Categorical imperative?

On Dec. 15, 2016, New York City issued the nation’s first public “intersex” birth certificate to Sara Kelly Keenan, 55, who was born with male XY chromosomes but with female genitals and mixed male and female internal organs. About 1 in 80,000 babies is born with this condition, called Swyer syndrome.

Keenan’s case is one transgender advocates are using to argue that gender is on a spectrum—that her biological intersex status at birth means that, scientifically, sex is not binary. Few Christian leaders have addressed this particularly thorny topic, and those who have are unsure how to handle the particulars like birth certificates.

For birth certificates, states typically base sex on the doctor’s report at the time of birth—and when a child is born with intersex characteristics, the parents and doctors make a determination one way or another. When Keenan requested a birth certificate change last year, the New York City Department of Health and Mental Hygiene agreed to revise her birth certificate on the grounds that “intersex” was an accurate record of her physical status at birth. The department said it wants to capture “data” correctly. (New York City’s current health department standards do not allow someone to change to intersex purely on the basis of self- identity.)

Intersex is an umbrella term that can refer to several rare conditions where a baby is born without defining physical features of one sex or another (an older term is hermaphrodite). Rarely, some babies have gonads that are neither ovaries nor testes. Some don’t have definable genitals, or have a jumble of male and female reproductive organs internally. Over the last decade doctors have begun checking chromosomes and hormones to determine sex when physical traits are unclear instead of basing the decision on visible tissues and proceeding with surgery.

Most states already allow people to change birth certificates to male or female after sex-change surgery, but some activists want to create a third category on government documents. (Australia has on all its official government forms the categories male, female, and “X.”) Keenan herself has supported blurring the line between the intersex condition and self-imposed gender identity—she was the second person to obtain the gender status of “non-binary” in California, where she lives.

Activist groups are divided on this subject. Toby Adams, Keenan’s lawyer, founded the Intersex and Genderqueer Recognition Project, “the first legal organization in the United States to address the right of non-binary adults to gender-self-identify on legal documents.” But the Intersex Society of North America (ISNA)—the main American advocacy group for children born with these kinds of conditions—doesn’t agree with applying the non-binary label to intersex children.

ISNA urges parents to assign their intersex children the gender of either male or female (though it does not advocate surgery). The organization says, “Many intersex people are perfectly comfortable adopting either a male or female gender identity and are not seeking a genderless society or to label themselves as a member of a third gender class. … Assigning an ‘intersex’ gender would unnecessarily traumatize the child.”

‘The existence of intersex conditions doesn’t mean that we no longer believe in the male and female binary.’

Some pastors think the cases should be evaluated individually, since there is so much variety in physical issues. “This birth certificate effort will … erase the line between intersex and transgender, making folks consider them both under the same umbrella term,” says Reformed Presbyterian pastor Sam Andreades, author of a theology book on gender, enGendered: “Yes, we should acknowledge these medical conditions, but not on birth certificates.”

Andreades says parents of intersex children should decide on a gender at birth, and surgically make that a reality: Most children will be “immensely grateful to their parents for having the operations done when they were babies.” If parents want to wait on deciding on a gender, the birth certificate could read, “To be determined.”

Several years ago Denny Burk, a Biblical studies professor at Boyce College and a Baptist pastor, spoke at a campus conference about gender confusion. A youth minister asked about a situation in his church where a child, born intersex, was struggling with her parents’ decision about her gender. Burk remembered being a “deer in the headlights,” entirely unsure how to respond.

Now Burk has a position: He suggests parents should focus on chromosomes and not push for surgery to make their children’s anatomy “fit in with the norm.” Burk refers to research about intersex children who have grown up and struggled with their parents’ surgical decisions. He thinks Matthew 19:12, where Jesus refers to “eunuchs who have been so from birth,” might refer to children with intersex conditions.

“The existence of intersex conditions doesn’t mean that we no longer believe in the male and female binary,” Burk says. “We live in a fallen world. Just like you have all manners of physical malady and disorders that afflict the human bodies, intersex conditions fall into that category. … Jesus isn’t saying that they can’t be His followers or His disciples if they’re in that ambiguous situation.”