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~Submitted by Stephen Baird, MD, Emeritus Professor of Pathology School of Medicine University of California at San Diego

This letter is provided as opinion/commentary from the author.
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Senator Marsha Blackburn (R-Tenn.) asked Judge Ketanji Brown Jackson, in her Supreme Court confirmation hearings, to define the word “woman.” What this has to do with eligibility to be elevated to the Supreme Court is unclear. KBJ declined. Here, for Senator Blackburn’s edification, is an attempt to answer her question.

The most common human woman has two X chromosomes and no Y. This results in a typical female habitus, with a lot of variation in shape and size of various anatomical attributes. Internally, she has a uterus, two ovaries, and a vagina for ingress and egress.  She is capable of conceiving and bearing children for about three decades, from menarche to menopause.  Her predominant sex hormones are estrogen and progesterone.  Most, but not all women, or females, are sexually attracted to males. Some are attracted to other women and some are attracted to both.

That’s the most common mammalian female but there are a lot of variants. Variation is the rule in every species on Earth.

In no particular order, some of these variants are one X and no Y, commonly called “Turner’s Syndrome.”  These people have a female body habitus but are reproductively sterile and have learning disabilities.  For more information, look up Turner’s Syndrome.

There are also females with three X chromosomes and no Y. This is usually called the Triple X syndrome and is associated with a wide range of developmental disorders,, including none. Most females with Triple X are taller than average. For more information, look up Triple X Syndrome.

We also very rarely see females with four X chromosomes. This syndrome is associated with many other defects in development and physical appearance.  As Casey Stengel once said, “You could look it up.”

All of these variations have no Y chromosome. But there are “women” who do have a Y chromosome, such as XY, but with a nonfunctional testosterone receptor. They develop a normal, even gorgeous, outer female habitus but have no uterus or ovaries and a short vagina.  The testicles are undescended so, from all outer appearances, these people are women. During childhood, they are raised as girls. At puberty, they do not begin menstruation, which may be the first time that they come to medical attention. There are several well-known examples in history and in our current society. They lead normal, “women’s” lives, except that they do not bear any children of their own. They are usually sexually attracted to men.

And, there are mosaics: people who have some XX cells and some XY cells. The effects on their body habitus are quite variable.

Now let’s move to people with two or more X chromosomes and a Y.  The first is XXY, called Kleinfelter’s Syndrome.  These people look like normal males. There may be a variety of physical findings but most often there are none. They often have low but not absent fertility and most probably go undiagnosed for their whole lifetime.

All the other numbers of X chromosomes described above may also have a Y chromosome, which makes the person look like a male but often with other physical findings.

Penultimately, there are people with an XY genotype, who, for their whole lives, feel that they are, or should be, female.  They are often intensely unhappy and are often treated by fellow children and adults as freaks, which increases their unhappiness.  This leads to a very high suicide rate.  Surgical techniques and hormone therapy are available to create a female body habitus and some of those who undergo these treatments, with appropriate psychological counseling, lead happy, fulfilling lives. They are usually sexually attracted to males. Parenthetically, there are also people with two X chromosomes, who, for their whole lives, feel that they are, or ought to be male. There are also surgical techniques and hormone therapy to convert these people to male body habitus, although the surgical techniques to go from male to female are easier.

Lastly, there are babies with XX or XY genotypes, who are born with ambiguous genitalia.  They often have defects in estrogen and androgen synthesis pathways. There are a number of different variants. Surgical “correction” is usually performed in infancy. And, generally, raising these children as females is the most successful. At puberty, hormonal and psychological therapy is often necessary to make life as a woman as normal as possible.

So, “Can you define the word, ‘woman’?” Senator Blackburn, does this answer your question?

We might also note that the Biblical story of God creating woman from the rib of man is completely backward as is described in the song lyrics “How To Make a Man,” which is appended.