MAN, WOMAN…OTHER
By John Uhl, M.D. FACEP

Man, Woman. . .Other


        In fact, under the defense of marriage laws now in place, and the Constitutional amendment being proposed by the president -- the one which limits marriage to “a man and a woman” -- she [a woman with Turner’s syndrome] could not have been legally wed in the first place. In other words, although advocates of the proposed amendment believe they possess the final moral word on the subject, they have yet to consider the medical technicalities of such a radical legislative proposal, and the endless complications that could ensue.
        Women have two X chromosomes (XX) in each cell nucleus. Men have one X and one Y chromosome (XY). But this young lady had Turner’s syndrome (XO), giving her only one X chromosome instead of two. That is why her aorta was predisposed to dissect at such a young age. Like all people with Turner’s syndrome, she was infertile, and although she certainly looked female, technically, she was not.
        Turner’s syndrome is not the only intermediate form on the continuum between man and woman. Indeed, Harrison’s *Principles of Internal Medicine, 15th Edition* requires 12 large pages of tiny print for its chapter entitled “Disorders of Sexual Differentiation,” which lists endless intermediate-gender conditions, including odd combinations of X and Y chromosomes, the presence of more than one type of cell line in the same person, and ambiguous genitalia resulting from a host of causes.
        Then there are those people who feel they are not the gender they appear to be. Others are instinctively attracted to their own sex rather than the other. Some men who are attracted to women look effeminate. Some women who are attracted to men look masculine. The variations and gradations between man and woman are practically unlimited.
        Therefore, if marriage is limited to “a man and a woman”, how do we then decide who qualifies? Shall we do genital examination? Shall we grade size, shape and function? (If your sex-change surgeon is gifted, you can marry; if not, forget it.) Shall we examine chromosomes? Hormones? Rely on lie-detector tests? Letters of recommendation?
        Do we want to spell out every conceivable sexual variation in the amendment itself, or spend years in court sorting it out?
        According to the latest studies homosexuality is almost certainly at least in part genetic. What if homosexuality is ultimately shown to be all or mostly genetic -- the result of genes rather than choice? How can a condition some people (and members of many other animal species) are born with be a sin? After all, there are laws protecting disabled people, so why should one particular genetic condition be grounds for legal discrimination, when another isn’t?
        Although most people don’t realize it, we all know, or like, and perhaps love someone who lingers somewhere in the realm between entirely male and entirely female. Some of us even *are* those individuals. Like the rest of us, they are good and bad, smart and dull, kind and cruel. None of them chose the genes that shaped their minds and bodies, nor the families that shaped their early years. Many suffer greatly as a result of the genetic hand dealt to them and should not be saddled with the additional burden of being further ostracized by a random legislative decree.

 

A Closer Look at a Simple Amendment

 

 

Both “defense of marriage” laws now in place and a proposed Constitutional Amendment limit marriage to a man and a woman.  Ignored is a seemingly silly, but important question:  who decides (and how do they decide) who is a man and who is a woman? 

 

Of course, it seems simple.  We generally assume that everyone is one or the other, and it is easy to tell who is what.  However, millions of people can testify, from painful personal experience, that life is not that simple.

 

Women have two X chromosomes (XX) in each cell nucleus.  Men have one X and one Y chromosome (XY). But there are also people with XO, XXY, XXX, XYY, XXYY, XXXY, and XXXXY chromosomes.  What gender are they?

 

Some people have had a mutation early in fetal development, and have “chromosomal mosaic”--more than one cell line in their bodies, such as X/XX, X/XXX, X/XY, and XY/XXY.  Some people have XY chromosomes like a male, but the Y is not expressed, so they appear female. Some people have XX chromosomes, but appear male because part of the Y chromosome translocated to the X chromosome.  What gender are they?

 

Some people have ambiguous genitalia, the result of partial virilization of a fetus due to too much or too little androgen due to various problems during fetal development.  Doctors and parents of these people generally choose a gender for them, and genital surgery may be done early in life.  But, as adults, these people are often very unhappy with the choices made on their behalf.

 

All these people presumably were not the intended target of the laws and amendment. Their situation is genetic--beyond their control and not of their own choosing.  Do we allow them to marry?  Which gender?  Should we let them marry anyone so long as one agrees to be designated a man and the other a woman?   If not, how do we decide who qualifies?  Shall we do genital examination?  Shall we grade size, shape, function?  If your sex-change surgeon is gifted, you can marry, if not, forget it.  Shall we examine chromosomes?  Hormones?  Lie detector tests?  Letters of recommendation?

 

Do we want to spell out every conceivable sexual variation in the amendment itself, or spend years in court sorting it out?

 

Some people do not even know they are in one of the above categories.  So, depending on how we define man and woman and what tests are required, there is a very small chance that even if you think you know what gender you are, you could be wrong!  And banned from marriage.

 

 

But the terrain between man and woman is more complex still.  About one person per 50,000 persistently feels he or she is not the gender he or she appears to be.  About 3-5% of people and some members of many other animal species are attracted to their own gender rather than the other. Some men attracted to women look effeminate. Some women attracted to men look masculine. Few of us would do well in a competition to choose the most female or the most male individual our species ever produced.  The variations and gradations between man and woman are almost unlimited.  But here again, evidence is strong that these variations are largely determined by genetic, intrauterine, and early childhood, influences. 

 

Think about it:  Why would someone choose to be a target for ridicule and discrimination?

 

But then, when there are laws protecting disabled people, why should one particular genetic disposition instead be grounds for legal discrimination? 

 

These conditions are not rare.  Although you may not realize it, you probably know and like, perhaps love, and possibly are someone somewhere in the realm between entirely male and entirely female.  Like the rest of us, they are good and bad, smart and dull, kind and cruel.  Like us, none of them chose the genes that shaped their mind and body, or the family that shaped their early years.  Many of them have suffered greatly as a result of the genetic hand they were dealt.

 

Perhaps if we are going to choose a simple phrase appropriate for marriage in our real world, it should not be “a man and a woman”, but rather, “live and let live”.

 


ãCopyrigth 2004 by John Uhl, reprinted here with permission. All rights reserved otherwise by the author, subject to normal fair use.

 

Read or purchase his book :  Uhl, John A., M.D.  Life on a Crowded Planet: How You Can Help Create a Sustainable Future. At  Lifeonacrowdedplanet.com, 2002, 2005.
_________________________________________________________
Dr. John Uhl is an Emergency Physician in
Mountain View, California.

He may be reached at http://www.lifeonacrowdedplanet.com/

 

I wrote this to Dr. Uhl:

 

I think that the psychological reaction of many "conservative" (??) people to the idea of gay marriage is based on their impression that somehow gay marriage (and gay "upward affiliation) insults their idea of kinship, biological family, and meaning attributed to the whole "tender trap" thing--many people of previous generations or even in many cultures today believe that you live for 'family first' before you define your own purposes.

 

He wrote back:

 

You may be right. But people need to understand that where one sits on the continuum between the most male and the most female person in the world (however they wish to define that) is largely determined for one by one's chromosomes, intrauterine hormonal environment, and early childhood influences, none of which we can control.  Furthermore, near the middle of the continuum, it is extremely difficult, (or arbitrary or capricious) to assign a gender at all.  In that context, defense of marriage laws either penalize many who were unintended (like the young married lady with Turner's syndrome who died) or excuses them "because their situation is genetic", and specifically discriminates against homosexuals, whose situation is also at least in part genetic. A law so simple simply cannot apply to a situation so complex.

 

In fact, my personal argument for gay marriage would be more "live and let live". but whether Paul was a johnny-come-lately apostle bigot, or a mouthpiece of God is debatable without scientific foundation.  On the other hand, the arguments in the essays ARE scientifically backed.  here they are:

 

(7/3/2004)