Talking about gender understandably brings up a lot of feelings. We’re having heated discussions around bathroom bills, gender-affirming medical care and transgender athletes. Politicians opine about the dangers of “gender ideology” in schools and children being “mutilated and sterilized.” Others have decried the rise in adolescents identifying as transgender and nonbinary as a “social contagion,” likening gender diversity to a disease.
It’s easy to get overwhelmed and want to run away from these discussions altogether. But engaging with questions around gender identity with nuance is essential as national debates escalate. Gender identity, for all of us, isn’t simple or binary; it’s neither just biology nor just a social construct. There’s dramatic variability in how people experience gender identity beyond cisgender (people who identify as the sex they are assigned at birth) and transgender or male and female. Younger people especially are opening up about gender and thinking about this part of their identities with more nuance and clarity than older generations typically have.
In my clinical practice, I often help parents talk to their trans children about gender identity using a three-part framework that I’ve found allows people to better understand one another. Perhaps it can help all of us engage with today’s political debates with more understanding and even help us — regardless of our gender identities — understand ourselves on a deeper level.
The most basic part of gender identity is what I call our transcendent sense of gender. In a way that goes beyond language, people often just feel male or female, and some more strongly than others. This can manifest in different ways. Some of my young patients draw themselves as a certain gender and have a “wow, this is me” feeling. Others have strong positive feelings when people use certain pronouns for them, or strong negative feelings when people use other pronouns. As is the case with many emotions, it’s hard to describe this transcendent feeling in words. But it is the foundation of our gender identity, the scaffolding we’re born with. Research, including studies focused on twins, suggests these transcendent gender feelings have a strong innate biological basis.
The next part of our gender identity is the social domain. As we move through life, we build on the biology of gender identity with language and social experience, influenced by everything from the TV shows we watch to how we interact with classmates and our families. Maybe you were raised to think women are nurturing, passive and creative while men are assertive and strong, or that dolls are for girls and football is for boys. What my work has taught me is that very few of us actually relate 100 percent to male or female social categories. Some people may love ballet and wrestling. Or they may enjoy pickup trucks and knitting. To make it even more complicated, these feelings can evolve over time — the way an 18-year-old college student thinks about her womanhood is likely different from how she thinks about it when she becomes a 40-year-old mother of three.
The social aspect can cut both ways. For some people, rejecting gender role stereotypes is even more vital to their gender identity than adhering to them. I’ve had patients, for example, who hate the expectations placed on women in American society. They began using they/them pronouns as a way to express rejection of those expectations. However, they loved their birth names and bodies and had no interest in gender-affirming medical interventions. There are others who identify strongly as cisgender and express their rejection of gender stereotypes in other ways. The existence of one type of person does not invalidate the experience of another.
The third part of gender identity is the physical domain — how we feel about our bodies. Some people identify as transgender and are happy with their bodies. Others are distressed by their gendered physical attributes. They may feel that their deepening voices or the shapes of their chests are at odds with their senses of self. This incongruence can lead to eating disorders, anxiety or depression, which is when doctors may consider gender-affirming medical interventions.
Among those who do have concerns with their physical sex characteristics, there is variation. For instance, many people have gender-related concerns about their chests, but not their genitals. Acknowledging this complexity, medical guidelines say it is essential for young people to have comprehensive mental health evaluations before initiating any gender-affirming medical intervention, to ensure their treatment team has a broad understanding of their gender identity experience and the best ways (both medical and nonmedical) to support them.
Gender identity is complex. It’s highly personal, and not everyone thinks about it the same way. To understand other people, we need to be flexible and listen to their self-conceptualizations, even when their frameworks are different from the ones we’re used to.
The three domains of transcendent sense of gender, social gender and our relationships to our physical bodies can combine in nearly infinite ways. If we want to understand and support one another, both at the individual level and in our political conversations, we need to appreciate this complexity.
It may even help us understand our own identities in ways we never have before.