The I stands for intersex: people born with sex characteristics that are not clearly male or female (medically also known as DSD — Disorders of Sex Development). This is a small group: approximately 0.02% of the population according to conservative estimates, or up to 1.7% if all variations are included.
The addition of the I to LGBT was primarily implemented in the 2010s by activist umbrella organizations.
Critical Analysis
Many intersex organizations—such as the American InterACT and the British DSD Families—do not want to be part of the LGBTQ+ umbrella. Intersex is a medical condition, not a sexual orientation or a gender identity. According to them, this grouping leads to the misuse of intersex conditions as “proof” for gender ideology, when in fact it is about something entirely different.
Political function of the acronym
An acronym like LGBTQI is not a linguistic invention but a political tool. Those who use the acronym simultaneously signal their acceptance of the associated ideological framework: identity trumps biology, self-declaration trumps diagnosis, language trumps reality. Those who refuse to go along with it are accused of being outdated or hateful.
Resistance to this pressure does not come solely from conservative quarters. Lesbian organizations, sports associations, women’s rights groups, and clinicians are voicing opposition to the blurring of category boundaries. The acronym itself is often defended on the grounds of inclusion, but in practice it forces the abandonment of categories that actually serve a protective function—for women, for lesbians, for children.
Medical Context and the Evidence
The medical side of the debate has completely shifted in just a few years. The Cass Review (2024) found that the evidence base for puberty blockers and cross-sex hormones in minors is weak. Based on this, NHS England ceased routine prescribing. SBU (Sweden, 2022), COHERE (Finland, 2020), UKOM (Norway, 2023), and NICE (UK, 2020) reached the same conclusion.
In the communications of organizations that embrace LGBTQI and related terms, these reevaluations are almost always absent. The image of settled science is maintained by remaining silent about the Cass Review and the Scandinavian shift. The WPATH Files (2024) showed that even among WPATH clinicians, there is uncertainty regarding informed consent for minors.
Implications for the public debate
Expanding acronyms is not without cost. Every new letter comes with a claim to recognition in legislation, education, and healthcare. Without evidence for the underlying category, policy is pursued as if the evidence were there. Those who ask questions receive no substantive answer but moral condemnation.
Language shapes policy. Those who accept the acronym implicitly accept the claim that all identities it encompasses are equal and scientifically grounded. That is a political claim, not a linguistic one. Criticism of an acronym is not criticism of individuals—it is criticism of a framework that is increasingly being placed beyond the reach of debate.
International Reconsideration
In recent years, various national health authorities have distanced themselves from the gender-affirming model for minors. The common denominator: the evidence for lasting benefits is lacking, while the risks are real.
Cass Review (2024). Review commissioned by NHS England, conducted by Hilary Cass. Conclusion: the evidence base for puberty blockers and cross-sex hormones in minors is weak. NHS England ceased routine prescribing of puberty blockers outside of clinical trials.
SBU — Sweden (2022). The Swedish Agency for Health Technology Assessment (SBU) and Karolinska University Hospital discontinued the use of puberty blockers and hormones for minors outside of clinical trials. Reason: lack of evidence for effectiveness and safety.
NICE — United Kingdom (2020). Two NICE evidence reviews (puberty blockers and cross-sex hormones) classified the evidence base as very low certainty. None of the studies identified met modern methodological standards.
COHERE — Finland (2020). The Finnish Council for Choices in Health Care revised the protocol: psychotherapy as first-line treatment, medical transition for minors only in exceptional cases and within a research setting.
UKOM — Norway (2023). The Norwegian UKOM classified transgender care for minors as experimental; existing protocols do not meet the requirements for evidence-based care.
WPATH Files (2024). Internal discussions among WPATH clinicians acknowledge that informed consent for minors is problematic and that serious side effects (bone density, fertility, cognitive development) are not adequately explained.