Thus, even the pioneers of sex reassignment surgery no longer maintain that one must change the genitals of a child in order to facilitate the child's healthy development as the assigned sex.

Further, as seen in John/Joan's case, infant surgeries can cause irreversible physical harm. For example, surgery often damages sexual and reproductive functions, can reduce or completely remove sensation and orgasm capability, and can even result in death. [FN30] Moreover, early genital surgery does not eliminate genital ambiguity: Infants who are subjected to surgery often need repeated surgical procedures throughout their life to maintain a "normal" genital appearance. [FN31]

Finally, since the time of Money's studies, scientists have learned that the balance of nature and nurture is not as well settled as was previously believed. Studies have shown that, in utero, the brain is imprinted with testosterone and other androgens that can dispose a child to develop a gender identity different from the sex assigned by physicians. [FN32] Consequently, Money's method of assigning sex based almost entirely on the size of the phallus does not always *134 accurately predict later gender identity. [FN33]

Thus, many in the medical community have acknowledged that healthy psychosexual development is not dependent on genital appearance, that performing early surgery can have devastating medical effects, and that the current methods for assigning sex do not necessarily conform to the identity a child will later form. The traditional paternalistic system--based on a single, failed case study--has been discredited. This leads to the obvious question: Why continue to perform genital-normalizing surgery at all?

II. THE CASE FOR A MORATORIUM ON INFANT GENITAL-NORMALIZING SURGERY

In the same decade that John/Joan came forward to tell his story, a group of adult intersexuals founded the Intersex Society of North America (ISNA). [FN34] ISNA is an advocacy group "dedicated to ending shame, secrecy and unwanted genital surgeries for children born with atypical sex anatomy"; [FN35] its positions are rooted in a philosophical belief in the autonomy and self-determination of the intersexed individual. [FN36] ISNA and other activists call for a moratorium on genital-normalizing surgery based on the autonomy of the intersexed individual [FN37] because surgery is unnecessary to achieve its purported goals [FN38] and because there is little medical evidence showing benefits of the surgery. [FN39] According to critics, the traditional treatment protocol conveys "the underlying attitude that intersexuality is so shameful that it must be erased before the child *135 can have any say in what will be done to his or her body." [FN40] A moratorium is justified on ISNA's ethical grounds alone; a legal analysis only strengthens the case.

Section A argues that there is no evidence that surgery is medically necessary or that intersexuality is a "disorder" that needs to be fixed. Until the medical profession is able to separate bona fide medical concerns from constricting and discriminatory social mores, the known detrimental effects of surgery mandate that it be halted. As discussed further in Section B, a state can trump parents' rights to make decisions regarding their children when there are competing medical theories. [FN41]

Section B asserts that when there is a lack of medical evidence to justify surgery and a high potential for a parental conflict of interest, parents are not legally empowered to make any decision regarding surgery. While assigning a gender to a child is a decision clearly within the scope of parental authority, consenting to irreversible surgeries--such as the removal or modification of gonads or genitalia--that the child may one day want to have reversed is not within parental authority. Physicians should consult with parents regarding the assignment of an appropriate gender identity based on all the available evidence, but should not look to the parents to authorize genital-normalizing surgery.

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