Nikki Blue knew that she was different from other girls. One day, her slice of the American dream would include a white picket fence and a wife. While she looks like a debutante, she has the swagger of a cocksure boy—a dichotomy that is as mystifying as it is alluring.
In the debut novel PRETTY BOY BLUE by Monika M. Pickett, Nikki finally learns the value of self-love and the wisdom of the old adage “that which does not kill you will make you stronger.” PRETTY BOY BLUE (Next Level Publishing) is available on Amazon.com and PrettyBoyBlue.com.
PRETTY BOY BLUE is unique yet timeless narrative, sure to connect with many in the LGBQT community eager to see their lives chronicled with honesty and compassion. At the same time, author Pickett doesn’t shy away from describing Nikki Blue’s moments of steamy passion, emotional pain, questionable choices, and struggle to walk in her truth.
“The book is a coming-of age-story—think Invisible Life meets The L Word,” says Pickett, referring to the groundbreaking 1994 novel by the late E. Lynn Harris and Showtime’s TV influential episodic drama focused on a group of lesbian friends. “This book is needed in the marketplace to create understanding, communication and compassion between LGBTQ young adults and their families. Although the country is moving towards equality, there are many individuals who suffer in silence.”
About The Author
Pickett based some of the novel’s storyline on her own life, and wrote it to heal from a rare brain disorder. A former advertising sales executive with The Washington Times and the National Society of Black Engineers, Pickett is a veteran of the United States Army who served as a medic in Operation Desert Storm and received an honorable discharge in 1991. She earned a Masters of Human Services degree from Lincoln University, Pennsylvania in 2001 and an MBA from The Johns Hopkins University in Baltimore, Maryland, in 2005. She currently lives in Woodbridge, VA.
Responding to the enormous need in the community it has been a part of for 90 years, the Santa Rosa Symphony, with support from Sonoma State University’s Green Music Center, will present a Free Fire Relief Benefit Concert on Monday, November 20, 2017 at 7:30 pm.
Conductor Emeritus Corrick Brown joins Music Director Bruno Ferrandis for this special event, which will also feature Conductor Laureate Jeffrey Kahane playing Beethoven’s Piano Concerto No. 1. The program also includes Aaron Copland’s Fanfare for the Common Man, Eglar’s “Nimrod” from Enigma Variations and Beethoven’s highly-praised Symphony No. 3, Eroica.
Donations collected at ticket reservation and at the concert support Redwood Credit Union’s North Bay Fire Relief Fund, Community Foundation Sonoma County’s Sonoma County Resilience Fund and Sonoma State University’s Noma Gives (which supports affected students, staff and faculty). The Symphony thanks the orchestra, conductors, ushers and stage crew for donating their time and talent.
Please join the Symphony on November 20 in Weill Hall, Green Music Center, for an evening shared with good friends, good will, heartfelt giving and excellent music. We are, indeed, stronger together. #SonomaStrong
Admission to this benefit concert is free (2 tickets per household), though requested donations are accepted at time of reservation and at the concert. Lobby opens at 6:30 pm.
Tickets available: Wednesday, November 8 at 10 am
Call (707) 546-MUSIC (546-8742)
(not available online)
Today, a 24-hour hotline and rapid response structure will be launched in Sonoma County to help defend undocumented immigrants from the increase of immigration enforcement, ICE raids and other attacks by the Trump administration that are
causing fear and anxiety in the immigrant community.
This endeavor consists of collaboration from over 50 community groups and organizations and involves over 600 individuals from all parts of Sonoma County. The structure includes:
• Bilingual dispatchers that will answer the hotline and send trained legal observers to
document ICE raids;
• Trained legal observers that will track, verify, and document ICE raids that may take
place in the workplace, homes, neighborhoods, and checkpoints; and
• Accompaniment teams that will provide support to families.
Two events to launch the hotline are taking place.
A press conference will be held Wednesday at 5:30 pm in Roseland Village Plaza
Students are taking action on campus to raise awareness of the 24/7 Hotline. Young people
from local MEChA & student activism clubs at Casa Grande High School, Petaluma High
School, Hillard Comstock Middle School, Roseland University Prep, Elsie Allen High
School, Sonoma Valley High School and Windsor High School are all planning to distribute
informational cards to parents dropping off students at school on the morning of November
8th. Many groups will be providing hot chocolate and pan dulce for families while informing
them of the purpose of the hotline and strengthening community solidarity.
Information on upcoming legal observer and accompaniment trainings can be found on The group’s
Facebook page: www.fb.com/NorthBayRapidResponse/ for those that may want to get involved.
The North Bay Rapid Response Network – Sonoma & Napa Counties, is a network of various
community groups and organizations in Sonoma and Napa Counties working to create a way for
people to respond to fear and anxiety in our community as a result of the increase in immigration
enforcement, ICE raids and other attacks against our communities. Our network provides a way
for people of goodwill to bear witness, accompany, and protect members of our community who
are living through the increase in immigration enforcement and ICE raids.
The National Center for Lesbian Rights (NCLR) and GLBTQ Legal Advocates & Defenders (GLAD) filed a response today in the Equality California case Stockman v. Trump challenging Trump’s transgender military ban in the U.S. District Court for the Central District of California. Today’s court filing is the first in Stockman since Judge Kollar-Kotelly’s ruling last week in NCLR and GLAD’s other case Doe v. Trump, finding Trump’s ban to be unconstitutional and issuing a nationwide injunction against the ban.
“California has the highest number of service members and LGBT people of any state in the country. Trump’s ban is a baseless, malicious attack on our own,” said Equality California Executive Director Rick Zbur. “We’re in this fight, and we’ll keep fighting until this ban poses zero threat to our community and our military.”
“Last week, we secured a nationwide injunction that halts Trump’s ban,” said NCLR Legal Director Shannon Minter. “Right now, every transgender service member is protected, and qualified transgender Americans who wish to enlist can do so as of January 1, 2018. But we know this battle is not over—every federal court that declares this ban unconstitutional moves us closer to a permanent end to this nightmare for our dedicated and courageous service members.”
“Trump’s not playing with toy soldiers – these are real people whose lives are at stake. Thousands of transgender Americans are currently serving in our armed forces, and these highly trained, dedicated, and courageous service members have been experiencing real harms since Trump’s impulsive Twitter announcement, ” said GLAD Transgender Rights Project Director Jennifer Levi. “Last week’s clear and powerful ruling from Judge Kollar-Kotelly confirmed what we already know: Trump’s ban contradicts military leaders and expert research, and is based on nothing more than bias against the transgender community. We won’t stop fighting until we are assured every qualified transgender American who wishes to serve our country can do so on equal terms with all other service members.”
Today’s filing is strengthened by reasoning included in Judge Kollar-Kotelly’s recent ruling, and on these key arguments:
In Stockman, the Trump administration makes the same arguments that Judge Kollar-Kotelly found to “wither under scrutiny” and relies on Interim Guidance characterized by Judge Kollar-Kotelly as a “red herring.”
Under Trump’s ban, Stockman plaintiffs suffer actual, imminent, concrete harms:
Plaintiffs are targeted for forced separation solely because they are transgender and will suffer the loss of tenure, career prospects, and medical care,
Plaintiffs are able and ready to accede into service but are categorically excluded simply because they are transgender Americans, and
Plaintiffs suffer from the injustice of a discriminatory classification that demeans their abilities and fitness to serve as transgender people.
In addition to Equality California, plaintiffs in Stockman v. Trump, filed September 5, 2017, include three unnamed and four named plaintiffs. The named plaintiffs include Nicolas Talbott from Lisbon, Ohio, a 23-year old who wants to enlist but is unable to do so because of the ban, and Aiden Stockman from Yucca Valley, California, a 20-year old who wants to join the Air Force and took the Armed Services Vocational Aptitude Battery (ASVAB) test in high school. Aiden currently works at a local grocery store and sees the Air Force as a promising career as well as a way to serve his country, but has been prevented from moving forward because of the ban. Tamasyn Reeves, 29, started the process to enlist in the military but has been unable to serve because of the ban. Jaquice Tate, 27, is an active-duty member of the Army, serving as a Sergeant, E-5 Rank. Unnamed plaintiffs who do not wish to disclose their names include John Doe 1, a 28-year old currently serving as a Non-Commissioned Officer E-5 Staff Sergeant in the Air Force. John Doe 2 is a 20-year old currently serving as an E-4 Specialist (SPC) Operator-Maintainer in the Army. Jane Doe is currently serving as a Staff Sergeant, E-5 Rank, in the Air Force, a Risk Management Framework Program Manager at a strategically important overseas base.
Former top military leaders who were instrumental in the meticulous year-long process of assessing and adopting a policy of open service for transgender service members have lent their voices in legal cases against the ban, including retired Admiral and former Chairman of the Joint Chiefs of Staff Michael Mullen, former Secretary of the Army Eric Fanning, former Secretary of the Navy Raymond Edwin Mabus, Jr., and former Secretary of the Air Force Deborah Lee James. All of these leaders have expressed their strong concern about the negative effects of Trump’s ban on military readiness, national security, and morale.
A hearing in Stockman v. Trump is scheduled for November 20 in the United States District Court for the Central District of California. Equality California, NCLR, and GLAD will continue to fight Trump’s ban in court until it no longer poses any threat to transgender Americans currently serving or who dream of serving our country.
In addition to NCLR and GLAD, plaintiffs in Stockman v. Trump are also represented by Latham & Watkins LLP.
HRC has learned that the U.S. General Services Administration (GSA) has removed sexual orientation and gender identity from their Equal Employment Opportunity (EEO) statement.
Under the Civil Service Reform Act and the Executive Orders signed by Presidents Clinton and Obama, sexual orientation and gender identity discrimination is prohibited in federal employment.
Earlier this year, the Department of Commerce took a similar action, but Secretary of Commerce Wilbur Ross restored the sexual orientation and gender identity language following new stories reporting on the change.
“Yet again, we see the Trump-Pence Administration actively seeking to undermine rights for LGBTQ people,” said David Stacy, HRC Government Affairs Director.
“The GSA’s move to exclude sexual orientation and gender identity from their Equal Employment Opportunity statement is mean-spirited, deceptive and irresponsible. The GSA’s EEO statement is meant to inform workers and applicants about their legal protections — protections that federal employees have had for decades. Cutting specific mention of sexual orientation and gender identity protections is a slap in the face to LGBTQ federal employees.
Following President Trump’s meeting with Republican senators to discuss the future of immigrant youth who have been thrust into legal limbo, civil rights leaders from across the country have united to call on President Trump and policymakers on both sides of the aisle to adopt inclusive immigration policies instead of racially divisive ones. The organizations issued the following joint statement:
“Congress has an opportunity to do something positive for the country by passing a bipartisan Dream Act by the end of this year. Doing so would allow young immigrants to finally be recognized as Americans on paper, allowing them to more fully contribute to their families, communities, and the country they call home. The clock is ticking for Congress to do its job: every day, DACA recipients run the risk of losing the work authorization they need to live free from fear of deportation.
“But any solution proposed must not come at the expense of other aspiring Americans. Our communities — of many faiths, backgrounds, skin colors, and languages — are stronger because of our diverse backgrounds and communities. Rather than serve to unify the country after the tragedy in New York, the president is fearmongering to advance his xenophobic agenda. We will stand in vigorous opposition to any attempt to dilute this country’s diverse richness or keep families apart.
“President Trump’s latest call for an end to the Diversity Visa program is yet another anti-immigrant proposal grounded in white nationalism. Policymakers on both sides of the aisle should know better than to try to score cheap political points by punishing an entire class of immigrants. We will not stand for more political scapegoating of immigrants or the pitting of Muslims and immigrants eligible for the diversity visa (many of whom are from Africa and the Caribbean) against Dreamers.
In times of tragedy, more than ever, our country needs us to come together. Inclusive policies that benefit all of us — like the Dream Act — are the solutions we deserve as a country.”
The list of organizations that have signed on to the statement include:
9to5, National Association of Working Women
Adhikaar
American Federation of State, County and Municipal Employees
American-Arab Anti-Discrimination Committee (ADC)
Arab American Institute
Asian Americans Advancing Justice – AAJC
Asian Americans Advancing Justice – Los Angeles
Asian Americans Advancing Justice- Asian Law Caucus
Asian Americans Advancing Justice-Chicago
Asian Pacific American Labor Alliance, AFL-CIO (APALA)
Bend the Arc Jewish Action
Black Women’s Roundtable
Center for Popular Democracy
Church World Service
Council on American-Islamic Relations (CAIR)
Demos
Equality California
Farmworker Justice
The Forum for Youth Investment
Global Progressive Hub
Hip Hop Caucus
Hope Border Institute
Human Rights Campaign
Lambda Legal
Las Cruces CIVIC
The Leadership Conference on Civil and Human Rights
League of United Latin American Citizens
League of Women Voters of the United States
Legal Aid at Work
Los Angeles LGBT Center
MALDEF
MPower Change
Muslim Advocates
Muslim Public Affairs Council
NAACP
NAACP Legal Defense and Educational Fund, Inc.
National Action Network
National Asian Pacific American Families Against Substance Abuse
National Asian Pacific American Women’s Forum
National Bar Association
National Center for Lesbian Rights
National Center for Transgender Equality
National Coalition for Asian Pacific American Community Development (National CAPACD)
National Council of Jewish Women
The National Coalition on Black Civic Participation
National Employment Law Project
National Hispanic Media Coalition
National Immigrant Justice Center
National Immigration Law Center
National Network for Arab American Communities
National Organization for Women (NOW)
National Partnership for Women & Families
National Urban League
New Orleans Workers’ Center for Racial Justice / National Guestworker Alliance
OCA – Asian Pacific American Advocates
PolicyLink
Presbyterian Feminist Agenda Network
Pride at Work
Queens Center For Gay Seniors
Religious Action Center of Reform Judaism
Religious Coalition for Reproductive Choice
Service Employees International Union (SEIU)
South Asian Americans Leading Together (SAALT)
UndocuBlack Network
UnidosUS (formerly NCLR)
United We Dream
Voting Rights Forward
A teacher at a New York school has been suspended from her job after teaching students about LGBT issues.
Jacqueline Hall, the health teacher at the Cambridge Central High School, was suspended with pay after inviting a guest lecturer to teach about LGBT issues.
The second day of lectures by the Pride Centre of the Capital Region was also cancelled by the school.
Parents had complained about a pack given out to students which taught about gender identity and sexual orientation.
One parent, Sirell Fiel, took to Facebook, recording a video expressing his disgust that his child would be taught about gender identity.
“When it comes to teaching our kids certain things, that should be left up to us,” he says in the video.
“Not the school district. Not health class in seventh grade.”
He also encouraged other parents to find the booklet and confiscate it.
The parent also took aim at the booklet for teaching the 11-year-old class that some people have same-sex relationships.
“This is something my eleven-year-old definitely does not need to know in health class in seventh grade,” he said.
“Unacceptable.”
Fiel did accept that students should be taught not to bully people for their sexual orientation.
He described the booklet as “state-funded porn”.
“Genital reconstruction surgery!” Fiel exclaimed, working through the extensive list. “Is that really something an eleven-year-old kid should be learning and knowing about? Nah. I don’t think so.”
In the video, Fiel says he plans to make phone calls to complain about the reading material.
He says he thinks parents should have been informed prior to the class that it was taking place.
“They are literally taking the innocence out of our children every day with this BS,” he says.
The superintendent of the school, Vince Canini, says he has concerns about the class.
“The parents have concerns, and they are mine as well,” he told the Post Star.
Canini also said the booklet contained information he considered to be “inappropriate.”
On November 9th, 2017 at the Roxie Theater in the Mission and on November 10th and 11th at the Goethe-Institut in Downtown San Francisco, America’s premiere festival of contemporary German cinema kicks off its 22nd season! The Autumn Showcase is presented in anticipation of the main 22nd edition of the Berlin & Beyond Film Festival (February 2018), and as the cinematic part of the 50th Anniversary Celebrations of the Goethe-Institut San Francisco with its series of cultural and community events this autumn.
The Autumn Showcase will feature the interactive film event The Verdict, the exhilarating Berlin film Tiger Girl, a night dedicated to Fritz Lang, a special encore screening of the 2017 Berlin & Beyond Film Festival Audience Award winner Stefan Zweig: Farewell to Europe, and Switzerland’s 2018 Academy Awards® entry The Divine Order.
SCHEDULE
Thursday, November 9th at the Roxie Theater:
6:30 PM – THE VERDICT (TERROR – IHR URTEIL)
Directed by Lars Kraume (120 min. including discussion. Germany. 2016)
Based on Ferdinand von Schirach’s “Terror”: Can it be justified to shoot down a civilian plane, converted by terrorists into a deadly suicide missile? This legal thriller tests the fundamental values of Democracy. US West Coast Premiere
9:15 PM – TIGER GIRL
Directed by Jakob Lass (90 min. Germany. 2017)
An exhilarating ride with Vanilla and Tiger, two girls struggling to fend for themselves in a city where free spirits are constantly broken by the world around them. Northern California Premiere
Friday, November 10th at the Goethe-Institut: Fritz Lang Night
6:00 PM – FRITZ LANG
Directed by Gordian Maugg (104 min. Germany. 2016)
Filmmaker Fritz Lang seeks inspiration for his first sound film by immersing himself in the case of serial killer Peter Kürten.
8:30 PM – M (M – EINE STADT SUCHT EINEN MÖRDER)
Directed by Fritz Lang (107 min. Germany. 1931)
A child murderer is on the loose in Berlin. The members of organized crime increasingly feel disturbed by the manhunt conducted by the police.
Saturday, November 11th at the Goethe-Institut:
5:15 PM – STEFAN ZWEIG: FAREWELL TO EUROPE (VOR DER MORGENRÖTE)
Directed by Maria Schrader (106 min. Germany/Austria/France. 2016)
Austria’s 2017 Academy Awards® entry: As a Jewish intellectual, Zweig struggles to find the right stance towards the events in Nazi Germany, while searching for a home in the new world. Encore Screening of the 2017 Berlin & Beyond Audience Award – Best Narrative Feature Gala
7:30 PM – THE DIVINE ORDER (DIE GÖTTLICHE ORDNUNG)
Directed by Petra Volpe (96 min. Switzerland. 2017)
Switzerland’s 2018 Academy Awards® entry: A young housewife challenges the status quo by fighting for women’s suffrage in 1971 Switzerland. San Francisco Premiere
TICKETS
Roxie Theater screening – per ticket: $13.00 general; $12.00 senior / student;
$11.00 Berlin & Beyond member
Goethe-Institut screening – per ticket: $10.00 general / senior / student; $8.00 Berlin & Beyond member
Double Feature “Fritz Lang” & “M” ticket set: $15.00 (no further discounts)
Festival Pass (all 6 films + priority entry): $60.00 general / senior / student; $50.00 Berlin & Beyond member
Since 1996, Berlin & Beyond Film Festival has been the leading festival of contemporary German cinema in the Americas, and has presented over 500 motion pictures, along with the presence of celebrated film figures, including Fatih Akin, Moritz Bleibtreu, Daniel Brühl, Hannelore Elsner, Florian David Fitz, Bruno Ganz, Maria Schrader, Barbara Sukowa, Wim Wenders. Including seasonal programming, Berlin & Beyond receives a combined attendance of over 12,000 people annually. The main 22nd Edition of the Berlin & Beyond Film Festival will take place February 9-11, 2018 at San Francisco’s iconic Castro Theatre, along with other dates and venues to be announced this autumn. berlinbeyond.com
GOETHE-INSTITUT
The Goethe-Institut is Germany’s official cultural center comprised of 159 institutes in 98 countries. The Goethe-Institut exists to promote art and films from Germany, the study of the German language, and encourage the international cultural exchange with Germany. Celebrating its 50th Anniversary in 2017, the San Francisco branch has been promoting German culture and language since 1967. Its year – round cultural activities include art exhibitions, film screenings, and special events with local cultural institutions. goethe.de/sf
As the the race for the governor’s mansion in Virginia goes down to the wire, GLAAD today called out Republican candidate Ed Gillespie’s anti-LGBTQ record leading into next Tuesday’s election.
GLAAD states that Gillespie’s actions during the 2017 gubernatorial race so far have proven that he is no “moderate” as he was once described, instead building his campaign on the racist stereotyping of the Latinx community and the foundation of a deeply troublesome anti-LGBTQ record.
“Ed Gillespie’s clear targeting of marginalized communities falls in line with the racist and anti-LGBTQ agenda of the Trump Administration,” said Zeke Stokes, Vice President of Programs at GLAAD. “His record of pushing anti-transgender legislation and opposing marriage equality – along with his dog-whistle campaign messaging – are out of line and out of touch with the values of the people of Virginia.”
The discriminatory anti-LGBTQ record of Ed Gillespie is an embrace of the same anti-LGBTQ agenda at the core of the Trump Administration, including Gillespie’s own push for a North Carolina-style legislation that would directly put transgender Virginians in harm’s way and his long record of opposition to marriage equality.
Ed Gillespie’s Anti-LGBTQ Record
Opposition to Marriage Equality
Opposes marriage equality: “‘I believe in my faith,’ which says marriage is between a man and a woman, he said. ‘So I don’t believe in government sanction of same-sex marriage.’”
While chair of the Republican Party, called on the GOP to “pursue whatever policy is necessary” to stop marriage equality: “The Republican Party platform is clear: We believe marriage is the legal union of one man and one woman. We must pursue whatever policy is necessary to protect this institution, including a Federal Marriage Amendment to the United States Constitution.”
Reportedly pressed former president George W. Bush to add extra lines to a 2008 commencement speech that explicitly condemned marriage equality.
As senior adviser to Mitt Romney’s 2012 presidential campaign, advocated for a federal marriage amendment.
Classified judicial rulings on marriage equality as “unhealthy”: “We’ve had courts injecting themselves into this decision making process, into the political process, in a way I think is generally unhealthy for unelected judges to make decisions about whether or not government should sanction gay marriage or not.”
Support of Anti-Trans Measures/Policies
Advocated for North Carolina–styled “bathroom bill.”
His campaign derisively said of his position on transgender bathroom access: “Ed doesn’t think girls should be compelled to share a locker room shower or hotel room on an overnight band trip with boys.” Gillespie believes that parents and local school boards should “enact common-sense policies to protect the safety and privacy of our children.”
Claimed Being LGBTQ as a “Choice”
Once claimed LGBTQ people are making a “choice” and that asking for acceptance is “religious bigotry”: “I accept people for who they are – and love them. That doesn’t mean I have to agree or turn my back on the tenets of my faith when it comes to homosexuality. I think when people say, ‘Well, no. That’s not enough that you accept me for who I am, you have to agree with – and condone – my choice,’ that, to me, is religious bigotry, and I believe that’s intolerant. I think they are the ones that are crossing the line here.’”
Historically, when children with atypical sex characteristics were born in the United States, the people around them—parents and doctors—made their best guess and assigned the child a sex. Parents then reared them per social gender norms. Sometimes these people—intersex people—experienced harassment and discrimination as a result of their atypical traits. But many lived well-adjusted lives as adults. During the 1960s, however, based largely on the unproven recommendations of a single prominent psychologist, medical norms in the US changed dramatically. Doctors began recommending surgical solutions to the supposed “problem” of intersex traits—internal sex organs, genitalia, or gonads that do not match typical definitions of male and female. This medical paradigm remains the status quo nearly everywhere in the world today.
Defaulting to surgery resulted in stigmatization, confusion, and fear. In some cases, doctors advised parents to conceal the diagnosis and treatment from the child, instilling feelings of shame in parents and children both. And as a result, many in an entire generation of intersex people did not learn about their conditions until they saw their medical files as adults—sometimes as late as in their 50s.
Over time and with support and pressure from advocates, some medical norms have evolved. Today, intersex children and their families often consult a team of specialists, and not just a surgeon. The medical community has changed its approach to intersex cases—which doctors often categorize as “Differences of Sex Development” or “DSD”—by establishing “DSD teams.” These teams convene multiple healthcare specialists, including mental health providers, to advise on and treat intersex patients. Disclosure of a child’s intersex traits to the child is widely recommended. During this evolution in care, cosmetic surgeries on intersex children’s genitals have become highly controversial within the medical community. However, while the establishment of “DSD teams” has been perhaps the most significant evolution in care and has changed practices considerably, it has not addressed the fundamental human rights issues at stake.
Most medical practitioners now acknowledge that in some cases parents may prefer to leave their child’s body intact as a way of preserving the person’s health, sexual function, fertility options, autonomy, and dignity. Consensus among specialists in intersex health has evolved to acknowledge data gaps and controversies—namely that there has never been sufficient research to show either that these surgeries benefit patients or that there is any harm from growing up with atypical genitals. A growing number of doctors are opposed to doing unnecessary early surgery under such conditions. Practitioners also increasingly recognize the suffering of intersex patients who underwent the operations without their consent.
However, despite these promising developments in care for intersex people, the field remains fraught with uneven, inadequate, and piecemeal standards of care—and with broad disagreements among practitioners that implicate the human rights of their intersex patients. While there are certain surgical interventions on intersex children that are undisputedly medically necessary, such as the creation of a urinary opening where one does not exist, some surgeons in the US continue to perform medically unnecessary “normalizing” surgeries on children, often before they are one year of age. These operations include clitoral reduction surgeries—procedures that reduce the size of the clitoris for cosmetic reasons. Such surgery carries the risk of chronic pain, nerve damage, and scarring. Other operations include gonadectomies, or the removal of gonads, which result in the child being sterile and forced onto lifelong hormone replacement therapy.
Healthcare providers are an important source of information and comfort amidst confusion. “Clinicians and parents alike refer to the period after the birth of an infant for whom gender assignment is unclear as a ‘nightmare,’” wrote Katrina Karkazis, a medical ethicist at Stanford University. “Not only does a child with ‘no sex’ occupy a legal and social limbo, but surprise, fear, and confusion often rupture the parents’ anticipated joy at the birth of their child.”
An endocrinologist told Human Rights Watch: “I understand the impulse for a parent to create something that looks normal—or at least normal according to a surgeon—at birth before the kid knows anything about it. I follow the logic pattern, but you have to run it against risks.” He said: “It’s important to be clear that a certain percentage of the time, something does go wrong and you have to do a re-op, and there’s a loss of sensitivity. So then the do-no-harm becomes: don’t do anything. What problem were you solving with surgery anyway?”
In July 2017, three former US surgeons-general, including one who was a pediatric endocrinologist, wrote that they believed “there is insufficient evidence that growing up with atypical genitalia leads to psychosocial distress,” and “while there is little evidence that cosmetic infant genitoplasty is necessary to reduce psychological damage, evidence does show that the surgery itself can cause severe and irreversible physical harm and emotional distress.” They said: “These surgeries violate an individual’s right to personal autonomy over their own future.” The three doctors concluded:
[B]abies are being born who rely on adults to make decisions in their best interest, and this should mean one thing: When an individual is born with atypical genitalia that pose no physical risk, treatment should focus not on surgical intervention but on psychosocial and educational support for the family and child.
For more than 50 years, the medical community in the United States has often defaulted to treating intersex children by conducting irreversible and unnecessary surgeries. Even after two decades of controversy and debate, there remains no research showing that early, medically unnecessary surgery is helpful to the intersex child. Nonetheless, to date, none of the clinics we surveyed have firmly instituted a moratorium on such operations. The evidence is overwhelming that these procedures carry risk of catastrophic harm. And while increasing numbers of doctors believe it is wrong to conduct these procedures, recent data demonstrate that many clinics continue to do so. Alice Dreger, a bioethicist who has written two books on intersex issues and served on a National Institutes of Health multi-site research project before resigning in protest in 2015, wrote of her two decades of engagement on the intersex surgery controversy: “While many clinicians have privately shared my outrage about these activities, in public, the great majority have remained essentially silent.”
International human rights bodies have recognized the practice as implicating and potentially violating a range of fundamental rights, including the rights to health, autonomy, integrity, and freedom from torture. At present, many of the doctors who advise or conduct surgeries on intersex infants and young children cite a lack of data on the outcomes for children who do not undergo surgery. “We just don’t know the consequences of not doing it,” a gynecologist told Human Rights Watch regarding medically unnecessary surgery. Others continue to call for data collection regarding the impact of the intact intersex body on families and society—as if intersex people are a threat to the social order. For example, a 2015 article co-authored by 30 DSD healthcare providers reflecting on genital surgeries published in the Journal of Pediatric Urology stated:
There is general acknowledgement among experts that timing, the choice of the individual and irreversibility of surgical procedures are sources of concerns. There is, however, little evidence provided regarding the impact of non-treated DSD during childhood for the individual development, the parents, society….
Human Rights Watch and interACT believe this approach has it exactly backwards: the experience of those who have undergone the surgery and principles of medical ethics suggest that unless and until there is outcome data establishing that the medical benefits of specific surgical procedures on infants and young children outweigh the potential harms, they should not be used.
Doctors have said they are seeking guidance on the issue so that they can avoid repeating the mistakes of the past. For example, in 2017, Dr. Ilene Wong, a urologist in Pennsylvania, acknowledged the harm in which she took part when she conducted surgery on an intersex child without her consent. She wrote: “Eight years ago, I did irrevocable damage to the first intersex person I ever met.” She said:
While some would argue that surgical practice has improved in the past decades, the fact remains that few attempts have been made to assess the long-term outcomes of these interventions. The psychological damage caused by intervention is just as staggering, as evidenced by generations of intersex adults dealing with post-traumatic stress disorder, problems with intimacy and severe depression. Some were even surgically assigned a gender at birth, only to grow up identifying with the opposite gender.
Others have offered similar testimony. Dr. Deanna Adkins, the Director of the Duke University Center for Child and Adolescent Gender Care, made an expert declaration to oppose North Carolina’s HB2, a sweeping statewide law repealing non-discrimination ordinances protecting lesbian, gay, bisexual, and transgender (LGBT) people and barring transgender people from shared facilities. In her statement, referring to intersex children, Dr. Adkins argued:
It is harmful to make sex assignments based on characteristics other than gender identity. For example, in cases where surgery was done prior to the ability of the child to understand and express their gender identity, there has been significant distress in these individuals who then have to endure further surgeries to reverse the earlier treatments. It has become standard practice to wait until the gender identity is clear to make permanent surgical changes in these patients unless the changes are required to maintain the life or health of the child.
An endocrinologist on a DSD team told Human Rights Watch: “That’s an adage in medicine—above all do no harm.” He added: “I don’t think you’re going to find anybody that runs a DSD clinic that would argue with the fact that outcomes are better when you delay intervention in general.” A DSD specialist Human Rights Watch interviewed argued that “there’s probably rare if any situations where surgery is absolutely necessary.” She said doctors needed “clear guidelines, clear practice standards”—what she called “general principles of care and make it very clear that the emerging data is in favor of not intervening.”
Such guidelines have begun to emerge. In 2016, the American Medical Association Board of Trustees issued a report recognizing that “DSD communities and a growing number of health care professionals have condemned…genital ‘normalizing,’ arguing that except in the rare cases in which DSD presents as life-threatening anomalies, genital modification should be postponed until the patient can meaningfully participate in decision making.” The board recommended adoption of a resolution that, “except when life-threatening circumstances require emergency intervention, [doctors should] defer medical or surgical intervention until the child is able to participate in decision making.”
Accordingly, Human Rights Watch and interACT are urging the AMA, the American Academy of Pediatrics, and other medical bodies, in line with the oath to “Do No Harm,” to support a moratorium on all surgical procedures that seek to alter the gonads, genitals, or internal sex organs of children with atypical sex characteristics too young to participate in the decision, when those procedures both carry a meaningful risk of harm and can be safely deferred.