“Real Women”: The Shared Responsibility to Use Gender-affirming Language

Dear Editor: “Transplantation of the uterus in the male rat” by Yang et al1 is promising research with the potential to advance understanding of options to bear children for people assigned male at birth who choose to have children. However, we write to point out that the language is neither gender-affirming nor inclusive for transgender people. Gender (the intrinsic deeply felt experience of being a man, woman, both, or neither) and sexuality (to whom a person is attracted) are confused and conflated.2 This is evident by referring to the surgical procedure as “heterosexual” and “transsexual” transplantation. Consider also the following excerpt: “Traditionally, gender remodeling changes their appearance and make[s] them look more like their preferred gender. However, the function to be a true woman remained unsolved.” “Preferred” is a problematic term because it implies choice both for the transgender person and for people who affirm the person’s gender. Gender is not a choice or a preference. People are assigned (without choice) male or female at birth. For some, this initial label aligns with their self-perceptions and identity (termed cisgender). Many other people (1.6 million in the United States3) later realize that the gender they were assigned at birth is not who they truly are. People may realize they are transgender, nonbinary, or other gender identities. The following excerpt is also problematic: “These results may provide a reference for bilateral transsexual UTx in animals and genetically 46 XY individuals who wish to become real women through transsexual UTx.” The term “real women” ignores the diversity of womanhood, reducing womanhood to reproductive abilities. Women (transgender and cisgender) are real women without any qualifiers; the capacity to give birth does not define womanhood. How women decide to express their gender (through clothing, hairstyle, hormone therapy, surgical procedures) also does not define womanhood. Regardless of what steps a person takes to affirm their gender, a transgender woman is a woman and a transgender man is a man. A person does not need to take any steps to be a “true woman” or “real woman.” Language is powerful in shaping cultural and social attitudes. Health disparities among transgender people are striking. Affirming inclusive spaces and discourse can mitigate minority stress, which is a documented driver of health disparities in transgender people.4 In the physical sciences, nearly half of transgender scientists have considered leaving their workplace because of a hostile climate or discrimination.5 We must do better. Research about transgender people should be authored, or at least steered, with a community advisory committee made up of transgender and gender-diverse people. We encourage journals in the field of transplantation to work together with members of various systemically discriminated communities to establish and publish diversity, equity, and inclusion writing guidelines, and to work with authors to ensure all submissions meet the standard before publication. Given its commitment to diversity, equity, and inclusion, Transplantation would be well-positioned to lead such an effort.

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