Jeffrey Eugenides' epic novel, Middlesex, tells the story of a hermaphrodite named Cal raised as a girl in the 1970's. Cal's hermaphroditism is the result of a mutated gene passed down by her grandparents. The main conflict in the novel, and in Cal's life, is obvious because it is physical. As she grows up and enters adolescence, she does not develop as normal girls do. Instead, her body stays boyish. What's more, she begins to experience feelings of attraction for other girls. Both of these occurrences lead her to choose the life of a male rather than a female.
Related to this is the conflict that many emigrants to America face. Because of their customs and their lifestyle, Cal's family are treated as outsiders by the other suburbanites. This only makes Cal's struggle to fit in even harder.
There is also an underlying conflict in the novel between fate and choice. This conflict is first raised when Cal tells the story of her grandparents' emigration from Greece to America. Though they were brother and sister, they fell in love with each other. They may have been fated to fall in love, but they choose to run away to America and live as husband and wife. Because of their incestuous marriage, they pass down the mutated gene which causes Cal's predicament--fate again. Yet again, Cal has a choice. Rather than continue to live as a woman, she chooses to have an operation and live as a man.