CAIS: Male or female?
Swyer Syndrome: Male or female?
What is "sex" (let alone gender)? Of the numerous axes, each with their subaxes:
1. Genetic:
* Karyotype (including mosaicism and chimericism)
* SRY presence / absence
* Gene presence, expression, and functionality (SOX9, RSPO1, WNT4, DMRT1, FOXL2, WT1, SF1, DHH, CBX2, AR, SRD5A2, HSD17B3, CYP19A1, etc)
* Müllerian inhibiting factor (AMH/AMHR2) expression and reception
* Epigenetic regulation (imprinting, methylation, chromatin remodeling)
* Androgen expression and reception
2. Gonadal
* Gonadal Type (ovaries, testes, ovotestes, streak gonads, dysgenetic gonads)
* Gonadal Function (steroidogenic capacity, gametogenic potential)
* Gonadal Position (abdominal, inguinal, scrotal/labial, absent)
* Germ Cell Presence/Absence (oocytes, spermatogonia, none)
* Gonadal Hormone Secretion (androgens, estrogens, AMH, inhibin)
3. Hormonal Axes
* Androgen levels (testosterone, DHT, androstenedione)
* Estrogen levels (estradiol, estrone)
* Progestogen levels (progesterone)
* Gonadotropin levels (LH, FSH)
* AMH levels (high in males, low in females)
* Adrenal androgens (DHEA, DHEAS in CAH)
* Hormone sensitivity (AR mutations, ER mutations)
4. Internal Reproductive Structures
* Vaginal Canal (depth, presence of cervix)
* Ejaculatory Ducts (patent, atretic)
* Wolffian Duct Derivatives (epididymis, vas deferens, seminal vesicles) - present, absent, or partially developed
* Müllerian Duct Derivatives (uterus, fallopian tubes, upper vagina) - present, absent, or partially regressed
* Prostate/Skene’s glands (size, functionality)
5. External Genitalia Axes
* Phallus structure (clitoris, penis, or intermediate)
* Size (micropenis, clitoromegaly)
* Urethral position (hypospadias, normal)
* Labioscrotal folding (labia majora, scrotum, bifid scrotum, fused labia)
* Vaginal opening (present, absent, urogenital sinus)
* Perineal configuration (distance from anus, midline fusion)
6. Secondary Sex Characteristics (e.g. post-pubertal)
* Breast development (Tanner stages, gynecomastia, absent)
* Body hair distribution (androgenic vs. non-androgenic patterns)
* Voice pitch (androgen-dependent deepening)
* Muscle/fat distribution (male vs. female typical)
* Bone structure (pelvic width, shoulder breadth)
* Larynx size (Adam’s apple prominence)
7. Reproductive Functional Axes
* Fertility status (fertile, subfertile, infertile)
* Gamete production (spermatozoa, ova, none)
* Menstrual status (eumenorrheic, amenorrheic, dysmenorrheic)
* Spermatogenic capacity (azoospermia, oligospermia, normal)
* Ovarian reserve (normal, diminished, premature failure)
8. Neurological & Behavioral Axes
* Brain sexual dimorphism (SDN-POA, BSTc, corpus callosum)
* Gender identity (congruent or incongruent with anatomy)
* Sexual orientation (androphilic, gynephilic, bisexual, asexual)
* Prenatal androgen exposure effects (CAH-related behavioral shifts)
There is no "single thing called sex". It is a vastly multidimensional space. The parameters in this space are *correlated* but not inherently causal. If you define purely based on any one factor, you come up with ludicrous consequences like pregnant women being classed as men or whatnot.
Furthermore, each subaxis has varying degrees of (A) malleability, and (B) impact on daily life. Some are highly malleable, others not at all with current technology. But it just so happens that the subaxes that impact daily life the most tend to be the most malleable, while the ones that impact it the least tend to be the least malleable. For example, the presence of SRY is not at all malleable, and yet it's also entirely irrelevant to a person's daily life. Yet curiously, "sex essentialists" always try to come up with their definitions based on subaxes that fall into the latter category, not the former category.
For the concept of "other sexes" (your words) to exist, you have to be able to have an essentialist definition of what one's immutable sex is (otherwise, the concept of there being some immutable "other sex" is incoherent). So what is your balance of the above axes, how did you reach that as being the most logical conclusion, and how would you respond to someone raising the case of someone who fits one sex within your definition but is flipped on most / all of the other axes?