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One of April's big news stories was Diane Sawyer's interview with Bruce Jenner, who has come out this year as transgender. Bruce, who noted plans to change name and pronoun in the near future, isn't the first transgender person in the spotlight.
Chaz Bono, born to Cher and Sonny Bono and named Chastity at birth, came out a transgender man in 2009. Laverne Cox is an accomplished actress (most recently on Orange is the New Black) and has been a vocal activist for transgender rights and Lana Wachowski, who directed The Matrix trilogy and Cloud Atlas with her brother, was the first major Hollywood director to come out as transgender in 2012. And while these people have bravely discussed their gender in the spotlight, they are a small fraction of the many people identifying as transgender around the world. We're learning more and more about the range of gender identities that exist, and this week we'll focus on an introduction to gender identity.
OK, back up. Are sex and gender identity different?
I'm glad you asked. There's a lot of language that gets thrown around in discussing gender, and it's important to define terms.
Let's start here:
Sex: Physical characteristics that are used to define male and female. For example, when an infant is born, that baby is usually declared "boy" or "girl" based on whether they have a penis or vagina (external genitalia).* Other characteristics used to define sex include genes/chromosomes, hormones, presence of a uterus/ovaries or testicles (internal genitalia), or changes that happen with puberty, like breast development or hair growth (secondary sex characteristics).
Gender identity: One's internal, deeply held sense of one's gender (masculine, feminine, both, or neither), which may or may not match the gender expectations for the sex that person was assigned at birth. For example, a baby may be assigned a male sex at birth based on the presence of a penis, but later identify as a girl or a woman.
Transgender is an umbrella term used for people whose gender identity differs from what is typically associated with the sex that they were assigned at birth.
Wait, an umbrella term? What's under that umbrella?
There are many, many different terms that people use to identify their gender. Facebook, for example, used to only allow users to choose between "male" and "female" But in 2014 Facebook expanded the gender options to include 56 different terms — and now allows users to use free text for their gender if that is their choice. Here are a few more common terms that you might hear:
Male-to-female (MtF), female-to-male (FtM): MtF and FtM are used by some transgender people to describe their past and present identities. For example, a person that was assigned a female sex at birth and now identifies as male might use FtM to describe or give more detail about their gender.
Transgender man or trans man, transgender woman or trans woman: These terms describe people's affirmed gender identity. For example, a person assigned a female sex at birth who later identifies as a man may use the term "trans man."
Nonbinary: Some people don't find that their identities fit into categories of "man" and "woman." "Nonbinary" describes gender identities that are between masculine and feminine or that are neither masculine or feminine. Some other terms that are used to describe nonbinary gender identity are transgender, trans or genderqueer.
Cisgender: This term is used in comparison to transgender to describe a person whose sex assigned at birth is aligned with their gender identity.
It's important to know the common terminology, but it can be difficult to keep up with new terms as they emerge. The most important thing to remember is that gender identity is an internal feeling and people use many, many different words to describe this identity. If you hear a word that you haven't heard before, respectfully asking what that term means to that person is the best source of information that you can get. It's also important to respect people's preferred name and pronouns (pdf), so ask if you're not sure what a person would like to be called.
Is this the same as being gay?
This is a really important distinction: gender identity and sexual orientation (who a person is romantically or sexually attracted to) are not the same. For example, a trans man attracted to woman may identify as heterosexual or straight, while a trans man attracted to man may identify as gay.
How many people identify as transgender?
Great question! And at this point, interestingly, no one really knows the answer. Older studies in Europe estimated that MtF transgender identity occurred rarely, in about one in 12,900 people, and that FtM transgender identity was even less common, at one in 33,800 people. Most experts think that this underestimates the true incidence of transgender identity, however, as these studies looked a very specific group of transgender adults who sought specific types of medical care. One more recent study in Boston, for example, showed that transgender identity may be as common as 0.5 percent of people.
Do kids ever identify as transgender?
Yes! Many children express their gender identity as soon as they can talk, but people can realize their gender identity at any age. Some adolescents have stress around puberty related to gender identity, as their bodies change in ways that may not match their internal feeling of gender (development of breasts, for example, in a person that identifies as a man). It's also important to know that gender identity may change or be fluid for some people. And don't forget that gender is complicated and comes from inside, so a kid playing with toys that are typically thought of as for the opposite sex may or may not be transgender or may be a girl that loves to play with trucks!
What is it like to be transgender?
How people experience gender — whether transgender or cisgender — is different for everyone. We do know, however, that many transgender people experience unjust discrimination, stigma and lack of social support. Some transgender people also experience gender dysphoria, which is distress around physical characteristics (such as breasts or genitals) that don't match their gender identity. All of these elements are thought to be the reason that transgender people have shockingly high rates of suicide attempt, as well as higher rates of substance use, dropping out of school and unemployment.
Again, these disparities are thought to be due to the stress from gender dysphoria and from discrimination that transgender people face, and are not from their specific gender identity. As more transgender people talk about their experiences publicly and as we gather more scientific evidence about gender, it's clear that the range of gender identities is normal and that fighting stigma and working toward support of transgender people will help address the risks that they currently face.
I want to learn more - what are some good resources?
There's so much more to say about gender identity and ways to support trans folks in their health and wellness! There are many great references out there, but here are a few to get you started:
American Family Children's Hospital Pediatric and Adolescent Transgender Health (PATH) Clinic: Information about our clinic for trans kids with lots of resources for kids, parents and other community members!
Jazz's Story (20/20): A series of interviews by Barbara Walters with Jazz, a transgender teen.
UCSF Center for Excellence for Transgender Health: Information and resources about transgender health.
* It's important to acknowledge that sex can't always be sorted easily into male or female. People with intersex conditions, or disorders of sex differentiation, may have some characteristics considered male and others considered female (such as having testicles internally while having a vagina and breast development with puberty).