Gender/Sex, Sexual Orientation, and Identity Are in the Body: How Did They Get There?

Conceptualizing transgender experiences in psychology: Do we have a 'true' gender?

Psychological research has acknowledged that the commonly accepted definitions of 'transgender', 'sex' and 'gender' within psychological research have resulted in limitations in accounting for the lived realities of transgender individuals. Such limitations include, but are not limited to, the continued pathologization of transgender experiences through idealizing sex and gender congruence and incapacity to account for non-normative and non-binary transition pathways. This paper provides a review of these limitations to first demonstrate how the incongruence definition of 'transgender' is reliant on the idea of a 'true' gender, and next suggest that problematising the idea of a 'true' gender allows new conceptions of transgender experiences to be advanced. To undertake this problematization, the work of Judith Butler and Sara Ahmed is used to consider how gender could be conceptualized otherwise in psychology and then applied to transgender experiences. In all, this paper theorizes transgender experiences without a reliance on the assertion of a true gender, to suggest instead a focus on contextualized transgender experiences. Last, the limitations and implications of this definition of transgender are briefly discussed. Overall, transgender experiences are conceptualized as those experiences that run counter to the dominant (re)production of binary sexed gender.

Key aspects in the development of gender identity and sexual orientation according to trans and gender diverse people: a qualitative approach

For decades, the sexuality of trans and gender diverse people has been researched from a pathologising and medical perspective. This approach makes assumptions about the experiences of trans people, limiting concern for unique and individual experiences, especially for those with non-binary or gender diverse identities. A growing number of articles however are beginning to take the viewpoints of trans people seriously, taking into consideration their unique experiences and insights within the context of sexual and romantic relationships. This study examines the development of gender identity and sexual orientation of a group of trans individuals in Spain. Thirteen self-identified trans participants were interviewed about their sexual orientation, gender identity and the interplay between both those aspects. A constructivist grounded theory methodology was employed to analyse the data. Five major categories were identified: reinterpreting experiences through identification with gender identity and sexual orientation; questioning gender identity and sexual orientation norms; understanding the interplay between gender identity and sexual orientation; developing as a couple; and building a community. Findings highlight the dynamic and relational nature of gender identity and sexual orientation and provide further insight into the interaction of these aspects in the development of trans and gender diverse identities.

Exploring perceived helpfulness of health services in men and women with dementia and care partners: A cross-sectional analysis

Introduction: The aim of this study was to examine the association of sex/gender and other factors with the perceived helpfulness of the diagnostic process and post-diagnostic services by persons with dementia and care partners.Methods: We conducted secondary cross-sectional analysis of surveys from the 'Cognisance' project. Sex/gender and other factors (e.g., demographic variables, help seeking behaviours, healthcare professional consulted) of persons with dementia and care partners from four countries were considered. Main outcomes were perceived helpfulness of diagnostic process and post-diagnostic services. We conducted descriptive and multivariate analyses.Results: Compared to men, more women with dementia perceived post-diagnostic services as helpful though not statistically significant. Sex/gender was not associated with perceived helpfulness of diagnostic process and post-diagnostic services among care partners. Satisfaction with and awareness of services were associated with perceived helpfulness among care partners.Discussion: These findings underscore the necessity for sex/gender-based research to enhance dementia care and for tailored interventions.

Policies on the collection, analysis, and reporting of sex and gender in Australian health and medical research: a mixed methods study

OBJECTIVE

To explore the policies of key organisations in Australian health and medical research on defining, collecting, analysing, and reporting data on sex and gender, and to identify barriers to and facilitators of developing and implementing such policies.

STUDY DESIGN

Mixed methods study: online planning forum; survey of organisations in Australian health and medical research, and internet search for policies defining, collecting, analysing, and reporting data by sex and gender in health and medical research.

SETTING, PARTICIPANTS

Australia, 19 May 2021 (planning forum) to 12 December 2022 (final internet search).

MAIN OUTCOME MEASURES

Relevant webpages and documents classified as dedicated organisation-specific sex and gender policies; policies, guidelines, or statements with broader aims, but including content that met the definition of a sex and gender policy; and references to external policies.

RESULTS

The online planning forum identified 65 relevant organisations in Australian health and medical research; twenty participated in the policy survey. Seven organisations reported at least one relevant policy, and six had plans to develop or implement such policies during the following two years. Barriers to and facilitators of policy development and implementation were identified in the areas of leadership, language and definitions, and knowledge skills and training. The internet search found that 57 of the 65 organisations had some form of sex and gender policy, including all ten peer-reviewed journals and five of ten research funders; twelve organisations, including eight peak body organisations, had published dedicated sex and gender policies on their websites.

CONCLUSION

Most of the organisations included in our study had policies regarding the integration of sex and gender in health and medical research. The implementation and evaluation of these policies is necessary to ensure that consideration of sex and gender is adequate during all stages of the research process.

Do Sex and Gender Have Separate Identities?

The largely binary nature of biological sex and its conflation with the socially constructed concept of gender has created much strife in the last few years. The notion of gender identity and its differences and similarities with sex have fostered much scientific and legal confusion and disagreement. Settling the debate can have significant repercussions for science, medicine, legislation, and people's lives. The present review addresses this debate though different levels of analysis (i.e., genetic, anatomical, physiological, behavioral, and sociocultural), and their implications and interactions. We propose a rationale where both perspectives coexist, where diversity is the default, establishing a delimitation to the conflation between sex and gender, while acknowledging their interaction. Whereas sex in humans and other mammals is a biological reality that is largely binary and based on genes, chromosomes, anatomy, and physiology, gender is a sociocultural construct that is often, but not always, concordant with a person' sex, and can span a multitude of expressions.

How Do Students Critically Evaluate Outdated Language That Relates to Gender in Biology?

Cisheteronormative ideologies are infused into every aspect of society, including undergraduate science. We set out to identify the extent to which students can identify cisheteronormative language in biology textbooks by posing several hypothetical textbook questions and asking students to modify them to make the language more accurate (defined as "correct; precise; using language that applies to all people"). First, we confirmed that textbooks commonly use language that conflates or confuses sex and gender. We used this information to design two sample questions that used similar language. We examined what parts of the questions students modified, and the changes they recommended. When asked to modify sample textbook questions, we found the most common terms or words that students identified as inaccurate were related to infant gender identity. The most common modifications that students made were changing gender terms to sex terms. Students' decisions in this exercise differed little across three large biology courses or by exam performance. As the science community strives to promote inclusive classrooms and embrace the complexity of human gender identities, we provide foundational information about students' ability to notice and correct inaccurate language related to sex and gender in biology.

An overview of the differences in the pharmacological management of post-traumatic stress disorder between women and men

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition with a worldwide prevalence between 6% and 9%, and more common in the female than in the male sex. The aim of this paper is to review and comment on the different factors that might explain the discrepancies in the pharmacological management of women and men.

AREAS COVERED

The available literature shows that there exists a vulnerability of women to develop PTSD that may depend on neurobiological as well as environmental/cultural factors. These variables might influence the clinical picture, the outcome and the response to specific treatments, given their consequences on the pharmacokinetics of commonly prescribed drugs. Women suffering from PTSD are more prone to consult and receive more prescriptions of psychotropic drugs than men. However, it is evident that the particular stages of a women's life such as pregnancy or breastfeeding might require a specific evaluation and care.

EXPERT OPINION

It is necessary to explore the pharmacokinetics of compounds highlighting sex-related differences, and their safety during pregnancy and lactation. Taking care of differences between women and men should represent a main focus of research, while being a primary target towards a really tailored pharmacological treatment of PTSD.

Gender/Sex Disparities in the COVID-19 Cascade From Testing to Mortality: An Intersectional Analysis of Swiss Surveillance Data

Objectives

This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age.

Methods

We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]).

Results

Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women's mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20-0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41-1.06).

Conclusion

Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.

Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making

Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.

Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care

In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.

A life-course approach to tackling noncommunicable diseases in women

Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.

Genetic counseling for fetal sex prediction by NIPT: Challenges and opportunities

Non-invasive prenatal testing (NIPT) has grown in ubiquity in the last decade and is now endorsed by Society for Maternal Fetal Medicine and American College of Obstetricians and Gynecologists as a screening tool for aneuploidy in all patients. Past studies have demonstrated a tendency among obstetrics patients to focus on the ability of NIPT to predict fetal sex chromosomes; however, data on the experiences of genetic counselors (GCs) counseling on NIPT and fetal sex prediction are limited. This mixed-methods study aimed to explore how GCs counsel about NIPT and fetal sex prediction, as well as the use of gender-inclusive language in this setting. A 36-item survey with multiple choice, Likert scale, and open-ended questions was distributed to GCs who currently offer NIPT to patients. Quantitative data were analyzed using R and qualitative data were manually analyzed and coded via inductive content analysis. A total of 147 individuals completed at least some portion of the survey. A majority of participants (68.5%) reported frequent interchangeable use of the terms 'sex' and 'gender' by patients. A majority (72.9%) of participants reported that they rarely or never discuss the difference between these terms in sessions (Spearman's rho = 0.17, p = 0.052). Seventy-five respondents (59.5%) indicated that they had taken continuing education courses on inclusive clinical practices for trans and gender-diverse (TGD) patients. Several themes arose from free responses; the most frequently identified themes were the need for thorough pretest counseling that properly describes the scope of NIPT and the challenge of discrepant pretest counseling by other healthcare providers. Results from our research identified challenges and misconceptions GCs face when offering NIPT and various tactics implemented to mitigate these. Our study highlighted the need for the standardization of pretest counseling regarding NIPT, additional guidance from professional organizations, and continuing education focused on gender-inclusive language and clinical practices.

Sex/gender differences in cognitive abilities

Sex/gender differences in cognitive sciences are riddled by conflicting perspectives. At the center of debates are clinical, social, and political perspectives. Front and center, evolutionary and biological perspectives have often focused on 'nature' arguments, while feminist and constructivist views have often focused on 'nurture arguments regarding cognitive sex differences. In the current narrative review, we provide a comprehensive overview regarding the origins and historical advancement of these debates while providing a summary of the results in the field of sexually polymorphic cognition. In so doing, we attempt to highlight the importance of using transdisciplinary perspectives which help bridge disciplines together to provide a refined understanding the specific factors that drive sex differences a gender diversity in cognitive abilities. To summarize, biological sex (e.g., birth-assigned sex, sex hormones), socio-cultural gender (gender identity, gender roles), and sexual orientation each uniquely shape the cognitive abilities reviewed. To date, however, few studies integrate these sex and gender factors together to better understand individual differences in cognitive functioning. This has potential benefits if a broader understanding of sex and gender factors are systematically measured when researching and treating numerous conditions where cognition is altered.

Alterations in the inferior fronto-occipital fasciculus - a specific neural correlate of gender incongruence?

BACKGROUND

Increasing numbers of adolescents seek help for gender-identity questions. Consequently, requests for medical treatments, such as puberty suppression, are growing. However, studies investigating the neurobiological substrate of gender incongruence (when birth-assigned sex and gender identity do not align) are scarce, and knowledge about the effects of puberty suppression on the developing brain of transgender youth is limited.

METHODS

Here we cross-sectionally investigated sex and gender differences in regional fractional anisotropy (FA) as measured by diffusion MR imaging, and the impact of puberty on alterations in the white-matter organization of 35 treatment-naive prepubertal children and 41 adolescents with gender incongruence, receiving puberty suppression. The transgender groups were compared with 79 age-matched, treatment-naive cisgender (when sex and gender align) peers.

RESULTS

We found that transgender adolescents had lower FA in the bilateral inferior fronto-occipital fasciculus (IFOF), forceps major and corpus callosum than cisgender peers. In addition, average FA values of the right IFOF correlated negatively with adolescents' cumulative dosage of puberty suppressants received. Of note, prepubertal children also showed significant FA group differences in, again, the right IFOF and left cortico-spinal tract, but with the reverse pattern (transgender > cisgender) than was seen in adolescents.

CONCLUSIONS

Importantly, our results of lower FA (indexing less longitudinal organization, fiber coherence, and myelination) in the IFOF of gender-incongruent adolescents replicate prior findings in transgender adults, suggesting a salient neural correlate of gender incongruence. Findings highlight the complexity with which (pubertal) sex hormones impact white-matter development and add important insight into the neurobiological substrate associated with gender incongruence.

Sex, gender, and sexuality in paleopathology: Select current developments and pathways forward

OBJECTIVE

Overall, paleopathology trails behind related fields in exploring sex, gender, and sexuality in past societies. Here, we interrogatively synthesize scholarship on topics not included in similar reviews, focusing on sex estimation methods, and considering the social determinants of health; trauma; reproduction and family; and childhood - to highlight novel, social epidemiology- and social theory-informed frameworks and interpretive devices.

CONCLUSIONS

Many paleopathological interpretations focus on sex-gender differences relative to health, with increasing use of intersectionality. Others consistently project present-day ideologies about sex, gender, and sexuality (e.g., binary sex-gender systems) into paleopathological interpretations (i.e., presentism).

SIGNIFICANCE

Paleopathologists have an ethical imperative to generate scholarship that contributes to social justice initiatives focused on dismantling structural inequalities, especially relative to sex, gender, and sexuality (e.g., homophobia), such as through denaturalizing presentist binary systems. They also have a responsibility towards greater inclusivity relative to researcher identity and diversification of method and theory.

LIMITATIONS

In addition to material limitations complicating reconstructions of sex, gender, and sexuality relative to health and disease in the past, this review wasn't comprehensive. The review was also limited by the relative paucity of paleopathological work on these topics.

SUGGESTIONS FOR FUTURE RESEARCH

The outlook for paleopathological research on sex, gender, and sexuality is, however, positive; paleopathology is well situated to tackle these aspects of social identity. Future work should consider critical, self-reflective movement away from presentism; more robust contextualization; and further engagement with social theory and social epidemiology theory and approaches, including the Developmental Origins of Health and Disease (DOHaD), social determinants of health, and intersectionality.

How to Ensure Inclusivity in Large-Scale General Population Cohort Studies? Lessons Learned with Regard to Including and Assessing Sex, Gender, and Sexual Orientation

Despite recent advances in the measurement of sex, gender, and sexual orientation in large-scale cohort studies, the three concepts are still gaining relatively little attention, may be mistakenly equated, or non-informatively operationalized. The resulting imprecise or lacking information hereon in studies is problematic, as sex, gender, and sexual orientation are important health-related factors. Omission of these concepts from general population cohort studies might dismiss participants' identity and experiences and pushes research on sexual or gender minority populations toward purposive sampling, potentially introducing selection bias. It also reinforces the unintentional notion of irrelevance of these concepts to health research, ultimately disadvantaging sexual and gender minority populations. Similarly, a lack of uniform measures on sex, gender, and sexual orientation hampers multi-cohort studies in which data from multiple studies are combined, facilitating increased statistical power. This paper discusses the encountered pitfalls and lessons learned on including and assessing sex, gender, and sexual orientation in large-scale general population cohort studies, exemplified by the Dutch Lifelines Cohort Study. Additionally, we propose hands-on strategies on how to operationalize these concepts in an inclusive manner that is useful for large-scale general population cohort studies.

Is love an abstract concept? A view of concepts from an interaction-based perspective

Research concerning concepts in the cognitive sciences has been dominated by the information-processing approach, which has resulted in a certain narrowing of the range of questions and methods of investigation. Recent trends have sought to broaden the scope of such research, but they have not yet been integrated within a theoretical framework that would allow us to reconcile new perspectives with the insights already obtained. In this paper, we focus on the processes involved in early concept acquisition and demonstrate that certain aspects of these processes remain largely understudied. These aspects include the primacy of movement and coordination with others within a structured social environment as well as the importance of first-person experiences pertaining to perception and action. We argue that alternative approaches to cognition, such as ecological psychology, enactivism and interactivism, are helpful for foregrounding these understudied areas. These approaches can complement the extant research concerning concepts to help us obtain a more comprehensive view of knowledge structures, thus providing us with a new perspective on recurring problems, suggesting novel questions and enriching our methodological toolbox. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.

L’identité de genre, entre faits naturels et faits construits, une approche intégrative et développementale

À partir des années 1950, l’identité de genre, en ce qu’elle définit la conviction de l’individu d’appartenir à un genre ou à un autre, devient un objet de recherche médicale et scientifique. Partant des premiers travaux de John Money et de Robert Stoller, qui posent la possibilité d’une dimension polyfactorielle de la construction de l’identité de genre, les recherches les plus récentes portant sur les facteurs génétiques, neuroanatomiques, socio-cognitifs et psychodynamiques, réactualisent l’intérêt de pouvoir envisager un modèle polyfactoriel. Le paradigme clinique des variations du développement génital et des troubles du spectre de l’autisme entrouvre des hypothèses quant à l’articulation possible de ces facteurs de différentes natures. Pour appuyer tant ces éléments historiques que les données issues de la recherche actuelle, nous développerons en quoi les pratiques médicales actuelles vis-à-vis du genre s’inscrivent, sur le plan déontologique, dans une approche nécessairement individualisée soutenant un modèle polyfactoriel développemental.

Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators

Health disparities faced by transgender people are partly explained by barriers to trans-inclusive healthcare, which in turn are linked to a lack of transgender health education in medical school curricula. We carried out a theory-driven systematic review with the aim to (1) provide an overview of key characteristics of training initiatives and pedagogical features, and (2) analyze barriers and facilitators to implementing this training in medical education. We used queer theory to contextualize our findings. We searched the PubMed/Ovid MEDLINE database (October 2009 to December 2021) for original studies that reported on transgender content within medical schools and residency programs (N = 46). We performed a thematic analysis to identify training characteristics, pedagogical features, barriers and facilitators. Most training consisted of single-session interventions, with varying modes of delivery. Most interventions were facilitated by instructors with a range of professional experience and half covered general LGBT+-content. Thematic analysis highlighted barriers including lack of educational materials, lack of faculty expertise, time/costs constraints, and challenges in recruiting and compensating transgender guest speakers. Facilitators included scaffolding learning throughout the curriculum, drawing on expertise of transgender people and engaging learners in skills-based training. Sustainable implementation of transgender-health objectives in medical education faces persistent institutional barriers. These barriers are rooted in normative biases inherent to biomedical knowledge production, and an understanding of categories of sex and gender as uncomplicated. Medical schools should facilitate trans-inclusive educational strategies to combat transgender-health inequities, which should include a critical stance toward binary conceptualizations of sex and gender throughout the curriculum.

The intergenerational transmission of sexual frequency

Intergenerational relationships are one of the most frequently studied topics in the social sciences. Within the area of family, researchers find intergenerational similarity in family behaviors such as marriage, divorce, and fertility. Yet less research has examined the intergenerational aspects of a key proximate determinant of fertility: sexual frequency. We use the National Survey of Families and Households to examine the relationship between sexual frequency of parents and the sexual frequency of children when adults. We link parental sexual frequency in 1987/1988, when children were ages 5-18, to the sexual frequency of the children in 2001-2003 when these grown children were ages 18-34. We find a modest, yet significant association, between parental and adult children sexual frequency. A mechanism behind this association appears to be the higher likelihood of being in a union among children of parents with high sexual frequency.

Sex and gender terminology: a glossary for gender-inclusive epidemiology

There is increased interest in inclusion, diversity and representativeness in epidemiological and community health research. Despite this progress, misunderstanding and conflation of sex and gender have precluded both the accurate description of sex and gender as sample demographics and their inclusion in scientific enquiry aiming to distinguish health disparities due to biological systems, gendered experiences or their social and environmental interactions. The present glossary aims to define and improve understanding of current sex-related and gender-related terminology as an important step to gender-inclusive epidemiological research. Effectively, a proper understanding of sex, gender and their subtleties as well as acknowledgement and inclusion of diverse gender identities and modalities can make epidemiology not only more equitable, but also more scientifically accurate and representative. In turn, this can improve public health efforts aimed at promoting the well-being of all communities and reducing health inequities.

Sex differences in the human metabolome

BACKGROUND

The sexual dimorphism represents one of the triggers of the metabolic disparities between the organisms, advising about wild implications in research or diagnostics contexts. Despite the mounting recognition of the importance of sex consideration in the biomedical fields, the identification of male- and female-specific metabolic signatures has not been achieved.

MAIN BODY

This review pointed the focus on the metabolic differences related to the sex, evidenced by metabolomics studies performed on healthy populations, with the leading aim of understanding how the sex influences the baseline metabolome. The main shared signatures and the apparent dissimilarities between males and females were extracted and highlighted from the metabolome of the most commonly analyzed biological fluids, such as serum, plasma, and urine. Furthermore, the influence of age and the significant interactions between sex and age have been taken into account.

CONCLUSIONS

The recognition of sex patterns in human metabolomics has been defined in diverse biofluids. The detection of sex- and age-related differences in the metabolome of healthy individuals are helpful for translational applications from the bench to the bedside to set targeted diagnostic and prevention approaches in the context of personalized medicine.

"It's impossible for them to understand me 'cause I haven't said a word": how women baby boomers shape social participation spaces in old age

The baby boom generation's retirement will change the conceptualization of participation in old age due to their particularities from having experienced a specific socio-historical context. Likewise, the feminization of old age underscores the importance of developing research from the perspectives of gender and critical feminist gerontology. The objective of the present study is to identify and analyze women baby-boomers' conceptualizations about social participation regarding the configuration of social participation spaces. Five discussion groups and five individual interviews were conducted with 56 baby boomers residing in Andalusia (Spain). Here we focus on a separate analysis of the 27 women participating in these settings. The results were organized around four factors: desirability of social participation spaces, adaptation of spaces to preferences, facilitators and barriers in the adaptation of spaces, and the importance of agency in the social participation spaces. Through the analyzed discourse it was observed that participants in this study gave special importance to promoting spaces that involve social contribution, self-management, and self-determination of the spaces, adaptation of access, as well as exercising agency.

Re-examining our roots: Queer history and anatomy

Since its establishment as one of the major authorities on the human body, Anatomy has played a crucial role in social and political spheres. In this article, I review how the history of Anatomy has intersected with queer history and how the effects of these interactions have affected queer lives today. In these historical cases, I aim to demonstrate how Anatomy has affected the social organization of human culture and society and also how society has affected anatomical knowledge in return. As this reciprocal connection between Anatomy and societal organization is elucidated, I argue that anatomists, clinicians, and educators have an ethical duty to address the connections of this history, both in our research and our classrooms. This historical tour begins in the ancient world, which established a connection between sexuality and physiology and reproduction. This is followed by an exploration of the Renaissance and Enlightenment, which highlight the connections between anatomical knowledge, the law, and social organization. The progressive and modern eras are explored next via modern research into the anatomical and biological origins of same-sex attraction and the use of modern technology in these investigations. Finally, the article ends with a call for reform along with suggestions for future steps.

A poststructural discourse analysis of the attitudes, beliefs, and values of undergraduate Canadian university students regarding sexual orientation

The socio-politico-cultural context of sexual orientation often influences the attitudes, beliefs, and values produced in a given society. This study employed a qualitative methodology to explore the current attitudes, beliefs, and values of Canadian undergraduate students about sexual orientation. Students in a large human sexuality course at a Canadian university completed open-ended questions on the educational platform Top Hat. The data were analyzed using discourse analysis and four threads of discourse emerged: 1) The Nature of Sexual Orientation, 2) Gender Norms and Bisexuality, 3) Shared Connections, and 4) Foundations of Friendships. These findings contribute to the growing body of knowledge relating to changing attitudes, beliefs, and values about sexual orientation of Canadian university students.

Self-Protection as an Adaptive Female Strategy

Many male traits are well explained by sexual selection theory as adaptations to mating competition and mate choice, whereas no unifying theory explains traits expressed more in females. Anne Campbell's "staying alive" theory proposed that human females produce stronger self-protective reactions than males to aggressive threats because self-protection tends to have higher fitness value for females than males. We examined whether Campbell's theory has more general applicability by considering whether human females respond with greater self-protectiveness than males to other threats beyond aggression. We searched the literature for physiological, behavioral, and emotional responses to major physical and social threats, and found consistent support for females' responding with greater self-protectiveness than males. Females mount stronger immune responses to many pathogens; experience a lower threshold to detect, and lesser tolerance of, pain; awaken more frequently at night; express greater concern about physically dangerous stimuli; exert more effort to avoid social conflicts; exhibit a personality style more focused on life's dangers; react to threats with greater fear, disgust and sadness; and develop more threat-based clinical conditions than males. Our findings suggest that in relation to threat human females have relatively heightened protective reactions compared to males. The pervasiveness of this result across multiple domains suggests that general mechanisms might exist underlying females' unique adaptations. An understanding of such processes would enhance knowledge of female health and well-being.

The Effects of Gender Trouble: An Integrative Theoretical Framework of the Perpetuation and Disruption of the Gender/Sex Binary

In the Western world, gender has traditionally been viewed as binary and as following directly from biological sex. This view is slowly changing among both experts and the general public, a change that has been met with strong opposition. In this article, we explore the psychological processes underlying these dynamics. Drawing on previous work on gender performativity as well as gender as a performance, we develop a psychological framework of the perpetuation and disruption of the gender/sex binary on a stage that facilitates and foregrounds binary gender/sex performance. Whenever character, costume, and script are not aligned the gender/sex binary is disrupted and gender trouble ensues. We integrate various strands of the psychological literature into this framework and explain the processes underlying these reactions. We propose that gender trouble can elicit threat-personal threat, group-based and identity threat, and system threat-which in turn leads to efforts to alleviate this threat through the reinforcement of the gender/sex binary. Our framework challenges the way psychologists have traditionally treated gender/sex in theory and empirical work and proposes new avenues and implications for future research.

Associations of observer's gender, Body Mass Index and internalization of societal beauty ideals to visual body processing

We examined whether visual processing mechanisms of the body of conspecifics are different in women and men and whether these rely on westernised socio-cultural ideals and body image concerns. Twenty-four women and 24 men performed a visual discrimination task of upright or inverted images of female or male bodies and faces (Experiment 1) and objects (Experiment 2). In Experiment 1, both groups of women and men showed comparable abilities in the discrimination of upright and inverted bodies and faces. However, the gender of the human stimuli yielded different effects on participants' performance, so that female faces, and male bodies appeared to be processed less configurally than female bodies and male faces, respectively. Interestingly, the reduction of configural processing for male bodies was significantly predicted by participants' Body Mass Index (BMI) and their level of internalization of muscularity. Our findings suggest that configural visual processing of bodies and faces in women and men may be linked to a selective attention to detail needed for discriminating salient physical (perhaps sexual) cues of conspecifics. Importantly, BMI and muscularity internalization of beauty ideals may also play a crucial role in this mechanism.

EDUCATIONAL OUTCOMES OF GENDER-DIVERSE YOUTH: A National Population-Based Study

Despite the growing population of youth identifying with a transgender or nonbinary gender identity, research on gender-diverse individuals' educational outcomes is limited. This study takes advantage of the first nationally representative, population-based data set that includes measures of gender identity and educational outcomes: the High School Longitudinal study of 2009. Using minority stress and structural symbolic interactionist frameworks, we examine the association between gender identity and high school and college educational outcomes. We compare the educational outcomes of gender-diverse youth-binary transgender, nonbinary, and gender unsure-with those of cisgender youth, and also examine differences within the gender-diverse population. Given the strong link between minority stress and educational experiences among gender-diverse youth, we examine differences in outcomes before and after accounting for school belonging and emotional distress. We also account for individuals' social-structural location, arguing that social positionality shapes both gender identity and educational outcomes. Results indicate important differences in educational outcomes within the gender-diverse population: Whereas binary transgender and gender-unsure youth exhibit educational disadvantage, relative to cisgender youth, nonbinary youth do not. The gender-unsure disadvantage remains even after accounting for differences in social-structural location and social-psychological factors associated with minority stress.

Social conditions and mental health during COVID-19 lockdown among people who do not identify with the man/woman binomial in Spain

Evidence suggests that non-binary people have poorer mental and physical health outcomes, compared with people who identify within the gender binomial (man/woman). Research on the impact of the COVID-19 pandemic on mental health has been conducted worldwide in the last few months. It has however overlooked gender diversity. The aim of our study was to explore social and health-related factors associated with mental health (anxiety and depression) among people who do not identify with the man/woman binomial during COVID-19 lockdown in Spain. A cross-sectional study with online survey, aimed at the population residing in Spain during lockdown, was conducted. Data were collected between the 8th of April until the 28th of May 2020, the time period when lockdown was implemented in Spain. Mental health was measured using the Generalised Anxiety Disorder 7-item (GAD-7) scale for anxiety, and the Patient Health Questionnaire (PHQ-9) for depression. The survey included the question: Which sex do you identify with? The options "Man", "Woman", "Non-binary" and "I do not identify" were given. People who answered one of the last two options were selected for this study. Multivariate regression logistic models were constructed to evaluate the associations between sociodemographic, social and health-related factors, anxiety and depression. Out of the 7125 people who participated in the survey, 72 (1%) identified as non-binary or to not identify with another category. People who do not identify with the man/woman binomial (non-binary/I do not identify) presented high proportions of anxiety (41.7%) and depression (30.6%). Poorer mental health was associated with social-employment variables (e.g., not working before the pandemic) and health-related variables (e.g., poor or regular self-rated health). These findings suggest that social inequities, already experienced by non-binary communities before the pandemic, may deepen due to the COVID-19 pandemic.

Sex-Differentiated Attire’s Impact on Individual Action and Mate Selection

Various theories highlight the importance of using the actor/environment as the ideal unit for theoretical and experimental focus. Clothing, placed as it is as the intermediary between body and environment, is typically treated as a symbol rather than as either an integral part of either the body or the environment. When clothing is considered an extension of the body, the historical development of clothing reflects persistent differences in the physical capabilities of the human animal and operates as an instrument for solo action. In addition, it is argued that due to the ecological mechanisms connecting perception and action, differential clothing options for the sexes has led in no small part to differences in self-perception as well as the perception of others. However, when it comes to the very specific behavior of mate selection and procreation, clothing can be understood as a tether between two systemic units, offering a description of a system that allows for communication of potential social affordances and opportunities for joint action.

Reflections on Binary Sex/Gender Categorization in Magnetic Resonance Tomography and its Future Challenges

This paper examines the role of technical, methodological conditions in functional magnetic imaging (fMRI) in the production of binary sex/gender differences. The aim is to investigate the scanning process with a focus on the statistical parameter of gendered markers within the technology, in order to make visible the problems entangled in typical research routines. It is especially important to elaborate this because the computer models currently being used and Big Data studies are reproducing and reapplying outdated and rigid concepts of sex/gender differences with the goal of improving science considerably. Therefore, the paper discusses the empirical methodologies and epistemic underpinnings of differentiation through statistics, and argues that counter-counting, weighing and sizing might not help to substantiate the idea of "equality" (not only for the sex/gender category) in brain studies. In relation to the topic of this special issue, I argue that in order to develop an interdisciplinary approach to criticizing dimorphism and differentiation by groups, a wider understanding of the technical and theoretical foundations used in brain research is needed.

Wearing same- and opposite-sex virtual bodies and seeing them caressed in intimate areas

Immersive virtual reality enables people to undergo the experience of owning an artificial body and vicariously feeling tactile stimuli delivered to it. However, it is currently unknown how such experiences are modified by the sexual congruency between the human and the artificial agent. In two studies, heterosexual men (Experiment 1) and women (Experiment 2) embodied same-sex and opposite-sex avatars and were asked to evaluate the experience (e.g., pleasantness, erogeneity) of being touched on social or intimate areas of their virtual body by a male or female avatar. Electrocardiogram and galvanic skin response were also recorded. Moreover, participants' implicit and explicit gender biases were examined via a gender-potency implicit association test and the Ambivalent Sexism Inventory. When embodying a same-sex avatar, men and women rated caresses on intimate areas from an avatar of the opposite sex as more pleasant and erogenous. Conversely, body swap-that is, wearing an opposite-sex avatar-enhanced participants' perceptions of pleasantness and erogeneity for caresses on intimate areas from a same-sex toucher. This effect was stronger in men than in women. Furthermore, physiological correlates of enhanced processing of arousing stimuli predicted behavioural outcomes during the body swap illusion. Wearing an opposite-sex avatar affects one's own body representations and may have important implications on people's attitudes and implicit reactivity to touch-mediated interactions. Men seem more susceptible to this type of body swap illusion. Our paradigm may induce profound changes of cross-sex perspective-taking and provide novel tools for promoting empathy and comprehension of sex-related diversity.

A Dynamic Systems Framework for Gender/Sex Development: From Sensory Input in Infancy to Subjective Certainty in Toddlerhood

From birth to 15 months infants and caregivers form a fundamentally intersubjective, dyadic unit within which the infant's ability to recognize gender/sex in the world develops. Between about 18 and 36 months the infant accumulates an increasingly clear and subjective sense of self as female or male. We know little about how the precursors to gender/sex identity form during the intersubjective period, nor how they transform into an independent sense of self by 3 years of age. In this Theory and Hypothesis article I offer a general framework for thinking about this problem. I propose that through repetition and patterning, the dyadic interactions in which infants and caregivers engage imbue the infant with an embodied, i.e., sensori-motor understanding of gender/sex. During this developmental period (which I label Phase 1) gender/sex is primarily an intersubjective project. From 15 to 18 months (which I label Phase 2) there are few reports of newly appearing gender/sex behavioral differences, and I hypothesize that this absence reflects a period of developmental instability during which there is a transition from gender/sex as primarily inter-subjective to gender/sex as primarily subjective. Beginning at 18 months (i.e., the start of Phase 3), a toddler's subjective sense of self as having a gender/sex emerges, and it solidifies by 3 years of age. I propose a dynamic systems perspective to track how infants first assimilate gender/sex information during the intersubjective period (birth to 15 months); then explore what changes might occur during a hypothesized phase transition (15 to 18 months), and finally, review the emergence and initial stabilization of individual subjectivity-the period from 18 to 36 months. The critical questions explored focus on how to model and translate data from very different experimental disciplines, especially neuroscience, physiology, developmental psychology and cognitive development. I close by proposing the formation of a research consortium on gender/sex development during the first 3 years after birth.

The Biology of Sex and Sport

Sex and gender are not the same. Sex is defined by the human genotype and pertains to biologic differences between males and females. Gender is a fluid concept molded by self-perception, social constructs, and culturally laden attitudes and expectations of men and women. In general, males have longer limb levers, stronger bones, greater muscle mass and strength, and greater aerobic capacity. Females exhibit less muscle fatigability and faster recovery during endurance exercise. Physiologic sex-based differences have led to an average performance gap of 10% that has remained stable since the 1980s. The performance disparity is lowest for swimming and highest for track and field events. The International Olympic Committee currently mandates that female athletes with differences of sex development, or intersex traits, and transgender female athletes must limit their blood testosterone to <10 nmol/L for 12 months to be eligible for competition in the female classification.

The need for a unified ethical stance on child genital cutting

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to "health benefits" as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a "loophole" through which certain forms of female genital cutting-or female genital "mutilation" as it is defined by the World Health Organization-could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital "mutilation" and so-called intersex genital "normalization" surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations-including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization-to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices.

Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research

Transgender and gender diverse (TGD) people are increasingly visible in U.S. communities and in national media. With this increased visibility, access to gender affirming healthcare is also on the rise, particularly for urban youth. Political backlash and entrenchment in a gender binary, however, continue to marginalize TGD people, increasing risk for health disparities. The 2016 National Institute of Health recognition of sexual and gender minority people as a health disparities population increases available funding for much-needed research. In this article, we speak to the need for a biocultural human biology of gender/sex diversity by delineating factors that influence physiological functioning, mental health, and physical health of TGD people. We propose that many of these factors can best be investigated with minimally invasively collected biomarker samples (MICBS) and discuss how to integrate MICBS into research inclusive of TGD people. Research use of MICBS among TGD people remains limited, and wider use could enable essential biological and health data to be collected from a population often excluded from research. We provide a broad overview of terminology and current literature, point to key research questions, and address potential challenges researchers might face when aiming to integrate MCIBS in research inclusive of transgender and gender diverse people. We argue that, when used effectively, MICBS can enhance human biologists' ability to empirically measure physiology and health-related outcomes and enable more accurate identification of pathways linking human experience, embodiment, and health.

Fluidity of gender identity induced by illusory body-sex change

Gender identity is a collection of thoughts and feelings about one’s own gender, which may or may not correspond to the sex assigned at birth. How this sense is linked to the perception of one’s own masculine or feminine body remains unclear. Here, in a series of three behavioral experiments conducted on a large group of control volunteers (N = 140), we show that a perceptual illusion of having the opposite-sex body is associated with a shift toward a more balanced identification with both genders and less gender-stereotypical beliefs about own personality characteristics, as indicated by subjective reports and implicit behavioral measures. These findings demonstrate that the ongoing perception of one’s own body affects the sense of one’s own gender in a dynamic, robust, and automatic manner.

Queering gendered disabilities

This project defines gendered disabilities broadly, including chronic illnesses that involve the uterus, ovaries, and other body parts traditionally classified as "female." I interrogate the usage of language such as women's health and gynecological using endometriosis, a common chronic illness that can cause severe pain, fatigue, system-wide effects, and infertility. It affects at least ten percent of cisgender women as well as unmeasured numbers of cisgender men and transgender and gender nonconforming people, occurring more commonly than migraines or Crohn's disease. Endometriosis symptoms are often debilitating and can lead to un-/under-employment, reduced quality of life, and even suicide. Once nearly invisible, endometriosis has enjoyed recent public discussion, as major news outlets have reported the individual and social costs of endometriosis, and public figures have spoken out about their experiences. However, increased public spotlight has led to the proliferation of a narrative that endo is primarily a reproductive disease, a myth begun in medical literature nearly a century ago, which overlooks significant medical evidence and drives interventions that have high rates of failure and often cause further impairment. This paper examines locations where queerness meets gendered ableism, arguing that imagining endo as a gendered disability would be a first step toward decoupling compulsory heterosexuality from compulsory able-bodiedness. I also articulate gender-neutral ways to discuss endo and recommendations for more inclusive and accurate language and practices.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

Escala de desarrollo armónico (EDA): Una propuesta para la evaluación clínica del desarrollo infantil desde la Teoría de Sistemas

Los profesionales de las ciencias de la salud y de la educación necesitan herramientas adecuadas para llevar a cabo la prevención de los trastornos del desarrollo infantil. La Escala de Desarrollo Armónico –EDA–, se presenta como una propuesta que permite la coordinación interdisciplinaria y la colaboración de los educadores. La escala se ha construido para observar el ascenso del paisaje epigenético individual desde el paradigma de los sistemas dinámicos. Para lograrlo, se han estudiado parámetros que pueden explicar la evolución del sistema –índice de armonía y cociente de desarrollo estable–, un mecanismo del cambio –tirón cognitivo– y fuerzas moldeadoras –velocidad y cristalización–, siguiendo el principio de «armonía» para alcanzar el máximo desarrollo potencial. La estructura de la escala es adecuada para funcionar como un test adaptativo informatizado, por lo que resulta accesible, fácil de usar y puede validarse siguiendo la metodología de respuesta al ítem –TRI–. Las cualidades «orgánicas» de la EDA permiten un funcionamiento interactivo a través de Internet –www.maternal.eu–, donde ya presta servicio a educadores, profesionales e investigadores.

Romantic Attraction and Substance Use in 15-Year-Old Adolescents from Eight European Countries

Sexual minority youth are at higher risk of substance use than heterosexual youth. However, most evidence in this area is from North America, and it is unclear whether the findings can be generalized to other cultures and countries. In this investigation, we used data from the 2014 Health Behaviour in School-aged Children (HBSC) study to compare substance use in same- and both-gender attracted 15-year-old adolescents from eight European countries (n = 14,545) to that of their peers who reported opposite-gender attraction or have not been romantically attracted to anyone. Both-gender attracted, and to a lesser extent, same-gender attracted adolescents were significantly more likely to smoke cigarettes, consume alcohol, get drunk and use cannabis, or be involved in multiple substance use in the last 30 days compared to their opposite-gender attracted peers. Those adolescents who have not been in love had significantly lower odds for substance use than all other youth. The pattern of results remained the same after adjusting for country, gender and family affluence. These findings are compatible with the minority stress and romantic stress theories. They suggest that sexual minority stigma (and love on its own) may contribute to higher substance use among adolescents in European countries.

Theorising women's health and health inequalities: shaping processes of the 'gender-biology nexus'

Since the theoretical frameworks and conceptual tools we employ shape research outcomes by guiding research pathways, it is important that we subject them to ongoing critical reflection. A thoroughgoing analysis of the global production of women's health inequality calls for a comprehensive theorization of how social relations of gender and the biological body mutually interact in local contexts in a nexus with women's health. However, to date, the predominant concern of research has been to identify the biological effects of social relations of gender on the body, to the relative neglect of the co-constitutive role that these biological changes themselves may play in ongoing cycles of gendered health oppressions. Drawing on feminist and gender theoretical approaches, and with the health of women and girls as our focus, we seek to extend our understanding of this recursive process by discussing what we call the 'shaping processes' of the 'gender-biology nexus' which call attention to not only the 'gender-shaping of biology' but also the 'biologic-shaping of gender'. We consider female genital mutilation/cutting as an illustration of this process and conclude by proposing that a framework which attends to both the 'gender-shaping of biology' and the 'biologic-shaping of gender' as interweaving processes provides a fruitful approach to theorising the wider health inequalities experienced by women and girls.