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Most intersex advocates and doctors agree that every child should be assigned a sex soon after birth, which simply involves calling a child a girl or a boy.

Arriving at a decision can be a painstaking process for parents.They have to take into account not only what their child’s genitals look like but also how their brain and body will develop.“Breathe and push,” Eric Lohman encouraged his wife, Stephani, as she squeezed his hand and bore down.After seven hours of labour, they were both eager to meet their baby, a daughter they had already named Rosalie—Rosie for short—after an ultrasound indicated they were having a girl.A few more pushes and Rosie made her grand entrance, wriggling and wailing and perfectly pink.

A nurse held up the alert newborn for her parents to see. “I told you ultrasounds could be wrong,” Stephani said to Eric, giving his arm a playful swat.

But, in many cases, surgery is performed purely to make a child’s appearance match their assigned sex—a highly controversial practice that advocacy and human rights organizations are working hard to stop.

“We’re trying to get away from this unnecessary urgency that’s created when intersex babies are born,” Zieselman says.

There’s research on how people with certain conditions identify on the gender spectrum, which can help guide decision-making.

For example, 95 percent of genetic females with CAH who were raised as girls identify as female.

Zieselman recommends parents make an educated guess and remain open to the possibility that their child may identify differently as they age.