Med school and the denial of biological sex

July 27, 2021 • 12:45 pm

In November of 2018, I noted that, in an announcement, the Society for the Study of Evolution (SSE) maintained that not only gender, but biological sex should be “more accurately viewed as a continuum.” That came as a shock to someone (me) who had spent his life sorting fruit flies into piles of males and females. (Once a year or so I’d find a “gynandromorph”, an individual having bits from both sexes, but that is not in itself a sex—and they’re extraordinarily rare.)

Here’s the SSE’s original announcement (my emphasis)

Variation in biological sex and in gendered expression has been well documented in many species, including humans, through hundreds of scientific articles. Such variation is observed at both the genetic level and at the individual level (including hormone levels, secondary sexual characteristics, as well as genital morphology). Moreover, models predict that variation should exist within the categories that HHS proposes as “male” and “female”, indicating that sex should be more accurately viewed as a continuum.

Re the part in bold: which models?, and no.

Later on, probably in response to people like me who objected, the SSE added an asterisk at the end of the paragraph and appended this note:

*Here we are speaking of the multi-dimensional aspects that underlie male-ness and female-ness, including hormones, physiology, morphology, development, and genetic aspects.  We acknowledge that many of these aspects are bimodal. Furthermore, some of these aspects are discrete categories (e.g., XX/XY, SRY presence/absence, gamete size, sperm production vs egg production, presence/absence of certain genitalia), but these categories don’t always align within individuals, are not always binary, and should be irrelevant to the determination of a person’s legal rights and freedoms.

Since the biological definition of sex is whether gamete size is large (female) or small (male), and that trait is bimodal and discrete, the SSE might as well have said that sex should not be viewed as a continuum. But of course the SSE is subject to the Zeitgeist, which, as the new article by Katie Herzog on Bari Weiss’s site notes, is definitely against recognizing two discrete biological sexes in humans. This denial of reality has serious medical implications, but read the piece to see them.

Click on the screenshot to read:

This is part 2 of Herzog’s series on the wokeification of med schools; part 1, about the silencing of people out of fear, is here.

Herzog begins with an example of an obese transgender man who died because he went to the hospital, did not know he was pregnant (and there was nothing about his natal sex in his records), and the fetus died because the staff took a while to recognize the pregnancy.  But most of the article is about the pressure applied to professors in medical school to conform to prevailing terminology and opinion, and how that is inimical to the practice of good medicine.  I’ll give a few quotes from a few areas.  Quotes from Herzog’s article are indented:

Censoring of language. 

The denial of sex doesn’t help anyone, perhaps least of all transgender patients who require special treatment. But, Lauren says, instructors who discuss sex risk complaints from their students — which is why, she thinks, many don’t. “I think there’s a small percentage of instructors who are true believers. But most of them are probably just scared of their students,” she says.

And for good reason. Her medical school hosts an online forum in which students correct their instructors for using terms like “male” and “female” or “breastfeed” instead of “chestfeed.” Students can lodge their complaints in real time during lectures. After one class, Lauren says, she heard that a professor was so upset by students calling her out for using “male” and “female” that she started crying.

Then there are the petitions. At the beginning of the year, students circulated a number of petitions designed to, as Lauren puts it, “name and shame” instructors for “wrongspeak.”

One was delivered after a lecture on chromosomal disorders in which the professor used the pronouns “she” and “her” as well as the terms “father” and “son,” all of which, according to the students, are “cisnormative.” After the petition was delivered, the instructor emailed the class, noting that while she had consulted with a member of the school’s LGBTQ Committee prior to the lecture, she was sorry for using such “binary” language. Another petition was delivered after an instructor referred to “a man changing into a woman,” which, according to the students, incorrectly assumed that the trans woman wasn’t always a woman. But, as Lauren points out, “if trans women were born women, why would they need to transition?”

Herzog recounts the downfall of Lisa Littman, who documented the rapid increase of female adolescents wanting to transition over the last decade (1000% in the US, 4000% in the UK), suggesting that this “rapid onset gender dyphoria” may have partly due to social contagion (approbation online as well as families and doctors too willing to affirm dysphoria and approve of transition without proper procedures. I’ve already discussed that.

Puberty blockers. We are universally assured that these drugs are both safe and reversible. They are used to put potentially transsexual pre-puberty individuals “on hold” while they consider their options. Herzog questions the safety and reversibility.

[Pediatrician Julia] Mason generally avoids prescribing puberty blockers, which inhibit the development of secondary sex characteristics like breasts or facial hair. The reason, she says, is that because there have been no controlled studies on the use of puberty blockers for gender dysphoric youth, the long term effects are still unknown. (In the U.K., a recent review of existing studies found that the quality of the evidence that puberty blockers are effective in relieving gender dysphoria and improving mental health is “very low.”)

In girls, Mason says, blockers inhibit breast development, but “you end up shorter, and the last thing a female who wants to look male needs is to be shorter.” Other side effects may include a loss of bone density, headache, fatigue, joint pain, hot flashes, mood swings and something called “brain fog.” In boys, blockers inhibit penis growth, which can make it harder for them to achieve orgasm and for surgeons to later construct those penises into “neo-vaginas,” a procedure known as vaginoplasty.

Trans activists often claim the effects of puberty blockers are fully reversible, but this remains unproven, and studies show that the overwhelming majority of teens who start on puberty blockers later take cross-sex hormones (testosterone for females and estrogen for males) to complete their transition. The combination of puberty blockers followed by hormones can cause sterility and other health problems, including sexual dysfunction, and the hormones must be taken for life — or until detransition. Little is known about their long-term effects. While the line that blockers are “fully reversible” is oft-repeated by activists and the media, last year, England’s National Health Service back-tracked this unsubstantiated claim on its website.

Desistance is the reversal of either identification as a transsexual or of the medical transition itself. To even bring the topic up is taboo in the transsexual activist community. But look at the statistics and then judge whether doctors and parents should be so quick to affirm transsexuality and then begin risky medical procedures (my emphasis):

In 2018, the American Academy of Pediatrics recommended that pediatricians “affirm” their patients’ chosen gender without taking into account mental health, family history, trauma, or fears of puberty. The AAP recommendations say nothing about the many consequences, physical and psychological, of transitioning. So perhaps it is not surprising that surgeons are performing double mastectomies, or “top surgery,” on patients as young as 13.

One leading clinician, Diane Ehrensaft, has said that children as young as three have the cognitive ability to come out as transgender. And the University of California San Francisco Child and Adolescent Gender Center Clinic, where Ehrensaft is the mental health director, has helped kids of that age transition socially.

But not all clinicians have cheered these developments. In a paper responding to the AAP guidelines, James Cantor, a clinical psychologist in Toronto, noted that “every follow-up study of [gender dysphoric] children, without exception, found the same thing: By puberty, the majority of GD children ceased to want to transition.” Other studies of gender-clinic patients, stretching back to the 1970s, have found that 60 to 90 percent of patients eventually grow out of their gender dysphoria; most come out as gay or lesbian. 

In an email to me, Cantor said: “The deafening silence from AAP when asked about the evidence allegedly supporting their trans policy is hard to interpret as anything other than their ‘pleading the 5th,’ as you in the U.S. put it.”

Knowing the bits in bold, shouldn’t we be a bit more cautious about rah-rah affirmation followed by puberty blockers—themselves almost inevitably followed by hormone treatment and/or surgery that leads to irreversible changes in physical characteristics, and often to sterility?

42 thoughts on “Med school and the denial of biological sex

  1. Yes that’s an excellent article by Herzog. Small edit: Herzog doesn’t report that the trans man died, but that his baby died.

    The weird part about the SSE (and statements like that) is why a scientific research and teaching organization should have anything to say either way about “the determination of a person’s legal rights and freedoms.”

    It’s disturbing that evolutionary biologists at SSE (of all people) should be so eager to deliberately blur the distinction between primary and secondary sex traits, and use the non-binary variation in some of the latter as a way to argue that the former is not binary.

    1. I fixed the bit about the baby, thanks.
      As for the SSE, they are an embarrassment these days. It goes to show that when truth and wokeness collide, the latter win, at least if you want your organization to look virtuous. In actuality, they should adhere to their mission: promulgating the study of evolution, something that they seem to be gradually abandoning.

    2. Her baby. Only women get pregnant and give birth. This person is clearly female and always will be, or she wouldn’t have be able to have had a baby.

  2. Knowing the bits in bold, shouldn’t we be a bit more cautious about rah-rah affirmation followed by puberty blockers—themselves almost inevitably followed by hormone treatment and/or surgery that leads to irreversible changes in physical characteristics, and often to sterility?

    Short answer: Yes

    Longer answer: You’re going to be in TROUBLE.

    I admire you for posting this. As men, we get much less flack for being skeptical on such issues than women do, but it does help gender critical women to see that men are willing to address these issues critically along with them.

    There are many issues in medicine that are specific to sex. For example, the symptoms of heart attacks are different in women than they are in men. How can they teach doctors to recognize that nausea in women is a symptom if they are not using the word “woman.” Health differences and treatments are not limited to the reproductive system.

    I realy don’t get this “Chestfeeding” thing, anyway. Everyone has breasts, even males. So why is “breastfeeding” verboten? Who’s not being included here?

  3. Until someone proves that any sort of gender fluidity can produce offspring, i.e., something other than male sperm and a female egg, the new, politicized science has no credibility. The political motivation behind prioritizing gender theory over biology (over science) is clear to all who will see it. One is tempted to say NOTHING is ever real because mistakes in DNA happen, hence any one thing may be a completely different thing. Relativists often resort to a deconstruction of physics to point out that statistics and probability is behind everything, so, “Don’t tell me I’m wrong.” I don’t know when this subversion of science and best practices will end. Abe Aamidor

    1. I’m confused by the apparent lack of biological knowledge in comments like this. Certainly, as biologists, we are aware of sexual fluidity in many animal species. One obvious ‘proof’ that you are looking for is simple — the well-studied phenomenon of parthogenesis, which occurs in vertebrates such as some New World lizards.
      Like many, I find too much politically correct shoe-horning of data into new categories distasteful, and at times clearly unscientific — but I also find a lack of biological knowledge disturbing.

      1. As a non-biologist, I am unclear as to how parthogenesis demonstrates fluidity. Do you mean to say that the process involves individuals expressing both male and female roles at various points in time? My understanding is that whiptails are females who produce offspring without needing insemination, or the contribution of motile, smaller, gametes. It’s not only a matter of knowledge, it’s a matter of agreement on terms, such as what is specifically meant by fluidity.

        That being said, the comment you are replying to does not acknowledge asexual reproduction.

      2. Individuals of some species can change sex during their lifetimes, but they don’t change into a third sex. They remain male or female (or both or neither).

        I did think his wording was confusing. Offspring are not sperm or eggs…(?)

        1. As was said, much of this depends on semantics. Are parthogenetic individuals female? — sure, in many ways, but they also are acting as ‘males’ in providing an additional set of chromosomes to maintain diploid offspring. Whether we want to call that fluidity, or the tendency of many fish species to change sex — well it doesn’t matter to me — that is a matter of definition. Trying to map this to human ‘gender identity’ doesn’t really make sense one way or another.
          In general, attempts to justify or denounce human behaviors by evoking the natural sciences often simplify both. On a practical, anecdotal level there may be little harm in this — we have long looked to nature to understand ourselves. But it gets rather nonsensical to try to take our interpretations very far.
          Regarding ‘one is tempted to say NOTHING is ever real because mistakes in DNA happen…’ — in my mind that thought belies a significant understanding of how evolution works. Evolution as we largely understand it (at least by the modern synthesis) acts upon existing variation, which are largely generated by those ‘mistakes.’ There is no platonic ideal of a species preserved in some cave — these concepts too are fluid. There is no teleology that separates ‘mistakes’ from ‘variation’ — that distinction, just as fitness measurements, can only be applied to past events.
          My pet peeve isn’t around ‘gender’ fluidity, but attempts to disregard the genetic variation between human populations in an attempt to deconstruct the concept of ‘race.’ Yes race is a ridiculously imprecise lumping of populations, and has clearly been used to justify terrible actions as well as subtle bias, but at times the baby is thrown out with the bathwater. We constantly find medical differences — as practical as different reactions to pharmaceuticals — between human populations, even as it has become unpolitic to discuss or admit such genetic contributions to human health.

  4. these categories don’t always align within individuals, are not always binary, and should be irrelevant to the determination of a person’s legal rights and freedoms.

    The SSE doth protest too much. Anyone really believing of the latter (‘should be irrelevant…’) should have no problem correcting the former (i.e. yes, mostly binary).

    Her medical school hosts an online forum in which students correct their instructors for using terms like “male” and “female” or “breastfeed” instead of “chestfeed.”

    Chestfeeding sounds annoying to me but at least it doesn’t actively prevent the transmission of important scientific and medical data. Trying to get rid of male and female and/or not distinguish between cis and trans members of a gender seems to me to do that. Rates and risks of things like colon and breast cancer are related to sex. The variations in rates stop making sense if you ignore sex.

    Look students, you need terms which refer to specific patient types for which medical risks and treatments are expected to be different. And even granting the ‘continuum’ argument, that shouldn’t stop us from applying such terms. Age is also a continuum, but that doesn’t stop us from talking about health risks associated with being an infant, child, pubescent, or elderly person. So I really don’t see how “it’s a continuum” is an argument against using male and female. Yep, continuum. Yep, some people don’t fit those categories. Just like not everyone falls into the two categories “elderly” and “infant.” They’re still useful categories, because they help us talk about the types of medical risks and interventions which may be needed by different individuals.

  5. Knowing the bits in bold, shouldn’t we be a bit more cautious

    Nope. Full steam ahead, damn the torpedos, and they couldn’t hit an elephant at this dist …
    Are, I wonder, these various doctors being backed in their activities by their medical malpractice insurance policies? And if so, are those insurance companies losing investors because of their exposure to repeated future lawsuits?

    1. I expect this is one of those problems where lots of people doing the best they can nevertheless crank out what could be a bad decision.

      I’m a bit reminded of the old “what if we clean up the air and water, and climate change turns out to be wrong?” cartoon. Ya still got clean air and water, right? Okay, so conservatives and moderate liberals hypothesize some part of gender dysphoria may have a social component. But to the left, this idea is so verboten we shouldn’t even speak it. Fine….how about we study and solve the problem of peer pressure and social anxiety amongst young teens, and worry about if it reduces gender dysphoria or “only” problems such as suicide, anorexia, and the like after we solve it? If the moderates are correct, we helped teens. And if the far left is correct, we helped teens.

      1. But to the left, this idea is so verboten we shouldn’t even speak it.

        I don’t know what is taught in America, but here I was taught that who rubs which of their mucosa against which mucosa of someone else, is precisely the concern of the two sets of mucosa involved and precisely nobody else’s business.
        When did that change, and who voted to impose the change on the rest of the world?

    2. The insurance questions seem like good ones. I’ve not seen either of them raised before.

      1. They seem obvious to me – though that may be because my first exposure to the American medical system was a class-mate’s father (an MD) complaining bitterly about having just had to pay his malpractice insurance premium – which then (1990) was considerably higher a premium than the combined salaries of any three people I’d ever met.
        I’d suspect that neither doctors nor insurance companies really want to put this problem into black and white. But their lawyers will really want to put it in black and white. Then everyone can just pass the consequences down the line to the customers and pretend (sense : claim) that all is for the best in this best of all possible worlds.

  6. This kind of nonsense has dangerous implications, for both patients and practitioners. Just today, in the UK,

    A doctor who offered hormonal treatment to children has appeared at a tribunal accused of failing to provide good clinical care to patients.

    Dr Helen Webberley, founder of online transgender clinic GenderGP, appeared via videolink at the Medical Practitioners Tribunal Service (MPTS) hearing in Manchester on Tuesday.

    The General Medical Council (GMC) charges against her include that she failed to provide good clinical care to three child patients before prescribing testosterone treatment and, in one case, puberty blocker treatment GnHRA, in 2016.

    It is alleged she prescribed testosterone to one of the children, referred to as patient A, when it was not appropriate for use in someone of that age.

    She is also alleged to have failed to obtain adequate medical histories and arrange adequate examinations before making the prescriptions.

    1. Ye gawds. Every paragraph in that article reads like a nightmare. She was a general practitioner (!) Is accused of not adequately examining the patients. And (I guess) prescribed testosterone to pre-pubescent children.

  7. Double mastectomies on 13 year olds? Gruesome, selfish and stupid. These people are fanatics and their fanaticism is leading them to do some pretty monstrous things.

  8. So, puberty blockers elicit, among other things, “brain fog”, Interesting, isn’t it, how glaring the logical inconsistency of the latest zeitgeist: the slightest exposure to opioid pain medication is a terrible social danger, but treating kids with puberty blockers is harmless, reversible, and even, it is appearing, rather cool. That illogic, together with the euphemistic boilerplate language of umpteen med school pronouncements—imitated weakly in the SSE statement—makes me wonder whether med school administrators haven’t been themselves wolfing down puberty blockers recently. As for the systems
    of student anonymous complaint about professors’ use of words that are now forbidden (including use of the wrong chosen pronouns), why the administrators of those systems must be on drugs that block not
    just puberty, but the entire 18th, 19th, and 20th centuries.

    ///Jon Gallant
    [Chosen pronoun form of address: Ваше Императорское Величество ]

    1. Claritin gives me brain fog. That’s not necessarily a good reason not to take a medicine.

      The more critical questions are about what constitutes truly informed consent for a teen experiencing social anxiety over some issue. A young person under emotional stress is probably about the worst case scenario for “human needs to successfully balance long-term vs. short-term goods.”

      The second kicker question is whether and when to use high-regret treatments, when we aren’t allowed to study or even talk about how to distinguish the permanent medical conditions from the temporary ones – nay, we can’t even hypothesize the notion of ‘temporary ones.’

  9. “…children as young as three have the cognitive ability to come out as transgender…”

    My younger daughter, now five years old, repeatedly and consistently told us she wanted a penis when she was around four. She wanted to be a boy, she said.
    She had just learnt about the differences between boys and girls and was deeply fascinated by them, trying to sort everyone around her into a neat category by their clothes, haircut and, well, genitalia.

    We just said that if she still wanted to be a boy later, she could become one – like her godfather (well, the secular equivalent), who is a trans man (and a dad as well). We meant it.
    Of course we allow her to dress as she likes. For a while she chose “clothes for boys”, as she called them, blue and green and grey instead of pink and unicorns, and no dresses please. I tried to explain that people can dress any way they like, but she seemed to think in very clearly defined categories. I guess that is normal for her age.

    But we would never have taken her to a doctor to start transition…

    Well, she grew out of it already, unicorns and pink are back, bur she does now allow some unisex stuff, like Pokemon or Lego.

    After reading this, I fear for other children like my daughter.

    1. The description here is common. “In the range of normal”, I like to say. I spent a few months attending an LGTBQ group in support of a young relative to learn more, and what I gathered was rather eye-opening in terms of how these things manifest at an early age. Even when a young person honestly starts out with transgendered tendencies at a young age, some of them later settle into other categories. They can become bi-sexual, or a cross-dresser, or gender-fluid. For all of these, its not really a good idea to get out the scalpel and hormones right away. Wait.

      1. Exactly. My first boyfriend (born 1962) told me he went through a period as a child where he was convinced he was a girl because he didn’t like ‘boy stuff’ and preferred hanging out with girls. Had he been born 50 years later, he’d be on hormones and destined for surgery.

  10. How soon will we in the USA have to resort to medical tourism in order to get reliable health care? And, since the English-speaking world has all but succumbed to the woke ideology, what countries should we visit for the proper diagnosis and treatment?

  11. The activists pushing all of this are not particularly concerned with the health or well-being of the individual victims involved.
    That seems to be the pattern with woke movements. In this case, it conflicts very strongly with the traditional ethics of medicine. This is Mengele-level practice, and it needs the same sort of response.
    Perhaps it would be different if it we had the ability to actually change someone’s sex, but we do not.
    Medical attempts to change a little boy into a little girl are marginally more successful than if the child wanted to be turned into a fish or a dinosaur. Lots of permanent harm done with the result being a very crude cosmetic approximation of the goal.

  12. Responding to Robert Elasser in #9—it sure is. The puzzle is how a new form of Lysenkoism (in regard to the Biology of sex, among other things) oozing out of “critical gender studies”, has
    taken hold so widely without the rule of an all-powerful General Secretary of a ruling
    vanguard party. Yet here we are, engulfed in spontaneous Lysenkoism. ???

    1. Like Lysenkoism, like the ‘Blank Slate’, the Gender Studies juggernaut is not a matter of objective truth but of political ideology. That these ideological beliefs are not based on objectives truths is not a bug but a feature. Only the ‘purest’ may extoll these ideological truths and to dissent is to display the wrong kind of consciousness.

      There are no concentration camps for the non-Woke, yet.

      1. Nor will there be. The actual fraction of the population that is full-tilt woke is probably minute, and a reaction is coming that I suspect will be ferocious. Already there is significant legal pushback, and the Republican camp has a fair chance of winning back a substantial number of the upper-middle class suburbs they lost in 2020 by aiming at the targets the wokistas—and the mainstream Democrat establishment which has so far been much too accommodating to these faux ‘progressives’—have so obligingly created. Significant chunks of crucial voterships—Hispanics and probably a very large fraction of Black voters—are going to listen sympathetically to appeals based on opposition to the kind of craziness that the topic of the current post is just one instance of.

        Unfortunately, academia is going to be contaminated with this stuff for the foreseeable future. But even there, my guess is that there’s going to be, eventually, a general purge of wokethink. Nothing lasts forever, even mandatory participation in Whiteness self-criticism/re-education tribunals.

  13. My theory is young boys and girls form their strongest attachments with members of the same sex. When hormones hit and sexual feelings arise I believe that for a lot of kids they apply these confusing feelings towards members of their sex for reasons just mentioned. And then nature sorts things out after a year or two. But along come the adults who mess everything up, especially the Sociology 101 Majors. Does this explain everything about the sexual makeup of young pubescent people? No, but I think it explains about 90% of it.

  14. Another petition was delivered after an instructor referred to “a man changing into a woman,” which, according to the students, incorrectly assumed that the trans woman wasn’t always a woman.

    The claim that “all people are born with a ‘gender identity’ (the internal sense that one is a man, woman, both, or neither) which is located in the brain and developed in the womb” is — or should be — testable. Yet where are the medical students clamoring for studies which confirm or fail to confirm its existence? Why aren’t they interested in a test which will definitively diagnose the condition of “neurological gender identity failing to align with external sex?” That’s usually what physicians want to do — be able to run tests which will give them an objective way to measure the results against a standard. “You are transgender.” “You’re not.”

    Instead, they cast confusion on the concept of sex, which like every other attempt to categorize reality has some fuzziness at the borders. And they switch roles: the patient’s self-diagnosis is sacrosanct. I suspect if there were such a test they wouldn’t use it for fear of telling the patient they were mistaken — which once again goes against the grain of clinical practice.

    1. “And they switch roles: the patient’s self-diagnosis is sacrosanct.”

      Yes this is weirdly inconsistent eh? The natural progression of this thinking will be medical professionals advocating for over-the-counter Lupron and testosterone.

  15. If we agree that it is not possible to change biological sex which depends on gametes, then the term “transsexual” used in the post is unfortunate. I was under the impression that even the “trans” lobby uses “transgender”.

    1. The trans lobby often conflates “sex” and “gender.” When separated, “sex” involves progression along a biological pathway towards one of two reproductive methods, and “gender” means “socially constructed norms, behaviors, and roles associated with being a man or woman.” That would mean that a man who “crossed over gender” would still recognize themselves as a man, but would behave in a more “feminine” way than expected; same for a woman being “masculine” instead of “feminine.” And of course that would mean different things in different cultures.

      But that’s not what they’re saying — or, at least, not what the trans lobby is promoting today. So I think it’s hard to know which term to use when trying to be accurate.

Leave a Reply