There are many genes involved in the main forms of DSDs, and variations of the genes can have subtle effects on anatomical and physiological sex. Due to a large diversity within male and females, defining people with a binary dichotomy is difficult. Since sex is defined in a number of ways, the line between males and females can be ambiguous.
At the start of life, the differences between sexes physiologically are indistinguishable to at least five weeks of age. The development of the gonad into testes or ovaries determines the hormones produced to form the being into what is known to be a male or female. Changes in development can have dramatic effects on an individual's sex. Gene mutations that affect gonad development can cause a person with male XY chromosomes to develop female characteristics. Alterations in hormone signaling can also do the reverse with XX individuals developing male characteristics.
Studies with mice have shown that the gonad goes between male and female throughout life and needs maintenance to retain its identity. The gonad, however, is not the only source of sex diversity. DSDs have also come from changes in machinery that respond to hormonal signals from the gonads and other glands. Knowing that sex determination is not as black and white as we may think, makes me view this with wide eyes. There is so still so much we don't know in the realm of genetics, but there is also so much that we have learned that is changing the way we view the world and each other.
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