Pushback Against HHS’ Updated Definitions of Biological Sex
In a move that has sparked significant controversy, the U.S. Department of Health and Human Services (HHS) recently updated its definitions of biological sex in federal policy, framing sex as strictly binary—male and female. This change aligns with President Donald Trump’s broader executive orders targeting gender identity and transgender rights. The updated guidance, issued on February 19, 2024, states that HHS "recognizes there are only two sexes: male and female" and defines "sex" as "a person’s immutable biological classification as either male or female." This stance has drawn sharp criticism from major medical associations, which argue that such definitions oversimplify the complexity of human biology and gender identity.
The Binary Definitions and Their Implications
The HHS guidance defines "female" as a person with a reproductive system capable of producing eggs and "male" as someone with a system capable of producing sperm. It also refers to "woman" as an adult human female and "man" as an adult human male, further solidifying a binary framework. The definitions exclude any mention of intersex individuals, who are born with sex characteristics that do not fit typical male or female classifications. Estimates suggest that about 0.018% of the population is intersex. Additionally, the HHS does not define "gender" in its updated guidance, narrowing its focus solely on biological sex. This approach has been criticized for ignoring decades of scientific research on the complexity of sex and gender.
The Scientific Community Weighs In
Arthur C. Evans Jr., Ph.D., CEO of the American Psychological Association (APA), has condemned the HHS’ new definitions, stating that they "ignore decades of science" and undermine critical mental health outcomes. Evans emphasizes that human biology is not confined to binary categories and that ignoring this reality can harm individuals, particularly transgender and nonbinary youth. He highlights the importance of affirming both sex and gender identity to promote mental health and well-being. Similarly, the Centers for Disease Control and Prevention (CDC), an agency under HHS, previously acknowledged a broader understanding of sex, describing it as "an individual’s biological status as male, female, or something else." However, under the Trump administration, the CDC removed such inclusive language from its website, sparking legal challenges.
Exclusion of Gender Identity and Its Consequences
The HHS’ updated guidance does not mention gender identity, a term that refers to an individual’s internal sense of self as male, female, or nonbinary. Evans argues that this exclusion disregards the psychological science supporting the validity of gender identity. Research consistently shows that recognizing and affirming gender identity is crucial for promoting mental health and reducing risks of depression and anxiety, particularly among transgender and gender-expansive individuals. By ignoring this scientific evidence, the HHS’ new definitions risk perpetuating harm and marginalization.
Reactions from Major Medical Associations
Several prominent medical organizations have pushed back against the HHS’ updated definitions. The American College of Obstetricians and Gynecologists (ACOG) has stated that it will not change its current definitions of sex and gender, emphasizing the importance of using inclusive language to affirm all patients. Similarly, the American Academy of Family Physicians (AAFP) has reaffirmed its commitment to recognizing diversity in gender identity and expression as a normal part of human existence, rather than a pathology. The American Academy of Pediatrics (AAP) has also expressed support for gender-affirming care and the importance of medical decisions being made by patients, families, and physicians based on scientific evidence. These organizations highlight the importance of inclusive care and the need to recognize the complexity of human biology and identity.
Broader Implications and the Ongoing Debate
The HHS’ updated definitions are part of a larger effort by the Trump administration to roll back inclusive policies and promote a binary understanding of sex and gender. White House press secretary Karoline Leavitt has framed the move as a reestablishment of "scientific and biological truth," asserting that sex is "not based and can never be based on gender identity." However, this stance has been widely criticized by medical professionals and advocacy groups, who argue that it ignores the diversity of human experience and the well-established science on gender identity. As the debate continues, the impact of these policies on transgender and nonbinary individuals, as well as intersex populations, remains a critical concern. The tension between federal policy and medical consensus underscores the ongoing challenges in reconciling biological, psychological, and social understandings of sex and gender.
