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Undoing the Gender Binary

May 2020

DOI:10.1017/9781108584234

ISBN: 9781108731133

Authors:

Charlotte Tate

San Francisco State University

Ella Ben Hagai

California State University, Fullerton

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

UNDOING THE GENDER

BINARY

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

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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, ctate2@sfsu.edu

Abstract: 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 biomedical 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.

Keywords: transgender, gender, nonbinary, transphobia

ISBNs: 9781108731133 (PB), 9781108584234 (OC)

ISSNs: 2631-777X (online), ISSN 2631-7761 (print)

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Contents

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 Scientiﬁc Studies of Rejection and Acceptance 48

7Reﬂections and Parting Wishes 62

References 68

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1 Introduction

This is a scholarly work about “gender”and 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

deﬁne), the endeavor to demystify “gender”and unpack its multiple meanings is

profoundly personal. A few years ago, a member of the author’s 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 ﬁrst 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 Reich’s (2012) Transgender 101 and

Anne Boedecker’s (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 ﬁt 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 “waves”is a useful way to

discuss this) including the 1960–70s, 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 ﬁnd 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 ﬁnd 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 classiﬁed 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 men–women

division is often extended to nonhuman entities as well (Bem, 1993). Think

mother earth and father sky. At ﬁrst 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 reﬂection, 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. That’s more than

ten times the population of Mongolia; it’s four times the population of

Switzerland.

Today Americans, especially those who live on either coast, seem increas-

ingly accepting of gender ﬂuidity (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

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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.

Identiﬁcation with a gender different than the one assigned by authorities is the

essential component of the deﬁnition 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 afﬁrmation

through concepts and information.

Our work proceeds in seven sections. After this introduction, we present

basic information, deﬁning 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 “gender”separate 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

ﬁnal Section 7 is speculative, addressing questions of both a philosophical

and practical nature.

General readers may ﬁnd 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 ﬁnd 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 ﬂuidity 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 ﬁrst 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,

2014).

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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 ﬁve

women who testiﬁed in front of Congress regarding the brutal rapes that

occurred during the 1866 Memphis Riots (Stryker, 2008).

Although some people have deﬁed the gender binary across the millennia, it

is only in recent times that transgender individuals are not singled out as

belonging to some deﬁned 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 speciﬁc current issue. We would like to imagine that readers will be sparked to

reﬂect 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

Let’s start by deﬁning 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

classiﬁcation 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 deﬁnition, 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 deﬁnition, 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 deﬁnition of transgender is not the ﬁrst or

only that exists in scholarly literature. One of the better-known deﬁnitions

of transgender is presented by Stryker (2008). Stryker deﬁnes transgender

broadly, using the concept of the transgender umbrella (also, American

Psychological Association, 2015;Williams, 2014). She uses the term

“transgender umbrella”to:

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 deﬁne 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 deﬁned or concretely occupied; still others simply feel the need

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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 “transgender”that I want to develop

here. (p. 1; italics in original)

Stryker’sdeﬁnition includes many experiences from changing one’s legal

designation, to behaving in ways described as gender nonconforming. Our

deﬁnition 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 genderﬂuid,genderblended,or androgynous –being

both female and male, either concurrently or alternately –and other speciﬁc

labels, that differ from their assigned sex. These speciﬁc labels of agender and

genderblended ﬁt into a larger class of experiences that other scholars have

labeled genderqueer –with queer meaning unexpected or unusual, or not ﬁtting

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 deﬁnition, 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 ﬁnd 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, one’s own identity, is connected to but different

from one’s 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 Gilligan’s (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 individuals’gender

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 truth”that 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 magniﬁed 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 conﬁg-

urations in addition to XX and XY. In fact, there are six major chromosomal

conﬁgurations 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 conﬁgurations of XXYY

(Nielsen & Wohlert, 1991), XXXY, and XXXXY (Kleczkowska, Fryns, & Van

den Berghe, 1988). It is clear that some chromosomal conﬁgurations affect

bodily morphology –that is, how the body looks during development. For

instance, X0 (also called Turner’s Syndrome) has a characteristic lack of

development of the secondary sex characteristics, speciﬁcally the chest area.

Although individuals with an X0 conﬁguration 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 conﬁgurations (also called Klinefelter’s 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 conﬁgurations 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

conﬁgurations 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 conﬁgurations based on being insensitive to the

update of androgens prenatally (Hines, 2005).

Hormones. Each chromosome in the conﬁguration (whether a singleton,

a pair, a trio, or larger) signals the releases of classes of speciﬁc hormones

collected into the general names of androgens and estrogens. While androgens

(e.g., testosterone, dihydrotestosterone) are sometimes called the “male”hor-

mones and estrogens (e.g., progesterone, estriol) the “female”hormones, all sex

chromosomes produce some amount of both of these classes. Thus, everyone

has “female”and “male”hormones even before birth.

Whatusuallydifferentiatesaroundtheeighthweekofgestationinto

afemaleconﬁguration (with a vulva and vagina) or a male conﬁguration

(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 conﬁgura-

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 conﬁguration

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 newborn’s 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

forms).

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-ﬁve

(rather than forty-six) chromosomes. Turner’s Syndrome is often depicted as

X0. Most individuals with the X0 conﬁguration develop a vagina and vulva at

birth –external genitalia –but their internal genitalia, speciﬁcally 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 identiﬁed 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)-deﬁciency

(or more formally “5-alpha-reductase deﬁciency”), 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 deﬁned 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 characteristics”include

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. “Secondary”literally 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 ﬂipside 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 difﬁcult 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 12,000–14,000 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 difﬁcult 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 difﬁcult 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 scientiﬁc 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

inﬂuences (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 “resist”gender 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-Sterling’s 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 child’s 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-Sterling’s argument is that how the child

is treated from birth to three years old forms the child’s 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 difﬁcult 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 individual’s 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 “women”in 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 men’s 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/them”and 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 person’s social

experiences. Gender designations show up on government-issued identiﬁcation

(e.g., state ID cards, driver’s licenses). Unsurprisingly, the gender designation

usually refers to the person’s 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 individual’s 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 one’s legal gender designator not only depends on the

availability of that option in one’s state, province, or country of residence, but

it also almost always depends on paying fees. Advertising one’s 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 ﬁnd 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 individual’s sense of self. Thus, bodily transition should

be viewed as simply one way to deﬁne the concept of “transition”for transgen-

der folks –one that often co-occurs with, but is secondary to, social

transitioning.

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-ﬁve 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-afﬁrming 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):

http://transhealth.ucsf.edu/protocols. 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

hormones.

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 child’s 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 Adam’s

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 body’s own pubertal process buys time before irreversible pubertal

changes occur. This in turn allows transgender children in particular to

receive afﬁrming 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,

2010).

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 “normal”teenagers.

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 ﬁnancial 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 ﬁrst 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 demystiﬁes processes and that demystiﬁcation 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

cancer.

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 person’s 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 ﬂattened 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

men’s external genitals, testosterone enlarges the clitoris; yet some trans men

may wish to have a surgically constructed penis and scrotum. For trans men’s

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

construction”and “scrotum construction”) that uses the man’s 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 ﬂap 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 ﬁlled 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 patients’self-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.

24 Undoing the Gender Binary

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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 ﬂuidity of gender and to

the complexity of the very concept of gender. We ﬁnd 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 ﬁrst 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

Gender

Birth-

Assigned

Gender