On Dec. 27, Sara Kelly Keenan became the first known person in the United States to receive an intersex birth certificate.
Keenan — who was born with male genes, female genitalia and mixed internal reproductive organs — received what is believed to be the first birth certificate issued in the country that reads “intersex” in the gender field instead of “male” or “female,” reports NBC News.
According to NBC, Keenan, now 55, was originally classified as a boy, then received a female birth certificate three weeks later. She did not know she was intersex, as her parents kept the fact a secret from her and raised her as female. They began her on hormone replacement therapy treatments when she turned 16, simply telling her she was “a girl who can’t make hormones,” and she continued the treatments throughout her life. In 2012, Keenan’s father revealed to her that she was born with male chromosomes. She later found out that she was biologically intersex.
“Not all intersex people will choose to identify legally as intersex, and not all parents will choose to have their intersex child identified as intersex on birth documents,” Keenan, who is an advocate for the Intersex & Genderqueer Recognition Project, told NBC Out. “But for those who do, the option must exist.”
WATCH: Alex Jinkinson Opens Up About Her Gender-Confirming Feminization Surgery
The issuing of an intersex birth certificate has been praised by advocacy groups, but some activists say there is still a ways to go when it comes to intersex rights.
“We applaud the extensive efforts of intersex activists working to pass the first intersex birth certificate, and it is also an important reminder that although recent victories when it comes to gender markers in legal documentation are worth celebrating, there’s still much more we can do to combat biological essentialist views in our culture and activism,” Bridget de Gersigny, director of communications of the Astraea Lesbian Foundation for Justice tells PEOPLE. “Gender markers have a legitimate function for non-binary people — both intersex and gender non-conforming people — but it is important to recognize their limitations.”
Hida Viloria, chairperson of the Organisation Intersex International, notes that Keenan’s historic intersex birth certificate comes on the heels of another victory for the intersex community: in November, a judge ruled in favor of allowing OII-USA’s associate director Dana Zzyym to be issued a passport despite not identifying as male or female.
“Intersex people have suffered for centuries because of the notion that only males and females exist, which is why our associate director Dana Zzyym successfully fought for federal gender recognition as intersex on their passport last year,” Hida Viloria, chairperson of the Organisation Intersex International tells PEOPLE.
“Having intersex acknowledged as a legal sex/gender category is critical to ending intersex oppression, such as the barbaric nonconsensual medical practices which attempt to render us all males or females,” Viloria continues. “We commend Keenan and Zzyym, and note that until equal services and protections are available to all intersex citizens, this designation should remain a voluntary one only, for adults who seek it.”