In the remaining 5 percent of D.S.D. conditions, Baskin argues, it is too hard to figure out how the child will ultimately identify — and so he is reluctant to recommend surgery. These conditions include ovotesticular disorder, which causes babies to be born with both ovarian and testicular tissue. (It was previously referred to as true hermaphroditism, while 5-alpha had been called pseudohermaphroditism.) Ovotesticular disorder made headlines in 2015 after the parents of a child identified as M.C. sued the hospital and state guardians who had approved their adopted son’s sex-assignment surgery. When M.C. was sixteen months old, doctors removed his two-centimeter penis and undescended left testicle to give his genitals the appearance of a vagina — but as M.C. grew older, he began to identify as male. His parents insisted that the choice should have been left up to him, and initiated the first public court case of its kind.
In Papua New Guinea, members of the Sambia tribe with 5-alpha are viewed as a third gender, called kwolu-aatmwol. Gilbert Herdt, an anthropology professor at San Francisco State University, identified fourteen intersex individuals among the Sambia. Five had been raised as females, the rest as kwolu-aatmwol, which is roughly translated as “male-like-thing into masculinity.” The tribe had strict gender norms, and there was suspicion among the men that women killed intersex infants at birth. While a few kwolu-aatmwol had risen to distinction through special achievements, most were “treated ambiguously and somewhat stigmatized due to their condition,” Herdt wrote in a 1988 paper published in Archives of Sexual Behavior. They were rarely given wives. “Why waste a good fertile woman on a hermaphrodite?” Herdt was often told.