Aside from a hole in his heart that surgery fixed early in his life, Mo Cortez didn’t have any notable medical complications growing up in San Angelo.
By all accounts, he was a normal, healthy kid. He fondly remembers playing the original Super Mario Bros. with his older brother and watching Garfield, imagining that if he had a real cat, it’d act the same way.
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But on July 20, 1989, a five-year-old Cortez awoke on a hospital table, forever interrupting his comfortably mundane life.
“I do remember, like, feeling a pain in my groin area and lifting the white sheet and seeing a red ‘X,’” Cortez said. He remembered the rust-like smell of blood that permeated through the operating room. “It was at that point, really, that I realized that something was unacceptable about my body.”
Cortez, a co-founder of The Houston Intersex Society (THIS), was born intersex, an umbrella term for people who are not born with reproductive anatomy that fit traditional definitions of male and female. Cortez was born with both male and female reproductive organs. Doctors removed his male reproductive organs to make him appear more female, a procedure that Cortez did not have a choice in — a persistent fear shared by many in the intersex community. Now, that fear has deepened after Texas lawmakers last summer passed a law that some intersex people say will force them to conform to a gender they do not identify with.
House Bill 229, also called Texas’ “sex definition” law, strictly defines man and woman based on a person’s reproductive organs at birth and applies these rules to state records. Because they do not fit neatly into the law’s definition of either genders, intersex Texans fear this law will make it hard for them to apply for passports and drivers’ licenses because their gender identity may not match their original medical documents’ gender markers.
Many also fear that they will no longer have the ability to change the gender that for many, was chosen for them as children and some fear worse outcomes: the law encouraging the types of dramatic surgeries like the one Cortez endured at a young age — one that forces parents to conform their intersex children to one gender or another.
While introducing HB 229 on Texas’ House floor last spring, Rep. Ellen Troxclair, R-Lakeway, called it the “women’s bill of rights” and said it establishes a “clear, consistent and biologically accurate” definition of what a woman is. She said her intention for the bill was to protect “the rights, safety and opportunities of women and girls across the state.” Troxclair declined to provide a comment for this story.
There is no official count of intersex people in the state, but of the 390,000 babies born in Texas between 2020 and 2024, 58 of them had genders that were listed as “unable to determine,” according to the Texas Department of State Health Services. This number does not reflect individuals whose intersex features appear later in life. Nationally, up to 1.7% of people are intersex, according to widely cited estimates.
Intersex people encompass “over 40 bodily variations blurring borders of binary male and female anatomy,” according to Adeline Berry, an intersex researcher at the University of Huddersfield in the United Kingdom, who left Texas in 2017 over fears of discrimination.
Not all intersex people are born like Cortez with two reproductive organs. Some other intersex variations include having an extra X or Y chromosome, abnormal levels of sex hormones or reproductive parts that develop differently, according to InterACT, an advocacy group for intersex youth.
According to Berry, intersex variations can be detectable as early as birth, puberty, or even post-mortem.
Recent transgender policies often inadvertently affect intersex people because they are aimed at prescribing a gender. Many intersex people don’t want the government or others assigning them a gender, said Juliette Thurber, a San Antonio transgender woman. She was born with Klinefelter syndrome, which is an intersex variation that causes a person to have XXY chromosomes.
“In a body that was not given the ability to define itself, I define myself as a woman,” said Thurber, who was born presenting as a male. “I was always an intersex male, and now… I’m an intersex woman, and that’s my choice.”
Addressing intersex people in HB 229
While deliberating over HB 229, state lawmakers heard over and over that the law would harm not only trans Texans, but intersex people as well.
In response to the outcry, Rep. Mary González, D-Clint, a member of the Texas House LGBTQ Caucus, amended the bill to say intersex people “are not considered to belong to a third sex” and “must receive accommodations in accordance with state and federal law.”
The amendment was the only one adopted and took just 22 seconds to approve.
Thurber said the amendment has little impact because it doesn’t specify any accommodations and doesn’t properly define either of the two binary genders. The law defines women as individuals “whose biological reproductive system is developed to produce ova” and men as individuals “whose biological reproductive system is developed to fertilize the ova of a female.” Because Klinefelter syndrome causes infertility for some individuals and Thurber’s testosterone levels are very low as result of her intersex variation, may not fit into either category.
“I literally fall into a third gender, according to this law, a third gender that is not defined. So does that mean I legally don’t exist?” Thurber said.
Rep. Jessica González, D-Dallas, the current chair of the Texas House LGBTQ Caucus said the amendment had positive intentions but the bill still harms intersex people. “[House Bill 229] is poorly written,” she said.
Mary González declined to provide a comment for this story.
The amendment’s prohibition on categorizing intersex people in a third gender can help intersex people by not making them feel othered, Cortez and Thurber said. But ensuring intersex people don’t belong to a third sex also isn’t a priority for some.
“I just want to slow down… the irreversible, forced sex change surgeries,” Cortez said.
Surgical interventions
Prior to his surgeries, Cortez was socialized as a woman and didn’t realize there was anything abnormal about his body. But according to medical records Cortez shared with The Texas Tribune, doctors repeatedly called his male reproductive organs and his intersex diagnosis a medical problem that needed to be addressed.
“It was very dehumanizing,” said Cortez, who received a phalectomy and a gonadectomy at five-years-old.
While Texas consistently discourages access to gender-affirming surgeries for transgender individuals, these same surgeries are often performed early in life on intersex individuals and with little regard for the physical or mental well-being of the patients.
These surgeries were so common on intersex people that in 2016, three former U.S. Surgeon Generals denounced cosmetic genital surgery on intersex infants. This procedure is “based on untested assumptions rather than medical research” and “usually causes more harm than good,” they said.
And when surgical intervention is recommended, parents tend to opt in. A 2016 study by the Journal of Pediatric Urology found that out of 37 families that were offered surgical intervention for their children, 35 accepted.
Despite backlash from medical professionals and continued high rates of surgery, the U.S. government has done little to curb the frequency at which these surgeries occur, according to InterACT. Instead, some intersex people say policies like HB 229 will increase their frequency because the law will force parents to conform their intersex children to male or female.
Cortez said his mother felt forced to agree to removing his male reproductive organs after she was reported to child welfare services over accusations that she was “raising a boy as a girl,” according to Cortez’s medical documents that referenced the interaction.
“They said ‘do the surgery or we’ll take away your kids,’” Cortez said.
Since the surgery, Cortez has had urinary tract infections at least every other month, which he attributes to the medical complications of his procedure, he said.
Complications with surgeries – or with the mental trauma associated with them – persist for other intersex individuals, as well.
On top of Berry’s lifelong social struggles related to her intersex identity, it’s been “excruciating to urinate” because of a genital surgery she received as a child, she said.
Government records concerns
Prior to HB 229 going into effect, many transgender and intersex people obtained court orders through sympathetic judges to change their gender on their birth certificates or drivers’ licenses. But months before HB 229 was enacted, Gov. Greg Abbott unilaterally ordered courts to no longer recognize these court orders, which was later supported by Attorney General Ken Paxton in a legal opinion.
HB 229 will inevitably lead to mismatched documents, said Shelly Skeen, a lawyer with Lambda Legal. When transgender and intersex individuals renew some documents, their gender will default to their sex assigned as birth even if they were able to successfully change their gender on records previously. Those people will likely have two kinds of documents – some that respect their gender identity and others that don’t, carrying their sex assigned at birth.
Troxclair and others have argued intersex people have long had either female or male indicated on their birth certificates and drivers’ licenses, and HB 229 would not change that. Multiple intersex people and their advocates say this is not true for all intersex people.
Some intersex people don’t have a sex assigned at birth — like Cortez, whose original medical documents don’t say “male” or “female.” Others might have both sexes listed. For these individuals, HB 229 doesn’t specify how the law would affect them, thrusting them into a legal loophole.
“The state law is going to have you running into trouble,” said Sylvan Fraser Anthony, InterACT’s legal and policy director.
Cortez already had some experience with the headache of changing gender markers on his documents — in 2015, a Harris County judge refused to change his gender marker from female to male on his birth certificate even though his attorney said he had XY chromosomes.
“They didn’t ask for medical records, they didn’t ask if I had any kind of gender affirming surgery,” Cortez said. “They just flat out said no.”
Later, a Travis County judge agreed to change his gender marker and the Texas Department of State Health Services changed the gender on his birth certificate to “male.”
Cortez fears the trouble he had to go through to change his gender markers will become more commonplace under HB 229.
“There’s still a lot of Republican judges now,” said Cortez, “Republican, conservative judges that are not eager to help us.”
Thurber, whose government records still list male, does not know if under HB 229, Texas would consider her a male because of her intersex diagnosis. But more importantly to her, she does not identify with being a male.
Thurber has wanted to change her name and gender in government records in part to make it easier for her to be identified as a woman in medical records. She said she submitted a name and gender change request in Bexar County two weeks before Ken Paxton’s March 14 legal opinion. As part of the application process, Thurber paid a $400 filing fee and went through an FBI background check.
After Paxton’s legal opinion was published, Thurber’s name and gender change were subsequently denied, she said.
“Because of all that, it was denied, and I’m out $400,” Thurber said. “I’m going to have a nightmare in the medical field trying to get it changed, because everybody still uses my old deadname.”
Priorities of the intersex community
Many advocates for intersex people want policies that don’t reduce them to a medical disorder that needs to be fixed.
Fraser Anthony said every state gender-affirming care ban for transgender minors passed to date includes a clause to allow surgeries on intersex kids, which they said is “the exact opposite of what we want to see.” InterACT also advocates for awareness campaigns about intersex variations for future parents and the general public, Fraser Anthony said.
Cortez wants children to have representation in discussions about their intersex-related surgeries. He also wants to establish formal standards of care for intersex people, which they said aren’t currently in place.
Outside of intersex peoples’ health care, he hopes to promote legislation that includes intersex individuals under hate crime protections and protections for intersex individuals in state-run care, like prisons and group homes.
Thurber said intersex policies that lawmakers support often take the form of an exception to a law intended to harm transgender people. She said these lawmakers are well-meaning, but “the path to hell is paved in good intentions.”
After repeatedly testifying before the Texas government, Thurber said she has not felt heard by lawmakers. She hopes for that to change. Above all, Thurber hopes lawmakers recognize the nuance behind intersex people’s gender identity by passing policies that reinforce their rights or leave the community alone.
“Intersex people are going to get attacked in just the same way as trans people are,” Thurber said. “People don’t understand intersex people – and they don’t want to – just like they don’t understand trans people – and they don’t want to.”
For mental health support for LGBTQ youth, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. For trans peer support, call the Trans Lifeline at 877-565-8860. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.