Gender identity is typically defined as the concept of the self as male or female. But the reality of gender identity is far more complex since gender variance is not uncommon. For example, gender identity may differ from an individual’s birth-assigned gender. Transgender people include those whose gender identity does not match their assigned gender. And transgender people differ.  While some experience distress and want to live as the other gender, this is not true of all transgender individuals (Cohen-Kettenis & Pfafflin, 2010). And gender identity is different than sexual orientation (e.g., a transwoman who identifies as a woman although their birth sex was male, may be straight, gay, or bisexual).

It is also important to recognize that not everyone is clearly biologically male or female. Approximately 17 of every 1,000 people are intersex and possess chromosomal and anatomical features of both males and females. And even those whose gender identities correspond to their birth-assigned gender vary in how compatible and contented they are with their gender group, how central their gender identity is relative to their other identities, and how they express their gender identification. 

Like most things human, gender identities arise from a combination of biological and social factors. Although uncertainty remains regarding the neurobiological basis of gender identity, it appears that prenatal intrauterine hormonal exposure in the second half of pregnancy interacts with multiple genes to influence brain development in ways that impact gender identification (Bao & Swaab, 2011). During puberty, sex hormones further activate sex-differentiated brain differences (Steensma et al., 2013). Because sex differentiation of the brain takes place later in fetal development than sexual differentiation of the genitals, gender identity may be incongruent with an individual’s biological sex. Gender identity variation is unsurprising when you consider this complex biological formula and how the ingredients and their combinations may vary.

Developmentally, most children identify themselves as a “boy” or a “girl” by age three. By middle childhood, children have fairly stable conceptions of how well they fit their gender category, how content they are with their gender assignment, and how much they are expected to conform to gender stereotypes (Egan & Perry 2001). Gender schema theory posits that once children internalize societal “gender lenses,” gender becomes an organizing cognitive framework and the child is motivated to construct their gender identity accordingly (Bem, 1993). 

Although most children come to identify with their natal (birth) sex, some experience gender incongruence with their birth-assigned gender and some are gender dysphoric (experience a sense of discomfort with their biological sex and assigned gender role), and at an early age (sometimes as early as two years), express dissatisfaction with their assigned gender.  This occurs to varying degrees with some indicating they want to become the other gender and some expressing anatomic dysphoria (dissatisfaction with their sex-specific anatomy) (Cohen-Kettenis, 2006).  However, less than a quarter of such children remain gender dysphoric in adolescence (Steensma, Biemond, de Boer, & Cohen-Kettenis, 2011). Gender dysphoria also occurs during and after puberty though underlying mechanisms remain uncertain (Steensma et al., 2013).

But despite diversity in gender identification and expression, and that intersex individuals are not uncommon, most cultures perceive gender as a clear-cut male/female binary to which we must conform. As a psychologist I am concerned about socially constructed gender binarism because it contributes to norms supportive of stigmatization, harassment, discrimination, marginalization, and violence towards those with non-conforming gender identities and expressions. Such minority stress negatively affects the well-being of many gender non-conforming people and leads many of us to suppress parts of the self associated with the other gender.

Pathologizing non-traditional gender identities is also problematic from a human rights perspective since it leads to violations of the human right to health and negatively impacts other rights, including the rights to housing, employment and education (see the Yogyakarta Principles on the Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity). 

I know that some people find the idea that gender variance is normal and acceptable jarring. Like Archie Bunker, they long for the days when “girls were girls and men were men.” They are uncomfortable with non-traditional expressions of gender (like women presenting as “masculine” or men displaying “feminine” traits). They get grumpy and frustrated when they can’t easily identity someone as female or male, gay or straight.  They see gender variance is a problem to be fixed with psychotherapy, surgery (“Pick a side!”), or by simple conformity to traditional gender identity expressions (“Why don’t you just get with the gender binary program!).

But when it comes to gender identity, I think more like Pop-eye (“I am what I am!”).  As a psychologist, I think the solution is to flex our gender conceptions to make room for those that do not fit the gender binary.  Think about it this way: perhaps it is not gender variant people that are in need of fixing.  Rather, what needs fixing is how we think about gender identity and gender identity expression. 






Bao, Ai-Min and Dick F. Swaab. 2011. “Sexual differentiation of the human brain: relation to gender identity, sexual orientation and neuropsychiatric disorders.” Frontiers in Neuroendocrinology, 32: 214-226.  DOI:10.1016/j.yfrne.2011.02.007

Bem, Sandra Lipsitz (1993).  The Lenses of Gender: Transforming the Debate on Sexual Inequality. New Haven, CT: Yale University Press.

Cohen-Kettenis, Peggy. 2006. “Gender identity disorders.” In A Clinician's Handbook of Child and Adolescent Psychiatry, edited by Christopher Gillberg, 695-725. New York, NY: Cambridge University Press.

Cohen-Kettenis, Peggy and Friedemann Pfäfflin. 2010. "The DSM diagnostic criteria for gender identity disorder in adolescents and adults." Archives of sexual behavior 39: 499-513. 

Egan, Susan. K., and David G. Perry, 2001. “Gender identity: A multidimensional analysis with implications for psychosocial adjustment.” Developmental Psychology, 37: 451-463. DOI: 10.1037//0012-I649.37.4.45I

Fausto-Sterling, Anne. 2000.  “The five sexes revisited.”  Sciences, 40:18-24.

Lorber, Judith. 2000.  "Using gender to undo gender: A feminist degendering movement." Feminist Theory, 1: 79-95.

Martin, Carol Lynn, Diane N. Ruble, and Joel Szkrybalo. 2004. “Recognizing the centrality of gender identity and stereotype knowledge in gender development and moving toward theoretical integration: Reply to Bandura and Bussey (2004).” Psychological Bulletin, 130: 702–10.  DOI: 10.1037/0033-2909.130.5.702.

Money, John, and Anke A. Ehrhardt. 1972. "Man and woman, boy and girl: Differentiation and dimorphism of gender identity from conception to maturity." (1972).  Oxford, England: Johns Hopkins University Press.

Newman, Louise.  2012.  “Questions about gender: Children with atypical gender development.” In: Disorders of Sex Development: An Integrated Approach to Management, Edited by John M. Huston, Garry L. Warne, & Sonia R. Grover, 31-39. Heidelberg: Springer Berlin:

Steensma, Thomas D., Roeline Biemond, Fijgie de Boer, and Peggy Cohen-Kettenis. 2011. “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study.” Clinical Child Psychology & Psychiatry, 16: 499–516. doi: 10.1177/1359104510378303

Steensma, Thomas D., Baudewijntje P.C. Kreukels, Annelou L.C. de Vries, and Peggy Cohen-Kettenis. 2013.  “Gender identity development in adolescence.”  Hormones and Behavior, 64: 288-297. 

Yogyakarta Principles. 2007.  Retrieved on February 20, 2014.  

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