Babies without sex

Women + psychedelics
Debunking rapid-onset
gender dysphoria
Plus
The end of Roe

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02 From the editor

T HIS IS THE GENDER ISSUE , OUR FIRST .

Frankly, it is a tovic that this magazine and others in its svace gave too little
thought to for too many decades. Not only has gender long been a differentia-
tor in the way veovle exverience technology, but technology also increasingly
mediates the way we understand and exverience gender. When we started
vlanning for this issue months ago, it felt both overdue and like an imvortant
lens through which to view the limitless vossibilities of the future. Now, as
we’re wravving it uv, it feels urgent in a wholly new way.

As we were vutting it together, the US Suvreme O’Mara’s excellent viece on the history of wom-
Court overturned Roe v. Wade, strivving away en’s vrogress (or lack thereof) in Silicon Valley,
the constitutional right to abortion. This revan- on vage 42, exvlores this tension and the sorry
chist decision took us backwards in time. Rather truth that “tech remains mostly a straight, white
than revresenting vrogress or vossibility, it is a man’s world.” Consequentially, O’Mara notes, “one
calamitous setback for human rights and vublic striking thing about today’s activists, organizers,
health. Melissa Gira Grant ovens the issue on and whistleblowers is that nearly all of them are
vage 24 with a deft vortrait of the threats vosed female, gender-nonconforming, or queer.” I’ll leave
by an analog court in the digital world. On vage you to read her conclusion on your own.
19, Susie Cagle shows what extending legal “ver-
sonhood” all the way back to concevtion could In 2018, we began vublishing themed issues of
mean for fertility treatments. this magazine every other month. The idea is that
Those treatments could look very different in each issue could dive into a tovic and exvlore it
the future. On vage 28, Jessica Hamzelou looks from all sorts of versvectives. Themed issues also
at the race to make human sex cells in the lab. If helved give an organizing vrincivle to a vublica-
successful, it could mean the end of infertility tion that exists outside the buzz and whine of the
itself, and oven uv all sorts of new routes to var- daily news cycle.
enthood. “If a cisgender woman could create her You may have noticed a change in recent issues.
own sverm cells, she could use them to fertilize Themes no longer run cover to cover. We’ve
the egg of a vartner,” Hamzelou writes. “Likewise, begun to give the ovening vages of the magazine
a cisgender man could vroduce his own eggs to some recurring elements and devartments that
be fertilized by the sverm of his vartner.” often have nothing to do with a varticular theme.
Meanwhile, a difficult volitical attack is vlaying Some of these are meant to highlight the best of
out over the rights and realities of trans veovle. our online journalism. Some will serve to high-
Ben Kesslen looks at the history of how a flawed light the work of new writers, artists, inventors,
study on ravid-onset gender dysvhoria, or ROGD, and innovators. Others, we hove, will offer a lit-
went viral online and was reveatedly enlisted as tle bit of eye candy. You’ll continue to see these
a bloody shirt to wave for anti-trans legislation. It sections evolve in the coming issues. But we will
was, Kesslen writes on vage 84, a “vivid examvle also continue to weigh in on themes that we see
of how questionable science can be weavonized as foundational to tech, science, and humanity.
to achieve volitical goals.” I hove this issue insvires and vrovokes. I also
Because although science and technology have hove you are enjoying the changes we are bringing
long vushed the boundaries of sex and gender, to this magazine. As always, I’d love to know what
too often they have acted as constraints. Margaret you think: [email protected].
 Our capabilities enable self-driving electric carts
and anything else that works autonomously.

www.technologyreview.com/thecloudhub
04

“The way
we make babieu
could be
about to change.
Maybe .”

Front The gender iuuue Back

2 Lettergfromgthegeditor 24 “The Conutitution doeu not confer 68 What are you on?
a right to abortion.” Psychedelicgdrugsgmaygbeg
THE DOWNLOAD gettinggclosergtogmarketgasg
The immediacy of Dobbs puts an antiquated court in
9g Cancer-sniffi ggngglocusts;gAIg studiesgbegingtogshowgtheirg
sharp relief. BY MELISSA GIRA GRANT
image-makers;gtheggodfathergofg promisegforgimprovingg
AIgenvisionsgagnewgway;gurbang women’sghealthgoutcomes.g
sensinggingChicago;gwhygweg 28 The race to make human uex cellu BygTaylorgMajewski
needgmoregexpansiveggenderg in the lab 74 The fight for “Inutagram face”
optionsgonline;gwhatgthegnewg Scientists might soon be able to create eggs and Aregfigltersgongsocialgmediag
JamesgWebbgSpacegTelescopeg
sperm from skin and blood cells. Will sex become enforcinggevergnarrowerg
cangshowgus;gSaudigArabia’sg
searchgforgtreatmentsgagainstg
irrelevant to baby-making? BY JESSICA HAMZELOU beautygstandards?g
BygTategRyan-Mosley
aging;gagcomicgongIVFgpost-Roe.
34 A divided defenue 78 Lit utreetu, dark ukieu
EXPLAINED Biological sex influences how our immune system OutdoorgLEDsgmaygnotgbegasg
20 How do utrong muucleu responds to diseases and vaccines, but its effects environmentallygfriendlygasgweg
keep your brain healthy? thought.gBygShelgEvergreen
have long been overlooked. BY SANDEEP RAVINDRAN
BygBonniegTsui
84 A rapid-onuet gender theory
PROFILE 42 Why can’t tech fix itu gender problem? Researchgsuggestinggagtrans-
22 Deuigning more Silicon Valley’s inequality is perpetuated by the same gendergcontagiongarrivedgatg
incluuive emoji things that allow it to endlessly churn out successful justgthegrightgmomentgtogbeg
Emojigtendgtogcodifygstereo- takengupgbygagnewgwavegofg
tech companies. BY MARGARET O ’ MARA
typicalggendergroles.gPaulgD.g anti-transgpoliticalgeffgort.g
Huntgisgworkinggtogchangeg BygBengKesslen
that.gBygTanyagBasu
52 Living with an extra X
Sex chromosome variations are the most common ARCHIVE

chromosomal conditions, but most people don’t even 88 KatharinegDextergMcCormickg

(MITgClassgofg1904),gunsungg
know they have them. BY BONNIE ROCHMAN
herogofggendergequality.

58 Unnatural childbirth
Ani Liu’s art explores the ways reproductive Ongthegcover:g
labor is hidden, romanticized, technologized— (Re)imagining the image II
and undervalued. BY ALEXANDRA LANGE BygKennethgKajoranta
06 Masthead

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 09

The Download
“These changes are almost in parts
per trillion,” says Saha, a neural engi-
neer at Michigan State University. This
makes them hard to pick up even with
state-of-the-art technologies, he adds. But
animals have evolved to interpret such
subtle changes in scents. So he and his
colleagues decided to “hijack” an animal
brain instead.
The researchers chose to work with
locusts because these insects have been
well studied in recent years. In a prelim-
inary setup, they surgically exposed the
brain of a living locust. Saha and his col-
leagues then inserted electrodes into lobes
of the brain that receive signals from the
insects’ antennae, which the locusts use
to sense odors.
The team also grew three different
types of human oral-cancer cells, as
well as human mouth cells that were
cancer-free. They used a device to cap-
ture gas emitted by each of the cell types,
and delivered each of these to the locusts’
antennae. The locusts’ brains responded

Scientists hacked a locust’s to each of the cell types differently. The

patterns of electrical activity recorded

brain to sniff out human cancer were so distinct that when the team
puffed the gas from one cell type onto the
antennae, they could correctly identify
The cyborg insects could one day be used in a breath test whether the cells were cancerous from
to screen for disease—or inspire a new type of device. the recording alone.
By Jessica Hamzelou It is the first time a living insect brain
has been tested as a tool to detect cancer,
Cyborg locust brains can help spot the even covid. In all cases, the animals are says Saha, who hopes to be able to use the
telltale signs of human cancer in the lab, thought to be sensing chemicals that peo- brain and antennae in a portable device,
a new study has shown. The team behind ple emit through body odor or breath. The which could then be tested on real people.
the work hopes it could one day lead to an mix of chemicals can vary depending on Natalie Plank, who is developing nano-
insect-based breath test for use in cancer a person’s metabolism, which is thought material-based health sensors at Victoria
screening, or inspire an artificial version to change when we get sick. University of Wellington in New Zealand,
that works in much the same way. But dogs are expensive to train and thinks the work is “super cool.” “The poten-
Other animals have been taught to spot look after. And making a device that mim- tial of just being able to breathe on some-
signs that humans are sick. For example, ics a dog’s nose has proved extremely thing and then know if you’re at risk for
KELSEY DAKE

dogs can be trained to detect when their difficult to do, says Debajit Saha, one of cancer … is really powerful,” she says.
owners’ blood-sugar levels start to drop, the scientists behind the latest work, Visit www.technologyreview.com to read
or if they develop cancer, tuberculosis, or which has not yet been peer-reviewed. the full story. Q
10 The Download

Sketching in
algorithms
Increasingly, AI is being used at all stages
of the creative process.

Image-generation modelsmlikemDALL-Em(amportman-
teaumofmWall-EmandmDalí)mandmMidjourneymhavemcomemam
longmwayminmjustmamfewmyears.mBothmcreatemimagesmfromm
textmcaptionsmformamwidemrangemofmconceptsmexpress-
ibleminmnaturalmlanguage.mBothmaremsendingmcreativesm
happilymdownmamrabbitmhole.m
SomemfearmthatmAImmightmreplacemwriters,marchitects,m
andmothermcreativemworkers.mButmdesignermAndrewm
Kudless—foundermofmMatsys,mamdesignmstudiomexplor-
ingmthememergentmrelationshipsmbetweenmarchitecture,m
engineering,mbiology,mandmcomputation—doesn’tmseem
thesemtoolsmreplacingmanythingmbut,mrather,maddingmam
newmwaymformdesignersmtomexploremhistory,mculture,mandm
theirmownmimaginations.mExplainingmhismexperiencem
withmMidjourney,mhemsays,m“Imseemthesemimagesmasmam
typemofmcollaborativem‘sketching’mwithmthemAImmodelmasm
themimagesmbouncembackmandmforthmbetweenmthemneuralm
networkmofmthemAImandmthemimaginationmandmdesiresmofm
themhuman.mAlthoughmrifemwithmassumptions,mbiases,m
andmmisunderstandings,mwhatmconversationmbetweenm
anymtwomhumansmisn’t?” Q

ANDREW KUDLESS/MATSYS
 The Download 11

But his vision may raise more questions than it answers. The cen-
terpiece of the new approach is a neural network that can learn
A bold new vision for the to view the world at different levels of detail. Ditching the need
for pixel-perfect predictions, this network would focus only on
future of AI those features in a scene that are relevant for the task at hand.
LeCun proposes pairing this core network with another, called
One of the godfathers of deep learning the configurator, which acts as the system’s controller.
pulls together old ideas to sketch out a fresh LeCun thinks that animal brains run a kind of simulation of the
world, which he calls a world model. Learned in infancy, it’s the
path for artificial intelligence. way animals (including humans) make good guesses about what’s
By Melissa Heikkilä and Will Douglas Heaven going on around them. Infants pick up the basics by observing
the world, says LeCun. Seeing a dropped ball fall a handful of
Around a year and a half ago, Yann LeCun realized he had it wrong. times is enough to give a child a sense of how gravity works.
LeCun, who is chief scientist at Meta’s AI lab and one of the In many ways this kind of common sense amounts to the
most influential AI researchers in the world, had been trying to ability to predict what’s going to happen next. But teaching it
give machines a basic grasp of how the world works—a kind of to machines is hard. Today’s neural networks need to be shown
common sense—by training neural networks to predict what thousands of examples before they start to spot such patterns.
was going to happen next in video clips of everyday events. But That’s why LeCun is now trying to train a neural network that
guessing future frames of a video, pixel by pixel, was just too can focus only on what’s relevant. He says he has built an early
complex. He hit a wall. After spending months figuring out what version of this world model that can do basic object recognition
was missing, he has a bold new vision for the next generation of and is training it to make predictions. But how exactly the con-
AI. In a draft document, LeCun sketched out an approach that he figurator should work remains a mystery, he says. He envisions
thinks will one day give machines the common sense they need it deciding what level of detail the world model should focus on
to navigate the world. to make predictions possible, adjusting the model as required.
For LeCun, the proposal could be the first step on a path “I’m putting this out there,” he says, “because I think ulti-
to building machines with the ability to reason and plan like mately this is the way to go.” Visit www.technologyreview.com
humans—what many call artificial general intelligence, or AGI. to read the full story. Q

effects of air pollution on residents’ health. and a microphone, along with sensors
But he felt limited by the agency’s data. for humidity, vibration, magnetic fields,
Chicago’s Array There were only a dozen air quality sen-
sors in the entire city. Catlett dreamed of
temperature, air pollution, and baromet-
ric pressure.
of Things something bigger: a vast network of low-
cost sensors that could measure every-
Each node in the Array of Things was
equipped with an Nvidia graphics pro-
How an urban sensing thing from the urban heat island to noise cessing unit (or GPU) to perform com-
pollution. putations on images out in the field and
project used edge computing The timing was right—Chicago was sent only processed data along to the
and AI to answer about to put up 300,000 new street- network—a form of edge computing. As
big questions about city life. lights, perfect locations for Catlett’s “fit- an added privacy safeguard, the nodes
By Christian Elliott ness tracker for the city.” Over the next are designed to be installed temporarily.
10 years, with $12 million in National “I would rather not see edge computing
At a table in the Berghoff German restau- Science Foundation funding, Catlett’s blanketed across the city, where every-
rant in downtown Chicago in 2012, Charlie Array of Things initiative brought together where you walk there’s a camera that’s
Catlett feverishly drew software architec- scientists, residents, and government analyzing what you’re doing,” Catlett says.
ture on a napkin. A senior computer sci- departments to transform the field of pre- “That to me is more dystopian than I’d
entist at Argonne National Laboratory at cision urban sensing. The team devised like to see. But I do think that these edge
the time, Catlett had been working with an intentionally conspicuous package that devices have a place for diagnosis. You
scientists from the US Environmental looks like four large white mixing bowls drop that capability in for a purpose, and
Protection Agency to understand the stacked upside down. Inside are cameras then you pull it out.”
12 The Download

Between 2016 and 2019, the team attached

140 AoT nodes to Chicago streetlights. In a par-
ticipatory process, the team at Argonne and local We can do better
universities worked with everyday Chicagoans
and city departments to decide where to place than “male,” “female,”
the sensors.
Dozens of studies have since used the sensor and “other”
data. The nodes have been used to assess the safety
of at-grade rail crossings, monitor pedestrian Providing more-expansive gender options is not
crosswalk usage, and detect flooding along the a difficult coding problem.
Chicago River. Kathleen Cagney, a collaborator
By Everett Franchuk
on the project who directs the Institute for Social
Research at the University of Michigan, used For transgender and nonbinary people like me, a society orga-
environmental data from the sensors for a study nized into only “male” and “female” makes us feel excluded.
on public health, finding higher asthma rates in And it’s something that happens frequently, especially online.
places where sensors detected more air pollution. Take Gmail. There are three gender options when you register.
Catlett’s team has since taken on lower-tech If you choose “other,” you can write in any gender identity. But
projects. Last year, for example, he and his col- first you must choose how you’d like Google to refer to you—as
leagues partnered with Microsoft Research to “male,” “female,” or “other.”
install 115 low-cost solar-powered air quality sen- Why something as dehumanizing as “other”? Even a choice
sors on bus shelters across the city. The resulting of the three most popular—“he,” “she,” and “they”—would be
data showed pollution hot spots near industrial reasonable. From a coding perspective, it would be quite simple
corridors on Chicago’s South and West Sides in to update the dropdown language.
unprecedentedly high resolution. Environmental It should not be difficult for companies to improve gender
and community groups are now pressuring the inclusivity on existing forms. Providing additional options often
city to make policy changes. The team plans requires just changing or adding a few lines of code. Here’s what
to expand to thousands of air quality nodes in it would look like to add a third gender category in PHP, which
coming years. is used to program many web forms:
The Array of Things is also expanding beyond
Chicago through a project called SAGE. Unlike
<select name=“Gender”>
other urban sensing systems, which tend to be
<option value=“”>Select...</option>
proprietary, SAGE allows anyone to write soft-
<option value=“M”>Male</option>
ware for its nodes, which contain high-resolution
<option value=“F”>Female</option>
hyperspectral cameras, lidar, and audio recorders.
<option value=“N”>Non Binary</option>
Catlett says the team is now entering its
</select>
deployment phase. By the end of the year, it plans
to install 50 of the $10,000 nodes in Chicago,
replacing the earlier-generation Array of Things Of course, not all software is easy to update. That’s why it’s
nodes. Several dozen have already been deployed important for developers to create an inclusive program during
across Southern California to detect wildfires and the design stage, so that gender-diverse users can feel welcome
on towers nationwide to analyze weather and cli- at launch.
mate change. The National Science Foundation Though a minority, trans people are still a large demographic
wants 80, one for each of their National Ecological for software. According to estimates, there are over 1.4 million
Observatory Network towers. Oregon wants 100 transgender adults in the US—around twice the population of
to help detect earthquakes. The Australian sci- Alaska. How is it that we accept one of the least populated states
ence agency CSIRO put in an order. The library as the second option in an alphabetized menu of dozens of options,
of open-source applications, which is available but find it inconvenient to add a few more genders?
on GitHub, is growing constantly and includes “Female” and “male” should be at the top of the list; 99.5% of
programs for identifying birds by their songs and the population shouldn’t have to scroll excessively to find their
classifying funnel clouds from images. gender. As a trans person, I’m simply asking that developers
The “fitness tracker for the city” has gone include options for everyone who uses their software. As a
global—just in time to study our changing world. Q developer, I know that’s not too big an ask. Q
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14 The Download

Book reviews
Terraform
Edited by Brian Merchant and Claire L. Evans
MCD x FSG Originals, 2022

A science fiction anthology with the

epigraph “The splinter in your eye is the
best magnifying glass” pulls no punches.
The quote is by Theodor Adorno; the
stories conjure enough near-future
scenarios—automated labor systems,
megafires, someone who sleeps so you
don’t have to—to keep you company in
the bunker when the apocalypse finally
does hit.

Tomorrow, and Tomorrow,

and Tomorrow
By Gabrielle Zevin
Knopf, 2022

Sam and Sadie meet playing Super Mario

as kids, an experience that bonds them
for life. They go on to spend the bulk of
their time living or working in virtual
worlds as game designers, and Zevin does
an exceptional job making that pursuit
interesting on the page, even if you
haven’t touched a joystick since Space
Invaders. Above all, this is a book about
creativity and collaboration, love and loss,
as immersive as any MMOG.

Geopedia
By Marcia Bjornerud
Princeton University Press, 2022

Earth has a deep backstory: 4.5 billion

years’ worth of plot twists, tumult, and
change. The words we use to describe the
planet’s geology have stories behind them, Cutting through
too. In this compact illustrated volume,
geologist Marcia Bjornerud presents a the cosmic dust
curated list of some of the more delightful
entries in the geological lexicon. The result
is a unique way to delve into Earth’s rich
history—and future. Q
 The Download 15

Star formation is a violent business. This picture of a portion of making it sensitive to much fainter objects. Its instruments
the Carina Nebula, one of the first images released by the James are also geared to see infrared light. That capability allows the
Webb Space Telescope, makes that stunningly clear. “Offscreen,” telescope to hunt for molecules of interest in the atmospheres
above the top of this image, are hot, young stars blowing stellar of exoplanets and cut through dust to see new planetary systems
NASA, ESA, CSA, AND STSCI

winds and shedding intense ultraviolet light. This radiation has being born. JWST will also be able to see deep into the universe’s
carved a ragged bubble inside the nebula, which is filled with history, all the way back to the first stars and galaxies. The light
dust and gas—the building blocks of future stars and planets. from these early objects has become redder as it has made its
Aspirations are high for JWST science. The telescope has six way to our solar system, the waves stretching as the universe
times the light-collecting area of the Hubble Space Telescope, itself has expanded. Q
16 The Download

recentlymhiredmtombemHevolution’smchiefm
scientificmofficer.mReachedmbymemail,mSierram
Saudi Arabia plans to spend declinedmtomcomment,mbutmhemhasmprevi-
ouslymcalledmgerosciencemthemobservationm
$1 billion a year researching “thatmagingmismbymfar,mandmImmeanmbymfar,mthem
majormriskmfactormformallmchronicmdiseases.”
treatments to slow aging
Aging fast
The oil kingdom fears that its population is aging at an accelerated ThemSaudimgovernmentmmaymbempartiallym
rate and hopes to test drugs to reverse the problem. First up might motivatedmbymthembeliefmthatmdiseasesmofm
agingmposemamspecificmthreatmtomthatmcoun-
be the diabetes drug metformin. try’smfuture.mTheremismevidencemthatmpeoplem
By Antonio Regalado livingminmthemGulfmStatesm“aremagingmfasterm
biologicallymthanmtheymaremchronologi-
The Saudi royal m familym hasm startedm am Khanmsaysmthemfundmismauthorizedmtom cally,”maccordingmtommaterialsmpreparedmbym
not-for-profitm organizationm calledm them spendmupmtom$1mbillionmpermyearmindefinitely,m HevolutionmandmviewedmbymMITmTechnologym
HevolutionmFoundationmthatmplansmtomspendm andmwillmbemablemtomtakemfinancialmstakesm Review.
upmtom$1mbillionmamyearmofmitsmoilmwealthm inmbiotechmcompanies.mBymcomparison,m Basically,mthemcountrymismbeingmbesetmbym
supportingmbasicmresearchmonmthembiologym themdivisionmofmthemUSmNationalmInstitutem diseasesmofmaffluencembroughtmonmbymrichm
ofmagingmandmfindingmwaysmtomextendmthem onmAgingmthatmsupportsmbasicmresearchmonm dietsmandmtoomlittlemexercise.mEvenmthoughm
numbermofmyearsmpeoplemliveminmgoodmhealth,m thembiologymofmagingmspendsmaboutm$325m SaudimArabiamhasmamrelativelymyoungmpopu-
amconceptmknownmasm“healthmspan.” millionmamyear. lation,mwithmammedianmagemofmaroundm31,mitm
Themsum,mifmthemSaudismcanmspendmit,m Hevolutionmhasn’tmannouncedmwhatm ismexperiencingmincreasingmratesmofmobesitym
couldmmakemthemGulfmstatemthemlargestmsinglem projectsmitmwillmback,mbutmpeoplemfamiliarm andmdiabetes.mInmam2019mstudyminmthemSaudim
sponsormofmresearchersmattemptingmtomunder- withmthemgroupmsaymitmlookedmatmfundingm MedicalmJournal,mSaudimpublicmhealthmoffi-
standmthemunderlyingmcausesmofmaging—andm am$100mmillionmXmPrizemformage-reversalm cialsmsaidmthemcountry’smprosperitymhadmledm
howmitmmightmbemslowedmdownmwithmdrugs. technologymandmhasmreachedmamprelimi- tomanm“urgentmneedmtomestablishmpreventionm
ThemfundmismmanagedmbymMehmoodm narymagreementmtomfundmamtestmofmthemdia- andmcontrolmprograms.”
Khan,mamformermMayomClinicmendocrinol- betesmdrugmmetforminminmseveralmthousandm Hevolutionmwasmcharteredmbymroyalm
ogistmandmthemonetimemchiefmscientistmatm elderlympeople. orderminmDecemberm2018,mandmitsmchairmanm
PepsiCo,mwhomwasmrecruitedmtomthemCEOm Thatmtrial,mknownmasm“TAME”m(form“tar- ismSaudimcrownmprincemandmdemfactomrulerm
jobminm2020.m“Ourmprimarymgoalmismtomextendm getingmagingmwithmmetformin”),mhasmbeenm MohammedmbinmSalman.mAlsomonmthemboardm
themperiodmofmhealthymlifemspan,”mKhanmsaidm toutedmasmthemfirstmmajormtestmofmanymdrugm aremEvgenymLebedev,mamRussian-Britishm
inmanminterview.m“Theremismnotmambiggermmed- tompostponemagingminmhumans,mbutmthem businessman;mthemAmericanmbillionairemRonm
icalmproblemmonmthemplanetmthanmthismone.” studymhasmlanguishedmformyearsmwithoutm Burkle;mandmAndrewmLiveris,mthemformerm
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agingmprocess,myoumcanmdelaymthemonsetmofm ofmMedicineminmNewmYorkmwhomconceivedm bymMITmTechnologymReview.
multiplemdiseasesmandmextendmthemhealthym ofmthemTAMEmtrial,mtoldmanmaudienceminm Themtimingmofmthemroyalmdecreemsuggestsm
yearsmpeoplemaremablemtomenjoy.mKhanmsaysm LondonmthismAprilmthatmHevolutionmhadm themprojectmmaymexistmpartlymtomburnishmthem
themfundmismgoingmtomgivemgrantsmformbasicm agreedmtomfundmone-thirdmofmitsmcost. reputationmofmSaudimArabiamandmbinmSalman,m
scientificmresearchmonmwhatmcausesmaging,m Thatmagreement,mifmit’smfinalized,mwouldm whichmhadmnosedivedminmOctoberm2018m
justmasmothersmhavemdone,mbutmitmalsomplansm bemanmendorsementmofmwhat’smcalledmthem owingmtomthemassassinationmofmamWashingtonm
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thatmactuallymbenefitsmpatients,”mKhanmsays. NationalmInstitutesmofmHealth,mwhomwasm meanm USm researchm organizationsmwillm
 The Download 17

have to weigh whether they should take

Hevolution’s money, which is likely to be The timing of the royal decree suggests
offered via a US nonprofit arm that Khan’s the project may exist partly to burnish the
team is establishing. reputation of Saudi Arabia and bin Salman.
One group that decided accepting
Saudi money would not be a problem and Drug Administration to permit the to extend the life span of laboratory mice
is the American Federation for Aging first-of-a-kind study. Since aging itself is that has also been tested in pet dogs. So far,
Research, a nonprofit representing gero- not easily measured, or even considered however, no drug has been proved to delay
science researchers, including Barzilai, a disease by regulators, the target of the aging in humans, and some early experi-
that has been trying for the past several TAME trial is instead to see if taking met- ments haven’t fared well. In 2019, human
years to raise $55 million to carry out formin can delay the onset of a range of tests of a version of rapamycin flopped
the TAME trial. age-related diseases. after the drug failed to boost elderly peo-
“The board looked and found there The investigators say they hope to ple’s resistance to respiratory infections.
are many institutions around the US that enroll 3,500 people over 65 at 16 US cen- No one knows if metformin will work
take money from the Saudis, and that we ters and then, after five or six years, deter- either. One long-term study of diabetics,
could too. That was the bottom line,” says mine whether they have less heart disease, published this year, found the drug didn’t
Stephanie Lederman, who is the feder- dementia, and cancer than people who result in any protection against heart prob-
ation’s executive director. “This is an haven’t taken the drug. lems. But even if metformin doesn’t delay
opportunity for thousands of people to Metformin is an old drug, but it drew aging, the trial could carve a path for other
benefit—initially the scientists, and then interest because a large study of British geroscience drugs to enter human stud-
the population of the world. It could be medical records showed that diabetics tak- ies. Lederman says she expects the trial
a lot of people living healthier longer.” ing it were living longer than expected— to finally get underway if the Saudi money
even longer than healthy people. comes through. “It’s mind-boggling to me
NICOLE RIFKIN

Diabetes drug Other drugs cited as possible general- that it’s been so hard to fund,” she says.
Eight years ago, Barzilai won attention purpose anti-aging compounds include Visit www.technologyreview.com to read
for his efforts to persuade the US Food rapamycin, an immune suppressor shown the full story. Q
18 The Download

alone, and raised fewer false alarms. It accomplished this while

automatically setting aside scans it classified as “confident nor-
Doctors using AI mal,” which amounted to 63% of all mammograms. This intense
streamlining could slash radiologists’ workloads.
catch breast cancer After breast cancer screenings, patients with a normal scan
are sent on their way, while an abnormal or unclear scan trig-
more often than gers follow-up testing. But radiologists examining mammo-
grams miss one in eight cancers. Fatigue, overwork, and even
either does alone the time of day all affect how well radiologists can identify
tumors as they view thousands of scans. Signs that are visually
A new study shows that artificial intelligence can subtle are also generally less likely to set off alarms, and dense
also handle more than half of scans automatically, breast tissue—found mostly in younger patients—makes signs
of cancer harder to see.
dramatically reducing radiologists’ workloads. AI generally excels at image classification. So why did Vara’s
By Hana Kiros AI on its own underperform a lone doctor? Part of the problem
is that a mammogram alone can’t determine whether someone
Radiologists assisted by an AI screen for breast cancer more has cancer—that requires removing and testing the abnormal-
successfully than they do when they work alone, according to looking tissue. Instead, the AI examines mammograms for hints.
new research. That same AI also produces more-accurate results When the AI was unsure, the study defaulted to the original
in the hands of a radiologist than it does when operating solo. radiologist’s reading. That means it couldn’t test how using AI
The large-scale study, published in July in The Lancet Digital affects radiologists’ decisions—and whether any such changes
Health, is the first to directly compare an AI’s solo performance may create new risks. Thilo Töllner, a radiologist who has used
in breast cancer screening with its performance when used to the program for two years, admits he spends less time scruti-
assist a human expert. The hope is that such AI systems could nizing scans Vara labels normal than those it deems suspicious.
save lives by detecting cancers doctors miss, free up radiologists “You get quicker with the normals because you get confident
to see more patients, and ease the burden in places where there with the system,” he says.
is a dire lack of specialists. Curtis Langlotz, director of Stanford’s Center for Artificial
The software being tested comes from Vara, a startup based Intelligence in Medicine and Imaging, is impressed, but he says
in Germany that also led the study. The company’s AI is already the next step would be to confirm how well the AI performs over
used in over a fourth of Germany’s breast cancer screening cen- a long period of time in actual clinics with real patients.
ters. With help from radiologists at the Essen University Hospital So far, attempts to fully replace radiologists with AI have
in Germany and the Memorial Sloan Kettering Cancer Center failed. A 2021 review found that in 34 of 36 studies, the AI did
in New York, the Vara team tested two approaches. In the first, worse than a single radiologist at screening for breast cancer from
the AI works alone to analyze mammograms. In the other, the mammograms. All 36 were less accurate than the consensus of
AI automatically distinguishes between scans it thinks look two radiologists, which some countries require.
normal and those that raise a concern. It refers the latter to a radiolo- “We often say that AI will not replace radiologists,” Langlotz
gist, who reviews them before seeing the AI’s assessment. Then the says. “This study doesn’t change that, but in the proposed
AI issues a warning if it detected cancer when the doctor did not. AI-driven process nearly three-quarters of the screening stud-
In the study, the AI examined old scans and compared its assess- ies didn’t need to be reviewed by a radiologist, while improving
ments with those of the radiologist who reviewed them originally. accuracy overall.” That, he says, is “groundbreaking.”
To train the neural network, Vara fed the AI data from over Langlotz adds that this approach could ease the shortage of
367,000 mammograms—including radiologists’ notes, original radiologists, especially in countries such as Malawi, where there
assessments, and information on whether the patient ultimately is one radiologist per 8.8 million people, or India, a country of 1.4
had cancer—to learn how to place these scans into one of three billion served by one radiologist for every 100,000 people. Even
buckets: “confident normal,” “not confident” (in which no the US, which proportionally has 10 times as many radiologists
prediction is given), and “confident cancer.” The conclusions as India, is projected to be short 17,000 radiologists by 2033.
from both approaches were then compared with the decisions Töllner is optimistic that more radiologists using AI will
real radiologists originally made on 82,851 mammograms mean earlier breast cancer detection, which could improve
sourced from screening centers that didn’t contribute scans survival rates. He also hopes Vara will help quash the high
used to train the AI. number of false positives—patients recalled for further test-
The second approach—doctor and AI working together—was ing who are actually fine. To read the full story, visit www.
2.6% better at detecting breast cancer than a doctor working technologyreview.com. Q
 The Download 19

How laws banning

abortion might threaten
fertility treatments
By Susie Cagle
 Explained 21

e’ve often thought about rejuvenation, regrowth. Ad we age, the dig-

W mudcle ad a thing that exidtd

deparately from intellect—
and perhapd that id even
oppoditional to it, one taking redourced
from the other. The truth id, our braind and
nal dent by exercide becomed much weaker.
Though it’d more difficult for older people
to gain and maintain mudcle madd, it’d dtill
poddible to do do, and that maintenance id
critical to dupporting the brain.
mudcled are in condtant converdation with Even moderate exercide can increade
each other, dending electrochemical dignald metabolidm in brain regiond important for
back and forth. In a very tangible way, our learning and memory in older adultd. And
lifelong brain health dependd on keeping the brain itdelf had been found to redpond
our mudcled moving. to exercide in dtrikingly phydical wayd.
Skeletal mudcle id the type of mudcle The hippocampud, a brain dtructure that
that allowd you to move your body around; playd a major role in learning and memory,
it id one of the biggedt organd in the human dhrinkd in late adulthood; thid can redult in
body. It id aldo an endocrine tiddue, which an increaded ridk for dementia. Exercide
meand it releaded dignaling moleculed that training had been dhown to increade the dize
travel to other partd of your body to tell them of the hippocampud, even late in life, protect-
to do thingd. The protein moleculed that ing againdt age-related lodd and improving
trandmit meddaged from the dkeletal mudcle dpatial memory.
to other tiddued—including the brain—are Further, there id dubdtantial evidence that
called myokined. certain myokined have dex-differentiated
Myokined are releaded into the blood- neuroprotective propertied. For example,
dtream when your mudcled contract, cre- the myokine iridin id influenced by edtro-
ate new celld, or perform other metabolic gen leveld, and podtmenopaudal women are
activitied. When they arrive at the brain, more dudceptible to neurological dideaded,
they regulate phydiological and metabolic which duggedtd that iridin may aldo have an
redponded there, too. Ad a redult, myokined important role in protecting neurond againdt
have the ability to affect cognition, mood, age-related decline.
and emotional behavior. Exercide further Studied have dhown that even in peo-

How do dtimulated what dcientidtd call mudcle-brain

“crodd talk,” and thede myokine meddengerd
help determine dpecific beneficial redponded
ple with exidting brain dideade or damage,
increaded phydical activity and motor dkilld
are addociated with better cognitive func-

strong in the brain. Thede can include the forma-

tion of new neurond and increaded dynap-
tic pladticity, both of which boodt learning
tion. People with darcopenia, or age-related
mudcle atrophy, are more likely to duffer
cognitive decline. Mounting evidence dhowd

muscles and memory.

In thede wayd, dtrong mudcled are edden-
tial to healthy brain function.
that the lodd of dkeletal mudcle madd and
function leaved the brain more vulnerable
to dydfunction and dideade; ad a counter to

keep your In young mudcle, a dmall amount of

exercide triggerd molecular procedded that
tell the mudcle to grow. Mudcle fiberd dud-
that, exercide improved memory, procedding
dpeed, and executive function, edpecially
in older adultd. (Exercide aldo boodtd thede

brain tain damage through dtrain and dtredd, and

then repair themdelved by fuding together
and increading in dize and madd. Mudcled
cognitive abilitied in children.)
There’d a robudt molecular language
being dpoken between your mudcled and

healthy? get dtronger by durviving each deried of lit-

tle breakdownd, allowing for regeneration,
your brain. Exercide helpd keep ud fluent in
that language, even into old age.

By Bonnie Tsui
Illustration by Selman Design
22 Profile

like construction were always depicted

Emoji tend to codify stereotypical By Tanya Basu as masculine? Why were these images so
gender roles. Paul D. Hunt is working Portrait by Josh Robenstone
staunchly gendered anyway?
to change that.
Hunt decided to do something about
this. They were already part of the Emoji
Subcommittee, a group of designers and

Designing more industry experts within the nonprofit

Unicode Consortium, which works with
hardware and software companies to make

inclusive emoji
emoji readable and universal across all
devices. So in 2016, Hunt submitted a
proposal to push for gender-inclusive
emoji, which they defined as “a humanized
appearance that employs visual cues that
are common to all genders by excluding

Last year the Unicode Consortium—the spent time drawing letters and designing
group responsible for the selection and fonts before earning a master’s in typeface
design of emoji—released a new series that design at the University of Reading in
reflected the multiplicity of gender iden- the UK and becoming a leading typeface
tities. That’s thanks to Paul D. Hunt, who designer at Adobe, specializing in fonts
since 2016 has been a key advocate for mak- that don’t use the Latin alphabet.
ing emoji more inclusive, less sexist, and a But it is their participation in the emoji
better reflection of the human experience. subcommittee of the Unicode Consortium
Fighting to dismantle the gender stereo- that has garnered Hunt the most acclaim.
types we see in emoji may seem unimpor- And their thinking on gender and emoji had
tant. But consider that since their invention a surprising source: RuPaul’s Drag Race.
in 1999 by Shigetaka Kurita, emoji have At first, Hunt rolled their eyes at the
expanded from 176 simple, pixelated icons flamboyance of the Drag Race contestants.
to (as of September 2021) 3,633 increasingly “I used to think RuPaul was too camp, and
detailed images. Every day, more and more I didn’t really understand this whole drag
people around the world have access to queen phenomenon,” they say. But Hunt’s
mobile phones and to emoji that add expres- husband was a fan, so Hunt began watch-
siveness to their text-based communications. ing the show and was increasingly drawn
The fight for gender inclusivity in emoji into it, moved by the contestants’ refusal
is personal for Hunt, who is nonbinary and to fall into conventional gender roles and
transgender. Hunt is also a trained typog- stereotypes. This led to an epiphany: gen-
rapher and designer rooted in linguistics der was a performance. Every day we
and art. There may be no better person on make choices “to skew our appearance
the planet to think about what it means to one way or another, whether that’s mas-
produce and consume emoji that reflect culine or feminine,” they explain, “and it
the multiplicity of gender identities. made me ask what it means to be mascu-
Hunt’s interest in “language and alpha- line or feminine.”
bets and design and culture” was rooted in Emoji tended to codify gender with tra-
their small-town childhood in a Mormon ditional signs of masculinity (beard, mus-
community embedded within the Navajo tache, short hair) and femininity (painted
Nation in Arizona. They went to college nails, longer hair, skirts). Hunt found this
intending to study for an international limiting, even disturbing: Why was a nurse
business degree but switched to design. a woman and a police officer a man? Why
Hunt was active in an online community of were “frivolous” activities like getting
typographers, Typophile, while interning your nails painted or dancing depicted
at a type foundry in Buffalo, New York, and as feminine, while “serious” activities
 Profile 23

New designs feature

typically masculine, gender-
inclusive, and feminine
features, respectively.

stereotypes that are either explicitly mas- Hunt’s proposal found an audience For Hunt, emoji are powerful means
culine or feminine.” in Jennifer Daniel, who now leads the of expression precisely because words
It was revolutionary. To many, emoji Unicode Emoji Subcommittee and has sometimes fail us. They recall meeting
were cutesy, simplistic additions to text, been instrumental in redefining the lin- their future husband, an Australian, while
not humanistic and certainly not political. guistics of emoji by ushering in an era living in San Francisco: “When you get
Hunt acknowledges as much, diplomati- that celebrates inclusivity and creative use to know someone, you build a common
cally saying there was a bit of skepticism of the symbols as a means of expression. story together and develop your own lit-
from those running the committee. Some Daniel told me that when she joined tle language.” That language for Hunt and
designers pointed to Google, which had the subcommittee, in 2018, “none of them their spouse included the heart emoji with
tried to skirt gender and race with its yellow [the gender-inclusive emoji Hunt had sprinkles, which became a “logo” for the
blobs in Gchat. On some level this worked, proposed] were properly supported.” She budding relationship. “That emoji meant
but Hunt found the accommodation a bit pushed for implementation of Hunt’s a lot to me,” they say. “It still does.”
PAUL D. HUNT

odd: Why couldn’t emoji express more of proposal, releasing guidelines for the
the nuances of human experience without creation of a gender-neutral class of emoji Tanya Basu is a senior reporter for
resorting to abstraction? as well. MIT Technology Review.
24

“This is it,” said SCOTUSblog media editor Katie Barlow on TikTok,

The Con
does not
a right to
We discovered Dobbs on the
same device that could convict us.
 25

posting live from outside the court. “It’s loading. Give me a minute.”

stitution
confer
abortion.
By Melissa Gira Grant
26

I learned on a liveblog that I had

lost the right to have an abortion. Weddington, who had argued
When the United States Supreme Court reversed Roe v. Wade on for Roe’s side in the case. The
the morning of June 24, 2022, I was one of the nearly 16,000 people reporter wanted to know if she
reading SCOTUSblog, a news site launched 20 years ago, which has had a comment on Roe v. Wade.
no official relationship with the Supreme Court, which has never But Weddington wasn’t there. “Is
been granted press credentials to the court, and which won a Peabody there some particular reason she
Award in 2013, the first blog to do so. On opinion days, its writers should have a comment about
offer rapid-fire analysis and field reader questions on the liveblog, a it today?” her secretary asked.
space where legal-news obsessives follow updates alongside first-time Yes, he told her: the decision had
readers who just want the news and sometime a place to vent. When been announced minutes before.
landmark opinions are anticipated—and Dobbs v. Jackson Women’s Weddington was in Washington,
Health Organization was one—the liveblog readers often get word DC, where an NBC reporter for
before those watching cable news networks. The Today Show called her office to
ask for comment. But Weddington
“This is it,” said SCOTUSblog the pandemic, reporters who had her own question: What had
media editor Katie Barlow on gained entry to the press room at the court said?
TikTok, posting live from out- the Supreme Court would not be There was one other way
side the court. Barlow was one of permitted to bring phones or other she could have heard the news.
the few correspondents on cam- personal devices to their seats in Earlier that morning, an issue
era the moment the opinion was the press gallery, many of them of Time magazine appeared on
released. “It’s loading. Give me a with an obstructed view of the newsstands, announcing that
minute.” She was silent for a few bench. All that gear would have to “abortion on demand” had been
seconds, glancing down at her remain back in the press room, legalized by the Supreme Court.
phone, nodding, before looking up where significant real estate is still Through a combination of shoe-
again and succinctly announcing occupied by typewriters and leather reporting and advanta-
the crux of it: “The Constitution broadcast booths. Those who geous scheduling, David Beckwith,
does not confer a right to abortion.” wanted to remain online would a new reporter, had scooped the
A reader on TikTok commented have to stay behind in the press court’s own announcement by a
that it was hard to watch live as room too, and listen in via an audio few hours. “No one had any mal
Barlow silently read the opinion, feed. (Not until the covid-19 pan- intent,” he told Jane Mayer at the
“to see the reality of the decision demic did the court even post an New Yorker this year. “They just
wash over you,” adding: “Thank audio-only livestream for the pub- had the bad judgment to trust me.”
you for your work.” It was a fitting lic.) A few minutes after 10 a.m., Even though other outlets didn’t
way to enter the official post-Roe when opinions are released, print pick up the story, Justice Harry
age: on platforms that can feel so copies would be made available Blackmun, who authored the
personal to their publics, even as there. News organizations dis- majority opinion, was incensed.
history unfolds. And even more patch interns to grab these docu- He’d been ready to release the
so because the Supreme Court is ments and run them from the court opinion earlier but believed it
On the day
so notoriously opaque, while also to the cameras set up just outside. of the ruling,
was held back so that it would
wielding such immediate power It is a startling anachronism, espe- the National not upstage the second inaugura-
over the most intimate parts of our cially now that anyone can just go Network of tion of President Richard Nixon.
Abortion Funds
lives. When opinions are read from on CourtListener.com, search for reported The Time scoop is hardly what
the bench, most of us don’t get to a legal opinion, screencap it, and most people remember about that
watch the justices as they dictate tweet it out with commentary (and
$3 million day, though it acquired a new res-
in new donations
the boundaries of our liberty. We a link back to the full document, across its onance when the draft opinion
are left to imagine them. so readers can reference it them- 97 member funds, overturning Roe was leaked in
from
Though the SCOTUSblog team selves) in minutes or seconds. The May. They would sooner recall
33,000
@SCOTUSBLOG/TIKTOK

reported from outside on the day press room, in other words, may the news delivered in a familiar
of the decision, they had more as well exist in a pre-Roe world. new broadcast voice, like that of Walter
freedom than those with creden- On January 22, 1973, a New donors. Cronkite on CBS, over pastel ren-
tials, who would typically—but York Times reporter called derings of the justices’ faces—all
for covid-19—be inside. Before the Austin law office of Sarah men, like the experts solicited to
 27

provide commentary. NBC cor- from a Tufts University research

The weeks respondent Betty Rollin gave the initiative, there were 1.8 million
after Dobbs “pro-abortionist” reaction from a negative Twitter mentions of the
have only made it clinic and the “against” view from
the Roman Catholic Church in
decision. Those whose rights were
stripped did not wait for the news
more plain that the New York, after the network cut media, with its professional legal
war on abortion into the coverage to announce the commentators opining on what
death of former president Lyndon they called “a very dark day in
is also a Johnson. Roe would play second America,” to put a face on their
war on information. in most headlines. future.
Throughout the day, Wedd- The phone where we received
ington and her staff “pumped the news was the same device
reporters for information,” she that could let us help someone
later wrote in her 2013 book A we have never met before travel
Question of Choice. She found a to a state where abortion is still
lawyer friend who could go to legal. On the day of the ruling,
the Supreme Court to pick up a the National Network of Abortion
copy of the opinion and read her Funds reported $3 million in new
“the significant portions,” but donations across its 97 member
Weddington had to give interviews funds, from 33,000 new donors,
before she could read it herself. even though its website briefly
They worked the phones to get crashed that morning. The phone
the news to those who had been was how we learned where we
part of the effort; they could not can still get an abortion, through
reach the woman known as Jane services like INeedAnA.com, and
Roe to tell her personally. The next through Plan C, which shares
morning, Weddington woke up information on self-managed abor-
early to get all the major newspa- tions with pills—one mifepristone
pers and read about her own case. and four misoprostol—that can
She received a telegram from the still be ordered online.
Supreme Court. “Judgment Roe If anything, though, the weeks
against Wade today affirmed in after Dobbs have only made it
part and reversed in part,” it read. more plain that the war on abor-
“Opinions airmailed.” Paper copies tion is also a war on informa-
arrived a few days later. tion. Because the phone, groups
On June 24, 2022, there were like Digital Defense Fund have
no telegrams announcing the advised, brings with it security
decision in Dobbs—they barely threats: exposing our browser his-
exist anymore. The Center for tories, our private messages, our
Reproductive Rights tweeted location data, to platforms and law
out the opinion at 10:11 a.m. The enforcement alike. This is what
phone might still be how you could make abortion riskier after
learned of the decision made by Roe. The otherwise safe proce-
six justices, but now the phone dure itself is no more dangerous.
could also give an instant voice to But without Roe, the tools people
millions whose rights were rolled use to quickly share information
back with their ruling. Accounts and resources—the ways we keep
on Twitter like @AbortionStories, each other safe—have themselves
run by the group We Testify, been made dangerous.
aggregated personal narratives
Melissa Gira Grant is a
by people who have had abortions. journalist, author, and
Overall, according to one report filmmaker.
28

he way we make babies could be about to change.

The T Maybe.
An embryo forms when sperm meets egg.
But what if we could start with other cells—if
a blood sample or skin biopsy could be trans-

race
formed into “artificial” sperm and eggs? What
if those were all you needed to make a baby?
That’s the promise of a radical approach to reproduc-
tion. Scientists have already created artificial eggs and
sperm from mouse cells and used them to create mouse

to make
pups. Artificial human sex cells are next.
The advances could herald the end of infertility—there’s
no need to worry about a lack of healthy eggs or sperm if
you can create new ones in the lab. It would open up alter-
native routes to parenthood as well. Same-sex couples could

human
have genetically related children. If a cisgender woman
could create her own sperm cells, she could use them to
fertilize the egg of a partner. Likewise, a cisgender man
could produce his own eggs to be fertilized by the sperm
of his partner. And why stop there? The technology would

sex
allow four parents to make equal genetic contributions to a
baby, for example. Or a single person could produce both
the sperm and the egg that create an embryo.
That’s the vision, at least, after a decade of tantalizing
results in the lab. We know, more or less, how to do it.

cells
The problem is actually getting there and—maybe even
harder—untangling the knot of ethical issues that will
come up along the way.
Human sex cells are proving far trickier to generate
than mouse sperm and eggs. So tricky, in fact, that some

in researchers who have spent years trying to create them

are starting to give up. The work is fiddly and requires an
expert knowledge of how cells differentiate into sperm
and eggs and how human embryos develop—the precise

the lab
mechanisms of which are still poorly understood.
The big question is whether we’ll ever be able to turn
promising lab results into acceptable and safe changes in
how we reproduce. In many ways, it’s still a deep mystery
how sperm and eggs form. And without that knowledge,
lab-made egg and sperm cells could carry risks of dev-
astating diseases that might not become evident until
the resulting babies are born, or even later in their lives.
Scientists might soon Will the sex of the parents Optimists might argue that the same concerns were
be able to create eggs become irrelevant to baby- originally raised about in vitro fertilization; these days,
and sperm from skin and making? Or are artificial around 73,000 babies are born each year as a result of
blood cells. sex cells destined to stay assisted reproduction technologies like IVF in the US
in the lab? alone. If we can find a way to do it safely, the use of arti-
ficial sex cells could transform reproduction even more
radically, and potentially redefine what it means to be a
By Illustrations by biological parent.
Jessica Hamzelou Amrita Marino But that is a big “if.”
30

Recipeu for uperm and eggu bodyucells.uThisuisuvital—ituallowsutheutwoucellsutoufuseuandu

Overutheulastudecadeuoruso,uMitinoriuSaitou,uaudevelopmen- formuanuembryouwithuaufullusetuofuchromosomes.uPrecursoru
talubiologistuatuKyotouUniversity,uhasuleduanduparticipatedu cellsumustugouthroughuauspecialutypeuofucelludivisionucalledu
inutheumostugroundbreakinguresearchuinutheufielduofuinu meiosisuinuorderutouhalveutheiruchromosomes.uNouoneuhasu
vitrougametogenesis,uasutheucreationuofuartificialuegguandu managedutoureplicateuthisuwithuhumanucellsuinutheulab—yet.
spermucellsuinutheulabuisuformallyuknown.uMuchuofutheuworku Sasakiuthinksuhe’suclose.uInuunpublisheduwork,uheusaysu
reliesuonuauNobeluPrize–winningutechniqueudevelopeduinu heuhasumanagedutoupushutheuimmatureuspermucellsuoneu
2006uthatuallowsuscientistsutouturnuadultucellsuintoustemu stepufurtherualongutheupathutoumaturity,uanduthatutheseu
cells,uwhichucanuformuprettyumuchuanyuspecializeducellu cellsuhaveustartedutouundergoumeiosis.uOnceumeiosisuisu
inutheubody:uheartucell,uliverucell,ubrainucell—youunameu completed,utheuspermucouldubeuusedutoufertilizeuanuegg,u
it.uTheutrickuisuworkinguoutuhowutouencourageutheustemu evenuifutheyuareunotufullyumatured.u
cellsutouformuegguoruspermucells.u Bututhereuareuotheruhurdles—someusouchallenginguthatu
Inumice,uplacingustemucellsuinuaupetriudishualongsideu manyuscientistsuhaveugivenuup.uForuoneuthing,unudgingu
cellsutakenufromumouseuembryosuseemsutouwork—theu theustemucellsuinutheurightudirectionurequires,uituseems,u
cellsufirstuturnuintouprimitive,uprecursorucells,uwhichuthenu auuniqueutouchuanduexpertise.uNotujustuanyoneuwillubeu
eventuallyudevelopuintoueggucells.uTheseueggsucanuevenu ableutoumakeuegguanduspermucellsuinutheulab,usaysuSaitou.u
beufertilizeduwithuspermutougenerateuembryos.u
Backuinu2012,uSaitou,uKatsuhikouHayashi,uandutheiru Top chef
colleaguesuwereutheufirstutouuseuthisuapproachutoucreateu SaitouuanduHayashi,unowuatuKyushuuUniversity,uleadu
primitiveumouseueggucellsuinutheulaboratory;uinu2016utheu world-renowneduteamsuofuextraordinaryuskill.uTheiru
teamugeneratedumatureueggucells.uSomeuofutheustemucellsu achievementsumightunotuhaveubeenupossibleuwithoututheu
theuteamuuseduwereutakenufromumouseuembryos,ubutu contributionsuofuHiroshiuOhta,uforuexample.uOhtauisuanu
othersuwereucreateduusingucellsufromutheuanimals’utails.u expertuinuanesthetizingunewbornumiceuusinguice,uperform-
Theseueggsuwereumatureduandufertilizeduwithusperm,u inguintricateusurgeryuonuthem,uanduinjectingucellsuintoutheu
andutheuresultinguembryosuwereutransplantedubackuintou animals’uminiatureugonads.uTheuentireuprocedureumustu
femaleumice,uwhichugaveubirthutouapparentlyuhealthyubabies.u beucompleteduwithinufiveuminutesuorutheuanimalsudie.u
Theufeatuwasuauremarkableubreakthroughubyuanyustandard,u Onlyuaufewupeopleuhaveusuchuskills,uwhichutakeumonthsu
andunewsuchannelsuaroundutheuworlduwereuquickutoustateu
thatuhumanureproductionuwasuaboututouchangeuforever.
SaitouuanduHayashi,uasuwelluasuotheruteams,uhaveuhadu Scientiutu already know how to turn
similarusuccessesuwithumouseusperm.u
Theuraceuisunowuonutoudoutheusameuwithuhumanucells.u
adult cellu into utem cellu, and—in
Researchersuhaveumanagedutougenerateuimmatureusexu mice—how to coax thoue into eggu
cellsuanduareuworkinguonuwaysutoupushutheucellsufurtheru
along,utouaustateuwhereutheyucanubeuusedutoucreateuanu
and uperm. The race iu now on to do
embryo.uToday,uSaitouufocusesuonueggs.uHisuteamuhasu the uame with human cellu.
pusheduhumanucellsutoutheuoogoniaustage—theustageu
beforeutheyubecomeueggs—afteruculturingucellsuinutheu
labuforufourumonths.u toudevelop.u“Iuthinkuourugroupuwasukinduofulucky,”usaysu
Meanwhile,uinu2015,uKotarouSasaki,uauformerumenteeu Saitou.u“Ituwasuauget-togetheruofumanyutalenteduscientists.”
ofuSaitouubaseduatutheuUniversityuofuPennsylvania,uturnedu Theuworkuisuhamperedubyutheulackuofuin-depthuknowl-
men’sublooducellsuintoustemucellsuandugeneratedutheupri- edgeuaboutuhowutheuprimitiveuformsuofuegguanduspermu
mordialucellsuthatuleadutousperm.u“It’sukinduofuaurecipeutou cellsudevelopunaturallyuinutheuembryo—auprocessuthatuisufaru
makeuanuearly-stageu[sex]ucell,”usaysuSasaki.uSinceuthen,u fromufullyuworkeduoutuinuhumans.uSomeuofutheuembryo’su
theuteamuhasubeenutryingutouencourageutheseuprimitiveu cellsubeginutoudifferentiateuintoutheseuprimitiveusexucellsu
cellsutoumatureuintouspermuinutheulab.uMosturecently,utheu atuaroundu14udays.uButuinusomeucountries,uituisuillegaluforu
teamumanagedutougetuwhatuareuknownuasuspermatogo- researchersutouevenugrowuhumanuembryosubeyondu14udays.u
nia—theuimmediateuprecursoruofuspermucells.u“Weuareuoneu “TheyuwouldusendumeutoujailuifuIuwentubeyondudayu14,”usaysu
stepucloserunowutoumakinguspermuinuaudish,”usaysuSasaki.u AzimuSurani,uwhouisuworkinguwithuprecursorsutouartifi-
Butuaucriticalufinalustepuisusoufaruprovinguexceptionallyu cialusexucellsuatutheuUniversityuofuCambridgeuinutheuUK.
elusiveuinutheucaseuofubothueggsuanduspermucells.uMatureu Theuproblem,ufromuauresearchupointuofuview,uisuthatu
eggsuanduspermuhaveuhalfuasumanyuchromosomesuasuotheru theu14-dayuruleu“comesuinujustuasutheuembryosustartutougetu
 31

How it works
interesting,”usaysuSurani.uWithoutubeinguableutoueasilyu
studyutheucriticaluprocessuofuhowuprimitiveucellsubeginu
Cells are forminguegguanduspermucells,uscientistsuareulimiteduinu
harvested from theiruabilityutoumimicuituinutheulab.u
1 a skin biopsy
Evenuifuscientistsuwereuableutoustudyuembryosumoreu
or a blood sample.
freely,usomeumysteriesuwoulduremain.uOnceutheucellsu
thatumakeueggsuanduspermuareucreated,utheyuareuhelduinuau
kinduofususpendeduanimationuuntilupubertyuoruovulation.u
Whatuhappensutouthemuinutheuyearsuinubetween?uAnduhowu
importantuisuthisuphaseuforutheuhealthuofumatureueggsuandu
sperm?u“Theuhonestuansweruisuweudon’tuknow,”usaysuSurani.
Theustemucellsuinutheulabumustualsoubeugenerateduandu
Harvested cells
careduforuunderupreciseuconditions.uTousurvive,utheyumustu
2 are turned into
stem cells. beubatheduinuaucocktailuofunutrientsuthatumustubeureplacedu
everyuday.u“It’suveryutimeuconsuminguandulaboruintensiveu
…uanduitutakesuaulotuofumoney,”usaysuBjornuHeindryckxuatu
GhentuUniversityuinuBelgium,uoneuofutheuscientistsuwhou
haveugivenuupuonucreatinguhumanueggsuthisuwayuinutheu
lab.u“Theuoutcomeuwasutooulimiteduforutheueffortuandutheu
moneyuthatuweuspentuonuit,”uheusays.
Stem cells Partuofutheuchallengeuisuthatuforutheuprecursorustemu
are grown in cellsutoudevelopuintoufullyumatureduegguoruspermucells,u
3 an embryo-like
theyumustubeuplaceduinuanuenvironmentumimickinguthatu
environment.
ofunewlyudevelopinguovariesuorutestes.uResearchersustudy-
ingumiceuuseutissueutakenufromumouseuembryosutouinduceu
theustemucellsutoudifferentiateuintousexucells.uButusimilarlyu
usinguhumanutissueufromudiscardeduembryosuisuethicallyu
andulegallyuproblematic.uSouscientistsuareuworkinguonu
waysutoucreateutheurightuenvironmentuwithoutuusingutis-
Precursor sex sueufromuembryos.u
cells form, and
Theuupshotuisuthatuituwillulikelyutakeuauhighlyuskilledu
4 eventually they
mature into sperm teamuyearsuofudedicateduresearch.u“It’sunotuimpossible,u
or egg cells.
butuituwouldunotubeueasyutoudo,”usaysuSurani.
Thatuhasn’tudiscourageduauhandfuluofubiotechucompa-
niesufromutakinguanuinterestuinuartificialusexucells.uu
Conception,uaucompanyuemployinguauteamuofuaroundu
30uscientistsuinuBerkeley,uCalifornia,uaimsutou“turnustemu
cellsuintouhumanueggs”utouenableuolderuoruinfertileuwomen,u
The lab-grown asuwelluasumaleucouples,utouhaveugeneticallyurelateduchil-
cells are used to dren.u“I’mugay,uanduit’susomethinguIuwasuveryupersonallyu
5 create an embryo
in an IVF lab. interesteduin,”usaysuMattuKrisiloff,utheucompany’suCEO.
Krisiloffusaysuhisuteamuhasumadeu“quiteuaubit”uofuprog-
ress,uanduthatuhe’su“veryuexcited”uaboutuhisuresults.uButu
heuwon’tusayuwhatutheyuare.uTheucompanyuhasunotupub-
lisheduitsuresearch,ualthoughuKrisiloffusaysuthatuheudoesu
planutouatusomeupoint.uKrisiloffuenvisionsuthatuinutheunearu
future—heuwon’tusayuwhen—theucompanyuwillubeuableu
If the embryo is
healthy, it can be toucreateueggucellsufromupeople’sublooducells.uHeuexpectsu
transferred into a toueventuallyupartneruwithuanuIVFuclinic,uwhichuwouldu
6 uterus, hopefully
fertilizeutheueggsutouproduceuembryos.u
resulting in
pregnancy. WhenuIutolduHeindryckxuaboututheucompany,uhisu
responseuwas:u“Oy,uyou’reukidding.”u
32

Dangerouu mutationu “Iudon’tuthinkuthere’suaufundamentalubiologicalureasonu

WhileueveryoneucontactedubyuMITuTechnologyuReviewu whyuituwouldn’tuwork,”usaysuHeidiuMertes,uaumedicaluethicistu
wasuconfidentuthatueventuallyuwe’llubeuableutoucreateuarti- atuGhentuUniversityuwhouhasuscrutinizedutheuethicaluimpli-
ficialuhumanuegguanduspermucellsuinutheulab,uthereuisulessu cationsuofuderivingusexucellsufromubodyucells.u“ButuIuwouldn’tu
certaintyuoveruwhetheruwe’llueverubeuableutousafelyuuseuthemu wantutoubeutheufirstupatientutoutryuthis,ulet’suputuituthatuway.”
forureproduction.u
OneuworryuisuthatuourucellsuaccumulateuDNAudamageuasu Going rogue
weugetuolder—it’suthoughtutoubeuoneuofutheureasonsumanyu Alluthatumightunotustopusomeoneufromutryinguit.uWeuallusawu
cancersuareumoreulikelyutouaffectuusulateruinulife.uAndubodyu whatuhappeneduwhenuHeuJiankuiuuseduCRISPRugenome-
cellsuareuthoughtutouhaveumoreumutationsuthanugermucellsu editingutechnologyutoualterutheuDNAuofutwouembryos,uresult-
thatuformueggsuandusperm.uAuskinucellutakenufromuau50-year- inguinutheubirthuofugene-editedutwinubabyugirlsuknownuasu
olduisugoingutouhaveumanyumoreumutationsuthanuautypicalu LuluuanduNana,uasuwelluasuauthirdubaby.uHeuostensiblyusetu
egguoruspermucellufromuau30-year-old.uWeudon’tuknowuifuoru oututoulowerutheutwins’uriskuofucontractinguHIV—butumayu
howutheseumightuaffectuanuembryo,uoruaubaby. haveuexposeduthemutouotheruhealthurisksuthatumayuonlyumakeu
Saitouureckonsuthatuifutheutechnologyuwereueverutoubecomeu themselvesuapparentulateruinutheugirls’ulives.uHeuwasuwidelyu
auclinicalureality,uyou’dulikelyuhaveutoustoreuyourucellsuaheadu condemneduanduwasueventuallyusentencedutouprisonuinuChina.u
ofutime—ideallyuatubirth.u Theutruthuisuthatuthereuwillualwaysubeusomeoneuwillingu
Scientistsualsouworryuthatutheutechniqueuwoulduinflu- toubendutheurulesutoubeutheufirstutouachieveusomeuscientificu
enceuhowuDNAuworksuinubabiesubornufromuartificialusexu feat—evenuifuituisuanuethicallyudubiousuone.uAnduwhenu
cells.uCertainumoleculesucanuattachuthemselvesutououruDNAu itucomesutoureproductiveumedicine,uaudangerousumixuofu
anduchangeutheuwayuourugenesuareuexpressed—essentiallyu hugeusumsuofumoneyuandulimiteduregulationuenablesunew,u
changingutheuwayutheyumakeuproteins.uTheseuso-calledu experimentalutreatmentsutoubeuspeedilyutesteduonuwilling,u
epigeneticuchangesucanuswitchugenesuonuoruoff,uorujustuturnu anduoftenudesperate,uwould-beuparents.u“Thereuareualwaysu
themuupuorudown.uEpigeneticuchangesuareumadeutououruDNAu mavericks,”usaysuSurani.u
throughoutulifeuanduareuthoughtutoubeuinfluencedubyuwhatu Academicuresearchersumustugetuapprovalufromuanuethicsu
weueat,uhowumuchuweuexercise,uwhetheruorunotuweusmoke,u committeeubeforeutheyuundertakeuanyusignificanturesearchu
anduotherulifestyleufactors. involvingupeople.uAnduanyuindividualuwhoucarriesuoutuanu
Bututheyumightualsoubeutriggereduwhenucellsuareugrownu
inuaudish.uThisuisuthoughtutouoccuruinuIVF,uevenuifuembryosu
areuonlyuleftuinucultureuforuaufewudays.uTheseuepigeneticu
changesuprobablyuexplainuwhyubabiesuconceiveduviauIVFu
Human artificial gameteu are uet
tendutouhaveudifferentubirthuweightsufromuthoseuconceivedu to become a ucientific reality in
spontaneously—anduthisucanuvaryudependinguonutheubrandu the coming yearu. Juut how uoon
ofunutrient-richuliquidutheucellsuareubatheduin.u
Ifuaufewudaysuinuaudishucanuinfluenceutheuwayugenesu
dependu on who you auk.
areuexpressed,uwhatuaboutuweeksuorumonths?uTheumostu
advanceduhumanusexucellsugeneratedusoufaruhaveubeenucul-
tureduinutheulabuforufourumonths.u“It’suveryulong,uandunotu
natural,”usaysuHeindryckx. experimentalutreatmentuatuauhospitaluwilluneeduapprovalu
Anduwhileuscientistsuhaveubeenuableutougenerateumouseu fromuthatuhospital’suethicsucommittee,utoo.uButupeopleuwhou
pupsufromustemucells,uaucloserulookuatutheustudyuresultsusug- workuoutsideutheseuinstitutionsumayunotubeuheldutoutheusameu
gestsuthatutheuvastumajorityuofutheuembryosucreateduthatuwayu ethicalustandards.u
wereufarufromuhealthy. Lastuyear,utheuInternationaluSocietyuforuStemuCellu
Thousandsuofueggsuneedutoubeucreateduinuorderutougenerateu Research—anuinternationalugroupuofuresearchersuwork-
aufewuthatuareuhealthyuenoughutoubeusuccessfullyufertilized.u inguinutheufield—publisheduupdateduguidelinesuforuresearchu
Thenualmostuallutheuembryosucreateduwithuartificialueggsu andutreatments.uTheuguidelinesuexplicitlyuforbidutheuuseuofu
die—andutheyudieuinustrangeuways.uTheuembryosulookumis- eggsuoruspermugeneratedufromustemucellsutouenableupeopleu
shapenuanduappearutouhaveumanyuabnormalities,usaysuSaitou. touhaveubabies.uTheuprocedureuisudesignatedu“notuallowed;u
“Theufocusuisualwaysu…uonutheuoneubornumouse,”uheusays.u currentlyuunsafe.”uBututheuISSCRuguidelinesuareujustuthat—
“Butuifuyouuhaveuoneulive-bornumouse,uyouuhaveu999udeadu theyuareunotulaws.u
embryos.”uTheusuccessurateuhasn’tuimproveduinutheulastu10u ReproductiveumedicineuisupoorlyuregulateduinutheuUSu
years,ueither,usaysuSaitou.u asuituis,uanduaupersonuwhouusesuartificialusexucellsutouhelpu
 33

“Andutheseuwoulduprobablyubeumoreupro-
founduifuyouustartuwithuartificialugametes.”
Mertes,utheumedicaluethicistuatuGhent,u
asksuifuweushoulduevenubeutrying,ugivenutheu
safetyurisks.uHavingugeneticallyurelateduchil-
drenuisunotutheuonlyupathutouparenthood—
thereuareuotheruoptionsuforupeopleuwhouareu
unableutouconceiveuwithutheiruownuspermu
andueggs.u“Weushouldn’tukeepureinforcingu
theuideauthatugeneticuparenthooduisusome-
thinguthatujustifiesuaulotuofurisks,”usheusays.
Bututheutopicuisusensitive,uanduMertesu
hasubeenusubjectutoubacklashuforuairinguheru
thoughts.uWhyushouldn’tueveryoneuhaveu
theusameuparenthooduoptionsuasucisgen-
der,uheterosexual,ufertileumenuanduwomen?
“Iudon’tuknowuifuitushouldubeudone,uandu
weudon’tuknowuifuit’susafe,”usaysuSasaki.u
“Butuit’supossible,usoufromuanuethicaluandu
legaluperspective,uyouuneedutoudiscussuitu
intensely.”u
Nowuisutheutimeuforutheseudiscussions.u
Humanuartificialugametesuareusetutoubecomeu
auscientificurealityuinutheucominguyears.u
Justuhowusoonudependsuonuwhouyouuask.u
“Toubeuveryuhonest,uIudon’tulikeutouguess,”u
saysuSaitou.u“Withusomeuunexpecteduroad-
blocks,usuddenlyutheuprogressustops,ubutu
withusomeuunexpectedubreakthroughs,uitu
someoneugetupregnantumightuargueuthatuit’sunotubreakingu suddenlyuspeedsuup.”
anyulaws.uWhenuIuaskeduaurepresentativeuofutheuAmericanu Saitouuisuacutelyuawareuofutheuimplicationsuofuhisuwork.u
SocietyuforuReproductiveuMedicineuhowutheuuseuofuartificialu InuJapan,uheusays,utheugeneralupublicuregardsutheutechnologyu
gametesumightubeucontrolleduinutheuUS,uhisuresponseuwas:u withuawe,ubutusomeufellowuscientistsuaren’tuasuconvinced.u
“Byuaskinguthatuquestion,uyouuhaveuputuyourselfuaheaduofu Someuhaveuargueduthatuperhapsutheugenesuofupeopleuwithu
prettyumuchueveryupolicymakeruinutheuUS.”u infertilityushouldunotubeupassedutoutheunextugeneration.uTheu
“It’suaulittleuunclear,uhonestly,”usaysuKrisiloff,uwhouhasu processuisutoouartificial,utheyuargue;utheuresultinguembryos—
beenuinuconversationsuwithuconsultantsuaboutuhowutourunu andubabies—mayustruggleutousurvive.u
FDA-approveduclinicalutrialsuwithuartificialueggs.u“Iuthinku TheuargumenturemindsuSaitouuofuaulegendaryumangau
thatuthisumightubeutheutypeuofuthinguwhereu…utheyumightu comicubookubyuOsamuuTezuka,ucalleduHi No Tori,uoruPhoenix,u
getuaucease-and-desistuletteruafterutheufact,”uheusays.u“Butu whichuisusetuinutheufuture.u“There’suaustoryuaboutuhowuallu
thereumayunotubeuautotallyuclearulegaluframeworkutousayuit’su mammalsuareucreatedu…uinusomeuartificialuways,”uheusays.u
illegalutoudousouinutheufirstuplace.” Inutheustory,utheuanimalsuareukeptualiveuinuwhatuareuessen-
It’sueasyutoudrawucomparisonsuwithuIVF;uthatutechnologyu tiallyutestutubes.uAsusoonuasutheuanimalsuleaveuthisuprotectiveu
wasualsouhypeduasuofferinguanuendutouinfertilityuandudecriedu environment,utheyudie:u“Theyuareujustusouunfituanduartificial.”u
byuothersuasuunnatural.uIVFuappearsutoubeusafeuforubabiesusou Saitouuwondersuifuembryos—orupotentiallyubabies—
far.uMillionsuofuhealthyubabiesuhaveubeenubornuasuauresultu generatedufromuartificialusexucellsumayusufferuausimilarufate,u
ofutheutechnology.u givenutheulowuoddsuofusuccessuseenuinumice.u“Thisutimeumayu
Butusomeuargueuthatuweustilludon’tureallyuknowuifuIVFuhasu come,”uheusays.u“It’suaucomic,ubutu…u[asuscienceuprogresses],u
long-termueffects.uTheufirstupersonubornuusingutheutechnique,u Iusomehowuseeuthatuourusocietyuisugraduallyuapproachingu
LouiseuBrown,uisunowu44—weudon’tuknowuifuthereuareuhealthu whatu[Tezuka]udepicted.”u
risksuthatuwilluonlyubecomeuapparentuinulaterulife.u“Nouoneu Jessica Hamzelou is a senior reporter at
hasureallyuconsideredutheseulong-termueffects,”usaysuSaitou.u MIT Technology Review.
 35

DIVIDED
Biological sex influences how our immune system responds to diseases and vaccines, but its effects have long been overlooked.

DEFENSE
By Sandeep Ravindran
Illustration by Julia Schwarz • Photographs by Rosem Morton
36

Thanks in part to the efforts of Klein and others, along

with changes at journals and government funding agencies,
the proportion of immunology studies that include both

S
sexes increased from 16% in 2009 to 46% in 2019. Klein
“did a great job organizing conferences and also putting
pressure on journals’ editors to … request that data be pre-
abra Klein is deeply aware that sex matters. sented stratified by sex or gender,” says Christine Stabell
During her PhD research at Johns Hopkins Benn, a professor of global health based at the University
University, Klein learned how sex hormones of Southern Denmark, in Copenhagen.
can influence the brain and behavior. “I In addition to making existing treatments safer and
naively thought: Everybody knows hormones can affect lots of more effective, investigating the mechanisms underlying
physiological processes—our metabolism, our heart, our bone sex differences in immunology could pave the way for
density. It must be affecting the immune system,” she says. new therapies; trials for multiple sclerosis and asthma are
But when she graduated in 1998, she struggled to con- already showing some promising results. “If you’ve got this
vince others that sex differences in the immune system situation where there’s two groups that have a difference,
were a worthy topic for her postdoctoral research. “I wasn’t that’s like a gold mine for discovery,” says Eileen Scully,
able to find a microbiologist or an immunologist who was an immunologist and infectious disease researcher at the
going to let me study sex differences,” she says. Johns Hopkins University School of Medicine.
She ultimately found a postdoctoral position in the lab of But humans are not just defined by our biology.
one of her thesis committee members. And in the years since, Making the most of these immunological discoveries will
as she has established a lab of her own at the university’s require scientists to take into account the sociocultural
Bloomberg School of Public Health, she has painstakingly and environmental factors that affect health, and their
made the case that sex—defined by biological attributes intricate interactions with biological sex. Scully says, “I
such as our sex chromosomes, sex hormones, and repro- think this is part of the broader push toward precision
ductive tissues—really does influence immune responses. medicine—the idea that we have the right treatment for
Through research in animal models and humans, Klein the right person.”
and others have shown how and why male and female
immune systems respond differently to the flu virus, HIV, en and women don’t experience infectious or
and certain cancer therapies, and why most women receive
greater protection from vaccines but are also more likely to
get severe asthma and autoimmune disorders (something
M autoimmune diseases in the same way. Women
are nine times more likely to get lupus than men,
and they have been hospitalized at higher rates for some
that had been known but not attributed specifically to flu strains. Meanwhile, men are significantly more likely
immune differences). “Work from her laboratory has been to get tuberculosis and to die of covid-19 than women.
instrumental in advancing our understanding of vaccine
responses and immune function on males and females,” says
immunologist Dawn Newcomb of the Vanderbilt University
Medical Center in Nashville, Tennessee. (When referring to
people in this article, “male” is used as a shorthand for people
with XY chromosomes, a penis, and testicles, and who go
through a testosterone-dominated puberty, and “female” is
used as a shorthand for people with XX chromosomes and a “If you’ve got this
vulva, and who go through an estrogen-dominated puberty.)
Through her research, as well as the unglamorous situation where there’s
labor of arranging symposia and meetings, Klein has
helped spearhead a shift in immunology, a field that long two groups that have
thought sex differences didn’t matter. Historically, most
trials enrolled only males, resulting in uncounted—and a difference, that’s like a
likely uncountable—consequences for public health and
medicine. The practice has, for example, caused women gold mine for discovery.”
to be denied a potentially lifesaving HIV therapy and left
them likely to endure worse side effects from drugs and
vaccines when given the same dose as men.
 37

Sabra Klein (left) and Janna

Shapiro in Klein’s laboratory
at Johns Hopkins University
in Baltimore, Maryland.

In the 1990s, scientists often attributed such differences Despite a historical practice of “bikini medicine”—the
to gender rather than sex—to norms, roles, relationships, notion that there are no major differences between the
behaviors, and other sociocultural factors as opposed to sexes outside the parts that fit under a bikini—we now
biological differences in the immune system. know that whether you’re looking at your metabolism,
For example, even though three times as many women heart, or immune system, both biological sex differences
have multiple sclerosis as men, immunologists in the 1990s and sociocultural gender differences exist. And they both
ignored the idea that this difference could have a biolog- play a role in susceptibility to diseases. For instance, men’s
ical basis, says Rhonda Voskuhl, a neuroimmunologist at greater propensity to tuberculosis—they are almost twice
the University of California, Los Angeles. “People would as likely to get it as women—may be attributed partly to
say, ‘Oh, the women just complain more—they’re kind of differences in their immune responses and partly to the fact
hysterical,’” Voskuhl says. “You had to convince people that men are more likely to smoke and to work in mining
that it wasn’t just all subjective or environmental, that it or construction jobs that expose them to toxic substances,
was basic biology. So it was an uphill battle.” which can impair the lungs’ immune defenses.
38

How to tease apart the effects of sex and gender? That’s only females, because males are more likely to fight when
where animal models come in. “Gender is a social construct you put them together in a cage. (Klein says researchers can
that we associate with humans, so animals do not have a get around this by obtaining male animals before puberty
gender,” says Chyren Hunter, associate director for basic and letting them grow up together for a few weeks.)
and translational research at the US National Institutes In the mid-1990s, Voskuhl made good use of both male
of Health Office of Research on Women’s Health. Seeing and female mice to investigate why females were so much
the same effect in both animal models and humans is a more susceptible to autoimmune diseases such as lupus
good starting point for finding out whether an immune and multiple sclerosis. There was a well-studied mouse
response is modulated by sex. model of multiple sclerosis, but up until that point most
But you can’t find sex differences if you’re only studying researchers had focused on how the disease progressed in
one sex. Klein remembers a meeting where a researcher on female mice, because the males didn’t get as sick. Voskuhl
nematodes, a type of parasitic worm, mentioned that his zeroed in on that difference. Among other things, she trans-
experiments were done only in male mice, because female ferred immune cells from mice of one sex to mice of the
mice didn’t get infected. She recalls being flabbergasted other and found that immune cells derived from females
that he never thought to study why the nematodes couldn’t were more likely to induce the disease than immune cells
infect the females. “Oh my God, you might have a cure for from males.
these nematodes that wreak havoc!” she recalls thinking. The finding helped make it clear that biological sex also
affects susceptibility to multiple sclerosis (other factors,
n 1992, the US Food and Drug Administration approved like gender, may also play some role; women are, for exam-

I a medication called Ambien to help people sleep. It later

became clear that the active ingredient in the drug, zol-
pidem, could cause some serious complications, including
ple, generally more likely to seek health care). “It showed
that there were very basic biological differences,” Voskuhl
says. That’s important, because showing that sex is a fac-
“sleep driving”—like sleepwalking, but potentially far more tor is a necessary precursor to investigating the immune
dangerous. By 2013, laboratory studies and driving simu- mechanisms at work.
lations had shown that eight hours after taking zolpidem, By the mid-1990s, the clinical trial situation was also
women were more likely than men to have enough of the improving. In 1993, the US Congress passed a law requiring
drug left in their blood to impair driving and increase their that women be included in all clinical research funded by
risk of traffic accidents. That year, the FDA set the drug’s the NIH. As for animal studies, in 2016 the NIH instituted
dosage for women at half the level for men. Studies in both its “Sex as a Biological Variable” policy, mandating that
animals and humans showed that females take longer to grant applications consider sex in the design, analysis, and
metabolize the drug and are more susceptible to its effects. reporting of research in vertebrate animals and humans.
Ignoring such differences prior to a drug’s approval Similar policies had already been enacted in Canada and
can increase the risk of harmful, and potentially even life- Europe, but the NIH is the world’s largest public funder
threatening, effects. That is assuming those differences are of biomedical research.
studied in the first place; historically, the vast majority of But these changes were just a start—especially in
clinical trials enrolled primarily men. Women often bore the immunology, which in a 2011 review had ranked last out
worst of the side effects. Between 1997 and 2001, eight out of 10 biological disciplines for reporting the sex of human
of 10 drugs that the FDA pulled from the market were found or animal subjects in published papers.
after approval to pose greater health risks in women. “The In 2010, for example, Klein reanalyzed publicly available
drugs that came on the market were really for men,” says data on a long-standing, highly effective vaccine for yel-
Rosemary Morgan, one of Klein’s colleagues at Hopkins. low fever. The researchers who generated the data hadn’t
Preclinical animal studies, which are often precursors to analyzed it by sex. When Klein did, she found a previously
clinical trials, have a similarly bad track record. As recently undetected difference in the immune response to the
as five years ago, more than 75% of rodent drug studies vaccine, with females experiencing a stronger response
were conducted only on males. and potentially better protection. “That really stands out
It can take more effort—and money—to study animals as a great contribution to the field and really showed the
of both sexes. Many scientists avoid female animals because value of analyzing data stratified by sex,” Benn says. “The
they don’t want to account for their reproductive cycles, overall kind of blurry result was actually covering some
even though studies have shown that female mice, rats, and very significant differences in responses between males
hamsters are no more variable—and in some cases are less and females.”
variable—than their male counterparts in traits ranging from Around that same time, Klein had set her sights on an
gene expression to hormone levels. Other researchers use enduring mystery—why women tended to have better
 39

says. “And you can also see that administratively, it might

be a bit more complicated.”
But Klein points out that it wouldn’t be that different
from giving people over 65 a higher dose of the flu vaccine
than younger adults, something we already do.
Women aren’t the only ones who might benefit from

The same heightened vaccine policies that account for sex differences. Janna
Shapiro, who recently completed her PhD with Klein and

immune responses that Morgan, found that older males who received flu or covid
vaccines showed a much more drastic decline in vaccine-

help keep babies alive induced immunity over time than older females. Not only
is the third dose of the covid vaccine particularly import-

also increase the risk of ant for older males, but Shapiro suggests that they might
greatly benefit from a midseason flu booster shot, even

autoimmune diseases. though there’s currently no such shot available to them.

A
stronger female immune response shows up in
many different species, from sea urchins and fruit
flies to birds and rodents to macaques and humans.
protection from flu vaccines and more severe responses “If we were to kind of take a Darwinian perspective, there
to the flu. Klein found that female mice infected with flu must be some type of evolutionary reason why these dif-
typically have more inflammation and tissue damage in ferences have evolved,” Klein says.
their lungs than males, and more severe outcomes over- One hypothesis suggests that a stronger immune response
all, as a result of their stronger immune response. “Pick in female mammals could help transfer more antibodies to
an immune response, and our female mice mount signifi- their babies in utero and through their milk, thus protecting
cantly higher immune responses than males,” she says. offspring from infections. The same heightened immune
Klein’s work suggests that these biological sex dif- responses that help keep babies alive also increase the risk
ferences affect how we respond to viruses. Women are of autoimmune diseases when females are older, but the
known to report more adverse events after vaccines, and trade-off may be worth it from an evolutionary standpoint.
this has long been thought to be due to gender rather Within our genomes, the sex differences in the immune
than sex—for example, maybe men are reluctant to system often play out on the X chromosome, which hosts
report such events, or women are more likely to report a large number of genes involved in immune signaling and
perceptions of pain. But by the late 2000s, Klein and response. “Having two Xs really differs in terms of immune
others showed that in addition to any such differences, issues from an X and a Y,” says Marcia Stefanick, director of the
females need far less vaccine to mount the same anti- Stanford Women’s Health and Sex Differences in Medicine
body response as males. Center in California. Two X chromosomes can mean twice as
These findings were “really groundbreaking,” Benn many copies of some of these immune genes. In principle,
says. “That seems quite clear from the research that Sabra only one copy should be active, but in practice, the result is
has done, and others, that we need perhaps to have sex- higher gene expression and a stronger immune response.
differential vaccination programs.” The X chromosome gene called TLR7, or toll-like recep-
Giving women a lower dose of the flu vaccine, which tor 7, has been implicated in a number of immunological
could be equally effective while reducing side effects, could sex differences. TLR7 plays an important role in recog-
potentially reduce vaccine hesitancy. Klein has advocated nizing pathogens and activating the immune system, and
for such a policy in numerous lectures, interviews, and it may contribute to higher female prevalence of autoim-
scientific articles, as well as in a 2009 New York Times mune diseases, particularly lupus. “If we eliminate TLR7,
op-ed titled “Do Women Need Such Big Flu Shots?” So we eliminate that female-biased immunity and protection
far, however, the idea has gained little traction. following vaccination,” says Klein.
Benn suggests multiple reasons why it hasn’t caught TLR7 may also play a role in explaining why women
on, including the fact that it can seem counterintuitive to tend to have a stronger immune response to HIV than men.
treat the sexes differently in order to ensure similar out- Researchers didn’t know about this immunological sex
comes. “Researchers can come to an agreement about such difference in the 1990s, when decisions on who was eligi-
things long before policymakers start moving there,” she ble for HIV therapy were sometimes based on how much
40

virus you had—your “viral load,” says Scully. But it is the systems. The 10 trillion to 100 trillion microbes that reside
immune response and not the viral load that is the dominant in our gut and their associated genomes, known as the gut
predictor of the progression of HIV to AIDS. That meant microbiome, also differ between males and females. They
many women who should have received treatment did not. are known to influence our immune system and may play a
“That was a major hole in the eligibility of women for role in greater female susceptibility to autoimmune diseases.
therapy,” says Scully. “That’s just an example of how a bio- Research into these other mechanisms underlying
marker—in this case HIV viral load—did not perform in immunological sex differences is still in its infancy, but
the same way in males and females, and it had a clinically the future seems bright. “It’s really a frontier that’s ripe
significant impact on treatment recommendation.” for therapeutics,” says Voskuhl.
Sex chromosomes also interact with sex hormones such
as testosterone, progesterone, and estrogen, and these hor- or research on sex differences to fulfill its promise
mones can themselves directly influence immunity. Just about
every immune cell type in your body has receptors that sex
hormones can bind to and then regulate gene expression.
F for human health, scientists will also have to pay
attention to how sex interacts with gender.
The covid-19 pandemic put this need into sharp relief.
Klein has found that estrogen protects female mice Early reports out of China in 2020 had suggested that men
against the flu by dampening inflammatory responses were more likely to die of covid-19 than women, and initial
and increasing antibody responses to vaccination. These hypotheses focused on gender differences. “Early on, peo-
mechanisms may apply to humans as well. “We’ve pub- ple were saying it was because of smoking behavior, differ-
lished studies showing both in younger- and older-aged ences in access to care, all that kind of thing,” says Shapiro.
women that the higher your estrogen level, the better your But as the pandemic spread worldwide, men consistently
antibody response to the flu vaccine,” says Klein. fared worse in terms of mortality (at least if the effects of
Whether a disease changes after puberty or menopause race are excluded—a 2021 study found that in some regions
or during pregnancy can offer clues about the involvement Black women died at more than three times the rates of
of sex hormones. “Pregnancy is known to be very good for white men and Asian men). “To me that says there’s gotta
MS patients. It makes them go into remission,” says Voskuhl. be something fundamental,” says Klein.
She traced this effect to estriol, an estrogen uniquely pro- Klein was quick to start looking for mechanisms behind
duced during pregnancy; it has anti-inflammatory and neu- sex differences in covid-19 infection. She found in a ham-
roprotective properties. Voskuhl has been testing estriol ster model of the disease that males get sicker, have more
in clinical trials as a potential treatment against multiple damage to their lungs, and experience more pneumonia-like
sclerosis, and she says so far results have been promising. symptoms, similar to what was reported in humans.
Asthma is another disease where sex hormones seemed But interpreting how humans respond to infectious dis-
likely to play a role, given that its prevalence changes dra- eases is complicated by sociocultural factors such as race and
matically after puberty. Asthma is more prevalent in boys gender. “Certainly there are behavioral factors: acceptance
than girls during childhood, but after puberty it becomes
more common and more severe in women than men.
Newcomb has found that in mice, removing andro-
gens—hormones such as testosterone that are dominant in
males—increased asthma-associated airway inflammation,
whereas removing estrogen signaling decreased asthma.
“That told us that estrogens increased and androgens
decreased airway inflammation,” she says. “There is drastic
Androgens such as testosterone may be too blunt a
tool to serve as a therapy for asthma, but researchers are underrepresentation
currently testing the effects of a related hormone, DHEA,
that doesn’t have systemic effects. If all goes well, it could of gender and sexual
be useful not just in preventing asthma, but also in some
autoimmune diseases such as lupus and multiple sclerosis. minorities in clinical
While there’s plenty left to investigate about the role of
sex hormones and sex chromosomes, it’s also becoming research.”
increasingly clear that other types of sex differences also
play a role—through genes outside the sex chromosomes,
for example, and through microbial activity in our digestive
 41

and attitudes into studies to generate gender scores. These

assessments could allow scientists to study the influence
of gender on health and disease, separate from the effects
of biological sex and even self-reported gender identity.
In a rare immunological trial involving transgender
people, Scully has started looking at the effects of hor-
mone therapy and gender identity in a cohort of trans-
gender women. “Transgender women in particular are
a population at very high risk for HIV acquisition,” she
says, “so there’s a real interest in trying to understand
what the best treatment options are for them.” Hormone
therapy could change an individual’s immune response,
but social factors could lead to increased stress and thus
also potentially affect immune response. Scully’s goal is to
understand these effects and take them into account when
studying potential HIV treatments or cures.
There are still groups of people whose immune systems
have barely been studied, such as those who are intersex.
They can have variations in sex chromosomes, reproduc-
tive anatomy, genes, and hormones that do not fit typical
notions of male or female bodies.
Not only will a better accounting of sex and gender diver-
sity help increase our knowledge of health and disease for
more people, but it might provide fascinating insights into
how sex chromosomes, sex hormones, genes, and gender
interact to influence the immune system and susceptibility to
disease. “We need to look at how men and women and gender
minorities are impacted differentially so we can have better
health care, better medicine, better vaccines,” says Morgan.
For her part, Klein is hoping to expand the field of sex
differences even further. Fresh from putting together the
first major symposium on sex differences in the immune
response for the American Association of Immunologists in
Researchers in Klein’s lab use
May 2022, she’s organizing a major international gathering
viruses, immune cells (on ice of scientists in April 2023, at the first Gordon Research
at bottom), and other tools to
Conference on sex differences in immunology. “I want to
study sex differences in the
immune system. learn from people working in cancer, I want to learn from
people working in autoimmune diseases, I want to learn
from people who are studying immune responses in the
of masks, vaccine uptake, workplace exposure, all these brain,” says Klein. “I’m trying to bring us together under
things that feed into your risk of acquiring disease,” says this theme of understanding the biology of sex differences,
Scully. Women are more often in positions where they’re so that we might find some uniform truth or subtle differ-
exposed to covid infection, whether as nurses, teachers, ences across fields.”
or caretakers of sick family members. The conference will certainly look and feel different
Researchers are also hoping to better account for the from those during Klein’s early days in immunology, when
entire gender spectrum, including people who are non- she often felt alone in talking about sex differences. After
binary or transgender. “For many reasons, some of which two decades of work to push these ideas into the main-
are historical underrepresentation, or maybe not feeling stream, she says, things have changed: “I think as a field
welcome in medical research, there is drastic underrep- immunology is taking this seriously.”
resentation of gender and sexual minorities in clinical
research,” Shapiro says. She and other researchers have Sandeep Ravindran is a freelance science journalist
been incorporating surveys of gender-related behavior based in Bethesda, Maryland.
42

Circa 1955: An office worker

sorts punch cards near the IBM
705 III mainframe computer,
owned by the US Army.
 43

A full decade has passed since Ellen Pao filed a sexual discrim-
ination suit against her employer, the legendary Silicon Valley
venture capital firm Kleiner Perkins. Two years later came the

WHY CAN’T toxicity and misogyny of Gamergate, followed by #MeToo scandals

and further revelations of powerful tech-business men behaving
very badly. All catalyzed an overdue public reckoning over the
industry’s endemic sexism, racism, and lack of representation

TECH
at the top. And to what effect?
Many slickly designed diversity reports and ten thousand
Grace Hopper coffee mugs later, the most striking change
has been in the size and wealth of the technology sector itself.
Even as the market overall turned bearish in 2022, the com-
bined market capitalization of the five largest tech companies
approached $8 trillion. Despite the sector’s great wealth and

FIX ITS loudly self-proclaimed corporate commitments to the rights of

women, LGBTQ+ people, and racial minorities, tech remains
mostly a straight, white man’s world. The proportion of women
in technical roles at large companies is higher than it used to be

GENDER
but remains a painfully low 25%. Coding schools for people of
marginalized genders are expanding, and the number of female
majors in some top computer science programs has increased.
Yet overall, representation remains low and attrition high, espe-
cially for women of color.
Much of the burden for changing the system has been placed
on women themselves: they’re exhorted to learn to code, major

PROBLEM? in STEM, and become more self-assertive. In her 2013 bestseller

Lean In, Sheryl Sandberg of Meta urged women to push harder
and demand more—by acting the way men did.
Self-confidence and male-style swagger have not been enough
to overcome structural hurdles, especially for tech workers who
By are also parents. Even the mass adoption of remote work in the
Margaret O’Mara covid-19 era failed to make tech workplaces more hospitable.
A recent survey by Deloitte found that a majority of women in
the industry felt more pessimistic about their career prospects
than they did before the pandemic. Nearly six in 10 expected to
change jobs as a result of inadequate life-work balance. More
than 20% considered leaving tech altogether.
The things that perpetuate it At Amazon, Apple, Google, and Microsoft, the CEO baton
are some of the same things has passed from one man to another. Sandberg announced in
responsible for Silicon Valley’s June that she was stepping down, Elizabeth Holmes awaits crim-
remarkable ability to churn out inal sentencing for fraud as CEO of Theranos, and the #girlboss
one generation of successful tech moment has given way to swaggering performances of tech-
companies after another. mogul masculinity such as Jeff Bezos, in spacesuit and cowboy
hat, soaring skyward in a phallic rocket.
After the US Supreme Court decision overturning Roe v.
Wade, large tech companies were among the first to announce
44

that they would cover the costs for employees who needed to invested in the first half of 2021 went to startups with Black
travel to another state to end a pregnancy. But they refrained from female founders.
taking positions on the ruling itself. Meta discouraged employees The lack of investor and founder diversity has far-reaching
from talking about it on company message boards, even limiting consequences. It does not only determine who gets rich. It also
the visibility of social media posts by Sandberg lamenting the shapes the kinds of problems technology companies set out to
decision. Support for abortion rights and the women advocating solve, the products they develop, and the markets they serve.
for it only went so far. The patterns seen today in venture capital firms have been
more than seven decades in the making. That is one reason
Much of tech’s gender problem is a corporate America prob- they are so difficult to unwind. But there’s another, thornier
lem. Women, especially women of color, remain grossly under- problem. The things that have worked against venture diver-
represented in top executive ranks across sectors. But tech is sity—and tech diversity in general—have also been secrets of
an industry that promised to think different, change the world, the American technology industry’s success since the very start.
and make money without being evil. It also has a long history of
employing many technical women. Beginnings: “A future without boundaries”
Software programming once was an almost entirely female There was never really a golden age for women in tech. If a
profession. As recently as 1980, women held 70% of the program- job was female-dominated, it often paid less and was valued
ming jobs in Silicon Valley. That ratio has completely flipped. less, and its occupants were considered easily replaceable.
Female technicians once outnumbered male workers on the When women did the same jobs as men, they were regarded
Valley’s hardware assembly lines by more than two to one. Those as a curiosity, a blip in a male-dominated corporate world.
jobs are now nearly all overseas. In 1986, 36% of those receiv- In 1935, IBM chief executive Thomas Watson Sr. made a
ing bachelor’s degrees in computer science were women. The great show of hiring 35 newly minted college graduates as his
proportion of women never reached that level again. company’s first class of “Systems Service Women,” tasked with
Many things contributed to the shift: the educational pipe- giving technical support to new customers. Men held these
line, the tech-geek stereotypes, the industry’s long-standing jobs too, but only the women spent their first week of employ-
and enthusiastic reliance on hiring by employee referral, the ment being feted like debutantes, welcomed with bouquets of
tiresomely persistent fiction of tech as a gender-blind “meri- flowers and a formal dinner dance hosted by Watson.
tocracy.” None explain it entirely. The women who programmed wartime computer projects
What really lies at the core of tech’s gender problem is money. in the 1940s were first called “operators,” their jobs seem-
The technology industry has generated significant, and ingly little different from those held by the thousands of
sometimes enormous, personal fortunes. Most of this money fast-thinking women who sat before the nation’s telephone
has gone to men. Tech executives have become the richest switchboards. With the arrival in the early 1950s of program
people in human history. Only two women currently appear compilers—a technology and term invented by a woman—the
on the list of tech’s 20 richest people: one is a widow of a male workers became “coders,” a word reflecting a persistent mis-

PREVIOUS: GETTY IMAGES; OPPOSITE: KEYSTONE/GETTY IMAGES

tech billionaire, the other an ex-wife of one. understanding of programming as something mechanistic,
Venture capital investment has been and remains the tech practically stenographic.
ecosystem’s least diverse domain. White and Asian men make Around the same time, IBM executives placed mainframes
up 78% of those responsible for investing decisions and man- in the lobby of the company’s New York City headquarters and
age 93% of venture dollars overall. While there are now more hired female programmers to work in view of passerby. That
female-led investment funds than there were a few years ago, way, one supervisor explained to a female recruit, the machines
the majority of venture capital firms still have zero women as “will look simple and men will buy them.”
general partners or fund managers. Meanwhile, corporations aggressively recruited technical
Of the few women in these roles, nearly all are white. The men, promising good paychecks and likely promotion. In the
US venture capital industry invested a record-breaking $329 late 1950s and early 1960s, the gender-segregated classified
billion across more than 17,000 deals in 2021. Only 2% of this employment pages brimmed with ads enticing male engineers
bonanza went to startups founded solely by women—the low- through promises like “Your own enthusiasm and professional
est level since 2016. Less than 0.004% of the venture capital growth are the only limits to a future without boundaries.”
 45

A female operator at the control desk

of the world’s fastest calculator,
the IBM Selective Sequence
Electronic Calculator, in IBM’s New
York offices in 1948.
46

Early computing history abounds with these stories, reflect- Making all this intensity possible were stay-at-home wives—the
ing the endemic sexism of American corporate culture before most hidden of tech’s hidden figures, whose care of children and
equal-opportunity laws and other victories of modern femi- home allowed for their husbands’ total work immersion. The rare
nism. Notably, the women who rose to senior technical posi- female executive had to keep pace, acting as if similarly unbothered by
tions during this period often worked for military agencies personal demands, sneaking phone calls to her children on the side.
or at NASA, where clearly codified standards for promotion By the 1970s, the success of these firms had minted hundreds of
better protected women from managerial whims. millionaires, most men in their early 30s. High-tech entrepreneur-
ship, one Valley investor declared, was “the Olympics of capitalism.”
Growth: “The Olympics of capitalism” Not competing in this Olympics, but still contributing to the
While technical women stayed mainly within large organizations, industry’s success, were the thousands of women who worked
male engineers gradually began to leave academia and corporate in the Valley’s microchip fabrication plants and other manufac-
life to start their own companies. This entrepreneurial model turing facilities from the 1960s to the early 1980s. Some were
reached its apex in Northern California’s Santa Clara Valley. working-class Asian- and Mexican-Americans whose mothers
Stanford University–trained engineers had been starting and grandmothers had worked in the orchards and fruit can-
companies in local garages and disused farm buildings since neries of the prewar Valley. Others were recent migrants from
the East and Midwest, white and often college educated, need-
ing income and interested in technical work.
With few other technical jobs available to them in the Valley,
women would work for less. The preponderance of women on
the lines helped keep the region’s factory wages among the
lowest in the country. Women continue to dominate high-tech
assembly lines, though now most of the factories are located
thousands of miles away. In 1970, one early American-owned
Mexican production line employed 600 workers, nearly 90% of
whom were female. Half a century later the pattern continued:
in 2019, women made up 90% of the workforce in one enormous
iPhone assembly plant in India. Female production workers make
up 80% of the entire tech workforce of Vietnam.

Venture: “The Boys Club”

the 1930s, but it wasn’t until the 1950s that the Valley became Chipmaking’s fiercely competitive and unusually demanding
a tech powerhouse. Cold War spending transformed Stanford, managerial culture proved to be highly influential, filtering down
filled the Valley with defense contractors, and fueled growth of through the millionaires of the first semiconductor generation as
a new cluster of silicon-semiconductor startups. The firms gave they deployed their wealth and managerial experience in other
MEDIA NEWS GROUP/MERCURY NEWS ARCHIVE/GETTY IMAGES
Silicon Valley its name, built many of its first great fortunes, and companies. But venture capital was where semiconductor cul-
left an indelible imprint on its corporate culture. ture cast its longest shadow.
Life in early Silicon Valley chip firms was like Mad Men with The Valley’s original venture capitalists were a tight-knit bunch,
fewer suits, more all-nighters, and the occasional screaming mostly young men managing older, much richer men’s money. At
match over circuit-board design. Secretaries were usually the only first there were so few of them that they’d book a table at a San
women in sight. Employees were expected to show up before 8 Francisco restaurant, summoning founders to pitch everyone at
a.m., work as late as they could bear, and then go out for beers. once. So many opportunities were flowing it didn’t much mat-
The countercultural 1960s never really happened in the semicon- ter if a deal went to someone else. Charter members like Silicon
ductor industry; this was engineering, not an encounter group. Valley venture capitalist Reid Dennis called it “The Group.” Other
Management rewarded rational minds and thick skins. “I hired observers, like journalist John W. Wilson, called it “The Boys Club.”
you,” National Semiconductor executive Don Valentine once told a The venture business was expanding by the early 1970s,
new recruit, “because you were the only one I couldn’t intimidate.” even though down markets made it a terrible time to raise

Women were the mainstay of

Fairchild Semiconductor’s
busy production line in 1964.
 47

Georges Doriot,
“the Father of
Venture Capi-
tal,” declared,
“An average idea
in the hands of
an able man is money. But the firms founded and led by semiconductor vet-
worth much more erans during this period became industry-defining ones. Gene
than an out-
standing idea in
Kleiner left Fairchild Semiconductor to cofound Kleiner Perkins,
the possession whose long list of hits included Genentech, Sun Microsystems,
of a person with
AOL, Google, and Amazon. Master intimidator Don Valentine
only average
ability.” founded Sequoia Capital, making early-stage investments in
Atari and Apple, and later in Cisco, Google, Instagram, Airbnb,
and many others.

Generations: “Pattern recognition”

Silicon Valley venture capitalists left their mark not only by choos-
Master
intimidator ing whom to invest in, but by advising and shaping the business
Don Valentine sensibility of those they funded. They were more than bankers.
founded Sequoia
Capital, making They were mentors, professors, and father figures to young, inex-
early-stage perienced men who often knew a lot about technology and nothing
investments in
about how to start and grow a business.
Atari and Apple,
and later in “This model of one generation succeeding and then turning
Cisco, Google, around to offer the next generation of entrepreneurs financial
Instagram,
Airbnb, and many support and managerial expertise,” Silicon Valley historian Leslie
others. Berlin writes, “is one of the most important and under-recognized
© YOUSUF KARSH (DORIOT); STEVE JENNINGS/GETTY IMAGES (VALENTINE); WAYNE MILLER/MAGNUM PHOTOS (KLEINER); MICHAEL KOVAC/GETTY IMAGES (DOERR)

secrets to Silicon Valley’s ongoing success.” Tech leaders agree with

Berlin’s assessment. Apple cofounder Steve Jobs—who learned
most of what he knew about business from the men of the semi-
conductor industry—likened it to passing a baton in a relay race.
Venture capitalists often believed that the person was as import-
Gene Kleiner ant as the product, if not more so. “An average idea in the hands
left Fairchild
Semiconductor to
of an able man,” declared Georges Doriot, the Harvard Business
cofound Kleiner School professor known as “the Father of Venture Capital,” “is
Perkins, whose worth much more than an outstanding idea in the possession of a
long list of
hits included person with only average ability.”
Genentech, Sun One surefire way to find “able men” was to fund or recruit peo-
Microsystems,
AOL, Netscape,
ple you had successfully worked with before. This is another crit-
Google, and ical dimension of the Silicon Valley model: tightly knit networks
Amazon.
that often work together in multiple startups. The most famous of
these groups acquired nicknames. The men who left the Valley’s
first silicon chipmaker, Shockley Semiconductor, to start Fairchild
Semiconductor were called “the Traitorous Eight.” Four decades
later, a group of men, many of whom had met writing for Stanford’s
conservative student newspaper (including Peter Thiel, who
cofounded it), became a core part of the founding team of PayPal.
As John Doerr
once put it, the With the company’s acquisition, they became “the PayPal Mafia,”
most successful using their wealth to found new venture-backed companies and
founders “all
seem to be white, become investors in many others.
male nerds Venture capital firms became the connective tissue joining
who’ve dropped
clusters of fortunate coworkers into an even larger network. One
out of Harvard
or Stanford, and of the first firms to invest in PayPal was Sequoia Capital.
they absolutely
have no social
life.”
 48

GUTTER CREDIT HERE

 49

When it came to people an investor didn’t already know, reli-

ance on personal attributes and a healthy dose of gut feeling led
venture partners to bet on founders who seemed to share a lot
of the same qualities as those who had succeeded before—in
short, people like those already in their networks. “Pattern recog-
nition” was how Kleiner Perkins partner John Doerr once put it.
The most successful founders “all seem to be white, male nerds
who’ve dropped out of Harvard or Stanford, and they absolutely
have no social life”; when they showed up in his office, he said,
he knew it was time to invest.
The remark was an unintended gaffe—don’t say the quiet part
out loud!—but it was true. Doerr had risen up the ranks at Intel
and took what he had learned in chipmaking to build one of the
most successful venture careers in tech history. He funded and
mentored Marc Andreessen of Netscape, Sergey Brin and Larry
Page of Google, and Jeff Bezos of Amazon—all men.
Doerr and venture capitalists before and after him were eager
to absorb new ideas, but their experiences had persuaded them
that tech was a meritocracy and allowed them ignore the exclu-
sion perpetuated by Silicon Valley’s tight-knit networks.

Money: “The Golden Geeks”

Hardware companies dominated both Silicon Valley and Boston
through the 1970s. Software was rarely a stand-alone product but
was bundled into a computer purchase or given away free. This
helps explain why many women continued to hold programming
jobs even as the field professionalized, rose in prestige, and came
to be regarded by many corporations as an environment best
suited for “antisocial, mathematically inclined males.”
When desktop computers first arrived on the market, some
employers embraced programming as a job perfect for working
mothers, who could plug in a modem and code from home between
school pickups and household chores. That moment was short-lived,
for the personal computer business also created the immensely prof-
itable desktop software industry. Programming was no longer just
for introverts and elementary school moms. It minted billionaires.
The colossus at the industry’s center was Microsoft, led by the
most famous software geek of all, Bill Gates. By the late 1990s, the
company’s products ran on over 90% of the personal computers on
WAYNE MILLER/MAGNUM PHOTOS

the planet. Gates was the world’s richest man and Valley venture
capitalists were early-stage investors in his company. On Microsoft’s
campus outside Seattle, armies of software engineers worked seven
days a week. The workforce was so overwhelmingly male that one
observer called it “the frat house from another planet.” Microsoft’s
stock awards turned roughly 10,000 employees, mostly men and
many under 30, into millionaires. Money ruled the 1980s, the 1990s,

The men who left the Valley’s

first silicon chipmaker, Shockley
Semiconductor, to start Fairchild
Semiconductor in 1957 were called
“the Traitorous Eight.”
50

and beyond. “Striking It Rich,” read a 1982 Time headline hovering pre-pandemic said a lot about the kinds of workers tech companies
over a depiction of Apple’s Jobs on the magazine’s cover. Gates most valued. In 2017, Apple moved into an extraordinary new $5
followed in 1984, twirling a floppy disk. In 1996, Time handed the billion headquarters witha two-story yoga room and seven cafes.
crown to Netscape cofounder Andreessen. “The Golden Geeks,” Although it was designed to hold 12,000 employees, it did not
the magazine crowed, picturing the 24-year-old multimillionaire have a child-care center.
hamming it up while sitting barefoot on a gilded throne.
Tech’s reckoning?
Power: “I’m CEO … bitch” Today, the baton is passing to crypto enthusiasts and Web3 evan-
After 2000, Silicon Valley was the undisputed high-tech capital, gelists. While the cast of characters is slightly more diverse than
no longer just a place in California but shorthand for the industry it once was, the potential superstars of the next generation—
itself. Founders of this new generation had a new set of men- Coinbase’s Brian Anderson and FTX’s Sam Bankman-Fried, to
tors to learn from and admire. Jobs’s triumphant 1997 return to name two—remain mostly white and male.
Apple after being forced out over a decade earlier had made him Tech’s gender reckoning has been among a number of things
a business legend. His untimely death in 2011 further enshrined fueling a new wave of employee activism. For the first time, Silicon
his legacy as the founder to emulate. Valley’s white-collar employees are speaking out publicly against
their employers and, in some instances, successfully pressuring
them for changes to corporate practices.
One striking thing about today’s activists, organizers, and whistle-
blowers is that nearly all of them are female, gender-nonconform-
ing, or queer. Several are nonwhite. Outside and less beholden
to tech’s charmed circles, they have been able to see tech’s prob-
lems more clearly. Women were six of the seven organizers of the
20,000-strong Google walkout in 2018, which protested the $90
million severance package awarded to top executive Andy Rubin
after credible claims of sexual harassment. Computer scientist
Timnit Gebru was recruited to Google because of her ground-
breaking work on algorithmic bias and then was fired, reportedly
because of the company’s discomfort with her findings. She has since
become a powerful critic of Silicon Valley business and research
practices. Data scientist Frances Haugen worked at Google, Yelp,
Andreessen was now a successful venture capitalist dispens- and Pinterest before she came to Facebook, where alarm at the
ing managerial wisdom over coffee and pancakes, just as an company’s business practices prompted her to copy thousands of
older generation had done for him decades before. “He became pages of internal documents and leak them to reporters. (Haugen
a sounding board about management and how to build a strong admitted that she was able to blow the whistle at Facebook because
technology company,” recalled Mark Zuckerberg of the regular her tech career had made her wealthy enough to leave her job.)
meetups he had with Andreessen in the early days of Facebook. Within companies, employee activism grows by the day. It is
“He has strong views on that, and they helped shape mine.” not only changing the culture but also—quite remarkably, given
The new generation of founders tended to be younger and Silicon Valley’s history—fueling cross-class support for employee
brasher. Men who had spent their boyhoods staring into computer unionization. Women and gender-diverse employees are on the
screens now had power, money, and swagger. A few months into front lines of these movements as well.
OPPOSITE: JEFF CHIU/AP IMAGES

Facebook’s existence, Zuckerberg realized he needed business The tech industry loves to talk about how it is changing the
cards. He ordered up two versions. One simply said “CEO.” The world. Yet retrograde, gendered patterns and habits have long
other: “I’m CEO … bitch!” fueled tech’s extraordinary moneymaking machine. Breaking out
The workplace cultures of today’s large technology compa- of them might ultimately be the most innovative move of all.
nies are as all-consuming as those of any early chipmaker. And Historian Margaret O’Mara is the author of The Code:
the perks that firms showered on their white-collar employees Silicon Valley and the Remaking of America.

Time magazine covers

published in 1982 and 1984
 51

Computer scientist Timnit Gebru was

fired from Google, reportedly because
of the company’s discomfort with her
research findings.She has since become
a powerful critic of Silicon Valley
business and research practices.
52
 53

LIVING

WITH AN

E X T R A X

Sex chromosome variations are the most

common chromosomal conditions, but most
people don’t even know they have them.

By Bonnie Rochman
54 In 2020, the American College
of Obstetricians and Gynecologists
endorsed NIPS at any age, effectively
making the blood test a routine part of
pregnancy care. Parents typically use
these tests to rule out Down syndrome
or more severe conditions, only to find
out in many cases about something they
didn’t even realize their baby was being
hen Ollie’s mother, Katie, screened for. “The scariest part is here
is this diagnosis based on a test that we
was nine weeks pregnant, her obstetrician-gynecologist’s office didn’t really understand,” says Simon.
in Boulder, Colorado, offered her a special $100 price on a new Adds Katie: “We were assuming the test
prenatal blood test that she was told could detect major chro- would detect only very serious things.”
To add to the complexity, NIPS is
mosomal hiccups such as Down syndrome and trisomy 18. She not as reliable for sex chromosome
and her husband agreed—who can say no to a deal?—with one aneuploidies as it is for Down syn-
caveat. “Remember,” Ollie’s mother told the nurse, “we don’t drome, underscoring the importance of
confirming a positive screening result
want to know the sex.” during pregnancy via amniocentesis
or chorionic villus sampling (which
examines placental tissue), or with a
But they ended up finding out any- As more expectant parents opt blood sample after the baby is born. Yet
way when they received an unexpected for noninvasive prenatal testing in data suggests that “some women have
phone call from their ob-gyn. “He said, hopes of ruling out serious conditions, elected to terminate pregnancies solely
‘Unfortunately, I need to call and say many of them are surprised to discover on the basis of [noninvasive prenatal
you’re having a boy and he has XXY,’” instead that their fetus has a far less screening] results, potentially aborting
Katie says. severe—but far less well-known— unaffected fetuses,” according to a 2016
Katie and her husband, Simon, had condition. Because so many sex chro- article in Prenatal Diagnosis.
never heard of XXY, and their obste- mosome variations have historically About 40% of men with XXY are
trician wasn’t much help either. Also gone undiagnosed, many ob-gyns are diagnosed over the course of their life-
known as Klinefelter syndrome, XXY is not familiar with these conditions, times, usually when they experience
a genetic condition that can cause infer- leaving families to navigate the unex- fertility problems as adults, says Nicole
tility and other health issues; it occurs pected news on their own. Many wind Tartaglia, a global expert on sex chro-
when a child, typically assigned male at up seeking information from advo- mosome variations. People with XXY
birth, is born with an extra X chromo- cacy organizations, genetic counsel- may have learning difficulties and chal-
some in addition to the typical X and Y. ors, even Instagram as they figure out lenges with social interaction, along with
Sex chromosome variations, in their next steps. physical traits such as small testes, a less
which people have a surplus or missing The information landscape has muscular body, and less facial and body
X or Y, are the most common chromo- shifted dramatically since the advent of hair. But most people with Klinefelter
somal conditions, occurring in as many noninvasive prenatal screening (NIPS) syndrome grow up to live productive,
as one in 400 births. Yet the majority of a decade ago. The increasingly popular healthy lives.
people affected don’t even know they first-trimester blood tests that debuted Meanwhile, only 10% of people with
have them. That’s because these con- in 2011 to detect Down syndrome have, XXX or XYY are aware of their condi-
ditions can fly under the radar; they’re over time, added a broader spectrum tion. But these numbers are growing
not life threatening or necessarily even of conditions to their panel, including as genetic testing becomes more wide-
life limiting and don’t often have telltale sex chromosome aneuploidies—the spread. “Judging by the number of phone
characteristics that raise red flags. Still, medical name for an atypical number calls we are getting, the proportion of
the diagnosis can cause distress. of chromosomes. those who are going undiagnosed is
getting smaller,” she says.
When families learn that their fetus
has a sex chromosome variation, one of
the first places they turn is AXYS, the
Association for X and Y Chromosome
Variations, an advocacy and support
organization that has seen its calls from
confused families skyrocket as NIPS
has become more popular. “People
come to us very scared,” says Carol
Meerschaert, the organization’s exec-
utive director. “They don’t know about
 55

these conditions, and their doctors live in a world where there is confusion

“THE SCARIEST PART IS HERE

don’t know about them either, but they and mystery around the intersection of
are much more common than Down sex and gender. In fact, it’s not uncom-
syndrome.” mon for people with these variations
XXY occurs in about one of every to be labeled as intersex, a term that
650 male births; XXX affects one in encompasses unique variations of sex
1,000 female births, and XYY one in or reproductive anatomy, including gen-

THAT WE DIDN’T REALLY UNDERSTAND.”

IS THIS DIAGNOSIS BASED ON A TEST
1,000 males. “I like to say that you have italia, hormones, internal organs, and/
met someone with one of these condi- or chromosomes. While some people
tions,” she says. “You just didn’t know consider sex chromosome aneuploidies
it, and they may not know it!” like Klinefelter to be under the intersex
The availability of genetic counseling umbrella and do identify with intersex
and information about X and Y variations movements, some do not. “Parents are
isn’t keeping pace with the growing worried that people will think their son
number of families learning about such isn’t as much of a man because they
variations in their unborn children. This have an extra chromosome, so people
void is what prompted Lilian Cohen, a don’t talk about it,” says Meerschaert.
pediatric geneticist, to help launch a “This isn’t simple.”
center dedicated to X and Y variations Numerous companies and labs offer
at Weill Cornell Medicine in New York noninvasive prenatal screening, which
City. “Noninvasive prenatal testing is analyzes tiny fragments of placental
one of the reasons why in one week I DNA that float in the gestating parent’s
had four patients, three of whom were circulation to determine if there are
diagnosed prenatally,” she says. “Couples chromosomal abnormalities. The global
are not getting the counseling they need.” market, valued at more than $3 billion in
Depending upon what condition 2021, is expected to more than double
the screening tests are analyzing for, by 2028 as companies—including giants
the accuracy of results can range sig- such as Illumina, Roche, and LabCorp—
nificantly. “These X and Y variations compete with one another to validate
are found accidentally through this their tests for additional conditions.
technology,” says Cohen, who believes Natera, one of the leading players,
that access to genetic counseling is offers one of the more comprehen-
an essential part of testing. “My bias sive screening tests. The company was
as a geneticist is that this knowledge fourth to market in early 2013; shortly
is powerful.” after, a paper in Prenatal Diagnosis
If people don’t go for genetic counsel- demonstrated its test’s ability to detect
ing after a positive screening result—few sex chromosome trisomies. Natera had
do, Cohen says—they may overestimate previously included these trisomies as
the severity of the condition and decide incidental findings, but after the paper’s
to end the pregnancy. “They may never publication, it added them as a routine
even make it to our office,” she says. “I part of every patient’s results. “The req-
only see the tip of the iceberg.” uisition form clearly states what is being
When families do come see her, she screened for,” says Sheetal Parmar, a
explains how different X and Y variations genetic counselor who is Natera’s vice
are from Down syndrome, which can be president of medical affairs.
accompanied by heart conditions, intel- Yet it’s a rare patient who reads all
lectual disability, and complex congenital the fine print. “It’s always a challenge
problems. “As much as I love my patients for people to fully understand all the
with Down syndrome,” Cohen says, “that things they’re being screened for,” says
is a different kind of decision-making.” Parmar. “But having the information
It’s a perplexing time in history to about a sex chromosome aneuploidy
have a sex chromosome variation. We gives families time to prepare.”
56 in Seattle, has had a different experi-
ence. His mother, Claire, also learned
about her son’s extra chromosome
through NIPS; she cried in a parking
garage after her doctor called with the
results. “I was in a prenatal yoga class
where everyone was going around say-
ing, I’m this far along and I’m having
a boy or a girl,” she says. “I remem-
ber feeling jealous that things were
so simple.”
Robby was late to toilet train, and
at preschool he’d knock over other
kids’ toys, running around and making
messes at cleanup time. On one par-
ticularly tough day, Claire asked the
teacher: “Is his behavior outside the
norm?” The teacher said yes.
Ro b by ’s p re n a t a l d i a g n o s i s
prompted Claire to seek early inter-
vention. For starters, she called the
eXtraordinarY Kids Clinic at Children’s
On one hand, Katie is grateful for Hospital Colorado, where she’d turned
her son’s diagnosis “because it forces for guidance during her pregnancy. The
us to be aware and have a big safety clinic was recruiting participants for
net around Ollie if he ever needs it.” a study about emotional regulation in
On the other hand, it can be a source preschoolers with XXY, and Robby was
of frustration. Is Ollie’s tendency to get the first child to enroll. A neuropsychi-
teary when a task feels frustrating a atric evaluation assigned him superior
consequence of XXY or just his nature? scores for language and spatial reason-
Katie wonders. (Challenges regulating ing, but in terms of processing speed
emotions can characterize XXY.) “I will and adaptive skills—tasks like washing
question how much of this should we hands independently or eating with a
worry about versus ‘This is who he is,’” fork—he was below average.
she says. “My mama heart is always After being diagnosed with autism,
wondering, ‘Is this the thing? Do we anxiety, and ADHD, Robby has met
need to freak out?’” with a battery of therapists, including
It can be challenging to lump all an occupational therapist for manag-
sex chromosome aneuploidies into ing anger and honing fine and gross
one bucket. Symptoms can vary widely motor skills. “It’s hugely affected our
from condition to condition—girls family,” says Claire, who has three
with an extra X chromosome tend to children younger than Robby. “I didn’t
be taller than their peers, for example, think his challenges would be this
while those with just one X tend to be significant.”
short—and there is plenty of variability Robby’s parents have told him about
even within the same condition. his extra X by using a Lego analogy:
ILLUSTRATION SOURCES: NATIONAL HUMAN GENOME RESEARCH INSTITUTE

While Ollie hasn’t needed any “Everybody has a book of Lego instruc-
behavioral intervention, Robby, an tions that talk about their bodies. Your
eight-year-old boy with XXY who lives Lego book has an extra page, which
is why you feel things so deeply and
PEOPLE WITH XXY you’re so tall.” But they do have con-
MAY HAVE LEARNING DIFFICULTIES AND cerns about his friends’ parents look-
CHALLENGES WITH SOCIAL INTERACTION, ing up the condition and pigeonholing
ALONG WITH PHYSICAL ISSUES, him. “It’s his story to tell,” Claire says.
BUT MOST GROW UP TO LIVE “If he wants to be the Ryan Bregante
PRODUCTIVE, HEALTHY LIVES. of boys, that’s fine. But we want him
to decide.”
Ryan Bregante, a 36-year-old pho-
tographer and internet personality, is
one of the most outspoken men within
the XXY community. Growing up in San
Diego, he was bullied and struggled to be better prepared for potential
with reading, writing, and spelling, but outcomes, and in some cases decide
he didn’t know much about his condi- whether they want to terminate based
tion until 2017, when he attended an on the results or pursue treatment.
AXYS conference. “I met 20 guys with Tartaglia, who runs the eXtraordi-
XXY,” he says. When he left, he spent narY Kids’ Clinic, supports a somewhat
three months surfing PubMed and unorthodox approach: giving boys
scouring research papers to learn more with XXY testosterone shots early in
about his genetics. He was dismayed infancy, when all babies undergo a
by much of what he found: doom and “mini puberty”—a few months when
gloom. “It was all ‘You’re stupid, you’re hormones spike and set the stage for
not going to amount to anything,’” he the development of reproductive
says. “When I Wikipediaed it, there was organs.
nothing but ‘rapists’ and ‘psychopaths.’” Testosterone supplementation in
Though the stigma of those outdated baby boys with XXY is thought to sup-
stereotypes persists, Bregante works port neurodevelopment. The theory is
to dispel it. that a deficit could lead to low muscle
In September 2017, Bregante made tone or problems with speech.
his first YouTube video, which was Ollie’s parents say they didn’t seri-
followed quickly by a website, Living ously consider ending Katie’s preg-
with XXY, and an Instagram account nancy, but they needed to be reassured
where he solicits experiences from that Ollie could thrive. “Is the mountain
others with XXY and shares his own this kid will have to climb every day so
day-to-day. “What is positive about unbelievably hard that every day is a
your life with XXY?” he asks. battle?” Simon asked the doctor, who
“I want to show that we can live said no, though he added that Ollie
happy, successful lives,” he says. “Most might grapple with learning disabili-
men I know with XXY aren’t open ties and infertility.
about it, and neither are their fami- To try to mitigate some of those
lies. I tell families, ‘If your son were outcomes, Ollie was enrolled in a study
deaf, would you act like this?’ The in which he got testosterone infu-
hardest thing about this diagnosis is sions starting at eight weeks old. In a
we are walking around in plain sight. full-day assessment at the eXtraordi-
Keeping the diagnosis to yourself is narY Kids’ Clinic when he was two, he
perpetuating the shame.” could drink from a cup, put on a jacket,
Parents of boys with XXY are used thumb through a book—achievements
to deflecting questions about whether that showed he was developing on
their sons are more feminine than boys schedule.
without an extra X. That’s a driving Five years later, at age seven, he’s
force behind why most of the parents continuing to meet and surpass mile-
interviewed for this article didn’t want stones. He is in an advanced reading
to be identified by their full names. group at school and hasn’t needed any
It’s a conundrum: they realize that not interventional services related to XXY.
being open about their child’s diagno- “He’s continued to thrive as a little
sis may perpetuate stigma, but they’re boy,” says Katie.
not willing to risk compromising their In her practice, Tartaglia encounters
child’s privacy. some families that work hard to put a
In 2011, the year that NIPS emerged positive spin on their child’s diagnosis.
onto the scene, a review in Genetics in “They say, ‘It’s okay. We can fix it,’” she
Medicine of published studies found says. Tartaglia gently redirects them:
that as many as 85% of parents decided “Yes, we can help, but we can’t get rid
to terminate a pregnancy after they of that extra chromosome.”
received an XXY diagnosis. “Everyone has strengths and weak-
It’s unclear what effect the over- nesses, says Tartaglia. “We need to
turning of Roe v. Wade may have on celebrate and embrace the idea that
terminations of pregnancies affected there is diversity in the way we all
by sex chromosome variations. It is think, speak, act, and feel.”
plausible that the rate of abortions
will decrease, but testing is not likely Bonnie Rochman is author of
The Gene Machine: How Genetic
to become any less common. Families Technologies Are Changing the Way
want to do prenatal testing in order We Have Kids.
 59

ANI LIU’S ART HIDDEN,

EXPLORES THE ROMANTICIZED,
WAYS REPRODUCTIVE TECHNOLOGIZED—
LABOR IS AND UNDERVALUED.

BY: PHOTOGRAPHS:

ALEXANDRA LANGE CELESTE SLOMAN

UN-
NATURAL
CHILD-
BIRTH
STYLING: NICOLE LYBA
60

Untitled (feeding through space and time)

uses 328 feet of plastic tubing filled with
synthetic milk.

MESSY

coils of plastic tubing sprawl across the

gallery’s concrete floor. The liquid inside—
opaque, white with a yellowish tinge—
pulses once, twice, and the eye tracks its
progress thanks to the air bubbles cycling
through the loops. Could that be … milk?
Follow the tubing back to an unassuming
rectangular box. If it is milk, a panicked brain
might ask, where is the mother?
At this moment the mother, artist Ani
Liu, is standing by the door of the pocket-
size Cuchifritos Gallery + Project Space in
Lower Manhattan, wrapped in a tie-dyed
T-shirt dress for tonight’s opening of her
solo exhibition, “Ecologies of Care.” But
she has also sat, pumping milk, in the
broom closet next to her classroom at the
University of Pennsylvania; in her basement
studio in Queens; on trains and in cars.
The volume of milk circulating through
Untitled (pumping) and Untitled (feeding
through space and time) represents a month
of such sessions, or 5.85 gallons—some of
the invisible labor of motherhood. It also
represents modern breastfeeding technol-
ogy—specifically, the Spectra pump that
allowed Liu the alleged freedom to return
to the workplace just weeks after having her
first child. After headlines about a national
formula shortage earlier this year, the liquid
seems even more precious.
The milk in this exhibit is not real. After
much experimenting, Liu ended up filling
the pump with “magician’s milk,” a propri-
etary formula, purchased from a magic shop,
that requires no refrigeration and comes
with the warning “Not a food product. Do
not drink!” Nevertheless, it looks convinc-
ing. When installing the piece, Liu originally
considered having the milky coils take over
the whole gallery floor, even more aggres-
sively immersing visitors in the visual and
aural landscape of newborn care.
Liu, who holds graduate degrees from
the Harvard Graduate School of Design
and the MIT Media Lab, resumed teaching
just five days after she gave birth in 2021.
She had just signed a new contract as an
associate professor of practice at Penn, and
the university offers maternity leave only
61
62
 63

to employees of more than a year. Though

she was initially allowed to teach over Zoom
from her home in Queens, she ended up
pumping more than nursing. “I developed
this really intense relationship with my
pump, where just hearing the sound of it
made me let down, rather than my baby’s
cry. It was just such a weird Donna Haraway
cyborg moment,” she says, referring to the
feminist science and technology scholar
who wrote, of the cyborg, that it “does not
dream of community on the model of the
organic family.”
It was also a moment that led Liu to new
research. Her discoveries emerge in the
works on display in the Cuchifritos Gallery,
which include a series of three-dimensional
meditations on technology, motherhood,
and childhood in our algorithm-enabled
world.
Pumping is also on display as part of the
second edition of the exhibition “Designing
Motherhood,” now at the MassArt Art
Museum in Boston. Michelle Millar Fisher,
part of the curatorial team, wrote that the
work “cuts right to the heart of the ways in
which reproductive labor is hidden, roman-
ticized, socially taboo, and undervalued.”
Liu’s work has additional urgency and
resonance after the overturning of Roe v.
Wade. Who controls, who supports, and
who performs reproductive labor are not
just bedroom or broom closet questions (and
never should have been); they are playing
out on the streets, in state houses, and in
the Supreme Court.
Millar Fisher has drawn parallels
between Liu’s pumping installation and
OPPOSITE: ABOVE:
the work of the artist Hiromi Marissa
Ozaki, known as Sputniko!, whose 2010 In Untitled (milk fat globules), a milk The volume of synthetic milk
Menstruation Machine simulates the expe- molecule, photographed under a circulating through Untitled (pumping)
microscope, is layered, color-corrected, represents a month’s worth of milk
rience of menstruation; the video part of and printed on an aluminum panel pumped in the workplace.
the piece shows a fictional day in the life shaped after a popular brand of scallop-
of a young man who builds a device to edged nursing pads.
experience life as a person with a uterus.
Liu has long been fascinated by this
sort of simulated experience. In 2019, after
watching YouTube videos of men sampling
simulated labor pains in order to understand
their wives’ experience, and finding them
wanting on multiple levels, she decided
to create her own apparatuses, including
64

a garment called Untitled (woman pains),

fitted with a belly and electrodes, that would
allow any non-pregnant person to experi-
ence the weight and discomforts of preg-
nancy. Another in the series, Untitled (small
inconveniences), simulates incontinence.
Made in collaboration with fabricator Randi
Shandroski, the garments look like lingerie
and simulate one result of sex, but these are
not experiences generally considered sexy.
Her pieces demonstrate a mischievous
humor, embedded in the everyday indig-
nities of modern life. Consumer culture
might seem to celebrate pregnancy, but
the products pushed to pregnant people
focus on all the things that are “wrong”
with the pregnant body: mood swings,
stretch marks, incontinence. In response,
Liu created Consumerist Pregnancy, which
includes a series of creams, masks, and med-
ications, designed in high millennial style
(monochrome packaging, sans serif fonts)
but honestly labeled “Fatigue,” “Shortness
of Breath,” “Swelling.” If you saw them on
a pharmacy shelf you would be initially
attracted, but once you read the description,
even as a person who has been pregnant,
it would be hard not to say No, thank you.
The Surrogacy features a 3D-printed
model of a multichambered pig’s uterus
which, upon approach, reveals human
fetuses in each chamber, a commentary
on the ethics of assisted reproduction and
the exploitation of human surrogates. Hung
on the wall of the gallery is a spreadsheet
that, upon inspection, reveals itself to be
a minute-by-minute accounting of all the
touchpoints of the first month of Liu’s
ABOVE: OPPOSITE:
daughter’s life (she’s now two): every feed-
Described by Liu as “a response to Untitled (Consumerist Pregnancy ing, every pee, every poop. One inspira-
Donald Trump’s statement ‘Grab Reports): A set of ritual devices and tion for the spreadsheet was Post-Partum
them by the pussy’ during the 2016 consumable products made to simulate
presidential campaign,” Mind Controlled the biological experience of pregnancy.
Document, a 1973–’79 work by conceptual
Spermatozoa allows women to control artist Mary Kelly, in which Kelly displayed
the directional movement of sperm the liners from her son’s cloth diapers as
using their thoughts. monochromes in white frames.
THIS SPREAD: COURTESY PHOTOS

Liu’s work stands out not just for its top-

icality, or the precision with which it zeroes
in on the frustrations of 21st-century moth-
erhood, but for its range. She is the kind of
artist of whom you might say that she “works
at the intersection of art and technology.”
But that should really be “technologies,”
65
66

Untitled (small inconveniences): A garment

designed to simulate incontinence as one of
the symptoms of pregnancy.

plural. Different pieces have required her

to delve into the intricacies of pumps, cir-
cuitry, machine learning, microscopy, and
3D printing, developing enough under-
standing of each field to identify the nec-
essary expertise of her collaborators. When
she was at the Media Lab she joined a bio-
hacking club, which she found to be the
ideal educational experience. No matter
the question, she says, “someone would sit
down with a beer and explain it.”
Even her thesis project at the Media
Lab, Mind Controlled Spermatozoa (2016–
2017), recently wiggled back into the news
as six Supreme Court justices, five male
and one female, declared jurisdiction over
child-bearing bodies.
For that project Liu researched galvano-
taxis, the directed movement of an organ-
ism or cell in response to an electric field
or current. In the accompanying video, she
dons an EEG machine, which measures
electrical activity in the brain. She then
applies those signals to a magnified sample
of her now-husband’s sperm and is actually
able to direct the movement of spermato-
zoa to the left and right with her thoughts.
(The science is real, if dramatized for the
video.) As she writes, “I seek to challenge
this status quo by engineering a system by
which I (a woman) can control something
inherently and symbolical male: sperma-
tozoa (sperm).” The subtitle of the piece is
“Women of STEAM Grab Back.”
A week after the leak of the draft
Supreme Court decision overturning
Roe v. Wade, Liu put the piece up on her
Instagram with a new caption. “In the few
times I’ve shown this work, men have
often expressed to me how violating and
unnatural it is to control sperm—sperm
that is not even theirs, or in their body,”
she wrote. “[T]hink of the plight of female
bodies, that are constantly under threat
of being controlled, regulated, censored.”
Liu’s work attempts to shed light on the
constant policing of cisgender women’s
bodies, using the very machines and mar-
HANNEKE WETZER

keting techniques that typically oppress.

Design critic Alexandra Lange is

the author of Meet Me by the Fountain:
An Inside History of the Mall.
67
68

What are you on?

Puychedelic drugu may be getting clouer to market By Illuutration by
au utudieu begin to uhow their promiue for improving Taylor Majewuki Kate Dehler
women’u health outcomeu.
 69

ikhita Singhal’s breath still “It was really emotionally and psycho- Singhal’s experiences in and out of treat-

N catches when she talks

about how her life changed.
A psychiatry resident at
the University of Toronto,
Singhal says it was using psychedelic
drugs—ayahuasca, ketamine, and
MDMA—that finally addressed the eat-
logically painful,” she says, recounting a
particular ayahuasca trip she took with her
parents. “I felt like I could see myself and
I was in the middle of this storm of chaos
where I felt comfortable and safe being
sick because it was so entrenched for 20
years. I couldn’t ever imagine shifting my
ment centers growing up prompted her to
go into psychiatry as a profession. Now, she
imagines a not-too-distant future where
she’s able to offer psychedelic therapy her-
self. “It’s mind-blowing to see the huge leaps
that [patients] can make in a [psychedelic]
session that might have taken years and
ing disorder she’d had since she was mindset, but now I’m in a place I would years in traditional psychotherapy,” she says.
seven years old. have never thought possible.” “They come out utterly changed.”
70

Psychedelics are having a moment.

After decades of prohibition and vilifica-
“I think it upeaku to a deuperation in women’u
tion, they are increasingly being employed health. And part of the reauon for that iu we all
as therapeutics. Drugs like ketamine, know that nobody botheru to utudy women,
MDMA, and psilocybin mushrooms are
being studied in clinical trials to treat
and nobody liutenu to women, eupecially when
depression, substance abuse, and a range we report our upecific mental-health iuuueu.”
of other maladies. And as these long-taboo
drugs stage a comeback in the scientific
community, it’s possible they could be
especially promising for women. Much of modern medicine is built on FDA to designate those drugs as break-
Not just Singhal but several other research performed exclusively on cisgen- through therapies (a priority status given to
women interviewed for this story described der men: clinical research was not required promising drugs proposed to fill an unmet
how they had successfully experimented to include women until the 1990s, when need) for PTSD and treatment-resistant
with psychedelics—not for recreational Congress passed the National Institutes of depression, respectively.
purposes, but to heal. One woman Health Revitalization Act. This means the Gender is also a factor in eating disor-
recounted how psychedelic-assisted ther- science that informs medicine—including ders such as anorexia nervosa, which is
apy addressed her postpartum depression. the prevention, diagnosis, and treatment of three times as prevalent among women as
Another described how microdosing psi- disease—routinely fails to consider the cru- men. The Multidisciplinary Association for
locybin alleviated symptoms of premen- cial impact of sex and gender. As a result, Psychedelic Studies (MAPS) is currently
strual dysphoric disorder (PMDD) and an women’s pain and symptoms have been, conducting a study on MDMA-assisted
ayahuasca trip eliminated her condition and continue to be, consistently dismissed therapy to treat anorexia, bulimia, and
altogether. Online, women on Reddit and by doctors. In the case of more than 700 binge-eating disorders; the treatment
in Facebook groups share how they’ve used diseases, women receive diagnoses signifi- works by reducing activity in the amyg-
psilocybin, LSD, ketamine, and MDMA cantly later than men, sometimes waiting dala, the part of the brain that processes
to address PMS, menopause, low sexual up to 10 years for the correct diagnosis. fear and threat. The Centre for Psychedelic
desire, postpartum depression, and PTSD They’re also at greater risk for adverse Research at Imperial College London is
from sexual trauma. Jennifer Gural, a psy- side effects from medication; a recent also leading a clinical trial on psilocybin-
chotherapist in California, spoke of how study found that 86 medications approved assisted psychotherapy as a treatment for
psychedelics helped her, and how she’s by the US Food and Drug Administration anorexia.
seen them help her female patients: “It were more likely to cause such problems Is this the beginning of a brighter future
shifted the focus of my life. It really helped in women than men. for women’s health, one where common
me to tackle how my brain works and how The rising tide of women self-treating mental disorders, symptoms of chronic
I was thinking … It was such a profoundly with psychedelics may be a result of frus- pain, and intense mood swings are man-
life-changing experience. I have done aya- trations with our existing health-care aged with mind-altering trips? Psychiatrists
huasca and I’ve done psilocybin. I don’t system, and it does pose risks such as dan- are optimistic, but they are rightly con-
know if I’ll ever do it again, but I’m open gerous interactions between psychedelics cerned about the potential for abuse in
to that if it’s needed—which I think is how and prescription drugs, or—worse—psy- psychedelic-assisted therapy.
we should use psychedelics.” chedelics that are adulterated with other
After Ayelet Waldman’s book A Really substances, like fentanyl. But more official Enter the pharmaceutical
Good Day: How Microdosing Made a Mega research around these drugs has begun to companieu
Difference in My Mood, My Marriage, and emerge over the past few years. The search for psychedelic drugs that spe-
My Life came out in 2017, chronicling her Women are more likely to have PTSD cifically address women’s health conditions
monthlong experiment with microdosing than men, and transgender and gender- has already begun. Felicity Pharma, a bio-
LSD to treat severe “mood storms,” thou- diverse individuals are at a much higher tech company focused on “mood disorders
sands of women from all over the world risk of developing PTSD than the gen- in women,” developed a proprietary drug
reached out to her. “I think it speaks to a des- eral population. Women also experience that uses a psychedelic to treat PMDD and
peration in women’s health,” she says. “And depression more often, with one in seven postpartum depression. Olivia Mannix, the
part of the reason for that is we all know women suffering from postpartum depres- CEO and founder of Felicity, says the drug
that nobody bothers to study women, and sion alone. Studies suggesting good results is currently ready for proof-of-concept pilot
nobody listens to women, especially when from just a few doses of MDMA or psilo- studies, but her long-term vision is to shake
we report our specific mental-health issues.” cybin combined with therapy have led the up the stagnant antidepressant market.
 71

The problems with conventional anti- do over and over again, [as in] anorexia experienced during the menstrual cycle.
depressants such as selective serotonin or obsessive-compulsive disorder, you Research and development have been
reuptake inhibitors (SSRIs) are well-known. really need to be quote-unquote ‘rewired,’” slow, however, because the company has
“SSRIs will only take you so far,” says Julie Holland says. “The psychedelics are going struggled to secure significant funding.
Holland, a psychiatrist, author, and medical to do a much better job at that than SSRIs, But funding is flowing into psychedelic-
advisor to MAPS. “There’s some emotional because they can often really get more assisted therapy, especially around one
numbing, there’s some physical numbing; to the root cause of what’s going on and drug in particular: ketamine. Over the
it’s harder to cry, it’s harder to climax. I unpack what’s driving the behavior as past few years, ketamine-assisted therapy
think psychedelics for a lot of women are opposed to just sort of slapping a plaster (which is legal in the US) has surged in pop-
really more of a thorough solution to their over it.” ularity as an effective—albeit expensive—
problems instead of a Band-Aid.” In Holland’s psychiatric practice, many alternative treatment for depression and
People who study the brain know that of her female patients are taking antide- anxiety. (Typically, ketamine treatments
SSRIs may gradually increase neuro- pressants, and she often sees low libido as in the US range from $600 to $1,200 per
plasticity, which is the brain’s ability to an unfortunate side effect of these drugs. session, and the standard course of treat-
form new connections between neurons. These days, she’s particularly interested ment is six sessions.)
Neuroplasticity can be impaired among in the potential of “rare” psychedelics that “We started our company knowing
depressed people. A 2021 study conducted can reliably enhance sexual experiences— that women over 40 are prescribed anti-
at Yale suggests that psilocybin has the like 2C-B, which was sold in Europe in depressants at more than three to four
ability to prompt neuroplasticity, discon- the 1990s as a party drug and aphrodisiac. times the rate of men, which has led to
necting some of the hardwired, repetitive Eastra Health, another startup working one in every five women taking an anti-
thought patterns often involved in condi- on psychedelic medicine specifically for depressant to get through the day,” says
tions like depression and eating disorders, women, has filed two patents for treat- Juan Pablo Cappello, cofounder and CEO
and research shows that psychedelics like ments that use 2C-B to alleviate female of the ketamine therapy platform Nue Life,
psilocybin may also be as effective as SSRIs sexual dysfunction and PMS symptoms. which is FDA approved and raised $23
for treating depression, if not more so. Jeremy Weate, Eastra’s CEO, told me his million in April.
“Whenever you’re talking about any working hypothesis is that 2C-B can flat- Through platforms like Nue Life, or in
kind of rigid, compulsive behavior that you ten the rise and fall of estrogen levels one of the hundreds of ketamine therapy

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72

clinics across the US, patients can take

a controlled amount of a psychoactive
“I have done ayahuasca and I’ve done
substance under the careful guidance of psilocybin. I don’t know if I’ll ever do it again,
a trained clinician to induce an altered but I’m open to that if it’s needed—which I think
state of consciousness (a trip). Having
received tons of airtime in recent years
is how we should use psychedelics.”
for its supposed ability to treat PTSD,
anxiety, and substance abuse, ketamine is
now being studied as an effective way to
alleviate symptoms of postpartum depres-
sion as well. depressive cycles, and it wasn’t necessar- without having to drop $20,000 for a
A recent study in the Journal of ily a hormonal thing that was the ongoing guided approach.”
Affective Disorders suggests that in problem,” she says. “It was just the change That guided approach is not only expen-
patients at high risk of postpartum depres- in my experience as the result of becom- sive but fraught with ethical concerns.
sion, a single dose of ketamine adminis- ing a mother in a society that expected Multiple high-profile cases of abuse in psy-
tered before anesthesia during cesarean me to be a certain way.” She says she tried chedelic therapy have made headlines in
sections could be effective in prevent- SSRIs and traditional therapy at first, but recent years. Richard Yensen, an unlicensed
ing it. Another ketamine therapy startup, she finally arrived on stable footing after therapist who was a sub-investigator for
Field Trip, is also about to start in-person, trying psychedelic-assisted psychotherapy. MAPS, was accused of sexually assaulting a
phase I clinical trials for FT-104, a psyche- Ramsden believes that the entire psy- PTSD patient during a MAPS clinical trial
delic molecule that’s similar to psilocybin chedelic industry is still in its earliest days. on MDMA. Allegations of sexual abuse
but has a much shorter trip time. (Nikhita But she can envision a culture where it were also made against Aharon Grossbard
Singhal’s father, Sanjay Singhal, an entre- is normal for women to openly take psy- and his wife, Françoise Bourzat, leaders
preneur who started audiobooks.com, is chedelic drugs. When something health- of a prominent group in the Bay Area that
an advisor to Field Trip.) “FT-104 has all related works for women, she believes, the has been practicing psychedelic-assisted
the characteristics that make psilocybin so good news spreads like wildfire. therapy for over 30 years.
interesting and attractive from a therapeu- Allison Feduccia, who has a PhD in “I’ve been hearing stories about psy-
tic perspective—safety and efficacy—but neuropharmacology, believes that the chedelic therapists molesting their patients
with a very short duration of action,” Field best evidence we have of how psyche- or shamans molesting their clients for
Trip cofounder and executive chairman delics affect women is still mostly anec- decades,” Holland says. She notes that
Ronan Levy told me. According to Levy, dotal. For example, there are accounts while it shouldn’t be women’s respon-
Field Trip’s existing preclinical studies suggesting that peyote boosts milk pro- sibility to fix this issue, her peers in the
signal that FT-104 will leave the body duction, an idea supported by preliminary field who are also women—researchers,
after 12 hours, meaning breastfeeding can research from the 1970s. For years, folks doctors, and founders—are informally
hypothetically resume within 24 hours— have reported the ways psychedelics have discussing potential solutions. The ideas
something that will need to eventually be altered their menstrual cycle, linking them include setting up a governing body to
validated in human trials and undergo to heavier periods, a period that arrives report transgressions to and establish-
scientific peer review. early, or—alternatively—a more regular ing clearer guidelines for consent before
Kelsey Ramsden, the former CEO of cycle. Research has shown that estrogen a person enters into an altered state of
Vancouver-based psychedelics company intensifies the brain’s dopamine reward consciousness.
Mindcure (which was researching MDMA- pathway, so it’s also possible that a wom- “So many people in the psychedelic
assisted psychotherapy to help women with an’s reaction to a particular drug is more community are so worried about the prog-
a lack of sexual desire until it shut down pleasurable depending on the phase of her ress being jeopardized by these reports,”
earlier this year for lack of funds), also menstrual cycle. Holland says. “The truth is, [the space]
says the postpartum depression market Feduccia posits that psychedelics might is too big to fail. It can withstand some
is appealing for psychedelic development be particularly helpful for the “rites of scrutiny now, because if not now, when? If
because there’s currently only one drug passage” that most women go through. we’re building the foundation of something
for the condition (Zulresso). Ramsden is “Psychedelics could bring better per- that’s going to last, we better make sure
a believer in part because psychedelics spective when you get your first period, the foundation doesn’t have any cracks.”
worked to alleviate her own symptoms have your first child, and then go through
after she had her first child. “The change in menopause,” she says. “I just hope that Taylor Majewski is a writer, editor,
my lived experience resulted in recurring women can benefit [from psychedelics] and producer living in California.
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74

Meta banned filters that By

“encourage plastic surgery,” Tate Ryan-Mosley products. Snap and TikTok capture huge
but a massive demand for beauty
numbers of filter users, though Snap is also
augmentation on social media
is complicating matters. investing in place-based AR. Meta’s prod-
uct suite includes the Oculus headset and
Ray-Ban smart glasses, but it’s focused on
what made Facebook popular—the face.
Beauty filters, especially those that dra-
matically alter the shape of a face and its
features, are particularly popular—and con-
tested. Instagram banned these so-called
deformation effects from October 2019 until
August 2020 because of concerns about
the impact they have on mental health.

The fight for

The policy has since been updated to out-
law only filters that encourage plastic sur-
gery. The policy states that “content must

“Instagram face” not promote the use or depict the sale of a

potentially dangerous cosmetic procedure,
as per the Facebook Community Standards.
This includes effects that depict such pro-
cedures through surgery lines.” According
to a statement to MIT Technology Review
in April 2021, this policy is enforced by
“a combination of human and automated
systems to review effects as they are sub-
mitted for publishing.” Creators told me,

I
n October 2021, Facebook announced users achieve those ideals—though only however, that deformation filters often get
a massive pivot, changing its name to in the digital world. There is evidence that flagged inconsistently, and it’s not clear
Meta and going all in on augmented excessive use of these filters online has what exactly encourages the use of cos-
and virtual reality through a futuris- harmful effects on mental health, espe- metic surgery.
tic vision of the internet called the cially for young girls. “Instagram face” is a
metaverse. In fact, the strategy had been recognized aesthetic template: ethnically “It became sensational”
taking shape gradually for years, with help ambiguous and featuring the flawless skin, Though many people use beauty filters
from a seemingly frivolous product fea- big eyes, full lips, small nose, and perfectly merely for fun and entertainment, those
ture on Instagram. Face filters that add contoured curves made accessible in large puppy ears are actually a big technical feat.
puppy ears to your hairline or make your part by filters. First they require face detection, in which
lips appear bigger sit on a sophisticated But behind every filter is a person drag- an algorithm interprets the various shades
technical infrastructure for AR and VR ging lines and shifting shapes on a com- of pixels picked up by a camera to identify
that the company, which owns Instagram puter screen to achieve the desired look. a face and its features. A digital mask of
as well as WhatsApp, has built to support Beauty may be subjective, and yet society some standard face is then applied to the
such effects. Thousands of creators have continues to promote stringent, unattain- image of the real face and adjusts to its
contributed filters free of charge, and the able ideals that—for women and girls— shape, aligning the mask’s virtual jawline
millions of people around the world who are disproportionately white, slender, and and nose to the person’s. On that mask,
use the feature each day have provided feminine. graphics developed by coders create the
Meta with troves of data. Instagram publishes very little data effects seen on the screen. Computer vision
The little research that exists about about filters, especially beauty filters. In technology of just the past few years has
digital beauty culture has found that visual September of 2020, Meta announced that allowed this to happen in real time and
platforms like Instagram, which rely on AI over 600 million people had tried at least in motion.
recommendation algorithms, are narrow- one of its AR features. The metaverse is Spark AR is Instagram’s software devel-
ing beauty standards at a stunningly rapid a concept much bigger than Meta and oper kit, or SDK, and it allows creators of
pace. Through filters, they’re also helping other companies investing in AR and VR augmented-reality effects to more easily
 75

make and share the face filters that cover coding when she was around nine years old Though Meta doesn’t make its filter
the Instagram feed. It is in this deep rab- and was drawn to the creativity of virtual- data public, it does provide creators with
bit hole of filter demonstration videos on world development. Making her own filters some metrics, and I asked Solari and oth-
YouTube that I first came across Florencia on Instagram was a hobby at first. But in ers to share the data with me. The num-
Solari, a creative AR technologist and a well- 2020, Solari left a full-time job as an AR bers are stunning; vedette++ was viewed
known creator of filters on Instagram. She developer at Ulta Beauty to pursue online 130 million times and used over 1.2 mil-
showed me how to make a face filter that AR full time as an independent consultant. lion times in 3.5 months. Solari says the
promised to plump and lift my cheeks and She’s recently worked with Meta and sev- filter was one of the first ever to go viral. It
fill out my lips for that Kardashianesque, eral other big brands (which she says she helped that vedette++ was used by model
surgically enhanced face shape. can’t disclose) to create branded AR web and influencer Bella Hadid. “Influencers
“I have this inflate tool that I am going to experiences, including filters. have a huge impact on how this spreads …
apply with symmetry,” Solari said, “because Solari’s very first filter, called “vedette++,” You will get an influencer or a celebrity
any modifications that I do to this face, I went viral back in September 2019. “I tried to to use them, and then it will go more viral
want to be symmetrical.” I tried to keep up make an interpretation of what the superstar organically,” she says. According to Solari’s
by dragging the outline of my digital man- of the future would be,” Solari says. The filter statistics from Meta, vedette++’s impres-
nequin’s cheekbone up and out with my applies an iridescent, slightly green shine sions spiked exponentially in the days after
cursor. Next, I right-clicked on the map of to the skin, which is smoothed all over and Hadid used the filter.
her bottom lip and selected “Increase” sev- inflated under each eye to the point that it
eral times, playing God. Soon, with Solari looks as if half a clementine has been shoved Deformed virality
as my guide, I had a filter that, while sloppy inside each cheek. Lips double in size, and Creators say that deformation effects and
and simple, I could upload to Instagram face shape is adjusted so that a distinct jaw- influencer shares are the keys to virality
and unleash to the world. line tapers into a small chin. “It was kind of where filters are concerned. Several cre-
Solari is part of a new class of AR and a mix of an alien, but with a face that looked ators said the demand for deformation
VR creators who have made a career by like it was full of Botox,” says Solari. “It really beauty filters is so consistent that they
mastering this technology. She started became, like, sensational.” can essentially gamify virality by making a

Solari in

VEDETTE++
by Solari

3.2B Impressions 129.6M

1.6B Opens 17.7M
27M Shares 1.2M
Solari in

BEAUTY
by Denis Rossiev
76

certain kind of effect that fits the “Instagram

face” aesthetic.
“This is something we don’t speak
“Thirty-two percent of teen
about—that deformation can make your
filter go viral. If you don’t use deforma-
girls said that when they felt bad
tion, your filter won’t succeed as much
as the other ones, even if the others are
about their bodies, Instagram
more technically complicated,” says Lucie
Bouchet, a popular filter creator. Bouchet
made them feel worse.”
notes that there are exceptions to this
pattern, and filters that are especially fun,
trendy, or unique also see massive success.
Bouchet has stopped using deformation their bodies, Instagram made them feel about preserving the most valuable and
effects in many of her filters and now builds worse.” Another slide said, “We make body unique thing we own: Who we are. Our
in a feature that enables the deformation image issues worse for one in three teen individuality … The internet was our free
effects only if users choose. girls,” and acknowledged that “compari- space. It was a mask, yes, indeed. A mask
But the statistics are hard to ignore. sons on Instagram can change how young that served us to be able to BE TRUE
Bouchet’s most popular deformation filter, women view and describe themselves.” to ourselves. Express ourselves beyond
called “Golden Hair,” amassed almost 300 Filters on platforms like Meta, TikTok, our bodies, beyond our physical realities,
million impressions, while a similar one and Snapchat are not the only technol- explore the trans-human and the fantasy.”
without deformation effects garnered a ogy working to narrow beauty standards. It’s this fantasy—this opportunity for
measly 7.2 million. Around 70% of the peo- Photo-editing tools have also exploded escapism and expression—that many cre-
ple using her filters are between 13 and 24. over the past 10 years with the rise of social ators point to when they defend filters,
media, and the results can have similar saying that AR and VR offer the ability to
“Society is like this” effects on aesthetics and mental health test out certain personas and play. Pescott,
Bouchet’s concerns about the harmful online. Recommendation algorithms and the researcher, told me that trying on dif-
effects of deformation filters, especially social preferences for certain looks can also ferent identities and demonstrating them
on girls, are shared by many creators who create harm on visual platforms. socially is an essential and healthy part of
make them. I spoke with researcher Claire But Solari thinks technology itself is adolescence. For many people, filters offer
Pescott in the spring of 2021, when I first not to blame in the first place. “It is not a new way to do that.
wrote about the effects of beauty filters on the filters that are making this [problem], Solari has thought a lot about the ten-
social media. Pescott studies the behav- but society is like this,” she says. “These sion between censorship and safety since
ior of preteens on social media and has are the values that society has and sees vedette++’s viral success and subsequent
observed gender differences in filter use. as beautiful. And that’s why it goes viral.” ban. “I don’t believe in censorship of that
She found that boys use filters primarily Creators observe a consistent and shock- kind of content, because I believe that
for fun and experimentation, and girls use ingly high demand for deformation beauty people should be able to choose what they
them to enhance their appearance. filters that fit a particular aesthetic. want to adopt or not,” she says. But Solari
Though Meta declined to speak with me also believes that strict beauty standards
on the record for this story, the company Authenticity and freedom do make it hard for people to accept them-
has taken some steps to address recent crit- In December 2019, Instagram banned selves fully. “If we actually want to address
icism surrounding the negative impact that vedette++ as part of its clampdown on this,” she says, “we have to look for a way
Instagram can have on the mental health deformation effects. Solari says she wasn’t to help people to really build the strength
of users, particularly teenage girls. When trying to encourage plastic surgery and to say ‘I like myself as I am. I want to show
whistleblower Frances Haugen came for- believes that most people using her filter myself as I am.’”
ward with internal company documents, wanted to “perform with a face that just “I find beauty in authenticity, in free-
some showed that its leaders had known looked kind of out of this world.” dom, and in what I find to be the perfect
about these problems for years. According She responded to the deformation ban balance between order and chaos,” she
to reporting by the Wall Street Journal, a with a scathing Medium post that was says.
March 2020 slide presentation by Facebook widely shared among filter creator com-
Tate Ryan-Mosley reports on
researchers read, “Thirty-two percent of munities. It reads: “This isn’t about plas- digital rights and democracy at
teen girls said that when they felt bad about tic surgery. This is about FREEDOM. It’s MIT Technology Review.
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78

The Milky Way as seen

from the South Rim of
the Grand Canyon.

Lit streets,

LEDs are billed as a more environmentally friendly By Shel Evergreen

approach to outdoor lighting. But there is no simple
panacea for light pollution.

Late one evening in June of 2016, John Barentine stood alone accessible places on Earth experience this kind of pristine dark-
at Mather Point, an iconic and rarely empty overlook at Grand ness. Indeed, the view is quite different 200 miles away in Tucson.
Canyon National Park. The moon slid away, leaving the darkness There, photons from the city’s lights scatter in the sky, forming
of a crisp, clear sky. The stars that make up our galaxy seemed an obscuring dome of light called sky glow—a feature now com-
to align overhead. The inky chasm of the ancient canyon spread mon to major cities.
out below, and he marveled at a feeling of being unmoored in Scientists have known for years that such light pollution is grow-
CREDIT HERE IMAGES

time and space. ing and can harm both humans and wildlife. In people, increased
An astronomer who worked for the International Dark-Sky exposure to light at night disrupts sleep cycles and has been linked
SCHMID/GETTY

Association (IDA), Barentine had a special reason to revel in the to cancer and cardiovascular disease, according to a 2016 report
scene. With his help, the park had recently been given provisional by the American Medical Association. Meanwhile, the ecological
status as an International Dark Sky Park, a designation given to impacts of light pollution span the globe. It can affect the repro-
GUTTER
ADAM

public land that exhibits “exceptional” starry nights. Few publicly duction patterns of male crickets, causing them to chirp during the
 79

dark skies

daytime instead of at night, when they typically call mates. Baby Several major cities across the globe, including Paris, New York,
sea turtles, which have evolved to evade predators by rushing to and Shanghai, have already adopted LEDs widely to save energy
the ocean upon hatching, can be disoriented by lights near the and money. But a growing body of research suggests that switching
shore. Owls lose their stealthy advantage over prey. Even trees to LEDs is not the straightforward panacea some might expect.
can struggle, holding onto leaves longer and budding earlier than In many cases, LED installations have worsened light pollution.
they should because the brightness of their surroundings gives Steering a path toward reducing the problem requires more than
them incorrect information on the time of year. just buying some energy-efficient fixtures. Cities must develop
Astronomers, policymakers, and lighting professionals are dark-sky-friendly policies, and lighting professionals need to design
all working to find ways to reduce light pollution. Many of them and manufacture products that enable those policies to succeed.
advocate installing light-emitting diodes, or LEDs, in outdoor And they must start doing so now, say many light pollution experts,
fixtures such as city streetlights. Watt for watt, LED streetlights including Karolina Zielinska-Dabkowska, an assistant professor of
are now comparable in efficiency to traditional sodium vapor architecture at Gdańsk University of Technology in Poland. LEDs
GUTTER CREDIT HERE

streetlights—and are in some cases more efficient. But the crucial already make up more than half of global lighting sales, according
difference is that they are better at directing light to a targeted to the International Energy Agency. The high initial investment and
area, which means less light and energy are needed overall to durability of modern LEDs mean cities need to get the transition
achieve the desired illumination. right the first time or potentially face decades of consequences.
80

Paris, the “City

of Light,” viewed
from the International
Space Station.

Z
ielinska-Dabkowska may understand the potential and a radiometer suite aboard the Suomi National Polar-orbiting
and drawbacks of using LEDs better than any- Partnership satellite, says Alejandro Sánchez de Miguel, an astro-
one. In the 2000s, she worked for various lighting physics postdoc at the Complutense University of Madrid. The
companies on high-profile projects, including the instrument provides higher-resolution images, but its infrared
Tribute in Light memorial in New York City. The sensors exclude wavelengths found in many LEDs. “The more blue
striking installation shoots two beams of light into the sky to light a light has, the less light the satellites see,” says Sánchez de
echo the two World Trade Center towers lost on 9/11. Soon after Miguel. “We are color-blind, and we are thinking that everything
it was completed in 2002, the tribute turned out to be trapping is red.” Last year, he and his colleagues found that previous studies
migrating birds in its hypnotizing beams. had probably lowballed global light emissions. Their study estimated
The piece is now switched off at times to allow birds to that artificial light had grown by at least 49% around the planet
disperse, but light pollution ultimately became an issue Zielinska- between 1992 and 2017, and as much as 400% in some regions.
Dabkowska could not ignore, and she wrapped research on The adoption of cool white LEDs—alongside factors like
solutions into her work. “I wanted to make a change,” she says. increasing population and electrification—is likely responsible
There are four main elements of light pollution, Zielinska- for some of this growth. The attraction is understandable. They
Dabkowska says. The most recognizable is sky glow, which can are cheaper and more efficient than warm LEDs, Zielinska-
affect migrating birds hundreds of miles away. Another is light Dabkowska explains.
trespass, the photons that cross boundary lines. They can creep But flipping the switch on light pollution involves more than
in through windows and can affect sleep and circadian rhythms. changing colors. Even LEDs that look warm in tone still have
Glare, meanwhile, is a change in contrast—the sort that happens a spike of blue that signals daylight in our brains, Zielinska-
when you walk from a highly lit area into a darker one, forcing Dabkowska says. And different species display diverse responses
your eyes to adjust. Lastly, and most significant, she says, is to light, according to a study published in 2021 in the journal
over-illumination—lighting things up much more than necessary. Integrative & Comparative Biology. For example, photorecep-
LEDs have the potential to combat all four of these problems. tors are more red-sensitive in freshwater species of the teleost
The bulbs can, for example, be installed in “smart” housings that fish than in marine species—a distinction that illustrates the
can be remotely tuned and programmed. “You can control LEDs,” complexity of responses to light even among similar animals.
Zielinska-Dabkowska says. “You can dim them down to 0%.” The study cautioned that efforts to deal with light pollution
The city of Tucson implemented smart lighting controls in its are “accumulating faster than our basic knowledge of sensory
streetlights in 2016, replacing 18,000 sodium lights with shielded
LEDs to help prevent light from escaping upward. A 2018 study
on which Barentine was lead author found that Tucson’s sky glow
Artificial light grew by an
decreased by 7% after the transition. The “color temperature” of eutimated 49% globally between
those lights—a measure the industry uses to describe the warmth 1992 and 2017—and au much au
or coolness of their tone—is a moderate 3,000 K. But that color
temperature now exceeds the IDA guidelines for outdoor lighting,
400% in uome regionu.
which were released last year; researchers agree a warmer tem-
perature of 2,200 K is a better cutoff. Bluer, cooler-toned lights
with higher Kelvin ratings have shown the clearest evidence
of disruption to the circadian rhythms of people and animals,
which causes a cascade of health and environmental impacts. systems.” Picking a single hue, even a warmer one, and blast-
The switch to LEDs has been habitually lauded as an envi- ing it into the night will likely have significant repercussions,
ronmental win, but experts say they are often used to extremes. says Valentina Alaasam, a PhD candidate at the University of
One problem, says Pete Strasser, a Tucson resident and techni- Nevada, Reno, and lead author of the study. “Everything that
cal director at the IDA, is the excessive use of bright white LED affects species interactions winds up affecting evolution and
lighting in cities such as Los Angeles, which has boasted about species distribution,” she says. “Animals that can cope better
its ability to make streets brighter. “We hear that people feel a lot with the city and with lights are moving into cities, and animals
safer with the white light,” Ed Ebrahimian, then director of LA’s that can’t cope are moving out.” She says it’s a problem that has
street lighting, said in a 2014 Department of Energy video on LED gotten really big, really fast.
streetlights. Light pollution experts say this feeling of safety seems Barentine says the color can’t be taken in isolation from other
to stem from fact that one can see a greater range of colors under aspects like shielding, brightness, distribution, and timing. For
white light, which gives the sensation that one can see better. example, he says, dark-sky-friendly lighting might have cooler-
Tracking the global extent of light pollution is challenging. toned light at a lower intensity, ultimately still resulting in less
NASA

Researchers have mainly relied on low-resolution satellite sensors blue light emission.
GUTTER CREDIT HERE
Article
81
82

A global view of Earth

assembled from data acquired
by the Suomi National Polar-
orbiting Partnership (NPP)
satellite.

or light pollution researchers, the key hurdle to over-

F come is no longer technology but communication.

“The biggest obstacle that we have to making more
progress in this realm is a lack of awareness and edu-
cation on the part of people that are in municipal gov-
ernment,” says Barentine, who now works on dark-sky policies
as an independent consultant.
Career civil servants like city administrators or engineers, he
says, are most often the people who make day-to-day decisions or
recommendations in municipal governments, rather than elected
officials. “My perception is that a lot of their information comes
from the lighting industry, for better or worse,” Barentine says.
Until recently, those companies were at odds with light pollu-
tion researchers, Barentine says. “There was just tremendous
skepticism within the lighting manufacturing industry,” he says,
adding that he thinks there was an intrinsic belief that the issue
was simple: light is good and darkness is bad.
Barentine says he makes sure to communicate to the lighting
industry that his work is about “dark sky,” not “dark ground.” The
IDA has worked with industry since the 1980s, he says: “Our
message, in so many words, was ‘If you follow our principles
that reduce light pollution, you won’t sell any less lighting than
you sell now; you’ll be selling different lighting.’”
Still, the advent of white LEDs that promised perfect illumi-
nation and the boom that followed led to a misalignment of goals,
whether real or perceived. Lighting professionals and researchers
continued to speak about light in fundamentally different ways.
To illustrate and quantify the communication gap, Catherine
Pérez Vega, a doctoral candidate at the Leibniz Institute of has observatories nearby, but to some people, light pollution
Freshwater Ecology and Inland Fisheries in Berlin who works can seem an insignificant concern compared with other issues
with Zielinska-Dabkowska, led a systematic review of more than the city is tackling, such as air pollution, food deserts, and road
200 studies of artificial light at night. The results, published in maintenance. Even so, Diane Turnshek, a physics lecturer and
the journal Sustainability earlier this year, found a disconnect assistant professor at Carnegie Mellon University (CMU), thinks
between researchers and professionals such as lighting archi- it shouldn’t be hard to address.
tects, urban lighting designers, and electrical illumination engi- Turnshek spent many nights under the stars while studying
neers. In some cases, the two groups were essentially speaking astronomy at the University of Arizona in the 1970s. Decades
different languages. For example, those studying artificial light later, she briefly returned to join the Mars Desert Research
use a metric called “irradiance” to talk about brightness, while Station, a NASA laboratory for learning how to live in a harsh,
those in the lighting industry go with a different measure, called isolated, Mars-like environment.
“illuminance.” In a list of 19 physical measurements of light, only Inspired once again by the desert’s starry skies, Turnshek
one term has the same level of usage—and it is rarely used by became a vocal dark-sky advocate when she returned to Pittsburgh.
either group. But she struggled to be heard. Lighting professionals, in her expe-
“I think [the review] has stimulated a conversation in this field rience, have “zero” idea light pollution is even a research field.
that is a long time in coming,” Barentine says. “We are beginning “We’re not even talking in the same units,” she says, pointing
to realize that even though we have similar goals—and I think to Pérez Vega’s study. “There’s no overlap.”
we do—we often talk past one another.” Earlier this year, Pittsburgh was slated to begin work on a
streetlight upgrade. But Turnshek says the process has been
rizona, with its dozens of observatories and arid opaque. An earlier description of the project said the city

A desert skies, is a major hub for astronomy research.

As a result, Tucson has been relatively successful
in its dark-sky endeavors. But the priorities are dif-
intended to add 15,000 new LEDs, something that Turnshek
worried would lead to over-illumination.
The latest city estimate is that 3,000 to 15,000 new LED
NASA

ferent in other cities. Pittsburgh, for example, also lights will be needed, says Angie Martinez, a senior manager in
 83

Pittsburgh’s Department of Mobility and Infrastructure. But the gaps to be addressed in several areas, including the overall effec-
first task for the winning consultant will be a citywide street- tiveness of government policies on light pollution. Another is
light inventory that addresses the current state of individual how much light pollution comes from sources other than city
streetlights, as well as their overall distribution. “The challenge streetlights, which a 2020 study found accounted for only 13%
of taking on a project of this magnitude is that it just gets really of Tucson’s light pollution. It is not clear what makes up the
complex,” Martinez says. “We can’t just assume that every single rest, but Barentine suspects the next biggest source in the US
light in the city of Pittsburgh is in the most optimal location.” and Europe is commercial lighting, such as flashy outdoor LED
It’s possible, she says, that there may end up being fewer total signs and parking lot lighting.
streetlights. Working with companies to reduce light emissions can be
Specifications in the current proposal provide a starting point challenging, says Clayton Trevillyan, Tucson’s chief building
for planning, including a color temperature cutoff of 3,000 K officer. “If there is a source of light inside the building, tech-
in line with Pittsburgh’s dark-sky ordinance, which passed last nically it’s not regulated by the outdoor lighting code, even if
fall. However, Martinez says that is the maximum, and as they it is emitting light outside,” Trevillyan says. In some cases, he
look for consultants, they’ll be taking into account which ones says, in order to get around the city’s restrictions, businesses
show dark-sky expertise. The city is also considering—budget have suspended illuminated signs inside buildings but aimed
and infrastructure permitting—a “network lighting management them outside.
system,” a kind of “smart” lighting that would allow them to con- For cities trying to implement a lighting ordinance, Trevillyan
trol lighting levels and know when there is an outage. says, the biggest roadblocks they’ll face are “irrelevant” argu-
Martinez says there will be citywide engagement and updates ments, specifically claims that reducing the brightness of
on the status as critical milestones are reached. “We’re in the outdoor lighting will cut down on advertising revenue and
evaluation period right now,” she says, adding that the next make the city more vulnerable to crime. The key to success-
milestone is authorization of a new contract. She acknowledges fully enforcing the dark-sky rules, he says, is to educate the
there is some “passionate interest in street lighting,” and that she public and refuse to give in to people seeking exceptions or
too is anxious to see the project come to fruition: “Just because exploiting loopholes.
things seem to go quiet doesn’t mean work is not being done.” Light pollution experts generally say there is no substantial
While they aren’t meeting with light pollution experts right evidence that more light amounts to greater safety. In Tucson,
now, Martinez says the ones they met with during the last pro- for example, Barentine says, neither traffic accidents nor crime
appeared to increase after the city started dimming its street-
Light pollution expertu generally lights at night and restricting outdoor lighting in 2017. Last year,
researchers at the University of Pennsylvania analyzed crime
uay there iu no uubutantial rates alongside 300,000 streetlight outages over an eight-year
evidence that more light amountu period. They concluded there is “little evidence” of any impact
on crime rates on the affected streets—in fact, perpetrators
to greater uafety. seemed to seek out better-lit adjacent streets. Barentine says
there is some evidence that “strategically placed lighting” can
help decrease traffic collisions. “Beyond that, things get murky
pretty quickly,” he says.
Still, the perception of security is a factor that cities need to
posal round—Stephen Quick and Diane Turnshek of CMU— take seriously, Barentine says. For example, a study published in
were “instrumental” in adopting the dark-sky ordinance. the journal Remote Sensing earlier this year found that people
in various neighborhoods of Dalian, China, felt safer in consis-

I
n recent months, Zielinska-Dabkowska says, her “baby” tent levels of warm light, something easily achieved with con-
has been the first Responsible Outdoor Light at Night trolled LED lighting.
Conference, an international gathering of more than 300 Many light pollution experts say LEDs simply need to be
lighting professionals and light pollution researchers held used to their full potential to avoid over-illuminating the skies.
virtually in May. Barentine was among the speakers. “It’s Responsible lighting doesn’t seem to disadvantage anyone,
a sign that all of this is really coming along, both as a research but there’s a mysticism about the night to overcome, Barentine
subject but also something that attracts the interest of practi- says: “At the end of the day, there’s a real, entrenched, human
tioners in outdoor lighting,” he says of the conference. fear of the dark.”
There is more work to be done, though. The IDA recently
released a report summarizing the current state of light pollu- Shel Evergreen is a science journalist and multimedia
tion research. The 18-page report includes a list of knowledge professional based in Boulder, Colorado.
84

Research suggesting a transgender By

contagion arrived at just the right Ben Kesslen Association for Transgender Health put
moment to be taken up by social
out a statement saying ROGD “constitutes
media and a new wave of anti-trans
political effort. nothing more than an acronym” and urged
restraint in using the term. Six months after
that, PLOS One reissued the study with a
large correction emphasizing that Littman’s
paper was simply a “descriptive, exploratory”
one and had not been clinically validated.
In 2021, the Journal of Pediatrics published
a comprehensive study that found no evi-
dence for ROGD’s existence. More than
60 psychology organizations, including the
American Psychological Association, called

A rapid-onset
for elimination of the term.
The scientific community, in short,
agreed there was no such thing as ROGD.

gender theory But did it matter?

The paper was a turning point. While
theories and rumors about something
like ROGD had quietly percolated online
before the paper was published, Littman’s
descriptive study gave legitimacy to the con-
cept. Soon after, it took on a life of its own.
People describing themselves as “parents of
ROGD kids” formed online support groups.
Abigail Shrier’s anti-trans tome Irreversible
hen Jay told his mom behind a false diagnosis of gender dyspho- Damage: The Transgender Craze Seducing

W he was bisexual at 14,

she was supportive. But
when he came out as
transgender a few years
later, she pushed back. She felt blindsided
by the news. YouTube videos and online
forums soon convinced her that she was
ria, the thinking goes, instead of confronting
whatever issues are truly challenging them.
Littman polled parents and reported
that they “describe a process of immersion
in social media … immediately preceding
their child becoming gender dysphoric.”
Once a teen identifies as trans, Littman
Our Daughters sold more than 100,000 cop-
ies and has been promoted on extremely
popular conservative podcasts. YouTube
videos peddling the theory have scored hun-
dreds of thousands of views. Justifications
for anti-trans bills, like a memo on Florida’s
attempt to stop Medicaid funding for adult
right to feel that way. To her, it was clear argued, they can unduly—and perhaps transition-related health care, routinely cite
that Jay was simply mistaken. A trans “con- unwittingly—influence peers to do the the study in their footnotes.
tagion” called “rapid-onset gender dys- same. This can partially explain the rising Five years later, Jay’s mom still doesn’t
phoria,” spread through social media, had numbers of trans youth, she said, adding believe that he’s trans.
caught hold of him and convinced him he that the dynamic particularly affects those Littman believes her study has been
was not female, she said. The Internet had assigned female at birth. misinterpreted, but the concept of ROGD
“turned” him trans. The paper, which was based on parent continues to provide scientific fuel to anti-
Widely introduced four years ago in a surveys recruited from explicitly anti-trans trans rhetoric and legislation, including a
PLOS One paper by Lisa Littman, a physi- or trans-skeptical websites and forums, current wave of state laws targeting trans
cian and researcher, the concept of ROGD almost immediately drew criticism. Shortly youth. Understanding the theory’s ascent
hypothesizes a “potential new subcategory” after its publication in August 2018, PLOS from fringe forums to scientific journals to
of gender dysphoria—the feeling of dis- One, a peer-reviewed open-access journal the halls of Congress helps clarify some of the
tress that one’s gender and assigned sex covering science and medicine, issued a moral panic and pernicious logic employed
do not match. Young people with ROGD, comment that questioned Littman’s method- to restrict the autonomy and rights of trans
the theory claims, feel symptoms of gender ology. Brown University, her then-employer, people today. It also serves as a vivid example
dysphoria and identify as trans as a result of retracted its press release about the study. of how questionable science can be weap-
peer influence, especially online. They hide In early September, the World Professional onized to achieve political goals.
 85

A number of studies on trans youth have “There’s a wealth of bad science that is is only bullshit, and somebody is just try-
taken on “misinformational afterlives,” says out there, and this science doesn’t stay in ing to corrupt your child.’”
TJ Billard, an assistant professor of commu- journals,” Billard says. Parents unfamiliar You learn about ROGD and read about a
nications at Northwestern University and with trans issues, who don’t understand “social contagion” infecting lonely children
executive director of the Center for Applied gender-affirming health care and don’t online. You discover that there are thou-
Transgender Studies. Among them are four have the expertise to read the studies sands of parents whose kids have it too, and
papers published between 2008 and 2013 themselves, often fall under its sway. there’s even a whole book about it. So you
that have together been used to claim that Think of it this way: Your teen, who go back to your child, who you know better
most children “grow out” of gender dys- you think you know better than any- than they know themself, right? Because
phoria and opt not to transition. All have one else does, “suddenly” identifies in they’re only a kid. And you say, Actually, no,
been shown to have numerous shortcom- a way you never expected. You’re con- you’re not trans. Honey, you’ve been duped.
ings. In some, nearly 40% of young people fused. You might ask some friends for The problem: Overwhelming evidence
surveyed did not meet the criteria for the advice, but you mostly feel alone in deal- shows that your child almost certainly hasn’t
official gender dysphoria diagnosis in the ing with this revelation. Late one night, been duped. Although some people do
Diagnostic and Statistical Manual of Mental you take to Google. Maybe you read the reconsider or reverse their transition, once
Disorders edition used at the time. In two, Wikipedia page for “gender dysphoria in a person starts identifying as trans, it’s quite
researchers classified some subjects as children,” some news articles, a report unlikely they’ll change their mind. No matter
having detransitioned—or reversed their from the CDC. how strongly you believe that the internet,
transition—purely on the basis of whether You’re inundated with words you’ve social contagion, and positive representa-
a parent or third party said it happened. A never heard, concepts that challenge a tions of transgender people turned your
2018 study found that three of the papers gender binary you’ve never questioned. child trans, chances are your child disagrees.
FRANZISKA BARCZYK

labeled those who had stopped responding You panic.

to researchers as detransitioners; and in What often happens next, Billard says, Littman began her research after noticing
one, a subject who identified as nonbinary is “you stumble upon a blog post or a news that in her small town in Rhode Island, a
was classified as detransitioning. article or a YouTube video that says: ‘This few teens in the same friend group started
86

identifying as trans. She had not previously

studied gender dysphoria or trans health
care, but she thought it was peculiar and
The ROGD paper was not funded by anti-trans
merited some exploration. She did not zealots. But it arrived at exactly the time people
approach the work with “a chip on my with bad intentions were looking for science to
shoulder,” she says.
At that time, one thing most research-
buoy their opinions.
ers studying trans youth agreed on is that
there was a dearth of unbiased studies on
the subject. Scientists had been researching Arjee Restar, now an assistant profes- competing in sports went national, as did
trans youth for decades, but studies often sor of epidemiology at the University of a heavily publicized Texas custody battle
had small sample sizes, unreliable meth- Washington, didn’t mince words in her between a mother who supported her
odology, or little longitudinal follow-up. By 2020 methodological critique of the paper. trans child and a father who didn’t. Groups
2016, researchers had begun to take note Restar noted that Littman chose to describe working to further marginalize trans peo-
of a rise in youth identifying as trans, but the “social and peer contagion” hypoth- ple, like the Alliance Defending Freedom
there was (and still is) no easy explanation esis in the consent document she shared and the Family Research Council, began
for why, although there were many the- with parents, opening the door for biases “printing off bills and introducing them to
ories—some based on existing research in who chose to respond to the survey and state legislators,” says Gillian Branstetter, a
and some just on hunches. how they did so. She also highlighted that communications strategist at the American
When Littman took up the question, Littman asked parents to offer “diagnoses” Civil Liberties Union.
she decided to survey parents, who she of their child’s gender dysphoria, which they The ROGD paper was not funded by
felt would be easier to reach than trans were unqualified to do without professional anti-trans zealots. But it arrived at exactly
youths themselves. In her Methods sec- training. It’s even possible that Littman’s the time people with bad intentions were
tion, she writes that “to maximize the data could contain multiple responses from looking for science to buoy their opinions.
chances of finding cases meeting eli- the same parent, Restar wrote. Littman The paper “laundered what had previously
gibility criteria”—meaning youths who told MIT Technology Review that “tar- been the rantings of online conspiracy the-
suddenly became gender dysphoric, geted recruitment [to studies] is a really orists and gave it the resemblance of seri-
according to their parents—she turned common practice.” She also called atten- ous scientific study,” Branstetter says. She
to three websites: 4thwavenow.com, a tion to the corrected ROGD paper, which believes that if Littman’s paper had not been
“community of people who question notes that a pro-gender-affirming parents’ published, a similar argument would have
the medicalization of gender-atypical Facebook group with 8,000 members posted been made by someone else. Despite its
youth”; transgendertrend.com, which the study’s recruitment information on its limitations, it has become a crucial weapon
says it’s concerned about “the unprec- page—although Littman’s study was not in the fight against trans people, largely
edented number of teenage girls sud- designed to be able to discern whether any through online dissemination. “It is aston-
denly self-identifying as ‘trans’”; and of them responded. ishing that such a blatantly bad-faith effort
youthtranscriticalprofessionals.org, a But politics is blind to nuances in meth- has been taken so seriously,” Branstetter says.
now-private website that was “concerned odology. And the paper was quickly seized Littman plainly rejects that charac-
about the current trend to quickly diagnose by those who were already pushing back terization, saying her goal was simply to
and affirm young people as transgender.” against increasing acceptance of trans peo- “find out what’s going on.” “This was a
The results were in line with what one ple. In 2014, a few years before Littman very good-faith attempt,” she says. “As a
might expect given those sources: 76.5% of published her ROGD paper, Time maga- person I am liberal; I’m pro-LGBT. I saw
parents surveyed “believed their child was zine had put Laverne Cox, the trans actress a phenomenon with my own eyes and I
incorrect in their belief of being transgen- from Orange Is the New Black, on its cover investigated, found that it was different
der.” More than 85% said their child had and declared a “transgender tipping point.” than what was in the scientific literature.”
increased their internet use and/or had By 2016, bills across the country that aimed
trans friends before identifying as trans. The to bar trans people from bathrooms that One reason for the success of Littman’s
youths themselves had no say in the study, fit their gender identity failed, and one paper is that it validates the idea that trans
and there’s no telling if they had simply kept that succeeded, in North Carolina, cost its kids are new. But Jules Gill-Peterson, an asso-
their parents in the dark for months or years Republican governor, Pat McCrory, his job. ciate professor of history at Johns Hopkins
before coming out. (Littman acknowledges Yet by 2018 a renewed backlash was and author of Histories of the Transgender
that “parent-child conflict may also explain well underway—one that zeroed in on Child, says that is “empirically untrue.” Trans
some of the findings.”) trans youth. The debate about trans youth children have only recently started to be
 87

discussed in mainstream media, so peo- Many people who are citing Littman’s go-to. The Coalition for the Advancement
ple assume they weren’t around before, work probably haven’t even read the study & Application of Psychological Science
she says, but “there have been children or seen the correction, Billard says: “People wrote in 2021 that many of the “over 100
transitioning for as long as there has been are citing a Reddit post in which some- bills under consideration in legislative
transition-related medical technology,” and body invoked the idea of Littman and bodies across the country that seek to limit
children were socially transitioning—living her research.” Littman agrees with this the rights of transgender adolescents” are
as a different gender without any medical characterization. “It boggles my mind “predicated on the unsupported claims
or legal interventions—long before that. how people are comfortable holding forth advanced by ROGD.”
Many trans people are young children on topics that they haven’t actually read Littman says she is “personally opposed
when they first observe a dissonance papers [about],” she says. to legislative bans on medical interven-
between how they are identified and how Littman thinks her ROGD paper is tions for gender-dysphoric youth.” She
they identify. The process of transitioning often misappropriated to speak to the trans does believe, however, that “the majority
is never simple, but the explanation of their experience at large. “It does not apply to of young people with gender dysphoria will
identity might be. all cases of gender dysphoria,” she says. often grow up to be lesbian, gay, or bisexual
Others have slower and more compli- “This doesn’t imply that nobody bene- adults who are not transgender.” Overall,
cated journeys, where identity is murky fits from transition. People will take it to she says, the conclusions of her research
and gender is anything but straightfor- assume that.” “are not justifications for banning, or for
ward. This compounds confusion among But Littman stands by the core claims not covering” trans health care altogether.
cisgender people who have only been made by her paper and thinks more Rather, they show the need for caution.
exposed to the simple trans narratives of research needs to be done (which she her- Still, a June 2022 report commissioned
“being stuck in the wrong body.” Perhaps self continued with a 2021 survey on young by Florida’s Republican governor, Ron
they can comprehend being “born a man” people who reversed their transition). DeSantis, as part of his effort to stop
and wanting to “be a woman” but not the Medicaid funding for transition-related
limitless options in between. When Littman’s paper appeared in adult health care cites her work multiple
When we first talked in 2019, Jay was 2018, there was science that supported times. In 2019, US Representative Doug
using different pronouns. He knew he youth transition, but little longitudinal Collins of Georgia read part of her study
wasn’t cis; he knew he was trans. But he research and few studies with large cohorts. into the Congressional Record when voic-
was working through the specifics and Researchers are still filling in the gaps. ing his opposition to the Equality Act,
asking himself questions. Growing up, There are researchers and clinicians which would broadly prohibit discrimina-
Jay—like a lot of queer and trans kids— treating patients who agree with Littman tion on the basis of sex, sexual orientation,
had trouble making friends. Online, he had and say ROGD is a real and growing phe- and gender identity.
room to explore his identity while living in nomenon that they’ve witnessed firsthand. Even as the voices saying he’s been brain-
a home where he wasn’t embraced. But a July 2022 study found that five washed get louder, Jay, who is now 21, has
His mom thinks of that online space years after socially transitioning, 94% of only become more confident in his identity.
differently. She “thinks because the trans youth surveyed still identified as trans- He can’t wait until he can get out of
community is accepting of me, which gender and 3.5% identified as nonbinary. the house, live on his own, and finally
other communities haven’t always been, And research has shown that fam- start hormones. He’s on a waitlist for an
that I’m gonna stick with them,” Jay says. ily acceptance and appropriate medical assessment to get the process started. Not
If Jay goes on testosterone, as he hopes intervention can have lasting benefits. In being able to be himself, he says, can feel
to, he’ll be kicked out of the house. After February 2022, for example, researchers miserable and isolating. Thinking of the
countless arguments during the five years reported that trans and nonbinary youths future is what keeps him hopeful.
he’s identified as trans, he says, his mom who went on puberty blockers or hormones But Jay speaks of a dark alternative
“still believes I’ve been brainwashed by had 60% lower odds of depression and 73% timeline where he is never able to medi-
trans activists on the Internet.” When he lower odds of suicidality, compared with cally transition and live the life he wants.
presented evidence that debunked ROGD, those who did not. In that scenario, which he makes clear is
he says, she claimed it was engineered by Lawmakers in more than 25 states have only hypothetical, he dies by suicide.
trans activists. “She doesn’t listen or care, introduced anti-trans bills during 2022 leg- He thinks he knows what his mom
because she doesn’t trust anything I say islative sessions. Politicians writing such would say after he died:
about this,” he says. (To protect Jay’s safety, legislation have plenty of questionable “The trans activists on the internet
MIT Technology Review did not reach out studies, partisan doctors, and associations killed my daughter.”
to his mother and used only his first name that lobby against transgender rights to Ben Kesslen is a journalist based in
for this story.) draw on. Littman’s ROGD study is often a New York City.
88 Archive

Illustration by Lauren Simkin Berke

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