Intersex surgery is condemned by the United Nations. Anti-trans bills are allowing it.

This story was originally published by The 19th

When Georgia lawmakers advanced a bill earlier this month that would ban gender-affirming care for youth, many argued that kids were too young to be making big health care decisions.

“We’re asking that children be 18 years old before they make this decision that will alter their lives forever,” Republican Sen. Carden Summers said, according to an ABC news article.

Summers’ argument is not uncommon. Opponents of trans rights have argued that kids are ill-equipped to decide on gender-related medical interventions. Those arguments largely confuse what gender-affirming health care for youth is. 

Still, Georgia’s bill does not outlaw irreversible gender-related surgeries on all kids. In fact, if the bill becomes law, Georgia will become one of several states to pass laws backing pediatric sex-related surgeries that have been condemned by the United Nations for more than a decade: those for people born intersex. 

More than two-thirds of the bills introduced this year that would ban gender-affirming care for transgender youth have specific intersex exemptions. The controversial exemptions allow doctors to assign minors who are born with secondary sex characteristics as “male” or “female” through surgeries, hormones or other interventions. 

“So you’re saying that trans kids are too young to consent, but intersex kids aren’t?” asked Bria Brown-King, director of engagement for the intersex rights group InterAct. “How does that make sense?” 

Sean Saifa Wall, an intersex scholar and activist, believes that medical interventions for trans kids and intersex kids have become conflated.

“We as a society do not understand the experiences of trans people and trans children,” said Wall. “A lot of trans young people don’t get surgeries until they’re 18. That’s what often happens to intersex young people, but because we don’t understand, we don’t understand neither trans nor intersex experiences, these bills float on by.”

Intersex conditions are common, according to scientists. A 2000 study by Brown University professor Dr. Anne Fausto-Sterling found that 1.7 percent of the population is born intersex. That’s about the same percentage of people born with red hair. 

While doctors have operated on intersex minors to assign them “male” or “female” sexes for decades, human rights organizations have long condemned the surgeries on kids as cosmetic, unnecessary and inhumane. That’s because many procedures are done on kids in infancy, without their knowledge or consent. 

Intersex adults often only discover they are intersex by accident, they report. Some have grown up being told by doctors or parents that they had painful surgeries because they had cancer. In reality, they learned, the surgeries were done to assign them a binary sex.

In 2013, the United Nations issued a report that called for an end to “genital-normalizing surgery, involuntary sterilization, unethical experimentation, medical display, ‘reparative therapies.’”

“A lot of these things are presented as medical problems that require fixing that are not actually medical problems,” Maddie Moran, director of communications for InterACT, said. 

The movement to outlaw intersex surgeries in the United States has made big strides in the last three years. Two prominent hospitals — Chicago’s Lurie Children’s Hospital and Boston Children’s Hospital — have stopped offering pediatric intersex procedures. The Biden administration has also been meeting with intersex advocates to talk about how to end the surgeries nationwide. In the meantime, California, often a leader on LGBTQ+ rights, has introduced a bill to ban pediatric intersex surgeries. The bill has yet to gain enough support to pass. 

But as the intersex rights movement becomes more mainstream, it has also become a target. According to InterAct and the National Center for Transgender Equality, more than two-thirds of the bills that target transgender medical care introduced this year (82 out of 120) have carve-outs for pediatric intersex procedures. Those carve-outs have consequences, advocates say:  Some of the first explicit anti-intersex language is being written into law. 

“The bills are really authorizing in the law, the practice of performing these unnecessary surgeries,” Moran said. “They are surgeries that are already happening . . . but they are now authorizing that practice in the law, which is the opposite of the direction that we want to be going.”

Wall thinks the bills are not about protecting children at all and said they are really about reinforcing rigid gender ideals and heterosexuality. 

“I see the attack on trans people, and I see the mandates to continue doing surgeries on intersex infants and children as a way of crushing bodily autonomy as a way of upholding ‘male’ and ‘female’ as sacred,” he said. “This harm has been really endemic and it’s been long-standing. The scary part about it, though, is when there’s a codifying it into law.” 

The 19th is an independent, nonprofit newsroom reporting at the intersection of gender, politics and policy.