Explore your birth certificate and you’ll note a label indicating sex. When you entered the world, your sex was determined based on a quick glance at your genitalia, with “male” or “female” typically being checked in the U.S. But the reality of sex is far more complex and not as binary as those labels suggest. In fact, research indicates that sex designation based on biological, anatomical, and chromosomal factors is more intricate than a simple designation on a birth certificate. This has led to a recent push to eliminate sex designation from birth certificates, with the American Medical Association calling for this yourself.
As a medical professor, I’ve been deeply involved in research and clinical experience focusing on LGBTQIA+ issues, and my co-author has been profoundly involved in the health of people who are trans and intersex. The evidence reveals that 0.1 to 0.2% of individuals are born with variations in genital anatomy. Also, unique sex traits, such as the presence of both a vagina and testes, complicate the male/female binary classification. Furthermore, even chromosomes – traditionally thought of as XX for females and XY for males – do not always conform to these standards, with some individuals having atypical sex chromosome pairings.
Furthermore, individuals who are inaccurately labeled as male or female at birth can experience severe physical and psychological harm, including unconsented surgeries for alignment to binary categories and restrictions on marriages due to perceived ambiguity regarding gender. Some private entities and organizations have also restricted participation in sports and activities due to perceived sex ambiguity. The U.S. as a whole needs to embrace sex diversity and move beyond these binary categories in societal norms, starting with the removal of sex designation from birth certificates.
Privacy note
Carl Streed Jr. receives funding from the National Heart, Lung, and Blood Institute and the American Heart Association. He is affiliated with the US Professional Association for Transgender Health and the American Medical Association. Frances Grimstad does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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