Intersex people in the United States have some legal protections, but significant gaps remain, particularly in protection from non-consensual cosmetic medical interventions and violence, and protection from discrimination. Actions by intersex civil society organizations aim to eliminate harmful practices, promote social acceptance, and equality. In recent years, intersex activists have also secured some forms of legal recognition.

History

Early accounts of intersex people in North America include those of English immigrant Thomas(ine) Hall, in 17th-century colonial Virginia and 19th-century Connecticut intersex man Levi Suydam, pronounced male and so eligible to vote. Early common law, like canon law, held that "hermaphrodites" were to be treated as male or female depending on the prevailing sex.E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812).

In September 2017, an intersex and non-binary student, Scout Schultz was shot dead at the Georgia Institute of Technology. In November 2017, Betsy Driver became the first intersex person openly elected to public office in the United States. Driver was elected as a council person in the New Jersey city of Flemington. Driver is the second publicly intersex person elected to office, following Tony Briffa in Australia.

Intersex medical interventions Since the mid-twentieth century, U.S. physicians have considered intersex status in infants a "psychosocial emergency" and performed "normalizing" or "reconstructive" genital surgery without considering non-surgical alternatives (e.g., counseling). When deciding whether to assign the intersex infant "male" or "female," the factors typically considered are potential for fertility and sexual penetration. These surgeries still continue in the U.S. today despite being medically unnecessary (that is, chiefly cosmetic) and potentially injurious to the patient's sexual pleasure.

The intersex movement The U.S. intersex movement developed in the 1990s and 2000s, through the establishment of the Intersex Society of North America (ISNA) and the AIS Support Group USA (now called AISDSD) in the 1990s, and Advocates for Informed Choice (now interACT), Bodies Like Ours, Intersex Initiative, and Organisation Intersex International, (now the Intersex Campaign for Equality) in the following decade.

The Intersex Society of North America (ISNA) was a non-profit advocacy group founded in 1993 by Cheryl Chase to end shame, secrecy, and unwanted genital surgeries.Re-membering a Queer Body , AISSG, syndicated copy of article from Undercurrents (May 1994: 11-13) by the Faculty of Environmental Studies, York University, Ontario.Re-membering a Queer Body , UnderCurrents (May 1994: 11-13), Faculty of Environmental Studies, York University, Ontario.Matthews, Karen (Oct 22, 2000). Debate Grows Over Using Surgery on Infants with Ambiguous Genitals. Los Angeles TimesMurrell, Nancy (October 28, 1998). Intersex group raises questions about genital surgery. Miami HeraldHackford-Peer, Kim (2005). Cheryl Chase Founds the Intersex Society of North America. in GLBT History, 1993-2004; 2005, p28-30, 2p Amongst other activities, it published the journal Hermaphrodites with Attitude.

Intersex activism between the late 1990s and mid 2000s led from demonstrating outside a national pediatric conference, to speaking inside clinical conferences, and the first human rights investigation into medical "normalization", by the Human Rights Commission of the City and County of San Francisco. However, coercive intersex medical interventions persist.

ISNA closed in June 2008 after supporting the creation of a new clinical term for intersex conditions, Disorders of Sex Development (DSD), albeit ambivalently as a means of opening "many more doors" and engaging with clinicians, and also supporting the establishment of a new organization, the Accord Alliance, set up to promote comprehensive and integrated approaches to healthcare. New organizations such as Intersex Campaign for Equality and interACT were since established with civil and human rights goals.

interACT has worked with MTV on the program Faking It, notable for providing the first intersex main character in a television show, and television's first intersex character played by an intersex actor. In 2017, interACT worked with model Hanne Gaby Odiele to tackle social taboos.

Physical integrity and bodily autonomy

Demonstration and American Academy of Pediatrics statement In October 1996, the American Academy of Pediatrics issued a press statement stating that:

The statement was issued in response to the first public demonstration by intersex people and allies, outside the annual conference of the Academy, in Boston on October 26, 1996. Morgan Holmes has written that the demonstration happened after activists Max Beck and Holmes were excluded from the conference. She states that the pair went to deliver an address, "on long-term outcomes and to challenging their still-prevailing opinion that cosmetic surgery to "fix" intersexed genitals was the best course of action", but were "met, officially, with hostility and were escorted out of the conference by security guards". The demonstration, by Beck and Holmes, with allies from Transexual Menace, is now marked as Intersex Awareness Day.

San Francisco Human Rights Commission report, 2005 A 2005 human rights investigation into the medical "normalization" of intersex people, by the San Francisco Human Rights Commission is thought "likely to be the first human rights report into the treatment of intersex people, certainly in the English language."

Clinical shift to Disorders of Sex Development In 2005, Cheryl Chase, Alice Dreger and others called for the replacement of the word "hermaphrodite" with "Disorders of Sex Development" (DSD). Later the same year, a clinical "Intersex Consensus Meeting" of US and European pediatric endocrine societies adopted "DSD" as a replacement for both intersex and hermaphrodite in medical settings.

The new language of Disorders of Sex Development was always contentious as was seen as pathologizing. Scholars and activists, such as Georgiann Davis, and Morgan Holmes, Esther Morris Leidolf, and clinical psychologists like Tiger Devore regarded this shift as a retrenchment of medical authority over intersex bodies. In May 2016, interACT published a statement opposing pathologizing language to describe people born with intersex traits, recognizing "increasing general understanding and acceptance of the term "intersex"".

A 2017 study by Lurie Children's Hospital, Chicago, and the AISDSD Support Group found that 80% of affected Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive. The hospital found that "disorders of sex development" terminology may negatively affect care, give offence, and result in lower attendance at medical clinics. The research results for "disorders of sex development" mirrored earlier results from a survey of a congenital adrenal hyperplasia support group, the CARES Foundation.

International advocacy In 2013, Pidgeon Pagonis testified for interACT before the Inter-American Commission on Human Rights about the medical interventions they were subjected to as an intersex child, alongside Latin Americans Mauro Cabral, Natasha Jiménez and Paula Machado. In 2014, Anne Tamar-Mattis was published on medical interventions as torture in healthcare settings, in a book by the Center for Human Rights & Humanitarian Law at American University Washington College of Law.

In 2016, the United Nations Committee Against Torture asked the United States government to comment on reports of intersex medical interventions on infants and children, following submission of a report by interACT.

Surgeons General statement, 2017 In June 2017, Joycelyn Elders, David Satcher, and Richard Carmona, three former Surgeons General of the United States published a paper at the Palm Center, citing a State Department statement and developments in Germany, Switzerland, Australia, Chile, Argentina, and Malta, and calling for a rethink of early genital surgeries on children with intersex traits. The statement reflected on the history of such interventions, their rationales and outcomes, stating:

Human Rights Watch/interACT report on U.S. children, 2017 In July 2017, Human Rights Watch and interACT published a report on medically unnecessary surgeries on intersex children, "I Want to Be Like Nature Made Me", based on interviews with intersex persons, families and physicians. The report states that:

The report found that intersex medical interventions persist as default advice from doctors to parents, despite some change in some regions of the U.S. and claims of improved surgical techniques, resulting in an uneven situation where care differs and a lack of standards of care, but paradigms for care are still based on socio-cultural factors including expectations of "normality" and evidence in support of surgeries remains lacking. "Nearly every parent" in the study reported pressure for their children to undergo surgery, and many reported misinformation. The report calls for a ban on "surgical procedures that seek to alter the gonads, genitals, or internal sex organs of children with atypical sex characteristics too young to participate in the decision, when those procedures both carry a meaningful risk of harm and can be safely deferred."

The American Academy of Pediatrics acknowledged the report as an important contribution to research.

Responses to developments

In a 2017 interview for Harper's Magazine, Laurence Baskin, chief of pediatric urology at University of California, San Francisco, told journalist Sarah Topol "that he would recommend early surgery not just for 5-alpha but for 95 percent of known D.S.D. conditions ... Baskin classifies such operations as corrective surgeries, no different from fixing a cleft palate or clubfoot. "We basically treat them because they have a congenital anomaly"."

In response to the 2017 Human Rights Watch report, Associated Press reported opposition to a ban by CARES Foundation, arguing that parents should be able to agree to surgeries to "reduce the size of the clitoris" without considering "moral and philosophical agendas". Kyle Knight of Human Rights Watch responded that there's no evidence of a health risk, and "There are limits to what parents can do to their kids". interACT states that they are "unaware of any jurisdiction in the U.S. that enforces its own FGM laws in cases where the girl undergoing clitoral cutting has an intersex trait".

In November 2016, GLMA: Health Professionals Advancing LGBT Equality passed a new policy position on patients with differences in sex development, recommending "delay of any surgical interventions and gender-related medical interventions for DSD that are not deemed medically necessary".

Associated Press reported in July 2017 that the American Medical Association Board of Trustees is considering a policy statement "urging doctors to defer intersex surgery on infants and young children" "except when life-threatening circumstances require emergency intervention".

On August 28, 2018, California became the first U.S. State to condemn nonconsensual surgeries on intersex children, in Resolution SCR-110.

Remedies and claims for compensation

M.C. v. Aaronson