Book Review | The Spectrum of Sex: Chapter 1

This is the first installment of a series of reviews I will be producing for each of the eight chapters of The Spectrum of Sex, a 2020 book claiming to be a “transformative guide completely breaking down our current understanding of biological sex and gender diversity” and an introduction to the “seven variations of human sex.”

Former colleagues of mine have touted this book as the definitive scientific case for viewing biological sex as a spectrum. Given that I have openly claimed the “sex spectrum” model of biological sex is pseudoscience and “false at every conceivable scale of resolution,” I believe it is a worthy time investment to engage with the claims made in this book for a wide audience. My goal is not to “debunk” this book, but to honestly and transparently investigate the claims being made and test them for their logical consistency and whether they accurately reflect reality. I will try to be as charitable as possible throughout.

Out of respect and a desire to reach a broad audience, I will honor Hida’s preferred they/them pronouns throughout.

This first review is free to all, but many of my reviews on future chapters will be subscribers-only content. So if you enjoy this piece and would like to read the remaining reviews, please subscribe!

On to the review!


This first chapter is written from the perspective of the first author, Hida Viloria. For background, Hida is a well-known activist who identifies as intersex, non-binary, and gender-fluid, and has claimed elsewhere to be “both and neither male nor female.” Hida is the founding director of the Intersex Campaign for Equality, and is a frequent guest on popular radio and television programs.

Hida is biologically female and has congenital adrenal hyperplasia (CAH), a condition that affects the adrenal glands, causing them to produce an excess of androgens. In females, this typically result in an enlarged clitoris or even male-appearing genitalia. Other features of their bodies can be more masculinized as well as a result.

In the opening paragraph to the book, Hida recounts a pivotal moment in their life—an interaction with a sexual partner who asked whether Hida had been “born a woman.” Hida responded, after some internal deliberation, “That’s what they told me.” This interaction triggered deep introspection. 

No one had questioned whether I was female throughout my childhood. I’d been easily accepted as a girl and started menstruating before most of my friends; I had even participated in the most stereotypically “girly” of activities, such as cheerleading… 

Given this history, you may be wondering how I could be asked such a question. The answer is rather simple. Our understanding of the category of sex, and its expression in humans, if often limited in a way that does not include everyone’s existence.

Immediately there is some confusion about terms. Particularly notable is the way Hida moves between the terms “woman,” “female,” and “girl,” sometimes depicting them as relating to biology (e.g. menstruation), and yet also describing them in terms of expression (e.g. cheerleading). This commingling of sex-related stereotypical behavior and expression with biology is something, as you’ll see, that Hida does throughout the chapter. 

Hida then goes on to make what appears to be one of the book’s central claims.

While many imagine sex to consist of only two categories, the truth, as biologists and other scientists have explained for decades, is that variations of sex are natural and plenty. In fact, sex is so diverse that even the three categories of male, female, and intersex—those born with bodies that do not fit typical definitions of male or female—don’t quite do justice to describe the spectrum of its expression. For within the umbrella of the category of intersex, there are many different variations resulting in bodies with very different sex traits and appearances that can be male, female, or in between. [emphasis added]

There is a lot of sleight-of-hand or, if I’m being generous, confusion in this paragraph, and I bolded the parts to make this easier to see. It begins by discussing the two supposedly outdated categories of sex—male and female—but then shifts to talking about “variations” and “expressions” of one’s sex, and even “sex traits and appearances.” There is a switcheroo taking place. The categories male and female are not defined by some multivariate assessment of an individual’s secondary sex characteristics and overall appearance. Rather, a person’s sex is defined by their primary sex organs, or gonads. 

Furthermore, Hida believes that intersex is a third sex category, when in reality it is an umbrella term for individuals whose sex is either ambiguous or there is some mismatch between internal sexual anatomy and outward sexual phenotype.

Let’s use the way Hida describes their own body in this chapter to highlight Hida’s error. 

Not only was my figure not typically female—with small hips and breasts, and a long torso—my genitals were different too. Still, there was no way for me to even conceptualize that I was anything other than female.

And later in the chapter Hida states:

Once I was aware of the extent to which I differ physically from other women, I told myself that I must just be “a different kind of female.” It was all I knew. Even when I learned that I’m intersex, I still hesitated to admit that my identity was truly outside the male/female binary.

From these and other passages throughout the chapter and interviews I’ve read elsewhere, it is clear that Hida believes that having a body with some traits that are neither male- nor female-typical means a person cannot be properly classified as being either male or female. In other words, you must be totally typical in every sex-related trait in order to be male or female. If one of your traits isn’t typical enough, then you’re something other than male or female. But hips and breasts and the shape of one’s torso don’t determine a person’s sex.

Despite Hida’s figure not being “typically female,” in a 2009 interview for CNN Hida reveals that they have ovaries, menstruate, and can get pregnant.

I'm intersex because, while I have ovaries, menstruate and can get pregnant, my genitalia is somewhat male-looking (simply put, I have a clitoris that's much larger than average).

Throughout my childhood, I never thought I was anything other than "female" because that's what I was labeled and raised as. While I felt more aggressive than other girls, I didn't think that anything other than male and female could exist.

From this we can gather that Hida is biologically female, albeit a female with a larger-than-average clitoris and a more “aggressive” personality. But these traits do not make Hida any less female. Likewise, a male with a smaller-than-average penis is not somehow less of a male. This view is the stuff of playground bullies.

Within males and females there is plenty of variation in penis and clitoris size, respectively. Hida has simply confused variation in sex-related traits such as breast size, hip width, clitoris size, and even behavioral traits like aggression, with sex itself. The result of such an error is the belief that one must be typical in all or most traits associated with males and females in order to truly be one.

This way of thinking is not only inaccurate, but it is also potentially harmful. A worrying corollary of this notion of “ideal” male or female traits is that parents who believe this may feel more justified in opting for “corrective” surgeries for their infants, sometimes at odds with an infant’s true (gonadal) biological sex, in order to make their child “ideally” (in their minds) more male or more female. While Hida decries surgical intervention on intersex infants (and rightfully so, in my opinion), Hida fails to consider how defining males and females so narrowly may encourage such practices.

Strangely, Hida believes it is those who claim there are only two sexes—male and female—who too-narrowly define what it means to be a male or female and encourage unnecessary surgical interventions: “...doctors have been performing medically unnecessary genital surgeries and gonad removal on intersex babies in order to send parents home with typical males or females.”

I agree with Hida that archetypal notions of the “ideal” male or female can be harmful and lead to invasive and unnecessary infant surgeries, but Hida’s extreme view that, for instance, a woman with a large clitoris isn’t truly female perpetuates this notion of sex idealism in spades. 

Hida goes on to make the following claim:

We have all been lied to every day by the societal reduction of sex to “either male or female.” This not only erases people, but portrays anyone who doesn’t naturally embody one of these “opposite” body types—such as small-breasted women, for example—as inferior to those who do.

This is an amazing statement, and is a view that should sound very familiar because it is exactly what Hida is guilty of doing when they claim women with large clitorises, narrow hips, or small breasts are not really female and don’t fit the male/female binary. 

On page 8 (and also quoted above) Hida states:

Not only was my figure not typically female—with small hips and breasts, and a long torso—my genitals were different too. Still, there was no way for me to even conceptualize that I was anything other than female. [emphasis added]

Then on page 12 Hida writes:

Once I was aware of the extent to which I differ physically from other women, I told myself that I must just be “a different kind of female.” It was all I knew. Even when I learned that I’m intersex, I still hesitated to admit that my identity was truly outside the male/female binary. [emphasis mine]

Hida claimed their own small breasts were evidence of not being entirely female, yet they now chastise those who “portray anyone who doesn’t naturally embody one of these ‘opposite’ body types—such as small-breasted women, for example—as inferior to those who do.” Hida is thus guilty of perpetuating the very same harmful views they claim to decry. 

Despite the book’s subtitle “The Science of Male, Female, and Intersex,” the rest of the chapter has very little to do with biology at all, and instead shifts to discussing Hida’s struggle with gender identity. Despite being raised “as a girl” and being completely content early on participating in stereotypically feminine activities and wearing typical feminine clothes, once Hida became aware of their condition it made them rethink their identity. 

But although I was out about having an intersex body, I struggled to accept that I didn’t actually feel like a man or a woman either. I’d stopped wearing makeup and women’s clothing and cut my hair after learning I wasn’t typically female. Almost overnight, everyone, including my own mother, mistook me for a young man. It was a surprise. Even more surprising was that I enjoyed being perceived as a man in the world as much as I had a woman.

This is interesting to me since nothing about Hida’s body had changed, yet the mere awareness that some of their traits were perhaps a standard deviation or two away from the female average caused them to dramatically alter their identity and expression. Hida went from having a stable and happy gender identity as woman, to one that shifted frequently between man and woman or somewhere in between. 

I struggled for years, attempting to choose between a masculine or feminine gender expression in a world that wasn’t comfortable with me embodying both. But each time I thought I’d finally settled on my “true” binary gender identity and expression, it would shift once again.

Hida then returned the moment when a past male sexual partner asked whether they were “born a woman.” 

Ultimately, truly accepting myself entailed admitting that I was neither a man nor a woman in my mind, heart, and soul. I embraced this non-binary gender identity although it was, and still remains, uncommon. And I have been loved and accepted as this person, too. 

When I was asked if I’d been born a woman all those years ago, I didn’t answer “Yes” but rather, “That’s what they told me.” Somehow, without ever being told I was intersex, or taught about it, the truth still permeated my being. All people should be allowed this experience: the right to know and be who we truly are.

Here we again see Hida exhibiting confusion about the difference between gender identity and biological sex. Due to Hida’s masculinized features and large clitoris, Hida’s past sexual partner asked whether they had been “born a woman.” Given the context, the man was clearly asking about Hida’s biological sex, not gender identity, when he used the term “woman.” Hida now seems to interpret this as him asking about Hida’s gender identity, and when Hida responded “That’s what they told me,” instead of a simple yes or no, Hida suggests this means they somehow knew they were intersex, deep down, all along. 

I can’t make any sense of this. It confuses biological sex with gender identity, and intersex with non-binary. As written, it is impossible to understand and appears to conflate biological sex, secondary sex characteristics, gender identity, and gender expression all at the same time. It is unclear whether this is the result of intentional obfuscation, pure ignorance, or poor writing.

Lastly, the chapter ends with a brief “note on language usage throughout the book.” I was excited to see this, since I always appreciate it when authors define their terms. This would have been more useful placed at the beginning of the chapter, but at least it should clear things up as I continue reading through the remaining chapters. Here is the first entry:

Sex/gender: Sex and gender terms are often used synonymously in both social and legal contexts. Accordingly, we will use the term “sex/gender” in situations where it is accurate to note that both sex and gender, or either sex or gender, are being referenced together.

I’m already confused. They will use “sex/gender” when both sex and gender, or either sex or gender are being referenced? This doesn’t make sense to me, but maybe it will be clear within context in future chapters. 

Boy/girl: The current usage of the terms “boy” and “girl” is a holdover from the pre-1950s era when the sex and gender terms “male/man” and “female/woman” were used synonymously (which is explored further in Chapter 7). As we are well aware today, only sex traits are determinable at birth, not one’s future gender. Thus, we will use the sex terms, “male, female, and intersex” along with the gender-neutral terms “baby” or “child” when referring to infants and minors whose gender is unknown.

This makes more sense than the first. However, instead of simply referring to one’s “sex” being determined at birth, they refer indirectly to “sex traits.” This is common for activists who don’t want to view male and female are discrete categories, but would rather define them on a spectrum according to many sex-related traits. So while this entry is at least intelligible, it is stacking the deck in favor of the sex spectrum by not providing you with the vocabulary to even talk directly about males and females as natural categories. 

Male/female: As this book will explore in depth, the way the terms male and female are applied to living individuals is not always consistent when it comes to people born with bodies that fall outside these terms’ definitions. In addition, the substitution of the term sex with the term gender in modern discourse and law (which we will explore in Chapter 8), has resulted in transgender individuals being required to use sex terms to describe their gender identity, as witnessed in the statement: “I just submitted the gender change request form to be registered as female instead of male.” 

Both of these situations illustrate that, when it comes to actual citizens, the terms male and female do not always mean what science says they do. Out of respect for these factors and these communities, we will use the terms “born with male sex characteristics” or “born with female sex characteristics” when possible.

They really don’t want to talk about males and females. Because, according to the authors, some people are “born with bodies that fall outside these terms’ definitions,” they will not refer to male and females per se, but will use “born with male sex characteristics” or “born with female sex characteristics” instead. They claim to be doing this out of compassion, but what this effectively does is prevent the reader from even thinking about males and females as discrete biological categories. They don’t want to talk about whole organisms, they want to talk about individual traits, most of which are associated with biological sex but do not define biological sex. 

Gendering of sex traits: As this book will explore in depth, certain sex traits that are commonly considered male are found in females, and vice versa. This is due to the fact that sex is naturally expressed in a multitude of ways not encompassed within the two categories of male and female. Thus, we will avoid gendering sex traits such as XX chromosomes as “female” or testes as “male,” as doing so is unnecessary and does not accurately reflect the lived experience of all humans.

This is just wrong, and also in direct contradiction to the “male/female” section above. It is wrong because the two categories of male and female absolutely do encompass a wide variation of traits. And it’s contradictory because the “male/female” section explicitly states that they will refer to males as individuals “born with male sex characteristics” and females as individuals “born with female sex characteristics,” yet now they say they will avoid referring to sex traits such as chromosomes and testes as being male or female traits. How can they refer to an individual as being “born with male sex traits” if they will not even refer to something like testes as a male sex trait? 

This just makes no sense. You cannot refer to a trait as being male or female if there are no males or females to reference them against. The only way we can refer to a trait like a penis or beards as being “male traits” is because we understand what a male is apart from those traits and we can observe the correlation between these sex-related traits and an individual’s biological sex. If the authors now don’t even want us to be able to refer to traits as being male or female, then the words male and female literally lose all meaning. 

Differences or disorders of sex development: In 2006, intersex variations were pathologized and labeled “disorders of sex development,” or “DSD,” by the global medical community. Thus, it is common to hear intersex referred to this way, particularly within healthcare settings where doctors may be reluctant to acknowledge the intersexness of their patients in an effort to maintain the male/female sex binary. More recently, “differences of sex development” has been used in an effort to avoid the pathologization of “disorder.” However, this change still maintains the DSD acronym. Also, it continues the trend of marginalizing intersex people as different and thereby, “other.” 

A person born intersex represents a natural variation of sex, and we support the advocacy by intersex individuals and the collective community, most recently epitomized by a joint statement to the World Health Organization, to change DSD to “variations of sex characteristics” (VSC). In place of DSD this new term will be used when needed to reference one of the many variances an intersex person can be born with.

The authors don’t want you to be able to refer to intersex people as having any sort of “disorder” or even think of them as “different,” since different apparently implies other, and other apparently implies bad. That is quite the leap of logic, and most people have absolutely no trouble acknowledging the fact that having a disorder, or an atypical trait, doesn’t make a person bad or “other,” but simply describes a condition.

Also, I’d like to point out that Hida went on at length in this chapter stating explicitly that people with atypical sex traits are not really males or females. While the authors claim that referring to “disorders” or “differences of sex development (DSDs) harms people by “othering” them, it’s hard to imagine a more extreme form of “othering” than telling women they’re not entirely female if they have large clitorises or small breasts. 

This was a very confusing chapter, and the “note on language usage” that was presumably added to reduce confusion has only made things worse. Next week’s review of chapter two “We Are All Mutants” will be a subscribers-only, so if you enjoyed this review and want to be able to read the next one, please subscribe below!

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