Changing Times

“The times they are a-changin,” Bob Dylan once sang.(1) Dylan’s song may have been from 1964, but the lyrics can be applied to the present day. Very recently, the world, and the United States in particular, has seen rapid changes in political landscapes.

For instance, America has seen an increase in anti-transgender legislation over the last several years, but also in the past few weeks and months. Many of these laws seek to ban gender-affirming care for transgender, gender non-conforming, and non-binary people, youth in particular., Another bill was introduced just 1 week prior to this post that would make it illegal to identify as transgender on legal documents in Texas, calling it “gender identity fraud,” and carrying with it potential felony charges and jail-time.(2)

What many don’t know is that in addition to charges like the one above, many of these bills also contain exceptions that allow for non-consensual surgeries to be performed on intersex infants and children. The Human Rights Watch states that these procedures on intersex children “are justified by decision-makers on the grounds that they will reduce stigma and prevent gender dysphoria, but they often have the opposite effect and also carry risks of scarring, loss of sensation, lifelong sexual dysfunction, urinary incontinence, psychological trauma, and permanent sterilization.”(3)

For example, in January 2025, an Executive Order from the United States government stated that it would “not fund, sponsor, promote, assist, or support” gender-affirming care for children under the age of 19 “and it will rigorously enforce all laws that prohibit or limit” gender-affirming procedures and treatments.(4) Many American hospitals immediately paused surgical and hormonal gender-affirming treatments for patients under the age of 19 following the order.(5) However, it was found by March 2025 that despite gender-affirming surgeries being paused, non-consensual surgeries were allowed to continue and were still being performed on Intersex infants and children during that time. These non-consensual Intersex procedures were performed by many of the same providers at hospitals who had stopped performing the gender-affirming procedures.(6)

On January 16, 2025, the United States Department of Health & Human Services released the Advancing Health Equity for Intersex Individuals report. This report affirmed the rights of Intersex people to bodily autonomy and informed consent, mentioned health equity barriers for Intersex people, and said that “health care providers and parents can work together to decide that it is in the best interest of the child to delay any non-emergent medical interventions until an intersex child is old enough to be involved in the decision-making about their sexual and reproductive health.”(7) InterACT Advocates for Intersex Youth, called the HHS report, “a victory for the right of intersex children to make their own choices about their own bodies.”(8)

Just days after the release of the HHS report, new government Executive Orders were issued that redefined words like “male,” “female,” “woman,” “man,” and “sex.”(9) This order was intended to impact the transgender and gender diverse communities. However, these Executive Orders impact the Intersex community, as well, as Intersex people can have any gender identity. InterACT says that “many grow up with a gender identity that does not align with their assigned sex at birth – meaning that there is overlap among transgender and intersex communities.”(10) These orders impact cisgender Intersex people, as well. According to InterACT, as “a woman with Complete Androgen Insensitivity (CAIS) may be assigned female at birth, and identify as a woman all her life, while having internal testes – yet the Order would define her sex by her gonads and the reproductive cells they produce.”(10)

***It’s important to note that with the introduction of the new Executive Order, the HHS report has been removed from the HHS and other government websites. InterACT saved the HHS report, and it is accessible on InterACT’s website at this time.***

As laws, reports, and orders are quickly shifting, the healthcare world is rapidly transforming with it. We may not know what local, national, or global changes are on the horizon for the world of politics, the world of healthcare, or the world in general. But one thing that we do know is that healthcare providers need to continue to be advocates for and continue to provide the best evidence-based healthcare to all of our patients, including those who are intersex or transgender.

To learn more about how to be an ally in healthcare and provide better evidence-based care to intersex folx, come take Intersex Patients: Rehab & Inclusive Care with me on May 3, 2025!

Resources

1. Dylan, B. (1964). The Times They Are A-Changin [Album]. Columbia Records.
2. Yurcaba, J. (2025, March 10). Texas Bill Would Make Identifying as Transgender a Felony Punishable By Jail. NBC News. https://www.nbcnews.com/nbc-out/out-politics-and-policy/texas-bill-identify-transgender-state-felony-rcna195642.
3. Human Rights Watch. (2022, October 26). S. Anti-Trans Bills Also Harm Intersex Children. https://www.hrw.org/news/2022/10/26/us-anti-trans-bills-also-harm-intersex-children.
4. The White House. (2025, January 28). Protecting Children from Chemical and Surgical Mutilation. https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/.
5. Betts, A. (2025, February 3). U.S. Hospitals Suspend Healthcare for Transgender Youth After Trump Order. The Guardian. https://www.theguardian.com/us-news/2025/feb/03/trans-youth-healthcare-hospitals-trump.
6. Rodriguez, B., & Sosin, K. (2025, March 10). Hospitals that Paused Youth Gender-Affirming Care Continued Controversial Intersex Surgeries, Group Says. The 19^th*. https://19thnews.org/2025/03/hospitals-intersex-surgery-gender-affirming-care-youth/.
7. S. Department of Health & Human Services Office of the Assistant Secretary for Health. (2025, January 16). Advancing Health Equity for Intersex Individuals. InterACT Advocates for Intersex Youth. https://interactadvocates.org/wp-content/uploads/2025/01/intersex-health-equity-report.pdf.
8. (2025, January 16). Intersex Health Equity Report. https://interactadvocates.org/hhs-supports-bodily-autonomy/.
9. United States Presidential Actions. (2025, January 20). Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government Executive Order. https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/.
10. InterACT Advocates for Intersex Youth. (2025, January 21). Trump’s Executive Order Ignores Science to Push Discriminatory Agenda. https://interactadvocates.org/trumps-executive-order-ignores-science-to-push-discriminatory-agenda/.

AUTHOR BIO
Molly O’Brien-Horn, PT, DPT, CLT, PCES

Molly O’Brien-Horn, PT DPT, CLT, PCES graduated from Rutgers School of Biomedical & Health Sciences (formerly the University of Medicine & Dentistry of New Jersey) with her Doctor of Physical Therapy degree. She is a Pelvic Health Physical Therapist, a Certified Lymphedema Therapist and an LSVT BIG Parkinson’s Disease Certified Therapist. Molly is also a sex counselor, a trained childbirth doula, and a trained postpartum doula. Molly is a member of the American Physical Therapy Association Academy of Pelvic Health Physical Therapy and is also a Teaching Assistant with the Herman & Wallace Pelvic Rehabilitation Institute.

Molly is passionate about providing accessible healthcare to pelvic health patients of all age ranges, all gender identities, all sexualities, all body variations, and all ability levels.

She also has experience in a variety of physical therapy settings over the years, including pediatric and adult oncology, school-based pediatrics, inpatient and intensive care unit hospital-based settings, skilled nursing facilities, outpatient and sports-based orthopedics, and wound care.