Trump administration policies will create worse health care for intersex people like me

Those of us who are intersex have always faced medical and social harm. But what is happening now is something altogether different: the government’s attempt to erase our very existence.

On Inauguration Day, President Trump issued an executive order that declared, “It is the policy of the United States to recognize two sexes, male and female.” New guidance from the Health and Human Services Office of Women’s Health also defines “sex” in a way that excludes intersex people as well as transgender individuals. Defining males as limited to people producing sperm and women as limited to those producing eggs erases millions of Americans. 

The newly released HHS guidance acknowledges that there are some “rare disorders of sexual development” but says we “do not constitute a third sex because these disorders do not lead to the production of a third gamete.” It attempts to clarify further, stating, “The reproductive system of a person with such a disorder does not produce gametes other than eggs or sperm.” It seems the Trump administration is arguing that people like me are neither male nor female but simply “disordered.” 

For decades, people born with intersex traits have been subjected to medically unnecessary nonconsensual surgeries and other harmful treatments in a futile attempt to assign them as either female or male using medications and surgeries. However, the new HHS guidance states that the use of hormones or surgical intervention does not change a person’s sex because “such actions do not change the type of gamete that the person’s reproductive system has the biological function to produce.”

This new guidance is clearly aimed at erasing the existence of transgender individuals who have undergone gender-affirming care. However, using that same logic, it also can be interpreted to recommend an end to harmful so-called gender normalizing surgeries on intersex infants and children, which are merely cosmetic and do not change their ability to reproduce. If such interventions don’t make us either female or male, and there is no accepted third sex, then what are we? Where do we fit in?

I have androgen insensitivity syndrome, one of the more common intersex conditions. Assigned female at birth, I have always identified and lived as a woman and have raised a family with my husband of more than thirty years. I also happen to have XY chromosomes, was born with testes inside my abdomen that can’t produce sperm, and have no ovaries. Like so many others, I underwent surgery as a child in an attempt to “normalize” my healthy, well-functioning body, and have suffered lifelong physical and emotional harm as a result. 

It is extremely painful to not only be erased but not to be considered female based on my biological inability to reproduce. What’s next? Vice President JD Vance has made it clear that, in his view, a woman’s primary role is to produce and raise children. 

The Trump administration’s restrictive binary definition of sex is not only invalid scientifically but also unconstitutional, violating rights to equal protection and privacy. Recently, a Montana court declared legislation attempting to define sex and binary at birth as discriminatory against trans, intersex, and two-spirit individuals. There will no doubt be similar future federal court cases. 

In the meantime, the impact of this administration’s reckless discrimination will include limiting necessary research and restricting access to desperately needed intersex-competent health care.

As an adult I have never been able to find competent intersex-affirming health care. I have struggled with the impact of losing my natural hormone production due to a forced childhood gonadectomy and the effects of hormone replacement therapy as well as profound mental health issues caused by the shame and stigma resulting from medical secrets and lies. Not finding out the truth about my body and what was done to me as a child until age 41 meant that I was not able to share accurate information with, or ask the right questions to, the medical providers caring for me for many years. Today, as a 59-year-old, I have learned to adapt by clumsily advocating for myself, but others have not been as fortunate. So many intersex people, including those much younger than I, report physical harms including chronic pain, loss of sensation and/or sexual function, urinary or vaginal complications, or early-onset osteoporosis. Much of the research into these problems would by nature involve “banned words” that are now flagged in NIH and VA grants.

Moreover, the new policies will force intersex individuals back into the closet due to reinforced stigma, shame, and perhaps even fear for their physical safety.

It’s particularly heartbreaking because just in the last few years, intersex Americans were finally starting to be acknowledged. The Biden White House hosted several listening sessions for intersex individuals to raise their voices in the People’s House for the first time. The Department of Education published guidelines for supporting intersex youth in schools. Then, four days before the inauguration of President Trump, HHS released a ground-breaking report on advancing intersex health, acknowledging our existence and making strong recommendations to fill the gaps in health equity across the lifespan.

As reported by HHS, the barriers to health for intersex people like myself are glaring, leading to unnecessary health risks, poor outcomes and medical mistrust caused by negative health experiences. Doctors and other health care providers need better medical training and cultural competency. Patients deserve better monitoring of potential side effects and complications from medical interventions, an awareness of potential comorbidities, reproductive and sexual health, and access to affirming primary care providers.

The Trump administration quickly removed this crucial health report along with the DOE guidelines from government websites. Most recently, the Federal Department of Veterans Affairs rescinded a 2018 policy providing for the respectful delivery of health care needs to the transgender and intersex veteran populations.

Intersex Americans like me can’t be erased by medicine or the government. We aren’t going anywhere, and we deserve better medical care.