As a non-binary person, I often get asked, upon stating my gender identity, this question: “Are you AMAB or AFAB?”, and quite frankly, I hate it, and I think it reeks of bad intentions. Now, I don’t think anyone who asks this is explicitly enbyphobic. There’s a good chance that they just simply might not understand, but to me, at the end of the day, it reeks of the toxic mentality that assigned sex at birth is a “trait” or a “state of being”. I don’t see it that way. As someone who is 23 years old, my assigned sex at birth is an event that happened 23 years ago and has no bearing on any inherent part of who I am in the present moment.
This is also why I always speak in past tense for these matters. For example, I never say things like “I’m AMAB”, and I feel repulsed in those insane contexts where AMAB and AFAB are used as nouns (like someone saying “I have a question for all the AFABs here” just disgusts me). I always explicitly say, in my context, “I WAS assigned male at birth”, and I leave it at that. If you’re non-binary yourself and prefer to handle these matters differently, that’s okay, as long as you’re not projecting that I should go along with your view of this subject. I just like to emphasize that, for me, it’s really contingent on context when it comes to how willing I am to state my assigned sex at birth.
The caveat is that, in most of these instances, people are not directly asking me what sex I was assigned at birth. Let me give you a few examples:
- I take hormones, right? If someone wants to ask me about my experiences for whatever good faith reason like relating to it or just wanting more information in order to be supportive of my transition journey, then that’s totally fine. With this in mind, people won’t ask me things like “Are you AMAB or AFAB?”, but instead, will ask me things like “Are you taking estrogen, or are you taking testosterone?” which I find significantly more acceptable.
- If you’re my doctor, and you need to know something that pertains to my reproductive system, reproductive capacity, general anatomy/physiology, or any other thing that makes knowing my assigned sex at birth crucial to know, then I don’t mind the doctor asking obviously. Like I said, though, often times, a doctor won’t ask me things like “Are you AMAB or AFAB?”, obviously. They will ask me things like “Do you have a prostate? Can you get pregnant? Can you impregnate others?” and all that stuff that makes the contextual aspect of it all the more sensible.
- For people interested in me in a sexual context who find it hard to assume my assigned sex at birth because of my androgynous gender presentation, asking me “Do you have a penis or a vagina?” makes sense, especially if I indicated reciprocating sexual interest here. In these contexts, knowing my genital configuration would be important to know how to proceed with me in a sexual manner. However, let me clarify that not all non-binary people who were assigned male at birth have penises and not all non-binary people who were assigned female at birth have vaginas.
- The last point I’d state is to make sense of some more niche contexts here. For example, I talk about how short I am all the time, right? I stand at a height of 5’5", which by the standard of an adult cisgender woman, is generally not considered short. If I claim I am short at my height of 5’5", sometimes I like to clarify that, even though I’m non-binary, I was assigned male at birth to make it make sense when I’m on a forum or community for vertically challenged individuals like myself.
At the end of the day, I just like to sniff out context. I hate to be pedantic, but whenever someone asks me things like “AMAB or AFAB?” and leads it on with the fact that they’re “just curious”, I question the “why” of their curiosity. As I see it, unless the context indicates it being relevant, it shouldn’t be taken as an important matter. It seems like a fishy tactic incorporated by those with a bioessentialist mindset to tie my assigned sex as a trait and pick out what my “true gender” is rather than accepting me as non-binary at face value. Like I said to start, many people who ask this are not doing so in bad faith. Often times, they’re just misinformed, so I try to explain to them some of the more problematic aspects of said questions being asked in unnecessary, irrelevant contexts.
I work in medicine and the idea that sex assigned at birth is relevant to patient care is actually a fundamental misunderstanding of the current state of transgender science. The entirety of information a doctor needs to correctly treat a patient in a medical context are the following:
Unfortunately, many clinical professionals are unaware of how this is the total sum of everything they need to know. They are misinformed in their beliefs that certain labs which have different reference values based on sex and do not know that it is actually a reflection of hormone profiles of the patient. For example, hematocrit labs have different reference ranges that are often attributed to sex. However, studies on hematocrit labs in transgender patients reveal that being on hormones for a reasonable period of time (3-6 months or longer) will move a patient to the reference range typically associated with the gender they identify as. If you take this a step further, it’s actually a pure function of the circulating levels of estrogen and testosterone (among other factors) and even for cisgender folks having reference ranges set by these hormones is of more use, especially when dealing with folks at times of life when these values change (postmenopausal cisgender women and elderly cisgender men both have drastic changes in hormones which affect hematocrit and are currently unaccounted for) and would more accurately reflect the diversity we have in biology.
The idea of sex essentialism deriving from one of chromosomal differences is actually a fundamental misunderstanding of how biological processes work. For those who find this to far a jump to take, I would point you towards studying what happens early in human development. When we are still forming as humans in the womb of our mother, there’s a period of time which sex is not differentiated. This is a direct reflection of hormones and bodily functions. Even among folks who posses XY or XX on the chromosome we most associate with sex, there are notable differences in biological functions which result in different outcomes for the developing fetus. We took shortcuts by associating these changes broadly with sex for a variety of reasons (namely it’s the most pertinent and strongest predictor) but it is a jump in logic and an inference about a complicated multi-lever process where many levers are typically influenced by a few key factors. If we wish to move into a world of personalized medicine and to further our understanding of all biological processes we need to challenge and throw out many of these assumptions to do so.
This is really interesting to read, thank you! I work in medical education, specifically around gender diversity - so knew a lot of this but not the detail you’ve shared here, so thanks!
Practically speaking - the questions OP mentioned doctors asked are also just the best ways to provide the best care we can. So often we use the sex marker on someone’s file as a shortcut to the kind of care they need, but there are obviously so many exceptions to those rules, and not just for trans and non-binary folks. One of the biggest questions I get asked is about differing care and needs based on sex, and it’s actually so easy - just treat the person in front of you like a whole, individual person, rather than a sex maker on a file.
Thank you, you’ve given me a really fun topic to bring up when we see a bunch of my family in a few weeks (several of them are doctors and nurses). I wonder if other hormonally regulated ranges normalize in similar timelines even if the ranges are further apart in the segment of the population that has been measured, or if there’s a greater period of “in between ranges” in those cases. (I’m unfamiliar with the difference in ranges in your given example, and frankly others too. There’s a reason I’m not in the medical field.)
Again, thank you.