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Articles in PresS. Am J Physiol Regul Integr Comp Physiol (March 31, 2010). doi:10.1152/ajpregu.00694.2009 1 R-00694-2009 Second Revision Opinion: A Call for Proper Usage of “Gender” and “Sex” in Biomedical Publications Bruce M. King Department of Psychology, Clemson University Correspondence: Dr. Bruce King Department of Psychology 418 Brackett Hall Clemson University Clemson, SC 29634 Phone: 864-656-7368 Email: [email protected] Copyright © 2010 by the American Physiological Society. 2 The term “gender” became popular among sociologists, psychologists, and sex researchers in the 1970s as a means to differentiate biological differences between men and women (“sex” differences) and differences due to socialization experiences (“gender” differences), or the act of having sex (e.g., 12, 19, 25, 27). In other words, unlike one’s biological “sex,” “gender” refers to the social construction of masculinity and femininity (19, 21). It does not exist within a person (10), but instead is a term that was designed to be used “only when discussing social, cultural, and psychological aspects that pertain to the traits, norms, stereotypes and roles considered typical and desirable for those whom society has designated as male or female” (8, p. 9). The distinctive usage of “sex” and “gender” was initially very successful, but in the last two decades the media, in particular, has increasingly used “gender” as a synonym for “sex.” Recent examples include reporting the use of autopsies on skeletal remains to determine the “gender” of victims, referring to “gender differences” when reporting performance differences between fillies and mares in horse racing, and reporting that a South African track star (who had won a gold medal in the women’s 800meters event in the World Games) was required to take a “gender test.” One’s gender cannot be determined by an anatomical exam, a urine test, or by an autopsy. Despite some published appeals for proper usage of “gender” and “sex” (e.g., 14, 22, 29), misuses of the terms have increasingly begun to appear in academic publications as well. These include textbooks (13, 22) and academic journals (14, 22). Unfortunately, in recent years, this also includes studies using non-human animals that were published in biomedical, physiology, and neuroscience journals (14). For example, a search in the database Medline indicated that between January 2005 and December 2009 there were 3 489 published studies with the key words “sex differences” and “rats,” and an unprecedented 197 articles with the terms “gender differences” and “rats” (compared to 326 and 20, respectively, in the period 1985-1989, and 343 and 59, respectively, in the period 1990-1994). Among the latter, 105 of them contained “gender” in the titles of the articles. Of course, the numbers would be greater if the Medline search were expanded to include non-human subjects other than rats. Regardless of the species, non-human animals do not display “gender differences.” The American Psychological Association has officially endorsed the distinctive usage of the terms “sex” and “gender” since 1994. In it’s Publication Manual of the American Psychological Association, 5th edition (1), Guideline 1: Describe at the appropriate level of specificity, the APA states: “Gender is cultural and is the term to use when referring to men and women as social groups. Sex is biological; use it when the biological distinction is prominent….Gender helps keep meaning unambiguous” (p. 63). Some other social science journals have also included the distinctive usage of the terms “sex” and “gender” as policy in their review of manuscripts (e.g., 9). The Institute of Medicine (17) endorsed a similar distinction in 2001: “Sex refers to the classification of living things, generally as male or female according to their reproductive organs and functions assigned by chromosomal complement. Gender refers to a person’s selfrepresentation as male or female, or how that person is responded to by social institutions based on the individual’s gender presentation. 4 Gender is rooted in biology and shaped by environment and experience” (p. 1). Noting the “inconsistent and often confusing” use of the two terms in both the media and scientific publications, one of the recommendations of the Institute of Medicine was to “clarify use of the terms sex and gender” (p. 6). This distinction does not mean that “gender” is always the appropriate term even when referring to humans. For example, “sex” is the appropriate term when categorizing male and female human subjects in biomedical studies. However, the term “gender” is never appropriate for non-human species. An example of the appropriate usage of the two terms with humans is with transsexual individuals, i.e., individuals who believe themselves to be of the opposite sex. “Sex” is the proper word to refer to their anatomy, whereas “gender” refers to their identity, and thus the term “gender identity disorder” (4). Similarly, in the case of children born with ambiguous genitalia, it was once the practice to do “corrective” surgery shortly after birth. This practice became less common when studies showed that for many of the children their assigned (by parents and physicians) anatomy did not agree with their sense of gender identity (7). There is no attempt here to trivialize the definitions of either sex or gender. Biological sex, whether defined by anatomy, chromosomes, hormones, or some combination, is not a dichotomous classification, for there are a large variety of intersexual individuals (20). The concept of gender is equally complex (see 28). The quoted short definitions by early social scientists (e.g., 8), the APA (1), and the Institute of Medicine (17) may not appear to be identical (perhaps because they addressed different aspects of the concept), but the intent of all is the same – to “distinguish 5 culturally specific characteristics of masculinity and femininity from biological factors” (15). Even if one were to attribute behavioral differences in male and female rats to a socialization process, that does not mean that they possess a sense of gender (and it would be anthropomorphic to suggest so). It should also be noted that a great many of the 197 articles referring to “gender differences” and “rats” that were published in the period 2005-2009 did not even study behavior, but instead were studies of cellular, tissue, or organ responses. Some recent examples (all are parts of titles) include “gender” differences in “GABAA receptormediated postsynaptic currents” (6), “cardiac ischemic injury and protection” (26), “S100 beta protein expression” (24), “erythrocyte and brain decosahexaenoic acid composition” (23), “liver and kidney expression of sulfate anion transporter sat-1” (5), “proliferation and osteogenic differentiation of bone marrow stromal cells” (16), “high-fat-diet-induced insulin resistance in skeletal muscle” (11), “beta-adrenergic receptor responsiveness” (3), “febrile response to lipopolysaccharide” (2), and “deoxycorticosterone acetate-saltinduced hypertension” (18). These examples, and numerous others, clearly have nothing to do with gender as defined by the Institute of Medicine (17). The media cannot be expected to use the terms “sex” and “gender” properly if academic publications do not do so. Two of the major reasons that researchers give for using the term “gender” when referring to non-human animals are a “desire to signal sympathy with feminist goals” and an attempt “to use a more academic term” (14, p. 9495). Both reasons are misguided, lack scientific objectivity, and are opposite the intentions of feminist scholars (e.g., 10, 12, 19, 25, 27) and the recommendations of both 6 the Institute of Medicine (17) and the American Psychological Association (1). Both organizations emphasize that the terms “sex” and “gender” are not synonyms. It is obvious from the Medline data that recommendations alone have not stopped the misuse of the term “gender.” Editors of biomedical journals are encouraged to consider adopting a policy following the recommendations of the Institute of Medicine when considering manuscripts for future publication. References 1. American Psychological Association. Publication Manual of the American Psychological Association (5th edition). Washington, DC: American Psychological Association, 2001, p. 63. 2. Ashdown H, Poole S, Boksa P, Luheshi GN. Interleukin-1 receptor antagonist as a modulator of gender differences in the febrile response to lipopolysaccharide in rats. Am J Physiol Regul Integr Comp Physiol 292: R1667-R1674, 2007. 3. Bilginoglu A, Cicek FA, Ugur M, Gurdal H, Turan B. The role of gender differences in beta-adrenergic receptor responsiveness of diabetic rat heart. Mol Cell Biochem 305: 63-69, 2007. 4. Bradley SJ, Zucker KJ. Gender identity disorder: A review of the past 10 years. J Am Acad Child Adolesc Psychol 36: 872-880, 1997. 5. Brzica H, Breljak D, Krick W, Lourić M, Burckhardt G, Burckhardt BC, Sabolić I. The liver and kidney expression of sulfate anion transporter sat-1 in 7 rats exhibits male-dominant gender differences. Eur J Physiol 457: 1381-1392, 2009. 6. Chudomel O, Herman H, Nair K, Moshé SL, Galanopoulou AS. 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A critical review of family sociology textbooks. Teach Sociol 18: 541-549, 1990. 14. Haig D. The inexorable rise of gender and the decline of sex: Social change in 8 academic titles, 1945-2001. Arch Sex Behav 33: 87-96, 2004. 15. Hawkesworth M. Confounding gender. Signs 22: 649-684, 1997. 16. Hong L, Sultana H, Paulius K, Zhang G. Steroid regulation of proliferation and osteogenic differentiation of bone marrow stromal cells: a gender difference. J Steroid Biochem Mol Biol 114: 180-185, 2009. 17. Institute of Medicine, Committee on Understanding the Biology of Sex and Gender Differences, Board on Health Sciences Policy. Exploring the Biological Contributions to Human Health: Does Sex matter? Report of the Institute of Medicine, edited by Wise WT and Pardue M-L. Washington, DC: National Academy Press, 2001, p. 1, 6. 18. Kawanishi H, Hasegawa Y, Nakano D, Ohkita M, Takaoka M, Ohno Y, Matsumura Y. Involvement of the endothelin ET(B) receptor in gender differences in deoxycorticosterone acetate-salt-induced hypertension. Clin Exp Pharmacol Physiol 34: 280-285, 2007. 19. Kessler SY, McKenna W. Gender: An Ethnomethodological Approach. New York: John Wiley & Sons, 1978. 20. King BM. Human Sexuality Today (6th edition). Upper Saddle River, New Jersey: Pearson, 2009, p. 201-207. 21. Komarovsky M. The concept of gender role revisited. Gender Soc 6: 301-313, 1992. 22. Laner MR. “Sex” versus “gender”: A renewed plea. Sociol Inq 70: 462-474, 2000. 23. McNamara RK, Able J, Jandacek R, Rider T, Tso P. Gender differences in 9 rat erythrocyte and brain decosahexaenoic acid composition: role of ovarian hormones and dietary omega-3 fatty acid composition. Psychoneuroendocrinology 34: 532-539, 2009. 24. Nogueira MI, Abbas SY, Campos LG, Allemandi W, Lawson P, Takada SH, Azmitia EC. S100 beta protein expression: gender- and age-related daily changes. Neurochem Res 34: 1355-1362, 2009. 25. Oakley A. Sex, Gender, and Society. London: Maurice Temple Smith, 1972. 26. Ostadal B, Netuka I, Maly J, Besik J, Ostadalova I. Gender differences in cardiac ischemic injury and protection – experimental aspects. Exp Biol Med 234: 1011-1019, 2009. 27. Unger RK. Toward a redefinition of sex and gender. Am Psychol 34: 1085-1094, 1979. 28. Vanwesenbeeck I. Doing gender in sex and sex research. Arch Sex Behav 38: 883-898, 2009. 29. Zurbriggen EL, Sherman AM. Reconsidering ‘sex’ and ‘gender’: Two steps forward, one step back. Fem Psychol 17: 475-480, 2007.