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Podcast Transcription 5/25

Elizabeth: Good afternoon and welcome back to Contentious Conversations, your podcast for all things biological, social, and always controversial! If this is your first time tuning in with us, let’s give a little bit of background about who we are. Here are our bodacious bios…

Connor: I’m connor and I’m a public health professional and physician with a primary focus on the intersection between medicine and gender/racial inequalities.

Elizabeth: Works as a biologist, doing research mainly in endocrinology, the study of hormones. with a focus on sex and gender differences in hormone metabolism.

Gabby: I have my PhD in neurobiology physiology and behavior and I work for the the Wilson Institute of Brain Sciences. My research interests include pediatric behavior, identity, and mental illness.

April: I work in public outreach of science education, especially anthropology and archaeology, I teach classes on early material culture, how humans change landscapes, and classes focusing on women gender and sexuality studies at my local community college!

https://www.youtube.com/watch?v=sURH-GLKxCc

Elizabeth: Today’s topic of conversation is human sex and gender variation. It’s a big one, so let’s jump in. We are going to be picking apart the biological basis of sex and gender. As always, we have a variety of viewpoints represented among us and we’ll be pulling from some of the more highly regarded literature. If you would like to follow along with the literature, copies of these articles or links to the originals are posted to our website, DNA-Power-Identity.tumblr.com! Our website also includes a complete transcript of this talk, for those who like to read or those who need to.

April: As we discuss today, let’s also keep in mind how timely and relevant this conversation is -- sex and gender are concepts that affect every individual every day and unfortunately serve as a mechanism of discrimination and injustice for many. As we heard in the beginning clip, just a couple months ago, Trump’s Department of Health and Human Services put forth the notion that all newborns would be designated male or female based “solely and immutably” on their genitalia, with genetic testing being pulled on as a resource in the event of ambiguous genitals. The administration’s memo claims this new process will be “clear, grounded in science, objective and administrable.”

Gabby: Anyways, we will return to the problems of this proposal at the end of the podcast. Let’s first figure out where this all started? Clearly some people believe the genitals you are born with reflect your sex, which should then reflect your gender. How can we parse all this out?

Connor: Let’s begin with a clear and simple question here - When most Americans think about sex, we think about two sexes: men and women. But is it really this simple?

Our categorization of people on the basis of sex even has ramifications for the ways in which we treat and bestow rights to others. One could legitimately say that sex is the organizing feature upon which our American society is based. But so often we assume that binary sex - the idea that you’re either a woman or a man (or trying to become one) - has a distinct biological basis. In other words, your chromosomes, your brain, your hormones must make you male or female. If you have a different set of chromosomes, or differently organized brain (whatever that looks like), or different levels of hormones than one may expect - you are often described by the medical community as possessing a “disorder of sex development” (or DSD). And although that wide catch-all category of “disorder” really fails to capture all of the biological variation that exists within it and even assumes that such variation is pathological in nature, that’s where the discussion about sex often ends.

April: Yet although many Americans assume that sex has always been thought of in this binary way, ideas about sex have actually always been in a state of flux. So before we begin to interrogate our current understanding of sex, we really need to take a brief look into the ways in which this has been historically conceptualized. We must come to understand how our notions of there being only two distinct sexes came to be.

Connor: To begin our discussion of how sex has been thought of, we’re going to focus on ways in which binary sex has been questioned, contradicted, and solidified, often all at the same time. One thing that is clear in examining historical records, is that people’s ideas of sex have always been rem. And thinking of sex in binary terms is far from the only way in which sex has been historically conceptualized. But since our idea of sex being binary is so influential today, it must be the one most cultures share, or at least the one that is right?

Elizabeth: Well, actually, in terms of the commonality of the idea of a strict binary, in turns out that different cultures have very different perceptions of sex, and often ones that defy the male/female binary. In fact, many non-Western cultures in particular have for a long time thought of sex as being more complicated than the binary male/female division suggests.

April: Yes, for example, Navajo culture has historically included categories that cross the male female gender divide, and disrupt the idea that sex always corresponds to gender. The Nadlehee were men and women who adopted the gender role of the other biological sex in dressing, behavior, sexuality and work and had a gender status between men and women.

Connor: These individuals were not necessarily those with genetic differences that we know today as the “disorders of sex development (or DSD),” but rather performed alternative gender roles within Navajo culture. They both fit into the “neither-male-nor-female” groups, and were often seen as functioning as mediators in quarrels and arguments between the sexes and thus filling a recognized social roles. And “neither-male-nor-female” concepts of sex exist in a wide variety of non- Western European colonial norms as well. We have the hijra in India, the shamans in Siberia, the vaze e betuar in Albania, the fa’afafine in Polynesia - I could go on and on, but what you should get a sense of is here is the fact that a wide variety of cultures who have thought of sex in wildly different ways than we do today.

Gabby: Okay, so we get that there are many different cultures that possess ideas about sex that are much more complicated than the male/female divide. But then how did we come to where we are today? It must be because the sex binary was shown to be a correct or effective way of thinking about sex, right?

Connor: Well before we discuss whether the binary idea of sex is actually correct or effective, as you say, let’s first consider how the idea of the binary became entrenched in the context of colonial America. European colonists came to the present-day United States with certain sort of contradictory ideas about sex in the sense that they acknowledged differences in sex but also persecuted it. Nevertheless, historically Western European cultures and the Catholic Church acknowledged that some individuals did not fit within the prescribed male/female categories. Originally, many people who did not fit within these categories - typically designated as hermaphrodites - seemed to be to be generally tolerated at least in the context of the Church, although the degree to which this is the case has definitely been debated. Nevertheless, what is clear is that ideas of sex and gender became much more restrictive in European circles during the Age of Exploration, and as Foucault points out, by the late 16th century, “hermaphrodites were considered to be monsters and were executed, burnt at the stake and their ashes thrown to the winds.” Western Europeans coming to British North America in the 17th and 18th Centuries may have come from countries with a history of penalizing those who didn’t fit the binary, but the fact that they recognized intersexuality as a threat and something to be destroyed suggests they knew these variant existed. [potential Morgensen bit]. In time, European colonists not only continued to target individuals whose sex could not be easily determined, but they categorized Native cultures that did not endorse the binary as a cultural norm as inferior and subject to targeting. Therefore, European colonists used differences in conceptions of gender itself as a means of othering ‘inferior’ groups who posed barriers to settler colonialism. This idea not only made European ideas about the sex binary even more restrictive, but they reinforced the nature of binary sex by erasing ‘deviant,’ non-European forms through cultural or physical elimination. But how do these strict European ideas of gender and sex - informed by increasingly rigid colonial cultural constructions - relate to the naturalization of the sex binary? That is, how did Western cultural values become further reinforced by medical practitioners to produce the sex binary we have come to know today?

Elizabeth: The evidence shows that European physicians embedded in this colonial cultural setting were preoccupied with gender, sex, and the sex binary. There is a wide variety of sources that document “borderline cases” whereby medical practitioners in early America attempted to classify intersexual individuals - those individuals who did not fall in either the male or female category - in terms of which sex they better fit. Embedded in both European and American doctors’ judgments, which labeled ambiguous bodies male or female, were traditional notions of femininity and masculinity. These decisions were made not only on one’s performance of a gender role, but also the size of their genitalia, their facial features, and their sexual orientation. Often these features were conflicting, but physicians were sure to always label borderline patients - even those with especially unusual conformations of external genitalia - as either mostly female or mostly male - and hence people could be prescribed their ‘true sex.’ Just as importantly, this allowed the two-sex system to remain largely intact. We see the threads of this today with gender reassignment surgery in children who are born with genitalia or outward appearances that don’t conform neatly to either sex. We often just choose one based on shifty and often inconclusive external appearances.

April: Okay, so sex has neither always been thought of as a binary nor is it always - even from a medical perspective - simple to designate it as such. But why does there exist such a dissonance between the way Americans and medical professionals commonly conceptualize sex and the actual variation in sex that exists?

Maybe this dissonance stems from how sex and sex development are taught. Or how ideas about binary sex are reflected in gendered bathrooms, gym classes, and certain gender roles ascribed to “men” and “women.” Or maybe it’s the way we conceptualize sex and gender and muddle the two.

Gabby: Perhaps a reorientation of our notions about sex - moving from a sex binary to thinking of sex as ‘layers’ - could be useful. Focusing on the history of science and how science intersects with gender and sexuality, Dr. Fausto-Sterling provides what may be a useful way of rethinking the way we conceptualize sex. Fausto-Sterling describes sex not as a binary biological phenomenon, but rather points to five distinct ‘layers of sex’ to underscore just how biologically complicated sex can be. We often think of sex as being almost exclusively chromosomal or based on external genitalia, but Fausto-Sterling describes this as only one layer of the complex network of features and processes that contribute to our sex. We also had a fetal gonadal sex, which involves the induction of a very complex genetic program that leads to the development of testes or ovaries from what is called a bipotential gonad.

Connor: But that’s not all, because we also have a fetal hormonal sex. Once we develop either ovaries or testes, levels of circulating hormones such as estrogen or testosterone generally increase, which allows for the development of internal reproductive sex - the formation of the vas deferens, epididymis, and seminal vesicles in males and uterus, cervix, and upper vagina in the females. One’s genital sex is also influenced by circulating levels of hormones which produce either a penis or clitoris from “an identical phallus structure.” All of these layers of sex are interconnected, but they can be discordant. For example, one can have male chromosomes and female external genitals. We’ll talk about that more later, but what you should come to understand is that sex isn’t just about one’s genitalia or chromosomes, it’s far more complex than that.

April: Wow, this is a lot to process. I guess I had always assumed that sex determination was a simple and streamlined process that produced either males or females. But one thing I don’t understand is how we came to conceptualize sex development this way?

Elizabeth: I get what you mean. I think some of this comes down to the way that the assumptions that scientists have about sex influences other scientists, medical professionals, teachers, and greater society. For example, when I was taught about sex determination in genetics courses, the assumption was that female development is the default program, and requires no active molecular/biological switch. Male development however, was described as requiring the action of certain genes, particularly those found on the Y-chromosome. The science from which this simple genetic explanation arises has important effects on the assumptions we all have about sex. We now know that females are not and should not be considered the developmental defaults; there is an important dance between genes, hormones, and environmental factors that all contribute to the development of different sex characteristics, both primary and secondary.

Gabby: With this simplistic explanation of sex determination as a binary switch, there appears to be little room for sexual complexity. The way we think about the chromosomes and hormones as gendered - either exclusively male or female - further reinforces this binary model. Even the cultural way we think of the chromosomes - the X as “sociable, controlling, conservative, and motherly” and Y as “macho, active, wily, and hyperactive” support this binary model in important ways. Science is beginning to elucidate the molecular details of female development, and the complexity underlying even chromosomal sex, but we have a long way to go. But what you should understand is that sex is complex and contested, and the way we teach sex development doesn’t capture even close to the whole story. The ways that sex intersects with gender - now that’s a whole other mess, and here the binary unravels even more….

Elizabeth: Thinking about gender in our society is inextricably linked to thinking about sex. So now let’s dive into gender a bit more, specifically with a focus on scientific studies that have worked to pinpoint biological foundations of gender. Now that we are going to launch into some more technical and biological discussion, let’s establish a couple overarching themes to keep ourselves oriented throughout. As researchers have looked at a biological basis for gender, they tend to focus on three levels of understanding: brains, genes, and hormones. So, in keeping with this method of analysis, we will look at results from studies that contribute to an understanding of gender at all three levels.

We are incredibly focused on that binary; even as people become more “progressive” and “liberal” in their understanding that gender is a social construct, they seem to ignore the ways in which what is viewed as biological sex profoundly informs the expectations and assumptions made about one’s gender. Work done as recently as 2004 by Craig, Harper, and Loat demonstrates this obsession with pinpointing a biological basis for gender differences and the lack of acknowledgement of any deviation from the binary -- male or female. Craig, the first author, published the paper out of the Institute of Psychiatry at St. Catherine’s College in Oxford. He has a Ph.D. in Biochemistry and Molecular Biology, so he clearly has a focus on the sciences -- he’s been published in Nature and Science, which are two very well respected journals. Currently, he is a professor of Genetics and head of the Social Genetic and Developmental Psychiatry Centre at Kings College in London. Keeping in mind this background in the sciences in mind, what did Craig do? The researchers review several studies that deal with genetic and biological mechanisms underlying sex differences in human behavior.

Connor: In reading that paper, I noticed that Craig operates from the underlying assumption that “human males and females tend to behave differently is an undeniable fact.” Isn’t this problematic from the beginning? His entire paper, analyzing the role of the sex chromosomes in producing tangible differences between men and women, is predicated on the fact that biology will reproduce the results he sees in his everyday life. He argues that there is compelling evidence that the “stereotypes may be based upon genuine disparities between male and female cognition and behaviour, which can be measured empirically.”

April: What about the social pressures? You can’t ignore social expectations! To begin with gender differences at the level of the brain, Craig cites several papers that have shown that the human brain is highly sexually dimorphic, but I hardly find it convincing when he posits that the organizational differences in the brain hemispheres between men and women result in different cognitive abilities, with men being more inclined towards spatial tasks and women verbal tasks. Overall, Craig’s analysis seems rather one-sided and fails to consider the complexity of sex and gender development in real life; he operates through extreme confirmation bias and fully ignores the idea that the brain is plastic, which is a very important concept that we will return to later.

Elizabeth: Yes, but Craig does bring up one compelling piece of evidence I don’t think we can ignore. More specifically, Craig discusses a brain region known as INAH3, which is a specific group of cells in the hypothalamus, the part of the brain responsible for regulating bodily functions. This is an important brain structure because Simon Levay, in 1991, documented differences in the INAH3 of homosexual men, meaning that the INAH3 was on the science communities radar as being implicated in homosexuality. Then, 13 years later, Craig says brain structure is three times larger in males than females. In other words, he is saying that there is a difference in the INAH3 that Levay posited was important for sexual behaviors. Four years later, esteemed researchers Dick Swaab, a neuro-endocrinologist and neurobiologist, and Alicia Garcia-Falgueras, an Assistant Professor with her PhD and a research focus on neurophysiology underlying gender differences, studied this region in the brain in depth. I think their results, building on Craig’s, have the potential to be viewed as convincing.

Gabby: In Garcia-Falgueras’ study they also studied the same INAH3 brain region that Craig brings up, as well as the BSTc, which is a brain region that is thought to be “sexually dimorphic.” They report that transgender individuals have BSTc and INAH3 structures that resemble their gender identity, not their natal sex. Trans women’s brains looked more similar to female control subjects. Furthermore, trans men had a similar INAH3 to the male control subjects -- without the influence of testosterone treatment. Garcia-Falgueras and Swaab even used pre- and post-menopausal women as controls to prove that estrogen treatment did not influence the trans women’s INAH3 resemblance to female controls. This study has to convince you that there are meaningful biological differences between the genders, right?

April: No! There have been many studies looking at the brain, hormone, and genetic phenotypes of trans people. That doesn’t make the evidence compelling. First, the authors reported subjects whose data points fit neither category, but brushed this off as an aside. Second, once again, the human brain is plastic. Regardless of pre and post menopausal women being used as a control, the brain changes based on how you interact with people, and also how they treat you. Lastly, we do not even know what that area of the brain really does, so how is a size difference between genders possibly important or significant? We have no idea whether it connotes a difference in function, so this study seems to be encroaching on phrenology. Clearly, the evidence for sex and gender differences in the brain are lacking.

Connor: Okay, so if there are no compelling differences in brain structures, what about at the level of genes? Genes are the underlying basis for each individual, so there must be some differentiation occurring in our DNA!

April: I wouldn’t make that jump. Thinking about another paper published at a similar time to Garcia-Falgueras and Swaab’s piece, by Eva-Katrin Bentz, I grow skeptical of the genetic evidence as well. Bentz is an MD who works in the Department of Obstetrics and Gynecology. She’s published several pieces on whether being trans is associated with single nucleotide polymorphisms, SNP, which are single changes in the DNA sequence. She has also worked on how hormone replacement therapy, HRT, used for gender confirmation in trans patients affects the body. So she does have the background and expertise to be studying this topic.

Elizabeth: To frame our discussion, let’s define a few biological terms first. She looks at alleles, which are the alternate forms of a gene, and genotypes, which are the combinations of alleles that an individual has. Bentz demonstrates that there is an association between an SNP of a specific gene, CYP17, and trans-men. The data, in my opinion, is tenuous, and the way she frames the discussion is incredibly problematic. Let’s break this down a bit, shall we?

They work with 104 trans women, 49 trans men, 756 control cis men, and 915 control cis women. First of all, these numbers are not instilling confidence in me with respect to statistical practices and power. The difference in the number of transgender people compared to control individuals is staggering; a good study would have equal control and target population sizes. Then, she finds a statistically significant difference in the allele frequencies and genotype distributions between trans men and cis females, but not between trans women and cis men. But, if we zoom in on this data a bit, the allele that she is targeting as a SNP is present in 44% of trans men and 31% of cis women.

Gabby: I don’t know about you, but the fact that this allele of interest is present in less than half of trans men does not convince me when she then argues that this SNP is associated with trans men. Functionally, how different is 44% compared to 31%? It doesn’t seem that big of a difference to me! This may be statistically significant, but especially given the fact that there was no associated difference in the blood levels of estrogen or testosterone -- which is the way of testing functional significance -- I don’t find these results compelling. Once again, we see that gender/sex-based biological differences are not significant at the level of the brain or genes. What’s left?

Elizabeth: Well, we haven’t formally yet discussed hormones yet, which you just alluded to, so let’s jump into that. And I think that despite the numbers, we should remember that CYP17 is a gene that encodes an enzyme to ultimately create testosterone and estrogen. If this change increases function of the enzyme and it implicates hormone metabolism, I could see how it may be logical that this gene SNP is associated with trans men. Hormones are relevant to consider, are they not? If we think about work that authors P.C. Kreukels and Antonio Guillamon did in 2015, I think we might begin to elucidate an important role for hormones in this discussion even if genes and the brain may not play the role we might have previously thought. Kreukels has a masters in psychology and also received her PhD from the Division of Psychosocial Research and Epidemiology. She now works in a Department of Medical Psychology and focuses on gender roles and identity and transgender health care. Her co-author, Antonio Guillamon, has an MD PhD and currently works in psychobiology and does similar work in HRT for trans patients and the potential effects in cortical thickness and other brain structures.

Connor: The authors perform an in-depth review that essentially establishes that there have been reported differences in grey matter, subcortical structures, hypothalamic activation, and brain connectivity between individuals with gender incongruence and those of their natal sex. But, the results I find the most intriguing are those pertaining to HRT. The authors report that the hormones did affect brain morphology. Trans women experienced a decrease in intracranial brain volume, a decrease in cortical thickness, and an expansion of ventricles. On the other hand, trans men have seen increased intracranial and hypothalamic volumes with androgen therapy. These profound morphological changes at the level of the brain coincide with a shift towards the individuals’ identified gender.

April: Okay, thinking about Kreukels and Guillamon’s work and the effects of HRT, perhaps Bentz, with her analysis of the SNP and being transgender, is onto something then. Even though a correlation/association is not causation and there was little-to-know discussion and no proof of functional biological significance found. I can admit that hormones have an effect on brain structures and therefore a SNP in a gene that is implicated in hormone metabolism may be relevant. But I also want to remind us that the brain is plastic, and the HRT that Kreukels and Guillamon point to may not have been the factor that changed the intracranial and hypothalamic volumes, for instance. The brains of trans women and trans men no doubt change in response to stress, social pressures, and lived experiences.

Elizabeth: Now that we are discussing hormones, I want to briefly return to that review by Craig that we talked about earlier -- the one that assumed the brain was sexually dimorphic and men and women were biologically entirely distinct. At one point, Craig discusses Congenital Adrenal Hyperplasia, or CAH, which is an autosomal recessive disorder characterized by difficulty producing specific hormones. He begins his discussion of CAH with analyzing testosterone and androgen impacts on rodent fetal development and then connects this to CAH and the overproduction of adrenal androgens during fetal development. He posits that the excessive adrenal androgen exposure in utero has a “masculinizing” effect on play behavior, aggression, and spatial ability of a female child once born.

Gabby: Okay, but I think he is making a gross oversimplification. How can we transition from rodent studies to human beings without taking a closer look at the additional factors at play. First of all, there is stereotyping involved in assuming testosterone is associated with male aggression and cognitive development favoring better spatial awareness. Where does this data come from? And how do we know men aren’t aggressive because society shows them they can and should behave this way? And in thinking about CAH, there are human factors that are very relevant to consider -- hormones aren’t that simple.

Connor: I want to jump in and complicate this argument, particularly as it pertains to hormones, a bit more by bringing in an article by van Anders. She studies queer science, social neuro-endocrinology and feminist neuroscience. In 2015, she studied the effect of gendered behavior on testosterone levels in women and men. I thought this work was interesting because the authors found support for a theory that “wielding power increased testosterone in women compared with a control, regardless of whether it was performed in gender-stereotyped masculine or feminine ways.” Testosterone levels are not simply higher in men and lower in women -- the issue is far more complicated than that. Differences in testosterone levels are embodied based on the ways people are socialized over the course of their lives with respect to gender. I fully recognize some of the potential issues with this study. For instance, the researchers had to employ “actors” so the situation they used as a representation of competition and “wielding power” -- firing a subordinate -- may not have been fully representative or authentic. But overall, I think van Anders is on to something here. It makes sense to me that given how entrenched gender norms are in our society, they could become a part of our biology.

Elizabeth: Okay, so let’s step away from the data and study results for a moment and summarize what we’ve covered so far. First, on the level of the brain, we see certain brain structures, such as the INAH3, that are thought to more closely resemble one’s gender identity as compared to natal sex, but once again, we don’t even know what the INAH3 does. Second, on the level of genes, we’ve seen that certain SNP have been associated with certain groups of trans individuals, although no functional or causal relationship has been elucidated, which is a major gap. So that’s brains and genes...what’s left? Hormones. We see that HRT does change brain structure morphology and people think that exposure to certain androgens in utero, for example, may impact “gendered” behavior, but these results seem lacking and based on stereotypes as well, especially when you consider that social pressures and power dynamics that characterize everyday life, such as those studied by van Anders, may affect testosterone levels in women. These hormone levels aren’t necessarily an innate method of differentiating men from women, but an embodied result of our lived experiences. So the idea of an innate, biological basis of gender beings begins to unravel at the level of brain structures, genes, and hormones.

April: I couldn’t agree more. And I can’t help but think about some of the dangers of conceptualizing these differences as “innate.” For instance, I am appalled at the way Bentz discusses transgender individuals. Even after explicitly establishing that there were cis- females with the SNP and trans men without it, and therefore the CYP17 SNP is not necessary or sufficient in identifying as transgender, she thinks she has localized a “genetic risk factor of “transsexualism.” She engages in the medicalization of being trans being trans-- making it seem as if those who don’t conform to our deeply entrenched binary are “abnormal” or “faulty” or even diseased, when in fact, no one fits perfectly into the binary! The binary isn’t even a binary…

Gabby: What do you mean the binary isn’t even a true binary? Let’s think about sex, which is where this binary all started…

April: Yes let’s explore this idea of a binary a little deeper, and in its exploration I believe we will find that sex is not singularly dimorphic, or at the very least is more complicated than we think. As we have stated defining biological sex is not as discrete as it might at first seem. Fausto-Sterling shows how there are lots of characteristics that are a part of sex determination. Fausto-Sterlings layered sex model manages to catch a lot of that complexity. However, we have not explored exactly what differences in those layers can mean. Claire Ainsworth (2015), a scientific freelance journalist, discusses yet another layer unexplored by Fausto-Sterling, sex on a cellular level. In her article, exploring biological sex in Nature magazine she explains that many people harbor cells of the opposite sex in their body even without their knowing! Mothers of XY babies experience a two way exchange of genetic material through the placenta. This means that she often will have XY cells that are incorporated into her body.

Connor: But I’m sure those do not stay, the body should treat them as foreign and rid itself of them!

Elizabeth: Ah but they do stay, and often incorporate themselves into important functions. The oldest woman found with these XY cells in a 2012 study by immunologist Lee Nelson and her team at the University of Washington in Seattle, was 94! These new cells often integrate into their new environment and can perform vital functions, like becoming neurons, at least in mice. This cellular exchange works both ways, as sons have been found to have XX cells from their mothers well through adulthood. This kind of cellular exchange, known by scientists as microchimaerism, is complemented with the much rarer macro-chimerism where you absorb a twin in the womb, and this twin does not need have the same karyotype, a term that refers to the number and appearance of one’s chromosomes. This completely derails the argument that one need only look at a karyotype in order to determine biological sex.

Connor: So is there any one factor that truly truly determines biological sex?

April: No, not really, and I really like the quote that Ainsworth used from Dr. Vilain, who at the Center for Gender-Based Biology at UCLA. He says that there is not one biological parameter for sex that takes over every other parameter.

Gabby: Ainsworth also brings up what are medically referred to as differences or disorders of sex development or DSD’s. People with DSD’s are intersex. These people do not have to have any kind of chimerism but differences in utero or postnatally that affect Fausto-Sterling’s layers of sex differentiation. Some DSD’s have been found to have genetic factors, where others do not. There is a broad diversity of differences of sex development.

April: I am glad you use the term differences instead of disorders because it humanizes and depathologizes these conditions and people.

Gabby: Right, I agree. In order to understand what forms these kinds of differences can exist as, let’s talk through an example, Complete Androgen Insensitivity Syndrome. Again there are some problems with the term syndrome as it makes the people with it sound sick or unwhole, but this is how the medical community has chosen to name it. People with CAIS have XY karyotypes and develop testes in utero. However when these testes release androgens, the body cannot process them. Therefore the rest of the body develops “femininely” and goes through a “female” puberty, as it can only respond to the estrogen that the body releases, not the testosterone. This person looks like a cis woman. Often people with CAIS do not know that they are intersex until they do not get their periods, and can live their lives without others knowing that they have XY chromosomes. By some estimates, about 2 percent of the population have some kind of difference of sex development, which is about the same as the amount of natural redheads.

Elizabeth: This reminds me of the diagram that Ainsworth put in her article. It shows the sliding scale of biological sex between male and female, with different DSD’s in between the two sexes.

April: She does but I’m not sure that that is also a good way to look at sex. Terms that get at the complexity of sexual variation might be better. Polymorphism, meaning many forms, could be more appropriate than continuum.

Connor: I agree. Looking to the opinions of actual intersex people, viewing biological sex as a continuum is quite reductionary. Biological anthropologist Claire Astorino, who is herself intersex, puts forth this idea of sexual polymorphism, instead of sexual dimorphism, meaning two forms. The only way to truly appreciate the variety of human sex characteristics is to stop viewing them along a binary sliding scale. If we do not do this, then our research then stays skewed by our view of the false sexual dimorphism. We will still be looking at people as part male and part female, and not as whole people as they deserve to be treated. .

April: The idea that there are two end members and those in between is disrespectful to those who do have a DSD. Polymorphism also allows for people to have more freedom to choose who they want to be, as it stops shoving people into strict boxes. This socially constructed veil of dimorphic sex colors all research that we do, in the hard and in the social sciences. Also by loosening up the idea of simple biologic sexes, it opens the door for a loosening the idea of gender and its rigidity. By ridding ourselves of the dimorphic idea of sex, we also automatically improve the lives of intersex people by ridding the idea of sexual reassignment surgery of infants with “ambiguous genitalia”. The truth of the matter with these surgeries is they are often quite damaging and reduce sensation in a very sensitive area as show by the Minto paper. Also according to the Human Rights watch and a study by Reiner and Gearhart this assignment surgery about half the time assigns the wrong sex based on the gender that these children identify as when they grow up.

Gabby: Now that we have talked about the social and biological construction of sex and gender, let’s take something that is at the crux of biological and social understanding: the concept of evolution. Evolution is based off of biological reproduction of people who are viewed as wholly men or wholly women. Knowing that no such clear distinction exists complicates this idea. The entire concept is structured around men performing certain tasks and women performing others in order to increase fitness and out-compete others. But these categories are incredibly socially based and, as we have shown, even biological sex is not a concrete black and white phenomenon. Moreover, acknowledging that not all people have the same reproductive capabilities yet still fully exist in our society disrupts the notion that evolutionarily, people are “fit” based on their ability to pass on their genes.

April: How can I be careful to talk about sex in an appropriate manner in my Introductory Biological Anthropology class? Or more broadly, how can any educator talk about this subject while being conscious of its societal implications?

Elizabeth: Well, I know when I was taking my biology courses as an undergrad and even graduate student, the construction of the distinction between gender and sex was presented as a strict binary, most likely for simplicity for professors and the textbooks that are available. If we think of gender as something that is variable and flexible to lived experiences and exposures, then sex is something that is biological concrete and rooted in hard science. This is how it is traditionally taught in science classes, but that definitely needs to change.

Gabby: Moving forward, I think it would be a huge step to address the variations. For example, as you talk about XX is female and XY and male, you must also address how this may not always be the case. In some individuals there may be excess hormones or a total sensitivity to hormones that actually lead to fluidity in gender and sex assignment.

April : Yeah, I also think in the discussion of intersex individuals, it is not okay to frame it is a disorder or a negative experience that families are burdened with.

Elizabeth: I absolutely agree. Okay, so stepping outside of science as a whole, how does this affect our thinking?

Connor: We have previously considered gender and sex to be two distinct concepts. Gender is the socially constructed phenomenon, while sex is the biological construct. But, are these really different? First, what our society has coined ‘gender’ is strongly influenced by ‘sex’. Whether you are XX or XY, you experience different hormone levels in utero and develop either phenotypically female or male genitalia. Both of these factors have an undeniable impact on how one chooses to identify. This is apparent because the vast majority of individuals identify with their biologically born sex. But, biology shows us that sex is more complex than a binary. By creating a simple binary, we are invisibilizing the complexity of sex and recreating the social construction.These imposed categories are not sufficient for describing the variation that exists. On the other hand, one’s gender also impacts the biological construct called “sex”. And as we have shown, the behaviors we display (whether those are culturally considered feminine, masculine, or neutral) can affect our hormones in different ways, which society sees as an indicator of biological sex.

April: Since sex affects gender and gender affects sex, this eradicates the distinction between the biological and social construct. It seems like our society has created this distinction to neatly categorize individuals when really the lines are blurred or nonexistent. What do you guys think?

Gabby: What can we do to respond to these issues we’ve raised?

Elizabeth: I think one way would be as a society, we need to change our conversation about gender and sex, but this is easier said than done. One small step that we and all our listeners can begin asking other’s pronouns.

Gabby: Dr. Vilain, who we discussed previously said “My feeling is that since there is not one biological parameter that takes over every other parameter, at the end of the day, gender identity seems to be the most reasonable parameter”. As Dr Valian argues, sex is a very complex idea that encompasses a whole lot of biological variation. For example for intersex people, their biological and physical characteristics may not be wholly male or female but lie somewhere in the grey area between. Dr. Valian understands that variations in gonadal tissue, ambiguous genitalia, missing or extra chromosomes, fluctuating hormones, brain development and more influence one’s sex. But, these characteristics don’t necessarily influence one another and can develop independently, which complicates sex. Even the biology supports that identity can be more fluid and polymorphic than a binary OR a continuum can support. Given the fluidity, asking for one’s pronouns can help people feel empowered by their own gender identity.

Connor: So with the idea that early experiences have a huge impact on identity, is there a proper way to interact with kids?

April: This reminds me of a New york times article about a preschool in Sweden. They noticed that the boys tended to be more physical while the girls would whimper, so the school decided to make changes! In order to reverse gender roles, the teachers put the boys in charge of the play kitchen, and made the girls shout No to help promote confidence! For recess, they organized play so that children would not sort by gender. The state curriculum even urged teachers to “counteract traditional gender roles and gender patterns.”

Connor: Oh yeah, and they had students refer to their peers as friends or by name rather than “boys and girls”. In 2012, they even introduced the gender-neutral pronoun “hen” to Swedish culture. Once the school began to make changes, they saw how intertwined these patterns of gender norms were. For example, the teachers would help one boy after another to get dressed and run out the door. But the girls were expected to dress themselves.

Gabby: I feel like even parents today in the US could learn a lot from this example!

April: Today, parents are so concerned with doing gender reveals with the classic pink balloons or blue balloons. We have already accessorized all of their future clothes and room in their respective color before they are even born into the world.

Elizabeth: That reminds me of the “Pink and Blue Project” that artist JeongMee Yoo designed. She took photographs of kids surrounded by all of their belongings, and the images were striking. It was interesting that a few of the girls did own a few purple or blue things amongst their sea of pink, but for the boys there was no pink. Kind of weird how our society has made it more acceptable for girls to be tomboys, yet are quick to judge boys who show an ounce of “femininity.”

Gabby: Reflecting back on my own childhood, my first room was painted a darker pink. My parents bought me barbies, while they bought my brother pokemon cards, trucks, and painted his room with animals. Infact, my brother and I both had bunk beds and mine was in the shape of a castle and his was a jungle tree house. Bu then when we were in lower and middle school, we did play a lot of the same sports including basketball, gymnastics, soccer, golf, tennis, and I would occasionally play football with my brother and dad.

Elizabeth: Yeah my parents definitely took advantage of gender norms when making decisions about the activities my brother, sister, and I were enrolled in. I truly believe they had the best intentions, but looking back, enrolling my sister and I in dance, figure skating, and gymnastics while they enrolling my brother in every sport under the sun definitely played into prescribed gender expectations.

Connor: My parents definitely did structure my after-school activities and playtime around with the assumption that I would 1) identify as a boy and 2) enjoy “male” activities and sports, but they weren’t necessarily trying to be restrictive in any overt way. I think they would have been fine if I chose a more quote-on-quote “feminine” activities, but there was no deliberate attempt to actually offer me those opportunities unless I asked for them.

April: Yeah, looking back, when I was little my room was a pale yellow, and it was Sesame Street themed. My mom said that she tried to pick lots of green and yellow clothes, as they were gender neutral. The next time my room was painted I was old enough to chose bright purple. She also enrolled me in both sports and dance from an early age until I decided I wanted to do neither!

Gabby: I was also reading article about this couple in Toronto who never revealed the sex of their child. They instead thought it was more important that they wait until their children were old enough to decide what gender they identify as. It was not until Star, their youngest child, was five and a half years old that she confidently admitted her pronoun of “she”. This was a choice that they let all three of their children have. Jazz, Star’s older sibling, prefers the pronouns “she” and “her” and identifies as a transgender girl. Kio- the other sibling- identifies as non-binary and uses the pronoun “they.” Kathy - one parents -also opts for “they,” while David, the other parent, uses “he or they.”

Elizabeth: Wow that is super interesting! And a good direction for parenting to go. Beyond parenting, this question of gender and sex has come up a ton in sports. Almost a little too much if you ask me. Maybe it's our competitive nature, but in women’s sports, there are always comments about a player being too masculine and may not even be a woman. Testosterone is the huge marker that is measured to predict if they are eligible to play.

Gabby: I remember I used to watch Brittney Griner play basketball at Baylor and there would be so many comments of “you sure that's a girl” or even demanding proof of her gender. I am not really sure what “evidence” they wanted. All of these comments just go to derail her accomplishments because she’s tall, strong, and possess some more masculine traits. She is now someone who loves her body and is proud of her image, but this could not have been an easy road. She even said “Being 6-foot-8, I definitely get stares. I think my feet are bigger than Kareem’s. They are size 17 men's. My hands are even bigger than LeBron's….. I remember around sixth or seventh grade the "cool girls" would reach out and touch my chest: "Yep, nothing." I felt like less than a person. It was crazy. I felt frozen. That was one of the worst things they could do.” She went on to talk about an incident in China where “One time when I went into the bathroom there, a lady was so shocked that she was pushing me out; she was so hysterically shocked that I was in there. I couldn't do anything but laugh. I didn't even try to defend myself and tell her I was a girl. I ended up just going over to the men's room and went into one of the stalls. I've even had to do that in the States a couple of times.”

April: For Caster Semnya, a cis-woman, was required by the International Association of Athletics Federations’ rule to take testosterone suppressants to compete in the women’s division 800 and 1500-meter races. This desire to categorize individuals into explicit male and female boxes, stems from the belief that there is some essential difference between men and women, leading to the presence of sex testing in women’s sports. The thought is that men will disguise themselves as women to win medals even though no man has ever been caught doing this. This is a classic scare tactic, one that is used in the same way that the discussions about trans women in womens bathrooms is. There have been no documented cases of trans women harassing cis women in bathrooms.

Connor: This discussion of gendered bathrooms ties backs to Trump’s proposal - which we talked about at the beginning. Let’s listen to a part of what we heard at the beginning and see what we can make of this after our discussion.

https://www.youtube.com/watch?v=sURH-GLKxCc

Connor: So you have it, in 2018 “the US Department of Health and Human Services (HHS) proposes to establish a legal definition of whether someone is male or female based solely and immutably on the genitals they are born with.”

If the external genitalia is ambiguous for whatever reason, than genetic testing for the presence of the Y chromosome will be used to determine sex.

Elizabeth: In that article about Trump’s proposal, it actually said that this memo for deciding the sex on a birth certificate will be “clear, grounded in science, objective and administrable,” which we now know is an absurd idea. To explicitly tie biological sex to gender makes this proposal even further from scientific and social reality, as scientists define gender as separate from sex.

Gabby: At this point, the issues with this proposal are pretty clear. As we’ve established, any mother who has had previous male offspring has the chance to test positive for a Y chromosome -- so what is she male now?

April: Yeah, also this single proposal has the power to underdo years of works that has gone into fighting to understand gender and sex. This proposal has no foundation in science and is rooted in strong societal norms. Additionally, this would lead to more discrimination and isolation of trans people or individuals who do not fall into the socially constructed Western male/female binary.

Connor: Given all we have talked about during this podcast today, it is clear that there is no biological binary for sex or gender. It follows logical thinking that if there is no biological binary for sex, that there exists similar complexity in gender identities. To say that there exists a simple biological determinant for sex, and that factor also determines gender, is a gross misrepresentation of what we scientifically know to be true.

Elizabeth: We know they are misrepresenting what we scientifically know to be true, so this leads me to question, why are they doing this? What are their motivations?

Gabby: The ones in power -- white cis men -- are explicitly targeting trans people with the intent of limiting their ability to operate comfortably in society.

April: For example, defining one’s sex and gender on a birth certificate prevents their ability to transition in the eyes of the government. This inability functionally limits how they can work in society in any place where their gender markers on their identification play into social interactions. This may occur in offices, going through airport security, and traffic stops. I remember reading about two trans women who were referred to as “it” at the DMV and told that they had to remove their makeup and wigs to better represent the “male” marker on their licenses. These are seemingly miniscule events that most of us don’t think of as important, but for someone whose rights have been stripped away, these everyday occurrences carry immense importance.

Connor: And finally, tying this back to what we discussed in the beginning, we need to be cognizant of the history behind the American state reinforcing the gender binary and controlling individual gender identity. From the arrival of Western Europeans to North America, colonists attempted to highlight their embodied gender binary as evidence of European superiority. This strict gender binary was imposed on non-Europeans, backed by scientists and physicians, and used to discriminate and eliminate. It’s hard not to see the legacy of this today.

So let’s do a quick recap of the main points from today’s discussion:

Ideas about gender and sex have their basis in cultural constructs developed in the colonial context. Physicians and scientists perpetuate this idea.

Elizabeth: Gender differences have no single biological basis at level of brain structures, genes, or hormones.

April: Sex is neither a binary ntor a continuum, but rather better conceptualized as polymorphic.

Gabby: A slippage occurs between gender and sex that affects people’s everyday lives.

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