23andMe added eight new regions within North America reflecting Indigenous genetic ancestry. The addition is in response not just to requests from thousands of customers, but also as part of an ongoing effort to create a 23andMe Ancestry Service that better reflects the diverse genetic ancestries of our customers.
With guidance from experts including Indigenous scientists, our team worked to provide some customers who have Indigenous ancestry from what is now the United States and Canada with more detailed ancestry results. In parallel, we created an experience that is both educational and transparent, in which we explain why genetic ancestry results cannot be used to seek or confirm any form of Indigenous belonging such as membership in a Tribe or Nation.
In 2019, we added a feature called “<a href="https://blog.23andme.com/articles/caribbean-latin-american/">Recent Ancestry in the Americas</a>,” which offers clues about our customers’ <a href="https://blog.23andme.com/articles/23andme-adds-more-detail-for-indigenous-mexican-ancestry">ancestry from Mexico</a>, Central America, South America, and the Caribbean. With this update in North America, we are now able to offer more detail about some customers’ Indigenous ancestry from what is now the U.S. and Canada, as well. Some customers will be seeing this update over the next several weeks as it is rolled out.
Customers can view their Ancestry Composition <a href="https://you.23andme.com/reports/ancestry_composition_hd/">here</a>.
<h3>What are the new regions?</h3>

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="700" height="536" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Regions-1.png" alt="" class="wp-image-28905" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Regions-1.png 700w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Regions-1-300x230.png 300w" sizes="auto, (max-width: 700px) 100vw, 700px" /></figure>
 
<h3></h3>
<h3>How was this analysis done?</h3>
<ol>
<li aria-level="1">To determine our reference groups, we selected customers with Indigenous American genetic ancestry who consented to participate in research and indicated in their <a href="https://you.23andme.com/research/surveys/family_origins_v2/">Family Origins survey</a> that at least one of their grandparents was affiliated with one North American Indigenous Tribe, Band, Sovereignty, First Nation, or other community. We excluded from the analysis any DNA predicted by our Ancestry Composition analysis to be inherited from a European, Asian, or African ancestor. In this way, we can ensure that the shared ancestry we are identifying was inherited from an Indigenous American ancestor.</li>
<li aria-level="1">Next, to uncover geographic patterns of Indigenous ancestry in what is now the US and Canada, we removed individuals from the analysis who shared large amounts of DNA with people whose grandparents were born in Mexico, Central America, South America, or the Caribbean.</li>
<li aria-level="1">Then, we used a technique called genetic clustering to identify potential groups of individuals who share higher levels of DNA with each other than they do with others in the analysis. These genetic groups became our reference groups for this feature, and we then are able to compare customers’ DNA to the DNA of individuals within these reference groups.</li>
<li aria-level="1">Finally, we generated maps based on where the individuals in these groups told us their grandparents who identified as Indigenous American were born.</li>
</ol>
For a more detailed explanation of the methods used in this analysis, visit our <a href="https://you.23andme.com/ancestry/indigenous-american-faqs/">Indigenous American ancestry FAQ page</a>.

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="512" height="501" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/Genetic-Cluster.png" alt="" class="wp-image-28904" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/Genetic-Cluster.png 512w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Genetic-Cluster-300x294.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /></figure>
 
<h3>Will customers’ percentages update?</h3>
No. For a given Indigenous North American region match we indicate our confidence in the result, reported as &#8220;likely match,&#8221; or &#8220;highly likely match.&#8221; This works the same way as our Recent Ancestor Locations feature. If we are not able to detect a genetic match to a region with confidence, we report this as &#8220;not detected.&#8221;
This update will only affect customers who already have Indigenous American genetic ancestry as estimated by 23andMe’s Ancestry Composition algorithm. In other words, if you did not already have some percentage of DNA predicted to match our Indigenous American reference population, then you cannot receive a match to one of these eight new regions. 
Furthermore, not everyone with Indigenous American ancestry will receive a match to a region at this time.
<h3>How many customers can expect to get a match to one of the new regions?</h3>
Fewer than 10 percent of customers with some Indigenous American genetic ancestry will receive a match at this time, though this number may be higher for customers with known Indigenous ancestry from North America. The science behind this update is both rigorous and conservative, meaning we focused on ensuring that there were as few false matches as possible. As a result of this approach, there will be some individuals with known Indigenous American ancestry from North America who do not receive a match to any region at this time. We understand that not seeing an expected match can be confusing, but our ability to match someone to a region based on DNA is only as good as the size and diversity of the reference groups and algorithms used to predict them. Over time, as more people with Indigenous American ancestors join 23andMe, customers’ results may change.  More information about unexpected results can be found in our <a href="https://you.23andme.com/ancestry/indigenous-american-faqs/">FAQs</a>.
<h3>What are the new regions?</h3>

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="1024" height="576" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-1024x576.jpeg" alt="" class="wp-image-29044" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-1024x576.jpeg 1024w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-300x169.jpeg 300w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-768x432.jpeg 768w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-880x495.jpeg 880w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001-1180x664.jpeg 1180w, https://blogcms.23andme.com/wp-content/uploads/2021/05/Indigenous-Region-Maps.001.jpeg 1920w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /></figure>
 
<ul>
<li>Alaska: Grandparents of individuals within this genetic reference group were primarily born in what is now known as Alaska, as well as some parts of western Canada.</li>
<li>Columbia River Basin: Grandparents of individuals within this genetic reference group were primarily born in what is now known as Washington, as well as some parts of southwestern Canada, Idaho, and Oregon.</li>
<li>Great Basin &amp; Colorado River Basin: Grandparents of individuals within this genetic reference group were primarily born in what is now known as Nevada and California, as well as parts of Arizona and southern Idaho.</li>
<li>Great Lakes and Canada: Grandparents of individuals within this genetic reference group were primarily born in what is now known as the Upper Midwest of the U.S., including Michigan, Wisconsin, Minnesota, as well as some parts of North Dakota, Montana, Oklahoma, Indiana, Illinois, Kansas, and central and southern Canada.</li>
<li>Northeast: Grandparents of individuals within this genetic reference group were primarily born in what is now known as New York, as well as other U.S. states in the Northeast, including Vermont, New Hampshire, Massachusetts, Connecticut, New Jersey, Rhode Island, Maine. Some individuals’ grandparents were born in parts of Indiana, Michigan, Pennsylvania, Ohio, and Oklahoma.</li>
<li>Plains: Grandparents of individuals within this genetic reference group were primarily born in what is now known as South Dakota, as well as some parts of Oklahoma, North Dakota, Montana, southern Minnesota, and Nebraska.</li>
<li>South Central: Grandparents of individuals within this genetic reference group were primarily born in what is now known as Oklahoma, as well as parts of Missouri, Arkansas, Kansas, Texas, Louisiana, Alabama, the Florida Panhandle, and Mississippi.</li>
<li>Southwest: Grandparents of individuals within this genetic reference group were primarily born in what is now known as New Mexico, as well as parts of Oklahoma, Utah, Colorado, and Arizona. 
</li>
</ul>
<h3>Here’s why we took our time getting this right</h3>
There are a few reasons we’ve been unable to provide additional geographic clues about our customers’ Indigenous American ancestry through DNA to date, including:
<ol>
<li aria-level="1">There has been a centuries-long eradication of Indigenous peoples by the settler-colonist societies of North America (including cultural assimilation and forced resettlements). This history makes it difficult for geneticists to distinguish biogeographic ancestry from different parts of North America.</li>
<li aria-level="1">Having observed decades of exploitation of Indigenous peoples at the hands of researchers from a host of biomedical disciplines, many Indigenous American leaders, activists, and scientists have advocated for greater community involvement in research, and cautioned their communities to require reassurances from scientists who seek to work with them, such as through collaboration, data sharing, and education about consent. In an effort to protect their communities, some Indigenous scientists and Tribal leaders have even called for outright moratoriums on genetic research.</li>
<li aria-level="1">Furthermore, as explored in greater detail in <a href="https://blog.23andme.com/ancestry-reports/native-american-dna/">this blog post</a>, many Indigenous scientists and activists are concerned about how the genetic ancestry testing industry creates an environment that implicitly allows and sometimes encourages consumers to misunderstand their DNA results and use those results to claim belonging or kinship with an Indigenous group. In large part, these concerns are centered on the potential for <a href="https://www.23andme.com/dna-ancestry" target="_blank" rel="noopener">genetic ancestry</a> tests to impact the sovereignties of North American First Nations and Tribes, such as when consumers attempt to access tangible or intangible benefits of membership through their DNA results, undermining an Indigenous Nation’s sovereign right to determine membership in the manner they choose.</li>
</ol>
<h3>What steps did our team take to mitigate potential harm to Indigenous sovereignties while providing additional geographic detail?</h3>
<ol>
<li aria-level="1">With guidance from experts including Indigenous scientists, we created an <a href="https://you.23andme.com/ancestry/indigenous-american-faqs/">educational page</a> with answers to common questions about this update, and information about how 23andMe defines Indigenous American genetic ancestry. This page is easily discoverable to customers through their results, and it is also viewable by the public.</li>
<li aria-level="1">In providing these new regions, and following recommendations by advisors, we did not use information about Tribe or Indigenous Nation affiliation to curate the genetic groups. Furthermore, because cultural, Tribe, Nation, or ethnic affiliation was not used to curate these groups — and because Indigenous peoples are not discrete genetic groups — each of the eight regions likely reflect ancestry from many Tribes or First Nations.</li>
<li aria-level="1">To create the region maps, we used only the customers’ reported grandparent birth locations, minimizing biased data curation.</li>
<li aria-level="1">We are transparent about the methods that were used to determine these regions as well as the methods used to provide customers with matches to these regions.</li>
<li aria-level="1">We have published educational material available to the public about how genetic ancestry testing can impact Indigenous sovereignties and peoples, including <a href="https://blog.23andme.com/ancestry-reports/native-american-dna/">this recent blog post</a>.</li>
</ol>
We hope that this update will inspire many to learn more about the complex histories and diversity of Indigenous Peoples in North America in a manner that respects the ways in which Indigenous Peoples define themselves.

A map of the bio-geographic ancestral regions that include the Columbia River Basin, the Great Basin & Colorado River Basin, Great Lakes& Canada, the Northeast, South Central, the Plains and Southwest.

23andMe Blog

23andMe Blog Team

A new analysis sheds light on some customers’ Indigenous genetic ancestry from North America

23andMe joined over 100 other companies, to stand up for equity and against state legislation that discriminates against the LGBTQ+ community. <a href="https://www.hrc.org/resources/business-statement-on-anti-lgbtq-state-legislation">The Human Rights Campaign</a> released a statement condemning this harmful state legislation for companies to sign. <a href="https://www.aclu.org/legislation-affecting-lgbt-rights-across-country">The legislation</a> efforts in question bar transgender people from participating in sports, having their gender identity reflected on IDs, and receiving necessary healthcare. <a href="https://www.aclu.org/legislation-affecting-lgbt-rights-across-country">Other bills</a> limit LGBTQ+ couples from starting a family via adoption or foster care.
“Pride month is a time to celebrate the love that’s in all our DNA, regardless of someone’s sexual orientation or gender identity. But even though we are all 99.5 percent genetically identical, we still aren’t treated 100 percent equally,” wrote Jey McCreight, PhD, Science Communication Sr. Program Manager at 23andMe.

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="1024" height="536" src="https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-1024x536.png" alt="" class="wp-image-28959" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-1024x536.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-300x157.png 300w, https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-768x402.png 768w, https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-880x461.png 880w, https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image-1180x618.png 1180w, https://blogcms.23andme.com/wp-content/uploads/2021/06/equality-image.png 1600w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /></figure>
 
23andMe has set specific objectives related to diversity, equity, and inclusion focused on building a more inclusive and accessible product for everyone, including the LGBTQ+ community. Customer reports separate biological sex from gender identity. In addition, the research team is examining how genetics can impact gender identity and <a href="https://blog.23andme.com/23andme-research/sexual-behavior-not-meaningfully-predicted-by-genetics-new-study-finds/">same-sex sexual behavior</a>. Customer surveys always use inclusive language. This strong support of the LGBTQ+ community is not only drawn from the company value of “we’re in this together,” but the value of trusting science.
“People who fear or distrust trans people often use ‘biology’ as a justification for attacking this community. But the reality is that the biology of sex and gender is more complicated than a simple binary,” explained Dr. McCreight. “Regardless of what science says, everyone should still treat trans people with respect because it’s just the right thing to do. But if you want to claim you ‘trust the science’ in order to attack trans people, then sorry – the science says that trans rights are human rights.”
As a company committed to uplifting LGBTQ+<a href="https://www.23andme.com/diversity-equity-inclusion"> employees</a> and customers and leading with science, 23andMe signed the Human Rights Campaign’s business statement this June in opposition to these unjust anti-LGBTQ+ state laws.
The statement reads: 
The companies joining this statement do business, create jobs, and serve customers throughout the United States. Our businesses strongly embrace diversity and inclusion because we want everyone who works for us or does business with us to feel included and welcomed as their true, authentic selves. Fairness, equal treatment, and opportunity are central to our corporate values because we care about our employees and the customers we serve. What’s more, these values also matter to our bottom lines. Inclusive business practices lead to more productive and engaged employees, increased customer satisfaction; and, ultimately, improved competitiveness and financial performance.
We are deeply concerned by the bills being introduced in state houses across the country that single out LGBTQ individuals &#8211; many specifically targeting transgender youth &#8211; for exclusion or differential treatment. Laws that would affect access to medical care for transgender people, parental rights, social and family services, student sports, or access to public facilities such as restrooms, unnecessarily and uncharitably single out already marginalized groups for additional disadvantage. They seek to put the authority of state government behind discrimination and promote mistreatment of a targeted LBGTQ population.
These bills would harm our team members and their families, stripping them of opportunities and making them feel unwelcome and at risk in their own communities. As such, it can be exceedingly difficult for us to recruit the most qualified candidates for jobs in states that pursue such laws, and these measures can place substantial burdens on the families of our employees who already reside in these states. Legislation promoting discrimination directly affects our businesses, whether or not it occurs in the workplace.
As we make complex decisions about where to invest and grow, these issues can influence our decisions. America’s business community has consistently communicated to lawmakers at every level that such laws have a negative effect on our employees, our customers, our competitiveness, and state and national economies.
As business leaders dedicated to equal treatment, respect, and opportunity for all &#8211; as well as to improving the financial and investment climate across the country &#8211; we call for public leaders to abandon or oppose efforts to enact this type of discriminatory legislation and ensure fairness for all Americans.
To learn more about these proposed bills and take a stand alongside 23andMe, visit the <a href="https://www.hrc.org/campaigns/the-state-legislative-attack-on-lgbtq-people">Human Rights Campaign site.</a>

23andMe Signs Business Statement on Anti-LGBTQ+ State Laws

By Jey McCreight, PhD, Science Communication Sr. Program Manager
Pride month is a chance to celebrate the LGBTQ+ community, which is important here at 23andMe where part of our job is understanding and celebrating human diversity. But we should not forget that Pride started as a protest for LGBTQ+ rights, and despite the progress we have made, there is still work ahead.
The last year during this pandemic has been a stressful time for all of us, but even more so for transgender people, especially during the last six months as cultural conversations have shifted to put trans rights at risk. In fact, 2021 has already become the worst year in recent history for <a href="https://www.hrc.org/press-releases/2021-officially-becomes-worst-year-in-recent-history-for-lgbtq-state-legislative-attacks-as-unprecedented-number-of-states-enact-record-shattering-number-of-anti-lgbtq-measures-into-law">anti-LGBTQ legislation in the US</a>. There have been more than 250 anti-LGBTQ bills introduced in state legislatures, and seventeen of those have already been enacted into law. These bills disproportionately target transgender people, especially youth. This year is also <a href="https://www.hrc.org/resources/fatal-violence-against-the-transgender-and-gender-non-conforming-community-in-2021">on track to become the most violent, fatal year</a> for the trans and gender non-conforming community.
Why are we bringing this up? Because these attacks and this legislation have real implications for the health and wellbeing for trans people. For us here at 23andMe, where science is at our core, it’s particularly painful to see some of these legislative efforts pushed under the rallying cry of “trust the science.” As a health company, we feel compelled to speak up about what the science actually says.
People who fear or distrust trans people often use “biology” as a justification for attacking this community. But the reality is that the biology of sex and gender is more complicated than a simple binary. The science shows us that sex itself is <a href="https://blog.23andme.com/23andme-research/how-was-your-sex-determined-it-might-be-a-lot-more-complicated-than-you-think/">not binary, but rather bimoda</a>l, with a range of diversity between the categories of male or female. Scientific research also <a href="https://blog.23andme.com/23andme-and-you/genetics-101/celebrating-pride-month-a-spotlight-on-sex-and-gender/">supports the existence of trans and non-binary gender identities</a> as a natural part of human diversity that have existed throughout history. 
But it is not enough to simply say “trans people exist.” Science also shows that trans people who are accepted and affirmed have better health outcomes and quality of life. 

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="1024" height="614" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-1024x614.png" alt="" class="wp-image-28914" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-1024x614.png 1024w, https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-300x180.png 300w, https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-768x461.png 768w, https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-880x528.png 880w, https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq-1180x708.png 1180w, https://blogcms.23andme.com/wp-content/uploads/2021/05/lgbtq.png 1200w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /></figure>
 
<h6>Supporting Social Transition</h6>
<div style="float: right; text-align: justified; width: 300px; background-color: #eee; padding: 15px; margin-left: 10px;">
Terms
Non-binary is an umbrella term to describe gender identities that cannot be described as entirely “male” or “female” (e.g. agender, androgyne, genderfluid, genderqueer, and more.)
Some non-binary people consider themselves to be transgender, while others do not.
</div>
The most well-established treatment protocol for gender dysphoria is social transition, which involves adopting a new name, using different pronouns, changing hair and clothing, and using public spaces associated with one’s gender identity. For trans youth in particular, studies have shown that <a href="https://pediatrics.aappublications.org/content/134/4/696?ijkey=61ee57685e1e08e366a9f122ecec4242d0864f87&#038;keytype2=tf_ipsecsha">having supportive family members</a> is associated with better mental and physical health. Trans adolescents who receive gender affirmation <a href="https://pubmed.ncbi.nlm.nih.gov/21587245/">have better academic success, relationship building, and future-orientated planning.</a> Simply <a href="https://news.utexas.edu/2018/03/30/name-use-matters-for-transgender-youths-mental-health/">using a trans youth’s chosen name</a> and <a href="https://www.thetrevorproject.org/2020/07/29/research-brief-pronouns-usage-among-lgbtq-youth/">respecting their pronouns</a> significantly reduces their risk of depression and suicide.
Social transition also includes allowing trans individuals to play on sports teams that match their gender identity. Despite the wave of legislation attempting to ban trans youth from participating in sports, <a href="https://www.scientificamerican.com/article/trans-girls-belong-on-girls-sports-teams/">there is no scientific evidence</a> that trans girls have inherent advantages over cis girls in sports that justify blanket bans.
<h6>Bathroom Access</h6>
<a href="https://www.ama-assn.org/delivering-care/population-care/advocating-lgbtq-community">Medical experts</a> also support allowing trans people to use bathrooms and other single-sex spaces that are in accordance with one’s gender identity. Laws that seek to force trans individuals to use a restroom that does not correspond with their gender identity increases the risk for trans people to experience harassment and violent assault. <a href="https://static1.squarespace.com/static/54f76238e4b03766696d8f4c/t/5782a8d9197aeaa57b589608/1468180715744/USTS-Preliminary-Findings-July-2016-2.pdf">Trans people often avoid public restrooms</a> because of fear of confrontation or worse, which can lead to higher rates of dehydration, kidney issues, and urinary tract infections.
<h6>Gender-affirming health care</h6>
<a href="https://www.ama-assn.org/delivering-care/population-care/advocating-lgbtq-community">The American Medical Association</a> supports gender-affirming health care, such as hormones and surgery, as receiving such care has been shown to dramatically reduce rates of suicide attempts, depression and anxiety, and substance abuse. Studies by the <a href="https://pediatrics.aappublications.org/content/145/2/e20191725">American Academy of Pediatrics</a>, Cornell University, and other institutions have found that pubertal suppression treatment for trans youth was associated with lower odds of suicidal thoughts. Despite <a href="https://jamanetwork.com/journals/jama/fullarticle/2780517">most mainstream medical associations opposing legislation</a> that limits gender affirming medical care for trans youth, this health care <a href="https://www.nbcnews.com/feature/nbc-out/arkansas-passes-bill-ban-gender-affirming-care-trans-youth-n1262412">has already been banned in the state of Arkansas</a>.
<div style="float: right; text-align: justified; width: 300px; background-color: #eee; padding: 15px; margin-left: 10px;">
Medical Opinion
The following medical associations oppose legislation that limits gender-affirming medical care for trans youth:
• American Medical Association
• American College of Physicians
• American Academy of Family Physicians
• American College of Obstetricians and Gynecologists
• American Osteopathic Association
• American Psychiatric Association
• American Academy of Pediatrics
• American Academy of Child and Adolescent Psychiatry
• The Endocrine Society
• The Pediatric Endocrine Society
• World Professional Association for Transgender Health
• US Professional Association for Trangender Health.
&nbsp;
</div>
<h6>Mental health</h6>
To be clear, there is no evidence that increased risk for mental illness among trans people is due to being transgender. The American Psychological Association and American Psychiatric Association have both firmly stated that <a href="https://pediatrics.aappublications.org/content/142/4/e20182162">this increased risk stems from stigma, social rejection, discrimination, and limited availability of gender-affirming health care services.</a>
<h6>What 23andMe is Doing in Product</h6>
To put it succinctly, there is no debate among the medical and scientific communities when it comes to accepting and affirming the gender identities of trans people.
This is why we have spent the last year working to improve our product experience for trans and non-binary customers. This has included research on best practices recommended by LGBTQ organizations, conducting focus groups with trans customers, and consulting trans employees. When these improvements go live later this year, customers will be able to input both their sex assigned at birth and their gender during kit registration and will be able to select the relationship labels (e.g. father, uncle, brother) that best reflect their gender identity, including gender-neutral options. The option to use gender-neutral pronouns is also available to cisgender customers who may want their gender anonymous for privacy reasons. 
This is only the first step in an overall commitment to improving our offerings for trans customers. As more research becomes available, for example on how hormone replacement therapy may affect risk estimates, we hope to keep improving our reports so they are more relevant for trans customers.
<h6>A Personal Conclusion</h6>
It’s easy to read a blog post on a company site and think it’s some detached statement. But I myself am a non-binary trans person. I’m hesitant to say this because I worry that some readers will no longer trust the scientific content of this post, despite my Ph.D. or my role leading 23andMe’s Science Communication program.
That fear of turning most of society against me is why I, like so many other trans people, stayed in the closet for so long. I was terrified that coming out would ruin my career, lose my family and friends, and put me at risk of violence. That fear directly came from the media I watched growing up, which cast trans people as monsters to be feared, pitied, or ridiculed. 
But a cultural shift is clearly happening. I finally found resources and language to describe how I’ve always felt, and to realize there were other people out there like me. I met trans people in real life and saw more role models in the media that showed me that, frankly, there is nothing wrong with being trans. 
I feel lucky to work at a place where I felt comfortable enough to publicly transition without losing my job or the respect of my colleagues. Being able to have that job security, which most trans people do not, enabled me to finally be myself completely openly, including to my closest family and friends. 
Do coworkers and family still occasionally mess up my pronouns? Yes. But overall I’ve been privileged by how supportive everyone has been. I can tell they’re making an effort to do better and to learn why affirming my gender matters so much to me because they care about my health and happiness. That willingness to learn sets them apart from transphobes who refuse to listen to scientists, doctors, and most importantly, trans people themselves.
But not every trans person is as privileged as I am. Many think trans people only care about pronouns, but from legislative attacks to literal violent attacks, it is a dangerous time to be trans. Trans people of color in particular are disproportionately affected by violence, discrimination, and lack of health care. Trans youth are already having life-saving gender-affirming health care made illegal, despite medical consensus supporting that care. I wish I would have had the support and science to not go through the wrong puberty, and it breaks my heart to watch kids have that taken away.
The least I can do from my position of privilege is to speak up. Regardless of what science says, everyone should still treat trans people with respect because it’s just the right thing to do. But if you want to claim you “trust the science” in order to attack trans people, then sorry &#8211; the science says that trans rights are human rights.

Trust the Science by Supporting Trans Health Care

By Samantha Ancona Esselmann, Ph.D., and Chelsea Robertson, Ph.D.*
Editor’s note: A version of this post originally appeared earlier this year in our premium content for <a href="https://www.23andme.com/membership" target="_blank" rel="noopener">23andMe+</a> members. We are reposting it on 23andMe&#8217;s blog for Pride Month. In this article, the term “sex” is used in a developmental and biological sense. This article does not focus on sexual orientation or gender identity, which were addressed in a <a href="https://blog.23andme.com/23andme-and-you/genetics-101/celebrating-pride-month-a-spotlight-on-sex-and-gender/">previous blog post</a>.  
A shallow understanding of the mechanisms that determine biological sex might lead one to suppose that sexual development is a simple matter of reading the same recipe and always ending up with the same cookie. It’s not.
We are astonishingly complex bags of organic and inorganic chemicals that defy entropy until we die. You can change the recipe and end up with the same cookie, or follow the same recipe and end up with a completely different cookie. (And, if baking were easy, we wouldn’t have just finished the 10th season of the “Great British Baking Show.”) 
Infinitely more complicated than baking a 20-layer Schichttorte are the biological processes that determine your sex. Your sex, like Schichttorte, has a lot of layers. <img loading="lazy" decoding="async" class="alignright size-medium wp-image-28892" src="https://blog-api.23andme.com/wp-content/uploads/2021/05/cookbook-2-251x300.png" alt="" width="251" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2-251x300.png 251w, https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2-768x920.png 768w, https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2-855x1024.png 855w, https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2-735x880.png 735w, https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2-985x1180.png 985w, https://blogcms.23andme.com/wp-content/uploads/2021/05/cookbook-2.png 1336w" sizes="auto, (max-width: 251px) 100vw, 251px" />
At the bottom, there’s your chromosomal and genetic sex. There are also sex organs, hormones, and secondary sex characteristics — like beards and breasts. Then, of course, there’s your biggest sex organ, your brain, wherein an incomprehensibly large ensemble of neurons shout, whisper, and sing a symphony of sexual identity that is wholly unique to you.
And while all those layers can be consistent with a binary definition of sex, sex is not binary: Any one of the layers can be swapped out for a different color or texture, or taste. Humans can be intersex.
In a recent 23andMe<a href="https://blog.23andme.com/23andme-and-you/genetics-101/celebrating-pride-month-a-spotlight-on-sex-and-gender/"> blog post</a> about sex and gender, Dr. Jey McCreight explained, “at least one in 1,500 births are intersex, meaning that a person’s anatomy and/or their chromosomes can’t be classified as typically male or female. This is a conservative estimate, as many people do not realize they are intersex until later in life. Some never find out.”
Let’s start at the very beginning.
<h6>The sex gene</h6>
During the first few <a href="https://www.ncbi.nlm.nih.gov/books/NBK279001/">weeks</a> of your life, you were an androgynous mass of cells. In form and face neither male nor female nor even recognizably human, you followed an age-old sequence of gestational milestones, starting with important ones like, “Grow heart!”

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="977" height="1024" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-977x1024.png" alt="" class="wp-image-28890" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-977x1024.png 977w, https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-286x300.png 286w, https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-768x805.png 768w, https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-840x880.png 840w, https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution-1126x1180.png 1126w, https://blogcms.23andme.com/wp-content/uploads/2021/05/embryos-with-attribution.png 1336w" sizes="auto, (max-width: 977px) 100vw, 977px" /></figure>
 
As you bobbed and rolled, tethered to life by a spongy tube full of filtered blood, the cells of your primordial gonads still existed in a bi-potential state, meaning they possessed the power to develop and multiply into either ovaries or testes.
Which path these cells eventually followed depended on either the absence or the activation of a gene located on the Y chromosome. That gene is called SRY, or the Sex-determining Region on the Y chromosome&#8230; a very un-sexy name for the “sex gene.”

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="512" height="216" src="https://blogcms.23andme.com/wp-content/uploads/2021/05/sex-chromosome.png" alt="" class="wp-image-28891" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/05/sex-chromosome.png 512w, https://blogcms.23andme.com/wp-content/uploads/2021/05/sex-chromosome-300x127.png 300w" sizes="auto, (max-width: 512px) 100vw, 512px" /></figure>
 
In the absence of SRY activation, the default human embryo is female. But, turn on that switch and, like a soupy Rube-Goldberg machine, a fractal cascade of carefully orchestrated chemical events is initiated, knocking that developing embryo onto a “male” path. This path is not simply a matter of making all the male bits. It also requires a manual override of ovarian development — an active silencing of the default human protocol.
Needless to say, there’s a vas deferens between these two paths.
<h6>Chromosomes and sex</h6>
Through services like 23andMe, people may learn that their chromosomal sex doesn’t match the sex they were assigned at birth. We all fall on slightly different points along a spectrum between typical biological female and typical biological male, but most of us go through life without ever knowing the exact complement of chromosomes in our cells.
You need at least one X chromosome to survive past the tumultuous early days of embryonic development. But beyond this most basic requirement, there’s a lot of wiggle room in the pantheon of chromosomal sex.
Generally, people with no Y chromosome appear biologically female, while people with at least one Y chromosome appear male: Most females are XX, and most males are XY. But there are other combinations too, such as XXX, XXY, XYY, XYYY, XXXY, XXXX, X (also known as XO), and mosaic XY/X or XX/X individuals, whose unusual karyotypes arose from a failure of sex chromosomes to end up in the right place during cell division. (A karyotype is the number and appearance of your chromosomes under a microscope.)
But, your sex isn’t only about which sex chromosomes you have.
<h6>More on chromosomes: Why it’s not all about the Y</h6>
Over tens of millions of years, the Y chromosome’s role in humans has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120474/">atrophied</a> to one of ferrying a few genes across the generations to enable us to reproduce sexually.
But, it’s possible to have a Y chromosome and be genetically female, hormonally female, and physically female (meaning you have a Y chromosome but lack a functioning SRY gene). It’s also possible to lack a Y chromosome and be genetically, hormonally, and physically male.
These situations typically arise in a father’s sex cells when there’s a mutation in the SRY gene, or when SRY jumps from a Y chromosome onto an X inside a sex cell — rendering the former almost completely vestigial and conferring the power of sex determination on the latter.
When an SRY-deficient Y chromosome is passed on, the sexual development of the XY fetus <a href="https://www.ncbi.nlm.nih.gov/books/NBK279001/">can</a> follow a similar path to that of a fetus without a Y chromosome. The other side of the same coin can mean that there are XX males who inherited an SRY gene on an X chromosome. There’s even <a href="https://academic.oup.com/molehr/article/12/5/341/1005702">a report</a> of a male with two X chromosomes who lacks the SRY gene, and scientists speculate that mutations in other genes related to sexual development can also promote masculinization. 
And, well, biological sex doesn’t exactly get less complicated from here.
Beyond SRY, sex determination and development also depend on a flurry of hormones that help direct and monitor the progress of the human build, from gestation to adulthood.
<h6>Hormones</h6>
Hormone signaling in the womb affected the progress of your sexual development and, in particular, the shape and formation of your external genitalia — the appearance of which had a big impact on the sex you were assigned at birth.
The assignment of a baby’s biological sex is rarely called into question when the infant&#8217;s genitalia appear “normal” or as expected. But by this point, you can probably guess, biological sex is not as simple as what’s visible in your nether regions.
Certain genetic variants affecting hormone production and signaling can have dramatic effects on the formation of genitalia in the womb. So while you can be XY or XX or X (XO), or any other combination, small changes in hormone production and signaling can push you in different directions along the spectrum of biological sex traits, much like how small changes in humidity or temperature can change the rise of your bake.
Got a variant that boosts your testosterone levels? Might not be noticeable if you are a male (XY) embryo, but XX females with a variant like this may have genitalia at birth that do not appear particularly male or female.
Got a variant that changes the way testosterone transmits signals to the cell? If you&#8217;re a female (XX) embryo you might not have any noticeable signs or symptoms at birth. But if you&#8217;re a male (XY)  embryo, your genitalia may appear more ambiguous.
What about when babies are born with the expected external genitalia, but nevertheless have differences in hormone production and signaling? Sometimes hormonal differences go largely unnoticed until the early teenage years when your hormones return to center stage in Act 2 of your sexual development — puberty.
Got a genetic variant that inhibits the production of testosterone? If you are a male (XY) embryo, it&#8217;s possible that your genitalia could appear female at birth. You could be raised as a female for over a decade, then puberty hits and your body doesn&#8217;t do the normal female puberty thing. Instead, you notice increased muscle mass, some facial hair, and a deeper voice.
So you can be XY, insensitive to the effects of testosterone in the womb, born with female genitalia, then go on to develop male secondary sex characteristics later in life.
Are the lines encircling the concepts of biological sex beginning to blur?
Let&#8217;s recap.
You can be chromosomally and genetically male or female, but depending on your particular hormone production and signaling systems, you might end up somewhere else on the spectrum of biological sex.
Hormonally and physically, you can be somewhere in between male and female.
<h6>So why does this matter?</h6>
Imagine, for a moment, how boring life would be if every baguette came out of the oven the same, or if every birthday cake had the same frosting, or the same filling. The more we understand about the textured, richly flavored layers of sexual development, the better equipped we are to mobilize empathy for others and their diverse experiences.
*Both Samantha and Chelsea are 23andMe Product Scientists, and both hold doctorates in neuroscience.
<hr />
<ol>
<li aria-level="1"><a href="https://www.ncbi.nlm.nih.gov/books/NBK279001/">Rey R, Josso N, Racine C. Sexual Differentiation. [Updated 2020 May 27]. In: Feingold KR, Anawalt B, Boyce A, et al., editors.</a></li>
<li aria-level="1">McCreight, J. 2020. “<a href="https://blog.23andme.com/23andme-and-you/genetics-101/celebrating-pride-month-a-spotlight-on-sex-and-gender/">Celebrating Pride Month, a Spotlight on Sex and Gender.</a>” 23andMe blog.</li>
<li aria-level="1">Bachtrog D. (2013). &#8220;Y-chromosome evolution: emerging insights into processes of Y-chromosome degeneration.&#8221; Nat Rev Genet. 14(2):113-24. https://pubmed.ncbi.nlm.nih.gov/23329112/</li>
<li aria-level="1">The Y chromosome is disappearing – so what will happen to men? by Darren Griffin, The Conversation. Retrieved October 25, 2020, from <a href="https://phys.org/news/2018-01-chromosome-men.html">https://phys.org/news/2018-01-chromosome-men.html</a></li>
<li aria-level="1">Montañez A. (2017). &#8220;Beyond XX and XY.&#8221; Sci Am. 317(3):50-51. https://pubmed.ncbi.nlm.nih.gov/28813372/</li>
<li aria-level="1">Gomez-Lobo V et al. (2016). &#8220;Disorders of Sexual Development in Adult Women.&#8221; Obstet Gynecol. 128(5):1162-1173. https://pubmed.ncbi.nlm.nih.gov/27741188/</li>
<li aria-level="1">Ha NQ et al. (2014). &#8220;Hurdling over sex? Sport, science,nd equity.&#8221; Arch Sex Behav. 43(6):1035-42. https://pubmed.ncbi.nlm.nih.gov/25085349/</li>
<li aria-level="1">MedlinePlus (2019, Aug 7). “Intersex.” Retrieved October 31, 2020, from https://medlineplus.gov/ency/article/001669.htm</li>
<li aria-level="1">MedlinePlus (2010, Feb 1) “CYP21A2 gene: Health Conditions Related to Genetic Changes.”  Retrieved October 31, 2020, from https://medlineplus.gov/genetics/gene/cyp21a2/#conditions.</li>
<li aria-level="1">MedlinePlus (2018, Sept 1)“Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency.” Retrieved October 31, 2020, from https://medlineplus.gov/genetics/condition/congenital-adrenal-hyperplasia-due-to-11-beta-hydroxylase-deficiency/</li>
<li aria-level="1">Ohnesorg T et al. (2014). &#8220;The genetics of disorders of sex development in humans.&#8221; Sex Dev. 8(5):262-72. https://pubmed.ncbi.nlm.nih.gov/24504012/</li>
</ol>

How was your sex determined? It might be a lot more complicated than you think

Over the last year, since the tragic murder of George Floyd, 23andMe has taken a number of steps to improve our approach in building a more diverse, equitable, and inclusive workplace. We identified four focus areas that we’ve been making progress on over the past year, including:
<ol>
<li aria-level="1">Hiring: Attract and hire top, diverse talent.&nbsp;</li>
<li aria-level="1">Employee Experience: Cultivate an inclusive environment that authentically celebrates our shared genome and unique differences.&nbsp;</li>
<li aria-level="1">Product &amp; Research: Use our product to build and sustain Diversity, Equity, and Inclusion (DEI) in every customer and community interaction.</li>
<li aria-level="1">Community Impact: Use our relationships to build diverse, equitable, and inclusive communities.</li>
</ol>
We have committed to holding ourselves accountable, while also rallying others to take action and be part of shaping a better future. To aid in these efforts, our CEO and co-founder Anne Wojcicki recently joined the<a href="https://www.ceoaction.com/"> CEO Action for Diversity &amp; Inclusion™</a> pledge to collaborate with other organizations in order to further our DEI efforts. The coalition, which now includes more than 1,600 CEOs across 85 industries, is the largest CEO-driven business commitment to advance diversity and inclusion within the workplace.
“Creating a more inclusive work environment and product is a lifelong journey that will require continuous input and feedback,” Anne said. “Joining this pledge will allow us to collaborate and learn from other organizations so that we can all build more diverse, equitable, and inclusive workplaces and products.”
The pledge centers around four main commitments that align with 23andMe’s commitments to DEI. They include:
<ul>
<li aria-level="1">Cultivate trusting workplaces that can have complex, and sometimes difficult, conversations.</li>
<li aria-level="1">Implement and/or expand unconscious bias education.</li>
<li aria-level="1">Share best—and unsuccessful—practices.&nbsp;</li>
<li aria-level="1">Create and share strategic inclusion and diversity plans with the board of directors (or equivalent governing bodies).</li>
</ul>
23andMe has already begun working on each of these four commitments, but this pledge offers another opportunity to hold ourselves accountable. We also hope that it will help encourage other companies to make similar moves toward creating more diverse, equitable, and inclusive workplaces.
&nbsp;

CEO Action for Diversity & Inclusion

Myriam Raber, a dentist in northeastern Ohio, is often mistaken for what she is not.



“I let people label me sometimes,” Myriam said. “I go the hospital, and they look at my husband or my kids and then me and, without asking, they check ‘white.&#8217;”



An immigrant from Haiti, Myriam often butts up against the labels used in the US.&nbsp;



“I don’t feel like I have to fit in any one box,” Myriam said. “I think there are more and more people like me, and there will be even more people like me in the future.”



<figure class="wp-block-image size-full is-resized"><img loading="lazy" decoding="async" width="267" height="300" src="http://35.88.189.111/wp-content/uploads/2021/03/Myriam-head-shot-267x300-1.jpg" alt="" class="wp-image-33678" style="aspect-ratio:1;width:375px;height:auto"/><figcaption class="wp-element-caption">Dr. Myriam Raber, DDS</figcaption></figure>



<h2 class="wp-block-heading" id="h-your-ancestry-and-your-health">Your Ancestry and Your Health</h2>



But Myriam also knows that there is a difference between how you culturally identify and what your genetics might say, and that difference could impact your health.



“I know what I am culturally — I’m Haitian,” Myriam said. “But genetically, I’m just a mix; I’m a Caribbean mix.”



While she isn’t bothered by being mistaken for being white, or Hispanic, or Jewish, she understands that, at least in medicine, it’s essential to know a person’s ethnicity. A person’s ethnicity plays a role in their risk for certain conditions or how they respond to certain medications.



Knowing about these differences is also the reason why she is participating in 23andMe’s research. Improving the diversity of research participants will help scientists learn new insights into conditions that affect people with African ancestry or mixed African and European ancestry, like Myriam.



“Obviously, I’m in healthcare, and I believe the future of healthcare is in DNA,” she said.



<h2 class="wp-block-heading" id="h-covid-19-s-uneven-impact">COVID-19’s Uneven Impact</h2>



Everybody responds a little differently to medicines or illness. Myriam believes that a person’s genetics — along with things like their diet and exercise — holds the key for researchers trying to better understand those differences.&nbsp;



The impact of COVID-19 offers perhaps the most vivid example of that, Myriam said. African Americans and Latinos are more likely to be hospitalized or die from the virus when compared to white patients. Poverty and access to adequate healthcare may explain some of it, but not all.



“I believe it’s probably in the DNA, and that’s the same for cancer or anything really,” Myriam said.



<h2 class="wp-block-heading" id="h-people-like-me">People Like Me</h2>



In dentistry, she has seen issues created by the lack of research among people of non-European ancestry. For example, during a lecture on tooth development when she was in dental school, the instructor told a class about when different teeth came into the mouth.&nbsp;



“Well, I knew that for a Haitian child, that tooth often comes in a whole two to four years earlier,” Myriam said. “This (data from the instructor) was more relevant for a white child from the midwest than a black child in Haiti. This has had serious consequences for many. I know it affected how Haitian children were being classified and processed by the United States immigration services.”



There were other examples, whether the timing for puberty or some medications were more or less effective depending on a person’s ethnicity. Myriam knew that the science was often incomplete for those with African ancestry, for instance, because those populations weren’t included in the research.



“So basically, there were no good studies for people like me,” she said.



<h2 class="wp-block-heading" id="h-participating-in-research">Participating in Research</h2>



In 2018 researchers found that about&nbsp;<a href="https://www.cell.com/cell/fulltext/S0092-8674(19)30231-4">78 percent of genome-wide association studies</a>&nbsp;were done in European populations alone. That means that these studies’ findings are often not as relevant for people of African or Asian or Latino or Indigenous&nbsp;<a href="https://www.23andme.com/dna-ancestry">ancestry</a>. Leaving those populations out of research also impedes a fuller understanding of the genetic architecture of disease.



For Myriam, it just makes sense to improve the diversity of research participants.



“As a mixed-race healthcare professional, I believe that medicine will rely heavily on genetics for custom-made preventive and curative programs,” she said. “Traditional research used to lump people into racial groups with minorities being underrepresented.”



For Myriam, changing that by participating in research may open up genetic discoveries that have the potential to benefit everyone and perhaps instill the same sense of wonder at the uncovered insights.

Research for People Like Me

As a family medicine doctor Abayomi Jones has seen disparities in healthcare firsthand — the lack of access, or insurance, or poverty, or all of the above contribute to poor outcomes, but there’s also more to it than that.&nbsp;
“Yeah I see it and I understand why there’s mistrust in the (Black) community around research or science in general. It’s hard not to,” said Dr. Jones.
&nbsp;

 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="1024" height="731" src="https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-1024x731.jpg" alt="" class="wp-image-28806" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-1024x731.jpg 1024w, https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-300x214.jpg 300w, https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-768x549.jpg 768w, https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-880x629.jpg 880w, https://blogcms.23andme.com/wp-content/uploads/2021/03/jones-abayomiPhoto-1180x843.jpg 1180w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /></figure>
 
<h6>Unequal Outcomes</h6>
Racism plays a role, she said. Some of it is historical, such as the infamous Tuskegee Syphilis Study. But some of it is happening right now, such as<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/"> how pain medication is administered</a> differently between Black and white patients. In other cases, it might be less obvious but even those subtle differences result in unequal outcomes.&nbsp;
And the pandemic has only “exposed the racism and equity gaps in healthcare that were already there, to begin with,” Dr. Jones said.&nbsp;
You see it in the vastly different outcomes for between Black and white patients with COVID-19, for example.
<h6>A Need for More Inclusive Research</h6>
But despite those problems with the current system, Dr. Jones sees value for her and other African Americans to participate in research. Right now, not enough <a href="https://www.23andme.com/research/">genetic health research</a> includes people from the Black community, leaving them less likely to benefit from the insights of that research. She’s also seen this firsthand in daily medical interactions in the clinic.&nbsp;
For example, oftentimes doctors take BMI as a total number, instead of looking at body distribution and body types, she said. And they use this “average” as a general metric for all populations.
“That feels like an insult,” Dr. Jones said. “I don’t think people take it that way but the data that was used to derive that table was taken from people who do not look like me or that doesn’t take into account people who look like me.”
It’s the idea that so much of health research talks about the “average population” but that in many cases that average isn’t from all populations.&nbsp;
“And I think a lot of times in healthcare (average) is a synonym for “normal” and I think that’s the unspoken bias,” Dr. Jones said. “It’s that the average is ‘normal,’ but what if you are not a part of that average? What does that make you?”
<h6>The Motivation to Participate</h6>
That’s part of her motivation for participating in 23andMe research. She also believes that if more African Americans participate in research, whether with 23andMe, or the National Institutes of Health, there will be more relevant data around conditions that are so much more prevalent within the African American community.
“Which are all the diseases that have some of the highest mortality rates like diabetes, heart disease and weight-related conditions like hyperlipidemia,” Dr. Jones said.
Dr. Jones is also interested, not just in how the healthcare system treats people differently depending on their race, or how health research has left out the Black population, but in the health effects of racism itself.
“How stress affects your health, and the post-traumatic stress of racism specifically,” she said.
By participating in research Dr. Jones hopes to contribute to research that will benefit the Black community.
“The biggest thing is transparency,” she said. “I want to know who is profiting from this research and how will it be used? I think there is a lot of interest in how this research&nbsp; can help us and other people too.”

Participating to Improve Representation in Research

By Elliot Aguilar, Ph.D.*
For nearly all its existence, America has not only been a multiracial nation but a nation of mixed-race people.
The truth is rarely acknowledged despite the evidence being easy to find. In the nineteenth century, famed antebellum diarist Mary Chesnut remarked on the mixed-race children in “everybody’s household.” At the same time, her contemporary, Fanny Kemble, made a note of some enslaved children who bore a striking resemblance to the white overseer of her husband’s plantation. From 1850 to 1920, the category of “Mulatto” appeared in multiple US Censuses.
And there are many other examples, from old newspaper advertisements for ‘bright mulatto’ runaway slaves to popular songs like The Yellow Rose of Texas, that celebrate the pivotal role of a mixed-race woman in the fight for Texan independence. Each is a testament to the truth of our country’s history.
<img loading="lazy" decoding="async" class="alignright wp-image-28805 size-medium" src="http://35.88.189.111/wp-content/uploads/2021/03/Diary-Feature-Image-Wide-300x137.png" alt="" width="300" height="137" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/03/Diary-Feature-Image-Wide-300x137.png 300w, https://blogcms.23andme.com/wp-content/uploads/2021/03/Diary-Feature-Image-Wide.png 395w" sizes="auto, (max-width: 300px) 100vw, 300px" />
<h2>History is Personal</h2>
While the historical evidence can tell us that racial mixing happened, the advent of DNA testing from 23andMe and other companies has helped to bring to light America’s complicated racial history on an individual level. The science of population genetics now allows us to quantify—and appreciate—the scale of past mixing and its effect on the ancestry of contemporary Americans.
My own family&#8217;s recent origins are in Central and South America where racial mixing is a more openly acknowledged fact of our history.  As a population biologist and a first-generation American, I am fascinated by how science can teach all Americans about our shared, intertwined history.
However, this history will come as no surprise to many African Americans, whose family lore often retains the memory of interracial unions, as well as the often traumatic circumstances that gave rise to them. Even then, science is illuminating and validating those family histories. As poet Caroline Randall Williams, the author of the acclaimed NYT op-ed, My Body is a Confederate Monument, has put it, “the science has made it easier to…claim and reframe” those family traditions.
<h2>DNA Reveals</h2>
A 2015 study by 23andMe senior scientist and population geneticist Kasia Bryc and colleagues in the <a href="https://www.cell.com/ajhg/fulltext/S0002-9297(14)00476-5">American Journal of Human Genetics</a> found that, on average, self-reported African Americans in a dataset of 23andMe customers had about a quarter European ancestry.  <a href="https://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1006059">Another study </a>— this one by researchers at McGill University published two years later — showed a lower, but still very significant average level of European ancestry, about 17 percent.
But both studies vividly illustrated not just the historical intermixing of people of African, European, and Native American ancestry, but also the regional differences of that mixing within the United States. Both studies also found a measurable number of self-identified European Americans had one percent or more African ancestry. Though far lower than the European contribution to African American genomes, these findings show that the direction of genes flowing between the groups was not exclusively one-way.
Another telling finding in both of these studies is that African Americans’ European ancestry was more often than not traceable to Northern Europe, the source of most early European settlers in colonial America. This finding points to intermixing from our nation’s earliest history.  It is also a testament to the centuries-long residence of African Americans in this country, stretching back long before the founding in 1776.
<h6>What that Means</h6>
The levels of European ancestry among African Americans can give us some idea of how often interracial unions — whether forced, coerced, or consensual — occurred. Using estimates from computer simulations of African American population history by anthropologist Jessica Gross based on g<a href="https://www.23andme.com/dna-ancestry">enetic data and historical records</a>, I calculated that an African American, randomly selected from any point in American history, had a nearly 17 percent chance of having at least one white grandparent.
<div id="attachment_28800" style="width: 235px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-28800" class="wp-image-28800 size-medium" src="http://35.88.189.111/wp-content/uploads/2021/03/Elliot-A-225x300.jpg" alt="A photo of the writer Elliot Aguilar." width="225" height="300" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/03/Elliot-A-225x300.jpg 225w, https://blogcms.23andme.com/wp-content/uploads/2021/03/Elliot-A-768x1024.jpg 768w, https://blogcms.23andme.com/wp-content/uploads/2021/03/Elliot-A-660x880.jpg 660w, https://blogcms.23andme.com/wp-content/uploads/2021/03/Elliot-A-885x1180.jpg 885w, https://blogcms.23andme.com/wp-content/uploads/2021/03/Elliot-A-scaled.jpg 1920w" sizes="auto, (max-width: 225px) 100vw, 225px" />Elliot Aguilar, PhD</div>
Put another way, if you could travel to any time between 1619 and today and poll an African American person randomly, there would be a one in six chance that he or she had at least one white grandparent. And this number is likely an underestimate as Gross’s models assumed that the European contribution per generation to the African American gene pool has been constant throughout American history. It was likely significantly higher during the time of slavery when some Americans held total dominion over the bodies of others.
<h2>Out of Many, One</h2>
The findings from these studies, and the results of individual genetic ancestry tests, undermine the long-held binary classifications of black and white.  This notion is the legacy of the so-called ‘one-drop rule,’ by which a person with a single known ancestor of African descent was considered black. This rule had its earliest origins in colonial-era legislation, but it wasn’t until the Jim Crow era that it became a fixed legal and social reality. The fact that race has been assigned according to laws and social definitions, as opposed to one’s actual ancestry, underlines the fact that race is a social construct and not a biological reality.
Ever since the 2000 US census allowed Americans to select multiple races, a lot of articles have been written about the increase of the country’s mixed-race population.  As the evidence above demonstrates, we have always been a nation with a sizable mixed-race population. What is new is that Americans can now claim their multiple ancestries without shame or discrimination.
America has endured centuries of social division based on race, despite our shared genetic ties. The challenge of our future is to make our famous motto ‘E Pluribus Unum’— out of many one — a social reality, just as it has been a genetic reality all along.
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*This post comes to us from a friend of 23andMe. Elliot is a scientific advisor for the Africa Center in New York City. He has an undergraduate degree in physics from Harvard and a Ph.D. in Evolutionary Biology from City University of New York. He did post-graduate work in mathematical biology at the University of Pennsylvania. Elliot’s day job is as a data scientist with an e-commerce company.

DNA Reveals America’s Mixed-Race History

Jordan Carroll, a social worker and patient advocate in San Diego, has a simple answer for why he’s participating in 23andMe’s <a href="https://blog.23andme.com/23andme-research/black-representation-in-research/">Black Representation in Genetic Research</a> study:&nbsp;
“I was happy to … I mean why not?” said Jordan, who has been contributing to 23andMe research since the launch of the company’s<a href="https://www.23andme.com/roots-study/"> Roots into the Future</a> initiative in 2011.
Jordan is no stranger to us here at 23andMe, having shared a healing<a href="https://www.youtube.com/watch?v=akc6tbW8aOg&amp;feature=emb_logo"> personal story</a> many years ago. Using 23andMe helped him discover a connection to a plantation in the south, and led him to connect with a white cousin.&nbsp;
But Jordan’s interest runs deeper than that. Wrapped up in his curiosity about himself and his family’s southern and African roots, is his lifelong interest in science, healthcare, and, most importantly, racial equity.
“My inspiration for giving my DNA to this research was to benefit marginalized Black Americans,” he said.
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 <figure class="wp-block-image size-large is-style-default"><img loading="lazy" decoding="async" width="768" height="1024" src="https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984-768x1024.jpg" alt="" class="wp-image-28784" srcset="https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984-768x1024.jpg 768w, https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984-225x300.jpg 225w, https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984-660x880.jpg 660w, https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984-885x1180.jpg 885w, https://blogcms.23andme.com/wp-content/uploads/2021/02/IMG_1984.jpg 1536w" sizes="auto, (max-width: 768px) 100vw, 768px" /></figure>
 
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<h6>A Family&#8217;s Commitment 
</h6>
Jordan, 34, hopes that including more people like him in research, offers hope that new discoveries from that research will mean that, “the Black community will have access to better healthcare and treatment.”&nbsp;&nbsp;
He and his family have been working for that kind of equity for a long time.
Both of his paternal grandparents were doctors. His grandmother,<a href="https://www.uncrownedcommunitybuilders.com/person/juanita-carroll-pitts"> Dr. Juanita Pitts</a>, was the first Black female doctor in Rochester New York. Dr. Pitts and her husband, Dr. Julian O. Carroll, opened a family practice in the city in the 1950s. Over the decades while raising seven children and running the family practice, Dr. Pitts also worked on community health screening for sickle cell anemia and did genetic counseling. She started a program to screen African Americans in the community for hypertension and cardiovascular disease. Her strong commitment to serving the community and alleviating racial inequities in healthcare came from witnessing those inequities. In a recorded oral history, she told of once seeing a Black man die while waiting for a hospital bed that had been prioritized for white patients.&nbsp;
Dr. Pitts instilled in her grandson an interest in science and equity, and Jordan’s early years spent in her home left a lasting impression on him. Whether it was learning to take his own blood pressure at 10, or simply understanding that African Americans didn’t always benefit from the amazing medical breakthroughs he’s seen in his lifetime. His upbringing is what both piqued his interest in medicine but also attuned him to helping underserved populations.
He sees those disparities every day at work among underserved Latino and Black families in Southern California — who have been disproportionately affected by COVID-19. Part of his work is to ensure access to vaccination programs and testing. But some of it also involves simple education in an effort to overcome long-held mistrust.
“I see it as my job to educate and dissipate the mistrust and skepticism of the American medical establishment within the Black community,” he said. “These feelings are rampant, and rightly so, due to historic and contemporary mistreatment at the hands of the medical establishment, namely the Tuskegee Experiments, which is still within living memory.”
<h6>Empowerment through Participation</h6>
He doesn’t see his job to push anything, but to simply answer questions, to be transparent about any risks, and help people have access to care if they want it.
But beyond his work, Jordan feels he can help his community by participating in research. He knows — because he likes to read about health studies — that most genetic research is done in populations that are almost entirely of European descent.
When he’s reading about a new study that has uncovered genetic associations for certain diseases, Jordan often asks himself:
“Does this actually apply to me?” he said. “I have European ancestry, but it’s only about one-third of my <a href="https://www.23andme.com/dna-ancestry">genetic ancestry</a>, the rest, 60 percent of African, so I ask myself, ‘Is this applicable to me and people who are genetically similar to me, or not?’”
Oftentimes the answer is “no.”
Knowing that can leave one feeling unable to do anything to change it, Jordan said.
“Feeling powerless is a common sentiment when you read reports, studies, and hear of racial disparities and maltreatment within the American medical establishment,” he said. “You hear of communities having unequal access to health and medical care all around the country. Although your frustration burns, you fall into despair since you realize that you cannot go in and assist every community at once.”
But, for Jordan, there is something he can do. He can participate in research, he said.
“The ability to potentially save lives is a privilege, and something that I feel is my duty as a human being,” he said. “If I can do this with something as simple as having my DNA tested, all the better.&#8221;

DEI — Page 6