Sex assignment

However, in about 1 in 2000 births, the baby's genitalia may not clearly indicate male or female, necessitating additional diagnostic steps, and deferring sex assignment.

[6] The prevalence of intersex conditions, where a baby's sex characteristics do not conform strictly to typical definitions of male or female, ranges between 0.018% and 1.7%.

[10][11] Societally and medically, it is generally assumed that a person's gender identity will align with the sex assigned at birth, making them cisgender.

The terminology has evolved across various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) maintained by the American Psychiatric Association.

In a 2024 op-ed for The Boston Globe, they contended that sex is an "objective biological reality" determined at conception and observed at birth, rather than assigned.

They say that using "assigned" terminology, which they view as an example of "social constructionism gone amok", distorts scientific facts and could undermine trust in medical institutions.

Some infants are born with enough ambiguity that assignment becomes a more drawn-out process of multiple tests and intensive education of the parents about sexual differentiation.

Intersex activists have criticised "normalising" procedures performed on infants and children, who are unable to provide informed consent.

In the 1950s, endocrinologists developed a basic understanding of the major intersex conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome, and mixed gonadal dysgenesis.

John Money and others controversially believed that children were more likely to develop a gender identity that matched sex of rearing than might be determined by chromosomes, gonads, or hormones.

[36][37] A report for the Dutch Ministry of Security and Justice states "Gender increasingly seems to be perceived as a 'sensitive' identity feature, but so far is not regarded, nor protected as such in privacy regulations".