FROM A BLACK AND WHITE
TO A
TECHNICOLOR
VIEW OF GENDER:
A DISCUSSION ON GENDER
IDENTITY AND GENDER
VARIANCE
By Aimee Beardslee
Spring 2012
TOPICS OF DISCUSSION

Let’s talk about sex…versus gender

What does “Intersex” mean? (It’s more common than you think!)

What does “Transgender” mean?

Hormone Therapy & Sex Reassignment Surgery

Gender Development Theories

Gender Variance Across Cultures

Gender identity development in childhood and adolescence

DSM-IV Diagnostic Criteria for Gender Identity Disorder &
Proposed Criteria for DSM-V

Why is studying gender identity and gender variance important?
SEX VS. GENDER…
SOME BASICS:

SEX: a term that typically describes an individual’s anatomical
structure. “Biology”

GENDER: a term that describes an imposed or adopted
social and psychological condition. “Culture/Society”

GENDER ROLE: a term that describes the patterns of
behavior that are learned or “acted” based on one’s gender
identification.
(Diamond, 2002)
*Gender role scripts, rules, and expectations vary across
cultures…but more on that later!
GENDER, AND EVEN SEX, ARE NOT
DICHOTOMOUS CATEGORIES

Not everyone is born either “male” or “female”.

Although one’s sex and gender are expected to be congruent, not
everyone grows up feeling that the two “match”.

Historically, the concepts of masculinity and femininity have changed,
and how they are defined varies across cultures.

There are many cultures that accept the existence of more than
two genders-and have for centuries!

Gender and sexual orientation are NOT the same. Gender variance
should not be conflated with homosexuality.
WHAT DOES “INTERSEX” MEAN?

An intersex person is “born with external genitalia,
chromosomes, or internal reproductive systems that are
not traditionally associated with either a ‘standard’ male
or female” (NCTE, 2009).

Medical experts state that 1 in 1,500 to 1 in 2,000
infants are born with “noticeably atypical” genitalia
(ISNA, 2008).

However, the actual number is likely to be significantly
higher, because many variations do not show up until
later in life (and some may never be noticed! ISNA,
2008).
HOW COMMON IS INTERSEX? (FROM ISNA)
Not XX and not XY
one in 1,666 births
Klinefelter (XXY)
one in 1,000 births
Androgen insensitivity syndrome
one in 13,000 births
Partial androgen insensitivity
syndrome
one in 130,000 births
Classical congenital adrenal
hyperplasia
one in 13,000 births
Late onset adrenal hyperplasia
one in 66 individuals
Vaginal agenesis
one in 6,000 births
Ovotestes
one in 83,000 births
Idiopathic (no discernable medical
cause)
one in 110,000 births
HOW COMMON IS INTERSEX?
(CONT’D)
Iatrogenic (caused by medical treatment,
for instance progestin administered to
pregnant mother)
no estimate
5 alpha reductase deficiency
no estimate
Mixed gonadal dysgenesis
no estimate
Complete gonadal dysgenesis
one in 150,000 births
Hypospadias (urethral opening in
perineum or along penile shaft)
one in 2,000 births
Hypospadias (urethral opening between
corona and tip of glans penis)
one in 770 births
Total number of people whose bodies
differ from standard male or female
one in 100 births
Total number of people receiving surgery
to “normalize” genital appearance
one or two in 1,000 births
WHAT DOES “TRANSGENDER”
MEAN?

“An umbrella term for people whose gender identity,
expression, or behavior is different from those typically
associated with their assigned sex at birth, including but
not limited to transexuals, cross-dressers, androgynous
people, genderqueers, and gender non-conforming
people. Transgender is a broad term and is good for nontransgender people to use. ‘Trans’ is shorthand for
‘transgender’” (NCTE).

Prevalence of transgenderism varies widely, from 1 in
30,000…to 1 in 5,000…to 1 in 500 (Pleak, 2009).
TRANSGENDER TERMINOLOGY

Transgender man or “transman”: individual born
biologically female who identifies as male. Also referred
to as “FTM” (female-to-male)

Transgender woman or “transwoman”: individual born
biologically male who identifies as female. Also referred
to as “MTF” (male-to-female)
TRANSGENDER HORMONE THERAPY

Many transgender individuals undergo hormone therapy to
develop secondary sexual characteristics. Transwomen receive
estrogen, and transmen receive testosterone.

Some effects of testosterone on secondary sex
characteristics include deepening of the voice, cessation of
ovulation/menstruation, growth of facial and body hair,
enlargement of the clitoris.

Some effects of estrogen on secondary sex characteristics
include breast growth, redistribution of body fat (hourglass
shape), reduction of musculature, softening of facial contour.
SEX REASSIGNMENT SURGERY

SRS may also be called gender reassignment surgery, genital reconstruction
surgery, sex affirmation surgery, sex realignment surgery, or a sex-change
operation.

“Surgery” can include hysterectomy, mastectomy (“top surgery”), removal
of the ovaries, removal of testicles, breast augmentation, genital
reconstruction, and facial plastic surgery.

“Pre-op”: indicates individuals who have yet to undergo SRS but desire it.

“Post-op”: indicates individuals who have undergone SRS.

“Non-op”: indicates individuals who do not desire to undergo SRS.
GENDER DEVELOPMENT THEORIES:
AN OVERVIEW

Biological theories: posit that gender differences are
“ancestrally programmed” or that hormonal influences
are the basis of gender differences in social behavior.

Psychoanalytic theories: posit that identification with
a certain gender is a result of child adopting
characteristics and qualities of the same-sex parent.
GENDER DEVELOPMENT THEORIES
(CONT’D)

Kohlberg’s Cognitive Developmental Theory: When children
achieve “gender consistency” they place value on their own gender
and seek to act in ways that are consistent with their gender.

Kohlberg’s stages of Gender Development:
Gender Identity: Ability to label oneself a boy or girl and others as boys
or girls (usually by age 2).
Gender Stability: Ability to recognize gender remains constant over
time. “I was born a boy and will grow up to be a boy” (usually by age
4).
Gender Consistency: Understanding that gender is invariant despite
outward changes. “That woman has short hair and is wearing shorts
but is still a woman” (usually by age 6 or 7).
GENDER DEVELOPMENT THEORIES
(CONT’D)

Gender Schema Theory: similar to cognitivedevelopmental theory. However, this theory posits that
as soon as a child masters gender identity (“I am a boy”
or “I am a girl”), gender schemas begin to develop. These
schemas expand and grow to include “knowledge of
activities and interests, personality and social attributes,
and scripts about gender-linked activities” (Bussey &
Bandura, 1999, p. 5).
GENDER DEVELOPMENT THEORIES
(CONT’D)

Social Cognitive Theory: In this theory, “gender
conceptions and roles are the product of a broad network of
social influences operating interdependently in a variety of
societal subsystems. Human evolution provides bodily
structures and biological potentialities that permit a range of
possibilities rather than dictate a fixed type of gender
differentiation” (Bussey & Bandura, 1999, p. 676).

Basically, biology is not destiny, and multiple factors (parents,
peers, educational institutions, the media, culture, etc.)
interact to determine gender identity.
TRANSGENDER DEVELOPMENT
MODELS: ARE THERE ANY?

Transgender experiences do not readily fit into stage models,
because they do not fit into the traditional gender binary
construction (Bilodeau & Renn, 2005).

“Mallon argued that it is inappropriate for social service
practitioners to use traditional human development models,
including those of Erikson and Marcia, because these theorists
posit concepts of gender role identification in traditionally
gendered, biologically based constructions” (Bilodeau & Renn,
2005, p. 33).

D’Augelli’s model has been used to understand transgender
development, but there is a need for the creation of new
models.
GENDER VARIANCE ACROSS
CULTURES

Many North American Indian tribes have a “third
gender”. Called “two-spirit” (formerly “berdache”), these
cross-gender individuals have been documented in over
150 groups. (Newman, 2002).

In the Dominican Republic (guevedoche), Papua New
Guinea, and the South Pacific, children with enzymatic
deficiency (who have ambiguous genitalia) are often
raised female, but if virilization occurs at puberty, the
child is allowed to adopt a male identity and this change
is socially accepted (Newman, 2002).
GENDER VARIANCE ACROSS
CULTURES (CONT’D)

“There is no consensus across world cultures regarding the
appropriate traits, characteristics, and patterns of behavior
that males and females should have” (Langer & Martin, 2004,
p. 13).

Even within the same country, different cultures and
subcultures have different roles and expectations for men and
women.

For example, there may be more gender role equality among
African Americans but more rigid gender roles for Latin
American families (Langer & Martin, 2004).
GENDER IDENTITY DEVELOPMENT
IN CHILDHOOD

Some children express feelings of wanting to be the other sex as
young as 1 and a half to 2 years old and pretend to be the other sex
when playing “pretend”.

Parents may be tolerant of such behavior up until the child enters
school; this is commonly when parents take children to see
psychiatrists.

Gender variant children may be quite isolated in early school years.
At age 8-10, teasing worsens and they may be targets of bullying and
violence.

Only a small number of gender variant children will remain gender
variant into adolescence and adulthood.

Outcomes for gender atypical children: most become gender
typical gay and lesbian adults, some become gender typical
straight adults, and a few will become transgender adults.
(Pleak, 2009)
GENDER IDENTITY DEVELOPMENT
IN ADOLESCENCE

Around age 11 to 13, gender atypicality or gender variance does
not change much going forward.

Considerable consensus that these young people will continue to
be transgender or transexual as they mature.
(Pleak, 2009)

Note: individuals may “transition” later in life, which may be due to
the necessity of suppressing their gender variance until more
freedom (or safety) is attained in adulthood.

Angie, transgender teen, 17 years old, NYC, trans
THE GENDER INTENSIFICATION
HYPOTHESIS

“Hill and Lynch proposed that puberty plays a role in the
differentiation of masculine and feminine characteristics by
serving as a signal to socializing others (parents, teachers,
peers) that the adolescent is beginning the approach to
adulthood and should begin to act accordingly, that is, in ways
that resemble the stereotypical male or female adult”
(Lerner & Steinberg, 2004, p. 240).

"Straightlaced (a documentary) unearths how popular
pressures around gender and sexuality are confining
American teens."
PEER RESPONSE TO GENDER NONCONFORMITY IN ADOLESCENCE

As Smith and Leaper (2005, p. 102) assert:
“Noting only the relation between gender typicality and selfworth without considering the social context might imply
that gender typicality per se leads to adjustment…”
However, “multiple patterns of gender identity and
adjustment exist for adolescents with peer acceptance being
a critical mediator. Importantly, there was no difference in the
self-worth of non-conforming and conforming adolescents if
they felt accepted by their peers” (emphasis in original).
TREATMENT OF TRANSGENDER
ADOLESCENTS

Option of delaying puberty via hormone therapy: this allows a
transgender adolescent to delay onset of secondary sex
characteristics (Ex/breast growth and menstruation in females
and facial hair growth and voice deepening in males) so that
he or she may have more time to decide on a gender identity
that feels right.

As mentioned, most adolescents are very aware their minds
and bodies don’t “match” and have the desire to make their
sex and gender congruent. However, for the few that may
decide against changing their gender, the treatment can be
stopped and genetic puberty will resume within 6 months.
(Spack, 2009)
DIAGNOSTIC CRITERIA FOR GENDER
IDENTITY DISORDER
(DSM-IV-TR)
A.
A strong and persistent cross-gender identification (not merely a
desire for any perceived cultural advantages of being the other
sex).
B.
Persistent discomfort with his or her sex or sense of
inappropriateness in the gender role of that sex.
C.
The disturbance is not concurrent with a physical intersex
condition.
D.
The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
DIAGNOSTIC CRITERIA FOR GID IN CHILDREN
(DSM-IV-TR)
(Under criterion A) In children, the disturbance is manifested by four (or more) of the
following:

repeatedly stated desire to be, or insistence that he or she is, the other sex

in boys, preference for cross-dressing or simulating female attire; in girls, insistence on
wearing only stereotypical masculine clothing

strong and persistent preferences for cross-sex roles in make-believe play or persistent
fantasies of being the other sex

intense desire to participate in the stereotypical games and pastimes of the other sex

strong preference for playmates of the other sex
In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be
the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the
conviction that he or she has the typical feelings and reactions of the other sex.
DIAGNOSTIC CRITERIA FOR GID IN CHILDREN
(DSM-IV-TR)
(Under criterion B)

In children, the disturbance is manifested by any of the following: in
boys, assertion that his penis or testes are disgusting or will
disappear or assertion that it would be better not to have a penis,
or aversion toward rough-and-tumble play and rejection of male
stereotypical toys, games, and activities; in girls, rejection of urinating
in a sitting position, assertion that she has or will grow a penis, or
assertion that she does not want to grow breasts or menstruate, or
marked aversion toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by symptoms
such as preoccupation with getting rid of primary and secondary sex
characteristics (e.g., request for hormones, surgery, or other procedures to
physically alter sexual characteristics to simulate the other sex) or belief
that he or she was born the wrong sex.
PROPOSED CRITERIA FOR DSM-V

Would change Gender Identity Disorder to Gender Incongruence

For Gender Incongruence in Children, children must meet criteria 1: "a
strong desire to be of the other gender or an insistence that he or she is
the other gender“

"This will appropriately prevent children with a gender variant expression
without an incongruence between gender identity and sex assigned at birth
to receive the diagnosis, which was a common point of critique for DSM
IV" (DeCuypere, Knudson, & Bockting, 2010).

The distress criterion is proposed to be removed, which would make the
diagnostic criteria "so broad that almost any transgender person could
meet criteria for a mental disorder regardless of whether or not they
experience clinically significant distress and desire or need intervention"
(DeCuypere, Knudson, & Bockting, 2010).
IS GENDER VARIANCE REALLY A
“MENTAL DISORDER”?

What it means to be a “man” or a “woman” has changed over time
and is still changing (ex: “stay-at-home dads”).

Gender roles vary across cultures; some cultures allow for more
than two genders. Also, gender roles vary within cultures.

So-called “distress” or “dysphoria” is not inherent in being gender
variant; “incongruence” is not inherently unhealthy.

There is MUCH controversy over the GID diagnosis and many
argue for its removal; arguments parallel those that eventually
resulted in homosexuality being removed from the DSM in 1973.
WHY IS STUDYING GENDER IDENTITY
AND GENDER VARIANCE IMPORTANT IN
OUR FIELDS?

Our conception of gender influences the questions we
ask in research.

The lens through which we view gender while
performing research affects the outcome of that research.

How we view gender identity influences how we treat
transgender and gender variant individuals, including
children.
AWARENESS LEADS TO ACTION!

Being aware of LGBTQI issues helps us understand struggles (across
the entire lifespan) that are common among these populations.

Awareness can also teach us to respond in ways that affirm individuals
with a transgender or gender variant identity, increasing their chances
for healthy outcomes. We can also develop important interventions,
some of which may be literally life saving.

For example, the suicide attempt rate for adolescents diagnosed with
GID has been found to be as high as 50 percent (Spack, 2009).

Other areas of concern are higher incidences of bullying, suicide, drug
abuse, domestic violence, rape, hate crimes, homelessness, and HIV
transmission (Youth Pride, Inc., 2010)
GENDER DIVERSITY ACCEPTANCE IS
A SOCIAL JUSTICE ISSUE!

Both the APA and ACA have ethical principles that
prohibit discrimination based on gender identity
(separate from gender).

Broadening our view of gender identity impacts everyone,
even “gender congruent” individuals.

A respect for gender diversity gives all people more
freedom to be themselves!
SOME RECOMMENDATIONS FOR FURTHER
LEARNING

Books:
Stone Butch Blues by Leslie Feinberg (a transgender man)
Gender Outlaw: On Men, Women, and the Rest of Us by Kate Bornstein (a
transgender woman)
Transgender Warriors : Making History from Joan of Arc to Dennis Rodman by
Leslie Feinberg
Middlesex (a novel) by Jeffrey Eugenides

Films:
Boys Don’t Cry (based on the true story of Brandon Teena)
Ma Vie en Rose
Transamerica (starring Felicity Huffman)
Southern Comfort (a documentary on the life of Robert Eads, a transgender
man)
Hedwig and the Angry Inch (an entertaining musical/comedy/drama about a
transgender German glam rocker)
WEBSITES:
The Trevor Project: The leading national organization providing crisis
intervention and suicide prevention services to lesbian, gay, bisexual,
transgender, and questioning youth.
http://www.thetrevorproject.org/
National Center for Transgender Equality: Non-profit organization
dedicated to advancing the equality of transgender people through
advocacy, collaboration, and empowerment.
http://transequality.org/
Human Rights Campaign (HRC): The largest civil rights organization
working to achieve equality for lesbian, gay, bisexual, and transgender
Americans.
http://www.hrc.org/
National Gay and Lesbian Task Force: Non-profit corporation that
works to build the grassroots political power of the LGBT community
to win complete equality.
http://thetaskforce.org/
REFERENCES:





American Psychiatric Association. (2000). Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.
Bilodeau, B. L., & Renn, K. A. (2005). Analysis of LGBT Identity Development
Models and Implications for Practice. New Directions for Student Services
(111), 25-39.
Bussey, K., & Bandura, A. (1999). Social Cognitive Theory of Gender
Development and Differentiation. Psychological Review, 106, 676-713.
DeCuypere, G., Knudson, G., & Bockting, W. (2010, May 25). Response of the
World Professional Association for Transgender Health to the Proposed DSM 5
Criteria for Gender Incongruence. Retrieved from World Professional
Association for Transgender Health Web site:
www.wpath.org/documents/WPATH Reaction to the proposed DSM Final.pdf
Diamond, M. (2002). Sex and Gender are Different: Sexual Identity and
Gender Identity are Different. Clinical Child Psychology and Psychiatry, 7 (3),
320-334.
REFERENCES





Intersex Society of North America. (2008). How common is intersex?
Retrieved from Intersex Society of North America Web site:
http://www.isna.org/faq/frequency
Langer, S. J., & Martin, J. I. (2004). How Dresses Can Make You
Mentally Ill: Examining Gender Identity Disorder in Children. Child
and Adolescent Social Work Journal, 21 (1), 5-23.
Lerner, R. M., & Steinberg, L. (2004). Handbook of Adolescent
Psychology. Hoboken: John Wiley and Sons.
Manners, P. J. (2009). Gender Identity Disorder in Adolescence: A
Review of the Literature. Child and Adolescent Mental Health, 14 (2),
62-68.
NCTE. (2009, May). Transgender Terminology. Retrieved from NCTE
Web site:
http://transequality.org/Resources/NCTE_TransTerminology.pdf
REFERENCES





Newman, L. K. (2002). Sex, Gender and Culture: Issues in the
Definition, Assessment and Treatment of Gender Identity Disorder.
Clinical Child Psychology and Psychiatry, 7 (3), 352-359.
Pleak, R. R. (2009). Formation of Transgender Identities. Journal of
Gay & Lesbian Mental Health, 13, 282-291.
Smith, T. E., & Leaper, C. (2005). Self-Perceived Gender Typicality and
the Peer Context During Adolescence. Journal of Research on
Adolescence, 16 (1), 91-103.
Spack, N. P. (2009). An Endocrine Perspective on the Care of
Transgender Adolescents. Journal of Gay & Lesbian Mental Health, 13,
309-319.
Youth Pride, Inc. (2010). Statistics. Retrieved from Youth Pride, Inc.
Web site:
http://www.youthprideri.org/Resources/Statistics/tabid/227/Default.a
spx#h
FOREST (FTM)
TALKS WITH HIS PARENTS
ABOUT GROWING UP TRANS

Talking With My Parents About Being Transgender

“This footage is the first time I have EVER talked openly
about being trans with my parents. It was very hard to
do, but the love was strong and I was impressed. To feel
acceptance from family is very important.”