Binary Sex Research Articles

Mental health assessment of transgender youth - Should standardised psychological measures be scored by norms of birth-registered sex?

Standardised psychometric measures are used in mental health care and research settings to identify risk, assist diagnosis, and assess symptom severity. Standardised scoring of these measures involves transforming respondents' raw scores using binary sex norms. However, scoring manuals offer no guidance as to appropriate scoring methods for trans and non-binary respondents. The Child and Adolescent Health Service - Gender Diversity Service (GDS) implemented a practice to score psychometric measures twice, according to both birth-registered sex (BRS) and the other sex (OS) norms (i.e., "double-scoring"). As it was unclear which choice of norm was the most clinically useful for the identification of risk, this study investigated whether there was any clinically meaningful difference in levels of psychopathology when scoring measures by OS versus BRS norms. We analysed clinical-range classification of scores (clinically significant versus sub-clinical) on four sex-normed psychometric assessment measures (Child Behavior Check List, Youth Self Report, Social Responsiveness Scale 2, and Beck Youth Inventory) completed by GENder identiTy Longitudinal Experience (GENTLE) participants, as part of standard initial assessment at the GDS (N=233). Sub-domains within all four measures resulted in inconsistent classifications of between 0 and 15% of participants into clinical versus sub-clinical ranges when scored using OS versus BRS norm. Scoring sex-normed standardised psychometric measures by BRS or OS results in different scores, in varying domains, and not in a uniform way. For clinical use, we suggest it is preferable to err on the side of sensitivity. For research purposes, we recommend standardised use of birth-registered sex norms for current measures. We suggest developing universal non-gendered psychometric measures which rate psychological symptoms according to distress and functional impairment, resulting in a more inclusive, equitable framework for evaluating mental health in gender diverse populations.

P-897. Inconsistent Participant Demographic Reporting in Published Antibiotic Clinical Trials Targeting Multidrug-Resistant Gram-Negative Organisms

Abstract Background NIH policies and reporting requirements relating to the inclusion of women and minoritized individuals in clinical trials have evolved since 2000. Over time, prioritization of gender equity in participant recruiting has been successful. However, many studies have demonstrated underrepresentation of participants from minoritized populations. With growing evidence of racialized disparities in antimicrobial resistance and prescribing, clinical trials for new antimicrobials should prioritize equitable participation. We aimed to assess participant demographic reporting in published clinical trials targeting multi-drug resistant gram-negative organisms (MDRGNOs). Record identification, screening, and inclusion Flow chart for record identification and review leading to the 38 included studies. Methods Four databases were searched to identify randomized controlled clinical trials of antibiotic regimens used to treat infections with MDRGNOs published 2010-2023 (Fig1). Participant demographics were extracted from eligible studies and data summarized with descriptive statistics. Fisher’s exact test evaluated associations between variables and Cochran-Armitage tested for trends. P< 0.05 was considered statistically significant. Study Characteristics Table showing the characteristics of information reporting across the 38 included studies. Results 38 full-text articles were included. All studies reported age and binary sex. 31/38 reported race or ethnicity; all 31 reported White race and 10/31 only reported White or Other race (Table). Adverse events, mortality, and efficacy were stratified by demographics 6 times in 5 unique articles. There was no significant pattern in reporting race or ethnicity in published trials for antibiotics targeting MDRGNOs between 2010 and 2023 (Fig2). Among federally funded studies 50% (3/6) reported race or ethnicity compared to 87% (28/32) of industry funded studies, which was marginally significant (p=0.063, Fig3). Figure 2 shows the number of published studies reporting race or ethnicity per year (gray line) compared with the number of included studies by year (black bar). Conclusion Sex and age reporting occurred across all published clinical trials reviewed focused on treating MDRGNOs. Major study outcomes were rarely stratified by participant demographics. We identified inconsistent reporting of race, ethnicity, and other demographic data. Attribution of demographic data is unstandardized and often not identified. Inconsistent and incomplete reporting limits the ability to accurately study participant demographic representation over time and across studies. Figure 3 shows the comparison of reported funding source (black bar) with studies reporting race or ethnicity (gray bar). 50% of federally funded studies reported race or ethnicity and 87% of industry funded studies included race or ethnicity. Disclosures Jacinda C. Abdul-Mutakabbir, PharmD, MPH, CSL Sequiris: Advisor/Consultant|CSL Sequiris: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria

Integrating Gender Identity and Sexual Orientation in Population-Based Administrative Data

Information regarding biological sex is collected for administrative and clinical purposes, and often is conflated with gender in clinical encounters as well as in population-based data studies. Sex is collected as either ‘male’ or ‘female’, adhering to the colonial notion of binary sex and gender identities. Meaningful information on sexual/romantic orientation is also absent from these datasets. Sex, gender, and sexual/romantic (SR) orientation are key aspects informing how people experience the world and how we interpret administrative data. SOGI-HE (Sexual Orientation and Gender Identity – Health Equity) will be the first 2SLGBTQIA+ dataset at the Manitoba Centre for Health Policy by using a novel survey tool to collect information on gender identity, and SR orientation. The data from this survey will be linked into the Population Health Data Repository housed at the Manitoba Centre for Health Policy, enabling analyses that incorporate constructs of sex, gender, and SR orientation. These data will make visible the experiences of the 2SLGBTQIA+ community that have been historically absent from population-based data studies. Data equity and 2SLGBTQIA+ visibility within data play an important role in advancing the field and lays the groundwork for future data linkage projects. In this presentation we will discuss the development of SOGI-HE through community-based research principles and the implications it has on future 2SLGBTQIA+ research conducted in the province of Manitoba (Canada). Further, we will discuss the ethical implications associated with queer data sovereignty in a precarious political climate for 2SLGBTQIA+ people and their rights.

(Not So) Lost in Translation: Considering the GA4GH Diversity in Datasets Policy in the Japanese Context

The genomics community has long acknowledged the lack of diversity in datasets used for research, prompting various stakeholders to confront this issue. In response, the Global Alliance for Genomics and Health (GA4GH) formulated a policy framework that recognizes the multiplicity of perspectives on diversity and proposed a systemic approach for more optimal data diversity. Given the importance of the research context, assessing this policy’s applicability within countries where diversity is less discussed is important. This study investigated the feasibility of implementing the GA4GH policy in Japan, a nation with a smaller genetic diversity than many Western countries. As the proportion of East Asian genomic research is limited internationally, focusing on the Japanese genome contributes to enhancing diversity. Meanwhile, labelling findings as “Japanese” can inadvertently reinforce perceptions of homogeneity and overlook ethnic minorities. Regions and socioeconomic status are also recognized as substantial factors of diversity within academia, yet concerns persist among the public regarding the heritability of stigmatized conditions. Social inclusion of sexual minorities has begun in Japan, but research surveys generally still use binary sex and gender categories, which underscores the need for additional variables. This study found that both academia and the public need to confront the overemphasis on homogeneity within Japanese society and hesitancy in addressing genetic factors. By doing so, more inclusive and diverse datasets can advance the field both ethically and scientifically. Perhaps the most important impact of the GA4GH policy will be to draw greater attention to the complex diversity challenges ahead in Japan.

Equality DanceSport doing transgender inclusivity in the United Kingdom: Cultural cisgenderism and transgender experiences

In this article, cultural cisgenderism is adopted to investigate Equality DanceSport, a sporting context emerging out of an LGBT+ community. 1 The study questions the extent to which Equality DanceSport enforces regulations and practices which promote trans-inclusivity. Drawing on a constructivist grounded theory approach, I conducted autoethnography and 35 semi-structured interviews with LGBT+ dancers representing diverse genders and sexualities. I examined the discourses shaping the recent revision of Equality DanceSport competition rules in the United Kingdom and the experiences of transgender dancers in the competitive arena. Findings suggest that despite challenging some cis and heteronormative practices in mainstream DanceSport spaces, essentialist notions of sex and gender continue to feed into the shaping of Equality DanceSport's competition rules. These notions are hinged on debates around fairness and inclusivity and inform the constitution of a binary sex category in the competition rules. Transgender dancers face several challenges within the binary sex system, tending to cope through identity compromise. Such a strategy contributes to transgender erasure and invisibility. Overall, this paper provides a critical understanding of trans-inclusivity in an LGBT+ sporting space in the United Kingdom. It highlights the complexity of achieving inclusivity and calls for a critical interrogation which does not conflate LGB with the T when investigating the inclusivity of LGBT+ sporting contexts. The paper concludes with a proposal for radical regulatory and policy changes that question the epistemological understandings of sex and gender and celebrate other values in competitive sports which de-emphasise the focus on winning.

(Re)conceptualizing Sex and Gender in Physical Education Through Social Role Theory

ABSTRACT The line between gender and sex has become increasingly muddled in literature. Tensions surrounding this topic are ever-increasing and definitions of the two are rarely consistent. For improving conceptual clarity, we adopted the Social Role Theory to explore how these two terms differ and relate by laying out a cyclical framework of biological, sociological, and psychological components. Herein, we discuss the origins of the binary sex construct, anatomical brain/cognition differences, and sex/gender role implications for education and physical education. We confront the topic in a content area that continues to be masculine-oriented with the purpose to conceptualize sex/gender in physical education research through clarifying the evolutionary biosocial spectrum. Offering a reconceptualization of gender as a multidimensional construct could inspire further curricular reform for the content to be more inclusive of all participants, learnable by all students regardless of sex and gender, and beneficial both mentally and physically to all learners.

Profiles of executive functions in middle childhood and prediction of later self-regulation.

Most research on the development of executive functions (EF) has applied variable-oriented approaches, neglecting the potential inter- and intraindividual interplay of these capacities. In a person-oriented approach, the present study identified varying profiles of performance for three cool EF facets: inhibition, working-memory updating, and cognitive flexibility, as well as two hot EF facets: affective decision-making and delay of gratification, in a community sample of 1,657 children (T1; age: 6-11 years, M = 8.36 years, 52.1% female) via latent profile analysis. The best-fitting model allowed for partial dependence across the three cool EF and included four profiles: all-average (69.4% of the children), low-delay (19.0%), regulated-decision-making (7.0%), and low-inhibition (4.6%). Age, binary sex, socio-economic status, multilingualism, and processing speed were identified as significant characteristics of EF profile membership. Longitudinally, a higher probability of belonging to the low-inhibition profile predicted lower rates of the self-regulatory outcome of inhibitory control 1 year later, while belonging to the regulated-decision-making profile predicted lower rates of the ability to plan and organize 3 years later. These results not only demonstrate the existence of subgroups with different concurrent within-person expressions of EF performance, but also identify related characteristics and longitudinal outcomes of subgroup membership. In turn, these conclusions stress the importance of person-oriented research to inform on differing weaknesses or strengths in EF performance for varying individuals, thereby providing valuable insight for educational and clinical research into the design of effective personalized support or interventions during middle childhood.

Secondary analyses of sex differences in attention improvements across three clinical trials of a digital therapeutic in children, adolescents, and adults with ADHD

BackgroundAttention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often persist into adulthood. AKL-T01 is a regulated digital therapeutic targeting inattention. We examined potential sex differences in the efficacy of AKL-T01 in three separate trials for 1) children, 2) adolescents, and 3) adults.MethodsWe conducted secondary analyses of clinical outcomes by sex in three AKL-T01 randomized clinical trials in ADHD (n1 = 180 children 30.6% female, M(SD) age = 9.71 (1.32); n2 = 146 adolescents; 41.1% female, M(SD) age = 14.34 (1.26); n3 = 153 adults; 69.9% female, M(SD) age = 39.86 (12.84)). Active treatment participants used AKL-T01 for 25 min/day over 4–6 weeks. Primary outcomes included change in attention on the Test of Variables of Attention (TOVA) and symptom change on the clinician-rated ADHD Rating Scale (ADHD-RS). To evaluate study hypotheses, we conducted a series of robust linear regressions of TOVA and ADHD-RS change scores by sex, adjusting for baseline scores.ResultsIn children, girls demonstrated greater improvement in objective attention relative to boys following AKL-T01 (TOVA Attentional Composite Score; Cohen’s d = .36 and Reaction Time Mean Half; Cohen’s d = .54), but no significant sex differences in ADHD rating scale change. We did not observe significant sex differences in outcomes in the adolescent or adult trials. Limitations include binary sex categorization and slight study design variation across the three samples.ConclusionAKL-T01 might notably improve attentional functioning in girls with ADHD relative to boys. Objective attention measures may be particularly important in the assessment of attentional improvement in childhood, given known gender biases in ADHD symptom reporting. We emphasize the importance of considering sex and gender-specific factors in ADHD treatment evaluation.Trial registrationsSTARS ADHD CHILD: ClinicalTrials.gov ID NCT03649074;STARS ADHD ADOLESCENT: ClinicalTrials.gov ID NCT04897074;STARS ADHD ADULT: ClinicalTrials.gov ID NCT05183919.

Transgender and gender diverse curriculum in medical imaging programs: a case study

BackgroundTransgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum.MethodsA case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data.ResultsThe study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports.ConclusionsUnderstanding educators’ perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.

The effect of time normalization and biomechanical signal processing techniques of ground reaction force curves on deep-learning model performance

Time-series data are common in biomechanical studies. These data often undergo pre-processing steps such as time normalization or filtering prior to use in further analyses, including deep-learning classification. In this context, it remains unclear how these preprocessing steps affect deep-learning model performance. Thus, the aim of this study is to assess the effect of time-normalization and filtering on the performance of deep-learning classification models. We also investigated the effect of amplitude scaling. Using a public dataset (Gutenburg Gait Database, a ground reaction force database of level overground walking at self-selected walking speed involving 350 healthy individuals), we trained convolutional neural network (CNN) and long short-term memory (LSTM) models to predict binary sex (male, female) using three-dimensional ground-reaction forces to which we applied different processing approaches: zero padding, interpolation to 100% of signal, filtering, and scaling (min–max, body mass). The results show that transformations resulted in differences in model performances. Highest performance was obtained using unfiltered data, zero-padding, and min–max amplitude scaling (F1-score of 91 and 87% for CNN and LSTM, respectively). Not filtering data and using min–max scaling generally improve performance for both model architectures. For interpolation, results are not consistent across model architectures. This study suggests that processing steps must be considered in applications where deep-learning classification performance is relevant.

Intersectional inequities and longitudinal prevalence estimates of opioid use disorder in Massachusetts 2014–2020: a multi-sample capture-recapture analysis

As overdoses continue to increase worldwide, accurate estimates are needed to understand the size of the population at risk and address health disparities. Capture-recapture methods may be used in place of direct estimation at nearly any geographic level (e.g., city, state, country) to estimate the size of the population with opioid use disorder (OUD). We performed a multi-sample capture-recapture analysis with persons aged 18-64 years to estimate the prevalence of OUD in Massachusetts from 2014 to 2020, stratified by sex and race/ethnicity. We used seven statewide administrative data sources linked at the individual level. We developed log-linear models to estimate the unknown OUD-affected population. Uncertainty was characterized using 95% confidence intervals (95% CI) on the total counts and prevalence estimates. The estimated OUD prevalence increased from 5.47% (95% CI=4.89%, 5.98%) in 2014 to 5.79% (95% CI=5.34%, 6.19%) in 2020. Prevalence among Hispanic females doubled (2.46% in 2014 to 4.23% in 2020) and prevalence rose to nearly 10% among Black non-Hispanic males and Hispanic males from 2014 through 2019. Estimates for Black non-Hispanic females more than doubled from 2014 through 2019 (3.39% to 7.09%), and then decreased to 5.69% in2020. This study is the first to provide OUD prevalence trend estimates by binary sex and race/ethnicity at a state level using capture-recapture methods. Using these methods as the international overdose crisis worsens can allow jurisdictions to appropriately allocate resources and targeted interventions to marginalised populations. NIDA.

Separate But Equal: Is Segregated Schooling (Still) Good for Girls?

AbstractThe UK’s Equality legislation prohibits formal segregation with limited exemptions. Single-sex schools are one such exemption. No rationale for this was provided at the time of the legislation, and it was not until 2017 in the case of Al Hijrah that the question arose of whether and when sex-segregation in schools is lawful. We take up this question, reviewing the equality costs and benefits of sex-segregated schools conceptually and empirically. We highlight the incoherence of equality law regarding schools, and the limited evidence of their benefits. Drawing on feminist theory, we recommend improvements that may be useful in future cases where sex-segregation is contested in the context of faith-based schools. Lastly, we note that these legal questions may one day be challenged by a deeper source of instability if there is a breakdown in the binary sex categories on which sex-segregation in schools currently depends.

Moral inferences from androgynous faces are beyond categorical uncertainty: Evidence of a positive bias towards androgynous targets

AbstractPostulating a negative bias towards social ambiguity, we conducted cross‐cultural online research to assess whether categorical discrepancies in the perception of androgynous faces were associated with the uncanny feeling and inferences of different morality. Across four studies, we found that androgynous faces were harder to classify into a binary sex category than sex‐typical faces, but this difficulty did not influence social judgements of androgynous targets in a negative fashion. In Study 1 (Spanish‐speaking sample,N = 76), we found that androgynous faces were rated as more trustworthy, less creepy, and less morally different than sex‐typical faces. Study 2 replicated most of the findings from Study 1 in an Italian sample (N = 45). Positive bias towards androgyny was not replicated with a different set of stimuli featuring faces of diverse ethnic backgrounds (Study 3, Spanish‐speaking sample,N = 140). However, results revealed a main effect of ethnicity in participants’ responses. When controlling for the effect of morphing procedures in stimuli selection, an overall positive bias towards androgynous targets arose, especially when compared to masculine targets (Study 4, Spanish‐speaking sample,N = 85). These findings suggest that, at least in certain conditions, a positive social bias towards androgynous faces may emerge that does not depend on categorical uncertainty and facial attractiveness.

A sociodemographic index identifies sex-related effects on insomnia in the Hispanic Community Health Study/Study of Latinos.

Sex differences are related to both biological factors and the gendered environment. We constructed measures to model sex-related differences beyond binary sex. Data came from the baseline visit of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We applied the least absolute shrinkage and selection operator penalized logistic regression of male versus female sex over sociodemographic, acculturation, and psychological factors jointly. Two "gendered indices," the gendered index of sociodemographic environment (GISE) and gendered index of psychological and sociodemographic environment, summarizing the sociodemographic environment (GISE) and psychosocial and sociodemographic environment (GIPSE) associated with sex, were calculated by summing these variables, weighted by their regression coefficients. We examined the association of these indices with insomnia, a phenotype with strong sex differences, in sex-adjusted and sex-stratified analyses. The distribution of GISE and GIPSE differed by sex with higher values in male individuals. In an association model with insomnia, male sex was associated with a lower likelihood of insomnia (odds ratio [OR] = 0.60, 95% CI [0.53, 0.67]). Including GISE in the model, the association was slightly weaker (OR = 0.63, 95% CI [0.56, 0.70]), and weaker when including instead GIPSE in the association model (OR = 0.78, 95% CI [0.69, 0.88]). Higher values of GISE and of GIPSE, more common in the male sex, were associated with a lower likelihood of insomnia, in analyses adjusted for sex (per 1 standard deviation of the index, GISE OR = 0.92, 95% CI [0.87, 0.99], GIPSE OR = 0.65, 95% CI [0.61, 0.70]). New measures such as GISE and GIPSE capture sex-related differences beyond binary sex and have the potential to better model and inform research studies of sleep health.

Mortuary Patterns at Turkey Creek Pueblo

Osteological and mortuary data are used to explore how sex, age, life history, and social prestige, as bioarchaeologically visible axes of gender identity, informed mortuary treatment at Turkey Creek Pueblo, Arizona (n=323), the earliest aggregated pueblo in the Point of Pines area of the Mogollon region (AD 1225–1286). The mortuary program at Turkey Creek Pueblo is suggestive of a homogenous community where burial treatment is not strictly conditional on the osteological sex of the individual, but is informed by age and life history, social roles, and social prestige. Through comparative analyses and ethnohistoric sources, we show that differences in mortuary arrangements in both typical and atypical burials at Turkey Creek Pueblo are reflective of social and ideological factors beyond age and osteological sex that are specific to the individual and their complex social positions within the community. This research illustrates how gender roles in the past were complex and not rigidly defined by sex, and these findings clarify how social power/prestige were not expressly divided along binary sex dimensions. At Turkey Creek, osteological sex is not the most significant axis of identity structuring social difference.

Speaking of Sex: Critical Reflections for Forensic Anthropologists

Forensic anthropologists have a responsibility to appropriately relay information about a decedent in medicolegal reports and when communicating with the public. The terms ‘sex’ and ‘sex estimation’ have been applied with numerous, inconsistent definitions under the guise that sex—a broad, complex concept—can be reduced to a female/male binary. This binary does not reflect biocultural realities and harms those whose bodies do not meet social expectations of maleness or femaleness. The University of Nevada, Las Vegas’ Forensic Anthropology and Bioarchaeology Laboratory (UNLV FAB Lab) advocates for the use of the term ‘assigned sex at birth’ (ASAB) to highlight that binary sex is not biologically inherent to the body, but rather, assigned by society. Additionally, we call for the use of disclaimers in case reports to denote the limitations of ASAB estimation methods, the differentiation between those with mixed trait expression (i.e., indeterminate) and those on whom an ASAB analysis cannot be performed (i.e., unknown), and the included consideration of gender in forensic anthropology research and case reports. Such applications challenge biological normalcy, allowing forensic anthropologists to actively advocate for those whose bodies do not meet biocultural expectations.

Sex, Science, and Society: Reckonings and Responsibilities for Biologists

Synopsis Individuals who may not fit European colonial ideas of dichotomous male or female bodies—those who are intersex—have been known across cultures and throughout human history. Unfortunately, acknowledgement of and engagement with this aspect of human biological diversity and the ongoing impact of binary misunderstandings of sex have been largely contained within the humanities and social sciences, while sex diversity beyond an assumed male/female binary has been either ignored or pathologized in the medical and biological sciences. The perceived social threat of intersex variation to the sex and gender binary has led to institutional and medical regulation of intersex people’s bodies, which has been the subject of increasing spotlight recently. Given the historical and ongoing role of the biological sciences in the pathologization of human sex variation and the deployment of medical technologies attempting to suppress this variation, we must actively acknowledge that our work does not exist and is not produced in a vacuum. Biological data demonstrate that sex is diverse and variable in animals, plants, and fungi. Despite this, the paradigm of binary sex has labeled diverse and variable sex as anomalous, especially in human populations. It is far past time to address this paradigm by actively examining the ways that our research, teaching, and communication engage with, articulate, and make legible particular narratives of sex diversity and variation.

A roadmap for sex- and gender-disaggregated health research

Sex and gender are fundamental aspects of health and wellbeing. Yet many research studies fail to consider sex or gender differences, and even when they do this is often limited to merely cataloguing such differences in the makeup of study populations. The evidence on sex and gender differences is thus incomplete in most areas of medicine. This article presents a roadmap for the systematic conduct of sex- and gender-disaggregated health research. We distinguish three phases: the exploration of sex and gender differences in disease risk, presentation, diagnosis, treatment, and outcomes; explaining any found differences by revealing the underlying mechanisms; and translation of the implications of such differences to policy and practice. For each phase, we provide critical methodological considerations and practical examples are provided, taken primarily from the field of cardiovascular disease. We also discuss key overarching themes and terminology that are at the essence of any study evaluating the relevance of sex and gender in health. Here, we limit ourselves to binary sex and gender in order to produce a coherent, succinct narrative. Further disaggregation by sex and gender separately and which recognises intersex, non-binary, and gender-diverse identities, as well as other aspects of intersectionality, can build on this basic minimum level of disaggregation. We envision that uptake of this roadmap, together with wider policy and educational activities, will aid researchers to systematically explore and explain relevant sex and gender differences in health and will aid educators, clinicians, and policymakers to translate the outcomes of research in the most effective and meaningful way, for the benefit of all.

Beyond the binary: Sex and gender diversity in population projections

For many people, their gender is the same as their sex recorded at birth. For some, gender and sex recorded at birth may not align, or they may not fall exclusively into the binary categories of male or female. There is growing recognition of the need to have quality estimates and projections of the population in a context beyond binary sex and gender. However, there is currently little demographic literature on this topic and production of such data is limited. In this paper, we use the demographic equation as a framework to describe the implications of considering sex and gender diversity in the production of population projections. In doing so, we consider implications for base population estimates, births, deaths and migration. We also consider implications of acknowledging gender as a concept that can change over time. We outline existing Australian and international approaches to data collection and address implications for the formation of projection assumptions. We conclude by outlining possible future directions for forming population projections that consider sex and gender beyond the binary.

Trans* inclusion and gender equality in sport and exercise – an (im)possible equation?

Heteronormativity and the idea of binary sex constrain sport and exercise as well as many gender equality measures that are implemented in sport and exercise contexts. This strongly affects trans people’s opportunities to participate. The purpose of the paper is to explore trans performativity in relation to gender equality efforts in sport and exercise. Through interviews with ten trans individuals, we untangle how trans is, in the words of Karen Barad, produced in and through agential intra-actions of multiple apparatuses of bodily production. Our diffractive analysis shows how meaning comes to matter in sport and exercise regarding what trans ‘is,’ who and how one can identify as ‘trans,’ and in what ways trans individuals experience inclusion and exclusion. The study demonstrates challenges with reconciling gender equality and trans inclusion in sport and exercise contexts given current conceptualizations of sport and exercise, gender equality, and trans.