Category: sex and gender issues

New paper by Ruuska et al: Gender reassignment does not reduce psychiatric morbidity in gender-dysphoric youth

April 13, 2026 • 10:00 am

It’s one of the commonplaces that young people who have gender dysphoria (“GD”) will experience both reduced psychiatric problems and reduced suicides if they proceed on to gender reassignment (GR) via “affirmative care”. The suicide claim was dispelled in 2024 by the Finnish investigators given below, who showed that both GD and GR, when compared to controls, do not show increased suicide beyond that predicted from psychiatric problems alone (they used controls).  That dispels the common claim by gender activists pushing GR: “Do you want a dead son or a live daughter?” (That’s for transitioning to female gender, but it can be reversed.)

A new paper from the same group, published in Acta Paediatrica, looks not at suicide but psychiatric “morbidity” (psychiatric problems).  The study was large, controlled, and takes advantage of the fact that in Finland every doctor visit is recorded for every citizen because of the country’s national health system.

The upshot is simple: children and young people (they used subjects up to 23 years old; henceforth called “subjects”) who sought treatment for GD had significantly more severe psychiatric problems and were referred far more often for “specialist level” treatment than were controls.  Those GD subjects were parsed into two groups: those who were given gender reassigment, and those who were not. The conventional wisdom is that if you have GD, then gender reassignment should significantly alleviate their dysphoria, measured by a reduced need for specialist psychiatric treatment.

The conventional wisdom was wrong: gender reassignment didn’t alleviate psychiatric compared to GD people who didn’t get reassignment. The conclusion is that gender reassignment, with its deleterious side effects, was not a good way to improve quality of life, at least measured by the need for psychiatric intervention.

Here’s how the term “gender reassignment” is used in the paper:

Medical GR interventions included masculinising/feminising hormonal treatments, chest masculinisation, and/or genital surgery (vaginoplasty/phalloplasty/metoidioplasty).

These treatments are all irreversible except that removed breasts can be restored by replacements.

Click below to access or download the pdf, or you can see the original paper online here.

As I mentioned, the sample size was large: there were 2,083 GD subjects who presented themselves for treatment, and for each of these subjects the investigators chose eight controls, four males and four females matched to the GD subjects by age and place of residence. The final controls numbered 16,643.

Here are the percentage of subjects who sought specialist-level psychiatric treatment between 2011-2019 (differences from 1996-2010 were in the same direction, but far more people who sought GD treatment had a history of specialized treatment in the later period. The authors don’t know the reason for the rise in GD-associated psychiatric difficulties, but it matches the rise in gender dysphoria in other places, including the U.S.

GD subjects

Sought specialized psychiatric treatment before the presentation for GD (“index date”):  47.9%
Sought specialized psychiatric treatment ≥2 years after the presentation for GD:               61.3%

Controls

Sought specialized psychiatric treatment before the presentation for GD (“index date”):  15.3%
Sought specialized psychiatric treatment ≥2 years after the presentation for GD:               14.2%

This shows that GD subjects, whether or not they went on to GR, initially had about three or more times the rate of psychiatric difficulties than did the controls. That is not new, as GD is generally related to psychiatric difficulties, and it’s likely that some people look for gender reassignment as a way to alleviate their gender dysphoria, or even as a way to alleviate general mental difficulties.  But GD subjects in general did not in general show a lessening of psychiatric difficulties after their presentation; in fact, the rate was increased by about 13.4%.

The important figures, though, are those showing whether or not GR treatment alleviated psychiatric difficulties. After all, that is the rationale for gender-reassignment treatment, whether it be hormones or surgery.  Here is Table 3 from the paper, with the last two columns being the important ones. They’re divided up by sex, and “GR-” means GD subjects not given gender reassignment, while “GR+” means GD subjects who were given gender reassignment. Click table to enlarge; I’ve put a red rectangle around the area of most importance:

This shows that GD subjects, both those who transitioned to female and those who transitioned towards male, did not have a reduction in psychiatric treatment contact (all contact, whether “specialized” or not) after their transition began or was completed. Au contraire: the psychiatric treatments went up sixfold for those transitioning to female genders and 2.5-fold for those transitioning towards male.

If you look at the third and four data columns, you can see the percentages of GD subjects who got psychiatric treatment for GD but who did not go on to reassignment. Curiously, the psychiatric treatment was more frequent in this group than in the group that went on to reassignment, but only before the data of first consultation for GD.

This difference between the third and fourth and the fifth and sixth data points on the first line is curious.  But what’s important here is that there is no marked alleviation of psychiatric contacts for GD subjects who went on to reassignment. They continue to consult psychiatrists, and at about the rate of GD subjects who didn’t go on to reassignment. Again, we don’t see the mitigation of psychiatric difficulties in GD patients that go on to surgery or hormones.  Since those procedures have deleterious side effects (anorgasmia and pronounced difficulties after surgery on genitals or even breasts), there is not a strong case to be made for gender reassignment of gender-dyphoric patients, at least in terms of alleviating mental illness.

The first two columns show the data for both male and female controls. Since they didn’t have consultations for GD, the “index date” for controls was given as the date that their matched GD subjects first had a consultation.  And, as expected, their psychiatric visits were far less numerous than the GD subjects two years after the index date (though the low levels of consultations for GR+ subjects compared to GR-subjects before the index date is still curious, and I may have missed the authors’ explanation).

This is just a cursory interpretation I’ve made after reading the paper twice, and I may have missed some data that feed into the authors’ conclusion below. What’s clear is that GD is associated with psychiatric disorders, though it may not be causal, and that gender reassignment does not improve mental health compared to dysphoric subjects who didn’t get reassigned.  All this suggests that “affirmative care” that puts GD subjects on the path to GR doesn’t, at least in this study, have the salubrious effects that are touted—as measured by the intensity of psychiatric treatment. Gender-reassigned subjects continue to suffer from mental disorders at a rate threefold to fivefold that of controls without gender dysphoria, so GR doesn’t come close to giving subjects the mental stability of controls.

The last paragraph of the paper gives what the authors see as the “Clinical Implications” of their results:

Regardless of gender, adolescents suffering from GD present with excessive psychiatric morbidity. Subsequent to medical GR, psychiatric treatment needs appear to increase. It should be noted that in some individuals, medical GR appears to be linked to deterioration in mental health. Possible mechanisms and vulnerable subgroups should be explored in future studies. The effects of medical GR and the expectations of the patient must be addressed before commencing the treatment. The considerable severe psychiatric morbidity prior to contacting the GIS, and its increase over time, suggest that for some of these adolescents, GD may be secondary to other mental health challenges. This underscores the need to thoroughly assess and appropriately treat mental disorders among those seeking GR before and after undergoing irreversible medical treatments. Psychiatric needs must be adequately met.

 

h/t: Christopher

The Supreme Court, free speech, and therapy: a big screwup by the Supremes

April 1, 2026 • 10:15 am

Yesterday, by a rare vote of 8-1, the Supreme Court struck down Colorado’s ban on “conversion therapy” for minors (we’re talking about a ban on speech, not medical procedures).  Judge Ketanji Brown Jackson dissented, breaking from her two liberal colleagues.

The background: in 2019, Colorado passed a bill banning “conversion therapy for a minor” (HB19-1129), which you can see here.  it defined “conversion therapy” this way:

(5.5) (a) “CONVERSION THERAPY” MEANS ANY PRACTICE OR TREATMENT BY A LICENSED PHYSICIAN SPECIALIZING IN THE PRACTICE OF PSYCHIATRY THAT ATTEMPTS OR PURPORTS TO CHANGE AN INDIVIDUAL’S SEXUAL ORIENTATION OR GENDER IDENTITY, INCLUDING EFFORTS TO CHANGE BEHAVIORS OR GENDER EXPRESSIONS OR TO ELIMINATE OR REDUCE SEXUAL OR ROMANTIC ATTRACTION OR FEELINGS TOWARD INDIVIDUALS OF THE SAME SEX.

(b) “CONVERSION THERAPY” DOES NOT INCLUDE PRACTICES OR TREATMENTS THAT PROVIDE:

(I) ACCEPTANCE, SUPPORT, AND UNDERSTANDING FOR THE FACILITATION OF AN INDIVIDUAL’S COPING, SOCIAL SUPPORT, AND IDENTITY EXPLORATION AND DEVELOPMENT, INCLUDING SEXUAL ORIENTATION-NEUTRAL INTERVENTIONS TO PREVENT OR ADDRESS UNLAWFUL CONDUCT OR UNSAFE SEXUAL PRACTICES, AS LONG AS THE COUNSELING DOES NOT SEEK TO CHANGE SEXUAL ORIENTATION OR GENDER IDENTITY; OR

(II) ASSISTANCE TO A PERSON UNDERGOING GENDER TRANSITION.

This is aimed only at minors—people under 18.  Conversion therapy was not characterized as a criminal offense, but as a violation of professional discipline—a form of “unprofessional conduct” that could be punished by licensing boards, including suspension of licenses and fines.

Note that although we hear a lot about the law banning “affirmative therapy,” most of us see that as a kind of therapy that urges children who are gender dysphoric to alter their gender or their sex. But the law as written also bans “gay conversion therapy”: attempts, once in vogue when homosexuality was seen as a mental illness, to prevent people from being gay—to keep them “straight.” There are laws in 27 states and the District of Colombia, as shown in the map below from the Measurement Advancement Project, prohibiting this kind of therapy.

As the SCOTUS blog reports (as does the Supreme Court’s decision, linked below), the ban was challenged by a therapist who wanted to help her clients transition the way they wanted:

The Supreme Court on Tuesday sent a challenge to Colorado’s ban on “conversion therapy” – treatment intended to change a client’s sexual orientation or gender identity – for young people back to the lower courts for them to apply a new standard. By a vote of 8-1, the justices agreed with Kaley Chiles, the licensed counselor challenging the law, that the ban discriminates against her based on the views that she expresses in her talk therapy. A federal appeals court, Justice Neil Gorsuch wrote for the majority, should have applied a more stringent standard of review, known as strict scrutiny, to determine whether the law violates the First Amendment as applied to Chiles.

But the Supreme Court also strongly hinted that the ban would fail that test. In his 23-page opinion, Gorsuch stressed that in cases like Chiles’, Colorado’s ban “censors speech based on viewpoint.” Because the First Amendment “reflects … a judgment that every American possesses an inalienable right to think and speak freely, and a faith in the free marketplace of ideas as the best means for discovering truth,” Gorsuch continued, “any law that suppresses speech based on viewpoint represents an ‘egregious’ assault on both of those commitments.”

Justice Ketanji Brown Jackson was the lone dissenter. She argued that the majority’s opinion “could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers.”

Chiles went to federal court in Colorado to challenge the constitutionality of the 2019 law and block Colorado from enforcing it against her. She contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”

A divided panel of the U.S. Court of Appeals for the 10th Circuit allowed the state to continue to enforce the law. The majority concluded that the conversion therapy ban simply regulated conduct – a licensed mental health professional’s treatment of a client – that also happened to involve speech. Therefore, the court of appeals concluded, it would review the ban using the least stringent test for constitutional challenges, known as the “rational basis” test – a relatively low bar, the court of appeals said, that the ban passed.

Chiles came to the Supreme Court in 2024, asking the justices to weigh in. On Tuesday, they reversed the 10th Circuit’s ruling and sent the case back to the lower courts for another look.

Curiously, Chiles apparently wasn’t trying to force her clients to adopt one course of action over another, but to achieve the course of action they wanted:

[Chiles] contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”

The issue here is that it’s still “affirmative” in that Chiles went along with what their (minor) patients wanted rather than examining what they wanted.

The grounds for the decision were narrow: banning conversion therapy violated the First Amendment’s provision for freedom of speech (my bold below):

Gorsuch characterized the question before the justices as “a narrow one”: whether Colorado’s ban on conversion therapy violates the First Amendment as applied to the talk therapy that Chiles provides, and in particular whether the 10th Circuit was correct in applying “rational basis review” to the ban.

The Supreme Court, Gorsuch observed, “has long held that laws regulating speech based on its subject matter or ‘communicative content’ are ‘presumptively unconstitutional’” and therefore trigger strict scrutiny, which requires the government to show that a restriction on speech is narrowly tailored to serve a compelling government interest. “Under that test,” Gorsuch added, “it is ‘“rare that a regulation . . . will ever be permissible.”’”

The court has also acknowledged, Gorsuch continued, “the even greater dangers associated with regulations that discriminate based on the speaker’s point of view. When the government seeks not just to restrict speech based on its subject matter, but also seeks to dictate what particular ‘opinion or perspective’ individuals may express on that subject, ‘the violation of the First Amendment is all the more blatant,’” Gorsuch stressed. “’Viewpoint discrimination,’” Gorsuch said, “represents ‘an egregious form’ of content regulation, and governments in this country must nearly always ‘abstain’ from it.”

“Applying these principles,” Gorsuch continued, “we conclude that the courts below failed to apply sufficiently rigorous First Amendment scrutiny in this case.” First and foremost, Gorsuch wrote, although “the First Amendment protects many and varied forms of expression, the spoken word is perhaps the quintessential form of protected speech. And that is exactly the kind of expression in which Ms. Chiles seeks to engage.”

. . . The majority rejected the state’s contention that the conversion therapy ban targets conduct or medical treatments, rather than speech, and therefore should be subject to a more deferential standard of review. Although the ban “may address conduct—such as aversive physical interventions” – Gorsuch wrote, Chiles “seeks to engage only in speech, and as applied to her the law regulates what she may say,” as well as “what views she may and may not express.” “Colorado,” Gorsuch concluded, “does not regulate speech incident to conduct; it regulates ‘speech as speech.’”

Note as well that Colorado’s ban wasn’t fully negated, nor were similar bans throughout the U.S.. Rather, the case was sent back to the lower courts for reevaluation on these grounds (from Grok, with sources); the applicable appellate courts must:

  • Apply strict scrutiny (the most demanding level of First Amendment review) to the law as it applies to Chiles’s talk therapy. Under this standard, Colorado bears the burden of proving that the restriction on Chiles’s speech is narrowly tailored to serve compelling state interests.
  • Reconsider the case in light of the Court’s determination that the law engages in viewpoint discrimination (banning one set of views on sexual orientation/gender identity while expressly permitting the opposing “affirmative” views, such as acceptance, support, identity exploration, or assistance with gender transition).

The Court’s opinion, concurrences, and Justice Jackson’s dissent can be found by clicking on the screenshot below:

I’ll be brief here (I hope): the Court screwed up big time here, failing to recognize, as Justice Jackson said in her 35-page dissent (which she read from the bench in toto), that in the case of therapy, medical or psychological, talk is more than just speech, it’s treatment. From her dissent:

No one directly disputes that Colorado has the power to regulate the medical treatments that state-licensed professionals provide to patients. Nor is it asserted that, when doing so, a State always runs afoul of the Constitution. So, in my view, it cannot also be the case that Colorado’s decision to restrict a dangerous therapy modality that, incidentally, involves provider speech is presumptively unconstitutional. In concluding otherwise, the Court’s opinion misreads our precedents, is unprincipled and unworkable, and will eventually prove untenable for those who rely upon the long-recognized responsibility of States to regulate the medical profession for the protection of public health.

Remember that medical therapy uses speech as well. Any doctor who simply told a patient to go home and drink vinegar with herbs to treat their cancer would be guilty of professional misconduct. Note that here the doctor doesn’t do anything, but could still be punished for malpractice.  The doctor must adhere to reasonable and accepted forms of treatment, and that includes treatments suggested only through speech.

Brown notes that conversion therapy is “dangerous,” and nearly everyone would agree with that vis-à-vis gay conversion therapy. It’s long been recognized by therapists and their organizations that trying to force someone out of becoming gay, instead of simply talking over the issue, is acting unethically and, insofar as this causes stress and may change someone’s life in a negative way, i.e. causing harm.

We’re beginning to recognize that the same holds for “affirmative therapy” as well.  If it works, affirmative therapy puts young people on a one-way treadmill leading to to puberty blockers, then to adult hormones, and perhaps to surgery.  Britain’s Cass Review, as well as studies in Scandinavian countries, have already recognized that “affirmative therapy” that leads to blockers and hormones is of unproven efficacy and could be dangerous over the long term. Insofar as talk therapy promotes these actions, then, it too is dangerous—much like telling someone they should take vinegar for cancer. It seems only rational that when a minor has a psychological problem around gender or sexuality, the therapist should be giving objective treatment—helping the patient sort out their feelings—and not imposing some outside ideology on the therapy. For outside ideology is exactly what is polluting “conversion therapy”: you shouldn’t be gay on the one hand, and on the other your gender dysphoria should be roundly affirmed (e.g., you feel like a girl inhabiting a boy’s body, and thus should go that route) rather than examined.

Perhaps when this case is remanded to lower courts, they will clarify these issues, notably that talk therapy is equivalent to action.  But surely the Supreme Court could have said that, and, as far as I can see, they messed up big time. I’m especially disappointed that the other two liberal justices, Kagan and Sotomayor, deemed the Colorado law a case of “viewpoint discrimination.” It may have been that way for legislators, but the law as written doesn’t deal with motivations. It is trying to prevent harm to minors.

I disagree strongly with the Court’s decision, while at the same time remembering that the law it banned is aimed at minors, not adults.

Alex Byrne recounts an episode of professional rejection involving yet another academic taboo

March 20, 2026 • 11:30 am

Over at The Philosopher’s Magazine, Alex Byrne (a professor at MIT who works in part on gender and sex), has written a tale of rejection that’s both amusing (in how it’s written) and depressing (in what it says).

Alex was invited to write a book review for Notre Dame Philosophical Reviews, an online site that publishes only reviews of philosophy books. Because reviews are invited (sometimes after a prospective reviewer offers to write one), they are rarely if ever rejected.

But not so with Byrne. Because he wrote a critical but not nasty review of a book on gender by a trans-identified male, Alex’s contribution was rejected—without the site even giving him an explanation.

Click the screenshot below to read Alex’s sad tale. Actually, it’s not really sad because his review will be published elsewhere, and this rejection does him no profesional damage.  But the way he was treated reflects yet another academic taboo like the one I discussed in the last post. In this case, the taboo involves saying anything critical about gender science or, in this case, philosophy, particularly about a book written by a trans person.

Some excerpts:

last October, I saw that Rach Cosker-Rowland’s Gender Identity: What It Is and Why It Matters had just come out with Oxford University Press. “Philosophically powerful,” “excellent, important, and timely,” and “fascinating, well-argued,” according to blurbs from well-known philosophers who work in this area. Timely, for sure. I thought reviewing Cosker-Rowland’s effort myself would be worthwhile, since I’ve written extensively on gender identity, in my 2023 book Trouble with Gender and other places.

Many readers will be aware that the topic of sex and gender has not showcased philosophers on their best behavior. It is almost ten years since Rebecca Tuvel was dogpiled by colleagues for writing about transracialism, and—incredibly—things went downhill from there. Dissenters from mainstream thought in feminist philosophy have been subjected to name-calling, no-platforming and other extraordinarily unprofessional tactics. As a minor player in this drama, I have had OUP renege on a contracted book and an invited OUP handbook chapter on pronouns rejected. My recent involvement in the Health and Human Services review of treatment for pediatric gender dysphoria has done little for my popularity among some philosophers.

I was not hopeful, then, that an invitation to review Cosker-Rowland’s book would spontaneously arrive. But NDPR welcomes “proposals for reviews from suitably qualified reviewers” (see above), and I had reviewed three times for them before. So, I emailed the managing editor in October. I was pleasantly surprised when Kirsten Anderson wrote back to me in December, “Good news! After consulting with the board about it, we’ve decided to move forward with your review.” OUP and NDPR were keen to get the book to me—I received a hard copy from both, and OUP also sent a digital version.

By mid-January I had finished, and sent the review to Anderson with the following note:

Review attached. It’s a big and complicated book but mindful of your guidelines I tried to keep the main text as short as I could—it’s a little over 2200 words. However, the review is very critical, and (again mindful of your guidelines) I need to give reasons for the negative evaluation, so I put a lot of the supporting evidence in the lengthy endnotes.

To which she replied:

Thanks for the review and the extra explanation! Your review will now go through the standard process, starting with being vetted by a board member covering the relevant area. If the length is a problem, I’ll let the board member weigh in along with any other revision requests that may arise. Otherwise, it’ll go straight to copyediting. After that, it’ll be published.

As I said, Alex’s review was not nasty but it was critical (there’s a link below), and he found a number of simple errors that Cosker-Rowland made. Here’s one:

I kept it clean and the overall tone was well within the Overton window for philosophy book reviews, which (as noted at the beginning) is wide. Terrible arguments in philosophy are common; more remarkable was Gender Identity’s slapdash scholarship and glaring factual mistakes. Here’s one example (from the review’s lengthy endnotes):

Gender Identity would have greatly benefited from fact checking. One particularly egregious error is the allegation that “in March 2023 there was a rally outside the Victorian Parliament in Melbourne at which neo-Nazis and gender critical feminists campaigned against trans rights and held up banners proclaiming that trans women are perverts and paedophiles” (158). The two groups did not campaign together and the feminists held up no such banners. The feminists’ rally, including banners and placards, can be seen in one of Cosker-Rowland’s own citations, Keen 2023. Cosker-Rowland even manages to misdescribe the neo-Nazis: their sole banner read “Destroy Paedo Freaks” (Deeming v Pesutto 2024: para. 100); although hardly well-disposed towards transgender people, whether the neo-Nazis meant to accuse them of pedophilia is not clear (para. 114).

I documented some other obvious errors and scholarly lapses in the review—by no means all the ones I noticed. “OUP should note,” I wrote, “that quality control in this area of philosophy is not working.”

Let’s reflect on Cosker-Rowland’s claim about the Melbourne rally for a moment. As a footnote in Gender Identity confirms, she knows that the gender-critical philosopher Holly Lawford-Smith was at the event. Cosker-Rowland believes, then, that Lawford-Smith, a philosophy professor employed by Melbourne University and an OUP author, is happy to attend—indeed, speak at—a rally at which fellow-feminists joined forces with neo-Nazis, both holding grotesque banners about trans women and pedophilia. Perhaps Lawford-Smith waved one of these banners herself! No one with a minimal hold on reality would find this remotely credible. Even more astounding is how this managed to get by the OUP editor and multiple referees—it’s not buried in a footnote, but is in the main text.

He found other errors that he didn’t mention in the review but gives in this piece (you can see his entire review here, in Philosophy & Public Affairs). Here’s Byrne’s summing up given in the last two sentences of his review:

Back in the day, we knew what it was to be transsexual. Transsexuality’s contemporary descendant, being transgender, is decidedly more nebulous and deserves an explanation. Gender identity as Cosker-Rowland conceives of it is of no help, and neither is obstetrical paperwork.

Some weeks after submitting the review to Notre Dame Philosophical Reviews, Byrne got a rejection that said only that the journal site was “not moving forward” with publication. No reasons were given. Alex wrote back to the editor asking if they would be so kind as to answer two questions:

1. Who was the board member who initially vetted my review? This is not blind reviewing, I take it. The board member knew who wrote the review. Seems only fair that I should know the identity of the board member. If the board member had reasonable concerns, then there should be no objection to making everything transparent.

2. What, exactly, was the reason why you have decided not to publish the review?

Well, reviewers aren’t always entitled to the names of those who vetted a review, but certainly reasons should be given for a rejection.  None were, except that one board member declined to vet Alex’s piece and the other “recommended strongly that it be rejected outright.” That was the only feedback he got. Byrne isn’t moaning about this, but his essay does have a serious point about the infection of the publication process in his field by ideology:

The philosophy profession has shown itself to be an institution of fragile integrity when put to the test. One can only hope spines will eventually stiffen, and academic law and order is restored. Meantime, we cannot solely rely on the fortitude of Philosophy & Public Affairs. I suggest that the Journal of Controversial Ideas starts publishing book reviews.

Amen!

Luana’s revealing class survey of the biological definition of sex

March 17, 2026 • 9:30 am

Yesterday I wrote a bit (well, more than a bit) about a dire paper in Ecology Letters promoting a unusable “multivariate” view of sex and criticizing the gamete-based definition of biological sex recognized by most savvy biologists as the best definition, corresponding to reality, being universal, and being the most useful definition in promoting research. Sadly, but perhaps understandably, the average person wouldn’t be able to define “biological sex”, though.  This was demonstrated yesterday by my colleague Luana Maroja, an evolutionary biologist who works at Williams College in Massachusetts.

This semester Luana is teaching Evolution to undergraduates, and, fortuitously sent me the slide below with a note:

Today I taught about sex binary in Evolution.  Here is the clicker slide I presented and the responses:

A “clicker slide” is one which gives students in the class a chance to vote on alternatives. Each student has a device that records their vote. In this one, Luana asked her students to choose one of five alternatives to answer the question, “How many biological sexes in animals and vascular plants?” (Note that “biological” is in italics; she’s not talking about gender but gave the students the chance to conflate sex and gender. They have five choices:

 

A.  Binary (males and females)
B.  Three sexes (males, females, and intersexes)
C. 4 sexes (males, females, intersexes, and hermaphrodites
D. Over 150 sexes (from “agender” to “zoogender”) .
E. Impossible to tell since sex is a continuum.

First the five alternatives were presented and then Luana put a box around the correct answer, which is shown below (click to enlarge):

 

Note that by far the most common answer was C:  four sexes: males, females, intersexes, and hermaphrodites.  The correct answer, two, was less than half of that at 21%, followed by a tie of 14% for “three sexes” and “over 150 sexes.”  The “impossible to tell because sex is a continuum” answer garnered only 7% of the votes (in this small class that is just one person): I guess the students have not yet been propagandized by the likes of Agustín Fuentes and Steve Novella.

Intersex individuals do not represent a distinct biological sex because their sex is indeterminate, while hermaphrodites are simply individuals that have both sexes (both gamete types) in single individuals. They are common in plants but, since they produce sperm and eggs only, and not any other types of gametes, combine both functions in one individuals. Hermaphrodites are quite rare in animals though more common in groups like worms.  “True hermaphrodites”—individuals capable of delivering both types of gametes—are not present in mammals, and I’ve found only a handful humans with both testicular and ovarian tissue, none of which had viable gametes of both types.

These students are smarter than the average American because Williams is a highly rated and selective undergraduate college. Nevertheless, they have no idea that sex in animals and plants is a binary representing two types of gametes: a large immobile gamete, characterizing females, and a small, mobile gamete, characterizing males.

You can see why so many people are susceptible to people who argue that sex is not a binary: they are already predisposed to believe that.

Luana asked me to mention that “the class is small and this is an improvement over what I had two years ago (the last time I surveyed the students). At that time most people chose the last option.”  (continuum). When I asked her what the improvement was, she added that, “The improvement is because they are not answering E anymore and many more people are picking the correct response.  ‘C’ is not as bad as ‘E'”

But note this other info from Luana, “With a small class like this one, we really don’t know where the bulk of students stand, but it is also important to notice that this is a 300 level class, thus all students already had Biology 102 (organismal biology) and thus should know better.”  Bio 102 is apparently not doing its job!

Of course you’ve learned by now that the entire debate about how many biological sexes there are is spurred solely by ideology.  If gender activists were not so eager to promote the incorrect idea that sex and gender are the same thing, and that we should confect scientific definitions to match people’s view of themselves, then biologists wouldn’t be arguing about this stuff. Alas, even some biologists (I’ve named two) have been seduced by the sirens of ideology. Others include the Presidents of the three major evolution societies. As I wrote on February 13 of last year:

. . . . the Presidents of three organismal-biology societies, the Society for the Study of Evolution (SSE), the American Society of Naturalists (ASN) and the Society of Systematic Biologists (SSB) sent a declaration addressed to President Trump and all the members of Congress. (declaration archived here)  Implicitly claiming that its sentiments were endorsed by the 3500 members of the societies, the declaration also claimed that there is a scientific consensus on the definition of sex, and that is that sex is NOT binary but rather some unspecified but multivariate combination of different traits, a definition that makes sex a continuum or spectrum—and in all species!

As it happened, a letter with about 125 signers from the evolutionary biology community took issue with the embarrassing “sex spectrum” claim, and the Tri-Society presidents decoded to remove it from the Internet, though I archived it and you can see it at this link. It stands as depressing testimony of how even influential evolutionary biologists can distort science when they want to conform to an au courant ideology.

But enough; the survey above gives you an idea of the extent of public misunderstanding of biological sex.

Another journal drinks the Kool-Aid: Ecology Letters publishes a misguided article that “There is no consensus on biological sex”

March 16, 2026 • 9:45 am

Ecology Letters, which I thought was a reasonably respectable journal, has now accepted a “viewpoint” article arguing that there is no consensus on biological sex, and that a definition based on gamete size—a consensus if ever there was one—is just viable as “multivariate” definition that incorporates a combination of chromosomes, genetics, and morphology.

They’re wrong and misguided in many ways, but, as Colin Wright notes in a tweet at bottom, there are so many mistakes and misconceptions in this paper that it would take a full reply to the journal to correct them.  I’ll just tender a few comments here, but you can read the paper for free by clicking the title below, or download the pdf at this site.

The authors give three definitions of sex: the classical one based on gamete size (males have small, mobile gametes, females large and immobile ones); a “multivariate” one, popular in some nescient quarters, that defines sex base on some combination of morphology, chromosomes, and “genetics,” and, finally something called “sex eliminativism,” which “eliminates the concept of sex altogether.” They graciously admit that they won’t discuss the last one because “rigorous research on sex-based variation remains vital.” True enough.

But they add that the “rigorous research” they propose be done “also challenges simplistic and harmful ideologies of the sex binary”.  This is a red flag that their criticism of the sex binary is partly (if not wholly) based not on biology but on ideology, for the “sex binary” is described as “ideological” and “harmful”. (They are talking, of course, about how a binary may harm people who don’t see themselves as fitting into it.) They later add that there are “ethical and political implications of defining sex.”  Only if they care to draw them; most real biologists don’t.

But sex was defined by gamete type long before the “gender” ideology began questioning the view that there are two sexes. And definition has been widely adopted, as I’ve said, not on ideology but on universality and utility. (See this discussion by Richard Dawkins.) All animals and vascular plants have only two sexes corresponding to gamete size, so the gametic definition holds across the animal kingdom. That leads to research questions about why this is so: why do animals, for instance, have only two sexes (some rare parthenogenetic species have only one sex: egg-producing females), but not three or more sexes. There are many papers discussing this question, and the answer seems to be that isogamous species evolve by natural selection to be anisogamous ones (two types of gametes), with that state now seen to be an evolutionarily stable to invasion by more sexes. This already shows that defining sex based on gametes is universal among animals and plants and, because it leads to research questions, also utilitarian. It becomes even more utilitarian when we see that the gametic sex dimorphism helps us understand many facts about biology, most notably the morphological and behavioral differences between males and females explained by sexual selection—an approach first suggested by Darwin in 1871.

What are the problems with a biological sex definition? The authors claim that in most cases biologists don’t look at gametes when discussing or enumerating sexes, and that is usually true.  When I divided fruit flies into piles of males vs. females, I looked not at their gametes, but their genitals. This is not a problem because in virtually all species there are proxies for gametes: traits like chromosomes or morphology that are closely correlated with sex. They are not 100% correlated, but pretty close to it.

But that’s not a problem, for the authors don’t seem to realize that there’s a difference between defining sex and recognizing sex.  The binary gamete-based definition is universal (and of course useful), while a definitions based on chromosomes, appearance, or genetics is not universal. (Many species have sex determined not by chromosome type or genetics but by rearing temperature, social milieu, haploidy, so on.) Still no matter how sex is determined, if you look at gamete types you always find two sexes.  Further, the authors don’t tell us how one is to combine the other traits in a multivariate way to define sex in any species. Would they care to give us a multivariate definition of sex for humans (or any other animal)? They refrain—and for good reason: it would be a futile task.

Their other criticisms of gametic sex are that it doesn’t deal with those species like algae or fungi that don’t have morphologically distinct gametes but are isogamous, with gametes looking the same. These species can have dozens of “mating types” based on genes, each of which can fuse only with gametes of a different type. These have long been called “mating types” and not “sexes” by biologists, and are not a problem for most species we’re interested in—including, of course, humans. As Colin notes below:

But anisogamy (reproduction via the fusion of gametes of different sizes) isn’t meant to apply to isogamous organisms (organisms that reproduce via the fusion of same-sized gametes). Anisogamy and the sexes—male and female—are fully intertwined and inseparable. Isogamous organisms don’t have sexes; they have “mating types.” They’re different from sexes, and that’s why biologists aren’t “inclusive” of isogamous organisms when talking about males and females.

The other criticism of gametic sex are just dumb: we can’t tell the sex of an individual before it produces gametes (like young men [in humans, newborn girls already have eggs!]) or after reproduction has stopped and gametes are no longer produced. From the paper:

 . . . this narrow [gametic] definition is not inclusive of reproductive approaches beyond anisogamy (e.g., isogamy) and does not classify organisms before sexual maturity or after reproductive cessation as having a sex.

According to these authors, then, newborn boys do not have a sex (newborn girls do) nor do postmenopausal women or some old men who don’t produce sperm.  That is crazy because the gametic definition of sex involves having the biological apparatus to produce large or small gametes; it does not have to be operational. To quote Colin again:

And the notion that a gamete-based definition doesn’t apply to sexually immature individuals or individuals who have ceased producing gametes ignores that the sexes are defined by having the biological FUNCTION to produce small or large gametes—and things still have a function even when it’s not being currently realized.

Below is a table from the paper comparing the gametic versus “multivariate” definitions of sex (the latter broken down into chromosomes, genetics, and morphology), seeing how useful each of the types is in defining sex in nine species (click to enlarge). Note that only one species, the New Mexico whiptail lizard (Aspidoscelis neomexicanus) is said to defy definition by gametes.  Yet it is called, in the footnoes, a “female only species”.  It is parthenogenetic, formed by the hybridization of two regular species having two gametic sexes, and the hybrids cannot produce males but produce females from unfertilized eggs that are diploid and genetic clones of the mother.  So if it’s hard to define organisms in this species as male or female, why do the authors call it a “FEMALE ONLY SPECIES.”  Because it produces eggs, Jake! It does not defy the binary at all, and you can put a “yes” in the first column where there’s a “no”.

Note that no other form of classification has “yes” all the way down: not chromosomal definitions, not genetic definitions, not morphological definitions (they again make the ludicrous claim that immature individuals don’t have sexes). And when you combine each of the three univariate non-gametic definitions in some multivariate way, you get a mess.  Only the first column, the operational definition using gametes, holds in all organisms. But we already knew that.

There’s another table that’s even more ludicrous. This one points out (as they do in the text, so the table is superfluous) that in some species of hummingbirds, some (not all) females have male-like coloration, even though they have large gametes. There is thus a disparity between the gametic definition of sex and a morphological one. But note that the morphology is used as a species-recognition trait here, not as a way to define sexes. This is one case where a proxy trait for sex doesn’t jibe with the gametes.

Are the females with male-like coloration really males? No biologist would say that, and if you look at the references for the table, you see papers like this (my bolding):

Bleiweiss, R. 1992. “Widespread Polychromatism in Female Sunangel Hummingbirds (Heliangelus: Trochilidae).” Biological Journal of the Linnean Society of London 45: 291–314.

Diamant, E. S., J. J. Falk, and D. R. Rubenstein. 2021. “Male-Like Female Morphs in Hummingbirds: The Evolution of a Widespread Sex-Limited Plumage Polymorphism.” Proceedings of the Royal Society B: Biological Sciences 288: 20203004.

Falk, J. J., D. R. Rubenstein, A. Rico-Guevara, and M. S. Webster. 2022. “Intersexual Social Dominance Mimicry Drives Female Hummingbird Polymorphism.” Proceedings of the Royal Society B: Biological Sciences 289: 20220332.

Falk, J. J., M. S. Webster, and D. R. Rubenstein. 2021. “Male-Like Ornamentation in Female Hummingbirds Results From Social Harassment Rather Than Sexual Selection.” Current Biology 31: 4381–4387.e6.

These all say that the male-appearing hummers are females that have evolved a male-like coloration (they apparently have done to avoid harassment and get more food). These are cases of polymorphism: some of the females look like males, while others look like regular females. The important question is this: why do all the authors call these male-looking birds “females”? It’s not hard to see: they produce large gametes and lay eggs (the authors used other traits associated with female-ness, like body shape in non-mimetic females, to suss out the male-like females).  The females that look like males also show territorial behavior characteristic of males, and that’s because biological males have to acquire territories to attract females. Why do only the males do this? Because of the disparity in gamete size—the male mating strategy is to mate with as many females as they can, while females are more selective. (This is a classic behavioral difference due to sexual selection.)

In sum. the authors only buttress the gamete-based definition of sex in their tables.  They do show argue that, in cases where you can be deceived about gametes by other traits, biologists like ones studying hummingbirds should describe the criteria they use for assessing sex. That seems okay to me and in fact that’s what’s done in the paper. But sure enough, the authors use color as a proxy for gamete size, not the other way around! Gamete size is fundamental. This is one case, where, as Colin says:

. . . every non-gametic view of sex is logically incoherent and self-refuting because they all rely on gametes as the conceptual anchor.

Here the color serves as a clue to what the conceptual anchor is and, sure enough, it’s gamete size.

In the end, this paper is deeply misguided and, I suspect, driven by ideology rather than biology. What else but ideology would cause four biologists to make such incoherent and misleading arguments? I could think of other reasons, but ideology is the most parsimonious (and the most au courant) given that the authors call the sex binary a “simplistic and harmful ideology” (it’s not an ideology, but an observation) as well as claiming that the definition of sex has ethical and political implications.  No, it doesn’t—unless you are an ideologue.

Colin says in his tweet below, “I have reached out to the editors of Ecology Letters asking if they would consider publishing a counter-Viewpoint.” I hope they do. If they don’t, then they are suppressing valid scientific dissent in the name of maintaining a “progressive” ideology. I would like to think that Ecology Letters would do that. Stay tuned.

Here’s Colin’s tweet, which should be expanded to see his take:

🚨ALERT: Top-ranking ecology journal Ecology Letters has published a “Viewpoint” paper titled “There is No Consensus on Biological Sex.”

h/t: Michael

Jesse Singal’s op-ed in the NYT: A turning point in “affirmative care”?

February 25, 2026 • 9:30 am

For two reasons I think that Jesse Singal‘s long op-ed (really a “guest essay”) in today’s NYT will mark a turning point in public and professional attitudes towards “affirmative care.”  First, the NYT saw fit to publish a piece showing that many American medical associations have promoted “affirmative care” of gender-dysphoric adolescents, despite those associations knowing that there was little or no evidence for the efficacy of such care.  Indeed, it seems that some of those associations lied or dissimulated about it, all in the interest of pushing a “progressive” ideology. As we know, left-wing “progressives” have been in favor of immediately accepting a child’s self-identification as belonging to its non-natal gender, so that teachers, parents, therapists, and doctors have united to start such children on puberty blockers and, later, surgery and hormones.

The NYT, while it has published pieces questioning the evidence for affirmative care, has been reluctant to come out as strongly as Singal does in the essay. That America’s Paper of Record deems this worthy of publication is news in itself.

For a number of reasons, most concerned with recent evidence (e.g., the Cass Review), the rah-rah affirmative therapy treadmill is grinding to a halt.  As Singal relates, recently two American medical associations—the American Society of Plastic Surgeons (ASPS) and now the powerful American Medical Association (AMA)—have admitted that we don’t know whether a gender-dyphoric child will “resolve” as gay or non-trans without medical intervention, and also that there should be no surgical intervention aimed at altering the gender of minors.

Singal has long called attention to these problems, and for his troubles he’s been branded a “transphobe,” shunned and blocked on social media.  There was even a petition to ban him from the site Bluesky, though, thank Ceiling Cat, it didn’t work.  Now, at long last, his views are getting a respectful airing, and society is coming to realize that the American zeal for “affirmative care”—not shared so much in Europe—is not only misguided but harmful.

The second reason is that the author ID says this about Singal:

Jesse Singal is writing a book about the debate over youth gender medicine in the United States and writes the newsletter Singal-Minded.

Although he’s already written one book. The Quick Fix: Why Fad Psychology Can’t Cure Our Social Ills, this is his first book on gender medicine, and if it expands on the theme of this article, it will be a landmark work with the potential to create big changes in gender medicine and how we view it.  Yes, it’s true that gender ideologues will oppose the article and upcoming book, but they have long put ideology over science, a strategy that is a loser, as we know from the failures of creationism and intelligent design.

Click on the headlines to read the article at the NYT, or find it archived for free at this site.

A few excerpts:

It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatme

. . .The science doesn’t seem so settled after all, and it’s important to understand what happened here. The approach of left-of-center Americans and our institutions — to assume that when a scientific organization releases a policy statement on a hot-button issue, that the policy statement must be accurate — is a deeply naïve understanding of science, human nature and politics, and how they intersect.

At a time when more and more Americans are turning away from expert authority in favor of YouTube quacks and their ilk — and when our own government is pushing scientifically baseless policies on childhood vaccination and climate change — it’s vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they aren’t, there’s simply no good reason to trust them.

And then Singal documents how organizations representing mainstream science and medicine haven’t been so trustworthy. The American Academy of Pediatrics (AAP) has been particularly  vocal—and clueless—in relentlessly pushing affirmative care:

A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans “know their gender as clearly and as consistently as their developmentally equivalent peers,” an extreme exaggeration of what we know about this population. (A single study is cited.) The document also criticizes the “outdated approach in which a child’s gender-diverse assertions are held as ‘possibly true’ until an arbitrary age” — the A.A.P. was instructing clinicians to take 4- and 5-year-olds’ claims about their gender identities as certainly true. It’s understandable why the Cass reviewers scored this policy statement so abysmally, giving it 12 out of 100 possible points on “rigor of development” and six out of 100 on “applicability.”

Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibarium’s reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.

Dr. Julia Mason, a 30-year member of the organization, wrote in The Wall Street Journal, with the Manhattan Institute’s Leor Sapir, that the A.A.P. deferred to activist-clinicians and stonewalled the critics’ demands for a more rigorous approach. Dr. Sarah Palmer, an Indiana-based pediatrician, told me she recently left the A.A.P. after nearly 30 years because of this issue. “I’ve tried to engage and be a member and pay that huge fee every year,” she said. “They just stopped answering any questions.” This is unfortunate given that, as critics have noted, in many cases the A.A.P. document’s footnotes don’t even support the claims being made in the text.

In the face of a lack of studies supporting their preferred ideology, organizations like the American Psychological Association (APA) have waffled, weaseled, and dissimulated, sometimes making contradictory statements.  Here’s one example (the AMA has also changed its stand but wouldn’t give Singal an interview). Bolding is mine:

The A.P.A. presents a particularly striking case of why transparency is important. In 2024 it published what it hailed as a “groundbreaking policy supporting transgender, gender diverse, nonbinary individuals” that was specifically geared at fighting “misinformation” on that subject. But when I reached out to the group this month, it pointed me to a different document, a letter written by the group’s chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.

The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a “comprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatments” for individuals “across the life span.” But in 2025, the group argued that “psychologists do not make broad claims about treatment effectiveness.”

In 2024 the A.P.A. criticized those “mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.” In 2025 it cautioned that gender dysphoria diagnoses could be the result of “trauma-related presentations” rather than a trans identity and that “co-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) … may complicate or be mistaken for gender dysphoria.” It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A. considered to be “misinformation.” (“The 2024 policy statement and the 2025 F.T.C. letter are consistent,” said Ms. McGuire in an email, and “both documents reflect A.P.A.’s consistent commitment to evidence-based psychological care.”)

Behavior like this should anger anyone wedded to evidence-based medicine and science, especially because the APA simply lies when it says that its stand has been consistent all along. And the APA is not alone in its bad behavior.  Other organizations are digging in their heels, maintaining unsupportable positions in the face of counterevidence—all because of the ideology that people can change sex and we should believe them when they say they are really of a different sex than their natal one. This is wedded to the view that surgery and hormones designed to change gender have been proven to be safe.

I should add here that many adults who have transitioned are nevertheless happy with the outcomes of their treatments. But note that Singal’s forthcoming book is about youth gender medicine. This is the focus of the controversy, and few people (certainly not me) would deny adults the right to go ahead with surgery and hormones, though perhaps the public shouldn’t have to pay for it.

Singal’s conclusion, which I hope is the theme of his book, is short and sweet:

Should we trust the science? Sure, in theory — but only when the science in question has earned our trust through transparency and rigor.

  It looks like most medical organizations should not be trusted until they start speaking the truth.

Jesus ‘n’ Mo ‘n’ “woman”

February 20, 2026 • 11:45 am

Here Mo puts on a burqa and asserts that he’s a woman because he feels like one.  Of course this panel is triggering for “progressives,” and, though the strip is six years old and recycled, the artist says this:

A Friday Flashback from almost exactly six years ago. Lost a couple of patrons that day. Let’s see if it happens again.

I suspect it will!