Apologies for the delay on publshing Part II. The weight of muddle proved too much for me at times! But I thought I must publish as far as I got…
This is Part II of an appraisal of Steven Novella’s claim that it is “not scientifically controversial” that science is not a “binary” of male and female but a “bimodal distribution”. (Part 1 here)
In short, is sex a discrete category that is objective and understandable, or is it more continuous and distributed and only characterised in rather arbitrary ways?
We saw in Part I that the claim that sex is bimodal is supported only by handwaving assertions and conceptual muddles about both statistics and biology. We saw evolution has only produced two discrete sexes, and each sex is defined in relationship to a reproductive role around a gamete type. The existence of various mutations and chromosome conditions still result in people who are unambiguously male or female in their development. Evolution has ensured coherent sex development is very robust. There are a handful of cases of genuine mixed sex development in people. Most still exhibit predominant male or female anatomy. These few cases cannot be used to create this “bimodal distribution”.
Novella’s conceptualisation of sex is not scientific. It is more like a “folk biology” understanding of sex than one based in an understanding of evolution, reproduction and development. Novella even explicitly rejects conceptualising sex on the foundations of reproductive biology. The “sex is bimodal” idea has no scientific explanatory and predictive power. No attempt is made to formally characterise it so that biologists or doctors can capture data on “sex” and use that in any research. It is an idea that lacks any formal empirical foundation. It is a concept that only exists outside of biology as a social and political claim. We might be tempted to forgive Novella and see his views as a product of the chauvinism of a doctor who only needs to worry about biology in the context of humans and as presented through the lens of disease, disfunction and disorders. But Novella sets himself as a defender of critical thinking and science, so we must judge him according to that standard. It does not look good.
But to continue. There was much more in Steven Novella’s post than just the biology of sex development. He talked about how other factors might create a bimodal distribution of sex. These factors include identity, sexuality, expression, behaviour and brain function. This second part will now explore these issues.
Once again, strap in. The level of incoherence and muddle is changing up a gear. We are heading into the world of gender.
The muddling of sex and sexual orientation
Novella tells us that
“Years of research has lead to the conclusion that sexual orientation among humans is simply more fluid than old-school strictly binary concepts.
Years of research has lead to the conclusion that sexual orientation among humans is simply more fluid than old-school strictly binary concepts. People are heterosexual, homosexual, bisexual, pansexual (romantic feelings are blind to sex or gender), asexual, and everything in between. I don’t think that anyone can reasonable defend today the position that sexual orientation is strictly binary, and any deviation is pathological.”
Although, I am not sure who claims sexual orientation is a strict binary, we might agree with Steven here. Where it goes off the wall is in him claiming, “I would consider sexual orientation to be part of biological sex” and using the multi-faceted aspects of sexual orientation to claim sex cannot be a binary.
What does this mean for our binary vs bimodal sex question? I think it makes it pretty clear that biological sex is not strictly binary, because we can see any combination of morphological sexual characteristics and sexual orientation – you can’t know someone’s sexual orientation by looking at their genitals.
Who claims you can?
Our sexual orientation is part of our sexuality and sexual behaviour. Early sexually reproducing life will not have needed sexual behaviour and orientation as you were probably stationary. There is no such thing as a gay algae. An Elkhorn coral has no need for a sexual orientation. A male coral polyp can spaff his small gametes into the sea and some will land on a female coral polyp. But as soon as animals start moving around, it will be reproductively advantageous to develop a host of behaviours around such thing as motivated mate finding, oestrus detection and response, courtship, bonding, copulation and parenting. Sexual orientation describes that aspect of motivated mate finding. Males will tend to seek out females and vice versa. We do not fully understand how that drive emerges in humans and how much is influenced by genes creating a potential for a sexuality, and how much is environmentally determined. But by the time of sexual maturity, that sexuality appears to be in place and locked in. We recognise that sexuality as stable and apparently inherent within us.
But we can only recognise sexual orientation if we recognise sex first. We can only recognise, for example, homosexual behaviour if the male sex of the individuals is independent of their behaviour. Your sex comes first: as male or female. Your sexual orientation does not shift your sex – they are orthogonal concepts.
What is Novella trying to say here? That your sexual orientation shifts you along his “bimodal distribution”? That being gay makes you less of a male? A lesbian female is not as female as a heterosexual female? We used to call such ideas homophobic. I am willing to apply Hanlon’s Razor here and just put this down to deep muddle.
The muddling of sex and gender.
We now move onto gender and gender identity. What is going to make this analysis a struggle is that Novella does not define either term, so we may be fighting a swirling mist as is common gender ideology. As such, because the claims are so ambiguous, I have no real option but to respond to asking him how he would define his terms.
We have seen that Novella failed to give any precision on what he means by “sex”. And so now, what I would love to ask him is “what do you mean by gender and gender identity”?
Novella’s treatment of gender identity is typical of so much writing here. Equivocation, conflation, vaguery and unquestioned assumptions riddle the article.
Are you using “gender” as a synonym for sex? If not, can you explain what a gender is? Can you give some examples of some genders and say what defines each of those?
Or is gender a sociological construct? Is it those socially constructed relationships between the roles, appearances and behaviours a society associates with each sex?
If gender is a social construct then surely it is the social roles, appearances and behaviours that are gendered? For example, “the shoes are feminine. The man takes in a feminine appearance by wearing the shoes.” How does a person have a gender if this is what it means?
If gender applies to a person, but is not a synonym for sex, then what exactly is it? You appear to use “sex assigned and birth” and “gender assigned at birth” interchangeably – what do these phrases mean?
I tend to find people get quite angry and defensive when you ask questions like these. It gets worse.
The muddling of sex and gender identity.
You say a “gender identity” is “how one understands and feels about their own gender”? Steven, in what sense are you using “gender” here? As a synonym for sex? As some other attribute of a person (what is that). Or as social stereotypes?
Just what is a “gender identity”?
I presume a gender and a gender identity are two separate concepts? Can a person have a gender and a gender identity or are they synonymous. Your writing does not make this clear, Steven.
Perhaps this is simple: is gender identity just the knowledge you have about your own sex? As a child develops, they become aware there are boys and girls and that they are one or the other. They are taught this. Or is it some sort of innate knowledge of your sex? Is it some part of the brain that is responsible for some sort of inner experience and knowledge of being a boy or girl?
This last idea is a very strange idea but appears widely held. Why would humans evolve with an innate knowledge of being male or female? How does this benefit anyone? We have seen how sexual orientation might well have genetic underpinnings to ensure we have the best chance of reproducing. But for what benefit is have a sense of being male female develop in the foetus?
You quote work by Dick Swaab who here appears convinced both gender identity and sexual orientation develop in the brain from conception during “fetal and neonatal development”? Do other animals develop a gender identity – a “feeling of being male or female”? Does my dog have a feeling of being male? What about my guinea pig? I am quite sure both have complex sexualities. But what purpose is this feeling in animals? How could we even know that or detect it in a dog? What purpose does “feeling male” serve?
I think this is nonsense. As humans, we learn that we are male or female. Adults tell us. We observe the reality of there being males and females around us. I am sure my dog does too. It is learned knowledge. Placing gender identity with sexual orientation is a category error. These are not alike concepts.
How could we even know that or detect gender identity in animals? What purpose does “feeling male” serve and how does it increase reproductive sex? I see no reason for my dog to know he is male to reproduce, just to have a sexual orientation that creates a motivation to engage sexually with females.
Novella says, “The principle of parsimony would suggest gender identity is also a brain phenomenon, and therefore just another aspect of biological sex.” The most parsimonious view of this would be to just accept child development goes through a phase where we gain understanding of humans being sexed, and we are one or the other sex – a boy or girl. There is no need to invoke new brain structures and concepts around this. It is just socially learned. If they reject this knowledge of being a boy or a girl is it because they have been told lies by adults? Or is it because they reject the gendered stereotypes associated with their sex? If they are told girls do not climb trees, but the girl likes climbing trees, are they coming to the conclusion that they are not a “real girl”?
Novella appears to think that “gender identity” awareness happens as about age 2 to 3 and so concludes this is “strong evidence is it biological”. Nonsense. This is an age of rapid language acquisition where children are learning to map words to concepts. He says, “it is not reasonable to place the burden of proof entirely on the biological side of the question.” Well it indeed is when you have to propose new concepts to explain a biological origin like “innate gender identity” when there are far simpler explanations.
There are a string of neuro-imaging studies that are used to suggest we can see a “gender identity” region in brains by studying people with a trans identity. These studies are almost always small, unreplicated and poorly controlled for obvious confounders like homosexuality.
We do not even need gender identity to explain the various trans experiences. It is nothing more than a “useful” construct, a shortcut to explain what we observe. But is also probably a fig leaf to hide paraphilias, or distressing feelings about a child’s emerging sexuality and understanding of their sex. It is used to paper over ignorance, or embarrassment, or the awful realities of how young people are put into such extreme social pressures to conform to social stereotypes about their sex and may not be coping with that.
Gender identity is a concept that is only a few decades old. Steven Novella must remember his youth where no-one talked about gender identity. No-one claimed to have one. The past decade has seen society talking about it as if we always have been. It did not emerge from the sciences but from various crackpot sociology academics and controversial sexologists. There may well be some psychologists who talk about gender identity in scientific and clear terms with limited scope to child development, but almost all the chatter we see is deeply ideological and incoherent.
Novella ends his post by claiming people like me are “Denying difference out of existence”.
Some people, however, may accept the specific arguments but reject the conclusion with what I consider to be dubious logic. One approach is to say – what is the practical difference between bimodal and binary? Why should sexuality in any way be defined by the 2% (to use a representative round figure) rather than the 98%? But this misses the actual issue, which is how we think about the 2% – are they part of biological diversity or can we define them out of existence?
Further (and this is often the point) they claim that any conflict between genitals and sexuality must be a mental disorder.
We have spent some time now wading through the muddles that led us here. Not least the fact the 2% figure is meaningless nonsense. Two sexes have evolved. Organisms like us can be classified as male and female depending on the evolved development path we have undergone. These pathways are remarkably robust even when serious genetic conditions occur. We are also very varied in our sexual characteristics. But these are variations within each sex class. Humans also exhibit rich sexualities. As males and females we may not always be attracted to the opposite sex. That does not makes us less male or female. It just expands the possible sexualities of males and females. And if we have difficult in classifying any individual as male or female for whatever reason, the only sexes we still have are male or female. We are not male or female by degree. There are no lesser or greater males and females.
How did Novella get into this muddle?
Let us take a step back and look at the grounding philosophy that underpins the web site “Science Based Medicine”. It was set up to put forward a very specific idea about how to improve health outcomes. Evidence-based medicine has been growing in importance for a while, but many thought that the application of clinical evidence from trials into clinical decision making was not enough.
The goal of science-based medicine is to ensure the results of clinical trials are not assessed in an isolated and abstract sense, but to ensure conclusions drawn are consistent with all that we know about physics, chemisty, biology and medicine. We have to have a prior position on what is plausible and makes sense. Otherwise we risk allowing spurious trial results to mislead us. Strong claims for a medicine need strong evidence and have coherence with all we know that is true about the world. For example, the ridiculous uniformity of positive results for acupuncture that come from China should not be seen as evidence for the effectiveness of acupuncture as there is no plausible prior reason to think that acupuncture could possibly work. But instead it should be seen as evidence of a corrupted scientific practrice within a totalitarian society that can only accept pro-nationalist results.
We can reject acupuncture on our prior understanding of science as it is based on mystical and superstitious concepts and not on a foundation of lower level, well established scientific results. Supporters of quackery claim this is ‘scientistic’ or ‘reductionist’ and we should not be trying to reduce complex phenomena like acupunture to a mechanical worldview but to see the ‘holistic’ picture.
It is somewhat amazing then to see Novella adopt the quacks’ lament.
Novella’s dismissal of sex being about reproduction as “reductionist” is at the heart of his failure to think clearly about the science of sex. His explicit approach is to never let us look at the many aspects of sex as resolvable phenomena in a hierarchy. He is always pushing to mush back together sex and reproduction, sexuality, orientation, identity, variation and disorders into one “bimodal” fog. We are never allowed to see any of these aspects in their own terms.
In The Blind Watchmaker, Richard Dawkins said,
For those that like ‘-ism’ sorts of names, the aptest name for my approach to understanding how things work is probably ‘hierarchical reductionism’. If you read trendy intellectual magazines, you may have noticed that *reductionism’ is one of those things, like sin, that is only mentioned by people who are against it.
To call oneself a reductionist will sound, in some circles, a bit like admitting to eating babies. But, just as nobody actually eats babies, so nobody is really a reductionist in any sense worth being against. The nonexistent reductionist the sort that everybody is against, but who exists only in their imaginations, tries to explain complicated things directly in terms of the smallest parts, even, in some extreme versions of the myth, as the sum of the parts! The hierarchical reductionist, on the other hand, explains a complex entity at any particular level in the hierarchy of organization, in terms of entities only one level down the hierarchy; entities which, themselves, are likely to be complex enough to need further reducing to their own component parts; and so on.
Novella is comparing hierarchical explanations of sex based in evolution, development and reproduction to this imaginary baby eating monster. We cannot hope to understand the complexities of such things as the human experience unless we are prepared to create a hierarchy of explanations. Your body existing as an evolved reproducing organism that is male or female is a perfectly good hierarchical place to start for so many conversations. To dismiss this explanation as missing out on the “complexities of human experience” is to fall into Dawkins’ Baby Eating Fallacy.
Hierarchical reductionism is at the heart of the scientific method and Novella’s Science-based medicine has to be grounded in such methods if it is provide the priors at the heart of his project. This abandonment of science in the name of ideology threatens the very foundation of science as a tool for understanding the world and creating better lives for people.
It’s sad to see how far Novella has fallen. The SGU podcast was a mainstay of mine for many years, and I will always be grateful to The Novella brothers and Perry DeAngelo (RIP) for introducing me to a lot of concepts which helped me to foster a set of tools for critical thinking.
However their show now is a mix of credulous futurism and politically motivated analysis. It is a far cry from what it used to be, and I don’t think they have even noticed the shift over the years. I stopped listening a few years back.
Then came gender ideology, and the audience capture is complete.They are in thrall to twitter activists who support their Patreon, and they cannot afford to alienate them. So Novella is probably using motivated reasoning to justify his position, ironically that is a phrase I first heard said by one Dr Steven Novella MD.
It’s all too easy to debunk ghost hunters like Ed and Lorraine Warren, but when a nonsensical ideology comes with strong left wing support he is either unable or unwilling to stand up to it.
It is such a sad state of affairs for Steven Novella and co.
I cannot imagine how we got to this place where they take an entire field of study at face value, when there are zero prospective, randomized, controlled trials of their treatments and zero subsequent metanalyses of the findings of various trials.
We aren’t even sure what we’re trying to achieve with gender affirming treatment, and whether the same could be achieved with less invasive, less permanent means. No one has bothered to study it, probably because it would be like finding a needle in a haystack given their effect sizes are piss poor the begin with.
Never let anyone tell you that scientific thinkers are impartial, because Novella is embarrassing the scientific community with his shockingly credulous reactions to people who would seek to label any dissenters as “conversion therapy bigots.”
I’m a Developmental Biologist. I have recently been teaching embryonic gonad etc development. At an early stage we all have Mullerian and Wolffian Ducts. The fate of these in Males and Females is starkly different. I recommend students learn one then the other rather than both together to avoid confusion. I expect if he has ever even approached this he got them muddled. It would explain much.
I agree the Trans brain scan studies are deeply flawed. All the best evidence done properly finds only human brains.
In my own life I married a woman who was doing a degree in Chemistry. Then she reassessed with my support and started a BA in pure Maths. She then did a BSc in Computer Science. Often she was the only woman in her classes.
I’m a poetry writing, cooking enthusiast Biologist. The Gender Borg would have turned my good wife who is a wonderful mother into an ersatz boy. Her parents had three girls I half suspect her father might have transitioned her to get a ‘son’.
I had three sisters so as the only boy that I was different from them was obvious. I was a miniature version of my father whom I resemble fairly strongly. I was not and am not a very macho man though I am athletic. I do not go down the pub with my mates. I prefer to go with my wife. Or did before she left me. The point is I’m not a very typical man in many ways.
I worry about the young, they have forgot the art of making rebellious tribes. I remember hippies and rockers. Then Skinheads and New Romantics which became Punks, Goths and Rockers. You could tell which tribes people belonged even with school uniform. I work in a school, there are no signs.
I remember noting before all this blew up that the young when paired were strictly woman dressed and made up to the nines. Guy a bit scruffy but male. Pretty much everyone. It must have seemed to the kids a bit like the ‘50s. But they chose weird ways to rebel. Ruin your body with hormones, blockers and surgery. Regret not at leisure but with much angst. Hear the howls of frustration from the post op Detrans people. There is no way back. Not fully.
I too was a faithful reader of SBM. When Novella published this piece, I immediately unsubscribed. His earlier trearment of Dr. Harriet Hall was also out of character. I wholeheartedly agree with your rebuttal.
What is also disappointing is the lack of any engagement by any of the many ‘skeptics’ who used to frequent the comments on your blog, Andy.
I’m sure some will claim they won’t engage with a ‘bigot’, but I think we know it’s more because they are unable to challenge anything you say or are they themselves not willing to be challenged.
For skeptics to have such closed minds is disappointing.
YOu are married to Maria, right? I love Maria. She is incredible.
That’s me! Yes, she is incredible.
Yet see https://sciencebasedmedicine.org/sleep-and-vaccination-response/
where Steven Novella happily embraces that there are Women and Men. I agree that the treatment of Harriet Hall by SBM in this context was pretty disgraceful and then had to justified by writing apologetics for a multi sex universe.
Some links you may find interesting andy
Thank you for your detailed dissection. It’s a tough job, but apparently someone has to do it, and you do it admirably.
Just one aspect where I have some half-baked thoughts to add: “Why would humans evolve with an innate knowledge of being male or female? How does this benefit anyone?” – our society is (or, at least, was for the longest time) organized along gender lines, and this far exceeds what would be necessary for reproductive purposes. Our gender determines (more or less) who we make friends with, who we compete with, with whom we need to fit in, what our duties are, what our aspirations and reasonable expectations in life can be, how we talk to others and expect to be talked to. This is not something that needs to be imposed on children “by society” – the social division between boys and girls emerges spontaneously, long before they have any concept of sex and reproduction, and despite the best efforts by adults to treat everyone the same. So, for better or worse, it seems to be innate.
What could be the advantages of having it built-in, and not completely malleable? Some protection from manipulation, for example – it keeps high-ranking males from telling young low-ranking males “no, you’re not actually men. You have no business aspiring to my position, nor to my harem, nor to anything other than poverty, and your job is to toil in the fields and feed me. Now what are you waiting for?” I mean, that’s what the aristocracy keeps trying, but they keep running up against men’s innate sense of what they are, as well as their innate aggression.
The important differences between the sexes are entirely biological, the societal bits of them are imposed after the fact. Sex on the one hand, gender on the other.
However Gender activists wish to impose those same unnecessary restrictions to people regardless of biological sex, not despite it. So they are imposing the same sexist distinctions on people, but removing the bit where it is connected to sex at all, and instead related to an internal feeling of what you are ‘supposed’ to be.
In other words, it used to be that women were expected to wear make up. Now someone who wears make up is expected to be treated as a woman under all circumstances.
Can you see why I don’t feel either position really deals with the issue of pervasive sexism?
Thank you for giving me the skeptical ammo to fight this pernicious attack on reality.