It's reductive but genetically, we can determine birth sex.
But birth sex is not the same thing as gender. Under currently guidelines,
gender is developmental and is self-determined.
And even when we can determine birth sex, that may not always be expressed consistently in physical gender characteristics, even in the absence of AIS.
Background 47,XYY is a chromosomal abnormality syndrome that is typically observed in patients with a male phenotype. Few patients with XYY syndrome will have infertility. We here report a case of 46,XY/47,XYY syndrome diagnosed in a patient with a female phenotype. Case presentation A...
bmcendocrdisord.biomedcentral.com
Many of these genetic variations are never diagnosed unless the patient has another anomalies that lead to genetic testing. Fertility also varies in atypical genotypes, so diagnosis is sometimes made during infertility treatment.
Let's spell that out-
Disorders of Sex Development which is a
medical term that is rejected by the
intersex community. Intersexed individuals do not want to medicalized and treated like they have a disorder. There has also been a move away from the old model of "optimal-gender policy".
Current recommendations for Intersex patients do involve genetic testing and a decision by the parents regarding socializing the child to the gender most consistent with their genotype. Mental health counseling is started early and parents are encouraged to be honest with their child. The only surgeries recommended are functional- to correct urinary tract abnormalities, for example. It is up to the child to make decisions about corrective surgeries to alter the appearance of their genitals.
The treatment recommendations are reflective of the point that many activists have been making for years:
that gender is a social construct, particularly in Western culture. There are other cultures that recognize more than 2 genders (i.e. male/female) but in cultures where gender is treated as binary, the recommendation is to start with the gender that is most consistent with the genotype of the child, however, this refers only to socialization. Now that younger generations are more accepting of gender on a spectrum, the recommendation may evolve to allow an intersex child to have more say in where on that spectrum they wish to be.
Much of this is ultimately off-topic but underlying the discussion is the
problem of equating birth sex with gender. Birth sex can be determined with
genetic testing but gender is evolving to be considered less binary.