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You've read 1 of 2 free monthly articles. Learn More. A nyone who doubts that genes can specify identity might well have arrived from another planet and failed to notice that the humans come in two fundamental variants: male and female. Cultural critics, queer theorists, fashion photographers, and Lady Gaga have reminded us— accurately—that these categories are not as fundamental as they might seem, and that unsettling ambiguities frequently lurk in their borderlands. But it is hard to dispute three essential facts: that males and females are anatomically and physiologically different; that these anatomical and physiological differences are specified by genes; and that these differences, interposed against cultural and social constructions of the self, have a potent influence on specifying our identities as individuals. That genes have anything to do with the determination of sex, gender, and gender identity is a relatively new idea in our history. The distinction between the three words is relevant to this discussion.

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As a clinical geneticist, Paul James is accustomed to discussing some of the most delicate issues with his patients. But in early , he found himself having a particularly awkward conversation about sex. A year-old pregnant woman had visited his clinic at the Royal Melbourne Hospital in Australia to hear the results of an amniocentesis test to screen her baby's chromosomes for abnormalities. The baby was fine—but follow-up tests had revealed something astonishing about the mother.
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