Three states, including California, have now officially endorsed a “third sex” by adding an identifier on documents like licenses: neither male nor female, but X. This concept is absolutely new in the annals of Western civilization.

Biologic sex, gender, dysphoria, transitions, DNA, hormones — it’s all so confusing. 

Clearly, understanding the issue is tremendously important, for those involved and for the wider society. So, directly from the science, here is a little sketch of the complicated topic.

Mammals, including humans, are determined by their chromosomes, from the moment of conception, as male (XY) or female (XX). These chromosomes are responsible for the cascade of sex differences that occur as humans develop in utero and beyond, with hormones as the mediating chemical. 

The hormone estrogen (in a girl fetus) and testosterone (in a boy) cause the genitals and the other physical sex characteristics to develop, so that at birth, a quick visual inspection determines sex. “It’s a ... !” is not an assignation, but an announcement of biologic fact. 

The “third-sex” option on licenses, then, addresses disorders of this universal norm, both physical and psychological.


On the physical side, because fetal development sometimes goes awry, very rarely it happens that a baby may carry an extra Y or an extra X. 

The most common of these abnormalities is known as where a man’s cells carry an extra X chromosome. The primary feature is sterility and these men are not prone to think of themselves as women. Other, even rarer sex-chromosomal aberrations exist, such as Turner syndrome, but you are unlikely to meet someone with one of these because prenatal diagnoses lead to more than half of these persons being aborted.

Sometimes the chromosomal sex of the child is not expressed properly in the genitalia, usually due to the absence of a hormone at a critical point in embryogenesis. This results in a baby who may have genitals that appear feminine but inside there are no female sex organs, and the chromosomes are male. 

This “intersex” condition is even rarer than chromosomal abnormalities — one in many thousands. An exhaustive examination follows, in order to determine the child’s true sex, and to plan medical intervention that will hopefully work best for the child, taking into account fertility, surgical outcomes, and, most importantly, chromosomes.

All of this to explain the science and medicine behind sex. But now we come to the psyche, and therefore gender, which is not the same thing. Gender is the “state” of being male or female (how one feels and acts) and usually refers to social and cultural factors. 

Across cultures, and for biologic and evolutionary reasons, the female sex is associated with female gender characteristics, like the quiet, nurturing disposition that attracts little girls to dolls and women to babies. 

It makes sense that females who are pregnant for nine months and then nursing a helpless infant for many more would have this disposition. Boys and men, on the other hand, are disposed to protectiveness and physical audacity, which also makes sense. As fathers, they had better be able to protect and support their wives and babies, or it would mean the end of the species. 

Biologic sex and gender don’t always line up psychologically. This is called “gender dysphoria.” Patients suffering from this show a persistent cross-gender identification, which is the desire to be, or the belief that one is, of the opposite sex.  

The incidence of this disorder is estimated to be about 0.005 percent of the population — a tiny fraction. Transgender ideology dictates that the “cure” for these patients is radical lifelong hormonal and surgical alteration, and a society that endorses this solution absolutely.

In summary, then, the third-sex identifier may be claimed by people suffering from chromosomal and developmental disorders, but also to those suffering from gender dysphoria, and are psychologically uncomfortable with their biologic sex.

All sorts of issues come up for the wider society when we go to the “third-sex” option, and I’m sure you can think of many. 

On a personal level we worry, rightfully, knowing that people suffering from gender dysphoria have a 40 percent suicide attempt rate, compared to less than 5 percent of the overall population. This figure does not improve when people live as the other sex, even after drastic hormonal and surgical alterations. And it does not improve even when the person feels accepted and celebrated by society. 

The complicated truth is that our country is embarking on an experiment regarding sex, as it has many times in the past. It may be many tumultuous decades before we can sort out all the ramifications and consequences of this modern approach to sex and gender, but in the meantime, I hope a little scientific clarity will help make the experience a little smoother.

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