Though there’s a lot going on to obscure it, quite a bit has been happening in the social-culture wars over gender and related matters, and it may be that it is once again reaching a decisive moment across the Anglosphere.
In the UK, the Tavistock Centre’s Gender Identity Development Service (GIDS) has been shut down following a scathing interim report by eminent paediatrician Hilary Cass, which accused the service of multiple failures in handling gender dysphoric adolescents, applying an uncritical ideology of gender self-determination, being overwilling to characterise complex adolescent sexuality and neurodivergence questions as transgender issues, excessively and dangerously prescribing puberty-blocking drugs, and ignoring multiple protests by highly qualified staff over the clinic’s direction.
The interim report went further in its condemnation than many thought it would. What is noticeable is the relative absence of any full-tilt defence of the clinic, or any attack on its closure.
I haven’t seen anyone in any of the UK left media willing to do that. The revelations of the report on the clinic have quite possibly shocked a few people who were willing to defend it, as well as the general practice of easy accession to adolescents’ self-identification as transgender.
The right meanwhile has piled on. In the “final two” competition for the Tory leadership — one that drives candidates to the right — Liz Truss has used the clinic’s closure as a springboard to declare that she would make redundant every civil service “diversity officer” in the UK, a program that will be met with great support in the “Red Wall” seats won from Labour in 2019.
The closure of GIDS comes as that old perennial is flaring up on the other side of the Atlantic: the struggle over “drag queen story hour”. The right, having for decades focused its grassroots campaigns on getting elected to school governing boards, has now turned its attention to library boards. That’s not only to continue the process of censoring the library’s holdings, but also to put a stop to libraries booking full-glam drag queens to read to small children.
Crikey readers will remember that a demonstration against such an event turned tragic several years ago, when a young man in Queensland who was part of the protest (which ended up scaring and upsetting the children far more than a fat tax accountant in a leopard print reading them Mem Fox) committed suicide, a victim of the cultural right’s thuggish dimension.
The first thing to say about drag queen story hour is that before it is anything, it is bewildering. Drag has been argued for and against for decades, by feminism, the gay lib and LGBTIQA+ movements, but one thing everyone has agreed upon, implicitly, was that it was an adult pleasure. Nor has anyone ever equated it, per se, with being transgender.
The pleasure of drag, in its post-1960s version, is that it is meant to be politically sinful, transgressive. It’s not the old mainstream act of “female impersonation”, but nor is it the old leagues club’s drag that exuded a misogyny, in serving as a “relief valve” for straight and gay men’s antagonistic feelings towards women.
Post-1960s drag is surely, still, misogynistic at its root — men are real, women aren’t — but tends to mock that aspect of itself, to varying degrees, to create an act that moves in and out of cultural slander. The residual, root misogyny comes out of the imbalance.
Drag “king” shows — women playing exaggerated men — only really work when done by skilful theatrical performers, are relatively rare, and simply less fascinating, due to deep cultural settings. Whereas this Saturday night, in a thousand pubs across the world, someone’s gangly uncle is calling themselves something like Lolly Suck, and belting out “I Will Survive” in EE falsies, and it won’t really matter how crap it is, it will still be riotous and fun.
What on earth is this adult “naughty pleasure” cultural practice doing, being relocated to the teaching of pre-adolescent children? It’s complex enough teaching small kids about transgender issues. Why then introduce someone who is pretending to be a lady but doesn’t believe themselves to be a lady, etc, etc. The answer lies in the queer conception prior to and parallel with the more recent gender self-determination movement.
This derived from Judith Butler’s founding work Gender Trouble (1990). Prior to this work, and the movement it came out of, even radicals had seen gender as a social-cultural extension to embodied sex. But Butler saw the creation of our gender identities as occurring at the culture-performative level, with our bodily sex was retroactively culturally framed by it. Drag was crucial to that, since Butler argued that its very existence ruptured the idea that embodied sex had any determination of gender at all.
Butler is, with that master-thought, the RD Laing of our era: pointing out some critical truths about received ideas, while also creating a massive movement powered by a simplified myth running parallel to reality. The ethical intensity of their challenge — they began as a theological adolescent, coming through Jewish hermeneutics (with its intense focus on the textuality of truth) to the “radical enlightenment” philosopher Spinoza and beyond, in proto-hipster America, a sort of lentil Yentl — has been the force that through the green fuse drives the flower. It’s not simply that the fixed notions of sex and gender that govern most people’s lives can be queered for liberatory purposes. They must be queered as widely as possible.
That lies at the root of the drag queen story time phenomenon, pushed by a small grouping in the queer and drag community, acceded to or encouraged by librarians who, as nice core knowledge class people, see their role in booking it as a moral affirmation of progress. So it’s more likely to happen in some places than others, and parents there, if they are somewhat disconcerted, are less likely to speak against it. The objection to it is that there is real embodied sex and real gender, and children need to learn it in order to make sense of the world.
The drag queen story hour response to that is that there is no such order. It is all the play of symbols. So, all dissembling aside, its cultural agenda is very clear, and for anyone who believes in the determinative role of real sex, or even simply of real gender, needs to be resisted. That its proponents seem uninterested in considering the objections raised draws on a regrettable feature of some minor strands of LGBTIQA+ politics: an inability or unwillingness to fully see the special and distinct character of the child as a form of being.
So how did we get from the queer notion of performative gender and fluid being to the operation of a gender identity clinic accused of being too willing to confirm adolescents in a “solid” gender that is not that of their body, and to offer them the means of physical modification? Well, the queer focus on fluidity and non-essential forms of being was at home among the social avant-garde. But as the genuine notion of gender complexity spread to wider social groupings, the radical framing slipped away, and the meaning of the process reversed. The transgender journey became one to the hidden “real” self.
Without doubting the reality of the process for many, it can also be said that the widespread understanding of the process reintroduced not only a body/self distinction, but the ghost of a body/soul one. Gender fluidity entered a world dominated by the rule of the brand and the commodity, and what emerged was the notion that liberation could be achieved through an ever-expanding list of different genders.
The journey became the heroic one of our era, and such a premium caused many to passionately attach to the theory, or at least lose critical faculties. The failure to thoroughly investigate the Tavistock GIDS’ practices during years of mounting concern will be a prominent historic moment in measuring how a movement went completely awry.
It will unquestionably prove a rallying moment for a movement within progressivism, to reconstitute a more reflexive, critical and materialist notion of sex and gender. There is a ways to go in the US and here. A story in The New York Times illustrates the rift: what looks like a freakish tale of an 83-year-old female murderer who had killed three victims, all of them women.
Except of course Marceline Harvey wasn’t a woman when, in 1963, he murdered a witness in a rape case against him. Released in 1983, he stabbed to death a heroin-addicted sex worker he was living with, and was put back inside. Paroled in 2019, and then transitioning, Harvey is now accused of stabbing and dismembering a 68-year-old woman.
The crucial fact of this is not the murders themselves, but the way in which Harvey is described throughout the record of a violent life as “she”. Here’s a typical excerpt from the story in the Times:
“At the time [of the 1985 murder], Ms Harvey was unmoored. She had no stable job, was caught up in street life and wanted to be a pimp, she later told parole officials. Ms Harvey and [victim] Ms Sierra occasionally lived together.”
“‘She was very fiery and provocative,’ Ms Harvey later told parole officials. Ms Sierra, she said, brought ‘johns and tricks to the apartment,’ and sold Ms Harvey’s flute for drugs.”
Galpals hanging out gone wrong? No, the victim was an addicted sex-worker living with a violent would-be pimp who killed her, and who was then, by the Times, retroactively regendered as a woman, after making — as some violent prisoners have done — a late-life transition. Yet none of this can be posed as a question in the liberal newspaper of record; it must be communicated in code:
“A homeless shelter worker and people close to [murder victim] Ms Leyden questioned whether, despite her gender identity, Ms Harvey should have been placed in a homeless shelter for women, given her history of attacking and murdering them.”
How is it that such a cultural centre has no capacity to pivot from a standard story in which trans identity would be taken at face value, to one in which a sceptical approach is essential to not wronging the memory of two or more women murdered from deepset misogyny?
It comes from a knowledge class centre that has not yet worked out an ethic beyond the uncritical celebration of the trans claim. Now surely the contradictions can start to be seen.
Does all this matter much, in a world of climate and economic disaster? The paradox of what might be seen as the politics of such social processes is that while they seem marginal to politics, the two sides have a greater division than, say, the question of who should own the steel industry — the sort of question that dominated the politics of modernity.
But questions of sex and gender are biopolitical — they decide who we, or the next generation, shall be and become. Just as the trans struggle was powered by the demand for identity, so too has its opposition been energised by the transformation of that biopolitical process. The brutal and inhuman responses by the right in the US to such transformations have partly occurred because no critical “third” discourse arose, between the adoption of gender questions as a heroic marker of liberation, and a flat refusal of their legitimacy.
In a whole set of institutions — refuges, prisons, hospitals, sports, schools — the questions of sex and gender are particular and non-transferable, and any reasonable pro-diversity/multiplicity position has to acknowledge that. Many should have acknowledged it a few years ago; now the extended absurdity of many of these unyielding positions — say, in a sport like swimming — pushes this small matter to the centre of public life, and gives it a symbolic meaning it might have avoided. That is a clear loss for team multiplicity, and coming up with a revised position on questions of sex, gender and institutions might stop further losses.
Beyond that, there are real questions about other things. School curricula and programs, for example. It is reasonable for everyone, including progressives, to question these intently. Many people would have a view that being transgender is real, but that embodied sex is the root of gendered being, that sex/gender congruence is a better state to be in, and that educational assumptions should lean towards that. This is an explicit materialist argument that fully acknowledges the reality and truth of being transgender, but also argues that social processes can produce a trans state out of a period of gender complexity in adolescence that could otherwise be resolved to embodied sex-gender congruence.
From a left-materialist-existentialist point of view, it argues that you are your body in the first and last instance, and it is a better choice to undertake the dialectical struggle to be it if you can — and that a child-raising/educational system should positively lean in that direction. But that would also need to be prudently aware of “non-produced” transgender people, and try and avoid oppressing them.
It is reasonable to ask whether the approaches of some schools are de facto transgenic in a manner that is not desirable, and whether — after factoring in specific cultural conditions (cough, inner-city, cough cough) — some schools are producing significantly more and unnecessary “gender trouble” than others. If so, the curricula and programs should change. This is not easy, to say the least.
Questions must also be asked about the way in which suicide among young transgender people is spoken of, and whether the urge to acknowledge its reality also offers it as an attractive identity to some very troubled young people. There has been a well-established curb on suicide reporting for decades; it’s reasonable to reflect on the potentially contradictory role this discourse might play.
Responding to all of this demands a certain amount of courage from progressives who were either swept along or unquestioning of this transformation of the culture, simply because it was progressive. Those who are finding these contradictions needling, but are still ignoring them as part of a progressive’s “duty” to disregard their own doubts, need to have a conversation with themselves about one of the left’s worst habits: hiding from messy questions of governance, by preferring a role “imagining utopia” or “fostering hope”. That is more about the protection of the progressive intellectual’s identity than it is any sort of vital social role.
The best thing those feeling sceptical about institutional transformations by radical gender ideologies can do is to be publicly critical, from within a progressive discourse. Quite aside from anything else, as we bear down for new fights on climate, earth, war and economy, as the political centre disappoints, and the left has a chance to lead, it is vital that we separate ourselves from an ideology that many people — radicalised on questions of the planet and the economy — simply will not accept as a condition of joining a movement.
The courage demanded of many in this new situation is about something rather more than the embarrassment of having to admit to a change of mind. There’s a lot going on, and all of this is a big part of it, in the death of a clinic.
A very good examination of this extremely complex topic. I think of myself as tolerant and constantly try to be tolerant of difference, often imperfectly of course. I am however, intolerant of hurtful intolerance. But I am ambivalent about gender fluidity. I agree that acceptance of one’s biology should be encouraged, but if that doesn’t work, don’t persecute the choice of another gender. I do not accept the argument that gender is fundamentally a matter of choice and that everyone should be encouraged to choose and that society ought facilitate, as a general principle, gender fluidity. I also do not agree that identity is wholly a matter of choice. Sure we choose our persona, by it seems to me that identity is a consequence of that persona’s interaction with society. It is not purely a matter of choosing your identity and demanding others unconditionally accept that persona as one’s exclusive identity.
It also seems to me that society makes its self much less productive by encouraging this navel gazing about gender and identity. Those obsessed with these cultural battles for unqualified social acceptance are largely consumed by that narcissistic battle, with little additional capacity to be useful to all of society more generally.
Having said all that, I will alway try to treat others fairly and kindly, however you choose to identify. But I am a bit weary of the constant cultural publicity for these things as if noting else matters; eg social and wealth equity, the environmental catastrophe, employment fairness and justice, the oppression of corporate capitalism oppressing is all etc.
Good post, and more readily understandable than the article.
“…more readily understandable than the article.” – Glad I’m not the only one. Methinks Mr Rundle should be writing philosophy. A tad heavy for a publication like this.
(I do try to read your analyses, Guy, but my eyes usually glaze over about half way through).
I enjoy struggling to understand Grundle. Because it is philosophy squeezed into journalistic form. I love the curmudgeonly old bastard. He really is one of treasures in the tradition of Mungo.
That is sacrilege.
My feelings too. As I was reading/slaving through this article, I thought Guy should go off and do a PhD.
Because though the post is good, it is saying a lot less and different to the article
I was only attempting to deal with a couple of aspects of the article.
Just go and do the dissertation that’s busting to get out of you Guy. Just make sure a ruthless subeditor subedits your work before submittal. Thanks.
It’s very easy to say that if you comfortably fit into conforming with conservative prejudices regarding gender expression. If you’re someone that never feels comfortable in wearing “male” or “female” clothing and have to choose ostracism and real threats of discrimination and violence or pretending to be a wholly different person, it’s not naval gazing to struggle with how to navigate a world that is not equipped for you.
Great comment SC. I’m fairly astounded by the seeming lack of empathy expressed in both the article and the comments, especially seeing as this is Crikey.
Indeed. I’m not even trans but I find it exhausting navigating gendered spaces.
Your proposing a gender-abolitionist or gender-minimalist position,basically. And I personally think that’s great! You absolutely should be able to do any gender expression or none that you want to. Nobody should police this.
But do you see how your position is the actual opposite of current gender theory as espoused by gender services and gender theorists? They have a gender-*maximalist* position. Everyone is supposed to be considering their “true” gender all the time, changing our bodies so that they “match” our genders (whatever that means … does having breasts “match” makeup and nail polish? Why? Does having a beard and a square jaw “match” playing football?) and being really concerned about whether other people are properly recognising our true inner proper genders.
What if we just … don’t? What if we recognise that gender is just a bunch of archetypes and stereotypes that we don’t have to pay attention to if we don’t want to?
The people doing the gender policing are not trans people. Who do you think harasses gender nonconforming people in gendered spaces? It isn’t trans people.
We long haired freaks (hippies was a media word) in the 60s & 70s copped heaps, including violence, forced shearing and active discrimination in jobs.
We did not demand to be celebrated, duchessed or that society change to accommodate our choice, just being ignored sufficed.
And did people defend other people murdering you?
The idea was to change our definitions of gender to suit ourselves rather than change ourselves (including our gender) to suit stereotypes. Remember how we were supposed to be deconstructing gender? How about we just accept that there ARE no inherently male or female clothes and let me wear dresses and women wear trousers (we already did one of those which was previously considered unthinkable)
Totally agree just do not tell me you are a man if you are a woman.
Masculinity or Femininity do not make you male or female, they are characteristics of who you are not what you are.
Identity is quite distinct from biological sex. There is nothing stopping people from exploring identity and not conforming to sex stereotypes. In fact, none of us conform completely anyway. The problem arises when identity is elevated above the reality of biological sex, becomes a belief that cannot be countered, then foisted on kids who are then encouraged to identify outside of their bodies, often with hormones and surgery and increasingly followed with regret, and (particularly) womend and girls lost their right to private and safe single sex spaces.
Society needs to become more accepting of gender nonconformity – particularly men. Women do not need to accommodate men in private spaces and sports for this to happen. Kids should not be plied with hormones to prop up a flimsy, unfounded notion of innate ‘gender identity’.
Good post. But absent from the gender debate is discussion of gender dysmorphia in the context of mental health. Also absent is discussion about gender stereotypes.
Considering that over 30% of women have been sexually abused as minors or adults, I can understand penis-males not wanting to identify as gender males. Over 20% of penis males are pedos and rapists. Gross.
4 years ago I went in a drag competition wearing a burka. No one laughed. Until I ripped open the burka to reveal a bikini barely containing a pair of pert double Es. I was groped. A lot. How humiliating.
My better half tells me that ‘pert double Es’ is a contradicton in terms but I’m more intrigued by “Over 20% of penis males are pedos and rapists.” – citation required.
Your better half (upper or lower?) is correct.
Here is reported stats. Add non reports which is difficult and hence inaccurate. https://www.abs.gov.au/articles/sexual-violence-victimisation
Too many women I know haven’t ever formally reported. Don’t know what percentage of offenders abuse more than one female.
Pert EEs was achieved with condoms. For some reason they appeared real in the sunlight.
“Here is reported stats” (sic!)
There was no mention in the ABS link of your absurd claim that “Over 20% of penis males are pedos and rapists.”.
How could there be when it is utterly ludicrous?
So the 30% percent of the population that have experienced sexual abuse just raped themselves?
It’s pretty obvious that people are saying that a smaller proportion of men are committing a disproportionately large amount of sexual abuse.
I’ve always found it curious that people who insist that gender and sexuality are fluid and difficult to define, also insist that some people know unwaveringly that they are the “wrong” biological gender!
Significant intellectual acrobatics there.
And that they often express their “true” gender in stereotypical gendered ways, often to the point of absurdity.
Surely we can aim for a less gendered society where people with whatever bits can be the way they want to be without having to cuts some bits and add other bits to allow them to wear a skirt or hold a chainsaw?
That said, I’m not sure how damaging drag queens at storytelling is. What next, Guy, a campaign to ban Santa Claus because it might confuse kids about the reality of Father Christmas?
And, as far as speaking out, well done for having a go, I’m sure you’ll get lots of sh*t for it. It certainly doesn’t seem to have made Germaine Greer many friends!
You write that “they often express their “true” gender in stereotypical gendered ways, often to the point of absurdity” – as in RuPaul’s Drag Race? – but also “I’m not sure how damaging drag queens at storytelling is”. What are tinies to make of some of the grotesqueries who might front up?
It cannot be lost on any thinking person that the stereotypes being aped are 50yrs out of date – mummy issues?
Bob
Santa Claus is something for children that adults give up. Thats what gives it meaning (sorry Bernard if yr reading this – had to find out some time)
Drag queens are something for adults that children are (or were) kept separate from. That was the meaning of drag. They’re opposite and mutually defining particularities – innocence and experience.
Actually you know, like everything, drag is evolving. RuPaul’s Drag Race has been (and continues to be) a cultural phenomenon. It has very much mainstreamed drag to a large extent. The audience is not just gay guys – it’s straight guys and girls too, and they love it.
Now what the heck is wrong with Drag Queen Story Time?! Especially when you consider the parents who go there with their kids CHOOSE to go there!! The queens are reading children’s books to them – they’re not doing a club show. I’ve seen kids around drag queens at Fair Day etc. and they love them. They love the make up and the costumes and the fantasy. It doesn’t confuse them and cause them to have some kind of existential crisis regarding gender. It’s (some) adults that have the issues. The parents that take their kids along to this stuff want them to have a broad range of experiences so that they don’t end up being the bigots of the future. Good on them!
I’ve never understood the visceral hatred some have for drag story time. Just like anything else, a children’s version is not the same as an adult version.
Cos it is one more opportunity for rightist bullies to mock and bully marginal groups.
Guy,
I think you’re reading way too much into this. Kids see someone in a funny costume acting unexpectedly, just like they do with Santa Claus, or a clown or Healthy Harold.
While I appreciate your insightful and subtle analysis, I don’t think it applies to kids perceptions – nor do I think it informs the far right’s opposition to Drag storytime, which I think is about a hatred for anything that undermines rigid and oppressive patriarchal gender roles.
Personally, I’ve always found drag tiresome, but lots of queers, including radical women (to use a loaded term – hah!) queers love it, so I have to assume there’s more than misogynistic, cartoonish views of womanhood involved. Here in the NT the Aboriginal drag queen Constantina Bush is popular across cultures and age groups – and the kids love her!
I agree that the implicit idea that getting Drag into libraries for kids is somehow progressively liberatory is silly and naive, but the idea that it needs to be stopped is repressive and retrograde and should be opposed.
Being the parent of a four year old I’m far more concerned about the cultural production of capitalism than queerdom – my little one had very limited notions of gender until he started mixing more with his peers, most of whom are encouraged to adopt gender roles and fed a diet of highly gender-reinforcing content.
Little girls are still openly praised for their appearance and little boys are still openly encouraged to repress their emotions, and the cultural product that is produced for them strongly, strongly reinforces that. This is stuff my parents generation opposed against and are probably appalled and bemused in equal measure that it’s not just still around, but more strongly promoted.
Have a look at the horror show that is Elsa in Frozen, or the stupid stereotypes in Peppa the Pig – or pretty much anything that is shoved down kids throats and there’s way more to be worried about than a “fat tax accountant in a leopard print reading them Mem Fox”.
Kids play dress-ups, role-play, are ‘polymorphously perverse’ just as they’ve always been. I remember entertaining the family I stayed with while my parents were away with my exaggerated female impersonation in a white dress from the toybox. Later that night I had to navigate the demands of the encroaching brothers in whose room I slept to “keep doing that voice”. That was in the 70s and there was no drag queen storytelling at the library. But the appearance of Divine as a pop star in the 80s was liberating, as was the androgyny of Annie Lennox for teens like me at a homophobic boy’s school, for whom the performative (posturing) nature of masculinity was all too apparent. It depends on the drag, but it’s the reality of men that is undercut more than that of women when the former impersonate the latter and not misogyny that underpins it.
In any case, shielding the little children from imaginative role-play..? Apart from being a kill-joy you’re pissing in the wind.
Sooner or later we’re just going to have to admit that the popular culture of the 1990s, and the second-wave feminists, largely got it right:
Gender is just sexist stereotypes and boys and girls, men and women, are not obligated to adhere to them – if not, they’re still just boys and girls, men and women.
The most gender non-conforming thing anyone can do is be homosexual – not only was that fine, but it didn’t make anyone the opposite sex.
Tomboyish and punk females, effeminate and androgynous males, all had their avatars in the 90s. None of it meant anyone thought they were the opposite sex.
How simple, how diverse. ‘Progressing’ from that is proving a regression.
How about this — it makes a transgender woman happy to be a transgender woman, when she was desperately unhappy before. Can’t that be enough?
Apparently the 80s were a utopia of acceptance for gender nonconforming people and there were no trans people whatsoever…
The evidence suggests otherwise – the psychological problems that led to the dysphora remain and often become more severe.
That is a disingenuous statement. Firstly, the idea that ‘psychological problems’ are what lead to dysphoria, and secondly that a safe, supported transition make those ‘problems’ more severe. And thirdly, that there is good evidence that suggests these statements.
This is very like the nasty old arguments that were widely believed about gay people – that they had ‘psychological problems’ that were the underlying cause of their homosexuality, and that ‘yielding’ to these made them worse.
It makes a schizophrenic happy tobe Napoleon, is that enough? What if there are other ways to help them feel better which don’t involve gaslighting the rest of the population?
I’m not a trans person but I’m perfectly comfortable with trans people existing in our society. Why aren’t you?
Their existence is not a problem – it is the demand that society in general adapts and “celebrate” what is, by any definition, a severe mental problem.
The requirement that the general community change laws, language, social norms, single sex spaces and accept behaviour that is extreme and growing more so with each incremental concession from otherwise accommodating people who might feel sorry for them.
Sure, but because of possession of a penis and progression through male puberty, some sensible restrictions will apply. Is that OK?
Thank you for that detailed discussion although I don’t think I grasped everything you were saying. After a fairly slow burn the issue seems to be everywhere now and I am still not sure what I think is the right way to go. Perhaps acceptance, letting kids experiment but not doing any irreversible until adulthood might be the way to go. I did support Bill Shorten’s move to put ‘mother’ back on that form which still gave those filling it in the opportunity to define themselves differently.
Excellent and thoughtful article. As a very minor footnote, my career has been in health statistics and I’ve been puzzled for decades about the strong push to simply replace the label for biological sex by gender. This I think originated in the USA with its strong puritanism in a simple discomfort about using the word “sex”. But what it resulted in were social pressures to simply replace sex as a category in health studies and more broadly socially, by gender. In 2016, the leading medical journal, the Lancet, wrote an editorial calling for the reporting of sex, gender or both in research studies. The Lancet explicitly defined gender as “Gender is a constellation of sociocultural processes that interact with and have the potential to influence human biology.” In other words, gender is not a variable with a definable set of categories, but a complex web of interacting processes modifying a huge array of health and other personal and group outcomes. The Lancet policy provides no guidance on how it may be possible for researchers to report results by gender.
However, in the USA and many other countries, people are now routinely asked to report their gender using a small number of categories, typically “male”, “female” and “other” or a write-in category. And not asked their biological sex, because in reality gender is being used as a synonym for it. This makes it largely impossible then to actually have discussions about sex and gender, let alone research the relationship between them or their role in health and society. So “men” and “women” have become gender terms rather than sex categories, and we have no words to actually refer to sex categories. And so to the social difficulties of actually have clear conversations, not only about trans issues, but about issues such as abortion which affect the rights of biological women to control their fertility. Instead of becoming a way of liberation to express your gender however you want, gender is tending to become a loss of freedom, as people have to invent yet more labels to put themselves in boxes within a constellation of sociocultural processes. Perhaps it is time to realize that we are all gender-fluid to varying degrees within two main categories of biological sex (male, female) and a small number of people are intersex or transexual (“transgender” having no actual meaning when gender is understood as a multidimensional continuum).