Gender Identity and Expression

What’s the difference between sex and gender?

Sex is both a biological and legal term. It is a term used to describe whether someone is male, female, or intersex. Biological characteristics of our sex include chromosomes, reproductive anatomy, and hormones. An individual is typically assigned a specific sex at birth, though that does not mean that they will grow up identifying with their assignment. Sex is different from gender in that sex only describes the biological attributes of an individual. Identifying as male, female or intersex tells us nothing about the person’s gender identity, gender expression, sexual orientation, personality, capabilities, attributes, or… much of anything!  

Gender refers to the socially constructed roles, behaviors, expressions, and identities, such as masculine, feminine, and androgynous. The gender spectrum is one way to conceptualize all the different ways gender can be expressed. How someone expresses their gender has a lot to do with how culture defines gender roles, expectations for behaving, and how identities become validated. Gender roles change across time and vary within cultures. For instance, some cultures created third genders, so specific roles and functions like helping the sick or earning wages to feed their family can be achieved, often breaking rules of what “men” and “women” are “supposed to do.” Because everyone expresses their gender in a unique way, there are as many ways to express gender as there are people in the world!

What does Transgender mean?

“Transgender” (or Trans) is an umbrella term for an individual’s gender identity that is different from their assigned sex. This can also extend to gender expression and the societal expectations of one’s assigned sex. Because transgender is an umbrella term, it includes individuals that identify as genderqueer, bigender, genderfluid, pangender, gender independent, transsexual, gender creative, gender expansive, agender, FTM (female to male), MTF (male to female), and many more. We do this to be as inclusive as possible to all people who are Trans and gender diverse.

What does Cisgender mean?

Cisgender is the term used for an individual’s gender identity that is the same as their assigned sex at birth. For example, a person born male and identifies with being male, and expresses being male, is considered cisgender. This term does not tell us anything about the person’s gender expression or sexual orientation. For example, a person assigned male at birth and identifies as male might express masculinity in a unique way and identify as bisexual or gay. A person assigned male at birth and identifies as male might express femininity and identify as heterosexual. There are as many ways of expressing being cisgender as there are people in the world!

What does Intersex mean?  

Intersex is also an umbrella term used to identify persons that encompass both male and female reproductive, chromosomal, or sexual anatomy which may be related to genitalia, secondary sex characteristics, and/or chromosomal make-up. For a person born as intersex a decision is made by the parents and/or doctor as to how to identify the sex on the birth certificate and surgery is performed to remove the sexual and numerous ways people identify being intersex; however, identifying as intersex does not tell us about the persons gender identity, gender expression, sexual orientation, personality, capabilities, attributes, etc. Some intersex folks may identify as transgender and some may not.

What does gender confirmation mean in health care?            

Gender dysphoria, the discomfort or distress because of the mismatch between their sex assigned at birth and gender identity, can decrease or go away with interventions. Some transgender folks need and want medical, psychological and social interventions to confirm their gender identity and to decrease dysphoric feelings. Gender confirmation services include psychological counseling, social support, and medical interventions such as hormone treatments and surgery.

Psychological counselors are not gate-keepers of gender or gender confirmation services. Several years ago, psychotherapy was mandated before other medical interventions were initiated. Current practice is to assist the individual in their transition process, coordinate care with physicians, and encourage connections to social supports.

Hormone therapy is the use of synthetic sex hormones to feminize, masculinize or androgynize the body. A physician must be consulted in order to start hormone therapy. It is common for the physician to consult with your psychological counselor or behavioral health treatment team to ensure you are ready for interventions. Hormone interventions are semi-reversible.

Surgical procedures, often called sex reassignment surgery, will change primary or secondary sex characteristics, and are irreversible. This is done so that the sex characteristics correspond with an individual’s gender identity.  These surgeries can result in feeling more at ease in your body, an ability to take a lower dose of hormones, increased safety in public settings, and the ability to stop binding, padding, or tucking. These surgeries are many times referred to as feminizing surgeries and masculinizing surgeries. The surgeries are also referred to as top or bottom surgeries.

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