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At what moment does a person understand themselves as intersex? This question opens up a complex world of identity tensions, constrained agencies, and negotiations with medical power that we explored with 14 intersex people in Chile.

Intersexuality refers to congenital variations in sex characteristics (chromosomes, gonads, hormones, or genitals) that do not fit typical binary definitions of male or female bodies. It is not a sexual orientation or gender identity, but a bodily reality. Between 1.7% and 2% of the population is born with some intersex variation, a proportion similar to red-haired people.

The central finding of our research reveals an active and often conflictive identity process: after diagnosis, people exercise agency to decide whether they want—or don't want—to identify as intersex, and how this identity relates to their gender. Some people integrate intersexuality within a binary identity ("intersex man" or "intersex woman"), others articulate trans and intersex identities simultaneously, some position "intersex" as their central identity, and others actively reject this label, preferring the information remain private.

We identified three diagnostic temporalities that configure different capacities for identity agency:

Diagnosis in childhood often nullifies agency for years. Doctors advise maintaining secrecy, creating a "subaltern childhood subjectivity." Gema, a person of the sample. explained: "I started to think I had cancer... I learned to not be present in my own body." Medical and familial silence denied her the possibility of understanding herself as intersex until adulthood.

Diagnosis in adolescence creates a profound "epistemic rupture" that opens space for agency, but also for conflict. Ana, another intersexual person, described it: "After knowing, everything changed. I had to relearn who I was." She decided to identify as an "intersex woman," confronting doctors who minimized this identity.

Diagnosis in adulthood allows for the greatest degree of epistemic agency. Pablo, diagnosed at 28, reinterpreted his entire medical history: "The problem wasn't my body, it was how others saw my body." He chose activism, but other adult participants rejected making this identity visible.

This identity agency always operates within "structural constraints": pathologizing medical discourses that speak of "correcting" bodies, families that react with shame or denial, and social structures that demand binarity. Despite regulatory advances in Chile, the tension between medical power and self-determination remains an identity battleground.

Intersex activism emerges as a transformative but also tension-filled space. Six participants described how community connection expanded their possibilities for self-understanding, but also generated conflicts about "how to be intersex correctly." Some found in activism pride and political identity; others decided to distance themselves, rejecting that intersexuality define their entire existence.