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Beyond the binary

- Ufrieda Ho

The gender binary has reached its expiry date but it still hasn’t been consigned to society’s dustbin.

While most of the world is moving towards a gender-neutral world, the fall of gender binaries – the idea that only two sexes, namely ‘male’ and ‘female’ exist – is late to the party – mostly because pigeonholes have for the longest time been the more convenient way to order things in society.

But the coming of a more expansive way of thinking about gender is on the horizon. The push is now to create environments and systems that support a gender-diverse world that is adaptive and flexible.

Professor Kevin Behrens, Director of the Steve Biko Centre for Bioethics, says that the traditional beliefs that someone can only ever be male or female is driven by a mix of ignorance, conservatism and rigid ideologies and belief systems. It is also much easier to simply sweep any conception that falls out of the gender binary mould under the carpet.

“It feels like the ‘T’ and the ‘I’ in the acronym ‘LGBTQI’ have lagged behind for decades, even though it has in recent years started to blip on broader society’s radar,” says Behrens.

In this well-known acronym, the ‘T’ represents ‘transgender’, while the ‘I’ stands for ‘intersex’ people. While it is a common belief that people are either born as a ‘boy’ or a ‘girl’, Behrens dispels this idea as a myth. 

“It scares people to think that a baby can be something other than male or female, even though the number of babies born with ambiguous sex is a lot more common than people realise – it’s just that it’s something that has been hidden,” he says.

Behrens has over the past four years been giving an ethics-based lecture to third-year medical students. The lecture is designed to sensitise students to gender identity, transgender surgery and therapies, and to help young healthcare professionals ask different questions when considering medical intervention. It also seeks to help healthcare professionals offer different choices and support for parents, when it comes to children born as intersex persons.

Behrens says that medical students are an easy audience to reach. It is broader society that also needs to understand and recognise the damage caused by entrenched gender binaries.

“You can typically present evidence to medical students and they get it. But with broader society, evidence and facts don’t necessarily change ideology. What does help is to try to understand people’s fears and questions, and what lies at the heart of their silence or discomfort,” he says. 

Not a disorder 

Internationally-renowned endocrinologist Professor Roy Shires says that the momentum of change in the demise of the gender binary system means that “we are seeing the tip of the iceberg of transgender people”. 

“It is, of course, not like there’s suddenly more transgender people, but now more people are finding access and personal courage to come forward for the likes of hormone therapies, surgeries and counselling support.”

Shires says that the demand for therapies and services to the transgender community currently outstrips availability in SA. The waiting list for these types of services at the Chris Hani Baragwanath Academic Hospital’s clinic where he works has exploded in recent years but they have been unable to take on more patients. 

Shires believes that people should be aware of the range and fluidity of gender identities, and come to grips with the fact that gender and gender identities are not fixed. 

Many are not cases that need medical intervention – they are not disorders. On the other hand, there are variations of sexual development that the public should know about, because in these cases medical intervention can help improve someone’s quality of life, he says.

For example, there is growing evidence that suggests that particularly with babies born with ambiguous sex, there is no urgency to medically intervene.

“Knowing more means that doctors and parents don’t need to be pressured to make their child fit into a gender box at birth,” he says.

“Underpinning everything is gender identity, and what that person feels is right for them in their head is what is most important. This is what we want to help them achieve, while managing their expectations,” he says.

But it is just as important for society to come to terms with these realities, and be more mindful of transgender and intersex people.

“This should be a moment for a willingness to deepen understanding and to build tolerance and diversity – not for people to retreat to their corners or to feel like they forever have to tread on eggshells around each other,” says Behrens. 

Shires agrees: “We can’t always be in someone else’s shoes, but what we owe to each other is to listen.”

Hopes and Dreams that Sound Like Yours: Stories of Queer Activism in Sub-Saharan Africa. © Taboom Media & GALA Queer Archive, 2021 | Illustrations by Lame Dilotsotlhe and Neil Badenhorst

Hopes and Dreams that Sound Like Yours: Stories of Queer Activism in Sub-Saharan Africa. © Taboom Media & GALA Queer Archive, 2021 | Illustrations by Lame Dilotsotlhe and Neil Badenhorst

Mainstreaming the Ts and Is

These lessons are a personal lived experience for Dudu*, a 30-year old transwoman who started undergoing hormone therapy through the Wits Reproductive Health and HIV Institute’s  (WRHI) Key Populations Programme at the beginning of 2020.

“I came to this late because you don’t know where to go for information or help. But I’m not just thinking about me, I’m thinking of the trans and intersex children and teenagers who are killing themselves because they don’t know what’s going on in their bodies and they have no one to talk to,” she says.

Dudu lives in the Vaal and there are no clinics close to her home where she can access therapy and services. She says that nurses at her local clinic dehumanise her and discriminate against patients like her.

“They will ask why I’m wearing a dress or say ‘why do you want to make yourself a woman?’, and they will do this so that everyone in the clinic can hear and everyone is looking at me,” she says.

For Dudu, a safe space like the WRHI facilities helps, but it can also be isolating. She says: “I want to go to a clinic where I’m with everybody else – not just other transgender people, sex workers and people who use drugs. We need to see transgender people in our courts, at the police station, in the clinics, that is how we start to change society; we can’t hide.”

But mainstreaming transgender and intersex genders goes much deeper than having the public understand them. It is about pushing medical aids to change their policies and funding; encouraging schools to have gender-neutral bathrooms and greater privacy for children; challenging the medical fraternity to adapt to trans children’s needs, and raising questions about policy and the laws that have not kept pace. 

For Shelley*, a Joburg mother of a transgender male who is now 17 years old, high school was especially hard for her child. However, it helped being able to bring trusted friends and family into their family circle, and building parent and children support groups and networks, as well as becoming an activist.

At two-years old, her child, a biological female, simply said no more girls’ clothes; no more pink everything.

“We were fine with that. But it took us years to fully understand what L* was trying to tell us,” she says, stressing the importance of listening and finding ways to let go of expectations or putting things down to ‘it’s a phase’.

Getting rid of the binary code

The South African government has only this spring announced that it will no longer be using a gender marker of male or female in the 13-digit ID numbers (the four numbers after a birthdate). The Department of Home Affairs acknowledged the current system is “binary in nature … which is unfair, exclusionary and unconstitutional”.

Mutondi Mulaudzi, a Lecturer at UNISA and a PhD candidate in the Wits School of Law, is looking into the scope within SA’s legal framework to go ‘beyond the binary’. A change in the binary gender markers of the 13-digit ID is a significant victory that will create momentum, she says. 

However, for Mulaudzi, SA cannot rest at this triumph or think that pieces of legislation while progressive, such as the Alteration of Sex Description Act of 2003, are adequate in a 2021 world. She says that the Act is patchy in the way it is applied in different cases. It has allowed, for example, a transgender woman to be regarded as a man and be incarcerated in a men’s prison.

“The problem is that if we keep things at the level of policy frameworks but don’t pull this through to the law then we will always have weaknesses, including a system that is medicalised rather than based on self-identification,” she says.

“It also means that we never take into account the socioeconomic realities of people who rely on stretched public hospitals that do not easily offer gender-reaffirming surgery and exclude people who identify outside of the binary, but do not wish to undertake gender-reaffirming surgery,” she adds. 

Mulaudzi’s argument is that although legal solutions are not a catch-all fix, clear, strong laws help move all of society in the same direction. This includes unlearning that gender binaries are the norm. This involves asking different questions about what props up the systems and structures in society – like who funds research, who benefits, and who gets left behind. She reminds us that the practise of racialising medical treatment remains an issue and that there were certain mental health conditions ascribed only to women not so long ago. 

“By reviewing the existing legal framework and by investigating alternative ones that are more inclusive of all gender identities, we can develop a human rights framework that protects gender-diverse people and that structures legislation that is inclusive and understanding of the different genders and processes of self-identification,” she says of the journey that still lies ahead to finally consign the gender binary to the bin of obsolescence.

*Identities withheld

  • Ufrieda Ho is a freelance writer.
  • This article first appeared in Curiositya research magazine produced byWits Communications and the Research Office.
  • Read more in the 13th issue, themed: #Gender. We feature research across disciplines that relates to gender, feminism, masculinity, sex, sexual identity and sexual health.