While science has historically used the word sex as a way to distinguish male from female, the word gender was also used to make distinctions, particularly by young people and others in a culture that felt awkward using the word sex in public. Sex for many people was both an act and a recognition of the scientific categories’ male and female. So, using the word gender was clear and easy for people because it was a word that did not make young people giggle and others blush.

For centuries people had grammatical distinctions to indicate gender, le for male and la for female. Mon ami for a male friend and mon amie for a female friend. Using the word gender to describe male and female made sense as both a grammatical function and social distinction.

Over the last several decades, and particularly the last twenty years, the word gender has evolved into a linguistic endeavor as imaginative and exotic as our contemporary zeitgeist will allow. But the actions being carried out are not imaginative and theoretical. They present serious challenges in our ability to identify, measure, and solve real problems.

In July of 2021, California Governor Gavin Newsom signed into law AB 439, allowing nonbinary to be listed as an option on death certificates. Some states are allowing nonbinary on birth certificates and death certificates. While this is not shared by most states, it is a gradual shift that may actually endanger marginalized people and much of the population.

While some see this action as advancing equality, it actually serves to create greater challenges for all people. A denial of biological sex as male and female will create devastating consequences when it comes to understanding the physical and mental aspects of the human condition that impact males and females differently, regardless of sexual orientation. This distinction is important. We do not need to deny biological sex to recognize people whose sexual orientation or whose habits and comforts may be atypical of the behaviors representative of the majority of males and females.

By using nonbinary as an indicator, we will find it much harder to identify groups who may be at risk.

• How do we trace suicide and opioid deaths of nonbinary people and demographically identify at risk groups?

• How we do recognize COVID deaths of nonbinary people and identify at risk groups?

• How do we identify differences in educational outcomes in particular populations?

Studies have shown, for instance, that suicide rates and suicidal tendencies are higher among transgender persons. Listing the category transgender persons fails to disaggregate data accordingly and, in doing so, conflates transgender as one category of persons, failing to acknowledge the higher deaths of trans women (biological males who transition to females) while failing to address the suicide deaths of trans men (biological females who transition to males) and its association to women. According to one study in Acta Psychiatrica Scandinavica, “trans women had a higher overall suicide death risk than trans men.” Trans women are 3.2 times more likely than trans men to die of suicide.

Data conflation has long plagued our understandings and created greater challenges. Black males, for instance, are behind black females in high school graduation rates and college readiness by signifiant margins, but the numbers are often conflated and discussed in the context of race. The same holds true with almost any racial group. In California, males do worse than their female counter parts of the same race in high school graduation rates and college readiness. We find similar trends throughout the US. Any study in education that does not disaggregate by sex (gender) is statistically misleading.

The same holds true with the category nonbinary and may lead us to lesser understandings. For decades medical trials did not include women. The intention was not to be exclusionary but protective. In doing so, the impacts of particular drugs on women could not be readily understood and created potential harms. (It is now common practice to include women in clinical trials).

Studies from the CDC have shown the variance of COVID vaccine on males. Reports, for instance, reveal males who receive the vaccine are 7x to 8x more likely to suffer a myocarditis/pericarditis. Although experiencing myocarditis/pericarditis is a very low risk, it is important to understand the reasons the disparities exist, particularly for boys between the ages of 12 to 17, 18 to 24, and 25 to 29. The label nonbinary would cloud our understanding.

People do not have to deny biological sex to associate with a particular orientation that is outside the experiences held by most people in their biological category. The nonbinary status will only conflate persons and create greater challenges. Understanding outcomes in physical and mental health, educational outcomes, and other key areas is essential for a healthy society looking to measure and identify in order to improve outcomes of all people.