Complete androgen insensitivity syndrome (CAIS) highlights the folly of judging or blaming someone for their biology.

In utero, an XY fetus triggers testosterone production, leading to genitalia generally assigned male. An XX fetus develops in less testosterone, leading to genitalia generally assigned female.

In CAIS, an XY fetus lacks testosterone receptors and cannot respond to intrauterine testosterone, leading to genitalia generally assigned female.

CAIS is usually diagnosed when the child fails to menstruate. Evaluation reveals a blind vaginal pouch, no uterus, and atrophic undescended testes which are removed to obviate the risk of testicular cancer. She then moves through life as a cisgender woman.

No one questions an XY woman with CAIS about her gender or sexual orientation because they understand her biology. It has nothing to do with choice, worthiness, or morality. It’s a nonissue.

Karyotypic variations, such as Klinefelter syndrome (47,XXY), Turner syndrome (45,XO), mixed gonadal dysgenesis (45,XO/46,XY), and tetragametic chimerism (46,XX/46,XY), and unnumbered variations in biochemical pathways lead to myriad manifestations, and sometimes ambiguous genitalia, but none are mistakes. They’re just biology.

Gender is multifactorial, not black & white, not binary. In fact, some people have XX in some cells and XY in others. Well-intended but ill-informed doctors have medically and/or surgically intervened to force intersex babies to appear more male or female. No wonder some souls never feel fully aligned with the gender someone else assigned their body.

Don’t conflate morality and biology. Science cannot identify every hormone, receptor, or biological pathway. That deficiency doesn’t invalidate someone’s personal reality. Science is inadequate to explain nature, and it’s too influenced by culture, religion, and personal bias.

Whatever gender may be in other realms, it is not binary in this physical realm.

Don’t invoke biology as an excuse not to love someone as they are.