Non-binary from a medical perspective

In this op-ed article, Uchenna Kennedy (Universitäts-Kinderspital Zürich) provides a brief overview on the terminology of sex and gender, development of the biological sex and key points on accompaniment of children with variations of sex characteristics.
22nd March 2023
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This article is part of a series relating to our association's efforts to accelerate equality, diversity and inclusion, including as agreed in our Declaration.

Sex and Gender – what is it?

When speaking about sex and gender, it is important to be familiar with the terminology. Sex and gender involve multiple dimensions, each of which can be seen as a spectrum rather than distinct categories. Also, within these dimensions, a variety of combinations is possible for any person (Ref.: The Genderbread Person, 2021).

1. Biological/anatomical Sex: Includes genetic and hormonal factors, external and internal genitalia, body hair, etc.

2. Gender identity (cis or trans including non-binary): Intrinsic (psychological) sense of self on a spectrum of “woman-ness” and/or “man-ness”.

3. Gender expression: Characteristics in personality, appearance, and behavior that -in a given culture and historical period- belong to a certain social role.

4. Sexual attraction or sexual orientation (e.g. heterosexual, homosexual (lesbian or gay),pansexual, bisexual, asexual, queer): The way we feel sexually or romantically attracted to other people.

Development of the biological sex and gender identity

The development of sex organs is a complex process that is influenced by a variety of genetic and hormonal factors. There are three levels in biological sex development: the genetic level, that depends on the sex chromosomes as well as multiple genes that have been shown to influence sex development. The gonadal level describes the development of the undifferentiated gonads into testes or ovaries. And the hormonal level describes the sex hormones that are produced by the gonads, which have effects on internal and external sexual characteristics.

There is a very broad spectrum of variability in this process and in variations of sex characteristics, all levels of the biological sex can be involved. In addition, the development of gender identity occurs as early as the age of 3-5 years and is influenced by a multitude of factors, both biological and societal.

Accompaniment of individuals with variations of sex characteristics

In the care and accompaniment of children with variations of sex characteristics, the child’s needs and integrity should always be at the centre. To reflect the complexity of the field, teams accompanying persons with variations of sex characteristics and their families should be transdisciplinary, including medical specialists, psychologists, ethicists and peer support groups. The aim should be to accompany a child in its individuality, supported by a surrounding that provides security and a sense of trust to the child. An open, age-appropriate communication about the variation and potential medical visits is crucial. An emphasis should also be put on peer support and peer exchange in helping to promote a healthy psychosocial development.

In conclusion, sex and gender include multiple dimensions (identity, attraction, expression, biological sex) all of which can be seen as a continuum.

The process of development of biological sex is complex and involves a variety of genetic and hormonal factors. And when accompanying a child with variation of sex characteristics and their family, the child’s integrity and needs should always be in the center.

Dr. Uchenna Kennedy is a Senior Physician at Universitäts-Kinderspital Zürich. Uchenna's presentation on this theme, as an invited guest speaker at our Task Force Human Resources meeting on 26 January 2023, can be viewed here (Members-only access, password can be created here).

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