Gender identity

Gender identity (otherwise known as core gender identity) is the gender(s), or lack thereof, a person self-identifies as. It is not necessarily based on biological sex, either real or perceived, nor is it always based on sexual orientation. The gender identities one may identify as include male, female, both, somewhere in between ("third gender"), or neither.

Gender identity was originally a medical term used to explain sex reassignment surgery to the public, but is also found in psychology, often as core gender identity. Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. Biological factors that may influence gender identity include pre- and post-natal hormone levels and gene regulation. Social factors which may influence gender identity include gender messages conveyed by family, mass media, and other institutions. One's gender identity is also influenced by the social learning theory, which assumes that children develop their gender identity through observing and imitating gender-linked behaviors, and then being rewarded or punished for behaving that way. In some cases, a person's gender identity may be inconsistent with their biological sex characteristics, resulting in individuals dressing and/or behaving in a way which is perceived by others as being outside cultural gender norms; these gender expressions may be described as gender variant or transgender.

Self concept or self identity has come to mean how a person understands the way others perceive them. Gender identity does not only refer to the placing of a person into one of the categories male or female; without including the concept of interaction with society at large, for without that, the term has no meaning. People who identify as transsexual may strongly desire that other people consider them to belong to a gender opposite of their karyotype; but often are simply trying to modify their bodies and behaviors to match how they feel inside, which may not have anything to do with being either male or female.

With the development of gender identity being influenced by so many factors, there can also be many problems associated with gender identity as well. One of the major disorders is Gender Identity Disorder. Gender Identity Disorder is defined by strong, persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex. The Diagnostic and Statistical Manual of Mental Disorders (302.85) has five criteria that must be met before a diagnosis of gender identity disorder (GID) can be made. "In gender identity disorder, there is discordance between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine."

Gender identity - below the surface
Many people consider themselves to be cisgendered, that is, belonging to either the man or woman gender corresponding to their biological sex of male or female. Before the 20th century a person's sex would be determined entirely by the appearance of the genitalia, but as chromosomes and genes came to be understood, these were then used to help determine sex. Those defined as women, by sex, have genitalia that is considered female as well as two X chromosomes; those viewed as men, by sex, are seen as having male genitalia, one X and one Y chromosome. However some individuals have combinations of chromosomes, hormones, and genitalia that do not follow the traditional definitions of "men" and "women". In addition, genitalia vary greatly or individuals may have more than one type of genitalia, and other bodily attributes related to a person's sex (body shape, facial hair, high or deep voice, etc.) may or may not coincide with the social category, as woman or man. A survey of the research literature from 1955-2000 suggests that as many as one in every hundred individuals may have some intersex characteristic. Intersex phenomena are not unique to humans. In a number of species, even more striking examples exist, for instance the bilateral gynandromorphic zebra finch (half-male, half-female body along its symmetry plane).

Transsexual self-identified people sometimes wish to undergo physical surgery to refashion their primary sexual characteristics, secondary characteristics, or both. This may involve removal of penis, testicles or breasts, or the fashioning of a penis, vagina or breasts. Historically, such surgery has been performed on infants who are born with ambiguous genitalia. However, current medical opinion is broadly against genital assignment, shaped to a significant extent by the mature feedback of adults who regret these decisions being made on their behalf at their birth. Gender reassignment surgery elected by adults is also subject to several kinds of debate. One discussion involves the legal sex-gender status of transgender people, for marriage, retirement and insurance purposes, for example. Another involves whether such surgery is ethically sound.

The most easily understood case in which it becomes necessary to distinguish between sex and gender is that in which the external genitalia are removed - when such a thing happens through accident or through deliberate intent, the libido and the ability to express oneself in sexual activity are changed, but the individual's gender identity may or may not change. One such case is that of David Reimer, reported in As Nature Made Him by John Colapinto. It details the persistence of a male gender identity and the stubborn adherence to a male gender role of a person whose penis had been totally destroyed shortly after birth as the result of a botched male circumcision, and who had subsequently been surgically reassigned by constructing female genitalia. In other cases, a person's gender identity may contrast sharply with that assigned to them according to their genitalia, and/or a person's gendered appearance as a woman or man (or an androgynous person, etc.) in public may not coincide with their physical sex. So the term "gender identity" is broader than the sex of the individual as determined by examination of the external genitalia, but also includes the sex or gender one identifies with mentally.

Conceptual origins
During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of homosexuality (which was viewed as a mental disorder at the time). In 1958, the Gender Identity Research Project was established at the UCLA Medical Center for the study of intersexuals and transsexuals. Psychoanalyst Robert Stoller generalized many of the findings of the project in his book Sex and Gender: On the Development of Masculinity and Femininity (1968). He is also credited with introducing the term gender identity to the International Psychoanalytic Congress in Stockholm, Sweden in 1963. Behavioral psychologist John Money was also instrumental in the development of early theories of gender identity. His work at Johns Hopkins Medical School's Gender Identity Clinic (established in 1965) popularized an interactionist theory of gender identity, suggesting that, up to a certain age, gender identity is relatively fluid and subject to constant negotiation. His book Man and Woman, Boy and Girl (1972) became widely used as a college textbook, although many of Money's ideas have since been challenged. Sigmund Freud also had a unique theory for the development of gender identity. He believed it was developed during the phallic stage of development. During this time, young boys develop an oedipus complex and young girls an electra complex, Freud believed that during this time, the child has an unconscious sexual desire for the parent of the opposite sex and jealousy or hatred for the same sex parent. That jealousy eventually turns into emulating and the child wants to be like that parent, eventually identifying with it.

In the DSM
The notion of gender identity appeared in the Diagnostic and Statistical Manual of Mental Disorders in its third edition, DSM-III (1980), in the form of two psychiatric diagnoses of gender dysphoria: gender identity disorder of childhood (GIDC), and transsexualism (for adolescents and adults). The 1987 revision of the manual, the DSM-III-R added a third diagnosis: gender identity disorder of adolescence and adulthood, nontranssexual type. This latter diagnosis was removed in the subsequent revision, DSM-IV (1994), which also collapsed the GIDC and transsexualism in a new diagnosis of gender identity disorder.

The conceptualization of sex-gender mismatch as a mental disorder is controversial.

International Human Rights Law
The Yogyakarta Principles, which is a document on application of international human rights law, provides definition on gender identity. In the preamble, "gender identity" is understood to refer to each person's deeply felt internal and individual experience of gender, which may or may not correspond with the sex assigned at birth, including the person's sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other experience of gender, including dress, speech and mannerism. Further, in Principle 3, that each person's self-defined gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. These Principles influenced the UN declaration on sexual orientation and gender identity.

Formation of gender identity
The formation of a gender identity is a complex process which involves critical growth processes during gestation and learning experiences after birth. There are points of differentiation all along the way, but language and tradition in many societies insist that every individual be categorized as either a man or a woman, although there are societies, such as the Native American identity of a two-spirit, which include multiple gender categories.

When the gender identity of a person makes them one gender, but their genitals suggest a different sex, they will likely experience what is called gender dysphoria.

Some research has been done that indicates that gender identity is fixed in early childhood and is thereafter static. This research has generally proceeded by asking transsexuals when they first realized that the gender role that society attempted to place upon them did not match the gender identity that they found in themselves and the gender role that they chose to live out. These studies estimate the age at which gender identity is formed at around 2-3. Such research may be problematic if it made no comparable attempt to discover when non-transsexual people became aware of their own gender identities and choice of gender roles.

Some critics question this research, claiming that the studies suffer from a sampling bias. The acquisition of Hormone replacement therapy (female-to-male or male-to-female) and sexual reassignment surgery is generally controlled by doctors. One of the questions some doctors ask to distinguish between "real" transsexuals and others is to ask them when they first felt identification with the opposite sex. The researchers may then be unintentionally eliminating some subjects from consideration when they try to determine a typical time of gender identity formation. There is also a possibility of reporting bias, since transsexuals may feel that they must give the "correct" answers to such questions in order to increase the chances of obtaining hormones. Patrick Califia, author of Sex Changes and Public Sex, has indicated that this group has a clear awareness of what answers to give to survey questions in order to be considered eligible for hormone replacement therapy and/or sexual reassignment surgery:

"None of the gender scientists seem to realize that they, themselves, are responsible for creating a situation where transsexual people must describe a fixed set of symptoms and recite a history that has been edited in clearly prescribed ways in order to get a doctor's approval for what should be their inalienable right."

- Patrick Califia

Gender identity and sex
Some people do not believe that their gender identity corresponds to their biological sex, including transsexual people, transgender people, and many intersexed individuals. Consequently, complications arise when society insists that an individual adopt a manner of social expression (gender role) which is based on sex, that the individual feels is inconsistent with that person's gender identity. Complications can also arise with the stereotyping, or gender typing of behavior for individuals for behavior related to a specific sex, when they identify as a different gender. This dissonance can lead to gender identity disorder.

One reason for such discordances in intersexed people is that some individuals have a chromosomal sex that has not been expressed in the external genitalia because of hormonal or other abnormal conditions during critical periods in gestation. Such a person may appear to others to be of one sex, but may recognize himself or herself as belonging to the other sex. The causes of transgenderism are less clear; it has been subject of much speculation, but no psychological theory has ever been proven to apply to even a significant minority of transgender individuals, and theories that assume a sex difference in the brain are relatively new and difficult to prove, because at the moment they require a destructive analysis of inner brain structures, which are quite small.

In recent decades it has become possible to surgically reassign sex. A person who experiences gender dysphoria may, then, may seek these forms of medical intervention to have their physiological sex match their gender identity. Alternatively, some people who experience gender dysphoria retain the genitalia that they were born with (see transsexual for some of the possible reasons), but adopt a gender role that is consonant with what they perceive as their gender identity.

There is an emerging vocabulary for those who defy traditional gender identity - see transgender and genderqueer.

Relationship to gender role
There are probably as many shades and complexities of sexual identity and gender identity as there are human beings, and there are an equal number of ways of working those gender identities out in the intricacies of daily life. Societies, however, tend to assign some classes of social roles to "male" individuals, and some classes of social roles to "female" individuals (as society perceives their sexes). In some societies, there are other classes of social roles for, e.g., surgically neutered physiological male. See Hijra (India), for example.

Sometimes the connection between gender identity and gender role is unclear. The original oversimplification was that there are unambiguously male human beings and unambiguously female human beings, that they are clearly men and clearly women, and that they should behave in all important ways as women and men "naturally" behave. Investigations in biology and sociology have strongly supported the view that "the sex between the ears is more important than the sex between the legs", and the implication has been that people with masculine gender identities will give external representation of their gender identities by adopting gender roles that are considered appropriate to men in their society, and, similarly, that people with feminine gender identities will adopt gender roles that are considered appropriate to women. It may be very difficult to determine, however, whether a specific drag queen is someone who has a female gender identity and is learning a female gender role, or whether that person is someone with a male gender identity who enjoys adopting a female gender role. Some, such as RuPaul, refuse to be categorized; others use terms like "genderqueer" or "gender fluid". Similarly, it may be very difficult to determine whether a specific drag king is someone who has a male gender identity and is learning a male gender role, or whether that person is someone with a female gender identity who enjoys adopting a male gender role.

Sexual differentiation and neurobiology
There is still much that is unclear regarding the development of the brain and (core) gender identity. It is known that sex hormones can influence behaviour, e.g. aggression and libido which are under direct influence of testosterone and power motivation which is under the influence of estrogen. Animal experiments (particularly rodent research) has led to a series of theories on prenatal hormonal influences on gender as well as theories regarding hormone-independent brain development.

Hormonal influences
Melissa Hines postulated three models of action of hormonal influences on gender in 2002.


 * The Classic Model of hormonal influences states that presence of testicular hormones (testosterone) during early fetal life causes a masculine development of rodents, while absence of testicular hormones causes a feminine development.
 * The Gradient Model describes a more gradual effect of hormonal influences on behaviour. Normal variations in hormones cause movement along a male and female gradient within each sex. Therein we assume that a greater amount of hormones administered in animal tests, creates a more dramatic change in behavior.
 * The Model of Active Feminization Theory postulates that ovarian hormones are, opposed to the previous mentioned models, needed to induce, in some degree, the female sexual differentiation. It is thought that ovarian hormones cause a lesser, but present effect of mild virilization to some brain areas.

In fact, all these models reveal different aspects of reality. The Classic Model can be explained in a human context through the human disease Congenital Adrenal Hyperplasia (CAH). This disease causes overproduction of male hormones in females and males, due to a steroid enzyme deficiency (often CYP21). The influence of testosterone on the female fetus causes virilization, showing in external sexual genitalia in various degrees: clitoral hypertrophy, labial fusion and sometimes appearing as fully ambiguous genitalia. The behavior of CAH girls is often described to be "tomboyish", more masculine due to the early influences of testosterone. The majority of these females, however, have a female gender identity.

Sexual differentiation of the human brain
Several brain areas have been found to be sexually dimorphic — they differ between males and females. The Sexually Dimorphic Nucleus of the PreOptic Area (SDN-POA) for example, shows a sexually dimorphic difference favoring males; the SDN is normally several times larger in males. When female rats are pre- and postnatally exposed to testosterone or to (synthetic) estrogens, the SDN-POA appeared similar in size.

Similar to the SDN, the Interstitial Nucleus of the Anterior Hypothalamus (INAH-3) was found to be almost 3 times as big in males. Also the Bed Nucleus of the Stria Terminalis (BNST) has been said to have a sex difference. It appeared 2.5 times larger in men. A particular part of the BNST, the BNST posteriomedial bed nucleus (BNSTpd), has been found to be female-sized in male-to-female transsexuals. Furthermore, in a female-to-male transsexual, the number of somatostatin neurons in the BNSTpd was found to be in the normal male range.

Fa'afafine
In some Polynesian societies, fa'afafine are considered to be a "third gender" alongside male and female. They are biologically male, but dress and behave in a manner considered typically female. According to Tamasailau Sua'ali'i (see references), fa'afafine in Samoa at least are often physiologically unable to reproduce. Fa'afafine are accepted as a natural gender, and neither looked down upon nor discriminated against.

Hijra
In the culture of the Indian subcontinent, a hijra is usually considered to be neither a man nor a woman. Most are biologically male or intersex, but some are biologically female. The hijra form a third gender, although they do not enjoy the same acceptance and respect as males and females in their cultures. They can run their own households, and their occupations are singing and dancing, working as cooks or servants, sometimes prostitutes (for men), or long-term sexual partners for men. Hijras can be compared to transvestites or drag queens of contemporary western culture.

Xanith
The xanith form an accepted third gender in Oman, a gender-segregated society. The xanith are male homosexual prostitutes whose dressing is male, featuring pastel colors (rather than white, worn by men), but their mannerisms female. Xanith can mingle with women, and they often do at weddings or other formal events. Xaniths have their own households, performing all tasks (both male and female). However, similarly to men in their society, xaniths can marry women, proving their masculinity by consummating the marriage. Should a divorce or death take place, these men can revert to their status as xaniths at the next wedding.