The journal Nature conflates sex and gender, decries “pigeonholing” people even though we do—and must

Lots of sites, including three scientific societies, have rejected the new Health and Human Services guidelines that provide a classification of a person’s sex into two categories. But these sites, and now an article in the prestigious journal Nature (click on screenshot below), conflate “sex”—which I take as biological sex recognized in humans by chromosomal constitution, which gametes you produce, and secondary sex characteristics—with “gender”, which I take as “the sex that an individual identifies with, whether or not it corresponds to their biological sex”. In this construal, which seems to make biological sense, a transgender woman would be a biological male but their gender would be female. There are also genders that aren’t “male” or “female”, as I note below.

Now the editorials that have appeared in scientific journals are well-meaning: their intent is to prevent intersexes and transgender individuals (the former much rarer than the latter) from discrimination. But that can be done without conflating sex and gender. For some purposes, like sports, recognizing an individual as either “male” or “female” (or “intersex”) is not only useful, but necessary.

As far as I can see, the Trump administration’s proposal, which may indeed be motivated by a desire to discriminate against intersexes or “non-binary” genders, is a definition not of gender but sex, at least as reported by the New York Times:

“Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” the department proposed in the memo, which was drafted and has been circulating since last spring. “The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”

The new definition would essentially eradicate federal recognition of the estimated 1.4 million Americans who have opted to recognize themselves — surgically or otherwise — as a gender other than the one they were born into.

But sex and gender are not equivalent, and if the Trump administration wants to equate them, it’s making a serious mistake and hurting people as well. Still, scientific societies do themselves (or progressivism) no favor by the constant conflation of sex and gender. Sex is a useful concept whose binary nature has served biology well for centuries.

As I’ve written before, while sex is not completely binary, in general it’s effectively so, for the vast majority of individuals can be classified as either “male” or “female”. And this dichotomy is the result of evolution, in which two sexes are the result of natural selection, while those rare individuals who are intersex result from genetic or developmental anomalies. A paper by Dr. Leonard Sax in Journal of Sex Research gives this clinical definition of “intersex”, that is, of individuals who fit in the nonbinary valley between the big frequency modes of “male” and “female”:

A more comprehensive, yet still clinically useful definition of intersex would include those conditions in which (a) the phenotype is not classifiable as either male or female, or (b) chromosomal sex is inconsistent with phenotypic sex.

Using this definition, Sax estimates that 0.018%, or 18 individuals out of 100,000, are intersex. This is much lower than Anne Fausto-Sterling’s estimate of 1.7%, which includes many individuals who don’t fit the definition above. But it doesn’t matter. Under either construal sex is binary, or nearly so. Saying that sex is a “continuum” is palpably misleading (if technically correct), for the “continuum” includes at most 1.7% of all individuals between the two well-defined “binary” modes. As a biologist colleague of mine said, “Of course sex is binary.  No biologist in their right mind would question that.” 

The same might be largely true, though less true, for transgender individuals, estimated at about 0.6% of the U.S. population. But that figure doesn’t include individuals who identify as bisexual, polysexual, and so on, so the bimodality for gender may be a bit less pronounced than for sex.

At any rate, Nature shoots itself in the foot with this well-intentioned editorial that maintains that sex is not a binary concept (they don’t mention sex in the title but it’s in the text):

First, Nature estimates, without giving a source, that the frequency of people with “differences or disorders of sex development” can be as many as 1%, though these aren’t intersexes, nor blur the strong bimodality of sex. Most of these aren’t people who would be the subject of oppression or discrimination.

Worse, Nature conflates gender and sex several times, to wit:

The proposal — on which HHS officials have refused to comment — is a terrible idea that should be killed off. It has no foundation in science and would undo decades of progress on understanding sex — a classification based on internal and external bodily characteristics — and gender, a social construct related to biological differences but also rooted in culture, societal norms and individual behaviour.

We do understand sex, and it’s for all practical purposes binary in most animal species, and certainly ours. Here’s another of Nature‘s conflations:

Political attempts to pigeonhole people have nothing to do with science and everything to do with stripping away rights and recognition from those whose identity does not correspond with outdated ideas of sex and gender.

Outdated ideas of sex? What are the updated ideas of sex? Is Nature rejecting the ideas of male and female based on the existence of biological anomalies or intersexes? If so, are they rejecting, for similar reasons, the ideas of male and females in deer, fruit flies, and most other animals?

Yes, ideas of gender may be outdated—we now know well that someone’s self-identity may not correspond to their biological sex—but not of sex. Please, Nature, stop distorting biology in the service of ideology. It’s neither seemly nor necessary, as we can protect transgender and intersexual individuals without deep-sixing the sexual binary that has served biology so well.

As for the practice of pigeonholing people being useless and having nothing to do with science and everything to do with oppression, surely Nature doesn’t really mean that. For one thing, pigeonholing by sex is necessary in two important cases: Title IX regulations, in which it’s illegal to discriminate against programs funding college education (including sports) on the basis of sex. To enforce that regulation, which is a good one based on civil rights, you have to recognize women’s opportunities and sports teams versus men’s. Individuals have to be pigeonholed, and there must be some guidelines. 

Pigeonholing is also important for sports, as in professional sports teams or the Olympics, where competitions involve either male teams or female teams, usually playing against same-sex teams. Without “pigeonholing” you simply have a mess. Does Nature advocate doing away with “men’s” and “women’s” teams? If not, then they recognize the usefulness of pigeonholing, and clearly must go along with some standard, even if it’s a somewhat arbitrary one. (How to define “male” and “female” in sports is a sticky issue, one that is above my pay grade.)

Second, does Nature oppose pigeonholing by ethnicity? Surely they don’t: they recognize the value of classifying individuals by ethnic backgrounds for the purpose of achieving either equal opportunity or equal outcome. In such cases “pigeonholing” on political grounds is generally salubrious, and certainly does not strip away people’s rights in the way the journal suggests above.

In the end, we progressives don’t need to distort biology to achieve our aims of treating people fairly. We don’t need to pretend that the idea of two distinct sexes in our species is “outdated.” It isn’t, and when Nature tries to pretend it is, they simply look silly.

 

77 Comments

  1. keith
    Posted November 29, 2018 at 11:48 am | Permalink

    Well said, Jerry. The left is going to have to stop referring to itself as the “reality-based community” if they don’t knock off their irrational nonsense. One can be in favor of equal treatment regardless of gender identity and sexual orientation without going full biology denier.

    • Posted November 29, 2018 at 12:45 pm | Permalink

      The left passed that line years ago.

      • Ken Kukec
        Posted November 29, 2018 at 1:46 pm | Permalink

        Because there’s a monolithic “Left.”

        There’s a left/right bimodality to politics, but — it being strictly a social construct — it occurs along a continuum with quite of bit of fluidity between the modes.

        • keith
          Posted November 29, 2018 at 1:55 pm | Permalink

          Heh-heh. Good points.

        • Posted November 29, 2018 at 2:09 pm | Permalink

          Is that per DNA or per self identification?

        • BJ
          Posted November 29, 2018 at 7:41 pm | Permalink

          You do very often refer to “the Right” in your posts though, Ken. We all do it from time to time.

          • Ken Kukec
            Posted November 30, 2018 at 5:37 pm | Permalink

            Sure, but I make those subtle distinctions between the Right, the Far Right, and the wingnut reactionaries.

            Plus, it’s me doin’ it, so it’s all cool. 🙂

  2. Sastra
    Posted November 29, 2018 at 12:15 pm | Permalink

    Yes, ideas of gender may be outdated—we now know well that someone’s self-identity may not correspond to their biological sex—…

    What happens when one outdated idea of gender (that people of the male sex cannot feel as if they were psychologically female) comes into contact with another outdated idea of gender (that there is such a thing as feeling ‘psychologically female?’)

    • Ken Kukec
      Posted November 29, 2018 at 1:15 pm | Permalink

      A matter/antimatter-like annihilation? 🙂

      • BJ
        Posted November 29, 2018 at 7:43 pm | Permalink

        We’ve yet to see! At this point, the two have been kept at a distance via a well-placed wall of cognitive dissonance.

        • Ken Kukec
          Posted November 30, 2018 at 4:53 pm | Permalink

          Sure, but I make those subtle distinctions between the Right, the Far Right, and the wacko reactionaries.

          Plus, it’s me doin’ it, so it’s all cool. 🙂

          • Ken Kukec
            Posted November 30, 2018 at 5:38 pm | Permalink

            Sorry, re-posted above.

  3. Jon Gallant
    Posted November 29, 2018 at 12:26 pm | Permalink

    As Paul Berman pointed out, “the postmodernist professors…led their adepts into an infinity of minicauses and controversies over language.” What is insidious is the way this sort of thing creeps from the postmodernist professors into other venues, including serious journals.

    Let me hazard a prediction. The struggle against “pigeon-holing” will next reject any mention of ethnic differences in specific disease susceptibilities; and the struggle for “Inclusion” will then denounce the use of the term “heterozygote advantage”.

    • Posted November 29, 2018 at 12:50 pm | Permalink

      I thought ethnic referred to the group you sel identified with. Akin to gender having nothing to with biology. In the case if ethnic groups having nothing to do eith DNA. IThe still current term for DNA differences was race but now may be soethinf such as DNA grouping by national origins.

  4. Posted November 29, 2018 at 12:37 pm | Permalink

    [E]quality is not the empirical claim that all groups of humans are interchangeable; it is the moral principle that individuals should not be judged or constrained by the average properties of their group.” – Pinker

    This is part of a larger problem that I saw when debating religious people.

    The human mind, when not thinking critically, tends to waffle between physical or empirical truths and social or moral/ethical truths.

    Not only that, but the moral/social truths operate on a higher level than the physical or empirical truths. It’s more “powerful”, if that makes sense. Sort of like metaphysics.

    Because of this there will always be scientific truths that are made as a burnt offering on the altar of an ethical theory. We already have ample examples of this when it comes to religion, but it happens to other ethical theories as well. Most moral or ethical theories have some facet of anti-epistemology by dint of tribalistic human nature. This tribalism usually manifests and calls their anti-epistemology Other Ways Of Knowing(TM).

    The confusion between sex and gender is another example of this. One is biological, the other is social. People have no problem asserting that the social truth informs the biological one (because the social is “more powerful”), but cry foul when going in the opposite way.

    The same thing happens with people’s religious beliefs. It’s a form of NOMA. No problem saying that god informs science, but you can’t use the scientific method to investigate god. It should come as no surprise, then, that as fields become less technical, the less its scholars think that human behavior can be studied scientifically.

    Not sure what to do about this, other than attempt to point it out. Nations becoming less religious only means that the focus of what led people to be religious in the first place gets redirected to different social Other Ways of Knowing.

  5. Christopher
    Posted November 29, 2018 at 12:46 pm | Permalink

    How the hell would taxonomy work if not for “pigeonholes”?

    • Posted November 29, 2018 at 1:00 pm | Permalink

      Taxonomy is an oppressive white western phallocentric colonializing paradigm. There are Other Ways of Knowing™.

      • Christopher
        Posted November 29, 2018 at 1:04 pm | Permalink

        Of course, how silly of me. Now bring on the Humanzees!

  6. Posted November 29, 2018 at 12:58 pm | Permalink

    Nature:

    “… biology is not as straightforward as the proposal suggests. By some estimates, as many as one in 100 people have differences or disorders of sex development, such as hormonal conditions, genetic changes or anatomical ambiguities, some of which mean that their genitalia cannot clearly be classified as male or female.

    This clearly does refer to intersex conditions, which are reliably estimated to affect c. 1% of the population, but which have nothing to do with gender dysphoria.

    Further, the majority of intersex conditions are mild, so external physical features such as genitalia can be reasonably classified as male or female. Further, certain karyotypic intersex conditions exhibit superficially typical male or female physical features. In nearly all such cases, individuals identify strongly with the sex of their prevailing characteristics.

    Nature has gone full SJW. Never go full SJW.

  7. Ken Kukec
    Posted November 29, 2018 at 1:26 pm | Permalink

    What you say here, Jerry, makes scientific and common sense. Those opposed — both Left and Right, those who refuse to recognize either the general bi-modality of “sex” or the somewhat greater fluidity of “gender” — are politically motivated, each by a desire to control the thoughts and actions of others inappropriately.

    • Posted November 29, 2018 at 2:32 pm | Permalink

      It is only inappropriate if I call a boy if I am referring to his gender. If I am referring to his sex it is not inappropriate.
      If he is offended I roll explain I was referring to his sex and not his gender. Then I will ask why he was presumptuous in assuming I was referring to his gender and demand an apology.

    • BJ
      Posted November 29, 2018 at 8:02 pm | Permalink

      I am not politically motivated in my refusal to recognize the (at least currently standard/fashionable) idea of gender and its fluidity. I recognize the fluidity of how one might express their sex, and that this might be labelled “gender.” But I reject the idea that a person born of female sex is a woman, or of male sex is a man, in every sense of those words. If a man chooses to wear dresses, makeup, have long hair, and act out what society considers the stereotypes of a woman, I don’t consider this person a woman, but a man who prefers to live in a different way than we normally expect men to live, and I am perfectly fine with them doing so. Every person has a right to live as they please and be treated equally in doing so, so long as they don’t cause harm to others.

      My problem is with the idea that this is somehow distinct from the fact that such a man is still a man. Further, this is all inextricably linked to gender dysphoria/trangenderism, and this is where my real problems with this issue come up. When it comes to gender dysphoria, I still fail to understand why we are trying to treat it first by severe surgeries and hormones that often sterilize and reduce lifespan and are generally irreversible.

      There are other psychological issues very similar to gender dysphoria that we treat as mental disorders by trying first to “correct” them, as we do with, for example, depression (via therapy and/or antidepressants). I’m thinking here in particular of body integrity dysphoria. The symptoms are almost exactly the same as gender dysphoria — the patient believes their body is not how it should be, and wishes to remove or mutilate part of it — but we don’t try to treat such people by legitimizing their concept of what their body should be and amputating their limbs or crippling them. Similarly, I do not see why the first or most popular course of action for gender dysphoria should be to legitimize the patient’s idea of what their body should be and have them engage in a series of dangerous, mutilating, and extremely expensive procedures and medications.

      None of this is motivated by my politics. This is simply what I believe is the most rational course of action and what is likely to do the least harm in the long run to the population that experiences gender dysphoria. I fear that, ten or twenty years from now, we will deeply regret allowing many teenagers to have irreversible surgical procedures on their genitals and take medications that had permanently deleterious side effects, rather than first trying to correct the disorder by treating the mental side of it. We’ve come to the point now where even researching the possibility of alleviating gender dysphoria through therapy and medication instead of surgery and hormones is being suppressed. Surely, this research should at least be done, especially when one considers that, if successful, such treatment would be far less harmful.

      • Posted November 30, 2018 at 2:28 am | Permalink

        A great many medications used to treat physical or mental diseases cause worse problems than the health problems for which they are prescribed. For example, blood pressure medications frequently cause sexual dysfunction. Read the lists of possible adverse side effects on any prescription container. Sometimes, medications cause health effects for which other medications are prescribed and the combinations can be worse than the problem being treated. It can take years for some problems to be properly diagnosed and medicated. How many of us are sicker on our medications than we were with just the condition we were being treated for? I’m pretty sure there are no statistics for this.

        • BJ
          Posted November 30, 2018 at 10:25 am | Permalink

          I’m very painfully aware of possible negative side effects from medications, but I feel like this is a bit of a diversion from my post. Anyway, I’ve been on medications for other issues all my life and have suffered the side effects for them.

  8. Posted November 29, 2018 at 1:37 pm | Permalink

    Nature:

    Some evidence suggests that transgender identity has genetic or hormonal roots, but its exact biological correlates are unclear.

    Sparse and contested evidence.
    cf. https://4thwavenow.com/research/

    Whatever the cause, organizations such as the American Academy of Pediatrics advise physicians to treat people according to their preferred gender, regardless of appearance or genetics.

    So glad to know our medical associations are urging radical, irreversible treatments when the etiology of the condition is still unknown.

    The research and medical community now sees sex as more complex than male and female, and gender as a spectrum that includes transgender people and those who identify as neither male nor female.

    Of which monolithic ‘research and medical community’ do they speak? A great deal of quality research refutes the SJW ‘gender spectrum’ & transgender dogma, including a growing body of evidence indicating a significant amount of transition regret (see link above). But these findings have been met with strident opposition, at times vicious personal attacks, and attempts to suppress the data, by radical trans activists. Sex researchers and clinicians such as Drs. Dean Amitay and Alice Dreger have commented on the extreme pressure and threat to careers met by professionals who stray one iota from the radical trans dogma. As a consequence, many researchers and clinicians remain silent, thus giving the the false impression of a consensus.

  9. Michael Fisher
    Posted November 29, 2018 at 1:49 pm | Permalink

    sub

  10. pablo
    Posted November 29, 2018 at 2:29 pm | Permalink

    Certain medications effect males and females differently. Is a doctor now supposed to perscribe based on what sex the patient feels xirself to be?

    • Curtis
      Posted November 29, 2018 at 2:40 pm | Permalink

      To add on to this thought, a doctor needs to know biological sex in order to decide whether a mammogram or prostrate exam is more appropriate.

      • Michael Fisher
        Posted November 29, 2018 at 3:02 pm | Permalink

        @pablo You are being pointlessly silly – the gender that a person assigns themselves [psychological] has no bearing on medical treatment [physical]. To take it to the extreme just for clarity – a person may be identify as some sort of cuddly, furry spirit animal, but the doc isn’t going to send Fido The Dog Person to the vet!

        @Curtis Is this somehow a problem for a medical doctor? It is rare for a doctor to have no history available on a patient.

        I do not understand why some commenters on WEIT feel the need to post such bullshit comments when the subject is broadly about identity. If you feel sex & gender are only ever equivalent terms then you’re living in a myth from the ’50s – real people are complex, multidimensional beings in their psychology.

        • Adam M.
          Posted November 29, 2018 at 4:06 pm | Permalink

          I do remember news articles about how the NHS doesn’t invite trans men for breast screening but does invite trans women for (useless) pap smears, etc. I got the impression that NHS simply used the patient’s self-identification to determine what sex-specific medical treatments they’d be scheduled for. I also got the impression that these appointments were largely automated; I don’t know what effects there are on human decision-making, but it does seem that the NHS goes out of its way to avoid offense to the transgendered even if it may compromise medical care (their own, or even others, as in the case of the woman who aborted her own pap smear when the female nurse she requested actually turned out to be a transwoman).

          • Michael Fisher
            Posted November 29, 2018 at 4:45 pm | Permalink

            Adam. With respect [I mean that] I dispute what you have written – mainly because you don’t provide evidence or links to show when, where, how etc.

            And you really need to support this grand claim:

            “…but it does seem that the NHS goes out of its way to avoid offense to the transgendered even if it may compromise medical care (their own, or even others…”

            with more than an impression you have or your example of a patient rejecting the services of a trans-woman nurse [presumably because she wanted to be attended by a ‘proper’ woman. By this logic we can have NHS patients rejecting nurses who are gay or black or white etc. Only so much is possible in accommodating the wishes of patients & the NHS perhaps goes to far in bending to the cultural wishes of patients [say Muslim women insisting on female only doctors & nurses].

            Moving on…
            HERE [PDF] is “Screening information for transgender users” by NHS Wales it covers Breast, cervical, AAA & bowel screening.

            HERE is one of many pages on NHS.UK re what to do [or not do] about medical services if one is a trans patient. This one is called “Should trans men have cervical screening tests?”

            It is clear that the NHS is doing its best to put the information out there for all types of users. As an example – I got a letter two weeks ago telling me that all my medical information will now follow me around digitally wherever I encounter medical services [there’s an option to opt out] – at the end of the letter is a list of all the medical orgs who are in this digital net.

            Obviously, as is clear in the links I’ve supplied, the ‘user’ has some responsibility in letting the NHS know about her own ‘identity’ & special needs [dietary, religious, sexual preference blah, blah, blah]

            • Adam M.
              Posted November 29, 2018 at 11:12 pm | Permalink

              A sincere request for evidence is always fair, I think.

              I do think their system should offer trans patients the correct procedures for their sex by default by either categorizing them by their sex instead of gender identity or by having “trans woman” and “trans man” as separate categories (or some other method that doesn’t require trans people to “opt in” to getting the correct treatments). If they don’t do this because of sensitivity to offense then they might indeed be prioritizing offense over health, but I have no knowledge of their motivations besides vague memories of news articles that could possibly have been sensationalized. I don’t know to whom the pamphlet in the first link is given. If they give it to all trans patients, I think that’s good enough. (If trans patients have to find it on their own, it might not be.) In the absence of concrete, up-to-date information to the contrary I’m willing to accept that they try to do their best for trans patients’ health.

              As for normal patients, my contention is that if NHS’ official answer to women who want a female doctor or nurse badly enough that they’re willing to forgo medical treatment if they don’t get one is “too bad” then they are prioritizing the feelings of transgender staff over the health of patients. I assume you’d agree with that. Now, does this actually happen? I do remember a couple articles saying so, but it was years ago and I don’t remember whether that was an official NHS response or just the responses of some individual staff members. Let me see if I can find any corroboration… well, after 10 minutes of poking around on Google I saw a couple cases, including one where the woman was ‘made to feel like a transphobic bigot’, but I can’t find information about NHS’s official stance on this issue or even if the women were, in the end, accommodated.

            • Michael Fisher
              Posted November 30, 2018 at 1:42 am | Permalink

              Adam. Where is the link to the incident or incidents you reference in the last sentence?

              I think we can agree that your memories re the NHS are from quite some time ago & I gather they are possibly from North American news sources. Depending on the source the NHS is to be loved/envied/admired or it’s a commie plot. 🙂

              The British Isles are densely populated & we’ve had an underfunded NHS for a long time. Thus today all Welsh transgender patients are referred to London for all matters transgender! Looking at a map that doesn’t seem much of a problem to North Americans perhaps [only one or two or three hundred miles travel], but it’s a day by trains/buses from deepest, darkest mid Wales. A compromise has been reached I think with a fairly local small net of specialist GPs who can deal with most non-surgical aspects. That’s the state of the NHS trying to do its best.

              I consider our convo closed unless you have something more concrete. Stats would be nice.

        • Posted November 29, 2018 at 4:51 pm | Permalink

          “a person may be identify as some sort of cuddly, furry spirit animal, but the doc isn’t going to send Fido The Dog Person to the vet!”

          The difference is that with patients identifying as spirit animals, doctors are not bullied by the thought police to validate the patient’s dysphoria.

          • Michael Fisher
            Posted November 29, 2018 at 5:18 pm | Permalink

            You want to throw around the phrase “thought police” with respect to GID? What emotive reactionary nonsense. If you think GID is not real or is real, but shouldn’t be accommodated by doctors & other professionals within healthcare then I’m hoping you are not involved in the provision of services that interact with these groups. If I’ve got the wrong end of the stick with respect to your comment mayamarkov then explain your reasoning more clearly.

            • Richard
              Posted November 29, 2018 at 5:52 pm | Permalink

              Our good host PCC(E) gets to tell people what to do on this (his!) website, not you.

            • Michael Fisher
              Posted November 29, 2018 at 5:58 pm | Permalink

              Richard:

              “Our good host PCC(E) gets to tell people what to do on this (his!) website, not you.”

              I agree with that Richard. Point me to the place in this thread where I tell people what to do & I’ll retract that command if you are correct.

              • Posted November 29, 2018 at 7:32 pm | Permalink

                And you really need to support this grand claim:

                In the above comment to Adam M

              • Michael Fisher
                Posted November 29, 2018 at 7:46 pm | Permalink

                @OG Please review the comment you just made to me. This is what I’m seeing:

                OG writes: “And you really need to support this grand claim:

                In the above comment to Adam M”

                You’ve missed out your quote of what I wrote to Adam M that you want me to support. Please clarify!

              • Posted November 29, 2018 at 8:57 pm | Permalink

                are you not telling Adam what he needs to do?

              • Posted November 29, 2018 at 9:10 pm | Permalink

                Richard complained that you were telling other commenters what to do. You asked him to point out where. He never answered but I did. I was pointing out what I believe was the source of the complaint made by Richard.

              • Adam M.
                Posted November 29, 2018 at 11:16 pm | Permalink

                He did phrase it as something I “need to” do, but I think it was fair for him to ask me to explain why I thought what I wrote.

              • Michael Fisher
                Posted November 30, 2018 at 1:23 am | Permalink

                In reply to Richard & OG

                Adam M. made observations based on his reading material. His impressions were:

                ** NHS doesn’t invite trans men for breast screening
                ** But does invite trans women for (useless) pap smears, etc.
                ** NHS used the patient’s self-identification to determine what sex-specific medical treatments they’d be scheduled for
                ** These appointments were largely automated
                ** NHS goes out of its way to avoid offense to the transgendered even if it may compromise medical care

                These are easy things to write when one doesn’t have to provide supporting links/references! So I wrote this:

                Adam. With respect [I mean that] I dispute what you have written – mainly because you don’t provide evidence or links to show when, where, how etc. And you really need to support this grand claim: NHS goes out of its way to avoid offense to the transgendered even if it may compromise medical care

                The above is not me commanding/telling Adam what he must do! I am asking for links or references to support five points & especially the last one… especially the last one because it’s an easy claim to make, but hard to demonstrate as it’s a non-specific observation [what does “going out of it’s way” entail for example?]

                What I’m saying is “You really need to back up your claims for me to take them seriously” I am not however demanding that he do so. I am also conscious that Adam M. spells like a North American so it’s important to me that he supplies sources – I have read wacky misrepresentations of “socialist medicine” emanating from people who have never been to this side of the herring pond – that’s journalists as well as common folk.

                Adam has listed five facts/impressions about the NHS/trans patients with no data provided about where, when, why, how. For example is Adam remembering from the days when trans patients were a rarity or is he speaking of now? Is he saying these errors have occurred with a small proportion of the total small numbers of trans on the NHS books?

                In my reply I also provided two links that partly illustrate how trans patients are dealt with TODAY [in one region of the massive NHS in the case of one link] – if those links are representative of general practise then Adam’s points are maybe from a different era or they represent a problem within one of the NHS trusts [there are many trusts – each one supplying their own particular good poor or bad quality of service] or they are news mis-reportings/exaggerations rather than a correct picture of NHS national/regional strategy.

                All in all I think Adam could have supported his five points – even just one “shock, horror!” news article.

              • Richard
                Posted November 30, 2018 at 2:13 am | Permalink

                I did not reply as I do actually sleep at times, but it is morning now here (and a cold, grey, wet one!).

                I took issue with what I felt to be your hectoring tone in this thread. I like the civility of this website.

                If you think that my observation was uncalled for then I apologize and I retract it.

            • BJ
              Posted November 29, 2018 at 8:31 pm | Permalink

              “You want to throw around the phrase ‘thought police’ with respect to GID? What emotive reactionary nonsense. If you think GID is not real or is real, but shouldn’t be accommodated by doctors & other professionals within healthcare…”

              Maya said no such thing about whether or not they should be accommodated by doctors and other professionals within healthcare. Considering her statement about “validat[ing] the patient’s dysphoria,” I imagine her view is close to the one I outline in response to Ken’s comment #7. You have no reason to talk down to her and others and put words in their mouths. This is a legitimately contentious issue and there is no reason it cannot be discussed civilly and with both sides being heard.

              And maya is right that there is a “thought police” with regard to this issue. As I mentioned in my response to Ken, and as Matt mentioned in comment 8, doctors and researchers who try to research other ways of treating GID that don’t involve validating the patient’s dysphoria and treating it with damaging medications and extremely expensive surgeries are being suppressed, smeared, and often drummed out of their positions. It is dishonest to act as if this is not true.

            • Adam M.
              Posted November 29, 2018 at 11:50 pm | Permalink

              I agree, Michael, that they should be accommodated and helped. But what do you think about the various other body dysphorias (e.g. BID, BDD, etc) or, say, anorexia?

              Personally I see little difference between a man who hates being a man and wants his penis removed and a man who hates being abled and wants an arm removed. Or a woman who hates her breasts and wants to be a man, and a woman who hates her eyes and wants to be blind or an unhealthily thin woman who thinks she’s obese and starves herself or an attractive/normal woman who won’t leave the house because she thinks she’s hideous. These are all mental disorders where a person’s conception of their self doesn’t match reality.

              However, the ethical treatment for anorexia is not to encourage a skinny woman in her belief that she’s fat so she’ll starve herself further, and the ethical treatment for BID is not to encourage someone to amputate a limb or pour bleach into their eyes (which they actually try to do). A we don’t tell women with BDD that they really are hideous and should stay out of sight. Although removing or destroying healthy body parts in an attempt to assuage their dysphoria has been tried, it’s rare and highly controversial. The best practice is to try to get them to accept the reality of their bodies. With enough therapy, they can overcome it.

              I don’t see why people with gender dysphoria alone out of all the various body dysphorias should be encouraged in the belief that they really are what they’re not and further encouraged to cut off healthy body parts, and why society must pretend for their sake or be called bigots. At least a person with BID actually can become blind or a quadriplegic or whatever they feel they’re “supposed” to be, whereas until we can create and implant new ovaries and testes, males and females cannot change sex.

              I just don’t understand the double standard.

            • Posted November 30, 2018 at 12:39 pm | Permalink

              I meant that doctors (like everyone else) are told to conform to how transgender people feel or else, so I wouldn’t be surprised if some doctor indeed prescribes what is appropriated for the gender, not for the sex.

              About my situation, nobody needs to worry; 1st, I am not involved in provision of such services, 2nd, we are backward here and do not yet have these problems, I expect them in about a decade.

        • Curtis
          Posted November 29, 2018 at 4:55 pm | Permalink

          If you don’t like doctor, how about insurance. Life insurance is cheaper for women because they live longer. Can I claim to be a female in order to get a lower rate? Who is to say I did not feel like a woman on that day?

          • Michael Fisher
            Posted November 29, 2018 at 5:26 pm | Permalink

            I really don’t care for your facile reasoning Curtis. You seem to be one of those people who thinks that some small % of biological male can’t possibly be psychologically more comfortable as a woman. If that is your belief then you’ve been nowhere & done nothing. You are no different than the primitives who insist that there’s no such thing as being gay or that gay exists, but it’s a disease to be cured.

            There is no point in a conversation if you fit in the above somewhere. If you don’t then please explain your beliefs/experience on this subject of gender identity.

            • Curtis
              Posted November 29, 2018 at 5:51 pm | Permalink

              Yes, a biological man can feel like a woman and I have no problem with a biological man living a gendered life as a woman.

              However, physically she is a man and has the biological traits (health, longevity and sports ability) of a man. In things related to these matter, she should be treated as man. For social purposes, she should be treated as a woman.

              Her gender and her physical sex are different and it is absurd to claim they are the same.

              • Michael Fisher
                Posted November 29, 2018 at 6:12 pm | Permalink

                So we have no disagreement then it would seem. Thus your remark that “a doctor needs to know biological sex in order to decide whether a mammogram or prostrate exam is more appropriate” is nothing, but the obvious statement it appears to be. So obvious that I asked:

                @Curtis Is this somehow a problem for a medical doctor? It is rare for a doctor to have no history available on a patient.

                That’s all cleared up then.

          • Posted November 30, 2018 at 12:43 pm | Permalink

            Do they really charge men more? This is outrageous!

            • infiniteimprobabilit
              Posted December 2, 2018 at 3:58 am | Permalink

              I presume you’re not being facetious?

              Yes, insurers charge premiums based on risk. Males are a bigger health risk for some medical conditions.

              Insurers also often charge male drivers higher premiums than women, based on accident statistics. Whether any ‘trans’ males have ever claimed lower premiums based on their identifying as women, I don’t know, but I guess it has happened.

              cr

              • Kelly
                Posted December 2, 2018 at 8:24 am | Permalink

                Alberta man changes gender on government IDs for cheaper car insurance
                He says he saved almost $1,100

                https://www.cbc.ca/news/canada/calgary/change-gender-identification-insurance-alberta-1.4754416

              • Posted December 2, 2018 at 4:24 pm | Permalink

                I suppose I am not being facetious (whatever this means 🙂 ), but all this sound very strange to me. Where I live, health insurance is a fixed share of the income up to a certain threshold, and car insurance is calculated based on the properties and age of the car (insurers vary in their offers, but take into account the same things).

        • Kelly
          Posted December 1, 2018 at 5:19 pm | Permalink

          “”You are being pointlessly silly – the gender that a person assigns themselves [psychological] has no bearing on medical treatment [physical]””

          Actually it does, since some trans patients regard their body parts to be of the opposite sex, for example, a female penis, or a male vagina, so to be told that they need a mammogram for their ‘lady parts’ for example, is considered an act of aggression, as it erases their gender identity, which is anathema in the trans world.

          • Michael Fisher
            Posted December 1, 2018 at 6:27 pm | Permalink

            Actually it does, since some trans patients regard their body parts to be of the opposite sex…

            An old Irish friend of mine, who I first met in the early 80s in a Birmingham Irish pub where he was doing his drag act: He’d come from rural Ireland at 17 because he didn’t fit & back then he’d regarded himself as possibly gay, but unsure of it – biggest problem was he couldn’t out himself or discuss with others in such a hostile environment. So he relocated to Brum to find out more about himself & of course he was somewhat bewildered at first.

            At the point I first met him in ’81 he was a 20 year old, male gay comedian & drag artiste – very funny & very successful. But he came to realise that he wasn’t attracted to men from a gay perspective, but from a female perspective – he realised he was a woman in his sensibilities & attractions. Over the next 30 years he took the long, hard road to transitioning to a [fully as medically, psychologically possible] female identity at a time when the NHS wasn’t completely up to speed on the subject & the language wasn’t available [or wasn’t common parlance] to discuss all the varieties of identities that are now placed under the umbrella term “transgender”

            There’s another pub ‘he’ [at the time] & I visited in the Jewellery Quarter [called the Rose Villa Tavern] around ’87/’88 where a dozen cross dressing men would turn up with their wives/girlfriends for a night out. One or two of those guys were ‘trans’ as per my friend, one was transvestite [kind of like Grayson Perry] but most were not – they saw it as just a side of themselves they liked to express at times & they resisted categorisation emphatically.

            My friend is now a 57 year old, married woman working for the Inland Revenue [tax office in Brum] in a boring office job. She’s happy as she is now, but does miss the crazy times when she hung out with an extraordinarily wide group of people. That was her university in a way.

            She & her old friends [quite a collection!] are all I know about transgender & related areas of sexual [& non sexual] identity. I never encountered a trans male or trans female who refused sex-based screening on the grounds that that sex was no longer part of their identity. Perhaps because that place & time & area of life [80s/90s Britain] was less imbued with the ideologies & identity politics that are everywhere today?

            So I’ve learned something thank you. Do you have a link I can read re these denialists of common sense? I will pass it on to my friend for her opinion.

            • Michael Fisher
              Posted December 1, 2018 at 6:39 pm | Permalink

              Inland Revenue = HMRC today

            • Kelly
              Posted December 1, 2018 at 6:54 pm | Permalink

              Gender dysphoria can be so intense amongst transgender people that the mere mention of a body part associated with femaleness ‘vagina’ or maleness ‘penis’ causes them a great deal of distress. So, for example, if a doctor were to talk to a transman about his ‘vagina’ or ‘breasts’ he would be reminded that he is biologically female, and this would upset him such that he would feel his gender identity is being erased. Hence the use of new words such as ‘front hole’ for vagina or ‘ladystick’ for penis.

              Here is an article which goes into greater detail:

              “”“For example, some trans and nonbinary-identified people assigned female at birth may enjoy being the receptors of penetrative sex, but experience gender dysphoria when that part of their body is referred to using a word that society and professional communities often associate with femaleness. ”

              “”
              “Traditional safe sex guides are often structured in a way that presumes everyone’s gender (male/female/nonbinary/trans) is the same as the sex they were assigned at birth (male/female/intersex or differences in sexual development) … These guides also often unnecessarily gender body parts as being “male parts” and “female parts” and refer to “sex with women” or “sex with men,” excluding those who ​​identify as nonbinary.

              Many individuals don’t see body parts as having a gender — people have a gender.

              And as a result, the notion that a penis is exclusively a male body part and a vulva is exclusively a female body part is inaccurate.”””

              https://www.pluralist.com/posts/1870-medical-site-adopts-the-term-front-hole-to-replace-vagina-in-the-name-of-gender-inclusivity

            • Kelly
              Posted December 1, 2018 at 8:11 pm | Permalink

              And here is another example for you, wherein a transwoman explains that its’ transmisogynistic to conflate ‘penis’ with ‘male’ as penises can be female if the owner declares it as such:

    • Posted November 29, 2018 at 4:23 pm | Permalink

      A patient apparantly feels to be a gender. It is only sex by biology.

  11. pablo
    Posted November 29, 2018 at 2:40 pm | Permalink

    I’m waiting for the regressives to go flat earther on us as a globe privileges the white northern hemisphere over the southern hemisphere of color.

    • Michael Fisher
      Posted November 29, 2018 at 3:05 pm | Permalink

      What does this mean pablo? You are spouting nonsense. What do you get out of being so negative & dismissive?

      • Kelly
        Posted December 1, 2018 at 5:16 pm | Permalink

        I am reading this thread and I am astounded at the amount of vitriol coming from you, and you alone.

  12. max blancke
    Posted November 29, 2018 at 3:40 pm | Permalink

    Gender and sex are not interchangeable terms, but they are strongly related. Hesther Heyer has some interesting perspectives on the correlation.
    In conversations about this, even with therapists who deal primarily with sex and gender issues, the conflation issue rises continuously. The therapist might correct me for the error, then do it herself in the next sentence.
    When talking to activists, they will use the conflation argument just to silence critics. Another big one is “isms”. Say “transgenderism” and you get snapped at for hateful language, because they believe an “ism” is a choice. I disagree, and use “hyperthyroidism” as an example. Of course, one can test for hyperthyroidism. The vast majority of trans persons are relying only on their own intuition for this diagnosis, which is always confirmed by advocates and activists. Also,they often dispute the “trans” part and say “I am just a woman, like any other”.
    The cynical part of me thinks part of this is the human tendency for dominance. In this case, it would be about getting people to make fervent statements that they know are not true.

    I wish I could just steer clear of this issue, but I cannot.

    • max blancke
      Posted November 29, 2018 at 3:40 pm | Permalink

      Spelling correction- Heather Heying

    • akvadrako
      Posted December 1, 2018 at 4:54 am | Permalink

      > I wish I could just steer clear of this issue, but I cannot.

      That’s the question, isn’t it?

      There is no way to please everybody; either we let females have their own private spaces (and sports), we let everything be mixed, or we let each organisation decide how to segregate people.

      Maybe it will be resolved by laws and courts, and ultimately voting, but it doesn’t feel like a fight either side will give up lightly.

  13. Posted November 29, 2018 at 5:35 pm | Permalink

    Unless you are viewing all people of your own sex as competitors for producing progeny, and all members of the opposite sex as potential partners in producing progeny, there are few reasons outside medical and scientific concerns to worry ad nauseam about this. We spend way too much time and energy on sex and gender. Why is it so hard to accept individuals in the way(s) they prefer that are most meaningful to them? In most other areas of human endeavor, we seem to have more latitude for acceptance of differences.

    • Adam M.
      Posted November 30, 2018 at 12:36 am | Permalink

      I can’t speak for everyone, but I just don’t like being told what to believe, especially when it seems like I’m told to believe that black is white and white is black. That’s kind of what cults do (not that they’re a cult).

      I don’t mind trans people doing their own thing. I don’t care what bathroom they use. But I feel like “live and let live” or “agree to disagree” is not enough for them. They’re not happy unless other people conform to their beliefs. Someone who doesn’t believe that sex can be changed (at least with current technology) mustn’t say so, or must hide behind a pseudonym, or else a Twitter mob may well try to get them fired from their job…

      • Posted November 30, 2018 at 2:06 am | Permalink

        I appreciate your response.

        I also would like to see more ““live and let live” or “agree to disagree””. But, I tend to see the lack of these attributes more commonly and virulently among conservative religious members of our society. Somehow, we all must get to a place in the middle (if not exactly a meeting of the minds)to stop condemning and telling others how they must live.

        The Bible says a great many things, pro and con, on this issue and many others about hatred or love of others. Each of us will be doing extraordinarily well if we can live our own lives in love and kindness, without hatred.

        • Davide Spinello
          Posted November 30, 2018 at 8:40 am | Permalink

          Rowena: at this point in space-time the source of sensitive training, implicit bias training (based on a test, the IAT, that doesn’t measure anything,) and moral panic about sex with suppression of sex research based on ideology is not preeminently the religious right. I would agree with you if we were talking about this not many years a go.

  14. Gabrielle
    Posted November 29, 2018 at 7:16 pm | Permalink

    In all these discussions about transgender individuals, there are significantly more comments/remarks made about transgender women than about transgender men. I’m puzzled about why this is, since their numbers must be roughly equal.

    • Adam M.
      Posted November 30, 2018 at 12:11 am | Permalink

      I’ve read that transwomen are significantly more common but when I went looking for citations it seemed rather hard to find reliable numbers.

      It does seem that transwomen are more vocal and active about wanting to be accepted as women. Society has many protections for women, like woman-only sports, job shortlists, scholarships, etc. and transwomen’s attempts to enter these is controversial because it’s considered to harm women (e.g. when transwomen dominate women’s sporting contests or take jobs earmarked for women only).

      As for transmen, there are far fewer man-only spaces, jobs (at least officially), or scholarships these days, and they don’t threaten the integrity of men’s sports. They also just don’t seem very vocal, for whatever reason…

  15. Posted November 29, 2018 at 7:44 pm | Permalink

    The word for some whose biological sex is male shown not be the same as the word for someone whose biological sex is male but their gender is female.

    Same us true for females.

    The two are not the same.

    There are many reasons people should be able to look at a perfon’s I.D. on their drive er’s License or one any other form and know the person’s sex as well as their gender.

    The main reason is medical. Someone treating the person in an emergency should shave that information at once.

    There are also ethical questions. A person should not conceal their identity and should not mislead or pretend to be something they are not. Deceit and misrepresentation are not ethical.

  16. Armando
    Posted November 29, 2018 at 9:35 pm | Permalink

    Nice piece Jerry. Just a small comment though. I am confused about the statement “But that figure doesn’t include individuals who identify as bisexual, polysexual, and so on, so the bimodality for gender may be a bit less pronounced than for sex.” As far as I understand it bisexuality and polysexuality have everything to do with sexual desire/attraction and nothing to do with gender. Right?

    • Posted November 30, 2018 at 4:23 am | Permalink

      I’m talking here about individuals who feel that they are of more than one sex: those who use the pronoun “they”. That’s what I meant by the words “biseuxal” and “polysexual,” but that was probably a confusing misuse.

    • akvadrako
      Posted December 1, 2018 at 5:21 am | Permalink

      There is a sub-movement to classify homosexuals as transgender¹. For those that consider gender to be a list of traits it’s consistent, since being attracted to females is a typical male trait.

      [1] https://samharris.org/podcasts/135-navigating-sex-gender/


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