June is National LGBTQ+ Pride Month. Somewhat recently, the Pride acronym has adopted more letters. Many sources now refer to the LGBTQIA+ community, which stands for lesbian, gay, bisexual, transgender, queer, intersex, and asexual. While some of those words are often discussed, others may need some further explanation. We turned to Laurel A. Beck, PhD, Senior Instructor in CU Denver’s Department of Integrative Biology to explain the “I” in LGBTQIA+.

First things first. One aspect that makes all the letters in LGBTQ+ difficult for some people to understand is the difference between sex and gender. Comedian and social justice activist Sam Killermann, who previously presented a comedy show called “It’s Pronounced Metrosexual” at college campuses nationwide, now creates edugraphics to explain the complexities of sex and gender. As his Genderbread Person illustrates, sex relates to a person’s anatomy, while gender refers to a person’s self-identified feeling of being male, female, or a combination.

Beck, who researches endocrinology, reiterates this difference: “While sex and gender are terms that are often used interchangeably by people, they really do mean different things. Sex is all about the chromosomes, organs, and external genitalia. Gender is a totally separate spectrum from sex; it’s more about how a person feels they best align with sociobehavioral norms or rules for each gender type.” 

An intersex person is born with a mix of female and male anatomy. “The chromosomes may not align with typical male or female sex organs and structures, or the sex organs and structures may fall somewhere in between typical male and female presentations,” Beck explains. Intersex people (once referred to as hermaphrodites—a term that is no longer acceptable because it stigmatizes people with intersex and their families) “fall somewhere in between the poles of female and male, through genetic or hormonal differences in development,” she said.

Intersex individuals exist on a spectrum of sex and may have internal and/or external biological characteristics of sex. It is estimated that 1.7% of people are born intersex, which is relatively common when compared to 0.3% chance of having identical twins (percentage is based on a systematic review of medical literature). However, many societies do not talk about intersex people. This may be because, culturally and historically, societies have held a binary view of sex (the purple and yellow intersex flag visually represents ambiguity, since it leaves off the standard plus and arrow signs that indicate female and male). 

Beck is one of 2600+ scientists who signed an open letter opposing the current administration’s gender definition proposal, which seeks to legally define gender as either male or female. The scientists’ letter states, “The relationship between sex chromosomes, genitalia, and gender identity is complex, and not fully understood. There are no genetic tests that can unambiguously determine gender, or even sex.” 

Babies born with intersex traits have traditionally been assigned a binary sex after birth. Beck believes this practice is “due to a combination of bias in medical training and parents wanting ‘what’s best’ for their baby, which often means trying to fit the intersex child into the very narrow definition of what society deems as ‘normal.’” In the U.S., many medical practitioners have encouraged parents of intersex babies to perform “gender-normalizing” surgery. Most surgeries occur when a child is less than two years old, according to the nonprofit InterACT, which is why Beck and others are trying to raise awareness of intersex persons and their legal rights.

According to InterACT, “Infant intersex surgeries violate principles of informed consent, bodily autonomy, and self-determination.” Yet there is very little legal protection for people who are intersex. In 2018, California passed the first successful U.S. legislation to protect intersex human rights, a non-binding resolution to, among other things, “defer medical or surgical intervention, as warranted, until the child is able to participate in decision-making.”

To be clear, intersex people are not the same as transgender people, which is why the “T” and the “I” are both included in LGBTQIA+. Intersex people have biological parts of both sexes. In transgender people, their sex and gender do not align. When an intersex person is old enough to choose a gender identity, they can choose to identify as male, female, or a combination. Their gender is unrelated to whatever sexual orientation they have (attraction to people of the same or different sex).

Beck, who has studied sexual dimorphism and sex morphology in the green anole lizard, advocates for LGBTQ+ rights, possibly because the animal world is full of sexual ambiguity and change. “The truth is more people are intersex than you might think,” she said. “More education of the public on the biological determinates of sex—and acceptance of a spectrum of sex—will help make a richer society for us all.”