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Rare condition

A LAW EACH DAY (KEEPS TROUBLE AWAY) - Jose C. Sison (The


Philippine Star)

This case is really quite rare as it involves intersex anatomy that applies to
human beings who cannot be classified as male or female because they
are afflicted with Congenital Adrenal Hyperplasia (CAH) which is a
condition where persons afflicted possess both male and female
characteristics. Studies show that only about 1 in 10,000 to 18,000 children
are born with CAH.

The person involved here is Jemma who was registered as a female in her
Certificate of Live Birth. While growing up however, she developed
secondary male characteristics and was diagnosed to have CAH. In her
early years, she was already diagnosed to have clitoral hyperthropy, and at
age 6, she underwent an ultrasound where it was discovered that she has
small ovaries. When she was 13 years old her ovarian structures had
minimized, she had stopped growing and she has no breast or menstrual
development.

Thus she filed a Petition in the Regional Trial Court (RTC) for Correction of
Entries in her birth certificate praying that her gender be changed from
female to male and her first name from Jemma to Jimmy. She alleged that
from all appearances and in mind and emotion, she has become a male
person.

To prove her claim, Jemma reiterated her above enumerated condition. The
doctor of the UP PGH Department of Psychiatry also testified and issued a
medical certificate affirming that Jemma really had CAH and that
genetically, she is female but because her body secretes male hormones,
her female organs did not develop normally. So she has two sex organs,
female and male, and her uterus is not fully developed because of lack of
female hormones. She also has no monthly period anymore and her
condition is permanent. Thus the doctor recommended the change of
gender because Jemma has already made up her mind and has adjusted
to her chosen role as male which would be more advantageous to her.
Hence the RTC granted Jemma’s petition by changing her name from
Jemma to Jimmy and her gender from female to male. The RTC said that
Jemma’s body produces male hormones and her actions and feelings are
that of a male. The court further said that Jemma’s choice to become male
and to be acknowledged and identified as male must be honored,
considering that except for her intersexuality, she (he) is a normal person.

The Solicitor General (OSG) however questioned this ruling before the
Supreme Court contending that Jemma’s medical condition of having
Congenital Adrenal Hyperplasia does not make her a male, so the lower
court erred in ordering the correction of entries in her birth certificate by
changing her sex or gender from female to male, and her name from
Jemma to Jimmy.

But the SC ruled that the RTC decision is correct.  It is undisputable that
Jemma has CAH which causes the early or inappropriate appearance of
male characteristics. A person with this condition produces too much
androgen, a male hormone. A person born with CAH usually has (1) a
swollen clitoris, with urethral opening at the base, an ambiguous genitalia
often appearing male than female; (2) normal internal structures of the
female reproductive tract such as the ovaries, uterus and fallopian tubes
but as she grows older, some features start to appear male, such as
deepening of the voice, growing of facial hair, and failure to menstruate at
puberty.

CAH is one of the many conditions that involve intersex anatomy where an
organism may have biological characteristics of both male and female
sexes. During the 20th century, medicine adopted intersexuality as a term
applying to human beings who cannot be classified as male or female.
In deciding this case, the court considers the compassionate call for
recognition of the various degrees of intersex as variations which should
not be subject to outright denial. In the absence of a law on the matter,  the
court will not dictate on Jemma about so innately private matter as
sexuality and lifestyle preferences, much less on whether to undergo
treatment in order to become or remain as a female. Jemma is the one who
has to live with his intersex anatomy. To her (him) belongs the right to the
pursuit of happiness and of health. Thus to her (him) should belong the
primordial choice of what action to take along the path of sexual
development and maturation. In the absence of evidence that he is
incompetent and that classifying her (him) as a male will harm other
members of society who are equally entitled to protection under the law, the
court affirms as valid and justified Jemma’s personal judgment of being
male. This is just giving respect to the diversity of nature and how an
individual deals with what nature has handed out. So Jemma’s congenital
condition and mature decision to be a male should be respected. And
considering also the consequence that Jemma’s change of name merely
recognizes his preferred gender, the change of her name from Jemma to
Jimmy should likewise be granted (Republic vs. Cagandahan, G.R.
166676, September 12, 2008).