I've been sitting with this topic for a while before writing about it, because I want to do it carefully. Intersex is a subject that gets discussed with good intentions and frequent imprecision, sometimes in ways that don't serve the people it's supposed to center. So I want to start with what is actually true, stay close to the voices and research that center intersex experience, and be honest about the places where society is still failing badly.

What Intersex Means

Intersex refers to people born with sex characteristics — chromosomes, gonads, hormones, or genitalia — that don't fit the typical definitions of male or female. This is not a single condition. It is an umbrella that encompasses dozens of distinct biological variations, including congenital adrenal hyperplasia, Klinefelter syndrome, androgen insensitivity syndrome, and many others. Some of these variations are visible at birth. Others are discovered at puberty, during fertility evaluations, or never discovered at all. Estimates of intersex prevalence vary significantly depending on which conditions are included. The figure most commonly cited by intersex advocacy organizations is approximately 1.7 percent of the population — a number drawn from Anne Fausto-Sterling's work at Brown University — though this figure encompasses a wide range of variation, some of which involves no visible difference and no medical implications whatsoever.

The Medical History That Still Shapes Experience

The history of intersex medical care is one that the medical community is still reckoning with. For most of the twentieth century, the dominant clinical approach to intersex infants was surgical: normalize the body, assign a gender, keep the intervention confidential. This approach was built on the theory, associated with psychologist John Money, that gender identity was entirely malleable and that surgery performed early enough would produce a child who identified unproblematically with their assigned gender. The evidence for this theory was thin and in key cases fabricated, as subsequent investigation revealed. Research from Johns Hopkins University tracking intersex individuals who underwent early surgical intervention found significant rates of later gender dysphoria, psychological distress, sexual dysfunction, and, critically, a profound sense of violation upon learning what had been done to their bodies without their knowledge or consent. The surgeries were frequently not medically necessary. They were aesthetically and socially motivated — performed to produce bodies that would be legible and acceptable to others.

The Consent Problem

The core ethical issue with non-consensual infant intersex surgery is not complex: an irreversible surgical intervention was performed on a person who could not consent, to address a social problem rather than a medical one, and that person was often not told what had happened. Many intersex adults discover their medical history through documents rather than conversations, because the conversations were never offered. A study from the University of California found that intersex adults who had undergone non-consensual normalization surgeries reported significantly higher rates of trauma symptoms, body dysphoria, and distrust of medical providers than those who had not. The major medical bodies — including the American Academy of Pediatrics — have in recent years moved toward deferring non-urgent interventions until the person can participate in decision-making. Implementation of this guidance is uneven.

A Tangent on the Distinction from Transgender

Intersex and transgender are distinct experiences, though they are sometimes conflated in public discourse. Intersex refers to biological sex characteristics. Transgender refers to gender identity. Some intersex people are transgender. Most are not. The conflation does harm in both directions: it implies that intersex people's gender identities are somehow determined by their biology, and it implies that transgender experience requires a biological basis. Both implications are wrong.

What Making Room Looks Like

Society has largely not caught up to the reality of intersex existence. Medical forms, legal documents, and social institutions still operate on binary assumptions that render intersex people invisible or force them into categories that don't fit. Making room means, at minimum, providing accurate information rather than silence, involving intersex people in decisions about their own bodies, and supporting research led by intersex people about what their communities actually need. It means listening before acting. This is not a high bar. It is, however, one that has historically not been cleared.