When Ambrose was twelve years old, he began to take female hormones. At eighteen, he prepared to undergo a vaginoplasty, the surgical reconstruction of the vagina. Suffering from depression, Ambrose contemplated suicide. “I knew that I wasn’t a girl,” he later told a reporter. The following year, Ambrose obtained his medical records, and discovered what had happened to him as an infant: “I was sterilized at birth—and no one ever told me.” Ambrose was born with a condition that inhibited testosterone production; after adolescence, he began to take testosterone shots, and had surgery to remove his breasts.
Approximately one in every fifteen hundred to two thousand children born each year is diagnosed with a disorder or difference of sexual development. (Accurate figures are difficult to obtain, because it is difficult to measure degrees of physical and hormonal difference, and because many, like Ambrose, may not know they were diagnosed as such.) Some advocates believe the numbers are even higher: by the broadest measurement, one out of every hundred children has some subtle form of “sex anatomy variation.” Parents whose newborn babies have indeterminate genitalia typically follow what has long been the standard medical advice, to have doctors perform surgery to help the child conform to one or the other fixed gender category. Traditionally, the choice has been which gender to assign to the baby, not whether to put a baby through invasive surgery at all.
Today, we pride ourselves on letting children defy antiquated gender stereotypes. Boys can now have dolls, and girls Erector sets; we agree that the salient differences between genders are social constructs, and give little leeway to those who insinuate that, say, women have less aptitude for science and engineering. Yet, even as many fight against the persistence of rigid gender norms, we still separate the sexes as soon as kids are old enough to be potty-trained; when gym class arrives and locker rooms are needed, we push the boys and girls even farther apart. For all the progress that has followed from the enlightened credo that gender is but a construct, we keep hesitating at the notion that sex, too, does not obey strict binaries. Some people aren’t just pushing away from prototypes of sinewy maleness or delicate femaleness; they were born with bodies that don’t conform to the “M” or the “F” boxes on the census form. There are children, in other words, whose genes have not defined for them which bathroom to use, or where to change for gym class; babies can be born with XX chromosomes in certain cells, and XY chromosomes in others—mosaic genetics.