In the villages where some girls grow into men, gender identity isn’t always clear. In Las Salinas de Barahona and Los Saladillos, a high concentration of genetically male children are born with ambiguous genitalia, converting these small pueblos into a hub for gender fluidity.

Streets are lined with tiny pastel colored houses in a small pueblo in western Dominican Republic known as Las Salinas de Barahona, named after a nearby salt mine. Men on motorcycles congregate at the bustling central square, where the sound of merengue music fills the air and children in neatly pressed uniforms walk by on their way to school.

In a nearby barbershop, men wait to get groomed before the town’s weekly celebration, where people of all ages gather in the street, cracking open Presidente beers and dancing into the early morning.

Waiting for his father to finish getting his haircut, a 12-year-old boy examines himself in the mirror.

He brings his face just a few inches away from the mirror, adjusting his “cachucha”, or baseball cap, raising and lowering it over his freshly shaved head until it looks just right.

It has been three years since the boy cut his hair off for the first time, trading in his long braids for a nearly bald head, dresses and skirts for long pants and the name Carla for Carlos.

Carlos’ condition is described as a disorder of sexual development and specifically known as a 5-alpha-reductase deficiency (5-ARD), though in the United States, he would be referred to as intersex.

Although people with this condition are genetically male, with one X and one Y chromosome in each cell, their bodies do not produce enough of a hormone called dihydrotestosterone. A shortage of this hormone disrupts the formation of the external sex organs before birth, causing children to be born with ambiguous genitalia, according to the U.S. National Library of Medicine.

As a result, they are raised as girls until the onset of puberty induces a second wave of testosterone to surge through their body. At that point, their testes descend and the clitoris-like penis and scrotum, which resembled a labia at birth, grow larger, as stated by the U.S. National Library of Medicine.

On the outside, they begin to look like men – their muscle mass increases, their voices deepen and their shoulders broaden.

“Without this enzyme [helping produce dihydrotestosterone], there is no sexual development, so he’s biologically male but with female aspects, phenotypically speaking,” said Alberto Mejia, a pediatrician with a specialty in pediatric urology in Santo Domingo.

He also mentions that the genetic mutation, which comes from a recessive trait, is thought to derive from pervasive intermarriage and small gene pools.

Although the exact incidence is unknown, Mejia says, ”We have one of the largest concentrations of these cases in the world.”

Turkey and Papa New Guinea are the only two other countries with high concentrations of 5-ARD cases.

On the other hand, the U.S. has a conservative estimate of one in 2000 children born with atypical genitalia, according to the Intersex Society of North America.

In the small village of 6,000 people, it seems as if the large number of folks living with 5-ARD traits make it easier for youth like Carlos to accept themselves.  

“When intersex is explained as a natural variation, which it is, then I think youth tend to accept and understand that their bodily difference is just a natural variation of the norm,” said Georgiann Davis, who was also born with an intersex trait and now teaches sociology at the University of Nevada, Las Vegas.

And in communities that view this condition as God’s will, it seems as if everybody knows a guevote or a guevedoce.

On a single dirt road past the cement mine in Los Saladillos, an 89-year-old man evades the relentless sun under the shade of his wooden home.

His weathered face is marked with freckles and ridge-like wrinkles, evidence of decades of hard labor working the agricultural fields.

Carrasco has the same condition as Carlos.

As an old man, Carrasco has a full head of gray hair and aches that hinder his mobility, but his niece, Conda, with whom he has coffee with every morning, remembers her “Tio” as a handsome man who was always out on the streets with different girlfriends.

Though he doesn’t recall the exact moment he discovered his manhood, he speaks of the pain of not being able to have kids.

Most individuals with 5-ARD are unable to have biological children without assisted reproduction, according to the U.S. National Library of Medicine.

“Without children, you are nothing,” he said.

Carrasco lives alone in a small wooden shack, surrounded by dozens of yucca plants and towering mango trees, in addition to a variety of other vegetables he grows.

Though he’s surrounded by cousins, nieces and nephews that check in on him everyday, Carrasco longs for the children he never had, to take care of his weakening body and deteriorating land.

The saddest part of not having children comes from not having anyone to pass down his childhood home to, he said.

Still, his wrinkled face lights up at the sight of visitors, whom he always greets with a loving embrace.

Reflecting on life as a guevote, Carrasco says, “We are neither man nor woman, we are just something that God created.”

On the opposite side of Los Saladillos is El Proyecto, an even smaller community lined with cinderblock homes and fences held together by branches and barb wire.

Josenis Ruiz Perez sits underneath a large tree. She had to stay completely out of the sun for three months following her breast implants, she said.

She is also what some would consider a guevote, except she is one of the few that chose to remain living as a woman.

Still, she always felt it in her blood that she was female.

The self-proclaimed rebel would argue with her parents about her clothes, and even her doctor, Teófilo Gautier, who at first insisted on giving her boxers instead of panties.

Gautier was conducting a series of studies on what was then referred to as the “underlying etiology of pseudo-hermaphroditism” when he unexpectedly died in a car crash on his way back to Santo Domingo.

Although years have passed since his death, people still talk warmly about him.

“He was like a father,” said the 35-year-old, wearing a long denim skirt and her hair in a tight bun. “Everything we needed, he would provide for us.”

Gautier had even opened a clinic devoted to “genital ambiguity” at the Robert Reid Cabral Children’s Hospital in Santo Domingo. He cared for children like Perez and showered them with love, she said.

Despite his support, her life was tough growing up.

She began wondering why her hips and breasts weren’t developing like the other girls. In the schoolyard, some kids would tease her and call her a “machihembra”, meaning “half man, half woman.”

Perez was strong-willed though — even as a young girl. She fought back until she didn’t have to anymore, fighting for what she always wanted, to be accepted for the woman she always knew she was.

Now, she says, “My community accepts me; my neighbors show me love and respect.”

And that’s the small wonder of these pueblos.

Despite strict gender norms and the pervasive nature of machismo in the Dominican Republic, residents in these small towns have accepted guevotes and their gender fluidity.

Most attribute it to the idea that no one chooses to be born a guevote – it’s simply something that comes from God and people have to accept.

In a similar manner, Carlos is also learning to accept his gender identity, despite not feeling man enough without sex reassignment surgery.

Although his community supports him just as he is, living life as a guevote would be better with an operation, he said. He just hopes his family will be able to afford it one day.

“There isn’t discrimination here like there are in other countries,” said Inocencia Rodriguez, Carlos’ teacher. “They are human beings like everyone else, they are made of flesh and bone like us.”

She knew Carlos when he was Carla — a soft-spoken little girl with dark brown curls and brightly-colored dresses. Living just one street over from the Terrero family, she remembers the girl that used to play with dolls just as vividly as the boy who raises chickens for cock fights.

Still, Rodriguez welcomed Carlos with open arms, much like the rest of the community does with any other child born as a guevote.

“It’s a condition that comes from above, so who are we to defy God’s plan?”