09/24/2025
When a medical professional says “XY = male, XX = female,” it may sound simple and definitive. That is the pattern most of us were taught in school, but human biology is far more varied.
Biological s*x is usually assigned at birth based on visible ge***alia. For most people, that aligns with their chromosomes, hormones, and development, so the categories of male and female work as expected. But biology is more complex than that. Some people are born with chromosomes, hormones, or developmental differences that do not fit neatly into male or female. This includes conditions like Turner syndrome, Klinefelter syndrome (XXY), androgen insensitivity, and conge***al adrenal hyperplasia. In those cases, relying only on ge***al appearance oversimplifies reality.
These variations are not curiosities but part of human diversity. They are not choices but realities written into human biology. Sometimes they are visible in the body, sometimes they show in hormones, and sometimes they are felt more deeply in identity and experience.
It is not only chromosomes that shape who we are, but also how genes are expressed. The SRY gene on the Y chromosome usually switches on to trigger male development, but if it is missing or silent, an XY person may develop along a female pathway. The opposite can also happen, where an XX person develops male traits because of shifts in gene expression. In other cases, the body produces hormones like testosterone, but the genes that allow cells to respond are inactive, so development takes a different course. In short, chromosomes set a starting point, but gene switches and hormone signaling help decide how development actually unfolds.
When the public is only given the simplified version, it is presented as the whole truth. That silence about complexity is not neutral. It narrows what is seen as real and leaves many misunderstood or dismissed. The public deserves better. Just as conversations about Tylenol and many other medications have moved beyond the oversimplified narratives of being “safe” or “one size fits all,” people deserve access to the deeper reality of human biology too.
History shows the cost of oversimplification. For decades, transgender people, especially those once called transs*xuals, could only access care under strict medical gatekeeping. To receive hormones or surgery, many were required to meet rigid psychiatric criteria, live publicly in a new role for extended periods, and conform to narrow gender stereotypes before approval. In the 1960s and 70s, clinics in the US and Europe quietly provided care, but only under tight control. Many were forced to hide, to live quietly, or to deny parts of themselves in order to survive.
For inters*x people, the gatekeeping looked very different. Instead of being denied procedures, many were subjected to surgeries as infants or children without their consent, sometimes multiple times, in order to force their bodies into the category of male or female. These interventions often led to complications, physical pain, and emotional harm. Unlike transgender adults who were told they must wait or prove themselves, inters*x children were never given the chance to wait and decide. Their rights to bodily autonomy and informed consent were taken from them before they were old enough to speak.
Over time, the word transgender came to be used as an umbrella term. It includes transs*xuals as well as many other people whose gender identity or expression does not align with the male and female binary. This shift was not only about language but about liberation. For much of the twentieth century, being transs*xual was pathologized, treated as a disorder that needed fixing, judged against rigid medical and social standards. The umbrella of transgender offered a broader and more humane understanding. It created space for gender diverse people to stand together under one shared identity, and it challenged the gatekeeping and stigmatizing frameworks that had kept so many people in the shadows.
This struggle is not only a Western story. Across cultures and throughout history, people who lived outside narrow definitions of male and female have existed. In some societies they were honored and integrated as part of the human story. In others they faced punishment under state authority. This is not just about one culture or one time period. It is a human story that stretches across continents and centuries.
Behind us is a record of persecution that cannot be forgotten. In the 1800s and early 1900s, homos*xuality was criminalized in much of the West, with imprisonment, loss of livelihood, and public shaming as punishment. In N**i Germany during the 1930s and 40s, gay men were sent to concentration camps under Paragraph 175, and gender nonconforming people were also targeted. In the United States, through the mid 1900s, police raids on gay bars led to arrest and humiliation. Authorities worked hand in hand to punish those who lived outside the binary. This is not distant history. It is within living memory.
And it is not only history. Around the world today, people who are transgender, gay, or inters*x still face imprisonment, violence, and death. In some countries, laws punish same s*x relationships with long prison sentences or worse. In others, public hostility and discrimination create unsafe conditions for those who live outside the binary. These realities are fueled by ideologies, political, cultural, and religious, that claim the right to control human diversity. The danger is not abstract. It is ongoing.
This is not about denying that XX and XY are the common patterns. We can name the usual pattern and still tell the whole truth. The public deserves complexity instead of slogans. People are strong enough to hold nuance, and it is far more dangerous to oversimplify than to share the deeper story.
The conversation about transgender care began with concerns about children in the 2010s but has now grown into restrictions for adults in the 2020s. Concerns about minors deserve discussion, but blocking competent adults from care removes medical freedom and patient choice. True medical freedom means respecting the right of individuals to work with their doctors and make informed decisions about their own bodies, even when those decisions do not align with another person’s beliefs. Too often, “medical freedom” is invoked only when it suits a particular viewpoint. Real freedom requires consistency. It includes choices you may not personally agree with, because the right to make those decisions belongs to the individual, not to ideology or theocracy.
To be human is to live with nuance. Clarity does not erase concern. It prevents harm. The public deserves nothing less.