The Washington Post

Intersex youths are also hurt by anti-trans laws, advocates say

- BY ANNE BRANIGIN

When Kristina Turner’s middle child, Ori, was around 4 or 5, she decided to steer them away from organized sports.

Around that time, Turner began reading about the obstacles South African track star Caster Semenya was facing competing internatio­nally. At 18, Semenya won the gold medal in the 800-meter race at the 2009 World Athletics Championsh­ips. But afterward Semenya, who has hyperandro­genism, a condition that causes her body to produce high levels of testostero­ne, was subjected to gender verificati­on tests. She was allowed to compete again but only if she took medication that altered her body’s natural hormone levels.

Ori is intersex, meaning they were born with sex traits associated with both male and female bodies. Turner feared the kind of discrimina­tion Ori might

encounter playing in organized sports.

“I was like, okay, I’m going to try to push the kids more towards art and music and other things,” said Turner, who lives in Washington state. If her children chose to play sports, she would support them, Turner said, but she didn’t encourage them to sign up for Little League or swim teams.

“I know that’s a minefield,” said the mother of three and advocate for intersex youths.

During the pandemic, Turner began mulling over those decisions: “It became more clear how much the politics of everything affected my parenting on unconsciou­s levels.”

The recent spike in state legislatio­n targeting transgende­r and queer children has raised alarm for Turner and other intersex advocates. Many of these bills explicitly target trans children and would make it more difficult to learn about themselves, play with their peers and get the kind of affirming care they have sought for many years, experts say. But the bills could also set a harmful precedent for intersex kids, whose needs and experience­s are often overlooked, advocates say.

“We have felt like we’re in a war for a long time — just trying to get care, talking to each other, navigating [the medical system],” Turner said. “It’s devastatin­g to see the war level up in this way when you thought you were actually getting progress.”

Many of the bills looking to ban gender-affirming treatments for trans minors, such as puberty blockers, chest surgery or hormone therapy, make explicit exceptions for people with intersex characteri­stics. In many cases, surgical procedures that are rarely performed on non-intersex children — such as vaginoplas­ties, which create or alter a vagina, or gonadectom­y, which removes a child’s gonads — are done when an intersex child is an infant or toddler. But those exceptions won’t protect these children, advocates say.

“There are a lot of overlappin­g issues between the trans and intersex community,” said Bria Brown-king, engagement director at Interact: Advocates for Intersex Youth, an organizati­on that advocates for intersex children. “What both communitie­s are really fighting for is the right to bodily autonomy.”

According to Interact, people born with intersex characteri­stics make up at least 1.7 percent of the population — a figure comparable to the share of people who are born with red hair. And that number doesn’t include people whose intersex traits show up later in life.

People can have a variety of intersex traits, such as not having the usual XX or XY chromosoma­l configurat­ion, undevelope­d or partially developed sex organs, or a mix of physical sex traits (those with androgen insensitiv­ity syndrome, for example, will have the external traits associated with females, but have internal testes instead of a uterus). While intersex describes a person’s biological traits, it is not a gender category — people who have intersex characteri­stics can identify as male, female, nonbinary or any other gender identity.

The medical community’s response to people with these traits has varied over the years. Many U.S. doctors will perform surgeries on intersex infants and toddlers to align them with a more typical male or female body. While some surgeries are needed to make a child’s body function properly, many procedures are more cosmetic, intended to “normalize” the kid’s appearance.

These surgeries are also a relatively recent phenomenon: U.S. doctors started performing them in the 1950s, a time when “pressure to conform to social norms was often unyielding,” three former U.S. surgeons general wrote in a 2017 analysis of the issue.

Today, physicians may recommend these surgeries but encourage parents to never tell their children about them, advocates say, meaning some never learn they are intersex. Physicians who advise parents to get these surgeries often cite concerns about the emotional trauma being intersex could have on kids, or future health risks.

Gender-affirming care bans like the ones recently passed in Alabama and Arkansas would ensure that doctors can still perform these operations on infants and young children, as well as give them other interventi­ons like hormone therapy — treatment that would be denied to trans teens under the same laws. Lawmakers who sponsor these types of legislatio­n say they are necessary to protect children from health risks, and prevent trans minors and their parents from making medical decisions they would later regret.

While some of the treatments trans youths and adults seek may be similar to those given to intersex kids, there’s a key difference, Brown-king said: Trans people are consenting to these interventi­ons, while intersex people usually are not. These gender-affirming care bans also uphold a harmful status quo for intersex youths, advocates say — one that forces parents and doctors to choose a gender in a way that could cause long-term physical and psychologi­cal damage.

A growing number of medical profession­als have pushed back against nonconsens­ual surgeries on intersex kids, saying that they should wait until children can make an informed decision about their needs. These procedures are not only unethical, these doctors say, but they can produce an array of irreversib­le complicati­ons, including scarring, sterilizat­ion, chronic pain, sexual dysfunctio­n and nerve damage.

There are also long-term psychologi­cal effects. Because follow-up care can be invasive (kids may undergo repeated genital examinatio­ns throughout their childhood), many intersex people feel stigmatize­d and traumatize­d by their doctors and develop shame around their bodies, Brown-king said. This damage can be compounded for intersex people of color, who already face systemic barriers to care.

In 2017, three former U.S. surgeons general who served under the Bill Clinton and George W. Bush administra­tions wrote a paper concluding that these infant “normalizat­ion” surgeries are “not justified” and often lead to greater physical and psychologi­cal harm.

“We hope that profession­als and parents who face this difficult decision will heed the growing consensus that the practice should stop,” they wrote.

Brown-king said these surgeries are ultimately based on fear and ignorance: They require parents and doctors “to make a lot of assumption­s about what gender they think their child would grow up to identify with and what type of body they think their child would want to have.” These assumption­s are rooted in the idea of a gender and sex binary, Brown-king added.

Laws targeting trans kids reinforce these misconcept­ions, said Brown-king — and that won’t just affect trans and intersex people. Advocates have pointed to legislatio­n barring trans girls from competing in female sports as particular­ly worrisome: Some have proposed genital exams to confirm children’s gender; some have empowered private citizens to enforce the bans by allowing them to sue schools if they suspect a trans girl is playing against cisgender girls.

“It means that anybody’s gender can be called into question,” Brown-king said. They pointed to recent political debates around how to define a woman: “There’s an image we have in our minds about the perfect type of woman” — somebody White, slender with features that are “unrealisti­c” for many women, Brown-king said. “If you have a body that doesn’t fit within that box, well, then it’s on you to do something about that.”

Turner, the parent and a former member of the Interact board, added that physicians who provide gender-affirming care for trans kids tend to be better equipped to take care of intersex patients. This includes simple behaviors that make children feel safe, such as using their correct pronouns.

Because of their public advocacy, Turner often fields questions from parents seeking advice on how to best support their intersex child. In response, Turner will often share the TED Talk they gave alongside Ori when Ori was 10: It gives parents solace to know that Ori is happy, healthy and confident in their identity, said Turner.

Now 15, Ori is just like any other teenager, says Turner — a “brilliant” nonbinary kid who likes anime and making art and is always on their phone. Still, with all the anti-trans rhetoric, Turner worries for the safety of Ori and her other two kids.

Turner particular­ly misses the time, before the pandemic, when Ori attended a kids’ day camp organized by Gender Odyssey, an organizati­on for trans youths.

“I remember asking one time, ‘Do y’all talk about being trans or being intersex?’ ” Turner recalled. “And Ori was like, ‘ No, we don’t talk about that stuff. We just play, and we all just get each other.’ ”

“I was like, okay, we’re making the right choice. They’re really happy.”

 ?? Istock/washington Post illustrati­on ??
Istock/washington Post illustrati­on

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