From the viewpoint of a home-school grammar teacher (since I was in seventh grade), a pronoun is just a short word that takes the place of a noun, so that you don’t have to keep saying the noun over and over.

Pronouns do not define your identity or create or solve social injustice.

Using an incorrect pronoun used to get you a red mark on your essay. Today, the red mark might be considered racist—a sign of white supremacy, implying that there is a correct answer. Or it might make someone feel unsafe or excluded.

Instead, there’s now a permanent Scarlet Letter, or job loss and cancellation, for not using a person’s preferred pronouns, no matter how ungrammatical.

The main grammatical requirement for pronouns is that they must agree with their antecedent (the noun they stand for) in number and gender, to avoid confusion. Gender used to be just a grammatical concept. In some languages, it is mostly arbitrary and does not necessarily have anything to do with sex. “The table” is “der Tisch” (masculine) in German and “la mesa” (feminine) in Spanish.

For decades, there has been trouble over the third-person singular pronoun in English. The default option or “common gender” was masculine when the person referred to (e.g., teacher, doctor, patient) could be of either sex. As Margaret Thatcher explained, “Man embraces woman.”

But feminists became outraged. Hence, all the “he or she” constructions. Instead of unobtrusively doing their job, pronouns constantly demanded attention. Then people asked why the “he” should come first; hence “she or he,” or perhaps alternating use of one or the other.

Then there is the grammatical atrocity of using “they,” “them,” or “their” (plural) to refer to a singular noun. (Das geht durch mich wie ein Messer—that goes through me like a knife—as my German teacher used to say.) This is becoming very common even in prestigious, supposedly scholarly publications.

The increasing number of genders and made-up pronouns greatly complicates the antecedent-agreement problem. And we now have an additional problem: “misgendering.”

Humans are very good at discerning sex unless extensive efforts are made to disguise it. Gender is more challenging.

There is a verb “to sex,” meaning “to identify the sex of.” If you are going to do genetics experiments with Drosophila (fruit flies), you need to sex the flies. If you are in the egg business, you need to sex the chicks. You don’t want to waste money feeding male chicks because no rooster has ever laid an egg—although they have something to do with the process as in that song. “They’re laying eggs now, just like they [the hens] usedter, Ever since that rooster came into our yard.”

So, how does one “gender”—or “misgender” someone?

It might have nothing to do with a physical characteristic and might be the opposite of the sex.

Apparently, people gender themselves. I suspect that these days even Rush Limbaugh would not be allowed to play the song with the words “I was born a woman. I didn’t have no say.”

People simply announce “their” pronouns on their nametag.

Long ago, the only way people might be offended by your use of pronouns was if, in talking to someone, you used the wrong second-person pronoun in a language that distinguishes by status. Did you address someone as “du” or “tu” (familiar) when you should have used “Sie” or “usted” (formal or polite)? If you were talking about someone (third person), then that person had no say about your use of pronouns and could not accuse you of trespassing on their identity. Someone calling you “sir,” instead of “ma’am,” was merely a faux pas, not a federal crime.

Beyond pronouns is meta-reality. Prescribers and surgeons are trying to mold bodies to conform, but self-identification is determinative. A person with male equipment and male proclivities must be accepted as a self-proclaimed female, even in prisons, shelters for abused women, and locker rooms. Maybe you have no sympathy for female prisoners, even if they weren’t formally sentenced to be caged with rapists, but what about your little girl?

Language is our tool for thinking, and even the smallest words count. Activists do not own pronouns, or English grammar, or our thoughts. They have no right to dictate our opinion of their gender or to force us to allow them access to our private spaces. And they cannot change the reality of sex.

Jane M. Orient, M.D. obtained her M.D. from Columbia University College of Physicians and Surgeons in 1974. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fifth editions of Sapira’s Art and Science of Bedside Diagnosis published by Wolters Kluwer. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics.