Sex and gender pervade nearly every aspect of our lives. Each time we use a public restroom, shop for clothes, or fill out a form, we are insistently reminded that we must be either male or female; men or women; boys or girls. Even things that ostensibly have nothing to do with sex or gender—what we eat, for example, or the books we read—are often sold to us as if they are necessarily feminine or masculine.

Some of these conventions currently face challenges, some more polarizing than others. On the milder end of things, enterprising online retailers promote gender-neutral clothing for babies, and city transport authorities mercifully abolish the phrase “ladies and gentlemen” from public announcements. And on the other side of the controversy scale, U.S. state legislators debate so-called “bathroom bills,” which would prohibit transgender individuals from using public restrooms corresponding to their gender identity. This dispute has prompted some venues to offer a gender-neutral restroom option, or simply to do away with gender distinctions altogether in their facilities.

Much of the public discourse in this arena centers on gender rather than sex, presumably because gender is understood to be somewhat subjective; it is a social construct that can be complex, fluid, multifaceted. Biological sex, on the other hand, appears to leave less room for debate. You either have two X chromosomes or an X and a Y; ovaries or testes; a vagina or a penis. Regardless of how an individual ends up identifying, they are assigned to one sex or the other at birth based on these binary sets of characteristics.

But of course, sex is not that simple either.

The September issue of Scientific American explores the fascinating and evolving science of sex and gender. One of the graphics I had the pleasure of working on breaks down the idea of biological sex as a non-binary attribute, focusing largely on what clinicians refer to as disorders of sex development (DSD), also known as intersex.

The project was originally conceived as a data-driven graphic exploring the spectra of sex and gender. I wondered, for instance, what data could tell us about the frequency of transgender and non-binary identities, what proportion of the population is intersex, and how that value might break down into rates of specific DSDs.

I hired the researcher Amanda Hobbs to look into these questions, and what she came back with, rather than answers, looked more like a series of new questions. The search for solid data on transgender and intersex populations proved challenging, and was confounded by a variety of factors. For example, surveys often lump transgender in with gay, lesbian, and bisexual identities. And DSDs, in addition to being variously defined by different entities, sometimes go undetected or emerge unexpectedly, either during sexual development or later in life.

The project abruptly transformed into an exercise in visualizing complexity. First, it seemed imperative to define a few terms. Sex, gender, and sexuality are all distinct from one another (although they are often related), and each exists on its own spectrum. Moreover, sex cannot be depicted as a simple, one-dimensional scale. In the world of DSDs, an individual may shift along the spectrum as development brings new biological factors into play. The density of science underlying this phenomenon compelled a shift towards intersex as the primary focus of the visualization.

Now that my task was clear, I set about assembling the content of the graphic and putting it down on paper. In part, this process clarified how much I could include, as the complete list of known DSDs and their various manifestations proved unwieldy for a single spread in a print magazine. I ended up with a visual outline of sorts depicting a diverse selection of conditions and their convoluted pathways of development over time. Although not an especially pretty sketch, it captured the sense of intricacy the topic demanded.

Visual outline
Credit: Amanda Montañez

Next I consulted with Dr. Amy Winsiewski, a DSD specialist at the University of Oklahoma, who was kind enough to review the content of my sketch for accuracy. And finally, I called upon the visualization experts at Pitch Interactive to help bring the project to life.

Credit: Pitch Interactive

Once the aesthetic of the graphic had been established, I continued to refine both the text and design elements, guided by feedback from my colleagues who helped identify areas that were unclear or difficult to follow.

The finished print graphic
Credit: Pitch Interactive and Amanda Montañez
Detail of the finished print graphic
Credit: Pitch Interactive and Amanda Montañez

The resulting visualization is a source of pride for me, as I hope it is for everyone who contributed to its development. (You can see a larger version here in the September digital issue.) Design and visual communication feats aside, I believe the content itself is of critical importance from a social and policy perspective.

DSDs—which, broadly defined, may affect about one percent of the population—represent a robust, evidence-based argument to reject rigid assignations of sex and gender. Certain recent developments, such as the Swedish adoption of a gender-neutral singular pronoun, and the growing call to stop medically unnecessary surgeries on intersex babies, indicate a shift in the right direction. I am hopeful that raising public awareness of intersex, along with transgender and non-binary identities, will help align policies more closely with scientific reality, and by extension, social justice.