Trans & Intersex Are Separate Categories, But Our Fates Are Inextricably Linked.

In a world increasingly polarized by debates about LGBTQIA+ rights, it is more important than ever to recognize the fundamental human right to bodily autonomy. Unnecessary and non-consensual surgical interventions on intersex children and bans on gender-affirming care for transgender youth emerge as a reminder of the United States’ lack of protection for this fundamental human right. Young people navigating a path marked by resilience and vulnerability have found themselves at the center of social, political, and cultural storms. With each step they take, harmful and misleading discourse follows as debates about what rights they should be afforded proliferate. Discourses of societal acceptance, individual freedoms, and evolving cultural norms are invoked and tested. 

When considering the lack of gender-affirming care for transgender and intersex youth specifically, it’s essential to understand the nuanced differences between these two groups. While transgender people have a gender identity that doesn’t align with their assigned gender at birth, intersex children are born with variations in their sexual or reproductive anatomy (e.g., chromosomes, gonads, or genitals) that don’t fit typical binary definitions of male or female. People with intersex conditions are generally assigned male or female at birth despite their atypical anatomy. If they identify as a different gender than the one forcibly assigned to them, they may identify as transgender. However, intersex conditions are not inherently related to gender identity; an intersex person can have any gender identity including the one they were coercively assigned at birth. There is some overlap in the communities and advocacy issues (especially around bodily autonomy and self-determination) however, transgender and intersex experiences are distinct. 

Understanding these distinctions sets the stage for recognizing the broader societal challenges that trans and intersex people face, especially in light of recent legislative actions. In 2023 alone, GOP lawmakers have filed almost 200 state bills that are meant to erode any and all protections for gender diverse youth and restrict access to topics related to LGBTQIA+ people in public schools. As today’s transgender and intersex youth are thrust to the forefront of discourse around bodily autonomy, they highlight the urgent need for validation, acceptance, and celebration of LGBTQIA+ people. The crux of debates over trans youth engage the topics of gender-affirming care, trans kids in sports, LGBTQI+ representation in educational literature and drag queen story hours. Advocates for these restrictive measures frame them as “shields,” protective barriers for youth. However, critical introspection begs the question: From whom or what are we shielding these young people? 

Upon examining today’s political and social climate, it becomes clear who is truly harming gender diverse and intersex youth. The threat doesn’t come from drag queens championing self-expression, literacy, and positive LGBTQ+ representation. Nor does it arise from parents seeking to support their children’s self-exploration and autonomy. Intersex children frequently undergo non-consensual surgeries and sterilizations at ages too young for consent, while transgender children confront potential bans on gender-affirming healthcare. As we tackle this pressing concern and advocate for the rights of these youth-centered frameworks, justice and autonomy are paramount.

Thankfully, Black feminist frameworks, deeply invested in justice for marginalized communities, outline the way forward. One such framework is reproductive justice (RJ), coined in 1994 by Black women who understood the lack of intersectionality within the social justice and women’s rights movements. Reproductive justice is a particularly instructive framework for its emphasis on bodily autonomy, raising three core tenets that attest to the importance of gender-affirming care. Incorporating the internationally-accepted United Nations human rights framework, reproductive justice finds its foundation in three core tenets that emphasize the importance of bodily autonomy. These tenets include:

1. the right to not have a child

2. the right to have a child

3. the right to nurture the children we have in a safe and healthy environment

According to Dr. Toni M Bond, one of the twelve founding mothers of the reproductive justice movement, a fourth tenet, the right to sexual expression and autonomy, was added to the RJ framework in 2006. This tenet underscores an individual’s right to express their sexuality and gender identity without fear of coercion, violence, or discrimination. It was added to the framework eIt acknowledges humans as sexual beings who have the right to experience and act on sexual feelings and supports all people in seizing their right to self-determination of their gender identity. The right to parent one’s child in a safe and sustainable environment includes the right of parents to make sure their children have access to whatever healthcare they require, including gender-affirming care. Legislation targeting gender-affirming care strips trans and intersex youth of their right to determine who they are and how they wish to express themselves.

Bills targeting the right of transgender children to self-expression and bodily autonomy are also targeting intersex children by including clauses that allow doctors to continue performing medically unnecessary surgeries on intersex youth, ironically while also banning gender affirming care. For example, Texas Bill HB 1399 proposed this year would allow doctors to perform surgeries on children “born with a medically verifiable genetic disorder of sex development” as well as those who “do not have the normal sex chromosome structure for male or female as determined by a physician through genetic testing.” In other words, doctors are allowed to select a gender for intersex kids, often through the use of surgeries performed on their genitals and/or the administration of sex hormones associated with the gender they were assigned at birth. This means that these bills intend to allow physicians to force intersex children to undergo gender-affirming surgeries and interventions while simultaneously banning trans children from accessing much of the same life-affirming care. 

Lack of access to the care trans kids need in addition to non-consensual surgeries being performed on intersex children further alienates and invisibilizes both groups, driving home the message that their identities are not valid and their comfort is secondary. This, in itself, is a grave reproductive injustice.  In addition to the need for access to comprehensive reproductive healthcare, there is an immediate need for policies that help parents and families best support their children. Trans and intersex youth should be able to access gender affirming care and make their own decisions about their bodies and reproductive futures. 

Beyond mere medical interventions, gender-affirming care represents a societal acknowledgment of an individual’s identity. It encompasses a range of social, psychological, behavioral and medical care designed to support and affirm a person’s self-determined gender identity. Equally as important as gender-affirming care is a gender-affirming environment. Parents, physicians, teachers, and all other adults in a child’s life play a critical role in a child’s psychological development. Denying a child gender affirming care translates to denying their fundamental right to bodily autonomy; to exist in whatever way is most affirming for them without coercion. Additionally, the absence of gender affirming environments can lead to monumental ramifications: from psychological traumas like depression, anxiety, and suicidal tendencies to physiological ailments stemming from the misalignment of their physical realities and internal identities such as substance abuse, self harm, and unwanted puberty. The American Academy of Child and Adolescent Psychiatry recommends gender affirming care for transgender youth, including the use of puberty blockers  and secondary sex hormones. They oppose any legislative efforts to block access to these safe and medically recognized interventions. 

In navigating the many terrains surrounding the rights of transgender and intersex youth, some truths are irrefutable. Most important among them is the imperative to recognize, honor, and champion each individual child’s unique identity. Crafting a brighter, more inclusive future demands more than passive support; it requires proactive advocacy, education, and unwavering commitment. History shows us that societies oscillate between periods of acceptance and intolerance, reflecting the dynamic and evolving nature of social attitudes and discourse. As torchbearers of the present, it’s our job to expedite the transition to acceptance and celebration, ensuring an inclusive tomorrow for all, including children. Delving into the complex nature of intersex and trans kids’ journeys, marked by a shifting legal landscape and pervasive prejudices, we are all called to protect them from those who intend to silence their voices, hopes, and dreams. Because the last thing we need to protect them from is themselves.