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11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).key

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11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).key

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11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).

11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).

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11. ARE THERE ONLY TWO SEXES ?- Ambiguous Genitalia, Intersexed, Hermaphrodites, Disorder of Sex Development (DSD).key

  1. 1. A Biblical ,Medical ,Scientific and Historical View -Antonio Bernard THE LGBT MOVEMENT Part 11
  2. 2. Ambiguous Genitalia INTERSEX HERMAPHRODITES DISORDERS OF SEX DEVELOPMENT (DSD)
  3. 3. Are there only two sexes? A generation ago, this might have seemed like a silly question. But given the rise of gender theory, transgenderism, intersexuality, and all of their related phenomena, the question now appears to be both complex and pressing. . . - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/
  4. 4. Are there only two sexes? What differentiates human males from human females? Is it the number of sex chromosomes? Is it the possession of the appropriate sex organs? Is it the amount of testosterone or estrogen? The difficulty is that none of these standards always works: some individuals are born with extra chromosomes, such as XXYY or XYY. Some individuals are born with both pairs of sex organs. Some females have higher testosterone levels than many men. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/
  5. 5. “GENETIC DISORDERS” “Chromosomal and hormonal pathologies may disrupt normal development, though in fact these abnormalities have essentially nothing to do with transgender ideology—except insofar as activists want to relabel such abnormalities as mere “differences,” in an effort to normalize disorders.”
  6. 6. Are there only two sexes? Biologically, intersex individuals seem to exist, as do people with other non-binary sex conditions. Hermaphrodites have male and female sexual organs. Some individuals with male organs have XX chromosomes. Some genetically male individuals have incomplete female sexual organs. What non-arbitrary but universal standard can there possibly be for determining sex? - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/
  7. 7. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Suppose we met a race of creatures—fairly clearly non-rational animals—that was very different from us: on Mars, say. And the question arises: are these creatures sexed? and if so, can we distinguish male and female? We need to think now how we would go about finding out these answers. We would not do it by investigating their psyches, nor even merely by just looking at (or cutting up) individuals. We would try to find out how they reproduced and what was the role of the different organs of the different individuals involved in reproduction. Thus, sex is a biological and teleological notion. Anything else which is called sexual is so called ultimately because it has some relation to this process, to these organs.” What Determines Sex?
  8. 8. - “Lawrence S. Mayer, M.B., M.S., Ph.D., and Paul R. McHugh, M.D., “Sexuality and Gender Findings from the Biological, Psychological, and Social Sciences,” Special Report, New Atlantis 50 (Fall 2016): 89.” “The underlying basis of maleness and femaleness is the distinction between the reproductive roles of the sexes; in mammals such as humans, the female gestates offspring and the male impregnates the female. More universally, the male of the species fertilizes the egg cells provided by the female of the species. This conceptual basis for sex roles is binary and stable, and allows us to distinguish males from females on the grounds of their reproductive systems, even when these individuals exhibit behaviors that are not typical of males or females.” What Determines Sex?
  9. 9. - “Sherif Girgis, “Windsor: Lochnerizing on Marriage?” Case Western Reserve Law Review 64 (2014): 988.” “…What differentiates them are not just different anatomical or genetic features, but—at a deeper level of explanation—their joint (basic) physical potential for a biological task: reproduction. And this task, its social value, and its link to sexual composition are certainly not mere social inventions” What Determines Sex?
  10. 10. - “Lawrence S. Mayer, M.B., M.S., Ph.D., and Paul R. McHugh, M.D., “Sexuality and Gender Findings from the Biological, Psychological, and Social Sciences,” Special Report, New Atlantis 50 (Fall 2016): 90.” “In biology, an organism is male or female if it is structured to perform one of the respective roles in reproduction. This definition does not require any arbitrary measurable or quantifiable physical characteristics or behaviors; it requires understanding the reproductive system and the reproduction process.” What Determines Sex?
  11. 11. What Determines Sex? - “Lawrence S. Mayer, M.B., M.S., Ph.D., and Paul R. McHugh, M.D., “Sexuality and Gender Findings from the Biological, Psychological, and Social Sciences,” Special Report, New Atlantis 50 (Fall 2016): 90.” “Different animals have different reproductive systems, but sexual reproduction occurs when the sex cells from the male and female of the species come together to form newly fertilized embryos. It is these reproductive roles that provide the conceptual basis for the differentiation of animals into the biological categories of male and female. There is no other widely accepted biological classification for the sexes.”
  12. 12. -Excerpt From: Ryan T. Anderson. “When Harry Became Sally”. Apple Books. ” “Males are organized to engage in sexual acts that donate genetic material, while females are organized to engage in sexual acts that receive genetic material and then gestate the resulting offspring. This fundamental difference in organization is what allows scientists to distinguish male from female.” What Determines Sex?
  13. 13. -“Expert Rebuttal Declaration of Lawrence S. Mayer, M.D., M.S., Ph.D., U.S. District Court, Middle District of North Carolina, Case 1:16-cv-00425-TDS-JEP.” When Dr. Deanna Adkins called this “an extremely outdated view of biological sex” in her declaration to a federal court in North Carolina, Dr. Mayer responded in his rebuttal declaration: “This statement is stunning. I have searched dozens of references in biology, medicine and genetics—even Wiki!—and can find no alternative scientific definition. In fact the only references to a more fluid definition of biological sex are in the social policy literature.” What Determines Sex?
  14. 14. -Excerpt From: Ryan T. Anderson. “When Harry Became Sally”. Apple Books. ” “Sex is understood this way across species. No one finds it particularly difficult—let alone controversial—to identify male and female members of the bovine species or the canine species. Farmers and breeders rely on this easy distinction for their livelihoods.” What Determines Sex?
  15. 15. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Our sex—male or female—is determined by our basic capacity to engage in sexually reproductive acts. If we observe that the members of a species reproduce asexually, then we rightly conclude that neither male nor female exist in that species. But if we observe that two are required for reproduction to occur, we rightly conclude that the species reproduces sexually by the union of the two. We name these two types differently—as male and female—based upon the roles they play in reproduction.” What Determines Sex?
  16. 16. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “There, thus, can only be two biological sexes for human beings. In syllogistic form, what I am arguing is this: (A) Biological sex is defined in relation to the roles played in sexual reproduction. (B) Sexual reproduction involves only two, namely, male and female. (C) Thus, biological sex is only two, namely, male or female. What Determines Sex?
  17. 17. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ Defects occur in nature, but defects imply a norm from which they deflect. A castrated man is still a male; a female with a mastectomy is still a female. The fact that one is born with ambiguous genitalia does not do away with one’s true sex. That it is hard to identify someone as male or female does not mean one is neither. Identical twins are hard to distinguish, but they are still distinct persons. Epistemological problems need not entail ontological ones.” What Determines Sex?
  18. 18. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Consider the case of plants that reproduce sexually. When we discover a plant missing parts of its sexual organs, we do not thereby conclude that we have discovered a third sex. Rather biologists rightly concur that what you have found is a defective plant. Likewise, in human beings, when one has an extra chromosome, or defective genitalia, you have just that: a sexual defect at the physical level. Such people often are wonderful, loving, and morally upright persons, but physically something has gone wrong. ” What Determines Sex?
  19. 19. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Hermaphrodites are individuals with both pairs of sex organs. While in very rare cases some human beings have both pairs of genitalia, in no case whatsoever has it ever been observed that both pairs are fully functioning. True human hermaphrodites with both male and female sexual organs that fully function don’t exist. Such is why no cases of self- fertilization have ever been recorded in human beings. ” What Determines Sex?
  20. 20. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Hermaphroditism, rather than disproving the traditional binary distinction, actually reinforces it. We would not even know hermaphrodites existed, let alone be able to speak of them, unless we knew of the male-female binary. ” What Determines Sex?
  21. 21. -“Gender Ideology Harms Children” , The American College of Pediatricians - https://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children/ “Human sexuality is an objective biological binary trait: “XY” and “XX” are genetic markers of male and female, respectively – not genetic markers of a disorder. The norm for human design is to be conceived either male or female.” What Determines Sex?
  22. 22. -“Gender Ideology Harms Children” , The American College of Pediatricians - https://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children/ “Human sexuality is binary by design with the obvious purpose being the reproduction and flourishing of our species. This principle is self-evident. The exceedingly rare disorders of sex development (DSDs),…” What Determines Sex?
  23. 23. -“Gender Ideology Harms Children” , The American College of Pediatricians - https://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children/ “…including but not limited to testicular feminization and congenital adrenal hyperplasia, are all medically identifiable deviations from the sexual binary norm, and are rightly recognized as disorders of human design. Individuals with DSDs (also referred to as “intersex”) do not constitute a third sex.” What Determines Sex?
  24. 24. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “How we fundamentally distinguish male and female then is based upon the two biological roles in reproduction. A human individual that has the basic capacity to reproduce with the female is biologically and truly a male. A human individual that has the basic capacity to reproduce with a male is biologically and truly a female. Male and female are defined in reference to each other, which is why they are correlative terms.” Differentiating Potencies
  25. 25. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Males are still males even when they are not actively reproducing with a female, or if they are unable to reproduce due to sterility, castration, or a genetic or physical defect. A mechanic that doesn’t have the proper tools is still “capable” of fixing your car, but not in the same way in which a mechanic with the proper tools is “capable” to fix your car in the here and now. A male is the type of organism that is capable to impregnate the female. In other words, he could impregnate her, given that he has the appropriate functioning organs. A female, however, cannot impregnate another female.” Differentiating Potencies
  26. 26. - Public Discourse | The online journal of The Witherspoon Institute: "Why There Are Only Two Sexes" JUNE 5, 2017 BY JOHN SKALKO https://www.thepublicdiscourse.com/2017/06/19389/ “Given that human beings reproduce sexually, they are biologically either only male or female. Men are men, and women are women. True hermaphrodites with fully functioning sexual organs do not exist in human beings.” Differentiating Potencies
  27. 27. * Declaration of Quentin L. Van Meter, M.D., U.S. District Court, Middle District of North Carolina, Case 1:16-cv-00425-TDS-JEP, Exhibit I. As the pediatric endocrinologist Quentin L. Van Meter writes, “The exceedingly rare DSDs are all medically identifiable deviations from the sexual binary norm. The 2006 consensus statement of the Intersex Society of North America and the 2015 revision of the statement does not endorse DSD as a third sex.” * After all, biological sex is grounded in the organism’s organization for reproduction. There is no third gonad. With DSDs, what can develop are dysfunctional ovaries and testes. No Third Gender/Gonad
  28. 28. 6,500 genetic differences between men and women Sex Chromosome only account for some of those genes. Other Cells and Organs contain the rest of these genes.
  29. 29. “ Biological sex is not assigned. Sex is determined at conception by our DNA and is stamped into every cell of our bodies. Human sexuality is binary. You either have a normal Y chromosome, and develop into a male, or you don’t, and you will develop into a female. There are at least 6,500 genetic differences between men and women. Hormones and surgery cannot change this.” 
 -Michelle Cretella, M.D., is president of the American College of Pediatricians, a national organization of pediatricians and other health care professionals dedicated to the health and well-being of children.
  30. 30. “Every cell has a sex. And what it means is that men and women are different down to the cellular and molecular levels.” Dr. Paula Johnson , TEDWomen 2013 : His and hers ... health care Dr. Paula A. Johnson is executive director of the Connors Center for Women’s Health at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School. EVERY CELL HAS A SEX
  31. 31. “It means that we're different across all of our organs. From our brains to our hearts, our lungs, our joints.” Dr. Paula Johnson , TEDWomen 2013 : His and hers ... health care Dr. Paula A. Johnson is executive director of the Connors Center for Women’s Health at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School. EVERY CELL HAS A SEX
  32. 32. “The result is that male and female bodies differ not only in their sex chromosomes (XX and XY) and in their organization for reproduction, but also, on average, in size, shape, bone length and density, fat distribution, musculature, and various organs including the brain.” Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books.
  33. 33. Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books. “These secondary sex differences are not what define us as male or female; organization for reproduction does that. But this organization leads to other bodily differences.”
  34. 34. Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books. “There are organizational differences and organism-wide differences in organs and tissues, as well as differences at the cellular and molecular levels. These differences affect not just our physiology, but also our minds.”
  35. 35. Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books. “Indeed, after the reproductive organs, the brain is possibly the most “sexed” organ in a human being.”
  36. 36. Excerpt From: Ryan T. Anderson. PhD, “When Harry Became Sally”. Apple Books. “This is not to say that there are male brains and female brains, but that on average there are differences in the brains of males and females that tend to make a difference in how men and women experience emotion and pain, how they see and hear, and how they remember and navigate.”
  37. 37. LARRY CAHILL .PHD. NEUROBIOLOGIST Larry Cahill, a neurobiologist at the University of California, Irvine, reviewed the literature for Scientific American in 2012 and reported: “a surge of findings that highlight the influence of sex on many areas of cognition and behavior, including memory, emotion, vision, hearing, the processing of faces and the brain’s response to stress hormones.” -.Larry Cahill, “His Brain, Her Brain,” Scientific American, October 1, 2012.
  38. 38. LARRY CAHILL .PHD. NEUROBIOLOGIST There are differences in the size of various regions and structures in the brain, as well as differences at the cellular level.. In addition to Cahill, see Amber N. V. Ruigrok et al., “A meta-analysis of sex differences in human brain structure,” Neuroscience & Biobehavioral Reviews 39 (2014): 34–50.
  39. 39. LARRY CAHILL .PHD. NEUROBIOLOGIST Larry Cahill, writing in the journal Cerebrum, grants that human brains are in some sense “mosaics,” but he emphatically rejects the argument that males and females share an essentially “intersex” brain. “Evolution,” he writes, “has produced in men and women bodies that are filled with similarities and differences, including in the heart, liver, lungs, immune system, and even knees.” -Cahill, “Equal ≠ Same: Sex Differences in the Human Brain.”
  40. 40. LARRY CAHILL .PHD. NEUROBIOLOGIST “To insist that somehow— magically— evolution did not produce biologically based sex differences of all sizes and sorts in the human brain...is tantamount to denying that evolution applies to the human brain.” -Cahill, “Equal ≠ Same: Sex Differences in the Human Brain.”
  41. 41. LARRY CAHILL .PHD. NEUROBIOLOGIST While male and female brains are similar in many ways, researchers have found “an astonishing array of structural, chemical and functional variations” between them. This is not to suggest that either men or women are smarter, and “no one has uncovered any evidence that anatomical disparities might render women incapable of achieving academic distinction in math, physics or engineering,” -Cahill, “His Brain, Her Brain.”
  42. 42. “Babies that are born with both male and female sexual organs, or characteristics of both organs, are called hermaphrodites or intersex. A child who is in an intersexual state is classified in one of three categories: (1) true hermaphrodite – an infant born with both ovaries and testicles and has both male and female sex organs. (2) female pseudohermaphrodite – a genetic female with male external sex organs. (3) male pseudohermaphrodite – a genetic male with external sex organs that fail to develop properly, resulting in female or male/female physical characteristics.”
  43. 43. “In times past, doctors would perform surgeries without first testing the infant to find out its true sex, and the child would sometimes grow up very obviously a man, with female genitalia. Now, specialists can perform an ultrasound, blood test, chromosome analysis, and even do exploratory surgery to find out the baby's true sex.”
  44. 44. Overview Ambiguous genitalia is a rare condition in which an infant's external genitals don't appear to be clearly either male or female. In a baby with ambiguous genitalia, the genitals may be incompletely developed or the baby may have characteristics of both sexes. The external sex organs may not match the internal sex organs or genetic sex. Ambiguous genitalia isn't a disease, it's a disorder of sex development. Usually, ambiguous genitalia is obvious at or shortly after birth, and it can be very distressing for families. Your medical team will look for the cause of ambiguous genitalia and provide information and counseling that can help guide decisions about your baby's gender and any necessary treatment.
  45. 45. Symptoms Your medical team will likely be the first to recognize ambiguous genitalia soon after your baby is born. Occasionally, ambiguous genitalia may be suspected before birth (prenatally). Characteristics can vary in severity, depending on when during genital development the problem occurred and the cause of the disorder. Babies who are genetically female (with two X chromosomes) may have: An enlarged clitoris, which may resemble a penis Closed labia, or labia that include folds and resemble a scrotum Lumps that feel like testes in the fused labia
  46. 46. Symptoms Babies who are genetically male (with one X and one Y chromosome) may have: A condition in which the narrow tube that carries urine and semen (urethra) doesn't fully extend to the tip of the penis (hypospadias) An abnormally small penis with the urethral opening closer to the scrotum The absence of one or both testicles in what appears to be the scrotum Undescended testicles and an empty scrotum that has the appearance of a labia with or without a micropenis
  47. 47. Causes Ambiguous genitalia primarily occurs when hormone abnormalities during pregnancy interrupt or disturb the fetus's developing sex organs. How sex organs form in the womb A baby's genetic sex is established at conception, based on the sex chromosomes. The mother's egg contains an X chromosome, and the father's sperm contains either an X or a Y chromosome. A baby who inherits the X chromosome from the father is a genetic female (two X chromosomes). A baby who inherits the Y chromosome from the father is a genetic male (one X and one Y chromosome).
  48. 48. Causes Male and female sex organs develop from the same tissue. Whether this tissue becomes male organs or female organs depends on the chromosomes and the presence or absence of male hormones. • In males, a region on the Y chromosome triggers the development of testicles, which produce male hormones. Male genitals develop in response to male hormones from the fetal testicles. • In a fetus without a Y chromosome — without the effects of male hormones — the genitals develop as female. Occasionally, a chromosomal abnormality may make determination of genetic sex complex.
  49. 49. Causes How ambiguous genitalia occurs A disruption of the steps that determine sex can result in a mismatch between the appearance of the external genitals and the internal sex organs or the genetic sex (XX or XY). • A lack or deficiency of male hormones in a genetic male fetus can cause ambiguous genitalia, while exposure to male hormones during development results in ambiguous genitalia in a genetic female. • Mutations in certain genes can influence fetal sex development and cause ambiguous genitalia. • Chromosomal abnormalities, such as a missing sex chromosome or an extra one, also can cause ambiguous genitalia. • In some cases, the cause of ambiguous genitalia may not be determined.
  50. 50. Possible causes in genetic females Causes of ambiguous genitalia in a genetic female may include: • Congenital adrenal hyperplasia. Certain forms of this genetic condition cause the adrenal glands to make excess male hormones (androgens). • Prenatal exposure to male hormones. Certain drugs that contain male hormones or that stimulate production of male hormones in a pregnant woman can cause developing female genitals to become more masculine. A developing baby also may be exposed to excess male hormones if the mother has a disease or condition that causes hormone imbalance. • Tumors. Rarely, a tumor in the mother can produce male hormones.
  51. 51. Possible causes in genetic males Causes of ambiguous genitalia in a genetic male may include: • Impaired testicle development. This may be due to genetic abnormalities or unknown causes. • Androgen insensitivity syndrome. In this condition, developing genital tissues don't respond normally to male hormones made by the testes. • Abnormalities with testes or testosterone. Various abnormalities can interfere with the testes' activity. This may include structural problems with the testes, problems with production of the male hormone testosterone or problems with cellular receptors that respond to testosterone. • 5a-reductase deficiency. This enzyme defect impairs normal male hormone production. Ambiguous genitalia can also be a feature of certain rare, complex syndromes that affect many organ systems.
  52. 52. DISORDER OF SEXUAL DEVELOPMENT CAUSES Male Female People with disorders of sexual development are grouped into three general categories: those with an XY set of chromosomes who develop female characteristics, referred to as XY DSD; those with an XX set of chromosomes who develop male characteristics, referred to as XX DSD. and those with more than one set of chromosomes who develop both ovarian and testicular cell lines and genitals—what used to be called true hermaphroditism, now referred to as ovo-testicular DSD. There are dozens of specific types of DSDs that fall into these three categories. We will look at a few of them to illustrate the phenomena.
  53. 53. DISORDER OF SEXUAL DEVELOPMENT CAUSES Male Female People with disorders of sexual development are grouped into three general categories: those with an XY set of chromosomes who develop female characteristics, referred to as XY DSD; those with an XX set of chromosomes who develop male characteristics, referred to as XX DSD. and those with more than one set of chromosomes who develop both ovarian and testicular cell lines and genitals— what used to be called true hermaphroditism, now referred to as ovo-testicular DSD. There are dozens of specific types of DSDs that fall into these three categories. We will look at a few of them to illustrate the phenomena.
  54. 54. DISORDER OF SEXUAL DEVELOPMENT CAUSES To take this last example first, sometimes a chromosomal disorder at conception results in more than 46 chromosomes or fewer, leading to a disorder in sexual development. Male Female Disorders of sexual development can have a variety of causes. They can arise from genetic mutations, hormonal influences, the formation of a chimera or mosaic as an early embryo, or chromosomal abnormalities at fertilization.
  55. 55. KLINEFELTER & TURNER SYNDROME Male Female People with Klinefelter syndrome have 47 chromosomes and are XXY. They develop as males, but tend to have abnormal body proportions, with enlarged breasts, and they frequently suffer from sexual and reproductive problems including infertility. People with Turner syndrome have only 45 chromosomes, with a single X chromosome rather than XX or XY. They develop as women but are infertile, because two X chromosomes are necessary for normal development of the ovaries. -Moore and Persaud, The Developing Human, 307.
  56. 56. XY DSD Consider two examples of XY DSD. As The Developing Human reminds us, “If a normal Y chromosome is present, the embryo develops as a male. If no Y chromosome is present, or the testis-determining region of the Y chromosome is absent, female development occurs.” -Moore and Persaud, The Developing Human, 307. SRY, is the gene that commences the formation of male gonads. The testes then produce testosterone, which influences the subsequent development of male reproductive organs and external genitalia. This is when development follows the typical pattern. Male Female
  57. 57. XY DSD & SRY MISSING But some XY people lack the SRY gene or have a severe mutation in it. As a result, the testes never form and the body never masculinizes; these individuals develop as females who are infertile (because they lack a second X chromosome)” Other XY people have a functional SRY gene but develop as females because they suffer from complete androgen insensitivity syndrome (CAIS). These individuals have a mutation in the gene that contains the androgen receptor protein, so they cannot be influenced by testosterone. Male Female -Bonnie McCann-Crosby and V. Reid Sutton, “Disorders of Sexual Development,” Clinics in Perinatology 42 (June 2015): 403. -Bonnie McCann-Crosby and V. Reid Sutton, “Disorders of Sexual Development,” Clinics in Perinatology 42 (June 2015): 406.
  58. 58. THE SRY GENE PURPOSE Though they are XY chromosomally, they develop as females in appearance: “People with androgen insensitivity syndrome develop as normal-appearing but sterile women, lacking a uterus and oviducts and having internal testes in the abdomen.” Male Female-Gilbert, Developmental Biology, 531. The SRY instructs them to develop testes and their testes produce testosterone, but it makes no difference in their development because their bodies do not respond to it. Thus they never develop a penis.
  59. 59. Male Female Now consider some examples of XX DSDs. Some people with XX chromosomes develop as males because one of their X chromosomes contains the SRY gene (which is normally on the Y chromosome). Typically this results from “a translocation of SRY from the paternal Y to the paternal X chromosome.” While ordinary cells divide and reproduce identical copies by a process called mitosis (as you may recall from high school biology), the sex cells form by meiosis, in which a 46-chromosome cell produces four 23- chromosome sex cells, either sperm or ova. As sperm are produced by this process in a male, the SRY gene can be translocated from a Y to an X in what’s known as meiotic crossover. -Adriana A. Carrillo, Middey Damian, and Gary Berkovitz, “Disorders of Sexual Differentiation,” Chapter 15 in Pediatric Endocrinology, 5th ed., ed. Fima Lifshitz (New York: Informa Healthcare, 2009), 2:374. -McCann-Crosby and Sutton, “Disorders of Sexual Development,” 402. XX DSD
  60. 60. XX DSD Male Female Because what matters most for male development is the presence of the SRY gene, individuals with SRY on an X chromosome develop for the most part as normal males except for being infertile, since they lack other important genetic material that is located on the Y chromosome. -McCann-Crosby and Sutton, “Disorders of Sexual Development,” 402. Other people with XX DSDs develop for the most part as women, though they may also develop some male genitalia in a process known as virilization. For example, some XX people have congenital adrenal hyperplasia (CAH), a disorder that prevents the normal production of cortisol. This results in the overproduction of androgen, the male sex hormone, which in turn can lead to the virilization of the female external genitalia. But internally these individuals develop and function as women.
  61. 61. XX DSD Male Female Now Let’s now consider the parallels between XY DSDs and XX DSDs. An XY without SRY will develop as a female, while an XX with SRY will develop as a male. An XY with SRY but without the ability to respond to androgen (CAIS) will develop as a female, while an XX without SRY but with too much androgen (CAH) will develop as a female with virilized external genitalia. These are just a couple of the ways in which minor genetic or hormonal abnormalities can lead to disorders of sexual development. -Excerpt From: Ryan T. Anderson. “When Harry Became Sally”. Apple Books. ”
  62. 62. Male Female In the third general classification of DSDs, the individuals possess cells with both XX and XY genotypes, resulting in a mixture of male and female characteristics. One common cause of this condition is the presence of two sets of DNA in the same person, and therefore two sets of sex chromosomes: XX and XY, or a single X and an XY. DISORDER OF SEXUAL DEVELOPMENT -See Alexandre Serra et al., “Uniparental Disomy in Somatic Mosaicism 45, X/46, XY/46, XX Associated with Ambiguous Genitalia,” Sexual Development 9 (June 2015): 136–43; and Marion S. Verp et al., “Chimerism as the etiology of a 46, XX/46, XY fertile true hermaphrodite,” Fertility and Sterility 57 (February 1992): 346–49.
  63. 63. Male Female When genetic mutations in the developing embryo result in two or more different genotypes in the same person, it’s called a “mosaic.” When two different embryos combine early in a pregnancy to form one, it’s called a “chimera.” In both cases, the result is two different sets of DNA, with some of the body’s cells being XX (or a single X) and some being XY, and these cells can direct the growth and development of different parts of the same person. DISORDER OF SEXUAL DEVELOPMENT -Carrillo et al., “Disorders of Sexual Differentiation,” 373–74.
  64. 64. Male Female As noted above, DSDs occur in approximately one out of every 5,000 live births, but specific types vary in frequency and in severity. For example, complete androgen insensitivity syndrome (CAIS) occurs in one out of every 20,000 to 64,000 births.53 The most common form of congenital adrenal hyperplasia (CAH) occurs in one out of every 14,000 to 15,000 births.54 DISORDER OF SEXUAL DEVELOPMENT
  65. 65. Male Female Ovo-testicular DSD occurs in one out of every 100,000 births. The examples of DSDs described here are the more easily understandable varieties. Others have a more complicated etiology and are less well understood. They can result in a more ambiguous body formation, including external genitalia. DISORDER OF SEXUAL DEVELOPMENT
  66. 66. Risk factors Family history may play a role in the development of ambiguous genitalia, because many disorders of sex development result from genetic abnormalities that can be inherited. Possible risk factors for ambiguous genitalia include a family history of: • Unexplained deaths in early infancy • Infertility, absent menstrual periods or excess facial hair in females • Genital abnormalities • Abnormal physical development during puberty • Congenital adrenal hyperplasia, a group of inherited genetic disorders that affect the adrenal glands If your family has a history of these risk factors, consider seeking medical advice before trying to conceive. You may also benefit from genetic counseling.
  67. 67. Complications Complications of ambiguous genitalia may include: • Infertility. Whether people with ambiguous genitalia can have children depends on the specific diagnosis. For example, genetic females with congenital adrenal hyperplasia usually can get pregnant if they so choose. • Increased risk of certain cancers. Some disorders of sex development are associated with an increased risk of certain types of cancer.
  68. 68. Diagnosis Ambiguous genitalia is usually diagnosed at birth or shortly after. Doctors and nurses who help with delivery may notice the signs of ambiguous genitalia in your newborn. Determining the cause If your baby is born with ambiguous genitalia, the doctors will work to determine the underlying cause. The cause helps guide treatment and decisions about your baby's gender. Your doctor will likely begin by asking questions about your family and medical history. He or she will do a physical exam to check for testes and evaluate your baby's genitalia.
  69. 69. Your medical team will likely recommend these tests: • Blood tests to measure hormone levels • Blood tests to analyze chromosomes and determine the genetic sex (XX or XY) or tests for single gene disorders • Ultrasound of the pelvis and abdomen to check for undescended testes, uterus or vagina • X-ray studies using a contrast dye to help clarify anatomy In certain cases, minimally invasive surgery may be necessary to collect a tissue sample of your newborn's reproductive organs.
  70. 70. Determining the gender The standard treatment for people with DSDs—for example, a newborn baby with ambiguous genitalia—begins with trying to discern the causes of the disorder, which may shed light on the underlying sex of the child.
  71. 71. Determining the gender Pediatric Endocrinology, a standard desk reference, says that after an “assessment of the anatomy of the sex organs,” the decisions regarding a course of treatment should rest “on the likely cosmetic appearance of the reconstructed genitalia, on the potential for normal sex steroid secretion at puberty, on the potential for normal sexual intercourse, and on the potential for fertility.”56
  72. 72. Determining the gender Using the information gathered from these tests, your doctor may suggest a gender for your baby. The suggestion will be based on the cause, genetic sex, anatomy, future reproductive and sexual potential, probable adult gender identity, and discussion with you.
  73. 73. Determining the gender In some cases, a family may make a decision within a few days after the birth. However, it's important that the family wait until test results are completed. Sometimes gender assignment can be complex and the long-term impact can be difficult to predict. Parents should be aware that as the child grows up, he or she may make a different decision about gender identification.
  74. 74. Determining the gender These children do not constitute a third sex; they are either male or female, but with a disorder in their development. The sound medical response is to identify the predominant underlying sex and then take measures to provide health and functioning, as far as possible, through hormones and possibly surgery.”
  75. 75. Treatment Once you and your doctor have chosen a gender for your baby, you may choose to begin treatment for ambiguous genitalia. The goal of treatment is long-term psychological and social well-being, as well as to enable sexual function and fertility to the greatest extent possible. When to begin treatment depends on your child's specific situation.
  76. 76. “Ambiguous genitalia is uncommon and complex, and it may require a team of experts. The team might include a pediatrician, neonatologist, pediatric urologist, pediatric general surgeon, endocrinologist, geneticist, and psychologist or social worker.”
  77. 77. Medications Hormone medications may help correct or compensate for the hormonal imbalance. For example, in a genetic female with a slightly enlarged clitoris caused by a minor to moderate case of congenital adrenal hyperplasia, proper levels of hormones may reduce the size of the tissue. Other children may take hormones around the time they would normally experience puberty.
  78. 78. Surgery In children with ambiguous genitalia, surgery may be used to: • Preserve normal sexual function • Create genitals that appear more typical The timing of surgery will depend on your child's specific situation. Some doctors prefer to postpone surgery done solely for cosmetic reasons until the person with ambiguous genitalia is mature enough to participate in the decision about gender assignment.
  79. 79. "For girls with ambiguous genitalia, the sex organs may work normally despite the ambiguous outward appearance. If a girl's vagina is hidden under her skin, surgery in childhood can help with sexual function later."
  80. 80. "For boys, surgery to reconstruct an incomplete penis may normalize appearance and make erections possible. Surgery to reposition the testes into the scrotum may be required."
  81. 81. “Results of surgery are often satisfying, but repeat surgeries may be needed later. Risks include a disappointing cosmetic result or sexual dysfunction, such as an impaired ability to achieve orgasm. Children with ambiguous genitalia require ongoing medical care and monitoring for complications, such as cancer screenings, into adulthood.”
  82. 82. If your baby is diagnosed with ambiguous genitalia, you may worry about your child's future. Mental health professionals can help you deal with this difficult and unexpected challenge. Ask your child's doctor for a referral to a mental health professional who has experience helping people in your situation. In addition to ongoing counseling for your family and your child, you may benefit from a support group, either in person or online. Your child can benefit from ongoing counseling by mental health professionals and participation in support groups into adulthood. Coping and support:
  83. 83. Not knowing the gender of your newborn immediately can turn a hoped-for celebration into a stressful crisis. Your medical team will provide you with updates and information as quickly as possible to help settle any questions about your child's health. Consider delaying a formal announcement of the birth until testing is complete and you've developed a plan with advice from your medical team. Give yourself some time to learn and think about the issue before answering difficult questions from family and friends. Coping and support:
  84. 84. Ask if there's anything you need to do in advance to prepare your infant for tests and procedures. Discuss family history with your relatives and bring key personal information, including family history of genetic diseases or conditions, such as ambiguous genitalia. Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot. Make a list of questions to ask your doctor. What you can do, Before your appointment:
  85. 85. "Disease has been transmitted from parents to children, from generation to generation. Infants in their cradle are miserably afflicted because of the sins of their parents, which have lessened their vital force. Their wrong habits of eating and dressing, and their general dissipation, are transmitted, as an inheritance to their children. Many are born insane, deformed, blind, deaf, and a very large class deficient in intellect." -The Health Reformer, September, November 1, 1872.
  86. 86. "The strange absence of principle which characterizes this generation, in disregarding the laws of life and health, is astonishing. Ignorance prevails upon this subject, while light is shining all around them. With the majority, their principal anxiety is, What shall I eat? What shall I drink? and wherewithal shall I be clothed? Notwithstanding all that is said and written with regard to how we should treat our bodies, appetite is the great law which governs men and women generally." -The Health Reformer, September, November 1, 1872.
  87. 87. "The moral powers are beclouded, because men and women will not live in obedience to the laws of health, and make this great subject a personal duty. Parents bequeath to their offspring their own perverted habits, and loathsome diseases corrupt the blood and enervate the brain. The majority of men and women remain in ignorance of the laws of their being, and indulge appetite and passion at the expense of intellect and morals, and seem willing to remain in ignorance of the result of their violation of nature’s laws.” -The Health Reformer, September November 1, 1872.
  88. 88. "They indulge the depraved appetite in the use of slow poisons which corrupt the blood and undermine the nervous forces, and in consequence bring upon themselves sickness and death. Their friends call the result of their own course the dispensation of Providence. In this, they insult Heaven. They rebelled against the laws of nature, and suffered the penalty. Suffering and mortality now prevail everywhere, especially among the children. How great is the contrast between this generation and those who lived during the first two thousand years!” -The Health Reformer, September November 1, 1872.
  89. 89. Before the Baby Comes
  90. 90. “God Himself appeared to the wife of Manoah and told her that she should have a son, and that he should be a great man and should deliver Israel. Then He gave her special instructions regarding her diet. . . . Let us regard this as instruction given to every mother in our world.” {Conflict and Courage 130.2} Teach us what we shall do unto the child that shall be born Judges 13:8.
  91. 91. “Let us regard this as instruction given to every mother in our world. If you want your children to have well-balanced minds, you must be temperate yourselves. Keep your own heart and affections sound and healthful, that you may impart to your offspring a healthful mind and body.” {Conflict and Courage 130.2}
  92. 92. “Every mother may understand her duty. She may know that the character of her children will depend vastly more upon her habits before their birth and her personal efforts after their birth, than upon external advantages or disadvantages.” {Conflict and Courage 130.2}
  93. 93. The child will be affected for good or for evil by the habits of the mother. She must herself be controlled by principle, and must practice temperance and self-denial, if she would seek the welfare of her child. If before the birth of her child she is unstable, if she is selfish, peevish, and exacting, the disposition of her child will bear the marks of her wrong course. . . . But if she unswervingly adheres to the right, if she is kind, gentle, and unselfish, she will give her child these traits of character. {The Faith I Live By 262.4} Before the Baby Comes
  94. 94. The Habits of the Mother
  95. 95. " The well-being of the child will be affected by the habits of the mother. Her appetites and passions are to be controlled by principle. There is something for her to shun, something for her to work against, if she fulfills God's purpose for her in giving her a child.” {Ministry of Healing Chap 31 The Mother Temperance and Self Control pg 156}
  96. 96. “If before the birth of her child she is self- indulgent, if she is selfish, impatient, and exacting, these traits will be reflected in the disposition of the child. Thus many children have received as a birthright almost unconquerable tendencies to evil. But if the mother unswervingly adheres to right principles, if she is temperate and self-denying, if she is kind, gentle, and unselfish, she may give her child these same precious traits of character.” {Ministry of Healing Chap 31 The Mother Temperance and Self Control pg 156
  97. 97. “Thus many children have received as a birthright almost unconquerable tendencies to evil. But if the mother unswervingly adheres to right principles, if she is temperate and self-denying, if she is kind, gentle, and unselfish, she may give her child these same precious traits of character.” -Ministry of Healing Chap 31 The Mother Temperance and Self Control pg 156
  98. 98. “Very many children are born with their blood tainted with scrofula (Infection of Tuberculosis) through the wrong habits of the mother in her eating and dressing. . . . These fashionably dressed women cannot transmit good constitutions to their children.” { Healthful Living 58.5}
  99. 99. “. . . Wasp waists may have been transmitted to them from their mothers, as the result of their sinful practice of tight lacing, and in consequence of imperfect breathing. Poor children born of these miserable slaves of fashion have diminished vitality, and are predisposed to disease. . . . The impurities retained in the system in consequence of improper breathing are transmitted to their offspring.” { Healthful Living 58.5}
  100. 100. “From their babyhood train your children for God. If in these earlier years the foundations of a righteous character are laid, their lives, as they grow into manhood and womanhood, will develop into beautiful temples for the Lord.” {18MR 119.3}
  101. 101. “If this kind of education had been given to our children, we should today see far less selfishness, far less envy and jealousy; we should have more manly young men and womanly young women.” {RH, December 9, 1890 par. 9}
  102. 102. “The position of a parent is one of the most responsible on earth, yet it is far too lightly regarded by the majority of the world. The things which are perishable receive their time, labor, and money, while the work which will be enduring as eternity is made a secondary matter. The future of the rising generation is in the hands of parents; for, in a great measure, they hold within their control the destiny of their children both for time and for eternity.” (Signs of the Times, December 19, 1878.)
  103. 103. “The salvation of the young depends almost wholly upon the training they receive in childhood. Christian parents, who believe the sacred truth of God, are required to regulate their own conduct by the sanctifying influence of that truth, and, by precept and example, impress lessons of morality and religion upon their children. Line upon line, precept upon precept they should be taught concerning the precious love of Jesus for man, and the virtue of his atonement. That love should be blended with all their studies and duties.” (Signs of the Times, December 19, 1878.)
  104. 104. https://www.dropbox.com/sh/mc08vpdjz1gzke0/ AAAQ517HZnf5ntn9jVX4dxxua?dl=0 REFERENCES BELOW Part 11 -Antonio Bernard , dindinbernard1@hotmail.com

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