Types of gender identity disorders
Gender Identity DisorderCindy M. Meston & Penny Frohlich
The DSM-IV describes gender identity disorder as a persistent and strong cross-gender identification and a persistent unease with ones sex. Gender identity disorder is not diagnosed if these symptoms co-occur with a physical intersex condition. As with the sexual disorders, a diagnosis is only made if the symptoms produce marked distress or impairment. According to the DSM-IV, gender identity disorder can occur in childhood, adolescence, and adulthood. Sexually mature individuals may be heterosexual, homosexual, bisexual, or may feel little sexual attraction to either men or women (American Psychiatric Association, 1994). Gender Identity Disorder is often confused with transvestism (cross-dressing) although the two are distinct.
When biological males and females feel a cross-gender identification, it is termed male-to female transsexualism (MF) and female-to-male transsexualism (FM), respectively. Prevalence estimates suggest that MF transsexualism is more common than FM transsexualism although a few studies have found a 1:1 ratio. Prevalence estimates range from 1:10,000 to 1:100,000 for MF and 1:30,000 to 1:400,000 for FM (Cohen-Kettenis & Gooren, 1999; Zucker & Green, 1992).
Studies examining the biological causes of gender identity disorder have typically examined the effects of prenatal hormones on prenatal brain development. During normal prenatal development, the presence of testosterone leads to the development of external male genitalia and to a male differentiated brain. It is hypothesized that for individuals with gender identity disorder, a discrepancy may exist between prenatal genital differentiation and brain differentiation such that the external genitals develop, for example, as male while the brain develops as female. The evidence to support this hypothesis is mixed. Genetic females exposed to high levels of testosterone in utero (e. g., congenital adrenal hyperplasia), rarely develop gender identity disorder. Similar prenatal exposure to antiandrogenic, androgenic, and estrogenic drugs rarely leads to gender identity disorder in either genetic females or males although some of these individuals display abnormal gender role behavior (Cohen-Kettenis & Gooren, 1999). The strongest evidence to suggest that abnormal prenatal brain differentiation may lead to gender identity disorder comes from a recent study examining hypothalamic brain nuclei in men with gender identity disorder. Zhou et al. (1995) found that the central subdivision of the bed nucleus of the stria terminalis (a region of the hypothalamus) was smaller in MF transsexuals compared to normal males but similar in size to normal females, a difference that was not accounted for by hormone therapy. Sadeghi and Fakhrai (2000) recently reported a case of 18-year old monozygotic female twins requesting gender reassignment surgery. The twins had a childhood history of cross-dressing. Unfortunately they were lost to follow up after the initial evaluation but this case suggests that gender identity disorder may have a genetic component.
Recent studies indicate that, compared to controls, MF transsexuals have more older brothers (but not more older sisters) and a later birth order (Blanchard et al., 1995; Zucker et al., 1997). Conversely, FM transsexuals are more likely to have several younger sisters but not brothers compared to controls (Zucker et al., 1998). The histocompatibility-Y antigen (H-Y antigen), which is responsible for the development of the male testes and brain differentiation, may be implicated in this process for males. With progressive male births, mothers may become immunized to the H-Y antigen, leading to increased production of H-Y antibodies, and a disruption in normal brain differentiation (Blanchard et al., 1998).
Social, parental, or familial factors have been associated with mild gender disturbance. MF transsexuals often report over controlling, rejecting fathers. FM transsexuals often report mothers and fathers who were rejecting and mothers who were over protective. It feasible, however, that these differences may have been the result of abnormal gender development, rather than the cause (Cohen-Kettenis & Gooren, 1999).
Childhood gender identity disorder may, in some cases, predict adult gender identity disorder. Fifty-five feminine boys with gender identity disorder were followed into early adulthood. Five of the feminine boys were diagnosed with gender identity disorder, one as a transvestite, 21 as homosexual, 14 as heterosexual, and 14 that were not rated. This suggests that childhood gender identity disorder reflects a high likelihood of either adult gender identity disorder or homosexuality (Green, 1987).
In cases where gender identity disorder is present, if the individual displays only a mild tendency, displays serious psychopathology, or is not functioning well socially, psychotherapy rather than sex reassignment surgery may be advised. For those with extreme symptoms of gender identity disorder, who are free of from psychopathology, and who are functioning well in society, sex reassignment surgery is still not permitted until the person has lived full time as the preferred gender, often for a period of two years. During this period, candidates may be required to change their name, inform their family, boss, and coworkers, cross-dress full time, and receive hormone treatment. This period is considered to be essential for determining whether surgery is appropriate. The candidates have the opportunity to experience what it is like to live as the other gender and to determine whether they are fully prepared for and fully comprehend the impact of living the remainder of their lives as the other sex (Cohen-Kettenis & Gooren, 1999).
A review of sex reassignment surgery outcome studies suggests that in most cases, surgery resolves the gender identity disorder. Depending on the study, between 71% and 97% of subjects were successfully treated with surgery and less than 1% later took steps to reverse the sex reassignment. Factors that predict a poor outcome include: misdiagnosed transvestism, poor surgery outcome, poor social or work functioning, suicidal tendencies, and sex reassignment surgery late in life. This suggests that the current procedure for determining appropriateness of sex reassignment surgery is effective, when applied strictly (Cohen-Kettenis & Gooren, 1999). Male to female transsexuals who are attracted to men (MF homosexuals) seem to have a better post-surgery outcome compared to MF transsexuals who are attracted to women (MF heterosexuals). MF heterosexuals may have a poorer post-surgery outcome because of the added stigma of becoming homosexual after surgery, and because they typically present for surgery much later in life than MF homosexuals and thus are likely to have more male-role investments (e.g., husband, father). FM transsexuals in general have better post-surgery outcome than MF transsexuals (Cohen-Kettenis & Gooren, 1999)
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Types of gender identity: Types and definitions
Gender is different from sex. Although genetic factors typically define a person’s sex, gender refers to how they identify on the inside. Only the person themselves can determine what their gender identity is.
This article will discuss what gender identity is, some definitions of different gender identities, and where people can find support. It will also look at how gender exists on a spectrum.
The term gender identity refers to the personal sense of an individual’s own gender.
Because a person’s sex and gender identity do not have to be the same, it is important to know the difference between them.
A person’s gender is how they identify internally and how they express this externally. People may use clothing, appearances, and behaviors to express the gender that they identify with.
The World Health Organization (WHO) note that gender is a social construction that people typically describe in terms of femininity and masculinity. In Western cultures, people associate femininity with women and masculinity with men, but this social construction varies across cultures.
However, gender is not neatly divided along the binary lines of “man” and “woman.”
A person’s sex is typically based on certain biological factors, such as their reproductive organs, genes, and hormones.
Like gender, sex is not binary. A person may have the genes that people may associate with being male or female, but their reproductive organs, genitals, or both may look different.
This is called differences in sex development. People may also refer to differences in sex development as intersex.
People typically use the terms “male,” “female,” or “intersex” to refer to a person’s sex.
Learn more about the difference between sex and gender here.
The concepts and terms that refer to gender identity continually change, as our perceptions evolve.
The term “gender identity” first appeared in the 1960s. It referred to a person’s inner sense of belonging to the category of male or female. In time, the term came to include people who identify in other ways. It refers to a person’s own sense of their gender, regardless of the sex a doctor assigned to them at birth.
Some terms, such as “transsexual,” have also changed meaning over time. In the past, this term referred only to people who had undergone certain medical procedures, such as a mastectomy or phalloplasty. The meaning of this term has since broadened to include people moving toward or having a gender identity that is different from the one assigned to them at birth.
Other language has changed in terms of acceptability. The term “queer,” for example, was historically used as a slur against people who did not conform to expectations about gender expression or identity. Now, some people have reclaimed it. It can be acceptable in some circumstances but offensive if people use it inappropriately.
It is also important to note that gender identify may not fit into a category. Labels may help a person understand their identify, but gender identities are not always classifiable in these ways. As people come to perceive their gender identity in new ways, they may find that no single term defines it. Or, they may identify in several ways.
A person’s gender identity is not restricted to being either a man or a woman. Some people do not identify with any gender, while others identify with multiple genders.
According to The Trevor Project, a person’s gender can consist of the following.
This term refers to the personal sense of an individual’s own gender.
Some people identify as a man, while others identify as a woman. Others may identify as neither, both, or somewhere in-between.
Gender expression and presentation
This refers to how a person expresses themselves to others and how they want the world to see them.
A person may present themselves as wholly masculine or wholly feminine. Or, a person may present themselves as androgynous or nonbinary.
Gender expression and presentation involve aspects such as mannerisms, clothing styles, names, and pronoun choices, to name a few.
Here, learn more about gender pronouns.
The following are some gender identities and their definitions.
A person who is agender does not identify with any particular gender, or they may have no gender at all.
Other terms for this may include:
- neutral gender
A person who identifies as androgyne has a gender that is either both masculine and feminine or between masculine and feminine.
A person who identifies as bigender has two genders.
People who are bigender often display cultural masculine and feminine roles.
Women, especially lesbians, tend to use this term to describe the way they express masculinity, or what society defines as masculinity.
However, the LGBTQIA Resource Center state that “butch” can also be a gender identity in itself.
A cisgender person identifies with the sex that they were assigned at birth.
For example, a cisgender woman is someone who still identifies with the sex — female, in this case — a doctor assigned them at birth.
The LGBTQIA Resource Center define gender expansive as an “umbrella term used for individuals who broaden their own culture’s commonly held definitions of gender, including expectations for its expression, identities, roles, and/or other perceived gender norms.”
Those who are gender expansive include people who are transgender and people whose gender broadens the surrounding society’s notion of what gender is.
A person who identifies as genderfluid has a gender identity and presentation that shifts between, or shifts outside of, society’s expectations of gender.
A person who identifies as a gender outlaw refuses to allow society’s definition of “male” or “female” to define them.
A person who identifies as genderqueer has a gender identity or expression that is not the same as society’s expectations for their assigned sex or assumed gender.
Genderqueer can also refer to a person who identifies outside of how society defines gender or someone who identifies with a combination of genders.
Masculine of center
A person who uses this term is usually a lesbian or a trans person who leans more toward masculine performances and experiences of gender.
A person who identifies as nonbinary does not experience gender within the gender binary.
People who are nonbinary may also experience overlap with different gender expressions, such as being gender non-conforming.
A person who identifies as omnigender experiences and possesses all genders.
Polygender and pangender
People who identify as polygender or pangender experience and display parts of multiple genders.
This is an umbrella term that encompasses all people who experience and identify with a different gender than that which their assigned sex at birth would suggest.
Although most people think of trans men and trans women when hearing the word transgender, this term also encompasses people who identify as a gender other than man or woman, including nonbinary and genderfluid.
Trans is a more inclusive term that covers those who identify as nonbinary and those who are genderless, according to the LGBTQIA Resource Center.
Two Spirit is an umbrella term that encompasses different sexualities and genders in Indigenous Native American communities.
There are many different definitions of Two Spirit, and Indigenous Native American people may or may not use this term to describe their experiences and feelings of masculinity and femininity.
This is a cultural term that is reserved for those who identify as an Indigenous Native American.
To discover more evidence-based information and resources for LGBTQIA+, visit our dedicated hub.
Not everyone is accepting of people with diverse gender identities, which can have a negative impact on a person’s mental health.
However, there are multiple websites and online communities that people can turn to for support. These include:
- The Trevor Project, which is an LGBT organization that provides education and support
- the National Center for Transgender Equality, which is an organization that provides education and support for transgender people
- PFLAG, which is an organization that provides support, education, and advocacy all over the United States, District of Columbia, and Puerto Rico
- Trans Youth Family Allies, which is a website that provides resources and education to family members, friends, and allies of transgender people
- TransLatina Coalition, which is an advocacy group for transgender Latin American people and communities
- Gender Spectrum, which is a resource and education site
- World Professional Association for Transgender Health, which is a website that provides a directory of healthcare providers and scholarship opportunities for transgender people
Here are some questions that people might ask about gender identity.
How many gender identities are there?
There is no fixed number of gender identities. They occur on a spectrum, which really means that the possibilities are infinite. Each person might find that a certain point on the spectrum feels most comfortable and accurate, and this may change over time.
People do not know precisely what influences gender identity. Some genetic factors and factors that a person is born with may play a role.
What influences gender identity?
Various factors play a role, including socialization and our own choices. Gender roles and traits are dynamic, which means that they can change. Whether a healthcare professional identifies a baby as male or female at birth does not go on to define that person’s gender identity.
How can I know my gender identity?
The first step is to figure out what gender identity, gender expression, sexual orientation, and sex assigned at birth mean and see how you feel about these ideas.
Then, think about the spectrum of gender identities and where you might feel comfortable. Maybe speak with friends of various gender identities for inspiration.
And keep in mind that there is no need for any specific label. You might want to go without a label or even create your own.
A person’s gender identity is not always the same as their biological sex, nor their assumed gender based on their assigned sex. It depends on how they identify as a person, and this can change over time.
People can identify as more masculine, more feminine, a combination of both, or neither. How a person expresses or describes their gender is personal to them.
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