Journal Article

Sex/gender entanglement: A problem of knots and buckets

Duchesne, Annie, Maney, Donna L., Grossi, Giordana

2025

Overview

When used as variables in biomedical research, sex and gender can be difficult to operationalize and measure. Questions have arisen about whether either category is stable or causally meaningful in a research context. Here, we discuss some of the limitations of using both or even one of these categories in correlational or experimental work. We argue that attempting to draw a distinction between sex and gender can reignite the nature/nurture debate, inadvertently bringing outdated metaphors and assumptions about innateness and causation into our research. Many researchers, including ourselves, have described sex and gender as separate collections of causal factors (which we describe as a “bucket” metaphor) or as entangled (a “knot” metaphor). Because they regard sex and gender as conceptually separable and internally consistent, such metaphors have limited value for understanding the drivers of diversity in our data. Rather than continuing to reify sex and gender as distinct buckets or threads of explanatory variables, we call for deconstruction of these categories by focusing instead on clearly operationalized, instantiating variables that researchers can manipulate or measure. Our proposed approach differs from recent, similar calls in that we are not suggesting the exclusion of a sex/gender category from statistical models; instead, we recommend keeping it—not as a representation of biological reality, but as a tool used under a careful set of assumptions. We provide example datasets to illustrate how a sex/gender category can, when thoughtfully operationalized, be used to improve statistical rigor and inferential precision. In addition, we advocate for attention to variation within sex/gender, which is more informative in investigations of mechanism than comparing means across sex/gender categories. Highlights Recent calls to consider gender, as well as sex, in biological and biomedical research come from an appreciation of the need to acknowledge complexity. Here, we consider the utility of using sex or gender categories to represent that complexity. The concepts of sex and gender, despite originating from very different disciplines and philosophies, are now regarded oppositionally in terms of the nature-nurture dichotomy, a framework that has been rejected in the biological and developmental sciences. Other authors have recently advocated for moving past binary sex and gender categories to instead consider instantiating, measurable variables of interest. We discuss the pros and cons of this approach, and, using sample datasets, present alternatives that can address its shortcomings. We advocate keeping a single, general sex/gender category—not as a representation of biological reality – but instead as a tool used to improve analytical rigor and inferential precision.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Behavior / Biology / Biomedical and Life Sciences / Biomedical research / Biomedicine / Ebola virus / Endocrinology / Entanglement / Eschewing the Binary: Sex and Gender Science in Human and Non-human Animal Research / Female / Gender / Gender differences / Gender Identity / Gender/sex / Hormones / Human Physiology / Humans / Kidneys / Male / Medical research / Medicine, Experimental / Operationalization / Physiology / Review / Sex Characteristics / Sex contextualism / Sex/gender / Statistical models / Variables / Women