Montana Governor Greg Gianforte has signed a bill making Montana the fourth state defining gender as strictly “male” or “female” and unchangeable.

Medical professionals says the law ignores that some people are born as intersex — a term that encompasses about 60 conditions in which a person is born with genitalia and reproductive that don't fit definitions of male or female.

The bill, which Gianforte signed on Friday, was approved during a legislative session that also passed a ban on gender-affirming medical care for transgender minors.