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The article did a good job of explaining what sex and gender is. It also explains how people get set into their gender role. What are your guys’ thoughts on this article? Based on how you were brought up do you also feel that the processes discussed in this article explain how you got set into your gender role? Anything relevant that you’d like to add to this topic would be appreciated.
Onto the article:
Source: http://emedicine.medscape.../917990-overview#showall
Sexuality, Gender Identity
Author
Shuvo Ghosh, MD Assistant Professor of Pediatrics, Developmental-Behavioral Pediatrician, Child Development Program, Division of General Pediatrics, McGill University Health Centre, Montreal Children's Hospital
Shuvo Ghosh, MD is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, Canadian Paediatric Society, Federation of Medical Specialists in Quebec, Physicians for Social Responsibility, Quebec Medical Association, Society for Developmental and Behavioral Pediatrics, and Society for Research In Child Development
[h3]Gender identity and gender role[/h3]
Gender identity is defined as a personal conception of oneself as male or female (or rarely, both or neither). This concept is intimately related to the concept of gender role, which is defined as the outward manifestations of personality that reflect the gender identity. Gender identity, in nearly all instances, is self-identified, as a result of a combination of inherent and extrinsic or environmental factors; gender role, on the other hand, is manifested within society by observable factors such as behavior and appearance. For example, if a person considers himself a male and is most comfortable referring to his personal gender in masculine terms, then his gender identity is male. However, his gender role is male only if he demonstrates typically male characteristics in behavior, dress, and/or mannerisms.
Thus, gender role is often an outward expression of gender identity, but not necessarily so. In most individuals, gender identity and gender role are congruous. Assessing the acquisition of this congruity, or recognizing incongruity (resulting in gender-variant behavior), is important in the developing child. It is important also to note that cultural differences abound in the expression of one's gender role, and, in certain societies, such nuances in accepted gender norms can also play some part in the definition of gender identity.
In order to understand gender identity development and related issues, definitions must be emphasized for clarity. The topic of gender identity is often discussed merely in terms of dysfunction, and the diagnosis of gender identity disorder is a known phenomenon in both children and adults. However, physicians should remember that all individuals possess a gender identity and that the process of becoming aware of it is an important part of the psychosocial development of a child. In the realm of pediatrics, recognition of gender identity is a process rather than a particular milestone, and variance from societal norms can cause distress to both the child and the child's family. It is necessary to understand the varied pathways that lead to a mature and congruent gender role in order to fully assess a person's behavioral health.
[h3]Sex and gender[/h3]
In the English language, the terms sex and gender are often used interchangeably in the vernacular. However, in a medical and technically scientific sense, these words are not synonymous. Increasingly, the term gender is being accepted to define psychophysiologic processes involved in identity and social role. Therefore, it is not uncommon to hear references to "gender" by professionals from numerous disciplines, including medicine, psychology, anthropology, and social science. Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own identification as male, female, or intersex; gender may also be based on legal status, social interactions, public persona, personal experiences, and psychologic setting.
Sex, from the Latin word sexus, is defined by the gonads, or potential gonads, either phenotypically or genotypically. It is generally assigned at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status. When an intersex condition is noted in a newborn, one sex is often chosen with the intention of simplifying social interactions and rearing.
A person's sex is a primary state of anatomic or physiologic parameters. A person's gender is a conclusion reached in a broad sense when individual gender identity and gender role are expressed. An often-used phrase to point out the difference, while an oversimplification, has some merit when dealing with these definitions: Sexual identity is in the perineum; gender identity is in the cerebrum. Increasingly, the more subjective sense of gender identity takes precedence in evaluating patients’ needs. In instances when a discrepancy exists between sex and gender, compassion and empathy are essential to foster better understanding and an appropriate relationship between the physician and the patient. Conceptually, professionals dealing with development may fairly state that sex is biologically determined, whereas gender is culturally determined.
Note that just as gender and sex are not interchangeable terms, neither are gender development and sexual development interchangeable. Physiologic sexual development progresses through distinct stages from the neonatal period through infancy, childhood, puberty and adolescence, and adulthood. Such physiologic change is distinguishable from gender-related behaviors during each of these stages. The sexual identity that emerges beyond childhood is very clearly a separate entity from gender identity. Aspects of physical sexual growth, eroticism, and eventual sexuality, although closely related to gender, should not necessarily be used to draw conclusions about a patient's gender definitions.
Next
[h2]Development of Gender Identity - Usual Patterns[/h2]
[h3]Prenatal influences[/h3]
A child's gender development, meaning maturation of gender identity, clearly begins in the intrauterine stage. Hormone-induced sexual dimorphism in the growing fetus probably plays a primary role. This is apparent in the fact that, most commonly, female sex corresponds with female gender, just as male sex and male gender are commonly linked.
Initially, all human fetuses are primed to have a female sex, in that the default pathway for development is toward female anatomy. During the eighth week of gestation, fetuses with a Y chromosome and a functional locus for the SRY gene product, also called the testes determining factor (TDF), undergo testicular development. This process converts the inherently female fetus into a male one, as a steadily increasing surge of testosterone is then produced by the testes. Much of the testosterone is converted to dihydrotestosterone, which is the key virilizing hormone during gestation. Along the biochemical pathway of hormone production, other recently identified gene products likely play an additional role in the masculinization of the fetus.
Further progression toward the eventual male phenotype occurs as antimüllerian hormone is produced, inhibiting the formation of müllerian ducts, which would lead to female genital development. The fetal brain is also affected by this process. MRI studies in human and animal models reveal that the corpus callosum, amygdala, cerebellum, and portions of the preoptic area of the hypothalamus are larger in brains exposed to intrauterine testosterone. Corresponding parts of the brain are smaller in female, or testosterone-deprived, fetuses. Indeed, in the absence of testosterone, the fetus continues its progression in the female state. Development of the ovaries and the female genital tract is likely triggered by follicle-stimulating hormone (FSH), which is present in both male and female fetuses, but whose effect is superseded by the testosterone surge in males.
The gender identity of a fetus, and later of an infant, is still incomplete by definition. Until a self-conceptualization of such an identity can take place, it remains in flux. At the same time, current research indicates that, because of the expected hormonal exposure secondary to genetic sex, all newborns probably have a certain gender bias toward a particular gender identity. Predicting this based on external anatomy or on other factors is not completely accurate because no specific means exist to verify the presupposition. In a small minority of newborns, it is also possible that the gender bias is neutral, in which case it may remain so or may be modified via environmental and epigenetic (or other gene-influencing) mechanisms.
Rudimentary gender identity at birth, although incomplete, is an important determinant in gender development. The dimorphism of the brain itself suggests a strong biologic underpinning to eventual gender development in the vast majority of individuals. Nevertheless, variations may occur when endogenous or exogenous factors create a fetal environment in which hormone levels do not follow the genetically predetermined pattern. In such situations, the gender bias of these infants may be tilted away from one that correlates with the genotype. Such variations are discussed below.
[h3]Early gender development[/h3]
The environment in which a baby is reared with respect to gender begins to take shape prior to birth. Prenatal ultrasonography now allows the sex of a fetus to be determined quite accurately by the second semester of gestation. Families who receive knowledge of the child's biological sex often use this information to tailor parental planning and reactions. Gender-specific names, items of clothing/toys, and even aspirations for the soon-to-arrive baby may differ depending on the anticipated sex. Thus, a preformed idea of the child's preferences is in place even before the child is delivered.
Upon assignment of sex at birth, a significant environmental role begins in gender development, as the parents usually rear the child as either male of female, with all of the associated social interactions. In recent years, the prevailing notion once fostered by John Money of Johns Hopkins University, that gender identity is malleable during the first years of life, after which it becomes irreversible, has been challenged. Whether particular gender identity is truly an inborn characteristic, or even if it remains unchangeable through the course of an individual's lifetime, has not yet been determined.
Several studies by Milton Diamond of the University of Hawai'i indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a number of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.
For the moment, a number of proposed theories appear to have some validity. Note that these theories are neither mutually exclusive nor universally applicable, given the latest evidence. An epidemiologic approach to the human population as a whole cannot be reconciled with the very personal, and often unique, experience of gender development. As such, the current state of knowledge remains somewhat incomplete.
Quite possibly, the multifactorial nature of mammalian development allows the inherent brain bias toward a particular gender identity to be molded during the first few years and, in some cases, perhaps even in later years. Clearly though, as gender development progresses in children, an acceptance and personal expression of a gender identity occurs. Traditionally, this has been called the core gender identity. Evidence suggests that this expression usually takes place by age 2-3 years. The gender role may not necessarily be well defined until age 5 years, although, in some cases, it is evident earlier. Although this concept and these reference-age ranges have been accepted for several decades, the full plasticity of gender identity has not yet been fully elucidated. Whether an absolute final point truly exists after which a gender identity is irrevocably fixed is still unproven.
During infancy, gender identity probably remains in the same incomplete stage in which it exists at birth. At this point, the parents create the gender role, and parental decisions play the largest part in determining environmental influences. Theories of social learning describe differing types of reinforcement in families. Opportunities to experience a variety of activities or restriction to sex-stereotypical ones may have some effect on gender development. Scientific evidence describes behavioral changes that occur when parents of either sex interact with male babies versus female babies. Females are touched and cuddled more; males are encouraged to play assertively with toys and balls. The disparity seems to be greater with fathers than with mothers.
Eventually, the concept of gender constancy develops in the growing child. This refers to the ability of a child to concretely differentiate between the genders, frequently occurring by age 2 years, at which time the first expressions of gender identity are commonly made. Gender constancy is thought to be achieved by age 6 years in nearly all children, barring those with specific variations from the usual pattern.
[h3]Continuing gender development[/h3]
Throughout the rest of childhood and school years, a child's gender identity is typically reinforced by gender role. A preference for same-sex playmates usually manifests by age 3-4 years, and the gender role is better defined by subsequent interactions. A general assumption has been that boys typically prefer more rough-and-tumble activities, often involving physical aggression. Conversely, girls have been thought to prefer quieter activities, with greater reliance on fantasy and imagined situations. Research by Money, among others, seems to indicate that these assumptions are largely true in the examination of school-aged children. The school environment often serves as a model for society, and ascription to either a male or a female gender role is often presented there, as well as at home.
In recent years, significant strides have been made in the awareness of gender-variant behaviors in both boys (male anatomic sex) and girls (female anatomic sex). Typically, female gender variance has been well-tolerated in Western society, with "tomboys" faring reasonably well in school activities. However, male gender variance ("sissy boys") have not been looked upon favorably by families or society and have been more easily recognized. That such gender variance is biologically equivalent in boys and girls, and that it is not necessarily an indicator of gender identity disorder in childhood, is growing clearer. However, the converse is also true; insofar as such behaviors have associations with confusion or incongruence of gender identity, both girls and boys may experience such symptoms.
In adolescence, the influential factors of sexuality, personality traits or disorders, peer interaction, and anxieties are most important in gender development. The nascent gender identity, fostered from infancy to childhood by parents, is first strengthened by playmates, schoolmates, and others. It is usually enhanced by the pubertal development of a child who progresses into adolescence, with its accompanying physical confirmation of the internal self-image. Although many believe that gender identity is fixed in early childhood, it is more certain that, by late adolescence and early adulthood, an established gender identity is unquestionably in place. In the usual case, an accompanying gender role is well defined, and gender identity in the context of one's sexual identity is also clear.
Previous
Next
[h2]Development of Gender Identity - Unusual Patterns[/h2]
[h3]Conditions Resulting From Genetic or Hormonal Influences[/h3]
Changes to the usual process of fetal development cause numerous differences in the resulting fetus. When levels of prenatal hormones are altered, phenotypic progression is also altered. The inherent brain bias toward one sex may be discordant with the genetic makeup of a fetus, or even with its external anatomic presentation. Other variations lead to psychologic stressors in later development but have their origin in the prenatal stage. A number of such conditions may ultimately affect a child's gender identity.
[h3]Chromosomal alterations[/h3]
Two very well-described syndromes involving sex and gender, Turner syndrome and Klinefelter syndrome, result from chromosomal abnormalities.
Turner syndrome
In Turner syndrome, one sex chromosome is missing, causing a single X karyotype (a solo Y chromosome is not compatible with life). Little evidence exists to suggest that hormone levels in utero are markedly lower than in the case of XX fetuses. The resultant XO individual is born with female external genitalia; however, in many such individuals, ovarian development is anomalous. Other characteristics usually include short stature, neck and chest anomalies, and cardiac defects.
A significant percentage of individuals with Turner syndrome have varying levels of mental ******ation. This is clearly not true for all XO individuals. Many XO physicians practice in the United States. Female secondary sex characteristics often do not occur, and patients require exogenous estrogen intervention at the time of puberty. The vast majority of individuals with Turner syndrome are infertile.
Although gender identity is usually female, many XO individuals have significant psychologic stress because of their infertility, their appearance, and, in some, the awareness of their genetic profile, which may make them feel inadequate or incomplete as females. This, in turn, may cause some to feel confusion about or to question their gender role.
Klinefelter syndrome
Klinefelter syndrome occurs when the fetus possesses a sex karyotype of XXY. Because of the presence of the Y chromosome and its components, fetal development is that of a normal male. However, as the child grows and approaches puberty, he experiences excessive gynecomastia, with low serum testosterone levels. Infertility is common, and general appearance is tall and thin. Gender identity is affected by these factors. In most cases, the gender role is, in fact, male; activities and rearing typically are also male.
A higher-than-expected percentage of individuals in the XXY cohort have been reported to have emotional disorders. Preliminary data indicate that a higher number of cases of gender identity disorder are specifically associated with Klinefelter syndrome; more research into this phenomenon is required.
[h3]Other chromosomal abnormalities[/h3]
Many other chromosomal findings are described in the literature, including XYY individuals (the extra Y chromosome has been linked to excessively aggressive or antisocial behavior, with no question of confusion about gender identity, which is male). Mosaicism of sex chromosomes can also be present, including XX/XY persons who may present with the anatomic features of either sex or who may present as intersexed (with characteristics of both sexes). Another condition is termed gonadal dysgenesis, with partial formation of testicular and ovarian tissue. Each of these very uncommon situations requires a separate assessment of the patient's gender identity.
You can stop reading here if you want, but if you want to read about Hermaphroditism click the spoiler.
Previous
Next
Cliffs:
Onto the article:
Source: http://emedicine.medscape.../917990-overview#showall
Sexuality, Gender Identity
Author
Shuvo Ghosh, MD Assistant Professor of Pediatrics, Developmental-Behavioral Pediatrician, Child Development Program, Division of General Pediatrics, McGill University Health Centre, Montreal Children's Hospital
Shuvo Ghosh, MD is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, Canadian Paediatric Society, Federation of Medical Specialists in Quebec, Physicians for Social Responsibility, Quebec Medical Association, Society for Developmental and Behavioral Pediatrics, and Society for Research In Child Development
[h3]Gender identity and gender role[/h3]
Gender identity is defined as a personal conception of oneself as male or female (or rarely, both or neither). This concept is intimately related to the concept of gender role, which is defined as the outward manifestations of personality that reflect the gender identity. Gender identity, in nearly all instances, is self-identified, as a result of a combination of inherent and extrinsic or environmental factors; gender role, on the other hand, is manifested within society by observable factors such as behavior and appearance. For example, if a person considers himself a male and is most comfortable referring to his personal gender in masculine terms, then his gender identity is male. However, his gender role is male only if he demonstrates typically male characteristics in behavior, dress, and/or mannerisms.
Thus, gender role is often an outward expression of gender identity, but not necessarily so. In most individuals, gender identity and gender role are congruous. Assessing the acquisition of this congruity, or recognizing incongruity (resulting in gender-variant behavior), is important in the developing child. It is important also to note that cultural differences abound in the expression of one's gender role, and, in certain societies, such nuances in accepted gender norms can also play some part in the definition of gender identity.
In order to understand gender identity development and related issues, definitions must be emphasized for clarity. The topic of gender identity is often discussed merely in terms of dysfunction, and the diagnosis of gender identity disorder is a known phenomenon in both children and adults. However, physicians should remember that all individuals possess a gender identity and that the process of becoming aware of it is an important part of the psychosocial development of a child. In the realm of pediatrics, recognition of gender identity is a process rather than a particular milestone, and variance from societal norms can cause distress to both the child and the child's family. It is necessary to understand the varied pathways that lead to a mature and congruent gender role in order to fully assess a person's behavioral health.
[h3]Sex and gender[/h3]
In the English language, the terms sex and gender are often used interchangeably in the vernacular. However, in a medical and technically scientific sense, these words are not synonymous. Increasingly, the term gender is being accepted to define psychophysiologic processes involved in identity and social role. Therefore, it is not uncommon to hear references to "gender" by professionals from numerous disciplines, including medicine, psychology, anthropology, and social science. Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own identification as male, female, or intersex; gender may also be based on legal status, social interactions, public persona, personal experiences, and psychologic setting.
Sex, from the Latin word sexus, is defined by the gonads, or potential gonads, either phenotypically or genotypically. It is generally assigned at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status. When an intersex condition is noted in a newborn, one sex is often chosen with the intention of simplifying social interactions and rearing.
A person's sex is a primary state of anatomic or physiologic parameters. A person's gender is a conclusion reached in a broad sense when individual gender identity and gender role are expressed. An often-used phrase to point out the difference, while an oversimplification, has some merit when dealing with these definitions: Sexual identity is in the perineum; gender identity is in the cerebrum. Increasingly, the more subjective sense of gender identity takes precedence in evaluating patients’ needs. In instances when a discrepancy exists between sex and gender, compassion and empathy are essential to foster better understanding and an appropriate relationship between the physician and the patient. Conceptually, professionals dealing with development may fairly state that sex is biologically determined, whereas gender is culturally determined.
Note that just as gender and sex are not interchangeable terms, neither are gender development and sexual development interchangeable. Physiologic sexual development progresses through distinct stages from the neonatal period through infancy, childhood, puberty and adolescence, and adulthood. Such physiologic change is distinguishable from gender-related behaviors during each of these stages. The sexual identity that emerges beyond childhood is very clearly a separate entity from gender identity. Aspects of physical sexual growth, eroticism, and eventual sexuality, although closely related to gender, should not necessarily be used to draw conclusions about a patient's gender definitions.
Next
[h2]Development of Gender Identity - Usual Patterns[/h2]
[h3]Prenatal influences[/h3]
A child's gender development, meaning maturation of gender identity, clearly begins in the intrauterine stage. Hormone-induced sexual dimorphism in the growing fetus probably plays a primary role. This is apparent in the fact that, most commonly, female sex corresponds with female gender, just as male sex and male gender are commonly linked.
Initially, all human fetuses are primed to have a female sex, in that the default pathway for development is toward female anatomy. During the eighth week of gestation, fetuses with a Y chromosome and a functional locus for the SRY gene product, also called the testes determining factor (TDF), undergo testicular development. This process converts the inherently female fetus into a male one, as a steadily increasing surge of testosterone is then produced by the testes. Much of the testosterone is converted to dihydrotestosterone, which is the key virilizing hormone during gestation. Along the biochemical pathway of hormone production, other recently identified gene products likely play an additional role in the masculinization of the fetus.
Further progression toward the eventual male phenotype occurs as antimüllerian hormone is produced, inhibiting the formation of müllerian ducts, which would lead to female genital development. The fetal brain is also affected by this process. MRI studies in human and animal models reveal that the corpus callosum, amygdala, cerebellum, and portions of the preoptic area of the hypothalamus are larger in brains exposed to intrauterine testosterone. Corresponding parts of the brain are smaller in female, or testosterone-deprived, fetuses. Indeed, in the absence of testosterone, the fetus continues its progression in the female state. Development of the ovaries and the female genital tract is likely triggered by follicle-stimulating hormone (FSH), which is present in both male and female fetuses, but whose effect is superseded by the testosterone surge in males.
The gender identity of a fetus, and later of an infant, is still incomplete by definition. Until a self-conceptualization of such an identity can take place, it remains in flux. At the same time, current research indicates that, because of the expected hormonal exposure secondary to genetic sex, all newborns probably have a certain gender bias toward a particular gender identity. Predicting this based on external anatomy or on other factors is not completely accurate because no specific means exist to verify the presupposition. In a small minority of newborns, it is also possible that the gender bias is neutral, in which case it may remain so or may be modified via environmental and epigenetic (or other gene-influencing) mechanisms.
Rudimentary gender identity at birth, although incomplete, is an important determinant in gender development. The dimorphism of the brain itself suggests a strong biologic underpinning to eventual gender development in the vast majority of individuals. Nevertheless, variations may occur when endogenous or exogenous factors create a fetal environment in which hormone levels do not follow the genetically predetermined pattern. In such situations, the gender bias of these infants may be tilted away from one that correlates with the genotype. Such variations are discussed below.
[h3]Early gender development[/h3]
The environment in which a baby is reared with respect to gender begins to take shape prior to birth. Prenatal ultrasonography now allows the sex of a fetus to be determined quite accurately by the second semester of gestation. Families who receive knowledge of the child's biological sex often use this information to tailor parental planning and reactions. Gender-specific names, items of clothing/toys, and even aspirations for the soon-to-arrive baby may differ depending on the anticipated sex. Thus, a preformed idea of the child's preferences is in place even before the child is delivered.
Upon assignment of sex at birth, a significant environmental role begins in gender development, as the parents usually rear the child as either male of female, with all of the associated social interactions. In recent years, the prevailing notion once fostered by John Money of Johns Hopkins University, that gender identity is malleable during the first years of life, after which it becomes irreversible, has been challenged. Whether particular gender identity is truly an inborn characteristic, or even if it remains unchangeable through the course of an individual's lifetime, has not yet been determined.
Several studies by Milton Diamond of the University of Hawai'i indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a number of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.
For the moment, a number of proposed theories appear to have some validity. Note that these theories are neither mutually exclusive nor universally applicable, given the latest evidence. An epidemiologic approach to the human population as a whole cannot be reconciled with the very personal, and often unique, experience of gender development. As such, the current state of knowledge remains somewhat incomplete.
Quite possibly, the multifactorial nature of mammalian development allows the inherent brain bias toward a particular gender identity to be molded during the first few years and, in some cases, perhaps even in later years. Clearly though, as gender development progresses in children, an acceptance and personal expression of a gender identity occurs. Traditionally, this has been called the core gender identity. Evidence suggests that this expression usually takes place by age 2-3 years. The gender role may not necessarily be well defined until age 5 years, although, in some cases, it is evident earlier. Although this concept and these reference-age ranges have been accepted for several decades, the full plasticity of gender identity has not yet been fully elucidated. Whether an absolute final point truly exists after which a gender identity is irrevocably fixed is still unproven.
During infancy, gender identity probably remains in the same incomplete stage in which it exists at birth. At this point, the parents create the gender role, and parental decisions play the largest part in determining environmental influences. Theories of social learning describe differing types of reinforcement in families. Opportunities to experience a variety of activities or restriction to sex-stereotypical ones may have some effect on gender development. Scientific evidence describes behavioral changes that occur when parents of either sex interact with male babies versus female babies. Females are touched and cuddled more; males are encouraged to play assertively with toys and balls. The disparity seems to be greater with fathers than with mothers.
Eventually, the concept of gender constancy develops in the growing child. This refers to the ability of a child to concretely differentiate between the genders, frequently occurring by age 2 years, at which time the first expressions of gender identity are commonly made. Gender constancy is thought to be achieved by age 6 years in nearly all children, barring those with specific variations from the usual pattern.
[h3]Continuing gender development[/h3]
Throughout the rest of childhood and school years, a child's gender identity is typically reinforced by gender role. A preference for same-sex playmates usually manifests by age 3-4 years, and the gender role is better defined by subsequent interactions. A general assumption has been that boys typically prefer more rough-and-tumble activities, often involving physical aggression. Conversely, girls have been thought to prefer quieter activities, with greater reliance on fantasy and imagined situations. Research by Money, among others, seems to indicate that these assumptions are largely true in the examination of school-aged children. The school environment often serves as a model for society, and ascription to either a male or a female gender role is often presented there, as well as at home.
In recent years, significant strides have been made in the awareness of gender-variant behaviors in both boys (male anatomic sex) and girls (female anatomic sex). Typically, female gender variance has been well-tolerated in Western society, with "tomboys" faring reasonably well in school activities. However, male gender variance ("sissy boys") have not been looked upon favorably by families or society and have been more easily recognized. That such gender variance is biologically equivalent in boys and girls, and that it is not necessarily an indicator of gender identity disorder in childhood, is growing clearer. However, the converse is also true; insofar as such behaviors have associations with confusion or incongruence of gender identity, both girls and boys may experience such symptoms.
In adolescence, the influential factors of sexuality, personality traits or disorders, peer interaction, and anxieties are most important in gender development. The nascent gender identity, fostered from infancy to childhood by parents, is first strengthened by playmates, schoolmates, and others. It is usually enhanced by the pubertal development of a child who progresses into adolescence, with its accompanying physical confirmation of the internal self-image. Although many believe that gender identity is fixed in early childhood, it is more certain that, by late adolescence and early adulthood, an established gender identity is unquestionably in place. In the usual case, an accompanying gender role is well defined, and gender identity in the context of one's sexual identity is also clear.
Previous
Next
[h2]Development of Gender Identity - Unusual Patterns[/h2]
[h3]Conditions Resulting From Genetic or Hormonal Influences[/h3]
Changes to the usual process of fetal development cause numerous differences in the resulting fetus. When levels of prenatal hormones are altered, phenotypic progression is also altered. The inherent brain bias toward one sex may be discordant with the genetic makeup of a fetus, or even with its external anatomic presentation. Other variations lead to psychologic stressors in later development but have their origin in the prenatal stage. A number of such conditions may ultimately affect a child's gender identity.
[h3]Chromosomal alterations[/h3]
Two very well-described syndromes involving sex and gender, Turner syndrome and Klinefelter syndrome, result from chromosomal abnormalities.
Turner syndrome
In Turner syndrome, one sex chromosome is missing, causing a single X karyotype (a solo Y chromosome is not compatible with life). Little evidence exists to suggest that hormone levels in utero are markedly lower than in the case of XX fetuses. The resultant XO individual is born with female external genitalia; however, in many such individuals, ovarian development is anomalous. Other characteristics usually include short stature, neck and chest anomalies, and cardiac defects.
A significant percentage of individuals with Turner syndrome have varying levels of mental ******ation. This is clearly not true for all XO individuals. Many XO physicians practice in the United States. Female secondary sex characteristics often do not occur, and patients require exogenous estrogen intervention at the time of puberty. The vast majority of individuals with Turner syndrome are infertile.
Although gender identity is usually female, many XO individuals have significant psychologic stress because of their infertility, their appearance, and, in some, the awareness of their genetic profile, which may make them feel inadequate or incomplete as females. This, in turn, may cause some to feel confusion about or to question their gender role.
Klinefelter syndrome
Klinefelter syndrome occurs when the fetus possesses a sex karyotype of XXY. Because of the presence of the Y chromosome and its components, fetal development is that of a normal male. However, as the child grows and approaches puberty, he experiences excessive gynecomastia, with low serum testosterone levels. Infertility is common, and general appearance is tall and thin. Gender identity is affected by these factors. In most cases, the gender role is, in fact, male; activities and rearing typically are also male.
A higher-than-expected percentage of individuals in the XXY cohort have been reported to have emotional disorders. Preliminary data indicate that a higher number of cases of gender identity disorder are specifically associated with Klinefelter syndrome; more research into this phenomenon is required.
[h3]Other chromosomal abnormalities[/h3]
Many other chromosomal findings are described in the literature, including XYY individuals (the extra Y chromosome has been linked to excessively aggressive or antisocial behavior, with no question of confusion about gender identity, which is male). Mosaicism of sex chromosomes can also be present, including XX/XY persons who may present with the anatomic features of either sex or who may present as intersexed (with characteristics of both sexes). Another condition is termed gonadal dysgenesis, with partial formation of testicular and ovarian tissue. Each of these very uncommon situations requires a separate assessment of the patient's gender identity.
You can stop reading here if you want, but if you want to read about Hermaphroditism click the spoiler.
Spoiler [+]
[h3]Hermaphroditism[/h3]
People with anatomically intersexed conditions are at times referred to as hermaphrodites (or true hermaphrodites). The word was coined by John Money and has been popularized by him and other workers in the field such as Harry Benjamin. It stems from the Greek god Hermes (Roman Mercury) and goddess Aphrodite (Roman Venus) and parallels the name of their son, Hermaphroditos.[sup][1] [/sup]The term is now commonly used to describe those with specific gonadal or genital aspects of both sexes.
In the past, almost unequivocally, one sex was chosen for rearing, with all the advantages and disadvantages brought on by that process. Now, increasingly, some suggest allowing hermaphrodites to remain in the intersex state until self-determination can be made to either continue as such or choose a male or female gender role. The brain bias is a matter of conjecture until adequate research studies are completed. The plasticity of gender identity is most apparent in intersexed patients. Some consider themselves both male and female. Others, believing hermaphrodeity, or hermaphroditism, to be a unique third gender, consider themselves to be neither male nor female. Still others begin life comfortably in one gender role with no sense of incongruence, but during puberty begin to find themselves most comfortable with another gender role that is more consistent with a fully developed gender identity.
[h3]Congenital adrenal hyperplasia[/h3]
Congenital adrenal hyperplasia (CAH) is the classic prenatal variation to female fetal development and, in North America, has an incidence of 1:12,000-14,200 population. In patients with CAH, the fetus is exposed to abnormally high levels of cortisol produced by its own adrenal gland. An enzyme defect exists in the pathway by which cortisol is produced; any one of several particular defects can occur. This leads to a greater amount of androgenic adrenal hormone production. For normal XX female fetuses, the prenatal exposure to androgens results in virilization of female genitalia, in what has been called female pseudohermaphroditism.
At times, virilization is complete, with substantial clitoromegaly. In such cases, the genitalia are so masculine that male sex is mistakenly assigned to the newborn at birth. Soon, clinical findings and symptomatology reveal the defect in the adrenal gland and the true female genotype of the child. Serious salt-losing nephropathy may be the presenting problem in certain infants with definable biochemical defects with this disorder. Exogenous adrenocorticoids, as well as mineralocorticoids, in some instances, are used to treat patients once the diagnosis is known.
Both the gender identity and gender role of females with CAH are controversial issues. Exposure to virilizing hormones would seem to cause a male brain bias, and evidence exists that this may be true. Several cases from the mid 20th century, when this diagnosis was more difficult and sometimes was not made until puberty, show that such infants were sometimes mistakenly raised as males, and their later gender identity and role were reportedly male.
Whether these cases truly constitute a diagnosis of gender identity disorder is not clear because of the hormone-induced changes and additional environmental influences involved during rearing. For the most part, gender identity in patients with CAH seems to remain consistent with the genetic profile. Genetic females with this condition have ovaries, so gonadal sex would be congruent with a female gender identity. The gender role can be more stereotypically masculine, with rougher play and a preference for male activities and dress. Further longitudinal studies are needed to assess the real impact of CAH on gender development.
[h3]Androgen insensitivity syndrome[/h3]
When a normal Y chromosome with a fully functional SRY locus is found in a patient with dysfunctional androgen receptors, as is the case in androgen insensitivity syndrome, which has an incidence rate of 1 per 20,000 population, virilization of the fetus does not fully take place. Although testosterone is produced in utero, it cannot change cells that lack normal receptors. In complete androgen insensitivity, the fetus has a total absence of functional androgen receptors. Therefore, progression in the default path toward female genital structure continues uninterrupted. It is growing more common, and such individuals are referred to as XY females.
In such situations, genetically normal XY males have female external genitalia and appear to be normal females at birth. The testes are undescended, although the vagina is blind-ending with no uterus or ovaries. Subsequent gender identity and gender role are typically incongruent with the biologic sex of the patient. The diagnosis is rarely made in early life, and both brain bias and environmental influences in infancy and childhood generally create a female gender identity.
During puberty, the testes produce testosterone, some of which is converted to estradiol. Given that circulating testosterone is unable to exert any virilizing effects, unopposed estradiol allows female secondary sex characteristics to develop. Because of the lack of even the relatively few functional androgen receptors that genetic females possess, body hair and other androgen-induced changes that normally occur in females are absent.
The eventual appearance of these individuals is usually tall, devoid of body and facial hair, with a low percentage of body fat, thin hips, and fully developed breast tissue. The testes may be removed because of the risk for malignant conversion in undescended testicles. Some literature now suggests that surgery may be avoided if consistent and close surveillance of the testes by ultrasonography and serum levels of typical tumor markers (eg, alpha-fetoprotein) are monitored. If the testes are discovered and removed prior to puberty, hormone replacement therapy is required to induce the described changes, since no source exists for the secretion of sex hormones.
Apart from infertility from the female standpoint, this condition has no clinical sequelae. It must be noted that the testes may be a source for spermatozoa, but it is quite unlikely that XY females will ask for this intervention. As mentioned above, despite the incongruity with the genetic profile, almost all such individuals express a female gender identity and assume a normal female gender role. For many, their appearance is perhaps even closer to a media-idealized female form than typical XX females. Thus, the presence of a Y chromosome is frequently accepted as a biologic quirk rather than the source of psychologic distress.
In partial androgen insensitivity, on the other hand, variable degrees of receptor function result in differing degrees of hypoandrogenization, virilization, and phenotypic presentation. In this less common variant of receptor dysfunction, micropenis may be present, as may hypoplastic labia (given an external female appearance). Because anatomic clues are often used for gender assignment, the degree of masculinization (or lack thereof) often determines recommendations for child-rearing. However, long-term studies appear to support a significant level of gender dysphoria in individuals with partial androgen insensitivity. Unlike the complete androgen insensitivity syndrome, this variant has proven to be difficult to manage in terms of gender congruence.
[h3]5-Alpha-reductase deficiency[/h3]
This, too, is an enzyme defect with effects during prenatal development. The incidence in North America is roughly 1:40,000. Lack of 5-alpha-reductase prevents the conversion of testosterone to dihydrotestosterone in normal male (XY) fetuses. Virilization is incomplete; the infant at birth appears female, although the external genitalia may be somewhat abnormal in size, shape, and color. The feminized phallus appears clitorislike, but the internalized gonads are normal and male, and androgen receptors are also fully functional. When the testes produce a surge of testosterone at puberty, bodily changes occur. A full conversion to male appearance is noted, with growth of the phallus. At this point, a female gender assignment quickly comes into question and then becomes clearly inappropriate.
Interestingly, the most striking cases of gender plasticity are observed in this patient population. Some of those who are raised as girls and who seemingly possess a female gender identity turn into males with puberty, converting to a male gender identity. Perhaps the brain bias for a male identity does occur with testosterone exposure prenatally, despite the inadequacy of genital virilization; it remains suppressed until puberty affirms it.
Others have undergone orchiectomy and have been raised as girls, with exogenous estrogen in adolescence to induce female pubertal changes. Some of these patients express and retain a female gender identity. Still others are raised ambivalently and are given the knowledge that, at puberty, they will differentiate into male status. Some do require slight androgen supplementation to fully complete the virilizing process. No consensus yet exists as to which choice is preferable, and many professionals are equivocal about this population, advocating a case-by-case evaluation of circumstances to decide on intervention.
[h3]Genital Abnormalities and Related Phenomena of Gender Variance[/h3]
Several rare conditions result in anomalous genitalia, either in form or function. Gender identity can be affected in some of these patients for a variety of reasons. One such situation is micropenis, in which a normal male is born with extremely small genitals. A small cohort of patients undergo botched circumcisions, causing phallic mutilation. Many parents in the past have been advised to allow these children to undergo surgery to construct female genitalia and raise them as girls. Case reports indicate that this is not necessarily the best option because most of such patients assigned a female gender develop a gender identity of male and wish to play a male gender role.
A similar situation is observed with cloacal exstrophy, in which intrauterine development of the urogenital structures is incomplete. Cloacal exstrophy has a North American incidence of 1:400,000. Males with this condition are born without a phallus, although testes are present. Reassignment of these children as females (earlier deemed appropriate because of a belief in neonatal neutrality of gender) has not been entirely successful because most demonstrate a desire for a male gender identity. Surgical and medical management, including orchiectomy, construction of a vulva, and exogenous hormone therapy to induce puberty, have classically been recommended for these patients. However, the gender role is frequently more masculinized than in their genetically female counterparts. Notably, this population appears to be very unpredictable in terms of later gender identity; therefore, a consensus recommendation for child-rearing has not yet been reached.
Even the relatively common condition of cryptorchidism may play a part in gender development. Cases exist of patients with undescended testes whose gender identity was questioned and development did not follow the normative path until psychologic intervention in later years. Such instances show that self-perception, personal knowledge about sex and gender, and comparison to societal standards can all be significant in the formation of a person's gender identity.
Subgroups of individuals also exist whose genitals have been deliberately altered. One such group consists of women who undergo female circumcision, a practice that is often termed female genital mutilation. This practice is found in many parts of Africa and sporadically in other areas of the world, as well as in the United States in the past. Severe alterations to the female external genital tract are performed as part of ritual tradition. In many of these individuals, the procedures are performed well after the expression of gender identity. Gender role is only confirmed by the practice, despite the injury to the genitalia.
Another subgroup is the hajra of India, who are eunuchs, males castrated during childhood and reared as neither male nor female. Lacking testes to induce pubertal development and through adherence to custom that effectively equals behavioral modification therapy, their gender role is mostly female. However, because of their prominent and unique status as a separate subgender, they are easily identified as such. This relegates them to a distinct role in society, and they are considered mystical creatures, to be kept apart. Their existence has been recorded for many centuries, with little information as to the origin of this practice. Whether their gender identity remains male is not well known, although most reported practices seem to indicate that their identity is in flux even in later years.
From a societal standpoint, reports also exist of tribes in both Africa and in Papua New Guinea where male individuals are raised for several years in a more typically female gender role, only to switch into a masculine gender role at the time of puberty. These individuals do not experience any alteration of genitalia but purely shift roles, which may or may not correspond to their gender identity. The shaman in North American aboriginal populations was often a gender-neutral or "bi-gendered" individual, and, in the ancient Middle East, there have been numerous reports of "third gender" persons who contributed to society in various specialized roles. Although, in some societies, there has been and remains outright ostracism for any type of gender atypicality or divergence from a strict male-female dichotomy, in many cultures throughout human history, gender variance has been recognized, tolerated, accepted, and even celebrated.
People with anatomically intersexed conditions are at times referred to as hermaphrodites (or true hermaphrodites). The word was coined by John Money and has been popularized by him and other workers in the field such as Harry Benjamin. It stems from the Greek god Hermes (Roman Mercury) and goddess Aphrodite (Roman Venus) and parallels the name of their son, Hermaphroditos.[sup][1] [/sup]The term is now commonly used to describe those with specific gonadal or genital aspects of both sexes.
In the past, almost unequivocally, one sex was chosen for rearing, with all the advantages and disadvantages brought on by that process. Now, increasingly, some suggest allowing hermaphrodites to remain in the intersex state until self-determination can be made to either continue as such or choose a male or female gender role. The brain bias is a matter of conjecture until adequate research studies are completed. The plasticity of gender identity is most apparent in intersexed patients. Some consider themselves both male and female. Others, believing hermaphrodeity, or hermaphroditism, to be a unique third gender, consider themselves to be neither male nor female. Still others begin life comfortably in one gender role with no sense of incongruence, but during puberty begin to find themselves most comfortable with another gender role that is more consistent with a fully developed gender identity.
[h3]Congenital adrenal hyperplasia[/h3]
Congenital adrenal hyperplasia (CAH) is the classic prenatal variation to female fetal development and, in North America, has an incidence of 1:12,000-14,200 population. In patients with CAH, the fetus is exposed to abnormally high levels of cortisol produced by its own adrenal gland. An enzyme defect exists in the pathway by which cortisol is produced; any one of several particular defects can occur. This leads to a greater amount of androgenic adrenal hormone production. For normal XX female fetuses, the prenatal exposure to androgens results in virilization of female genitalia, in what has been called female pseudohermaphroditism.
At times, virilization is complete, with substantial clitoromegaly. In such cases, the genitalia are so masculine that male sex is mistakenly assigned to the newborn at birth. Soon, clinical findings and symptomatology reveal the defect in the adrenal gland and the true female genotype of the child. Serious salt-losing nephropathy may be the presenting problem in certain infants with definable biochemical defects with this disorder. Exogenous adrenocorticoids, as well as mineralocorticoids, in some instances, are used to treat patients once the diagnosis is known.
Both the gender identity and gender role of females with CAH are controversial issues. Exposure to virilizing hormones would seem to cause a male brain bias, and evidence exists that this may be true. Several cases from the mid 20th century, when this diagnosis was more difficult and sometimes was not made until puberty, show that such infants were sometimes mistakenly raised as males, and their later gender identity and role were reportedly male.
Whether these cases truly constitute a diagnosis of gender identity disorder is not clear because of the hormone-induced changes and additional environmental influences involved during rearing. For the most part, gender identity in patients with CAH seems to remain consistent with the genetic profile. Genetic females with this condition have ovaries, so gonadal sex would be congruent with a female gender identity. The gender role can be more stereotypically masculine, with rougher play and a preference for male activities and dress. Further longitudinal studies are needed to assess the real impact of CAH on gender development.
[h3]Androgen insensitivity syndrome[/h3]
When a normal Y chromosome with a fully functional SRY locus is found in a patient with dysfunctional androgen receptors, as is the case in androgen insensitivity syndrome, which has an incidence rate of 1 per 20,000 population, virilization of the fetus does not fully take place. Although testosterone is produced in utero, it cannot change cells that lack normal receptors. In complete androgen insensitivity, the fetus has a total absence of functional androgen receptors. Therefore, progression in the default path toward female genital structure continues uninterrupted. It is growing more common, and such individuals are referred to as XY females.
In such situations, genetically normal XY males have female external genitalia and appear to be normal females at birth. The testes are undescended, although the vagina is blind-ending with no uterus or ovaries. Subsequent gender identity and gender role are typically incongruent with the biologic sex of the patient. The diagnosis is rarely made in early life, and both brain bias and environmental influences in infancy and childhood generally create a female gender identity.
During puberty, the testes produce testosterone, some of which is converted to estradiol. Given that circulating testosterone is unable to exert any virilizing effects, unopposed estradiol allows female secondary sex characteristics to develop. Because of the lack of even the relatively few functional androgen receptors that genetic females possess, body hair and other androgen-induced changes that normally occur in females are absent.
The eventual appearance of these individuals is usually tall, devoid of body and facial hair, with a low percentage of body fat, thin hips, and fully developed breast tissue. The testes may be removed because of the risk for malignant conversion in undescended testicles. Some literature now suggests that surgery may be avoided if consistent and close surveillance of the testes by ultrasonography and serum levels of typical tumor markers (eg, alpha-fetoprotein) are monitored. If the testes are discovered and removed prior to puberty, hormone replacement therapy is required to induce the described changes, since no source exists for the secretion of sex hormones.
Apart from infertility from the female standpoint, this condition has no clinical sequelae. It must be noted that the testes may be a source for spermatozoa, but it is quite unlikely that XY females will ask for this intervention. As mentioned above, despite the incongruity with the genetic profile, almost all such individuals express a female gender identity and assume a normal female gender role. For many, their appearance is perhaps even closer to a media-idealized female form than typical XX females. Thus, the presence of a Y chromosome is frequently accepted as a biologic quirk rather than the source of psychologic distress.
In partial androgen insensitivity, on the other hand, variable degrees of receptor function result in differing degrees of hypoandrogenization, virilization, and phenotypic presentation. In this less common variant of receptor dysfunction, micropenis may be present, as may hypoplastic labia (given an external female appearance). Because anatomic clues are often used for gender assignment, the degree of masculinization (or lack thereof) often determines recommendations for child-rearing. However, long-term studies appear to support a significant level of gender dysphoria in individuals with partial androgen insensitivity. Unlike the complete androgen insensitivity syndrome, this variant has proven to be difficult to manage in terms of gender congruence.
[h3]5-Alpha-reductase deficiency[/h3]
This, too, is an enzyme defect with effects during prenatal development. The incidence in North America is roughly 1:40,000. Lack of 5-alpha-reductase prevents the conversion of testosterone to dihydrotestosterone in normal male (XY) fetuses. Virilization is incomplete; the infant at birth appears female, although the external genitalia may be somewhat abnormal in size, shape, and color. The feminized phallus appears clitorislike, but the internalized gonads are normal and male, and androgen receptors are also fully functional. When the testes produce a surge of testosterone at puberty, bodily changes occur. A full conversion to male appearance is noted, with growth of the phallus. At this point, a female gender assignment quickly comes into question and then becomes clearly inappropriate.
Interestingly, the most striking cases of gender plasticity are observed in this patient population. Some of those who are raised as girls and who seemingly possess a female gender identity turn into males with puberty, converting to a male gender identity. Perhaps the brain bias for a male identity does occur with testosterone exposure prenatally, despite the inadequacy of genital virilization; it remains suppressed until puberty affirms it.
Others have undergone orchiectomy and have been raised as girls, with exogenous estrogen in adolescence to induce female pubertal changes. Some of these patients express and retain a female gender identity. Still others are raised ambivalently and are given the knowledge that, at puberty, they will differentiate into male status. Some do require slight androgen supplementation to fully complete the virilizing process. No consensus yet exists as to which choice is preferable, and many professionals are equivocal about this population, advocating a case-by-case evaluation of circumstances to decide on intervention.
[h3]Genital Abnormalities and Related Phenomena of Gender Variance[/h3]
Several rare conditions result in anomalous genitalia, either in form or function. Gender identity can be affected in some of these patients for a variety of reasons. One such situation is micropenis, in which a normal male is born with extremely small genitals. A small cohort of patients undergo botched circumcisions, causing phallic mutilation. Many parents in the past have been advised to allow these children to undergo surgery to construct female genitalia and raise them as girls. Case reports indicate that this is not necessarily the best option because most of such patients assigned a female gender develop a gender identity of male and wish to play a male gender role.
A similar situation is observed with cloacal exstrophy, in which intrauterine development of the urogenital structures is incomplete. Cloacal exstrophy has a North American incidence of 1:400,000. Males with this condition are born without a phallus, although testes are present. Reassignment of these children as females (earlier deemed appropriate because of a belief in neonatal neutrality of gender) has not been entirely successful because most demonstrate a desire for a male gender identity. Surgical and medical management, including orchiectomy, construction of a vulva, and exogenous hormone therapy to induce puberty, have classically been recommended for these patients. However, the gender role is frequently more masculinized than in their genetically female counterparts. Notably, this population appears to be very unpredictable in terms of later gender identity; therefore, a consensus recommendation for child-rearing has not yet been reached.
Even the relatively common condition of cryptorchidism may play a part in gender development. Cases exist of patients with undescended testes whose gender identity was questioned and development did not follow the normative path until psychologic intervention in later years. Such instances show that self-perception, personal knowledge about sex and gender, and comparison to societal standards can all be significant in the formation of a person's gender identity.
Subgroups of individuals also exist whose genitals have been deliberately altered. One such group consists of women who undergo female circumcision, a practice that is often termed female genital mutilation. This practice is found in many parts of Africa and sporadically in other areas of the world, as well as in the United States in the past. Severe alterations to the female external genital tract are performed as part of ritual tradition. In many of these individuals, the procedures are performed well after the expression of gender identity. Gender role is only confirmed by the practice, despite the injury to the genitalia.
Another subgroup is the hajra of India, who are eunuchs, males castrated during childhood and reared as neither male nor female. Lacking testes to induce pubertal development and through adherence to custom that effectively equals behavioral modification therapy, their gender role is mostly female. However, because of their prominent and unique status as a separate subgender, they are easily identified as such. This relegates them to a distinct role in society, and they are considered mystical creatures, to be kept apart. Their existence has been recorded for many centuries, with little information as to the origin of this practice. Whether their gender identity remains male is not well known, although most reported practices seem to indicate that their identity is in flux even in later years.
From a societal standpoint, reports also exist of tribes in both Africa and in Papua New Guinea where male individuals are raised for several years in a more typically female gender role, only to switch into a masculine gender role at the time of puberty. These individuals do not experience any alteration of genitalia but purely shift roles, which may or may not correspond to their gender identity. The shaman in North American aboriginal populations was often a gender-neutral or "bi-gendered" individual, and, in the ancient Middle East, there have been numerous reports of "third gender" persons who contributed to society in various specialized roles. Although, in some societies, there has been and remains outright ostracism for any type of gender atypicality or divergence from a strict male-female dichotomy, in many cultures throughout human history, gender variance has been recognized, tolerated, accepted, and even celebrated.
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Cliffs:
Spoiler [+]
Cliffs:
Gender identity and gender role
Gender identity in most cases, is self-identified.
Gender role is manifested within society by observable factors such as behavior and appearance. Thus, gender role is often an outward expression of gender identity, but not necessarily so.
Assessing the acquisition of this congruity, or recognizing incongruity (resulting in gender-variant behavior), is important in the developing child.
All individuals possess a gender identity and the process of becoming aware of it is an important part of the psychosocial development of a child.
Sex and gender
The words sex and gender in a medical and technically scientific sense are not synonymous.
The term gender is being accepted to define psychophysiologic processes involved in identity and social role.
Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own identification as male, female, or intersex; gender may also be based on legal status, social interactions, public persona, personal experiences, and psychologic setting.
Sex, from the Latin word sexus, is defined by the gonads, or potential gonads, either phenotypically or genotypically. It is generally assigned at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status.
A person's sex is a primary state of anatomic or physiologic parameters. A person's gender is a conclusion reached in a broad sense when individual gender identity and gender role are expressed.
An often-used phrase to point out the difference, while an oversimplification, has some merit when dealing with these definitions: Sexual identity is in the perineum; gender identity is in the cerebrum.
Conceptually, professionals dealing with development may fairly state that sex is biologically determined, whereas gender is culturally determined.
Gender and sex are not interchangeable terms, neither are gender development and sexual development interchangeable.
Physiologic sexual development progresses through distinct stages from the neonatal period through infancy, childhood, puberty and adolescence, and adulthood.The sexual identity that emerges beyond childhood is very clearly a separate entity from gender identity. Aspects of physical sexual growth, eroticism, and eventual sexuality, although closely related to gender, should not necessarily be used to draw conclusions about a patient's gender definitions.
Part 2 Usual Development
Prenatal influences
An un-born child is more likely to become a female than a male.
Testes convert the female fetus into a male fetus.
The gender identity of a fetus, and later of an infant, is still incomplete by definition.
The gender bias of these infants may be tilted away from one that correlates with the genotype.
Early gender development
The environment in which a baby is reared with respect to gender begins to take shape prior to birth.
Families who learn what sex their child is start tailoring their parental planning around that sex.
Thus, a preformed idea of the child's preferences is in place even before the child is delivered.
A gender identity that is an inborn characteristic or unmalleable through out one's life has yet to be proven.
Several studies from Milton Diamond indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals.
It is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.
For the moment, a number of proposed theories appear to have some validity. Note that these theories are neither mutually exclusive nor universally applicable, given the latest evidence. An epidemiologic approach to the human population as a whole cannot be reconciled with the very personal, and often unique, experience of gender development. As such, the current state of knowledge remains somewhat incomplete.
The multifactorial nature of mammalian development allows the inherent brain bias toward a particular gender identity to be molded during the first few years. as gender development progresses in children, an acceptance and personal expression of a gender identity occurs. Traditionally, this has been called the core gender identity. Evidence suggests that this expression usually takes place by age 2-3 years.
During infancy, gender identity probably remains in the same incomplete stage in which it exists at birth. At this point, the parents create the gender role, and parental decisions play the largest part in determining environmental influences. Scientific evidence describes behavioral changes that occur when parents of either sex interact with male babies versus female babies. Females are touched and cuddled more; males are encouraged to play assertively with toys and balls.
Eventually, the concept of gender constancy develops in the growing child. Gender constancy is thought to be achieved by age 6 years in nearly all children.
Continuing gender development
Throughout the rest of childhood and school years, a child's gender identity is typically reinforced by gender role. In adolescence, the influential factors of sexuality, personality traits or disorders, peer interaction, and anxieties are most important in gender development. The nascent gender identity, fostered from infancy to childhood by parents, is first strengthened by playmates, schoolmates, and others. It is usually enhanced by the pubertal development of a child who progresses into adolescence, with its accompanying physical confirmation of the internal self-image. Although many believe that gender identity is fixed in early childhood, it is more certain that, by late adolescence and early adulthood, an established gender identity is unquestionably in place.
Part 3
Unusual Patterns
Conditions Resulting From Genetic or Hormonal Influences
Changes to the usual process of fetal development cause numerous differences in the resulting fetus. When levels of prenatal hormones are altered, phenotypic progression is also altered. A number of such conditions may ultimately affect a child's gender identity.
Chromosomal alterations
Turner Syndrome
In Turner syndrome, one sex chromosome is missing, causing a single X karyotype (a solo Y chromosome is not compatible with life). The resultant XO individual is born with female external genitalia; however, in many such individuals, ovarian development is anomalous.
The vast majority of individuals with Turner syndrome are infertile. Although gender identity is usually female, many XO individuals have significant psychologic stress because of their infertility, their appearance, and, in some, the awareness of their genetic profile, which may make them feel inadequate or incomplete as females. This, in turn, may cause some to feel confusion about or to question their gender role.
Klinefelter Syndrome
Klinefelter syndrome occurs when the fetus possesses a sex karyotype of XXY. Because of the presence of the Y chromosome and its components, fetal development is that of a normal male. However, as the child grows and approaches puberty, he experiences excessive gynecomastia, with low serum testosterone levels. Infertility is common, and general appearance is tall and thin. Gender identity is affected by these factors. In most cases, the gender role is, in fact, male.
A higher-than-expected percentage of individuals in the XXY cohort have been reported to have emotional disorders. Preliminary data indicate that a higher number of cases of gender identity disorder are specifically associated with Klinefelter syndrome; more research into this phenomenon is required.
Lastly, in some societies, there has been and remains outright ostracism for any type of gender atypicality or divergence from a strict male-female dichotomy, in many cultures throughout human history, gender variance has been recognized, tolerated, accepted, and even celebrated.
Gender identity and gender role
Gender identity in most cases, is self-identified.
Gender role is manifested within society by observable factors such as behavior and appearance. Thus, gender role is often an outward expression of gender identity, but not necessarily so.
Assessing the acquisition of this congruity, or recognizing incongruity (resulting in gender-variant behavior), is important in the developing child.
All individuals possess a gender identity and the process of becoming aware of it is an important part of the psychosocial development of a child.
Sex and gender
The words sex and gender in a medical and technically scientific sense are not synonymous.
The term gender is being accepted to define psychophysiologic processes involved in identity and social role.
Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own identification as male, female, or intersex; gender may also be based on legal status, social interactions, public persona, personal experiences, and psychologic setting.
Sex, from the Latin word sexus, is defined by the gonads, or potential gonads, either phenotypically or genotypically. It is generally assigned at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status.
A person's sex is a primary state of anatomic or physiologic parameters. A person's gender is a conclusion reached in a broad sense when individual gender identity and gender role are expressed.
An often-used phrase to point out the difference, while an oversimplification, has some merit when dealing with these definitions: Sexual identity is in the perineum; gender identity is in the cerebrum.
Conceptually, professionals dealing with development may fairly state that sex is biologically determined, whereas gender is culturally determined.
Gender and sex are not interchangeable terms, neither are gender development and sexual development interchangeable.
Physiologic sexual development progresses through distinct stages from the neonatal period through infancy, childhood, puberty and adolescence, and adulthood.The sexual identity that emerges beyond childhood is very clearly a separate entity from gender identity. Aspects of physical sexual growth, eroticism, and eventual sexuality, although closely related to gender, should not necessarily be used to draw conclusions about a patient's gender definitions.
Part 2 Usual Development
Prenatal influences
An un-born child is more likely to become a female than a male.
Testes convert the female fetus into a male fetus.
The gender identity of a fetus, and later of an infant, is still incomplete by definition.
The gender bias of these infants may be tilted away from one that correlates with the genotype.
Early gender development
The environment in which a baby is reared with respect to gender begins to take shape prior to birth.
Families who learn what sex their child is start tailoring their parental planning around that sex.
Thus, a preformed idea of the child's preferences is in place even before the child is delivered.
A gender identity that is an inborn characteristic or unmalleable through out one's life has yet to be proven.
Several studies from Milton Diamond indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals.
It is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.
For the moment, a number of proposed theories appear to have some validity. Note that these theories are neither mutually exclusive nor universally applicable, given the latest evidence. An epidemiologic approach to the human population as a whole cannot be reconciled with the very personal, and often unique, experience of gender development. As such, the current state of knowledge remains somewhat incomplete.
The multifactorial nature of mammalian development allows the inherent brain bias toward a particular gender identity to be molded during the first few years. as gender development progresses in children, an acceptance and personal expression of a gender identity occurs. Traditionally, this has been called the core gender identity. Evidence suggests that this expression usually takes place by age 2-3 years.
During infancy, gender identity probably remains in the same incomplete stage in which it exists at birth. At this point, the parents create the gender role, and parental decisions play the largest part in determining environmental influences. Scientific evidence describes behavioral changes that occur when parents of either sex interact with male babies versus female babies. Females are touched and cuddled more; males are encouraged to play assertively with toys and balls.
Eventually, the concept of gender constancy develops in the growing child. Gender constancy is thought to be achieved by age 6 years in nearly all children.
Continuing gender development
Throughout the rest of childhood and school years, a child's gender identity is typically reinforced by gender role. In adolescence, the influential factors of sexuality, personality traits or disorders, peer interaction, and anxieties are most important in gender development. The nascent gender identity, fostered from infancy to childhood by parents, is first strengthened by playmates, schoolmates, and others. It is usually enhanced by the pubertal development of a child who progresses into adolescence, with its accompanying physical confirmation of the internal self-image. Although many believe that gender identity is fixed in early childhood, it is more certain that, by late adolescence and early adulthood, an established gender identity is unquestionably in place.
Part 3
Unusual Patterns
Conditions Resulting From Genetic or Hormonal Influences
Changes to the usual process of fetal development cause numerous differences in the resulting fetus. When levels of prenatal hormones are altered, phenotypic progression is also altered. A number of such conditions may ultimately affect a child's gender identity.
Chromosomal alterations
Turner Syndrome
In Turner syndrome, one sex chromosome is missing, causing a single X karyotype (a solo Y chromosome is not compatible with life). The resultant XO individual is born with female external genitalia; however, in many such individuals, ovarian development is anomalous.
The vast majority of individuals with Turner syndrome are infertile. Although gender identity is usually female, many XO individuals have significant psychologic stress because of their infertility, their appearance, and, in some, the awareness of their genetic profile, which may make them feel inadequate or incomplete as females. This, in turn, may cause some to feel confusion about or to question their gender role.
Klinefelter Syndrome
Klinefelter syndrome occurs when the fetus possesses a sex karyotype of XXY. Because of the presence of the Y chromosome and its components, fetal development is that of a normal male. However, as the child grows and approaches puberty, he experiences excessive gynecomastia, with low serum testosterone levels. Infertility is common, and general appearance is tall and thin. Gender identity is affected by these factors. In most cases, the gender role is, in fact, male.
A higher-than-expected percentage of individuals in the XXY cohort have been reported to have emotional disorders. Preliminary data indicate that a higher number of cases of gender identity disorder are specifically associated with Klinefelter syndrome; more research into this phenomenon is required.
Lastly, in some societies, there has been and remains outright ostracism for any type of gender atypicality or divergence from a strict male-female dichotomy, in many cultures throughout human history, gender variance has been recognized, tolerated, accepted, and even celebrated.
