TMC PULSE

t m c » p u l s e | o c t o b e r 2 0 1 7 31 "That was a springboard moment of this community coming together and not being afraid to speak out anymore," Koomah said. That day—Oct. 26—has since been declared Intersex Awareness Day. Last year, Houston's City Hall was illuminated in yellow and purple to mark the occasion. This year, the illumi- nation will take place on Oct. 25. Intersex individuals, along with the United Nations, human rights organiza- tions and some medical professionals, have also been questioning the practice of performing medically unnecessary surgery on intersex infants or young children before they have the ability to understand and consent. On 2016 Intersex Awareness Day, the U.S. Department of State released a statement saying, "Intersex persons routinely face forced medical surger- ies that are conducted at a young age without free or informed consent. These interventions jeopardize their physical integrity and ability to live free." And more recently, in June 2017, three former surgeons general— M. Joycelyn Elders, M.D., David Satcher, M.D., and Richard Carmona, M.D.—released a document entitled "Re-Thinking Genital Surgeries on Intersex Infants." They urge that "treatment should focus not on surgi- cal intervention but on psychosocial educational support for the family or child … until children are old enough to voice their own view about whether to undergo the surgery." The question of informed consent is a key ethical consideration when it comes to medically unnecessary sur- gery on children, Malek said. "The idea here is that we should let the child be the one to make that decision. If the parents choose to have the surgery very early on, they take that choice away from the child," Malek said. "Out of respect for the fact children will grow into adults who will need to make their own decisions, we want to offer them that choice." The AMA does not currently have a specific policy for treating intersex patients, however the AMA's House of Delegates is expected to consider adopt- ing an official policy at a future meeting. The organization does have established ethical opinions and policies that broadly address decisions for minors, including one that "encourages involv- ing minor patients in decision making at a developmentally appropriate level." This past legislative session, Cortez and Koomah contributed to Texas Senate Bill 1342, which would have amended the Texas Family Code to prohibit "nonconsensual genital surgery" on intersex minors under state care. But the bill, introduced by Sen. Sylvia R. Garcia, D-Houston, died in the State Affairs Committee at the end of the session. Koomah and Cortez both empha- sized that the bill was focused on sur- geries that are "medically unnecessary." "There are things that do need surgical intervention right away, and we are not trying to prevent those kinds of surgeries," Koomah said. "But if it's just cosmetic, it's something that can safely be put off until someone is older and can make their own decision." As part of that decision-making process, Marni Axelrad, Ph.D., a child and adolescent psychologist at Texas Children's Hospital, counsels intersex children, as well as their parents. "I talk a lot about gender identity, which is in some ways easier when it's an older child, because the gender iden- tity is established," Axelrad said. "With a baby, it's tricky because we don't know what a baby's gender identity is going to be." She added that typically children can reliably report their gender identity between ages two and four, "when it really becomes more established and clear." (continued) Imagine living on Hermann Drive — Houston's own version of New York City's Central Park West. Located in historic 1400 Hermann Drive high rise condominiums, this architect-designed residence is nestled in trees, has two bedrooms, two baths, and directly overlooks Hermann Park. Living room, dining room, and master bedroom face the McGovern Centennial Gardens. Kitchen and guest bedroom enjoy swimming pool and tennis court views. Only two homes in the city have this location and view — and one of them is now for sale. Live above it all. Downsize your nest. Upgrade your lifestyle. www.1400Hermann.life 713-523-3425 C M Y CM MY CY CMY K TMC_Pulse_Archimage_October_2017 copy.pdf 1 9/6/17 5:37 PM

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