More than half of states now have laws in place that bar access to gender-affirming care—the consensual, necessary healthcare that allows transgender teens and young adults to feel at home in their bodies. All of these bans contain a so-called “intersex exception”—usually named by the pathologizing term “medically verifiable disorder of sex development” in this legislation. The U.S. Congress, following dozens of state legislatures, has targeted gender-affirming care for federal-level restrictions also featuring these same “exceptions.” This creates a grave misconception that intersex people aren’t affected by gender-affirming care bans. It couldn’t be further from the truth.
Gender-affirming care bans threaten intersex healthcare.
Despite “exceptions,” intersex people across the country are losing access to necessary healthcare, just like transgender people are. Some intersex people require hormone therapy to supplement what their bodies make. Others suffered the unnecessary removal of their gonads in infancy, and need hormones to replace what their bodies used to make. Many have found that their doctors are increasingly reluctant to prescribe the hormones they need, worried that this care could be perceived as gender-affirming—whether or not the patient is transgender.
Gender-affirming care bans put intersex patients at risk of being denied their hormonal treatment, regardless of any “exceptions.” When policymakers ban gender-affirming care, they push their limited view of who a person is “allowed” to be onto everyone—how a person’s body can look and function, and who they can become. Their goal is to enforce a strict sex and gender binary. Adding an “intersex exception” doesn’t fundamentally change that.
Practically, an exception might only permit access to healthcare perceived as “aligned” with a person’s assigned sex. Limiting an intersex person assigned female at birth to estrogen therapy when their body does best with testosterone could effectively revoke their access to life-saving medical care. “Exceptions” also haven’t stopped intersex patients’ medical providers from being required to jump through new insurance-related hoops, all while intersex people going without needed medication suffer physical pain and health consequences such as hormonal crises, osteoporosis, anemia, and more.
“Exceptions” aren’t for intersex healthcare. They are for intersex mutilation.
Every state ban on gender-affirming care specifically exempts procedures on intersex children, endorsing the nonconsensual surgeries still performed on intersex infants across the U.S. Federal legislation attempting to restrict funding for gender-affirming care has started to follow suit.
These exceptions don’t protect consensual healthcare, but rather surgical attempts to “normalize” intersex infants’ bodies to fit narrow, binary stereotypes of what many doctors think male and female bodies should look like. Outside of rare medical emergencies, it is not medically necessary to perform these operations in infancy. Subjecting an intersex child to non-urgent genital surgery before they can weigh in on whether surgery aligns with their own wishes and needs is a violation of their human rights. This nonconsensual practice is called intersex genital mutilation (IGM), and the exceptions in gender-affirming care bans are IGM exceptions.
IGM exceptions aren’t about protecting intersex patients who need medical care—they’re about protecting surgeons who continue the non-consensual operations that hurt intersex children.
Intersex exceptions protect no one but the doctors performing IGM.
Historically, as well as currently, intersex mutilation is most commonly a result of the biases and perspectives of doctors. Hospitals around the U.S. still perform surgeries on intersex infants (usually under the age of two) who can’t consent. A surgeon may construct a vagina on an infant with the assumption the infant will grow up identifying as female and will want heterosexual sex in the future. Doctors will cut down an intersex infant’s clitoris to fit cosmetic stereotypes of “feminine appearance.” They may remove a person’s gonads at birth (sterilizing them) because those gonads are perceived as not “matching” the person’s assigned sex. Doctors commonly relocate a working urethra on a baby boy without medical problems based on cosmetic and social norms, frequently creating new medical problems in the process.
Intersex genital mutilation exposes children to risks they cannot consent to. Infant surgery often results in lifelong complications. Furthermore, rushing to operate in infancy may surgically conform a person’s body to a sex assignment that might be incorrect for them as they grow up and develop an understanding of their own gender identity. (This will be the case for at least 5% of intersex people—ranging up to 60% for people with certain intersex variations.) The intersex community and a growing number of medical experts have called for IGM to stop. The United Nations has described this practice as a human rights violation and a form of torture.
No infant should be subjected to unnecessary, irreversible surgeries before they can have a say in what they want for their own body. But these violations are the very practices that are given a pass by politicians who demonize the affirming care that transgender adolescents and adults desperately need.
Intersex mutilation exceptions preach control, not care.
The practice of intersex genital mutilation is strikingly different from gender-affirming care. Gender-affirming care is necessary medical care performed with a person’s informed consent in order to align their body with their own wishes and needs. Access to gender-affirming care is increasingly under threat, and far-right politicians have recently co-opted language around the “mutilation” of children in an effort to legitimize attacks on trans youth. There are real children being mutilated—but they are intersex babies, not consenting transgender adolescents.
Gender-affirming care is also critical healthcare for many intersex people. Some intersex people are also transgender and seek healthcare to affirm their gender identity. There are other times when intersex people who are not transgender need medical treatment that could be perceived as gender-affirming care, such as hormone therapy or surgery to meet healthcare needs specific to their intersex variation.
But under gender-affirming care bans, the reason intersex people seek healthcare does not matter. If the medical treatment an intersex person seeks doesn’t align with their sex assigned at birth, restrictions that target gender-affirming care might obstruct access all the same. Yet gender-affirming care bans make exceptions for IGM specifically because IGM is about reinforcing stereotypes associated with the assigned sex—with no regard for how the intersex person will identify as they grow. Intersex people are harmed by gender-affirming care bans—even those with “exceptions”—because the exceptions are not for protecting healthcare, but protecting the interests of doctors whose surgical practices seek to erase intersex traits.
Bans on gender-affirming care alongside endorsements of IGM to “normalize” infants’ intersex traits without their consent are blatant attempts to control people’s bodies and conform them to rigid stereotypes. Policies like this deprive both transgender and intersex people of bodily autonomy. We all have the right to make our own decisions for our own bodies—and no lawmaker has the right to strip our autonomy away.
