Gender-affirming care is under attack — for everyone. A wave of legislation and executive actions have targeted transgender people, particularly teens, by stripping away gender-affirming care and other essential rights, but intersex people and anyone who doesn’t conform to strict sex binaries also stand to lose something as a result.
While we usually talk about gender-affirming care in relation to trans people, research suggests that cisgender people are most commonly the recipients of these kinds of treatments. Though we do also hear about intersex people when gender-affirming care comes under attack, we’re not getting the full story.
Intersex people are born with variations in their sex traits that deviate from what is considered “typical” for male or female bodies. They might identify as cisgender or transgender, but either way, many need the same health care that trans people do.
For intersex people, gender-affirming care can mean hormone therapy for teens whose bodies do not naturally produce their own, don't make enough, or make too much. It can look like facial or bodily feminization or masculinization to align with gender identity in people whose sex was incorrectly assigned at birth due to their intersex traits. For some intersex people, incorrect sex assignments are surgically enforced before they can have a say.
In many bills that ban gender-affirming care for trans people, there is what’s called an “intersex exception,” a clause that, judging by the name, suggests it protects care for intersex people. Instead, these clauses permit nonconsensual surgeries to “normalize” the sex characteristics of intersex babies and children. This kind of legislation often attempts to penalize doctors providing consensual care to trans teens, while protecting surgeons who operate on intersex infants who cannot consent.
At first glance, bills with “exceptions” suggest that intersex people’s access to medical care isn’t affected. Instead, these bills protect a kind of intervention we don’t want and can’t consent to, while jeopardizing necessary health care, such as access to hormone replacement therapy for intersex people across the country.
Here, six intersex people explain why they deserve unfettered access to gender-affirming care — and why trans teens do too.
Spencer, 21 (they/them)
My name is Spencer, and I’m 21. I’m a Deaf ASL user, I work in the kitchen of a family-owned restaurant, and I run craft booths in the summer.
Gender-affirming care is the reason I was able to experience puberty and can function as a college student. I was born without any functioning gonads, which makes my body unable to produce an adequate amount of sex hormones like testosterone and estrogen.
Until I started hormone replacement therapy (HRT) as a pre-teen, I was experiencing unmanageable fatigue, cognitive difficulties, and muscle weakness that kept me home from school and “othered” by my peers. HRT allowed me to finally begin puberty and hit the developmental milestones I’d been missing out on.
At a young age I was able to access the medical care I needed, but as an adult I now have to jump through hoops so I can continue receiving hormones and avoid a medical crisis — hoops that have been written into the law more and more as I’ve aged. It should not take me months to receive the medication I’ve needed since middle school.
Tendaji, 25 (he/she)
I’m Tendaji, a 25-year-old transfem person who produces music and writes poetry.
I was born with PCOS (polycystic ovary syndrome), and the cysts on my ovaries have left me both physically bedridden for months and mentally in anguish because I could no longer do the things I love.
I started taking testosterone this year and felt my life begin to turn around. I felt energized again. I was no longer entirely bedridden and could feel my mental health improve due to my physical health being taken care of now too. For the first time, I felt my life beginning to take shape again — all because my doctor took my concerns as an intersex person seriously.
Gender-affirming care for me is more than a way to ease my dysphoria. My testosterone is also my health medicine, a lifesaving hormone that has allowed me to function as a human being. Myself and countless other people shouldn’t have that right stripped from us due to bigotry and ignorance.
Emory, 29 (they/them)
I’m Emory, I’m a computer scientist and I live with my partner and cats in Kentucky.
To me, access to gender-affirming care is about consent. Because of a needless surgery when I was a baby, I lost the ability to produce my own hormones. That surgery was intended to change my gender forever, but I had no say in it. Doctors looked at my body, and they couldn’t decide whether to mark M or F on my birth certificate. So instead of changing the form, they tried to change my body.
What I experienced is the opposite of gender-affirming care; it's gender enforcement. And that's the reality that intersex young people face when they are treated without their informed consent. In my state, there’s a new law that bans any kind of gender-affirming care for young people. It also says that every kind of gender enforcement on intersex people is fair game.
I deserved to make those decisions for myself, and I needed support to help me do that. That’s what gender-affirming care means to me. Everybody deserves autonomy, and everyone deserves community. I hope I get to see that in my lifetime.
Courtney, 25 (they/them)
I’m Courtney, a graduate student and writing teacher who enjoys fiber arts, bad reality TV, and good books.
Because of my intersex variation, access to hormone replacement therapy is life-or-death for me. I have a rare and potentially fatal type of periodic paralysis that impacts all of my muscles, including ones needed to breathe and pump blood.
It is technically hormone replacement therapy that regulates my symptoms. As someone living in a conservative state with ongoing challenges to HRT access, doctors have been wary to prescribe medically necessary, life-preserving medications for fear that such care will violate state and federal restrictions.
An intersex exception would not help guarantee access to care, since I will continue to get progressively and irreversibly worse the longer that I cannot access treatment. I would have to find a doctor brave enough to fight for an exception and undergo the time-consuming and paperwork-intensive process of proving an exception, all the while still extremely sick and getting sicker.
Nessa, 24 (she/he/they/any)
I’m Nessa, a 24-year-old professional videographer living in Maryland.
As an intersex endocrinology patient, I had been on birth control pills for years. I was told by doctor after doctor that it was the only treatment for my sex hormone imbalance, and that if I stopped, I wouldn't get my period anymore. Then, they said, I would get cancer.
I tried and tried and tried, but after a third failed attempt at hormonal birth control to raise my estrogen levels, I'd had enough and quit my medication, accepting the risk that came with that.
Years later, I was taking testosterone injections under the care of an endocrinologist for gender-affirming reasons, and I loved every change it brought to my body: the light dusting of a beard across my jaw; the depth and richness my voice developed; the way it changed the shape of my body from curvy to rectangular.
For the first time in my life, a doctor told me that testosterone injections came with the side effect of thinning out the lining of my uterus, reducing the risk of reproductive cancer. Doctors usually don't recommend testosterone to cisgender, non-intersex patients because of the masculinization it causes. In my case, testosterone literally and tangibly has saved my life.
Because of my assigned sex at birth, a gender-affirming care ban would bar me from taking the only endometrial cancer reduction drug that has ever worked for me. My life and welfare depends on gender-affirming care.
Elliott, 23 (he/him)
My name is Elliott. I’m a grad student in a master of public health program and passionate about harm reduction, disability justice, and intersex liberation.
As an intersex and trans person, accessing gender-affirming care is vital for my health and well-being. I’ve been taking hormones in one form or another since I was 14. Due to my intersex variation, I will require access to hormonal therapy for my whole life.
Informed consent for gender-affirming care allowed me to take charge of my own health journey, access hormones that meet my medical needs, and heal from the devastating emotional impact of surviving forced medical interventions as an intersex child.
Gender-affirming care bans often use the language of “safety” and “protecting children,” but we know better: Bans aren’t bringing safety; they’re promoting paternalistic control at the expense of intersex and trans people’s lives. Although intersex people deserve protections from coercive treatment, gender-affirming care bans are not the way to achieve that. Bans like these just cut us off from accessing lifesaving, affirming care that we chose.
Ultimately, intersex and trans people deserve the bodily autonomy to make our own informed decisions about the health care that we need to live.
