Throughout history, many civilizations have distinguished between sex and gender identity despite lacking the technology to further explore this question. Kānaka Maoli culture in Hawaii identified a third gender, “māhū”, the Polynesian people in Samoa similarly recognize a separate third gender, “fa’afafine”, and the list continues. Yet in present day, this distinction has become a contentious topic in our binary world. In our digital world, we regularly encounter countless claims on this topic from podcasters, news sites, and even Instagram stories. How often do these voices provide substantiated evidence? Though these assertions are no longer shared by many scientists, including the CDC and the WHO, many still believe sex is equal to gender and is either male or female.
Before continuing, ask yourself: How often have I heard phrases like: “it’s just basic biology”, “you can’t change your chromosomes”, “there are only 2 genders”, or even “facts over feelings” used in these debates? Especially on social media platforms, these assertions come in multitudes, identical in their brevity and lack of sources. But what if I told you it was a bit more complex than just chromosomes or feelings? What if I told you that the actual explanation is much beyond the elementary level of biology to which the discussion of sex and gender is often attributed?
Before moving on, click below to learn more about the terminology used in this post!
Cisgender: An adjective describing a person whose gender identity is the same as the sex which they were assigned at birth.
Gender: “Gender refers to the characteristics (…) that are socially constructed. This includes norms, behaviours and roles (…) As a social construct, gender varies from society to society and can change over time” (World Health Organization).
Gender Identity: Gender identity is related to sex and to gender, but is a much more “deeply felt, internal and individual experience of gender” (World Health Organization).
Sex: Sex “refers to the different biological and physiological characteristics of females, males and intersex persons, such as chromosomes, hormones and reproductive organs” (World Health Organization). People are typically assigned male (AMAB), female (AFAB), or intersex at birth. Intersex is a term referring to natural sexual variations, whether in chromosomes, gonads, or genitals. Intersex people further demonstrate that nothing relating to sex or gender identity is as binary as we believe.
Transgender: For the purposes of this post, transgender is an adjective describing a person whose gender identity is not the same as the sex which they were assigned at birth. Many may choose to go by different labels, as transgender is a broad umbrella term.
What Do We Know Now?
Despite the slow progress of research into gender identity due to a history of intolerance, studies have already uncovered important clues into when gender identity contradicts assigned sex at birth.
Twin studies have shown that there is a genetic component to gender identity. Even more concretely, though, we can also see biological components to gender identity. Certain parts of the brain are sexually dimorphic, meaning that these areas are markers for distinguishing between a “male” and “female” brain. However, gender identity can alter these markers.
Two independent studies in 1995 and 2000 explored one particular sexually dimorphic region of the brain: the bed nucleus of the stria terminalis (BSTc or BNST). The BSTc is responsible for stress or anxiety-related emotional and behavioral responses. Typically, the BSTc is two times as large and more densely packed with cells in cisgender males than in cisgender females. The major cell population in the BSTc are SOM-expressing neurons. Gender-affirming hormone therapy (HRT) can alter the BSTc, but both studies used only pre-HRT transgender subjects.
Both studies observed that a person’s gender identity dictated the appearance of their BSTc. The 1995 study, Zhou et. al, found that the BSTc in male-to-female (MTF) transgender females was more similar that in cisgender females. The 2000 study, Kruijver et. al, expanded on these findings. Cisgender males typically had almost twice as many SOM-expressing neurons as cisgender females. Yet results showed that female-to-male (FTM) transgender males had numbers closer to cisgender males and MTF females had numbers closer to cisgender females, as seen in Fig.1.
Other studies have also explored neurological sexual dimorphism and gender identity. A 2010 study, Rametti et. al, examined white matter fibers of cis- and transgender males and females, finding that in three out of four regions, FtM males had white matter more similar to that of cisgender males than to cisgender females. Another study found 19 variants in 21 genes in estrogen-signaling pathways, which help to determine if a brain is more male or female.
Without a doubt, more research needs to be done on gender identity. A 2009 study, Luders et. al, found that in MTF females, the regional pattern of grey matter was more similar to cisgender males, but the regional volume of grey matter was more similar to cisgender females. Contradictions like these emphasize the need for research into such an important topic. However, research so far has provided evidence that a biological basis for gender identity, even when contradicting assigned sex, exists.
Call For Action
We cannot wait for more research to improve our systems. The Trevor Project’s “National Survey on LGBTQ Youth Mental Health 2020” highlights that there is still work to be done in order to create a safe and equitable world for transgender people. The following statistics clearly highlight a strong correlation between support and safety: transgender youth with less support were less safe. The following list includes 2020 statistics for LGBTQ+ youth, 13-24, regarding gender identity and mental health, safety, and acceptance:
Children may recognize their gender identity at a young age. Schools are where children spend most of their time. Logically, schools must be better equipped to educate children about gender identity. Good education can ensure that more transgender children grow up in supportive environments. This might look like:
- Being open with children who ask about gender identity
- Breaking down gender norms at an early age
- Respecting pronouns, name, bathroom, and teams
- Having books in classrooms and reading curricula with transgender characters
- Including social-emotional learning (SEL)
- Having open talks with those who make discriminatory statements
- Having all-gender sex education classes with gender inclusive language and discussions of gender identity
- Using language intentionally in science classes and explaining sex and gender identity at an age-appropriate difficulty level
- Having a safe and accessible counseling office
- Providing support for students who are unsafe at home, especially with housing instability
- Guiding students through complicated legal processes, such as, but not limited to, official name changes or license updates
- Connecting students to support spaces, online or in-person
Healthcare & Medical Research
My course focused on not just solving medical case study problems, but also on addressing issues within the healthcare system. It is important for healthcare to be a safe system so that transgender and nonbinary people can receive good medical support. Transgender people may seek gender-affirming treatment, from puberty blockers and hormone therapy to surgery, and it is important for them to feel safe while doing so.
There were seven major reasons for lack of access to mental health care among transgender and nonbinary responses. The most popular was cost, but the list also included issues like no LGBTQ-competent providers and past negative experiences. These barriers for transgender people likely also exist in other healthcare services.
Oppressive legislation has prevented access to coverage for gender-affirming treatments. In the 2015 US Transgender Survey, 25% of respondents reported difficulty with health insurance related to their gender identity. Furthermore, 1/3 of respondents mentioned having a negative experience with a provider in the previous year, 1/7 reported unnecessary questions about their gender, and 1/4 said that they had to educate their provider to get care. There are issues within the healthcare system that must be addressed to ensure adequate coverage for transgender people.
Moving forward, we need to improve the healthcare system to better support transgender and nonbinary people. This could look like:
- Addressing misconceptions about medical transition:
- Young children are not being placed on HRT.
- Young children are not receiving gender-affirming surgery.
- Puberty blockers are reversible and create extra time for people to think before making permanent decisions (HRT and surgery).
- All of the above are carefully restricted.
- Protecting transgender people’s access to insurance-covered treatments
- Funding research into gender identity to improve past studies and medical transition techniques
- Better educating healthcare providers on treatments for interested transgender patients
- Emphasizing social justice in medical school
- Equipping providers with the tools to support transgender people through equity training
- Ensuring medical/hospital records have preferred names noted down, even if the name has not been legally change
The above goals are quite lofty and must be pursued on a national, even a global, scale. On a more local level, everybody can make a difference in this movement. No matter how “safe” your community may seem, transgender people may struggle to find enough support, whether at home, school, work, or just in public. So what can you do?
- If your local politician, whether state, federal, or even just town, has expressed anti-transgender sentiment or neutrality on the topic, call their office! Be sure to give your address if you leave a voicemail.
- Research books with transgender protagonists/characters and suggest them to your local library and school!
- Do your research and speak out when someone sources unsupported information.
- For parents or educators, teach this to children! Children are the future and teaching them to be accepting at a young age is promising for the future.
- For my peers, support your fellow students and do your part in making schools a safer and more accepting place!
- Be intentional with your language.
Change happens by improving our systems, both education and healthcare, but it starts locally, one conversation at a time. Not everything is known yet about the science behind gender identity and sex (for example, follow-up studies on the BSTc showed that full sexual dimorphism is not present until the early 20s, but many realize their gender identity at a young age). What we do know is that kindness saves lives and we must create more supportive systems for everyone, transgender people included.
Engage with me and others in the comments!
- What have you heard about gender identity, science or not?
- Where did you learn about gender identity?
- Tell me more about what a more supportive world for transgender people looks like to you!