Moving Beyond the Biomedical Binary
Addressing the two-gender bias in biomedical research.
Posted Mar 25, 2020
There comes a point in many scientists’ careers when they stop being receptors for scientific knowledge and start criticizing research. I encountered this notion at the end of my undergraduate career, and it was both terrifying and intoxicating.
Being empowered to question science instilled a desire to push beyond current knowledge to determine, “What questions are being asked?” and “What evidence informs the interpretation?” It wasn’t long before I started wondering “What questions are not being asked?”; ”Who is asking the questions?”; and “Who is interpreting the results?”
I remember learning how the scientists who used rodents to model human medicine historically relied on male mice and rats. They believed, among many unscientific assumptions, that the female estrous cycle would create too many variables to produce valuable data. One unacceptable result was the death of women using medicines tested in males alone . For example, cisapride, a gastrointestinal stimulant, and erythromycin, an antibiotic, have an increased chance of inducing life-threatening cardiac pathologies in women .
Thankfully, NIH policy now reflects a need to include “both” sexes in biomedical research  to prevent such tragedies. It is important to acknowledge that this binary sex model is beneficially utilized by scientists to create meaningful data and simplify procedures and outcomes within biomedical research. However, not all humans fit into the current scientific models for “male” and “female.”
Like cis women, the transgender and non-binary community is underrepresented and faces significant barriers and discrimination in STEM [4, 5]. This is important because the absence or presence of particular groups in the production of scientific research influences the questions asked and methods used. For example, by shifting the line of inquiry and changing/creating new methods and statistical equations, women have altered the scientific landscape and challenged the sexist assumptions that once led to the male-gender bias in medical research. Dr. Rebecca Shansky provides a powerful statement regarding the necessary contributions of women in STEM: “When females are studied through a male lens, the true crux of the research question for females can be missed.” 
This rings true for queer communities as well. Without a significant transgender and non-binary lens, researchers fail to ask questions relevant to trans/non-binary bodies. It is therefore unsurprising that only four studies have utilized rodent models to specifically address the medical and health needs [7-10] of the nearly 1.2 million transgender individuals in the US . This places trans and non-binary folks in a dangerous position. For example, we know gonadal hormones alter the risk of using cisapride and erythromycin  but how hormone replacement therapy may influence this is unknown. Additionally, scientists could easily utilize animal research to decrease the detrimental side-effects of gender-affirming medicine itself.
As a comparison, approximately 1 million individuals in the U.S. have Parkinson’s’ disease  and hundreds of thousands of papers regarding Parkinson’s disease utilize rodent models. Even healthcare providers struggle to obtain information regarding transgender medicine and medical care to educate themselves, describing current medical knowledge as “two-gender medicine” . This can only be considered a failure to address significant health needs within the United States and one cannot help but wonder what scientists should do.
Biological researchers must dismantle cisnormative and transphobic justifications for research. That is, decenter the concerns of cisgender individuals by asking questions that affirm and address the lived experiences of the trans and non-binary community. By “affirm,” I do not mean the researchers make sure to offer emotional support through their research. I mean their questions must tacitly accept transgender and non-binary experiences as irrefutable fact while tackling their unique healthcare needs. By “address their lived experiences,” I do not mean examine transgender biology in various scenarios. I mean making sure the line of inquiry is driven by the needs of transgender and non-binary folks, as expressed by transgender and non-binary folks.
In this lens, studies on the biological basis for transgender and non-binary experiences may only serve to address internalized transphobia for some science-oriented members of the transgender community. I do see value in this, as it took me a long time to address my internalized transphobia and, as a science-minded person, I leaned heavily on biological knowledge. However, the biological information currently collected regarding members of the transgender community may now be used to inform years of biomedical research.
Affirming transgender and non-binary communities does not require scientific evidence; rather, research that implicitly accepts their experiences and addresses their needs can create a more affirming environment.
Having biomedical research designed to model and address the transgender and non-binary community’s unique health needs by improving current gender-affirming therapies and creating new options would help normalize non-cis identities in medicine. By treating these subjects as essential to public health, researchers help to dismantle the structures within science and society that consistently question transgender and non-binary experiences. Rather than continually situating trans and non-binary individuals as subjects of scientific interest, it is time they are positioned as beneficiaries of scientific research.
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