Mere moments after being sworn in as the president of the United States, President Donald Trump made a sweeping statement in his inaugural address:
“As of today, it will henceforth be the official policy of the United States government that there are only two genders: male and female,” Trump said.
Hours later, in one of his first executive orders titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”, he extended that to biological sex, stating: “It is the policy of the United States to recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality.”
But Dr. Ilene Wong, an adult urologist, says biological sex, like almost all aspects of biology, has never been black and white. There are people who are born neither 100% male or 100% female - these people are known as intersex.
“I define intersex as a biological condition that people are born with where either their gonads, chromosomes or internal, extra external genitalia don't conform to our society's standard definition of male or female,” Wong said.
Wong says intersex people have always been around - but have been referred to in many different ways throughout history.
“I think that for many people, there is this idea of the old-fashioned, you know, hermaphrodite, that you can have be born both,” Wong said, referring to a slur used to reference intersex people. “But I think that what intersex, to me, is the fact that there's a spectrum of male and female, and so intersex is anything within that spectrum when you don't conform to what people consider, 'normal.'”
Niki Khanna is an intersex person and a marriage and therapy therapist. She says the intersex community has long been misunderstood and overlooked.
“This executive order was designed to harm trans and nonbinary people, but the truth is they didn't even know that intersex people existed, right? I mean, they should have, right? But they didn't have an understanding that we existed. So we're sort of bystanders in this. We’re scattershot in the efforts that was put forth,” Khanna said.
While intersex is a biological condition, intersex isn’t inherently a gender identity. Khanna says the intersex community is made up of people with a variety of different identities - all of which are unique to each person.
“There's a slightly higher percentage of folks who are intersex who also identify as trans, but the vast majority of folks who are intersex identify with the gender that they were assigned at birth, i.e., they are cisgender or not trans, and so. And some people, again, will identify as being nonbinary for the identity,” Khanna said.
Around the world, it’s extremely rare for babies to be assigned “intersex” at birth, even if their external genitalia doesn’t clearly fit the traditional definitions of “male” or “female”.
That means many intersex children are assigned a binary sex at birth, no matter whether it actually reflects their biology. Many of these children grow up to identify with the sex they were assigned at birth, but some identify as trans or nonbinary.
Statistics referenced by the United Nations Office of the High Commissioner estimate that up to 1.7% of the global population is born with intersex traits - in Missouri, the intersex population has never been measured.
Sylvan Fraser Anthony is the legal and policy director at interACT, an organization that advocates for intersex youth. They identify as nonbinary, and say trans and nonbinary people were the targets of these executive orders - and many intersex people are also directly targeted because they are included in those communities, regardless of their intersex status. But Fraser Anthony says all intersex people - even those who identify as cisgender - are impacted.
“We've seen just a barrage of executive orders attacking trans people primarily, and many of these actions are going to also impact intersex people, even if they're not directly named or addressed in these orders or in the language being used by the administration right now,” Fraser Anthony said.
Fraser Anthony said some hospitals are already changing policies around providing care to transgender youth, making it hard or impossible for some patients to access things like hormone therapy. But these treatments aren’t optional or voluntary for some intersex people – some need specialized medical care that can involve hormones and surgery. For example, some intersex people don’t produce the hormones needed for normal bodily functions and need hormone replacement therapy, and some might require surgery to address conditions that could impact their health.
“I expect that we're going to see intersex people losing access to necessary and affirming care that they need as well, which they may or may not define for themselves as gender-affirming care,” Fraser Anthony said.
The Trump administration has routinely used phrases such as “chemical/surgical mutilation” and “non-consensual surgeries” when referring to gender-affirming care for trans and non binary people. Dr. Wong said these notions are inaccurate, and they ignore the real problem.
“You want to talk about genital mutilation? You want to talk about what they've done to intersex children historically?” Wong said.
She’s talking about actual non-consensual surgeries performed on intersex children, often newborn babies. It’s a medical practice that’s been well-documented since the 19th Century.
“Decades before they have even been able to to present their gender identity, before they're even able to talk and give consent,” Wong said.
Wong said these surgeries are less common now, but still happen. Sometimes, even without a parent’s knowledge. Wong says the surgeries can vary widely - some remove parts that aren’t “normally” there.
Wong said surgeries like these can be devastating and leave people with symptoms that last a lifetime - like trouble urinating, difficulty having children or the inability to have sex. One week before Trump was sworn into his second term, the U.S. Department of Health and Human Services (HHS) released a report calling for greater bodily autonomy for intersex people - the report has since been wiped from the HHS website.
Instead of focusing on non-consensual procedures, Wong and other advocates say current policy has targeted elective, consensual gender affirming care instead - completely overlooking practices the intersex community has long fought to eradicate.
“I mean, it's a completely different decision than that made by, you know, the parents of adolescent transgender children who are old enough to give access,” Wong said.
Fraser Anthony and other legal and policy experts say instead, current executive orders are only making it harder for intersex people to live their daily lives.
Marcia McCormick is a Professor of Law at St. Louis University and specializes in gender and the law. McCormick says it’s been hard to understand exactly how these executive orders can be applied under the law.
“What this one executive order purports to do is to make a federal definition for what sex is and gender is, and a federal policy on recognizing sex or gender, but the President does not have the power to do that. Congress might - but Congress as well, would be limited by the Constitution,” McCormick said.
McCormick said that as of right now, the biggest impact legally has been on federal documents. An “X” marker for nonbinary is no longer available for passports, and many transgender people have reported their federal documents have been reissued under their sex assigned at birth.
Fewer than half of states allow “X” gender marker designations, and many restrict sex designation changes on legal documents. In Missouri, “X” gender markers are not available, and a 2024 policy change from the Missouri Department of Revenue requires proof of surgery or a court order to change a gender marker.
Khanna said obtaining legal documents has always been hard for the intersex community - and has only been getting harder. But she said sweeping executive orders that state intersex people don’t exist are unprecedented - and create intense stress.
“What happens if I don't exist as a person, or if I'm not allowed to exist as a person, right? Then, do I lose my ability to have citizenship? Do I lose my ability to have an ID, regardless of the gender marker on that ID?” Khanna said.
Khanna said circumstances such as these - where the legal impact is uncertain and seems to change every day - make it scary for intersex people to live their daily lives.
“You know, if you say, for example, go through TSA, right? Your gender marker says one thing on the form, and that's been the gender marker you've always had. But you might go through the scanner and your body might look different than what the TSA agent is expecting it to say on the form with your gender marker because there's this expectation this gender marker equals this kind of body, right? And what sort of chaos might that - will you be accused of fraud? Which is the same sort of terror that a lot of trans people are experiencing as well,” Khanna said.
For now, Khanna emphasized the intersex community is experiencing a lot of uncertainty - and it’s scary. But she and advocates like Sylvan Fraser Anthony say the intersex community is here - it’s very real, and it’s never going away - and they’ll continue to fight for their rights.
“I would emphasize that people do still have the rights that they have, and we can't predict that those will stick around in the same form that they have existed in previously. But I would encourage people to not hesitate in asking for their rights to be enforced while we still have them,” Fraser Anthony said.
