Defending Gender Equity and Scientific Integrity in the Face of White House Executive Order 14168: Why the SAGER Guidelines Matter.

Abstract

One of the Trump administration's first executive orders, issued on January 20, 2025, was framed as an effort to defend women from "gender ideology extremism." It defines sex as binary and attempts to erase gender as a scientific topic of inquiry. In this essay, we argue that these efforts are unscientific and unrealistic. In contrast to the White House's contention that sex is strictly binary, this essay points out that human gonadal development is more complicated and multifaceted, and that gender shapes exposure to health risks, access to care, interactions with health workers, resource allocation, and service availability within health systems, ultimately affecting health outcomes. The denial of gender as a scientific concept undermines decades of work toward evidence-based standards such as the Sex and Gender Equity in Research (SAGER) guidelines, which aim to strengthen scientific rigor by systematically integrating sex and gender analyses. More importantly, such measures are detrimental to the health of all populations, as neglecting sex and gender dynamics compromises evidence, skews public health responses, and deepens inequities. (<i>Am J Public Health</i>. Published online ahead of print July 30, 2026:e1-e6. https://doi.org/10.2105/AJPH.2026.308574).