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Last month, the startup Clue tried an experiment.

"Help us evolve language around gender and menstrual health," the period-tracking app's account tweeted. "We're testing 'fem@le health' instead of 'female health' to be more inclusive of our whole audience: women and people with cycles. Thoughts?"

Tweet may have been deleted

Responses were swift.

"Only women have cycles, right?"

"Do not ask me to be ashamed of having a period so that I can make other people feel comfortable."

"My thoughts are I HATE IT."

Clue is a period, fertility, and cycle app that lets its users track their menstrual cycles and reproductive health.

Apart from the technology involved, figuring out what to call all of that has been one of the hardest parts of growing the 4-year-old app.

Of the options out there, it's one of the most progressive and mindful of gender-inclusivity: no pink, flowers, or gendered design.

It also tries to use language that applies to all its users: women, trans men who have periods, users experiencing menopause who don't have cycles, gender-nonconforming users, and anyone else who doesn't identify with any of those categories. Traditional language surrounding "women's health" often excludes many of the people who have downloaded Clue.

Last year, the company settled on the phrase "female health" and wrote an explanation for why. Since "female" technically refers to sex, not gender identity, the company argues that, unlike "women's health," it doesn't explicitly exclude users who don't identify that way. "Reproductive health" can exclude people who aren't using the app to track their fertility or users who are experiencing menopause. Phrases like "people with cycles" and "people with uteruses" similarly left some users feeling excluded.

"We feel it best captures the area of health that Clue is currently designed to support, while being the least exclusive of all the ways to describe that biology," the startup wrote in the Medium post about its choice.

The best-available term seemed outwardly settled, although internally the staff has continued to evaluate these choices, until Clue tried out "fem@le health" in July. Since the startup had first explained the rationale behind its choice of language a year earlier, its audience had grown. Subreddits that sent anti-trans trolls to communities on the internet discussing issues of gender and accessibility had found Clue's accounts, Director of Marketing Lisa Kennelly said.

The way Clue chose to describe its app set off more bigoted bat signals than it had a year before. Basically, the tweet got a lot of hate.

People objected to "fem@le health" from the progressive side, too. Some people who responded to Clue's experiment said that the term incorrectly used the @ symbol, which serves a specific linguistic purpose when used in words like "Latin@." Others agreed with Clue's initial assessment that "female health" referred to biology, not identity, and it was just fine to leave as is.

Tweet may have been deleted

Tweet may have been deleted

The entire episode served as a reminder that these conversations are still very much ongoing—as it pertains to period apps and in broader culture. As conversations around gender and inclusivity have gone more mainstream with results both good and very bad in politics, media, and tech, a tweet like Clue's represents a lot more than just one simple choice of phrase.

More than one app

Clue's public-facing experiment revealed conversations that a lot of progressive startups are having: how do we reach as wide an audience as possible without excluding any of our customers?

Thinx, in its better days, had its famous "people with periods" subway ads. The breastfeeding community has started to use the term "chestfeeding" to include trans men who nurse their babies, although most breastfeeding tech startups haven't caught on yet.

Despite these ongoing conversations, the overwhelming experience of choosing a menstrual tracker is still a gendered one.

"If you go to your app store and type in 'period tracker,' you’re still going to be inundated with flowers and the colors pink and purple," said Cass Clemmer, a trans artist whose work helps counteract period stigma for trans and gender-nonconforming people. "Not that there is anything wrong with any of this, it just serves as another reminder that my period is something the world sees as inherently feminine."

And there are plenty of other period apps out there facing these choices in language that affect users like Clemmer. The app Dot in its materials refers to "anyone with a menstrual cycle," but also "women." Glow, "the world's largest health community by women, for women" mainly talks about women's health. Android's Period Tracker is one of the culprits Clue hints at when it criticizes pink and floral design.

They might not be as public as Clue, but they're thinking about this too.

"This is something that is really evolving for us," said Leslie Heyer, president of Cycle Technologies, which runs the Dot app. "We want to be inclusive and understand that many people with periods don’t necessarily identify as female."

"When we say, 'It’s designed for women with cycles between 20-40 days long,' it helps clarify that we’re talking about menstrual cycles and fertility by giving potential users more context," Heyer added. "Still, we think we can improve on this, and are continuing to evaluate how to be both inclusive and clear."

Reaching customers

These are important conversations, and they're tricky for companies whose goal is ultimately to reach as many customers as possible.

Clue was prompted to start thinking about all of this in part by trans men who worked on its staff. The Berlin-based startup is dealing with these questions across multiple languages, too; it generally uses "people," not "women," in all languages but encounters some challenges in languages that use gendered adjectives and nouns. And the startup values education; it often tweets out facts about female health and menstrual health and aims to give its audience new, useful information.

Tweet may have been deleted

Beyond small language choices, apps can make a concerted effort to value inclusivity in all aspects of their design. Including options for customization of gender, including representations of different anatomy, asking for users' pronouns if the app includes a conversation bot, and including a diverse selection of avatars of different genders users can choose are all other ways these apps can improve the user experience, Clemmer said.

The important part for Clue—and its peers working on menstrual health—is making sure everyone reading that information understands what it's about without sacrificing inclusivity.

"What we need to remember is that language is incredibly tricky and there are no perfect terms," Clemmer said. "When it comes to finding descriptors for this area of health, the best that we can do is try our hardest to continue to adapt and evolve our language to ensure we are being as inclusive and humanizing as possible."

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