Follow the Science -- Except for Sex and Gender

Throughout the real-life science fiction movie called COVID, we have been told to “follow the science.” 

The face of COVID, Dr. Anthony Fauci, condescendingly proclaimed, “I am the science.” It comes to light now that most of his assertions turned out to be incorrect.

Gender and sex are the latest battlefront in the realm of “science,” and this, too, is turning out to defy actual science and common sense. But as both COVID and gender are now political and advocacy issues rather than the science once taught in biology class, we are no longer following science and instead engaging in magical thinking.

What’s the difference between sex and gender? Once upon a time they were interchangeable terms. But that changed. Did the science change or did these terms become politically charged?

The word ‘sex’ has other connotations, so it was an easy transition from sex to gender as the latter had no acts associated with the word. Yale School of Medicine summed it up the “new science” well, “What do we mean by sex and gender? Aren’t these terms interchangeable? Perhaps at some point in time they were used as synonyms, but this is no longer true in science.”

How did the science change? In the past, one could pull down one’s pants and observe both sex and gender with a quick downward glance, just as the obstetrician does when announcing at the moment of birth, “It’s a boy!”

The new science goes like this, “The term sex should be used as a classification, generally as male or female, according to the reproductive organs.” While “The term gender should be used to refer to a person's self-representation as male or female, or how that person is responded to by social institutions on the basis of the individual's gender presentation.”

In other words, sex is science and gender is magical thinking.

Can this thought process be applied to species? Can a dog identify as a cat or vice versa? There are humans who identify as animals, for example “furries”. There are rumors of schools providing litter boxes for students identifying as cats. Apparently, this is just a rumor, but not long-ago males competing against female athletes was also viewed as a far-fetched rumor, and here we are.

This all might be considered frivolous but when it comes to medicine, the stakes are exponentially more significant.

As recently reported by The Telegraph, “Endometriosis is not a gynaecological condition, the founder of a charity supporting women with the disease has suggested, after appointing a transgender woman as its chief executive.”

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Let’s break that down. The Cleveland Clinic describes a gynecologist as,  “A physician who specializes in diagnosing and treating diseases of the female reproductive system.” No politically incorrect mention of “women.”

Notice how they cleverly avoid the obvious, that gynecologists care for women. The Merriam-Webster dictionary is less woke and defines gynecology in a clearer manner, “A branch of medicine that deals with the diseases and routine physical care of the reproductive system of women.”

Years ago when I was in medical school at Northwestern, my obstetrics/gynecology rotation was at the Prentice Women’s Hospital. Not the “Prentice Female Hospital.” And not as Merriam-Webster dictionary would name it as, “Prentice ‘sex that typically has the capacity to bear young or produce eggs’ Hospital.” What a mouthful. Imagine putting that on a sign or brochure. Has the science changed that much in a few decades?

What is endometriosis? Let’s ask Mayo Clinic,

Endometriosis is an often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometriosis growths may be found beyond the area where pelvic organs are located.

Notice the mention of female reproductive organs, even though they studiously avoid mentioning the word ‘female,’ which according to the Cleveland Clinic, falls under the care of a gynecologist. This is not complicated. By logic, endometriosis falls under the province of gynecology, despite what the new CEO of Endometriosis South Coast asserts.

The science is clear that endometriosis is a disorder of women and that gynecologists, who by definition treat women, manage this disorder. Using pretzel logic to avoid explicitly stating the obvious is not good science.

Sure, endometriosis can rarely occur in men, with 20 cases reported. This would be due to an overabundance of estrogen, usually from hormone therapy to treat prostate cancer. But that’s the rare exception.

Medicine always has rare exceptions, but we practice based on likelihoods. When you hear hoofbeats, at least in America, it’s likely a horse, not a zebra. Citing the odd exception is not an excuse for turning science on its head.

Why is such precision important in medicine? Because many conditions or diseases are exclusive to men or women, but not both. The most common example is pregnancy.

If a woman of childbearing age presents to the emergency room with cramping abdominal pain, a pregnancy test is at the top of the list of diagnostics. A man of the same age presenting to the ER with similar pain would not be given a pregnancy test.

But if one sex or gender identifies as the other, then what? Particularly if they have had gender reassignment surgery and their true gender is not readily apparent. What if the patient is unconscious or in too much pain to provide a detailed history? Misdiagnosis in this situation can be fatal.

Prostate cancer is another example as a prostate gland is only present in men, regardless of gender identity or preference. For the sticklers out there, women can “sort of” get prostate cancer, not in the prostate but in the Skene’s glands which are similar to the prostate. But like endometriosis in men, Skene gland cancer in women is also extremely rare. Or as we would call it, “a zebra.”

But prostate cancer in trans women is a hot topic of research. A paper in the Journal of the American Medical Association discusses prostate cancer in transgender women. The “science” says that trans women are still biological men, and even if they have had gender reassignment surgery, still have a prostate gland.

This was a study of patients in the Veterans Affairs Health System. Apparently, such research is more important in finding out why there are so many homeless veterans in the US and fixing the problem. Or why, according to the CDC, “71% of young people in the United States would not be able to join the military if they wanted to” due to health issues and obesity.

As China grows its military, you can be sure they are watching the priorities of the American defense system.

Instead, the emphasis should be on the obvious, that men who identify as women are still men and still at risk for prostate cancer. Just like women who identify as men, are still women who can get endometriosis. Is there more important medical research to be performed than this?

Today “the science” is playing word games to disguise the obvious. Why isn’t the medical establishment figuring out why life expectancy in the US has dropped two years in a row, with COVID far in the rear view mirror.

Or why all of a sudden we are seeing headlines like this, “Doctors seeing increase of heart attacks in young people”? Along with myriad young healthy individuals dying suddenly.

This is the science that affects individuals, families, and society, not whether endometriosis is a gynecological condition. The medical community has obfuscated and spewed misinformation throughout the COVID pandemic, seriously damaging its credibility.

How about a course reset, trying to “follow the science” for a change. And start with sex and gender.


Brian C. Joondeph, M.D., is a physician and writer. Follow me on Twitter @retinaldoctor, Substack Dr. Brian’s Substack, Truth Social @BrianJoondeph, and LinkedIn @Brian Joondeph.

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