"The U.S. Constitution promises equality, rights and benefits for all citizens," Becker noted. "But, as the Constitution is structured and interpreted, individuals who do not meet the binary definition for male versus female don't have the same benefits and aren't completely protected from discrimination."
Children may be particularly vulnerable to negative consequences resulting from binary or gender-based laws, Becker added. If one partner in a same-sex union dies, for example, the surviving partner may face a legal battle to retain custody of the children, thus inflicting a second major trauma on the grieving children. A host of legal documents that convey rights and benefits, from birth certificates to passports and drivers' licenses, require declaration of one gender or the other, which may be impossible for some people.
Various conditions can cause genital ambiguity. For example, a condition called Congenital Adrenal Hyperplasia (CAH) in genetic girls (XX chromosomal makeup) results in prenatal exposure to androgen, the steroid that triggers male development. Genital features of girls born with CAH may appear to be male. In other cases, collectively known as Androgen Insensitivity Syndrome (AIS), genetic males (46 XY chromosomal makeup) may have female characteristics when a mutation of the gene that encodes for the androgen receptor results in resistance to androgen's masculinizing effects during development. Depending upon the timing of exposure to androgens in the uterus, a host of other conditions may result in ambiguous genitalia.
Through his clinical work with some 100 patients, Reiner said, those who are genetically male, with the 46 XY makeup, will tend to identify themselves as boys if they can