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Robert A. Nye, Corvallis, Oregon, USA

We are presently experiencing a genuine crisis of meaning about what we

mean by ‘sex’ and what we mean by ‘gender’. In popular and scholarly texts
alike, one can find numerous examples of the words ‘sex’ and ‘gender’ being
used interchangeably to refer to men and women and male and female.
In journalistic practice, ‘gender’ is often favoured in headlines, and ‘sex’ is
buried in the small print. When China announced it was going to re-impose
(discontinued in 1999) ‘sex-testing’ on female Olympic athletes in July 2008,
initial press reports used the official translation ‘sex-testing’ provided by the
Chinese translators, but later articles in the Anglophone world substituted
‘gender-testing’ (Anon., 2008).
The ambivalent use of these terms extends even to the technical science
literature. In an issue of Science devoted to ‘Women’s Health’, several
articles freely inter-mix ‘gender’ and ‘sex’. One article, entitled ‘Gender
in the pharmacy: Does it matter?’ uses them in consecutive sentences:
‘Clinicians still don’t always analyse data on women separately, and more
research – and better research tools – may yet reveal more serious gender
differences, they say. Even subtle sex differences may be important in an
era of personalized medicines’ (Kaiser, 2005, p. 1572). This is not an isolated
Perhaps it takes a historian to permit a clearer focus on this
terminological conundrum. Alice Dreger, who has written historical studies
of hermaphroditism and intersex phenomena, refers to both ‘sex’ and
‘gender’ in an article on the current controversy about the proper way
to test the eligibility of female athletes (Dreger, 1998, 1999); but Dreger
also quotes experts who study the variability in human sex development
as an interdisciplinary task comprising genetics, endocrinology, anatomy
and psychology, and distinguishes ‘transsexualism’ from ‘transgender’ and
‘gender-identity questions’ in this complicated field (Dreger, 2009).

ROBERT A. NYE is The Horning Professor of the Humanities and History Emeritus at
Oregon State University. He is the author of 50 scholarly articles and chapters and five
books including Masculinity and Male Codes of Honor in Modern France (Princeton
University Press, 1993) and an Oxford Reader, Sexuality (Oxford University Press,
1999). He continues to do research and write on the history of sexuality. Address for
correspondence: [nyer@onid.orst.edu]

Psychoanalysis and History 12(2), 2010

© Edinburgh University Press 195

Getting the terminology right is as important for medical humanists

like Dreger as it is for the scientists who study these phenomena. The
terminology, however, is in a state of rapid evolution. Some terms are
replacing others: intersex is replacing hermaphrodite, gender is replacing
sex. But if we examine usage, it turns out that neither sex nor gender is
exactly what it used to be either. Of course, signifiers come and go when the
status or nature of their referents change, but when words have political and
ideological resonance like all the above, and carry profound implications for
empirical research and scholarship, we will benefit from pulling back a bit
and taking a longer historical perspective.
David Haig, an evolutionary biologist, has searched 30 million academic
articles between 1945 and 2001 for occurrences of the words ‘sex’ and
‘gender’. He has found that ‘gender’ was used sparingly and in the sense
of a grammatical category at the beginning of this period, but that in the
social science, arts and humanities categories it now outnumbers the usage
of ‘sex’. In the natural sciences ‘gender’ is now used half as often as ‘sex’.
When the terms ‘gender difference’ and ‘sex difference’ are scanned in
all categories, the former term has been dominant since 1994. When Haig
asked working scientists why they chose to use ‘gender’ rather than ‘sex’
in biological contexts, they responded they wished to signal sympathy for
feminist goals or ‘to avoid the connotation of copulation’ (Haig, 2004, p. 95).
This massive linguistic shift has gone mostly unnoticed by scientists. The
science historian, Londa Schiebinger, whose pioneering work on science
and gender is well known, has acknowledged the struggle to distinguish
between gender and sex while continuing to explore their interrelationships
(Schiebinger, 1999, pp. 16–17). The problem for working scientists is often
more concrete. Writing in the American Journal of Physical Anthropology,
P.L. Walker and D.C. Cook found that during the 1990s more than half the
articles they indexed in the physical anthropology and biomedical literature
used both ‘gender’ and ‘sex’ and failed to make a useful distinction between
them. How, they ask, can bioarcheologists weigh the data from the recovery
of sex ratios in human DNA against the evidence for gender roles in ancient
cultures, or do epidemiological studies that do not distinguish between
biological and social categories (Walker & Cook, 1998)?
There are some obvious reasons for this slippage. Surely, political
correctness is partly at fault, especially in puritanical North America, where,
in common parlance, ‘sex’ means ‘sexual intercourse’. The appearance of
the culture wars in politics is also involved in this development. Science and
social science grant-writers to NSF and NIH review boards have learned to
use the term ‘gender’ because conservative watchdogs search for the word
‘sex’ in grant applications in order to choke off federal support for morally-
questionable research.
Feminist appropriations of gender are also partly responsible. Simone
de Beauvoir famously wrote in The Second Sex in 1949 that: ‘One is not

born a woman, one becomes one’ (De Beauvoir, 1949, p. 249). By the early
1970s, feminist theorists had begun to use ‘gender’ to pry loose culturally
constructed ascriptions of men and women’s roles from male and female
bodies, but as late as 1970 they were still making do with terminology such
as Margaret Mead’s term ‘sex role’ or Shulamith Firestone’s term ‘sex class’
(Firestone, 1970, pp. 10–12). Ann Oakley (1972) might have been the first
social scientist to make the distinction in her 1972 book Sex, Gender and
Society, an advance followed up by the anthropologists Sherry Ortner and
Harriet Whitehead (1981) among others by the early 1980s. This and other
feminist-inspired theory posited that women could and did transcend the
roles traditionally ascribed to their ‘sex’ and should not be discriminated
against on account of it.
If the sex/gender distinction has flourished since the 1970s it is also partly
on account of English linguistic imperialism; Anglo-American culture has
embraced ‘gender’ more quickly than other Western societies. ‘Genero’
largely retains its grammatical identity in Spanish, ‘genre’ is making very
slow headway in France, and ‘Geschlecht’ still means ‘sex’ to most German
speakers, despite efforts to attach ‘role’ to it to signify gender. (For the
French case, see Offen, 2006.) When non-English writers want to signify
‘gender’ they will often use the English word instead of a doubtful native
In the USA, ‘gender’ has achieved complete dominance as the favoured
concept for justifying legal activism. When the Education Amendments to
the Civil Rights act of 1964 were passed in 1972 (Title IX), they banned
any discrimination on the basis of ‘sex’ by any institution receiving federal
funds. However, by 1992, an important follow-up study of the effects of
Title IX determined that much more needed to be done in the way of
‘gender equity’. This evolution has also prevailed at the international level.
UNESCO’s current ‘Gender Mainstreaming Implementation Framework’
mentions sex not at all. It states: ‘The concept of gender is vital because,
applied to social analysis, it reveals how women’s subordination (or men’s
domination) is socially constructed. As such, the subordination can be
changed or ended. It is not biologically predetermined nor is it fixed forever’
(UNESCO, 2003, p. 17).
Social and religious conservatives readily appreciate what is at stake in
this linguistic turf battle, and have sought to retain ‘sex’ as the operative
term for discussing men and women generally. One of Pope John Paul’s last
encyclicals on ‘The Collaboration of Men and Women in the Church and in
the World’, of July 2004, deplored the opposition encouraged between men
and women by those who:

In order to avoid the domination of one sex or the other, their differences tend
to be denied, viewed as mere effects of historical and cultural conditioning. In
this perspective, physical difference, termed sex, is minimized, while the purely

cultural element, termed gender, is emphasized to the maximum and held to be

primary. The obscuring of the difference or duality of the sexes has enormous
consequences on a variety of levels, [not least the dangers of homosexuality and
threats to the] natural two-parent structure of mother and father. (Vatican, 2005)1

The contest between ‘natural’ sex and ‘cultural’ gender is not likely to
disappear any time soon, though common usage, as we have seen, is moving
to conflate the terms, not distinguish them. We must certainly acknowledge
the force of the influences I have previously cited – political correctness,
the progress of feminist analysis, and campaigns for gender equality – but I
wish to argue there is another powerful explanation for these developments
that is best appreciated from the perspective of the history of sexuality.
I will make two observations. Firstly, I show that the history of gender
as a category of analysis reveals that gender has appropriated some of
the qualities formerly reserved to sex and now has a biological dimension
that most feminist theorists did not originally intend it to have when they
adopted it in the 1970s. Secondly, I will argue that if gender has prospered
it is because ‘sex’ as a unitary concept has been destabilized by a number of
In the last 40 years or so, historians have grown accustomed to utilize
‘gender’ to analyse variability in masculine and feminine social roles over
time. Before ‘gender’ emerged, ‘sex’ satisfactorily explained these social
arrangements. The word ‘sex’ as a category of difference has been around
as long as language itself; although the term was not fitted out in its
characteristically modern form of biological determinism until the 18th
century, it was the way in which people made sense of the physical and social
differences between men and women.
This model restricted gender and sexuality to more or less direct
expressions of male and female sex. Articulated in language and causality
appropriate to the times, male sex produced masculinity and a reproductive
desire for vaginal intromission, while producing femininity in females and
the desire to be penetrated and fertilized. This orthodoxy was undergirded
first by religious and philosophical and later by scientific authority in ways
that preserved a remarkable degree of continuity. Both kinds of authority
recognized the existence of intermediary sexual forms and corresponding
expressions of gender and of sexual desire, but these were, according to the
usage, unnatural or pathological, infrequent, and providentially sterile.
Many contemporary gender historians and social scientists have tended
to treat ‘sex’ uncritically as the inscrutable foundation for the interpretive
work they then perform on the mutable superstructures of gender and
sexual desire, or have treated sex as a category for compiling survey statistics

1. Available from: http://www.vatican.va/roman_curia/congregations/cfaith/documents/

rc_con_cfaith_doc_collaboration_en.html (accessed 25 May 2007).

on men and women that are amenable to gendered analysis.2 In short, they
make gender everything by ignoring sex altogether. On the other hand,
many biological researchers continue to study sex difference in the hope
of presenting masculinity and femininity and sexual desire as unmediated
expressions of genes or hormones. In short, they hope to reduce gender to
expressions of sex (Geary, 1998; Rhoades, 2004).
We gain little understanding either by emptying or utterly materializing
the category ‘sex’. A few biologists, historians, and theorists are exploring
the processes by which sex has been and is being constructed – in
evolutionary theory, in molecular biology labs, and in medical practice. The
biologist Anne Fausto-Sterling argues against the unitary nature of sex. As
she writes in Sexing the Body: ‘The more we look for a simple physical
basis for “sex” the more it becomes clear that “sex” is not a purely physical
category. What bodily signals and functions we define as male or female
come already entangled in our ideas about gender’, although she also makes
the more radical claim that our beliefs about gender ‘affect what kinds of
knowledge scientists produce about sex in the first place’ (Fausto-Stirling,
2000, pp. 4–6).
I will return to this argument later but now I should like to return
to the history of sexuality for a little perspective on why ‘gender’ took
thousands of years to make its appearance as a way of conceptualizing
male and female difference. From Linnaeus onwards, the mammalian model
of reproduction has served as our template for male/female dimorphism
in human societies (Schiebinger, 1993). Like mammals, humans have
made powerful investments in reproductive fertility to ensure survival.
Conversely, as Angus McLaren (1990) has shown, there is evidence to
suggest that even ancient societies acted to limit fertility when population
outstripped material resources. Since in both cases the management of
procreation was the key to assuring survival of the group, great value was
placed on the procreative capacities of males and females and on the sexual
practices that ensured or regulated births.
Because genitalia, ‘normal’ body morphology and sexual function have
controlled the assessments of these capacities in the past, we can understand
why the sexed body has served for so long as a symbol in the social
imaginary for the foundation of life. However, while it might seem
reasonable to conclude from the crucial importance of procreation to
human survival that sex and sexual capacity are primordial and gender
is a secondary, cultural effect, in fact, the opposite is more nearly the
case. Despite the many forms it has assumed in human societies, gender

2. The editorial website of Gender and Society contains ‘A Note about Terms: “Sex”
and “Gender” and “Gender Roles”’ which duly warns against conflating sex and gender
but warns against using ‘sex’ as a way of discussing men and women or boys and
girls in preference to ‘gender’. Available from: http://www.intl-gas.sagepub.com/upm-

appears to be the stable and persistent category while the sexed body
and its sexuality have been more changeable and adaptive. The gender
arrangements of most societies have dictated what is valued and permitted
in the domain of sexual identity and behaviour and have done so for
the most part within binary male/female orders that have historically
reproduced themselves as systems of male dominance. These norms have
socially organized the necessity of biological sex, policing the boundaries of
the sexually permissible, nourishing ideals of sexual love and dictating the
rules governing sexual aim and object.
Tom Laqueur (1990) has argued that, until the 17th or 18th centuries,
anatomical and physiological representations of male and female bodies
in Western medicine relied on a single, androgynous body with differently
positioned but homologous reproductive organs in each sex, the vagina
being an inverted and internalized penis and so forth. However, by degrees,
Western scientists and doctors became increasingly persuaded that women’s
and men’s bodies were primordially different, particularly in skeletal
structure and in reproductive function, but also physiologically. Male and
female bodies were described as incommensurable but complementary,
with physical attraction depending on the relative differences in masculine
and feminine traits (Nye, 1993, pp. 57–8). By this time, children born with
ambiguous genitalia were no longer thought to be exemplary punishments
for collective sin but biological exceptions on a natural spectrum of
pathology and norm (Daston & Park, 1999, pp. 329–63).
The consolidation of this ‘two-sex’ system by the end of the 18th
century essentially locked men and women into a modern discourse of
biological determinism. This materialization of gendered bodies confirmed
the differences between male and female sexualities, and legitimated the
confinement of women to the domestic sphere at a time when many middle-
class families could live on the husband’s income alone and when claims for
political rights were first expressed in a discourse of rational ‘capacity’. In
this scheme, sex, sexuality and gender (in our modern sense) were conflated.
Biological sex, it was believed, determined every (normal) expression of
men and women’s behaviour and its telos aimed at procreative (marital)
However, to paraphrase Milton Diamond (2000), if nature loves
variety, society hates it. Departures from these norms were systematically
pathologized in the last decades of the 19th and the first decades of
the 20th centuries. In the medical schemata of the era, perversions
were excesses or deficiencies of normal organic functions. Excessive
heterosexual libido led to nymphomania in women and satyriasis in men.
Sadism was an exaggeration of normal sexual aggression and dominance;
masochism – pleasure taken in being dominated – was its contrary, passive
expression. Deficiencies in what was believed to be the innate aim of sexual
libido – to have intercourse with the opposite sex – produced attractions

to inappropriate objects or bizarre actions that fell well short of full

heterosexual intercourse. This list was long indeed, including all varieties of
fetishism, exhibitionism, bestiality and, in particular, inversion, which was
the preferred term for an unnatural attraction to someone of the same sex
(Oosterhuis, 2000).
There are two notable things about this classification system. First is
the fact that the desired norm against which all the perversions were
measured was procreative heterosexual intercourse. Secondly, the entire
logic of the effort to identify and cure the perversions depended on the
gender orthodoxies of Western societies. The invention of the perversions
was to a great extent an effort to police a perceived crisis in traditional
gender roles and widespread fears that ‘normal’ sexual drives were being
deflected from their rightful ends. Women were taking jobs and entering the
professions in increasing numbers; some were even bold enough to demand
equal rights and the vote. In the years leading up to World War I, some
European statesmen were convinced that the growth of perversions had
lowered birth rates and weakened their nation’s defences (for Germany,
see Hull, 1982; for Italy, see Horn, 1994; for France, see Nye, 1994). This also
explains the contemporary fascination and horror with the sado-masochistic
perversions that characterized women as whip-wielding dominatrixes and
men as groveling slaves, a subversive inversion of the gender hierarchy
(Noyes, 1997, pp. 105–39).
At virtually the same time, physicians and surgeons were employing
new techniques to help identify the ‘true sex’ of individuals known at the
time as hermaphrodites. Alice Dreger has argued that, despite growing
evidence for the anatomical and physiological complexity of some of these
individuals, doctors insisted on placing even the most ambiguous cases in
one sex or other, according to the gonadal evidence. As she writes, an
adherence to:

[t]he gonadal definition of sex was driven not by a strictly ‘scientific’ rationale but
instead for the most part by pragmatism: it accomplished the desired preservation
of clear distinctions between males and females in theory and practice in the face
of creeping sexual doubt. (Dreger, 1998, p. 153; for a parallel development in the
USA, see Reis, 2009)

Near the end of the 19th century, this same doubt worked to shape
evolutionary biologists’ understanding of the advantages of sexual as
opposed to non-sexual reproduction. It was argued that reproduction
between distinctly ‘male’ and ‘female’ gametes conferred an evolutionary
advantage on species that reproduced sexually by ensuring natural
variability and adaptability. For Charles Darwin and his contemporaries,
Patrick Geddes and J. Arthur Thomson, the evolution of sex confirmed
the natural advantages of contemporary gender arrangements and the logic

of bodily dimorphism. As Geddes and Thomson famously wrote in 1890:

‘What was decided among the prehistoric protozoa cannot be annulled by
an act of Parliament’ (Geddes & Thomson, 1890, pp. 266–7).
The history of hormone research in the first half of the 20th century
tells a similar tale. In his history of sex, glands and hormones, Chandak
Sengoopta argues that the quest to understand the role played by
internal secretions in sexual development and sexuality was driven by
the compulsion to confirm the naturalness of sex difference. Despite the
fact that laboratory research revealed the plasticity and instability of the
sexual body, researchers persisted in adhering to a model of antagonistic
‘sex’ hormones that undergirded ‘typical’ masculine and feminine traits
and behaviour in experimental subjects (Sengoopta, 2006, pp. 117–152;
see also Oudshoorn, 1994). This comforting outlook was not shaken by
the discovery that androgen and oestrogen compounds were produced
in both male and female gonads, and in the adrenal glands, and that all
internal secretions were regulated in part by the pituitary gonadotrophins.
By the 1930s, the polyglandular nature of hormonal function had established
beyond doubt that all complex organisms were only predominately male
or female. Nonetheless, Eugen Steinach, the Austrian endocrinologist who
had been most responsible for perfecting sex transformations in animals
through cross-sex glandular transplants, summed up his life’s work in 1940
by writing that: ‘The sex hormone is therefore not only sex-specific, but it
is also counter-specific, . . . thus assuring, as nature intended, the principle of
normal differentiation between male and female’ (Steinach, 1940, pp. 7–8).
Since the principal findings in hormone research coincided with the
development of modern genetics, one might have expected that the
discovery of the complex chemical and genetic underpinnings of sexual
desire and the sexed body would ultimately weaken traditional gender
orthodoxies by drawing our attention to the extraordinary variability in the
anatomy and physiology of sex. In reality, something more complicated has
taken place. As sex (in the old, unitary sense) has become disaggregated
into genes and hormonally-driven development, gender has begun to take
its place, not simply as a way to fill a lexical gap created by our politically-
correct culture, but as the biomedical foundation of male and female being.
The first steps in this direction were taken in a series of papers written in
the early 1950s by John Money and his colleagues at Johns Hopkins. Money
used ‘gender’ as an indispensable element in the neonatal intersex protocol
he developed and applied in subsequent decades. Money considered all
infants to be more or less sexually neutral, so if ambiguous genitals were
surgically reconstructed to align with the most reasonable estimate of the
child’s biological sex, and the child was raised as the corresponding gender,
his or her successful adjustment to adult life would be assured. As Haig has
confirmed in his scan of the ISI Web of Science, Money was the first to use
the term gender in this non-grammatical sense (Haig, 2004, p. 91).

However, if Money and his colleagues’ conception of gender broke the

mould of a sex-determined model of sexual and personality development,
they employed highly deterministic learning mechanisms borrowed from
theories of language acquisition and from Konrad Lorenz’s concept of
imprinting to provide gender a robust and enduring nature. Many scholars
have pointed out that Money’s protocol supported traditional gendered
certainties (Fausto-Sterling, 2000, pp. 57–73; Meyerowitz, 2002, pp. 117–20;
also Reis, 2009, pp. 135–52). Deborah Rudacille (2006) has recently summed
up Money’s intersex work: ‘Money’s research thus combined radicalism (the
theory of psychosexual neutrality) with a profound conservatism (emphasis
on sexual dimorphism)’ (p. 103).
As it happens, Money’s work with intersex children followed closely
in the wake of Christine Jorgenson’s sensational transsexual debut
in 1952, which invited further speculation on the mechanisms that
impelled individuals to believe themselves trapped in the wrong body.
Harry Benjamin, an early supporter of Eugen Steinach’s ‘sex’ hormone
experiments, who had been counselling individuals dissatisfied with their
sex for years, wrote in 1966 that ‘sex’ was losing its scientific meaning and
that anatomy was on the verge of being dethroned by gender, which he
believed was shaped by a ‘mixture of [unspecified] inborn and acquired
traits’ (Benjamin, 1966, p. 15).
Robert Stoller, an MD/psychoanalyst practising at UCLA, suggested a
more complex picture. Based on a number of clinical experiences with
intersex and transsexual patients, Stoller argued in Sex and Gender (1968)
and later in Presentations of Gender (1985) not for the dethronement of sex,
but an acknowledgement that sex and gender occupied ‘two realms’ (Stoller,
1968, p. ix). As he put it, a child’s ‘sense of its sex’ preceded ‘gender identity’,
the term he coined for the imperious sense of selfhood that became firmly
anchored by the age of two and a half years and which he distinguished
from the performative category of ‘gender role’ (Stoller, 1968, p. 40). Stoller
acknowledged the power of postnatal life experience in shaping gender, but
he never failed to admit of exceptions to it. As he put it in 1985: ‘Usually – I
used to say almost always – the gender identity of hermaphrodites conforms
to the sex assignment at birth . . . ’ (Stoller, 1985, p. 74). He cited case
studies of exceptions in which ‘biological forces’ that were ‘the algebraic
sum of the activities of a number of neuro-anatomical centers and
hierarchies of neuro-physiological functions’ overwhelmed sex assignment
(Stoller, 1968, p. 74). Stoller also consistently opposed what he called
‘wastebasket’ syndromes like ‘gender dysphoria’ in contrast to careful, case-
by-case diagnoses that respected individual aetiologies. He also disliked
the term ‘transsexualism’ because sex re-assignment surgery only produced
a ‘facsimile’ of sex change. Nonetheless, Stoller did advance in his work
the notion that biological forces were important components of gender

Despite Stoller’s vigorous advocacy of caution, hormone therapy and sex-

reassignment surgery proliferated in the late 1960s. John Money helped
found the Johns Hopkins Gender Identity Clinic in 1966 and in the
following decade thousands of operations were performed in Europe and
the USA. ‘Gender dysphoria’ soon emerged as the diagnosis in which
an individual’s subjectively ‘true’ gender did not correspond to his/her
anatomy. In the first few decades of this surgery, many transsexuals
considered the reconstruction of the ‘appropriate’ genitals a kind of rite
of passage that finally squared their bodies with their internal sense of
gender (Bolin, 1988, pp. 179–81). Medical textbooks on gender dysphoria
in the 1980s reflected the lexical ambivalence noticed by Haig in all the
scientific literature at this time by using ‘cross-gender’ and ‘cross-sex’ or
the terms ‘opposite gender’ or ‘opposite sex’ interchangeably. However,
few researchers doubted the deterministic power – whether learned or
inborn – of the force of the syndrome itself, or imagined that their patients
wanted anything other than being one sex/gender or the other (Steiner,
1985, pp. 34, 160, 262, 371). By the end of the 1980s, we might say that
the body’s external morphology, rearranged by hormones and surgery, had
become the ‘sign’ of the body’s gender. Thus, in under 40 years, gender
had made a transition; it had begun, under the aegis of John Money and
his team, as the ‘sex of assigned rearing’ – a testimony to the power of the
environment – and had developed in a few decades into the bedrock of
personal identity.
This evolution in usage is reflected in the successive editions of
the Diagnostic and Statistical Manual of Mental Disorders (DSM).
‘Transsexualism’ appeared first in the 1980 edition as applying to
‘gender-dysphoric’ individuals who demonstrated ‘continuous interest in
transforming their sexual anatomy and roles’. In 1987 ‘gender identity
disorder’ was added to the DSM and, in the 1994 edition, ‘transsexualism’
was removed and its symptoms amalgamated with ‘gender identity
disorder’, which became the omnibus category for the condition. In
effect, the desire to change one’s genitals, to become the other sex, was
incorporated into a default diagnosis of this disorder and applied to a far
larger category of people who were unhappy with their sex, but were not
prepared to undergo, or were unable to attain or afford sex reassignment
surgery. This development occurred despite the fact that there is ample
testimony that people of uncertain gender arouse far more hostility and
rejection than those who can pass, as is the case with many transsexuals.
(For these developments, see Rudacille, 2006, pp. 190–9.)
In the same way, since the late 1980s the term ‘transgender’ has
begun to displace ‘transsexual’ among those unhappy in their bodies.
As transsexuals had done before them, transgender people often speak
about the implacable foundations of their identity, even though fewer of
them are opting for surgical transformation (Devor, 1997). Advocates for

intersex people such as The Intersex Society of North America also agree
in wanting to acknowledge the profound psychological reality of gender
while campaigning against non-essential surgery (Currah, 2006, pp. 3–31;
Currah et al., 2006, pp. xiv–xxi). Because the transgender ‘umbrella’ covers
so many different and sometimes competing interest and advocacy groups,
there is far less emphasis placed on the nature of gender and more on what
these various groups share in common: the right to alter bodies, dress and
behaviour in a way that satisfies individual gender identity without fear of
violence or discrimination.
However, in what appears to confirm the irresistible allure of material
origins, some transgender activists have been deeply involved in identifying
a range of developmental disorders of epigenetic origin alongside the
anomalies of sex and gender that appear regularly in human reproduction.
Deborah Rudacille has speculated that the administration of synthetic
oestrogen (diethylstilbesterol or DES) to as many as 10 million women
between 1941 and 1971, in the belief that it would prevent miscarriages,
resulted in developmental disorders that medical professionals identify as
‘gender variance’ in male children exposed to the hormone in utero. 50%
of the men who joined a DES Sons’ Network exhibited some degree of
genital or identity variance and many indicated they were gender-dysphoric,
transgender, transsexual or intersex (Rudacille, 2006, pp. 244–60). Medical
researchers and developmental biologists are looking for other endocrine-
disrupting chemicals (EDCs) like phthalates that might be responsible
for giving rise to ‘gender variance’. (See the summary of recent research
indicating ‘gender-specific effects’ in Fiore [2009].)
It may seem paradoxical that many transgender and intersex activists
who otherwise endorse the material and deterministic conception of gender
share with feminists a fundamental critique of the oppressiveness of the
sex/gender order. Transgender writer Kate (formerly Al) Bornstein argues
that to eliminate the pernicious requirement that we be one sex or the
other we must abolish the gender categories that drive that need: the
‘differences’ that the gender order presently identifies and pathologizes
will ‘then fall aside of their own accord’ (Bornstein, 1994, p. 114). Coming
from an entirely different direction, the feminist theorist Judith Butler, who
has long and famously championed the idea that sex is merely a discursive
effect of a patriarchal gender system, has recently made some concessions
to the material aspects of gender. In Undoing Gender (2004) she advances a
constructionist approach to gender identity in which:

Gender is not exactly what one ‘is’ nor is it precisely what one ‘has’. Gender is the
apparatus by which the production and normalization of masculine and feminine
take place along with the interstitial forms of hormonal, chromosomal, psychic,
and performative that gender assumes. (Butler, 2004, p. 42)

In recent years, partly as a protest against gender orthodoxies, many

transgender radicals have embraced this performative notion of gender,
insisting, as one has said: ‘Trans is something I’m doing, not who I
am.’ The term ‘genderqueer’ is a self-description adopted by many such
individuals. One of the many websites devoted to transgender issues writes
of genderqueer folk that: ‘Some believe they are a little of both or feel
they have no gender at all. Others believe gender is a social construct
and choose not to adhere to that construct.’3 The elective quality of
gender, according to the transgender radical Pat Califia, extends to sexual
orientation and desire, both of which can be continuously reinvented.
Califia writes that this point of view ‘is unpopular in an era in which
every claim for gay rights is based on pseudoscientific sulking about how
we can’t help being queer; we’re just born that way. Thanks, but I don’t
want to receive my civil rights as charity bequeathed to me by my genetic
A posture of permanent rebellion against gender norms is for the brave;
the rest of us will follow with intense personal interest the rich and
complicated exchanges among feminists, transgender and intersex radicals,
queer theorists, and the medical and scientific establishment about the
nature and future of sex and gender (Rosario, 2004). For what it is worth,
some evolutionary theorists like Joan Roughgarden, a transgender biologist,
are convinced that ‘transgender’ categories, having roots in the natural
world, will persist far longer than the either/or of sex or even the identities of
sexual orientation (Roughgarden, 2004a, pp. 289–91; 2004b). It is certainly
true that in practice we all resist as best we can the cards dealt us by the
biology of sex and aging. Modern medical and pharmaceutical technologies
permit us to shape and energize our bodies with cosmetic surgery, hormone
replacement therapy and potency medications. On the other hand, we
overwhelmingly employ these therapies and medications in order to re-
establish or reinforce the ‘normative’ sexual characteristics of gender and
of sexual desire and function. Thus, notwithstanding growing uncertainty
about nature’s plan for the sexual body, experts and most of humanity
continue to look for evidence that confirms sex and/or gender difference
and hetero-normal sexuality.
Modern science and medicine have destabilized the biological
foundations of sex that have sustained the material and ideological structure
of male and female difference for much of the last two centuries, but there is
ample evidence that we may be on the verge of replacing sex with a material
form of gender that performs much the same function as sex once did.
The question is whether we can avoid the systematic reification of gender
that has characterized most of the historic trajectory of the category ‘sex’.

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This article argues that ‘sex’ which had been commonly assumed in the West to
refer to a permanent set of biological and behavioural traits particular to men and
women, is gradually being replaced in general usage by ‘gender’. Though feminist
theorists attempted to attach a constructivist meaning to gender, a generation
of developmental theorists, clinicians and analysts has imbued the term with the
determinism and biological qualities formerly ascribed to ‘sex’. The triumph of this
materialist conception of gender is not assured, but it threatens our ability to think
about gender identity as a historically-constructed category.
Key words: sex, gender, perversions, transsexual, transgender, John Money, Robert

DOI: 10.3366/E146082351000067X
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