#feel free to correct me if I've gotten something wrong I'm not an expert and this stuff is complicated for an outsider

[canisalbus]

I just recently started following you so i don't have the full lore of your murderous gay religiously traumatized doggos, BUT, from my understanding, they are Italian and i don't know what part of Italy they are from, yet i can't help headcanoning Vasco as Tuscan, while Machete is probably from some part of Veneto. And as an Italian who has heard Tuscans and Veneto dialet, well it's an hilarious mental image.

Vasco is indeed Tuscan, Florentine to be specific. He comes from a wealthy and influential noble family that has lived in Florence for centuries. He's proud of his roots, and it's usually easy for strangers to tell where he's from. He's a resonably successful politician and has worked as an ambassador and representative of Florence on numerous occasions.

Machete is originally Sicilian (ironically about as far from Veneto as possible), although he was taken to mainland at young age and has lived in several places since then, before ending up in Rome. The way I see it, he exhibits very little local color, his demeanor and (even though Italian hadn't become a standardized language yet) way of speaking are formal, neutral and scarcely give away any hints about his personal history, at least in the 16th century canon.

[awed-frog]

Hey! I vaguely remember that you are a GoT fan (correct me if I'm wrong) and I've just gotten into the show. I was wondering whether or not you read Dany as a queer character? I keep getting that vibe from her, but I'm not sure how to articulate why I feel that way. Feel free not to answer this if you don't want to discuss it, since I know your blog isn't really focused on GoT.

Hi there! Yes, I do like GoT and my short answer would have to be, you probably read Dany as queer because she sleeps with women in the books and they left some of it in the subtext, but I don’t know if I see Dany as a queer character.

Long(er) answer - and this is just a feeling I have, because I’ve seen the series and read the books but I’m not an expert of anything, so I could be dead wrong - my reading of sexuality in that world is that the Seven Kingdoms are a bit like us, while the other people are a bit like ancient people? What I mean is, Westeros was famously inspired by the War of the Roses, and how characters behave sexually seems to conform to that period. You’ve got someone like Sansa, who’s destined to be a king’s wife and will be a virgin when she marries; someone like Jon, a second son who’ll be shipped out to the army (or, well, to a freakish cult) and is almost encouraged to have sex with any woman who’ll have him; and someone like Ned, happily married and yet (allegedly) sleeping around on campaign, and nobody is really weirded out at all. And sure, it depends who you ask, but in Westeros, sex is not really painted in the best of lights. I seem to remember other characters being all disapproving of Tyrion’s love of prostitutes, for instance (and of course, what’s specifically horrifying is that he pays them well and respects them and even falls in love with them). An open enjoyment of sex is also part of the reason why Westerosi aristocracy turns its nose up at Oberyn and his retinue. And then there’s people like Loras and Renly - they’re too important to be beaten up in the streets, but nobody is all that accepting of their behaviour (‘pillow-biter’ it’s what Loras is called). So this is Westeros. As for the other people, it’s not like we were given a thorough exploration of their sexual or religious mores, but it’s made abundantly clear that those are a bit laxer than they are in Westeros. The Targaryens marry their siblings (like the Egyptian pharaohs). The Dornish are sort of openly bisexual (more or less like people in Rome and Greece - although, that’s also partly a myth). Xaro, the one character we met from Qarth, is gay (he proposes to Dany, but is also very clear that he has little interest in her body).

So, well - that said, I always read Dany as someone who has an ‘ancient’ view on sexuality. Both in the books and in the show, she is shown to have a clear interest in men - it’s men she thinks about, and it’s men she falls in love with - but in the books, she will sometimes summon as (female) servant and have sex with her. To me, that doesn’t make her bi in the modern sense of the world, because those encounters are not about desire, exactly - they’re more about comfort, about finding some peace and zone out for a while. If you look at a ‘finishing school’ for girls in ancient Greece, like the one Sappho headed, you’ll see what I mean: we’re reasonably sure many girls there must have experimented with each other, but they also did so because it was a social costume and because - in this brutally segregated society - they would always have a deeper bond with another woman than they would ever had with a man (in Greece, a high-born a woman didn’t have male friends; she couldn’t even talk to a man who wasn’t a relative, and even those meetings - with brothers and cousins - were strictly regulated). The prospect of marrying was, no doubt, in equal parts exciting and completely terrifying, and sex was also both dreaded and anticipated - not only because sex with an older, and generally unknown, man could be painful and unpleasant, but also because of the dangers associated with pregnancy. So that’s one of the reasons girls had sex with one another, just like men did (as weird as it seems, they had the same problem, specifically a lifetime of being tied to a person they had nothing in common with - not a partner, but often a half child they had to instruct on everything). And just like it happened to the men, I have no doubt some girls were what we’d consider ‘gay’ in today’s society - that is, they actively enjoyed having sex with people of their own gender and endured, or avoided, sex with the other gender - but other girls were probably not; these were girls who - like Dany - would actually prefer a man’s body, and obsess over a man’s love, and would only initiate or accept sex with a woman because it felt nice. For us, after twenty centuries of Christianity, is almost impossible to fathom how flexible people used to be, but other societies, like Dorne or wherever, probably don’t see sex (and your choice of sexual partners) as that big a deal. Like, I was reading a book by Roman emperor Marcus Aurelius the other day, and at one point he says he’s happy he never had sex with Benedicta or Theodotus - not because Theodotus was a boy, and not because they both were slaves, and therefore could not give consent - but simply because Marcus was a Stoic, and considered sex as something to be avoided or enjoyed in strict moderation. ‘I thank the gods’, he says, ‘that I kept the flower of my innocence and did not play a man’s part until the right age or even rather later; and that, when I did feel erotic passion, I was cured of this’.

Anyway - I hope that made some kind of sense? If you’d like to know how the characters’ sexuality in the show compare with the books and who is ‘canonically’ queer, you can have a look at this article (warning: contains spoilers).

[intersex-support]

I was wondering if any of the mods could hear me out because I'm truly at my wit's end here. I'm AFAB and in my early 20s and have never had a period. All of my other parts have developed fine (though I think my vagina might be a tad on the small side). I'm currently diagnosed as having PCOS with hyperandrogenism, but I feel like my issues go further than that. For starters, I've been prescribed multiple strong doses of HRT and none of them have caused me to have a period. I also have a very thin lining on my womb (which I've been told doesn't align with PCOS) and a resistance to insulin not caused type 2 diabetes (which makes me believe I actually have NCAH instead since I had an early puberty too). I've also recently had a karyotyping done and the results on the letter I got said I have 46XY, which I know isn't what I should have but to be completely honest I think that's just a mistake, though I'm definitely planning on confronting my doctors about it. I was just wondering if the mods had any idea about what's wrong with me? Being on this treatment and not seeing any results for years now has caused me so much grief and I feel like I can't trust doctors anymore because I've been shamed and violated by them throughout. I'd much rather hear what other intersex people have to say on it, since the only thing I'm certain about is my hyperandrogenism.

So we have to start off by saying we can't diagnose you, but we can give you some ideas about what could be going on. None of us are medical experts, but the mod team does know a fair amount about intersex variations and we worked together for this answer! Intersex diagnosis can be so complicated, and unfortunately our answer might just leave you with some more questions. However, we’re going to try to break it down into possible scenarios that could be your intersex variations. We’re also going to rule out things that it could not be, in hopes that this helps narrow the search. It could be any of these suggestions, or none of them, but hopefully this can help you in your research!

First off, I agree that it is most likely not just PCOS-the things you’ve described seem like there is a lot more going on than that. Oftentimes, PCOS is just the first thing doctors diagnose with and it can be a sign that there is other stuff going on.

Second off, I’m curious if you know for certain if you have ovaries, since you didn’t mention it. I’m assuming that you do, because it sounds like you’ve done a lot of testing and have been through a lot of treatment, but let me know if you don’t have ovaries, because that would change some of the things I described.

Third off, in my experience with karyotype, it's not common for it to be wrong, but you're not wrong to seek a second opinion.  So with that in mind, I’m going to walk you through what the possibilities are if it is accurate and you do have 46 XY. It could potentially be Swyer Syndrome (also known as XY gonadal dysgenesis). Swyer syndrome is when you have 46 XY and a vagina, uterus, and oftentimes an enlarged clitoris, but no ovaries. People with Swyer Syndrome also do not have a period without HRT. However, the thing that does seem to make that a little unlikely is that usually, people who go on HRT with Swyer syndrome get a period. With Swyer Syndrome, you also don’t go through puberty without HRT, so if you had puberty before HRT, that might be another sign that it’s not Swyer syndrome. Also, the fact that you’ve said you have hyperandrogenism also makes me pause-as far as I can tell, hyperandrogenism is not associated with Swyer Syndrome at all.  Still, it could be a possibility, although I’m not sure it’s a very likely one.

There’s also a chance it could be Androgen Insensitivy syndrome, but I’ve gotten conflicting information about whether or not you can have a womb and AIS-some sources say that you can, some say that you can’t. So that’s something defintely worth asking a doctor about. But with AIS, you have 46XY, can have a uterus and a vagina with PAIS, but never start your period. Also, although it seems counterintuitive, hyperandrogenism is actually something associated with AIS, because your testosterone levels will be in the “normal” range for “male” people and diagnoses of hyperandrogenism is made by comparing it to the “female” levels. People with AIS generally have a clitoris and vagina, although it can be more shallow sometimes. If you had AIS, you would also have internal testes that could be found through an ultrasound, if I’m not mistaken. I’m really unsure about whether or not you can have a womb with AIS though-most of the sources said you can’t, but two sources said you could. So that’s something you defintely need an expert’s opinon on. 

We can also rule out 5-alpha reductase deficency, another 46XY variation, because you have a uterus and a womb. I’m assuming you would have mentioned if you didn’t have a uterus, but let me know if I’m assuming wrong!

Here’s what I think might actually be likely: 46 XX/ 46 XY chimerism. This is a really rare intersex variation, so statistically it is not likely, but because of what you’ve described, I think it actually is a possibility for you. With 46 XX/ 46 XY, you essentially have both XX and XY cells in your body. So this doesn’t always show up on karotype tests, because the way the random distribution of cells work, they might just test some of the XX cells or some of the XY cells. Chimerism has such a wide range of physical presentation that it can look like almost anything. It can look like having “typical” AFAB presentation with vagina, uterus, and womb, but maybe with factors such as a shallow vagina or a larger clitoris. This could also be a cause of hyperandrogenism. This could also explain why you don’t have periods. If you were interested in persuing diagnosis of this, you would likely have to get more karotyping done with a wider sampling of cells. 

Another option I think might be possible is mixed gonadal dygensis, which is also known as 45,X/46,XY mosaicism. This is also another statistically rare one, so doctors tend not to like to test for it, but I still think it could be a possibility for you. It’s similiar to 46 XX/ 46 XY chimerism in that you have two different types of cells, but it’s different in the way it’s formed and it’s due to losing the Y chromosome in some cells. Also like chimerism, it has a wide range of physical presentation-you can have a womb, vagina, uterus, but also could have mixed gonadal tissue and have both ovarian tissue and testicular tissue, which would be a reason that you wouldn’t have periods. Virilization/hyperandrogenism is also associated with this in AFAB people, which would explain that. 

None of the variations I’ve listed are specifically associated with insulin resistance, but hyperandrognism is associated with it and hormones are honestly so weird with intersex people, so there could defintely be a connection there. 

Now I’m going to talk about what the options would be if you didn’t have 46 XY. 

You’re absolutely right that NCAH could be a possibility that explains hyperandrogenism and insulin resistance. I’d actually lean more towards full CAH because completely absent periods are more prevalent in CAH than in NCAH. So if you don’t have 46XY, I’d say it is really likely that you could have CAH. 

However, CAH cannot be comorbid with 46XY if you have a uterus. There is a type of CAH called lipoid CAH that does present in people with XY, but if that is the case, you would not have a uterus, and the inner vagina would be absent so what you would have for a vagina would be extremely shallow. So having CAH and 46XY would all depend on whether or not you have a uterus.

I don’t think it’s likely to be other intersex variations like Klinefelters, Turner’s, or MRKH, becuase you don’t have the physical characteristics of those or the karotype. 

So honestly, if your karotype was incorrect, the two most likely options are going to be CAH or PCOS, and I would lean towards CAH. If your karotype was correct, I’d think that chimerism or mosaicism might actually be the most likely options, but that would require further karotyping

That was a lot of information, so please feel free to come back and ask any more questions, or just if you need support and want to vent. This whol process can be so confusing, and I’m really sorry that you’ve been shamed and violated by your doctors. You deserved better, and you always have a right to be respected and support in the diagnosis and treatment process. I’ve been there and I really feel for you, and I want you to know that you’re not alone in this, even if that doesn’t help solve everything. You desreve to find answers about your own body, and I know how hard and stressful it can be what you just don’t know what’s going on.There’s a lot of intersex people who get it and who are here to support you through this, and you are welcome in the intersex community. (If you want to come off anon, I’m happy to give you a link to an intersex discord server I’m in-it’s a really supportive place and you’d be welcome there.) 

Please feel free to ask as many questions as you need, or just to vent! We are here for you and we really hope that you’re able to find some answers 💜💜💜 

-Mod E