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A sex and gender distinction is not universal, and Peletz's description of gender as designating biological variations as well as cultural practices is not unique.In a study of arguments that intersex people fit into a third gender classification, intersex scholar Morgan Holmes argues that much analysis of a third sex or third gender is simplistic: much of the existing work on cultural systems that incorporate a 'third sex' portray simplistic visions in which societies with more than two sex/gender categories are cast as superior to those that divide the world into just two.

In March 2017, an Australian and Aotearoa/New Zealand community statement called for an end to legal classification of sex, stating that legal third classifications, like binary classifications, were based on structural violence and failed to respect diversity and a "right to self-determination".

It also called for the criminalization of deferrable intersex medical interventions.

Gender may be organized differently in different cultures.

While mainstream western scholars, notably anthropologists who have tried to write about Native American and South Asian "gender variant" people, have often sought to understand the term "third gender" solely in the language of the modern LGBT community, other scholars especially Indigenous scholars, stress that their lack of cultural understanding and context has led to widespread misrepresentation of third gender people.

At the same time, feminists began to draw a distinction between (biological) sex and (social/psychological) gender.

Sell also discovered similarities between the third genders of the East and those of the West.

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