The Casualties of Concept Creep

How definitional expansion in medicine and advocacy distorts public understanding and harms the people it’s meant to help.

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About the Author

Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, and CEO/Editor-in-Chief of Reality’s Last Stand. His writing has appeared in The Wall Street Journal, The Times, the New York Post, Newsweek, City Journal, Quillette, Queer Majority, and other major news outlets and peer-reviewed journals.

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The gay rights movement achieved something remarkable, and its success can largely be attributed to asking people to accept a simple truth: gay and lesbian individuals were already part of their communities—neighbors, coworkers, family members. The strategy of “coming out” was effective because it revealed what was already there, breaking down prejudice through familiarity. Most importantly, the movement didn’t require anyone to accept a radical ideology or believe anything that wasn’t factually true.

This strategy of normalization through familiarity was so successful that it became a template for other advocacy movements. However, gays and lesbians as a population have certain characteristics that prevent other minority populations from using the same playbook effectively. The gay rights approach works when a population is large enough that most people actually know someone from that group. It becomes much harder when you’re dealing with truly rare populations that the average person will never encounter.

Faced with this challenge, activists found a simple workaround: expand the definition. If a group is too small to achieve normalization through familiarity, make it appear larger. While this approach may initially be well intentioned, this “definitional drift” or “concept creep” has flooded our culture with misleading statistics that distort public understanding and, ironically, often harm the very people these movements intend to protect.

Intersex

Consider people with so-called “intersex” conditions—developmental anomalies that result in sexually ambiguous genitalia or mismatches between sex chromosomes and physical appearance. These conditions are genuinely rare, affecting about 0.018 percent of the population, or roughly 1 in 5,500 people. To put that in perspective, you could fill a mid-sized sports arena and expect to find maybe three or four people with true “intersex” conditions (in the same arena, you’d likely find around 500–1,000 gay/lesbian people, based on estimates that 3–6 percent of the population are homosexual).

But advocates worried that such a small number wouldn’t generate the public concern needed to protect these individuals from unnecessary medical interventions and social mistreatment. So they broadened the definition to include nearly any difference in sexual development, no matter how minor. This inflated statistic then took on a life of its own, getting co-opted by activists in the transgender movement to argue that sex exists on a continuum rather than as a binary. They use these numbers to claim that the categories of male and female are “social constructs” that should be open to self-identification, arguing that individuals should be allowed to enter any sex-segregated space they choose.

This definitional expansion traces back to biologist Anne Fausto-Sterling’s influential 2000 paper, “How Sexually Dimorphic Are We?” In it, she redefined intersex to include any departure from what she called the “Platonic ideal” of male and female, which included conditions like Klinefelter syndrome (XXY males), hypospadias, and even atypically large labia—conditions in which individuals are unambiguously male or female.

By lumping in these far more common conditions that don’t result in sexual ambiguity, activists were able to claim that as many as 1.7 percent of people are “intersex”—a figure now regularly cited by major organizations like Amnesty International and the United Nations as being “as common as red hair.”

I learned firsthand how entrenched this inflated statistic has become in a Facebook discussion with one of my former college professors who confidently repeated the 1.7 percent figure. When I explained that the true prevalence of these conditions is nearly one hundred times smaller—closer to 0.018 percent of the population—he accused me of bigotry and “denying the existence” of intersex people. But I wasn’t denying anyone’s existence; I was simply reporting accurate numbers.

This matters more than you might think. In medical contexts especially, expanding the definition of intersex can do real harm. Casting a needlessly broad definitional net leads doctors to pathologize people who don’t need treatment while diverting attention and resources from those who genuinely do.

Trans

A similar expansion occurred with what it means to be “trans.” Originally, “trans” was shorthand for “transsexual,” a term describing a very specific group: individuals who, from early childhood, experienced persistent and severe distress about their biological sex—distress that continued through puberty and led to an unwavering desire for medical transition. This described perhaps 0.05 percent of the population at most.