To best answer this question we must identify and distinguish between what defines sex and what determines sex. In the life sciences, sex is defined by how that organism is structured to function during the reproductive act.[1] The primary purpose of the reproductive system is to propagate the species. Among organisms that reproduce sexually (whether plant or animal), the structure of the sexual reproductive system consists of two complementary halves. Sexual reproduction requires the union of exactly two distinct sex cells which arise from exactly two distinct sets of sexual organs to form a new organism. Organisms whose reproductive organs are structured to donate genetic material during the reproductive act are designated male. Organisms whose reproductive organs are structured to receive that genetic material during the reproductive act are called female. This is why sex is a binary trait. In humans, sex is determined at fertilization by sex-determining genes on the sex chromosomes.[2] Every nucleated cell in a person’s body—every organ—has the same sex chromosomes. Thus, no one is born with an ‘opposite-sexed brain’; no one is ‘born in the wrong body’. The sex-determining genes in individuals with XY chromosomes result in the development of male gonads (testes) which produce male sex cells (sperm); sex-determining genes in individuals with XX chromosomes result in the development of female gonads (ovaries) which produce female sex cells (ova). Since drugs and surgeries do not change a person’s genetics, they also do not change a person’s sex. This is why sex is an innate and immutable trait.

No. Intersex conditions are not additional sexes reflecting a spectrum of sex; they are rare disorders in the development of the normal binary reproductive system called Disorders of Sexual Development (DSD). DSD are conditions that fall into one of two categories. One set of DSD includes disorders like congenital adrenal hyperplasia (CAH) which cause infants to be born with ambiguous genitalia. Infants with ambiguous genitalia do not represent a new sex because they do not possess any new reproductive sex cells. Further medical testing will in fact reveal that they are either male or female. A second set of DSD, including but not limited to complete androgen insensitivity syndrome (complete AIS) is associated with unambiguous genitalia, but causes patients’ physical appearance (phenotype) to be inconsistent with what their sex chromosomes (genotype) would predict. For example, due to a genetic abnormality, females with complete AIS are found to have XY chromosomes.[3] Here again, the genetic abnormality fails to produce new functional sex cells; complete AIS is not another sex. Abnormalities, genetic or otherwise, that affect the reproductive system are disorders – not a spectrum of functional human sexes.

In other words, DSD or intersex conditions are medically diagnosable disorders of the body that disrupt the normal development of the binary male/female sexual reproductive system. These disorders may unfold during and/or after the prenatal period. None of these disorders produce new functional sex cells (which is what is required to define a new sex). Instead, all DSD result in deficiencies and/or malformations of the normal male/female reproductive system, and all categories of DSD have been associated with impaired fertility.[4] Although the majority of males and females with DSD can be successfully diagnosed and treated, affected individuals experience varying degrees of suffering. For all of these reasons, intersex conditions are correctly understood and identified as disorders of sex development. Fortunately, DSD are exceedingly rare, occurring in only 0.02% of the general population. 

Don’t people with abnormal combinations of sex chromosomes, such as individuals with Turner’s Syndrome who have an XO karyotype and individuals with Klinefelter’s who have an XXY karyotype, prove there are additional sexes? 

No. To be an additional sex, one must possess a new functional reproductive sex cell (something other than male sperm or female eggs that can result in human offspring). The absence of an X chromosome does not result in these individuals producing new sex cells. Individuals with Turner’s Syndrome are anatomically female as would be expected in the absence of a Y chromosome. Similarly, individuals with Klinefelter’s do not represent an additional sex; they are anatomically male as directed from fertilization by the presence of male sex-determining genes on their Y chromosome. [3]

Prior to the 1950s, the term gender was used almost exclusively in grammar to identify nouns and noun modifiers in romance languages as either masculine or feminine. However, during the 1950’s and without evidence, sexologists, led by Dr. John Money, began using gender to mean “a person’s internal sexed identity” which they argued could differ from one’s biological sex. This new definition was invented to justify their use of maiming surgeries in “transexual” men and in children with ambiguous genitalia who were under their care. There remains no evidence of any such inborn and unchangeable “internal sexed identity.”[5] The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) acknowledges that a person’s perceived gender (or gender identity) is not solely determined by biology, but is also significantly influenced by psycho-social and cultural factors.[6] The reason for an ever growing list of possible genders (cis; trans; agender; non-binary; two-spirit; incels; etcetera) in Western Culture generally, is due to queer theory separating Western culture’s understanding of gender from biological sex, and instead linking gender to any imaginable sexual identity.[5]

A healthy gender identity is an awareness of and psychological comfort with being either biologically male or biologically female. When one is aware of one’s sex and emotionally distressed by that reality, one meets the definition of gender dysphoria in the Diagnostic and Statistical Manual 5th edition.[6] Gender identity is not a trait determined by genes or biology alone. Gender identity requires an awareness of oneself as male or female. While it may be influenced by one’s biology, gender identity is not solely determined by biology. It is heavily influenced by psychological and cultural factors. No one is born with a gender identity because no one is born with an awareness of being male or female. This awareness develops over time as a result of the interaction of many factors. Like all developmental processes, gender identity formation may be derailed by children’s subjective perceptions, relationships, and adverse childhood experiences from infancy forward. People who identify as “the opposite sex” or “somewhere in between” do not become what they believe, regardless of how persistently and consistently they insist upon it, nor do they comprise an alternative sex. Objectively, they remain for life either males or females as determined by their sex-determining genes at fertilization.

Gender dysphoria is a condition described in the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5); gender incongruence is the same condition as classified by the World Health Organization in 2019. Both refer to the situation in which an otherwise healthy boy believes he is a girl, or an otherwise healthy girl believes she is a boy. This “disconnect” between the objective reality of the child’s body and the child’s subjective self-perception is accompanied by feelings of emotional distress and often interferes with social functioning.[6] Modern psychology and medicine, having embraced a gender ideology, do not view the patient’s disconnect with physical reality as the disorder, however. Rather, they see the emotional distress and impaired social functioning as the disorder, which gender ideology claims must be treated by socially and/or medically altering the body. This is despite the fact that modern medicine and psychology do not embrace a similar approach to treat other conditions in which there is a disconnect between body and mind. For example, modern medicine and psychology do not “ socially and medically affirm” patients with anorexia nervosa, body integrity identity disorder or body dysmorphia. 

No. This is medically impossible. A child’s sex is determined by sex-determining genes at fertilization. From that point forward, every nucleated cell of the body has the same genetic sex. No one’s brain has a different sex from any other organ or nucleated cell in the body.[7] 

Boys who prefer art and playing house to rough and tumble play do not have a “female brain” trapped in a male body; they are boys who have a personality that prefers stereotypically female activities. This does not alter their sex, but may affect their self-perception and identity formation. Similarly, girls who prefer stereotypically male activities, or girls on the autism spectrum with extreme male thought patterns like literalistic concrete thinking, remain fully female. However, they may feel more comfortable around boys.

But, haven’t MRI brain studies shown that trans people have opposite-sexed brains?

No. The claim that people with transgender belief have opposite-sexed brains arises from the misinterpretation of flawed brain studies. A study by Rametti and colleagues found that the white matter microstructure of the brains of female-to-male (FtM) transsexual adults, who had not begun testosterone treatment, more closely resembled that of men than that of women. Other diffusion-weighted MRI studies have concluded that the white matter microstructure in both FtM and male-to-female (MtF) transsexuals falls halfway between that of genetic females and males. These and more recent studies, however, fail to prove causation due to several design flaws. A properly designed brain difference study needs to be prospective and longitudinal; it would require a large randomly selected population-based sample of a fixed set of individuals, would follow them with serial brain imaging from infancy through adulthood, and would have to be replicated. Not one brain study to date meets a single one of these requirements to be considered rigorous research design. Even if they did, causation would not be certain due to neuroplasticity. Neuroplasticity is the well-established phenomenon in which thinking and behavior alters brain microstructure. There is no evidence that people are born with brain microstructures that are forever unalterable, but there is significant evidence that experience changes brain microstructure.Therefore, if scientifically rigorous studies ever do repeatedly identify consistently similar transgender brain differences, these differences will most likely be the result of transgender belief and behavior rather than its cause.[8]

The best research to date reveals gender dysphoria arises from the interaction of many factors from among three categories. These categories include a person’s biological vulnerability (e.g.: certain personality traits, autism/other neurologic difference, mental illness), plus one or more of a person’s environmental factors (e.g: childhood traumas, parent mental illness), plus individual free will choices (e.g. joining LGBT student groups, binging on social media).[8] For example, two large studies found that the vast majority of  self-identified transgender youth experienced on average five childhood traumas and/or suffered from mental illness, sometimes including suicidal thoughts, before developing signs of gender dysphoria or expressing transgender belief. [9, 10] Since the traumas, mental illness and suicidal thoughts occurred prior to any sign of gender dysphoria or transgender identification for the majority of youth, one cannot conclude that the mental illness and suicidal ideation among transgender identified youth  is due to lack of social acceptance or lack of “gender-affirming care”.

“Gender-affirming care” is a misnomer as it refers to encouraging children with gender incongruence to socially, medically and surgically impersonate the opposite sex. Social transition consists of name and pronoun changes, cross-dressing and the like. Medical impersonation involves the use of puberty blocking drugs and cross-sex hormones. Surgical impersonation involves the use of cosmetic surgeries that maim children’s healthy bodies including, but not limited to, double mastectomies and hysterectomies for girls, and castration and so called vaginoplasties for boys. [8]

No. The American Psychological Association has stated that routine social transition “runs the risk of neglecting individual problems the child might be experiencing and may involve an early gender role transition that might be challenging to reverse if cross-gender feelings do not persist…”[11] It has also been pointed out that “social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery).” [12] In addition, a 2020 study by Dr. Walter Schumm re-analyzed the full dataset of a team of trans-affirming pediatric researchers and found that, contrary to the authors’ published findings, the youth affirmed as “trans” by their parents actually had greater anxiety and lower self-esteem than age-matched peers.[i] Finally, as described below, youth who are socially affirmed as “transgender” are more likely to assent to puberty blockers and sex-impersonating hormones as young as 8 to 13 years of age, placing themselves at risk for permanent sterility and other serious diseases described below.

“Conversion therapy” is a derogatory term that refers to talk therapy that seeks to help those unhappy with their same-sex attractions and/or gender incongruence. Conversion therapy most often conjures up images of tortuous forms of behavior modification such as electroshock and ice baths that were abandoned by the 1970s. This derogatory term was invented by lay and professional activists opposed to therapy choice for patients unhappy with their same-sex attractions and gender incongruence. For more information visit the National Task Force for Therapy Equality.

Gender exploratory therapy recognizes that gender identity has been documented to change across the lifespan. For example, there are at least 16 case series reports to document the alignment of gender identity with sex among adolescents and adults in the psychiatric literature. Gender exploratory therapy rejects gender ideology and embraces science plus the medical ethics principle of “first do no harm”. When a child presents with gender dysphoria and/or transgender identification gender exploratory health professionals will help explore and treat possible underlying causes of the child’s gender incongruence. For more information visit the Gender Exploratory Therapy Association.

Everyone can come to understand that disrupting normal puberty is objectively harmful because puberty is not a disease. Puberty is a normal and critical time-limited period of healthy physical, cognitive, emotional and social development. Diseases, like precocious puberty, endometriosis and prostate cancer, in contrast, disrupt normal development, function and health. The proper use of medication restores normal health, function and development. In the context of the above mentioned diseases, the potential for Lupron to restore and/or improve patient health usually outweighs Lupron’s potential negative side effects (which are still disclosed to patients as a matter of informed consent). This is not the case with gender dysphoric children. Children with gender dysphoria are physically healthy. They do not have a disease of the body; they are emotionally and psychologically distressed. Prescribing puberty blockers to these children permanently disrupts their physical, cognitive, emotional and social development. This disruption causes a loss that is permanent because no one can return the time they have lost in normal pubertal development should they wish to desist; that amount of normal pubertal development – be it several months or several years – is permanently stolen from them. This matters because prior to the routine use of puberty blockers, the vast majority of youth desisted from their gender dysphoria and identified with their sex by young adulthood.[14] With the routine use of puberty blockers, the vast majority of gender dysphoric children instead go on to identify as transgender, use dangerous cross-sex hormones, and many even pursue cross-sex surgeries.[15-19] Clearly, blocking normal puberty in these physically healthy but emotionally suffering children robs them of the developmental period during which many might otherwise outgrow their dysphoria and embrace their bodies. 

Gender dysphoric children put on Lupron are also exposed to the following side-effects listed on the package insert: emotional lability, worsening of current psychological illness or new onset psychological illness, and the rare side-effect of Pseudotumor cerebri (brain swelling). In addition to these, Drs. Laidlaw and colleagues have cited evidence of low bone density and sexual dysfunction among gender dysphoric youth on puberty blockers. [20] Finally, since sex hormones normally secreted during puberty are responsible for the organizational development of the brain, and Lupron blocks this normal secretion, it is possible that gender dysphoric youth could be cognitively impaired.[21] Lupron is already known to impair memory in adults taking it to treat certain gynecological conditions, breast cancer and prostate cancer. [22]

Yes, under the following conditions:  Children placed on puberty blockers prior to developing mature sperm or eggs, and then prescribed cross-sex hormones, will be permanently sterilized. Without any sperm or eggs to harvest and preserve, they will never be able to conceive genetically related children, even with artificial reproductive technology. [20]

Testosterone use in females and estrogen use in males are associated with dangerous health risks across the lifespan including but not limited to cardiovascular disease, high blood pressure, heart attacks, blood clots, stroke, diabetes, and cancer. [20]

All surgeries carry a risk of excessive bleeding, infection and even death. Transgender surgeries do not restore function or cure disease. Instead, every transgender surgery is disfiguring, maims healthy tissue and/or destroys healthy organs. They are therefore all objectively harmful, and no surgeon dedicated to the medical ethics principle of “first do no harm” will perform them. Three minute video testimony of parent Scott Newgent.

Girls with gender dysphoria often compress their breast tissue with commercially sold binders, elastic bandages, duct tape or even saran wrap in order to appear masculine. According to surveys, common negative effects include restricted breathing, chest pain, skin irritation, overheating and skin infections.[23]

Tucking refers to a practice in males with gender dysphoria of either wearing confining underwear that diminishes the contour of the penis and scrotal contents, or the pushing of the testes back up into the inguinal canal on each side.  In either circumstance, the testes experience heat-induced damage which significantly drops the quantity and quality of sperm, thereby aiding and abetting infertility.[24]

No. First, suicide risk among trans-identifying youth is similar to the elevated risk rates among other at-risk youth. Based upon data from the United Kingdom’s Tavistok Gender Identity Clinic, Oxford sociologist, Dr. Michael Biggs, has reported that being trans-identified increases suicide risk by a factor of 13. He notes that this elevated risk, while concerning, is less than or within range of the suicide risk associated with other disorders: anorexia increases suicide risk by a factor of 18; depression multiplies one’s risk by a factor of 20, and autism raises suicide risk by a factor of 8. Anorexia, depression and autism also often coincide with gender dysphoria. 

Although individuals may experience a “honeymoon period” of relief and happiness with their cosmetic results from drugs and surgeries, these interventions do not improve mental health in the long run. A thirty year study of a large population of transgender-identified adults who used hormones and surgeries to impersonate the opposite sex (in LGBT-affirming Sweden) found that their mental health was significantly worse than that of the general population ten years after surgery and by the conclusion of the study, their completed suicide rate was 19 times greater than that of the general population. [25] A comprehensive and scientifically referenced discussion of gender dysphoria and suicide is found in this booklet.

  1. All people are “assigned a sex” at birth based on the appearance of genitalia.
  2. Some people are born in the wrong body with an opposite-sexed brain.
  3. Thus, people’s self-professed gender identity overrides biological markers of sex in  determining whether they are male or female or “something in between”.
  4. Intersex conditions prove that sex is a spectrum and that the sexual binary is a social construct.
  5. Since the sex binary is a social construct, there are no significant differences between males and females; e.g.: “Transwomen are women.”
  6. Children and adults can safely and effectively be transformed into a different sex along the spectrum through social affirmation, prescription drugs, and surgeries.

ENDNOTES

[1] McHugh PR and Meyer LS. Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences. The New Atlantis; No.50, Fall 2016, p90. Available at http://thenewatlantis.com/wp-content/uploads/legacy-pdfs/20160819_TNA50SexualityandGender.pdf  Accessed September 1, 2023.

[2] Wilhelm D, Palmer S, Koopman P. Sex Determination and Gonadal Development in Mammals. Physiological Reviews. American Physiological Society. 2007;87(1). Available at  https://journals.physiology.org/doi/full/10.1152/physrev.00009.2006.  Accessed September 1, 2023.

[3] Sax L. How Common is Intersex? A response to Anne Fausto-Sterling. J. Sex Res. 2002 Aug;39(3):174-8. doi: 10.1080/00224490209552139. PMID: 12476264. Available at https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/ Accessed September 1, 2023.

[4] Slowikowska-Hilczer J, Hirschberg AL, Claahsen-van der Grinten H, Reisch N, Bouvattier C, Thyen U, et al. dsd-LIFE Group. Fertility outcome and information on fertility issues in individuals with different forms of disorders of sex development: Findings from the dsd-LIFE study. Fertility and Sterility, 108. 822-831. Available at https://www.fertstert.org/article/S0015-0282(17)31708-9/fulltext Accessed September 1, 2023.

[5] Jeffreys S. Gender Hurts: A Feminist Analysis of the Politics of Transgenderism. Taylor Francis Publishing; 2014.

[6] Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013.

[7]Institute of Medicine (US) Committee on Understanding the Biology of Sex and Gender Differences; Wizemann TM, Pardue ML, editors. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington (DC): National Academies Press (US); 2001. 2, Every Cell Has a Sex. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222291/

[8] Cretella M. Gender Dysphoria. A Position Statement of the American College of Pediatricians published 2016. Available at https://acpeds.org/position-statements/gender-dysphoria-in-children Accessed September 1, 2023.

[9] Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR. Attachment Patterns in Children and Adolescents With Gender Dysphoria. Front Psychol. 2021 Jan 12;11:582688. doi: 10.3389/fpsyg.2020.582688. PMID: 33510668; PMCID: PMC7835132.

[10] Becerra-Culqui TA, Liu Y, Nash R. et al. Mental Health of Transgender and Gender Nonconforming Youth Compared with Their Peers. Pediatrics. 2018;141(5).

[11] W. Bockting, Ch. 24: Transgender Identity Development, in 1 American Psychological Association Handbook on Sexuality and Psychology, 750 (D. Tolman & L. Diamond eds., 2014).

[12] Zucker, K.  Debate: Different strokes for different folks. Child and Adolescent Mental Health. Accepted for publication: 18 March 2019

[13] Schumm W and Crawford DW. Is Research on Transgender Children What It Seems? Comments on Recent Research on Transgender Children with High Levels of Parental Support. Linacre Quarterly(87;1), February 2020, (pp.9-24). Available at https://journals.sagepub.com/doi/epub/10.1177/0024363919884799

[14] Kenneth J. Zucker (2018) The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism, 19:2, 231-245, DOI: 10.1080/15532739.2018.1468293

[15] Brik T, Vrouenraets LJJJ, de Vries MC, Hannema SE. Trajectories of adolescents treated with gonadotropinreleasing hormone analogues for gender dysphoria [published online ahead of print March 9, 2020]. Arch Sex Behav. doi:10.1007/s10508-020-01660-8

[16]  Kuper LE, Stewart S, Preston S, Lau M, Lopez X. Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics. 2020;145(4):e20193006

[17] Annelou L.C. de Vries, et al., “Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study” The Journal of Sexual Medicine 8(8): 2276–2283 (2011).

[18] Wiepjes CM, Nota NM, de Blok CJM, et al. The Amsterdam cohort of gender dysphoria study (1972-2015): trends in prevalence, treatment, and regrets. J Sex Med. 2018;15(4):582–590

[19] Carmichael P,  Butler G, et al. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. medRxiv 2020.12.01.20241653.

[20] Laidlaw M, Van Meter QL, Hruz PW, Van Mol A and Malone WJ. The Journal of Clinical Endocrinology & Metabolism, 2019;104(3): 686–687, https://doi.org/10.1210/jc.2018-01925

[21] Vigil P, et al., “Endocrine Modulation of the Adolescent Brain: A Review” Journal of Pediatric & Adolescent Gynecology 24(6):330-337 (December 2011).

[22] Craig MC, Fletcher PC, Daly EM, Rymer J, et al. Gonadotropin hormone releasing hormone agonists alter prefrontal function during verbal encoding in young women. Psychoneuroendocrinology. 2007;32(8-10):1116-27. DOI:10.1016/j.psyneuen.2007.09.009

[23] Peitzmeier S, Gardner I, Weinand J, Corbet A and Acevedo K,  Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study,Culture, Health & Sexuality, 2017 VOl. 19, NO. 1, 64–75 http://dx.doi.org/10.1080/13691058.2016.1191675

[24] de Nie I, Asseler J, Voorn-de Warem IAC, Kostelijk EH, den Heijer M, Huirne J, van Mello NM. A cohort study on factors impairing semen quality in transgender women, Am J Obstet Gynecol 2022 206 390.e1.pdf

[25] Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Langstrom N, et al. (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. doi:10.1371/journal.pone.0016885.  Available at https://pubmed.ncbi.nlm.nih.gov/21364939/ Accessed September 1, 2023.

For information that is referenced to the scientific literature about sex differences see Sex is a Biological Trait of Medical Significance.