I recently reviewed the book Intersex in Christ: Ambiguous Biology and the Gospel. The author, Jennifer Anne Cox, PhD, teaches systematic theology as an Adjunct Faculty Member at Tabor College in Perth, Western Australia. She was nice enough to sit down with me and talk about her book.

Lianne: How did you become interested in intersex?

Jennifer: I am a theologian (although it is difficult to do this professionally, mostly because there is no money in it). In late 2013 I was at a women’s Bible study group and someone (who was once a nurse) asked me what my opinion was about intersex. I did not have an answer at that time because I was unwilling to make a statement when I knew pretty close to nothing at all about the subject.

Lianne: How did that interest develop into the book?

Jennifer: When I was asked the question, I was in the middle of a PhD (the topic of that is severe autism and human personhood). I did not have time to pursue the intersex question. At first I thought that I could do some research and write a short article. But once I began researching the topic, I realised that a short article would not be able to cover all the issues involved.

So I decided to write a book. But I had to finish the PhD first. So I asked my supervisor how fast I could finish my PhD because I really wanted to get on with the intersex research. I worked as hard as I could and I finished early. After I submitted the PhD I took one week off and then got straight into serious research about intersex.

Lianne: Can you share a bit about the intersex people you’ve met? Or corresponded with?

Jennifer: This is a tricky question. How many intersex people have I met? I have no idea because it is not a question that I ask people. As my friend who is a sexologist is fond of saying, “You don’t ask people what is in their undies.”

But as to people who I know are intersex, there are two, one of whom is Lianne. The other person I met at a sexuality and gender conference (secular) where I presented a paper in 2016. My paper was about intersex and the gospel (an openly Christian discussion in a secular conference). There a man spoke to me about his own intersex conditions (several genetic issues).

I have not corresponded with the man I met at the conference. I have had a bit of correspondence with Lianne prior to this interview. I did not write the book because I knew someone with an intersex condition. I am simply drawn to issues surrounding people on the margins I think.

I wanted to explore the issue, particularly because I was so ignorant about it. I thought that if I am this ignorant about something that is going on all around me (and I am an educated woman), then other Christians are probably ignorant as well.

Ignorance is dangerous for Christians (and not doubt for unbelievers too). If we think we know about something and we really don’t, then there is great potential for harming other people.

Most people I have spoken to about the book respond on the assumption that intersex equals transgender, which it does not, or they want me to comment on homosexuality. Theological questions about intersex are different to those about transgender or homosexuality. Ignorance does not help Christians to navigate the real issues.

Lianne: You seem to be of the school that allows intersex children to decide on a gender when they come of age. Quite a few Christians reduce sex to a single biological parameter. I’m thinking, for instance of Denny Burk of the Council for Biblical Manhood and Womanhood, who appears to base sex entirely on the presence or absence of a Y chromosome. Would you comment on that?

Jennifer: In the course of researching the book I read some of Denny Burk’s book What is the Meaning of Sex? He does reduce sex to the presence or absence of a Y chromosome. In a way I can understand why he does this.

It would be so easy if the phenomenon of intersex could be understood in this way. All the hard questions would go away. In the beginning, and by this I mean the first few days of my research, I also thought that a simple solution to all the issues could be found.

Something like this is a nice, cut-and-dried way of avoiding the hard questions and the hard decisions that people (parents and intersex persons) have to make. It would also make Christian theology simple.

However, although I began naive and ignorant, I did not stay that way. Sometimes people face difficult decisions, like choosing a sex for their child when things are ambiguous.

Sometimes adults with intersex conditions choose to transition to a different sex to the one they were raised as. These are not trivial or easy choices that can be made with a DNA test. I have not had to make a decision like that, but I believe (based on the psychological research and simple human imagination) that it would be hard.

Since I don’t think that theology should avoid difficult questions, I tried to approach this matter by reading as much as I could of medical and psychological research and also sociology.

People’s stories of real pain, shame and even abuse made me want to produce some theology that took all this into account. Theology that is simplistic, which I think is the case with Denny Burk’s comment about Y chromosomes, does not help those who are actually trying to work through real life ambiguity.

For this reason, I have taken an approach that tries to balance the biblical view of humans as male and female with the reality that some people have ambiguous sexual biology. Surgery may well be a good idea, but many times it turns out that doctors and parents get this wrong for intersex children.

Sometimes the surgery is done to cover up the shame of producing a child who is not “normal”. God is not ashamed of intersex children or their bodies. So allowing a child to demonstrate through play and preferences which sex is most appropriate is less likely to result in adults that have to try to undo unwanted surgeries. Once you do the surgery it is hard to go back.

In saying this, I want to acknowledge that many parents have made hard choices about surgery for their children. In the past there has been little or no support for parents of intersex children. There was possibly even coercion in regard to surgeries. Christians need to give support to parents facing this, whether it happened in the past or is happening in the present. It is easy to make statements from a distance. However, having said this, I think that I would advise waiting rather than committing to surgery on children, unless something life-threatening is involved (which may be true for some intersex conditions).

Lianne: There’s not really a consensus among Christians on what constitutes intersex and what doesn’t. Preston Sprinkle, for instance, says that Turner Syndrome and Klinefelters aren’t intersex. Can you give us an idea where you think the lines should be drawn?

Jennifer: I know that there are a lot of issues in drawing a line in the sand. From one side, there is a matter of including as many people as possible under the intersex umbrella so that it does not seem rare or freakish. This is not really necessary because intersex, even as a rare phenomenon need not be considered freakish. Intersex people are people and are most certainly more than their genitals.

But including a lot of people under the intersex umbrella also serves an agenda that insists that sex and gender are fluid. Aside from the fact that I don’t believe that sex or gender is fluid, I am quite opposed to intersex people being used as pawns in any political agenda. If individual intersex people want to become political that is their decision, but co-opting intersex as a means to a political end is abusive.

On the other hand, including Turner’s or Klinefelters or hypospadias as intersex conditions makes some sense. From a theological perspective, there are a lot of similar issues surrounding these conditions.

Medical treatments can sometimes be unwanted, surgery may be involved and have negative results, and there is shame attached to the naked photos taken for medical purposes. There can be identity issues for men with Klinefelters; some find themselves unsure of their own sexual identities because their sexual development is different to their peers.

Although no one claims that Turner’s or Klinefelters result in serious ambiguity of sex as such, they are unusual variations of sexual biology and a theology of intersex can fruitfully consider these conditions.

Lianne: Thank you so much for agreeing to an interview.

The recently published Nashville Statement represents the beliefs of a coalition of conservative evangelical leaders regarding same-sex marriage, gender identity, and even intersex.

Although their position regarding intersex may seem innocuous enough, I want to take a closer look at its implications.

I’m a Christian housewife. My husband and I are long-standing members of conservative Presbyterian churches. We’re familiar with quite a few of the signatories of the Nashville Statement and acknowledge them to be learned Christian men.

I’m intersex. My body’s not entirely female or male. I was raised for a time as a boy. In 1974, after prayerful consideration, and with the consent of my doctors and mother, I switched to living as a girl.

The Nashville Statement repeatedly stresses a male-female sex binary and the connection between what they call biological sex and one’s self-conception as male or female (What most of us would call gender identity.)

Although intersex is not directly mentioned, Article VI says:

“WE AFFIRM that those born with a physical disorder of sex development are created in the image of God and have dignity and worth equal to all other image- bearers. They are acknowledged by our Lord Jesus in his words about ‘eunuchs who were born that way from their mother’s womb.’ With all others they are welcome as faithful followers of Jesus Christ and should embrace their biological sex insofar as it may be known.

WE DENY that ambiguities related to a person’s biological sex render one incapable of living a fruitful life in joyful obedience to Christ.”

Intersex is, to the signatories, a disorder. Note that Merriam-Webster defines a disorder as a physical or mental condition that is not normal or healthy. By specifying ‘physical disorder of sex development,’ the Statement effectively eliminates any mental differences resulting from intersex, including gender identity.

How should one interpret the last line of the affirmation? How does an intersex Christian embrace their biological sex insofar as it may be known?

I struggled for a long time to embrace my intersex condition as God’s particular Providence in my life rather than constantly longing to be entirely female or male. By His Grace, I’m reasonably content with my body now. Embrace my status as a Matthew 19:12 from-my-mother’s-womb eunuch? You bet. But is that what they meant?

With their emphasis on the male-female binary, it’s more reasonable to assume that they don’t consider intersex a sex category. They seem to think that an intersex person is still either male or female, but the DSD has obscured or confused their true sex. It is that so-called true sex (i.e. male or female) that the signatories want an intersex person to embrace.

Medical studies of intersex suggest that the most reliable way of determining the gender of an intersex child is to wait until they’re old enough to speak and ask them. But with the signatories’ refusal to recognize the biological roots of gender identity (i.e. self-conception), I must assume that the sex they wish that child to embrace would be based on some subset of their physical attributes—a reduction of the diversity of the child’s biology to fit a male-female binary.

Should we look to Chromosomes for the “true sex”?

I’ve often heard that boys are XY, and girls are XX. It’s as simple as that. My chromosomes are mixed, though—some of my cells have a Y chromosome; others don’t.

If you consider a woman with the complete form of Androgen Insensitivity Syndrome—who has XY chromosomes as well as internal testes, but typical external female genitalia—the Bible would consider her a barren woman rather than a man. So the Bible doesn’t care about XY or XX.

Should we look to gonads for the “true sex”?

Most boys have testes and most girls ovaries. I had a mix of tissue types. So I guess that doesn’t help much. And, again, the Bible considers our lady with CAIS and internal testes to be a woman.

Should we look to genitals for the “true sex”?

Quite a few people will say it’s all between the legs. And one could argue that the Bible agrees. But Deuteronomy 23:1 tells us that if a male cuts off his penis and testes, he’s no longer male in the eyes of the law, but a eunuch. Let me repeat that in another way—he just changed his legal sex category surgically. And in Matthew 19:12, Jesus says that some people who do that do so for the sake of the Kingdom. He also goes on to say that a lot of people just won’t understand the changing your legal sex thing.

Did I have a penis? Suffice it to say that I wasn’t capable of vaginal intercourse without surgery—as a man or a woman. I’ve had that surgery. So I’m pretty much female-typical down there now.

What then is the sex I should embrace? And who should decide?

So why did I switch from living as a boy to living as a girl? Did I one day decide to rebel against God’s clear plan? No. I prayed about it. A lot. Did I have a desperate need to be a girl? Um. No. At times being a girl sucks. Like when a man won’t listen to me because I’m a woman.

So why did my gender matter so much? Because I was close enough to death to smell the lilies at my funeral. My life revolved around my inability to function socially as a boy to the satisfaction of those around me.

I wanted a life. I wanted peace. I wanted to live for Jesus rather than die by my own foolishness. I wanted to honor God with the hand he’d dealt me.

I liked my feminine body. And—most of all—I wanted people to leave me alone.

My doctor said that with my face and demeanor I wouldn’t have any trouble being accepted as a girl. He was right. The bullying stopped.

For more than forty years I’ve been able to focus on things other than my gender, to be a productive member of society, or as Article VI says, to “live a fruitful life in joyful obedience to Christ.”

Who then should decide the “true sex”? Based on which sex markers?

The assumption of a true binary sex in the Nashville Statement ignores the complexity of human biology, the variety of the experiences of intersex people, and the damage done to intersex people by a medical establishment that enforces a binary sex on them.

I’m grateful that the Nashville Statement says that we who are intersex are “created in the image of God and have dignity and worth equal to all other image-bearers.” But I’m troubled that this affirmation appears to require us to give up our bodily integrity and embrace some doctor’s guess at what sex God meant us to be.

Understand this—your Nashville Statement drives intersex people away from the Gospel. Historically, doctors have castrated us, surgically assigned us a sex, given us hormones, told us lies, kept secrets from us, and caused us to live in shame. All in the name of your precious binary vision of sex.

It’s time you stood up for us rather than telling us to embrace what’s being done to us.

[Note: In my conversations with various people who signed the Nashville Statement, it became obvious that their intent was neither to condone medically unnecessary genital surgeries nor to drive anyone away from the Gospel. It is unfortunate that the wording led to such disparate interpretations.]

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Andrea Horner

Thank you so much for being here, Andrea. Would you tell us a little about yourself?

It’s great speaking with you today, I’m Andrea Horner, I reside in Kansas City. I was born with a Chromosomal disorder called Turner Syndrome. I am the author of the book Beauty for Ashes, By Andrea Leigh Horner. I am founder of the ministry Beauty4asheskc here in KC. I love coffee and good music, hanging out with my friends, traveling and the outdoors.

How and when were you told your diagnosis?

When I was 4 years old I was diagnosed with Mosaic Turner Syndrome. I did not really learn about it till I was seven years old and I had to stay in the hospital several days. That is where I heard it that is also when they started my treatment which was growth hormone therapy.

Can you explain a little about your condition?

Turner Syndrome or TS as I refer to it affects approximately 1 in 2500 females. So as we say Turners is a girl thing. It happens when there is either an x chromosome missing (classic) or both x chromosomes are present and one is misshapen or deformed in some way (mosaic). It is usually found on the second x chromosome in a TS girl. It has a 1-2% survival rate before birth. It is believed to be responsible for about 10% of all miscarriages. There are two types Classic and Mosaic. I have mosaic, and usually with that there are less of the typical features present and less severity in the health issues. There are a variety of health issues that associated with TS that can vary for each girl, some server some are not. Most can be managed with proper medical care. The biggest health issue with TS girls is heart issues and hearing issues. TS also has some learning issues as well called non verbal learning disorder. I struggled the most with that fortunately I have not had many health problems thus far. The most common characteristic is short stature, the other is infertility. TS can affect our female development. That is why most of us get on growth hormones and estrogen therapy hormones because of my TS I don’t do that naturally and that helps with development. With that said that means I don’t have periods. So if I don’t have the hormones I won’t have a period. So it’s nice to not have to deal with those like females normally have to.

Writing a book about your life is a pretty bold move. How has the publicity affected you and your family?

There has not been a lot of publicity yet, however they do very well. My family has been great. They very supportive. My mom has always encouraged me. She has told me she thinks I needed to go around and speak more and get more involved with the TS society. I like to say we are pretty normal and we like to keep it that way.

How has your condition affected your relationships?

My friends are great they accept me many of them I think forget I’m short. Sometimes they tease me but most of my friends don’t freak out and treat me like anyone else. It is usually when I am in public and strangers comment where I feel the most affected and aware of my condition.

Has it affected your religious views? How have Christians treated you?

I used to have a denial about having Turners because I am so independent and normal. I wanted to think that I’m no different than another person. Reality is being as short as I am it is a daily factor. So I can’t always do everything just like everyone else. I used to not like that, however now as a Christian I see that as a good thing. God made me unique and special and I realize I am created perfectly. I believe it is a miracle that I am here and God has a purpose for our lives. So I don’t mind standing out.

Have you ever thought about who you might have been without your condition?

Yes I have a lot as a kid, I would think how did this happen? I wanted to figure who I could blame…where did the bad gene come from? I honestly don’t know. My family is tall, I was tall when I was first born. I have long legs for my height. So I know I would have been tall. I don’t know how I would be personality wise, but I know I would have a different view on life and how precious it is or appreciation for those with disabilities than I do now. When I was a kid if I could have been taller I would have loved it. But now I like being me. Sure being as short as I am it can be inconvenient and frustrating at times. But I think I am a better me having TS, than if I would have been if I had been born without it.

Is there something you’d like to share that might surprise people?

I have a variety of interest, I like being girly but one of my interest is Taekwondo. Many are surprised when they find out I am a Taekwondo martial artist.

What’s the one thing you’d most like people to know about you?

I am just a girl that just wants to make a difference in the world, and hopefully I can do my part to make it a better place. I love to let those that I am around know that they are loved no matter the struggle. I don’t know your situation, if it’s a disability, or another issue, but it does not matter what the world or people may say about you. you matter! We all have a purpose in this life I encourage everyone to find there’s and don’t be afraid to try.

Well, thanks for dropping by!

Andrea’s book is available on Amazon.

“This is not just a story about being short, or having Turner Syndrome. Though it is my story it can also be anyone’s story. We all have a story and difficult circumstances we have faced. This book has something everyone can relate to. I have found that the true beauty in our lives can be found when we live our life fully for the one who created it. I was made to stand out growing up I did not know I could do that with a purpose. I wanted to fit in. I did not like growing up short the obstacles seemed more than I wanted or thought I could handle. That is where God steps in and when we give the brokenness of our lives over to God, He will make something beautiful from them. Our weaknesses can often be our greatest strength when God uses them. This is my story of how I experienced Gods life transforming power and exchanged my ashes for a life full and blessed by God. I have two growing disorders. I talk about what it is like to live with one of them called Turner Syndrome. Turners is a growth disorder many do not know about and comes with complications that I share as you read about it I believe you will see how I am blessed to be here and living life today. Miracles do exist and I am just one of them. God is making something beautiful out of my life, and He deeply desires to do that for you. I hope this book will be the window to help you see all who you were made to be.” —Andrea Horner