False Binary: Real Harm

[The following essay was published in the Fall 2013 issue of Cultural Encounters. I’ve reverted many of the editor’s changes which were made because the original phrasing was “too heterodox” for publication (for example, restoring the original title and thesis statement), made a few other light edits for accuracy and clarity (like updating the link in footnote 1 to a more current and accurate article), and reformatted everything for the web. Since the original publication I have stopped identifying as a Christian, for the reasons raised at the end of the essay and a number of additional ones as well. Also, I’ve come to embrace a wider definition of intersex and transgender than I held at the time of original writing, and now identify (if only slightly) as both.]

I am in unrelenting agony. My left testicle feels like it is being continually squeezed and yanked out of place. The sensation varies from gut-wrenching to unbearable. It is quite literally disabling. The intensity and relentlessness of the pain are such that I can no longer work or study, even when every accommodation I can think of has been made for me.

The origin of my pain is inextricably bound up with the false notion that gender is divided into a rigid binary. Let me explain.

Starting off life just a little bit different

I was born two months premature, back when that kind of thing was a real challenge for the NICU. I was also born with atypical genitalia,1 the primary manifestation being that my testicles did not descend: they resided permanently in my abdomen instead of my scrotum. This matter went unnoticed (or ignored, and rightly so, in favor of more pressing matters pertaining to my survival) during the frantic chaos that surrounded my birth. And so, when I was growing up, since my private parts (and everyone else’s) were private, I had no idea that my anatomy was unusual; I liked my body as it was and I never felt that my body wasn’t the way it should be.

It wasn’t until my first routine physical when I was ten years old that I discovered that my genitals were atypical. The differences weren’t drastic—I was just a little odd in a few ways. My doctor noted with seriousness that my testicles hadn’t descended. And then I was sent to more and more doctors and specialists for second and third opinions and consultations and options.

And in all the appointments, the poking and prodding, the hushed, serious voices, the failed attempts of one doctor in hiding his revulsion/disgust at seeing my genitals, none of it caused me to rethink how I thought of gender. My gender identity was male (as it still is), and I saw gender as binary because it didn’t occur to me that it could be otherwise. Learning that gender wasn’t a simple binary would have to wait almost two decades, when I would finally stumble across an article about people who were intersex—people who were born with ambiguous genitalia. If only I knew as a ten-year-old what I would realize by reading that article years later.

Sex vs. Gender; Gender Binary vs. Gender Spectrum

It will be helpful to pause at this point and define a few terms carefully, in particular, ‘sex’ and ‘gender’. Many people use them interchangeably, but that is a mistake that causes much confusion. Indeed, I prefer to use the phrases ‘biological sex’2 and ‘gender identity’ to help set them apart. Your biological sex is determined by what organs you have and their arrangement, which genitals and hormones and chromosomes comprise your body. If a person has typically female components/configurations, then their biological sex is female; if a person has typically male components/configurations, then their biological sex is male.

On the other hand, your gender identity is part of your identity—part of your self and how you see yourself as a person. Most people say it is part of one’s psychology. While I agree, I’m inclined to go even deeper and say that it (as with all identity relations) is a part of our spirituality, ontology, and sociality. Each society has its own notion of what it means to be male or female as a gender norm. So, we say, for example, “I am male” (i.e. “My gender identity is male”), meaning “I am a part of this group and follow these norms.”

For the vast majority of the population, their biological sex and their gender identity correlate very closely.3 Please note that neither ‘biological sex’ nor ‘gender identity’ has anything to do with those to whom you are sexually attracted. Sexual attraction falls under ‘sexual orientation’.

When people divide up humanity by biological sex, they usually categorize everyone under either ‘male’ or ‘female’, thus forming two monolithic groups with nobody in between. This move makes for a nice binary distinction: you’re either in one group or the other. But this highly inaccurate—there are people in the middle, but they are mostly hidden from view.

The article noted above told the stories of these people in the middle, people who at birth are intersex (e.g. people who have ambiguous genitalia). One such person told their story of having both a partially developed vagina and a partially developed penis. Another person had a shortened vaginal canal and undescended testicles. Another person’s biological sex was female despite having male sex chromosomes (XY). Many had surgery as infants to “assign” a biological sex to them to “reduce confusion”. Quite often that backfired, causing much more confusion when the child reached puberty and discovered what their parents and doctors had done to them.

What became instantly clear to me in reading such stories and reflecting on my own experience in light of them was that biological sex is not a rigid binary,4 but rather it is a spectrum of different possibilities that are very densely populated at the male and female ends, and sparsely populated in the middle by those who are intersex. Accompanying this realization was the corresponding discovery about gender: gender identity (which so closely correlates with biological sex) isn’t a rigid binary either, but is also clearly a spectrum5 of different possibilities that are densely populated at the male and female poles, and sparsely populated in the middle by those who are genderqueer.6

Suddenly, so much of my life and body and experience made more sense! I took a few years to research and digest and process it, but I feel like my gender identity fits me much better now than it ever did under the gender binary framework with its rigid and monolithic expectations. Those expectations lead people to think and feel that there is only a singularly right way to be male and a singularly right way to be female. Like many other people, I don’t fit into that rigid framework very well. Now if one approaches the subject from the vantage point of a gender spectrum, everything looks different: on this view, there is a whole range of ways to be male. From the vantage point of this approach, I see myself on the outer edge of the male territory, adjacent to the intersex/genderqueer territory.

There is a lot of privilege in being able to identify as male. Even with all I have gone through, I know I haven’t suffered but a fraction of what the intersex community and the genderqueer community have suffered. Still, I see them as my neighbors who have done a lot to help me. So although I identify as male, I stand with those who are intersex and/or genderqueer.

Gender Binary ➔ Surgery ➔ Unrelenting Agony

To return to the earlier discussion on my childhood experience, after seeing all the doctors and specialists and enduring their poking and prodding, furrowed brows and concerned and serious voices, finally the surgeons showed up and announced “Good news! We can fix you.” And by that, they meant that they could surgically bring my testicles into my scrotum and sew them into place. The doctors clearly said that this is what I should do and convinced my parents that this was the right course of action. As a ten-year-old Chinese-American and devout Evangelical Christian, I was compliant; I was always eager to do the right thing, even though I did not understand what was so “right” about what they recommended.

So I had the surgery and got “fixed”. Everything appeared to be fine, except that every now and then, if I sat in the wrong position for too long, my left testicle would start to ache. It was no big deal, but over time it got worse and worse until eventually I had to have another surgery to fix it. Things got better for a time, but then the pain resurfaced; and then not only did the pain come back, it intensified. More surgery came and went with the same results each time: (partial) relief for a little while, only for the pain to return in an increasingly severe manner. To date, I have had five testicular surgeries with the end result being chronic, grinding, disabling pain.

Perhaps the most frustrating thing about the whole ordeal is that my current doctors say that the first surgery was unnecessary and it shouldn’t have been done.7 While there’s no way to know for certain, we’re pretty sure that if I hadn’t had that first surgery, then I wouldn’t have needed any of the subsequent ones either. All of this pain could have been so easily avoided. All that would have needed to be done was for the surgeons to leave me alone.

The reasons given to my parents and me for the surgery were bad ones, though we/I didn’t know it at the time. So why was surgery suggested? Why was this option pushed so strongly? Why not just leave me alone? The answers always come back to the gender binary mindset and the associated notion that there is a right way to be male (and a right way to be female). Having undescended testicles is not the right way to be male on this view, and so it required fixing.8

I want to be clear here that I don’t blame my doctors or my parents. I believe that they were sincerely trying to do what was best for me as best as they knew how. But still, they had brought into their decisionmaking the false notion of the gender binary to disastrous effect.

With the previous point in mind, I want to express my deep empathy for people who are transgender. Not that I’ve faced anything like the oppression that transgender people routinely face, but I feel like my experience of not wanting or needing surgery and yet having it forced on me is the mirror image of many transgender people’s experience of wanting or needing surgery and being denied it. Their experience and my own are two sides of the same coin of the gender-binary smack-down: there’s a right way to be and you’ll be forced to conform.

Replacing the Gender Binary with the Gender Spectrum

The gender binary hurts everyone. It is most obviously harmful for the ones caught in the middle: intersex, genderqueer and transgender. The gender binary either refuses to acknowledge their existence, or it declares them broken. It is clearly harmful for people like me who are a little bit different; we can be forced to conform—surgically/violently. The gender binary is also subtly, insidiously harmful to the population at large: girls are held to an impossible physical standard; boys are shamed for liking anything that is insufficiently ‘macho’. Even when the gender ideals are adjusted to account for those who don’t embody the dominant culture’s ideal categories of femininity or masculinity, the overarching parameters of the gender binary enforce conformity and uniformity instead of celebrating variety and diversity.

Binary thinking leads to reductionistic and often painful, even oppressive results. Even minor deviations from the norm demand forceful (in my case surgical) solutions that can cause huge and lasting harm. Even with good intentions, this notion that there is something to be fixed is harmful, literally damaging. We need to switch from a “this is something that has to be fixed” binary culture to a “this is something to be celebrated” spectrum culture.

I am finding the struggle increasingly problematic in my Evangelical Christian community and am seriously considering leaving the Evangelical faith tradition in which I was raised. My question to my faith community and those segments of the population at large who still operate by way of the gender binary is: what are you going to do with someone like me?

2016 Addendum: Current Identification and a Few More Definitions

In the years since I originally wrote this essay, I’ve come to embrace somewhat wider definitions of Intersex and Transgender and now identify (if only slightly) as both.

Perhaps some new definitions are in order here. In the original essay, I left out the term ‘Gender Non-conforming’ for the sake of simplicity. Whereas we use the term ‘genderqueer’ for someone who has a non-binary (i.e. neither ‘male’ nor ‘female’) gender identity, we use the term ‘gender non-conforming’ for someone who does identify as ‘male’ or ‘female’, but does so in an untraditional manner. My gender identity is ‘gender non-conforming male’—gender-wise, I’m male with some quirks.

Now let’s revisit ‘Intersex’. There are many layers to biological sex; a non-exhaustive list includes: chromosomes, functional hormone levels, what organs you have, and how those organs are arranged. There is a ‘typical’ female configuration for all of these, and a ‘typical’ male configuration, but if any part of the configuration on any of the layers is atypical (i.e. non-binary, i.e. not strictly-male or strictly-female), then you qualify as intersex. It’s a spectrum—a pretty broad one at that—and more people technically qualify than they probably realize. In my case, essentially, I had male organs in a female arrangement (my testicles were where ovaries would typically be). This is pretty minor as far as intersex goes—basically, I’m biologically male with some quirks.

I use that phrasing to draw the parallel between my biological sex and my gender identity. In fact, I’m going to make up a completely new term here (seriously, no one else uses this term, I’m making it up new): (Biological) Sex Non-conforming. So now I can say this: My biological sex is sex non-conforming male, and my gender identity is gender non-conforming male. They aligned nicely, didn’t they. Neat!

Now let’s revisit ‘Transgender’. Someone is transgender (or just ‘trans’, for short) if their biological sex and their gender identity don’t align.9 Conversely, someone is ‘Cisgender’ (i.e. not Transgender) if their biological sex matches their gender identity. So in my case, I was born Cisgender—sex non-conforming male matching gender non-conforming male. But because of the gender binary, doctors “transitioned” me to a more conventional male sex, bringing me out of alignment and I was made Trans.

Admittedly, my sex non-conforming was minor, and my misalignment similarly slight, and if that were all there was to it I probably wouldn’t bother identifying as Intersex and Trans. But I could feel that my testicle was out of place. It felt wrong. And that feeling of bodily wrongness is called ‘Dysphoria’, which is a classic trait of being Trans.10 Now, if it just stopped at that minor dysphoria, I still probably wouldn’t bother identifying as Trans because the dysphoria was easily ignorable. Until one day it wasn’t. And then not only was the dysphoria not ignorable, it was painful. Then excruciating. Then disabling. And now the pain is a fundamental part of my identity, and as a result, Intersex and Trans are also fundamental parts of my identity.

Testicular Neuralgia

[This post is part of my Medical Conditions Series.]

It feels like my left testicle is being squeezed and yanked out of place. (And that is not an entirely inaccurate description of what has actually happened.) And yes, it feels just as miserble as it sounds. The pain varies in intensity, but it never goes away or even dips below excruxiating. What started as an occasional mild discomfort after a surgery I had when I was 10 gradually grew over the years into an intense, disabling neuralgia. I’ve had various surgeries over the years in an attempt to deal with it, and each helped a bit for a little while, but then the pain would return even worse than before. Our best guess is that a nerve (or several) got caught in some scar tissue and is getting pinched increasingly harder as the scar tissue hardens over time. Doctors are somewhat reluctant to try more surgery for fear of creating more scar tissue; I am considerably more reluctant than the doctors at this point.

The pain makes any sort of activity difficult. Lying down and resting is tolerable. I can sit for a few minutes without difficulty, but after 30 min the pain will ramp up and will continue getting worse until I lie down and rest. Standing is worse–anything longer than 5 minutes will ramp the pain. I can walk (more like limp) short distances, but anything longer than a block will be slow, painful, and exhausting. Around the house, I’ll shuffle from room to room; outside the house, I generally use a wheelchair. Stairs are very difficult and I have to take them slowly. Running and jumping are technically possible, but I pay a heavy price for them over the course of the following weeks so I studiously avoid them.

It takes an enormous amount of energy to fight off the pain; I am easily exhausted. I typically spend half of my day sleeping, and the other half resting or reading while lying down. The pain makes it very hard to concentrate and my meds fog my brain as well, so I’ve had to abandon both work and school. What little energy I do have, I spend on taking care of my kids and (what remains of) my health.

Sustainably, I can do activities and interact with people for an hour or two each day. On any given day I can do more, but it will cost me–my pain will ramp up as the activity goes on and I will need extra rest over the next few days (or weeks if over-do it). If I’m careful and plan ahead, I can get extra rest in the days before an activity and then splurge for an extra-long activity without the aftermath becoming too severe, but I can only pull that off once a month or so.

Medical Conditions Series

I have a whole host of medical issues–some are chronic and disabling, and others are episodic or merely disruptive. Over the next few blog posts, I’m going to give a brief description of each of my main conditions and how they affect me. Hopefully, these will help you to see what my disability looks like, how a typical day goes, and why I feel so miserable all the time.

  1. Depression
    I was going to start off this series with Cluster Headaches, but then Robin Williams died and everyone is currently talking about Depression and Suicide. So in an effort to be timely, I’m starting off with this one.
  2. Cluster Headaches
  3. Testicular Neuralgia
  4. Insomnia
  5. “Shockies”
  6. Keloids
  7. Overall