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In humans, biological sex is determined by five factors present at birth:<ref name="KnoxSchacht2011">{{REFbook
| last=Knox, |first=David; |last2=Schacht, Caroline | firstfirst2=Caroline | year=2010 | title=Choices in Relationships: An Introduction to Marriage and the Family | url=http://books.google.com/books?id=iVOXAp27iQkC&pg=PT64 | work= | editor= | edition=11th edition | volume= | chapter= | pages=64 | location= | publisher=Cengage Learning | isbn=9781111833220 | quote= | accessdate= | note=
}}</ref>