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Guest Essay

The Problem With Saying ‘Sex Assigned at Birth’

By Alex Byrne and Carole K. Hooven

Mr. Byrne is a philosopher and the author of “Trouble With Gender: Sex Facts, Gender Fictions.” Ms. Hooven is an evolutionary biologist and the author of “T: The Story of Testosterone, the Hormone That Dominates and Divides Us.”

As you may have noticed, “sex” is out, and “sex assigned at birth” is in. Instead of asking for a person’s sex, some medical and camp forms these days ask for “sex assigned at birth” or “assigned sex” (often in addition to gender identity). The American Medical Association and the American Psychological Association endorse this terminology; its use has also exploded in academic articles. The Cleveland Clinic’s online glossary of diseases and conditions tells us that the “inability to achieve or maintain an erection” is a symptom of sexual dysfunction, not in “males,” but in “people assigned male at birth.”

This trend began around a decade ago, part of an increasing emphasis in society on emotional comfort and insulation from offense — what some have called “ safetyism .” “Sex” is now often seen as a biased or insensitive word because it may fail to reflect how people identify themselves. One reason for the adoption of “assigned sex,” therefore, is that it supplies respectful euphemisms, softening what to some nonbinary and transgender people, among others, can feel like a harsh biological reality. Saying that someone was “assigned female at birth” is taken to be an indirect and more polite way of communicating that the person is biologically female. The terminology can also function to signal solidarity with trans and nonbinary people, as well as convey the radical idea that our traditional understanding of sex is outdated.

The shift to “sex assigned at birth” may be well intentioned, but it is not progress. We are not against politeness or expressions of solidarity, but “sex assigned at birth” can confuse people and creates doubt about a biological fact when there shouldn’t be any. Nor is the phrase called for because our traditional understanding of sex needs correcting — it doesn’t.

This matters because sex matters. Sex is a fundamental biological feature with significant consequences for our species, so there are costs to encouraging misconceptions about it.

Sex matters for health, safety and social policy and interacts in complicated ways with culture. Women are nearly twice as likely as men to experience harmful side effects from drugs, a problem that may be ameliorated by reducing drug doses for females. Males, meanwhile, are more likely to die from Covid-19 and cancer, and commit the vast majority of homicides and sexual assaults . We aren’t suggesting that “assigned sex” will increase the death toll. However, terminology about important matters should be as clear as possible.

More generally, the interaction between sex and human culture is crucial to understanding psychological and physical differences between boys and girls, men and women. We cannot have such understanding unless we know what sex is, which means having the linguistic tools necessary to discuss it. The Associated Press cautions journalists that describing women as “female” may be objectionable because “it can be seen as emphasizing biology,” but sometimes biology is highly relevant. The heated debate about transgender women participating in female sports is an example ; whatever view one takes on the matter, biologically driven athletic differences between the sexes are real.

When influential organizations and individuals promote “sex assigned at birth,” they are encouraging a culture in which citizens can be shamed for using words like “sex,” “male” and “female” that are familiar to everyone in society, as well as necessary to discuss the implications of sex. This is not the usual kind of censoriousness, which discourages the public endorsement of certain opinions. It is more subtle, repressing the very vocabulary needed to discuss the opinions in the first place.

A proponent of the new language may object, arguing that sex is not being avoided, but merely addressed and described with greater empathy. The introduction of euphemisms to ease uncomfortable associations with old words happens all the time — for instance “plus sized” as a replacement for “overweight.” Admittedly, the effects may be short-lived , because euphemisms themselves often become offensive, and indeed “larger-bodied” is now often preferred to “plus sized.” But what’s the harm? No one gets confused, and the euphemisms allow us to express extra sensitivity. Some see “sex assigned at birth” in the same positive light: It’s a way of talking about sex that is gender-affirming and inclusive .

The problem is that “sex assigned at birth”— unlike “larger-bodied”— is very misleading. Saying that someone was “assigned female at birth” suggests that the person’s sex is at best a matter of educated guesswork. “Assigned” can connote arbitrariness — as in “assigned classroom seating” — and so “sex assigned at birth” can also suggest that there is no objective reality behind “male” and “female,” no biological categories to which the words refer.

Contrary to what we might assume, avoiding “sex” doesn’t serve the cause of inclusivity: not speaking plainly about males and females is patronizing. We sometimes sugarcoat the biological facts for children, but competent adults deserve straight talk. Nor are circumlocutions needed to secure personal protections and rights, including transgender rights. In the Supreme Court’s Bostock v. Clayton County decision in 2020, which outlawed workplace discrimination against gay and transgender people, Justice Neil Gorsuch used “sex,” not “sex assigned at birth.”

A more radical proponent of “assigned sex” will object that the very idea of sex as a biological fact is suspect. According to this view — associated with the French philosopher Michel Foucault and, more recently, the American philosopher Judith Butler — sex is somehow a cultural production, the result of labeling babies male or female. “Sex assigned at birth” should therefore be preferred over “sex,” not because it is more polite, but because it is more accurate.

This position tacitly assumes that humans are exempt from the natural order. If only! Alas, we are animals. Sexed organisms were present on Earth at least a billion years ago, and males and females would have been around even if humans had never evolved. Sex is not in any sense the result of linguistic ceremonies in the delivery room or other cultural practices. Lonesome George, the long-lived Galápagos giant tortoise , was male. He was not assigned male at birth — or rather, in George’s case, at hatching. A baby abandoned at birth may not have been assigned male or female by anyone, yet the baby still has a sex. Despite the confusion sown by some scholars, we can be confident that the sex binary is not a human invention.

Another downside of “assigned sex” is that it biases the conversation away from established biological facts and infuses it with a sociopolitical agenda, which only serves to intensify social and political divisions. We need shared language that can help us clearly state opinions and develop the best policies on medical, social and legal issues. That shared language is the starting point for mutual understanding and democratic deliberation, even if strong disagreement remains.

What can be done? The ascendance of “sex assigned at birth” is not an example of unhurried and organic linguistic change. As recently as 2012 The New York Times reported on the new fashion for gender-reveal parties, “during which expectant parents share the moment they discover their baby’s sex.” In the intervening decade, sex has gone from being “discovered” to “assigned” because so many authorities insisted on the new usage. In the face of organic change, resistance is usually futile. Fortunately, a trend that is imposed top-down is often easier to reverse.

Admittedly, no one individual, or even a small group, can turn the lumbering ship of English around. But if professional organizations change their style guides and glossaries, we can expect that their members will largely follow suit. And organizations in turn respond to lobbying from their members. Journalists, medical professionals, academics and others have the collective power to restore language that more faithfully reflects reality. We will have to wait for them to do that.

Meanwhile, we can each apply Strunk and White’s famous advice in “The Elements of Style” to “sex assigned at birth”: omit needless words.

Alex Byrne is a professor of philosophy at M.I.T. and the author of “Trouble With Gender: Sex Facts, Gender Fictions.” Carole K. Hooven is an evolutionary biologist, a nonresident senior fellow at the American Enterprise Institute, an associate in the Harvard psychology department, and the author of “T: The Story of Testosterone, the Hormone That Dominates and Divides Us.”

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