In defence of both sex and gender
They defy clean distinction but it is worth understanding where the fuss comes from and why they remain worth distinguishing
Note: I wrote an earlier version of this piece for Medium back in 2021. Recent events, particularly in the USA this year – following the second Trump inauguration – have given a new salience to my attempt to give an even-handed and nuanced view on a topic that is both polarised and largely resistant to nuance. I have chosen not to update the article, but rather to lightly edit it for sense and insert a few pull quotes labelled “2025 update”. Please add your thoughts in the comments at the end.
In Australia, when you turn 50, you get a card and a present from the government. Well, the card is actually a letter informing you that you’ve entered a higher-risk category for bowel cancers, and the present is a do-it-yourself kit for gathering a couple of small samples and sending them in for testing. The whole process, from simple instructions to custom-designed sample tubes, is really quite impressive. Only one step in the process confused me.
Question 4 on the ‘Participant Details’ form asked me, “What gender do you identify as?” The options were Male, Female, and Other. I’m a scientist who studies sex differences and the complexities of gender, and I wasn’t surprised to see a question about gender. I was, however, confused because the categories of male and female are usually reserved for sex. Questions about the genders people identify as usually provide options like ‘Woman’ and ‘Man,’ or more variegated options we will get to later.
I’m sure most participants find it as easy to answer question 4. Most men tick ‘male,’ and most women tick ‘female’ without a second thought. But innocuous as question 4 might seem, it belies a tangled mess around questions of gender and sex. That tangle can lead to conflict, misery, and, possibly, worse outcomes for cancer screening patients.
Sex
To biologists, sex refers to biological status as male or female. In animal species where individuals produce one of two different kinds of reproductive cells, those that make big cells (called eggs) are considered female, and those that produce small cells that move about looking for eggs (sperm) are the males. This straightforward convention proves easy for biologists looking at other species to follow.
2025 Update
You might recognise the egg-sperm dichotomy of male and female from the Trump Administration’s attempt to define away gender.
In humans and other mammals, egg-producers have two copies of the X chromosome, and sperm-producers have an X and a Y. More specifically, they have a gene on the Y called Sry, which stands for ‘sex-determining region on the Y chromosome.’ With a working copy of Sry, an embryo develops as a male; without it, the embryo becomes female.
All of this packs most humans into one of two boxes, female or male. We tick those boxes when we fill out forms that ask our sex.
Except when we don’t. Male or female development involves far more genes than Sry. A fascinating variety of genetic variants contribute to the fact that as many as 1 in 100 people have what scientists call a difference or disorder of sex development (DSD). So-called intersex conditions form part of the spectrum of DSDs. Often they defy attempts to categorize individuals into unambiguous biological sexes.
Gender
The complexity ramps up considerably when it comes to gender, an aspect of an individual’s social identity far more variegated than binary categories. Many sources, in grappling with gender, emphasize the socially and culturally constructed nature of gender. That is to say that notions of gender develop and change with social and cultural practices and meanings. For example, the American Psychological Association says, in their useful style guidelines,
Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex. Gender is a social construct and a social identity.
In the rough seas of sex and gender, the temptation to grasp the biological-social distinction as a flotation device can prove overwhelming. If we can only figure out whether we are talking about chromosomes, genes, and hormones or about socialization, meanings, and culture, then we can retreat to the safety of either biological or social science, secure in knowing whether we are discussing sex or gender. But will that convenient flotation device keep our heads above water?
I’m not so sure. For example, one of the senses in which gender is used involves continuous variation in femininity and masculinity. Two people, both female, might vary in stature, body shape, and voice pitch, such that an observer could confidently say that one is more feminine than the other. That kind of variation among women can arise via biological processes that differentiate mature females from males.
Indeed, many of the genes implicated in DSD generate everyday variation among females, among males, or both, in traits associated with gender. It doesn’t take much imagination to see how some gender variation between women and men arises from the process that creates sex differences between females and males.
Let us turn our attention to the observer, whom I thrust – without asking them – into the vexed business of judging femininity. Their worldview and experience, by which they distinguish between women based on femininity, could be entirely social in origin. And yet, it need not be. Notions of femininity (and masculinity) change as societies do, but even these notions might not be unmoored from biology.
Recognizing cues of gender has likely been useful in all manner of life-or-death and reproductive situations throughout humanity’s evolutionary past. Discerning whether a person is likely to be dangerous, cooperative, or fertile would probably involve applying filters of gender or even of sex.
Two or more
Whereas sex allows a relatively simple assignment of most individuals into one of two categories, gender involves both continuous variation and – where classification is involved – more than two categories. In one of the most useful articles on sex-gender that I have read, Phillip L Walker and Della Collins Cook referred back to the linguistic origins of the terms:
Gender is derived from Indo-European roots related to kinship, as in generation, gene, and gentile; it refers to a system of classification in which there may be many categories. Sex is derived from Indo-European roots related to separation, as in sect or dissect; it refers to dichotomous relationships in which two categories are divided one from another.
Of course, the deep origins of terms need not restrict their contemporary meanings. Anthropologists Walker and Cook find the possibility of many gender categories important because of the empirical fact that categories other than ‘woman’ or ‘man’ are important social realities in many societies.
Walker and Cook’s motivation to tidy up the use of ‘sex’ and ‘gender’ arose from a frustration at the terms being used interchangeably. What frustrated them in 1998 continues, in 2021, to frustrate many of us who work in the uncomfortable zone where biological and social forces interact to shape human behaviour. Perhaps more so today, where questions of gender identity have grown far more prominent.
Gender identity
According to the American Psychological Association, “gender identity is a component of gender that describes a person’s psychological sense of their gender.” Many people’s deeply-felt sense of being a woman, a girl, a man, or a boy, does not correspond to their biological sex (often referred to as their ‘sex assigned at birth’). Other people have a no less deeply felt sense of not fitting those binary categories, identifying as genderqueer, gender-neutral, agender, or gender-fluid.
Gender identity, then, might correspond to biological sex (cisgender) or not (transgender), or it may not conform to categories that are commonly associated with sex (gender-nonconforming). The APA helpfully points out that
gender identity applies to all individuals and is not a characteristic only of transgender or gender-nonconforming individuals.
That may be true, but the relative ease with which gender-conforming people move through their social worlds means many of us may well not even notice our gender identity. It isn’t made clear to us that we are ‘different.’ We don’t field prurient questions about genitals and surgery within minutes of meeting strangers. And nobody asks us when we first realized we were cis or how we became cis.
The growing prominence of transgender and gender-nonconforming identities throws up another challenge to the socially constructed – or, more generally, acquired – nature of gender. Early comparisons of brain structure and function suggest that trans-gendered adolescent’s brains resemble cis members of the gender they identify as more than they do cis members of their sex. For some trans people, these findings gel with an overwhelming sense that they are ‘born this way.’
I often argue that the extent to which a trait is acquired or inherited should not be the basis for the legitimacy of something as important as gender identity or sexuality. I found myself nodding along in agreement when Shon Faye argued in The Guardian,
It may well be that our brains learn to develop certain patterns of function in line with the gendered expectations and norms of the world around us. In other words: the biological basis of identity and selfhood is as complicated and rich as the diversity of every human being who walks this planet.
Very few traits arise entirely from inborn nature or acquired nurture. Anchoring our understanding of important phenomena like sex, gender, gender identity, sexuality, or our general sense of self to the rusty old poles of nature and nurture seems in every way a losing proposition.
Mouthtalking
Even though distinguishing sex and gender grows slippery when we try to pin the terms down to their origins, they remain worth distinguishing. But it’s an ongoing battle to keep the two from blurring into meaningless sameness.
some people use ‘gender’, when they actually mean ‘sex’, in order to convey a desirable social identity
Walker and Cook saw the distinction blurring within the ranks of professional anthropologists way back in 1998.
Other social and biological anthropologists seem only dimly aware of this technical distinction and use the terms gender and sex as equivalents or preferentially use one term (usually gender) because of the desirable social connotations doing so has to them. This last usage nicely fits the definition of what Elman Service (1969) called ‘‘mouthtalk’’: words used to advertise the speaker’s social identity instead of to communicate about the matter at hand.
The delightful term ‘mouthtalk’ doesn’t seem to have endured into the era of internet dictionaries (even urban ones). It seems somewhat related to the currently-popular ‘virtue-signalling,’ although the use of the latter term seems to have become a form of mouthtalk itself.
Some very well-meaning people use ‘gender’ when they actually mean ‘sex.’ They often seem to do so to advance an inclusive and accommodating social persona, signalling an important and generally agreeable social identity.
It doesn’t help that ‘sex’ has other meanings to do with the combining of DNA from a sperm and an egg, and with the interpersonal acts whereby sperm and eggs occasionally find one another. Sometimes one’s inner prude hesitates to say ‘sex’ and ends up uttering the gentler-sounding ‘gender’ instead. At other times, gender just sounds more inclusive and variegated. Walker and Cook, again:
To some, the substitution of gender for sex might seem a harmless way of emphasizing the extent to which the gender roles that males or females assume are social constructs. This well-intentioned desire to emphasize the social influences on our sexual identities is misguided.
Politics
Sex and gender swirl about one another in a political maelstrom so fierce that many fear to dip even a toe.
Right-wing politicians seem willing to go to any length of cynicism to score points. U.S. Representative Marjorie Taylor-Greene, who carries a royal flush of conspiracy cards, spent her early weeks in Congress antagonizing transgender people and their allies. She erected a poster outside her office that blared “There are TWO genders. Trust the science!”
Greene’s clumsy conflation of sex and gender, and her laughably inept attempt to claim the scientific high-ground, were made worse by sheer meanness. The main target of her antagonism, Representative Marie Newman, is a champion of trans rights and mother of a trans daughter. Greene was merely one in a conga-line of Republican cynics seeking to sow anti-trans fear about bathrooms and now children’s sport. They will undoubtedly seek to open new fronts wherever they can, at the expense of LGBTQI+ people and their families.
2025 Update
Recent events indicate the US Republicans, and politicians elsewhere including Australia joined the conga-line with enthusiasm
The political tempest on the left, however, sometimes makes the furor surrounding Taylor-Green and her ilk look like a side-show. Successive feminist waves have smashed against binary views about sex and stultifying gender norms, exposing and eroding the space between gender and sex. But nothing stands still. Much of the political storm has shifted to gender identity and new understandings of the relation between sex and gender.
Feminism is caught up in that storm, with deep differences over how to recognize and affirm trans-women while also recognizing the important ways in which sex differences shape individual lives. As journalist Susanna Rustin put it, in The Guardian,
if “sex” ceases to be talked and thought about, how will we recognise and tackle sex-based oppression, not just in western countries but around the world?
The troubles surrounding sex and gender reflect the importance of the subject matter for people’s lives and a deep, layered complexity that cannot be simplified by wishful thinking. Understandings of what sex and gender are— and how they arise — continually morph with the shifting weight of evidence and the force of argument.
Philosophers, scientists, and individuals with very different experiences of the world will likely be working the seams for generations to come. In the meantime, I would like to advance a modest request that we make a pragmatic return to taking sex seriously.
Time for some pragmatism?
Returning to the bowel cancer screening test, for a moment, it seems obvious to me that there should have been two parts to question 4:
What is your biological sex? Female / Male / Prefer not to answer
What gender do you identify as?
The gender question could offer any number of possible gender identities, including woman and man, or it could leave the answer open-ended. The former option could go some way to bringing other gender identities greater visibility. The latter is harder for data capture but ensures that people can give an answer they are comfortable with in the fast-proliferating fluorescence of gender identity descriptions.
Importantly, neither question compels anybody to answer. Yet both maximize the chance that the participant gives the kind of answer that the researchers have in mind.
This is what I do when my research group and I design a study. I learned the hard way, first by conflating sex and gender, and then by offering constraints that rule too many people out. Our approach still irks some people, including those who think sex should be irrelevant and those who think stepping outside hard man-woman binaries will hasten the apocalypse. But it allows us to capture the most accurate picture of the information indispensable to our studies.
Applying an option like the one I propose in the cancer screening program will allow researchers to study the influence of both gender and sex on the incidences and symptoms of bowel cancer. We already know that men are more likely to develop colorectal cancers, and they do so at younger ages than women. We don’t know nearly enough about how biology and social factors contribute and combine to influence cancer risk.
Accurate information about whether samples come from male or female participants is essential in improving both screening and subsequent treatment outcomes. Medical science has recently learned the peril of treating sex as irrelevant and studying — or developing treatments using — only one sex.
Unfortunately, the salutary zeal for studying both male and female participants, and for being open to the fact that their bodies don’t develop diseases or respond to treatments in precisely the same ways, stands at risk of being diluted. Conflating sex and gender in the important discussions currently reshaping medical science risks all the gains that might be made by studying sex differences.
For the most part, male or female humans will identify — when asked — as men or women respectively. But including gender in addition to sex will allow researchers to tease apart the effects of sex from the effects of gender. That will open up new vistas within medicine, including estimating the disease incidences that are especially heightened or attenuated in transgendered patients.
Not the main game?
Critics might consider medical data a small issue, not worth making a fuss about. Cis-gendered people can fill out the forms easily and be on their merry way, largely untroubled by the complexities and contradictions that trans, agendered, and genderqueer people face, once again, in filling out this kind of form. Medicine can wait for us to sort out the politics, the critics might say.
Yet the medical realpolitik of whose cancer gets spotted, who gets treated, and the appropriateness of the treatment they get, might just provide the impetus for progress. We already know that gender and gender identity are wound tightly with mental health and wellbeing, including because of how people are supported and understood. Perhaps an opportunity to think about and examine gender and sex in terms of their consequences for diseases like cancer might help clarify their deep complexities in ways that philosophic and political discussion never will.
To do so, however, we have to be willing to entertain both sex and gender and continue working openly towards an understanding of how they relate to one another.