Gender identity
Gender identity is the personal sense of one's own gender.[1] Gender identity can correlate with a person's assigned sex or can differ from it. In most individuals, the various biological determinants of sex are congruent, and consistent with the individual's gender identity.[2] Gender expression typically reflects a person's gender identity, but this is not always the case.[3][4] While a person may express behaviors, attitudes, and appearances consistent with a particular gender role, such expression may not necessarily reflect their gender identity. The term gender identity was coined by psychiatry professor Robert J. Stoller in 1964 and popularized by the controversial psychologist John Money.[5][6][7]
"Gender identification" redirects here. For the process of determining the sex of a human, see Sex assignment. For the process of determining the sex of an individual animal, see Sexing.
In most societies, there is a basic division between gender attributes associated with males and females,[8] a gender binary to which most people adhere and which includes expectations of masculinity and femininity in all aspects of sex and gender: biological sex, gender identity, gender expression,[9][10] and sexual orientation. Some people do not identify with some, or all, of the aspects of gender associated with their biological sex;[11] some of those people are transgender, non-binary, or genderqueer. Some societies have third gender categories.
The 2012 book Introduction to Behavioral Science in Medicine says that with exceptions, "Gender identity develops surprisingly rapidly in the early childhood years, and in the majority of instances appears to become at least partially irreversible by the age of 3 or 4".[12][13] The Endocrine Society has stated "Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity."[14]
Essentialists argue that gender identity is determined at birth by biological and genetic factors, while social constructivists argue that gender identity and the way it is expressed are socially constructed, instead determined by cultural and social influences.[15]
Age of formation
There are several theories about how and when gender identity forms, and studying the subject is difficult because children's immature language acquisition requires researchers to make assumptions from indirect evidence.[16] John Money suggested children might have awareness of and attach some significance to gender as early as 18 months to 2 years; Lawrence Kohlberg argued that gender identity does not form until age 3.[16] It is widely agreed that core gender identity is firmly formed by age 3.[16][12][17] At this point, children can make firm statements about their gender[16][18] and tend to choose activities and toys which are considered appropriate for their gender[16] (such as dolls and painting for girls, and tools and rough-housing for boys),[19] although they do not yet fully understand the implications of gender.[18] After age three, it is extremely difficult to change gender identity.[13]
Martin and Ruble conceptualize this process of development as three stages: (1) as toddlers and pre-schoolers, children learn about defined characteristics, which are socialized aspects of gender; (2) around the ages of five to seven years, identity is consolidated and becomes rigid; (3) after this "peak of rigidity", fluidity returns and socially defined gender roles relax somewhat.[20] Barbara Newmann breaks it down into four parts: (1) understanding the concept of gender, (2) learning gender role standards and stereotypes, (3) identifying with parents, and (4) forming gender preference.[18]
According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) comprehensive sexuality education should raise awareness of topics such as gender and gender identity.[21]
Factors influencing formation
Nature versus nurture
Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. In particular, the extent to which it is determined by socialization (environmental factors) versus innate (biological) factors is an ongoing debate in psychology, known as "nature versus nurture". Both factors are thought to play a role. Biological factors that influence gender identity include pre- and post-natal hormone levels.[22] While genetic makeup also influences gender identity,[23] it does not inflexibly determine it.[24]
Social factors which may influence gender identity include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in a child's life.[25] When children are raised by individuals who adhere to stringent gender roles, they are more likely to behave in the same way, matching their gender identity with the corresponding stereotypical gender patterns.[26] Language also plays a role: children, while learning a language, learn to separate masculine and feminine characteristics and subconsciously adjust their own behavior to these predetermined roles.[27] The social learning theory posits that children furthermore develop their gender identity through observing and imitating gender-linked behaviors, and then being rewarded or punished for behaving that way,[28] thus being shaped by the people surrounding them through trying to imitate and follow them.[29] Large-scale twin studies suggest that the development of both transgender and cisgender gender identities is due to innate genetic factors, with a small potential influence of unique environmental factors.[30]
John Money was instrumental in the early research of gender identity, though he used the term gender role.[31] He disagreed with the previous school of thought that gender was determined solely by biology. He argued that infants are born a blank slate and a parent could be able to decide their babies' gender.[32] In Money's opinion, if the parent confidently raised their child as the opposite sex, the child would believe that they were born that sex and act accordingly.[33] Money believed that nurture could override nature.[32]
History and definitions
Definitions
The terms gender identity and core gender identity were first used with their current meaning—one's personal experience of one's own gender[1][16]—sometime in the 1960s.[88][89] To this day they are usually used in that sense,[8] though a few scholars additionally use the term to refer to the sexual orientation and sexual identity categories gay, lesbian and bisexual.[90] Gender expression is distinct from gender identity in that gender expression is how one chooses to outwardly express their gender through one's "name, pronouns, clothing, hair style, behavior, voice or body features."[91] It is thus distinct from gender identity in that it is the external expression of gender but may not necessarily portray a person's gender identity and may vary "according to racial/ethnic background, socio-economic status and place of residence."[92]
Early medical literature
In late-19th-century medical literature, women who chose not to conform to their expected gender roles were called "inverts", and they were portrayed as having an interest in knowledge and learning, and a "dislike and sometimes incapacity for needlework".[93] During the mid-1900s, doctors pushed for corrective therapy on such women and children, which meant that gender behaviors that were not part of the norm would be punished and changed.[94][95] The aim of this therapy was to push children back to their "correct" gender roles and thereby limit the number of children who became transgender.[93]
Freud and Jung's views
In 1905, Sigmund Freud presented his theory of psychosexual development in Three Essays on the Theory of Sexuality, giving evidence that in the pregenital phase children do not distinguish between sexes, but assume both parents have the same genitalia and reproductive powers. On this basis, he argued that bisexuality was the original sexual orientation and that heterosexuality was resultant of repression during the phallic stage, at which point gender identity became ascertainable.[96] According to Freud, during this stage, children developed an Oedipus complex where they had sexual fantasies for the parent ascribed the opposite gender and hatred for the parent ascribed the same gender, and this hatred transformed into (unconscious) transference and (conscious) identification with the hated parent who both exemplified a model to appease sexual impulses and threatened to castrate the child's power to appease sexual impulses.[28] In 1913, Carl Jung proposed the Electra complex as he both believed that bisexuality did not lie at the origin of psychic life, and that Freud did not give adequate description to the female child (Freud rejected this suggestion).[97]
1950s and 1960s
During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of homosexuality (which was viewed as a mental disorder at the time). In 1958, the Gender Identity Research Project was established at the UCLA Medical Center for the study of intersex and transsexual individuals. Psychoanalyst Robert Stoller generalized many of the findings of the project in his book Sex and Gender: On the Development of Masculinity and Femininity (1968). He is also credited with introducing the term gender identity to the International Psychoanalytic Congress in Stockholm, Sweden, in 1963.[98] Behavioral psychologist John Money was also instrumental in the development of early theories of gender identity. His work at Johns Hopkins Medical School's Gender Identity Clinic (established in 1965) popularized an interactionist theory of gender identity, suggesting that, up to a certain age, gender identity is relatively fluid and subject to constant negotiation. His book Man and Woman, Boy and Girl (1972) became widely used as a college textbook, although many of Money's ideas have since been challenged.[99][100]
Butler's views
In the late 1980s, gender studies scholar Judith Butler began lecturing regularly on the topic of gender identity, and in 1990, they published Gender Trouble: Feminism and the Subversion of Identity, introducing the concept of gender performativity.[101] Butler argues that the traditional view of gender is limiting in that it adheres to the dominant societal constraints that label gender as binary. In scrutinizing gender, Butler introduces a nuanced perception in which they unite the concepts of performativity and gender.[102]
Present views
Medical field
Transgender people sometimes wish to undergo physical surgery to refashion their primary sexual characteristics, secondary characteristics, or both, because they feel they will be more comfortable with different genitalia. This may involve removal of penis, testicles or breasts, or the fashioning of a penis, vagina or breasts.[103] In the past, sex assignment surgery has been performed on infants who are born with ambiguous genitalia. However, current medical opinion is strongly against this procedure on infants, and recommends that the procedure be only conducted when medically necessary.[104] Today, gender-affirming surgery is performed on people who choose to transition so that their external sexual organs will match their gender identity.[105]
In the United States, the Affordable Care Act provided that health insurance exchanges would have the ability to collect demographic information on gender identity and sexual identity through optional questions, to help policymakers better recognize the needs of the LGBT community.[106] In 2020, however, the Trump administration finalized a rule that "would remove nondiscrimination protections for LGBTQ people when it comes to health care and health insurance" in the Affordable Care Act and extends to "regulations pertaining to access to health insurance."[107] This rule "is one of the many rules and regulations put forward by the Trump administration that defines "sex discrimination" as only applying when someone faces discrimination for being male or female, and does not protect people from discrimination on the basis of sexual orientation or gender identity."[107]
Measurement
No objective measurement or imaging of the human body exists for gender identity, as it is part of one's subjective experience.[119][120] Numerous clinical measurements for assessing gender identity exist, including questionnaire-based, interview-based and task-based assessments. These have varying effect sizes among a number of specific sub-populations.[121] Gender identity measures have been applied in clinical assessment studies of people with gender dysphoria or intersex conditions.