Real-time processing and manipulation of biological signals require bioelectronic devices with integrated components capable of signal amplification, processing, and stimulation. Transistors form the backbone of such circuits, but numerous criteria must be met for efficient and safe operation in biological environments. Here, we introduce an internal ion-gated organic electrochemical transistor (IGT) that uses contained mobile ions within the conducting polymer channel to permit both volumetric capacitance and shortened ionic transit time. The IGT has high transconductance, fast speed, and can be independently gated to create scalable conformable integrated circuits. We demonstrate the ability of the IGT to provide a miniaturized, comfortable interface with human skin using local amplification to record high-quality brain neurophysiological activity. The IGT is an effective transistor architecture for enabling integrated, real-time sensing and stimulation of signals from living organisms.