Sara Kelly Keenan was born intersex — with male genes and female genitalia — and after over 50 years, she has finally been able to get a birth certificate that represents her true gender identity, NBC reports Keenan, who goes by female pronouns, made history on Tuesday when she was issued a birth certificate in New York City that lists "intersex" as her gender instead of "male " or "female." Hers is the first known intersex birth certificate in the country.According to NBC, when Keenan was born, her parents and doctor agreed to keep her intersex gender a secret, issuing her a birth certificate reading male — and then suddenly changing her birth certificate to read "female" three weeks later. At age 16, she began hormone replacement therapy after being told that she was "a girl that can't make hormones."Keenan is the latest example of people petitioning for more gender options on birth certificates — in June, Oregon-resident Jamie Shupe became the first person to legally change their gender to non-binary — and this new case is sure to pave the way for others."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 told NBC. "But for those who do, the option must exist.""The Health Department has interpreted our gender marker rule to mean that a person may amend their birth certificate to have 'intersex' reflected on their birth certificate with appropriate documentary evidence from a U.S.-licensed doctor," Department of Health and Mental Hygiene assistant press secretary Julien A. Martinez told NBC. "The Department will continue to work with community partners as we adopt changes to more accurately reflect a person's sex."Keenan's case reflects a changing tide in the way we think about gender. Hopefully, we can continue to challenge binary norms and acknowledge that gender is a spectrum.