Gender identity is a person's sense of identification with either the male or female sex, as manifested in appearance, behavior, and other aspects of a person's life.
Psychologists believe human sexual identities are made up of three separate components. The first shows the direction of a child's sexual orientation, whether he or she is heterosexual (straight), homosexual (gay), or bisexual. The second is the child's style of behavior, whether a female is a "tomboy" or homemaker-type and a male is a "macho guy" or a "sensitive boy." The third component is what psychologists call the core gender identity. According to an article in the May 12, 2001 issue of New Scientist, it is the most difficult to ascertain but is essentially the deep inner feeling a child has about whether he or she is a male or female.
In most people, the three components point in the same direction but in some people, the components are more mixed. For example, a gay woman (lesbian) might look and act either feminine or masculine (butch), but she still deeply feels she is a female. Scientists are uncertain about where the inner feeling of maleness or femaleness comes from. Some believe it is physical, from the body, while others believe it is mental, from the hypothalamus region of the brain. There is also debate on whether the determination is shaped by hormones, particularly testosterone and estrogen, or by genes assigned at conception.
Gender identity emerges by the age of two or three and is influenced by a combination of biological and sociological factors reinforced at puberty. Once established, it is generally fixed for life.
Aside from sex differences, other biological contrasts between males and females are already evident in childhood. Girls mature faster than boys, are physically healthier, and are more advanced in developing oral and written linguistic skills. Boys are generally more advanced at envisioning and manipulating objects. They are more aggressive and more physically active, preferring noisy, boisterous forms of play that require larger groups and more space than the play of girls the same age.
In spite of conscious attempts to reduce sex role stereotyping in the final decades of the twentieth century and in the early 2000s, boys and girls are still treated differently by adults from the time they are born. The way adults play with infants has been found to differ based on gender. Girls are treated more gently and approached more verbally than boys. As children grow older, many parents, teachers, and other authority figures still tend to encourage independence, competition, aggressiveness, and exploration more in boys and expression, nurturance, motherhood and childrearing, and obedience more in girls.
Infancy and toddlerhood
There is a growing amount of scientific research that suggests gender identity develops at a very early age.
Gender identification is often associated with the choice and use of toys in this age group, according to a number of studies done in the 1970s, 1980s, and 1990s. Sex differences in toy play have been found in children as young as one year old. By age two, children begin to spontaneously choose their types of toys based on gender. Several of these studies show that by age one, boys display a more assertive reaction than girls to toy disputes. By age two, the reaction of boys is more aggressive.
Most two-year-olds know whether they are boys or girls and can identify adults as males or females. By age three, most children know that men have a penis and women have breasts. Also at age three, children begin to apply gender labels and stereotypes, identifying gentle, empathic characteristics with females and strong, aggressive characteristics with males. Even in the twenty-first century, most young children develop stereotypes regarding gender roles, associating nurses, teachers, and secretaries as females and police officers, firefighters, and construction workers as males.
Preschoolers develop an increasing sense of self-awareness about their bodies and gender differences. Fears about the body and body mutilation, especially of the genitals, are often major sources of fear in preschoolers. As children become more aware of gender differences, preschoolers often develop intense feelings of vulnerability and anxiety regarding their bodies.
By the age of six years, children are spending about 11 times as much time with members of their own sex as with children of the opposite sex. This pattern begins to change as the child approaches puberty, however.
By the teenage years, most children have an established sexual orientation of heterosexual, homosexual, or bisexual. They have also established their style of behavior and core sexual identity. However, a very small fraction have not.
While most children follow a predictable pattern in the acquisition of gender identity, some develop a gender identity inconsistent with their biological sex, a condition variously known as gender confusion, gender identity disorder, or transsexualism, which affects about one in 20,000 males and one in 50,000 females. Researchers have found that both early socialization and hormonal factors may play a role in the development of gender identity disorder. Children with gender identity disorder usually feel from their earliest years that they are trapped in the wrong body and begin to show signs of gender confusion between the ages of two and four. They prefer playmates of the opposite sex at an age when most children prefer to spend time in the company of same-sex peers. They also show a preference for the clothing and typical activities of the opposite sex; transsexual boys like to play house and play with dolls. Girls with gender identity disorder are bored by ordinary female pastimes and prefer the rougher types of play typically associated with boys, such as contact sports.
Both male and female transsexuals believe and repeatedly insist that they actually are, or will grow up to be, members of the opposite sex. Girls cut their hair short, favor boys' clothing, and have negative feelings about maturing physically as they near adolescence. In childhood, girls with gender identity disorder experience less overall social rejection than boys, as it is more socially acceptable for a girl to be a tomboy than for a boy to be perceived as feminine. About five times more boys than girls are referred to therapists for this condition. Teenagers with gender identity disorder suffer social isolation and are vulnerable to depression and suicide. They have difficulty developing peer relationships with members of their own sex as well as romantic relationships with the opposite sex. They may also become alienated from their parents.
The psychological diagnosis of gender identity disorder (GID), commonly called transsexualism, is used to describe a male or female who feels a strong identification with the opposite sex and experiences considerable distress because of their actual sex. Children with gender identity disorder have strong cross-gender identification. They believe that they are, or should be, the opposite sex. They are uncomfortable with their sexual role and organs and may express a desire to alter their bodies.
While not all persons with GID are labeled as transsexuals, there are those who are determined to undergo sex change procedures or have done so, and, therefore, are classified as transsexual. They often attempt to pass socially as the opposite sex. Transsexuals alter their physical appearance cosmetically and hormonally and may eventually undergo a sex-change operation.
Most children eventually outgrow gender identity disorder. About 75 percent of boys with gender identity disorder develop a homosexual or bisexual orientation by late adolescence or adulthood, but without continued feelings of transsexuality. Most of the remaining 25 percent become heterosexuals (also without transsexuality). Those individuals in whom gender identity disorder persists into adulthood retain the desire to live as members of the opposite sex, sometimes manifesting this desire by cross-dressing, either privately or in public. In some cases, adult transsexuals (both male and female) have their primary and secondary sexual characteristics altered through a sex change operation, consisting of surgery and hormone treatments.
Children with gender identity disorder refuse to dress and act in sex-stereotypical ways. It is important to remember that many emotionally healthy children experience fantasies about being a member of the opposite sex. The distinction between these children and gender identity disordered children is that the latter experience significant interference in functioning because of their cross-gender identification. They may become severely depressed, anxious, or socially withdrawn.
According to an article in the January 2003 issue of The Brown University Child and Adolescent Behavior Letter, psychiatrists offer these suggestions for parents of children diagnosed with GID:
- Create an atmosphere of acceptance so the child feels safe within the family to express his or her interests. Identify and praise the child's talents.
- Use gender-neutral language in discussing romantic attachments.
- Watch television programs and movies and read books that have gay themes or characters.
- Encourage the child to find activities that respect his or her interests, yet help the child "fit in" to society.
- Insist on classroom discussions about diversity and tolerance. Ensure the child's school has anti-discrimination policies that include gender identity and that the policies are enforced.
- If indicated, take the child to a psychotherapist with expertise and tolerance for issues related to gender identity and sexual orientation.
Core gender identity—The deep inner feeling a child has about whether he or she is a male or female.
Estrogen—Female hormone produced mainly by the ovaries and released by the follicles as they mature. Responsible for female sexual characteristics, estrogen stimulates and triggers a response from at least 300 tissues. After menopause, the production of the hormone gradually stops.
Gender identity disorder (GID)—A strong and lasting cross-gender identification and persistent discomfort with one's biological gender (sex) role. This discomfort must cause a significant amount of distress or impairment in the functioning of the individual.
Psychotherapy—Psychological counseling that seeks to determine the underlying causes of a patient's depression. The form of this counseling may be cognitive/behavioral, interpersonal, or psychodynamic.
Testosterone—Male hormone produced by the testes and (in small amounts) in the ovaries. Testosterone is responsible for some masculine secondary sex characteristics such as growth of body hair and deepening voice. It also is sometimes given as part of hormone replacement therapy to women whose ovaries have been removed.
Transsexualism—A term used to describe a male or female that feels a strong identification with the opposite sex and experiences considerable distress because of their actual sex. Also called gender identity disorder.
When to call the doctor
Gender identity disorder is generally diagnosed when children display any four of the following symptoms:
- They repeatedly state a strong desire to be, or insist that they are, of the opposite sex.
- They show a marked preference for cross-dressing.
- They display a strong and long-term preference for fantasies and role-play as members of the opposite sex.
- They participate in or want to play stereotypical games of the opposite sex.
- They show a strong preference for friends and playmates of the opposite sex.
GID is typically diagnosed by a psychiatrist or psychologist, who conducts an interview with the patient and takes a detailed social history. Family members may also be interviewed during the assessment process. Most children diagnosed with GID eventually grow out of it, but some psychiatrists try to speed up the process, usually using psychotherapy. This treatment itself is controversial and has received much criticism within both the psychiatric and gay, lesbian, bisexual, and transgendered communities. For children, a clear diagnosis may not be possible until the teenage years, since most children grow out of GID problems.
Some psychiatrists are critical of the psychiatric classification of gender identity disorder, saying it is more a social stigma. To prove their case, some psychiatrists point to the fact that boys are up to six times more likely to be diagnosed with GID and singled out for treatment than girls. This is not because the disorder is more common in boys, but because most parents tend to worry more if a son starts wearing dresses than if their daughter starts playing with toy trucks.
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Archer, John, and Barbara Lloyd. Sex and Gender. Cambridge, UK: Cambridge University Press, 2002.
Cohen-Kettenis, Peggy T., and Friedmann Pfafflin. Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices. London: SAGE Publications, 2003.
Zderic, Stephen A., et al. Pediatric Gender Assignment: A Critical Reappraisal. New York: Kluwer Academic/Plenum Publishers, 2002.
Barrett, James. "Disorders of Gender Identity." The Practitioner (June 4, 2003): 472.
Bartlett, Nancy H., et al. "Cross-sex Wishes and Gender Identity Disorder in Children: A Reply to Zucker." Sex Roles: A Journal of Research (August 2003): 191–92.
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The Gender Identity Research & Education Society. Melverly, The Warren, Ashtead, Surrey, KT21 2SP, UK. 01372–801554. Web site: <www.gires.org>.
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Gender Education and Advocacy, 2004. Available online at <www.gender.org> (accessed September 3, 2004).
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Ken R. Wells