麻豆传媒

On July 31, a user posted a link to a blog post titled, "Med Schools Are Now Denying Biological Sex." On a Reddit board that typically garners anywhere from one to 200 comments per post, the link (uploaded by a self-identified MD) currently has 665 comments, filled with heated debate over how sex and gender are being taught in medical schools.

The -- written by podcast host Katie Herzog and published on former New York Times op-ed writer Bari Weiss's Substack -- posited that "wokeness" has eroded the fabric of medical education by forcing professors to teach biological sex as a social construct, thereby stripping sex of its scientific validity and medical relevance. According to Herzog's reporting, teachers from top medical schools are "running scared of students," afraid that one slip-up -- such as using terms like "male" and "female" in a lecture -- may lead to a public shaming or, even worse, the end of their career.

A Social Construct?

"Some of the country's top medical students are being taught that humans are not, like other mammals, a species comprising two sexes," Herzog wrote. "The notion of sex, they are learning, is just a man-made creation."

NYU's Grossman School of Medicine is one of those top medical schools. However, Richard Greene, MD, MHPE, an associate professor and the director of Health Equity Education for NYU's office of diversity affairs, told 麻豆传媒 that teaching biological sex as a social construct is not just about inclusivity or "wokeness" -- it's about medical correctness.

"Cisgender boys going through puberty who have excess estrogen in their bodies will also have breast tissue," Greene posed as an example. "So if we're being medically correct and precise in our language, then we're going to talk about pathology that comes with breast tissue -- we're not going to talk about women's pathology."

Using gender-neutral terms is not indicative of the erasure of biological sex from medical education, Greene explained. He doesn't deny its significance, either -- despite what Herzog's reporting might suggest.

"When we talk about binary sex, we're talking about a combination of chromosomes, hormones, and anatomy. But these things don't always neatly fall into the buckets of 'male' and 'female,' and they never have," Greene said, acknowledging that differences in sex development -- experienced by intersex individuals and others -- have always existed.

In an email to 麻豆传媒, NYU medical student Augustus Parker described the significance of teaching biological sex and reproductive systems inclusively. An instructor of his was discussing the various negative side effects that can occur after menopause -- such as bone degradation and cardiovascular disease -- and how such symptoms could be worsened if menopause happened prematurely because of a hysterectomy; postmenopausal estrogen therapy, however, can prevent most of these symptoms.

Parker, a trans man, walked away from the lecture confused and filled with dread: He had undergone a hysterectomy, and can't start estrogen therapy because he's on testosterone therapy.

"Ultimately, I am a man who had a uterus. When menopause is discussed as a part of medical education, I am a part of the patient population being discussed. The medical students are learning about the intricacies of my health, just as much as they are for cisgender women," Parker wrote. "Therefore, it is inaccurate to discuss menopause as something happening only to women. It is inaccurate to say that the uterus is a strictly 'female' reproductive organ."

Sharpening one's understanding of this terminology, he said, prepares future physicians to approach patients in more nuanced ways in order to fulfill the fundamental shared goal of learning how to provide the best possible care.

Fear or a Heightened Sensitivity?

In her piece, Herzog cited an instance at an unidentified prestigious medical school in California, in which students petitioned a professor after she used cisnormative -- defined by blog as "the assumption that all, or almost all, individuals are cisgender" -- language during an endocrinology lecture. Ultimately, Herzog wrote, the professor apologized to the class via email; now, instructors have reportedly developed an unreasonably acute awareness of the language they choose to use in their classes.

Similar concerns were echoed by commenters under the Meddit post. One user -- a self-described MD who claims to prescribe hormone replacement therapy for trans patients -- expressed frustrations regarding the growing frequency of these student-led petitions against professors. And while the user believes that distinctions between sex and gender should be taught in medical schools, the pendulum has swung too far in that direction.

"Every single topic, no matter how unrelated it is, must be centered in language related to trans and nonbinary folks," the user commented.

"Much of the new language that they try to impart -- like 'birthing people' -- to me is inherently dehumanizing," they continued. "Reducing cis women -- who make up 98% of women -- to their organs, when they almost certainly identify as women, as mothers -- is wrong. And honestly? Most of my trans patients seem to understand that too."

For Marcia Stefanick, PhD, the founding director of Stanford's Women's Health and Sex Differences in Medicine Center, finding the most inclusive ways to talk about sex and gender is "a constantly evolving situation," she told 麻豆传媒.

While Stefanick sees gender as an unmistakable social construct, she doesn't personally believe that biological sex is socially constructed.

"Women and men are not the same," she said. "We can't keep talking about people like there's just one body or just two bodies -- we do have to at least acknowledge that there are big differences that go way beyond genitalia or whether you have breasts or not."

Stefanick herself was educated during the women's movement of the late 60s and 70s. And, not unlike the Meddit commenter, she admits to feeling like women have been pushed out of the conversation. However, she continues to use inclusive, gender-non-specific terms as much as possible, she said.

Stefanick doesn't live in "fear" of her students, necessarily -- but it's "in that direction."

"I want to figure out how I can teach and communicate in a way that doesn't trigger somebody," she said. "It's a sensitivity -- maybe a hypersensitivity -- which almost borders on fear, but it's not quite fear."

Herzog described this in her piece as a phenomenon of "students policing teachers; of students being treated as the authorities over and above their teachers." In practice, though, confronting a professor about their approach to sex and gender isn't always as contentious as it's portrayed.

Rather, as Greene put it, it's an opportunity for "co-learning," wherein teachers learn from their students and vice versa.

"When we put people in situations where they're uncomfortable, and then we shame them about it, we lose the opportunity to have that dialogue," Greene said. "I put that blame on cancel culture writ large ... But individual students and learners are able to have the conversation and say, 'this is what I learned, this is what I think, help me understand better.'"

A rising second-year medical student at NYU (who requested to remain anonymous) also recognized the wide variability when it comes to where professors are in the sex/gender conversation. He recalled his own endocrinology lectures, during which students and instructors acknowledged that they were all trying their best -- learning, listening, and adapting along the way.

"[Professors] are not going to be perfect every time and that's okay," he said. "It takes time for people who have grown up where things are one way, to learn about how things might be different."

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