Intersex intersectionalities with gender diversity

This page details some of the general differences and similarities between the experience of transgender/gender diverse and intersex individuals. In general, these comparisons reflect our understanding in Australia, but many of the same principles apply elsewhere.

Introduction

Intersex is not a part of the trans umbrella (such as transgender or transsexual) nor is intersex a form of gender diversity, because intersex is not about gender, or transition. Intersex is about bodies; about congenital physical differences in sex characteristics.

Intersex, transgender, and same sex attraction are distinct concepts and issues, and people with intersex variations face distinct health and human rights issues.

We recognise that some people born with intersex variations change sex classification, and that some identify with the trans community. Intersex people who change sex or gender classification may or may not associate that with any social or medical transition – for example, they may choose a classification that avoids or reduces stigmatisation due to their sex characteristics, or they may see the change in classification as correcting an error made by doctors at birth.

An overlap in these experiences is no more or less remarkable than when intersex or trans people are lesbian or gay. All LGBT and I populations overlap – but this means we have to recognise also that many intersex people are heterosexual and identify with sex assigned at birth. A conflation of intersex with being transgender or gender diverse fails to recognise that most intersex people identify with sex assigned at birth. Assuming that we are all the same, or that we pursue the same goals, obscures the specific goals of the intersex human rights movement.

Issues to do with sex and gender markers are not the most fundamental issue that intersex movement seeks to address. The most longstanding (and intractable) issue that intersex people face is a lack of bodily autonomy, and the risk of forced or coercive medical interventions. A particular difficulty faced by many intersex people who change sex/gender marker is the risk of forced and irreversible medical treatment to make their bodies appear more like their incorrect assigned sex. These human rights violations faced by intersex people who change sex/gender marker are obscured in flawed ideas that being transgender is somehow a kind of “brain intersex”. Such claims are not made by same sex attracted persons, despite comparable research.

More generally, all identity-based frameworks have limited application to the lived, material experiences of intersex people. As described by Morgan Carpenter, many human rights violations faced by intersex people occur before we are old enough to have agency to freely express any identity.

These issues highlight intersectionalities where discourse about transphobia and homophobia, and of the stigmatisation of LGBTI peoples, can fail to address the specific issues faced by intersex people. Kimberle Crenshaw coined the term intersectionality to describe precisely such concerns.

Issues that all LGBTI peoples share in common lie in the ways that we are stigmatised for failing to meet social or medical norms relating to sex and gender. These give stronger grounds for collaboration, in particular through recognition of the existence and intrinsic value of bodily diversity.

Comparisons

Trans/Gender Diverse

Intersex

  • Self-identified gender does not match sex assigned at birth.
  • Unless born with an intersex variation, possess full and functional reproductive capacity, at least prior to any chosen transition process.

  • Innate variations in biological sex characteristics do not fit medical and social expectations for female or male bodies.
  • The concept of sex assigned at birth was developed to describe the assignment of intersex children as girls and boys.
  • Most intersex people identify/live in line with sex assigned at birth, while a minority identify in other ways.

  • Medicalised and pathologised as Gender Dysphoria, formerly Gender Identity Disorder.
  • Able to participate fully and in an informed manner in their surgical and hormonal options.
  • Subject to financial considerations and regulations affecting access to gender markers, will have a chosen experience of transition, whether surgical and/or hormonal, permanent or temporary, and may make arrangements for fertility preservation.
  • Subject to financial considerations and regulations affecting access to gender markers, may choose the extent of any transition.
  • Subject to financial considerations, the ability to choose the time of gender affirmation.
  • Access to medication relating to diagnosis is subject to medical management, including psychological assessment.
  • Sterilisation for gender recognition violates human rights.
  • Irreversible surgical and/or hormonal intervention is prohibited at least until a person is old enough to consent with access to peer support.
  • Effective medical protocols exist for binary gender affirmation by adults.
  • An identical twin of a trans person may or may not be trans.

  • Medicalised and pathologised as Disorders of Sex Development (DSD).
  • Physical variations may affect the whole of the body including genetic, chromosomal and hormonal variations, and especially sex anatomy. May be accompanied in some cases by cognitive variations.
  • May have limited or no fertility due to innate or iatrogenic factors.
  • Early irreversible surgical and/or hormonal intervention is routine, prior to a person’s ability to personally consent, despite a lack of evidence of necessity and established adverse consequences for sexual function and sensation.
  • Forced and coercive medical interventions violate human rights.
  • Many diagnosis-specific medical protocols exist, with over sixty years of medical research, predominantly focusing on genitalia and “normalising” treatments.
  • No long-term follow-up, and no clear evidence of good outcomes.
  • Inappropriate and harmful medicalisation may occur if or when individuals do not conform with diagnostic or gender identity expectations.
  • Often surgery is conducted without consent; often surgery is coerced with no peer support.
  • Reparative surgery to deal with consequences of early interventions without consent may be regarded as elective or cosmetic, and not funded by Medicare.
  • An identical twin of an intersex person will also be intersex, except in rare recorded cases of mosaicism that stretch the definition of ‘identical’.

  • Basic public understanding recognises the existence of transgender people, often reduced to concepts such as being “born in the wrong body”
  • Public conceptions and understandings do not reflect the diversity of transgender experiences, but do not adversely impact the goals of the transgender movement.
  • The transgender movement is established and growing, with many people employed to work on systemic advocacy, campaigning, healthcare, and peer support.
  • Misconceptions about being transgender have consequences for mental health, and for seeking help from peers.
  • Can be subjected to stigmatisation and assumptions about personal identities, and subjected to body shaming.

  • Public confusion about the nature of intersex is widespread, often conflating intersex with non-binary gender identities or a third sex classification.
  • Public misunderstandings do not fit the reality and diversity of intersex lived experience, have no grounding in community declarations and the goals of the intersex movement, and adversely impact community organising.
  • The intersex movement is smaller and poorly resourced, with few people employed to work on systemic advocacy and peer support.
  • The intersex movement is well organised, with a regional declaration on intersex rights: the Darlington Statement.
  • Misconceptions about being intersex have consequences for access to healthcare services, and for access to peer support by individuals, families and potential families.
  • Read demographic data.
  • Can be subjected to stigmatisation and assumptions about personal identities, and subjected to body shaming.

  • As with same sex attracted people, physical differences may be apparent in a correlation with ‘brain sex’ differences (though we note that sex differences in the brain are vigorously contested as form of “neurosexism”).
  • Ideas are widespread that the existence of a biological basis for being transgender can promote the human rights of transgender and gender diverse people.
  • No prenatal testing or screening for ‘brain sex’ differences.
  • No selective termination on grounds of trans gender identity.

  • Prenatal testing available for many intersex traits, with selective termination possible on grounds that intersex traits are disorders of sex development.
  • Administration of harmful drugs to pregnant women in an effort to prevent intersex births with a possible outcome of brain damage to the foetus.
  • Intersex organisations contest discriminatory attitudes and practices in relation to the application of prenatal and preconception screening and genetic modification technologies.
  • More information on eugenics and intersex.

  • Participation of trans women in sport is complicated by a Court of Arbitration in Sport ruling that accepted a 10% performance difference between women and men in athletics, based on extensive data.
  • May be required to undergo irreversible surgeries to compete in sport in self-identified gender; able to compete as originally assigned sex.

  • Participation of women born with intersex variations in sport is problematised despite a marginal performance advantage, if any, and “sparse” supporting data.
  • May be required to undergo irreversible medical interventions to compete in sport in line with sex assigned at birth (with examples of such interventions including gonadectomies and clitoral surgeries).

The medical model for the treatment of people with intersex variations means that the intersex movement also has much in common with the disability movement.

Recommendations

Recognise the specific circumstances of intersex people and the actual goals of the intersex movement. Do not instrumentalise intersex people, for example, by referring to our existence in debates about the rights of other populations without attention to the rights of intersex people and the goals of the intersex movement.

Recognise the diversity of the intersex population, and promote respect for our sex assignments and gender identities. Resist the harmful reduction of intersex issues to sex markers and gender recognition.

Collaborate and work with us to end forced and coercive medical practices, and in pursuit of access to medical interventions on the basis of personal informed consent, supported by peers.

We believe that intersex people, and intersex-led organisations, must be centred in work on intersex issues.

Stories about being both

These articles were written by people who are both intersex and transgender, about the exerience of being both:

More on intersectionalities by Intersex Human Rights Australia

More reading on intersectionalities between being intersex and transgender, by Intersex Human Rights Australia:

More information

This page is not intended as an introduction to intersex. Introductory information, and reading on related issues:

This article was originally written for the Camp Betty Intersex 101 workshop in June 2011. This page is periodically updated.