"Gender identification" redirects here. For the process of determining the sex of a human, seeSex assignment. For the process of determining the sex of an individual animal, seeSexing. Forlegal gender, seeGender self-identification.
Gender identity is the personal sense of one's owngender.[1] Gender identity can correlate with a person'sassigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent and consistent with the individual's gender identity.[2]Gender expression typically reflects a person's gender identity, but this is not always the case.[3][4] While a person may express behaviors, attitudes, and appearances consistent with a particulargender role, such expression may not necessarily reflect their gender identity. The termgender identity was coined by psychiatry professorRobert J. Stoller in 1964 and popularized by psychologistJohn Money.[5][6][7]
In most societies, there is a basic division between gender attributes associated with males and females, agender binary to which most people adhere and which includes expectations ofmasculinity andfemininity in all aspects ofsex and gender: biologicalsex, gender identity, gender expression, and sexual orientation.[8][9][10] Some people do not identify with some, or all, of the aspects of gender associated with their biological sex; some of those people aretransgender,non-binary, or genderqueer. Some societies havethird gender categories.[11]
The 2012 bookIntroduction to Behavioral Science in Medicine says that with exceptions, "Gender identity develops surprisingly rapidly in the early childhood years, and in the majority of instances appears to become at least partially irreversible by the age of 3 or 4".[12][13] TheEndocrine Society has stated "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity."[14]Social constructivists argue that gender identity, orthe way it is expressed, aresocially constructed, determined by cultural and social influences. Constructivism of this type is not necessarily incompatible with the existence of an innate gender identity, since it may be the expression of that gender that varies by culture.[15]
Age of formation
There are several theories about how and when gender identity forms, and studying the subject is difficult because children's immaturelanguage acquisition requires researchers to make assumptions from indirect evidence.[16] John Money suggested children might have awareness of and attach some significance to gender as early as 18 months to 2 years; Lawrence Kohlberg argued that gender identity does not form until age 3.[16] It is widely agreed that core gender identity is firmly formed by age 3.[16][12][17] At this point, children can make firm statements about their gender[16][18] and tend to choose activities and toys which are considered appropriate for their gender[16] (such as dolls and painting for girls, and tools and rough-housing for boys),[19] although they do not yet fully understand the implications of gender.[18] After age three, it is extremely difficult to change gender identity.[13]
Martin and Ruble conceptualize this process of development as three stages: (1) as toddlers and pre-schoolers, children learn about defined characteristics, which are socialized aspects of gender; (2) around the ages of five to seven years, identity is consolidated and becomes rigid; (3) after this "peak of rigidity", fluidity returns and socially defined gender roles relax somewhat.[20] Barbara Newmann breaks it down into four parts: (1) understanding the concept of gender, (2) learninggender role standards and stereotypes, (3) identifying with parents, and (4) forming gender preference.[18]
Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. In particular, the extent to which gender identity is determined by nurture (social environmental factors) versus biological factors (which may include non-social environmental factors) is at the core of the ongoing debate in psychology known as "nature versus nurture".[22][23] There is increasing evidence that the brain is affected by the organizational role of hormones in utero, circulating sex hormones and the expression of certain genes.[23]
Social factors which may influence gender identity include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in a child's life.[24][clarification needed] Thesocial learning theory posits that children furthermore develop their gender identity through observing and imitating gender-linked behaviors, and then being rewarded or punished for behaving that way, thus being shaped by the people surrounding them through trying to imitate and follow them.[25][26]
Large-scaletwin studies suggest that the development of both transgender and cisgender gender identities is due to genetic factors, with a small potential influence of unique environmental factors.[27]
A well-known example in the nature-versus-nurture debate is the case ofDavid Reimer, born in 1965, otherwise known as "John/Joan". As a baby, Reimer went through a faulty circumcision, losing his male genitalia. PsychologistJohn Money advised Reimer's parents to raise him as a girl. John Money was instrumental in the early research of gender identity, though he used the termgender role.[28] He disagreed with the previous school of thought that gender was determined solely by biology. He argued that infants are born a blank slate and a parent could be able to decide their babies' gender.[29] In Money's opinion, if the parent confidently raised their child as the opposite sex from earlier than age two, the child would believe that they were born that sex and act accordingly.[30] Money believed that nurture could override nature.[29]
Reimer underwentsex reassignment surgery at seventeen months and grew up as a girl, dressing in girl clothes and surrounded by girl toys. In the early 1970s, Money reported that Reimer'ssex reassignment to female was a success, influencing the academic consensus toward the nurture hypothesis, and for the following 30 years, it became standard medical practice to reassignintersex infants and male infants withmicropenises to female.[29]
After Reimer tried to commit suicide at age 13, he was told that he had been born with male genitalia. Reimer stopped seeing Money, and underwent surgery to remove his breasts and reconstruct his genitals.[31] In 1997, sexologistMilton Diamond published a follow-up, revealing that Reimer had rejected his female reassignment, and arguing against the blank slate hypothesis and infant sex reassignment in general.[32]
Diamond was a longtime opponent of Money's theories. Diamond had contributed to research involving pregnant rats that showed hormones played a major role in the behavior of different sexes.[30][page needed] The researchers in the lab would inject the pregnant rat with testosterone, which would then find its way to the baby's bloodstream.[29] The females that were born had genitalia that looked like male genitalia. The females in the litter also behaved like male rats and would even try to mount other female rats, proving that biology played a major role in animal behavior.[30][page needed]
One criticism of the Reimer case is that Reimer lost his penis at the age of eight months and underwent sex reassignment surgery at seventeen months, which possibly meant that Reimer had already been influenced by his socialization as a boy. Bradley et al. (1998) report the contrasting case of a 26-year-old woman with XY chromosomes whose penis was lost and who underwent sex reassignment surgery between two and seven months of age (substantially earlier than Reimer), whose parents were also more committed to raising their child as a girl than Reimer's, and who remained a woman into adulthood. She reported that she had been somewhat tomboyish during childhood, enjoying stereotypically masculine childhood toys and interests, although her childhood friends were girls. While she wasbisexual, having had relationships with both men and women, she found women more sexually attractive and they featured more in her fantasies. Her job at the time of the study was a blue-collar occupation that was practiced almost exclusively by men.[33] Griet Vandermassen argues that since these are the only two cases being documented in scientific literature, this makes it difficult to draw any firm conclusions from them about the origins of gender identity, particularly given the two cases reached different conclusions. However, Vandermassen also argued that transgender people support the idea of gender identity as being biologically rooted, as they do not identify with their anatomical sex despite being raised and their behaviour reinforced according to their anatomical sex.[34]
Other cases
One study by Reiner et al. looked at fourteen genetic males who had sufferedcloacal exstrophy and were thus raised as girls. Six of them changed their gender identity to male, five remained female and three had ambiguous gender identities (though two of them had declared they were male). All the subjects had moderate to marked interests and attitudes consistent with that of biological males.[35] Another study,[36] using data from a variety of cases from the 1970s to the early 2000s (including Reiner et al.), looked at males raised as females due to a variety of developmental disorders (penile agenesis, cloacal exstrophy or penile ablation). It found that 78% of those males raised as females were living as females.[37] A minority of those raised as female later switched to male. However, none of the males raised as male switched their gender identity. Those still living as females still showed marked masculinisation of gender role behaviour and those old enough reported sexual attraction to women. The study's authors caution drawing any strong conclusions from it due to numerous methodological caveats which were a severe problem in studies of this nature. Rebelo et al. argue that the evidence in totality suggests that gender identity is neither determined entirely by childhood rearing nor entirely by biological factors.[38]
Biological factors
Several prenatal biological factors, including genes and hormones, may affect gender identity.[22][39] It has been suggested that gender identity is controlled by prenatalsex steroids, but this is hard to test because there is no way to study gender identity in animals.[40] According to biologistMichael J. Ryan, gender identity is exclusive to humans.[41]
The medical consensus in the late 20th century was that transgender and gender incongruent individuals suffered a mental health disorder termed "gender identity disorder". Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid. Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity.
Some studies have investigated whether there is a link between biological variables andtransgender ortranssexual identity.[42][43][44] Several studies have shown thatsexually dimorphic brain structures in transsexuals are shifted away from what is associated with their birth sex and towards what is associated with their preferred sex.[45][46] The volume of the central subdivision of thebed nucleus of a stria terminalis or BSTc (a constituent of thebasal ganglia of the brain which is affected byprenatal androgens) of transsexual women has been suggested to be similar to women's and unlike men's,[47][48] but the relationship between BSTc volume and gender identity is still unclear.[49] Similarbrain structure differences have been noted between gay and heterosexual men, and between lesbian and heterosexual women.[50][51] Transsexuality has a genetic component.[52]
Research suggests that the same hormones that promote the differentiation of sex organs in utero also elicit puberty and influence the development of gender identity. Different amounts of these male or female sex hormones can result in behavior and external genitalia that do not match the norm of their sex assigned at birth, and in acting and looking like their identified gender.[53]
Estimates of the number of people who areintersex range from 0.018% to 1.7%, depending on which conditions are counted as intersex.[54][55] An intersex person is one possessing any of several variations insex characteristics includingchromosomes,gonads,sex hormones, orgenitals that, according to the United NationsOffice of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies".[56] An intersex variation may complicate initialsex assignment[57] and that assignment may not be consistent with the child's future gender identity.[58] Reinforcing sex assignments through surgical and hormonal means may violate the individual'srights.[59][60]
A 2005 study on the gender identity outcomes of female-raised46,XY persons withpenile agenesis,cloacal exstrophy of the bladder, or penileablation, found that 78% of the study subjects were living as female, as opposed to 22% who decided to initiate a sex change to male in line with their genetic sex.[36] The study concludes: "The findings clearly indicate an increased risk of later patient-initiated gender re-assignment to male after female assignment in infancy or early childhood, but are nevertheless incompatible with the notion of a full determination of core gender identity by prenatal androgens."
A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experiencedgender dysphoria.[61] Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure. At birth, 52% of persons in the study were assigned female, and 41% were assigned male.[62][63]
A study by Reiner & Gearhart provides some insight into what can happen when genetically male children with cloacal exstrophy are sexually assigned female and raised as girls,[64] according to an 'optimal gender policy' developed byJohn Money:[59] in a sample of 14 children, follow-up between the ages of 5 and 12 showed that 8 of them identified as boys, and all of the subjects had at least moderately male-typical attitudes and interests,[64] providing support for the argument that genetic variables affect gender identity and behavior independent of socialization.
Social and environmental factors
In 1955, John Money proposed that gender identity was malleable and determined by whether a child was raised as male or female in early childhood.[65][66] Money's hypothesis has since been discredited,[66][67] but scholars have continued to study the effect of social factors on gender identity formation.[66] In the 1960s and 1970s, factors such as the absence of a father, a mother's wish for a daughter, or parental reinforcement patterns were suggested as influences; more recent theories suggesting that parentalpsychopathology might partly influence gender identity formation have received only minimal empirical evidence,[66] with a 2004 article noting that "solid evidence for the importance of postnatal social factors is lacking."[68] A 2008 study found that the parents ofgender-dysphoric children showed no signs of psychopathological issues aside from mild depression in the mothers.[69] It has also been suggested that the attitudes of the child's parents may affect the child's gender identity, although evidence is minimal.[70]
Parental establishment of gender roles
Parents who do not support gender nonconformity are more likely to have children with firmer and stricter views on gender identity and gender roles.[53] Recent literature suggests a trend towards less well-defined gender roles and identities, as studies of the parental association ("coding") of toys as masculine, feminine, or neutral indicate that parents increasingly code kitchens and in some cases dolls as neutral rather than exclusively feminine.[71] However, Emily Kane found that many parents still showed negative responses to items, activities, or attributes that were considered feminine, such as domestic skills, nurturance, and empathy.[71] Research has indicated that many parents attempt to define gender for their sons in a manner that distances the sons from femininity,[71] with Kane stating that "the parental boundary maintenance work evident for sons represents a crucial obstacle limiting boys' options, separating boys from girls, devaluing activities marked as feminine for both boys and girls, and thus bolstering gender inequality and heteronormativity."[71]
Many parents form gendered expectations for their child before it is even born, after determining the child's sex through technology such asultrasound. The child thus is born to a gender-specific name, games, and even ambitions.[39] Once the child's sex is determined, most children are raised to in accordance with it, fitting a male or female gender role defined partly by the parents.
When considering the parents' social class, lower-class families typically hold traditional gender roles, where the father works and the mother, who may only work out of financial necessity, still takes care of the household. However, middle-class "professional" couples typically negotiate the division of labor and hold an egalitarian ideology. These different views on gender can shape the child's understanding of gender as well as the child's development of gender.[72]
A study conducted by Hillary Halpern[72] demonstrated that parental gender behaviors, rather than beliefs, are better predictors of a child's attitude on gender. A mother's behavior was especially influential on a child's assumptions of the child's own gender. For example, mothers who practiced more traditional behaviors around their children resulted in the son displaying fewer stereotypes of male roles while the daughter displayed more stereotypes of female roles. No correlation was found between a father's behavior and his children's knowledge of stereotypes of their own gender. Fathers who held the belief of equality between the sexes had children, especially sons, who displayed fewer preconceptions of their opposite gender.
Gender identity can lead tosocietal security issues among individuals that do not fit on a binary scale.[73] As of 2022, only 23 states plus Washington D.C. currently have state laws that explicitly prohibit discrimination based on sexual orientation and gender identity. Moreover, only "53% of [the] LGBTQ population live in states prohibiting housing discrimination based on sexual orientation and gender identity", while "17% of [the] LGBTQ population lives in states explicitly interpreting existing prohibition on sex discrimination to include sexual orientation and/or gender identity".[74]In some cases, a person's gender identity is inconsistent with their biological sex characteristics (genitals andsecondary sex characteristics), resulting in individuals dressing and/or behaving in a way which is perceived by others as outside cultural gender norms. These gender expressions may be described asgender variant, transgender, or genderqueer (ornon-binary)[75] (there is an emerging vocabulary for those who defy traditional gender identity),[76] and people who have such expressions may experiencegender dysphoria (traditionally called gender identity disorder or GID). Transgender individuals are often greatly affected by language and gender pronouns before, during, and after theirtransition.[77][78]
Some people who experience gender dysphoria seeksex reassignment surgery to have their physiological sex match their gender identity; others retain the genitalia they were born with (seetranssexual for some of the possible reasons) but adopt a gender role that is consistent with their gender identity.[79] Although sex reassignment surgery is expected to become more popular, the surgery is still not destigmatized in a lot of countries, including the United States. Such stigmatization has been shown to have adverse health effects on LGBTQ+ individuals, especially during the COVID-19 pandemic.[80]
History and definitions
Definitions
The termsgender identity andcore gender identity were first used with their current meaning—one's personal experience of one's own gender[1][16]—sometime in the 1960s.[81][82] To this day they are usually used in that sense,[8] though a few scholars additionally use the term to refer to thesexual orientation andsexual identity categoriesgay,lesbian andbisexual.[83] Gender expression is distinct from gender identity in that gender expression is how one chooses to outwardly express their gender through one's "name, pronouns, clothing, hair style, behavior, voice or body features."[84] It is thus distinct from gender identity in that it is the external expression of gender but may not necessarily portray a person's gender identity and may vary "according to racial/ethnic background, socio-economic status and place of residence."[85]
Early medical literature
In late-19th-century medical literature, women who chose not to conform to their expected gender roles were called "inverts", and they were portrayed as having an interest in knowledge and learning, and a "dislike and sometimes incapacity for needlework".[86] During the mid-1900s, doctors pushed for corrective therapy on such women and children, which meant that gender behaviors that were not part of the norm would be punished and changed.[87][88] The aim of this therapy was to push children back to their "correct" gender roles and thereby limit the number of children who became transgender.[86]
Freud and Jung's views
In 1905,Sigmund Freud presented his theory ofpsychosexual development inThree Essays on the Theory of Sexuality, giving evidence that in the pregenital phase children do not distinguish between sexes, but assume both parents have the same genitalia and reproductive powers. On this basis, he argued that bisexuality was the original sexual orientation and that heterosexuality was resultant of repression during thephallic stage, at which point gender identity became ascertainable.[89] According to Freud, during this stage, children developed anOedipus complex where they had sexual fantasies for the parent ascribed the opposite gender and hatred for the parent ascribed the same gender, and this hatred transformed into (unconscious) transference and (conscious) identification with the hated parent who both exemplified a model to appease sexual impulses and threatened to castrate the child's power to appease sexual impulses.[25] In 1913,Carl Jung proposed theElectra complex as he both believed that bisexuality did not lie at the origin of psychic life, and that Freud did not give adequate description to the female child (Freud rejected this suggestion).[90]
1950s and 1960s
During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins ofhomosexuality (which was viewed as amental disorder at the time). In 1958, the Gender Identity Research Project was established at theUCLA Medical Center for the study ofintersex and transsexual individuals. PsychoanalystRobert Stoller generalized many of the findings of the project in his bookSex and Gender: On the Development of Masculinity and Femininity (1968). He is also credited with introducing the termgender identity to the International Psychoanalytic Congress inStockholm, Sweden, in 1963.[91] Behavioral psychologistJohn Money was also instrumental in the development of early theories of gender identity. His work atJohns Hopkins Gender Identity Clinic (established in 1965) popularized aninteractionist theory of gender identity, suggesting that, up to a certain age, gender identity is relatively fluid and subject to constant negotiation. His bookMan and Woman, Boy and Girl (1972) became widely used as acollege textbook, although many of Money's ideas have since been challenged.[92][93]
Butler's views
In the late 1980s, gender studies scholarJudith Butler began lecturing regularly on the topic of gender identity, and in 1990, they publishedGender Trouble: Feminism and the Subversion of Identity, introducing the concept ofgender performativity.[94] Butler argues that the traditional view of gender is limiting in that it adheres to the dominant societal constraints that label gender as binary. In scrutinizing gender, Butler introduces a nuanced perception in which they unite the concepts of performativity and gender.[95]
Present views
Medical field
Transgender people sometimes wish to undergo physical surgery to refashion theirprimary sexual characteristics, secondary characteristics, or both, because they feel they will be more comfortable with different genitalia. This may involve removal of penis, testicles or breasts, or the fashioning of a penis, vagina or breasts.[96] In the past, sex assignment surgery has been performed on infants who are born with ambiguous genitalia. However, current medical opinion is strongly against this procedure on infants, and recommends that the procedure be only conducted when medically necessary.[97] Today,gender-affirming surgery is performed on people who choose totransition so that their external sexual organs will match their gender identity.[98]
In the United States, theAffordable Care Act provided thathealth insurance exchanges would have the ability to collect demographic information on gender identity and sexual identity through optional questions, to help policymakers better recognize the needs of theLGBTQ community.[99] In 2020, however, theTrump administration finalized a rule that "would remove nondiscrimination protections for LGBTQ people when it comes to health care and health insurance" in the Affordable Care Act and extends to "regulations pertaining to access to health insurance."[100] This rule "is one of the many rules and regulations put forward by the Trump administration that defines "sex discrimination" as only applying when someone faces discrimination for being male or female, and does not protect people from discrimination on the basis of sexual orientation or gender identity."[100]
Gender dysphoria (previously called "gender identity disorder" or GID in theDiagnostic and Statistical Manual of Mental Disorders or DSM) is the formal diagnosis of people who experience significantdysphoria (discontent) with the sex they were assigned at birth and/or the gender roles associated with that sex:[101][102] "In gender identity disorder, there is discordance between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine."[81] The DSM (302.85) has five criteria that must be met before a diagnosis of gender identity disorder can be made, and the disorder is further subdivided into specific diagnoses based on age, for examplegender identity disorder in children (for children who experience gender dysphoria).
The concept of gender identity appeared in the third edition of the DSM,DSM-III (1980), in the form of twopsychiatric diagnoses of gender dysphoria: gender identity disorder of childhood (GIDC), and transsexualism (for adolescents and adults). The 1987 revision of the manual,DSM-III-R, added a third diagnosis: gender identity disorder of adolescence and adulthood, nontranssexual type. This latter diagnosis was removed in the subsequent revision, DSM-IV (1994), which also collapsed GIDC and transsexualism into a new diagnosis of gender identity disorder.[103] In 2013, theDSM-5 renamed the diagnosisgender dysphoria and revised its definition.[104]
The authors of a 2005 academic paper questioned the classification of gender identity problems as amental disorder, speculating that certain DSM revisions may have been made on a tit-for-tat basis when certain groups were pushing for the removal of homosexuality as a disorder. This remains controversial,[103] although the vast majority of today's mental health professionals follow and agree with the current DSM classifications. In recent years, however, there has been a "growing chorus of voices contesting the pathologization of transgender lives and the dominance of medical-scientific narratives about trans experience."[105] As such, in 2019, theWorld Health Organization removed gender dysphoria from the mental illness chapter and moved it instead to the sexual health chapter, changing the term "Gender Dysphoria" to "Gender Incongruence", thereby removing gender dysphoria as a pathological mental illness.[106]
International human rights law
The Yogyakarta Principles, a document on the application ofinternational human rights law, provide in the preamble a definition of gender identity as each person's deeply felt internal and individualexperience of gender, which may not correspond with the sex assigned at birth, including the person's sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other experience of gender, including dress, speech and mannerism. Principle 3 states that "Each person's self-defined [...] gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilisation or hormonal therapy, as a requirement for legal recognition of their gender identity."[107] Principle 18 states that "Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical conditions and are not to be treated, cured or suppressed."[108] Relating to this principle, the "Jurisprudential Annotations to the Yogyakarta Principles" observed that "Gender identity differing from that assigned at birth, or socially rejectedgender expression, have been treated as a form ofmental illness. The pathologization of difference has led to gender-transgressive children and adolescents being confined in psychiatric institutions, and subjected to aversion techniques – includingelectroshock therapy – as a 'cure'."[109] The "Yogyakarta Principles in Action" says "it is important to note that while 'sexual orientation' has been declassified as a mental illness in many countries, 'gender identity' or 'gender identity disorder' often remains in consideration."[110] These Principles influenced theUN declaration on sexual orientation and gender identity. In 2015, gender identity was part of theUnited States Supreme Court caseObergefell v. Hodges in which marriage was no longer legally restricted to be only between man and woman.[111]
The anti-gender movement is a global phenomenon that opposes concepts often referred to as "gender ideology" or "gender theory". These loosely defined terms are commonly used by the movement to critique a range of issues related togender equality,LGBT rights, andgender studies including the validity of the concept of gender identity itself.
Originating in the late 20th century, the movement has drawn support fromright-wing populist groups,conservative religious organizations, andsocial conservatives and thefar-right worldwide. It views advances in gender inclusion and LGBT rights as threats totraditional family structures, religious values, and established social norms. The movement has been criticized for promotingdiscrimination and undermininghuman rights protections, particularly those concerning individuals with diverse gender identities and sexual orientations. Critics argue that it employsmisinformation to delegitimize efforts toward gender inclusion and has been described as a form ofmoral panic orconspiracy theory.
A type ofanti-gender rhetoric where people are ascribed a gender that does not match their gender identity is calledmisgendering. One example of misgendering isdeadnaming, i.e. using a pre-transition name for someone instead of a post-transition one.
Measurement
No objective measurement or imaging of the human body exists for gender identity, as it is part of one's subjective experience.[112][113] Numerous clinical measurements for assessing gender identity exist, including questionnaire-based, interview-based and task-based assessments. These have varying effect sizes among a number of specific sub-populations.[114] Gender identity measures have been applied in clinical assessment studies of people withgender dysphoria orintersex conditions.
Before the§ 1950s and 1960s, the termgender wasused exclusively as a grammatical category.[115][116] The termsmale andman, orfemale andwoman, were used more or less interchangeably when referring to people of one sex or the other. As the termgender took on new meaning following the work ofJohn Money[65][additional citation(s) needed],Robert Stoller, and others, adistinction began to be drawn between the termssex andgender. As a result of the new understanding of gender, academic usage of the termsex began to be more restricted to biological aspects, and associated with the choicesmale andfemale, while the termgender was associated initially withman orboy,girl orwoman.[116]
While academic usage of termsman andwoman began to diverge at the same time, and become more restricted to concepts related to gender,[116] this distinction was not universal (and still is not) even in academic usage, and even less so in more informal writing or in speech, which often conflate the two.[117][118]
Some people, and some societies, do not construct gender as abinary in which everyone is either a boy or a girl, or a man or a woman. Those who exist outside the binary fall under the umbrella termsnon-binary orgenderqueer. Some cultures have specific gender roles that are distinct from "man" and "woman". These are often referred to asthird genders.
InSamoan culture, orFaʻa Samoa,fa'afafine are considered to be a third gender. They are anatomically male but dress and behave in a manner considered typically feminine. According to Tamasailau Sua'ali'i (see references), fa'afafine inSamoa at least are often physiologically unable to reproduce. Fa'afafine are accepted as a natural gender, and neither looked down upon nor discriminated against.[119] Fa'afafine also reinforce their femininity with the fact that they are only attracted to and receive sexual attention from straight masculine men. They have been and generally still are initially identified in terms of labour preferences, as they perform typically feminine household tasks.[120] TheSamoan Prime Minister is patron of theSamoa Fa'afafine Association.[121] Translated literally, fa'afafine means "in the manner of a woman".[122]
Hijras are officially recognized asthird gender in the Indian subcontinent,[123][124][125][126] being considered neither completely male nor female. Hijras have a recorded history in the Indian subcontinent since antiquity, as suggested by theKama Sutra. Many hijras live in well-defined and organised all-hijra communities, led by aguru.[127][128] These communities have consisted over generations of those who are in abject poverty or who have been rejected by or fled their family of origin.[129] Many work assex workers for survival.[130]
The word "hijra" is aHindustani word.[131] It has traditionally been translated into English as "eunuch" or "hermaphrodite", where "the irregularity of the male genitalia is central to the definition".[129] However, in general hijras are born male, only a few having been born with intersex variations.[132] Some hijras undergo an initiation rite into the hijra community called nirvaan, which involves theremoval of the penis, scrotum, and testicles.[130]
Thekhanith form an accepted third gender inOman. The khanith aremalehomosexualprostitutes whose dressing is male, featuring pastel colors (rather than white, worn by men), but their mannerisms are female. Khanith can mingle with women, and they often do atweddings or other formal events. Khaniths have their own households, performing all tasks (both male and female). However, similar to men in theirsociety, khaniths can marry women, proving theirmasculinity by consummating themarriage. Should adivorce or death take place, these men can revert to their status as khaniths at the next wedding.[133]
Manyindigenous North American Nations had more than two gender roles. Those who belong to the additional gender categories, beyondcisgender man and woman, are now often collectively termed "two-spirit" or "two-spirited". There are parts of the community that take "two-spirit" as a category over an identity itself, preferring to identify with culture or Nation-specific gender terms.[134]
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^Eller JD (2015).Culture and diversity in the United States: so many ways to be American. Abingdon, Oxon: Routledge. p. 137.ISBN978-1-317-57578-8.most Western societies, including the United States, traditionally operate with a binary notion of sex/gender
^MacKenzie GO (1994).Transgender nation. Bowling Green, OH: Popular Press. p. 43.ISBN978-0-87972-596-9.transvestites [who do not identify with the dress assigned to their sex] existed in almost all societies;Zastrow C (2013).Introduction to Social Work and Social Welfare: Empowering People. Cengage Learning. p. 234.ISBN978-1-285-54580-6.There are records of males and females crossing over throughout history and in virtually every culture. It is simply a naturally occurring part of all societies. (quoting the North Alabama Gender Center)
^abcdefSolomon K (11 November 2013).Men in Transition: Theory and Therapy. Springer Science & Business Media. pp. 101–102.ISBN978-1-4684-4211-3.Archived from the original on 3 February 2021. Retrieved10 January 2021.Gender identity is the individual's personal and private experience of his/her gender.
^A few authorities say it forms between ages 3 and 4 rather than precisely at age 3, e.g.Bryjak GJ, Soraka MP (1997). Hanson K (ed.).Sociology: Cultural Diversity in a Changing World. Allyn & Bacon. pp. 209–45.
^Christopher Bates Doob,Social Inequality and Social Stratification in US Society
^Martin C, Ruble D (2004). "Children's Search for Gender Cues Cognitive Perspectives on Gender Development".Current Directions in Psychological Science.13 (2):67–70.doi:10.1111/j.0963-7214.2004.00276.x.S2CID33579865.
^abZhu YS, Cai LQ (April 2006). "Effects of male sex hormones on gender identity, sexual behavior, and cognitive function".Zhong Nan da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences.31 (2):149–61.PMID16706106.
^Nolen-Hoeksema S (2014).Abnormal Psychology (6 ed.). McGraw-Hill. p. 368.ISBN978-1-308-21150-3.
^Diamond, Milton; Sigmundson, H. Keith (1 March 1997). "Sex Reassignment at Birth: Long-term Review and Clinical Implications".Archives of Pediatrics & Adolescent Medicine.151 (3):298–304.doi:10.1001/archpedi.1997.02170400084015.PMID9080940.
^Vandermassen G (2005).Who's Afraid of Charles Darwin?: Debating Feminism and Evolutionary Theory. Lanham: Rowman & Littlefield Publishers. pp. 112–113.ISBN978-1-4616-4707-2.
^abMeyer-Bahlburg HF (August 2005). "Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation".Archives of Sexual Behavior.34 (4):423–438.doi:10.1007/s10508-005-4342-9.PMID16010465.S2CID34971769.
^Saraswat A, Weinand JD, Safer JD (February 2015). "Evidence supporting the biologic nature of gender identity".Endocrine Practice.21 (2):199–204.doi:10.4158/EP14351.RA.PMID25667367.
^Rebelo E, Szabo CP, Pitcher G (March 2008). "Gender assignment surgery on children with disorders of sex development: a case report and discussion from South Africa".Journal of Child Health Care.12 (1):49–59.doi:10.1177/1367493507085618.PMID18287184.S2CID46058150.
^abGhosh S."Gender Identity". MedScape.Archived from the original on 6 March 2021. Retrieved29 October 2012.
^Gizewski ER, Krause E, Schlamann M, Happich F, Ladd ME, Forsting M, Senf W (February 2009). "Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: an fMRI study".The Journal of Sexual Medicine.6 (2):440–448.doi:10.1111/j.1743-6109.2008.00981.x.PMID18761592. Found that a sample of androphilic trans women was shifted towards the female direction in brain responses.
^Rametti G, Carrillo B, Gómez-Gil E, Junque C, Segovia S, Gomez Á, Guillamon A (February 2011). "White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study".Journal of Psychiatric Research.45 (2):199–204.doi:10.1016/j.jpsychires.2010.05.006.PMID20562024. Found that the white matter pattern in gynephilic trans men was shifted in the direction of biological males even before the female-to-male transsexuals started taking male hormones.
^Carlsson NR (2010).Psychology: The Science of Behavior (7th ed.). Boston: Allyn & Bacon. p. 418.ISBN978-0-205-54786-9.
^Rosenthal SM (December 2014)."Approach to the patient: transgender youth: endocrine considerations".The Journal of Clinical Endocrinology and Metabolism.99 (12):4379–4389.doi:10.1210/jc.2014-1919.PMID25140398.the sexually dimorphic differentiation of the BSTc in humans is not present until puberty, in contrast to rats, where such differences in the BST occur in the early postnatal period and apparently require perinatal differences in T levels (44, 45). Given that many transgender adolescents experience significant gender dysphoria before puberty (and before sex differences in BSTc volume emerge), the relationship between BSTc volume and gender identity would appear to be unclear.
^Byne W, Tobet S, Mattiace LA, Lasco MS, Kemether E, Edgar MA, et al. (September 2001). "The interstitial nuclei of the human anterior hypothalamus: an investigation of variation with sex, sexual orientation, and HIV status".Hormones and Behavior.40 (2):86–92.doi:10.1006/hbeh.2001.1680.PMID11534967.S2CID3175414.
^Furtado PS, Moraes F, Lago R, Barros LO, Toralles MB, Barroso U (November 2012). "Gender dysphoria associated with disorders of sex development".Nature Reviews. Urology.9 (11):620–627.doi:10.1038/nrurol.2012.182.PMID23045263.S2CID22294512.
^abcdKreukels BP, Steensma TD, de Vries AL (2014).Gender dysphoria and disorders of sex development: progress in care and knowledge. New York: Springer.ISBN978-1-4614-7441-8.
^Fausto-Sterling A (2000).Sexing the body: gender politics and the construction of sexuality (1st ed.). New York, NY: Basic Books.ISBN978-0-465-07713-7.
^Swaab DF (December 2004). "Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation".Gynecological Endocrinology.19 (6):301–12.doi:10.1080/09513590400018231.PMID15724806.S2CID1410435....direct effects of testosterone on the developing fetal brain are of major importance for the development of male gender identity and male heterosexual orientation. Solid evidence for the importance of postnatal social factors is lacking.
^Wallien MS, Cohen-Kettenis PT (December 2008). "Psychosexual outcome of gender-dysphoric children".Journal of the American Academy of Child and Adolescent Psychiatry.47 (12):1413–23.doi:10.1097/CHI.0b013e31818956b9.PMID18981931.
^Weinraub M, Clemens LP, Sockloff A, Ethridge T, Gracely E, Myers B (August 1984). "The development of sex role stereotypes in the third year: relationships to gender labeling, gender identity, sex-typed toy preference, and family characteristics".Child Development.55 (4):1493–503.doi:10.2307/1130019.JSTOR1130019.PMID6488962.Previous investigators have failed to observe a relationship between parental attitudes and children's early sex role acquisition...
^Maizes V (2015).Integrative women's health (Second ed.). Oxford: Oxford University Press. p. 745.ISBN978-0-19-021480-7.Many transgender people experience gender dysphoria – distress that results from the discordance of biological sex and experienced gender (American Psychiatric Association, 2013). Treatment for gender dysphoria, considered to be highly effective, includes physical, medical, and/or surgical treatments [...] some [transgender people] may not choose to transition at all.
^ab"The term 'gender identity' was used in a press release, November 21, 1966, to announce the new clinic for transsexuals at The Johns Hopkins Hospital. It was disseminated in the media worldwide, and soon entered the vernacular. ... gender identity is your own sense or conviction of maleness or femaleness."Money J (1994). "The concept of gender identity disorder in childhood and adolescence after 39 years".Journal of Sex & Marital Therapy.20 (3):163–177.doi:10.1080/00926239408403428.PMID7996589.
^Unge RK (2001).Handbook of the psychology of women and gender. New York: Wiley. p. 102.ISBN978-0-471-65357-8.Gender identity was introduced into the professional lexicon by Hooker and Stoller almost simultaneously in the early 1960s (see Money, 1985). For example, Stoller (1964) used the slightly different termcore gender identity...
^Brym RJ, Lie J, Roberts LW, Rytina S (2012).Sociology: Your Compass for a New World (4th Canadian ed.). Toronto: Nelson Education.ISBN978-0-17-650386-4.
^Diamond, Milton (July 2002). "Sex and Gender are Different: Sexual Identity and Gender Identity are Different".Clinical Child Psychology and Psychiatry.7 (3):320–334.doi:10.1177/1359104502007003002.S2CID144721800.
^abZucker KJ, Spitzer RL (January–February 2005). "Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note".Journal of Sex & Marital Therapy.31 (1):31–42.doi:10.1080/00926230590475251.PMID15841704.S2CID22589255.
^Obergefell et al. V. Hodges, Director, Ohio Department of Health, et al. (U.S. Supreme Court 26 June 2015), Text, archived from the original on 12 April 2019.
^Dahlen S (March 2020)."De-sexing the Medical Record? An Examination of Sex Versus Gender Identity in the General Medical Council's Trans Healthcare Ethical Advice".The New Bioethics.26 (1):38–52.doi:10.1080/20502877.2020.1720429.PMID32011214.No genetic marker, biochemical test, brain imaging, or objective measurement exists in medical practice for gender identity, which is itself of an unknown aetiology (NHS 2016, Bizic et al. 2018, Gerritse et al. 2018, Bewley et al. 2019). The central claim rests on a consistent declarative statement of the trans patient's subjective experience of self-hood. Therefore, we cannot prove or disprove a gender identity. Gender identity is a deeply held, spiritually significant, personal belief that can neither be confirmed nor rebutted by external evidence and biological data.
^Stuhlsatz, Molly A. M.; Buck Bracey, Zoë E.; Donovan, Brian M. (December 2020). "Investigating Conflation of Sex and Gender Language in Student Writing About Genetics".Science & Education.29 (6):1567–1594.Bibcode:2020Sc&Ed..29.1567S.doi:10.1007/s11191-020-00177-9.S2CID229490367.However, 40% of the students in the genetics of human sex condition and 16% in the genetics of plant sex condition used gender language in their responses. The patterns associated with students who use gender language in their responses in the genetics of plant or human sex conditions are indicative of conflation. ...Conflation of biological sex and gender has been shown to engender unscientific essentialist beliefs about the nature of human difference that could manifest in sexism and transphobia.
^Hall, Jennifer; Jao, Limin; Di Placido, Cinzia; Manikis, Rebecca (July 2021)."'Deep questions for a Saturday morning': An investigation of the Australian and Canadian general public's definitions of gender".Social Science Quarterly.102 (4). Wiley-Blackwell:1866–1881.doi:10.1111/ssqu.13021.S2CID238679176.Archived from the original on 4 December 2023. Retrieved13 January 2024.The next most common response category pertained to responses in which participants simply provided the terms male and female, without any further description or explanation. Examples of such responses included: 'Gender would be male/female' (A2P45) and 'Male or female' (C3P48). ... As shown, similar proportions of Australian and Canadian participants provided responses that were coded as Feelings/Identification or that were coded as Biology. The stark difference in response patterns by country pertained to responses that were coded as Male/Female: This was the modal category for the Australian participants, with nearly one‐third of participants providing such a response, whereas Male/Female was not even in the top three response categories for the Canadian participants.
^Sua'ali'i T (2001). "Samoans and Gender: Some Reflections on Male, Female and Fa'afafine Gender Identities".Tangata o te moana nui: the evolving identities of Pacific peoples in Aotearoa /New Zealand. Palmerston North, N.Z.: Dunmore Press.ISBN978-0-86469-369-3.
^Vasey PL, Bartlett NH (2007). "What can the Samoan "Fa'afafine" teach us about the Western concept of gender identity disorder in childhood?".Perspectives in Biology and Medicine.50 (4):481–90.doi:10.1353/pbm.2007.0056.PMID17951883.S2CID37437172.
^Nanda S (1985). "The hijras of India: cultural and individual dimensions of an institutionalized third gender role".Journal of Homosexuality.11 (3–4):35–54.doi:10.1300/J082v11n03_03.PMID4093603.The most significant relationship in the hijra community is that of theguru (master, teacher) andchela (disciple).
^abNanda S (1999).Neither Man Nor Woman: The Hijras of India. Wadsworth Publishing Company. p. 116.ISBN978-0-534-50903-3.Archived from the original on 19 December 2021. Retrieved19 December 2021.None of the hijra narratives I recorded supports the widespread belief in India that hijras recruit their membership by making successful claims on intersex infants. Instead, it appears that most hijras join the community in their youth, either out of a desire to more fully express their feminine gender identity, under the pressure of poverty, because of ill-treatment by parents and peers for feminine behavior, after a period of homosexual prostitution or for a combination of these reasons.
^Reddy G (2010).With Respect to Sex: Negotiating Hijra Identity in South India. University of Chicago Press. p. 243.ISBN978-0-226-70754-9.Archived from the original on 19 December 2021. Retrieved19 December 2021.By and large, the Hindi/Urdu termhijra is used more often in the north of the country, whereas the Telugu termkojja is more specific to the state of Andhra Pradesh, of which Hyderabad is the capital.
^Nanda S (1991)."chpt. 7. Deviant careers: the hijras of India". In Freilich M, Raybeck D, Savishinsky JS (eds.).Deviance: Anthropological Perspectives. Bergin & Garvey.ISBN978-0-89789-204-9.Archived from the original on 19 December 2021. Retrieved19 December 2021.Among thirty of my informants, only one appeared to have been born intersexed.
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