The easiest way to handle this in Ars Magica is: applying essential nature to sex, not to gender.
I should add, that it always was better in Ars Magica to not apply essential nature to behaviour casually, but rather reserve it for specific Essential Personality Traits (RoP:M p.43).
That is still true. There is still no mention in the game of what makes someone a man or a woman, however.
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I'm not talking about behaviour, I'm talking about the equivalent of a Hermetic magician trying to answer the proverbial call of Emperor Elagabalus for a physician to change their sex. They would be forced to say "no, can't do" even with magic.
Also, the statement upthread that
seems rather incompatible with this ontological view of sex. If I'm not mistaken, intersex people were not part of the 13th century understanding of the world. The way Bonisagus' magic works leverages Aristotelian ontology in a way that, to me, goes beyond game 'flavour' into game cosmology and mechanics. In other words, you simply cannot assume a 21st century understanding of physics (let alone chemistry, biology, or psychology) aplies in-game. Following that assumption to its logical consequences will break the magic system.
Isn't there a gender non-conforming magus written up (statless) in the Byzantine book?
Very non-conforming for whatever gender you choose.
There is one magus/maga there who is stated to be a genuine hermaphrodite.
(Syagricus of House Jerbiton, p117)
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Searching for Syagricus throws up this thread from 2011, which is interesting on the subject of sex being "essential nature".
Only if you wish to see the sex of an individual as always either male or female. Hermaphrodite Syagricus is an extreme (and definitely not 1 in 60) example magus showing this not to be the case.
Even in the modern day the 1 in 60 figure is controversial. I could refer to scientific papers, and then others would counter with different articles, and by the end of a multi-post heated argument we'll all still be holding dearly to what conforms to our pre-conceived biases.
Let's skip that and suggest in a fictional world, if someone wants a world with 1 in 60 people with an intersex condition that would be identifable in Mythic Europe, awesome, and if someone wants a world where the topic never comes up, also awesome.
I'm not arguing from my own preference. What I'm saying boils down to observing that the Ars Magica magic system, game-mechanically, is based on Aristotelian philosophy being substantially correct, warts and all. And the realms of power, game-mechanically, are based on Christian theology being substantially correct.
I don't personally like either, but you're going to break things either game-mechanically or in canon if you bring into the game modern knowledge of human physiology or claims that pagan gods belong to the Divine and not the Faerie realm.
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I agree with you. Certain intersex conditions can not be identified without modern medicine. To suggest canonical ME has 1 in 60 people intersex doesn't hold together logically, however, if someone wants their world to be like that, so be it.
I'm not bothered in breaking canon if it makes it better for the players and it is agreed upon.
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While Christian Theology has a large weight in the game, it's not all encompassing, so why should gender be under it's aegis? After all, not all of the things in the game are exactly medieval, and some of them have been affected by our more modern sensibilities, like female Maga being fully equal to Magi.
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Hermetic magic is central to the game mechanics and that is subject to two absolute limits: the Limit of the Divine and the Limit of Essential Nature.
On the limit of the Divine, the rules say
Hermetic Magic cannot affect the Divine. ... Hermetic powerlessness in the face of miracles is a result ... Only direct action by god is completely innune.
On the limit of Essential Nature, the rules say
Any magic which violates a thing's essential nature must be maintained. ... A thing's essential nature cannot itself be changed. ... All human beins are essentially human, mortal creatures with reason, senses, and the ability to move and reproduce. ... Men are essentially male, and women are essentially female.
This is essentially Aristotle.
This stuff happens to interact with Christian theology. Joan of Arc, mentioned upthread as violating cultural gender norms, was executed as a heretic. Her heresy involved in no small measure her gender non-conformance, including the fact of wearing male clothing. During her trial she recanted from her heresy, including agreeing to wear women'a clothes. She then relapsed into heresy and that's why she was executed. And one of the things she relapsed about was wearing male clothing. Even her defence that wearing a skirt in prison would have made her vulnerable to rape by her guards was dismissed as an extenuating circumstance to the fact that wearing male clothing was in fact heresy.
That's a pretty clear example that, at least in the 15th century, Christian theology considered male/female gender to be God-given essential nature and going against it was heretical.
You can play your saga anyway you want, but that doesn't mean that this Flaw needs to not exist. The flaw doesn't change your Essential Nature, it defines your Essential Nature, same way that being a Dwarf, or having Hunchback, Poor (Characteristic), or any other Flaw would define your character's Essential Nature.
The limit of Essential nature only means that if someone has Dwarf, for example, there's no way you can permanently cause him to be size +0. That's part of his Essential nature, even if most people's have size +0 be part of their Essential Nature.
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Joan of Arc was charged of a lot of things and under a lot of pretexts by her English enemies, with the purpose of being able to kill her. But her trial in Rouen occupied by them was anything but a shining example of Christian theology at work.
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More than a change I'd call it an improvement. The debate hold in this forum to change from Transvestite to Gender Nonconforming was something to frame and put on a museum on how to improve a game by realizing how some people were extremely uncomfortable with things as written only twenty years ago, and taking and active effort to be as inclusive and respectful as possible.
Regarding gender or sex and essential nature, I don't see why a gender nonconforming character had to be waved away as male or female just because gender at birth. I would happily arge that how they feel about their own sex and gender is indeed their essential nature, despite the book (or Aristotle for that matter) only quoting two genres, which I would understand as two (the most common) examples, not an exhaustive list.
Is it not into the medieval paradigm? Given that what an essential trait is is just a theoretical construct, I think the answer to that question is something you are making up, not something carved in stone. So I'd be careful to answer the question in the more open an less excluding way.
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Aristotle - or ancient medicine in general - were neither dumb nor biased, and knew about the possibilities of human anatomy.
Here is a decent, short text on Hermaphrodites, which you might wish to read in its entirety. It is from a collection of summaries of conferences of the Beaux Esprits in Paris from the end of the 17th century.
https://sites01.lsu.edu/faculty/virtuosi/conference-cii-of-hermaphrodites/
We find there:
Plato saith, that Mankind began by Hermaphrodites, our first Parents being both Male and Female, and that having then nothing to desire out of themselves, the Gods became jealous of them, and divided them into two; which is the reason that they seek their first union so passionately, and that the sacred tye of Marriage was first instituted. All which Plato undoubtedly learn’d out of Genesis; For he had read where ’tis said, (before Eves formation, or separation from Adam is mention’d) That God created Man, and that he created Male and Female.
And about Aristotle:
Aristotle believed that when there was not enough matter to create twins of different genders they came together to make one person with both male and female genitalia. In other words, there were no true hermaphrodites, only excess growth due to the copiousness of matter.
Both concepts of 'monstrosity' and of 'perfection' come up in the summary - and we see 17th century scholars quite unable to agree on an explanation. This might also help to represent the confusion Syagricus might cause in a saga.
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FWIW, I'd argue that, even if we dismiss history, mythically speaking, there are lots of room for hermaphrodite characters, gender changes, whatever.
I suck at culture and stuff, so this is the only thing that comes to my mind, but take a look at loki, which, canonically, exists and has been male, female, and whatever else.
It would perfectly make sense for a character with mythic blood related to them to be intersex, or servants of loki to be non-conforming, rebels to cultural norms (just as their patron)
And that is heavy-handed. I don't think we even need such a connection.
And yet, Joan of Arc became a saint.
And even the church represents her in armor, not in a skirt.
So maaaaybe, the Church isn't the Divine? 
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Found the thread. Thanks for pointing it out.
I think the thread does support calling it a change in perspective. The flaw apparently was introduced by a trans game developer, but that was in the 1990s and sensitivities even within the trans community have changed.
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While the Ars Magica paradigm with the Divine Realm revolves around the idea that, in the game, the "religions of the book", and Christianity in particular, are mostly right, it also unequivocally proves that none of them are completely correct. In the case of Christianity, for example, the mere fact that Islam is part of the Divine Realm is alone proof that Christianity got some things wrong.
I think it's kind of a central idea of the cosmology of the game that the Divine religions got a lot right, but all of them got some stuff wrong. So the idea that there are only two sexes and two genders, male and female, could be one of the things they didn't get right.
In our game, for example, Essential Nature regarding binary transgendered people means they were born with a gender that is not their Essential Gender. And regarding nonbinary people it means that their Essential Nature does not properly align with either their society-assigned role, what they were phisically born with, the ganders supposedly available, or whatever fits their particular circumstance.
You don't need to break the game cosmology to fit a more modern view, it just won't fit with the general Medieval mindset. But then again, other parts of the game's cosmology don't fit it perfectly either. IMHO Mythic Europe works mostly like Medieval people thought it would, but not completely.
I feel Mythic Europe is a world that would make Medieval people's believes more correct than they actually were, but assumes they still got some stuff wrong. Just not as much stuff as they really did.
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I'm not a huge fan of essential nature. I like the idea of an instant muto spell turning someone in to a toad permanently. In many fantasy settings magi can make such permanent changes.
To any SG out there you can throw out essential nature or tweak it how you want. It's your game. The point made regarding essential nature is without large tweaks to essential nature or the paradigm, an open inclusive essential nature doesn't fit. Medieval Europe was not open or inclusive, and Mythic Europe is mapped on that.