Talk:Sex assignment

From Wikipedia, the free encyclopedia

[edit] reasons for reversion of AlexR version

I am reverting this because of multiple defects of fact, POV, and language. You have not improved the article. Unlike you, I will provide the courtesy of explanation.

Fact errors

1. Your statistics are absurd. The incidence of ambiguity significant enough to be described by this article as a conscious assignment decision involving delay or testing is inflated about 10 fold.
2. It is no less true now than 30 years ago "that assignment in these cases may be less a matter of discerning what the infant is than deciding what the infant should become. I have no idea why you would claim that is "in the past."
3. Your claim that this process of deciding how to raise the child has been challenged is simply false, and the reason given is a non-sequitur. I'm not sure what point you are trying to make, but the only challenge that fits your sentence is the fringe opinion that no sex should be assigned until the child is old enough to show the parents or tell the parents the "real sex". In the real world this is considered lunacy by parents, doctors, psychologists, and even most grown intersex patients. If you want to put this in, we should at least make it clear what you are talking about and how little support it has garnered.
4. Your examples of bad outcomes are examples of assignments made in the past on criteria thought at the time to be the best. This is the clearest specific example of an assignment criterion that is now considered obsolete. Why include it here without explanation or perspective? It can be used to support a role of early testosterone in determining gender identity, and it can be used to reject the long-obsolete idea that gender identity is totally a matter of assignment and social learning. It is as the authors point out, of uncertain relevance to cases of ambiguity due to inadequate testosterone effects. Outcomes in the past have been far less clear. You don't use it to make either of these points, so please explain.
5. With regard to reassignment in infancy because of better understanding of an infant's hormonal, anatomic, or potential fertility status, you wrote "However, there are few follow-up studies regarding the success of such reassignments, and those that exist often contradict the theory that gender identiyy is independent of the sexual characteristics existing at birth, and can be changed through surgery and gender-appropriate rearing." I can't tell what this means-- that you think assignment should always be based on first impressions of external genitalia?
6. With regard to the Reimer case, I couldn't find any published claims by Money after it was clear that the reassignment was reversed that it was successful. Do you know of any? Otherwise it isn't the kind of claim to make casually. Don't we deal with it in excruciating detail in its own article?

POV I can't even figure out where you are coming from, except that you have some sort of hostility to medical attempts to assist parents in the management of children with the more difficult type of intersex conditions and genital birth defects, and are willing to misrepresent and distort to express it. The only two examples of assignment you choose to illustrate are of extremely rare conditions in which outcomes are problematic no matter what choice is made. You don't even suggest any specific alternative. Have you got so little understanding of intersex disorders, compassion, or imagination that you can't understand that doctors in 1970 were basing management exactly on what liberal social values of the time were preaching-- to consider gender a learned social construct? Criticising 1970s management in hindsight is cheap, but we've got the points made in other articles and I don't think we need it here.

Language offenses These are multiple. Every paragragh has errors of spelling, usage, syntax, or grammar. This makes it a little harder to accept your choice of words over mine. alteripse 02:36, 4 Jan 2005 (UTC)

You don't know where I come from? And what exactly has that do to with your revert? Which I will of course revert again, because the old article was terribly inaccurate and POV, and you have offered no remotely valid reason whatever for your revert. The old article was misrepresenting such assignemts as completely unproblematic, something that can be falsified with even the most cursory Google searches. And what do you mean by "1970s management" - it is not as if there were not still more than enough doctors around who think exactly the same thing. It is you who promotes exactly those 1970s ideas by reverting the article, BTW, ideas which by now have come under quite some criticism, which you attempt to remove from the article. As for "errors of spelling, usage, syntax, or grammar" - English is not my first language, so if there are such errors, correct them. Usually I am told, though, that I don't make all that many of them, and at any rate, you can hardly use these as an argument for your unfounded revert which restores an absolutely POV version advocating the mutilation of children.

Should you wish to debate some points of the article, feel free - however, I will treat further reverts and mindless rants as the one above as nothing but vandalism. -- [[AlexR 05:04, 4 Jan 2005 (UTC)]]

AlexR, you did not point out a single inaccuracy in the old article: my version did not claim that intersex assignments were unproblematic. Your revision provided a combination of factually wrong information and recounting of a 1960s disaster as if it represented current policy. This is dishonest and the readers deserve better. You offer nothing but personal attacks, insults and dishonest claims in your reply, which is far more a "mindless rant" than my objections. You offer to debate, but answered NONE of my objections. Do I need to spell them out in more detail? Are YOU capable of discussing this without simply repeating your insults? alteripse 13:35, 4 Jan 2005 (UTC)

The inaccuracies I corrected should have been obvious from the fact that I did correct them. And the old version does very much claim that the assignments were largely unproblematic. Some examples:

The physicians involved are more conscious than the infant's parents that assignment in these cases may be less a matter of discerning what the infant is than deciding what the infant should become, Yes, well, but obviously this politic, also called "easier to make a hole than a pole" does not quite work, does it - as the study I cited clearly shows. And that has been the undisputed standard until a few years ago, and is only now being challenged.

When this is done for good reasons in the first month of life it nearly always goes smoothly beyond some temporary embarrassment for the family. Obviously, as the comment shows, that edit was seen by others as not exaclty unproblematic. There are two problems there: One, obviously, as the study I cited (among others) shows, assignment is problematic even when done in the first months of life, and second, the word "embarassment" is highly POV - why should people be embarrassed by a medical condition their child has? Of course, it is exactly that sense of embarrassment that causes parents to make that decision, and stick to it even when it is obvious that the decision was wrong (see study for examples). But that is hardly a reason for a WP article to talk about that "embarrassment" without mentioning the problems that causes.

It's companion piece is of course Reassignment carried out by parents and doctors after early infancy is fraught with more danger of interfering with or opposing the process of gender identity development. implying once again that assignment in early infancy is unproblematic, which it clearly is not.

As for the rest of what you call "fact errors"

1. The number I gave is not "absurd". It is from the article intersex and is was confirmed a few months ago on a conference by medical caregivers, who know a lot more about figures than you do.
2. The "in the past" refered to the fact that this treatment by now is not undisputed any more. Better wording might be entirely possible, but will be hardly achieved by mindless reverts to POV-pushing versions.
3. I am not offering an easy solution, since there is none, and certainly I am not advocating what you are trying to claim I am.

And one last thing: You try to push those problematic assignments firmly back into the 60s and 70s, while at the same time claiming that they not only are still (undisputed) standard, which is changing, but also claiming that they are unproblematic, which they are clearly not. Maybe you ought to make up your mind about these things - either they are a thing of the past, or they are not. And of course you might check pages like isna.org for your claim that early assignments are usually without problems. You know, compassion and imagination are one thing, but facts don't hurt, either. -- AlexR 15:11, 4 Jan 2005 (U

Well, at least you put down some specifics. Here is what you are misunderstanding or misconstruing.

1. The process of deciding on best sex assignment has always involved some element of constructive fitting into one of two social boxes for children who biologically are somewhat in-between. The paragraph emphasizes that physicians are aware that the decision depends greatly on what criteria we consider most important, while parents usually assume the process is one of "discovering" what sex the child really is. Is this too subtle for you? It is a very obvious distinction if you are part of the process and no less true today than 30 years ago. That's all it says. The paragraph said nothing about "holes and poles," which is an allusion to the change of assignment criteria over the last 30 years. The fundamental process is still the same.
   1. Unfortunalely, if that should indeed be what you are trying to express, the wording is vastly improvable. However, there is nothing to suggest that this was indeed what you tried to express, judging from the rest of this POV rant. [AR]
2. Patient group challenges now date back to the mid-1990s and have elicited lots of reconsideration and changes of policy. Why pretend otherwise unless you just like to have villains to bash?
   1. Oh, so a few hospitals have changed their practice. And that of course means all the hospitals in the world did so, and of course, today there won't be any mistakes, either. Then why do I keep getting cases on my desk that clearly say otherwise? [AR]
3. You certainly aren't offering any solution, but each time a child like this is born someone makes the assignment decision. The difficult ones are made with much awareness that the outcome will be less than perfect no matter what criteria are used or what surgeries are done or not done. It is a matter of trying to do the best for the child. So what is the reason for pointing out the imperfections of two of the rarest and most clearly altered assignment criteria? There is no context or explanation. I didn't understand what point you were trying to make. If the point is simply that there are potential problems no matter what is done for the difficult cases, let's say that. If the point is that assignment criteria have evolved in 30 years, let's say that. What point should we make?
   1. I was merely pointing out the problems, using two examples - the first of which already was in the article. And surely criteria have changed in the last 30 years, but still not the general attitude - and one might think about that what one likes, it merrits mentioning. You, on the other hand, obviously prefer to pretend that there are no problems, at least not today. That is clearly POV. [AR]
4. The reason I complained that you are referring to 30 year old policies is that the three specific allusions you make: Reimer, holes and poles, and cloacal exstrophy all date back to the 1960s and 1970s. People were criticizing and caricaturing the holes and poles argument by the 1980s, and as far as the other two examples go, you couldn't have picked any two clearer examples of obsolete management. There is no current debate about either one, but you act like you haven't gotten the message.
   1. Funny, but if you had read the study I mentioned you might have noticed that by no means all cases are 30 years old. But hey, don't check facts - they might disturb your theories. [AR]
5. The number you gave IS absurd when you suggest that 1 or 2 in a thousand births present difficult assignments. Roughly 50% of ambiguity consultations turn out to be females with CAH. Newborn screening programs are now giving us accurate incidence numbers in the range of 1 in 30,000 births (half of the roughly 1 in 15,000 incidence in both sexes). Add a similar number for all the forms of undervirilized males & other rare things and it gives you a ballpark number of 1 in 10-15,000, or 0.01% of live births. This matches the experience of those of us who see these children. Just because ignorant critics invent other numbers does not make them accurate. I
   1. Ah, so doctors who actually are consulted in a lot of IS cases in Germany are giving out "absurd" figures, but you know better. Wow, then it is really good that you are here to correct such obvious errors. And "those of us who see these children" - well, obviously not, or you would not claim such an utter bullshit. [AR]

And generally speaking, your "arguments" suffer from a serious flaw - on the one hand you are claiming that the idea of assigning children, which is based on the idea that gender is learned, is some odd liberal politic advocated 30 years ago and deprecated today. And on the other hand you argue that the very same politic (of course, "refined" today) should be continued. Can't you at least be consistent with your non-arguments? Either the basis of these sex assignments is stable, and gender can be learned, or it can not. You can't have it both ways.

I mean, I know the part of the medical establishment that just hates to learn that there might have been mistakes not only in the past but also in the present argues just like you, with insults, false and inconsistens information and non-arguments and whining about the credentials you are claiming you have, but this is the Wikipedia, here we prefer facts. You might check yours, and you might want to re-read some of your rants in other articles as well, because there you are POV-pushing and insulting, too. Otherwise I can look forward to working on these, and threre are a lot of things I'd rather do. -- AlexR 17:26, 4 Jan 2005 (UTC)

Your first paragraph is mystifying. You say I describe the old "gender is based wholly on social learning" theory as obsolete, but then you accuse me of continuing it. I have not argued that we should continue to assign sex on the basis of a "gender is wholly learned" theory. Why do you keep accusing me of that? The basic criteria for recommending assignment in difficult intersex and birth defect cases have changed since the 1970s. I have said it repeatedly in multiple articles. You accuse me of advocating views I do not, you accuse me of "hating to learn there might have been mistakes in the past" and then abuse me for it. Yet I wrote most of the article on David Reimer, specifically the part that pointed out exactly how devastating his case was to the old management practices, and in other articles I have clearly described unfavorable outcomes from some of the surgeries. I have written more about unsatisfactory outcomes from older practices than you have. I have not provided any false information, I have not argued on my credentials, and I have offered far fewer insults than you. You have yet to refute any of my objections to your text with anything resembling facts. Please argue with what I have written, not what you fantasize that I have written. alteripse 00:21, 5 Jan 2005 (UTC)

So what's wrong with your responses up there?

The issue with the numbers is a specific fact. Part of reason for such widely varying estimates is that various groups of conditions are included in various estimates. You introduced the 0.1-0.2% figure in the context of discussing difficult assignment. I quite explicitly claimed that the percentage of births that represented exactly the type of assignment challenge you were addressing is far smaller. You like many others have been confused by misleading and ignorant claims that nearly any congenital disorder of the reproductive system is "intersex" and then imply that most of those are difficult ambiguous genitalia cases. They are not. Most of them are assigned by the primary physician and parents without hesitation or consultation. I am sorry if you don't like the numbers but I stand by them. The difficult cases of ambiguity you were discussing are much rarer than the total number of children with some type of developmental disorder of the sex chromosomes or reproductive system. If your medical experts provided that number, they were referring to a larger category and you misunderstood or misrepresented it.

You misunderstood or misrepresent my claim that the report of exstrophy outcomes was 30 years old-- I said the management approach was 30 years old. Most of the cases were infants in the late 1980s and early 1990s, and the report validates the criticisms and doubts raised in the mid-90s. It needed to be published, and I have cited it elsewhere, but I questioned your use of it in this article without providing perspective.

As for your claim that some hospitals are still doing some of the things I am claiming are obsolete, that is no reason we should write as if that is what everyone is doing. I can cite lots of publications of the last decade to support what I am claiming. Why should we not describe recommended care rather than older approaches? And DO NOT claim that I deny there might be unsatisfactory outcomes with current approaches... just thought I would save your fingers the trouble. alteripse 01:00, 5 Jan 2005 (UTC)

Well, listen - first of all, if there were insults, you started them. Second, you contradict yourself the whole time without even noticing. Thirdly, you have that funny way lots of self-styled "experts" (whether with a medical degree or not) have who simply claim that every fact they do not like are either made up or "misunderstood". Sorry, but I know what I am talking about. And that ammount of time you have been wasting right now with endless repetitions of "I said so, therefore it has to be correct" and insulting me and contradicting yourself would have been better spent elsewhere - like with educating yourself, for example, or trying to see the contradictions and insults you are dealing out. Until you do, there is obviously no point in any further debate. But then, this never was one in the first place. -- AlexR 03:09, 5 Jan 2005 (UTC)

I have not contradicted myself; you have misrepresented half of what I have said. You appear unable to cope with someone who doesn't fit your preconceived stereotype, so you imagine or invent what you think I said and then attack it.

Getting back to the article, let me see if I can understand what your valid points were among the nonsense:

1. A very small number of babies present a challenge to determine what sex to assign.
2. Our criteria for assignment have changed over the last 4 decades (especially the last decade) for a small number of disorders, largely because some of the outcomes were less satisfactory than hoped.
3. The "small number of disorders" for which a change of assignment criteria has occurred has been mainly conditions involving genetic males with working testes and normal testosterone effects (examples: cloacal and bladder exstrophy and ablatio penis).
4. The specific "less satisfactory" outcome (relevant to this article) is that assigning those specific males as female and raising them as girls turned out to result in a large percentage of cases in a person dissatisfied with their gender of rearing, and many have switched gender.
5. Currently most pediatric endocrinologists and urologists no longer recommend raising males with these conditions as girls.
6. Specific aspects of this change of criteria due to unsatisfactory outcomes include (1) a consensus that early hormones may influence later gender identity, and (2) a greater sense that gender identity may be less influenced by medical treatments, surgery, and childrearing practices than once thought, (3) suggestions have been made to be slower to do irreversible surgeries for conditions where it is harder to predict eventual gender outcome.
7. Outcomes may be unsatisfactory in some way no matter what choice is made. For some of the disorders it is more a matter of choosing a "least bad" course rather than choosing between a right one and a wrong one.

One of the points I think is worth making but you didn't like is:

1. The babies who present the most difficult assignment challenges have a variety of conditions but are in some biological way somewhat "in-between." The doctors who do this have a sense of deciding which one of two social boxes to fit the baby into based on criteria that have changed in the past and may change again in the future, while parents prefer to think of the process as "discovering what sex the baby really is." Can you think of a way to say this that doesn't offend you? It is certainly as accurate a description of the process of assignment today as 30 years ago, but you seemed to have trouble with the concept in the original version.

Have I listed all the key points? Do you disagree with any of them? Any major points I am leaving out? Shall I put them into a revised version of the article? alteripse 04:49, 5 Jan 2005 (UTC)

[edit] Assigning sex/gender

Since Mr. Welsh prefers to continue this rather odd debate, moved message from the user talk pages here (formating fixed). The same issue arose at Transwoman, hence there are some references to that article; the issue, however, is exactly the same:

Please, the last name is "Welch", with a "c". — Phil Welch 07:55, 29 Apr 2005 (UTC)

Fine, but I think the article, either way, has serious POV issues. — Phil Welch 02:53, 29 Apr 2005 (UTC)

In response to your remark:

Would you kindly stop making those stupid and incorrect edits to transwoman? It is obvious that you have no clue about gender assignments, so stop putting BS into the article, or you might find yourself treated as a vandal.

I'm not familiar with the theory, but you're presenting POV as fact and being bold as vandalism.

This is not an objectable POV I am presenting, but I merely insist that the article states the facts as they are.

For example, one is not born in any sex

One is definitely born with a set of sex chromosomes and genitalia. There is established POV that states that sex is a matter of genetics and anatomy.

You removed the format - particularly, the italics around "in". One is born with a sex, but not in a sex. Hence you missed my point. [AR]

there are debates whether transgender people are clearly one sex

My edits have never made a factual statement either way about that issue.

Oh yes, they did - they state clearly that a transwoman was born "in the male sex", but since sex is a rather complex issue, the fact that there is some evidence that the sex of transgender people might not be quite so unambiguous needs to be noted. Not to mention that transwoman can also cover intersex women, in which case the matter is even less clear. [AR]

and intersex people can get assigned another gender at any time, not only shortly after birth.

Fair enough.

And, the most basic thing: You may have something hanging between your legs, but what gets into the papers is not put there by said thingy, but by people - namely, doctors, midwifes and/or parents.

What gets into the papers, according to your POV, decides or "assigns" one's sex. I assert that in most cases, it is simply an empirical observation of a pre-existing biological condition that is recorded. But this is a matter of POV, not fact--as editors, we must often be careful not to confuse the two. — Phil Welch 03:14, 29 Apr 2005 (UTC)

It does not "decide" once sex, that is a purely biological matter. It does however, for example legaly, but also in almost all cases also socially, "assign" a sex/gender, and that can be thoroughly independant of biological facts. Granted, that is the exception, but still, it is a plain fact that there are the biological facts, and that there is the sex/gender assignment, and that those are two seperate issues, although usually one is the basis for the other. "Usually", however, is not the same thing as "always", and certainly not "necessarily so". -- AlexR 07:46, 29 Apr 2005 (UTC)

I am glad we are in agreement on the point that one's sex is a purely biological matter. However, this is radically different from the conventional meaning of the word "assign". To "assign" something usually means to add something that wasn't already there, not to make an empirical judgment about what is already there. Usage of that term therefore connotates the POV that sex is a purely social construct. In order to reach NPOV, we have to explain on the relevant articles that one's sex is, according to most scientific POV, a matter of biology, and not socially constructed.

By the way, I would like to thank you for contributing to the enlightened level of calm and rational discussion here on Wikipedia. It is always a pleasure to deal with those who are above calling people who disagree with them "vandals".

— Phil Welch 07:55, 29 Apr 2005 (UTC)

I think I've made an edit that clarifies the point adequately. What do you think? — Phil Welch 08:01, 29 Apr 2005 (UTC)

Re additions/changes:

• There are still POV issues with what you've added. To say a term is "misleading" is POV, as the meaning of "assign" in this context to many is quite clear, and it is this meaning that I have tried to emphasise instead.
• The "In the medical and scientific communities, it is commonly accepted that one is born into either sex (except for intersex individuals) by virtue of genetics and anatomy." point is not quite accurate. I doubt it is "commonly accepted" in the way you describe, as it is an extremely convoluted description -- what I would suggest is more accurate is that for many individuals they are born with characteristics of (genitalia, hormone, chromosome, gender identity) which are uniform, however for a number of individuals there may be differences between any of those characteristics; but at birth, they are assigned a sex based on the appearance of the genitalia. This is a more accurate description of sex and sex assignment, IMO.

Dysprosia 09:40, 29 Apr 2005 (UTC)

Fair enough. I've taken your edits into consideration, but there's a couple other things I felt like stressing as well, see if my last edit is any better. — Phil Welch 17:13, 29 Apr 2005 (UTC)

[edit] rewrite

I wrote this article to start with, intending it to be a brief description of what sex assignment is without going into extensive details of intersex mgmt or the changing "rules" for assignment in those cases. Another editor wanted to add those and I gather several would like the topic covered here. I have provided a far more extensive account of the history of intersex surgery with more detail and all of the references mentioned here. However, I am deferring to public opinion and provided a brief overview of the changes of assignment practices over the last half century.

I also corrected the preposterous statistics. If someone needs an explanation of the difference between ambiguity with difficult/controversial assignment, slight variations of anatomy with no assignment implications, and the whole category of developmental disorders of the reproductive system, I will patiently spell it out. Please do not put erroneous stat claims back in because you don't understand the difference or refuse to acknowledge the non-identity of those categories. Thanks. alteripse 07:45, 1 May 2005 (UTC)

Just because you consider the state preposterous, they don't have to be. Multiple sources, including a project by a German university, with participants from other universities, confirm the stats you in your all-knowingness removed; and nobody has ever suspected that project to be particularly inclined to unnecessarily booster the numbers. So will you revert your baseless edits yourself or shall I? -- AlexR 09:06, 1 May 2005 (UTC)

Well, at least your response is not a revert with insults, as before. We are off to a better start. All right, here is the patient explanation. First, the definitions, so we are not arguing about different things. You seem to have trouble with that.

1. Intersex is not synonymous with ambiguity (e.g. complete androgen insensitivity is not ambiguous).
2. Intersex and ambiguity are not synonymous with disorders of reproductive development (E.g., gonadotropin deficiency and Turner syndrome are more common defects of reproductive development than CAH, but they are not intersex conditons.).
3. In the earlier article and in the earlier argument I have been quite precise in my use of the terms and the statistics. You have not. Once again, I am claiming that the percentage of live term births that result in even a brief confirmation by testing or consultation, without delaying announcement by parents, is less than 0.001%.
4. The percentage of those with enough ambiguity to result in a delay of assignment pending tests or the advice of a consultant is much smaller. This is the category in which management has been debated over the last decade. The figure of 0.0001-0.00005% (1 in 10-20,000) is an overly generous estimate. It is derived from two facts that have been reported over and over, as follow.
5. First, with the development of newborn screening programs for classic (mostly salt-wasting) 21OH CAH, we finally have reliable incidence statistics. The incidence varies by population, but in the general North American and European populations the incidence of classic CAH is generally in the range of 1 in 15,000 12064893, [1], [2]. The ratio of salt-wasting to simple virilizing forms is at least 3:1. Note that half of these are boys (and hence not intersex in any sense), so the incidence of ambiguity due to CAH is roughly 1 in 30,000, assuming that all the girls have significant ambiguity. In many it is mild enough that it does not delay assignment.
6. The second fact is that in the experience of all physicians who deal with ambiguous genitalia, XX CAH comprises at least half of those severe enough to require testing and delay of assignment for even a few hours. [3]. My experience is no different. Therefore if at least half of sigificant ambiguity is due to XX CAH at 1 per 30,000, we get a total estimate for significant ambiguity requiring testing and at least brief delay of assignment in 1 in 15,000. This is not complicated.
7. These stats can be corroborated by things like the ratio of new diabetes (incidence about 1 in 400 by age 18) or congenital hypothyroidism (incidence about 1 in 2000) to new ambiguous genitalia (most pediatric endocrine services see at least 50 new cases of diabetes and at least 10 cases of congenital hypothyroidism for every case of serious ambiguity). Take a look at the total numbers of patients (of any age, not just newborns) with the main intersex diagnoses seen in over 2 decades with each diagnosis reported at what is the institution in the world with the largest reported experience with intersex conditions (Johns Hopkins Hospital); I have provided references and a synopsis of the numbers at history of intersex surgery.
8. So why do people like you have the impression that the numbers are much larger? Those who believe the numbers are larger demonstrate two things, that they have no direct experience in the care of these infants (like someone who claims that 1% of homes burn down each year obviously doesn't work for the fire department), and that they have gotten their information from advocacy groups (which uncritically report the nonsensical statistics of Anne Fausto-Sterling). Her statistics are still used by ISNA despite the fact that they have been thoroughly debunked in print twice because they are full of elementary errors and dishonest assumptions (like categorizing boys with CAH as intersex), and she has even admitted in print that they were concocted by a couple of Brown undergraduates for purposes of political advocacy. I can provide references and quotes if you still think she should be taken seriously, but the two journal articles are not publicly available online. The most charitable explanation is that most self-appointed intersex advocates do not understand the differences between the categories I described above and do not realize what a small percentage of reproductive abnormalities are intersex, and what a small percentage of intersex conditions result in significant ambiguity. I recognize that you know more about adult transgender disorders than I do, but I have been amazed and dismayed at your persistent and uncivil ignorance about intersex. It would be perhaps understandable if we were arguing about management, but the statistics are a simple matter of published fact. Go back and read your "source" more carefully: if it comes from an advocacy group without pediatric endocrinologists, it is probably a parrotting of the F-S statistics. If it comes from people who directly care for these infants I suspect you are either misunderstanding their categories or misrepresenting them to us. But if you can quote or link to something published I am always willing to learn. alteripse 16:49, 1 May 2005 (UTC)