommend a bit of skepticism with such reports as that.

Did you not read the OP at all before jumping in? 1.7 percent of the population. You most likely do know someone. Having an intersex condition is not the same thing as gender dysphoria. Their biological sex is ambiguous in some way, they don’t feel a mismatch between a clear biological gender and their sense of gendered self.


I actually read that article when I was doing research for the unit. On the one hand, it is true that if you only count ovotesticular disorder (people born with both sets of genitalia), the number is very low. But it is simply inaccurate to assert that every other instance of non-dimorphic sexual development doesn’t “count” as an intersex condition in the eyes of the medical community or in the eyes of the people who live with them. Most of the 1.7 percent comes from late onset congenital adrenal hyperplasia, which affects 1.5% of the population.

In regards to the quote you posted, that contention has received significant pushback.

This statement actually contains two distinct definitions (separated by the word “or”) relating to phenotypes and chromosomes. It is an arbitrary and ideological analysis that requires individuals who have come to the attention of medicine due to their innate physical characteristics to be investigated as to the cause. Depending on that cause, they may or may not fall within Sax’s definitions.

From the organization Intersex Human Rights Australia Intersex population figures – Intersex Human Rights Australia

If we are pushing for compassion and inclusion (as is befitting of Christians), we should listen to the groups that are advocating for compassion and inclusion.

They say (same link as above):

IHRA does not support the analysis by Sax, largely because we attribute a different meaning to the word intersex, based on lived experience. Many intersex people who fall outside Sax’s narrow two definitions face stigmatisation and suffer human rights violations in the same way as intersex people who fall within the definitions, because their physical development does not conform to medical or social norms for female or male bodies. Many such individuals, including people with XXY, hypospadias and MRKH, have helped found and help lead the intersex human right movement.

In this sense, the difference between narrow and broad definitions in medicine is arbitrary and ideological. It is arbitrary in that investigation and testing is required to establish the cause of relevant biological characteristics. It is ideological in that intersex people share common ground due to the shared experience of stigmatisation of our atypical sex characteristics. It is the perceived need for diagnosis and treatment itself that defines the intersex population, and not necessarily a specific and narrow set of causal factors.

In this context, a 2006 shift in medical terminology is illuminating. “DSD” was defined by clinicians as a “replacement” medical term for hermaphrodite, pseudo-hermaphrodite and intersex. The term itself remains highly contested: Australian and many other intersex organisations regard it as inherently pathologising; it tends to sanction medical intervention. Our contention was supported by the Australian Senate’s Community Affairs Committee in a 2013 report on the Involuntary or coerced sterilisation of intersex people in Australia .

Even though we object to the term “DSD”, it encapsulates a range of atypical physical or anatomical sex characteristics. These share in common their non-conformance with medical and social sex and gender norms. This non-conformance with stereotypical standards for male and female is why intersex differences are medicalised in the first place and, while that remains the case, it makes sense to us to include them in a definition of intersex.

The low figure of 1 in 1,500 or 1 in 2,000 live births is not borne out by data published elsewhere. The NSW Ministry of Health reports data from the State’s Mothers and Babies Report 2009 showing that infants with visible reportable differences of sex anatomy between 2003-2009 comprised 0.59% of all births, or 1 in 169. No breakdown of additional (often not yet apparent) relevant chromosomal “anomalies” is given.

Thus, in the absence of better internationally-accepted data, Intersex Human Rights Australia cites a systematic review by Blackless, Fausto-Sterling and others showing intersex to be around 1.7% of all live births.

This more broad treatment is also how intersex conditions are presented at this Christian intersex advocacy website: https://www.intersexandfaith.org/

Recommend you look into this a little more carefully. You aren’t as informed as you think you are.

See also this article about inclusion in the church:

  • re: the thread title and OP. Neat little minefield you’ve planted here, @MarkD.’ :grinning: Having said that: I hasten to add that the topic fascinates me, too. At the risk of saying something that gets this thread moved to a PM bin, I’ll comment.
    • Notes to self:
      1. No Politics.
      2. No Neologisms.
      3. Play nice.
  • The term “biological messiness” brings to mind the work(s) of art, among my favorites, by the American artist, Charles Bragg, titled: “In the Beginning, There Were Mistakes”. And together, “biological messiness” and “mistakes” raises–for me–the question: "When is ‘a mistake’ and “messiness” a undesirable and messy?

“Petty human biases”??? Is that a scientific classification? I ask because I don’t see it included in my chart of cognitive biases.


I was going to warn you, but thought better of it. I wasn’t kidding when I called out this thread for its “minefield”. My sympathies.

Not to my knowledge and not the intention in my use of those words. Plain language is good enough for me.


I think there is something fishy about that 1.7% number. People who actually have Swyer syndrome is between .001% and .005%. And genetic anomalies in general is more like .02%. So where are these exaggerations coming from to multiply this number by 100 to 1000 times?

I tried looking up “late onset congenital adrenal hypoplasia” but I am only finding “late onset congenital adrenal hyperplasia.” uh… guess that is what you meant. Many don’t even have any symptoms. Others just have some minor male characteristics like facial hair or baldness later in life. They have children and are female in every other way so that frankly looks like these are added to inflate the numbers dishonestly.

Of course the main point of the article is asking people to be kind and non-judgemental… which is something people ought to be anyway. The more troubling part of this for most people is the implied attack on their very identity and a number of privileges which go with it such as restrooms designed for their own sex so they don’t have to confront the opposite sex when attending to such needs. Most likely things will change as they already have in many places around the world with unisex restrooms. But resistance to any change is natural and understandable some places more than others.


Fair enough. So, what’s the plain language definition of “victims”? From my POV, as a Christian, evolution doesn’t “make” victims.

I used it to indicate that those with the intersex conditions are burdened/victimized by unlucky biology as opposed to any choice they themselves have made.


I agree with most of what you say here except for the idea that conditions which aren’t really intersex are being included in order to pump up the numbers. I don’t understand it all well enough to have an opinion about that, but I don’t see any reason to doubt the sincerity of those who include all these conditions as intersex.

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Maybe it would help to compare this with something less controversial … are people ever born missing limbs (but otherwise ‘okay’)? Would we ever dream of treating such a person as a second-class citizen in church because of such a thing - or question their status as a loved child of God?

Nor do I think would we begin to feel threatened that fully accepting and welcoming such people would begin to erode our notion that God created humanity to have two arms and two legs each. That is the norm - and remains the norm despite the fact that it isn’t universal. Would we object against accepting such people because we feel their presence threatens our conviction that healthy humans generally have two arms and two legs each? Of course not - we just realize that life always has ‘edges’ and that not everybody is in the middle of every ‘norm’.


Yes, hyperplasia, I will edit that.

There is a chart of the distributions at the link I posted. It is from the referenced systematic review by Fausto-Sterling.

Cause Estimated frequency per 100 live births
Non-XX or non-XY (except Turner’s or Klinefelter’s) 0.0639
Turner Syndrome (45,X or 45,XO) 0.0369
Klinefelter Syndrome (47,XXY) 0.0922
Androgen Insensitivity Syndrome (i.e. Complete AIS) 0.0076
Partial Androgen Insensitivity Syndrome (PAIS) 0.00076
Classic CAH (omitting very high frequency population) (Congenital Adrenal Hyperplasia) 0.00779
Late-onset CAH 1.5
Vaginal agenesis 0.0169
True hermaphrodites (now termed ‘Ovotestis’) 0.0012
Idiopathic 0.0009
Total 1.728

Who is this “they” that is “inflating the number dishonestly”? The organizations of intersex individuals advocating that we take the lived experience of intersex individuals seriously? If the people in that group self-identify with the group and think they need advocacy based on their lived experience, then the people outside the group don’t get to tell them they don’t count because they aren’t “intersex enough.” Wouldn’t that be like telling someone they aren’t Black enough to experience racism?

That is conflating transgender persons with intersex persons.


Of course not, people make victims. Societies enculturate people into biases that victimize people who do not fit societal ideals. This is not controversial. Societies have ideals around gender roles and gender binaries. Those ideals result in marginalization of those who don’t fit them.


Did you bother to go past that and look up anything for yourself? I don’t know if the author from the first article has an agenda to push. DSD covers dozens of conditions, from mild (you wouldn’t know you had it unless you were checked for it) to extreme. Many of the severe conditions have less than 150 victims since the conditions were discovered.
List here:

Exactly. Humans are genetically diverse. A Christian ethic does not look at people born with Down syndrome or congenital deafness or autism as in need of “fixing” of some sort. We acknowledge that is how God has created them. That is the same acknowledgment that intersex individuals are asking for from Christians. You do not need to neatly fit into an exclusively male or exclusively female biological gender binary in order to participate in the kingdom of God or bear God’s image. When the Bible says God created humanity in his image, male and female, he isn’t saying that only people who fit either male or female are created in God’s image. He is saying all humans are God’s image.


Yes, Patrick. I just helped write an instructional unit on this topic that was expert reviewed by multiple Christian scientists.

What are people worried this “agenda” is? How is accepting people the way they are born a nefarious agenda?