Understanding gender identity

Even before an infant is born, there’s often much discussion about their gender. Parents and others may want to know if the baby will be a boy or girl. “Gender reveal” parties are hosted. Room and wardrobe colors are chosen.

However, we now understand a person’s gender identity is not restricted to just two possibilities.

According to the World Health Organization (WHO), gender is a social construct — an idea or belief that’s been created and generally accepted by the people in a society — related to assumed characteristics of the biological sexes (male and female), such as masculine or feminine. These norms, behaviors and roles are associated with being a woman, man, girl or boy.

Gender, the WHO reports, is different from sex, which refers to the biological and physiological characteristics of females, males and intersex persons. (Approximately 1% to 2% of people are intersex, a general term used to refer to people born with a combination of male and female biological traits.) These characteristics include chromosomes, hormones and reproductive organs.

Gender and sex — as well as sexual identity, or orientation, which is an attraction to other people — are different from gender identity. Gender identity refers to a person’s deeply felt, internal and individual experience of gender, which may or may not correspond to their physiology or sex assigned at birth.

While some may find these distinctions confusing, they are incredibly important, says Dr. Kelsey Bradshaw, a clinical psychologist with the Child and Adolescent Inpatient Program at Sharp Mesa Vista Hospital. Being gender-nonconforming — having a gender expression that doesn’t conform with binary or male and female gender norms — is highly individual, where each experience is unique. And it is vital that people in this population are supported.

Important terms related to gender

First, Dr. Bradshaw says, it is important to understand the terms used to express gender nonconformity. The Human Rights Campaign Foundation offers the following glossary:

• Genderqueer. Genderqueer people typically reject notions of static categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as genderqueer may see themselves as being both male and female, neither male nor female, or as falling completely outside these categories.
  
  

• Gender-expansive. A gender-expansive person has a wider, more flexible range of gender identity or expression than typically associated with the binary gender social construct. This is often used as an umbrella term when referring to young people still exploring the possibilities of their gender expression or gender identity.
  
  

• Gender-fluid. A gender-fluid person does not identify with a single fixed gender or has a fluid or unfixed gender identity.
  
  

• Nonbinary. A nonbinary person does not identify exclusively as a man or a woman. Nonbinary people may identify as being both a man and a woman, somewhere in between, or as falling completely outside these categories.
  
  

• Transgender. An umbrella term for people whose gender identity or expression is different from cultural expectations based on the sex they were assigned at birth. Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc.

Awareness creates understanding

According to Dr. Bradshaw, individuals’ awareness that they might be gender-nonconforming is varied. Many know from a very young age that what they were assigned at birth — male or female — is not accurate to how they identify. Others may tend to recognize this in adolescence, especially as they enter puberty.

And while it may seem we are hearing more about gender-nonconforming people than we have in the past, it is not likely there are now more people who identify as such. Like many things that are within the field of mental health, Dr. Bradshaw notes we have simply become more aware, are more open to discussing, and can more easily identify varied gender identities than in the past.

“It may seem like there are more people identifying as transgender or gender-nonconforming due to the younger generation being much more aware of transgender and gender-nonconforming people and experiences,” Dr. Bradshaw says. “Moreover, we may see that some younger people are becoming open to a gender spectrum as opposed to a gender binary, especially as it relates to historical gender stereotypes and gender expression.”

Responding to a gender-nonconforming identity

While not all gender-nonconforming or transgender people transition ­— which is the process that some people undergo to live more fully as their true gender — many find it is an important step to decrease discomfort and increase well-being. Transitioning can include a combination of social, physical, medical and legal changes.

“Some people may transition socially, in which they may dress or present themselves more as the identity they identify with,” Dr. Bradshaw says. “This may also include use of a name that is not the same one given at birth. Other individuals may want to medically transition, which can include the use of hormone treatments and surgeries to physically present more as the identity they identify with.”

Dr. Bradshaw says that medical providers and family members can be affirming by using a person’s chosen name and pronouns — such as he, she, they, it, zer — the person identifies with. Research indicates such support and gender-affirming medical care offers overall benefits of improved well-being and mental health.

“There is no suspected risk to gender-affirming care, which on a basic level is accepting the individual for who they are, without pressure or overemphasis on their gender identity,” Dr. Bradshaw says. “On the other hand, gender-nonconforming individuals have some of the highest risk for suicide. Love, support, acceptance and access to care is vital to ensure they thrive.”

Bri Dubose, a registered nurse and Lean Six Sigma Black Belt who has worked at Sharp since 2011, has three sons, one who transitioned. Her best advice for people with a loved one who is gender-nonconforming is to strive to create moments of “gender euphoria.” This is defined by some as enjoyment or satisfaction caused by a correlation between a person’s gender identity and physical characteristics or the joy felt in positive social experiences, such as when one is gendered, or identified, correctly.

“These moments can be sparked by calling someone by the correct pronoun or name without prompting or by introducing yourself by your pronouns to create safety,” DuBose says. “If you aren’t sure what their correct name or pronoun is, ask. Simply acknowledging their uniqueness, creating an environment built on inclusion, and honoring diversity goes a long way.”

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