The U.S. Administration recently notified the media that they are considering the adoption of a narrow definition of gender. The new definition limits gender to male or female, based entirely on an assessment of genitalia at birth. For those cases of ambiguous genitalia, gender would be based on genetic testing. This approach is put forward through the Health and Human Services Department, and would establish the legal definition of sex under Title IX, the federal civil rights law that bans gender discrimination in educational programs that receive federal funding. The change would reverse the recent recognitions and protections afforded transgender people by decisions of the previous administration.

The transgender population in America is estimated to be 1.4 million. Aside from eliminating recent legal protections for transgender people, the new narrow definition also contradicts scientific understanding of gender, which is recognized to be more complex then phenotypic anatomy. Gender identity is also influenced by genetics, development, circulating hormones and hormone receptors, as well as psychological and cultural influences. The medical literature provides evidence of the mental health consequences resulting from gender dysphoria when individuals gender identity is incongruent with the sex assigned by society. As gynaecologic surgeons, we have the historical precedent of surgery for ambiguous genitalia based on surgical expediency as an example of causing gender dysphoria through assigning gender. The evidence is clear that allowing individuals to self identify gender optimizes their mental health related to gender.

Given the scientific consensus on gender identity, the proposed narrow definition of gender appears to be politically motivated. Our Society supports public health policy informed by medical science, and consequently, the Board is compelled to release the following statement on gender identification:

AUGS Statement on Gender Identification
October 25, 2018

The American Urogynecologic Society does not support recent calls to define gender as male or female based on genitalia at birth. This political oversimplification does not reflect current social, medical or scientific understanding.

An individual’s gender identity is informed by multiple factors, including genes, the production and activity of hormones, physical anatomy including genitalia, and psychological and cultural influences. Science has shown that these factors do not always align within some individuals. Studies have also shown that optimizing the mental health of these individuals is best achieved by allowing them to self-identify their own gender. Efforts to assign gender based on limited criteria, such as genitalia, can result in gender dysphoria. Importantly, for those who experience such distress, the causes are not only due to psychological or behavioral issues, but also biological ones related to genetics or hormonal influence before birth.

The American Urogynecologic Society advocates for a more evidence-based and encompassing interpretation of gender, and for the avoidance of limited and possibly discriminatory definitions. Modern science should be used to inform public health policy.