Woooow... that is wild. I honestly had no idea. It seems that almost anything you could imagine is a possible genital configuration.

It's strange to think that 99% of people (including myself) who make jokes about having two dicks have no idea that diphallia is an actual thing.

I find it depressing how eager people are to assign a gender. Surely that's the kind of thing common sense would say to wait on, till the person is old enough to decide on their own?

While I understand that some people do choose something different than they are assigned, I don't know that I'd say it's common sense to wait.  It's equally surely easier to accomplish changes while the person is still in their infancy, before the impact of one's own hormones set in.  From a medical and social standpoint, I think that doctors are doing the right thing by trying to fix at least the most severe cases - at least barring any evidence that large numbers of them choose something other than what they are assigned.  I do understand that doing so can lose them sexual function or pleasure, or sometimes both.  But that's not the end-all, be-all of existence - nor even the existence of that region of their body.

Taking chordee as an example - from a sexual function standpoint, I can't see a great reason why it needs correcting.  Pragmatically, I can imagine a kidney stone could become a serious medical problem in anatomy like that - and stones are a common enough occurrence you'd want to plan ahead. 

I cannot imagine what it would be like, socially, to grow up with vaginal agenesis, or to grow up male without a penis - both of which are incapable of any sort of normal sexual function.  Facing the cruelty of children (who are bad enough if you're born tall, short, red-haired, freckled, ugly, or excessively pretty), teens who are worse, facing a life where a normal marriage and such are denied to you unless you happen to be able to afford and get corrective surgery at some later date - I can imagine it would be a far unhappier life than if mom and dad and the doctor said, "we can fix this - at least partially." 

The entire article struck me as bitter and biased, with many word choices that reflect a complete disdain for the best medicine can offer.  I did learn a lot from it, but I did not find the viewpoint at all compelling because I could not get past the language.  Certainly, historically, and even today, I can find examples of medicine preferring males in their study and practice.  Things are getting better.  When my mother and grandmother had menstrual cramps, the doctor would advise that it was all in their heads.  Mine diagnosed endometriosis, and attempted to cure me.  There is still certainly bias preferring preserving male sexual function over a lifetime (the little blue pill) over women's reproductive rights (abortion coverage in health insurance).  Doctors tend to take men's illnesses more seriously.  Then again, women tend to visit the doctor more; I'd think that if a man came to me as a doctor, I'd think it likely more serious, because most men don't see a doctor unless they're pretty sure it's serious.  That's not me being biased against a woman's concern, that's my subconscious learning from experience, and applying it.  And medicine is learning things like that women present differently with heart attacks, and so forth.  Short version:  Yes, it's been bad.  Yes, it's still bad, but we're learning.  I'll bet catfish is  much better informed on women's issues than some older physician who learned medicine in the 60s, when the practice was far less concerned with women's issues.  All of that said, I do not so much see these attempts to normalize gender as being penis-centric, as much as attempting to resolve what they see as a medical issue using available material, to make the most-normal baby they are capable of.   This guy seems to give no credit whatsoever for the good intentions of doctors - they're all focused on the cock and how you have to have one for penetrative sex with a woman, and can't possibly have anything resembling one and still be a woman.  As I said, I get that doctors are biased, but I don't think that bias is the primary force in play here.  Using words like "brag" to describe doctors' discussing improvements to their technique, putting quotes around words like "repair" to denote disagreement that it is in fact restorative, dismissing physician's concerns as "laughable" (see hypospadias) without any actual discussion of whether there's been research done - all of these denote a level of contempt I see throughout this article.  It leaves me with a sense of skepticism as to the objectivity of their view.

I can certainly understand, reading this,  how painful it might be to also have to live without normal sexual sensation.  However, doctors tend to try to fix things within the ability of medical science to be "normal."  Nobody seems to be asking if kids with cleft palates or club feet or flipper hands would rather be left as they are, allowed to decide their anatomy at a later date.  I can see where this is an incomplete analogy, but I still think it's reasonably fair from a medical standpoint.  Baby won't be in a position to express a preference for a few years, and won't be a reliable witness of their preference until many more have passed.  I would not assign gender to a five-year-old, say, because their opinion is still likely based on external factors that have nothing to do with sexual function.   There's nothing wrong or inherently biased in trying to fix something that is going to lead to a non-normal life.  Maybe it'd all turn out okay, the kid would be happy and well adjusted, and would learn to live with their unique gender identity.  Maybe

It also seems to me that if a procedure to assign gender at an early age is likely to cause problems with sexual function, it is likely that it will cause the same problems at later ages, as well.  That is, just because we've waited for baby to make up his/her mind, doesn't mean that they're going to get out of it all they'd hoped it would be.  And I honestly doubt that most of them, given the choice, would say, "I'm happy with things just the way they are.  Leave it be" - with the obvious exception of those who do have a set of organs capable of fairly normal function.

The only other argument I can come up with in favor of assignment later in life is that the field of knowledge may improve.  There may be newer techniques that are more sparing of sexual function.  It may be that in a decade or two, we'd be able to provide these kids with fully functional and pleasurable genitalia of the correct type for their phenotype.  Possibly then it will be better, or even easier, to do so after the child is old enough to express a preference that will (hopefully) stick with them the rest of their lives.  I say hopefully because I know one male-to-female transsexual who reached the conclusion that he'd made the wrong choice - coworker of my mother's.  Given that's the only transsexual I personally know, my sample's not large enough to draw conclusions, save that not everyone who gets their heart's desire finds it to their liking in the end.

Finally, by way of an observation about the frequency of these surgeries, as compared to the frequency of intersex birth, I found this on the isna.org website,

To answer this question in an uncontroversial way, you’d have to first get everyone to agree on what counts as intersex —and also to agree on what should count as strictly male or strictly female. That’s hard to do. How small does a penis have to be before it counts as intersex? Do you count “sex chromosome” anomalies as intersex if there’s no apparent external sexual ambiguity?1 (Alice Dreger explores this question in greater depth in her book Hermaphrodites and the Medical Invention of Sex.)

Here’s what we do know: If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won’t show up until later in life.

Also:

Below we provide a summary of statistics drawn from an article by Brown University researcher Anne Fausto-Sterling.2 The basis for that article was an extensive review of the medical literature from 1955 to 1998 aimed at producing numeric estimates for the frequency of sex variations. Note that the frequency of some of these conditions, such as congenital adrenal hyperplasia, differs for different populations. These statistics are approximations.
Not XX and not XY   one in 1,666 births
Klinefelter (XXY)   one in 1,000 births
Androgen insensitivity syndrome   one in 13,000 births
Partial androgen insensitivity syndrome   one in 130,000 births
Classical congenital adrenal hyperplasia   one in 13,000 births
Late onset adrenal hyperplasia   one in 66 individuals
Vaginal agenesis   one in 6,000 births
Ovotestes   one in 83,000 births
Idiopathic (no discernable medical cause)   one in 110,000 births
Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother)   no estimate
5 alpha reductase deficiency   no estimate
Mixed gonadal dysgenesis   no estimate
Complete gonadal dysgenesis   one in 150,000 births
Hypospadias (urethral opening in perineum or along penile shaft)   one in 2,000 births
Hypospadias (urethral opening between corona and tip of glans penis)   one in 770 births
Total number of people whose bodies differ from standard male or female   one in 100 births
Total number of people receiving surgery to “normalize” genital appearance   one or two in 1,000 births

In short, I find it interesting to notice that 1-2 out of 1000 receive corrective surgery, while apparently 1 in 1500-2000 babies are born visibly intersex.  While I'd expect that some of these simply cannot afford the surgery, I suspect that many of these are born with issues that are not felt severe enough to require medical repair, or where parents elect not to have the procedure done, or otherwise.

That site (isna.org) is in my opinion a much more useful resource, in that it's backing up it's claims where possible with science.  I find their case a little more compelling that intersex infants don't need genital surgery to fix them, however, the two strongest supports they find for this theory come from studies in 1937 and 1952.  The one finds that most of the dozens of intersex people being followed were satisfied with their bodies and didn't want surgery.  I think that in 1937, I'd learn to be satisfied ahead of having surgery - surgery was a much rougher prospect then with higher risks of bad outcome, and penicillin wouldn't be available yet commercially for a few more years, so infection risks were much worse.   The study in 1952 is perhaps more compelling, but I'd still like to see what was defined as psychopathology, over what period the study was conducted (over how many years did he study the individuals, and at what ages, and so forth), and his analysis.  I also suspect it would be a little harder these days - the emphasis on a normal physical form is much, much greater now (consider the stress to be thin, to have a pretty face, the right nose, etc.), so I'd think we'd need a repeat study under more modern conditions to get a good read on how being intersex in today's society works.

I'm still not convinced treatment is a Bad Thing.  I am inclined to give both sides the benefit of the doubt, and I'm glad it's a conversation that's being had.  Overall though, I can't muster up a definite sense that it's harder to be a post-surgical intersex person than a pre-surgical one, in many cases.

Let me shorten this then.  Perhaps I could have done better if I'd spent a few days composing, but that's not in keeping with making a thread post.  It's a complex, meaty issue I've never much thought about.  But here goes with the Readers Digest version:

1.  Doctors are trained to see things that lie outside a normal range as problems.  Within the limits of their ability, they tend to try to bring these things into the normal range.  This applies regardless of if the issue is one of genitalia, stature, physical deformity, or other issues - most of which, but not all, have demonstrable impact on overall quality of life.  That is the nature of medical practice. 

2.  Science isn't perfect, medical science (with apologies to catfish) perhaps the least perfect, because the systems we are trying to manage are immensely complex, and have different opinions about what constitutes "best" function.   Thus, there will always be disagreement as to best practice in almost any area of treatment. 

3.  As far as these surgeries go, my understanding has always been that (a) the gonads - testes and ovaries - play a role in changing/producing sex hormones which help determine the overall femenizing/masculinizing of the body.  Thus, if a child has testicular tissue and is going to be made female, it's better to remove it while the child is young.  Likewise for ovaries in a prospectively male child. 

4.  The article itself was so rife with it's own prejudices, I found it hard to be sympathetic to the author's viewpoint regarding the medicine. Another website I linked to gave better support for changing the medical approach to intersex people - while also seeming to demonstrate that physicians are perhaps not always as quick to jump to surgery as the first article claims.  That presents a more compelling case, but still to me ultimately not completely convincing, that holding off on surgery is always a sound choice.  I certainly agree it's a viable choice in a great many cases, but not uniformly the best decision as this author appears to think.

5.  "Large numbers" - I wouldn't define this as a majority; let us say for simplicity that if more than twice as large a percentage of intersex children want gender reassignment as the percentage of the general population seeking the same, these are beginning to be "large numbers".  Large is relative in science, but my usual criteria would be enough to be statistically significant in demonstrating that doctors are getting it wrong too often.  From what I saw on the ISNA site, progress is being made in identifying a child's innate gender well before puberty, by various subtle clues in their test results.

6. All that said, I hope I made clear that I have a considerable new understanding of the issue, and think it's great that people are pushing medical science to do better here.  I may not agree in every particular with what they are saying, but I certainly find it a worthwhile issue where there's certainly room for improvement.  While I disagree I certainly don't think I've been disrespectful about it - excepting only my contempt for the author's tone.  I stand by that complaint unreservedly.

I hope you find this condensation simpler to read.  I'm trying hard not to be snide myself, because your response on one hand infuriates me, because you didn't take the time to understand my position before arguing with it.  On the other hand, you've apologized for being moody.  So I'm trying to be fair.  I hope I've succeeded in that at least.

Thank you for posting that article.  Very informative.

As I read it, the first question that kept coming up in my mind was, "Is it harder to assign/reassign gender in an adult than an infant?  Or an adolescent?"  This was followed by, "What are the success rates of such procedures?" and "How do the long-term effects of the assignments differ when performed at infancy, childhood, adolescence or adulthood?"

If the reassignment procedures become impossible or inadequate before the child is old enough to decide on his/her own, then the parents and doctors will need to make those hard choices about the child's apparent gender anyway.  The best they can do is be informed and thoughtful about it.

(I should clarify here that I am using the word "procedures" rather than "surgeries" to include hormone treatments and other means in the discussion.)

If these procedures have good success rates at any age, when should they be employed?

To me, the obvious answer is "at puberty."  The individual's body hasn't had a chance to develop the outward characteristics of gender yet (genitalia aside), so the child would have a chance to develop the characteristics of their gender of choice (or remain intersex-expressed, if so desired).  But to what extent can an adolescent clear-headedly make major decisions like these?

The more I think about this issue, the more questions I have.  I don't think it's is as cut-and-dried as Dr. Costello seems to think it is.

We need more information, and we need more input from multiple disciplines as well.  We're having medical doctors trying to make decisions about a person's future gender identity.  Can we get some psychologists in on the discussion?  How about an intersex advocate, like Dr. Costello?  Maybe a teacher could shed some light on the social issues intersex children face in their sensitive developmental years.

Hopefully, we'll see this information come to light over the next couple generations.

...

You are the reason our society doesn't fucking function.

I have written rude words and deleted them in response five times now.

Get stuffed.

Edit: Longer version.

I started reading the post. Like many in the western world, I am trained to believe the first few paragraphs of a story will give a general taste of what is to follow. As such, I have become a skimmer. I delve more deeply into stories that catch my interest.

So in the first paragraph, I have some issues. Some of the remarks raise questions.

Questions, you should know, are not the same as challenges.

I start responding. I realize after a while that I haven't got any farther into the post than the very beginning. I also realize that in my current mental state and time and place, I was not going to get to the rest in any reasonable time. I ADMIT THAT I DIDN'T READ IT ALL and tried to then narrow the scope of my reply to what I did read.

I have a general opinion on the matter, and that is that being intersexed isn't necessarily a problem to be fixed, and that making optional or cosmetic surgical decisions for infants is problematic in general.

Obviously, in practice, things are more nuanced than that, and I'd sure hate to be the one to have to make those decisions.

Sure the article has an agenda. I think it also makes many valid points. Having people be actually aware of these variations in how humans get put together would probably be the most useful thing. It's easier to make sound medical decisions if you are not also screaming OH MY GOD WHAT IS IT KILL IT WITH FIRE.