Sex-Affirming Care for Intersex People: A Deep Dive

By interSupports | Visibility is Our Strength

What’s the Difference Between Gender-Affirming and Sex-Affirming Care?

While these two types of care are often confused or used interchangeably, they serve different communities and needs.

• Gender-Affirming Care supports individuals (often transgender people) whose gender identity doesn’t align with the sex they were assigned at birth. It includes surgeries, hormone therapy, and psychological support to help them live in alignment with their gender identity.

  
  

• Sex-Affirming Care supports intersex individuals, whose bodies naturally vary from typical definitions of male or female. This care respects and supports their biological reality—not based on an identity change, but a correction of medical mismanagement, pain, or dysphoria stemming from mismatched or misunderstood anatomy, hormones, or chromosomes.

What Is Intersex Sex-Affirming Care?

Sex-affirming care for intersex people helps support the body’s natural biology rather than forcing it into binary expectations. This includes:

1. Hormonal Correction (e.g., Estrogen Support)

For XY individuals with a natural female presentation—such as in cases of Androgen Insensitivity Syndrome (AIS) or 45,X/46,XY mosaicism—the body doesn’t produce or respond properly to androgens (like testosterone). As a result, estrogen therapy is critical for:

• Bone density (preventing early osteoporosis)

• Cardiovascular health

• Reproductive organ support

• Mental health stability

• Preventing thyroid and autoimmune complications

2. Surgical Correction

Sometimes the natural development of intersex anatomy creates physical pain, pelvic pressure, or even health risks due to ambiguous or improperly formed genital or internal structures. Sex-affirming surgery may involve:

• Reconstruction of external genitalia for functional alignment

• Uterine access correction or canal formation

• Gonadectomy (removal of undescended or cancer-risk gonads)

• Removal of painful or obstructive tissue

3. Gonadal Monitoring

For intersex people with undescended testes or streak gonads, there's a heightened risk of malignancy. Medical monitoring or surgical removal may be part of affirming care—not as forced sterilization, but as informed, consensual preventive care.

Why Does It Matter?

Intersex individuals often face medical neglect, misdiagnosis, or outright dismissal because their biology doesn’t fit narrow expectations. This leads to:

• Delayed diagnosis of serious conditions (like cancer or hormonal imbalance)

• Physical pain that worsens without correction

• Emotional trauma from repeated medical invalidation

• Mental health decline from long-term dysphoria or misalignment

Sex-affirming care honors the truth of the body, not a forced ideal. For those with XY chromosomes and female presentation, it’s not about changing identity—it’s about respecting and supporting the natural path their body already took.

Examples of Intersex Sex-Affirming Care in Practice

Care Type	Description
Estrogen Hormone Replacement	Supports natural female development and prevents early-onset osteoporosis and other hormonal deficiencies.
Surgical Correction	Removes anatomical barriers causing pain or misalignment, such as reconstructing genital anatomy or removing malformed tissue.
Pelvic Pain Relief	Addressing congenital tissue that causes back, hip, or reproductive organ pressure through individualized procedures.
Monitoring Gonadal Health	Screening or removing gonadal tissue to prevent cancer development in XY intersex bodies.
Mental Health Support	Validating the intersex identity and offering counseling that avoids gender-assumptive bias.
Advocacy and Patient Education	Teaching patients about their own anatomy, chromosomes, and rights to informed, respectful care.

In Their Words: 7 Questions to Ask Your Provider

Want to bring sex-affirming care into the conversation with your doctor? Start here:

1. What exactly does sex-affirming care mean for someone with an XY intersex variation who is female?

2. How does estrogen support my bone, heart, and hormone health—and what are the risks if I don’t receive it?

3. Are there surgical options to address pelvic or back pain related to my anatomy?

4. Can we monitor my gonads for cancer risk or hormonal imbalance?

5. What psychological resources exist to support someone with a DSD/intersex history?

6. What happens if this care is delayed—am I at risk for long-term complications?

7. Can you personalize a care plan that respects both my intersex biology and my identity?

Why Sex-Affirming Care Deserves More Awareness

Unlike gender-affirming care—which is now better understood and advocated for—sex-affirming care for intersex individuals is still widely misunderstood, underfunded, and stigmatized. Most systems still focus on forcing a binary outcome, rather than embracing biological diversity and listening to what the body needs. We need to stop confusing intersex identity with gender transition. Intersex care isn’t about becoming someone else—it’s about being allowed to be who we’ve always been.

Closing Thought from interSupports

“My care isn’t about changing who I am. It’s about correcting what was done wrong—and finally supporting the truth of my biology. This isn’t gender-affirming. This is sex-affirming.” Whether you are an intersex person seeking justice, a medical provider wanting to learn, or an ally hoping to help—interSupports is here to educate, uplift, and fight alongside you.

🌀 Visibility is our strength. Biology is our truth. 

🟠 interSupports