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  • Writer's pictureEvie Clayton

Let's talk about (biological) "sex", baby

Updated: Nov 11, 2020

If you did high school human biol like me, you might remember learning that “race” is a scientifically meaningless term; there’s more genetic variation within racial groups than there is between. That hasn’t stopped people from enacting eugenics and genocide on groups based on skin colour, and it doesn’t erase the social meanings of race—ongoing histories of colonialism, oppression, slavery, genocide, wealth inequality, social inequality, microaggressions; these things aren’t erased because there’s no genetic distinction between races; racism exists, and that's because there are social distinctions between races, not because there is anything scientific driving it, and the misuse of science as a basis for that racism is definitely a part of the problem.

Well, here’s the thing; the same is true of “biological sex”. It’s a scientifically arbitrary and tautological categorisation. That doesn’t erase the patriarchy and all the results of gender inequality; it doesn’t change the fact that upwards of 80% of all medical research only looks at white cis men, or the ways that impacts people who aren’t white cis men—acknowledging that sex is a meaningless construct doesn’t erase the harm that is done by misogyny.

"Biological sex" is the way that humans discretely categorise people based on an array of characteristics that aren’t discrete and that are often incongruent with one another—those incongruences get touted as "abnormalities", but they're part of normal human variation, and defining them as "abnormal" is part of circular logic of defining "biological sex" as binary.

[Image description: a bimodal distribution function showing "frequency" on the y-axis and "morphological trait" on the x-axis; the two overlapping ranges are shown in pink and blue, with the overlap shown in purple] This is an example of any *one* trait; a single hormone range, height, weight, amount of body hair, clitoris/penis size, breast tissue etc.

We are taught to conceptualise "men" and "women" as the dotted lines; the most common value, but any value along the x axis represents a specific, individual value, and each individual will fall in a different place on the x axis depending on which trait we are looking at, and for many traits an individual's place on the x axis will fluctuate throughout their life. These distributions also change depending on what population you're measuring.

It's a bit like deciding that dark brown and very light blonde are the only two "real" and "normal" hair colours, and then defining all other shades of blonde and brown as deviations from the "norm"; and pathologising and medicalising auburn, red, mousy hair colours for being too far from "proper" hair colours. When it comes to "biological sex" this is the basis for inhumane, unnecessary non-consensual surgeries and treatments performed on intersex people when they are infants, and for perisex (non-intersex) people these variations may be used to invalidate or ignore unrelated medical conditions.

What does that mean? We understand “sex” as being the “sum” of: someones chromosomes, hormone levels and physiological responses to their hormones, secondary sex characteristics (body hair or lack thereof, breast tissue etc), their internal reproductive system (ovaries, testes, uterus) and their external reproductive organs (genitals). But not one of these characteristics are binary; chromosomes are the only ones that are sort of discrete (ie, not measured on a continuous spectrum; but even then it's possible to have fragments, so that's not really discrete) but they’re also the one that is least likely to be known and ultimately has the least influence on a person’s “biological sex” as defined by medicine.

People tend to think of biological sex and birth gender assignment as the same thing, and that this is something that is “real”, “finite” and “immutable”. Like you can “change” your gender, or not identify with your birth assignment, but that “biological sex” doesn’t change.

But generally, all that is measured to define someone’s biological sex is their external genitalia, and I think most here should agree that genitals aren’t the most important factor; most people don’t know their karyotype (whether you have XX or XY chromosomes or another variation), and in fact what relevance is it if someone’s karyotype is incongruent with their other sex characteristics? There are XY women who have given birth without medical intervention.

[Image description: screenshot from facebook comments section Philip Batterham: This video is misleading, possibly deliberately so. There are people born with Y chromosomes who are female and it is not that rare. To say so is not leftist. You just need an education in genetics. Further, there are people born intersex, and it's genetic.

Replier's name redacted: You look like a nice guy Philip, but she is a Pediatrician (hospital emoji, microscope emoji, book emoji, light globe emoji) Philip Batterham: [name redacted] and I am the President of the International Genetics Federation.]

So, why do we have the concept of “biological sex” so deeply ingrained in medicine and society? In part it’s because of white supremacy and hierarchical culture that comes from colonialism—many Indigenous and pre-colonial cultures acknowledged sex and gender outside of the binary; celebrating human variation rather than pathologising it. Because medicine doesn’t exist in a vacuum, so like everything else it has been influenced by misogynistic, patriarchal, white supremacist, colonialist values, which means “look for the evidence that supports the theory of binary biological sex (and therefore inferiority of women and anyone else who doesn't fit white male standards) and ignore the evidence that says hey maybe this theory doesn’t always make sense”.

[Authors note: a week after writing this blog I came to realise that this blog post, and following paragraph especially, whitewashes history by not adequately acknowledging or giving details about the specific work of white supremacy in how biological sex came to be defined. I've written a follow up blog post to acknowledge this, which has a link to an article that gives vitally important historical context about how science has long been misused to promote white supremacy and harm Black people, and specifically about how the very concept of biological sex is the work of white supremacy. Please read it. I've decided for now not to change anything in this blog post, for the sake of honesty and clarity, but if anyone reading this feels like leaving it as is is problematic, please let us know (there's a contact form at the bottom of the website).]

And then the other, less sinister reason is that people like to categorise things, especially when we’re talking about science. The point of classifications, like sex, or for example, like animal taxonomy, is to make generalisations during the process of learning about things, and make generalisation that make it easier to communicate something. Categorising things seems to be inherent in human behaviour as a part of understanding our environments, but categorising things has a limit to its helpfulness—if you’ve never come across it, look up the explanations about how a coconut fits the requirements to be considered a mammal, or how if a chicken was born without feathers meets most of the requirements to be considered a primate. And beyond categorising things being not always helpful; when you’re categorising humans, there’s often a point when it becomes actively harmful; once again, see racism, eugenics and intersex surgeries.

Having general rules that were arbitrarily decided on make it easy to characterise and categorise things doesn’t make those generalisations true, accurate or even useful (unless your intended “use” is the subjugation of a subset of humans).

We now have the ability to measure and individual’s karyotype when it’s relevant, and we can easily learn about someone’s hormones levels, and we have imaging that can tell us about internal reproductive organs—but we have no reason to learn about any of these things unless there is a genuine pathology (that is; notably harmful from individual’s perspective— pathologising and medicalising intersex bodies is NOT an example of this. Intersex people deserve body autonomy and their bodies should not be altered to conform with this outdated, harmful definition of binary biological sex). This means that each of us knows our own “biological sex” about as well as a coconut knows it is a mammal, and that information is about as helpful and necessary.

When it comes down to it, sex is a pretty unnecessary and unhelpful system of classification for individuals. There’s always a more relevant piece of information, and by asking a question of sex you are invariably going to come up with the wrong answer some of the time, so instead you should just ask the question that is ACTUALLY relevant and not exclusionary. Plus it’s generally only in medical scenarios that any of these things are relevant anyway;

Does this person have a testosterone or oestrogen dominant endocrine system?

Do they have a penis? A vulva? A vagina? A combination of these?

Can this person become pregnant? Can they impregnate someone else?

Do they carry an X-linked condition? Do they have a Y-linked condition?

Do they grow facial hair?

Are they at risk of breast cancer?

Unless you have medical questions—in which case you should be more specific about them anyway—sex is not a useful classification, and EITHER WAY it’s almost meaningless when you get to an individual level.

That doesn’t mean your experiences of misogyny, of menstruating, or growing facial hair, erections, becoming pregnant or getting someone else pregnant, giving birth or any other thing that we associate with a certain sex become erased or invalidated, it just means that we can talk about these things in their own terms.

We still need to talk about misogyny, but we also need to acknowledge that it’s not something exclusively experienced by people with vaginas, or women, or people assigned female at birth. So, when we need to discuss misogyny, couldn’t we just talk about it in terms of “people affected by misogyny”?

And we definitely still need to talk about how the selection bias in medicine means that our medical systems are all skewed towards white, typical men; all of what I am saying here doesn’t invalidate or discount the fact that medicine ignores and enacts harm and violence on women, afab people, intersex people, People of Colour, non-biotypical people, and anyone that can’t fit into the archetype of an able bodied, white, cis male (ie society's view of a "default human"). The fact that 80% of all medical research ignores the existence of folks with uteruses is fucked up, y’all; even if trying to pin other characteristics to people because of the number of uteruses they have is also fucked.

Our medical system is based on arbitrarily defining sex as binary based on often incongruent, non-discrete characteristics and then using that arbitrary definition to disqualify more than half of the population from medical research. The effect of that is very fucking real.

This isn’t my first blog post that basically boils down to this concept, but as always, this really comes down to being precise, specific, and accurate, in a way that lets everyone into the room who needs to be there, and gives everyone a seat at the table and says to everyone who shares that experience “your voice is valid and welcome here”.

And then beyond that, well, we need a revolution in our medical systems and scientific research if we're ever going to understand and embrace human variation, and be able to humanely and compassionately care for everyone.



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