Reference Corner

Book review of Why Gender Matters

This book asks: How much of any one child's gender expression needs to be accepted and nurtured, and when, if ever, should parents try to shift children towards culturally valued norms? Spoiler alert: in reading "expert" advice, be wary of cherry picked data.
By Aaron Cohn, PhD

Parents are increasingly perplexed about how to socialize children about appropriate gender behaviors and attitudes. While parents are still confident that they are important models and transmitters of cultural gender norms, they also know that many differences between the genders and within each gender are innate and relatively unmalleable. The essential question for parents is how much of any one child's gender expression needs to be accepted and nurtured, and when, if ever, should parents try to shift children towards culturally valued norms?  Leonard Sax, conservative psychologist, physician and author of Why Gender Matters (2nd Edition) tries to present an easy-to-read guide to help parents use scientific data that addresses these issues with their own children. Unfortunately, the data presented is sometimes cherry picked to bolster his arguments.

Sax offers a practical but at times tendentious guide to current research and rebuts the extreme progressive and feminist models of gender that he finds dangerous and disturbing. He argues that feminists, in their eagerness to promote gender equality, have championed the mistaken view that sex is entirely a cultural construct with no underlying biological basis. At the same time, he disagrees with ultra-conservatives who insist that deviations from gender-typical behavior are invariably signs of moral decrepitude and ought to be corrected.

With science as a guide, Sax tries to plot a course between the Scylla of social constructionism and the Charybdis of genetic determinism. At key junctures, Sax appears to strike the right balance with reasonable advice, urging parents to accept their children, irrespective of how strongly they conform to their assigned gender and to remain alert to the dangers children face who deviate from their biological sex. Yet among these moments of warm acceptance and commonsense biology, Sax seems swept away by his own uncomfortableness with gender fluidity. He worries that traditional ideas of how men and women and boys and girls ought to behave are now passé; the new model of a gender continuum overwhelming the traditional male and female silos. Unable to fully embrace social constructivist models, Sax warns that the culture has been seized by radical feminists, such as Judith Butler, who in his view want to do away with all gender-based social institutions and leave children without appropriate cultural guideposts to help them differentiate between the genders. Readers suspicious of feminism will share his alarm, while others, especially those for whom feminism and empirical science are a natural fit, are likely to wonder what Sax is so afraid of.

In Sax's reckoning, the pendulum seems to have swung so far in the direction of dogmatic blindness to gender differences, that he has little obligation to consider the role of institutional sexism in the development and maintenance of boys' aggression or the alienation of girls from math and science. Having positioned himself as a defender of inconvenient gendered truths revealed by science, he regards discussion of culturally imposed and institutionalized gender inequality as the intrusion of politics into the objective and scientifically grounded neurobiological differences between the sexes. He heaps particular scorn on Sandra Bem's hypothesis that psychological androgyny is a salubrious condition for children. One wonders what Sax would make of a recent study that used updated measures to revisit Bem's ideas, and which found that children who saw themselves as possessing attributes of both genders are both well-adjusted and low in sexist beliefs (Pauletti, Menon, Cooper, Aults, & Perry, 2017).

In support of his thesis, Sax provides sociobiological data for a great many stereotyped truths about the sexes. Girls and women smell and hear more acutely than do boys and men: an unequal distribution of natural gifts that may explain female superiority in the areas of housekeeping and listening. Boys may be biologically predisposed to risk-taking, while girls may need encouragement to enjoy outdoor adventures such as rock climbing. Boys can be physically aggressive, while girls can be interpersonally vicious.

Sax believes that the biological differences between boys and girls requires a responsive parenting that respects different dispositions and different behavioral trajectories. For example, he feels it is imperative to acknowledge the genetic contribution of male biology to inattention, aggression and impulsivity and to find cultural and social interventions that respect and work within those given tendencies. Only after such efforts does Sax find it acceptable to write a prescription for a stimulant or neuroleptic. Although the bulk of his sympathy is reserved for boys, Sax notes that girls, too, have been overlooked in the classroom, citing biologically based learning differences in young girls that may account for their relatively weak enthusiasm for math and science and urging teachers to use real-world examples to motivate their interest in numbers. Unfortunately, many of his conclusions are untethered to the accumulating evidence that goes against his arguments.

For example, Sax believes that contemporary adolescent sexuality is in an especially frightful state. The chapter on heterosexual sex forwards the hypothesis that oral sex has recently become fashionable among today's youth as an outlet for the overwhelming, testosterone-fueled desires of teenage boys to the emotional detriment of their female partners. Incurious about the potential contribution of a cultural ideology that sanctions male entitlement to sex (Schwartz, 2015) or data that supports this contribution (Widman & McNulty, 2010), Sax's answer is not to interrogate or try to change boys' attitudes but to harness their proclivities and recommend abstinence: "We should regard sexual relationships in the same way we regard alcoholic beverages: as an adult pleasure to be enjoyed by adults only." Given the small effect sizes achieved by educational programs that promote abstinence (Silva, 2002), it is not surprising that Sax provides no concrete recommendations towards this end.

Also unsurprising, given Sax's ideological leanings, is his unsympathetic look at the allegedly growing eagerness of parents to support children who exhibit gender non-conforming behavior or experience gender dysphoria by wondering whether it means their child will someday have same-sex attractions or is transgender. "When in doubt," Sax insists, "err on the side of normal variation," that is, assume the child is heterosexual and cisgender. Sax is alarmed by the recent practice of "gender affirmation," which in Sax's view means that caregivers immediately interpret gender dysphoria as an unambiguous sign of being transgender and "change his name to a girl's name and send him to school in a dress" without a second thought. Irrespective of Sax's characterization of current practices, the World Professional Association for Transgender Health (WPATH), in their Standards of Care (2011), recommends, prior to the initiation of social transition or any hormone or surgical treatments, a careful investigation of each patient's history of gender dysphoria and a thorough discussion of the risks and potential benefits of social transition and gender-affirming medical procedures. Sax may be reassured that even in our interesting era, jumping to conclusions is no one's idea of competent healthcare.

It is in his discussion of gender-atypical children that Sax shows some of the personal vulnerabilities that seem to motivate his defense of parents who hope their children will conform to gender expectations. In a revealing passage, he reflects on his own childhood experiences as a boy who shunned fighting and enjoyed macramé and whose eccentricities were met with cruelty from many of his peers. This treatment led Sax to become a lonely and withdrawn boy. Sax assures us that "anomalous" or gender-non-conforming, males are physiologically distinct from normative boys and therefore ought not to be forced to adopt more masculine behaviors. Yet in the same breadth, Sax paradoxically suggests that some withdrawn boys could become normatively assertive men with a little urging from their parents. Sax wants to keep the world safe for parents who might want to do just that. Non-conformity, he argues, ought not to be valued for its own sake. Of course, the psychotherapeutic retort to that is, "Why not?"

In the case of this embattled "anomalous male," it may be possible to see to the child's best interest without imposing any gender ideology, conformist or otherwise. Experiential avoidance, a widely recognized factor in the development of psychopathology (Chawla & Ostafin, 2007), may be construed as the problem faced by a boy whose gender atypical tendencies have led to withdrawn behaviors. Increasing the child's distress tolerance could free him up to pursue more of what he wants, be it gridiron glory or more macramé. It seems a comfortably realist position to hold that individuals differ in their adaptation to gender-based expectations and sensible to recommend that children who are a poor fit for their context receive support to develop skills to cope with the additional stress they must bear. Copious reminders from the media and peers make it likely that most children already know that gender-conforming behavior is the customarily preferred kind, even if their parents fail to remind them. For the current author, it is obvious that atypical behavior need not be praised or blamed but rather a child can and should be supported, empowered and protected, irrespective of their gender expression.

Sax's book is a challenge for the progressive psychologist. At a time when we are all struggling to tolerate and learn from opinions that differ from our own, this book forces one to articulate the grounds on which we disagree. Conversely, it contains much ammunition for readers sympathetic to his cause. Yet the book is valuable as a non-offensive opener for diverse community groups to discuss their concerns about children and gender conformity. It will hopefully leave parents open to hearing the best data available and the lack of definitive answers. Why Gender Matters would also be a provocative addition to an undergraduate gender studies course or an introductory graduate counseling course.


Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871-890. doi:10.1002/jclp

Pauletti, R. E., Menon, M., Cooper, P. J., Aults, C. D., & Perry, D. G. (2017). Psychological androgyny and children's mental health: A new look with new measures. Sex Roles, 76(11-12), 705-718. doi: 10.1007/s11199-016-0627-9

Schwartz, J. P. (2015). College male sexual assault of women and the psychology of men: A commentary. Psychology of Men & Masculinity, 16(4), 367-369. doi: 10.1037/a0039692

Silva, M. (2002). The effectiveness of school-based sex education programs in the promotion of abstinent behavior: A meta analysis. Health Education Research, 17(4), 471-481. doi:10.1093/her/17.4.471

Widman, L., & McNulty, J. K. (2010). Sexual narcissism and the perpetration of sexual aggression. Archives of Sexual Behavior, 39(4), 926-939. doi: 10.1007/s10508-008-94617

World Professional Association for Transgender Health. (2011). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th version). Elgin, IL: Author.