COGS 1st International Meeting (2020): Talks

Keynote: 2020 Vision for Sex and Gender Science

Cara Tannenbaum (Institute of Gender and Health)
January 8, 2020

This is just a historical moment in time, it really is, and there are so many things that I love about today. Jill, I love that you held the meeting in the first week of a new decade. I love that you are bringing everyone together to start a new era, I love the complexity of what we’re doing!

I think back, you know I get interviewed a lot for CBC and other sorts of things, and they always ask questions and “why didn’t they look at sex and gender before” and I always like to say that the 20th century was really a paradigm of reductionist science. It was a time where we looked at variables in isolation, where we tried to get rid of all the noise, where we tried to remove all the complexity, so that we could boil things down to single, tiny, microscopic particles. But the 21st century is one where I’m proud to say, again there’s a paradigm shift where we’ve realized that human beings are not reductionist, that science is not reductionist. That if we don’t start embracing complexity, if we don’t start bring together the biological and the social, then we will not be able to make those leaps in knowledge that we need to answer some of the most pressing questions of our time, both scientifically, research wise, and quite frankly, societal wise.

And so, I’m thrilled today to be a part of the launch of the Canadian Organization for Gender and sex and I feel that in your hands, there’s really power to shape the future. Called it COGS, and I also love the COGS! I love that you’re positioning this organization at a time where we have these- the first four COGS, these first four pillars of research and science, that quite frankly are arbitrary, as basic science, should it really not be included in clinical research? And yet, we’re trying to stand the breadth of these four pillars as we forward with what we’re thinking about.

Sex and gender and engineering, I love! The word health, and you know maybe I shouldn’t be saying this because of a conflict of interest, but the word health is not in cogs! It’s actually about sex and gender science that maybe applies to engineering! Maybe should be applied to environmental science. Definitely applies to artificial intelligence when we talk about gender bias and the training data that goes into it.

And so, this power that we have to shape the future by embracing the complexity is something that I think really will distinguish this organization and position it as a world-front leader. But of course, with great power comes great responsibility. And I honestly don’t know if it was Spider-Man or Voltaire who said it first, but there’s a responsibility to get it right. And so, it’s vision 2020, the year 2020, but also 2020-vision, in terms of making sure that we do the right thing.

And so, what I wanna do in the next 25 minutes with you, is to really invite you to reflect with me on the history of sex and gender, some intended good things, but also unintended consequences that have occurred, where the field of sex and gender science should go, and what actions we need to take to get us there. Does that sound okay to you? Let’s go.

So, sex and gender historical journey. So, I could’ve started at any moment in time and constructed a beautiful story narrative about where we’ve been in history with respect to sex and gender. But we decided to start with Darwin. And we decided to start with Darwin because of his view of biological, either essentialism or determinism, or however you want to regard it, and really it’s one of the first historical mentions of sex, in relation to males and females having different characters as a function of their different genetic makeup. And so here genes are determining the successful procreative or survival strategies or behaviors that occur throughout the species.

Now, that may seem out of date now, but that was actually quite groundbreaking at the time. And yet, it foreshadows the problems. Number 1, is it really just genes that determine what’s male and female? Are all behaviors genetically determined, or are there some environmental and other social effects on how sex plays out in the real world? And I’ll fast forward here because everyone’s talking about climate change, so I’ll just throw it in, but the effect of the environment on sex, and what would Darwin say today if he knew, and maybe he did know, but that sex determination in many species is actually temperature dependent, it’s not genetically determined, and here the poor sea turtles in Australia, we know that they’re having serious population distribution shifts, because when the temperature is colder it biases more towards male sex determination, and when it’s warmer, and things heat up, it biases more towards female sex determination. And so right now in Australia, there are 4.6 male sea turtles for every female sea turtle, and so right now they are at risk of extinction.

And so, even this concept of sex that Darwin had a long time ago is evolved in really mind-blowing ways. And if you follow Darwin and you look at all of the different amazing thinkers that led us up to the 20th century, I could read all these quotes, but you know if started out as the male organizations as one, and the female organizations as another. But then by 1906, there are men,women and women,men with mixed mental characteristics quite independent of complete sexual separateness.

And so, over a century ago, I think we were getting some concept of gender. And you can continue reading through the history of sex and gender in every normal-and I’ll use the word normal but that’s something we’ll talk about-male or female individual traces are found in the apparatus of the opposite sex, and I’ll let you just take a minute to read the other quotes, because I know when you read in the audience you can read a lot quicker than a speaker who’s reading it off the slide.

So, there has been an evolution, and yet still prior to 1949, science and philosophy both assume that sex equals gender, and I think it was Simone de Beauvoir, maybe she wasn’t the first but definitely one we refer to, who said “one is not born, but rather becomes a woman”, suggesting that societal influences play a major role in determining gender. And it was John Money in 1965, who first determined the biological distinctions between biological sex and gender as playing a role in psychology and talking for the first time about gender identity. And yet, it still took 15 years before this idea, this distinction between biological sex and the concept of gender, occurred.

Now we’re getting into the 21st century, and the institute of gender defines sex and gender, as sex being the classification of living things, generally is male and female according to their reproductive organs and functions assigned by chromosomal compliments, so still talking about genes. But also defining gender as a person’s self-representation as male or female, or how that person is responded to by social institutions, based on the individuals stance or presentation, and even here they say gender is rooted in biology, and shaped by environment and experience.

Around the same time, Health Canada-the government of Canada-was coming up with a policy was coming up with a policy about sex and gender at the same time that the institute of medicine was coming up with their definitions, and Canada had a gender based analysis vision even back in the year 2000. And so, sex and gender based analysis is something that is uniquely Canadian, and something that I’m gonna talk a little more about, and this is from a policy perspective, this is about how do we take knowledge and evidence and apply it to improve society and peoples’ lives today.

And then of course there’s the institute of gender and health. And I’d be remised to not acknowledge the work that’s been done before I stand before you today, both by Miriam Stewart and Joy Johnson, and I don’t know if anyone heard but there was an announcement today that Joy Johnson has been announced the next president and Vice Chancellor of Simon Fraser University at UBC, which is why she’s not able to be here. And Xena, you certainly worked with Joy as assistant director of the institute of gender and health for all the years that we raised awareness and laid a foundation for the great work that’s being done today.

And Jill you mentioned that Canada does have a unique position, and I think we do. We have classic definitions of sex and gender that we’ve had for quite a whole now. And to be honest, being here today makes me wonder if it’s time to update those definitions, and if the Canadian Organization of Gender and Sex should be helping us do that as we go forward. And this of course is at the great infographic, and it’s very similar to the Institute of Medicine definition.

Where we get stuck though, is yes sex is biology and gender may be psychosocial, but where I’m getting stuck in supporting researchers across all disciplines to consider these components, is that gender is multi-component, and when people say “how do I account for gender” I say “well which component of gender do you want to account for? In your research is it important to be looking at gender identity? Or are you talking to me about gender roles, or environmental expectations or societal expectations? In your research are you more concerned with gender relations and the interactions between people, or are we looking at gender from a societal and institutional perspective?

And I would say one piece of advice that I would give is, let’s please try and be specific about which aspect of gender we’re looking at so that we can educate others that it’s not just gender that we need to consider because both the methods, the interpretations, and the applications of gender related research findings are going to be very different depending on which aspect of gender that we’re looking at.

So, this is how we got here and I like to add a lot and I could’ve talked, and maybe other people talk about other things, and great things have happened with this history of sex and gender! Look how far we’ve come. And so, this graph leads us from the Spring of 2011, when that famous sex and gender box for those of you who don’t know, when you apply for funding from CIHR you have to fill in sex accounted for in your research design, methods and analysis, and knowledge dissemination plan, and is gender accounted for and please explain how, and you can look at that green line for sex, the proportion of CIHR applicants on the y-axis, and in the past let’s say 8 years, we went from a little over 20% to almost 80% of researchers saying that they see relevance of sex and they tell us that they will account for it in their research proposal. The gender line is also going up a little bit, but both are going up a little bit there too, and I firmly acknowledge that in most basic science research, gender is probably not appropriate.

And as you can see in basic science, when we ask what proportion of you research, and as you can see here I have broken it down by pillars, which is very artificial and I’m not sure if this is how we should be doing it anymore. You can see the tremendous increases in the amount of researchers who are accounting for sex, and I don’t think they’re doing it just because there’s a box, but I think they’re doing it because they think it’s important. And what I was telling you, is that in basic science, I’m not sure if it’s a win or not, that now 12% of researchers in basic science are saying that gender is important, I kind of wonder if they’re confusing the terms, but if they are I would love to speak to those researchers because I think this would be really exciting to have them here at the next annual meeting to know how they’re accounting for gender in their basic science research.

Other Canadian funders, many of whom we have here, have started implementing sex and gender requirements, and this is becoming a cultural impact on the research being done in Canada. Because everywhere you go, it’s not just a strategic initiative by the institute of gender and health, but everywhere you go people are talking about this. At scientific meetings around the globe, people are standing up, in non sex and gender related conferences saying “sorry, did you include females?” or “did you disaggregate the data” and “how are you accounting for gender”. And even in the 5 years that I’ve held this position, I see a ripple effect and the conversations truly are changing. And this is what we want to happen.

I like to say that I’ve done some consulting for the European commission on their gender dimension program, and they still only use the word gender I have to tell you. And in the states if we’re lucky, they use the word sex, as a biological variable, although kudos to them, and Jenine Klinton will tell you that being inspired by Canada, the NIH has launched their first funding opportunity on the interaction between sex and gender. So, the effects that we’re having here are truly rippling across the globe. And I would agree with you Jill that we’re positioning Canada as a leader in sex and gender science. And we’re gonna hear about the huge scientific breakthroughs, I am going to argue that the most impressive scientific breakthroughs that have occurred, have occurred by a lot of the speakers who we’re going to hear from today. And there’s a lot more so I’m not going to take away your thunder so I won’t tell you about them, although it takes me great pleasure to go all over the world to talk about the great work that Canadian researchers are doing in this field.

But I’d be remised at the start of a sea change, to not try to learn some lessons about unintended consequences that have occurred in the field of sex and gender science to date. To learn from them, and to avoid them going forward.

And so, I got all excited and told you that now people know that sex is distinct from gender, and that they’re being treated as dichotomous variables, sex male, female, and maybe gender “do I self-identify as a man or a woman”, but I would argue that maybe this isn’t always a good thing, because maybe sex isn’t always binary. It can come many different shapes and sizes, and this is a slide that Stacey Ritz shared with me, if you look at sex related variables, this could be height, this could be sex hormones, this could be so many different, even genetic composition if you will. So treating sex as “am I including males and females, am I disaggregating by sex”, is a great first step and of course it’s going to depend on the readiness of the research community, but we would be doing a disservice if we think that at one point, some people would say, “every cell has a sex”, well does it? It has its chromosomal compliment and has its hormonal milieu in which it lives, and the body which may or may not be receiving exogenous hormones, so does every cell truly have a sex, or does it exist along a spectrum? And the same for humans. And estrogen is not a female hormone, and testosterone is not a male hormone. Here you can see from the maximum levels of testosterone and estradiol across the life-span, and while there are certainly points where the hormones are higher in one sex than another, at every given moment in time, both males and females have estrogens and testosterones in their body. So should we even be calling these sex hormones? Or ovarian hormones? Or gonadal hormones? We’re even thinking they should just be called steroid hormones, and refer to them as estrogen and testosterone, and consider that the distribution is not necessarily dichotomous or needs to be disaggregated.

And this leads to real-life confusion. These are scientific conundrums in a way, that have implications on the world and individual people. And for those of you who don’t recognize them, these are two Olympic athletes, who were born as long as they remember as girls and women and competed in the female categorization of the Olympics, very talented individuals, who at one point had blood tests that showed their testosterone levels were higher than normal, that women should have. It’s almost been about 6 or 7 years now where there’s been debates about what constitutes a female, and who should be allowed to run in the women’s sports category. And so, for those of you following this adventure, you could see that, while we could sit here and have healthy scientific debate about what constitutes sex and gender, these conversations are reverberating around the world, and are even in the area of sports, and the decision of sports, and what kind of consequences is this having when we consider sex and gender as binary normal or not normal.

And so, you could argue that, “yay there’s a difference between sex and gender!” but we also limit out knowledge in practices, by artificially separating the two. And it’s been proposed that the term sex/ gender should be used in many circumstances. And again, pros and cons here, but perhaps that will take us to the new level of knowledge generation because when we continue separating sex and gender, we also get into stereotypes. So gender stereotypes, where women have to be like this, and I don’t know if you’re familiar with the World Health Organization Gender responsive intervention scale, which says that a lot of the programs that we’re putting in place, not only in developing countries, but truly everywhere, have gender bias or reinforce gender inequities that we’re seeing in society. And this meeting isn’t about gender equity I would say, I think that we’re really trying to focus on sex and gender in the context of science, but the point is that when it comes to interventions and people, we don’t want to be having interventions that are gender unequal, which is defined as an intervention that perpetuates gender inequalities, and exploits it, gender blind interventions claims to be fair by treating everyone equally, gender sensitive considers and acknowledges gender issues, gender specific interventions, intentionally targets some benefits to specific groups, and what we’re aiming for is gender transformative, which really means that we’re looking at people as people and not as a function of discrimination because of gender stereotypes that are attributed to them.

And so, the social implications of what’s coming out of sex and gender science and how the world and the global literacy around sex and gender is influencing outcomes, health and wellness is something that truly needs to be considered. And I know Nancy Pole and Loraine’s not able to be here, but this is a fascinating topic, and I mention it because I think maybe it falls within the sphere of sex and gender science.

And now, Canada urges sex and gender-based analysis. Here’s another term! So far I’ve talked to you about sex, I’ve talked to you about gender, I’ve talked to you about sex/gender, and now I’m going to talk to you about what we called SGBA, which is sex and gender based analysis. All these terms, do they mean the same thing? Are they understood the same way? Like I said, I think it’s wonderful that Canada wants us to do sex and gender-based analysis. And the reason I think it’s wonderful because I think it’s meant to answer the “why we see problems and how we can solve them”. Is the term being used correctly, and is the analysis part being done in the way we envision it should be done? And I say 101, sex and gender-based analysis, start off by asking in the population data, are there sex differences? And if there are, please don’t stop there and say “yay! I found a sex difference!”. In fact, many people think we shouldn’t be promoting sex difference research at all, because people think it ends if you find a difference. And so if you find a difference that’s good! That’s the first step of another 6 steps.

And so, WHY is there a sex difference? This is the interesting part. This is where we’re going to get into mechanisms. This is where we’re going to try to understand if gender plays a role in explaining that sex difference. Is this the way most people approach a sex and gender-based analysis? In my experience, probably not. They say “are there sex differences? No, end of story”. But if you’re really doing a sex and gender-based analysis, you’d ask, “is the pathway to that same outcome the same for both sexes?” Because if we want to improve an outcome, then we need to know what’s leading individuals to that outcome, and sometimes the pathway is not the same. And as a very simple example, Jeff I know you’re going to talk about experiences in pain, both men and women experience or males and females experience pain, but certainly the pathway to get there is not the same. And so, that’s really critical and if pathways not the same, does gender play a role. And then make an action plan to improve health outcomes that take into consideration sex and gender.

So, for those of you here from the population in public health disciplines, you’re going to have to consider am I going to go with sex and gender? Am I going to try and breakdown the gender component? Am I going to approach this as a SGBA analysis and I haven’t even defined which components of gender might play a role here. So, lots of work needs to be done!

And then of course we have our data claims here, who say “oh well my data set here only has a sex variable”, and then of course “how can I explain a sex difference by a gender variable if I don’t have a gender variable”. And here there’s a whole other field of study, “well is there a gender related variable? Are there proxy’s for gender? Should we be constructing gender scales?”. But most importantly, who cares? Why are you asking this question? What I’m starting to see is people just feel like they need to construct a gender variable and I say “well what’s your research question? What are you actually trying to answer? What are you trying to impact?” so again, which component of gender, and what are you going to do with that information?

And so, thinking about this not only in knowledge generation, but also in the application of the knowledge that we’re generating is I think going to be critical to the success of sex and gender science for it to be seen outside of science as truly making a difference in its societal impact.

And so, I’ll wrap it up by saying, and challenging you with, how do we wanna shape the future? And so with great power comes great responsibility. I think we wanna be promoting the messages such as sex exists on a spectrum, just like gender, that there’s different components of gender, and that we need to embrace the complexity of both sex and gender, and I think this is one of the main messages that is truly coming out. Sex and gender are intimately intertwined, and so should our definitions reflect that? Or is there still value in the 101, people don’t even know the difference between what we mean to say by sex and gender, before we can tell them that it is intimately intertwined. And so, again, course levels 101-401 sex and gender science and COGS is probably on 401, but if you want to bring people into the fold, then I think we need to be aware of the different levels of science, same as you maybe have neuroendocrinology 101 and 401. Is this a discipline? And should it be taught at universities at this level and like this?

The question “is it sex or gender” should I think change to “is it sex, gender or both”. You know I say “microbiome, what do you think of?” and everyone says “sex!” because it’s one of the different bacteria that live in your gut, clearly that is a sex related factor. But what environmental exposures lead to those bacteria being in your gut, and was gender at play? Was it exposure to different environmental influences that lead to different microbiota inhabiting your body? And what about epigenetic programming? Is that more of a gender component. And so, when you think microbiome, don’t just think sex. And then you think human robot interactions, got that one, it’s definitely a gender relation type thing! But what about the voice, is the voice a sex characteristic? Is the color that we choose, I mean robot and machine learning, everything that’s coming up, chat boxes, siri, alexa, is that sex or is that gender?

And so, I challenge people to reflect on the many instances in which sex and gender already interact and which we’re trying very hard to artificially separate whether it’s sex or gender. And of course, we have to mention that it’s more than sex and gender, and how is intersectionality going to come into this.

Thank you Harlen for your introduction and for teaching me that two spirit, and I think you’re going to teach the 7 different spirits that exist, talk about embracing complexity, acknowledging feminist theory around race and power imbalance, and in human research at least, how are we going to be considering aspects of intersectionality, age, race, geographic location, indigenous status, in the work we do here with the Canadian organization for gender and sex. And of course, some people think we should get rid of the term sex and gender, and just call it intersectionality. And a lot of the intersectionality proponents think we’re doing a disservice to intersectionality, by putting sex and gender in the middle of it. And so, again, challenges that I think you need to reflect on as we move on.

And so, my call to challenge to you over the next few days, is to thoughtfully embrace and address these challenges moving forward. I think we need to build on where we are today, in order to get to where we wanna be tomorrow. And so, challenge number 1, how are we going to address the diverse needs of the entire research community? I’ve taken some quotes from some of the discussions we’ve had with researchers at CIHR, “why are the gender of my mice important?” and I’ll acknowledge Chris who’s sitting at the back who has started saying at all of her talks “everybody raise your right hand, and repeat after me, I solemnly swear on the scientific method that I will never again refer to the gender differences in the mice again, until they can talk and tell me their preferred pronoun”. But you know people are still conflating these terms, and even if they’re using these terms correctly, maybe they’re failing to perform appropriate analyses, you know “I included male and female animals, get off my back!” Well what do we do, and how do we address that statistically, and what kind of experimental design can we use, like a factorial design maybe where we could save sample size, and what about those sample size questions? These are all questions that people have, and to move forward with the science without answering these questions maybe would be a barrier.

Integration of sex or gender, appropriate integration of sex, gender and other intersecting variables. How do I combine, in a methodological fashion, both the biological and social? Okay! You’re convinced me that they interact, but what’s the method that I need to use? How many basic scientists are using the four-chord genotype method? How many non-basic scientists have both biological and social psychological variables that they’re collecting, and how are they actually analyzing it? Is it with mixed methods? Are there new methods that we should be coming up with?

So, on the one hand we want to enforce best practices, but on the other hand, we wanna grow the science. Maybe COGS will decide that they just wanna grow the science, or maybe there’s a role for COGS in promoting best practices. Should we be providing guidance on measuring gender? There are two sides of the coin, right? On the one hand, we need to have common language, or an indicator, that all researchers can relate to and compare findings, I mean science is about reproducibility, right? But on the other hand, not all studies probably need a measure, it doesn’t all have to be quantitative and reproducible? Like with qualitative frameworks. And of course, if gender changes as a function of context, time and setting, then how could we possibly develop a stagnant measuring tool?

On our website and our training modules, we have lots of examples of gender measures, and yet, there’s criticism of some of those measures because maybe they were constructed in a time when gender was understood differently, in a social and historical context. And so, I think Louise is going to talk to us a little bit about some of the amazing findings that she found using the BEM sex-role inventory that some people think is outdated, and in the end, it’s still contributing to our knowledge. So how are we going to address that? And standard practices change quickly, statistics Canada is now informed by Greta Bawerswerk and others, and we’ve started to see this two-step question: what was your sex assigned at birth? And how do you currently self-identify? And that’s fabulous! But then how do you do a longitudinal analysis where five years ago, we were only asking if you were male or female? And what does that mean now?

How to ensure that the new findings are applied to evidence-based decision making? I am sure we are going to come up with great new knowledge. Let’s make sure that we have a process in place to make sure that that knowledge informs practice, policy and programs.

So, there’s great promise for gender and sex research. And I am so excited today to be here, to be a part of this historic moment, launching COGS. And for the next gen of sex and gender scientists, for all of you trainees who came out to this conference this morning, who are forming the ideation training network, you are the next generation of sex and gender scientists. And based on our discussions this morning, we had a pre workshop type workshop thing, WOW! I know that we are in good hands. And so, I invite you, to be bold and push boundaries. You’ve already done that Jill, by bringing us all together and establishing COGS. I invite you not only to be a leader, but to be a successful leader. And a successful leader is when other people follow. So, I invite you to be a leader that other people will follow into this domain. Once we thought the world was flat, now we know the world is round. These kinds of paradigm leaps and changes can happen, and one day, the world will thank you.

And with that, I thank all of you today for coming out to this historic moment. Thank you Jill, thank you on behalf of CIHR and Canada, for really being a leader, that I’m confident our world will follow.

Supporting Organizations

Women's Brain Health Initiative logo and website link Women's Health Research Cluster logo and website link Ontario Brain Institute logo and website link Women's Health Research Institute at BC Women's logo and website link Libin Cardiovascular Institute of Alberta logo and website link Canadian Institutes of Health Research logo and website link Women and Children's Health Research Institute logo and website link Elsevier logo and website link Centre for Gender and Sexual Health Equity logo and website Linköping University logo and website link Heart Stroke logo and website link centreDeRecherche logo and website link UMontreal logo and website link Einstein lab logo and website link