If you’re born with sex characteristics that don’t fit expectations about male and female anatomy, you’re likely to receive destructive and macabre genital surgery in early childhood to try to make you look normal. I did.

Despite being based on discredited ideas from the psychology of the 1950s about how genital appearance determines gender, intersex medicine has proved weirdly resistant to critique from generations of patient advocates, scholars, and even doctors themselves.

That’s why I wrote Intersex: A Manifesto Against Medicalization­—a book that explores why medicalization is so embedded in contemporary society and how to challenge it.

Three key insights from the book overturn assumptions about how intersex medicine works—and about how we should protest it.

1.  Doctors and parents face challenges, but they are not powerless.

Right now around the world, doctors and parents are making decisions to do irreversible genital surgeries on children with intersex anatomies. When talking about their experiences of such decisions, they commonly describe feelings of intense difficulty.

It feels difficult for them because they genuinely believe surgery in early childhood can create genital normality, despite being repeatedly confronted by its failures. Surgery often causes scars, complications, and nerve damage.

Because surgical normalization is so difficult to achieve, doctors and parents think they’re powerless. This hides what’s really happening.

Genital surgery for intersex makes bodies wounded, not normal. The scars, complications, and lasting nerve damage are central effects. Once we recognize this, we see that doctors and parents who choose surgery for children do not lack power. Quite the opposite. They wield real power to harm intersex bodies—regardless of their intentions.

2. Intersex rights are independent of identity.

Some campaigners believe that recognizing intersex as an identity is the first step toward establishing intersex rights. They argue that to secure bodily autonomy and freedom from medical interference, we must define a category of “intersex people” to whom those rights will apply.

However, I disagree for two reasons.

First, not everyone with intersex attributes identifies as “intersex,” raising the question of whether people with intersex bodies who don’t identify as such are entitled to those rights. Clearly they should be.

Second, intersex is not an identity comparable to other minority identities under the LGBTQ+ banner. For example, identifying as gay or lesbian involves living a certain way and expecting respect for that way of life. There’s no specific way of life that follows from having an intersex anatomy. On the contrary: Intersex liberation means being free from medical assumptions that your genital anatomy will determine how you live your life.

3. Prioritizing medically essential treatments doesn’t challenge medical authority.

Critics of intersex medicine have long tried to distinguish between necessary and unnecessary interventions to focus their criticisms on the latter. Cosmetic surgery to reduce clitoris size is a prime example of an unnecessary intervention.

While the difference is clear in some cases, it’s not always so. The urgency of some surgeries may be due to complications from earlier surgeries, not a preexisting need. And increasingly, doctors advocate surgeries that change genital function and appearance at the same time, making it impossible to categorize them as either necessary or unnecessary.

It is tempting to think that policy makers should just be more specific about which procedures are necessary. However, new medical technologies will continue to blur the lines between what’s possible and what’s needed.

The focus on stopping unnecessary interventions means critics will always be dependent on medical authority to define necessity. As long as we are attached to the idea of medical necessity, we will never truly demedicalize intersex.

Intersex examines these and many other problems and paradoxes in the urgent and controversial debate over intersex medicine. Understanding the true nature of intersex medicine will help us navigate and overcome the complexities of dismantling it.