The culture war has opened a new battle. The rights of trans people are front and center. There were grumblings and small pre-battles before (a bathroom controversy that I wrote about in 2016), but things have gotten more contentious now. Indeed, in talking to a friend recently, it made me think that outside of my liberal bubble, there are Americans who are genuinely terrified about the direction of the country because of some misguided view of gender-affirming care (and what it is) and because of men participating in women’s sports. I have so many thoughts. Enough of them that I turned back to this old outlet for them, an outlet I haven’t used much recently.

I want to start by making it clear that I am not an expert on the neurobiology of gender, but I do have some expertise in the neurobiology of sex differences. Gender is associated with sex, but it is not the only thing. I do have a view of the world that some things are most commonly binary when it comes to sex. Genitalia are almost always recognizably male or female. The gonad is generally in the form of an ovary or testis. Cells either have a Y chromosome or they don’t. Cut and dry. But even these things that were clearly binary in our view decades ago, are now recognized to be capable of falling somewhere in between. Genitalia can fall somewhere in between male and female. Enlarged phallic clitorises exist. Ovotestis, when the gonad is partially testis and partially ovary, is a real thing. It’s not common, but it’s possible and does happen if the right genetic code is present. And, of course, we now have documented examples of individuals who have some cells with two X chromosomes (traditionally female) and some cells that have an X and a Y chromosome. Again, this isn’t common, but individuals with this (likely arising from absorbing a twin in the womb) have “male” cells and “female” cells. These cases can fairly be called abnormalities or even disorders, but it still allows for the thought exercise of how categorizing a whole individual into “male” or “female” doesn’t take into account all the different parts that can (sometimes not so easily) be categorized in isolation.

It’s not hard for me, with expertise on the biology of sex in mammals, to imagine that gender is just one of these things that can be male-like or female-like, and it’s easy for me to imagine that gender isn’t even one thing. There are so many parts of humans that are part of gender. How do we feel? What do we ‘see’ when we imagine ourselves? What clothing or social norms do we feel most comfortable following? What toys do we like to play with? Who are we better being friends with and getting close to? All of these things can be recognized as being part of gender in humans, and anybody who thinks about it for a minute should have no trouble imagining that all the parts that go into the whole might not be the same. Is a person who finds high heels really uncomfortable less female than a person who feels at home wearing them? What about makeup? Is a person who feels more comfortable with makeup on more female than a person who hates wearing makeup? Notice that I was careful to not include the sex/gender assignment there. Is the answer different if we do that? Is a man who feels at home wearing high heels more female than a woman who finds high heels very uncomfortable? Is a woman who hates wearing makeup less female than a man who feels like his real self when he applies eyeliner and lipstick? What about a person who hates makeup but loves to wear a dress? Is that a mix of male and female? One may argue that these aren’t as extreme as a person who was born a man but now wants to be treated as if s/he were a woman, but that ignores the lesson: that this is not as simple as our society has treated it in our past.

The lack of simplicity is uncomfortable for some. Simplicity is often easier to digest. I get that. But here I turn to something that I wrote a while ago that I revisited today (and found and fixed a broken image, which was satisfying). Feel free to follow the link, but the short version is that we have no problem recognizing all different categories of things in the world. Often when we start, we only see black and white, but it’s not hard to see and accept lots of shades between.

Based on everything I wrote above, one might walk away with the impression that I think it’s all simple. But that’s not true. I do think there are complicated issues that we, as a society, need to deal with. Most of them are self-imposed. We wouldn’t have these issues if our society didn’t have such segregation of men and women. Some of that segregation is helpful, but some is just the way we’ve been, almost arbitrarily. Yes, urinals are convenient for men, but a bathroom with a urinal and a toilet could easily be used by men and women. We separate them because that’s what we do. We keep things separate, even when they don’t have to be. Sure, some of that is safety and how safe/unsafe we might feel. But I suspect that’s also socialized. Little kids don’t care about using the same bathroom. Little boys go into women’s rooms all the time with their moms and little girls use men’s rooms with their dads. That’s not strange or frowned upon at all. I imagine that if we never separated them, it would feel pretty normal to have them combined. But, they are separate now, and joining them on a mass scale probably isn’t going to happen anytime soon, although there is some of that happening.

There are, however, at least two things that I, personally, think are incredibly complicated, and that are being unfortunately politicized: gender-affirming care and sports. Most of what bothers me here is the apparent inability to have important conversations without straw men taking over. We should be able to discuss gender-affirming care without being accused by one side of wanting to mutilate the genitals of a baby or being accused by the other side of not caring that people’s lives are at stake. It’s fair to put the brakes on a bit when talking about things. That’s not to say that I don’t recognize that lives are at stake or that there are people who want to perform surgery on young children, but I think we should be able to approach these things rationally (keeping with the whole Spock-like goal of Hitting Bregma).

Let’s start with gender-affirming care, because other than thinking we need to be cautious about making permanent changes to the bodies of prepubescent children (something we’re really not doing), I largely defer to experts and think a piece in Scientific American does a great job of covering it. I would very much like every non-expert (and even some experts) with a view on gender-affirming care to give it a read. A key point that’s worth reiterating here is that the current guidelines are that neither surgery nor gender-affirming hormones are to be used on children under 16. Puberty blockers can be used earlier to give more time for somebody to make a decision about their gender. Those seem like reasonable guidelines to me, and I suspect they’d seem reasonable to most people who took the time to learn about them. They are hardly advocating child mutilation like some members of Congress have called them.

On sports. So complicated. Part of me says that I just don’t care and that maybe we shouldn’t have separated boys and girls sports so early in age like we do. Another part of me recognizes that there are distinct anatomical differences that need to be acknowledged and that separating boys and girls sports allows girls to excel in sports in ways that they couldn’t (in some sports) before efforts like Title IX. As an aside, it’s interesting to me that the fight against transgender rights has turned some people into Title IX advocates (not that they would admit that, but they inadvertently voice support for the things that Title IX was intended to support). Also, it’s not just about having people feel empowered, but it’s also a career for some, and a potential career for others. I think the most compelling example is in fighting sports (e.g., boxing or mixed-martial arts). There is a large financial incentive for a man to claim (dishonestly) to be a women in order to compete with women and use his advantage to make a career that he wouldn’t be able to have if competing with men. That seems wrong. Until there’s some biological marker of gender, however, I feel strongly that we should respect the gender that an individual claims to be. But maybe gender isn’t what we care about with sports. Maybe gender is just one thing amongst many that we care about. We can’t say that we care about having an advantage, because that’s what makes elite athletes elite. What about hormone levels? We have weight groups for some sports (e.g., boxing). Maybe we should have androgen classes. Instead of just having a lightweight division in boxing, we should have high, medium, and low androgen divisions of lightweight and allow men and women to compete in any that they can make. Just like a fighter tries to make weight through diet/exercise/fasting/dehydration, drugs could be used to lower testosterone to make a level for a division. There are already athletic organizations that require testosterone-lowering treatment in order to compete in women’s divisions. Make this universal and open to men and women, maybe. Or, even better, what about some kind of a point system. Each athlete is given a set of points for some pre-defined measures. Have a Y chromosome, there’s a point. Have testosterone over a certain level, there’s a point. Have some other measure that’s particularly male or female, there’s a point. Leave gender out of it completely, or include it as a point. I really don’t know the answer, but I do know one thing. The last people I want making those rules are Marjorie Taylor Greene or Ron DeSantis. Let’s at least have thoughtful reasonable (and kind) people putting thought into this. That would be great.