What do you mean by “decided”? Do you mean how to doctors find out, or what actually determines it biologically?
If your question is the latter, the thing that determines the sex is the sperm cell. All eggs have an x chromosome and all sperm have either an x or a y. If a x chromosome sperm fertilizes an egg, that fertilized egg will have 2 x chromosomes and will become female. If a y chromosome sperm fertilizes an egg, that fertilized egg will have 1 x and 1 y chromosome and will become male.
Intersex is an umbrella term for when a person does not fall neatly into either male or female. Sometimes this is because of sex chromosome abnormalities, other times it’s other genetic conditions, and other times it’s the result of developmental abnormalities that are not genetic.
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