CADE HILDRETH

GENDER SPECTRUM
A SCIENTIST EXPLAINS WHY
GENDER ISN’T BINARY
 INTRODUCTION

The gender spectrum is an understanding that gender is not

binary (female/male), but rather a spectrum of biological,
mental and emotional traits that exist along a continuum.

In contrast, the gender

binary, also called gender
binarism or genderism, is
the belief that gender is
composed of two distinct
and opposite genders
(female and male) in which
there is not overlap.

Unfortunately for those who

believe in a gender binary, it
is not scientifically or
medically correct.

Today, numerous scientific fields, including biology,

endocrinology, physiology, genetics, neuroscience, and
reproductive science, have confirmed that sex and gender
exist as a spectrum, both for humans and across the animal
kingdom.
 SEX (AND GENDER) ARE
BIMODAL, NOT BINARY

For all too long, the government, the medical system, and
even our parents have assumed that sex (and gender)
are binary. Based on science, this is not biologically or
medically accurate.

What is true is that sex characteristics tend to be bimodal,

meaning there are clusters of characteristics that tend to be
associated with people that we call “female” or “male.”

On average, men do have penises, and on average, women do

have vaginas, which is what allows for reproduction. However,
there are many examples where this is not the case, such as
intersex people. External genitals (a biological marker of sex)
present across a spectrum from full-size penis to small penis
to micro-penis to clitoromegaly to enlarged clitoris to
standard-sized clitoris.

SEX IS
On average, men tend to have
XY chromosomes and women

NOT
tend to have XX chromosomes.
However, sex chromosomes
come in a wide variety as well,

BINARY
with at least 16 different
naturally occurring variations
(see details below). This means
that chromosomal presentation
is not binary either.
On average, men also tend to have more facial and
body hair than women (a secondary sex characteristic), but
there are also women with coarse and dense body hair and
men who can’t grow a full beard.

On average, men tend to be taller than women, but there are

most certainly women that are taller than some men. If
skeletal structure (a biological marker of sex) was binary, then
all men would have to be taller than all women, which of
course, they are not.
As explained by these examples, gender is not binary,
because it cannot be grouped into two separate,
non-overlapping groups.

However, bimodal sex characteristics are not uncommon.

Bimodel means the presence of two (“bi”) statistical modes,
which can be seen as peaks in a graph. The two modes
represent probability clusters.

With regard to human sex, this means that for some sex
characteristics, there may be common norms among people
whom we tend to assign as “male” and “female,” but there are
also clearly overlaps present between the peaks. This is what
makes sex (and gender) bimodal, and not binary.

Finally, at risk of getting too mathematical, a bimodal

distribution is by definition, a continuous probability
distribution with two different modes. In other words, it is
a spectrum that has clusters.

DIFFERENCE BETWEEN SEX AND GENDER

In describing the terms sex and gender, it’s important to note

that within Western culture the word “sex” describes
biological differences between people (male, female,
intersex, etc.), while the term “gender” is a broader term that
reflects how a person lives within society (that is, gender
identity).
Despite the binary options on most state and federal IDs,
your biological sex can be variable.
This is true for people who are intersex and likely for others
as well. Intersex means that a person was born with
variations in their sex characteristics, including but not
limited to internal and external genitalia, gonads,
chromosomes, hormones, brain structure, and more.

Current research estimates that intersex people

compose 1.7% of the population, which makes being intersex
about as common as having red hair.

However, this metric is understated for the following reasons:

1. Not all doctors, parents, or individuals release this

medical information.
2. There are subtle forms of sex variations that do not show
up until later in life which go undocumented.
3. Definitions of what intersex is have not reached
consensus. The Intersex Society of North America uses the
following examples: “How small does a penis have to be
before it counts as intersex? Do you count sex chromosome
variations if there’s no external sexual ambiguity?”

In short, it’s unfortunate that federal and state-issued

documents often use external genitalia to make a binary sex
(male/female) assignment, because for many people this is
an inaccurate or incomplete description.
 SEX AND GENDER

Even sex and gender are not fully separate from each other.
Across many cultures, they are intertwined.

Examples of this include:

Two-Spirited People for Native American/First Nations
people
Hijra for South Asian people (also known as Kinnar or
Kinner)
Māhū for Kanaka Maoli (Hawaiian) and Maohi (Tahitian)
cultures
Fakaleiti for Tongans
Ffa’afafine for Samoans
And many others

One of the people who has done a phenomenal job of

deconstructing the concept that sex and gender are separate
is Alok Vaid-Menon.

Alok describes the prevailing idea that gender is “cultural”

and exterior and sex is “biological” as neglectful of the fact
that biological sex is also cultural. Alok explains that in
contrast to Western beliefs, many other cultures do
not perceive clothing or adornment as a supplement to the
body, but as foundational to its constitution.
 WHY A SEX AND GENDER SPECTRUM?

As a nonbinary person, I have heard people say things like,

“Gender is determined by what is in your pants. If you have a
penis you are a man. If you have a vagina, you are a woman.”

However, as a scientist, I can tell you that both sex and gender
are complex, and across all species, exist as a spectrum.
Currently, sex gets assigned at birth based on external
genitalia, but there are at least 10 medically accurate markers
of sex (and likely more).

Biological markers of sex include:

Chromosomes – Types of chromosomal expression.
Gonads – Organs that produce gametes (testis or ovaries).
Hormones –Types and level of hormone secretion, which
vary within and across the sexes.
Secondary Sex Characteristics – Features that appear
during puberty, but are not involved with reproduction.
External Genitalia – Genitals visible outside the body.
Internal Genitalia – Genitals present within the body.
Skeletal Structure – Sex differences may be seen in the
pelvis, jaw bone, brow, and limb length and thickness.
Gene Expression –Levels and types of gene expression.
Genes dictate the proteins made by the body. Known genes
that impact sex include DMRT1, SRY (produces Testis-
Determining Factor), and Foxl 2.
Brain Structure – Both brain structure characteristics
(including the ratio of white matter to grey matter) and
brain activation patterns vary by sex.
 Personal Identity – How a person self-identifies. It is
often a result of the other factors interacting, making it
a valuable marker.

WHY GENITALS DON'T DETERMINE SEX?

With regard to assigning sex to people by their external

genitalia, it is an inaccurate system at best. There are several
reasons for this, as described below.

1) External Genitalia Are Diverse

In newborn humans, genitals are extremely diverse in size and
shape. Until about week 7 to week 8 of pregnancy, all fetuses
have what’s known as a “genital ridge.”

This genital ridge is the tissue that eventually becomes the sex
organs.
At the time of birth, a newborn’s genitals are usually labeled by
a physician as male or female, even if the newborn presents
with sex organs or characteristics that are intersex, ambiguous,
or undefined.In a few places, such as Ontario (Canada), 11 U.S.
states, and Washington, DC, “nonbinary” or “gender
unspecified” options now exist, but this is not yet the norm.

All sex organs come from the same genital ridge, with the testes
in men being equivalent to labia and ovaries in women and the
penis being equivalent to the clitoris.
This is why the penis and vagina do not exist as a binary,
but rather, as a spectrum that includes the following:
Full-size penis
Small penis
Micro-penis
Clitoromegaly, also called a “Pseudopenis”
Enlarged clitoris
Standard-sized clitoris

2) Existence of Intersex People

Intersex means that a person was born with variations in their
sex characteristics, such as the biological markers described
above, including but not limited to internal and external
genitalia, gonads, chromosomes, hormone levels, and brain
structure.
Intersex people are biological proof that sex is not binary.

What about Chromosomes?

While chromosomes are another

biological trait that some people
try to use to explain the gender
binary, chromosomes are also
varied and diverse across the
human species. On average, most
people assigned male at birth
have XY chromosomes, while
most people assigned female at
birth have XX chromosomes.
However, other sex chromosomal variations frequently
exist as a result of the loss, damage, or addition of one or
both of the sex chromosomes.

In humans, the following sex chromosome variations are

naturally occurring:
45, X, also called Turner syndrome
45,X/46, also called XY mosaicism
46, XX/XY47, XXX, also called  Trisomy
X47, XXY, also called Klinefelter syndrome
47, XYY with normal phenotype
48, XXXX
48, XXXY
48, XXYY
49, XXXXY
49, XXXXX
XX Male Syndrome
XX Gonadal Dysgenesis
XY Gonadal Dysgenesis
Where Gonadal Dysgenesis is listed above, it refers to
reproductive tissue (gonads) being replaced by non-
reproductive fibrous tissue during prenatal development.

GENDER AND THE BRAIN

The brain is another biological marker of sex that presents

with great diversity, further supporting the concept of a
gender spectrum.
In a fascinating study published May 2018 by the European
Society of Endocrinology researchers discovered, “Brain
activity and structure in transgender adolescents more closely
resembles the typical activation patterns of their desired
gender.”

When MRI scans of 160

transgender youths were
analyzed using a technique
called diffusion tensor
imaging, the brains of
transgender boys’
resembled that of cisgender
boys’, while the brains of
transgender girls’ brains
resembled the brains of cisgender girls’.
Put simply, transgender kids’brains resemble their gender
identity and not their biological sex.

Cisgender means that a person’s gender identity aligns with the

sex assigned to them at birth, while transgender means a person’s
gender identity does not align with the sex assigned to them at
birth.
As stated by Julie Bakker, lead researcher from the University of
Liege, “We now have evidence that sexual differentiation of the
brain differs in young people with [gender dysphoria], as they
show functional brain characteristics that are typical of their
desired gender.”

This study explored the brains of cis girls, cis boys, trans girls and
trans boys. The next step is for more sexes and genders
to become integrated within this neuroscience research.

THE ROLE OF THE MIND VS THE BRAIN

Of course, the brain and the mind are also two different things.

The brain is the physical structure in your head that is

composed of grey and white matter, has neurons firing within
it, and uses neurotransmitters as chemicals messengers.
The brain can be thought of as your central processor, because
it integrates and facilitates all of the functions within your body.

As noted by Julie Bakker (lead reseacher in the MRI study

above) and others, brain structure and activation patterns
present along a spectrum.

The mind, on the other hand, is the conscious product of that

biological activity that creates emotions, ideas, memories,
interpretations, and creative thought.
It determines your personality, plays a role in how you prefer to
present, and impacts how you interact with the world. The mind
plays a central role in your gender identity.

SEX IDENTIFICATION AT BIRTH

As described above, external genitals are not an accurate

marker of sex to use at birth, because they are one of at least
10 different biological markers of sex.
External genitals are also highly variable across our
species, may be ambiguous, and can potentially have both
male and female sex organs present.
Furthermore, performing sex assignment at birth based on
external genitals does allow an Ob/Gyn to integrate
information about the child’s internal genitals, gonads,
chromosomes, gene expression, brain structure, or
importantly, how the child will grow up and express
themselves within society.

While I am not opposed to the option to note sex on a

child’s birth certificate, I am opposed to:
The requirement that parents select a sex for their child.
Parents should be allowed not to indicate a sex for their
child if this is their preference.
Binary options for sex, when it is clear that sex exists
along a spectrum. At the very least, there should be the
option to choose Female (F), Male (M), or (X) for all other
genders.
That sex being glued to a child for the rest of their life,
unless they present medical papers to prove otherwise.
 GENDER DIVERSITY ACROSS
THE ANIMAL KINGDOM

Finally, gender diversity is widely present across the animal

kingdom. For example, seahorses, pipefish, and sea dragons
all have pregnancy as a male reproductive process.
In these species, the male fertilizes eggs that are
deposited within a pouch in his belly and then he carries his
developing embryos until they are ready to be birthed.

In another example, female spotted hyenas have a pseudo-

penis that is capable of erection and can be as much as 90%
the size of a male hyena’s penis.
They have two fleshy masses at the base of their
pseudopenis that contain fat and connective tissue which
appear analogous to a scrotum. Where you’d expect there
to be a vagina, spotted hyena females have fused labia.
Female spotted hyenas also dominate males behaviorally.

Chickens can also naturally undergo gender changes. This is

because female chickens only use one functional ovary on
their left side. However, they have two sex organs that are
present from their embryonic stage onward through their
lifespan. If the left ovary shrinks within a hen, then its right
gonad may start secreting androgens, turning the hen into
a rooster.

In short, sex and gender exist as a spectrum for humans

and animals (and in fact, plants too). We might as well
embrace it, because after all, natural variation has caused
the rise of our species to 7.7 billion strong!
 THANK YOU
CADE HILDRETH
Cade Hildreth attended Dartmouth College & Smith College for
Undergraduate Studies in Biology and then acquired a Master’s
Degree in Biochemistry and Molecular Biology with Specialization
in Biotechnology from Georgetown University, where they were
Valedictorian. Cade is the Founder/President of BioInformant.com,
the world’s largest stem cell industry news site that attracts nearly
one million views per year and serves all-star clients that include
GE Healthcare, Pfizer, Goldman Sachs, PerkinElmer, and Merck.
Cade has authored over one-thousand articles about the stem cell
industry and interviewed hundreds of executives from across the
industry. As a media expert on stem cells, Cade has been
interviewed by the Wall Street Journal, Los Angeles Business
Journal, Xconomy, & Vogue Magazine. As a professional real
estate investor, Cade owns a portfolio of residential and
commercial properties.