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Sara Kelly Keenan was sitting in a booth with her father at Santa Cruz Diner eight years ago this month when he admitted that doctors had wanted to assign her a gender when she was born: “They said that they could make you a 3-inch penis if I wanted them to, but I said, ‘Hell no, that’s my daughter, she’s a girl!’”

“That’s when I realized that he knew I was genetically a male,” says Keenan. It took 49 years and the onset of advanced Alzheimer’s for Keenan’s father to confirm what she had suspected all along—that Keenan wasn’t fully male or female. In December, Keenan’s gender designation was finally recognized when New York City, where she was born, issued a birth certificate with “intersex” on it. It’s the first known intersex birth certificate issued in the U.S.

“I no longer need to check a box that is a lie, I no longer need to perjure myself to file a tax return or get a driver’s license,” says Keenan, who uses female pronouns because, after five and a half decades, that feels most natural. “I’ve existed in the shadows for 55 years and now, I, and people like me, have the right to legally exist in an authentic way in our society.”

Keenan was born genetically male—with XY chromosomes—but with female anatomy. Knowing the truth and now also having the birth certificate to match feels empowering, she says. Growing up, Keenan felt like she never really fit in with women or men, and that the world didn’t know what to do with her.

“I prove, by my biological existence, that gender is not strictly binary,” says Keenan, who lives in Ben Lomond. “I want the world to wake up and realize that the world isn’t flat as was thought hundreds of years ago, and that biological sex exists along a spectrum.”

Other gender-nonconforming people across the nation have been making headway in the fight for legal visibility too, including Jamie Shupe in Oregon, who was the first to legally change their sex to non-binary in June 2016.

Keenan realized she could do the same in California, so in August she went to the Santa Cruz Superior Court and next to the boxes “Male” and “Female” wrote in “non-binary.” After the court initially refused to accept the paperwork, they granted Keenan a non-binary court order.

Now a Triangle Speaker for the Diversity Center and a volunteer with the Intersex and Genderqueer Recognition Project (IGRP), Keenan has been fielding calls from national and international news sources covering the first intersex birth certificate. She’s using her “15 minutes of fame,” as she calls it, to help other intersex and genderqueer Californians. Keenan and the IGRP are working with people in New York and Washington, as well as locally in San Francisco, Alameda, Santa Clara and San Mateo counties to help them file for their true gender designation.

It goes beyond a piece of paper, says Keenan, and it’s about securing the right for non-binary and intersex people to make decisions about their own bodies. “To have been lied to for 49 years of my life, to have been denied the reality of my own biology, it was an unintentional act of cruelty on the part of parents and doctors,” says Keenan.

When Keenan was born, the conventional medical wisdom relied on Dr. John Money’s now-discredited theory that said children do better if surgically assigned a gender before 18 months. In some cases, and often without fully informed consent, a doctor would choose the gender for the child by performing genital reconstruction surgery—an enlarged clitoris, a penis with a urethra that didn’t come fully to the tip, or genitals that didn’t look fully male or female would be surgically fashioned to look “normal.” Doctors—like the ones who wanted to give her a penis when she was a baby—still do this, says Keenan, instead of waiting for the person to reach the age of consent.

“The United Nations Commision on Human Rights calls it genital mutilation, calls it medical torture,” says Keenan. “When we look at African countries and say ‘Oh, they’re so bad for mutilating female’s genitals as a matter of social custom,’ well, we’re doing the same damn thing to babies every day in America. That has to change.”

Doctors used to advise parents to keep these surgeries secret—and still do in some cases, which is why Keenan didn’t know about her intersex biology, even though she had surgery as a teenager to remove some testicular tissue. Doctors told her it was to stop her growing, since she was already 6 feet tall by 9th grade.

That history of secrecy has made it impossible to collect data on how many people are born intersex—estimates say one in every 2,000 babies—or trace the impacts of growing up outside the gender binary for those given that choice, says LGBT Alliance steering committee secretary Adam Spickler.

But the New York City Department of Health’s decision to allow “intersex” on Keenan’s birth certificate was monumental, says Spickler, who is also a Diversity Center Triangle Speaker along with Keenan. (Keenan had actually tried to get listed as “non-binary,” which includes gender identities that don’t fit into male or female, regardless of anatomy, but the department refused.)

“It’s emblematic of the progress we’ve made and the progress that has yet to take place. We’re in the midst of the early stages nationally, politically, culturally, of a really earnest conversation about gender beyond the binary,” he says.

Spickler and Keenan agree that there’s more to accomplish.

On the state level at least, changes have begun that LGBTQ activists are looking forward to. The California DMV has signaled to the IGRP that the agency will create a third gender option within about a year, says Keenan.

“For me it’s just the first step in pointing out that intersex people have always been here,” says Keenan. “We don’t need to cover it up. We’re just a flower in humanity’s garden and we don’t need to have our beautiful petals cut.”