Gender identity

Gender identity (or core gender identity) is a person's own sense of identification as male or female. The term is intended to distinguish this psychological association, from physiological or sociological determinations of gender. Gender identity was originally a medical term used to explain sex reassignment procedures to the public. The term is also found in psychology, often as core gender identity. Sociology, gender studies and feminism are still inclined to refer to gender identity, gender role and erotic preference under the catch-all term gender.

Gender identity is affected by "genetic, prenatal hormonal, postnatal social, and postpubertal hormonal determinants." Biological factors include the influence of testosterone and gene regulation in brain cells. Social factors are primarily based on the family, as gender identity is thought to be formed by the third year of life.

The Diagnostic and Statistical Manual of Mental Disorders (302.85) has five criteria that must be met before a diagnosis of gender identity disorder (GID) can be made. "In gender identity disorder, there is discordancy between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine."

Gender identity - below the surface
Most human beings are considered to be cisgendered, attributed to either women or men, on the basis of their biological sex. Before the 20th century a person's sex would be determined entirely by the appearance of the genitalia, but as chromosomes and genes came to be understood, these were then used to help determine sex. Those defined as women, by sex, have genitalia that is considered female as well as two X chromosomes; those viewed as men, by sex, are seen as having male genitalia, one X and one Y chromosome. However some individuals have combinations of chromosomes, hormones, and genitalia that do not follow the traditional definitions of "men" and "women". In addition, genitalia vary greatly or individuals may have more than one type of genitalia, and other bodily attributes related to a person's sex (body shape, facial hair, high or deep voice, etc.) may or may not coincide with the social category, as woman or man, assigned to that person according to her or his genitalia. Recent research suggests that as many as one in every hundred individuals may have some intersex characteristic. Transgender individuals are those whose gender expression and/or their genitalia and sex chromosomes differ from the traditional definitions.

Gender identities (specifically, which aspects are considered proper behavior and appearances for men, women, etc.) differ greatly across societies, and many people's gender identities do not exactly follow the stereotyped roles of "women" and "men", although some diverge more than others. The most easily understood case in which it becomes necessary to distinguish between sex and gender is that in which the external genitalia are removed - when such a thing happens through accident or through deliberate intent, the libido and the ability to express oneself in sexual activity are changed, but the individual's gender identity may or may not change. One such case is that of David Reimer, reported in As Nature Made Him by John Colapinto. It details the persistence of a male gender identity and the stubborn adherence to a male gender role of a person whose penis had been totally destroyed shortly after birth as the result of a botched circumcision, and who had subsequently been surgically reassigned by constructing female genitalia. In other cases, a person's gender identity may contrast sharply with that assigned to them according to their genitalia, and/or a person's gendered appearance as a woman or man (or an androgynous person, etc.) in public may not coincide with their physical sex. So the term "gender identity" is broader than the sex of the individual as determined by examination of the external genitalia.

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

When the gender identity of a person makes him a man, but his genitals are female, he may experience what is called gender dysphoria, i.e., a deep unhappiness caused by his experience of himself as a man and his lack of male genitals.

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

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


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

Gender identity and sex
Some people do not believe that their gender identity corresponds to their biological sex, namely transgender people, including transsexual people and many intersexed individuals as well. Consequently, complications arise when society insists that an individual adopt a manner of social expression (gender role) which is based on sex, that the individual feels is inconsistent with that person's gender identity.

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

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

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

Relationship to gender role
The related term, "gender role," has two meanings that in individual cases may be divergent: First, people's gender roles are the totality of the ways by which they express their gender identities. Second, people's gender roles may be defined as the kinds of activities that society determines to be appropriate for individuals possessing their kind of external genitalia.

There are probably as many shades and complexities of sexual identity and gender identity as there are human beings, and there are an equal number of ways of working those gender identities out in the intricacies of daily life. Societies, however, tend to assign some classes of social roles to "male" individuals, and some classes of social roles to "female" individuals (as society perceives their sexes). In some societies, there are other classes of social roles for, e.g., surgically neutered physiological male. See Hijra (India), for example. Sometimes the connection between gender identity and gender role is unclear. The original oversimplification was that there are unambiguously male human beings and unambiguously female human beings, that they are clearly men and clearly women, and that they should behave in all important ways as women and men "naturally" behave. (Compare Heteronormativity) Investigations in biology and sociology (see Biology of gender) have strongly supported the view that "the sex between the ears is more important than the sex between the legs", and the implication has been that people with masculine gender identities will truthfully give external representation of their gender identities by adopting gender roles that are appropriate to men, and, similarly, that people with feminine gender identities will adopt gender roles that are appropriate to women. It may be very difficult to determine, however, whether a specific drag queen is someone who has a female gender identity and is learning a female gender role, or whether that person is someone with a male gender identity who enjoys mimicking a female gender role to entertain others, to taunt the more rigid members of his society, or for some other reason, such as to repudiate the value or validity of rigid gender roles. Some, such as RuPaul, refuse to be categorized.

Some famous people known for their cross-dressing or androgynous appearances in the 20th century include Brett Anderson,Dame Edna, Gladys Bentley, David Bowie, Pete Burns, Eddie Izzard, Boy George, Norman Iceberg, k.d. lang, Annie Lennox, Jaye Davidson, Marilyn Manson, Marlene Dietrich, Mylène Farmer, Gackt, Grace Jones, Patrick Wolf, Marc Bolan, Brian Molko, Pat, Phranc, Madonna, Prince, Susan Powter, Kate Bornstein, and Kristen McMenamy.

Conceptual origins
During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of homosexuality (which was still viewed as a mental disorder at the time). In 1958, the Gender Identity Research Project was established at the UCLA Medical Center for the study of intersexuals and transexuals. 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 1963. Psychoendocrinologist 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. Money's famous case study was David Reimer. Money wrote that Reimer's sex reassignment proved that gender identity is socially constructed. Reimer later went public with accusations that he had always identified as male, and that Money had largely fabricated his results.

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

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

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

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

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


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

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

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

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