Interdisciplinary care in disorders/differences of sex development (DSD): The psychosocial component of the DSD—Translational research network / Does having a Y chromosome make you a man? Does lacking one make you a woman?

No. Being a man or a woman is a matter of gender identity, not a simple matter of a chromosomal algebra. Certainly the genes on our chromosomes contribute to our development, but they don’t simply dictate our gender identities as boys or girls, men or women.

The X and Y chromosomes are called “sex chromosomes” because they contribute to how a person’s sex develops. Most males have XY chromosomes and most women have XX chromosomes.

But there are girls and women who have XY chromosomes. This can happen, for example, when a girl has androgen insensitivity syndrome. And there are boys and men who have XX chromosomes. This can happen, for example, when a gene on the Y chromosome ends up on an X chromosome, causing that X chromosome to function more like a Y.

There are genes on chromosomes other than the X or Y that also contribute to sex development. Because of all this, the term “sex chromosomes” is really something of a misnomer. Just looking at whether a person has XX or XY (or some other variation) won’t tell you conclusively about that person’s sex development, and it certainly won’t tell you about that person’s gender identity.

It is worth remembering that most of us know whether we are men or women even though we have no idea what our “sex chromosomes” are. Gender identity is about who you know yourself to be, not about how your sex chromosomes look on a microscope slide. Doctors look at the “sex chromosomes” of people with DSD as part of coming up with a diagnosis, but they don’t treat the “sex chromosomes” alone as a simple answer to anything. Our “sex chromosomes” are just part of the picture of who we are.

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