This entire piece is fascinating, but this paragraph in particular jumped out at me, especially given US v. Skrmetti, which is very much on my mind at the moment: "If trans activists had not sued red states for protecting minors from gender medicine, I think it’s unlikely the AGs would now be investigating the AAP. After all, the AAP’s recommendations about puberty blockers would be null and void in their states thanks to the bans."
Unrelated to this specific article, but this adult human male read your amicus brief in Skrmetti last night. I found it to be the most succinct and eloquent argument I have ever seen for how the incoherence of transgender as a defined class harms women and girls. Anyone here who hasn't read it should. It's downloadable for free and an accessible read even to people like me with no legal background. Bravo.
However, I kinda think that much of your effort is vitiated by some rather unscientific conceptions of both sex and gender. You may wish to consider, at least as a starting point, a rather cogent and quite illuminating analogy from the late great US Justice Anton Scalia:
Scalia: "Throughout this opinion, I shall refer to the issue as sex discrimination rather than (as the Court does) gender discrimination. The word 'gender' has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes."
No doubt there are, as you and WDI are arguing, a great many "regressive sexist stereotypes" that come in under the rubric of "gender". Though, analogously, one might say the same about "race" -- no doubt a bunch of "regressive racist stereotypes", but that doesn't mean races are not a useful set of categories.
Likewise with gender -- a great many personality and behavioural differences between men and women -- "gender" writ large --though they tend not to be unique to either sex. How we can talk about "gender-nonconformance", about masculine women and feminine men.
"sex" and "gender" are two entirely different kettles of fish -- losing sight of that causes no end of problems.
I'm going to stitch a few quotations together to make a point. The first two are taken from this piece.
"Since October 2018, the influential American Academy of Pediatrics has advised that sex is assigned at birth, people are attracted to gender (not sex), and young children 'know their gender.' It 'recommends' that kids who say they’re trans receive 'gender-affirming' interventions; that medical records 'respect' gender identity (by stating the wrong sex?); and that pediatricians agitate for trans political goals."
The AGs have asked the AAP to:
“Explain efforts by the AAP to incorporate its recommendations (including the 2018 AAP policy statement) into patient care by any doctors or medical providers, including through ‘smart phrases’ or other systems that automatically incorporate medical standards.”
The final quotation requires some explanation. I recently discovered that my medical records at two of my health care organizations give my "sex assigned at birth" and my "gender identity." I objected.
To say my sex was assigned at birth is neither factually nor scientifically correct. When I was born almost 70 years ago in South America, the notion that sex is assigned at birth in the Queer sense of the term had yet to be summoned from the void by Queer Theory philosophers. I'm trapped in an anachronism. Scientifically speaking, my sex was determined biologically at conception and, since my physiology is not ambiguous, observed and recorded by the physician who delivered me.
As for gender identity, I explained that I do not have one. I do not "identify as" a male. I AM male.
Lastly, I said that sex assigned at birth and gender identity are rooted in philosophy and activism, not science, and have no place in medicine.
I asked that the organizations correct the errors in my medical records.
That brings me to the reply I received a while ago from the manager of compliance, risk and quality for one of the organizations:
"Thank you for bringing your concerns to our attention. The sex assigned at birth and gender identity fields are fixed fields in the medical record. Thus, the information cannot be removed. However, you are welcome to select the "Choose not to disclose" option if you do not wish to select an answer. Sex assigned at birth is the recognized nomenclature in health care. This is also the nomenclature used by the CDC. As you mentioned, the sex that is assigned by a medical provider is based on the genitalia (and in certain cases other factors) observed at birth."
"We appreciate your feedback regarding gender identity, but as an organization that is proud to serve a diverse population of patients, we believe that it is important to give all patients the opportunity to express their identity and have that identity acknowledged. Please feel free to select the "Choose not to disclose" option if you do not wish to provide an answer for the gender identity field."
The positions she expresses clearly reflect efforts on the part of an unknown actor to incorporate its multifaceted positions on gender into patient care. Was it the AAP? The identity of the activist doesn't matter as much as the fact that those pernicious concepts have metastasized and become lodged in nooks and crannies throughout the American health care system.
Neither of the suggested solutions is satisfactory.
The last thing I want to do is create potentially dangerous uncertainty in my medical record about something as basic and vital as my biological sex by opting for "Choose not to Disclose."
With respect to the “Gender Identity” box, selecting "Choose not to Disclose" would be no improvement. I would still be conceding that I have a gender identity. The point is that I do not.
The only satisfactory option is to let me select “none” under the gender identity heading. Otherwise it would be like asking for a patient’s religion and not allowing patients to select “none.” (The clinic does give patients the option of choosing "None" in the religion category. ) Since gender ideology is more like a religion than a science, the very least The Portland Clinic could do is give me the same choice with respect to gender identity.
I have been wrestling with how to characterize the compliance manager's rhetoric. It was only when I read a recent essay by the British author and cultural writer Helen Pluckrose that I found a passage that describes it perfectly. The health care organizations are:
"conflating sexuality with gender and gender with sex, “educating' everybody in their own theories, policing language, making people affirm things they don’t believe and trying to shoehorn issues of sexuality and gender into absolutely everything even when it has no relevance at all."[1]
Alone, I stand no chance of purging the genderist terminology that has embedded itself in my medical records and those of the organizations' other patients. It's indisputable that it needs to go. Since the errors reside in the same third-party provider's patient interface (MyChart), they are systemic and very likely affect patients in many states. Maybe I should drop the Idaho AG a line.
In closing, in addition to having been general counsel for financial services business before I retired, I have also been a compliance manager and a compliance officer. Among other things, I practiced preventive consumer law. The health care organization's response makes me grateful that when I was in the compliance field I never had to be an advocate for unscientific concepts or thwart a customer's reasonable request with specious arguments. I do not know whether either of the organizations have a gender medicine practice. I do know that I would have many sleepless nights if I were the risk manager for a trans chop shop.
> "To say my sex was assigned at birth is neither factually nor scientifically correct."
Nope, sorry. Technically and scientifically speaking, we don't ACQUIRE a sex until the onset of puberty and can subsequently lose it thereafter as a result of the vicissitudes of life, misadventures, or medical malpractices. You might take a gander at my Note and comment here:
Steersman: "... the AAP has something of a point that sexes are 'assigned at birth'. By standard biological definitions for the sexes, to have a sex is to have functional gonads of either of two types, those with neither being, ipso facto, sexless. Technically speaking, we don't acquire a sex until the onset of puberty, though it's a pretty solid bet -- 49 to 1 -- that the vagina-havers turn out to be females and that the penis-havers turn out to be males. Birth certificate ems and efs are just markers of potential or probable sexes, not current statements of fact."
On those biological definitions you might also take a gander at my open letter to the erstwhile reputable biological journal "Cell" which had asked, apparently in all seriousness, "Is 'sex' a useful category?":
Abandoning the field unbloodied? Apprehensive about "offending" the many on the distaff side who, rather like too many transloonie nutcases, have turned the sexes into "immutable identities 🙄" based on some "mythic essences 🙄"? 😉🙂
Kind of the crux of the matter -- how to define the sexes in law, social policy, and biology. Y'all might have some interest in this article on the topic:
"The Kansas law legally defines a woman as someone whose reproductive system is designed to produce ova, and a man as someone whose reproductive systems are designed to fertilize ova."
Some somewhat inaccurate statements there, but I can sympathize with the efforts. Although that quote raises some thorny questions, notably how to determine that design -- Genesis perhaps? -- and what to do about the intersex who are clearly not designed to produce either sperm or ova.
Though some benefits in defining "woman" absent a direct connection to "female" as doing so raises the question of defining that term. But to obviate those difficulties, that is why I've suggested defining "woman" as "adult human with ovaries of past, present or future functionality" -- ovaries being the sine qua non for "female".
But more problematic are those States which are trying to define the sexes in law, particularly where they conflict profoundly, as they do, with those standard biological definitions.
Think I did "reply to your queries" -- several times in fact. Don't think you're listening or want to face the facts -- you, and others here, may wish to review our conversation:
In particular, y'all might note the many reputable biologists who agree with my "strange claim 🙄".
As for your "induces puberty", I thought, and think, that that is very badly phrased at best. I know you're not a big fan of definitions but you might try thinking about this one from Google/OxfordLanguage:
"puberty: the period during which adolescents reach sexual maturity and become capable of reproduction."
Kids "become capable of reproduction" -- i.e., have or acquire a sex -- at that point because their gonads become fully functional, because they're then able to produce gametes that can actually be used in the process of reproduction.
The Policy Statement does concede in a footnote that “reversibility is based on the little data that are currently available.” I don’t that’s enough to save the AAP. In fact, it shows the AAP knows its claim is shaky — a fact that can lead to higher penalties.
Superbly written, I’d read any book you published - clear, lucid and the flow of reasoning was entertaining and illuminating.
If this agency is a general version of how medicine self-regulates, then it’s going to call into question the entire process of medicine’s unimpeded and unregulated drive against quantitative science in diverse areas.
This also confirms what I’ve said in different forums. If tomorrow medicine (psychiatry, endocrinology, and here pediatric medicine) simply said “no” to “affirmation” treatments for delusional thinking, no matter what all the non-medical supporting agents say the system halts.
The problems began with and are propagated by medicine in complete absence of science - psychiatry and in this case pediatric medicine. It so transparent it is startling. “Gender” has no testable medical definition, and in particular there is no differential diagnosis of gender opposed to delusional thinking.
I know I should not comment, but my language was clear:
Testable medical definition.
Last I checked Scalia was not a medical doctor.
Scalia is also in contradiction of the plain meaning of other statutes, so I wouldn’t cite a confused judicial source as a strong support for a medical meaning.
His comments are at odds with (of course) the plain wording of “on the basis of sex”, from title VII of the civil rights act of 1964, as well as title IX of the education amendments in 1972.
As such I could claim it is not a testable legal term. People in law tend to have very strict requirements for definition.
To the extent that "gender" refers to sexually dimorphic personalities and behaviours -- a more or less standard definition despite your "obstinate" reluctance to accept it -- then to that extent it is, in fact, "a testable medical definition". You might try getting your head out of your nether regions and read this article, co-authored by Colin Wright, which gives chapter and verse on that score:
> "Last I checked Scalia was not a medical doctor."
Commenting on a fairly solid convention endorsed by many more or less reputable biological and medical sources. For example, the British Medical Journal:
"Distinction is critical for good healthcare
Sex and gender are not synonymous. Sex, unless otherwise specified, relates to biology: the gametes, chromosomes, hormones, and reproductive organs. Gender relates to societal roles, behaviours, and expectations that vary with time and place, historically and geographically. These categories describe different attributes that must be considered depending on the purpose they are intended for."
Nor is there a medical test for case, mood, tense, number, person, degree, aspect, definiteness or polarity.
Before you search Supreme Court papers again, here’s a sooting recipe for Princess Cake
A Princess Cake (Prinsesstårta) is a traditional Swedish cake, typically consisting of layers of sponge cake, pastry cream, whipped cream, and raspberry jam, all covered with a smooth dome of green marzipan. Here’s a basic recipe to make your own Princess Cake at home.
Ingredients
Sponge Cake:
• 4 large eggs
• 1 cup granulated sugar
• 1 cup all-purpose flour
• 1 tsp baking powder
• 2 tbsp melted butter
Pastry Cream:
• 2 cups whole milk
• 1 vanilla bean (or 1 tsp vanilla extract)
• 5 large egg yolks
• 1/2 cup granulated sugar
• 2 tbsp cornstarch
• 2 tbsp unsalted butter
Whipped Cream:
• 2 cups heavy whipping cream
• 2 tbsp powdered sugar
• 1 tsp vanilla extract
Raspberry Jam:
• 1/2 cup raspberry jam (seedless, if preferred)
Marzipan Covering:
• 14 oz marzipan
• Green food coloring (to make the traditional green color)
• Powdered sugar (for dusting and rolling)
Decoration:
• Pink marzipan rose (optional)
• Powdered sugar for dusting
Instructions
Step 1: Make the Sponge Cake
1. Preheat your oven to 350°F (175°C). Grease and line a 9-inch round cake pan with parchment paper.
2. In a large bowl, beat the eggs and sugar together until pale and thick (about 5 minutes).
3. Sift together the flour and baking powder, then gently fold it into the egg mixture.
4. Add the melted butter and gently fold it in until combined.
5. Pour the batter into the prepared cake pan and bake for 25-30 minutes, or until a toothpick inserted comes out clean.
6. Let the cake cool completely, then slice it horizontally into 3 even layers.
Step 2: Make the Pastry Cream
1. In a saucepan, heat the milk and vanilla bean (or vanilla extract) until it starts to simmer.
2. In a separate bowl, whisk together the egg yolks, sugar, and cornstarch until smooth.
3. Slowly pour the hot milk into the egg mixture, whisking constantly.
4. Return the mixture to the saucepan and cook over medium heat, stirring constantly, until thickened (about 5 minutes).
5. Remove from heat, stir in the butter, and let it cool completely.
Step 3: Whip the Cream
1. In a large bowl, beat the heavy whipping cream, powdered sugar, and vanilla extract until stiff peaks form. Set aside.
Step 4: Assemble the Cake
1. Place the bottom layer of sponge cake on a serving plate and spread a thin layer of raspberry jam.
2. Add a layer of pastry cream on top of the jam.
3. Place the second layer of sponge cake on top and repeat with more raspberry jam and pastry cream.
4. Place the final layer of sponge cake on top and spread the whipped cream, forming a domed shape on top of the cake.
Step 5: Prepare and Cover with Marzipan
1. Knead the marzipan with green food coloring until you reach the desired shade of green.
2. Dust a work surface with powdered sugar and roll the marzipan out into a large circle (about 12 inches in diameter) to cover the entire cake.
3. Carefully drape the marzipan over the cake, smoothing it over the domed shape. Trim any excess marzipan at the base.
Step 6: Decorate
1. Optionally, decorate with a pink marzipan rose on top and dust the cake lightly with powdered sugar.
Step 7: Serve
Let the cake chill in the refrigerator for about an hour before serving to allow the flavors to meld together.
Nor is there a medical test for case, mood, tense, number, person, degree, aspect, definiteness or polarity. ...."
🙄 Classic case of someone with their fingers in their ears, or head up their arse or those of their buddies, saying, "Nyah, Nyah, can't hear you!"
That "gender" has had some use in a grammatical context hardly precludes its redefinition for other uses in other contexts, and related ones to boot. You might just as well try denying the use of "male" and "female" to denote electrical and plumbing connectors, a definition which goes back to the 1600s:
Could you please invite people to debate on your own substack instead of carrying it on here? I don’t like having long acrimonious tangents in my comment sections.
Sorry about that chief -- I'll try to keep that in mind.
However -- if I may Counselor -- a couple of brief comments. Firstly, how relevant do you think some thousand words of a cake recipe, of intellectually dishonest and evasive boiler plate is to anything?
Secondly and as mentioned or suggested, I think you, Kara Dansky, her WDI, and many others are doing yeoman's work in trying to turn the transloonie tide -- a civilization threatening/ending movement in the credible view of Helen Dale and Helen Joyce. However, the general problem -- evidenced here in this thread several times -- is that virtually every last man, woman, and otherkin has wildly antithetical, inconsistent, incoherent, and quite unscientific definitions for both "sex" and "gender".
For example, Dansky's WDI is quoted here as insisting that "Sex is binary and immutable; the sex you are in your mother’s womb is the sex you will always be ..."
Certainly "sex is binary" comports with standard biological definitions but the rest is incoherent twaddle, quite unscientific claptrap and dangerously if not criminally so.
Not quite sure how y'all think the law is going to adjudicate competing claims when virtually no one can agree on what the relevant terms actually mean. And lawyers and politicians creating definitions that flatly contradict scientific facts, principles, and theories just compounds the problem -- the UK's "Gender Recognition Act" being a case in point.
Not an encouraging prognosis or useful precursor to any progress when virtually everyone is riding madly off in all directions. Reminds me of the classic "Who’s on First?" from Abbott and Costello: https://www.youtube.com/watch?v=sYOUFGfK4bU
Y'all might give some consideration to an elaboration on a Voltaire quip by philosopher Will Durant:
“ 'If you wish to converse with me,' said Voltaire, 'define your terms.' How many a debate would have been deflated into a paragraph if the disputants had dared to define their terms! This is the alpha and omega of logic, the heart and soul of it, that every important term in serious discourse shall be subjected to strictest scrutiny and definition. It is difficult, and ruthlessly tests the mind; but once done it is half of any task.”
Kinda think you -- we all -- need to differentiate between stereotypes ("expectations") and the brute facts that they're often based on -- both of which are often included in the term "gender". Somewhat analogously, it's a brute fact that there are MORE neurotic women than there are neurotic men, and there are MORE rapist men than there are rapist women -- both of which might be called, respectively, feminine and masculine "genders". But it is sexist stereotyping to say that, because of those facts, ALL women are neurotic and that ALL men are rapists.
For elaborations, see:
Wikipedia: In social psychology, a stereotype is a generalized belief about a particular category of people. It is an EXPECTATION that people might have about every person of a particular group. The type of expectation can vary; it can be, for example, an expectation about the group's personality, preferences, appearance or ability. Stereotypes are often overgeneralized, inaccurate, and resistant to new information. A stereotype does not necessarily need to be a negative assumption. They may be positive, neutral, or negative.
Those stereotypes ARE "accurate" BECAUSE many individuals in "particular categories of people" exhibit particular traits, because one "EXPECTS" to find that trait in all members of the category. You might try reading the above linked article from 4th Wave Now for confirmation of those "sexually dimorphic personality traits" -- "gender" writ large. But the problem with "gender", at least one of them, is in "stereotyping" people, is in insisting that, for example, if some dude isn't out raping and pillaging then he is not a "Real Man (™)" ...
Which underlines the benefits of clearly differentiating between "sex" -- i.e., reproductive abilities -- and "gender" -- i.e., personality and behavioural traits more typical of one sex than the other while generally not being unique to either males or females.
> " 'Gender' has no testable medical definition ..."
Horse crap. You might at least try thinking about a cogent and quite illuminating analogy from the late great US Justice Anton Scalia:
Scalia: "Throughout this opinion, I shall refer to the issue as sex discrimination rather than (as the Court does) gender discrimination. The word 'gender' has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes."
This action will nicely complement the civil actions against practitioners of "affirming care" in that it will help to invalidate the argument that this "expert" organization's recommendations are based on
science. Of course, nothing replaces real experts from doing the solid science that produces substantive evidence either supporting the care model or discrediting it.
To whom you are attracted sexually is purely subjective and therefore cannot reasonably be contested by an outside observer.
Where you decide to live your life on a spectrum of superficial, stereotypical male to female attributes (and we all do) is also purely subjective and similarly cannot be questioned.
However, your biological sex reflects an objective reality which cannot be changed by your subjective personal view and futile attempts to do so can result in serious health impacts to you as well as harms to members of the sex you are impersonating (primarily women).
Others who are grounded in objective reality should never be forced to accept your subjective version of your actual biological sex.
Finally, it's past time for the LGB community to separate themselves from the trans activists who are trying to take away the rights of women to fairness in sports and to privacy and safety in their restrooms, locker rooms and prisons. They also advocate for the chemical and surgical mutilation of children many of whom would grow up gay.
Their actions are evil and the
understandable negative reaction to the harm they are causing is spilling over to innocent people who are just going about their business, marrying and leading their lives.
I continue to maintain that sex informs gender, not the other way around. Over the past 5-10 years people have tried their damnedest to make gender informing sex the socially constructed law of the land. It is a complete inversion.
Thank you for writing this. I'd had it in the back of my mind that the 8th deadline had come and gone and have been trying (unsuccessfully) to find an update. One quick question for you, and one general comment:
- Do you (or anyone else) have any suggestions for where lay folk like myself can find updates on how AAP is responding to this request? You say that AAP "likely" negotiated an extension, which leads me to wonder if anything like this exists for the general public.
- I've generally had mixed feelings about state laws banning medicalization of gender dysphoria in minors for a couple of reasons unrelated to whether I think these practices should happen (I do not think they should happen): 1) in a functioning system the practice of medicine should be regulated by medical organizations, and 2) as a "normie lib" I still have a gut level skepticism that red state AG's are actually acting out of genuine concern for these kids' well-being rather than a desire to just score some culture war points. THAT SAID, they have resulted in some very important disclosures that can help chip away at the credibility of organizations like WPATH and the AAP (for example, the revelations about US government interference in SOC8 that came out of lawsuits related to the Alabama law). I think this has the potential to be one of those, which is one reason I'm curious to follow how it progress.
I suspect the AG's have a lot of reasons, as do the GOP voting Americans who they are responding to, and some are probably acting out of hatred. But many might have just taken a look and realized it is a medical scandal harming children and realized the Dem party is giving them a gift by being so factually wrong about what is happening, and by pushing for harm. So they might be doing it just because it highlights that the Dems are making a huge mistake in pushing these interventions so recklessly.
As Christina Buttons said at the 2nd genspect meeting--you can't give informed consent if you are being given misinformation (but she said it better than that), so their going after fraud is in support of medical best practices, isn't it?
It's misinformation because it's not like the quality of evidence is a secret at this point. They don't even need to do a systematic review, I think there are now over a dozen relevant ones for pediatric gender medicine alone. That's why some countries are just taking advantage of their findings. It's not like any of the new papers are revealing anything useful (the trevor project one has a lot wrong with it, each new paper is claimed to solve all the problems of the previous ones, only to be found lacking, by which time another one is being trumpeted... here's a start at analysis of that one: https://genderstats.substack.com/ )
A lot of the blue states are claiming that it's their way or the red state way, a false choice. Or pointing to the Cass Review and saying the Cass Review is not doing a full ban....but...the Cass Review is surely not recommending what either HHS or the blue states are doing. (Don't look at what I'm doing....the GOP isn't following the UK, look at them!)
> "In April 2024, when the US Department of Education tried to re-write Title IX to let boys into girls’ locker rooms, it cited the AAP’s support of the idea as authority. ....
In the past I’ve questioned whether the Republican party is serious about fighting the gender industry. Now I think many of its state officials are."
If I were able to vote in US elections then I might consider that alone as sufficient reason to vote for Trump. While the States can still presumably advance on that front with Harris in the White House, Trump has explicitly said he would put an end to boys in girls' sports leagues -- Title IX being a proximate cause of that.
Although that Harris has recently gushed over transwoman/male-transvestite/sexless-eunuch Dylan Mulvaney "living authentically" as a woman, I'm not sure she has a flaming clue about the difference between males and females, much less how the law and social policy should deal equitably with those differences. At least Trump apparently knows what to expect if he "grabs" someone, so to speak ...
But a very thorough summary and analysis of the problem and efforts to deal with it. However, as something that may look like a quibble but in fact speaks to the thorny problem of what it takes to qualify as male and female in the first place, the AAP has something of a point that sexes are "assigned at birth". By standard biological definitions for the sexes, to have a sex is to have functional gonads of either of two types, those with neither being, ipso facto, sexless. Technically speaking, we don't acquire a sex until the onset of puberty, though it's a pretty solid bet -- 49 to 1 -- that the vagina-havers turn out to be females and that the penis-havers turn out to be males. Birth certificate ems and efs are just markers of potential or probable sexes, not current statements of fact.
This entire piece is fascinating, but this paragraph in particular jumped out at me, especially given US v. Skrmetti, which is very much on my mind at the moment: "If trans activists had not sued red states for protecting minors from gender medicine, I think it’s unlikely the AGs would now be investigating the AAP. After all, the AAP’s recommendations about puberty blockers would be null and void in their states thanks to the bans."
Unrelated to this specific article, but this adult human male read your amicus brief in Skrmetti last night. I found it to be the most succinct and eloquent argument I have ever seen for how the incoherence of transgender as a defined class harms women and girls. Anyone here who hasn't read it should. It's downloadable for free and an accessible read even to people like me with no legal background. Bravo.
Thank you!
Reminds me a bit of Mermaids going after the LGB Alliance in the UK. Now Mermaids is on the back foot
Read your "WDI USA files Supreme Court brief in US v. Skrmetti" the other day for which you and WDI are to be commended:
https://karadansky.substack.com/p/wdi-usa-files-supreme-court-brief?triedRedirect=true
However, I kinda think that much of your effort is vitiated by some rather unscientific conceptions of both sex and gender. You may wish to consider, at least as a starting point, a rather cogent and quite illuminating analogy from the late great US Justice Anton Scalia:
Scalia: "Throughout this opinion, I shall refer to the issue as sex discrimination rather than (as the Court does) gender discrimination. The word 'gender' has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes."
https://supreme.justia.com/cases/federal/us/511/127/
No doubt there are, as you and WDI are arguing, a great many "regressive sexist stereotypes" that come in under the rubric of "gender". Though, analogously, one might say the same about "race" -- no doubt a bunch of "regressive racist stereotypes", but that doesn't mean races are not a useful set of categories.
Likewise with gender -- a great many personality and behavioural differences between men and women -- "gender" writ large --though they tend not to be unique to either sex. How we can talk about "gender-nonconformance", about masculine women and feminine men.
"sex" and "gender" are two entirely different kettles of fish -- losing sight of that causes no end of problems.
I'm going to stitch a few quotations together to make a point. The first two are taken from this piece.
"Since October 2018, the influential American Academy of Pediatrics has advised that sex is assigned at birth, people are attracted to gender (not sex), and young children 'know their gender.' It 'recommends' that kids who say they’re trans receive 'gender-affirming' interventions; that medical records 'respect' gender identity (by stating the wrong sex?); and that pediatricians agitate for trans political goals."
The AGs have asked the AAP to:
“Explain efforts by the AAP to incorporate its recommendations (including the 2018 AAP policy statement) into patient care by any doctors or medical providers, including through ‘smart phrases’ or other systems that automatically incorporate medical standards.”
The final quotation requires some explanation. I recently discovered that my medical records at two of my health care organizations give my "sex assigned at birth" and my "gender identity." I objected.
To say my sex was assigned at birth is neither factually nor scientifically correct. When I was born almost 70 years ago in South America, the notion that sex is assigned at birth in the Queer sense of the term had yet to be summoned from the void by Queer Theory philosophers. I'm trapped in an anachronism. Scientifically speaking, my sex was determined biologically at conception and, since my physiology is not ambiguous, observed and recorded by the physician who delivered me.
As for gender identity, I explained that I do not have one. I do not "identify as" a male. I AM male.
Lastly, I said that sex assigned at birth and gender identity are rooted in philosophy and activism, not science, and have no place in medicine.
I asked that the organizations correct the errors in my medical records.
That brings me to the reply I received a while ago from the manager of compliance, risk and quality for one of the organizations:
"Thank you for bringing your concerns to our attention. The sex assigned at birth and gender identity fields are fixed fields in the medical record. Thus, the information cannot be removed. However, you are welcome to select the "Choose not to disclose" option if you do not wish to select an answer. Sex assigned at birth is the recognized nomenclature in health care. This is also the nomenclature used by the CDC. As you mentioned, the sex that is assigned by a medical provider is based on the genitalia (and in certain cases other factors) observed at birth."
"We appreciate your feedback regarding gender identity, but as an organization that is proud to serve a diverse population of patients, we believe that it is important to give all patients the opportunity to express their identity and have that identity acknowledged. Please feel free to select the "Choose not to disclose" option if you do not wish to provide an answer for the gender identity field."
The positions she expresses clearly reflect efforts on the part of an unknown actor to incorporate its multifaceted positions on gender into patient care. Was it the AAP? The identity of the activist doesn't matter as much as the fact that those pernicious concepts have metastasized and become lodged in nooks and crannies throughout the American health care system.
Neither of the suggested solutions is satisfactory.
The last thing I want to do is create potentially dangerous uncertainty in my medical record about something as basic and vital as my biological sex by opting for "Choose not to Disclose."
With respect to the “Gender Identity” box, selecting "Choose not to Disclose" would be no improvement. I would still be conceding that I have a gender identity. The point is that I do not.
The only satisfactory option is to let me select “none” under the gender identity heading. Otherwise it would be like asking for a patient’s religion and not allowing patients to select “none.” (The clinic does give patients the option of choosing "None" in the religion category. ) Since gender ideology is more like a religion than a science, the very least The Portland Clinic could do is give me the same choice with respect to gender identity.
I have been wrestling with how to characterize the compliance manager's rhetoric. It was only when I read a recent essay by the British author and cultural writer Helen Pluckrose that I found a passage that describes it perfectly. The health care organizations are:
"conflating sexuality with gender and gender with sex, “educating' everybody in their own theories, policing language, making people affirm things they don’t believe and trying to shoehorn issues of sexuality and gender into absolutely everything even when it has no relevance at all."[1]
Alone, I stand no chance of purging the genderist terminology that has embedded itself in my medical records and those of the organizations' other patients. It's indisputable that it needs to go. Since the errors reside in the same third-party provider's patient interface (MyChart), they are systemic and very likely affect patients in many states. Maybe I should drop the Idaho AG a line.
In closing, in addition to having been general counsel for financial services business before I retired, I have also been a compliance manager and a compliance officer. Among other things, I practiced preventive consumer law. The health care organization's response makes me grateful that when I was in the compliance field I never had to be an advocate for unscientific concepts or thwart a customer's reasonable request with specious arguments. I do not know whether either of the organizations have a gender medicine practice. I do know that I would have many sleepless nights if I were the risk manager for a trans chop shop.
[1] Pluckrose, Helen. “Why Do You Need to Talk About Sexuality at All?” The Overflowings of a Liberal Brain. 8 September 2024. https://substack.com/@helenpluckrose/p-148622634
Thank you!
> "To say my sex was assigned at birth is neither factually nor scientifically correct."
Nope, sorry. Technically and scientifically speaking, we don't ACQUIRE a sex until the onset of puberty and can subsequently lose it thereafter as a result of the vicissitudes of life, misadventures, or medical malpractices. You might take a gander at my Note and comment here:
Steersman: "... the AAP has something of a point that sexes are 'assigned at birth'. By standard biological definitions for the sexes, to have a sex is to have functional gonads of either of two types, those with neither being, ipso facto, sexless. Technically speaking, we don't acquire a sex until the onset of puberty, though it's a pretty solid bet -- 49 to 1 -- that the vagina-havers turn out to be females and that the penis-havers turn out to be males. Birth certificate ems and efs are just markers of potential or probable sexes, not current statements of fact."
https://substack.com/@humanuseofhumanbeings/note/c-72599190
On those biological definitions you might also take a gander at my open letter to the erstwhile reputable biological journal "Cell" which had asked, apparently in all seriousness, "Is 'sex' a useful category?":
https://humanuseofhumanbeings.substack.com/p/is-sex-a-useful-category
I’m not going to engage with you on this point.
Abandoning the field unbloodied? Apprehensive about "offending" the many on the distaff side who, rather like too many transloonie nutcases, have turned the sexes into "immutable identities 🙄" based on some "mythic essences 🙄"? 😉🙂
Kind of the crux of the matter -- how to define the sexes in law, social policy, and biology. Y'all might have some interest in this article on the topic:
"These states are narrowly defining who is 'female' and 'male' in law" https://www.npr.org/2023/05/03/1172821119/kansas-montana-tennessee-narrowly-define-sex-female-male-transgender-intersex#:~:text=The%20Kansas%20law%20legally%20defines,are%20designed%20to%20fertilize%20ova.
"The Kansas law legally defines a woman as someone whose reproductive system is designed to produce ova, and a man as someone whose reproductive systems are designed to fertilize ova."
Some somewhat inaccurate statements there, but I can sympathize with the efforts. Although that quote raises some thorny questions, notably how to determine that design -- Genesis perhaps? -- and what to do about the intersex who are clearly not designed to produce either sperm or ova.
Though some benefits in defining "woman" absent a direct connection to "female" as doing so raises the question of defining that term. But to obviate those difficulties, that is why I've suggested defining "woman" as "adult human with ovaries of past, present or future functionality" -- ovaries being the sine qua non for "female".
But more problematic are those States which are trying to define the sexes in law, particularly where they conflict profoundly, as they do, with those standard biological definitions.
You didn't reply to my last queries Steersman.
What do you call the property of humans that induces male or female puberty?
And, if definitions and language are consensus, what are you appealing to with your strange claim which noone agrees with?
Think I did "reply to your queries" -- several times in fact. Don't think you're listening or want to face the facts -- you, and others here, may wish to review our conversation:
https://boghossian.substack.com/p/billboard-chris-and-dr-colin-wright/comment/71195393
In particular, y'all might note the many reputable biologists who agree with my "strange claim 🙄".
As for your "induces puberty", I thought, and think, that that is very badly phrased at best. I know you're not a big fan of definitions but you might try thinking about this one from Google/OxfordLanguage:
"puberty: the period during which adolescents reach sexual maturity and become capable of reproduction."
Kids "become capable of reproduction" -- i.e., have or acquire a sex -- at that point because their gonads become fully functional, because they're then able to produce gametes that can actually be used in the process of reproduction.
Quick typo:
The Policy Statement does concede in a footnote that “reversibility is based on the little data that are currently available.” I don’t that’s enough to save the AAP. In fact, it shows the AAP knows its claim is shaky — a fact that can lead to higher penalties.
I don’t [think,believe] that’s enough…
Superbly written, I’d read any book you published - clear, lucid and the flow of reasoning was entertaining and illuminating.
If this agency is a general version of how medicine self-regulates, then it’s going to call into question the entire process of medicine’s unimpeded and unregulated drive against quantitative science in diverse areas.
This also confirms what I’ve said in different forums. If tomorrow medicine (psychiatry, endocrinology, and here pediatric medicine) simply said “no” to “affirmation” treatments for delusional thinking, no matter what all the non-medical supporting agents say the system halts.
The problems began with and are propagated by medicine in complete absence of science - psychiatry and in this case pediatric medicine. It so transparent it is startling. “Gender” has no testable medical definition, and in particular there is no differential diagnosis of gender opposed to delusional thinking.
Again, superb.
I know I should not comment, but my language was clear:
Testable medical definition.
Last I checked Scalia was not a medical doctor.
Scalia is also in contradiction of the plain meaning of other statutes, so I wouldn’t cite a confused judicial source as a strong support for a medical meaning.
His comments are at odds with (of course) the plain wording of “on the basis of sex”, from title VII of the civil rights act of 1964, as well as title IX of the education amendments in 1972.
As such I could claim it is not a testable legal term. People in law tend to have very strict requirements for definition.
> "Testable medical definition."
To the extent that "gender" refers to sexually dimorphic personalities and behaviours -- a more or less standard definition despite your "obstinate" reluctance to accept it -- then to that extent it is, in fact, "a testable medical definition". You might try getting your head out of your nether regions and read this article, co-authored by Colin Wright, which gives chapter and verse on that score:
https://4thwavenow.com/2019/08/19/no-child-is-born-in-the-wrong-body-and-other-thoughts-on-the-concept-of-gender-identity/
Of particular note is the joint probability distribution showing the significant differences --
on average -- in feminine and masculine personalities and behaviours:
https://i0.wp.com/4thwavenow.com/wp-content/uploads/2019/08/Malone-updated-bell-curve-chart.jpg?ssl=1
> "Last I checked Scalia was not a medical doctor."
Commenting on a fairly solid convention endorsed by many more or less reputable biological and medical sources. For example, the British Medical Journal:
"Distinction is critical for good healthcare
Sex and gender are not synonymous. Sex, unless otherwise specified, relates to biology: the gametes, chromosomes, hormones, and reproductive organs. Gender relates to societal roles, behaviours, and expectations that vary with time and place, historically and geographically. These categories describe different attributes that must be considered depending on the purpose they are intended for."
https://www.bmj.com/content/372/bmj.n735
@Steersman: stop it! Just stop it.
What, exactly, do you object to? Brute facts? You're "offended" by them?
No, there’s no medical test for gender.
Nor is there a medical test for case, mood, tense, number, person, degree, aspect, definiteness or polarity.
Before you search Supreme Court papers again, here’s a sooting recipe for Princess Cake
A Princess Cake (Prinsesstårta) is a traditional Swedish cake, typically consisting of layers of sponge cake, pastry cream, whipped cream, and raspberry jam, all covered with a smooth dome of green marzipan. Here’s a basic recipe to make your own Princess Cake at home.
Ingredients
Sponge Cake:
• 4 large eggs
• 1 cup granulated sugar
• 1 cup all-purpose flour
• 1 tsp baking powder
• 2 tbsp melted butter
Pastry Cream:
• 2 cups whole milk
• 1 vanilla bean (or 1 tsp vanilla extract)
• 5 large egg yolks
• 1/2 cup granulated sugar
• 2 tbsp cornstarch
• 2 tbsp unsalted butter
Whipped Cream:
• 2 cups heavy whipping cream
• 2 tbsp powdered sugar
• 1 tsp vanilla extract
Raspberry Jam:
• 1/2 cup raspberry jam (seedless, if preferred)
Marzipan Covering:
• 14 oz marzipan
• Green food coloring (to make the traditional green color)
• Powdered sugar (for dusting and rolling)
Decoration:
• Pink marzipan rose (optional)
• Powdered sugar for dusting
Instructions
Step 1: Make the Sponge Cake
1. Preheat your oven to 350°F (175°C). Grease and line a 9-inch round cake pan with parchment paper.
2. In a large bowl, beat the eggs and sugar together until pale and thick (about 5 minutes).
3. Sift together the flour and baking powder, then gently fold it into the egg mixture.
4. Add the melted butter and gently fold it in until combined.
5. Pour the batter into the prepared cake pan and bake for 25-30 minutes, or until a toothpick inserted comes out clean.
6. Let the cake cool completely, then slice it horizontally into 3 even layers.
Step 2: Make the Pastry Cream
1. In a saucepan, heat the milk and vanilla bean (or vanilla extract) until it starts to simmer.
2. In a separate bowl, whisk together the egg yolks, sugar, and cornstarch until smooth.
3. Slowly pour the hot milk into the egg mixture, whisking constantly.
4. Return the mixture to the saucepan and cook over medium heat, stirring constantly, until thickened (about 5 minutes).
5. Remove from heat, stir in the butter, and let it cool completely.
Step 3: Whip the Cream
1. In a large bowl, beat the heavy whipping cream, powdered sugar, and vanilla extract until stiff peaks form. Set aside.
Step 4: Assemble the Cake
1. Place the bottom layer of sponge cake on a serving plate and spread a thin layer of raspberry jam.
2. Add a layer of pastry cream on top of the jam.
3. Place the second layer of sponge cake on top and repeat with more raspberry jam and pastry cream.
4. Place the final layer of sponge cake on top and spread the whipped cream, forming a domed shape on top of the cake.
Step 5: Prepare and Cover with Marzipan
1. Knead the marzipan with green food coloring until you reach the desired shade of green.
2. Dust a work surface with powdered sugar and roll the marzipan out into a large circle (about 12 inches in diameter) to cover the entire cake.
3. Carefully drape the marzipan over the cake, smoothing it over the domed shape. Trim any excess marzipan at the base.
Step 6: Decorate
1. Optionally, decorate with a pink marzipan rose on top and dust the cake lightly with powdered sugar.
Step 7: Serve
Let the cake chill in the refrigerator for about an hour before serving to allow the flavors to meld together.
Enjoy your Princess Cake!
> "No, there’s no medical test for gender.
Nor is there a medical test for case, mood, tense, number, person, degree, aspect, definiteness or polarity. ...."
🙄 Classic case of someone with their fingers in their ears, or head up their arse or those of their buddies, saying, "Nyah, Nyah, can't hear you!"
That "gender" has had some use in a grammatical context hardly precludes its redefinition for other uses in other contexts, and related ones to boot. You might just as well try denying the use of "male" and "female" to denote electrical and plumbing connectors, a definition which goes back to the 1600s:
https://www.etymonline.com/word/female
Could you please invite people to debate on your own substack instead of carrying it on here? I don’t like having long acrimonious tangents in my comment sections.
Unfortunately when you respond to a troll they got you. It was my fault for a three word response.
Sorry about that chief -- I'll try to keep that in mind.
However -- if I may Counselor -- a couple of brief comments. Firstly, how relevant do you think some thousand words of a cake recipe, of intellectually dishonest and evasive boiler plate is to anything?
Secondly and as mentioned or suggested, I think you, Kara Dansky, her WDI, and many others are doing yeoman's work in trying to turn the transloonie tide -- a civilization threatening/ending movement in the credible view of Helen Dale and Helen Joyce. However, the general problem -- evidenced here in this thread several times -- is that virtually every last man, woman, and otherkin has wildly antithetical, inconsistent, incoherent, and quite unscientific definitions for both "sex" and "gender".
For example, Dansky's WDI is quoted here as insisting that "Sex is binary and immutable; the sex you are in your mother’s womb is the sex you will always be ..."
"Expert derangement": https://www.genderclinicnews.com/p/expert-derangement
Certainly "sex is binary" comports with standard biological definitions but the rest is incoherent twaddle, quite unscientific claptrap and dangerously if not criminally so.
Not quite sure how y'all think the law is going to adjudicate competing claims when virtually no one can agree on what the relevant terms actually mean. And lawyers and politicians creating definitions that flatly contradict scientific facts, principles, and theories just compounds the problem -- the UK's "Gender Recognition Act" being a case in point.
Not an encouraging prognosis or useful precursor to any progress when virtually everyone is riding madly off in all directions. Reminds me of the classic "Who’s on First?" from Abbott and Costello: https://www.youtube.com/watch?v=sYOUFGfK4bU
Y'all might give some consideration to an elaboration on a Voltaire quip by philosopher Will Durant:
“ 'If you wish to converse with me,' said Voltaire, 'define your terms.' How many a debate would have been deflated into a paragraph if the disputants had dared to define their terms! This is the alpha and omega of logic, the heart and soul of it, that every important term in serious discourse shall be subjected to strictest scrutiny and definition. It is difficult, and ruthlessly tests the mind; but once done it is half of any task.”
— Will Durant
https://quotefancy.com/quote/3001527/Will-Durant-If-you-wish-to-converse-with-me-said-Voltaire-define-your-terms-How-many-a
How do you medically define or medically test a societal role expectations that vary with time and place, historically and geographically?
Kinda think you -- we all -- need to differentiate between stereotypes ("expectations") and the brute facts that they're often based on -- both of which are often included in the term "gender". Somewhat analogously, it's a brute fact that there are MORE neurotic women than there are neurotic men, and there are MORE rapist men than there are rapist women -- both of which might be called, respectively, feminine and masculine "genders". But it is sexist stereotyping to say that, because of those facts, ALL women are neurotic and that ALL men are rapists.
For elaborations, see:
Wikipedia: In social psychology, a stereotype is a generalized belief about a particular category of people. It is an EXPECTATION that people might have about every person of a particular group. The type of expectation can vary; it can be, for example, an expectation about the group's personality, preferences, appearance or ability. Stereotypes are often overgeneralized, inaccurate, and resistant to new information. A stereotype does not necessarily need to be a negative assumption. They may be positive, neutral, or negative.
https://en.wikipedia.org/wiki/Stereotype
And something in the same vein from Substacker Lee Jussim:
"Stereotype Accuracy is One of the Largest and Most Replicable Effects in All of Social Psychology"
https://spsp.org/news-center/character-context-blog/stereotype-accuracy-one-largest-and-most-replicable-effects-all
Those stereotypes ARE "accurate" BECAUSE many individuals in "particular categories of people" exhibit particular traits, because one "EXPECTS" to find that trait in all members of the category. You might try reading the above linked article from 4th Wave Now for confirmation of those "sexually dimorphic personality traits" -- "gender" writ large. But the problem with "gender", at least one of them, is in "stereotyping" people, is in insisting that, for example, if some dude isn't out raping and pillaging then he is not a "Real Man (™)" ...
Which underlines the benefits of clearly differentiating between "sex" -- i.e., reproductive abilities -- and "gender" -- i.e., personality and behavioural traits more typical of one sex than the other while generally not being unique to either males or females.
> " 'Gender' has no testable medical definition ..."
Horse crap. You might at least try thinking about a cogent and quite illuminating analogy from the late great US Justice Anton Scalia:
Scalia: "Throughout this opinion, I shall refer to the issue as sex discrimination rather than (as the Court does) gender discrimination. The word 'gender' has acquired the new and useful connotation of cultural or attitudinal characteristics (as opposed to physical characteristics) distinctive to the sexes."
https://supreme.justia.com/cases/federal/us/511/127/
Thank you for this in-depth analysis and great investigative journalism.
WOW!!!!! Thank you.; this gives me hope.
Thanks for this incredible article! Excellent work!
thank you for this!
This action will nicely complement the civil actions against practitioners of "affirming care" in that it will help to invalidate the argument that this "expert" organization's recommendations are based on
science. Of course, nothing replaces real experts from doing the solid science that produces substantive evidence either supporting the care model or discrediting it.
It is wild to me that the conservative stance is: we need to let tomboys and effeminate boys grow up to be their true lesbian and gay selves!!!
And the liberal stance is: these children are born in the wrong body!!
To whom you are attracted sexually is purely subjective and therefore cannot reasonably be contested by an outside observer.
Where you decide to live your life on a spectrum of superficial, stereotypical male to female attributes (and we all do) is also purely subjective and similarly cannot be questioned.
However, your biological sex reflects an objective reality which cannot be changed by your subjective personal view and futile attempts to do so can result in serious health impacts to you as well as harms to members of the sex you are impersonating (primarily women).
Others who are grounded in objective reality should never be forced to accept your subjective version of your actual biological sex.
Finally, it's past time for the LGB community to separate themselves from the trans activists who are trying to take away the rights of women to fairness in sports and to privacy and safety in their restrooms, locker rooms and prisons. They also advocate for the chemical and surgical mutilation of children many of whom would grow up gay.
Their actions are evil and the
understandable negative reaction to the harm they are causing is spilling over to innocent people who are just going about their business, marrying and leading their lives.
I continue to maintain that sex informs gender, not the other way around. Over the past 5-10 years people have tried their damnedest to make gender informing sex the socially constructed law of the land. It is a complete inversion.
Thank you for writing this. I'd had it in the back of my mind that the 8th deadline had come and gone and have been trying (unsuccessfully) to find an update. One quick question for you, and one general comment:
- Do you (or anyone else) have any suggestions for where lay folk like myself can find updates on how AAP is responding to this request? You say that AAP "likely" negotiated an extension, which leads me to wonder if anything like this exists for the general public.
- I've generally had mixed feelings about state laws banning medicalization of gender dysphoria in minors for a couple of reasons unrelated to whether I think these practices should happen (I do not think they should happen): 1) in a functioning system the practice of medicine should be regulated by medical organizations, and 2) as a "normie lib" I still have a gut level skepticism that red state AG's are actually acting out of genuine concern for these kids' well-being rather than a desire to just score some culture war points. THAT SAID, they have resulted in some very important disclosures that can help chip away at the credibility of organizations like WPATH and the AAP (for example, the revelations about US government interference in SOC8 that came out of lawsuits related to the Alabama law). I think this has the potential to be one of those, which is one reason I'm curious to follow how it progress.
Fellow lib here.
I suspect the AG's have a lot of reasons, as do the GOP voting Americans who they are responding to, and some are probably acting out of hatred. But many might have just taken a look and realized it is a medical scandal harming children and realized the Dem party is giving them a gift by being so factually wrong about what is happening, and by pushing for harm. So they might be doing it just because it highlights that the Dems are making a huge mistake in pushing these interventions so recklessly.
As Christina Buttons said at the 2nd genspect meeting--you can't give informed consent if you are being given misinformation (but she said it better than that), so their going after fraud is in support of medical best practices, isn't it?
It's misinformation because it's not like the quality of evidence is a secret at this point. They don't even need to do a systematic review, I think there are now over a dozen relevant ones for pediatric gender medicine alone. That's why some countries are just taking advantage of their findings. It's not like any of the new papers are revealing anything useful (the trevor project one has a lot wrong with it, each new paper is claimed to solve all the problems of the previous ones, only to be found lacking, by which time another one is being trumpeted... here's a start at analysis of that one: https://genderstats.substack.com/ )
A lot of the blue states are claiming that it's their way or the red state way, a false choice. Or pointing to the Cass Review and saying the Cass Review is not doing a full ban....but...the Cass Review is surely not recommending what either HHS or the blue states are doing. (Don't look at what I'm doing....the GOP isn't following the UK, look at them!)
Check out di-ag.org perhaps?
Thanks, very interesting - I suspect that people would tend to delete anything incriminating wouldn't they and only submit the innocuous stuff.
Did you mean "abnormal" here or "referring to puberty as normal"? Couldn't quite figure out this quote:
Republican politicians are referring to “experimentation” as “normal” and suggesting it’s wrong to interfere with gay children’s natural development.
> "In April 2024, when the US Department of Education tried to re-write Title IX to let boys into girls’ locker rooms, it cited the AAP’s support of the idea as authority. ....
In the past I’ve questioned whether the Republican party is serious about fighting the gender industry. Now I think many of its state officials are."
If I were able to vote in US elections then I might consider that alone as sufficient reason to vote for Trump. While the States can still presumably advance on that front with Harris in the White House, Trump has explicitly said he would put an end to boys in girls' sports leagues -- Title IX being a proximate cause of that.
Although that Harris has recently gushed over transwoman/male-transvestite/sexless-eunuch Dylan Mulvaney "living authentically" as a woman, I'm not sure she has a flaming clue about the difference between males and females, much less how the law and social policy should deal equitably with those differences. At least Trump apparently knows what to expect if he "grabs" someone, so to speak ...
But a very thorough summary and analysis of the problem and efforts to deal with it. However, as something that may look like a quibble but in fact speaks to the thorny problem of what it takes to qualify as male and female in the first place, the AAP has something of a point that sexes are "assigned at birth". By standard biological definitions for the sexes, to have a sex is to have functional gonads of either of two types, those with neither being, ipso facto, sexless. Technically speaking, we don't acquire a sex until the onset of puberty, though it's a pretty solid bet -- 49 to 1 -- that the vagina-havers turn out to be females and that the penis-havers turn out to be males. Birth certificate ems and efs are just markers of potential or probable sexes, not current statements of fact.