Quote from: kuudos on August 30, 2017, 04:52:45 PM
I've seen both sides to the argument - Intersex people saying that being trans is different from being interesex, but I've also heard trans people make good points: ->-bleeped-<- has been categorized by some medical practitioners as an intersex disorder, a mixture of a brain-body switch and hormones present during fetal stage that didn't fully develop, along with the fact that transgender individuals undergoing transition fit the loose definition of intersex - Having physical qualities from both sexes. I would normally class the two as completely separate things, but I started wondering this question again after I did research and learned that transmales often have a mixture of both genitals, even a clit that can get fully erect.
There's a popular, but incorrect, belief that whether you develop as male or female depends on whether you have XY or XX chromosomes. In fact, all the X and Y chromosomes do is, about 6 weeks into your embryonic development, cause you to develop either ovaries or testicles. Everything from that point onwards is driven by hormones. More specifically, if you have functional testicles churning out their usual complement of hormones (and your body is able to respond to those hormones), you'll develop as male. Otherwise you'll develop as female instead. Whether your chromosomes are XX or XY doesn't make any difference. This is easily demonstrated by a condition called Swyer's Syndrome, in which the testicles of a genetically male fetus fail to develop.
Here's an example of one such person:
https://www.interfaceproject.org/ali-von-klan/as you can see, despite being genetically male, she both looks and behaves just like any normal woman would. She was born with female genitals, and has all the female internal reproductive organs too (apart from ovaries). With the appropriate hormone treatment to mature her uterus and with eggs implanted via donor IVF, she could even fall pregnant and give birth. That's how important testicular hormones are in determining sex!
There's a condition called Complete Androgen Insensitivity Syndrome (CAIS), which also produces people who are genetically male but developmentally female, and who both look and behave like women. With CAIS, the testicles do actually develop as normal and produce their hormones like they should, however the condition involves a mutation that renders that person completely unresponsive to the androgenic hormones the testicles produce, so all their development takes place as if those hormones weren't there. As with Swyer's syndrome, the result is a person who appears female at birth, looks and behaves like a girl while growing up, and often doesn't even discover until her teenage years that she's unusual in any way. This allows us to narrow things down even further and say that it's mainly testosterone and a hormone derived from it called dihydrotestosterone (or DHT), that causes a person to develop as male. Without those hormones, you develop as female instead, even if you have XY chromosomes.

This is a diagram taken from an endocrinology textbook, showing the key events in male genital development. You can see how nearly all the important stuff takes place from week 7 to week 12 after conception, the only further development taking place after that point is enlargement of the penis and testicular descent.
If the testicular hormone production of a genetically male baby goes wrong between week 7 and week 12, that person will be born with hypospadias, or in really severe cases the scrotum will be split and have a cavity in the middle. If their testicular hormone production goes wrong from week 13 onwards, there won't be much physical evidence of it apart from possibly undescended testicles and/or a penis that's shorter than normal. The medical definition of intersex is based around genitals, so under that definition, intersex people are those who had something go wrong with their hormones between week 7 and 12 after conception.
However, it's not just the genitals that differ between the sexes. There are important differences in the brain as well, that drive most of the differences between adult men's and women's social and sexual behaviour (and your inner sense of whether you're a man or a woman). As with the genitals, those brain differences are driven by the presence or absence of testicular hormones. We know this because, among other things, scientists have produced female animals with male brains and male behaviour, just by exposing them to externally administered testosterone at the appropriate stage in their prenatal development. Exposing female fetuses to testosterone early in their development mainly affects their genitals; later in development it mainly affects the sex of their brain and their subsequent adult behaviour.
So, intersex isn't just something that can affect the genitals. It can affect the brain as well, and there's increasing scientific evidence that being transgender is caused by a form of intersex affecting the brain.
Unfortunately, none of this seems to have filtered through to the world of medicine, where doctors have happily been treating pregnant women with hormones of various kinds ever since the 1940s (when it first became possible to mass produce hormones for use as medicines). Due to differences in the way fetal metabolism works, at least two hormones that saw substantial use during pregnancy in the 1950s and 60s, ethisterone and norethisterone, turned out to be potent testosterone mimics in unborn babies. From 1940 to about 1980, an estrogen called diethystilbestrol (or DES), that acts as a powerful chemical castration agent in adult men, was extensively used in pregnancy too.
Considering the importance of testicular hormones (particularly testosterone) in determining whether you develop as male or female, exposing unborn babies to these drugs is an obvious recipe for disaster, and is likely to result in people who've partly developed as the wrong sex. Most of the exposure to these and other drugs given to prevent miscarriages tends to happen after the critical week 7 to week 12 period for genital development has ended, so you'd expect the result to be people who physically appear to be their genetic sex, but whose brain is the opposite sex or a mixture of male and female. That's what appears to have happened with DES, and I think it's happened with ethisterone and norethisterone too (although hardly anyone knows about these two drugs, since unlike DES there was no cancer scare and never any activist movement associated with them).