LGBTQ+ YA has come an incredibly long way in the past few years. Where it often used to feel like variations on the same story–often tragic ones, cautionary tales, and the like–there’s now a huge range: stories in different genres, stories in which coming out is the focus, stories in which it isn’t, stories between boys, between girls, featuring trans and genderqueer kids…it’s a pretty wonderful thing. But when a book is among the first to address its topic, it’s common for it to fall into the trap of trying to speak for every experience, to cover all the bases in order to make up for the conspicuous absence, to gloss over certain difficulties in order to be “more appropriate” for a younger audience.

Despite being one of the first YA books featuring an intersex main character, None of the Above by I.W. Gregorio never falls into that trap. What Gregorio delivers in her debut is an engaging, authentic, sad, supportive, funny, sweet, heartbreaking, optimistic, and yes, at times educational contemporary novel that succeeds not because of its main character’s genetic makeup but because it’s good. It doesn’t feel like it exists to teach more than to entertain, but it does in fact do both, and to that end, I asked author I.W. Gregorio to share a little bit about her background and tackling intersexuality in YA.

What is intersex, and how common is it?

Intersex is a word that describes a really wide range of biological conditions in which a person’s chromosomes, internal or external sex anatomy doesn’t fit the typical definitions of “male” or “female.” The interesting thing is, rather than there being any single type of intersex, there are actually over 40 different medical conditions that fall under the umbrella term. This includes Androgen Insensitivity Syndrome, which is what my main character has: Though she looks like a girl from the outside, Kristin has XY chromosomes, no uterus, and internal testes instead of ovaries.

Statistics about how common intersex is range widely, and the one I typically use is that 1 in 2,000 children have some variation on intersex. I’ve seen some numbers that say that 1–2% of all people are intersex. The people who came up with these numbers probably included some really common childhood conditions, including undescended testes (which is exactly what it sounds like) and hypospadias, where a boy’s urethra (or pee-hole) isn’t in its regular place, both of which urologists see quite often. The Intersex Society of North America website has compiled some good statistics on several different conditions.

Regardless of the “true” numerical frequency, the bottom line is that intersex isn’t that uncommon—there are probably a few intersex people at every NBA game in America, if you go by the numbers. As the wonderful people of InterAct Youth say, “We’re not rare, just invisible,” because of the shame and stigma associated with anything that has to do with with sex organs or genitalia.

What’s your background and what made you want to write about intersex?

Personally, I’ve been intrigued by intersex since reading Jeffrey Eugenides’ Middlesex. The idea of being able to work with children with ambiguous genitalia is something that led me to consider pediatric urology, and I helped take care of several intersex children during residency.

I began writing YA during my lab year, and the year after that met the girl who inspired None of the Above. After the Caster Semenya story hit, I was kind of disgusted by how the media sensationalized the story, which really preyed upon stereotypes and ignorance. I knew at that point that I had to write a YA Middlesex. Luckily, I was at Stanford and had access to its world class medical library, and was able to do a lot of book reading there. My most valuable research, though, was my interviews with intersex women, as well as the firsthand reports and video blogs I managed to find online.

What are some common misconceptions about intersexuality?

Yikes, where to start?

These are the things I chose to highlight on my website:

What intersex is not:

It does not (usually) mean that a person is transgender

It does not (usually) mean that a person has both a penis and a vagina

It is not a choice. People are born intersex.

But I should add a bit about the continuing misconception re: terminology. I mention in None of the Above that the word hermaphrodite is a very outdated and inaccurate term, but it bears repeating because it’s clear from at least one or two comments that I wasn’t clear enough. The classic “hermaphrodite,” the mythological creature that has fully formed and functional male and female organs, does not exist. For a long time doctors used the H-word to describe some forms of ambiguous genitalia, but they no longer do, and many people in the intersex community find it horribly offensive and hurtful.

But it’s tough—even some intersex activists use the H-word when they explain intersex to people who don’t know what it is, because it’s some individuals’ only context for understanding. There just isn’t the widespread knowledge of what the word intersex means, to the point where some of my doctor friends have jumped to the conclusion that intersex = transgender, when in fact most women with AIS, for example, have a very clear sense of gender identity. I go into more detail on this, and five other myths about intersex, on my website.

What were some major challenges you faced when writing None of the Above?

Needless to say, with all these misconceptions about intersex I needed to debunk, writing None of the Above was incredibly tricky! I felt like I was constantly walking a tightrope between explaining too much, and not enough. I didn’t want to sound didactic, so I made sure to pace the plot well, but at the same time I did want people to learn from the book. It doesn’t sound very sexy, but the proudest moments of my debut year so far have been the number of teachers who can’t wait to share it with their students.

One thing I really wrestled with was whether or not my character would have surgery, because the intersex community is necessarily very, very vocal that a lot of surgeries performed on intersex children are unnecessary. Indeed, many times—possibly more often than not—these surgeries cause irreparable harm and pain. I don’t want to spoil the book, but my character ended up making a decision that was very personal to herself, but that not all intersex women might agree with.

Finally, the biggest challenge I faced was to write the book in a way that it was less a book about intersex and more a book about a character who happened to be intersex. I wanted Kristin to be a real, three-dimensional person readers could empathize and go on an emotional journey with, and I wanted people to realize it was a journey they or their friends and children could just as easily embark upon. There are times in every teen’s life when they worry about what their friends think of them, when they struggle against the rigidity of the gender binary, when they wonder if they’re “normal.”

I hope I did my job!