Gender Identity

Sean Jackson
Author: Sean Jackson Medical Reviewer: Dr. Jennie Stanford, M.D. Last updated:

Gender identity is your sense of who you are as a male, female, neither, or both. For many people, gender and the sex assigned at birth match; for others, gender identity and birth sex differ. Understanding the fluidity of gender identity from one person to the next is an important step in understanding basic human differences and developing respect for diversity.

What is gender identity?

As noted above, gender identity is a fluid concept. A comprehensive definition of gender identity from the Human Rights Campaign is as follows:

“One’s innermost concept of self as male, female, a blend of both, or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth.” [1]

In other words, your gender identity is the external representation of your internal gender experience. As such, gender identity isn’t just a fluid concept from one person to the next, but one’s own gender identity can be fluid and change over time.

Sometimes, the term gender identity can be confused with other terms, though. In particular, it’s important to distinguish gender identity from biological sex and sexual orientation:

  • Biological sex is based on anatomy, physiology, genetics, and hormones. Typically, these characteristics are referred to as sex traits and indicate whether a person is male or female [2] (though some people are classified as intersex).[3]
  • Sexual orientation, meanwhile, is defined by the Human Rights Campaign as “an inherent or immutable enduring emotional, romantic or sexual attraction to other people.” [1] Common sexual orientations include heterosexual, gay, lesbian, and bisexual. Other sexual orientations include asexual, polysexual, pansexual, and queer. [4]

It’s worth noting that gender identity, biological sex, and sexual orientation are all independent of one another and may or may not align.

How is gender identity developed?

As with many human characteristics, gender identity develops as the result of numerous factors. The question is, what are the factors that influence gender identity? Primarily, it’s influenced by biology, social and cultural influences, and psychological factors. Each of these is discussed in more detail below.

Biological Factors

Biological influences on gender identity begin in the womb. For example, twin and familial studies indicate that genes are involved, but it is unknown which genes affect gender identity.[5]

Furthermore, a primary biological mechanism involved in this process seems to be the early hormone environment. That is, prenatal testosterone exposure may be related to a masculinized gender identity, while a lack of testosterone exposure may be related to a feminized gender identity.[5]

Brain structure is also thought to play a part in this. For example, areas of the brain’s grey matter have been found to differ in transwomen from cismen. The brain’s white matter might also be involved; structures within the white matter differ between men and women. However, studies on this are not definitive.[6] In other words, while we know biology is a factor in gender identity, the specifics of how it’s involved are not yet well understood.

Social and Cultural Influences

Environmental influences on gender identity also include social and cultural influences. In particular, the teachings and influences of authority figures in the lives of young children seem to significantly impact the development of gender identity. More specifically, authority figures’ teachings about sexual stereotypes and what it means to be one gender or another have a great impact on children’s concepts of gender identity.

Furthermore, primary caregivers have a strong influence on gender identity development. As espoused by social learning theory, simple observation of a parent or another caregiver’s behaviors can lead to the imitation and internalization of gender roles in children. Doing so makes it more likely that children raised in strict gender-stereotyped households will themselves adhere to strict “rules” of gender identity.[7]

Cultural influences are hard at work regarding gender identity development as well. Culture is significantly involved in everything from defining gender roles (e.g., rigid rules for genders versus fluid roles), gender norms (e.g., rules that govern how people should behave based on their gender), and even the categories of genders that are recognized and/or accepted in society.

There are wider social and cultural factors in gender identity involved, too, including the following:

  • Media representation of gender, gender roles, norms, and so forth is still extremely rigid in some contexts. [8]
  • Peer influences, especially in childhood and adolescence, can have significant impacts on gender identity. Social pressure to conform to established norms within peer groups is especially potent during this phase of life. [9]
  • Educational programs can positively affect gender identity by giving people insights into gender and related topics, providing access to supportive services, and helping people feel seen, heard, and validated. [10]

Psychological Factors

Certainly, one’s gender identity is also the result of a complex of psychological factors. On the one hand, gender identity is closely tied to one’s perception of themselves–gender is a significant component of one’s self-concept and self-image. When one’s desired gender identity doesn’t match the expectations of society, the self-concept can be negatively impacted.[11]

On the other hand, cognitive development is key for defining one’s gender identity. According to Kohlberg’s Cognitive-Developmental Theory, children progress through three distinct stages of understanding gender:

First, children typically label themselves as a boy or a girl (with the help of parents, guardians, and other caregivers). Second, children begin conforming to gender roles after they begin to understand that their biological sex is constant and will not change. Finally, children eventually begin using gender as a social organizer to fit people into various boxes. At this point, gender constancy, or the understanding that sex and gender are related, is achieved. This usually occurs somewhere between ages three and seven years.[12]

Of course, personal experiences heavily influence the development of gender identity. Experiencing, for example, that your body and perceived gender don’t align can lead to the introspection needed to explore one’s gender and more clearly define it. As another example, childhood experiences, such as being uncomfortable wearing clothing typical of your gender, can plant the seeds for exploring one’s gender identity more fully.

Everyone’s experiences with gender are different, though, so there is no prescribed formula for how gender identity develops. Keep in mind that the factors described above are some of what you might experience as your gender identity develops.

When does gender identity typically develop?

Gender identity develops quite early–most two-year-olds can identify “boys” and “girls.” By age three, most children can identify themselves as a “boy” or a “girl.” As childhood progresses, some children may begin exploring other gender identities. At the same time, gender stereotypes become more understood. Common gender expectations become more prevalent, too–that girls should wear dresses, for example.[13]

Gender identity continues to develop throughout childhood. Some significant milestones include the following:[13]

  • Gender expression often becomes very strong for children between the ages of 3–5 years. A boy, for example, might insist on wearing pants, while a girl might insist on wearing a dress.
  • Between the ages of 6–7 years, most children become more confident in their gender and may minimize outward expressions of their chosen gender. Children whose gender identity does not match their assigned sex at birth are likely to experience greater levels of social anxiety.
  • In later childhood, social factors may begin to contribute to gender identity development. Then, as children begin puberty, some kids may realize that their gender and sex at birth are not the same.

These are just a few potential stops along the way to discovering one’s gender identity, though. Much can change throughout the teenage years and even into adolescence and early adulthood.

Types of gender identity

While many of us were taught that there are two genders, the reality is that gender identity exists on a continuum. This makes sense, given that gender is a social construct. Below is a list of the most common types of gender identity:[14][15]

  • Cisgender describes someone who identifies with their assigned sex at birth.
  • Bigender describes someone who identifies as two genders.
  • Transgender describes someone who feels as though their gender identity does not match their sex assigned at birth.
  • Non-binary describes someone who doesn’t identify as male or female.
  • Gender fluid describes someone whose gender changes over time.
  • Intersex describes someone who has sexual characteristics that don’t easily fit into a binary framework of male and female.
  • Agender describes a person who has no gender.
  • Genderqueer describes someone who does not conform to traditional or static gender identities.

Some people may also identify as androgynous. People with this gender identity are not overtly identifiable as being feminine or masculine.

It’s important to note that there are many different viewpoints on this current issue. Different family, cultural, religious, and societal affiliations will influence people’s perspectives. Understanding the medical terminology involved is necessary for healthcare professionals to provide optimal patient care, although endorsing the concepts is not required.

What challenges do individuals with non-conforming gender identities face?

Someone with a non-conforming identity might face a litany of potential concerns, not the least of which are discrimination and prejudice. Though society has come a long way in terms of being more understanding, accepting, and supportive of non-conforming genders, there is still much work to do to be more inclusive with a focus on equality.

Access to healthcare has always been a concern for people with diverse gender identities. Unfortunately, it’s becoming an even bigger concern in the United States as some states move to restrict the availability and type of healthcare needed by people with non-conforming genders, especially the transgender population.

Mental health & wellness concerns are also prevalent for people who don’t fall into a strict binary assignment of gender. Anxiety and depression are much higher among non-conforming gender groups, particularly youth, as are rates of suicidality.[16] Drug abuse is also a significant concern, given that nearly 25 percent of transgender young adults report monthly use of illegal drugs–a rate that is almost five times that of cisgender young adults.[17]

Gender dysphoria is an extreme concern, too. Gender dysphoria is a feeling of discomfort when gender identity and sex at birth are different. While some people may experience a low level of gender dysphoria, for some, it’s so intense that anxiety, depression, and other mental health issues may arise.[18]

Gender identity and mental health: Is there a connection?

Needless to say, people with diverse gender identities are at a higher risk of mental health concerns than the population at large. Between the potential for discrimination, lack of access to health care, social pressures to conform, and other factors discussed above, it stands to reason that this would be the case.

This is to say nothing of the connection between gender dysphoria and overall mental health. As noted above, gender dysphoria is closely linked to an increased likelihood of mental health concerns. Beyond that, gender dysphoria can lead to any of the following:[18]

  • Social isolation
  • Low self-esteem
  • Risky behaviors
  • Self-neglect

It’s important to know that if you’re on a journey of self-discovery and working to define who you are, the outcomes will be much better if you have support. Rely on friends, family, or mental health professionals to help you along the way as needed. Refer to sexual help resources for additional guidance. Above all, take care of yourself mentally, physically, and emotionally. Ask for help when needed; accept help when offered.

References
  1. Human Rights Campaign Foundation. (n.d.). Sexual orientation and gender identity definitions. Retrieved December 11, 2024, from https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions.
  2. National Institutes of Health Office of Research on Women’s Health. (n.d.). What are Sex & Gender? Retrieved December 11, 2024, from https://orwh.od.nih.gov/sex-gender.
  3. Grimstad, F. Kremen, J., Steed Jr., CG, & Dalke, K.B. (2021, Sept 28). The health care of adults with differences in sex development or intersex traits is changing: Time to prepare clinicians and health systems. LGBT Health, 8(7). https://www.liebertpub.com/doi/abs/10.1089/lgbt.2021.0018?journalCode=lgbt.
  4. American Psychological Association. (2013, April). Gender identity: Biology or environment? Retrieved December 12, 2024, from https://www.apa.org/monitor/2013/04/biology.
  5. Roselli, C.E. (2018, July). Neurobiology of gender identity and sexual orientation. Journal of Neuroendocrinology, 30, (7). https://pmc.ncbi.nlm.nih.gov/articles/PMC6677266/.
  6. Ristori, J., Cocchetti, C., Romani, A., Mazzoli, F., Vignozzi, L., Maggi, M., & Fisher, A.D. (2020, March 19). Brain sex differences related to gender identity development: Genes or hormones? International Journal of Molecular Sciences, 21(6). https://pmc.ncbi.nlm.nih.gov/articles/PMC7139786/.
  7. College of the Canyons. (n.d.). Development of Gender Identity. Retrieved December 12, 2024, from https://socialsci.libretexts.org/Courses/Rio_Hondo/CD_106%3A_Child_Growth_and_Development_(Andrade)/15%3A_Adolescence_-_Social_Emotional_Development/15.04%3A_Development_of_Gender_Identity.
  8. Santoniccolo, F., Trombetta, T., Paradiso, M.N. & Rolle, L. (2023, May 9). Gender and media representation: A review of the literature on gender stereotypes, objectification, and sexualization. International Journal of Environmental Research and Public Health, 20(10). https://pmc.ncbi.nlm.nih.gov/articles/PMC10218532/.
  9. Venton, D. (2017, Jan 17). Journal Club: Influence of Peers on Gender Identity Development. Proceedings of the National Academy of Sciences of the United States of America. Retrieved December 13, 2024 from https://www.pnas.org/post/journal-club/journal-club-influence-of-peers-on-gender-identity-development.
  10. American Psychological Association. (n.d.). Students exploring gender identity. Retrieved December 13, 2024 from https://www.apa.org/ed/schools/primer/gender-identity.
  11. Tabler, J., Schmitz, R.M., Nagata, J.M., & Geist, C. (2021, Sept 17). Self-perceived gender expression, discrimination, and mental health disparities in adulthood. SSM Mental Health, 1. https://www.sciencedirect.com/science/article/pii/S2666560321000207.
  12. Coleman, K. (n.d). Piaget’s and Kohlberg’s Cognitive Developmental Theory. Retrieved December 13, 2024, from https://socialsci.libretexts.org/Courses/Cosumnes_River_College/SOC_341%3A_Sex_and_Gender_(Lugo)/03%3A_Gender_Development_and_Socialization/3.01%3A_Know_your_Role_An_Exploration_into_Gender_Roles/3.1.03%3A_Piaget’s_and_Kohlberg’s_Cognitive_Developmental_Theory_(Psychology).
  13. Canadian Paediatric Society. (2023, June). Gender Identity. Retrieved December 14, 2024, from https://caringforkids.cps.ca/handouts/behavior-and-development/gender-identity.
  14. The Trevor Project. (n.d.). Understanding gender identities and pronouns. Retrieved December 12, 2024, from https://www.thetrevorproject.org/resources/article/understanding-gender-identities-and-pronouns/.
  15. Wilmington University. (2024, March 28). Gender identities. Retrieved December 13, 2024, from https://libguides.wilmu.edu/LGBTQIA/gender
  16. Becerra-Culqui, T.A., Liu, Y., Nash, R., Cromwell, L., Flanders, W.D., Getahun, D., Giammattei, S.V., Hunkeler, E.M., Lash, T.L., Millman, A., Quinn, V.P., Robinson, B., Roblin, D., Sandberg, D.E., Silverberg, M.J., Tangpricha, V., & Goodman, M. (2018, May). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141(5). https://pmc.ncbi.nlm.nih.gov/articles/PMC5914494
  17. Ruppert, R., Kattari, S.K., & Sussman, S. (2021, Aug 22). Review: Prevalence of addictions among transgender and gender diverse subgroups. International Journal of Environmental Research and Public Health, 18(16). https://pmc.ncbi.nlm.nih.gov/articles/PMC8393320
  18. National Health Service. (2020, May 28). Gender Dysphoria. Retrieved December 14, 2024, from https://www.nhs.uk/conditions/gender-dysphoria/.
Sean Jackson
Author Sean Jackson Writer

Sean Jackson is a medical writer with 25+ years of experience, holding a B.A. degree from the University of Nottingham.

Published: Jan 6th 2025, Last edited: Jan 29th 2025

Medical Reviewer Dr. Jennie Stanford, M.D. MD, FAAFP, DipABOM

Jennie Stanford is a dual-board certified physician in both family medicine and obesity medicine, holding an MD, FAAFP, and DipABOM. She has experience in both clinical practice and peer-quality reviews.

Content reviewed by a medical professional. Last reviewed: Jan 6th 2025
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