Figure 1. Sex describes the physical differences between males and females, while gender is a concept describing a person’s internal perception about their sex. (Photo courtesy of FaceMePLS/flickr)

When filling out a document such as a job application or school registration form, you are often asked to provide your name, address, phone number, birth date, and sex or gender. But have you ever been asked to provide your sex and your gender? Like most people, you may not have realized that sex and gender are not the same. However, sociologists and most other social scientists view them as conceptually distinct. Sex refers to physical or physiological differences between males and females, including both primary sex characteristics (the reproductive system) and secondary characteristics such as height and muscularity. Gender refers to behaviors, personal traits, and social positions that society attributes to being female or male.

A person’s sex, as determined by their biology, does not always correspond with their gender. Therefore, the terms sex and gender are not interchangeable. A baby who is born with male genitalia will most likely be identified as male. As a child or adult, however, they may identify with the feminine aspects of culture. Since the term sex refers to biological or physical distinctions, characteristics of sex will not vary significantly between different human societies. Generally, persons of the female sex, regardless of culture, will eventually menstruate and develop breasts that can lactate. Characteristics of gender, on the other hand, may vary greatly between different societies. For example, in U.S. culture, it is considered feminine (or a trait of the female gender) to wear a dress or skirt. However, in many Middle Eastern, Asian, and African cultures, sarongs, robes, or gowns are considered masculine. The kilt worn by a Scottish man does not make him appear feminine in that culture.

Sex

A baby boy who is born with male genitalia will be identified as male. Since the term sex refers to biological or physical distinctions, characteristics of sex do not vary significantly between different human societies. Males have a penis, testes, and XY chromosomes. During puberty, most males will experience changes in testicle, scrotum, and penis size and color, as well as voice dropping, and underarm, leg, and facial hair growth. Generally, persons of the female sex have a vagina, ovaries, and XX chromosomes. During puberty, most females will menstruate, develop breasts that can lactate, and grow vaginal, underarm, and leg hair. Both sexes might experience increased sweating, acne, and mood changes, among other biological changes, during puberty.

Males typically have XY sex chromosomes, and females XX. These chromosomes trigger the development of the sex steroids, of which testosterone is found in higher levels in males and estradiol in higher levels in females. As you read in the opening example about Caster Semenya, some females have naturally occurring high levels of testosterone, which becomes an issue for elite athletes when milliseconds matter because increased testosterone levels can be attributed to performance boosts of 10 to 13 percent.^[1]

Intersex refers to a combination of primary sex characteristics, an umbrella term that can describe any individual who doesn’t fit binary sexual distinctions. It can also be referred to as Differences of Sexual Development (DSD). Intersex or DSD individuals were once called hermaphrodites, a term that is no longer used. According to the Human Rights Watch, approximately 1.7 percent of babies are born with chromosomes, gonads, internal or external sex organs that are atypical. Some of these are apparent at birth and others do not show themselves until puberty, and irreversible surgeries can cause infertility, pain, loss of sensation, and, more importantly, can take away an individual’s choice when they are performed on children.^[2]

Gender

Gender is deeply cultural. Like race, it is a social construction with real consequences, particularly for those who do not conform to gender binaries. In order to describe gender as a concept, we need to expand the language we use to describe gender beyond “masculine” or “feminine.” Gender identity, or the way that one thinks about gender and self-identifies, can be woman, man, or genderqueer.

Those who identify with the sex they were assigned at birth are often referred to as cisgender, utilizing the Latin prefix “cis,” which means “on the same side.” (The prefix “trans” means “across.”) Because they are in the majority and do not have a potential component to transition, many cisgender people do not self-identify as such. As with transgender people, the term or usage of cisgender does not indicate a person’s sexual orientation, gender, or gender expression (TSER 2021). And as many societies are heteronormative, they are also cisnormative, which is the assumption or expectation that everyone is cisgender, and that anything other than cisgender is not normal.

Transgender is a term used to describe people whose sense of personal identity does not correspond with their birth sex. Gender expression, or how one demonstrates gender (based on traditional gender role norms related to clothing, behavior, and interactions) can be feminine, masculine, androgynous, or somewhere along a spectrum.

Gender Identity

Figure 2. This identity spectrum shows the fluidity between sex, gender identity, gender expression, and sexual orientation.

Individuals who identify with the role that is the different from their biological sex are called transgender. A transgender woman is a person who was assigned male at birth but who identifies and/or lives as a woman; a transgender man was assigned female at birth but lives as a man. Transgender is not synonymous with sexuality, a distinction that will be made in this module. While determining the size of the transgender population is difficult, it is estimated that 1.4 million adults (Herman 2016) and 2 percent of high school students in the U.S. identify as transgender (Johns 2019). The term “transgender” does not indicate sexual orientation or a particular gender expression, and we should avoid making assumptions about people’s sexual orientation based on knowledge about their gender identity (GLAAD 2021).

Transgender individuals who attempt to alter their bodies through medical interventions such as surgery and hormonal therapy—so that their physical being is better aligned with gender identity—are often called transsexual (transsexual man or transsexual woman), although increasingly some find this term outdated and prefer the term transgender. They may also be known as male-to-female (MTF) or female-to-male (FTM). Not all transgender individuals choose to alter their bodies; many will maintain their original anatomy but may present themselves to society as another gender. This is typically done by adopting the dress, hairstyle, mannerisms, or other characteristic typically assigned to another gender. It is important to note that people who cross-dress, or wear clothing that is traditionally assigned to a gender different are not the same as those identifying as trans. Cross-dressing is typically a form of self-expression, entertainment, or personal style, and it is not necessarily an expression against one’s assigned gender (APA 2008).

Figure 3. The most widely known transgender pride flag was designed by transgender woman and U.S. Navy veteran Monica Helms. Other designers have different interpretation of the transgender flag, and other groups within the LGBTQ community have their own flags and symbols. Interestingly, Gilbert Baker, the designer of the first widely adopted pride flag, made a point to avoid trademark or other limits on the flag, so that it could be reinterpreted and reused by others. (Credit: crudmucosa/flickr)

Some people who are not conforming to the expressions of masculinity or femininity are considered gender non-conforming. Non-binary and genderqueer are other terms used by individuals who feel that their gender identity and/or gender expression fall outside the categories of man and woman.^[3]

After years of controversy over the treatment of sex and gender in the American Psychiatric Association Diagnostic and Statistical Manual for Mental Disorders (Drescher 2010), the most recent edition, DSM-5, responds to allegations that the term “gender identity disorder” is stigmatizing by replacing it with “gender dysphoria.” Gender identity disorder as a diagnostic category stigmatized the patient by implying there was something “disordered” about them. Gender dysphoria, on the other hand, removes some of that stigma by taking the word “disorder” out while maintaining a category that will protect patient access to care, including hormone therapy and gender reassignment surgery. In the DSM-5, Gender dysphoria is a condition of people whose gender at birth is contrary to the one they identify with. For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. In children, the desire to be of the other gender must be present and verbalized. This diagnosis is now a separate category from sexual dysfunction and paraphilia, another important part of removing stigma from the diagnosis (APA 2013). It is important to note that not all transgender people experience gender dysphoria, and that its diagnostic categorization is not universally accepted. For example, in 2019, the World Health Organization reclassified “gender identity disorder” as “gender incongruence,” and categorized it under sexual health rather than a mental disorder. However, health and mental health professionals indicate that the presence of the diagnostic category does assist in supporting those who need treatment or help.

Changing the clinical description may contribute to a larger acceptance of transgender people in society. A 2017 poll showed that 54 percent of Americans believe gender is determined by sex at birth and 32 percent say society as “gone too far” in accepting transgender people; views are sharply divided along political and religious lines.^[4]

People become aware that they may be transgender at different ages. Even if someone does not have a full (or even partial) understanding of gender terminology and its implications, they can still develop an awareness that their gender assigned at birth does not align with their gender identity. Society, particularly in the United States, has been reluctant to accept transgender identities at any age, but we have particular difficulty accepting those identities in children. Many people feel that children are too young to understand their feelings, and that they may “grow out of it.” And it is true that some children who verbalize their identification or desire to live as another gender may ultimately decide to live in alignment with their assigned gender. But if a child consistently describes themselves as a gender (or as both genders) and/or expresses themselves as that gender over a long period of time, their feelings cannot be attributed to going through a “phase” (Mayo Clinic 2021).

Some children, like many transgender people, may feel pressure to conform to social norms, which may lead them to suppress or hide their identity. Experts find evidence of gender dysphoria—the long-term distress associated with gender identification—in children as young as seven (Zaliznyak 2020). Again, most children have a limited understanding of the social and societal impacts of being transgender, but they can feel strongly that they are not aligned with their assigned sex. And considering that many transgender people do not come out or begin to transition until much later in life—well into their twenties—they may live for a long time under that distress.

Studies show that people who identify as transgender are twice as likely to experience assault or discrimination as nontransgender individuals, and they are also one and a half times more likely to experience intimidation (National Coalition of Anti-Violence Programs 2010; Giovanniello 2013). Trans women of color are most likely be to victims of abuse. A practice called “deadnaming” by the American Civil Liberties Union, whereby trans people who are murdered are referred to by their birth name and gender, is a discriminatory tool that effectively erases a person’s trans identity, and also prevents investigations into their deaths and knowledge of their deaths.^[5] Organizations such as the National Coalition of Anti-Violence Programs and Global Action for Trans Equality work to prevent, respond to, and end all types of violence against transgender, transsexual, and homosexual individuals. Read about organizations educating the public about gender identity and empowering transgender and transsexual individuals. These organizations hope that  educating the public will help lead to the end of this violence.

Gender Expression

U.S. society allows for some level of flexibility when it comes to acting out gender roles or gender expression. To a certain extent, men can assume some feminine roles and women can assume some masculine roles without interfering with their gender identity. Males who work as teachers, nurses, and social workers, traditionally female-dominated occupations, often adopt norms that are traditionally feminine. Many women in the U.S. workforce who are in male-dominated occupations must take on more traditionally masculine forms of dress (i.e., fire department or police department or military) and often adopt a set of behaviors that fit that job requirements that are traditionally masculine. In most cases, the gender identity remains cisgender although the gender expression might be more fluid.

Figure 3. A portrait of We-Wa, a Zuni berdache, taken sometime in the late 1800s.

The dichotomous view of gender (the notion that someone is either male or female) is specific to certain cultures and is not universal. In some cultures gender is viewed as being fluid. In the past, some anthropologists used the term berdache to refer to individuals who occasionally or permanently dressed and lived as a different gender. The practice has been noted among certain Native American tribes (Jacobs, Thomas, and Lang 1997). The more current term used by indigenous people in the United States is “Two-Spirit” (Estrada, Gabriel S. 2011). Also, in this regard, some of these indigenous groups believe that there are at least four genders. In some tribes, Two-Spirits hold positions of higher social status because of they were believed to possess supernatural powers. In general, Native American groups viewed sex and gender as a spectrum as opposed to the binary view held by European colonists.

Samoan culture accepts what Samoans refer to as a “third gender.” Fa’afafine, which translates as “the way of the woman,” is a term used to describe individuals who are born biologically male but embody both masculine and feminine traits. Fa’afafines are considered an important part of Samoan culture. Individuals from other cultures may mislabel them as homosexuals because fa’afafines have a varied sexual life that may include men and women (Poasa 1992). As we will see in this module, the tendency to label one’s sexuality because of sex and gender can lead to many misconceptions and inaccurate labels.