Human sex chromosomes

(L) Female sex chromosome (R) Male sex chromsome
In November of 2018, I noted that, in an announcement, the Society for the Study of Evolution (SSE) maintained that not only gender, but biological sex should be "more accurately viewed as a continuum." That came as a shock to someone (me) who had spent his life sorting fruit flies into piles of males and females. (Once a year or so I'd find a "gynandromorph", an individual having bits from both sexes, but that is not in itself a sex — and they're extraordinarily rare.)

Here's the SSE's original announcement (my emphasis)
Variation in biological sex and in gendered expression has been well documented in many species, including humans, through hundreds of scientific articles. Such variation is observed at both the genetic level and at the individual level (including hormone levels, secondary sexual characteristics, as well as genital morphology). Moreover, models predict that variation should exist within the categories that HHS proposes as "male" and "female", indicating that sex should be more accurately viewed as a continuum.
Re the part in bold: which models?, and no.

Later on, probably in response to people like me who objected, the SSE added an asterisk at the end of the paragraph and appended this note:
*Here we are speaking of the multi-dimensional aspects that underlie male-ness and female-ness, including hormones, physiology, morphology, development, and genetic aspects. We acknowledge that many of these aspects are bimodal. Furthermore, some of these aspects are discrete categories (e.g., XX/XY, SRY presence/absence, gamete size, sperm production vs egg production, presence/absence of certain genitalia), but these categories don't always align within individuals, are not always binary, and should be irrelevant to the determination of a person's legal rights and freedoms.
Since the biological definition of sex is whether gamete size is large (female) or small (male), and that trait is bimodal and discrete, the SSE might as well have said that sex should not be viewed as a continuum. But of course the SSE is subject to the Zeitgeist, which, as the new article by Katie Herzog on Bari Weiss's site notes, is definitely against recognizing two discrete biological sexes in humans. This denial of reality has serious medical implications, but read the piece to see them.
headline med schools deny biological sex
© Katy Herzog/Twitter
This is part 2 of Herzog's series on the wokeification of med schools; part 1, about the silencing of people out of fear, is here.

Herzog begins with an example of an obese transgender man who died because he went to the hospital, did not know he was pregnant (and there was nothing about his natal sex in his records), and the fetus died because the staff took a while to recognize the pregnancy. But most of the article is about the pressure applied to professors in medical school to conform to prevailing terminology and opinion, and how that is inimical to the practice of good medicine. I'll give a few quotes from a few areas. Quotes from Herzog's article are indented:

Censoring of language
The denial of sex doesn't help anyone, perhaps least of all transgender patients who require special treatment. But, Lauren says, instructors who discuss sex risk complaints from their students — which is why, she thinks, many don't. "I think there's a small percentage of instructors who are true believers. But most of them are probably just scared of their students," she says.

And for good reason. Her medical school hosts an online forum in which students correct their instructors for using terms like "male" and "female" or "breastfeed" instead of "chestfeed." Students can lodge their complaints in real time during lectures. After one class, Lauren says, she heard that a professor was so upset by students calling her out for using "male" and "female" that she started crying.

Then there are the petitions. At the beginning of the year, students circulated a number of petitions designed to, as Lauren puts it, "name and shame" instructors for "wrongspeak."

One was delivered after a lecture on chromosomal disorders in which the professor used the pronouns "she" and "her" as well as the terms "father" and "son," all of which, according to the students, are "cisnormative." After the petition was delivered, the instructor emailed the class, noting that while she had consulted with a member of the school's LGBTQ Committee prior to the lecture, she was sorry for using such "binary" language. Another petition was delivered after an instructor referred to "a man changing into a woman," which, according to the students, incorrectly assumed that the trans woman wasn't always a woman. But, as Lauren points out, "if trans women were born women, why would they need to transition?"
Herzog recounts the downfall of Lisa Littman, who documented the rapid increase of female adolescents wanting to transition over the last decade (1000% in the US, 4000% in the UK), suggesting that this "rapid onset gender dyphoria" may have partly due to social contagion (approbation online as well as families and doctors too willing to affirm dysphoria and approve of transition without proper procedures. I've already discussed that.

Puberty blockers

We are universally assured that these drugs are both safe and reversible. They are used to put potentially transsexual pre-puberty individuals "on hold" while they consider their options. Herzog questions the safety and reversibility.
[Pediatrician Julia] Mason generally avoids prescribing puberty blockers, which inhibit the development of secondary sex characteristics like breasts or facial hair. The reason, she says, is that because there have been no controlled studies on the use of puberty blockers for gender dysphoric youth, the long term effects are still unknown. (In the U.K., a recent review of existing studies found that the quality of the evidence that puberty blockers are effective in relieving gender dysphoria and improving mental health is "very low.")

In girls, Mason says, blockers inhibit breast development, but "you end up shorter, and the last thing a female who wants to look male needs is to be shorter." Other side effects may include a loss of bone density, headache, fatigue, joint pain, hot flashes, mood swings and something called "brain fog." In boys, blockers inhibit penis growth, which can make it harder for them to achieve orgasm and for surgeons to later construct those penises into "neo-vaginas," a procedure known as vaginoplasty.

Trans activists often claim the effects of puberty blockers are fully reversible, but this remains unproven, and studies show that the overwhelming majority of teens who start on puberty blockers later take cross-sex hormones (testosterone for females and estrogen for males) to complete their transition. The combination of puberty blockers followed by hormones can cause sterility and other health problems, including sexual dysfunction, and the hormones must be taken for life — or until detransition. Little is known about their long-term effects. While the line that blockers are "fully reversible" is oft-repeated by activists and the media, last year, England's National Health Service back-tracked this unsubstantiated claim on its website.

Desistance is the reversal of either identification as a transsexual or of the medical transition itself. To even bring the topic up is taboo in the transsexual activist community. But look at the statistics and then judge whether doctors and parents should be so quick to affirm transsexuality and then begin risky medical procedures (my emphasis):
In 2018, the American Academy of Pediatrics recommended that pediatricians "affirm" their patients' chosen gender without taking into account mental health, family history, trauma, or fears of puberty. The AAP recommendations say nothing about the many consequences, physical and psychological, of transitioning. So perhaps it is not surprising that surgeons are performing double mastectomies, or "top surgery," on patients as young as 13.

One leading clinician, Diane Ehrensaft, has said that children as young as three have the cognitive ability to come out as transgender. And the University of California San Francisco Child and Adolescent Gender Center Clinic, where Ehrensaft is the mental health director, has helped kids of that age transition socially.

But not all clinicians have cheered these developments. In a paper responding to the AAP guidelines, James Cantor, a clinical psychologist in Toronto, noted that "every follow-up study of [gender dysphoric] children, without exception, found the same thing: By puberty, the majority of GD children ceased to want to transition." Other studies of gender-clinic patients, stretching back to the 1970s, have found that 60 to 90 percent of patients eventually grow out of their gender dysphoria; most come out as gay or lesbian.

In an email to me, Cantor said: "The deafening silence from AAP when asked about the evidence allegedly supporting their trans policy is hard to interpret as anything other than their 'pleading the 5th,' as you in the U.S. put it."
Knowing the bits in bold, shouldn't we be a bit more cautious about rah-rah affirmation followed by puberty blockers — themselves almost inevitably followed by hormone treatment and/or surgery that leads to irreversible changes in physical characteristics, and often to sterility?