“One of these realities is right, and one isn’t.”
That’s one of the viewpoints  that was shared as the S.D. House HHS Committee debated HB 1225, which seeks to limit athletes to participating in S.D. high school sports activities to the division for the sex that was written on their birth certificates.
For those who have never questioned our own sex or gender, or the sex or gender of those around them, it seems clear: Boys are boys, and girls are girls! We were born one or the other! It’s the natural order of things! It’s the way God made us!
Except, once you start looking at nature—at “reality”—and the way that God actually made some of us, it’s not that clear at all.
It turns out that instead of there being one group over here that’s male and another group over there that’s female, with a clear line between them, there is a gray area in the middle where people can have characteristics of both. “Biological sex is not black or white,” explains Emily Quinn, who gave a TED Talk  about her own experience. “It’s on a spectrum.”
What shall we use to determine sex? Looking at genitalia—vagina or penis?—is easiest. But there are actually seven ways that sex can be determined: besides genitalia, there’s chromosomes, gonads (testicles or ovaries), internal sex organs, hormone production, hormone response, and secondary sex characteristics (breast development or body hair). “Those seven areas of biological sex all have so much variation, yet we only get two options—male or female,” Quinn said.
Quinn describes herself as a woman, and from all external appearances looks like a woman. But, in addition to having a vagina, she has testes instead of ovaries. Her chromosomes are XY—male.
Variations in the seven areas of biological sex are unusual, but are less rare than you might assume. Statistics vary; some physicians estimate that variations in genitalia occur in 1 in every 1,500 to 2,000 births, but that doesn’t measure other variations that don’t show up until later in life. For example, a woman described in an article in the journal Nature (“Sex redefined”  by Claire Ainsworth, Feb. 18, 2015) learned, when pregnant with her third child, that some of her chromosomes were male.
“Doctors have known for a long time that some people straddle the boundary—their sex chromosomes say one thing, but their gonads (ovaries or testes) say another,” Ainsworth writes. The term for this is “intersex.”
My father-in-law, who worked with database systems at a children’s hospital for a decade, noted there were far more opposite-sex surgeries for babies than one would have assumed. He had to create a new category in the system so those surgeries were no longer tagged as errors.
Considering all the possible ways biological sex can vary, something outside the traditional male/female divide could occur in as many as 1 out every 100 people, according to some researchers.
Every S.D. school has at least 100 students—it’s statistically possible, then, that one of them is intersex. What would have been written on their birth certificate? Would it have accurately reflected their sex?
It’s important to note the difference between biological sex and gender, which is the societal role that a person belongs to. If society says we have only two genders, then at least some percentage of humans are going to be slotted into a gender in which their sex does not clearly align.
Understanding that biological sex occurs on a spectrum doesn’t immediately suggest what the S.D. High School Activities Association should do about where transgender youth should play sports. What happens (to describe a related example) when a woman with naturally occurring high testosterone competes and wins in track, as is the case with Caster Semenya of South Africa? Since our sports are gendered, we still need to have conversations about where to draw the line to ensure fair competition.
But S.D. legislators should know that drawing the line at what is written on a child’s birth certificate does not reflect “reality.” Reality is a good deal more complicated than that.