Sex is not binary. Gender is not binary.

by Juno Obedin-Maliver, MD, MPH, MAS, Co-Director, The PRIDE Study 
Co-Investigator, PRIDEnet

Astounded. Terrified. That’s how I’m feeling right now — as a doctor, as a researcher, and as a queer person — while our government threatens to erase the existence and experience of transgender and gender expansive people.

This is not a fringe issue. This is a deliberate move to define personhood in a very particular way. A straight, white, male cisgender-dominated, republican, wealthy, colonial way.

News flash: Sex is not binary. (There are more than two sexes). Gender is not binary. (There are more than two genders). And sex and gender don’t always match. In short, some men have vaginas. Some women have penises. And some people have both.

Today I worked on three projects: one about challenges to abortion and contraception for trans masculine and gender expansive people, one about family-building and fertility preservation for transgender people, and another about contraception and abortion for sexual minority women, especially lesbian and bisexual women. What all of these projects have in common is that they arise from the understanding that health care is WORSE when we don’t acknowledge ALL of who people are.

That includes recognizing people’s gender as potentially different from their sex assigned at birth. And, recognizing that there are more than two genders. When our laws define sex as either male or female, and gender as either woman or man, real people receive worse care, avoid care, or are harmed in the process of getting health care. Legislating the fallacy of binary sex won’t make things better for anyone. In fact, there is tons of evidence that denying the existence of transgender people and their health care needs and resiliencies leads to worse health care. And, that when we provide services needed to transgender people, life is better and participation in civic activities is easier (like getting a job, getting a driver’s license, having health insurance, and going to school, etc).

When this country is unsafe for anyone — specifically immigrants, people of color, and now, this added blow for transgender people (and especially folks who live in all of these domains at the same time) — it is unsafe for us all. We are all hurt by narrowed definitions of humanity that only seek to limit the possibilities of life. We are all diminished when some among us are rendered invisible, cloaking the true diversity of nature and humanity.

We must all fight now because our lives depend on it. Even if you are not LGBTQ or trans specifically, we must fight. Now.

This fight must be waged beyond the ballot box. Speak out. Write op-eds. Talk to friends and families. Tell people about the lives of trans folks and how this move flies in the face of science and what is supported in medicine. Do what you can in your jobs and in your free time. Support trans run programs, projects, and businesses with time, money, and visibility. Hold people accountable to being trans inclusive and supportive. Teach your kids not to assume gender or ascribe gendered activities to people. (And while you’re at it, teach yourself to do the same…. it can be tough to unlearn that life is more than either/or, but it’s not hard to understand if you simply respect people as who they are, and listen and love people.)

For the 1.5 million trans people in the US (at minimum), I will keep fighting every day to make sure your lives are recognized, respected, and that we make medicine and health care a better place for you all and all of us in the process. I hope you’ll join me.