How the Biden administration can help intersex kids, according to experts

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Policymakers should not be 'enforcing very narrowly defined conceptions of what people's bodies should or should not look like,' one expert said.

The federal government should make policy moves to protect the rights of intersex people, especially intersex youth, who are often put through physically and psychologically harmful medical procedures as children, experts say — and the Biden administration can take the lead.

Along with interACT, an organization that advocates for the rights of intersex youth, the Center for American Progress surveyed 1,528 LGBTQ adults, including some who identified themselves as intersex — or, born with differences in their sex traits and reproductive anatomy — in 2020, seeking to learn more about the most pressing issues facing them today.

According to that survey, LGBTQ intersex people reported experiencing higher rates of discrimination in health care than non-intersex LGBTQ people.

Specifically, 88% of LGBTQ intersex people surveyed said they had been discriminated against by a health care provider or physician in the past year, compared to 19% of LGBTQ non-intersex people. Such discrimination may include physical abuse, refusal of care, or hurtful language.

Additionally, LGBTQ intersex individuals are often "subjected to nonconsensual, medically unnecessary interventions to alter natural variations in genital appearance or reproductive anatomy with the aim of conforming their bodies to binary sex stereotypes," the survey data showed.

"The United Nations has found that these forced and coercive intersex surgeries on minors, frequently performed without their full, free, and informed consent, 'violate rights to the security of person, right to bodily and mental integrity, freedom from torture and ill-treatment, and freedom from violence,'" the Center for American Progress wrote in a summary of its findings on Tuesday.

Such unnecessary or coerced medical procedures may leave lasting psychological damage in addition to any unwanted physical harm. As the Palm Center, a think tank based at the University of California, Santa Barbara, noted in a 2017 policy brief, "While there is little evidence that cosmetic infant genitoplasty is necessary to reduce psychological damage, evidence does show that the surgery itself can cause severe and irreversible physical harm and emotional distress."

The answer to these types of problems, the summary authors suggested, could at least in part be intervention at the federal level.

Caroline Medina, policy analyst for the LGBTQ research and communications project at the Center for American Progress, who compiled the summary along with research assistant Lindsay Mahowald, told the American Independent Foundation that research on intersex people should be expanded in federally funded surveys to better understand how to implement policies to improve the health and well being of intersex people. They added that the Department of Health and Human Services could also launch a campaign to better educate health care professionals on how to properly treat intersex patients.

"[Awareness campaigns] are important to the public and certainly for medical professionals, and are about the need to provide affirming care that respects the rights of intersex folks and their ability to participate fully in decision-making by delaying these kinds of procedures until they're able to provide that consent," Medina said.

Education campaigns may also help mitigate the damage done by discriminatory legislation at the state level, which has recently targeted intersex people specifically.

Bills banning transition-related care such as hormone therapy, puberty blockers, and surgery for transgender young people under the age of 18 often include provisions that say procedures on intersex kids — or as one Texas bill worded it, children who don't "have the normal sex chromosome structure for male or female as determined by a physician through genetic testing" — are not subject to these restrictions.

InterACT has condemned those exemptions, writing on its website, "These bills attempt to set a standard for how individuals can feel good in their bodies, and what a 'normal' body should look like, in regards to sex and gender. We support our transgender peers in their fight to access necessary care. It’s all about individuals leading decisions about their own bodies."

According to the LGBTQ advocacy group Freedom for All Americans, 33 separate bills or laws have been introduced at the state level recently that include statements carving out such exemptions. Fourteen of those bills were introduced in the Texas Legislature. One, an Arkansas law prohibiting treatment for gender dysphoria that made an exemption for surgeries on intersex kids, was blocked by a federal judge in July following a lawsuit from the American Civil Liberties Union.

An education campaign could help mitigate the harm caused by these bills as well, Medina said.

"These bills are deeply harmful for so many reasons, even if they don't get passed, just in terms of the environment and the climate that they create," they explained. "And it's very fear-based and about pushing forward and enforcing very narrowly defined conceptions of what people's bodies should or should not look like or how people should identify. That in and of itself causes a lot of harm."

The Biden administration has indicated its support for intersex individuals in the past.

On Oct. 26, the State Department tweeted in honor of Intersex Awareness Day, writing that it was "committed to promoting and protecting the human rights of intersex persons.” And on Wednesday, the department issued the first ever U.S. passport with an X gender marker, the culmination of a previously announced policy change benefiting anyone for whom the "M" or "F" designation did not fit.

Civil rights groups are now pushing for all federal agencies that produce documents with gender markers to add an X designation, with a number of them writing in a letter to the White House in June, "This government-wide issue requires a timely and consistent whole-of-government approach across all federal agencies that only Presidential action can ensure. While many other actions are needed, or currently underway, to ensure safety, health, and equity for LGBTQI+ people—especially trans and intersex youth—this is an issue where you, Mr. President, can act decisively and immediately to improve people's daily lives."

Published with permission of The American Independent Foundation.