Understanding Intersex: What is a Person Who is Both Sexes Called?

I remember a conversation with my friend, Alex, that really stuck with me. Alex had always felt a little “different,” if you know what I mean. Not in a bad way, just… not quite fitting the usual boxes. Growing up in a small town, everyone was pretty much either “boy” or “girl,” and that was that. But Alex’s body told a more nuanced story. They had gone through puberty with some confusing physical changes, and doctor visits often felt like navigating a maze of hushed tones and medical jargon. It wasn’t until their late twenties, after years of feeling like an anomaly, that Alex finally received a clear explanation from a specialist who simply said, “You’re intersex.” That one word, for Alex, was both a revelation and a profound sense of relief, a label that finally offered a framework for understanding their own unique biology.

So, to answer your question directly and clearly: A person who is both sexes, meaning they are born with sex characteristics — including genitals, gonads, and chromosome patterns — that don’t fit typical definitions of male or female, is medically and respectfully referred to as intersex. It’s a broad umbrella term encompassing a variety of natural bodily variations, highlighting the beautiful diversity of human biology beyond the binary of strictly male or female. Understanding this term and the experiences it represents is crucial for fostering a more inclusive and informed society.

Unpacking the Term: What Does Intersex Truly Mean?

The concept of “both sexes” can conjure up various images, but when we talk about a person who is intersex, we are referring to a biological reality. It’s not about gender identity, which is how someone feels internally about being a man, woman, both, neither, or somewhere else on the spectrum. Instead, intersex refers to a range of natural variations in sex characteristics. These characteristics can include chromosomes, gonads (testes or ovaries), internal sex organs (like a uterus or prostate), and external genitalia.

Think of it like this: most folks are born with sex characteristics that align neatly with either “male” or “female.” They have XY chromosomes and testes, or XX chromosomes and ovaries, and their external anatomy generally matches up. However, nature is wonderfully diverse, and sometimes, a person’s sex characteristics don’t fit into these two neat categories. This isn’t an illness or a disorder; it’s simply a variation in human biology. It’s estimated that as many as 1 in 100 people are born with some form of intersex trait, though visible ambiguity at birth is less common.

Historically, medical terms for these variations were often loaded with stigma, like “hermaphrodite,” which is now widely considered outdated and offensive. The preferred and accurate term today is “intersex.” This shift in language reflects a greater understanding and respect for individuals with these biological differences. It underscores that intersex people are not anomalies but simply part of the natural spectrum of human sex.

Intersex is Not the Same as Transgender or Non-Binary

This is a really important distinction, and one that often causes confusion. Let’s clear the air:

• Intersex refers to biological sex characteristics. It’s about a person’s body.
• Transgender refers to gender identity. It’s about a person’s internal sense of self, which differs from the sex they were assigned at birth. A transgender man, for example, identifies as a man, even if he was assigned female at birth.
• Non-binary is a specific gender identity, meaning someone doesn’t exclusively identify as a man or a woman. Many non-binary people identify as transgender, too.

An intersex person can be a man, a woman, non-binary, or any other gender identity. Their gender identity is separate from their intersex status. For instance, an intersex person might identify as a woman and live as a woman, or they might identify as a man and live as a man. They could also identify as non-binary. Being intersex describes a bodily reality, not an identity or an orientation. This nuance is crucial for respectful communication and understanding.

A Deeper Dive: Common Intersex Variations and How They Manifest

The term intersex is an umbrella, covering a wide array of conditions, each with its own unique genetic, hormonal, or anatomical characteristics. It’s not a single condition but rather a spectrum of possibilities. Let’s explore some of the more commonly recognized variations:

Androgen Insensitivity Syndrome (AIS)

Imagine your body cells are like little locks, and hormones are the keys. Androgens are male hormones, like testosterone. In Androgen Insensitivity Syndrome (AIS), a person has XY chromosomes (the typical male chromosomal pattern) but their body’s cells don’t respond properly to androgens. It’s like having the key, but the locks don’t open. This means that despite having male chromosomes, the external genitalia may develop as typically female, or somewhere in between. Internally, testes are present but are usually undescended and might be found in the abdomen or groin, and there’s no uterus or ovaries. Individuals with Complete AIS (CAIS) are typically raised as girls and develop female secondary sex characteristics at puberty, like breasts, but they don’t menstruate.

Congenital Adrenal Hyperplasia (CAH)

This is a group of inherited conditions that affect the adrenal glands, which are small glands located on top of the kidneys. The adrenal glands are supposed to produce essential hormones, but in CAH, there’s a problem with enzyme production. This can lead to an overproduction of androgens. For individuals with XX chromosomes (the typical female pattern), this excess androgen exposure before birth can cause the external genitalia to appear masculinized, sometimes significantly. This might mean an enlarged clitoris that resembles a small penis, or fused labia that look like a scrotum. Internally, however, they have a uterus and ovaries. CAH can range in severity, with some forms also causing life-threatening salt-wasting crises.

Klinefelter Syndrome (XXY)

Normally, people have either two X chromosomes (XX) or an X and a Y chromosome (XY). In Klinefelter Syndrome, a person is born with at least one extra X chromosome, most commonly XXY. These individuals are typically assigned male at birth because they have a Y chromosome and usually develop male external genitalia. However, the extra X chromosome can lead to a range of characteristics, often becoming more noticeable during puberty. They might have smaller testes, reduced fertility, less body hair, and breast development (gynecomastia). They may also be taller than average and have some learning differences. While usually identifying as male, their unique chromosomal pattern places them under the broader intersex umbrella due to the variations in sex characteristics.

5-alpha-reductase Deficiency

This is another fascinating variation related to hormone processing. Individuals with 5-alpha-reductase deficiency have XY chromosomes and testes, but their bodies can’t properly convert testosterone into dihydrotestosterone (DHT) – a more potent androgen that is crucial for the development of external male genitalia before birth. As a result, they may be born with external genitalia that appear more female, or ambiguous. However, at puberty, the surge of testosterone can cause a “second puberty,” where some masculinization occurs, such as the clitoris enlarging into a penis-like structure and the testes descending. Many individuals assigned female at birth due to this condition might then identify as male or choose to live as male after puberty, though others continue to identify as female. This condition beautifully illustrates the complex interplay of hormones and development.

Gonadal Dysgenesis (Mixed Gonadal Dysgenesis, Pure Gonadal Dysgenesis)

This category refers to conditions where the gonads (testes or ovaries) don’t develop properly. In Mixed Gonadal Dysgenesis (MGD), a person might have one streak gonad (undeveloped gonad) and one testis, or other combinations. Chromosome patterns can vary, often involving mosaicism (where some cells have one set of chromosomes, and other cells have another). The external genitalia can be ambiguous, and internal reproductive organs can also be mixed. Pure Gonadal Dysgenesis (PGD) involves the presence of streak gonads on both sides, typically leading to a female external appearance, regardless of chromosomal sex, due to the absence of functional gonads producing hormones. These individuals are usually infertile and require hormone replacement therapy.

This isn’t an exhaustive list, but it gives you a sense of the biological complexity. Each variation tells a unique story about how human bodies can develop in ways that challenge our conventional definitions of male and female.

The Evolution of Language: From Stigma to Respect

Language matters, especially when discussing sensitive and personal topics like someone’s bodily reality. The journey from stigmatizing terms to respectful, accurate language for intersex individuals has been a long one, mirroring a broader societal shift towards understanding and acceptance.

Why “Hermaphrodite” is Outdated and Harmful

For centuries, the term “hermaphrodite” was used to describe individuals with ambiguous genitalia. This term originates from Greek mythology, referring to Hermaphroditus, the child of Hermes and Aphrodite, who became merged with a nymph, acquiring both male and female physical traits. While it might seem descriptive on the surface, its use in a medical or social context today is deeply problematic:

• Imprecise: “Hermaphrodite” implies that an individual possesses fully functional male and female reproductive systems, which is exceedingly rare, if not biologically impossible, in humans. Most intersex conditions involve a mix of characteristics, not a complete set of both.
• Dehumanizing: It treats individuals as mythical beings rather than real people with complex anatomies and lives.
• Stigmatizing: The term has been historically associated with sensationalism, objectification, and even seen as a “freak of nature,” leading to immense psychological distress for those labeled with it.

For these reasons, the intersex community and medical professionals strongly advocate against using “hermaphrodite.”

The Power of “Intersex”

“Intersex” emerged as the preferred term for several reasons:

• Accuracy: It accurately describes the biological variations in sex characteristics.
• Neutrality: It’s a medical and biological descriptor, free from the mythological and sensational baggage of “hermaphrodite.”
• Empowerment: It was largely adopted by the intersex community itself, reflecting a move towards self-determination and the reclaiming of identity.
• Inclusivity: It encompasses the wide range of variations, from chromosomal to anatomical, under a single, respectful umbrella.

When you encounter someone who is intersex, or are discussing the topic, always use “intersex.” It’s a sign of respect and an acknowledgement of their humanity and dignity.

Key Terms to Keep Straight

To really grasp this topic, it helps to understand a few fundamental concepts:

• Sex: This refers to biological attributes, including chromosomes, gonads, internal and external genitalia, and hormones. It’s often categorized as male, female, or intersex.
• Gender: This is a social and cultural construct, referring to the roles, behaviors, expressions, and identities that a given society associates with being a man or a woman, or other gender identities. It’s fluid and culturally specific.
• Gender Identity: This is a person’s internal, deeply held sense of being male, female, both, neither, or somewhere else on the gender spectrum. It’s completely distinct from biological sex.
• Sexual Orientation: This describes who a person is attracted to romantically, emotionally, and/or sexually (e.g., heterosexual, homosexual, bisexual, asexual). Being intersex has no bearing on one’s sexual orientation.

By understanding these terms, we can have more precise and respectful conversations about the complex realities of human diversity.

The Medical Journey: From Diagnosis to Self-Determination

The medical journey for intersex individuals has been, and continues to be, a complex and often fraught one. While medical advances have brought incredible understanding, ethical questions persist, particularly regarding interventions on infants and children.

When and How Intersex Conditions are Discovered

The discovery of an intersex condition can happen at various stages of life:

1. At Birth: This is often when external genitalia appear ambiguous. Medical professionals might notice that the infant’s genitals don’t clearly look like typical male or female anatomy.
2. In Childhood: Sometimes, the condition becomes apparent later in childhood if, for example, a child with XY chromosomes and female external genitalia develops unexpected secondary sex characteristics or if growth patterns differ from peers.
3. During Puberty: Many intersex conditions become apparent during puberty, as the body undergoes significant hormonal changes. For example, a person assigned female at birth might not start menstruating, or a person with XXY chromosomes might experience breast development.
4. In Adulthood: Some intersex traits might go unnoticed until adulthood, perhaps during investigations for fertility issues, unexplained medical symptoms, or even by chance during unrelated medical imaging. As my friend Alex’s story illustrates, sometimes it takes years to get a clear diagnosis.

The diagnostic process typically involves a combination of physical examination, chromosome analysis (karyotyping), hormone level tests, and imaging studies (like ultrasounds or MRIs) to visualize internal organs.

Historical Approaches: A Difficult Past

For decades, the dominant medical approach to intersex conditions, particularly when discovered at birth, was what’s often referred to as “normalization” surgery. The idea was to quickly assign a sex (usually female, as it was considered “easier” to achieve surgically) and surgically alter the infant’s genitalia to align with that assignment. The rationale was to “fix” the baby, alleviate parental distress, and prevent future social stigma.

However, this approach had severe and often devastating consequences:

• Loss of Sensation: Genital surgeries on infants could lead to a permanent loss of sexual sensation.
• Incorrect Sex Assignment: Sometimes, the assigned sex did not align with the child’s later gender identity, leading to profound distress and the need for further, often more complex, medical and social transitions.
• Lack of Consent: These surgeries were performed on non-consenting infants, denying them bodily autonomy and the right to make decisions about their own bodies later in life.
• Secrecy and Shame: Families were often advised to keep the intersex diagnosis a secret, fostering an environment of shame and isolation for the child.

Looking back, it’s clear that while the intentions might have been to reduce suffering, the outcome often created new forms of trauma and harm. This history serves as a stark reminder of the importance of ethical considerations in medical practice.

Current Ethical Considerations and Best Practices

Thankfully, medical understanding and ethical standards have evolved considerably. Today, there’s a growing consensus, supported by intersex advocates and many medical organizations, that non-emergency, irreversible genital surgeries on intersex infants and children should be deferred until the individual is old enough to participate in the decision-making process. This approach prioritizes bodily autonomy and informed consent.

Key components of modern, ethical care include:

• Interdisciplinary Teams: Care is ideally managed by a team of specialists, including endocrinologists, geneticists, urologists, gynecologists, psychologists, and social workers, ensuring a holistic approach.
• Open Communication: Parents are encouraged to be open and honest with their child about their intersex status, fostering an environment of acceptance rather than secrecy.
• Support for Families: Parents need support and education to understand their child’s condition and navigate complex decisions.
• Deferred Surgeries: Surgeries that are not medically necessary to preserve health (e.g., to address a life-threatening adrenal crisis) are typically delayed until the individual can provide informed consent.
• Focus on Well-being: The primary goal is the physical and psychological well-being of the intersex individual, supporting them in their journey of self-discovery and self-determination.

The conversation around intersex care is still evolving, but the movement towards respecting the bodily integrity and autonomy of intersex individuals is a significant step forward.

Living as an Intersex Person: Challenges and Triumphs

Life for intersex individuals is as varied as for anyone else, but it often comes with unique challenges and, importantly, unique strengths and triumphs. Navigating a world built on binary assumptions can be tough, but intersex people are resilient, diverse, and increasingly visible.

Navigating Identity and Disclosure

One of the most significant aspects for many intersex individuals is the journey of understanding and forming their identity. This can involve:

• Self-Discovery: Coming to terms with their intersex status, often after years of confusion or feeling “different.” This can be a profound process of self-acceptance.
• Gender Identity: As mentioned, intersex status does not dictate gender identity. An intersex person may identify as male, female, non-binary, or another gender. Finding a gender identity that resonates can be a key part of their journey.
• Disclosure: Deciding when, how, and to whom to disclose their intersex status. This is a very personal choice, influenced by factors like safety, trust, and the perceived understanding of others.
• Community: Finding support within intersex communities, whether online or in person, can be incredibly validating and empowering. Sharing experiences with others who truly understand can combat feelings of isolation.

Social Stigma and Discrimination

Despite growing awareness, intersex people still face significant challenges due to societal lack of understanding and deeply ingrained binary thinking:

• Misinformation: Many people still don’t know what intersex means, leading to awkward questions, inappropriate comments, or outright discrimination.
• Medical Trauma: The legacy of non-consensual surgeries and the secrecy often surrounding intersex births can lead to long-lasting psychological and physical trauma.
• Legal Hurdles: Navigating birth certificates, passports, and other legal documents that often only offer “M” or “F” options can be challenging and frustrating.
• Bullying and Harassment: Children and adults with visible intersex traits can be targets of bullying, ridicule, or prejudice.

Advocacy and Human Rights

Globally, intersex advocates are working tirelessly to secure human rights for intersex individuals. Key areas of advocacy include:

• Bodily Autonomy: The right of intersex individuals to make their own decisions about their bodies, free from coercion, especially regarding non-consensual medical interventions on infants.
• Non-Discrimination: Protection from discrimination in employment, housing, healthcare, and other areas.
• Legal Recognition: The ability to choose a gender marker on official documents that accurately reflects their identity, and in some countries, the option of a third gender marker.
• Education and Awareness: Increasing public understanding to reduce stigma and foster acceptance.

The intersex movement is gaining momentum, pushing for a world where all bodies are celebrated and respected, regardless of their variations.

Things You Might Not Know About Intersex People

Let’s bust some common myths and offer a few practical considerations:

• Intersex People are Not Rare: While visibly ambiguous genitalia at birth might be less common, the broader definition of intersex variations affects approximately 1 in 100 people. That’s comparable to the number of people with red hair!
• Intersex is a Biological Term, Not a Gender Identity or Sexual Orientation: We’ve covered this, but it bears repeating. An intersex person’s body is intersex; their gender identity and sexual orientation are separate aspects of who they are.
• Not All Intersex Conditions Are Visible at Birth: Many conditions only become apparent during puberty or even later in life, sometimes only through genetic testing or medical investigation for other reasons.
• Intersex People Can Have Children: While some intersex conditions can affect fertility, many intersex individuals are fertile and can have biological children.
• The “I” in “LGBTQI+” Stands for Intersex: This acronym recognizes intersex individuals as part of the broader community of people who challenge traditional norms around sex, gender, and sexuality, even though intersex itself is a biological variation, not an identity or orientation.

Supporting Intersex Individuals: A Checklist for Allies

If you encounter an intersex person or want to be an ally, here’s a simple checklist:

1. Use Respectful Language: Always use “intersex” and avoid “hermaphrodite.”
2. Respect Their Self-Identification: Ask for and use their preferred pronouns and gender identity.
3. Educate Yourself: Learn about intersex variations and issues from reputable sources, especially intersex advocacy groups.
4. Don’t Ask Intrusive Questions: Their medical history or specific anatomy is private. Don’t demand details.
5. Challenge Misinformation: Gently correct misconceptions when you hear them.
6. Advocate for Bodily Autonomy: Support policies and practices that protect the right of intersex individuals to make their own medical decisions.
7. Listen and Learn: If an intersex person chooses to share their experiences, listen with an open mind and a compassionate heart.

My hope is that Alex’s story, and this discussion, helps you understand that intersex individuals are just people, full stop. Their unique biological makeup is a part of their story, but it doesn’t define their worth, their capabilities, or their right to live a life free from judgment and discrimination. By shedding light on the complexities and nuances of what it means to be intersex, we can move towards a society that embraces the full spectrum of human existence with empathy and respect.

Frequently Asked Questions About Intersex

What is the difference between being intersex and having a disorder of sex development (DSD)?

Historically, medical professionals often used the term “Disorders of Sex Development” (DSD) to describe intersex conditions. The phrase “disorder” implies that there is something inherently wrong or broken with an individual’s body. While some intersex variations do require medical attention for health reasons (like Congenital Adrenal Hyperplasia with salt-wasting), many do not pose a health risk and are simply variations in human anatomy.

The intersex community and many advocates find the term “DSD” pathologizing and stigmatizing. They prefer “intersex” as a more neutral and descriptive term that acknowledges biological diversity without labeling it as a “disorder.” While “DSD” is still used in some medical contexts, particularly for specific diagnostic categories, “intersex” is increasingly the preferred social and advocacy term, emphasizing that these are natural variations rather than pathologies that inherently need to be “fixed.”

Can an intersex person change their sex?

This question touches on a complex area of medical intervention and personal identity. When someone is intersex, their biological sex characteristics are already a blend or variation. For individuals born with ambiguous genitalia, parents or doctors historically made decisions to surgically “assign” them a sex (usually male or female) and alter their bodies to conform. These surgeries were often performed on infants, without their consent, and could lead to significant physical and psychological harm later in life if the assigned sex didn’t match their internal sense of self or if sensation was lost.

Today, the focus is shifting. Instead of “changing sex,” the emphasis is on supporting intersex individuals to determine their own gender identity and make informed decisions about their own bodies. This might involve hormone therapy or, if the individual chooses later in life, surgeries to align their body with their gender identity and personal comfort, much like some transgender individuals choose. However, these choices should be made by the intersex person themselves when they are old enough to give fully informed consent, not imposed upon them as infants.

Are intersex people accepted in society today?

The level of acceptance for intersex people in society is definitely growing, but it’s still a mixed bag, to be honest. On one hand, there’s significantly more awareness and advocacy today than ever before. Intersex organizations are working tirelessly to educate the public, challenge discriminatory practices, and fight for the human rights of intersex individuals. Major human rights bodies and medical organizations are increasingly recognizing the importance of bodily autonomy and the right to self-determination for intersex people, particularly regarding non-consensual medical interventions.

However, despite these advances, intersex individuals still face considerable challenges. Many still encounter stigma, misunderstanding, and discrimination in various aspects of life, from healthcare settings to legal recognition of their sex on documents. The deeply ingrained binary understanding of “male” and “female” in many cultures means that anyone who falls outside these neat categories can experience marginalization. There’s a long way to go before full acceptance and understanding are widespread, but the conversation is certainly moving in a more positive and inclusive direction.