Skin Deep.

November 13, 2007

On the Season 2 episode of House, M.D. (1) entitled “Skin Deep“, Dr. Gregory House (2) treats a teenage super-model who presents with the symptoms of sudden rage, nausea, intermittent short-term memory problems, and convulsions. House suspects cancer, but is unable to find the source – until an MRI reveals that the individual who presents as female possesses undescended testicles (easily mistaken for under-developed ovaries on an ultrasound, but properly identifiable on MRI), and furthermore, that there is a tumor on the left testicle.

When House presents the news to the patient and hir (3) father, he characteristically does so in a brusque manner, indicating that the patient formerly known as “she” has cancer on “his” left testicle. While it is the norm to reduce biological sex to an either-or position of XY or XX chromosomes (4), the fact of the matter is that it is not always that simple. There are many variations, such as XXY (5), which may go unnoticed until puberty – and in some cases, never noticed at all. In the case of this intersexual (6), ze did not have a chromosomal abnormality, but rather suffered from androgen insensitivity – in which the fetus is immune to testosterone in the womb and continues to develop as female, despite having XY chromosomes. It is simply incorrect to refer to this female-bodied and female-socialized (7) individual as “he” as hir chromosomes do not have any bearing on hir identity.

I could go on a very long digression about how pronoun usage in general is a rather clumsy thing as it is up to the individual hirself to define hir own gender identity and the pronoun that ze chooses to use to match, but I’ll just leave it at that. Identity and pronoun usage can not simply be reduced to biological sex, especially when biological sex itself can not simply be reduced to either/or.

Also used in this episode as an example of how tricky biological sex can be is Couvades Syndrome in which some expectant fathers exhibit “sympathetic pregnancies.” Their bodies become flooded with estrogen, perhaps from inhaling the estrogen fumes of their pregnant partners, and this causes the body to react. Male and female bodies respond the same way to estrogen: developing breasts, increased fatty tissue in the midsection, the typical “womanly-ass.” The differentiation in the sexes comes from the male-body’s ability to process testosterone, which, when lacking, instead produces an individual of – in House’s words – “pure estrogen.” House points out that in this case, the result is the “perfect woman.” He goes so far as to say “The perfect woman, is a man.”

In the right context, this statement could be an affirmation for transgender MTF women. However, in this case, it is just problematic. Neither of these individuals is a perfect woman – the man’s male identity is not sublimated just because he has developed breasts (8). Nor is the intersexed model a perfect woman, despite her admittedly perfect secondary sex characteristics (9), as hir body is anatomically different from that of your typical woman, meaning that ze will never experience the typically female events of menstruation or pregnancy (10).

In the end, there is no perfect woman, or perfect man. Even the typically sexed XX woman is going to watch football at some point in her life. Rumor has it that some XY men have even been known to cry, though possibly also related to football. Gregory House might be as close to the perfect man as they come, but even he doesn’t know everything.


1) The Best TV Show In The Entire World. 2004-2007.

2) AKA, The love of my life. You Can’t Have Him, He’s Mine, 2004-2007.

3) Ze/Hir – Gender Neutral Pronouns, championed by Leslie Feinberg. See also, hi, I found this MetaFilter comment that *I* made while Googling for this. Sheesh. Continual Struggle for Alternative Gender Acceptance – Dawn of time through Present.

4) The fancy word for chromosomal sex is “Karyotype.” Everybody, et al. Wikipedia, 2007.

5) Klinefelter’s Syndrome. Everybody, et al. Wikipedia, 2007.

6) That’s Right, I Just Made That Word Up. No One Else Had A Better One. C’mon, People, Get On It. 2007.

7) Socialization, AKA That’s Right, Gender is a Social Construct. Everybody, et al. Wikipedia, 2007.

8 ) Though I Doubt He Would Agree With Me On This. I’m Talking Out of My Ass, 2007.

9) She Really Does Have a Nice Rack. I Dare You Not To Notice, 2007.

10) Some Women Are Envious Of This. We Really Hate Having Cramps. Dawn of Time – Present.