Riding home on his electric scooter after work one day, Fan Xifa was stopped dead in his tracks by the sound of an infant crying. The cries, cutting through the noise of the heavy rain, led him to a cardboard box that lay beside the road.

It was November 2012, and Fan, a migrant worker in Sanya, in China’s southern province of Hainan, had just made a discovery that was to change his life beyond measure.

Inside the box was a newborn baby. Its lips were blue from cold, and its naked body was covered in blood from its uncut umbilical cord. Instinctually, Fan wrapped the baby up in his coat, and took it to the nearest hospital two blocks away, where a doctor told Fan it was unlikely that the baby would survive. It weighed just 1.4 kilograms.

Once the doctor had cut the baby’s umbilical cord and wiped away all the blood, Fan noticed something. The baby was intersex, born with both male and female genitals. This, Fan believes, was the reason the baby was abandoned.

Three and a half years on, Fan is still the guardian of the child, who goes by the pet name Zheng Zheng. Ever since finding Zheng Zheng, Fan has been preoccupied with the question of what can — and should — be done about the child’s gender. Fan’s dilemma has also heralded a chorus of conflicting voices from charities, NGOs, and intersex advocates around Asia. 

The United Nations defines a person as intersex if they are “born with sex characteristics that do not fit typical binary notions of male or female bodies.” Being intersex is different from one’s gender identity — female, male, both, or neither — or sexual orientation. According to U.N. statistics, those with intersex traits account for between 0.05 and 1.7 percent of the world’s population.

Like many places around the globe, discrimination against intersex people in China — particularly rural China — is commonplace, and the consequences sometimes tragic. Fan has firsthand experience with this: Two people in the small village where he grew up in the central province of Henan were intersex.

One of them, who self-identified as a woman, was discarded by her newly-wed husband when he discovered she was intersex. That divorce was the first of several.

School bullying drove the other intersex villager to suicide.

Memories of their plights motivated Fan — a widower without a child of his own — to take the baby under his wing. He left his job as a construction worker, and took on the role of parent full-time, relying on his 30,000 yuan (around $4,500) of life savings to get by. Determined that his child would not suffer the same fates as the two intersex individuals from his village, he decided to explore surgical options.

In 2013, tests by doctors in Hainan’s provincial capital Haikou showed the child had both mature ovarian and testicular tissue, a condition known as “true hermaphroditism.” Yet a chromosomal balance leaning a few percent to the male side has led Fan to decide that his child will be raised a boy, beginning as soon as possible with genital surgery. “I don’t want Zheng Zheng to hate me for not fixing the problem at an early age,” Fan says.

Dreams of rearing sheep and bringing up his child in his home village led Fan to make the 2,200-kilometer journey back to Henan in 2015. Fan’s village is not far from Zhengzhou, Henan’s provincial capital. It was then that Fan gave his child a name — Juzheng, a homonym for “living in Zhengzhou.”

Still determined to pursue surgical options for his child, Fan went to a local hospital for a second opinion on the available options. The hospital advised Fan that Zheng Zheng should undergo surgery that would remove his ovaries, pull down one of his testicles from his groin, and adjust his penis so that he could urinate standing up. Following the surgery, Zheng Zheng’s female reproductive functions would be irreversibly damaged.

Not everybody is convinced that such drastic surgery is the right course of action. Among them is Taiwan-based intersex rights advocate Chiu Ai-Chih, who speaks to Fan twice a month by phone to give advice on intersex issues. Fifty-year-old Chiu is a firm believer that an intersex individual must be able to give consent before any irreversible gender-assignment surgery is performed, a belief she emphasizes without fail to Fan each time they speak.

For Chiu, the subject is very close to home. Chiu’s body is genetically female, yet produces a high level of testosterone. Chiu was made by family members to undergo surgery to reduce what they considered an enlarged clitoris, when Chiu was just six years old, causing severe damage to the sexual function of Chiu’s genitals.

While advocates like Chiu have been appealing to Fan to reconsider his decision, Zheng Zheng’s case has also attracted the interest of some children’s charities who share Fan’s concerns that Zheng Zheng’s condition will lead to a life of prejudice and discrimination.

After raising money for Fan, the China Charities Aid Foundation for Children advised him that he should take Zheng Zheng for a health check-up at Beijing Children’s Hospital, considered one of the country’s best pediatric hospitals.

A consultation there in February this year revealed that Zheng Zheng was suffering from heart disease, a condition that had no relation to his hermaphroditism. Surgery on his heart was successful, and now Fan is waiting for him to recover before he broaches the issue of Zheng Zheng’s hermaphroditism with the hospital, which he plans to do with a formal consultation in June.

Gong Chunxiu, director of the hospital’s department that oversees hormones-related procedures, shares the same view as Chiu. Drastic and irreversible surgery should be delayed until the child is old enough to decide which gender they identify as, she tells Sixth Tone.

Nevertheless, she believes Zheng Zheng should undergo so-called “repair surgery” at the hospital in June that would give his penis full functionality yet would not remove his female sex organs. Gong explains that the treatment would leave Zheng Zheng the option to change his sex in the future, should he identify as female.

Luk Small Ela, an intersex woman from Hong Kong, has also weighed in on Zheng Zheng’s plight, having communicated her concerns directly to Fan. The 51-year-old is not against the less drastic surgery for Zheng Zheng in June if it’s necessary, as she believes temporarily raising Zheng Zheng as a boy has its benefits. “It’s the safest way to protect the child from being discriminated against at school,” she says.

“When I was at school, there were no separate cubicles in the men’s bathroom,” Luk recalls. “The boys could see how I urinated.” This is Fan’s biggest concern. He worries about how difficult it will be for Zheng Zheng in school as an intersex person. “Which bathroom should Zheng Zheng go to — male or female?” Fan says. “The discrimination could be traumatizing.”

As a child Luk underwent a series of unsuccessful surgeries to enable her to urinate standing up. After over a dozen painful surgeries, a 13-year-old Luk refused any further procedures. A large part of Luk’s parents’ desire for her to undergo surgery came from the wish that — as a male — Luk could continue the family line. Yet in her twenties, she learned that she had no sperm in her body. “All the surgery I went through was in vain,” she says.

The focus on fertility was also behind the recommendations by doctors in Hainan and Henan that Zheng Zheng undergo the drastic, irreversible genital surgery. According to them, Zheng Zheng’s chances of fertility are greater as a male than as a woman.

The question of fertility, along with concerns about how Zheng Zheng will be treated by those around him in later life, weighs heavy on Fan’s mind. But following his communication with people like Chiu and Luk, it seems likely that Fan will forego the irreversible surgery in favor of the less drastic procedure, which would preserve Zheng Zheng’s female sex organs. If, at a later date, Zheng Zheng wishes to identify as female, Fan says he will support that decision.

Whatever path Zheng Zheng takes, Fan says he will have no regrets. “If I passed by without picking up the baby that day, I wouldn’t have been able to forgive myself for the rest of my life.”

(Header image: Fan Xifa and Zheng Zheng kiss each other at Beijing Children’s Hospital, Feb. 29, 2016. TAORAN/IC)