In response to an inquiry by the German Ethics Council in 2012, the government passed legislation in 2013 designed to classify some intersex infants as a de facto third category.

The 12th-century canon law collection known as the Decretum Gratiani states that "Whether a hermaphrodite may witness a testament, depends on which sex prevails" ("Hermaphroditus an ad testamentum adhiberi possit, qualitas sexus incalescentis ostendit.").

[6] In 1932 gynecologist and obstetrician Hans Naujoks performed what was described as the first complete and comprehensive intersex surgery and hormone treatment on a patient with both ovarian and testicular tissue, at the University of Marburg.

[10] Time magazine later reported that Ratjen tearfully confessed that he had been forced by the Nazis to pose as a woman "for the sake of the honor and glory of Germany".

[18] Civil society organizations, including Intergeschlechtliche Menschen, OII Germany and Zwischengeschlecht, have submitted reports to Land, federal and international human rights institutions.

[19] The organization Intersexuelle Menschen first submitted a Shadow Report to the United Nations Committee on the Elimination of All Forms of Discrimination Against Women (CEDAW) in July 2008, detailing human rights violations in medical settings and failures to act in the best interests of the child.

[22] Research published by Ulrike Klöppel at the Humboldt University in December 2016 shows that, over the period 2005 to 2014, there were no significant trends in numbers of intersex medical interventions.

"[25] In 2017, Amnesty International published a report condemning "non-emergency, invasive and irreversible medical treatment with harmful effects" on children born with variations of sex characteristics in Germany and Denmark.

[26][27][28][29] A law that provides for a general ban on operations in children and adolescents with 'variations of sex development' ('Varianten der Geschlechtsentwicklung') was passed in the German parliament on 25 March 2021.

"[15] The German Ethics Council and the Swiss National Advisory Commission also criticized the law, saying that "instead of individuals deciding for themselves at maturity, decisions concerning sex assignment are made in infancy by physicians and parents.

[17][22][43] The Council of Europe Issue Paper on intersex restates these concerns: Human rights practitioners fear that the lack of freedom of choice regarding the entry in the gender marker field may now lead to an increase in stigmatisation and to "forced outings" of those children whose sex remains undetermined.

[14]In June 2016, Germany's High Court ruled that German law would not allow entry of a third option of "inter" or "diverse" in the birth registry.

The High Court said it found no violation of the plaintiff's basic rights since intersex people have been able since 2013 to leave the gender entry in German birth registries blank.

[47] On 22 December 2018, the adopted act entered into force, allowing the choice for intersex people (both at birth and at a later age) between "female", "male", "diverse" and no gender marker at all.