Doing Gender Author(s): Candace West and Don H. Zimmerman Source: Gender and Society, Vol. 1, No. 2 (Jun., 1987), pp. 125-151 Published by: Sage Publications, Inc. Stable URL: http://www.jstor.org/stable/189945 . Accessed: 22/03/2014 18:29

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West, Zimmerman / DOING GENDER 137

enterprise is fundamentally interactional and institutional in char- acter, for accountability is a feature of social relationships and its idiom is drawn from the institutional arena in which those relation- ships are enacted. If this be the case, can we ever not do gender? Insofar as a society is partitioned by "essential" differences between women and men and placement in a sex category is both relevant and enforced, doing gender is unavoidable.

RESOURCES FOR DOING GENDER

Doing gender means creating differences between girls and boys and women and men, differences that are not natural, essential, or biological. Once the differences have been constructed, they are used to reinforce the "essentialness"of gender. In a delightful account of the "arrangement between the sexes," Goffman (1977) observes the creation of a variety of institutionalized frameworks through which our "natural, normal sexedness" can be enacted. The physical features of social setting provide one obvious resource for the expression of our "essential" differences. For example, the sex segregation of North American public bathrooms distinguishes "ladies" from "gentlemen" in matters held to be fundamentally biological, even though both "are somewhat similar in the question of waste products and their elimination" (Goffman 1977, p. 315). These settings are furnished with dimorphic equipment (such as urinals for men or elaborate grooming facilities for women), even though both sexes may achieve the same ends through the same means (and apparently do so in the privacy of their own homes). To be stressed here is the fact that:

The functioning of sex-differentiated organs is involved, but there is nothing in this functioning that biologically recommends segregation; that arrangement is a totally cultural matter ... toilet segregation is presented as a natural consequence of the difference between the sex- classes when in fact it is a means of honoring, if not producing, this difference. (Goffman 1977, p. 316)

Standardized social occasions also provide stages for evocations of the "essential female and male natures." Goffman cites organized sports as one such institutionalized framework for the expression of manliness. There, those qualities that ought "properly" to be associated with masculinity, such as endurance, strength, and com-

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138 GENDER & SOCIETY / June 1987

petitive spirit, are celebrated by all parties concerned-participants, who may be seen to demonstrate such traits, and spectators, who

applaud their demonstrations from the safety of the sidelines (1977, p. 322).

Assortative mating practices among heterosexual couples afford still further means to create and maintain differences between women and men. For example, even though size, strength, and age tend to be normally distributed among females and males (with considerable overlap between them), selective pairing ensures couples in which boys and men are visibly bigger, stronger, and older (if not "wiser") than the girls and women with whom they are paired. So, should situations emerge in which greater size, strength, or experience is called for, boys and men will be ever ready to display it and girls and women, to appreciate its display (Goffman 1977, p. 321; West and Iritani 1985).

Gender may be routinely fashioned in a variety of situations that seem conventionally expressive to begin with, such as those that present "helpless" women next to heavy objects or flat tires. But, as Goffman notes, heavy, messy, and precarious concerns can be constructed from any social situation, "even though by standards set in other settings, this may involve something that is light, clean, and safe" (Goffman 1977, p. 324). Given these resources, it is clear that any interactional situation sets the stage for depictions of "essential" sexual natures. In sum, these situations "do not so much allow for the expression of natural differences as for the production of that difference itself" (Goffman 1977, p. 324).

Many situations are not clearly sex categorized to begin with, nor is what transpires within them obviously gender relevant. Yet any social encounter can be pressed into service in the interests of doing gender. Thus, Fishman's (1978) research on casual conversations found an asymmetrical "division of labor" in talk between hetero- sexual intimates. Women had to ask more questions, fill more silences, and use more attention-getting beginnings in order to be heard. Her conclusions are particularly pertinent here:

Since interactional work is related to what constitutes being a woman, with what a woman is, the idea that it is work is obscured. The work is not seen as what women do, but as part of what they are. (Fishman 1978, p. 405)

We would argue that it is precisely such labor that helps to constitute the essential nature of women as women in interactional contexts

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West, Zimmerman / DOING GENDER 139

(West and Zimmerman 1983, pp. 109-11; but see also Kollock, Blumstein, and Schwartz 1985).

Individuals have many social identities that may be donned or shed, muted or made more salient, depending on the situation. One may be a friend, spouse, professional, citizen, and many other things to many different people-or, to the same person at different times. But we are always women or men-unless we shift into another sex category. What this means is that our identificatory displays will provide an ever-available resource for doing gender under an infinitely diverse set of circumstances.

Some occasions are organized to routinely display and celebrate behaviors that are conventionally linked to one or the other sex category. On such occasions, everyone knows his or her place in the interactional scheme of things. If an individual identified as a member of one sex category engages in behavior usually associated with the other category, this routinization is challenged. Hughes (1945, p. 356) provides an illustration of such a dilemma:

[A] young woman ... became part of that virile profession, engi- neering. The designer of an airplane is expected to go up on the maiden flight of the first plane built according to the design. He [sic] then gives a dinner to the engineers and workmen who worked on the new plane. The dinner is naturally a stag party. The young woman in question designed a plane. Her co-workers urged her not to take the risk-for which, presumably, men only are fit-of the maiden voyage. They were, in effect, asking her to be a lady instead of an engineer. She chose to be an engineer. She then gave the party and paid for it like a man. After food and the first round of toasts, she left like a lady.

On this occasion, parties reached an accommodation that allowed a woman to engage in presumptively masculine behaviors. However, we note that in the end, this compromise permitted demonstration of her "essential" femininity, through accountably "ladylike" behavior.

Hughes (1945, p. 357) suggests that such contradictions may be countered by managing interactions on a very narrow basis, for example, "keeping the relationship formal and specific." But the heart of the matter is that even-perhaps, especially-if the relation- ship is a formal one, gender is still something one is accountable for. Thus a woman physician (notice the special qualifier in her case) may be accorded respect for her skill and even addressed by an appropriate title. Nonetheless, she is subject to evaluation in terms of normative conceptions of appropriate attitudes and activities for her sex

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140 GENDER & SOCIETY / June 1987

category and under pressure to prove that she is an "essentially" feminine being, despite appearances to the contrary (West 1984, pp. 97-101). Her sex category is used to discredit her participation in important clinical activities (Lorber 1984, pp. 52-54), while her involvement in medicine is used to discredit her commitment to her responsibilities as a wife and mother (Bourne and Wikler 1978, pp. 435-37). Simultaneously, her exclusion from the physician colleague community is maintained and her accountability as a woman is ensured.

In this context, "role conflict" can be viewed as a dynamic aspect of our current "arrangement between the sexes" (Goffman 1977), an arrangement that provides for occasions on which persons of a particular sex category can "see" quite clearly that they are out of place and that if they were not there, their current troubles would not exist. What is at stake is, from the standpoint of interaction, the management of our "essential" natures, and from the standpoint of the individual, the continuing accomplishment of gender. If, as we have argued, sex category is omnirelevant, then any occasion, conflicted or not, offers the resources for doing gender.

We have sought to show that sex category and gender are managed properties of conduct that are contrived with respect to the fact that others will judge and respond to us in particular ways. We have claimed that a person's gender is not simply an aspect of what one is, but, more fundamentally, it is something that one does, and does recurrently, in interaction with others.

What are the consequences of this theoretical formulation? If, for example, individuals strive to achieve gender in encounters with others, how does a culture instill the need to achieve it? What is the relationship between the production of gender at the level of interaction and such institutional arrangements as the division of labor in society? And, perhaps most important, how does doing gender contribute to the subordination of women by men?

RESEARCH AGENDAS

To bring the social production of gender under empirical scrutiny, we might begin at the beginning, with a reconsideration of the process through which societal members acquire the requisite categorical apparatus and other skills to become gendered human beings.

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1992 Cheryl Miller Lecture

BELIEVING IS SEEING: Biology as Ideology

JUDITH LORBER Brooklyn College and Graduate School City University of New York

Western ideology takes biology as the cause, and behavior and social statuses as the effects, and then proceeds to construct biological dichotomies to justify the "naturalness" of gendered behavior and gendered social statuses. What we believe is what we see-two sexes producing two genders. The process, however, goes the other way: gender constructs social bodies to be different and unequal. The content of the two sets of constructed social categories, 'females and males" and "women and men," is so varied that their use in research withoutfurther specifica- tion renders the results spurious.

Until the eighteenth century, Western philosophers and scientists thought that there was one sex and that women's internal genitalia were the inverse of men's external genitalia: the womb and vagina were the penis and scrotum turned inside out (Laqueur 1990). Current Western thinking sees women and men as so different physically as to sometimes seem two species. The bodies, which have been mapped inside and out for hundreds of years, have not changed. What has changed are the justifications for gender inequality. When the social position of all human beings was believed to be set by natural law or was considered God-given, biology was irrelevant; women and men of different classes all had their assigned places. When scientists began to question the divine basis of social order and replaced faith with empirical

AUTHOR'S NOTE: Parts of this article are excerptedfrom Paradoxes of Gender (New Haven, CT: Yale University Press, 1994). Prepared with research supportfrom PSC-CUNY668-518 and 669-259.

REPRINT REQUESTS: Judith Lorber, Department of Sociology, CUNY Graduate School, 33 West 42nd Street, New York, NY 10036.

GENDER & SOCIETY, Vol. 7 No. 4, December 1993 568-581 ?1993 Sociologists for Women in Society 568

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Lorber / BIOLOGY AS IDEOLOGY 569

knowledge, what they saw was that women were very different from men in that they had wombs and menstruated. Such anatomical differences destined them for an entirely different social life from men.

In actuality, the basic bodily material is the same for females and males, and except for procreative hormones and organs, female and male human beings have similar bodies (Naftolin and Butz 1981). Furthermore, as has been known since the middle of the nineteenth century, male and female genitalia develop from the same fetal tissue, and so infants can be born with ambiguous genitalia (Money and Ehrhardt 1972). When they are, biology is used quite arbitrarily in sex assignment. Suzanne Kessler (1990) interviewed six medical specialists in pediatric intersexuality and found that whether an infant with XY chromosomes and anomalous genitalia was categorized as a boy or a girl depended on the size of the penis-if a penis was very small, the child was categorized as a girl, and sex-change surgery was used to make an artificial vagina. In the late nineteenth century, the presence or absence of ovaries was the determining criterion of gender assignment for hermaphro- dites because a woman who could not procreate was not a complete woman (Kessler 1990, 20).

Yet in Western societies, we see two discrete sexes and two distinguish- able genders because our society is built on two classes of people, "women" and "men." Once the gender category is given, the attributes of the person are also gendered: Whatever a "woman" is has to be "female"; whatever a "man" is has to be "male." Analyzing the social processes that construct the categories we call "female and male," "women and men," and "homosexual and heterosexual" uncovers the ideology and power differentials congealed in these categories (Foucault 1978). This article will use two familiar areas of social life-sports and technological competence-to show how myriad physiological differences are transformed into similar-appearing, gendered social bodies. My perspective goes beyond accepted feminist views that gender is a cultural overlay that modifies physiological sex differences. That perspective assumes either that there are two fairly similar sexes distorted by social practices into two genders with purposefully different characteristics or that there are two sexes whose essential differences are rendered unequal by social practices. I am arguing that bodies differ in many ways physiolog- ically, but they are completely transformed by social practices to fit into the salient categories of a society, the most pervasive of which are "female" and "male" and "women" and "men."

Neither sex nor gender are pure categories. Combinations of incongruous genes, genitalia, and hormonal input are ignored in sex categorization, just as combinations of incongruous physiology, identity, sexuality, appearance,

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Lorber / BIOLOGY AS IDEOLOGY 571

times in races of other lengths within the next 50 years because they are increasing their fastest speeds more rapidly than are men (Fausto-Sterling 1985, 213-18).

The reliance on only two sex and gender categories in the biological and social sciences is as epistemologically spurious as the reliance on chromo- somal or genital tests to group athletes. Most research designs do not investigate whether physical skills or physical abilities are really more or less common in women and men (Epstein 1988). They start out with two social categories ("women," "men"), assume they are biologically different ("fe- male," "male"), look for similarities among them and differences between them, and attribute what they have found for the social categories to sex differences (Gelman, Collman, and Maccoby 1986). These designs rarely question the categorization of their subjects into two and only two groups, even though they often find more significant within-group differences than between-group differences (Hyde 1990). The social construction perspective on sex and gender suggests that instead of starting with the two presumed dichotomies in each category-female, male; woman, man-it might be more useful in gender studies to group patterns of behavior and only then look for identifying markers of the people likely to enact such behaviors.

WHAT SPORTS ILLUSTRATE

Competitive sports have become, for boys and men, as players and as spectators, a way of constructing a masculine identity, a legitimated outlet for violence and aggression, and an avenue for upward mobility (Dunning 1986; Kemper 1990, 167-206; Messner 1992). For men in Western societies, physical competence is an important marker of masculinity (Fine 1987; Glassner 1992; Majors 1990). In professional and collegiate sports, physio- logical differences are invoked to justify women's secondary status, despite the clear evidence that gender status overrides physiological capabilities. Assumptions about women's physiology have influenced rules of competi- tion; subsequent sports performances then validate how women and men are treated in sports competitions.

Gymnastic equipment is geared to slim, wiry, prepubescent girls and not to mature women; conversely, men's gymnastic equipment is tailored for muscular, mature men, not slim, wiry prepubescent boys. Boys could com- pete with girls, but are not allowed to; women gymnasts are left out entirely. Girl gymnasts are just that-little girls who will be disqualified as soon as they grow up (Vecsey 1990). Men gymnasts have men's status. In women's

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572 GENDER & SOCIETY / December 1993

basketball, the size of the ball and rules for handling the ball change the style of play to "a slower, less intense, and less exciting modification of the 'reg- ular' or men's game" (Watson 1987,441). In the 1992 Winter Olympics, men figure skaters were required to complete three triple jumps in their required program; women figure skaters were forbidden to do more than one. These rules penalized artistic men skaters and athletic women skaters (Janofsky 1992). For the most part, Western sports are built on physically trained men's bodies:

Speed, size, and strength seem to be the essence of sports. Women are naturally inferior at "sports" so conceived.

But if women had been the historically dominant sex, our concept of sport would no doubt have evolved differently. Competitions emphasizing flexibil- ity, balance, strength, timing, and small size might dominate Sunday afternoon television and offer salaries in six figures. (English 1982, 266, emphasis in original)

Organized sports are big businesses and, thus, who has access and at what level is a distributive or equity issue. The overall status of women and men athletes is an economic, political, and ideological issue that has less to do with individual physiological capabilities than with their cultural and social meaning and who defines and profits from them (Messner and Sabo 1990; Slatton and Birrell 1984). Twenty years after the passage of Title IX of the U.S. Civil Rights Act, which forbade gender inequality in any school receiv- ing federal funds, the goal for collegiate sports in the next five years is 60 percent men, 40 percent women in sports participation, scholarships, and funding (Moran 1992).

How access and distribution of rewards (prestigious and financial) are jus- tified is an ideological, even moral, issue (Birrell 1988, 473-76; Hargreaves 1982). One way is that men athletes are glorified and women athletes ignored in the mass media. Messner and his colleagues found that in 1989, in TV sports news in the United States, men's sports got 92 percent of the cover- age and women's sports 5 percent, with the rest mixed or gender-neutral (Messner, Duncan, and Jensen 1993). In 1990, in four of the top-selling newspapers in the United States, stories on men's sports outnumbered those on women's sports 23 to 1. Messner and his colleagues also found an implicit hierarchy in naming, with women athletes most likely to be called by first names, followed by Black men athletes, and only white men athletes rou- tinely referred to by their last names. Similarly, women's collegiate sports teams are named or marked in ways that symbolically feminize and trivialize them-the men's team is called Tigers, the women's Kittens (Eitzen and Baca Zinn 1989).

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Lorber / BIOLOGY AS IDEOLOGY 573

Assumptions about men's and women's bodies and their capacities are crafted in ways that make unequal access and distribution of rewards accept- able (Hudson 1978; Messner 1988). Media images of modern men athletes glorify their strength and power, even their violence (Hargreaves 1986). Media images of modern women athletes tend to focus on feminine beauty and grace (so they are not really athletes) or on their thin, small, wiry androg- ynous bodies (so they are not really women). In coverage of the Olympics,

loving and detailed attention is paid to pixie-like gymnasts; special and extended coverage is given to graceful and dazzling figure skaters; the camera painstakingly records the fluid movements of swimmers and divers. And then, in a blinding flash of fragmented images, viewers see a few minutes of volleyball, basketball, speed skating, track and field, and alpine skiing, as television gives its nod to the mere existence of these events. (Boutilier and SanGiovanni 1983, 190)

Extraordinary feats by women athletes who were presented as mature adults might force sports organizers and audiences to rethink their stereotypes of women's capabilities, the way elves, mermaids, and ice queens do not. Sports, therefore, construct men's bodies to be powerful; women's bodies to be sexual. As Connell says,

The meanings in the bodily sense of masculinity concern, above all else, the superiority of men to women, and the exaltation of hegemonic masculinity over other groups of men which is essential for the domination of women. (1987, 85) In the late 1970s, as women entered more and more athletic competitions,

supposedly good scientific studies showed that women who exercised in- tensely would cease menstruating because they would not have enough body fat to sustain ovulation (Brozan 1978). When one set of researchers did a yearlong study that compared 66 women-21 who were training for a marathon, 22 who ran more thari an hour a week, and 23 who did less than an hour of aerobic exercise a week-they discovered that only 20 percent of the women in any of these groups had "normal" menstrual cycles every month (Prior et al. 1990). The dangers of intensive training for women's fertility therefore were exaggerated as women began to compete successfully in arenas formerly closed to them.

Given the association of sports with masculinity in the United States, women athletes have to manage a contradictory status. One study of women college basketball players found that although they "did athlete" on the court-"pushing, shoving, fouling, hard running, fast breaks, defense, ob- scenities and sweat" (Watson 1987, 441), they "did woman" off the court, using the locker room as their staging area:

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574 GENDER & SOCIETY / December 1993

While it typically took fifteen minutes to prepare for the game, it took approximately fifteen minutes after the game to shower and remove the sweat of an athlete, and it took another thirty minutes to dress, apply make-up and style hair. It did not seem to matter whether the players were going out into the public or getting on a van for a long ride home. Average dressing time and rituals did not change. (Watson 1987, 443)

Another way women manage these status dilemmas is to redefine the activ- ity or its result as feminine or womanly (Mangan and Park 1987). Thus women bodybuilders claim that "flex appeal is sex appeal" (Duff and Hong 1984, 378).

Such a redefinition of women's physicality affirms the ideological subtext of sports that physical strength is men's prerogative and justifies men's physical and sexual domination of women (Hargreaves 1986; Messner 1992, 164-72; Olson 1990; Theberge 1987; Willis 1982). When women demon- strate physical strength, they are labeled unfeminine:

It's threatening to one's takeability, one's rapeability, one's femininity, to be strong and physically self-possessed. To be able to resist rape, not to commu- nicate rapeability with one's body, to hold one's body for uses and meanings other than that can transform what being a woman means. (MacKinnon 1987, 122, emphasis in original)

Resistance to that transformation, ironically, was evident in the policies of American women physical education professionals throughout most of the twentieth century. They minimized exertion, maximized a feminine appear- ance and manner, and left organized sports competition to men (Birrell 1988, 461-62; Mangan and Park 1987).

DIRTY LITTLE SECRETS

As sports construct gendered bodies, technology constructs gendered skills. Meta-analysis of studies of gender differences in spatial and mathe- matical ability have found that men have a large advantage in ability to mentally rotate an image, a moderate advantage in a visual perception of horizontality and verticality and in mathematical performance, and a small advantage in ability to pick a figure out of a field (Hyde 1990). It could be argued that these advantages explain why, within the short space of time that computers have become ubiquitous in offices, schools, and homes, work on them and with them has become gendered: Men create, program, and market computers, make war and produce science and art with them; women microwire them in computer factories and enter data in computerized offices;

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17

2Sex and Gender Beyond the Binaries

Joy L. Johnson

Robin Repta

Research variables—“sex” polarized as “females” and “males,” “sexu- ality” polarized as “homosexuals” and “heterosexuals,” and “gender” polarized as “women” and “men”—reflect unnuanced series that conventionalize bodies, sexuality, and social location. Such research designs cannot include the experiences of hermaphrodites, pseudo- hermaphrodites, transsexuals, transvestites, bisexuals, third genders, and gender rebels as lovers, friends, parents, workers, and sports participants. Even if the research sample is restricted to putative “normals,” the use of unexamined categories of sex, sexuality, and gender will miss complex combinations of status and identity, as well as differently gendered sexual continuities and discontinuities. (Lorber, 1996, p. 144)

For more than a decade researchers such as Lorber (1996, 2005) have challenged us to carefully reconsider the ways that we use the terms gender and sex in research. Despite these challenges, health researchers, on those occasions when they have considered sex and gender in their research, have tended to rely on conceptually stagnant notions of gender and sex that contrast masculine males with feminine females. “Moving beyond the binary” involves two important elements: first, reconsidering how we have conceptualized distinctions between masculine/feminine and male/female, and second, rethinking conceptualizations of gender as strictly social and of sex as strictly biological. A serious problem faced by

18 PART II DESIGN

researchers is that our methods have not kept pace with our theoretical work in the area of sex and gender. A research design provides a blueprint for a research project. The way sex and gender are conceptualized has implications for all aspects of the design including the methodological approach, the data collection procedures, and analytic techniques. Incorporating gender and sex into a research design therefore requires consideration of all these elements. For example, while gender is typically theorized as a multidimensional, context-specific factor that changes according to time and place, it is routinely assumed to be a homogeneous category in research, measured by a single check box (Knaak, 2004). Furthermore, even in social science research where theories of gender originated, dangerous and static associations between women and femi- ninity and men and masculinity are often assumed, eroding much of the diversity that exists within and among these categories (Dworkin, 2005). If the science of gender and health research is to advance, we must also con- sider ways not only to continually refine our base concepts, but also to promote interplay and praxis between theory and method.

With respect to sex, in health research, when it is conceptualized as a binary biological category (male and female), studies are often designed to compare two groups on particular parameters. While this approach is appropriate in some studies, it obfuscates the variation that occurs within and across sex with respect to genetics, anatomy, and physiology and also detracts from the fluid continuum of sex-related characteristics (Johnson, Greaves, & Repta, 2007). The same holds true for gender: If a study is guided by a conceptualization of gender that focuses on the roles that women and men hold in society, this will have implications for the research design. As Addis and Cohane (2005) attest, “Understanding the social context of masculinity (and gender more broadly) is similar to understanding the social context of race and ethnicity. Approaching important questions from only one perspective of difference is a bit like assuming we can only understand one racial, cultural, or ethnic group by comparing it with another. . . . Gender is about much more than sex dif- ferences between men and women on interesting dependent variables” (p. 635). To date, in health research there has been a lack of precision related to conceptual definitions of sex and gender and subsequent design. Researchers have tended to indicate that they are using a gender analysis or focusing on sex differences without appropriately delineating which aspects of gender or sex are of interest. Researchers need to move toward increased conceptual clarity and methodological precision. In this chapter we discuss various ways that sex and gender can be conceptualized and the implications of these conceptualizations for research design.

Before proceeding, it is important to reflect on research as a gendered practice. Science is a social enterprise, not created in a vacuum but influ- enced by societal opinions and politics. Scholars have investigated the ways that science has changed over the years, drawing attention to women’s involvement in the scientific enterprise and detailing how societal shifts in

Chapter 2 Sex and Gender 19

gender roles have contributed to different research foci, methods, and epistemologies (Schiebinger, 1999). The fact that these changes have occurred emphasizes the socially constructed nature of research. Research design is similarly gendered as the questions we ask and the methodologies and methods we use are influenced by our gender as researchers and by gendered ideas about “hard” and “soft” research approaches. These types of distinctions underlie power dynamics in science, claims about the legitimacy of various scientific approaches, and distinctions made between biomedical/clinical research and social science research. For example, while clinical trials are now the universally accepted standard for clinical and health policy and practice, this is only one “way” of knowing, which has been shown to serve the financial interests of the physicians and research institutions that conduct this type of research (Mykhalovskiy & Weir, 2004). In light of the gendered nature of the scientific process, it behooves us to consider not only the ways that conceptualizations of gen- der influence design but also the ways that our research processes and research institutions are imbued with gender bias.

Sex

Sex is a biological construct that encapsulates the anatomical, physiologi- cal, genetic, and hormonal variation that exists in species. Our knowledge and understanding of sex has changed as we have come to appreciate the great diversity that exists within populations. For example, previous con- ceptions of sex assumed chromosomal arrangements XX and XY as the typical makeup for women and men, respectively, while we now under- stand that chromosomal configurations XXX, XXY, XYY, and XO exist, as well as XX males and XY females (de la Chapelle, 1981; McPhaul, 2002). The existence of these chromosomal arrangements has led to greater understanding of the genetic contributions of X and Y chromosomes to human phenotypic development and health (de la Chapelle, 1981) and indicates the need for research to expand narrow conceptualizations of sex to include this type of diversity. Within and across sex categories, variation also exists with respect to metabolic rate, bone size, brain function, stress response, and lung capacity. This variation cannot be captured by simple “male” and “female” designations, which is why it is important to think about sex in more than binary terms.

Conceptualizing sex accurately is important because of the great influ- ence it has on health. There are many sex differences in the development of diseases such as coronary heart disease, Alzheimer’s disease, and lung cancer, but the causal mechanisms that account for these differences are not always clear. To begin to identify these mechanisms we must concep- tualize sex more precisely. Sex affects health, beginning with the different chromosomal compositions assigned to the sexes, which leads to variation