Michael Gurian writes, “Wherever I travel to speak and consult this year, whether in person or via Zoom, I am asked about sex, gender, trans, gender non-binary, and connections to the brain and child development.  With thousands of young people struggling with gender dysphoria and many more asking gender identity questions, we must grapple with a new situation.”

In this blog, Michael provides a number of resources for understanding and helping all our youth, including policies and procedures schools and other organizations can use to take into account both sexual dimorphism and gender exploration.

I spoke recently in a community with audience members from coed schools, boys schools, girls schools, and homeschooling.   Each is trying to figure out how to serve not just some, but all children.  We agreed that it is important our society comes together to develop a common language and policies to help ALL people–this means accounting for sex and gender, both.

To help schools, communities, and policy makers, I have provided four research-based essays, and a video clip (linked at the end of this blog post).   If you haven’t read or viewed any of these before, you might want to look at them now.  They provide the background evidence for the summary of the science of sex and gender I will present in this blog post, as well as basic and practical suggestions for school and social policy I will further explore with you today.  Some of my science-based suggestions for policies and procedure may not agree with extreme responses certain medical groups have promulgated in recent years.  Overall, though, I think most medical and psychiatric professionals would agree with the science and the policy suggestions.

Summary of the Science of Sex and Gender

Other recent books and articles to look at:

Harvard Professor Carole Hooven’s, The Story of Testosterone, The Hormone that Dominates and Divides Us, Henry Holt & Co:  New York, 2021.

Dr. David Geary’s Geary, D. C. (2022, September 1). “The ideological refusal to acknowledge evolved sex differences”; Quillette; https://quillette.com/2022/09/01/the-ideological-refusal-to-acknowledge-evolved-sex-differences/

This recent Reuters special report,  https://www.reuters.com/investigates/special-report/usa-transyouth-care/?utm_source=pocket-newtab

In these resources and those below, you’ll find important science for understanding our children’s explorations and nature.   For your own community discussions, here is a summary of the science.

•  Sex and gender are not the same thing:  Sex is hard-wired via chromosome markers that act in utero to differentiate male and female body/brain.   This sexually dimorphic differentiation is crucial to systems theory and thus to policy making.   For the medical system to understand and treat a patient most successfully, it needs to know whether the patient is male or female.  If it does not, life-threatening mistakes can occur.  Similarly, though more subtle, if a social system, like a school or family, is going to most effectively raise and educate children, male and female need to be accounted for; if not accounted for, the system will lose or leave behind millions of kids.  In schools, sometimes girls, but usually boys; in homes, churches, neighborhoods, both boys and girls will be lost.   The feminist movement has showed us how important sex is.  Women and men, and girls and boys should have equal rights as they have particular and lasting needs we must help them fulfill.
• After accounting for sex in all our systems, we must also account for exceptions-to-the-rule on the brain sex spectrum.  Most exceptions are related to bridge brains, who account for a approximately 1 in 7 human brains.  The bridge brain child or adult is male or female, still, but its brain exists in the middle (as a bridge) between the two sexes.  It is important to remember:  just as we can see male and female brains on brain scans from any country, culture, or race, we can also see male and female bridge brains on brain scans from around the world.  A female architect or mechanical engineer will tend to scan as a bridge brain; a male kindergarten teacher will often scan as a bridge brain.  Not just the brain but the hormonal system of the bridge brain may also exist toward the middle of the spectrum, as an exception-to-the-rule.
• After accounting for sex differentiation in all our systems, including bridge brain exceptions, gender and its social language must be accounted for.  Generally, gender is not hard-wired in the same way sex is (though it can connect with sex in many ways, including the bridge brain); it is mainly an amalgam of important social constructions regarding individual and group identity.  Gender, thus, has recent sociological roots (changing gender norms and gender roles) while also enjoying neural roots to, mainly, bridge brains.   Given that most of our gender nonconforming children will end up telling us in later adolescence, “I’m gay,” rather than “I’m trans” or “I’m gender nonconforming,” it is important we understand what gender is and what it is not:  it can be fluid now and in the future as self-perception changes, but (except for trans and gay) it is not mainly hard-wired like sex is.
• Though LGBTQ+ are linked for political purposes, the first four, LGBT, are more hard-wired than gender nonconforming and questioning are.   Lesbian, gay, bisexual–like heterosexual–is hard-wired in utero into the sexually dimorphic nucleus of the anterior hypothalamus.  A child may or may not know that he or she is gay until adolescence, but by adolescence or somewhere in adulthood, he or she will know.   What is already hard-wired into the hypothalamus usually gets triggered and expressed when hormones wash through.  Lesbian, gay, bisexual is not a “choice” as we once thought–it is part of who the person is, from deep in the core of the brain, just like heterosexuality is.  Approximately 5 – 10% of humans and other mammals are LGB.
• The trans brain is also not a “choice.”  In neural language, it scans as an extreme bridge brain (see the articles below for these references).  We can distinguish between trans and gender non-conforming brains today via brain scans with a trans brain more hard-wired than a gender nonconforming brain (that is not trans).  While “trans” is used these days by children and adolescents for nearly every brain difference, only .3% or so human beings would scan as trans.  And given that most children who tell us they are trans will end up later saying they are gay not trans, we must be careful in how we study, treat and care for our gender dysphoric children.
• By understanding the difference between sex and gender, we can best treat everyone; we can treat brain-sex dysphoria (trans) and gender dysphoria (gender nonconforming) in ways that are supportive, medically sound, and psychologically wise.  By distinguishing sex and gender, we can avoid overreacting or under-reacting to a child who says, “I’m gender nonbinary” by taking time to explore with the child whether he or she is gay or straight, trans or gender nonconforming.  We can affirm the exploration without jumping to conclusions.  To provide hormone therapy and transitional surgery to a gender nonconforming or gay child who is not trans can be dangerous to that child both as an individual and within the child’s nurturing system; at the same time, to withhold transitional resources from trans adolescents can also be dangerous to them and our systems, including higher suicide rates in this population.
• As we use the sex/gender distinction to help us work with exceptions among bridge brains, we will be able to continue to advocate for girls and boys and women and men as sex groups that need specific attention.  Sex is not zero sum, nor is gender.   Both are important elements of human development.  Sex sex affects all children and adults; gender heavily affects exceptions-to-the-rule.  By distinguishing and understanding sex and gender together, we can make sure not to take parents out of childhood/adolescent decision-making unless the parents are abusing the children.   Parents generally have tools with which to help their children navigate adolescent identity searches, including around sex and gender.
• Ultimately, our society is challenged with creating policies and procedures that safely utilize the difference between sex and gender.  If we don’t utilize gender, we miss helping millions of children.  But if we don’t use sex as the baseline, we not only do damage to women’s/girls’ and men’s/boy’s rights in systems; we encounter backlash against helping exceptional children.  We are seeing both the lack of completion of boys’ and girls’ needs-assessments, and the backlash, all over the world right now.  Girls’ and women’s rights are paralyzed in some states as “girl,” “woman,” and “mother” (all of which are based in sex) are encountering cultural erasure for the sake of an extreme social positions on gender while recent gains helping boys in school–where boys have been behind for decades–are now stymied by the proposed erasure in academe and the media of “boy” and “man.”  To assist with recent gender explorations culture-wide, we are trying to erase sex, which is a significant mistake for unified cultural progress.

Because this background and policy statement grows from discussions in a school district, I will suggest the following policy notes for the whole society, and then for school deliberations.  Please customized these for your own systems.

• Knowing that the word “trans” is being used to include hundreds of thousands of bridge brains who are, in fact, not trans, we must postpone whenever possible any significant biological intervention for children and teens who present as trans but are most likely gay and/or bridge brains exploring a gender nonconforming identity.  Beginning in academe, and spreading through government and media, policy makers should utilize professionals who have studied both sex and gender to teach children, adults, parents, and others the biology of each category–sex, gender, trans, gender nonconforming, lesbian, gay, bisexual–so that adults can help children understand their internal explorations from a science-based perspective.  Society-wide, and especially in psychiatry and medicine, we must better define “gender affirming care” to include sex and gender, both.   This will mean taking the sex denial (denying sexual dimorphism and male/female) out of social policy.  It will also mean empowering medical professionals to work with our gender exploring populations first in the bridge brain category, while studying the child for a trans brain.
• Society will utilize “he” and “she” in human discourse without penalty, but with sensitivity.  Our linguistic pronouns are based in the reality of sexual dimorphism in which we all participate and belong (even a person who is gender fluid still is male or female at a molecular level), so using he and she is, in fact, inclusive of all human beings even gender nonconforming, trans, and gay exceptions.  That said, using these pronouns accurately for the human population as a whole does not mean a person can’t ask for “they” to be used; nor does it mean we should refuse to use “they” when we can for a bridge brain who is exploring gender, or for the trans person in transition.  It means, though, that sex will remain our human baseline because sex applies to ALL while gender applies to some.  Employing this approach will involve teaching exceptional children they are resilient if “they” is not used for and with them; pulling back from thinking those who don’t use “they” are not generally abusive people or “transphobic”; and agreeing as a whole that non-use of “they” does not exclude the gender exploring boy or girl.  This both/and approach acknowledges the accuracy of existing pronouns for sex while allowing for curiosity regarding expanding gender.
• When a trans person is in biological transition between physiologic sexes, which she or he is doing to match brain sex with body, that person will likely want the future sex pronoun used (i.e., if he is becoming a she and vice versa); in exceptional cases, this person will want “they” or X to be used.  We can follow this person’s wishes as much as possible, and go further from a policy perspective to learn from the trans person about brain sex itself via brain scans and other science.  The trans person has a lot to teach us about human variety and the bridge brain spectrum.  We can learn from the trans person, as well, about the positives and potential negatives of transition, medication, and life-changes.   The science of trans is new science; we are learning as we go.  While some people are very glad they have transitioned, some people recant and are not.  In this global experiment, policy-makers need to collect information from the people in the trenches just in case new policy will need to be created or old policy evolved to match what scientific inquiry learns.
• Linguistically and inclusively for all schools, the use of “he,” “she,” and “they” as noted above can be applied across the board.  A coed school will likely take in all students from both sexes and across the gender spectrum.  For a single sex school, however, issues about which students to recruit are important at the level of sex.  Given the difference between sex and gender, a gender nonconforming boy or girl is still a boy or girl–“gender-nonconforming” acts as adjective (gender) and “boy” or “girl” as the noun (sex).   School policy to not recruit a gender nonconforming girl identifying as male into boys school is, thus, appropriate because the child’s sex still female even though the child’s social identity experimentation is presently linked to gender nonconformity.   Similarly, in a girls school, the school should not be required to take a biological male, even if that male is identifying as female or gender nonconforming, given that the child’s sex is male.   Systems need to start with their baselines, then move forward from there.  If a trans male has completed biological transition to female, however, she is now female, so she need no longer be considered a gender nonconforming boy; she is a girl.  That said, it is potentially unsafe to transition children and adolescents fully while still children, thus this scenario will likely be moot for most schools.
• As puberty approaches, athletics and sports should be defined by sex first, gender second.  In some sports and in basic daily play young boys and girls play together successfully without negative consequence.  However, by the time puberty begins, sex will need to prevail in order to be fair to all children, but especially to girls and women.  To do otherwise is to set women’s rights back without good reason.  Girls will lose in competition to more naturally muscular boys whose advantages go beyond muscle into cardio-vascular and other internal systems.  Many countries and international organizations have begun to catch up to the importance of this, pulling back on insistence that a gender nonconforming boy (identifying girl) compete, in adolescence or adulthood, with females.
• Similarly, the baseline of sex needs to prevail legislatively in matters of maternity and paternity.   Mothers are mothers, and fathers are fathers at the level of sex.  While a mother can be a gender nonconforming mother (identifying as a man), she is still female.  Equally so, a male who transitions to a female is now female:  if this female has a child via scientific experimentation or social arrangement, she is a mother.  We make a mistake that will haunt us for decades by trying to legislate “birthing person” instead of “mother” into social language.  To legislate this is like legislating “they” instead of “he” or “she” with penalties for non-use of the word that just don’t fit common sense and will only diminish the rights of mothers and fathers.
• If a person has transitioned, policy must agree across the board that this person has altered reproductive organs and completed the adjustment of hormonology to become the target sex; this new woman or man is a fit for the previously cross-sex environment.  This new man can go to a men’s college; this new woman can go to a woman’s college and play sports with the new sex if certain baseline testosterone level standards have been met.  This person will want, it is likely, to be called by the target pronoun, he or she, given the significant investment in altering epigenetics toward the target, i.e. this person will likely not want to be “they” anymore because the sex has changed, and so has the pronoun to the “other sex.”  We should support this person as a woman or a man now–we should honor the investment with our shift in pronoun from he to she or she to he.
• Schools already teach sex ed in fourth grade and beyond so it is developmentally appropriate for all the above aspects of sex and gender to be taught by the school at that time.  Meanwhile, teachers must be provided with science-based (non-political, non-ideological) curricula and training so they can teach both sexual dimorphism and gender development within science, biology, gym class, and other relevant forums.  With science in tow, these teachers can explain to children entering early puberty that 90 – 95% of all mammals are heterosexual, but 5 – 10% of mammals are gay (LGB).  They will be able to distinguish sex and gender for children as they teach the “birds and the bees”, noting that 99% of people or more are not in conflict regarding their sex while around 1% of bridge brains are in conflict and even more than that are bridge brains.  Teachers and parents can, thus, help support everyone on the spectrum via training and education in the same way we are now trained to help autism spectrum kids, and indeed every child, with scientific information.

When we base policy in what is hard-wired while including exceptions that manifest against the background of hard-wiring, we protect everyone’s civil rights, thus operate as a fully democratic system (e.g. a school) and society in the whole.   The policy suggestions in this blog post are politically moderate thus inclusive of 100% of people we meet.   If we move from politics to science, we will understand that bridge brains constitute the lion’s share of LGBTQ + individuals; thus, we will be able to pull back at a macro level from political attacks and backlash against certain populations.  Further, we will understand via brain science that there are exceptions to every rule in science, exceptions we can learn from and absorb into the mosaic of society, and into policy.

On a micro level, by taking both sex and gender in to account, with sex as baseline and gender as exception, we will complete both a systemic and a case-by-case analysis of each child and adolescent rather than utilizing a one-size-fits-all reactivity.  Given that nearly all of the LGBTQ + children we are discussing present to health professionals first and foremost with gender dysphoria (depression), we must treat the dysphoria first and foremost.   To do so, we must use with everything in our arsenal, from all mental health assets, and in both the sex and gender spheres.  Parents and health professionals need to marshal together, not in opposition, to treat brain’s issues and bridging in a concerted way, without knee jerk politics in tow.

All this said, I know some people will be angry at my positions:  some will feel that we must do whatever someone in the LGBTQ community says we should do because this person or cohort says we should do it.  Others will feel that we should do nothing to accommodate vulnerable LGBTQ populations.  In truth, we must work together to include everyone, first on the basis of sex, and then on the basis of the internal gender battle thousands of people are exploring right now.  These people are our brothers, sisters, colleagues, friends, and children who expand boundaries not only on behalf of themselves and their own mental health, but also as an experiment in culture we need to respect.

Let me go further to say:  we should mine these internal journeys for our own better evolution.  Children are always the knife-edge of a spear, even as we protect them from battle.  The human mind is both well and safely entrenched in what has worked for a million years–its sex difference–but is also experimenting, via our children, with building a larger bridge between the sexes in hopes of expanding human ingenuity.  A double blind study is occurring right now among our children and adolescents.  Let’s take control of the experiment more than we are doing right now; let’s remove our confused social policies that don’t respect the scientific basis for sex while also enjoying the evolving wisdom our next generation is bringing to the journey of human freedom.

–Michael Gurian, 2022

Not Breast-Feeding but Chest-Feeding? A Culture of the Exception, Part I

Remove “Male” and “Female” from Birth Certificates?  Culture of the Exception, Part II

Transgender Athletics and Women’s Rights, Culture of the Exception, Part III

Does the Child Have Brain Sex Dysphoria or Gender Dysphoria?  Culture of the Exception, Part IV

Transgender Brains Don’t Negate Male and Female Brains