February 22, 2023

Claiming Sex, Reclaiming Gender

Roughly one year ago, in February 2022, sixteen swimmers on the University of Pennsylvania women’s team penned a letter to their school officials, hoping to prevent Lia Thomas—their teammate and a trans woman—from competing in the NCAA championships the very next month.

Thomas had started hormone therapy in May 2019, while still swimming on the men’s team. “It was a lot of unease,” she said, “basically just feeling trapped in my body. . . . I decided it was time to come out and start my transition.” Not long after, the Ivy League canceled its 2020-21 season, postponing Thomas’ eligibility to the 2021-22 season, where she would now be on HRT for nearly three years.

“We fully support Lia Thomas in her decision to affirm her gender identity and to transition from a man to a woman,” the letter said. “Lia has every right to live her life authentically. However, we also realize that when it comes to sports competition, that the biology of sex is a separate issue from someone’s gender identity.”

What Lia’s teammates are referencing here is the infamous sex/gender distinction, the idea that one’s gender identity is a completely separate issue from one’s biological sex. Anyone who has witnessed the “trans debate” is certainly familiar with the phrase, “Sex and gender are completely different things!” However, while this line is usually voiced by trans people or their allies, in the case of Lia Thomas, it is being used to bar her from competing as a woman. What is to be made of this reversal?

In my view, this letter perfectly demonstrates the way cis people view the relationship between sex and gender. Sure, gender may be socially constructed, but sex is static and biological. When we say that sex and gender are completely different, they hear: gender is complicated, but sex is simple. If this is true, they say, trans athletes such as Lia Thomas, no matter how much of a woman they may be, are still biologically male.

But myself and others see things differently. What if sex is not so simple?

Claiming Sex

The nature of biological sex seems straightforward at first glance: we are a dimorphic species, so there are males and females, and that’s it. This question gets more complicated, though, when we dig in a little bit and try to define male and female. As Katrina Kazarkis points out in her short essay on the misuses of “biological sex,” scientists have been trying and erring on this front for a long time:

For a century, scientists studied an array of human characteristics that inform our ideas of what makes someone a woman or a man, seeking to pin down a single, definitive biological indicator of sex. Bodies troubled these schemes and socially untenable categorizations ensued. If gonads were understood as the essence of sex, women who were phenotypically female but had testes were men. This seemed illogical, so scientists proposed yet other traits. Even as they debated which biological trait or combination of traits signalled its essence, scientists understood sex as biological and involving multiple, if contested, factors.

Biological sex broadly refers to the reproductive anatomy of an organism—in this case, humans. While “reproductive anatomy” is a fuzzy concept, it is generally agreed to include chromosomes, hormones, gonads, and secondary sex characteristics such as breasts and facial hair. Of these characteristics, which can be said to reveal the secret of one’s “true sex”?

Maybe chromosomes are the determining factor. But if this is true, what is to be made of people with XY chromosomes who develop typical female characteristics due to mutations in the genome?1 And what about people with XX chromosomes who develop characteristics typical of males because of alterations in hormone signaling? Or people with some cells that are XX and others that are XY?

So maybe sex cannot be reliably determined by chromosomes. What about gonads, then? Here, too, the notion of an easily definable sex is troubled. XY individuals carrying the gene WNT4 can develop gonads that don’t look traditionally male, as well as Fallopian tubes and a rudimentary uterus. And in XX individuals where the gene RSPO1 is working differently than usual, they can develop gonads where areas of both ovarian and testicular development are present.

Hormones are no easier. Complete androgen insensitivity syndrome (CAIS) can stop the cells of XY individuals from responding to male hormones, causing them to develop as females. On the other hand, congenital adrenal hyperplasia (CAH) can cause XX individuals to produce large amounts of testosterone, which can lead to male patterns of facial and body hair, as well as irregular menstrual cycles.

In fact, any proposed measure of someone’s “true” biological sex will succumb to the same weaknesses. There is no one-size-fits-all solution to sex, which has led some scientists to offer a new definition: “sex is a context-dependent summary of a multidimensional variable space.”

While this definition seems overly complicated, all it means is that sex is made up of multiple variables, including chromosomes, gonads, and hormones, and that one’s biological sex is dependent on context. For an example of what this means, I’ll turn to my own body, one that does not fit neatly within the confines of male or female.

My chromosomes, as far as I am aware, are an X and a Y. My hormone levels, as of less than a month ago, are outside of the range typical of males. I have not undergone “the surgery,”2 but I have breasts, hips, and an overall feminine fat distribution. As a trans person on HRT, I am neither biologically male nor female. Referring to a trans woman on estrogen as biologically male, or a trans man on testosterone as biologically female, is not only offensive, but also medically inaccurate. When I go in for a cancer screening, if my doctor reads me as male, we will screen for prostate cancer while forgetting to screen for breast cancer, and vice versa if I'm read as female. In this instance, the problem with trying to dictate sex along neat and simple lines becomes clear: I have breasts and a prostate.

This new science of sex is also the key to understanding why the Penn swimmers’ letter regarding Lia Thomas is so aggravating. It is simply untrue that “the biology of sex is a separate issue from one’s gender identity,” as one’s gender identity can impel them to make significant changes to their biological sex. It is these faulty notions of sex that threaten to bar Thomas from competing.

You may still be wondering, if sex cannot be defined along the lines of any single characteristic, but a holistic understanding of someone’s sex is still important for medicine, how are we to navigate this? My favorite answer to this day comes from Katrina Kazarkis’ 2019 article on biological sex, which I mentioned above:

Years ago I wondered, “if one postulates bodies (including genitals, gonads, chromosomes, and hormones), what more does the word sex buy us? . . . The body as a material fact is given, but sex is not.” It is long overdue that we understand sex not as an essential property of individuals but as a set of biological traits and social factors that become important only in specific contexts, such as medicine, and even then complexity persists. If we are concerned with certain cancers, for example, knowing whether someone has a prostate or ovaries is what’s important, not their “sex” per se. If reproduction is the interest, what matters is whether one produces sperm or eggs, whether one has a uterus, a vaginal opening, and so on. For those arenas where it’s not clear what purpose sex designation serves, we might question whether we need it at all. Doing so could lead to better science and health care, and, crucially, less harm.

Reclaiming Gender

I have troubled sex enough, but since this is an essay about the sex/gender distinction, I ought to turn to gender next. It is often thought that the concept of gender was invented to complicate simple notions of sex. Gender, the line goes, was invented by gender activists and radicals to obscure the simple notion that sex is straightforward and binary. But as a number of scholars have begun to show in the past several years, the category of gender was not born out of the “simplicity” of sex, but was invented in the mid-20th century as a way of dealing with its staggering complexity.3

By the year 1955, building on decades of medical experimentation on intersex patients, the sexologist John Money was intimately familiar with the complexities of sex. That year, he published an article titled “Hermaphroditism, Gender and Precocity in Hyperadrenocorticism: Psychologic Findings.” Hiding behind this title was the first usage of the word “gender” to describe a human attribute. Gender, per Money’s usage, referred to the degree of masculinity or femininity experienced and expressed by his patients.

Since the later years of the 19th century, sexologists had slowly uncovered the troubled nature of sex. By the time the torch was passed to Money in the middle of the 20th century, the biological sex binary had been shown to be wildly unstable. As Money wrote in a retrospective essay, science had abandoned “the unitary definition of sex as male or female,” and in its place established a list of features that were independent of one another, including chromosomes, gonads, and hormones.

At the end of this list, though, was something Money referred to as “an unnamed blank that craved a name.” The emptiness of this blank referred to the fact that due to Money’s very own proliferation of words to refer to sex, the sexual binary was a concept in risk of collapse. Money sought out to contain this threat, and “After several burnings of the midnight oil [he] arrived at the term, gender role.” Gender, then, came into being as an attempt to restore a unitary nature to a newly fragmented concept of sex. While his own research and that of his contemporaries had done away with the concept of “true sex,” Money could now use gender in its place.

Recall that the bulk of Money’s research had been on intersex patients. This research often involved determining an intersex person’s “true sex,” or in other words, the sex they were “supposed to be,” and performing surgical and hormonal treatment to make their body fit that sex. Money’s research was largely done on children and infants, and as such, he would issue these treatments without their consent.

Following Money, though, gender took a surprising turn. In 1972, the sociologist Ann Oakley published Sex, Gender, and Society, in which she drew from Money’s work to argue that sex is biological and gender is cultural. In doing so, she asserted that biology is not destiny, hoping to liberate women from the confines of a biologism that sought to enforce their subordinate status. In a recent interview, contemporary sexologist Anne Fausto-Sterling says, “I found [gender] very useful in those early days when we were arguing against the idea that women were biologically incapable of participating in the public sphere.” Oakley’s sex/gender distinction was adopted by feminist activism and is the version we know today, leaving gender’s dark underbelly—the forced normalization of intersex youth—to be forgotten.

In the past few decades the academic discourse has grown more complicated, as scholars have pointed out the myriad ways in which sex and gender are entangled. Arguably the most important development in this history was Judith Butler’s publication of Gender Trouble in 1990, where she argued that “gender ought not to be conceived merely as the cultural inscription of meaning on a pregiven sex . . . gender must also designate the very apparatus of production whereby the sexes themselves are established.” Meaning, while sex is often seen as the biological basis for gender, we can also come to see gender as the ideological basis for sex. Research on biological sex and sex differences, for example, is not performed in a bubble, but by people who are immersed in a gendered society and who—knowingly or unknowingly—bring their social and cultural beliefs about gender into their research.

More recently, Anne Fausto-Sterling, author of Sexing the Body: Gender Politics and the Construction of Sexuality (2000), has led to a sort of revival of Butler’s position. Her work is a part of what some call the “return to biology” in feminist theory, as she argues that “material embodiment needs to be part of the theoretical discussion.” Understanding sex is obviously important to understanding gender, as the former provides a material basis for the latter. However, she says, “Social institutions such as gender . . . certainly provide the framework within which biologists do their research, so gender ends up shaping experiments, methods, descriptive language, and conclusions. The two are intertwined. Neither precedes the other” (emphasis my own).

For years we have been telling people that “sex and gender are completely different,” but if there is one lesson we can take from this complicated history, it is that gender and sex are not so different after all. Some researchers have taken to saying “gender/sex” to recognize that “the biological and the sociocultural are typically inseparable.” In telling people that gender and sex are entirely different matters, we not only obscure the history of gender itself, we also allow people to neatly shift their essentialist thinking from gender to sex, without questioning that very essentialism.

For example, while the Penn swimmers were drafting their letter, Lia Thomas had been hormonally transitioning for three years. By this point, the actions she had taken because of her identity had meaningfully changed her sex. But because of the ways the sex/gender distinction has pervaded our rhetoric surrounding transition, Lia’s teammates were able to assert that she was merely changing her gender, conveniently ignoring the biological reality of transition.

We ought to be more careful with our rhetoric about sex and gender. In the same interview I quoted above, after being asked whether she thinks sex and gender are concepts that must be differentiated, Fausto-Sterling replies,

My answer to this has to be contextual. At a theoretical level, I believe that sex and gender are two sides of the same coin. As such they constitute one another in a manner that makes them inextricable. At a practical level, however, I often distinguish between them, either for political reasons—to break open a biological determinist argument or point of view—or for empirical investigation. Sometimes it can help to bracket the interconnections in order to more effectively examine some small part of one side of the coin. This approach can work if one remembers the need to reintegrate partial findings into the whole coin.

For all the effort to drive them apart, sex and gender have become, in effect, “two sides of the same coin.” And if there’s anything to learn from the Penn swimmers’ letter, it’s that maybe this is a good thing.