I.W. Gregorio is a practicing surgeon by day and YA writer by night. She is a founding member of We Need Diverse Books and serves as its VP of Development. After getting her MD, she did her residency at Stanford, where she met the intersex patient who inspired her groundbreaking debut novel, None of the Above. She shares the extraordinary back story below.
I was a fifth-year resident when I treated my first intersex patient, and I think of her still. Because Megan* looked like a girl externally, she didn’t find out until she was 17 that she had XY chromosomes, internal testes and no uterus.
Like many people, Megan didn’t even know what the term intersex meant. Not surprising, given that many doctors still confuse intersex—when someone is born with biology that doesn’t fit the typical “male” or “female”—with transgender—which refers to people whose biological sex doesn’t conform with their gender identity.
Back then it was standard procedure to recommend surgery to remove patients’ internal testes, as there is a small risk of cancer (since then, this surgery has been criticized as unnecessary by many). I saw Megan once after her surgery, and was sad to find that she’d come to the appointment alone. She seemed stoic, almost bored, and I realized with dismay that she had barely registered her diagnosis. She didn’t know that she would need hormones, and that she might need to do vaginal dilations. She hadn’t yet been connected with a support group.
Shortly after our meeting, I moved on to a different rotation and never saw Megan again. But I’ve always wondered what she told her family, and whether she ever told her friends. Would they even know what the word intersex meant, or would they use the outdated term “hermaphrodite,” not knowing that some consider it a slur? Megan had said she didn’t have a boyfriend, but what would she tell the next person she dated? Would she despair and fold into herself, or did she reach out to the support group for reassurance that she was not alone? Did she know that, by some calculations, 1 in 2000 people are intersex?
These questions swirled around in my head for quite some time, until the Caster Semenya controversy hit, and I watched with sickened despair as the media made her alleged intersex condition a sideshow and a punchline. I had recently had my first child, a girl, and it became clear to me that intersex was a perfect jumping-off point for a discussion of everything that’s wrong with the gender binary. It begged so many questions: What does it mean to be a man or a woman? Why do people need to be defined by their sex characteristics? And what role does your biology play not only in who you love, but who loves you?
Because I grew up wanting to write children’s books, I knew immediately that I wanted to write a YA Middlesex to introduce teens to these complex but vital questions. I wanted people to realize that the girl next door could be intersex—and that it wouldn’t change who she was. There are times in everyone’s life when they struggle for friendship and acceptance, when they resist the rigidity of the gender binary, and when they wonder if they’re “normal.”
They say that young people today are so much more aware than older generations that gender is a spectrum, and as such I truly hope that readers find None of the Above to be, in the end, a universal story.
*Not her real name
I.W. Gregorio lives in Pennsylvania with her husband and two children. Find her online at www.iwgregorio.com, and on Twitter, Tumblr, Facebook and Instagram at @iwgregorio. Discover more about intersex at http://www.interactyouth.org or http://aisdsd.org.