Fluidity models in ancient Greece and current practices of sex assignment

Abstract

Disorders of sexual differentiation such as androgen insensitivity and gonadal dysgenesis can involve an intrinsic fluidity at different levels, from the anatomical and biological to the social (gender) that must be considered in the context of social constraints. Sex assignment models based on George Engel’s biopsychosocial aspects model of biology accept fluidity of gender as a central concept and therefore help establish expectations within the uncertainty of sex assignment and anticipate potential changes. The biology underlying the fluidity inherent to these disorders should be presented to parents at diagnosis, an approach that the gender medicine field should embrace as good practice. Greek mythology provides many accepted archetypes of change, and the ancient Greek appreciation of metamorphosis can be used as context with these patients. Our goal is to inform expertise and optimal approaches, knowing that this fluidity may eventually necessitate sex reassignment. Physicians should provide sex assignment education based on different components of sexual differentiation, prepare parents for future hormone-triggered changes in their children, and establish a sex-assignment algorithm.

Disorders of sex development

“…When presented with a child with ambiguous genitalia, unique decision-making challenges can occur regarding sex of rearing, parent and patient education, and medical management [5]. It is important to note that sex does not indicate gender; sex refers to the biology of the internal and external genital structures that is traditionally considered to be a binary categorization.…”

“…Tales from Greco-Roman cultures, e.g. Hermaphrodite and Daphne, have documented and celebrated transformations and fluidity in sex and gender identity [5].…”

Psychological Health Influences of Legal-Marriage and -Partnerships on Same-Sex Couples

“…This fourth limitation demonstrates that a respondent's reported sexual identity is not necessarily equivalent to that respondent's sexual behavior or to the sex/ gender of that individual's spouse-particularly in our era of increasingly fluid sexual and gender identities [37][38][39] and growing researcher attention to the intersectionality framework to integrate the complexity of individual lived experiences within efforts to improve care and research in health and well-being [40][41][42]. For a more comprehensive understanding of the influences of sexual identity, gender identity, and marital status on human health and well-being, survey questions may elicit not only the sex/gender identity of a respondent but also of the respondent's spouse, for example, to help determine the influence of same-or opposite-sex marriage on the health of bisexual or transgender people.…”