A bill moving through the California legislature this session would ban surgeries on children born with disorders of sexual development, sometimes called intersex traits, until they are old enough to give informed consent.
The measure’s sponsor, Democratic state Sen. Scott Wiener of San Francisco, has packaged it as a human rights issue. Advocates argue the bill will stop physicians and surgeons from pushing cosmetic treatments or procedures on the sex characteristics of infants and children born with intersex traits to “normalize” their bodies. They claim these surgeries harm children who later regret the decisions made by their parents. The bill comes just months after the California legislature—a wide and fast highway for progressive social legislation—passed a nonbinding resolution, also sponsored by Wiener, that condemned such surgeries.
But critics claim the measure is motivated by ideology, mischaracterizes a diverse spectrum of conditions, is not in the best interest of children, and strips parents of the right to make informed decisions about their child’s individualized medical care.
“The overarching question is what expertise does the state have to come in between the medical professionals and their patients to decide what is needed and when?” said Andre Van Mol, a family physician in California and the co-chairman of the Adolescent Sexuality Committee of the American College of Pediatricians. Van Mol told me the bill raises serious concerns, both in the way it describes these conditions and the way it limits options for parents and children.
The term “intersex” can describe several uncommon and vastly different conditions involving abnormalities in a person’s internal reproductive organs, external genitalia, sex chromosomes, or sex-related hormones. Intersex activists use the term as a large umbrella, with some claiming as many as 1 in 2,000 babies is born with an atypical chromosome pattern or reproductive or sexual anatomy anomalies. Others, using an even more exhaustive list of conditions, argue nearly 2 percent of people are intersex, making it as common as being born with red hair. They also use the term as an identity, proof of that gender fluidity exists, and the I in the acronym LGBTQIA+. The bill itself backs that sentiment: “Intersex people are a part of the fabric of our state’s diversity, to be celebrated, rather than an aberration to be corrected.”
But Van Mol, like many doctors, thinks many of these conditions do need correction, sometimes sooner rather than later. He said the bill would restrict physicians and surgeons from carrying out medically necessary procedures such as early surgery that can preserve fertility for patients with congenital adrenal hyperplasia, one of the most common causes for a diagnosis of atypical genitalia. Van Mol also prefers the term “disorders of sexual development” to the term intersex and believes the condition is much more rare—affecting more like 1 in 20,000 people. “The person is not disordered, but they are carrying a disorder in their body,” said Van Mol.
The California Medical Association and the Societies for Pediatric Urology oppose the measure. “This legislation is anti-choice, anti-parental rights, anti-science, and anti-patient,” Lane Palmer, a pediatric urologist in New York and the president of the Societies for Pediatric Urology, wrote in an op-ed for the LGBT newspaper The Bay Area Reporter.
“Pediatric urologists, the doctors whose responsibility is to care for these children, are not pro-surgery any more than they are anti-surgery,” wrote Palmer, adding that they instead support “parental and patient education, usage of evidence-based literature, family-centered care, a multidisciplinary approach, and an individualized focus informed by the child’s input and unique situation,” all things this bill wouldn’t allow.
Other doctors argue the legislation lumps together surgeries that have had questionable outcomes with others that are much more straightforward and successful. “We need to find a way to make things better and that isn’t by mandating that we sweep a diagnosis under the rug for 15 to 18 years,” Steve Lerman, chief of the UCLA Division of Pediatric Urology, told the Los Angeles Times. “That would absolutely be a mistake.”
Van Mol pointed out that many organizations that advocate for laws like this one also call for sex change therapy and surgery for transgender youth. They use words like “lifelong,” “irreversible,” and “medically unnecessary” to explain why minors with intersex traits shouldn’t undergo surgery, while advocating treatments for minors with gender dysphoria that are just as permanent.
The bill had an initial hearing before the California Senate Business, Professions, and Economic Development Committee earlier this week. The committee didn’t vote, and the bill’s next hearing has not been scheduled. Other states are considering similar measures: A legislative panel in Connecticut on Monday approved a study of surgeries on children with disorders of sexual development. The study was a compromise after legislators pulled a measure to ban intersex surgeries amid pushback from parents and physicians.
Christians often shy away from talking about intersexuality, but Van Mol pointed out that early Christian teaching promoted the idea that someone with a disorder is not a castoff. The 2017 Nashville Statement, a document affirming Biblical teaching on human sexuality that received signatures from more than 100 evangelical leaders, including WORLD founder Joel Belz, Editor-in-Chief Marvin Olasky, and board member Albert Mohler, addresses disorders of sexual development, affirming that people born with such disorders “are created in the image of God and have dignity and worth equal to all other image-bearers.”