Man, woman, or ...?

One of the results of tracking weird news is occasionally coming across stories like Man Admitted to Hospital for Kidney Stone, Discovers He’s a Woman - a US example - and 66-year-old Chinese man goes to hospital, discovers he’s a woman. I assume that there's likely more of these cases, though not all are likely to make the press, particularly if the person involved disagrees with the doctor's diagnosis.

Then recently I came across the following bit excerpted from an apparently-upcoming book by Denny Burk: (emphasis mine)

At the conclusion of my talk, a youth minister from a small church in the area approached me for advice on how to deal with a perplexing pastoral situation that he was facing in his congregation. A young girl in his youth group had recently decided that she wanted to become a boy. My usual reaction to a pastoral conundrum like this one would be to advise the young girl of what the Bible teaches about how God created us as male and female, how Christians must embrace what God made us to be, and how God has a design for her life as a female. But there was more to this young girl’s story than a spontaneous desire to change genders. There was an additional detail that would turn my usual response on its head.

This particular girl had been born with a rare biological condition that made it difficult at birth to determine whether she was a girl or a boy. The condition is known as intersex, and intersexed persons are born with reproductive or sexual anatomy that does not seem to fit the typical pattern for female or male. Until relatively recently, the most common medical treatment for intersex has been for doctors to recommend a gender, to encourage the parents to embrace that gender, to reshape the genitals and reproductive organs accordingly through surgery, and to advise parents not to express any ambiguity to the child about the selected gender. The young woman in question had undergone such surgery as an infant but now as a teenager felt that she was not really a girl after all. She felt that her parents had made the wrong choice about what sex she was, and now she was in the midst of an identity crisis. She wanted to become what she felt she was born to be. She wanted to be a boy.

On what basis would you insist that this person was strictly a woman? On what basis would you insist that this person was strictly a man? Do they get to choose in this instance or are they forced to adopt their parents' choice at birth (which seems to in a sense have amounted to flipping a coin)? How does your answer here generalize to other cases in which individuals not exhibiting the same chromosomal abnormalities similarly feel that the gender they feel themselves to be doesn't match their appearance? If you think the individuals with these chromosomal abnormalities do get to choose, what happens if they later decide that they chose wrongly - are they allowed to change their choice? If so, would this count as a "sex change"? Is something like the following viable:

you can be she/her at one event and then you go to lunch and you say, OK, now I am he/him.

Can such individuals claim to be both male and female? Are the above sorts of questions ones to which "I don't know" is a viable answer or are you required in practice to make a choice (e.g. with Denny Burk consistently referring to the person in the case above as a girl)?

In comments on a blog post last year, Denny Burk makes the following assertion:

I don’t think you understand what intersex is. Even in cases with ambiguous genitalia, you are still dealing with persons who have X and Y chromosomes. Yes, in some of these cases, there is a chromosomal abnormalty. But even in those cases, those who have only one or more X chromosomes should be treated as female, and those that have a Y chromosome should be regarded as male.

As some of the other commenters on that post note, Denny Burk himself seems to misunderstand things as it seems a bit more complicated than that. Meet complete androgen insensitivity wherein someone whose DNA would seem to make them male winds up with a body that appears female. It seems that often this doesn't get picked up until puberty as no menstrual cycle kicks in in these individuals. If Denny Burk's assertion in that blog post is one he still maintains in his book it would seem to imply that such individuals must be male rather than female even though they'd spent their whole lives up to that point being told they were women and that's also how their bodies appear. So, what's a viable way forward? How would you classify these people? Male or female or ...? (If you follow the genes rather than the physical appearance and insist that such individuals are male this would seem to imply then that society has been wrong about how they previously would have classified these people).

And, as weird as the above seems, there's more yet to consider. What about situations like the following article (well worth reading), dealing with chimerism in which the body contains multiple genomes:

In 1953, for example, a British woman donated a pint of blood. It turned out that some of her blood was Type O and some was Type A. The scientists who studied her concluded that she had acquired some of her blood from her twin brother in the womb, including his genomes in his blood cells.

Chimerism, as such conditions came to be known, seemed for many years to be a rarity. But “it can be commoner than we realized,” said Dr. Linda Randolph, a pediatrician at Children’s Hospital in Los Angeles who is an author of a review of chimerism published in The American Journal of Medical Genetics in July.

What do you do if different parts of the same body appear as different genders in test results? Could someone's left foot be male but their right foot female? There's at least one verified example of the following: "a male human had some partially developed female organs due to chimerism"

There are also the implications for things like paternity testing as, e.g.,

One woman discovered she was a chimera as late as age 52. In need of a kidney transplant, she was tested so that she might find a match. The results indicated that she was not the mother of two of her three biological children.

... but I disgress.

It's worth noting that for me this remains to this point a thought experiment, and I'm unaware of having met any such individuals. That said, it seems that based on that available data I probably have. i.e. The size of this population doesn't seem all that different from the size of the population with primarily same-sex sexual attraction:

The prevalence of intersex depends on which definition is used. According to the ISNA definition ... 1 percent of live births exhibit some degree of sexual ambiguity. Between 0.1% and 0.2% of live births are ambiguous enough to become the subject of specialist medical attention, including surgery to assign them to a given sex category (i.e. male or female). According to Fausto-Sterling's definition of intersex, on the other hand, 1.7 percent of human births are intersex.