Intersex, Sex and/or Gender Diverse People and the Death of Transgender
as an Umbrella Term

Paper presented at Health in Difference 2010: Doing Diversity: 7th National LGBTI Health Conference
Sydney, Australia, 29 April -1 May 2010

By Dr Tracie O'Keefe DCH

Abstract

The paper discusses intersex, sex and/or gender diverse (ISGD) people who are made up from many differing groups including people who are intersex, transexed, transsexual, transgendered, androgynous, without sex and gender identity, and people with sex and gender culturally specific differences. They are people who experience variations in physical presentation and social behaviour that is other than stereotypically male or female. Each group may have its own physical, psychological, social, legal and political issues that may not necessarily relate to any of the other groups.

Historically these separate groups have often had a history of hostility towards each other as differing groups seek to speak out publicly in the others' names. This has, over the past decade, found social construction theorists mistakenly attempting to usher all of them under the umbrella term 'transgender' but the word has failed to satisfy the needs of some individual groups within this category of people. We are on the cusp of counter-revolution by many to reassert the individuality of each of these groups and their needs.

Over the past nine years Sex And Gender Education (Australia) has campaigned to the government for the rights of each and every one of these groups and continues to do so under the new term 'intersex, sex and/or gender diverse' people (ISGD). It has, however, become obvious that collective bargaining under the term 'transgender' has failed to work because it alienates too many of the aforementioned groups of people. The Australian Human Rights Commission in its 2009 report on the legal rights of sex and gender diverse people successfully negotiated its inquiry by using the open language phrase 'sex and gender diverse' while including each groups' concerns and issues. The phrase is now becoming more popular with health professionals, government and some political campaigners and SAGE proposes the new term 'intersex, sex and/or gender diverse' people (ISGD) as an overarching model.

Intersex, Sex and/or Gender Diverse People and the Death of Transgender as an Umbrella Term

Intersex, Sex and/or Gender Diverse (ISGD) People as an Overarching Model

Nature produces human diversity in all manner of physiological manifestations: short, tall, pale, dark-skinned, hairy, bald and so on. In relation to sexing human beings many physiologists, biologists and microbiologists understand that sex is a not a bipolar option of either male or female but a collage of many different characteristics such as genetics, gonads, reproductive organs, breast tissue, musculature, stature, brain features and hormonal activation. Some people have both a mixture of male and female physical characteristics. Other people may have medical conditions that mean they are unable fulfill the absolute stereotypical physiological male or female criteria. They become a diverse variation on the physical sex theme, therefore intersex or sex diverse (O'Keefe, 1999).

Gender is a social construct not a physiological feature. One acts out gender in a performance of behavioural social interpretations of what may be considered stereotypically masculine or feminine. There is much confusion with health professionals and the public concerning the difference between sex and gender and for accuracy they cannot be used interchangeably. People act out their gender performance in degrees of femininity, masculinity, androgyny or neuter interpretations (Money, 1986). To use a feminist analogy, 'One is not born with a gender, one adopts an agenda.'

So people who find themselves neither strictly physiologically male or female could be said to be intersex or sex diverse because they are a variation beyond a strictly male or female theme. Other people who find their socially constructed selves, in relation to society, as less than stereotypically feminine or masculine could be considered gender diverse. Some people are intersex, solely sex diverse while others are gender diverse, and still further some people can be both sex and gender diverse or intersex and gender diverse.

Over the past 100 years nomenclature in the field of clinical, academic sexology, intersex studies and sex and/or gender diversity has been riddled with contentions (Ellis, 1905) (Hirschfeld, 1991) (Kinsey, Pomeroy, Martin, 1949 &1953) (Dreger, 1998 &1999) (Krafft- Ebing, 1886) (Cauldwell, 1949) (Prince, 1997) (Benjamin, 1966) (Money, 1986) (Bailey, 2003) (Lee, 2006). Useage of labelling for these different experiences has been a battleground between the medical establishment's attempt to overpathologise intersex, sex and/or gender diversity and those individuals' quests for self-differentiation. Clinical descriptive labelling has often been associated with psychopathology even for individuals who have recognised medical intersex conditions (O'Keefe, 1999).

Using the research phrase, 'Deviation from the norm' has seen intersex, sex and/or gender diverse people subjected to psychiatric and psychoanalytical over-psychopathologisation, social exclusion, civil rights denial and physical violence (Serano, 2007) (Tully, 1992) (Califia, 1997) (Film: Boys Don't Cry, 1999).

Such prejudices have come from academia, the medical profession (particularly HBIGDA (Harry Benjamin International Gender Dysphoria Association), now known as WPATH (World Professional Association for Transgender Health), who sought to classify transsexualism under the title 'Gender Identity Disorder' as a psychopathology in the DSM 111 (APS, 1980), society at large, religious denominations, lawmakers, and even from some civil rights campaigners operating their own agendas (Raymond, 1979).

When talking about the collective groups of intersex, sex and/or gender diverse people I include people who are intersexed, transexed, transsexual, transgendered, androgynous, sinandrogenous (without sex and gender identity). We must also include people from other cultures that may have different ideas of masculinity and femininity that are unlike the Western Judeo/Christian stereotypes; for example the hijra of India and Pakistan, khusra of Pakistan, and male-role women (O'Keefe & Fox, 1997) (O'Keefe, 1999) (Young, 2000) (Ramet, 1996). Since new groups will emerge in time and there are probably types of people I might not have even mentioned, let us safely say that I mean all people that are other than stereotypically male or female.

Intersex people have frequently had medical treatments forced upon them that they sometimes, on reflection, did not want (Dreger, 1998 &1999). Some intersex people, however, who were not happy with their identity, managed to transition identities without resistance by clinicians (Langley Simmons, 1995). Forms of androgyny of mind and behaviour were considered curiosities to be studied (Faithfull, 1938) (Money, 1986).

Transsexual people were frequently unjustly categorised as having a mental disorder (Stoller, 1973) (DSM 111, 1980) (Califia, 1997). Cross-dressers have been persecuted and suffered violence with threats of prison (Von Mahlsdorf, 1995) (O'Keefe, 1999). Others have sought notoriety as drag queens (Gorman, 1998); and the wealthy, shrewd and infamous ones have led privileged lives (Collis, 2001) (Kates, 1996). Cultural specific cross-gender identification is also well documented (Young, 2000).

The catalogue of suffering of intersex, sex and/or gender diverse people at the hands of others is indeed a litany far too long to be noted in this paper. That persecution is not only past but truly current, causing great distress to many intersex, sex and/or gender diverse people and disallowing them from living a peaceful and orderly life. Furthermore, each of these groups has their own issues around self-naming their identity.

The History of Sexing and Gendering of Intersex, Sex And /Or Gender Diverse People

When we look at the early autobiographies and biographies of people who changed their sex (their words), they were labelled transsexuals according to their own description. There is no mention of gender identity (Cowell, 1954) ( Jorgensen, 1967) (Morgan, 1973) (Morris, 1974) (Hodgkinson, 1989) (Stirling, 1989) (Cossey 1991), (Ashley 2006). For them, they changed their sex. In The Transsexual Phenomenom (Benjamin, 1966), the first major work by a clinician on people changing their sex identity, there was no emphasis on the phrase 'gender identity'. The authors referred to such people as changing their sex and being transsexuals.

The major proponent of gender identity in this field was John Money (1986 & 1995), Professor of Paediatrics and Psychiatry at Johns Hopkins University. He developed the theory that gender programming could be successful with infants regardless of their original natal sex (Money, 1995). In the case of David Reimer, a twin who suffered a disastrous circumcision accident, Money sanctioned penile amputation of the infant. Money then convinced the family to bring the child up as a girl (Colapinto, 2000). Extremely distressed in adolescence, the child reverted to a male identity and committed suicide in adulthood. This, however, set the stage for the concept that sex and gender identity may be different things but Money failed to truly differentiate between sex identity and gender identity.

Benjamin went on to form the Harry Benjamin International Gender Dysphoria Association (HBIGDA) in the 1970s for professionals working with transsexuals in the field of changing sexes (Matt, Devor, Vladicka, 2009). The Association was originally formed to protect professionals from being sued for working with patients who might regret their decision but also from being sued by the patients' relatives, particularly spouses. Such work was viewed as medically risky and unproven by many in the medical profession. Members of HBIGDA sought to give it professional credence by their association. HBIGDA held conferences, issued Standards of Care for clinicians and the members sought to pathologise the cross-sex and cross-gender identity process, resulting in transsexuals being listed in the Diagnostic & Statistical Manual of Mental Disorders (DSM, 111, (APS, 1980).

In some countries, particularly the UK, this facilitated the gaining of funds from the government to treat transsexuals by psychiatry, psychology, hormones and surgery. In America the Johns Hopkins Hospital, University of Minnesota, Stanford University, University of Oregon and Case Western Reserve took on the role with limited funds (Califia, 1997). Later doctors in other countries managed to get funds out of their governments for such work, even in China, often under the disguise of research but most treatments were and still are funded privately by the individual.

This was the initiation of what became known as the gatekeeper system when people had to pass interviews before they would be allowed treatment to transition to other strictly male or female roles. It was a clinical policing system operated by clinicians to guide patients into firmly male or female heterosexual roles. Patients who refused to fit into the model were rejected for treatment and frequently further psycho-pathologised as delusional with added personality disorders. The gatekeeper system began to collapse in the early 1980s with the death of the British psychiatrist John Randall and the scaling down of help for people in America as funding began to dry up as Money's influence dwindled. The gatekeeper system, however, was active in many parts of the world as psycho-theorists in HBIGDA were prevalent and dominated the field. Today it is still active in many parts of the world and patients are still rejected for treatment.

At the same time and into the 1990s in America the beginnings of the gender liberation movement was starting with activists in California and New York (Feinberg, 1996) (Green, 2004) (Bornstein, 1994) (Wilkins, 1997), which spread across the globe piece by piece into the 1990s. Since sex changing was officially under the express control of medical establishments, if people were funded by the state, gender was considered a possession of the community over which controlling clinicians could not rule. Gender deviation became an act of counter-revolution (Volcano, 1999). Thus progressed the transgender liberation movement on the tailcoats of the gay liberation movement and the feminist's use of gender as an identity variance rather than sex.

The transgender movement was supposed to set trans people free from the control of society, clinicians, outdated laws and prejudice. It was to include all trans oppressed people. In doing that, however, it became an oppressor itself. In the mid-1990s I was involved in the first trans section in the London Pride march. One organiser, himself a transman, turned up the official banner declaring 'transgender rights'. I pointed out to him that many sex and/or gender diverse people were not transgendered identified but by that time he had been bitten by the transgender virus and abandoned his previous transsexual identity.

I published my books Sex, Gender and Sexuality: 21st Century Transformations (1999), Finding the Real Me (2003) and Trans People in Love (2008), with my partner Katrina Fox and focused across a wide sex and/or gender diverse spectrum, never using the term 'transgender' as an umbrella term. We had contact with many intersex, trans and sex and/or gender diverse people who did not identify as transgender in any way whatsoever. For many their transformation was about their physical body and biological sex characteristics not about their gender performance. Some were partially intersex or intersex identified but not transgender identified.

Recently I wrote an article entitled 'Don't call me Transgender' for The Scavenger online magazine (O'Keefe, 2010) because I am both transexed and intersex but not transgendered. Some of the responses I got were very supportive and some abusive. Some of the abusive ones I received were from professionals in the field, even doctors, who made it obvious that they saw me as some kind of deranged reprobate because I would not fit into their transgender dictum. Indeed, what used to be the transsexual mafia at the HBIGDA has now been replaced with the transgender fascista at WPATH - new name, same old prejudices towards people who do not fit their narrow categorisations.

This is likely to be partly due to the Americans' discomfort with the word sex, WPATH being mainly an American organisation. Money wrote in The Destroying Angel (1985) of a long history of religiosity and prudishness in the USA. Since America is a deeply religious country the evangelical religious sector of society is often sex phobic. The problem in trans liberation was the word 'transsexual' which was based on Cauldwell's (1949) original indication of sexual deviance. While Krafft-Ebing (1886) at the end of the 19th century and Hirschfeld (2003) at the begin of the 20th did see transsexualism as a form of intersex, the translations from the German crossed identity too far into a sexuality when Freud influenced popular culture and focused on psychoanalytic psychopathologies. To be fair, even Freud did not like the translation of his works into English (Freud, 1953) (Taylor, 1996). Since the word gender was considered more respectable, acceptable and less confrontational, the American trans liberationists in the 1990s adopted transgender to replace transsexual in a bid for greater sympathy in society.
Even the American trans liberationist and campaigner Jamison Green wrote:

"Transsexual people usually wish to be perceived and taken seriously as members of the gender class to which they feel comfortable." (Green, 1999 (in More and Whittle p117 (Eds.)

While this seeks to be sympathetic it fails to understand that many transsexual and transexed people experience sex dysphoria or exploration and not gender dysphoria, and that their issues are about their physiological bodies not their social roles - which, for those who are dysphoric, is the same kind of dysphoria frequently suffered by many officially intersex people who have been assigned inappropriate sexes.
Green previously lived as a lesbian and struggled with his gender issues for many years before transition so he was likely impregnated with the language of feminists, which is based around gender not around sex. While there are transitioning people who do have issues around their gender, many transexed and transsexual people only have issues about their anatomical bodies and sex characteristics.

The trans-intersex divide

During the 20th century intersex and trans identities were separated by internal political prejudices. In many parts of the intersex and trans movements there are still pockets of people who continue to discriminate against either group. The transgender movement in the 1990s and 2000s left many intersex, sex and/or gender diverse people feeling they did not belong to the movement as they did not identify as transgendered but as intersex, androgynous or without sex and/or gender identity.

People with intersex variations outnumber trans people with some frequency of varying kinds of around one in 100 people (O'Keefe, 1999) for both. Like trans people, intersex people have suffered persecution at the hands of the medical profession, society and the lack of protection in law (Campbell, 1997). They too are often psycho-pathologised when refusing to accept treatment that the medical professionals believe is best for them or refusing to accept an assigned sex and/or gender.

For fear that they may be subjected to the terrible treatments that many trans people encountered, the intersex networks distanced themselves from indentifying with trans people. Intersex people still need protection from the medical profession foisting treatments on them without their consent. WPATH in 2008 added an intersex section to its committees regardless of great international protests from intersex communities because of WPATH's lack of consultation with intersex groups. What followed was a classic internet row between the then president of WPATH and members of Organisation International Intersexual (OII), which clearly demonstrated the historical mistrust between trans and intersex groups, academics, and the top-down management approaches of many clinicians about people's choices over their lives.
(http://whittlings.blogspot.com/2008_07_01_archive.html, July 2008)

How Transgender as an Overview Failed

Ekins and King (p9, 2005) write about how Virginia Prince, an American male pharmacologist who went on to live as a female, coined the term transgender. In trying to place her (preferred pronoun) in a historical context they also recorded how Prince was against sex realignment surgery and her disdainful attitude towards transsexuals who underwent genital modification.

She also claims to have "coined the terms 'transgender' and 'transgenderist' as nouns describing people like myself who have breasts and live full time as a woman but who have no intention of having genital surgery." (Prince, 1997a: 469) Ekins & King, 2005).

Prince was a biological purist who did not believe that sex was changeable, seeing it only as its early crude biological concomitants. She did not strictly view herself as a cross-dresser but someone who wanted to live more permanently as female and did not want genital surgery. She believed that her solution was a change of gender not a change of sex. Unfortunately, she was unable to see or appreciate the whole spectrum of human sex and/or gender diversity.

In the 1990s the word transgender became popular in America with many people who did not feel they fitted the classical transsexual model written about by Benjamin. The model determined that the classical transsexual did everything they could to change their natal sex and identified as their destination other sex.

Many transgender identified people could not afford surgery, did not want it, were too ill to undergo it or challenged its cultural necessity. For many who did not fit that extreme transsexual model, transgenderism was a blessing, allowing them to simply be a mix of male and female. It allowed those identifying as transgender to be successful as transgendered and not failures as transsexuals when they did not pass in public as their destination sex identification or did not qualify under the HBIGDA criteria.

There were those who, like Prince, had clear transgendered identities and those who through poverty or ill health were unable to go medicinally very far with their transition and adopted the transgender approach out of absolute necessity. There were also those who felt that medical options open to them were too risky or undesirable, so terms like non-operative transsexual and transgendered were used to accommodate and legitimate those identities (Feinberg, 1996) (Bornstein, 1994) (Stryker & Whittle, 2006).

Many people started to use the term transgender to describe all sex and/or gender diverse people, which it could not because the spectrum of experiences is too wide. Many thousands of transexed and transsexual people were and are not comfortable with the term transgender. Rachael Wallbank, the Australian lawyer, has consistently spoken out publicly about her experience as a woman with a transsexual history and her disassociation from the transgender experience (Wallbank, 2010).

Also many people who are androgynous or without sex and gender identity do not identify as transgender, such as Norrie, the Australian who was granted what is believed to be the world's first sex no specified documents (the document was later rescinded by the government).
http://www.thescavenger.net/glbsgdq/sex-not-specified-australia-leads-the-way-in-legal-document-756345.html, March, 2010)
Now the public is confused because people who cross-dress are also referring to themselves as transgendered or gender adventurous and telling the world they do not want to medically transition (Novic, 2004). So the public now often thinks that all so-called transgender people can live without transition.

This foray into intersex and trans internal politics is only a taster and the field is far too complex to be addressed by this paper but the reader might consider how contentious the use of the word transgender, as an overview, is for many intersex, sex and/or gender diverse people and sometimes deleteriously impacts on their social and legal rights.

The co-opting of the word transgender by academics to cover the whole spectrum of sex and/or gender diverse people has been a phenomenal failure. Each group has its very specific needs. The transexed (transsexuals who indentify as intersex) and transsexual group are struggling to get governments to pay for treatment and change laws to allow them to live in their needed sex and/or gender. The transgender groups often do not want or want limited medical treatment or surgical intervention and frequently do not identify as their opposite natal sex unlike many transexed or transsexual people. Further complications now occur when some transsexual, transexed and some self-identified transgendered people describe the same life experiences but are calling it by different names.

When a person appears on the television calling themselves transgender and declares that there is no need for hormones or surgery for them, the public think all transgendered people think like that way. If the same label is then attempted to be used to describe someone of intersex, transexed or transsexual experience the public once again sees someone they assume does not want those treatments. They have been imprinted with the notion that transgender means not wanting medical intervention. For those intersex, sex and/or gender diverse people who do not identify as transgender this can be very distressing because their very life may depend upon accessing hormones and surgery; but even more it can impinge upon their civil rights because the public only wants to give them the rights of the person who does not want medical intervention.

Now of course the person who does not want or only wants limited medical intervention has a truly valued experience. However, the price of using the transgender label as a generalisation that includes intersexed, transexed, transsexual or other identities is too confusing to the public and for some the cost is too high to pay.

The advocates of transgender as an umbrella term will tell you it has two meanings: one as a man in a dress or a woman in a man's suit and someone who does not want surgery or hormones; and the classic transexed or transsexual (some even include intersex). Such a highly charged and descriptive word as transgender cannot have two clear meanings when such complex issues are involved - it becomes linguistically reckless. Language is never that simple and there is a need to realise how the use of the word transgender for all the intersex, sex and/or gender diverse groups steals many of their experiences as well as human and legal rights by mislabelling them.

In using a highly charged word like transgender as a personal noun, in a political arena its surface meaning and root meaning must be congruent and not open to misunderstanding. The word transgender can never be truly grammatically congruent within that context. This only leads to animosity if someone believes their needs have not been met by their interests being mis-described.

While some intersex, sex and/or gender diverse people might not be offended when mistaken for transgender people, when they are not, it is detrimental to their legal and social rights if people assume they want the same rights as those who simply want to cross-dress. Each intersex, sex and/or gender diverse groups' needs should be considered in their own right. After writing my 2010 article recently asking people not to refer to me as transgender someone left this comment on the comments section:

Transgender' has become one of the most dangerous words in the gender variant lexicon. Over the years, I have seen it used as an umbrella term for all people with issues of gender or sex variance, as an alternative term for transvestite and as a third gender, among others. I have listened to people accept the variation in definitions and to people who assert that their definition is THE correct one. I have listened to them exclude themselves from being transgender because they are women or men 'with a history', because they are transvestites, because they are intersex, because they are transsexual…the list is endless. (January 2010)

We must also reconsider the rights of those who do actually meet the criteria of Prince's original meaning of transgender because when that meaning is bastardised too far beyond its grammatical roots the social space for such people is also stolen, distorted and destroyed.

Branding and Its Commercial Application to Intersex, Sex and/or Gender Diverse Identities

When we trace the branding of intersex, sex and/or gender identities we can see how they have belonged to the freak status, particularly for intersex people, even though in some cultures they were revered. In the 19th century intersex people sometimes worked in circus carnivals as curiosities to survive. Shame around their very being was laden upon them by medicine, the law and social mores. We can see how in the 20th century the medical establishment, along with psychology, commercialised intersex, sex and/or gender variations through pathologisation and control of the individual's fate with the gatekeeper system and how trans people inherited some of the shame and lack of control over their own lives that intersex people frequently experienced (Dreger, 1998 & 1999) (O'Keefe & Fox 1997) (Califia, 1997).

Academics then took possession of sex, gender and sexuality identity, rebranding it as queer - that is, non-normative (Atkins, 1998). In the 2000s we saw trans academia attempting to rebrand all non-normative intersex, sex and/or gender diverse people as transgender, even rewriting history and ignoring that some of those people's histories were not in fact transgendered at all as they were intersexed, transsexual, transvestite or a myriad of other identities (Currah et al, 2006) (Stryker, 2008) (Stryker & Whittle, 2006).

A more sinister turn has been HBIGDA changing its name to WPATH in 2009. This ostensibly became a closed cult and no longer a holistic professional healthcare association, if it ever was, where all sex and/or gender diverse people were respected. WPATH selectively sanctions members' contribution to the debate on its discussion list for what appear to be the dissenters to transgender branding and still does today. I am such a rebel without apology. Many WPATH members fail to respect the rights of individuals to self-identify as not being transgendered. Anthropological sexology, it seems, is secondary to branding for many members of WPATH and certainly for its ruling élite.

This whole rebranding of intersex, sex and/or gender diverse people, as intended, has been hugely successful in liberating trans people who do not strictly identify as male or female. The knock-on effects, however, have been catastrophic for intersex, sex and/or gender diverse people who do not identify as transgender. Within the trans community non-transgender people are being pilloried, abused, ignored and bullied for not being identified as transgendered and fitting the transgender mould.

Intersex people are frequently unhappy with WPATH members and clinicians equating their identities as disorders of sexual development. They do not see themselves as transgendered and frequently do not see themselves as having disorders at all. Some intersex people, however, do have to get themselves diagnosed as trans in order to get the medical treatment they need that they cannot get as intersex people. Let us also not forget that much of the fight for many intersex people is not to have treatment they have not approved forced upon them without their permission.

GLBTI: The Theft of Intersex, Sex and/or Gender Diverse Identities

From the mid 1990s the gay, lesbian and bisexual (GLB) movement would at times tag T for transgender onto the end of their campaigning acronyms in an attempt to swell their numbers and to appear politically correct. This often caused enormous animosity by many sex and/or gender diverse people towards the GLB movement as their fight for social justice is not about sexuality. For the majority of intersex, sex and/or gender diverse people their fight for equal rights is about sex and/or gender identity, which are different things. At times some of the trans equal rights movements solicited conjoint lobbying power with the GLB movement and still at times attempts to today. Crossover occurs at times with drag queens and transvestites whose cross-sex associations are part of the expression of their sexuality.

The T can stand for transexed, transsexual, transgender or transvestite, transfluid and each of these groups may have different social, medical and legal needs so GLB people frequently misunderstand those needs. This can severely endanger trans people in that GLB campaigners for equal rights get the requirements of the trans groups wrong and can cause more political damage than good. The gay press constantly runs stories about trans people with incorrect facts. It is a myth that GLB people understand trans people more than heterosexual people.
Again the GLB community often tag 'I' on the end of their acronym, not truly understanding the complex medico/legal issues involved in campaigning for intersex people to elect or refuse medical treatment or become involved in legal battles against discrimination.

These concerns can be about the right to choose identity or highly complex medical conditions that may at times present a life or death situation, and reading a few government documents cannot substitute for a lifetime of experience had by intersex people themselves. For those who identify as intersex their needs are very specific and they may not wish to be branded with the gay tag because it buries their issues rather than highlighting them. There are further those who are intersexed who are heterosexual identified and do not want to be gay branded, just as many trans people do not want to be gay branded.

The GLB movement constantly speaks out as the GLBTI movement, without the proper consultation, knowledge or the permission of many ISGD people. The internal politics of the trans and intersex movements are very complex and in continual flux, which GLB people cannot generally understand or be up to date with.

Having co-opted TI into their acronym the GLB campaigning groups then often dump ISGD matters when it comes to collective bargaining power with politicians for their own profit and equal rights gain, having used ISGD numbers to swell their own bargaining power. They are fair-weather friends to ISGD people. This frequently angers the ISGD groups because it uses their name ineffectually. There is also the fact that there are people who are sex and/or gender diverse who do not identify as trans or intersex who are missed out by the T or I labels.
At this very conference transgender and intersex were listed as sexualities. After that was a listing of sex and gender diversity with a bracket showing (GBLT), further showing GBL peoples lack of understanding about ISGD issues. On the conference evaluation form was only spaces for people to tick male or female when there were intersex speakers listed.

When lobbying for GLBT issues and equal rights, this does not cover discrimination against intersex people but many campaigners I have spoken to are unaware of that problem. What the GLB movements must stop doing immediately, however, is faking knowledge about ISGD issues without consulting with each and every SGD sub-group, since each group has different medical, psychological, social and legal needs. After 40 years of being involved in civil rights I have come to the conclusion at the end of the day that ISGD people would do better campaigning collectively on their own on their own issues than allow GBL groups to speak in their name. If there were to be any alliance it must be made clear to GBL groups should not to speak in ISGD peoples' name.

Clinical Useage

The study of sexology has existed for over a hundred years now. What has unfortunately happened is that anthropological and sociological observations of people's sex, gender and sexual behaviour has been over-medicalised into pathologies for the health professionals to make money. Psychology and psychoanalysis are just as guilty of this as generalised medicine. SGD people have been subsumed to a plethora of pathologies and clinicians' humanity has frequently been abandoned as medicine has attempted to foist stereotypical concepts of correct maleness and femaleness upon them as well as inaccurate diagnostic criteria.

I wish I could say this medicalisation has always been for the furtherment of science; but the extremely high level of unhappiness of many intersex, sex and/or gender diverse people with the treatment they received and suicides tells us that many of the clinicians and academics who quote from text books, rarely listen. Because of the complex needs of intersex, sex and/or gender diverse people they can need high healthcare clinic hours and dollars to help them, not only to define their identities, but also strengthen those identities to form strong self-sufficient personalities. Psycho-pathologisation may work for some clinicians but it does not generally work for the patient/client who needs to return to their ordinary life as a whole person, after clinical intervention. ISGD people as an umbrella term avoids psycho-pathologisation and respects the nature and nurture differences, without seeking to quantify them with absolutism that creates yet another prison for the person.
If I am diagnosing a physical condition I have a duty to tell the person what the condition is.

In matters of intersex, sex and/or gender diversity, I can only assist them to determine what is right for them. I do not tell people what their sex or gender identity is or should or should not be. I do not have to live their life for them or encounter the consequences of their actions. The client plays a game of pick and mix: a catalogue of different identities to pick from are offered that may or may not suit them; sometimes they make up their own identity and that is OK too. I know many of my colleagues see this as me joining in a folie à deux with patients/clients, but I see it as following a personal-centered approach.

This approach has been successful because the patient/client gets a perfect fit for the identity they wish to have, regardless of what that might be; whether it is male, female, intersex, transexed, transgendered, cross-dresser, androgynous or to have no sex and gender at all.
I now use intersex, sex and/or gender diverse (ISGD) as a collective umbrella but never as a personal noun. If it was used as a personal noun it would then become an oxymoron because it simply becomes another categorised label. For instance to say all Americans have brown hair or all Europeans speak French would be a ridiculous set of generalisations and untrue, and so would considering all intersex, sex and/or gender diverse people as being transgender.

Fear of loss of identity

As the phrase sex and/or gender diversity went around the world it was received very well. The 26 April had been designated International Sex and/or Gender Diversity Day with the first one happening in 2010, with a sub-phrase of 'no labels day'. (Click HERE for images).

For the very first time, people of all those different intersex, sex and/or gender diverse identities came together in peace and awareness of their existence. Many organisations including trans, intersex and androgynous had supported the use of the phrase as a metaphrase. I responded to a question posted on an article I wrote about the event on The Scavenger online magazine:

Q: So, if we don't want labels, why do we need another label, SGD? There's LGBT, TS, TG, TV, IS, GQ, GI(D), DSD, and now SGD. SGD, a new box to shove all those that won't fit in the others. Instructed to play nicely together in our own box. So many days - ISD, IAD, TGDR, Pride etc. Now it's SGD as well. So it goes...
A: You have a really good question and I'm so glad you asked it. The answer though was in my 1997 book Trans-X-U-All: The Naked Difference and it is very simple. You need to look to the internet. 1990 no civil rights for virtually all sex and/or gender diverse people - globally. Internet arrives we find each other, gather numbers and make huge strides. We are however still very divided and oppressed by our own divisions. Intersex fighting for this, transsexuals for that and transgendered for the other and the poor cross-dresser seen as the great unwashed - need I go on? It's time to put down our exclusive members' cards for those iconoclastic clubs and connect against the oppression of all sex and/or gender diverse people everywhere. - Tracie O'Keefe. (http://www.thescavenger.net/glbsgdq/1st-sex-and-or-gender-diversity-day-26-april-72456.html, April 2010)

One negative theme that came back was the fear of the loss of identity by the differing intersex, sex and/or gender diverse groups. Their fear was that SGD would seek to replace their current labels but it would have been used incorrectly if that were the case. It was simply intended as a metaphrase for all non-stereotypical sex and/gender diverse people. It was never intended to be used as a personal noun or as a replacement label for different experiences. No one person could be SGD, only a collective of differing sex and/or gender diverse groups.
What happened in Sydney on 26 April 2010 was beyond all expectations. Around a hundred people from all the aforementioned groups came together for the Still Fierce Picnic in way that I have never witnessed before, in absolute harmony and support of each other. Because of the phenomenal success of this event and in the spirit of co-operation SAGE voted to change its nine-year overarching phrase from sex and/or gender diverse (SGD) people to intersex, sex and/or gender (ISGD), people. As a civil rights movement we decided to move into a more united future.

Conclusion

The Australian Human Rights Commission, under the advice from the campaign group Sex and Gender Education (SAGE) Australia, in its 2009 Sex Files report on the legal rights of sex and/or gender diverse people, decided to use the phrase as a meta-analytical perspective. The phrase quickly caught on in Australia among health professionals and campaigners as a metaphrase. Intersex people, however, felt their needs were not sufficiently paid attention.

In conclusion it is plain to see that transgender as an umbrella term for intersex, sex and/or gender diverse (ISGD) groups of people has failed completely to satisfy the needs of many intersex, sex and/or gender diverse (ISGD) groups. As a word 'transgender' misdescribes many intersex, sex and/or gender (ISGD) people. This particularly pertains to those who are intersex, transexed, transsexual, androgynous or without sex and gender identity and other sex and/or gender diverse identities. The word transgender's double meaning and historical context angers many intersex, sex and/or gender diverse people (ISGD) who do not identify as transgender, robbing them of their self-identification and disadvantaging their equal rights.

Since those people will not change their identities there is a need to be more careful with language and use a softer, less specific, open option like intersex, sex and/or gender diverse (ISGD) people as an overview. This allows each group and individual under that umbrella to categorise their own identity in a way that is right for them. Language changes to reflect changing culture so I commend the use of intersex, sex and/or gender diverse (ISGD) as an overarching model for the future.

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Film
Boys Don't Cry, Fox Searchlight Pictures, USA, 1999.

Images from the 'No Labels Picnic' celebrating the 1st International Sex and/or Gender Diversity Day, Camperdown Park, Sydney 26 April 2010.

Photos by Tracie O'Keefe

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