Britta N. Torgrimson and Christopher T.

Minson
J Appl Physiol 99:785-787, 2005. doi:10.1152/japplphysiol.00376.2005

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J Appl Physiol 99: 785–787, 2005;
doi:10.1152/japplphysiol.00376.2005.
Sex and gender: what is the difference?
IT IS CLEAR THAT SEX IS A key biological variable that should be
considered in all basic physiological and biological research.
However, despite a long history of interest in sex-based inves-
tigations, this topic has historically not been well studied. The
current importance of sex research is obvious by the recent rise
in articles reporting on sex-based biology across scientific
journals, including the Journal of Applied Physiology. There
are two terms being used in this contemporary dialogue to
describe the sex-based research: “sex” and “gender.” The term
gender is becoming more common in scientific publications to
describe biological variation traditionally assigned to sex, and
this nonspecific language merits a standardized approach. In-
creasingly, researchers are becoming aware of the appropriate
use of the terms sex vs. gender. Still, some scientists are
vaguely aware that a distinction exists between these terms or
that this difference is an important one. The purpose of this
article is to publicize the necessity for implementing a stan-
dardized use of the terms sex and gender in physiology. Thus
this article will present a general history examining the tran-
sition in the frequency of use of the term gender instead of sex
in physiology, present standard definitions by promoting the
recommendation from the Institute of Medicine (IOM), and
provide examples of appropriate use of these terms in reference
to specific contexts.
Coming to a consensus in the use of terminology is a
worthwhile endeavor for disciplines such as physiology that
rely heavily on specific language to explain phenomena. Other
disciplines, including psychology and anthropology, have put
into practice distinguishing between the terms sex and gender
in their discourse (4, 11, 12). As physiologists, we will likely
find that adopting this distinction can only improve communi-
cation within as well as outside our discipline.
Physiologists are at the forefront of the nationally and
internationally recognized work on sex-based research and
women’s health. Although certainly sex-based research is
growing in all areas of science, it is critical to understand the
history. Physiologists are aware of and socially sensitive to a
history of science where the long-standing norm was a 70-kg
man. The prominence of research investigations using the
established “norm” of a 70-kg man shaped an understanding of
human biology that lacked information in regard to female-
specific biology, anatomy, pathology, and treatments for dis-
ease. In 1985, the US Public Health Task Force on Women’s
Health declared that “the historical lack of research focus on
women’s health concerns has compromised the quality of
health information available to women as well as the health
care they receive” (7). This report prompted federal legal
action and started a momentum of sex-based research that has
led to fundamental changes in science. By the mid-1990s, the
National Institutes of Health, the Food and Drug Administra-
tion, the Government Accounting Office, the Congressional
Caucus on Women’s Issues, and most prominently the Society
for Women’s Health Research had collectively established the
Women’s Health Equity Act, and new National Institutes of
Address for reprint requests and other correspondence: C. T. Minson, Dept.
of Human Physiology, 1240 Univ. of Oregon, Eugene, OR 97403 (e-mail:
minson@uoregon.edu).
http://www. jap.org 8750-7587/05 $8.00 Copyright © 2005 the American Physiological Society
Editorial
Health policies demanding the inclusion of women in federally
funded clinical trials and ensuring that women and minorities
are included in all human subjects research (7).
The American Physiological Society (APS) has been a
leader in integrating sex-based research into its journals and
has devoted issues of the Journal of Applied Physiology to
sex-based differences, including the Highlighted Topics series
on “Genome and Hormones: Gender Differences in Physiol-
ogy.” In the series editorial by Dr. Gary Sieck, physiologists
are recognized for their ever-growing efforts in sex-based
physiology research and interdisciplinary approaches to these
investigations (9). Importantly, the editorial highlights the
confusion within APS over the use of these terms. In this
editorial, sometimes “gender,” sometimes “sex,” and some-
times “gender/sex” is used to describe the recent advances that
physiologists are making in recognizing the important impli-
cations of sex difference on all physiological systems. The
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growing interest in sex-based research and growing publica-
tions related to this work have led to the increased use of the
term gender instead of the term sex.
Before the 2001 Journal of Applied Physiology Highlighted
Topic series, from July 1948 through December 2000 there
were 59 Journal article titles that contained the words sex
and/or gender. From January 2001 through December 2004
there have been 60 titles containing the terms sex and/or
gender. Notably, in the last 5 years the Journal has included
more sex-based research articles in the journal than in the last
50⫹ years. However, this increase in sex-based research is
connected to the appropriation of the term gender as a synonym
for sex and has led to misuse of that term in physiology. The
increase in frequency of the use of the term gender in the
American Physiological Society journals is highlighted in
Table 1. In the journals of the American Physiological Society,
gender was first introduced into a title in 1982, whereas sex had
been used since the early 1920s. It was not until the mid-1990s
that use of the term gender began to exceed use of the term sex
in APS titles, and today gender more the doubles that of sex
(Table 1). The term gender appears to have undergone appro-
priation by some scientists as a politically correct way to talk
about sex. This may be because some scientists are sensitive to
the verity that discussing sex often means discussing difference
and gender may be construed as a less loaded term.
Accordingly, it is imperative that scientists and editors come
to a consensus on these terms to alleviate any confusion in their
usage. These words have specifically different etymologies and
meanings. In the most basic sense, sex is biologically deter-
mined and gender is culturally determined. The noun sex
includes the structural, functional, and behavioral characteris-
tics of living things determined by sex chromosomes. Sex
(noun) is derived from the Latin word “sexus,” meaning either
of two divisions of organic nature distinguished as male or
female, respectively (8). According to the Oxford English
Dictionary, sex (noun) has a definition as “the sum of those
differences in the structure and function of the reproductive
organs on the ground of which beings are distinguished as male
and female, and of the other physiological differences conse-
quent on these; the class of phenomena with which these
differences are concerned” (8). Gender can be thought of as the
785
Editorial
786
Table 1. Increase in frequency of the use of gender in the journals of the American Physiological Society
and in the Journal of Applied Physiology from 1960 to 2004
1960 –79 1980 – 84 1985– 89 1990 –94 1995–99 2000 – 04

All American Physiological Society journals

Sex keyword search 1,066 1,009 1,605 1,867 1,845 2,246
Gender keyword search 5 30 133 303 840 1728
Ratio of gender to sex 0.005 0.030 0.083 0.162 0.455 0.769
Sex in title search 44 19 20 19 28 48
Gender in title search 0 3 5 12 48 106
Ratio of gender to sex 0.000 0.158 0.250 0.632 1.714 2.208
Journal of Applied Physiology
Sex keyword search 578 310 508 547 342 450
Gender keyword search 1 16 91 153 323 618
Ratio of gender to sex 0.002 0.052 0.179 0.280 0.944 1.373
Sex in title search 9 6 4 5 0 18
Gender in title search 0 2 4 6 14 48
Ratio of gender to sex 0.000 0.333 1.000 1.200 0.000 2.667

behavioral, cultural, or psychological traits typically associated “genetic background and gender on hypertension” are exam-

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with one sex. Gender (noun) is derived from the Latin word ples of publications where specificity and consistency between
“genus” referring to kind or race (8). Gender (noun) is defined using sex and gender are imperative because sex and gender
as “a kind, sort, or class referring to the common sort of can be differentially related to health outcomes in humans.
people” (8). It is through an understanding of these principal Across science, there is growing interest in understanding how
definitions that scientists can apply these terms in a specific levels of stress relate to depression, alcoholism, hypertension,
manner to sex-based research. and cardiovascular risk in individuals whose stress may be
After the late 20th century legislation on sex-based research directly related to particular gender roles and/or socioeconomic
initiatives, the IOM established the Committee on Understand- variables.
ing the Biology of Sex and Gender Difference to outline the There are also an increased number of investigations on how
most important issues and establish future direction for sex- hormones affect human physiology and human behavior. An
based research (1). Included in this essential IOM report was a article by Sheri Berenbaum (2), “Effects of early androgens on
recommendation for using the terms sex and gender in re- sex-typed activities and interests in adolescents with congenital
search. The recommendation identified by the 2001 IOM report adrenal hyperplasia,” succeeds in examining both sex and
calls for researchers to clarify and be specific in their use of the gender in humans. The report examines mechanisms of steroid-
terms sex and gender in publications and, by doing so, create mediated development of the human brain and includes a
consistency across the literature. The Committee provided model that considers behaviors like toy play, playmate prefer-
three guidelines for using sex and gender correctly in human ences, and gender identity in children tracked through child-
and animal research. First, in the study of human subjects, the hood to evaluate the effects of exposure to prenatal androgens
term sex should be used as a classification according to the while considering cultural exposure to gender ideology in the
reproductive organs and functions that derive from the chro- development of behaviors. In another topic related to hor-
mosomal complement. Second, in the study of human subjects, mones, recognition of the sex and gender difference will serve
the term gender should be used to refer to a person’s self-
representation as male or female, or how that person is re-
sponded to by social institutions on the basis of the individual’s
gender presentation. Third, in most studies of nonhuman ani-
mals the term sex should be used. Although clearly any
discipline or author could choose to define sex and gender
according to their intentional meaning, these are a standard set
of definitions for use in sex-based research and this is the
theoretical basis for the use of these terms in other disciplines
(1, 4, 11, 12). For physiologists who have only recently begun
to use the term gender rather than sex in their writing, these
definitions will prove to have utility in a number of circum-
stances.
Using the IOM term specificity as a guide, the vast majority
of articles published in APS journals are reporting on sex in
humans and animals, not gender. Of the article titles examined
by the authors of this article from 1960 to 2004 in the Journal
of Applied Physiology, all titles using gender were sex-based Fig. 1. Number of articles titles from 1960 to 2004 examined by the authors
investigations (Fig. 1). APS article titles that indicate sex-based in which the term gender was used as an equivalent term for sex in sex-based
research was conducted on “age, gender, and ethnicity” or research publications in the Journal of Applied Physiology.

J Appl Physiol • VOL 99 • SEPTEMBER 2005 • www.jap.org


physiologists to better describe the growing data on hormones
and transgender and transsexual individuals. Transgender in-
dividuals have a genetic sex but occupy a gender role other
than that typically assigned to their sex. Some transgender
individuals are using exogenous sex hormones in their day-to-
day life, and these hormones are impacting their physiology.
Alternatively, transsexual individuals are genetically one sex
and have gone through a range of surgical modifications and
hormonal interventions that allow sex reassignment. Progres-
sively there are more interest and more data coming from
research involving trans individuals that are helping to eluci-
date organizational and activational effects of endogenous and
exogenous sex hormones in female-to-male and male-to-fe-
male transitions in areas such as vascular function (10), met-
abolic disorders (3), and breast tumors (5, 6).
Along these lines, physiologists will surely be contributors
in upcoming debates on the biological categorization of trans-
gender and transsexual individuals. For instance, in May 2004
the International Olympic Committee (IOC) announced that
transsexual individuals will now be able to compete in Olym-
pic events in their new sex after a sex-change surgery. This
poses some interesting new physiological questions yet to be
answered, but certainly of great importance in this area. For
instance, how many structural and or hormonally mediated
changes in gene regulation and over what time period are
required for an individual to be physiologically transitioned to
a new sex? The IOC Medical Commission has issued the
recommendation that eligibility can occur 2 yr postgonadec-
tomy and after hormonal therapy has been administered for a
sufficient length of time to minimize differences between
genetic females and males and those with sex reassignment.
The IOC Medical Commission recommendation makes clear
that there is a necessity for sex-based research in exploring
whether there is ever sufficient time to overcome the genetic
influence of the XX or XY chromosome on performance and
whether there are physiological functions that cannot be mod-
ulated by sex steroid hormones if there is the presence of a Y
chromosome. As physiologists, we will certainly engage in this
debate by providing the data necessary, and using the proper
terminology will be of utmost importance in this potentially
confusing topic.
The continuing dedication by physiologists to sex-based and
women’s health research comes from the understanding that
although females and males share many physiological similar-
ities, they are fundamentally different. This is a basic biolog-
ical principle in all species in which sexes exist, and there is an
obvious need to explore the differentiation that the evolution of
sex has afforded humans and their biology, but female and
male sex-based research is not the same as gender-based
research. The point is that avoiding synonymous use of the
terms sex and gender serves to avoid misusing the concepts of
J Appl Physiol • VOL
Editorial
787
sex and gender across disciplines of science. In summary, it is
appropriate to use the term sex when referring to the biology of
human and animal subjects, and the term gender is reserved for
reference to the self-identity and/or social representation of an
individual. Although certainly there will be those who do not
feel that this specificity of terms is necessary in physiology, on
the whole this approach will reduce wordiness in publications
and allow for simpler integration of discussion on human
biology. Outside of physiology, many social scientists draw on
biological and psychological data to better understand the
human condition and explain human behavior in a more com-
prehensive way. Because of this, it seems valid to argue that a
consensus for using sex and gender in a standard context, as
outlined by the IOM, needs to be implemented in physiology to
provide consistency and alleviate confusion within as well as
outside this discipline.
REFERENCES
1. Anonymous. Exploring the biological contributions to human health: does
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35: 102–110, 1999.
3. Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell
JC, and Gooren LJ. Effects of sex steroids on components of the insulin
resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf) 58:
562–571, 2003.
4. Gentile DA. Just what are sex and gender, anyway? A call for a new
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5. Grabellus F, Worm K, Willruth A, Schmitz KJ, Otterbach F, Baba
HA, Kimmig R, and Metz KA. ETV6-NTRK3 gene fusion in a secretory
carcinoma of the breast of a male-to-female transsexual. Breast 14: 71–74,
2005.
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and Garcea R. Breast fibroadenoma in a male-to-female transsexual
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7. Marts SA and Keitt S. Foreword: a historical overview of advocacy for
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8. Oxford English Dictionary. New York: Oxford University Press, 1989.
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Britta N. Torgrimson
Christopher T. Minson
Department of Human Physiology,
University of Oregon, Eugene, Oregon
99 • SEPTEMBER 2005 • www.jap.org