Sex, gender and medical science

In medicine, we study the similarities and differences in health outcomes in men and women. For example, coronary artery disease is two to four fold higher in men than in premenopausal women.

In the past the terms sex and gender were used interchangeably. This is no longer true. Therefore, what do we mean by sex and gender?

The Institute of Medicine (IOM) is an independent, nonprofit organization that works to provide unbiased and authoritative advice to decision makers and the public on medical issues. In 2001, the IOM studied the issues of whether it was important to study the differences in health outcomes as a function of the biology of men and women.

The IOM concluded there was more than sufficient evidence that, “beyond reproductive biology, there were major differences in the biology of women and men that greatly affected their health and influenced treatment and prevention strategies.”

Further, the IOM emphasized that the health outcomes of women and men are not simply the product of biology. The sociocultural and psychological experience of men and women also influences their health. To differentiate between these areas of investigation, they developed working definitions of “sex” (when referring to biology) and “gender” (when referring to self-representation influenced by social, cultural, and personal experience).

Sex is defined as male or female, according to the reproductive organs and functions that derive from the chromosomal complement [generally XX for female and XY for male].

Gender should be used to refer to a person’s self-representation as male or female, or how that person is responded to by social institutions based on the individual’s gender presentation.

While other combination of sex chromosomes exist, (e.g. Turner’s syndrome in women XO and Klinefelter’s syndrome in men, XXY) these do not represent variations on a spectrum of chromosomal sex. Instead, they represent unfortunate genetic abnormalities with adverse health consequences.

In addition, there are children born with abnormalities in the development of their sex organs. Their genitals are not fully male or female. The rate of sexual organ ambiguity is 0.018%. The ambiguity is a result of a disease state or medication exposure in the womb and are not part of a spectrum of biologic sex.

In addition, an individual’s internal sense of gender may be the same as their biological sex (cisgender), different from their biological sex (transgender) or neither female nor male (nonbinary). Finally, these terms are separate from an individual’s sexual orientation.

The issue of sex and gender is roiling in our society. We have individuals of male sex competing against individuals of female sex because sports participation is based on gender and not sex. The recent Supreme Court appointee demurred that she was not a biologist and therefore could not define what a woman was.

In medicine sex matters. Risk of diseases, response to treatments and outcomes of treatments are different between males and females. We must be respectful of transgender individuals. However, we must also treat them based on their biology and not their self-identification.