Many of us probably get our core gender identities as much from our biological origins as we do from our gender educations.

I keep running into smart people who seem to think I believe that sex “isn’t real” because it is all “socially constructed.” Allow me to correct this erroneous social construction of me by summarizing here what I think about sex and gender. I’m tempted to say “what I know about sex and gender” because there are few things I feel as sure about as this.

Testes are real. Ovaries are equally real. They sometimes make real gametes. (I don’t mean to imply they sometimes make fantasy gametes—just that they sometimes don’t make gametes.) Chromosomes and genes are also real. As anyone who’s every forgotten to wear a pad on the right day knows, menstrual blood is real. To the delight of this straight woman, penile erections are real. So are clitoral erections. I’m equally delighted about those. When I say these are “real,” what I mean is that these things have a material existence independent of our ability as humans to notice, study, deny, politicize, or categorize them. I can’t believe I even have to assert this claim, but some academics have gone over the deep end and disagree. (I don’t hang out with such people unless there I have some form of pain killer at the ready.)

So why would I write a book with the phrase medical invention of sex in the title?

Because the way we choose to categorize and delineate males and females (and others) is basically a social decision ... a decision some would call a social construction. I might even call it that, if it didn’t lead people to believe I am looped. (That’s why I used “invention” in the book’s title and not “construction,” but I guess the subtlety didn’t work.)

Yes, most men have recognizable penises, scrotums, testes, etc. Most women have recognizable clitorises, labia, vaginas, etc. But some people are born with versions of these organs that are in-between. Most people have either XX or XY chromosomes, though (because of genetic variations) some people have the opposite of what you’d guess from the way their bodies look and/or function, and some people have combinations like XXY or XO or XX/XY. Nature doesn’t care that we humans tend to like discrete categories. The real world is messy. To quote a guy who knew a lot about the fictions of sex, “There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.”

For any given child, we can’t predict with certainty what gender identity or sexual orientation she or he will grow up to have, even if the child is raised in a very sex-role-strict culture.

Can you decide what ultimately makes someone male, female, or other? Practically speaking, sure. That is to say, you can go ahead and make a decision. You won’t be the first. Over time, various scientists, doctors, midwives, grandmothers, judges, etc. have in practice decided who will count as male, female, or other. They’ve decided things like how small a penis has to be before the person attached to it counts as “other” (what we might call intersex). Some Texas judges have decided which chromosome (Y) you have to have to count as male and have to lack to count as female.

But such decisions are based on social need. They lack scientific and intellectual vigor—there are always reasonable objections and exceptions to each attempt. In fact, these decisions keep getting revised, over and over and over again, and I suspect they always will. People want their anatomical categories neat, but nature is (in this metaphor) a slob. We’re an odd couple that way.

In short, while lots of aspects of what we call “sex” are real—so real we can truly say they have been discovered and not constructed—the borders human draw on sex categories are ... invented. They are invented like other tools, to do a special job. Sometimes that job is to assign a sex to a kid, sometimes that job is to try to prohibit “same-sex” marriage, sometimes that job is to try to keep Japan’s emperor from becoming an empress.

What, then, about gender?

And what is gender? For those of you who haven’t had Sex/Gender-101, “sex” is a term usually used to talk about biological aspects of males and females, and social scientists sensibly break down “gender” into two basic ideas, “gender roles” and “gender identities.”

“Gender roles” are the parts males and females are expected to play in social settings. Are these “socially constructed”? Sure. The expectation that women will perform more housework and childcare and be paid less at work than men is a social construction in the sense that we find constant social reiterations of these gender-based expectations. The expectation that men will be strong, insensitive, and hornier than women could also be described as a social construction.

But—and here’s a big but—social gender roles may very well be fuzzy manifestations of our ontogeny (individual development, from conception onward) and phylogeny (the evolution of our species). In other words, the plasticized gender role expectations we find in the toy aisles of Target may be like the end of a telephone game where the start is our evolutionary history and our genes.

I think there’s good reason to think this is the case. First off, there’s some pretty good evidence that across almost every (if not every) culture, there is some consistency in gender role expectations. Boys across cultures are expected to—and do—play with toys meant to represent weapons. Girls across cultures are expected to—and do—play with toys that represent cooking and parenting. This doesn’t mean all children meet these expectations (we know they don’t), it just means all cultures seem to share some basic gender expectations.

OK, so maybe we could say “weapon” toys are also toys that represent a form of cooking and parenting—after all, weapons can be used to hunt for food and protect the young—but here we’re getting into the reality versus representation problem. And I think the reality is that there are some consistent patterns in male and female behaviors across cultures. Any feminist mother who has ever seen her carefully-raised three-year-old son pick up a stick and pretend to shoot or sword-play with it, or her carefully-raised three-year-old daughter go into full princess mode, will tell you this. Is it possible these kids learned these things from their culture? Sure, but it’s tough not to notice the persistence of the gender/behavior correlations anecdotally and in good studies.

Let me be clear: I’m not advocating we give up on trying to end oppressive gender norms. Just because something may be natural doesn’t mean we shouldn’t try to figure out what might be better.

This, then, brings us to the issue of gender identity. Gender identity can be described as the internal feeling of being a boy, girl, man, woman, or something else. Is gender identity socially constructed—that is, are people taught to feel like one or the other?

When I started doing intersex work, I thought so. I thought we were taught to feel, act, and behave like girls and boys. But I don’t think that anymore. That is to say, sure we’re taught these things, but many of us probably get our core gender identities as much from our biological origins as we do from our gender educations. I’ve met too many people who, in spite of careful gender educations—sometimes even intensive gender educations—just clearly felt the gender assigned to them was the wrong one. I’ve also seen a lot of evidence from intersex that prenatal hormone levels correlate with gender-type behaviors, gender identities, and even sexual orientation. (Correlate, not cause! But correlations can be useful clues to causal factors.) I am not one of the people that flips out when the scientist Mike Bailey points out that, statistically speaking, gay men enter feminine-identified professions more than straight men, any more than I flip out when the scientist Bruce Bagemihl points out the tremendous sexual (and gender!) diversity found in the natural world. I’m fascinated, not infuriated, that the scientist Marc Breedlove has found some evidence that prenatal androgen levels seem to correlate with sexual orientation. Species show patterns in sex and gender diversity; we humans are no different.

It makes me crazy that some of my feminist friends try so hard to stop their kids from being gender-typical. I have one such friend who has a fairy-princess daughter, and my friend keeps trying to keep her daughter butch, as if she owes this to Susan B. Anthony. I asked my friend, “If your son wanted to wear a pretty pink dress, would you let him?” She turned red and said, “Yes.” I answered, “Then why isn’t it gender-based oppression to deny your daughter a pretty pink dress?”

Oy! Is this what we’ve come to?

While on the road a few years back, I met a stridently-feminist soon-to-be mom who pulled me aside to worry aloud about how she was going to raise her child. How was she going to keep this child free from gender expectations? Here’s what I told her: Gender isn’t just about oppression. It’s also about pleasure. We get pleasure from our genders. You will get pleasure from your child’s gender, and will sometimes delight in it the same way you will delight in your child growing and learning how to count. Your child will get pleasure from his or her gender. When we have sex, it is often in gendered ways—we enjoy sex as a woman with a man, or as a woman with a woman. How much more evidence do you need that gender can be joyfully delicious? Why oppress yourself and your child with your expectation that gender is always about oppression?

On this note, let me just say this: People who think gender identities, gender roles, and sexual orientations are all socially constructed are the most naive biological determinists I’ve ever seen. They think all human brains are completely without structure when it comes to these things; we all have empty slates in our skulls at birth. No, we don’t! Really!

In fact, I think we can’t know that much about any individual person’s biology without a huge amount of study on that person—and even then, it’s hard to know much. (I think the same is true about an individual person’s social history.) In this sense, I’m much less of a strict biological determinist than the social constructivists people incorrectly lump me with. I happen to think that, for any given child, we can’t predict with certainty what gender identity or sexual orientation she or he will grow up to have, even if the child is raised in a very sex-role-strict culture. Some will go against our best guesses and educational attempts—we know that again from cross-cultural studies, where transgender, lesbian, bi, and gay children and adults show up again and again.

Should we work to end economic and resource disparities between men and women? Absolutely. Should we press for LBGT rights? I got a big ol’ rainbow flag waving outside my house. But as we do all that good political work, I don’t think we should deny the findings of science. And I also don’t think we should deny pretty pink dresses and dolls to the significant numbers of little girls who want them just because some people wrongly think it profoundly unnatural that a few little boys want pretty pink dresses and dolls, too.

So, please, please don’t say Alice Dreger thinks sex is socially constructed (if what you mean by that is that gonads, gametes, and genes aren’t real) and please don’t say that Alice Dreger thinks we should get rid of gender. That’s not the real me.

This post originally appeared on the author's personal site.