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Undoing the Gender Binary



The central question of this Element is this: What does it mean to be transgender - in general and in specific ways? What does the designation mean for any individual and for the groups in which the individual exists? Biologically, what occurs? Psychologically, what transpires? The Element starts with the basics. The authors question some traditional assumptions, lay out some bio-medical information, and define their terms. They then move to the question of central concern, seen first in terms of the individual and then in terms of the group or society. They conclude with some implications, urging some new approaches to research and suggest some applications in the classroom and beyond.
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Elements in Applied Social Psychology
edited by
Susan Clayton
College of Wooster, Ohio
Charlotte Chucky Tate
San Francisco State University
Ella Ben Hagai
California State University, Fullerton
Faye J. Crosby
University of California, Santa Cruz
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DOI: 10.1017/9781108584234
© Charlotte Chucky Tate, Ella Ben Hagai, and Faye J. Crosby 2020
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Undoing the Gender Binary
Elements in Applied Social Psychology
DOI: 10.1017/9781108584234
First published online: May 2020
Charlotte Chucky Tate
San Francisco State University
Ella Ben Hagai
California State University, Fullerton
Faye J. Crosby
University of California, Santa Cruz
Author for correspondence: Charlotte Chucky Tate,
Abstract: The central question of this Element is this: What does it mean to
be transgender in general and in specic ways? What does the
designation mean for any individual and for the groups in which the
individual exists? Biologically, what occurs? Psychologically, what
transpires? The Element starts with the basics. The authors question
some traditional assumptions, lay out some biomedical information,
and dene their terms. They then move to the question of central
concern, seen rst in terms of the individual and then in terms of the
group or society. They conclude with some implications, urging some
new approaches to research and suggest some applications in the
classroom and beyond.
Keywords: transgender, gender, nonbinary, transphobia
© Charlotte Chucky Tate, Ella Ben Hagai, and Faye J. Crosby 2020
ISBNs: 9781108731133 (PB), 9781108584234 (OC)
ISSNs: 2631-777X (online), ISSN 2631-7761 (print)
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1 Introduction 1
2 The Basics 5
3 The Processes of Transitioning Away from the Gender
Assigned at Birth 14
4 Multifaceted Model of Gender 25
5 Lived Experiences of Public Figures 36
6 Social Scientic Studies of Rejection and Acceptance 48
7Reections and Parting Wishes 62
References 68
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1 Introduction
This is a scholarly work about genderand the vast array of its meanings in US
society. Open-minded people who are not transgender constitute our primary
audience. For at least one of the authors, who is cisgender (which we will
dene), the endeavor to demystify genderand unpack its multiple meanings is
profoundly personal. A few years ago, a member of the authors family, deeply
loved by the author, announced his intention to live as the gender he had felt to
be his true gender even when the world saw him rst as a girl and then as
a woman. The author wished to understand more about the experiences of her
family member but did not want to burden the family member with the task of
education. She found texts like Nicholas Reichs (2012) Transgender 101 and
Anne Boedeckers (2011) The Transgender Guidebook that offered excellent
beginnings, and these texts spoke primarily to a trans audience rather than to an
audience of cisgender allies. The author was left with questions, especially
about the t between society and trans individuals. She hungered for more
concepts to help guide her thinking. When the opportunity arose to join forces
with the other two authors, both authorities on issues of gender identity and
sexual orientation and how they differ the knowledge-hungry author felt joy
and relief.
Yet, the project of writing a monograph is also personal and, in this case, the
challenge we faced as authors was trying to coordinate the thoughts, perspec-
tives, and voices of three very different women. We come from three very
different generations (or cohorts) of academic scholarship within the same
discipline (psychology), which means that our own ideas about how to intro-
duce, discuss, and explain issues of gender are quite distinctive. Unabashedly,
our perspectives come from different waves of feminist thought in the United
States (even if some would disagree about whether wavesis a useful way to
discuss this) including the 196070s, the 1990s, and the early 2000s, in addition
to trying to speak to current feminist issues (circa 2019). Consequently, the
narrative voice of this monograph is not univocal; instead, the reader will hear
three different voices alternating sometimes between sentences but those
voices are directed toward a common goal. We hope that a strength of the
different voices is that a broad set of readers can access this work and nd their
own cultural references and touchstones within the trove presented that literally
spans many decades. It is in this spirit that we invite readers to bring their own
experiences and nd whatever usefulness they can in this work. Additionally,
we focus squarely on the United States in our discussion of these issues. Two of
the authors were born and raised in the United States, and all authors have
conducted scholarly work (in whole or in part) in the cultural context of the
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United States. Consequently, we feel most comfortable making statements
about the US cultural context and not necessarily about cultures with which
we have little direct experience.
Many humans classify themselves and are classied by others as either
female or male. Some societies (e.g., Argentina, Denmark, India, Malta,
Norway, Spain, Sweden, the United Kingdom) have gone further in their
cultural expectations of what two genders could mean and that there are more
than two genders. Some cultures (e.g., India, Sweden) even include third-gender
pronouns that refer to people rather than the generic third-person forms of many
languages. Nonetheless, when thinking about just two genders think Adam
and Eve, Romeo and Juliet, Fred and Ginger the list of couples could go on and
on. Such a list would seem natural to those who assume that humans come in
two forms: men and women. Such a list also would and often does reinforce
the assumption of the universality of the gender binary. So strong is the
tendency to see the world in terms of the gender binary that the menwomen
division is often extended to nonhuman entities as well (Bem, 1993). Think
mother earth and father sky. At rst glance, the division of the world into male
and female might seem to spring inevitably from the demands of sexual
reproduction. Sexual reproduction, we learn from elementary textbooks, occurs
when the combination of genetic information from two separate organisms or
two types of organisms (i.e., the male type and the female type) results in new
life. Sexual reproduction contrasts with asexual reproduction, which occurs
when a single organism reproduces itself, as in mitosis. Sexual reproduction is
critical for evolution, allowing as it does for novel combinations of genetic
material. Upon reection, the division between male and female becomes less
universal and rigid. Some animals, like the banana slug, are hermaphroditic.
Other animals, like striped bass, change their biological sex over the life span
(Berlinsky & Specker, 1991). Fungi have many sexes (Raper, 1966).
The vast majority of humans self-categorize their gender in the way that is
consistent with how those in authority categorized them at birth. Yet, if only one
half of one percent of humans did not see themselves as entirely male or female
in accord with the label given them by one or more experts, an estimated
35,000,000 people worldwide would defy the gender binary. Thats more than
ten times the population of Mongolia; its four times the population of
Today Americans, especially those who live on either coast, seem increas-
ingly accepting of gender uidity (Aitken et al., 2015;Travers, 2018). But while
overtly accepting of new norms, many individuals still harbor old prejudices
(Goldberg & Kuvalanka, 2018;Goldberg et al., 2019). And prejudiced or not,
many people acknowledge an uncomfortable lack of knowledge and a galling
2Undoing the Gender Binary
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confusion about terminology. Many potential allies to the transgender (trans)
community may fear that they create a bad impression on would-be friends
through sheer ignorance about terminology and basic concepts.
The central purpose of our Element is to present the basics, clarifying terms
and demystifying knowledge about people who identify as transgender. We
hope to present sound scholarship in a nontechnical and inviting way. We hope
that those who are not part of any trans community will gain new understand-
ings of what is involved in living as a trans person.
Cisgender people (or cis people, for short) are those who experience their
gender with the same label that they were gender assigned at birth. Transgender
people (or trans people, for short) are people who experience their gender as
different from their assigned gender at birth. Some, but not all, transgender
people may choose to change their legal status or their physical appearance.
Identication with a gender different than the one assigned by authorities is the
essential component of the denition of transgender identity that we adopt in
this volume.
Even though cis people constitute our primary audience, we hope that our
work will prove reassuring as well as helpful to people on the transgender
spectrum. We expect that some of the information contained here will be new
even to those who are active in trans communities. For those who are question-
ing aspects of their gender identity, this work is meant to be an aid. For example,
in Section 4, we present the multifaceted model of gender. Some of the
conceptualizations presented there might give expression to ideas that have
sought concrete form in the minds of some trans people. Even for people who
have been thinking about these issues for a long time, we hope that we are
providing a vocabulary for helpful discussions. We wish to allow for afrmation
through concepts and information.
Our work proceeds in seven sections. After this introduction, we present
basic information, dening terms and outlining the biological foundations of
what is called sex.In the third section we give basic information about
different paths that can be taken when a person transitions away from the sex
assigned at birth, including information about hormonal and surgical inter-
ventions. The fourth section presents the facet model of gender.We do not
claim that individuals walk around with this model in their heads any more
than we name the parts of speech each time we form a sentence. Our model,
developed by Charlotte Tate, provides conceptual clarity, allowing us to keep
the referents of genderseparate from each other. We turn in Section 5 to the
lived experiences of those on the transgender spectrum as recounted in
popular memoirs. It is through these sources that most of the public learns
about transgender issues, and so we accord to them a separate part of our
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work. In Section 6 of our Element, we examine the attitudes of the majority
toward those in the minority as documented by social scientists. Our short
nal Section 7 is speculative, addressing questions of both a philosophical
and practical nature.
General readers may nd themselves skimming over some sections of the
work, especially if they have a low tolerance for technical details. And specia-
lized readers like gender researchers may nd themselves lingering over some
new information while feeling quite familiar with other information. Although
it is of course impossible to satisfy and intrigue all audiences all the time, we
hope that our work offers a welcoming entry for many into a world of thought-
provoking knowledge and ideas, and we hope that some readers will develop
into the next generation of researchers and perhaps even authors on issues of
gender and gender identity.
1.1 Topical and Enduring Issues
We believe that contemplation of what it means to be transgender is important not
only because it allows us to understand the lived experiences of a particular
demographic group. Rather, we propose that thinking about a world in which
some people are transgender whether or not you are one of those people allows
us to explore the idea of gender uidity and to thus rethink what is gained and what
is lost when we think of human beings as falling into discrete, immutable categories.
Our Element project is quite topical, but the transgender experience is quite
ancient (Green, 1998). Consider the Hijra in India who appeared rst in ancient
Hindu texts like the Kamasutra. The Hijra community in India are understood as
being a third gender. Hijra wear colorful saris and makeup. They are believed to
have a spiritual power to bless or curse. The Ramayana tells the story of Rama
who was banished to a forest for fourteen years. In the forest, he called to his
followers telling those who were men or women to return to the city. Members
of the Hijra community did not feel bound to such a call (as they did not identify
as men or women), so they stayed in the forest and Rama blessed them for their
loyalty. Currently, the Hijra live mostly in Mumbai; their community is hier-
archical in that older Hijras take care of younger Hijras (Hylton, Gettleman, &
Lyons, 2018;Michelraj, 2015). As early as the sixteenth century, two-spirit
people held important roles among the Cherokee and other Native American
tribes. The two-spirit category represents people who integrate feminine and
masculine traits. Two-spirit identity was believed to be grounded in super-
natural intervention that became known through visions or dreams. Two-spirit
people were and are often healers, shamans, and ceremony leaders (Smithers,
4Undoing the Gender Binary
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Among other postcolonial Americans, too, history contains examples of
individuals who presented as the gender not assigned to them by others. The
historian Susan Stryker (2008) writes, in the eighteenth century, numerous
women and trans masculine people most famously Deborah Sampson
enlisted in the Revolutionary Army as men(p. 46). Transgender soldiers also
participated in the American Civil War. Transgender soldiers, Albert Cashier
and Harry Burford, served in the Union and the Confederate army respectively.
Frances Thompson, a black slave and transgender woman, was one of the ve
women who testied in front of Congress regarding the brutal rapes that
occurred during the 1866 Memphis Riots (Stryker, 2008).
Although some people have deed the gender binary across the millennia, it
is only in recent times that transgender individuals are not singled out as
belonging to some dened and separate form of humanity. It is only now that
individuals in the mainstream of society are not certain to be stigmatized for
defying the impulse toward the gender binary. We believe that twenty years ago,
a review like ours would likely not have existed. And thus we see this work as
wholly contemporary.
There is another way in which this Element shows a timestamp. We expect
and hope that many parts of our volume will be out-of-date within a decade or
two. Medical realities will change. The current medical thinking, for example, is
that puberty-arresting drugs have few negative side effects, and so are helpful
for youth who are not sure if they wish to transition; but continued study over
time may change that opinion. Attitudes will evolve. As more and more people
feel it is safe to express their identities, gender nonconformity will become less
controversial; and that in turn may make it seem even safer to even more people
to eschew rigid gender roles. As realities change, scholarly understandings will,
of necessity, shift.
Even as we embrace the topical nature of our work, we also hope that the
information presented here will do more than contribute to how readers see
a specic current issue. We would like to imagine that readers will be sparked to
reect on enduring realities. How privileged we are to be able to pause and
contemplate eternal questions of what it means to be female, what it means to be
male, what it means to be nonbinary, and ultimately what it means to be human.
2 The Basics
2.1 Terms
Lets start by dening some terms. We do this for expository clarity but not to
dictate that all other researchers use exactly the same terms as we do. We
recognize that there have been some scholarly battles over evolving
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terminology (American Psychological Association, 2015;Crawford & Fox,
2007). But, like Teich (2012), a social worker with a distinctly compassionate
approach to scholarship, we think that some discussion of key terms will help
with an understanding of more complex concepts.
In many instances, the terms sex and gender are used interchangeably, but
usually, we use the term sex to refer to the anatomical features that are com-
monly used to classify humans into female and male. Assigned or birth sex is the
classication that adults including adult authorities like physicians use when
they classify human babies as female or male. The assignment is generally made
on the basis of external genitalia. On an average of one birth per two thousand
live births, the genitalia are ambiguous. In such cases, the child might be called
intersex, but sooner or later, authorities may push the child toward one designa-
tion or the other.
When an individual has the same label as their birth-sex throughout life, that
individual is said to be cisgender because cis is Latin for on the same side as.
Individuals who were assigned to the category of female at birth and who
continue to experience themselves as female become, as adults, cis women.
Individuals who were assigned to the category of male at birth and who continue
to experience themselves as male become, as adults, cis men.
Not all individuals continue to experience themselves as being the sex
assigned to them at birth. Such individuals, we call transgender (or trans for
short). In our denition, a trans woman (adult) or trans girl (child) is any
woman or girl who was assigned to the category male at birth (almost always
based on external genitals) and who nonetheless experiences gender category as
female. Likewise, in our denition, a trans man (adult) or trans boy (child) is
any man or boy who was assigned to the category female at birth (almost always
based on external genitals) and who nonetheless experiences his gender cate-
gory as male.
It should be noted that our denition of transgender is not the rst or
only that exists in scholarly literature. One of the better-known denitions
of transgender is presented by Stryker (2008). Stryker denes transgender
broadly, using the concept of the transgender umbrella (also, American
Psychological Association, 2015;Williams, 2014). She uses the term
transgender umbrellato:
refer to people who move away from the gender they were assigned at
birth, people who cross over (trans-) the boundaries constructed by their
culture to dene and contain that gender because they feel strongly that
they properly belong to another gender in which it would be better for them
to live; others want to strike out toward some new location, some space not
yet clearly dened or concretely occupied; still others simply feel the need
6Undoing the Gender Binary
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to get away from the conventional expectations bound up with the gender
that was initially put upon them. In any case, it is the movement across
a socially imposed boundary away from an unchosen starting place
rather than any particular destination or mode of transition that
best characterizes the concept of transgenderthat I want to develop
here. (p. 1; italics in original)
Strykersdenition includes many experiences from changing ones legal
designation, to behaving in ways described as gender nonconforming. Our
denition is much more targeted because we only focus on the birth-assigned
and self-assigned labels for oneself not behaviors consistent or inconsistent
with gender stereotypes or gender conformity.
Focusing on birth-assigned and self-assigned labels also allows us to include
those whose self-assigned gender identity labels are not exclusively female or
male. For example, there are people who identify as agender being neither
female nor male irrespective of their assigned sex category. There are also
people who identify as genderuid,genderblended,or androgynous being
both female and male, either concurrently or alternately and other specic
labels, that differ from their assigned sex. These specic labels of agender and
genderblended t into a larger class of experiences that other scholars have
labeled genderqueer with queer meaning unexpected or unusual, or not tting
within the gender binary (e.g., Nestle, Howell, & Wilchins, 2002). Currently,
scholars also use the label nonbinary to indicate people who do not think of
themselves as exclusively one of the familiar two categories (e.g., Galupo,
Pulice-Farrow, & Ramirez, 2019;Hyde et al., 2019;Tate, Youssef, &
Bettergarcia, 2014).
Trans individuals are, by denition, unable to be complacent about issues of
sex and gender in a society that is so interested in a very particular form of the
binary in which everyone is expected to be cisgender. Because assigned genders
almost always convey expectations about how one should act, to whom one
should feel attracted, and with whom one should have sexual contact, gay and
bisexual people also generally nd complacency out of their reach. It seems
natural, therefore, that trans and gay people have sought a common cause in
resisting prejudice and discrimination. Organizations often use the phrases
LGBT (lesbian, bisexual, gay, and transgender) or LBGTQ (adding queer) or
LBGTQIA+ (adding other sexual orientations and gender identities, as well as
other sexual and gender identities with the +).
Although solidarity among sexual and gender minorities is politically and
socially helpful, phrases like LGBT can introduce confusion among people who
are not centrally involved in the issues. The phrase LGBT confounds gender
identity and sexual orientation.
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Yet, self-assigned gender is not the same as sexual orientation or
sexual preference. How one thinks of oneself as female or male or
neither or both that is, ones own identity, is connected to but different
from ones attraction to sexual, romantic, or affectional partners. For
example, some trans women (i.e., individuals who were assigned to the
category of a male at birth and who think of themselves as women) might
have sexual partners who are exclusively men; other trans women have
sexual partners who are exclusively women; still other trans women have
sexual partners who are men and women; still other trans women do not
have sexual partners because they are not sexually attracted to other
people. The same would apply to a trans man. Stated another way, any
trans woman might be a lesbian, straight, bisexual, or asexual, just as
a trans man might be a gay man, straight, bisexual, or asexual. Of course,
the same applies to any cis woman or cis man. We will return to this
issue in the next section, but one simple way to keep the concepts clear is
to remember that sexual orientation (straight, bi, gay) refers to whom you
would like to go to bed with while gender identity (cis, trans) refers to
who you go to bed as.
2.2 Biological Bases of Gender
Think of a time when one of your friends returned from a special trip and you
asked about the people living in the destination. Perhaps your friend replied
saying, Well, fundamentally, people are just people.Perhaps you nodded,
agreeing about the universality of humanity.
Notice how different is the assumption of universality from the prejudgment
that humans are fundamentally different from each other in profound ways. The
profoundly different view of people held sway in the 1980s, 1990s, and early
2000s. For instance, Carol Gilligans (1982) book, In a Different Voice, enjoyed
huge success in academic circles, purporting to show that women have an ethic
of care while men have an ethic of justice. Outside the academy, popularizers
like John Gray (2009) gained currency with the catch phrase: Men are from
Mars, women are from Venus.
Those who emphasize gender dimorphism, who see females and males as
fundamentally distinct life-forms, might be surprised to learn that biological sex
is a multidimensional concept. Researchers usually identify four components
that are thought to make up the primary sex characteristics: chromosomes,
external genitalia, internal genitalia, and hormones (Crawford, 2006). Some
authors also differentiate between prenatal or uterine hormones, on the one
hand, and, on the other, postnatal hormones.
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2.2.1 Multidimensional Nature of Biological Sex
The multidimensional nature of biological sex means that gender categories are
less black-and-white than envisioned by authors like Gilligan and Gray. Primary
sex characteristics usually, but not always, align with individualsgender
identity, behavior, and/or presentation. And to complicate matters even more,
the dimensions are just that: dimensional existing along a continuum.
We suspect that a portion of the discomfort that some people feel about trans
people springs from a sense of dissonance and unease that can arise by con-
fronting the errors of a truththat we as a society have taken as founda-
tional. Just as ancient theologians assumed that the sun rotated around the earth,
so do many of us assume that gender or biological sex is uncomplicated, being
immutable and unidimensional. In fact, gender is neither immutable nor uni-
dimensional. But while it is simply false to imagine that all humans come in one
of two clear, absolutely distinct, and unchanging varieties (male and female), it
can also be unsettling to recognize the problems of our prior conceptualizations.
Galileo was no hero to many of his contemporaries not only because his
calculations were hard to conceive, but also because his new conceptualization
of the heavens challenged old truths taken to be sacred and self-evident.
Chromosomes. You can start with chromosomes. Many people believe that
assigned sex is controlled entirely by sex chromosomes, which are commonly
depicted as X or Y based on how they look when magnied under a microscope.
The common belief is that an XX chromosomal pair will always lead to the
assigned sex of female and that an XY chromosomal pair will always lead to the
assigned sex of male.
Reality is more complex. To begin, there are many sex chromosome cong-
urations in addition to XX and XY. In fact, there are six major chromosomal
congurations for humans: (1) XX, (2) XY, (3) X0 (i.e., a single X-chromosome
without a partner), (4) XXY, (5) XYY, and (6) XXX (Blackless et al., 2000). In
addition to those, there are the even less common congurations of XXYY
(Nielsen & Wohlert, 1991), XXXY, and XXXXY (Kleczkowska, Fryns, & Van
den Berghe, 1988). It is clear that some chromosomal congurations affect
bodily morphology that is, how the body looks during development. For
instance, X0 (also called Turners Syndrome) has a characteristic lack of
development of the secondary sex characteristics, specically the chest area.
Although individuals with an X0 conguration have vaginal and vulval genital
structures, they do not develop the fatty tissue and contours around the chest
area that are described as adult breasts (e.g., Gravholt et al., 1998). In parallel,
those people with XXY congurations (also called Klinefelters Syndrome)
often have adult breasts and a penile scrotal structure (e.g., Kruse et al., 1998).
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While morphological effects of chromosomal congurations are apparent,
psychological outcomes are less understood. But for one perspective, reviewing
much of the literature to that point, Hines (2005) has argued that the psychology
associated with gender identity may have more to do with prenatal hormones
uptake and/or insensitivity to androgens in particular than chromosomal
congurations as such. Part of her argumentation can be seen by the fact that
there are some adult women (who have vaginal and vulval structures from birth)
who have XY chromosomal congurations based on being insensitive to the
update of androgens prenatally (Hines, 2005).
Hormones. Each chromosome in the conguration (whether a singleton,
a pair, a trio, or larger) signals the releases of classes of specic hormones
collected into the general names of androgens and estrogens. While androgens
(e.g., testosterone, dihydrotestosterone) are sometimes called the malehor-
mones and estrogens (e.g., progesterone, estriol) the femalehormones, all sex
chromosomes produce some amount of both of these classes. Thus, everyone
has femaleand malehormones even before birth.
afemaleconguration (with a vulva and vagina) or a male conguration
(with a penis and scrotum) starts out as one mass of undifferentiated genital
materials. These are shown in Figure 1.Bythetwelfthweekofinutero
gestation, the [internal or external] genitals have usually reached their
prenatal maturation state.
Figure 1 Initial genital material for humans and fully developed genital
divergence around twelfth week of fetal development
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Genitalia. Generally, the newborn has one of these two genital congura-
tions. We should think of the component parts (e.g., the clitoris or the glans) as
parallel structures, as seen in Figure 2, having emerged from undifferentiated
tissue shown in Figure 1. On rare occasions, the external genitalia are ambig-
uous. Human genital development is a difference of degree, not kind, and
controlled by androgen uptake in utero not directly by sex chromosomes.
This means that any person with an XX pair of sex chromosomes could have
any of the genital forms from vulva/vagina to penis/scrotum (Dessens, Slijper,
& Drop, 2005;Hines, 2005;Hines, Brook, & Conway, 2004). Likewise,
a person with a pair of XY chromosomes could have any of the genital forms,
including a vulva/vagina form. Current thinking sees the female conguration
as the default option, with the vulva and vagina forming from the undifferen-
tiated genital tissue prior to the penis and scrotum. Our current understanding of
intersex genital conditions is that they are largely the consequence of releasing
either too little or too much intra-utero androgen, or, separately, the body either
being insensitive to the uptake of androgens or being overly sensitive to them
(Rodriguez-Buritica, 2015).
It is worth noting that when babies are born in the United States and other
industrialized nations, obstetricians rarely conduct DNA tests to understand sex
chromosomes, measure hormone tests to determine androgen levels or andro-
gen receptivity, or look atthe internal genitalia. Instead, pediatricians look at the
form of the newborns genitals and make a designation of whether the baby
should be assigned to the category of female (based on the clear presence of
vulva/vagina forms) or male (based on the clear presence of penis/scrotum
When the genital form is not so clear, obstetricians rely on a Prader scale (see
Figure 2) to determine how close to either the vulva/vagina form or the penis/
scrotum form the genitals are to determine which type of surgery should be
performed to make these intersex genitals appear more like one of the two
prototypical forms.
The story does not stop with the external genitalia. Sometimes the internal
genitalia do not correspond to the external genitalia. In what is called Turner
Syndrome, an individual has a single X chromosome, resulting in forty-ve
(rather than forty-six) chromosomes. Turners Syndrome is often depicted as
X0. Most individuals with the X0 conguration develop a vagina and vulva at
birth external genitalia but their internal genitalia, specically the uterus, is
underdeveloped biologically speaking and often remains so after the rush of
pubertal hormones (Morgan, 2007). Consequently, many medical professionals
believe that in order for the internal genitalia to develop in-utero and continue at
puberty, an individual needs at least two sex chromosomes (cf. Morgan, 2007).
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Figure 2 The Prader scale for determining assigned sex at birth for intersex conditions
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Internal and external genitalia can develop differently for other reasons as
well. Medical professionals have identied several forms of what is called
androgen insensitivity (Mazur, 2005;Zuloaga et al., 2008). This insensitivity
to androgens can happen in-utero during the differentiation of genital develop-
ment and also persist into puberty. A consistent feature of androgen insensitivity
is that the internal structures are usually undifferentiated as either testes or
ovaries. Because of this, if the individual is assigned female at birth, people can
be surprised when menstruation does not occur during puberty (Gurney &
Simmonds, 2007).
In another medical condition called dihydrotestosterone (DHT)-deciency
(or more formally 5-alpha-reductase deciency), people appear to have vulva
and vaginal structures at birth, but, during puberty, testicles descend into the
labia majora (the outer lips, which are the same biological material as the
scrotum) and a penile shaft emerges (which is the same biological material as
the clitoris and the vaginal canal) (Cohen-Kettenis, 2005;Imperato-McGinley
et al., 1979). Clearly, biological processes are more varied and intricate than is
commonly presented in popular discussions of biology when it comes to both
sex and gender.
Secondary Sex Characteristics. While only four components are generally
thought to make up the primary sex characteristics, there are additional compo-
nents that comprise the secondary sex characteristics. Secondary sex character-
istics are not always dened in the same way by human biologists, human
anatomists, and medical professionals. Some scholars emphasize what is called
vital capacity,which is the volume of air held by the lungs. Other aspects of
anatomy that are commonly seen as secondary sex characteristicsinclude
center of gravity, leg length at any given height, facial shape, vocal depth, and
shoulder and hip movement when locomoting. However, there is near universal
agreement across disciplines on three secondary sex characteristics: (1) breast
size and shape, (2) muscle-to-fat ratio, and (3) body hair coverage and thick-
ness, including facial hair. Interestingly, during childhood, none of the three
secondary sex characteristics differentiates females from males. Children do not
differ much in their chest size, muscle-to-fat ratios (without intensive exercise),
or their body hair coverage and thickness.
During puberty, with the onslaught of estrogens and androgens in different
quantities, humans appear increasingly dimorphic in terms of secondary sex
characteristics. Secondaryliterally signals that the changes happen second in
a time sequence at puberty and not at or before birth. Those assigned female at
birth tend to show growth in breast size and shape (e.g., sometimes initially
called breast budding) that far outpaces the growth of the same tissue in those
assigned male at birth. Breast development is based largely on the action of
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estrogens. Similarly, and related to the development of comparatively larger
breast tissue as increased adipose (or fat), the muscle-to-fat ratio tends to be
more equal for those assigned female at birth. This muscle-to-fat ratio is again
attributable to the action of estrogens increasing body fat in certain areas (e.g.,
breasts, hips, buttocks). On the ipside of this same phenomenon, those
assigned male at birth tend to have a higher muscle-to-fat ratio; remember,
however, this is a distribution meaning that some may have a ratio of muscle-
to-fat that is lower than that of some who are categorized as female. The muscle
mass increase is based largely on the action of androgens.
Finally, during puberty, those labeled male at birth tend to increase their body
hair coverage and thickness at a level that far outpaces the same action in those
assigned female at birth. (Notice that everyone has an increase in body hair
coverage and thickness; the statement is comparative. The more direct way to
understand this is to notice the genital hair coverage and thickness being similar
in all people at puberty, irrespective of their birth-assigned category). The body
hair coverage and thickness are largely based on the action of testosterone.
Thus, adult cis men tend to enjoy more and thicker body hair and facial hair than
adult cis women do; but, remember that there are social factors at play too,
including consistent hair removal for many adult cis women on areas of their
bodies, especially the face.
3 The Processes of Transitioning Away from the Gender
Assigned at Birth
It is difcult to get reliable information about some of the basic questions that
people might have about transgender experience because much of the medical
and psychological literature is either incomplete or has not focused on certain
topics. For instance, the fourth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV; APA 2014) has estimated the prevalence of trans
women in the United States to be 12,00014,000 persons. The estimated pre-
valence of trans men was a smaller number. However, both estimates are based
on only those who sought and received genital reassignment surgeries.
Consequently, those trans women and men who did not receive surgeries are
missing from this count. Furthermore, before the 20-teens, genital surgeries for
trans men seem to have been less prevalent based on the techniques available
before that time, making the count for trans men necessarily lower than that for
trans women. Additionally, the DSM-IV did not count genderqueer or nonbin-
ary trans individuals that is, those trans persons who do not consistently or
exclusively identify as women or men. When nonbinary persons are included in
research both past and present, the samples have been small (e.g., Factor &
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Rothblum, 2008) and have been largely used for qualitative analysis on ques-
tions about lived experiences (e.g., Galupo et al., 2019)not for population-
based estimates.
Similarly, because the focus has been on trans women and men and those who
have received genital surgeries, it is extremely difcult to provide good answers
to basic quantitative questions, such as: What are the average (mean) and most
frequent (modal) ages of transitioning? Even an age-focused question is com-
plicated by access to medical services that varies with ethnicity and socio-
economic class in the United States and many other societies. Likewise, since
surgery tends to be the main record-keeping focus, it is difcult to determine the
actual incidence of trans people who retain their trans identity over time
because this would, at best, be limited to those individuals who received surgery
(and follow-up post surgery).
If there is any consensus about studying transgender people, it is that the
ultimate cause is currently unknown. Of course, each scientic discipline with
human behavior as a focus has its own hypotheses and predictable starting
points. Genetics researchers point science toward the possible genetic under-
pinnings of trans experience (e.g., Hare et al., 2009;Henningsson et al., 2005;
Reiner & Gearhart, 2004). Neurologists and anatomists point science toward the
possible brain anatomy differences and similarities that could provide an
explanation for trans experience (e.g., Kruijver et al., 2000;Rametti et al.,
2011a,2011b;Zhou et al., 1995). Other biologists suggest maternal hormonal
inuences (e.g., Cohen-Kettenis et al., 1999;Green & Young, 2009). Purely
psychological theories are not yet well equipped to participate in hypothesis
generation about the origins of trans experience. This is because trans people
exist even while classical conditioning and other theories of learning and
reinforcement would predict the exact opposite. Take for example, a trans
woman. If that trans woman was treated by everyone in her immediate social
experience as a boy when she was younger, how is it that she was able to resist
(or be immune to) all of the male socialization? Current psychological theories
would predict that socialization creates identity based on principles of learning
and behavior. Trans persons show that this explanation is obviously incomplete.
Purely psychological theories would need to account for how some people
namely trans people are able to resistgender socialization, while other
people and the vast majority as cis people are not able to resist the same
socialization pressures.
However, there is at least one intriguing new theory about how psychological
processes might connect with biological presets or tendencies. Fausto-Sterling
(2019) has recently argued that socialization before the age of three an
apparently neglected research area in behavioral science for studying identity
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dynamics could interact with gene activations and postnatal physiological
processes to that point to create cis and trans experience. This idea is basically
a model of embodied cognition for gender and the sense of self, and is purely
theoretical at this time with no empirical studies to directly support it.
Nonetheless, it is worth mentioning because it is one attempt to connect classic
psychological theorizing with biological predispositions during infancy.
Fausto-Sterlings basic premise is that from birth until the age of three years
old, children are engaging with the world using all their sensory capacities (e.g.,
vision, touch, hearing) and that the sensations experienced from caregivers
and others interacting with the child form the template for the childs sense of
gender self-categorization. This is the meaning of embodied cognition”–that,
our sense experience forms the basis for and constrains our thoughts, feelings,
and behaviors. Quite literally, Fausto-Sterlings argument is that how the child
is treated from birth to three years old forms the childs self-concept of whether
they are a boy or a girl or nonbinary. What is more, the origin of this self-concept
is not easily remembered by almost anyone because most people do not have
clear memories of these years (birth to three). Again, an intriguing argument but
one without any studies to support it yet.
In sum, until all of the sciences get a sharper focus on basic research issues
related to transgender populations, we will continue to have a difcult time
answering what might appear to other scientists (or nonscientist observers) to be
basic or preliminary questions.
3.1 Social and Legal Transitioning
Social Transitioning. At least one of us has argued that all transitions for
transgender people are social in nature, while only some are legal and/or bodily
(Tate et al., 2014). The social transition refers to the individuals behavior of
changing some or many of their social presentations of gender to the larger
world. Consider a trans woman, for example, who changes her pronouns to
she/her; asks others to use those pronouns for her; grows her hair long; and
starts to wear make-up and dresses in clothing and accouterments associated
with the social group womenin her culture. Any one of the listed behaviors
would count as a social transition different pronoun use, different accouter-
ments, different clothing use. And, using that example as a case in the larger
point, hopefully it is clear to the reader that social transitions take a variety of
forms, but at base they concern changing how the self is viewed in social
settings. Take another example, a trans man. He may change his pronouns to
he/him; ask others to use those pronouns for him; yet, he may not change his
hairstyle that much; he may already wear mens clothes and accouterments and
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continue to do so. He too has engaged in a social transition. Finally, consider
a nonbinary person who only switches their pronouns to they/themand asks
others to use those pronouns. This person may dress and behave in exactly the
same manner as before, but they are now trans.
Legal Transitioning. Most industrialized countries, like the United States and
the United Kingdom, attach a legal gender designation to a persons social
experiences. Gender designations show up on government-issued identication
(e.g., state ID cards, drivers licenses). Unsurprisingly, the gender designation
usually refers to the persons birth-assigned category as either female or male
F or M. But, given the success of trans activism in the legal arenas of many
national cultures, this gender can be changed to match the individuals self-
assigned category rather than the birth-assigned category. In parts of the United
States (e.g., California, Massachusetts), there is even a nonbinary designation
that is neither F nor M, but another category (e.g., X). As one might expect,
however, changing ones legal gender designator not only depends on the
availability of that option in ones state, province, or country of residence, but
it also almost always depends on paying fees. Advertising ones name change in
a local newspaper and visiting a physician come with costs, as do the legal steps.
Consequently, some transgender people in industrialized countries simply can-
not afford to legally change their gender marker.
3.2 Bodily Transitioning
Bodies are a focus for many of the lived experiences of many people on the
transgender spectrum. Many, but not all transgender people nd it useful to
make changes to their bodies or desire to do so (see Factor & Rothblum, 2008).
It seems useful at present to consider that all choices about bodily changes are
valid expressions of an individuals sense of self. Thus, bodily transition should
be viewed as simply one way to dene the concept of transitionfor transgen-
der folks one that often co-occurs with, but is secondary to, social
Like the legal gender-marker change, bodily changes require some access to
money and the larger healthcare system within any country. In the United States,
some insurance companies pay for certain bodily surgeries or hormone supple-
ments for transgender persons, sometimes with an age stipulation (e.g., before
twenty-ve years old). Of course, other insurance companies do not offer
payments because they consider surgeries and hormones as elective or cosmetic
medical procedures. Given the sheer expense of bodily transition, it is currently
only accessible to some segments of the population in countries like the United
States that lack a universal healthcare. And, to that point, there has been a long-
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standing practice of transgender people throwing fundraising parties or, in the
modern Internet age, creating fundraising social media campaigns to cover
some or all of the medical expenses.
3.2.1 Hormone Therapy
For those who wish to change their bodies and can afford it, there are a variety of
options. From the limited behavioral research that we have, it seems that a large
number of transgender people take some type of hormone (e.g., Factor &
Rothblum, 2008), variously referred to as hormone replacement therapy
(HRT) or as gender-afrming hormone therapy. Several medical textbooks
now cover the basics of hormone therapy, and there are also online resources,
such as the one provided by the Transgender Center for Excellence (which is
associated with the University of California, San Francisco Medical School): To review the basis of hormone therapy
here: as we noted, everyone produces estrogens and androgens in their bodies.
The goal of hormone therapy is to either up-regulate or down-regulate existing
hormone levels to make individuals more similar in these estrogen and testos-
terone levels to either cis women (usually trans women) or to cis men (usually
trans men). For trans women, hormone therapy has two parts. In one part, trans
women are given estrogen to increase their production of this hormone to bring
about the bodily changes associated with high levels of estrogen, such as those
found in cis women larger breast size and more adipose on the hips, stomach,
and arms. However, estrogen is not a testosterone agonist, meaning increasing
levels of estrogen do not necessarily decrease testosterone production
(Hembree et al., 2009). Thus, in the second part, trans women are usually
given testosterone-blockers to down-regulate the amount of testosterone that
the body produces. Blocking testosterone enhances the bodily changes brought
about by giving estrogen.
For trans men, hormone therapy tends to have one part because testosterone is
an estrogen agonist, meaning that increasing the amount of androgen erases or
cancels the effects of estrogen (Hembree et al., 2009). Thus, trans men may be
given testosterone to increase muscle mass throughout the body and increase
hair growth across the body, including facial hair.
For nonbinary trans folks, there is not yet good documentation regarding
hormone use. Factor and Rothblum (2008) have shown that use of hormone
therapy is generally lower among nonbinary folks as compared to trans women
and men. Why? One reason might be that there are so many different ways to be
nonbinary. Another reason might be that nonbinary folks might use testosterone
for a shorter time than trans men or use estrogen for a shorter time than trans
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women to create only what might be seen by medical professionals as partial
effects.In any case, there are important opportunities for the medical establish-
ment by focusing on how, how much, and for what reasons nonbinary folks use
Puberty-slowing drugs. One aspect of hormone therapy may seem a bit
esoteric, unless of course it concerns a body that is of interest to you,
including that of your child or yourself: the use of drugs to slow down the
onset of puberty. Imagine yourself to be the parent of an eleven-year-old male
who feels certain he wishes to live as a girl. You make predictions about the
stability of the childs wishes and also cast your mind into an imagined future
of your grown trans woman daughter. How will that future woman cope with
a potential laryngeal prominence (colloquially called a prominent Adams
apple), a potentially deep voice, and potentially tall stature? You consult the
pediatrician. Modern medicine understands the physiological changes that
occur during puberty quite well so much so that medical professionals can
actually slow the pubertal process via physiological intervention. The process
is often described in medical terms as using chemical agonists that block
gonadotropin-releasing hormones (the latter initialized as GnRH; Lambrese,
2010). These GnRH agonists block the release of two main hormones in the
pituitary gland, thereby preventing the release of estrogen and testosterone.
Delivered early enough in human biological development, these GnRH ago-
nists can effectively slow the progression of the tell-tale signs of puberty in
the primary and secondary sex characteristics (e.g., further development of
the genitals; breast budding; facial and genital hair growth). This slowing of
the bodys own pubertal process buys time before irreversible pubertal
changes occur. This in turn allows transgender children in particular to
receive afrming hormonal treatments (which were, in the past, described
as cross-sex hormone treatments) in place of their own bodies producing
unwanted or undesirable physical changes (e.g., Giordana, 2008;Lambrese,
A natural question for bioethics is whether pubertal suppression should be
provided to transgender children. If so, should it be provided only to those who
have already sought psychiatric intervention and been diagnosed with gender
identity disorder or dysphoria? What about those who resist the label of
dysphoria? Bioethicists note that there are good arguments for allowing pub-
ertal suppression and good arguments against it (Giordana, 2008,Lambrese,
2010). As Giordana (2008) notes, the intervention appears to help reduce the
high rate of suicide among adolescent and young adult trans people, allowing
transgender children to grow into their evolving bodies like normalteenagers.
On the other hand, some clinicians believe that puberty may be key to having
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children understand their true gender identity and that suppressing puberty does
not allow this process to unfold (Lambrese, 2010).
3.2.2 Surgeries
Although manifold physical changes can be wrought by hormone therapies, two
areas of the body remain virtually unchanged in appearance: the chest area and
the genitals (internal and external). Some, but not all, trans people opt for some
form of surgery to effect changes. Surgeries are not free, in a nancial sense or
any other; but some trans individuals feel the results are worth the costs.
Surgery on the chest area is less challenging than surgery on the genital area,
perhaps in part because many cis individuals have needed chest surgery for
decades. Consider rst trans women. Although the addition of estrogen and the
blocking of androgens make the breasts somewhat larger than their previous
form, some trans women want to have larger and more prominent breasts. These
trans women often seek a type of top surgery that is already called breast
augmentation in the medical community. Plastic surgeons have been perform-
ing breast augmentation on cis women for decades and have advanced their
techniques and materials. Older techniques of breast augmentation required
large incisions on the underside of the breast to insert an implant to augment
breast size. Newer techniques can create smaller incisions, including through
the areola, in a type of reverse keyhole procedure,to insert the implant with
minimal scarring.
For trans men, testosterone does make the chest area more muscular, but the
fatty tissue inside the breasts and the mammary glands do not usually become
smaller. Thus some trans men wish to have top surgery, which in this case means
removal of the fatty breast tissue and reduction or removal of the mammary
glands. Additionally, some trans men are concerned about the size of the areola
and nipple, and this type of top surgery can also reduce the size of these
structures. Top surgeries for trans men fall under the medical heading of
mastectomies (literally removing the mammaries). Because medical profes-
sionals have performed mastectomies for decades as one way to manage or
eliminate breast cancer, this type of top surgery for trans men is fairly routine
nowadays. It seems that two different surgical approaches are currently favored.
The traditional form of top surgery can create deep scarring on the underside of
the pectoral muscles. In the newer keyhole procedure,fatty tissue is removed
through small incisions, usually in or near the areola. The older technique may
still be preferred by individuals who had worn a bra with larger than a (US)
B-size cup while the newer procedure may be favored by individuals who had
smaller breasts.
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What about the genitals? Many in the trans community feel worried about the
obsession of cis people, even allies, with their external genital structures. Our
belief is that information demysties processes and that demystication can
help everyone.
Differentiating between internal and external genitalia, there may be good
reasons for trans women to have their testes removed. If the gonads are removed
before puberty, androgen production will be greatly diminished and thus the
individual may not undergo some of the secondary changes such as the
lowering of voice that occur during adolescence. Whenever done, removal
of the testicles means that the individual is free from the later risk of testicular
For surgery on the external genitalia, several options existed for trans women
in the past; but today the most consistently used is the modern vaginoplasty
(literally vagina construction), whose name masks the fact that a vulva is
created as well. In this type of bottom surgery, the penis is surgically inverted
(and literally turned inside out), then inserted into the space between the
prostate and the anus. The head of the penile structure (called the glans) is left
intact with its nerve endings attached to form the persons clitoris. (As we noted
above, the glans of the penis is the same structure as the clitoris.) The former
penile shaft (now inverted) becomes the new vaginal canal. The urethral tube
remains encased by the glans, so, unlike cis women, trans women with surgery
urinate through their clitoris (while cis women have a separate urethral opening
underneath the clitoris). Because of the homo-materiality of the penile shaft and
the vaginal canal, the new vagina self-lubricates with sexual excitement.
Finally, the scrotal skin is attened to form the new labia major (outer lips).
In trans men, a full hysterectomy will eliminate menstruation and make it
impossible for a pregnancy to occur. Removal of the ovaries, fallopian tubes,
and uterus also removes the risk of ovarian, uterine, or cervical cancer. For trans
mens external genitals, testosterone enlarges the clitoris; yet some trans men
may wish to have a surgically constructed penis and scrotum. For trans mens
bottom surgeries, several options have existed in the past, but a recent option is
to engage in what is called a phalloplasty and scrotoplasty (literally phallus
constructionand scrotum construction) that uses the mans genital tissue and
skin from either his forearm and from his inner thigh. In this type of surgery, the
skin of the forearm or thigh creates the outer skin of the penile shaft and is
connected with nerves and blood vessels of the existing genital issue. When an
erectile device is also surgically implanted, phalloplasty may allow for erec-
tions. The existing urethral duct is connected to a new urethral duct to extend it
through the length of the new penile shaft, permitting urination via the new
penis. While some people choose to leave the labia majora opening intact others
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Figure 3 Male to female vaginoplasty
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Figure 4 Forearm ap phalloplasty
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choose to have their labia majora (outer lips) sewn together to create the scrotal
structure. The new scrotal sac can be lled with cosmetic testicles the same
kind developed for cis men who lose one or both testicles to testicular cancer.
The skin of the forearm or the inner thigh is quite sensitive to the touch, and thus
trans men can (re)learn to become aroused by stimulation of this skin now on
their new penis.
3.2.3 Treatments and Gender Dysphoria
Individuals who experience psychological distress because of the incongruence
between their gender identity and the gender assigned at birth are said to suffer
from gender dysphoria. Gender dysphoria differs from gender nonconformity in
that gender nonconformity focuses on behavior rather than feelings or cogni-
tions (American Psychiatric Association, 2016).
The severity of gender dysphoria varies. Some children, as early as two years
of age, may feel anger for being born as the wrong gender or the wrong body.
Some transgender adults report increased feelings of stress, anxiety, or depres-
sion as they live their lives conforming to their assigned gender at birth. Other
transgender people may not feel high levels of stress and discomfort, even if
they wish to change their appearance or their legal status (Lev, 2013a). The
extent to which transgender individuals may experience gender dysphoria may
associate with social and cultural factors (Shirdel-Havar et al., 2019).
Some transgender people seek hormonal and/or surgical therapy as a means
for dealing with gender dysphoria. Seen from another angle, an expression of
dysphoria is one means to help assure that insurance pays for at least part of the
cost of hormonal and surgical therapy. Indeed, according to the Standards of
Care for transgender people one of the criteria for prescribing hormonal therapy
and/or genital surgery is persistent and well-documented gender dysphoria
(Coleman et al., 2012).
Among people who seek and go through hormonal or surgical treatment,
level of satisfaction is generally high and a sense of regret is generally low
(Byne et al., 2012;Coleman et al., 2012;Green & Fleming, 1990;Wiepjes et al.,
2018). Consistently, hormone therapy and surgical procedures alleviate symp-
toms associated with gender dysphoria. Follow-up studies of hormonal and/ or
surgical intervention suggest that those increase patientsself-esteem, capacity
for sexual satisfaction, body image, and happiness (Byne et al., 2012;Green &
Fleming, 1990;van de Grift et al., 2017). The success of the hormonal and or
surgical treatment depends on a number of factors. The younger the patient, the
greater the satisfaction. Family support is also critically important in increasing
levels of happiness.
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4 Multifaceted Model of Gender
Just as biological sex is a summary term that includes various components, so
does the term gender. As we have said earlier, any serious investigation of the
transgender experience opens our eyes to the uidity of gender and to
the complexity of the very concept of gender. We nd ourselves discarding
the old simplistic views about gender as soon as we question the gender binary.
Gender includes a number of dimensions or facets. A useful way to con-
ceptualize the many meanings of gender is to take the perspective that gender is
a bundle of different phenomena. Figure 5 presents the facet model of gender
(Hyde et al., 2019;Tate et al., 2014). The usefulness of the facet model is that it
collects the meanings of gender that scholars want to think about across the
social and behavioral sciences. Although all the facets relate to each other, we
can analyze them separately.
4.1 Assigned Gender at Birth
The rst facet, birth-assigned gender category, corresponds roughly, but imper-
fectly, to biological sex. As we have noted, in industrialized societies, cultural
authorities such as obstetricians, pediatricians, and other adults assign a gender
to the newborn. Almost always they do so on the basis of visual inspection of the
external genitalia. Hardly ever does the assignment to one sex or the other
depend on components of biological sex (chromosomes, internal genitalia,
hormonal levels) other than the external genitalia.
Gender assignment at birth is utility in medical science because it allows for
the imperfect but generally accurate prediction of pubertal and postpubertal
hormone levels of both androgens and estrogens. Yet, it is important to
(a) (b) (c) (d)
Figure 5 Gender as a bundle of phenomena
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remember that the naming of genital forms using gender terms helps set into
motion a host of other phenomena that are interpersonal. Using their own
preconceptions, parents or legal guardians of newborns make assumptions
about what the babys likes, interests, and preferences will be or should be.
Assumptions help shape the behaviors of parents and other caregivers which, in
turn, have consequences for how the baby experiences the world through the
earliest developmental stages of infancy, toddlerhood, and then adolescence
and likely beyond those stages.
In the present time, social media can amplify problems. Parents are encour-
aged to revealuniquely and creatively the gender of their child in parties (e.g.,
exploding cakes with pink or blue llings), creative social media posts using
games (e.g., Scrabble), and merchandise (Gieseler, 2018). With gender being
determined and announced even before birth, the assigned sex facet of Figure 5
can be viewed as otherscategorization of the individual, and further sets into
motion how that individual person is socially perceived, controlled, and encour-
aged or discouraged to behave (Hyde et al., 2019).
4.2 Current Identity
Meanwhile, there are other phenomena at play, collected under the heading of
the current identity facet in Figure 5. Current identity refers to the well-known,
and somewhat adequately studied experiences of children coming to understand
their location in the world in terms of a gender category. Originally Lawrence
Kohlberg (1966) proposed that children come to an understanding during their
early years that they are a girl or a boy and that they will remain a girl or boy.
The term gender constancy refers to the concept, which generally solidies at
some point in preschool development, that a persons own self-label and other
peoples self-labels will remain the same over time. Children know, for instance,
that an adult womans gender identity will likely remain the same into later
adulthood. They know that she probably experienced her gender identity as
a girl when she was a child.
Among developmental psychologists, the focus has traditionally been on
timing (Ruble et al., 2007). Scholars have sought to document when children
come to acquire the concept of gender constancy. Some scholars have referred
to this experience with various verbs, such as having,”“nding,”“realizing,
accepting,or otherwise developing a sense that they are a girl or a boy and
these are usually the only categories studied or recorded (Keener, Mehta, &
Smirles, 2017;Leaper, 2000;Liben & Bigler, 2017;Martin & Ruble, 2004)
Recently, some of us have noticed that Kohlbergs (1966) original concep-
tualization was overly simplistic. It did not recognize that children may
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distinguish between their private understandings and outward or public pre-
sentation (Tate, 2014;Tate, et al., 2014). As an example case, a trans boy may
(a) privately self-categorize as boyand (b) privately pay attention to the
gender norms for boys but (c) may publicly allow references to himself and
then later self-reference (based on social pressures) as girl.The trans child
may, thus, have a much more complicated and sophisticated analysis of self than
Kohlberg imagined. Of course, the same split between privately held views and
views that are shared also applies to cis children, especially as the children come
to understand that it is not safe to share some of their private thoughts with
Some psychology researchers have begun to focus on current identity
dynamics during childhood and early adolescence in a manner consistent with
the implications from Tate et al.s (2014) gender bundle understanding and
Aaron Devors (2004) conceptual model of transgender development. Kristina
Olson and her colleagues, for example, have examined self-concepts using
standard cognitive psychology tasks to show that trans girls and trans boys
appear to have self-concept representations as either girl or boy, respectively
that are (statistically) indistinguishable from cis girls and cis boys, respectively,
who are of the same age and other similar demographic characteristics (e.g.,
Olson, Key, & Eaton, 2015; Olson & Gülgöz, 2017). Additionally, when
supported by their families, trans girls and boys have mental health outcomes
that are basically the same as cis girls and boys who are matched on relevant
demographic characteristics (e.g., Olson et al., 2016; Olson & Gülgöz, 2017).
Taken together, the empirical ndings support the implications and predictions
from transgender theorists (viz., Devor; Tate) that current identity dynamics
appear to be symmetrical between trans and cis experiences of gender self-
4.3 Gender Roles
As children develop, other experiences become very salient to them namely
interpersonal experiences and the expectations of social interactions that coin-
cide with or are based on gender. In Figure 5, we refer to these experiences as the
gender roles, expectations, and ideologies facet. Gender roles and ideologies
are probably the most socially well-known of the facets of the gender bundle.
Gender roles are the known expectations for how people in different gender
groups are supposed to behave in a society.
Some cultures view gender roles as complementary meaning that one
gender group is expected to have the qualities that another gender group
lacks, and vice versa while other cultures view gender roles as more equal
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or similar. In any event, much time in childhood is spent guring out how one is
expected by caregivers and peers to behave based on being a girl or a boy (Bem,
1983;Helgeson, 2016;Thorne, 1993). This mental work continues as children
enter adolescence and then adulthood.
Of course, individuals are not passive vessels only taking in and being
completely guided by others expectations. Instead, individuals consider how
comfortable they feel when they behave consistently or inconsistently with
the gender roles of their time and place. In general, people may feel comfor-
table with some gender role expectations for their gender group but not with
others; comfortable with all the gender role expectations for their gender
group; or comfortable with none of the role expectations for their gender
Considerations about gender roles are also complicated by factors such as
sexual orientation. In the United States, for example, heterosexuality may feed
into complementary gender role expectations for women and men. For example,
those who subscribe to a heterosexual norm might assume that women should
be emotionally available and emotionally supportive of men but not agentic, on
one side; and that men should be more competitive, stoic (or less emotional),
and be nancial providers for women, on the other side (Glick & Fiske, 1997).
Thus, even if a woman is uncomfortable with some gender role expectations, if
she is heterosexual, she may nd that her partner pool of heterosexual men pulls
her in the direction of societys gender role expectations.
4.4 Gender Presentation (or Performance)
Yet another set of experiences that are referred to as genderis the social
presentation of gender the fourth of the ve facets depicted in Figure 5. This
set of experiences is often lumped together with gender roles but deserves to be
separated. One of the easiest ways to think about what we mean by social
presentation is to think about phrases like gender performativityand all the
behavioral manifestations that one can think of that correspond to that phrase
(Martin, 1998;West & Zimmerman, 1987).
The behaviors that people engage in to express their gender identity or that
are associated with gender are numerous. In industrialized societies, apparel and
accoutrements (e.g., jewelry, makeup) constitute one way to performgender.
Entire industries are devoted to curating and selling womens apparel and mens
apparel. One of the obvious uses of these apparel styles in society is to
determine whether a stranger is a woman or a man. Presumptively, individuals
buy and wear apparel in part at least to convey messages to others about their
gender self-labeling.
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Another way to perform gender is to modulate ones vocal pitch. In many
industrialized societies, women are expected to speak with a higher pitch to
their voices and men are expected to speak with a lower pitch. While everyone
knows that there is variability in voice pitch within and between gender
categories, the expectation allows strangers to infer another persons gender
category. Transgender people often change their voice pitch to t social con-
ventions for their category (Lev, 2013a). The mis-gendering of intersex people
because of gender-nonconforming voice pitch can be distressing (Nygren et al.,
Names communicate gender. The names Charlotte,”“Ella,and Faye
would lead most English speakers to believe that these individuals are
women. Similarly, the names Carl,”“Elmer,and Frankwould lead most
English speakers to believe that these individuals are men. Chrispresents
How people move their bodies is yet another way to perform gender (Henley,
1977;1995;Pascoe, 2011). In the United States, women are taught from
a young age to walk by rolling their hips more than their shoulders, while
men are taught to engage in the opposite pattern. Likewise, women are taught to
cross their legs when seated, while men are taught to (or allowed to) keep their
legs open when seated.
Gender performativity shifts according to context (Deaux & Major, 1987;
Mehta, 2015). When young girls play with other girls, they tend to be more
agentic compared to when they play with boys when they often turn more
passive (Maccoby, 1990). When adolescent boys and girls play with each
other, boys tend to increase their level of femininity while girlslevel of
femininity remains the same (Leszczynski & Strough, 2008). In a study done
with college students, men reported greater levels of masculinity when they
were with other men compared to when they were with female students; the
opposite result was found for women who tended to report a greater sense of
femininity with other women compared to when they were with men (Mehta &
Dementieva, 2017). These results show that being in certain contexts shifts how
people perform and understand their gender and the extent to which they
identify as masculine or feminine.
4.4.1 Gender Performance, Sexuality, and Sexual Orientation
The context of heterosexual relationships in the United States requires women
to exaggerate stereotypically feminine traits and men to exaggerate stereotypi-
cally masculine traits. Indeed, heterosexuality reinforces its status as being
naturalby framing people with penises as naturally more masculine,
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aggressive, and agentic, and as the subject of sexual desire, while those with
vaginas are framed as naturally more feminine, nurturing, and passive, and as
the object of sexual desire (Glick & Fiske, 1997). Cultural practices and values
link masculinity to male bodies (e.g., masculine bodies are strong bodies) and
femininity to female bodies (e.g., womens breast are nurturing life).
Naturalizing masculinity and femininity into male and female bodies makes
heterosexuality, which brings together these two complementarytraits,
appear normal, universal, and natural (Balzer Carr, Ben Hagai, & Zurbriggen,
2017;Bem, 1995;Butler, 1990). Such heterosexual scripts accentuate cisgender
performances; think of the teenage girl spending hours applying lipstick and
nail polish and prancing around in very short and very pink shorts. Think of the
teenage boy using his free time in front of the mirror exing his muscles,
practicing how to deepen his voice, and dreaming of a date.
Since traditional gender performance is linked to heterosexuality, those who
deviate from conventional gender performances are suspected of homosexual-
ity. Historically, transgender people were categorized as a type of homosexual.
People who were assigned male at birth but expressed their gender in a feminine
manner were seen by others as doing so because of their desire to sleep with
men; people assigned female at birth who performed their gender in a masculine
manner were seen as wishing to have sex with women (Meyerowitz, 2009).
Such historical misconceptions and prejudices that link transgender identity to
homosexuality are still prevalent in certain misinformed and/or transphobic
Sexual orientation is a modern scientic phrase that describes the observation
that people tend to orient toward certain groups of other people (usually based
on gender labels) for sexual and emotional attraction (Savin-Williams, 2009).
Scientists also agree that, for humans, sexual orientation is multidimensional.
Sometimes this dimensionality is referred to as the ABCs of sexual orientation.
The Astands for attraction,and refers to a desire for sexual contact with
certain people. An emotional attraction may also be part of the A,although for
some people sexual and emotional attractions are focused on different kinds of
people. The Bstands for behavior,and refers to the types of people with
whom a person actually has sex or wants to have sex (especially if a person has
not had sex yet). The Cstands for categorization,and refers to the label (or
category) that a person would use to describe his- or herself to others usually
in order to succinctly express the Aand Bdimensions (Savin-Williams &
Diamond, 2000).
The proliferation of gender categories is also associated with a trend toward
the proliferation of sexual categories (Bem, 1995;Butler, 1990;Halberstam,
2017). Individuals who are attracted to people regardless of their gender may
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choose to identify as pansexual or polysexual (terms that move beyond binary
assumptions of bisexual identity). Other people who prefer to be in multiple
loving relationships may identify as polyamorous, and people who do not feel
sexual attraction to others may choose to identify as asexual (Cerankowski &
Milks, 2010;Samons, 2009). Transgender people may identify with any of these
sexual categories or may choose to identify with more traditional categories
such straight, gay, lesbian, or bisexual. Finally, some people may prefer not to
categorize themselves in terms of attraction to a general gender category or
gender identity.
A recent online survey of 506 trans people recruited from college campuses
across the United States (through announcements at campus resource centers
and LGBTQ groups) found that among undergraduate and graduate transgender
students, only 3.4 percent identied as heterosexual(Goldberg et al., 2019).
Another study of 292 transgender and gender-variant people recruited from
different transgender and gender-variant groups (i.e., convenience sampling)
found that 14 percent of the sample identied as heterosexual. Pansexual and
queer were the most commonly endorsed sexual orientation (Kuper, Nussbaum,
& Mustanski, 2012). Altogether, transgender may identify with a wide range of
sexual identities including queer, pansexual, bisexual, gay, asexual, or straight.
Given that the LGBTQexpression lumps together both sexual and gender
identities, are we uncomfortable with current references to the LGBT commu-
nityor the LGBTQ community? The answer is no for two reasons. First, like
people who defy heterosexist norms, people on the trans spectrum cannot be
complacent about issues of gender. Second, like those in the LBG(Q) commu-
nity, those in the trans community have often been stigmatized or marginalized
by mainstream society.
The Term Queer.Even though it invites confusion of gender identity with
sexual orientation, the term queer, used in the sense of nonconforming, cur-
rently has utility. Consider a lesbian cis woman lets call her Lucia who
began dating a partner whom Lucia thought was another cis woman. If Lucias
partner discloses that he is actually a trans man, Lucia might no longer consider
herself a lesbian, but she might self-identify as queer. One factor among the
many that may inuence Lucias decision to change sexual orientation labels
may be that she can retain a self-concept that she is mostly attracted to women
and now possibly to trans men too. The traditional understanding of lesbian
does not convey this additional attraction to trans men specically, but queer
may function to convey some larger sense of not being heterosexual even if
she might be viewed as such by observers because she is with a man. Likewise,
consider a cis man lets call him Fred whose is married to a cis woman. If
Fredswifetransitions into being a trans man, the word queermight come
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in handy. Fred maynot think of himself as gay, but he might identify as queer as
a way to suggest that his attraction is mostly to cis women with additional
attraction to one (trans) man. In this way, queercan be a very useful term for
those with a view of the world that is not easily conveyed by labels that are too
rigid to capture nuances within sexual attraction.
There is another reason to embrace the term queer. From a queer perspective,
gender and sexuality are historical constructions grounded in power relations
(Balzer-Carr, Ben Hagai, & Zurbriggen, 2017;Butler, 1990;Cohen, 1997;
Foucault, 1978). Patriarchal power relations that enforced the submission of
women to men throughout history also worked to construct a binary under-
standing of gender. Queers reject this binary.
4.5 Gender Evaluations
The reality of stigma brings us to the last element depicted in Figure 5:gender
evaluations. Individuals may see themselves as similar to or different from other
people in their gender category (Egan & Perry, 2001). They may also favor
those in the same gender category or those in another gender category, which is
usually referred to as sexism(Spence, 1993). Thus, for example, a woman
may see herself as typical of all women, and yet she may overvalue men and
undervalue women.
It seems that most people in all cultures have sex stereotypes. These stereo-
types are often produced and reinforced by unequal distribution of resources
between people in society. In patriarchal societies, in which men hold most of
the wealth and political leadership, sex stereotypes depict women as less
capable and worthy compared to men. Anti-women stereotypes rationalize
and justify womens lower social status and lack of accesses to resources
(Baldner & Pierro, 2019;Glick & Fiske, 1997;Robnett, 2016).
The ve-facet model of gender proves a useful tool when we wish, as
observers, to understand the experience of being on the trans spectrum. By
differentiating between various facets of identity, we see that a trans identity
involves a conict between two components: gender assigned at birth and
gender identity. We note that gender roles, gender performance, and gender
evaluations are distinct from the gender identity one feels for oneself and the
gender identity assigned by experts.
4.6 Burgeoning Research on Transgender and
Gender-Nonconforming Children
With the understanding that gender is multifaceted, we can now turn to some of
the burgeoning or still developing research on transgender and, separately,
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gender-nonconforming children. The perspective that gender is multifaceted
will help the reader understand this new research in a deeper way and a way that
is consistent with the latest scientic theorizing about gender.
There are diverse trajectories for the emergence of transgender identity. Some
people know they are transgender at a later stage of their lives and some know at
a very young age (McGuire et al., 2016). A transgender child may assert to their
parents a gender different than the parents perception of them. For instance, one
mother of a transgender child named Lilly thought she had a son, but her
daughter told her when she was four years old that she had a girls heart,
brain, and soul(Kuvalanka et al., 2014, p. 359). In recent years, reports from
different gender clinics indicate a large increase in the number of transgender
children who are seeking help and services (Nealy, 2017;Spack et al., 2012).
Recent research and treatment of transgender children is rooted in a gender-
afrming paradigm (Ehrensaft, 2014;Lev, 2013a;Nealy, 2017). If in the 1980s
and 1990s transgender children were seen as socially malleable and encouraged
to learn behavior that conrmed to their gender assigned at birth, in the 2000s
a new gender afrming paradigm has emerged that focuses on the diversity of
gender expressions in human populations (Cohen-Kettenis & Pfäfin, 2010;
Coleman et al., 2012;McGuire et al., 2016;Olson, 2016;Olson, Key, & Eaton,
2015). This new paradigm of research and clinical treatment of transgender
children aims to listen to children and afrm childrens gender identity, even
when this identity does not fall within the traditional understanding of every
child as essentially cisgender. Moreover, this paradigm focuses on the ways in
which gender dysphoria is not an inherent part of the transgender experience but
rather is derived from societys oppressive treatment of transgender and non-
binary children and adults (Coleman et al., 2012).
Transgender and gender nonconforming children. At two years of age, some
childrens gender identication doesnt match how others categorize them.
These children assert a gender different than the gender they were assigned at
birth. A feeling that they are categorized into the wrong gender by others may
become clear to some children at the age of two, ve, or later in their lives. Some
children who do not conform to their assigned gender during childhood persist
to physically transition when they are teenagers or adults (usually 227 percent
of children visiting clinics in childhood); other children who are gender non-
conforming may desist feeling alienated from their birth gender when they enter
adolescent (Steensma et al., 2011). Differences between persisters and desisters
are associated with the content of their discontent. Persisters (children who
begin social and physical transition in adolescents) are more likely to feel that
they are a different gender, which is in-line with the idea of the current gender
identity facet in the multifaceted understanding of gender discussed by Tate
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et al., (2014). Desisters are more likely to express a feeling that they want to
engage in behaviors traditionally associated with the other gender or wish to be
part of the opposite gender group in terms of social expectations, which would
be consistent with the idea of gender roles and expectations in the multifaceted
understanding of gender (see Olson, 2016,Steensma et al., 2011).
Gender identity development. Psychological research on gender identity
development suggests that as early as the age of two children can categorize
themselves into a gender category. Childrens identication with a particular
gender category (e.g., being a boy or a girl) motivates them to seek peers who
share their gender group (Martin, Ruble, & Szkrybalo, 2002). With the help of
peers and adults, children learn gender stereotypes and how to do gender
correctly. Around six years of age childrens endorsement of gender stereo-
types, such as girls have long hair and boys have short hair, peaks and then
decline in adolescents. During this time childrens gender stereotyping is rigid
and they tend to dislike people who do not conrm to traditional gender norms
(Bem, 1993;Leaper & Farkas, 2015;Ruble et al., 2007). Childrens early
understanding of gender, especially for others, is relatively supercial in that
they believe that certain visual or behavioral characteristics can change
a persons gender. They also see gender as unstable, meaning it can change
across time. At about seven years of age children achieve an understanding of
gender as consistent and stable (Olson & Gülgöz, 2018).
Comparative research on cognitive gender development among children who
socially transitioned compared to children who use the same label as their birth
gender category suggests that both sets of children go through similar develop-
mental milestones. Specically, Olson and colleagues compared transgender
children to gender conforming (typical) siblings, and a control group of