It was March 2018. University students in the Reserve Officers’ Training Corps (ROTC) were busy running field training exercises (FTXs) just as the cold East Coast weather was beginning to thaw.
One of the soldiers, a young turban-clad figure – the 10th Sikh ever to receive religious accommodation – falls between the crags, falling in such a way that the thighs begin stretching out, crumbling underneath forces from the lateral stretching and the vertical weight from gear.
When the FTX was over, the pain did not subside.
Eventually, this student, soldier and Sikh goes to the doctor to get diagnosed.
First the doctor x-rays the upper leg – no bone damage is found.
Then the doctor turns to a CAT scan to check for tissue damage.
The screen shows not a lack of tissue from damage but extra tissue in the pelvic region that the average male should not have: “female bits.”
That CAT scan showed that this Lafayette College senior had an intersex condition.
And that soldier, who was raised male but is genetically female, is Lillian Kaur Gill, ’15.
Gill has one variation of De La Chapelle syndrome, or XX-male, an umbrella term for any crossover between the X and Y chromosomes during meiosis. In its broadest sense, according to the Journal of Clinical Case Reports, De La Chapelle affects 1 in 20,000 births – but Gill has an even rarer form of the condition, she said.
Some cases of De La Chapelle don’t result in any changes, as the part that gets carried to the X chromosome in a problematic crossover could be any part of the Y chromosome.
“Sometimes parts of the Y chromosome that don’t have anything to do with development get onto the X chromosome in crossing over, so some women can have
no noticeable difference,” she said.
Because there were multiple possible sex disorders with her symptoms, Gill was whisked in and out of clinics for more tests, blood draws and endocrinologists’ visits – all to find out her specific situation.
Like most De La Chapelle cases, Gill’s condition arose from a crossover error, Kaiser Permanente genetic counselor Johanna Martinezmoles explained.
“All chromosomes pair up before cell division, and when the cell divides, that’s how you get your copy,” she said.
“You can have part of the X be on the Y if they didn’t line up correctly – it can happen.
“In this case with the X and Y chromosomes, which (are) unbalanced, there’s only one area where they pair up and cross over: SRY (the sex-determining region on the Y chromosome).”
According to the U.S. National Library of Medicine, the SRY gene contains a series of genes that code for the expression and development of male traits.
For Gill, she got the “master switch” portion of the SRY gene: the portion for the activation of male puberty.
“It was enough to make me develop as male, but it didn’t have the adult testosterone regulation gene,” she said. “There always were slight problems – like low testosterone – but until the end of puberty, that’s how I developed.”
And, according to Gill, having low testosterone, especially in the army, was “a setback.”
“I’d do the same training as any soldier but progressed at a much slower rate,” she said.
“One of my superiors once asked me if I was skipping meals – ‘Why are you not gaining muscle? Why aren’t you bulking up?’
“Well, now we know why.”
And the feeling of not fitting in didn’t end when the drills were over; it carried over to social aspects.
“In the military, when hanging out with other guys, there’s a lot of masculinity,” she said.
“It never clicked with me – I never interacted that way.”
Furthermore, Gill said these “slight problems” were always at the back of her mind.
“I felt certain things were wrong maybe as early as middle school,” she said. “It’s hard to put an exact date on it, but it got stronger throughout the years.
“I felt strongly that something was not right with the way I was developing.”
Gill said earlier in her life she had gone to therapy and internally debated whether or not she was transgender.
“I had dysphoria in general, just not liking my body, a feeling of not being in the right body,” she said. “This feeling got stronger and stronger in college.”
That’s why, that spring day CAT scan gave her “affirmation.”
“There was a mixture of relief and overwhelming feelings,” Gill said.
“It was kind of a lot that hit me at once, both happiness and just the feeling of, ‘Wow, I’m that one-in-a-few-million that has this specific sort of condition.’”
Following the relief and good feelings, she said, came a tinge of frustration.
“I thought, ‘Why couldn’t they have caught this earlier; was there a corrective surgery that could have been done?’” she said.
“Relief was there, yes, but I wished it could have happened earlier.”
However, due to modern medicine, this revelation didn’t mean that Gill had to transition outwardly to female – she chose to.
“I thought on it a long time,” she said. “I didn’t just make a gut decision.”
And in early May, a few months after the initial CAT scan, Gill had made her decision.
According to Gill, her parents were also supportive.
“They said, ‘We want you to be happy, and if this is what’s right for you, and you know it, then this is how it is,’” she said.
But as for why she decided to transition, she said there was no single reason.
“I can’t say what the real reason was, but there was something in me that knew that if I stayed as male, I would be unhappy,” she said.
“It was a culmination of those feelings I had felt my whole life. I already had a lot of thought going into it.”
And she had more than just her emotions and genetic evidence to motivate her.
“I’m not an expert in psychology or genetics – I just know what I read off of research papers on PubMed,” she said with a laugh.
“But there was something else – not just, ‘Oh, I have XX, so I’m going to go female’ – that’s not the only reason.”
One of the many other reasons was Gill’s spiritual consultation, which she received through her Sikh religious leaders – Granthis.
“The Granthis helped me know this was right spiritually,” she said.
“Even though, in all facets, Sikhism treats women and men equally, there’s still a stigma that if you’re a male, then you’re a male and all that.
“But then, what am I? If I do nothing, I would turn back into a female. The estrogen was surpassing the testosterone, and that’s that. In terms of religion – what do I do?”
That was the exact question that she brought to her Granthi, who she said was “fairly modern and progressive, in support of the LGBT movement.”
The Granthi’s response was, as Gill put it, one of self-empowerment. “Look, she said, God gave you the power here to choose your own destiny, and the future isn’t set.”
Gill also took a Hukamnama, which she explained in her Sept. 18 coming-out Facebook post as “a Sikh message chosen at random from the Guru Granth Sahib, (the Sikh) holy text.”
The verse, according to Gill, was a “hymn to the power of God, a testament to what God can do and what humans can do with God’s blessings.”
The verse reads: “The beggar is transformed into a king, the idiotic fool into a religious scholar. He fills what is empty – and empties what is full. The woman is transformed into a man and the man into woman.”
Gill said this reminded her that God can act in various ways.
“There is a lot up to interpretation in the words of the holy text, but it is clear that you have the power to make your own decision,” she said.
“Sure, God gave you this condition, but He put you in this situation for a reason.”
Gill also said that the cyclical nature of the passage reminds her of her situation.
“If you’re an arrogant, inhumane king, then you’ll turn into a beggar,” she said. “If you’re a beggar, but you’re caring and working hard and live the life of a good human being, you’ll turn into a king.
“That, to me, means that there is no black and white again. It’s fluid – there’s spectrum.”
Gill further said that the passage emphasizes individuals for their qualities.
“It doesn’t matter if you’re a farmer in the fields or the president,” she said. “If you are good person with good morals, doing what is right, then God will give you His favor.
“I don’t think that my gender defines me; me as a person defines me.”
It was this sentiment that helped Gill publicize her condition with her friends on Facebook.
“I decided there comes a point where I can’t hide it and shouldn’t have to hide it,” she said.
“I am who I am.
“I thought, ‘I’m just going to put this out, and if people hate me for it, unfriend me – good. Then I’ll know who my real friends are.”
But no one unfriended her; no one left negative comments, a “surprise” for Gill.
Instead, she was met with “kind words and support, an outpour of love”: an “unexpected” 171 likes and over 70 comments.
“The country should only be protected by cool, kind and responsible people like you. Keep soldiering on, Lillian!” Ethan Simmons, a fellow student at Lafayette College, said.
“You are an amazing person. Thank you for being so open and sharing your journey with others 🙂 You are incredibly strong and brave. I’ve always admired how well spoken you are. I wish you best on this new transition,” Elinor Hilton, ’16, said.
Even former Country Day teachers, such as Ron Bell, responded.
“It obviously took a lot of courage to post this, and it’s also important to be aware of De La Chapelle: I didn’t, but knowing about it makes me more aware of the many complexities of gender – and that we’re all normal, because we’re who we are,” Bell said.
Few have seen the “complexities of gender” more than Martinezmoles, but even she is “challenged” at how she “perceives and processes” gender.
“We’re more than just one gene,” Martinezmoles said in reference to the X and Y chromosomes.
“There are changes in sexual differentiation, nature versus nurture and its effect on gender, hormones.”
Androgen insensitivity, Martinezmoles explained, is a condition where women identify and feel as though they’re women but in fact have an XY genotype due to a mutation in the androgen-recognizing receptors.
“The levels of testosterone would equal her male counterparts, but the receptors that would use that androgen – and make them go down the male pathway – just don’t work,” she said.
“So there’s no uterus, no ovaries, infertility. These girls are picked up because they don’t start their periods – but they identify as girls.”
And even though Gill studied at Stanford University Medical Center – where she was able to use their medical library and research intersex conditions like Klinefelter’s – she too said that her condition helped her “take a step back” and more closely examine the intricacies of gender.
“Before my diagnosis, I had never even heard of De La Chapelle,” she said.
But knowing about De La Chapelle has “made things make sense” for her.
“Roughly when I was around 18, my body had already started changing,” she said.
“After I turned 18, my facial hair froze where it was. That’s when the X chromosome part of things took over again following the conclusion of puberty.
“By then there was already a high level of estrogen and low levels of testosterone in my body.”
Because of her chromosomal condition, she has transitioned faster than her endocrinologist – and the timeline for transgenders without an intersex – had proposed at first.
“This made me very happy and excited,” she said. “How well my body was and is taking to the hormones was affirming, too.
“I took to the hormones a little differently than others, and things moved along a lot faster than I originally anticipated.
“My voice shifted a little, and my appearance shifted a lot.”
After only two-and-a-half months of hormone therapy, Gill is already presenting as female.
“There’s a steep decline in body and facial hair growth off the bat,” she continued. “Also (there’s) lots of fat and bone redistribution to the hips, waist, chest – even some in the face.
“The point of the hormone treatment is to ensure I’m not going through six years of weird stuff, an awkward second puberty. It’ll speed up the process.”
And since her hormone therapy is merely a speeding up of a process that would naturally occur, the government is approaching her condition differently from transgender soldiers.
“I was put under the transgender umbrella at first because I was still assigned male at birth and transitioning to the other gender,” she said.
However, as of the week of Oct. 15, the army has changed their stance.
“They’re re-evaluating the situation,” she said. “They’re going to treat me outside the transgender umbrella. Down the line, I’ll get support for hormone therapy because I’m only a cadet right now.
“I am also most likely not going to get any surgeries.”
Gill said that the army is also accepting.
“Nothing has changed much,” she said.
Her room, via Lafayette College, is still a single; the army is coed, so she trains with the same people as before; she’s had no “fallouts” with friends.
And as for the name, Gill chose that while with her friends.
“People were passing out names, and then someone passed out the name Lily,” she said.
“The lily flower is associated with three Greek goddesses: Athena, goddess of wisdom; Aphrodite goddess of love; and Hera, goddess of family. The lily is common to all of them; it sounded appealing to me.
“I just lengthened it to Lillian.”
—By Chardonnay Needler
Originally published in the Oct. 30 edition of the Octagon.