The American Medical Association (AMA) is receiving warranted criticism after its House of Delegates called for removing sex markers on birth certificates, with an advisory committee arguing that their inclusion “perpetuates a view that [sex] is immutable.”
Dr. Michelle Cretella, Executive Director of the American College of Pediatricians said, “This is precisely why sex does belong there.” She explained, “Identifying sex in the public portion of the birth certificate affirms the scientific fact that sex is an innate and immutable binary trait of public significance; a trait determined by genetics at fertilization. This is explained in detail in the ACPeds position statement I coauthored Sex is a Biological Trait of Medical Significance.”
Dr. Michael Artigues, Vice President and co-author of the statement stated “Due to genetics males are different from females at the cellular level from fertilization. Biological sex differences due to genetics and sex hormones affect the tendency to develop certain diseases, alter responses to drugs, toxins and pain, and also cause important physical, cognitive, emotional and behavioral differences between the two sexes.” This is why the NIH recognizes sex as a binary biological variable in research and medical practice.
Acknowledging inborn genetic sex differences is also crucial for creating sound public policy. Dr. Cretella notes, “Overall, males are bigger, stronger, faster and more aggressive than females. Genetics – not wishful thinking and not only testosterone – is what makes males male. Genetics is why a male who self-identifies as female remains male, and explains why giving estrogen to a male does not transform him into a biological female. While it is true that a male using estrogen will lose muscle strength and impair other aspects of his physiology, he does not alter his genetics; he remains male at the cellular level in all body systems. Similarly, a female who self-identifies as male remains a biological female, and giving her testosterone does not transform her into a male. In terms of genetics, she remains female at the cellular level.”
Dr. Cretella emphasized, “Females, who self-identify as male, including those on testosterone, remain genetically female and should not be housed with males in homeless shelters or prisons, nor should they be competing against males in sports. Males, who self-identify as female, including those on estrogen, remain genetically male and have no objective reason — let alone a right — to be housed with or competing against females.”
The scientific bottom line is that sex markers belong in the public portion of birth certificates because acknowledging the innate differences between males and females in health care and public policy is critical to ensuring the health and safety of children and adults alike.