In a small village in the Dominican Republic, some children are born appearing female and grow up to be men. They’re known as guevedoces: “penis at twelve.” Others call them machihembras – “first woman, then man.” Raised as girls in early childhood, their bodies shift dramatically at puberty: voices deepen, muscles develop, male genitalia emerge. Most transition socially and live their adult lives as men, fully accepted by their community. The community adapts, quietly, competently, without fanfare. They didn’t need a theory. They needed language that tracked what actually occurs. And they created it: guevedoces, machihembras, terms that hold space for transformation, for a body’s journey from one state to another. The language itself anticipates change.
There’s no scandal. No crisis. No parliamentary debate or safeguarding panic. Just life unfolding as it sometimes does. What’s remarkable isn’t the biology; 5-alpha-reductase deficiency is well-documented, understood, and even predictable. What’s remarkable is what doesn’t happen.
This adaptation in Las Salinas reveals something deeper: the assumptions underlying our modern institutions. We have moved to a rigid concept, which, when critically examined across social, medical, and psychological terms, shouldn’t hold weight, but remarkably in the United Kingdom today, it has become a belief ingrained in the media, in social policy, and in social institutions – classification at birth is permanently predictive.
This assumption is rarely stated outright. It’s treated as neutral, as if it were science itself, rather than a bureaucratic assumption that has calcified into ideology. And what we find in places like Las Salinas is the opposite. When bodies change, and systems update accordingly, there is no collapse. There is continuity. Recognition. Care.
What determines whether transition becomes dangerous isn’t chromosomes or hormones, it’s whether a society allows its classifications to evolve when reality does. In Las Salinas, childhood isn’t treated as destiny. Puberty isn’t a threat; it’s a meaningful inflexion point, met with adjustment, not alarm.
Elsewhere, similar changes, whether through intersex variation, medical transition, or acquired conditions, are often treated as administrative emergencies. Not because they’re inherently risky, but because our systems were built on the belief that change shouldn’t happen at all.
Classification exists for a purpose: to help us respond wisely, to route care, assess risk, and offer protection. But when a category no longer reflects material reality, when it actively misleads, it ceases to serve.
Consider the UK police, who alarmingly have created a new category of “male breasts” in response to our queries about transitioned women. This isn’t just linguistically awkward, it’s medically nonsensical. Trans women’s breasts aren’t “male.” They develop through the same endocrine processes as cis women’s breasts: estrogen-driven ductal development, lobular differentiation, the same tissue and architecture that makes them susceptible to the same pathologies. Calling them “male breasts” doesn’t preserve accuracy. It obscures it. And it signals something darker, that no matter what the body actually is, physically and biologically, the label must not change.
Consider what happens when rigid classification meets changed bodies in practice. A medically transitioned woman, years on estrogen, post-surgical, living fully as female in every observable aspect of her life, arrives for a routine health check. She has breast tissue. She needs breast cancer screening. But her records say “male.” Does she even try to book the mammogram? Or does she avoid it, terrified of how the radiographer might respond, whether she’ll be treated as the woman she presents as, or interrogated as a man, a threat, something to be managed? The cancer risk doesn’t care about birth certificates.
And then there’s safeguarding. We’re told that rigid natal classification protects vulnerable women. But what about the transitioned women who are vulnerable? The data is stark: trans women experience sexual violence at rates exceeding those of cis women. They face intimate partner violence at some of the highest documented rates of any demographic. They are simultaneously the most stigmatised and least protected group when it comes to gender-based violence. A transitioned woman fleeing domestic abuse is routed based on a birth certificate that no longer describes her physiology, her social vulnerability, or the nature of the threat she faces. Compounding this, disclosure itself can become a weapon in the hands of an abuser. The question isn’t whether all spaces should be universally accessible; it’s whether routing decisions meant to protect people should be based on current risk and vulnerability, on current biological and social reality, or on an outdated classification that no longer predicts either.
Medical misclassification and safeguarding misclassification stem from the same root: systems that privilege natal records over current reality. When a woman’s medical records don’t match her body, she avoids care. When her legal records don’t match her social vulnerability, she’s routed to the wrong protective response. Both failures come from the same assumption: that birth classification remains permanently predictive.
Yet increasingly, policy treats transitioned women as categorically dangerous. Not case-by-case. Not based on individual risk. Categorically, because their birth records say “male,” and that designation is treated as permanently, overridingly predictive of threat, regardless of physiology, social reality, or years of stable transition.
The guevedoces face nothing like this. Their transitions are expected, their adult male status unquestioned. No one suggests they remain dangerous or suspect because they were once raised as girls. The community simply sees them as they are. And that’s the difference: one society designed its language and practice to accommodate predictable change. The other insists that change must be treated as a permanent error. This isn’t an argument that sex-based considerations never matter. It’s an argument that when those considerations do matter, for safety, for medical care, for accurate risk assessment, they should be based on current physiological and social reality. A system that routes a post-transition woman to male facilities, ostensibly for safety, isn’t being cautious if her vulnerability profile has fundamentally shifted.
And here’s what makes the rigidity especially puzzling: medicine already updates classifications all the time. Post-hysterectomy patients aren’t screened for cervical cancer based on “female at birth.” Mastectomy patients aren’t routed through breast imaging protocols. When anatomy changes, through surgery, through illness, through any acquired condition, systems adapt. Accurate classification is how you deliver appropriate care.
Except, increasingly, when the person transitions. Medically transitioned women would face the same structural issues the guevedoces would face if Las Salinas suddenly refused to acknowledge their adulthood. Their current biophysical reality, hormone profiles, body composition, and anatomy have shifted, observably and durably. The guevedoces live fully integrated as men, with systems functioning based on observable reality rather than childhood records. For medically transitioned women, functional integration similarly depends on whether systems can operate on the current biophysical state, not as a matter of concealment, but because accurate classification shouldn’t require constant disclosure of medical history.
It’s about whether the system was designed expecting change… or forbidding it. This isn’t about whether medical transition is “natural” in the same way 5-ARD is. It’s about whether our institutions can handle any stable change in sex characteristics without treating it as a permanent category error.
Las Salinas doesn’t collapse under ambiguity. It stabilised. By letting language and practice track material reality, the community avoids panic, reduces harm, and maintains social cohesion. No one needs to win an argument. No one needs to prove a belief. The system simply stays aligned with what exists.
This isn’t compassion replacing competence. It is competence. A safeguarding system that routes people based on outdated classification isn’t being cautious; it’s malfunctioning. We’re often told that adaptive classification is dangerous, that it undermines order, confuses safeguards, or erodes boundaries. But the evidence points the other way. Rigidity is what breaks systems. Adaptation is what keeps them functional.
The path forward isn’t radical. It’s already been walked. By villages like Las Salinas. By oncologists updating screening protocols after surgery. By any institution that’s ever corrected a record when reality changed. It doesn’t require agreement on metaphysics. It doesn’t ask anyone to abandon concern for women’s safety or dignity. It doesn’t deny differences between populations.
It asks only this: when a body has stably, measurably changed, can our systems notice? Not out of ideology. Not out of sentiment. But accurate classification is how we prevent harm.
This is not activism. It’s maintenance. It’s institutions recognising that physical transition materially changes someone beyond the category label given at birth, and updating their systems accordingly, the way they already do for acquired medical conditions.
There’s a quiet wisdom in Las Salinas: it doesn’t fear change. It doesn’t demand that labels be frozen. It doesn’t assume that biology is destiny. It simply observes and responds. And that’s what we need to learn: not how to define people, but how to recognise them.
