11 Queering the Sex Binary: Decolonial Biology

Queering the Sex Binary: Decolonial Biology

Dani LaLuzerne

Artwork throughout by Fenna Schilling (2021)

Introduction: Key Themes & Background on the Sex Binary

What makes a body healthy? Where is the boundary drawn between natural and pathological, or is this very divide the issue in itself? Western medicine prides itself on being rational and impartial, bettering the body with scientific innovation. In reality, medicine functions as a tool of coloniality, exercising biopower¹ by setting classifications for normalcy that are rooted in white supremacy, establishing the healthy body as one that is white, heterosexual, cisgender, and able-bodied. The sex binary is a prime example of how medicine polices bodies that deviate from this normative ideal. This is especially evident in the case of differences in medical care for intersex and transgender individuals.

Before discussing the implications of a colonial sex binary on individuals, it is important to understand the current classifications of sex. Historically, scientists have debated whether both behavioral and physical traits are a result of nurture vs. nature, meaning genetically or socially determined. This has evolved into a debate of unitary vs. interactive explanations, where unitary explanations focus solely on genetic determinism, and interactive explanations see genes as inseparable from the multitude of social influences on the body. In a critique of this unitary theory, neurobiologist Lesley J. Rogers writes, “The simple message ‘genes cause behavior’ may have nothing to do with the processes involved in differentiation of the behavior of women and men, which are much more complex, but it sells well in the media and it has sociopolitical power to maintain the status quo of gender roles” (2011, p. 28). Rogers continues to point out logical fallacies within bio-essentialist views on sex and gender, noting how evolutionary biology is retrospectively subscribed with intense gender difference in hunter-gatherer pasts despite minimal behavioral data; how studies with inadequate sample size are accepted into popular knowledge, such as a 2009 study that compared 3 female fetal brains with 1 male fetal brain; how there is a lot of research on sex differences but little on commonalities; and how adult sex differences are used as proof for genetic sex differences, ignoring how socialization impacts morphological and behavioral traits.

In contrast, interactive theories of sex view genes as malleable, understanding the complexities of how genes and socialization impact each other, and that sex differences are often exaggerated to uphold Western gender ideology. Rogers argues that sex should be seen as complex and malleable, noting how, “the X- and Y-chromosomes with their respective genes should not be seen as canalizing the development of males and females in tightly constrained and diverging paths” (Rogers, 2011, p. 38). While sexual differentiation among humans does exist, it is largely overemphasized and commonly misinterpreted. For example, a morphological trait, such as height, may show that on average men are taller than women, but this does not mean that a randomly chosen man would be taller than a randomly chosen woman. Sex is instead an amalgamation of chromosomal, gonadal, hormonal, and physical traits that is highly individualized and often oversimplified. Although research on interactive models of sex is limited, as individual factors cannot be cleanly isolated to examine their effects, there is the question of why genetic determinism is accepted as the default until proven otherwise. Rogers writes, “Those who believe in genetic determinism see the human condition as unchanging and unchangeable. They give genetic reasons for the inequalities in society and thereby legitimize all manner of social oppression along racial, class, sexual, and other lines” (Rogers, 2011, p. 29). Bio-essentialist views of sex are accepted until proven otherwise because they uphold the very systems that necessitate their presence in the first place. The refutation of distinctly categorized sexes therefore challenges the status quo.

Along similar lines, it is no coincidence that the sex binary upholds racist, sexist, and transphobic ideology, in fact, it was established as a colonial tool to dehumanize non-Western populations and justify their subjugation. Schuller (2018) argues that binary sex did not originate in parallel to race, but rather as a function of 19th century racial biopower: “sex difference was elaborated as a biopolitical security strategy in which power maintains the homeostasis of the population through material givens inherent to its biological existence, a process that sacrifices the existence of the aberrant for the cohesion of the whole” (Schuller, 2018, p. 17). By exaggerating the importance of sex, those in power weaponized sexual differentiation as a measure of civilization, setting in stone previously fluid identities. Scholar Sally Markowitz argues that “in dominant Western ideology a strong sex/gender dimorphism often serves as a human ideal against which different races may be measured” (Markowitz, 2017, p. 44). The belief that high degrees of sexual differentiation indicated evolutionary advancement was integrated into bio-essentialist justifications for racism. Therefore, the enforcement of the sex binary is an intensely racialized process.

Based on this understanding that the biology of sex is much more complicated than binary depictions, this paper attempts to deconstruct normative assumptions of sex and replace them with queer and decolonial alternatives. Using theoretical frameworks established by queer feminist thinkers (Lugones, 2008; Butler, 2014; Cohen, 2004; Kafer, 2013), the following discussion will situate the understandings of the sex binary within Western medicine within established theories of coloniality, gender performativity, disability theory, and deviance. The primary case used to support this analysis is the pathologization and treatment of sex variance within Western medicine, specifically the differential treatment of intersex and transgender individuals. These experiences are sourced through news interviews, articles, and studies (Daniari, 2020; Davis et al., 2016; Fausto-Sterling, 2000; Macaluso, 2023; Markowitz, 2017; Rogers, 2011; Schuller, 2018). The combination of the aforementioned theoretical frameworks and case examples informs the following central argument. Enacting structures of coloniality, normativity, and biopower, Western medicine enforces a bio-essentialist sex binary through its pathologization and cure of sex and gender variance.

Queer Feminist Frameworks: Coloniality, Normativity, and Deviance

Deconstructing the establishment of sexual dimorphism as a tool of colonial imposition, Lugones (2008) builds upon Aníbal Quijano’s (2000) theories on the coloniality of power with intersectional understandings of how gender interacts with race, class, and sexuality. Coloniality is defined as the lasting structures of beliefs, knowledge, and power that established hierarchies based on race, gender, and other axes of positionality, assuming the most privileged of each identity to be the default. While Quijano assumes colonial perspectives on gender to be true, Lugones sees the introduction of heteropatriarchy as directly responsible for the subjugation and disempowerment of Indigenous and African women, defining this structure and its lasting impacts as “the modern/colonial gender system” (Lugones, 2008, p. 1). She speaks on pre-colonial perceptions of sex, particularly the acceptance of sex variance and fluid gender identity being integrated into many Indigenous societies. Lugones asserts that heteropatriarchy is not inherent to gender, citing Oyéronké Oyewùmí’s The Invention of Women, which demonstrates how gender and race were used as tools of domination upon pre-colonial Yoruba society that did not emphasize gender. This is true of many Indigenous communities across the world that recognized queer gender identities or were organized matriarchally–for example the Yuma, Iroquois, Cherokee, and more (Lugones, 2008, p. 10). Lugones describes both “light” and “dark” sides of the modern/colonial gender system: the former creating hegemonic relations of gender and compulsory heterosexuality within white society, the latter dehumanizing women of color with extreme violence and exploitation (Lugones, 2008, p. 15-16). She notes how race is gendered and gender is raced, with different depictions of each existing based on positionality.

Gender performativity, as theorized by Butler (2014) is helpful as a framework to understand how gender reproduces within a society, as well as prior feminist debates on the sex binary. Butler references two common modes of thinking about sex: constructivism, which argues that sex and gender are socially constructed, and essentialism, which argues that sex and gender are innate characteristics. They argue that sex is constantly being materialized within “a temporal process which operates through the reiteration of norms; sex is both produced and destabilized in the course of this reiteration” (Butler, 2014, p. 10). This reiterative (de)construction of sex results in sex and gender performance. In a way, this creation of sex is sex itself; the regulation of bodies into performative categories. Butler calls such regulation of sex into heterosexual norms “the heterosexual imperative” (Butler, 2014, p. 2). It is these processes that materialize sex over and over again.

Based on understandings of anti-normative existence, Kafer’s (2013) theories on modeling disability are specifically relevant to understanding the pathologization of sex variance. Disability is often viewed under an individualized medical model, which designates abnormality as pathological, necessitating medical treatment. She writes, “Solving the problem of disability, then, means correcting, normalizing, or eliminating the pathological individual, rendering a medical approach to disability the only appropriate approach” (Kafer, 2013, p. 5). Kafer instead proposes a political/relational model of disability, that understands disability to be defined in relation to surrounding barriers to access, a result of an able-bodied status quo. She argues that disability is a fluid political category, interacting with systems of power and domination that create and devalue disabled people. She therefore positions crip existence and futurity as political resistance against a society that values worth based on capacity.

In relation to the rejection of dominant social beliefs, Cathy Cohen holds true that deviant behavior can be a form of resistance in itself. Cohen centers Black feminist theory and queer theory to analyze the rejection of normativity. She argues that deviance, specifically among Black communities, should be taken seriously in order to understand how and why people reject dominant social values: “These deviant choices, which are by no means chosen freely in the liberal sense, have the ability to help us delineate the relationship between agency, autonomy, and opposition that has been missing in many of our most insightful analyses of oppositional politics by oppressed people” (Cohen, 2004, p. 38). It is worthwhile to examine why behaviors are considered deviant in the first place, and how deviant expression can be a reclamation of agency in an otherwise stifling society. Cohen specifies that deviance may not be inherently radical on an individual level, but that the amalgamation of deviant behaviors connected through communities can mobilize into forms of resistance.

The Case: Biopower within Intersex and Transgender Medicine

If intersexuality in an infant is identified by medical providers, a “corrective” surgery is often performed to make their genitalia fall into more traditional depictions of binary sex. Intersexuality is defined by the presence of ambiguous sex traits, or a combination of sex traits associated with both male and female anatomy. Approximately 1.7% of people are born intersex, which is roughly equivalent to the number of people who are born as twins (Daniari, 2020). An interview with families of intersex children notes how doctors pressure parents to consent to such surgeries (Daniari, 2020). Both pairs of parents in question chose to abstain from surgery, and were grateful, as their children’s gender identities ended up being different than what the doctors would have assigned (Daniari, 2020). Additionally, it is not uncommon for medical providers or parents to lie to intersex children throughout their lives, saying that surgery for their intersex traits is for cancer or another medical issue, as is the case in Macaluso (2023).

While the medical treatment of intersexuality pathologizes sex variance, gender-affirming surgery requires transgender people to pathologize their experiences as disorders to receive treatment. This occurrence is analyzed in a 2016 qualitative study on differences in treatment among medical professionals who treat intersex people receiving sexual normalization surgeries versus transgender people receiving gender affirming care² (Davis et al., 2016). The study uses Foucault’s concept of the “medical gaze,” which designates bodies as either healthy or morbid: in this case, sexually variant bodies as morbid, or abnormal. Davis et al. write:

“While providers could affirm intersex and trans as healthy differences on a continuum of normative sexed embodiments, instead, our data suggest, they often frame intersex and trans embodiments as pathologies on the basis of a belief that people are either male or female. Their judgments, in turn, can be a powerful incentive for intersex and trans folks—or their parents—to seek sexed embodiments via medicalized intervention” (Davis et al., 2016, p. 493).

In other words, sex and gender variance are labeled as medical issues to support the notion that binary sex is a healthy and correct way of being. Gender-affirming surgery is conditionally accepted under the premise that transgender individuals were born in the wrong body, and must be medically corrected to achieve their correct sex.³

Successful treatment, in the case of both intersex and transgender patients, is marked by medical providers as the ability to pass as a binary gender, and live a “normal” cishet life. Davis et al. concludes, “providers view successful medical interventions as those that align sex, gender, and even sexuality, according to the binary ideology that upholds heteronormativity” (Davis et al., 2016, p. 503). These practices maintain the belief that sex variance and gender nonconformity are unhealthy, not allowing for the existence of queerness or fluidity within transness. Similarly, scholar Anne Fausto-Sterling writes on intersex surgeries:

“infant genital surgery is cosmetic surgery performed to achieve a social result—reshaping a sexually ambiguous body so that it conforms to our two-sex system. This social imperative is so strong that doctors have come to accept it as a medical imperative, despite strong evidence that early genital surgery doesn’t work: it causes extensive scarring, requires multiple surgeries, and often obliterates the possibility of orgasm.” (Fausto-Sterling, 2000, p. 80).

Such invasive procedures are only allowed on intersex children due to the belief that they will not be able to lead pleasant lives without conforming to binary standards of sex, reasserting that a healthy body must be identifiably male or female.

The way in which Western medicine complies with binary sex standards is most evident in its normalization surgeries for intersex people and denial of gender affirming care for transgender people. In a 2023 NPR interview with Sean Saifa Wall, it is noted that many states in the U.S. with bans on gender-affirming care allow intersex surgery, despite these decisions being made for intersex individuals before they can consent–the same rhetoric used against young transgender people (Macaluso, 2023). There are many obstacles in place to reaching gender-affirming care, such as referral letters, insurance coverage, etc., making it inaccessible even in places where it is permitted. Similar results were noted in the 2016 study; “Medical providers in our comparative analysis are often quick to respond to intersex with medically unnecessary and often irreversible interventions, but they are slow to approve and provide similar practices when trans people request them” (Davis et al., 2016, p. 508). The lack of current legislation restricting intersex normalization surgery in the U.S. (Daniari, 2020), compared with the intense barriers to accessing gender-affirming care clearly demonstrates how Western medicine upholds normative ideas surrounding sex.

Analysis: The Sex Binary as a Colonial Tool

As a result of the coloniality of gender, beliefs surrounding sex normativity still impact the lives of intersex and transgender people today, controlling sex variation and access to related medical care. As established by Lugones (2008), Western beliefs about gender and sex were used as a tool of domination, imposed upon Indigenous communities during the process of colonization and erasing any existence of non-normative sex or gender variance. The case of intersex surgery is a modern example of this coloniality, prioritizing normativity under the guise of medical necessity. It is not physical reality, but notions of body normativity/deviance that assigns intersex identity as unnatural. Gender affirming care, on the other hand, is less accepted because it does not adhere to “civilized,” genetically predetermined sexual dimorphism. Medicine, in this sense, exhibits a coloniality of power that enforces the coloniality of gender (Quijano, 2000, and Lugones, 2008). It enacts this dominance through the regulation of sex/gender performance, the pathologization of sex variance, and the disapproval of sex deviance, as expressed through the following respective frameworks by Butler (2014), Kafer (2013), and Cohen (2004).

Using Butler’s (2014) theories on the regulation of sex and gender performativity, the impacts of socialization in relation to interactive theories of sex can be better understood. Butler’s comparison of constructivist versus essentialist views of sex mirrors Rogers’ (2011) comparison of interactive versus unitary views of sex. Constructivist arguments are somewhat different from interactive ones in that radical constructivism focuses solely on social elements of gender, ignoring the materiality of sex characteristics. Butler themself seems to primarily agree with Roger’s interactive theory, noting that sex does not exist in a binary categorical form, as this would homogenize the sexes, though still concurring that there are material elements to sex. Butler also argues that sex is socially constructed through regulatory norms, for example the occurrence of sexual normalization surgeries among intersex youth. After such surgeries, parents are encouraged to raise their children as the gender assigned by medical providers, intensifying their socialization (as is the case in Davis et al., 2016). Success, in this case, is measured by the individual identifying with the sex chosen for them. In this sense, sex is directly regulated by the medical providers and parents of intersex children.

Kafer’s (2013) criticism of normativity-focused cure is relevant to the pathologization of gender variance. The initial binary of healthy versus morbid is problematic, as it places disability in opposition to normal existence, denying it as a natural part of life. Under the medical model of disability, intersex and transgender identities are seen as an abnormality in need of treatment, as is often the case within actual medical settings. Under Kafer’s relational/political model, intersex and transgender identities are seen as normal variations of sex and gender that have been politically suppressed due to their non-conformity. A future that prioritizes intersex and transgender identities has a lot in common with one that prioritizes crip identities. Both rely on bodily agency within medicine, allowance for ambiguity, and a fluidity of thought that opposes such strict classifications.

With the understanding that the current binary and categorical definitions of sex uphold racial and colonial biopower, Cohen’s (2004) theory of deviance as resistance can provide a possible source of transformation. Cohen (2004) states that deviant behaviors can help to reclaim a sense of autonomy in oppressive circumstances, which can be collectivized as a form of resistance. In this case, sex and gender deviance could help to reclaim agency in opposition to a history of forced conformity to a strict binary. Since the sex binary is rooted in colonialism in racism, rejection of it in favor of a queer expansion can be a form of resistance. This would entail not just normalizing fluidity and variance within sex and gender as natural occurrences, but rejecting the classification of parts of existence as (un)natural at all.

Conclusion: Queer Futures

As expressed, the sex binary functions as a racialized tool of colonialism, pathologizing sex variance that was viewed as normal within pre-colonial societies. The increased importance of sexual dimorphism is a direct result of white supremacy, exercising biopower as a form of domination. Lugones’ (2008) theory of the coloniality of gender demonstrates how sexual dimorphism is used to justify colonialism; Butler’s (2014) theory of regulated sex performativity demonstrates feminist thinking surrounding the social creation of gender; Kafer (2013) and Cohen (2004) demonstrate the radical possibilities of embracing anti-normativity & deviance as forms of resistance. In dreaming up a future that prioritizes decolonial queer understandings of sex, categorical and binary classifications of sex must be shed. There is a need for more complex models of sex in medicine, if not a complete change in the structures of pathologization.

Deconstructing the coloniality of the sex binary results in the need for a different model of sex that centers queerness as a normal expression of sex variance. Combining interactive theories of sex biology (Rogers, 2011) and constructivist theories of gender performance (Butler, 2014), assemblage theory⁴ may be able to offer a model for understanding sex that allows for fluidity of both identity and society. Biological sex in itself is a composite of chromosomal, gonadal, hormonal, and physical characteristics that differ for each person over time. When combined with understandings of colonial and pre-colonial histories, sex becomes something that can exist in ambiguity. This is of course not to say that binary identity is wrong, as there are many people who feel that a binary gender or sex identity is suited to them, and binary identities can exist within a larger spectrum of sex variance. Instead, an assemblage view of sex would allow for an expansion of identity wherein dimorphic differences are deemphasized. Sex would then become an assemblage of bodily characteristics that may or may not be specifically gendered. Such queering of the sex binary would allow for fluidity in which people can enact their desires for gender affirmation without social restriction. This approach would dismantle biopower–including that held by medical providers–in favor of a coalescence between medical technologies, alternative medicines, and decolonial theory that prioritizes the desires of gender variant people.

References

Butler, J. (2014). Introduction. In Bodies That Matter: On the Discursive Limits of “Sex” (pp. 1-23). Taylor & Francis Group.

Cohen, C. (2004). Deviance As Resistance: A New Research Agenda for the Study of Black Politics. Du Bois Review: Social Science Research on Race, 1(1), 27-45. doi:10.1017/S1742058X04040044

Daniari, S. (2020, July 14). Are hasty operations on intersex children becoming a thing of the past?. The Guardian. https://www.theguardian.com/lifeandstyle/2020/jul/14/intersex-children-hasty-operations

Davis, G., Dewey, J. M., & Murphy, E. L. (2016). Giving Sex: Deconstructing Intersex and Trans Medicalization Practices. Gender and Society, 30(3), 490–514. http://www.jstor.org/stable/24756183

Fausto-Sterling, A. (2000). Should There Be Only Two Sexes? In Sexing the Body: Gender politics and the Construction of Sexuality (pp. 78-114). Basic Books. https://ebookcentral.proquest.com/lib/claremont/detail.action?docID=904413

Kafer, A. (2013). Introduction: Imagined Futures. In Feminist, Queer, Crip (pp. 1–24). Indiana University Press. http://www.jstor.org/stable/j.ctt16gz79x.5

Lugones, M. (2008). The Coloniality of Gender. Worlds & Knowledges Otherwise.

Macaluso, J. (2023, April 11). Where gender-affirming care for youth is banned, intersex surgery may be allowed. NPR. https://www.npr.org/2023/04/11/1169194792/some-states-that-ban-gender-affirming-care-for-trans-youth-allow-intersex-surger

Markowitz, S. (2017). Pelvic Politics: Sexual Dimorphism and Racial Difference. In C. Cipolla, K. Gupta, D. A. Rubin, & A. Willey (Eds.), Queer Feminist Science Studies: A Reader (pp. 43–55). University of Washington Press. http://www.jstor.org/stable/j.ctvcwn8vd.7

Rogers, L. J. (2011). Sex Differences Are Not Hardwired. In J. A. Fisher (Ed.), Gender and the Science of Difference: Cultural Politics of Contemporary Science and Medicine (pp. 27–42). Rutgers University Press. http://www.jstor.org/stable/j.ctt5hj2h3.5

Schilling, F. (2021, July 7). WePresent [Collage Series]. WeTransfer. https://wepresent.wetransfer.com/stories/institute-of-queer-ecology

Schuller, K. (2018). Introduction: Sentimental Biopower. In The Biopolitics of Feeling: Race, Sex, and Science in the Nineteenth Century (pp. 1-34). Duke University Press. https://doi-org.ccl.idm.oclc.org/10.1215/9780822372356.

Endnotes

     ¹ Biopower is defined as power exercised over bodies, lives, and death, as coined by Michel Foucault throughout his work.

² Gender-affirming care can consist of many different components, such as clothing, hormone therapy, vocal training, surgery, etc. This analysis focuses mainly on gender-affirming surgeries, but it is worthwhile to note that what is affirming is different for everyone. This may include, all, none, or some of the above practices.

³ To clarify, intersex and transgender people who seek out surgery are valid, as it can be a source of euphoria and bodily agency. My criticism is of the way that Western medicine rationalizes surgical transition as a curative practice.

⁴ Assemblage theory is defined as a fluid and connective framework that redistributes individual agency into a socio-material collective, as coined by philosopher Gilles Deleuze throughout his work.