Do Intersex Men Have Periods?

I’ve been asked to comment on some of the claims made by Jessica Yaniv in their recent British Columbia Human Rights Tribunal hearing (there’s some background to the case here for those not familiar with it), as well as other comments they have made in the past pertaining to being intersex.

Let’s get the easy one out of the way first, Yaniv has said in the tribunal that intersex means people having “both genitalia”. This is a common misconception. I’ve written about ambiguous genitalia and what this means before (clue: it’s not both), so I’m not going to go into detail again here (edit: as Yaniv has made repeated claims about having “intersex genitalia in both the tribunal amd media interviews, I’ve written a more detailed blog about ambiguous genitalia. You can find it here). Suffice to say, if Yaniv has a penis, they do not also have a vagina. The claim I am going to explore in more detail is that Yaniv has periods.

To begin with, let’s remind ourselves what a period is. A period is part of the menstruation cycle, namely monthly bleeding caused by the shedding of the lining of the uterus and unfertilised ova. Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina. You can find a more detailed description here, should you need it.

I think it’s fair to assume, as we know that Yaniv cannot have “both sets of genitals” and that the cases are centred around the waxing of genitalia, that Yaniv has a penis. If they had a vulva (there has been a lot of talk of waxing vaginas – let’s be clear the vagina is internal, the vulva external), then I assume they would not be making up claims of both sets of genitals or evading answers about their own body parts.

So, the obvious question is; can a person with a penis menstruate?

The condition I’ve seen most used to back up this claim (Yaniv isn’t the first, to be fair), is Persistent Mullerian Duct Syndrome (PMDS). PMDS occurs when there is a mutation in the AMH gene. I’ve written a bit about the AMH gene before, but here’s a quick reminder – female reproductive organs develop from the Mullerian duct. In typical male development, the gene AMH causes this structure to break down. In cases of PMDS the gene does not activate, so a uterus and fallopian tubes develop alongside male reproductive organs – a penis and testes.

PMDS is rare, and a quick scan of the scientific literature reveals that men with PMDS run an increased risk of certain testicular tumours, which really puts to bed the suggestion that men with PMDS ovulate. We know, again from existing, extensive studies into DSDs and discussions around labels such as “hermaphrodite”, that there has never been a person who has both working ovaries and testes. I did find one example of a man with PMDS who was found to have some ovarian tissue, although it is clear from the paper that this was not functioning, and there is no suggestion that the patient reported any symptoms of menstruation. It’s also worth noting that the uterus in PMDS cases is often misplaced and severely underdeveloped.

There are other, rare DSDs, such as mixed gonadal dysgenesis (MGD), where a person with a penis can be born with a mixture of ovarian and testicular tissue and with internal female organs but with male genitalia (MGD can also present with female genitalia, although whether male or female, the genitalia is likely to appear ambiguous at birth). Again, these cases are not hermaphrodites. MGD can present with any mix of gonadal tissue. This can include ovotestes (gonads with a mix of testicular and ovarian tissue – these are non-functioning), streak gonads (where reproductive tissue is replaced with functionless, fibrous tissue) and sometimes either a single working testis or ovary. MGD is always apparent at birth, as it would also involve ambiguous genitalia. If the presence of a functional ovary were detected, this would lead to female sex being recorded. Similarly, a functional testis would lead to male sex being recorded. So, even in complex cases like this, we do not encounter men having periods.

I have come across two news stories about men menstruating and have seen people refer to these before, so I’m going to try to address these here too. Firstly, there is this case, in which a man with PMDS claims to have a complete reproductive system, including ovaries and a history of menstruation. As already stated, it would be impossible for anyone to have both working testes and ovaries, and the man clearly also states that he had a successful operation on an undescended testicle when he was a baby, so it seems likely he is confused about the ovaries. This seems to be related to him having experienced blood in his urine. It’s worth pointing out that blood in the urine is not uncommon with PMDS, in fact it is often what alerts adults with PMDS who have gone undiagnosed as babies to their condition. This is thought to be caused by hormone imbalances, not menstruation.

The second case is this one from China. This is much simpler to explain as the person in this case had been raised as male but was actually female with congenital adrenal hyperplasia (CAH), meaning their genitalia had appeared virilised at birth, and so they had been recorded as the incorrect sex. It’s worth noting that incorrect sex assignment is increasingly rare and even in this case did not result in an unambiguous male appearance in adulthood.

It’s probably worth, as a final note, mentioning that no other DSDs which result in an unambiguous male phenotype would involve the presence of any of the necessary organs for menstruation. XX males, males with Klinefelters, MAIS, PAIS, 5-ARD deficiency, etc, all have testes, although not necessarily fertile.

In summary, there is no DSD where someone with male genitalia menstruates. There are a number of complex conditions that can lead to a mix of internal organs. These often involve other health implications and can be traumatic and life changing for people to come to terms with upon diagnosis. They are not fun talking points by which other people can validate their gender identities by the spreading of misinformation. It does not help people with those conditions.

One thing that does strike me is that as long as intersex is being kicked around in cases involving gender identities, by people with no real knowledge of what it means, there should be an insistence that the evidence and claims cannot be used without an actual DSD expert to assess the validity of them first. It’s disappointing and frustrating to see trans activists being allowed to get away with this, and capitalise on their own and other’s ignorance, to advance a political movement that really has no interest in intersex matters or reality.

Update: since I wrote this blog, Yaniv has done a radio interview in which they clearly state they have a penis and testicles. Good work to Niall Boylan for cutting through the bullshit here and getting to the truth.