People with intersex traits make up around 2 percent of the U.S. population, accounting for more than 5 million Americans. “Intersex” is an umbrella term that applies to a variety of variations related to differences in sex characteristics, such as genetic or chromosomal differences. Some intersex traits are noticed at birth, but other individuals may not know they are intersex until much later in life.
The 2024 Center for American Progress/NORC LGBTQI+ Community Survey examined barriers and challenges that people with intersex traits face in daily life. The results paint a concerning picture of systemic hardship in accessing equitable health care. Findings also reveal persistent discrimination across many facets of life, including at work, in public spaces, and in obtaining federally funded community services. This column breaks down key issues facing the intersex community and provides suggestions for reducing these stark disparities.
In 2024, CAP partnered with NORC at the University of Chicago to complete the third wave of the LGBTQI+ Community Survey. This survey is nationally representative, examining experiences of discrimination and barriers to community participation for LGBTQI+ adults in America.
People with intersex traits are active in their communities
The 2024 CAP/NORC LGBTQI+ Community Survey found that people with intersex traits are very likely to be caregivers and parents. More than half of intersex individuals had children in their households in 2024, compared with about one-third of people without intersex traits. (see Figure 1) The survey found that intersex individuals were also much more likely to take time off to care for elderly parents or other family members.
Despite a history of regulations restricting military service for some adults with intersex traits, findings from the survey also revealed that people with intersex traits serve in the military at high rates. Nineteen percent of intersex individuals were serving in active duty at the time of the survey, and 28 percent had formerly served in active duty. (see Figure 2) This aligns with research revealing that some marginalized communities, such as Black adults and transgender people, serve in the military at higher rates.
The high rate of military service and likelihood of being familial caretakers reveal that a large share of people with intersex traits are particularly active in their communities. This is a critical consideration when examining the high rates of discrimination that intersex individuals face.
Experiences of discrimination
People with intersex traits experience some of the highest rates of discrimination when compared with the broader LGBTQI+ community. Sixty-five percent of intersex individuals experienced some form of discrimination in the year prior to the 2024 CAP/NORC survey, compared with 36 percent of LGBTQI+ adults and 18 percent of people who do not have intersex traits. (see Figure 3)
The survey also revealed that the highest rates of discrimination were in the workplace, with 32 percent of intersex individuals experiencing some type of discrimination at work—such as not getting a promotion or even being fired from a job.
Barriers accessing health care
According to the CAP/NORC survey, intersex individuals deal with immense hardship accessing safe, affordable, and equitable health care. Cost is a high barrier to care, with 60 percent of intersex individuals postponing accessing medical care due to cost in the year prior to the survey, compared with 15 percent of nonintersex people. (see Figure 4) The intersex community also avoided getting both preventive and needed care in order to avoid experiencing discrimination. For this survey, “needed care” refers to medical care required to treat an illness or injury.
Intersex people are significantly affected by legislation restricting access to reproductive health care. Because of such laws, intersex people had to change medical providers (28 percent), travel long distances for reproductive health care (23 percent), and even move out of state (20 percent) at higher rates than any other group of respondents in the year prior to the survey. Eleven percent of intersex people were unable to access abortion care.
The survey also suggests that many providers are unaware of the health needs of intersex individuals; nearly half of those with intersex traits—48 percent—had to teach their providers about intersex people in the year prior to the survey. (see Figure 5)
Perhaps most concerning is that many intersex individuals dealt with providers who were physically rough or even abusive while being treated. More than one-third of intersex adults were forced or pressured by medical providers to undergo unwanted procedures related to their intersex traits. While intersex infants and young children are often subjected to nonconsensual and unnecessary medical interventions to forcibly conform their bodies to stereotypes associated with the sex category assigned to them at birth, providers’ pressure on intersex adults underscores how commonly intersex people’s bodily autonomy is devalued at all stages of life.
Anti-LGBTQI+ rhetoric particularly harms intersex people
Anti-LGBTQI+ bills are becoming law in states across the country at record rates, and the intersex community is caught in the crossfire of anti-LGBTQI+ rhetoric and policies permeating national political conversations. For example, since 2021, 27 states have passed laws banning or restricting lifesaving medical care for transgender youth. Many of the bills that have been enacted to date—such as Ohio’s H.B. 68, Missouri’s S.B. 49, and Texas’ S.B. 14—ban gender-affirming care for young people while specifically endorsing procedures to “normalize” intersex children’s bodies; most of these procedures occur when patients are under 2 years old.
The survey findings show that these efforts to restrict LGBTQI+ rights are negatively affecting the mental health of many LGBTQI+ people, and particularly intersex individuals. More than half of those with intersex traits saw moderate or significant impacts to their mental health due to debates about LGBTQI+ rights in the year prior to the survey, compared with 11 percent of nonintersex individuals. (see Figure 6)
Transgender medical care is evidence based and supported by every major medical association in the country. Read more about what this care includes and why it is so important.
Intersex individuals urgently need greater protections from discrimination, particularly considering their experiences with stigma and mistreatment. Comprehensive nondiscrimination protections that explicitly extend to people with intersex traits, such as those proposed in the Equality Act, are urgently needed. These protections would ensure intersex individuals are protected from discrimination at work and school, in public places, and more.
Medical providers must also be given tailored education and competencies in treating intersex patients in ways that respect their bodily autonomy and dignity while meeting their specific health care needs. Health departments at all levels of government should provide training courses or financial incentives to cover the cost of continuing education specific to the needs of people with intersex traits.
Conclusion
People with intersex traits face incredibly high rates of discrimination and difficulties accessing equitable health care. Comprehensive nondiscrimination protections and competency training requirements for health care providers are crucial steps toward equity for the intersex community.
The author would like to thank Sylvan Fraser Anthony and Erika Lorshbough of interACT for their valuable feedback on this column.