In her first argument as a lawyer before the Supreme Court, Ruth Bader Ginsburg famously quoted the abolitionist Sarah Grimké, who said, “I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks.” At some point, however, Ginsburg was encouraged to use an alternative to the term sex.
“I’m typing all these briefs and articles for you and the word sex, sex, sex is on every page,” her secretary at Columbia Law School told her. “Don’t you know that those nine men”—that era’s Supreme Court justices—“they hear that word, and their first association is not the way you want them to be thinking?” The secretary suggested substituting gender to “ward off distracting associations.”
But sex and gender don’t mean the same thing. The two terms have never been stable. Still, I recall a time when, among educated people, sex was typically understood to refer to matters of biology, such as a person’s reproductive organs, and gender to refer to matters that are socially constructed, such as the norm of dressing little boys in blue pants and little girls in pink dresses. Today, there seems to be no standard usage. Parents throw gender-reveal parties to disclose the sex of their baby. President Trump said in his 2025 inaugural address, “It will henceforth be the official policy of the United States government that there are only two genders: male and female”—but “male” and “female” are sexes. A statute in California defines sex (in part) as follows: “‘Sex’ also includes, but is not limited to, a person’s gender. ‘Gender’ means sex, and includes a person’s gender identity and gender expression.”
The confusion that results from this lost distinction causes problems in academia––see the recent kerfuffle in anthropology––as well as in medicine, law, public policy, and more. People mistake meanings and talk past one another about matters that are fraught even when definitions are clear. How did we get into this semantic mess?
The concept of a “gender role” was introduced in a 1955 paper by the researcher John Money to signify “all those things that a person says or does to disclose himself or herself as having the status of boy or man, girl or woman.” He believed that people born with ambiguous or atypical genitals, whom he called “hermaphrodites or intersexes,” contributed to “this new meaning of gender.” Would such individuals operate in society as men or women? He thought that rearing would better predict a person’s “gender role” than biology.
The term gender identity, first defined as “one’s sense of being a member of a particular sex,” dates back to at least the early 1960s. The psychoanalyst Robert Stoller wrote that “gender role is the overt behavior one displays in society, the role which he plays.” By the ’70s, feminists were the most prominent group to adopt gender and related terms, using them to differentiate biological differences between men and women from differences imposed by society. In the 1972 book Sex, Gender, and Society, the feminist sociologist Ann Oakley suggested that biology may play little or no role in determining gender identity (that is, one’s sense of being a member of a particular sex). If a biological predisposition to a male or female gender identity exists at all, she wrote, it “may be decisively and ineradicably overridden by cultural learning.” In the 1990 book Gender Trouble, Judith Butler challenged the common assumption that gender mirrors sex and is binary, arguing that “a gender cannot be said to follow from a sex in any one way.” Butler also argued that “perhaps this construct called ‘sex’ is as culturally constructed as gender,” and the supposed distinction between them “turns out to be no distinction at all.”
In 1997, the sex researcher Milton Diamond and the psychiatrist Keith Sigmundson reached the conclusion that sex is a distinct and important category. The two revisited a case that Money had included in his research. “The penis of an XY individual was accidentally ablated”—that is to say, severely damaged or removed—“and he was subsequently raised as a female,” the authors recounted. “Initially this individual was described as developing into a normally functioning female.” Money had treated the case as confirmation that nurture reliably overrides nature. But the story later changed: When older, the patient rejected “this sex of rearing” and “switched at puberty to living as a male.” This mattered in part because, the authors explained, “the standard in instances of extensive penile damage to infants is to recommend rearing the male as a female.” They urged doctors to reconsider that practice.
The importance of sex as a category was further affirmed in 2001 by a group of experts convened by the Institute of Medicine (since renamed the National Academy of Medicine). Recounting several public-health guidelines that excluded women of child-bearing age from clinical trials on the erroneous assumption that they “will not differ significantly in response to treatment in most situations,” the report noted: “Sex, that is, being male or female,” is “an important basic human variable that should be considered when designing, analyzing, and reporting findings from studies.”
But the importance of sex as a category of study did not guarantee sex a stable place in scholarship, as the Harvard evolutionary biologist David Haig showed by documenting a dramatic decline in the term sex and a rise in gender in the titles of academic articles between 1945 and 2001. At first, feminist scholarship converged on socially constructed gender and biologically determined sex, Haig wrote, but “that distinction was difficult to maintain,” because “no term remained to refer to situations in which causation was unknown, disputed, or involved an interaction between biology and culture.” Soon gender spread to other disciplines, and eventually gender rather than sex began to appear even in scholarship on the physiology of animals. “Among the reasons that working scientists have given me for choosing gender rather than sex in biological contexts,” Haig wrote, “are desires to signal sympathy with feminist goals, to use a more academic term, or to avoid the connotation of copulation.”
By the 2000s, yet another obstacle to mutual understanding arose: What people meant by gender was changing, not only in academic discourse, but in popular usage. For many of the early feminists, gender was a cage built by society. Parents gave little girls but not little boys Easy-Bake Ovens, reproducing a gendered expectation that girls would grow up to do the cooking. But as the decades wore on, gender came to carry a second meaning, one very different from social norms imposed from the outside. The term now sometimes refers to an internal aspect of a person’s sense of self, or even the essence of who they truly are.
While some people kept using gender as shorthand for something from which they sought liberation––to weaken gender norms was to fight the patriarchy––others saw it as an identity, perhaps innate, that individuals discerned and expressed, and that a just society ought to affirm. In 2014, Facebook announced that users would no longer have to identify as male or female––they could choose among at least 58 “gender” options (including intersex, a term that tells us something about a person’s reproductive or sexual anatomy but not about their gender identity).
That brings us to the present era, when sex and gender loom larger than ever in political, legal, and cultural debates––but usage keeps changing faster than the public can keep up, and many semantic choices are made for reasons other than advancing shared understanding. Three examples help illustrate the dysfunction that can result:
- When Australia asked individuals to note their sex in its 2021 census, the form gave three options: male, female, and nonbinary, “to allow respondents to participate in the Census when the male and female sex categories did not accurately describe their sex,” the Australian Bureau of Statistics explained. Among the 25,422,788 people that the census counted, 43,220 respondents chose nonbinary. But this “did not yield meaningful data,” the bureau later acknowledged, because the respondents hadn’t agreed upon a definition of nonbinary. Among the small number of respondents who selected nonbinary and explained why, “a very small number” indicated that they were intersex; “a small number” noted their sexual orientation; and three-fifths listed a gender identity. The bureau found the data unusable “to estimate the prevalence of any specific group.” The 2026 census will ask about sex and gender separately.
- A 2024 study from JAMA Ophthalmology reviewed pivotal clinical trials in the field between 1995 and 2022. It sought to determine whether sex and gender were used correctly (relying on the National Institutes of Health definitions of sex as “a biological characteristic, reflected genetically by chromosomes and physiologically by sex hormones, internal reproductive organs, and external genitalia” and gender as “an aspect of identity that is self-determined and influenced by sociocultural and environmental factors”). The researchers found that in 85 trials, “over three-quarters applied sex and gender terminology incorrectly” and that “no trial reported how sex or gender were collected,” even though “sex and gender are gaining increasing recognition as important determinants of disease epidemiology, health outcomes, and health care disparities.” The authors concluded that the “policies of biomedical journals on sex and gender are incongruous and uncoordinated” in a way that hurts the field’s mission.
- In a 2023 interview with Time magazine, the soccer player Megan Rapinoe objected to barring trans women from playing on the same sports teams as biological females. “I see trans women as real women,” she declared. “What you’re saying automatically in the argument—you’re sort of telling on yourself already—is you don’t believe these people are women.” But her formulation elides the fact that women is used variably, sometimes to signify sex and sometimes to signify gender. Many proponents of segregating sports by sex do not reject the gender identity of trans women. For example, in the prominent case of Lia Thomas, a trans woman who, controversially, swam on the women’s team at the University of Pennsylvania, 16 teammates sent a letter to Penn that stated, “We fully support Lia Thomas in her decision to affirm her gender identity and to transition from a man to a woman. Lia has every right to live her life authentically. However, we also recognize that when it comes to sports competition, that the biology of sex is a separate issue from someone’s gender identity.” Only by distinguishing between sex and gender can we distinguish between two different viewpoints: that sports leagues should reject a trans person’s account of their own gender, or that gender is irrelevant to this debate and sex alone should govern policy around eligibility to play.
Different ideological groups will continue deploying language that best suits their ends. But we all ought to value terms that are accurate and aid mutual understanding. Clarity is best advanced by using sex to refer to biology––and, when appropriate, to specify whether the particular trait relevant to a given discussion concerns gametes, chromosomes, hormones, anatomy, or some combination. In contrast, gender should be used to refer to matters that are socially constructed––and concepts such as gender norms, gender identity, and gender expression should be used to distinguish different conceptions of gender from one another. If and when disputes arise about whether we’re referring to sex or gender or a mix, speakers should explain why they chose a given term and what precisely they mean by it.
These usage conventions can’t tell us who belongs on what sports team or what is required or forbidden under antidiscrimination law, nor can it settle any number of other debates. But they can help us all better understand and engage in them.
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