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America is going in the wrong direction for intersex children

Lawmakers are criminalizing care for trans youth, while permitting irreversible harm to intersex babies

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I live with the consequences of what America is willing to condone in the name of “protecting children.”

When I was young, doctors and adults made irreversible decisions about my body without my informed consent. They weren’t responding to an emergency. They were responding to discomfort with innate physical differences and the social and medical pressure to make a child’s body conform to a rigid female-male binary. That’s the part people like to skip over when they talk about “child welfare”: the harm didn’t begin with my identity. It started with adults deciding my healthy body needed fixing.

That’s why the hypocrisy unfolding right now from statehouses to Capitol Hill feels so familiar, and so dangerous. 

While harmful medical practices on intersex children, the nearly 2 percent born with differences in one or more of their physical sex characteristics, have been ongoing in the U.S. for decades, until recently, there was no law specifically condoning it. 

This month, House Republicans passed one of the most extreme anti-trans bills in modern American history, advancing legislation that would criminalize gender-affirming medical care for transgender youth and threaten doctors with severe penalties for providing evidence-based treatment. The bill is framed as a measure to “protect children,” but in reality, it weaponizes the criminal legal system against families and providers who are trying to support young people in surviving adolescence.

At the same time, the administration has proposed hospital and insurance policies designed to choke off access to affirming care for trans youth nationwide by making providers fear loss of federal funding, regulatory retaliation, or prosecution. This is a familiar strategy: don’t just ban care outright; instead, make it so risky that hospitals stop providing it altogether. The result is the same everywhere. Young people lose access to care that major medical associations agree can be lifesaving.

All of this is happening under the banner of preventing “irreversible harm.”

But if America were genuinely concerned about irreversible harm to minors, the first thing lawmakers would address is the medically unnecessary, nonconsensual surgeries still performed on intersex infants and young children, procedures that permanently alter healthy tissue, often without urgent medical need, and long before a child can meaningfully participate in the decision. Human rights organizations have documented for years how these interventions are justified not by medical necessity, but by social pressure to make bodies appear more typically “female” or “male.” 

Here is the uncomfortable truth: all of the state laws now banning gender-affirming care for transgender youth explicitly include exceptions that allow nonconsensual and harmful intersex surgeries to continue.

A recent JAMA Health Forum analysis found that 28 states have enacted bans on gender-affirming care for minors that carve out intersex exceptions, preserving doctors’ ability to perform irreversible “normalizing” procedures on intersex children even while prohibiting affirming care for trans adolescents.

This contradiction is not accidental. It reveals the real priority behind these laws.

If the goal were truly to protect children from irreversible medical interventions, intersex kids would be protected first. Instead, these policies target one group of children, transgender youth, while continuing to permit permanent interventions on another group whose bodies challenge the same rigid sex and gender binary that lawmakers are trying to enforce.

Intersex people are routinely erased from American policy debates, except when our bodies are invoked to justify harmful laws, warning that intersex children are being used as legal loopholes rather than protected as human beings. This “protect the children” rhetoric is routinely deployed to justify state control over bodies, while preserving medical practices that stripped intersex children like me of autonomy, good health, and choice. Those harms are not theoretical. They are lifelong.

What makes this moment even more jarring is that the federal government had finally begun to recognize intersex people and attempt to address the harms suffered.

In 2024, at the very end of his term, the Biden administration released the first-ever intersex health equity report — a landmark admission that intersex people have been harmed by the U.S. health care system. Issued by the Department of Health and Human Services, the report documents medically unnecessary interventions, lack of informed consent, and systemic erasure and recommends delaying irreversible procedures until individuals can meaningfully participate in decisions about their own bodies.

This should have been a turning point. Instead, America is moving in the opposite direction.

On day one, President Trump issued an executive order defining “sex” in a way attempting to delegitimize the existence of transgender Americans that also erased the existence of many intersex people. 

When medicine is used to erase difference, it is called protection, while care that supports self-understanding is treated as a threat. This is not about medicine. It is about control.

You cannot claim to oppose irreversible harm to children while legally permitting surgeries that intersex adults and human rights experts have condemned for decades. You cannot claim to respect bodily autonomy while denying it selectively, based on whose bodies make lawmakers uncomfortable.

Protecting children means protecting all children, transgender, intersex, and cisgender alike. It means delaying irreversible interventions when they are not medically necessary. It means trusting and supporting young people and families over politicians chasing culture-war victories.

America can continue down the path of criminalizing care for some children while sanctioning harm to others, or it can finally listen to the people who have lived the consequences.

Intersex children deserve laws that protect their bodies, not politics that hurt and erase them.

Kimberly Zieselman is a human rights advocate and the author of “XOXY: A Memoir”. The author is a co-author of the JAMA Health Forum article cited, which examined state laws restricting gender-affirming care.

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Commentary

Stand with displaced queer people living with HIV

Dec. 1 is World AIDS Day

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Today, on World AIDS Day, we honor the resilience, courage, and dignity of people living with HIV everywhere especially refugees, asylum seekers, and queer displaced communities across East Africa and the world.

For many, living with HIV is not just a health journey it is a journey of navigating stigma, borders, laws, discrimination, and survival.

Yet even in the face of displacement, uncertainty, and exclusion, queer people living with HIV continue to rise, thrive, advocate, and build community against all odds.

To every displaced person living with HIV:

• Your strength inspires us.

• Your story matters.

• You are worthy of safety, compassion, and the full right to health.

• You deserve a world where borders do not determine access to treatment, where identity does not determine dignity, and where your existence is celebrated not criminalized.

Let today be a reminder that:

• HIV is not a crime.

• Queer identity is not a crime.

• Seeking safety is not a crime.

• Stigma has no place in our communities.

• Access to treatment, care, and protection is a human right.

As we reflect, we must recommit ourselves to building systems that protect not punish displaced queer people living with HIV. We must amplify their voices, invest in inclusive healthcare, and fight the inequalities that fuel vulnerability.

Hope is stronger when we build it together.

Let’s continue to uplift, empower, and walk alongside those whose journeys are too often unheard.

Today we remember.

Today we stand together.

Today we renew hope.

Abraham Junior lives in the Gorom Refugee Settlement in South Sudan.

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Perfection is a lie and vulnerability is the new strength

Rebuilding life and business after profound struggles

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I grew up an overweight, gay Black boy in West Baltimore, so I know what it feels like not to fit into a world that was not really made for you. When I was 18, my mother passed from congestive heart failure, and fitness became a sanctuary for my mental health rather than just a place to build my body. That is the line I open most speeches with when people ask who I am and why I started SWEAT DC.

The truth is that little boy never really left me.

Even now, at 42 years old, standing 6 feet 3 inches and 225 pounds as a fitness business owner, I still carry the fears, judgments, and insecurities of that broken kid. Many of us do. We grow into new seasons of life, but the messages we absorbed when we were young linger and shape the stories we tell ourselves. My lack of confidence growing up pushed me to chase perfection as I aged. So, of course, I ended up in Washington, D.C., which I lovingly call the most perfection obsessed city in the world.

Chances are that if you are reading this, you feel some of that too.

D.C. is a place where your resume walks through the door before you do, where degrees, salaries, and the perfect body feel like unspoken expectations. In the age of social media, the pressure is even louder. We are all scrolling through each other’s highlight reels, comparing our behind the scenes to someone else’s curated moment. And I am not above it. I have posted the perfect photo with the inspirational “God did it again” caption when I am feeling great and then gone completely quiet when life feels heavy. I am guilty of loving being the strong friend while hating to admit that sometimes I am the friend who needs support.

We are all caught in a system that teaches us perfection or nothing at all. But what I know for sure now is this: Perfection is a lie and vulnerability is the new strength.

When I first stepped into leadership, trying to be the perfect CEO, I found Brené Brown’s book, “Daring Greatly” and immediately grabbed onto the idea that vulnerability is strength. I wanted to create a community at SWEAT where people felt safe enough to be real. Staff, members, partners, everyone. “Welcome Home” became our motto for a reason. Our mission is to create a world where everyone feels confident in their skin.

But in my effort to build that world for others, I forgot to build it for myself.

Since launching SWEAT as a pop up fundraiser in 2015, opening our first brick and mortar in 2017, surviving COVID, reemerging and scaling, and now preparing to open our fifth location in Shaw in February 2026, life has been full. Along the way, I went from having a tight trainer six pack to gaining nearly 50 pounds as a stressed out entrepreneur. I lost my father. I underwent hip replacement surgery. I left a relationship that looked fine on paper but was not right. I took on extra jobs to keep the business alive. I battled alcoholism. I faced depression and loneliness. There are more stories than I can fit in one piece.

But the hardest battle was the one in my head. I judged myself for not having the body I once had. I asked myself how I could lead a fitness company if I was not in perfect shape. I asked myself how I could be a gay man in this city and not look the way I used to.

Then came the healing.

A fraternity brother said to me on the phone, “G, you have to forgive yourself.” It stopped me in my tracks. I had never considered forgiving myself. I only knew how to push harder, chase more, and hide the cracks. When we hung up, I cried. That moment opened something in me. I realized I had not neglected my body. I had held my life and my business together the best way I knew how through unimaginable seasons.

I stopped shaming myself for not looking like my past. I started honoring the new ways I had proven I was strong.

So here is what I want to offer anyone who is in that dark space now. Give yourself the same grace you give everyone else. Love yourself through every phase, not just the shiny ones. Recognize growth even when growth simply means you are still here.

When I created SWEAT, I hoped to build a home where people felt worthy just as they are, mostly because I needed that home too. My mission now is to carry that message beyond our walls and into the city I love. To build a STRONGER DC.

Because strength is not perfection. Strength is learning to love an imperfect you.

With love and gratitude, Coach G.


Gerard Burley, also known as Coach G, is a D.C.-based fitness entrepreneur.

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Elusive safety: what new global data reveals about gender, violence, and erasure

Movements against gender equality, lack of human rights data contributing factors.

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Activists who participated in a 2024 Pride march in San Salvador, El Salvador, carry a banner that calls for a country where “being a woman is not a danger.” (Photo courtesy of Colectivo Alejandría)

“My identity could be revealed, people can say whatever they want [online] without consequences. [Hormone replacement therapy] is illegal here so I’m just waiting to find a way to get out of here.”

-Anonymous respondent to the 2024 F&M Global Barometers LGBTQI+ Perception Index from Iraq, self-identified as a transgender woman and lesbian

As the campaign for 16 Days Against Gender-Based Violence begins, it is a reminder that gender-based violence (GBV) — both on– and offline — not only impacts women and girls but everyone who has been harmed or abused because of their gender or perceived gender. New research from the Franklin & Marshall (F&M) Global Barometers and its report A Growing Backlash: Quantifying the Experiences of LGBTQI+ People, 2022-2024 starkly show trends of declining safety among LGBTQI+ persons around the world.

This erosion of safety is accelerated by movements against gender equality and the disappearance of credible human rights data and reporting. The fight against GBV means understanding all people’s lived realities, including those of LGBTQI+ people, alongside the rights we continue to fight for.

We partnered together while at USAID and Franklin & Marshall College to expand the research and evidence base to better understand GBV against LGBTQI+ persons through the F&M Global Barometers. The collection of barometers tracks the legal rights and lived experiences of LGBTQI+ persons from 204 countries and territories from 2011 to the present. With more than a decade of data, it allows us to see how rights have progressed and receded as well as the gaps between legal protections and lived experiences of discrimination and violence. 

This year’s data reveals alarming trends that highlight how fear and violence are, at its root, gendered phenomena that affect anyone who transgresses traditional gender norms.

LGBTQI+ people feel less safe

Nearly two-thirds of countries experienced a decline in their score on the F&M Global Barometers LGBTQI+ Perception Index (GBPI) from 2022-2024. This represents a five percent drop in global safety scores in just two years. With almost 70 percent of countries receiving an “F” grade on the GBPI, this suggests a global crisis in actual human rights protections for LGBTQI+ people. 

Backsliding on LGBTQI+ human rights is happening everywhere, even in politically stable, established democracies with human rights protections for LGBTQI+ people. Countries in Western Europe and the Americas experienced the greatest negative GBPI score changes globally, 74 and 67 percent, respectively. Transgender people globally reported the highest likelihood of violence, while trans women and intersex people reported the highest levels of feeling very unsafe or unsafe simply because of who they are. 

Taboo of gender equality

Before this current administration dismantled USAID, I helped create an LGBTQI+ inclusive whole-of-government strategy to prevent and respond to GBV that highlighted the unique forms of GBV against LGBTQI+ persons. This included so-called ‘corrective’ rape related to actual or perceived sexual orientation, gender identity, or expression” and so-called ‘conversion’ therapy practices that seek to change or suppress a person’s gender identity or expression, sexual orientation, or sex characteristics. These efforts helped connect the dots in understanding that LGBTQI+ violence is rooted in the same systems of inequality and power imbalances as the broader spectrum of GBV against women and girls. 

Losing data and accountability

Data that helps better understand GBV against LGBTQI+ persons is also disappearing. Again, the dismantling of USAID meant a treasure trove of research and reports on LGBTQI+ rights have been lost. Earlier this year, the US Department of State removed LGBTQI+ reporting from its annual Human Rights Reports. These played a critical role in providing credible sources for civil society, researchers, and policymakers to track abuses and advocate for change. 

If violence isn’t documented, it’s easier for governments to deny it even exists and harder for us to hold governments accountable. Yet when systems of accountability work, governments and civil society can utilize data in international forums like the UN Universal Periodic Review, the Convention on the Elimination of All Forms of Discrimination Against Women, and the Sustainable Development Goals to assess progress and compliance and call for governments to improve protections. 

All may not be lost if other countries and donors fill the void by supporting independent data collection and reporting efforts like the F&M Global Barometers and other academic and civil society monitoring. Such efforts are essential to the fight against GBV: The data helps show that the path toward safety, equality, and justice is within our reach if we’re unafraid of truth and visibility of those most marginalized and impacted.

Jay Gilliam (he/him/his) was the Senior LGBTQI+ Coordinator at USAID and is a member of the Global Outreach Advisory Council of the F&M Global Barometers.

Susan Dicklitch-Nelson (she/her/hers) is the founder of the F&M Global Barometers and Professor of Government at Franklin & Marshall College.

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