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The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults

Findings from pew research center focus groups, table of contents, introduction.

Transgender and nonbinary people have gained visibility in the U.S. in recent years as celebrities from  Laverne Cox  to  Caitlyn Jenner  to  Elliot Page  have spoken openly about their gender transitions. On March 30, 2022, the White House issued a proclamation  recognizing Transgender Day of Visibility , the first time a U.S. president has done so.  

More recently, singer and actor Janelle Monáe  came out as nonbinary , while the U.S. State Department and Social Security Administration announced that Americans  will be allowed to select “X” rather than “male” or “female” for their sex  marker on their passport and Social Security applications. 

At the same time, several states have enacted or are considering legislation that would  limit the rights of transgender and nonbinary people . These include bills requiring people to use public bathrooms that correspond with the sex they were assigned at birth, prohibiting trans athletes from competing on teams that match their gender identity, and restricting the availability of health care to trans youth seeking to medically transition. 

A new Pew Research Center survey finds that 1.6% of U.S. adults are transgender or nonbinary – that is, their gender is different from the sex they were assigned at birth. This includes people who describe themselves as a man, a woman or nonbinary, or who use terms such as gender fluid or agender to describe their gender. While relatively few U.S. adults are transgender, a growing share say they know someone who is (44% today vs.  37% in 2017 ). One-in-five say they know someone who doesn’t identify as a man or woman. 

In order to better understand the experiences of transgender and nonbinary adults at a time when gender identity is at the center of many national debates, Pew Research Center conducted a series of focus groups with trans men, trans women and nonbinary adults on issues ranging from their gender journey, to how they navigate issues of gender in their day-to-day life, to what they see as the most pressing policy issues facing people who are trans or nonbinary. This is part of a larger study that includes a survey of the general public on their attitudes about gender identity and issues related to people who are transgender or nonbinary.

The terms  transgender  and  trans  are used interchangeably throughout this essay to refer to people whose gender is different from the sex they were assigned at birth. This includes, but is not limited to, transgender men (that is, men who were assigned female at birth) and transgender women (women who were assigned male at birth). 

Nonbinary adults  are defined here as those who are neither a man nor a woman or who aren’t strictly one or the other. While some nonbinary focus group participants sometimes use different terms to describe themselves, such as “gender queer,” “gender fluid” or “genderless,” all said the term “nonbinary” describes their gender in the screening questionnaire. Some, but not all, nonbinary participants also consider themselves to be transgender.

References to  gender transitions  relate to the process through which trans and nonbinary people express their gender as different from social expectations associated with the sex they were assigned at birth. This may include social, legal and medical transitions. The social aspect of a gender transition may include going by a new name or using different pronouns, or expressing their gender through their dress, mannerisms, gender roles or other ways. The legal aspect may include legally changing their name or changing their sex or gender designation on legal documents or identification.  Medical care  may include treatments such as hormone therapy, laser hair removal and/or surgery. 

References to  femme  indicate feminine gender expression. This is often in contrast to “masc,” meaning masculine gender expression.

Cisgender  is used to describe people whose gender matches the sex they were assigned at birth and who do not identify as transgender or nonbinary. 

Misgendering  is defined as referring to or addressing a person in ways that do not align with their gender identity, including using incorrect pronouns, titles (such as “sir” or “ma’am”), and other terms (such as “son” or “daughter”) that do not match their gender. 

References to  dysphoria  may include feelings of distress due to the mismatch of one’s gender and sex assigned at birth, as well as a  diagnosis of gender dysphoria , which is sometimes a prerequisite for access to health care and medical transitions.

The acronym  LGBTQ+  refers to lesbian, gay, bisexual, transgender, queer (or, in some cases, questioning), and other sexual orientations or gender identities that are not straight or cisgender, such as intersex, asexual or pansexual. 

Pew Research Center conducted this research to better understand the experiences and views of transgender and nonbinary U.S. adults. Because transgender and nonbinary people make up only about 1.6% of the adult U.S. population, this is a difficult population to reach with a probability-based, nationally representative survey. As an alternative, we conducted a series of focus groups with trans and nonbinary adults covering a variety of topics related to the trans and nonbinary experience. This allows us to go more in-depth on some of these topics than a survey would typically allow, and to share these experiences in the participants’ own words.

For this project, we conducted six online focus groups, with a total of 27 participants (four to five participants in each group), from March 8-10, 2022. Participants were recruited by targeted email outreach among a panel of adults who had previously said on a survey that they were transgender or nonbinary, as well as via connections through professional networks and LGBTQ+ organizations, followed by a screening call. Candidates were eligible if they met the technology requirements to participate in an online focus group and if they either said they consider themselves to be transgender or if they said their gender was nonbinary or another identity other than man or woman (regardless of whether or not they also said they were transgender). For more details, see the  Methodology . 

Participants who qualified were placed in groups as follows: one group of nonbinary adults only (with a nonbinary moderator); one group of trans women only (with a trans woman moderator); one group of trans men only (with a trans man moderator); and three groups with a mix of trans and nonbinary adults (with either a nonbinary moderator or a trans man moderator). All of the moderators had extensive experience facilitating groups, including with transgender and nonbinary participants. 

The participants were a mix of ages, races/ethnicities, and were from all corners of the country. For a detailed breakdown of the participants’ demographic characteristics, see the  Methodology .

The findings are not statistically representative and cannot be extrapolated to wider populations.

Some quotes have been lightly edited for clarity or to remove identifying details. In this essay, participants are identified as trans men, trans women, or nonbinary adults based on their answers to the screening questionnaire. These words don’t necessarily encompass all of the ways in which participants described their gender. Participants’ ages are grouped into the following categories:  late teens; early/mid/late 20s, 30s and 40s; and 50s and 60s (those ages 50 to 69 were grouped into bigger “buckets” to better preserve their anonymity).

These focus groups were not designed to be representative of the entire population of trans and nonbinary U.S. adults, but the participants’ stories provide a glimpse into some of the experiences of people who are transgender and/or nonbinary. The groups included a total of 27 transgender and nonbinary adults from around the U.S. and ranging in age from late teens to mid-60s. Most currently live in an urban area, but about half said they grew up in a suburb. The groups included a mix of White, Black, Hispanic, Asian and multiracial American participants. See  Methodology  for more details.

Identity and the gender journey

Most focus group participants said they knew from an early age – many as young as preschool or elementary school – that there was something different about them, even if they didn’t have the words to describe what it was. Some described feeling like they didn’t fit in with other children of their sex but didn’t know exactly why. Others said they felt like they were in the wrong body. 

“I remember preschool, [where] the boys were playing on one side and the girls were playing on the other, and I just had a moment where I realized what side I was supposed to be on and what side people thought I was supposed to be on. … Yeah, I always knew that I was male, since my earliest memories.” – Trans man, late 30s

“As a small child, like around kindergarten [or] first grade … I just was [fascinated] by how some people were small girls, and some people were small boys, and it was on my mind constantly. And I started to feel very uncomfortable, just existing as a young girl.” – Trans man, early 30s

“I was 9 and I was at day camp and I was changing with all the other 9-year-old girls … and I remember looking at everybody’s body around me and at my own body, and even though I was visually seeing the exact shapeless nine-year-old form, I literally thought to myself, ‘oh, maybe I was supposed to be a boy,’ even though I know I wasn’t seeing anything different. … And I remember being so unbothered by the thought, like not a panic, not like, ‘oh man, I’m so different, like everybody here I’m so different and this is terrible,’ I was like, ‘oh, maybe I was supposed to be a boy,’ and for some reason that exact quote really stuck in my memory.” – Nonbinary person, late 30s

“Since I was little, I felt as though I was a man who, when they were passing out bodies, someone made a goof and I got a female body instead of the male body that I should have had. But I was forced by society, especially at that time growing up, to just make my peace with having a female body.” – Nonbinary person, 50s

“I’ve known ever since I was little. I’m not really sure the age, but I just always knew when I put on boy clothes, I just felt so uncomfortable.” – Trans woman, late 30s

“It was probably as early as I can remember that I wasn’t like my brother or my father [and] not exactly like my girl cousins but I was something else, but I didn’t know what it was.” – Nonbinary person, 60s

Many participants were well into adulthood before they found the words to describe their gender. For those focus group participants, the path to self-discovery varied. Some described meeting someone who was transgender and relating to their experience; others described learning about people who are trans or nonbinary in college classes or by doing their own research.  

“I read a Time magazine article … called ‘Homosexuality in America’ … in 1969. … Of course, we didn’t have language like we do now or people were not willing to use it … [but] it was kind of the first word that I had ever heard that resonated with me at all. So, I went to school and I took the magazine, we were doing show-and-tell, and I stood up in front of the class and said, ‘I am a homosexual.’ So that began my journey to figure this stuff out.” – Nonbinary person, 60s

“It wasn’t until maybe I was 20 or so when my friend started his transition where I was like, ‘Wow, that sounds very similar to the emotions and challenges I am going through with my own identity.’ … My whole life from a very young age I was confused, but I didn’t really put a name on it until I was about 20.” – Nonbinary person, late 20s

“I knew about drag queens, but I didn’t know what trans was until I got to college and was exposed to new things, and that was when I had a word for myself for the first time.” – Trans man, early 40s

“I thought that by figuring out that I was interested in women, identifying as lesbian, I thought [my anxiety and sadness] would dissipate in time, and that was me cracking the code. But then, when I got older, I left home for the first time. I started to meet other trans people in the world. That’s when I started to become equipped with the vocabulary. The understanding that this is a concept, and this makes sense. And that’s when I started to understand that I wasn’t cisgender.” – Trans man, early 30s

“When I took a human sexuality class in undergrad and I started learning about gender and different sexualities and things like that, I was like, ‘oh my god. I feel seen.’ So, that’s where I learned about it for the first time and started understanding how I identify.” – Nonbinary person, mid-20s

Focus group participants used a wide range of words to describe how they see their gender. For many nonbinary participants, the term “nonbinary” is more of an umbrella term, but when it comes to how they describe themselves, they tend to use words like “gender queer” or “gender fluid.” The word “queer” came up many times across different groups, often to describe anyone who is not straight or cisgender. Some trans men and women preferred just the terms “man” or “woman,” while some identified strongly with the term “transgender.” The graphic below shows just some of the words the participants used to describe their gender.

The way nonbinary people conceptualize their gender varies. Some said they feel like they’re both a man and a woman – and how much they feel like they are one or the other may change depending on the day or the circumstance. Others said they don’t feel like they are either a man or a woman, or that they don’t have a gender at all. Some, but not all, also identified with the term transgender. 

“I had days where I would go out and just play with the boys and be one of the boys, and then there would be times that I would play with the girls and be one of the girls. And then I just never really knew what I was. I just knew that I would go back and forth.” – Nonbinary person, mid-20s

“Growing up with more of a masculine side or a feminine side, I just never was a fan of the labelling in terms of, ‘oh, this is a bit too masculine, you don’t wear jewelry, you don’t wear makeup, oh you’re not feminine enough.’ … I used to alternate just based on who I felt I was. So, on a certain day if I felt like wearing a dress, or a skirt versus on a different day, I felt like wearing what was considered men’s pants. … So, for me it’s always been both.” – Nonbinary person, mid-30s

“I feel like my gender is so amorphous and hard to hold and describe even. It’s been important to find words for it, to find the outlines of it, to see the shape of it, but it’s not something that I think about as who I am, because I’m more than just that.” – Nonbinary person, early 30s

“What words would I use to describe me? Genderless, if gender wasn’t a thing. … I guess if pronouns didn’t exist and you just called me [by my name]. That’s what my gender is. … And I do use nonbinary also, just because it feels easier, I guess.” – Nonbinary person, late 20s

Some participants said their gender is one of the most important parts of their identity, while others described it as one of many important parts or a small piece of how they see themselves. For some, the focus on gender can get tiring. Those who said gender isn’t a central – or at least not the most central – part of their identity mentioned race, ethnicity, religion and socioeconomic class as important aspects that shape their identity and experiences.

“It is tough because [gender] does affect every factor of your life. If you are doing medical transitioning then you have appointments, you have to pay for the appointments, you have to be working in a job that supports you to pay for those appointments. So, it is definitely integral, and it has a lot of branches. And it deals with how you act, how you relate to friends, you know, I am sure some of us can relate to having to come out multiple times in our lives. That is why sexuality and gender are very integral and I would definitely say I am proud of it. And I think being able to say that I am proud of it, and my gender, I guess is a very important part of my identity.” – Nonbinary person, late 20s

“Sometimes I get tired of thinking about my gender because I am actively [undergoing my medical transition]. So, it is a lot of things on my mind right now, constantly, and it sometimes gets very tiring. I just want to not have to think about it some days. So, I would say it’s, it’s probably in my top three [most important parts of my identity] – parent, Black, queer nonbinary.” – Nonbinary person, mid-40s

“I live in a town with a large queer and trans population and I don’t have to think about my gender most of the time other than having to come out as trans. But I’m poor and that colors everything. It’s not a chosen part of my identity but that part of my identity is a lot more influential than my gender.” – Trans man, early 40s

“My gender is very important to my identity because I feel that they go hand in hand. Now my identity is also broken down into other factors [like] character, personality and other stuff that make up the recipe for my identity. But my gender plays a big part of it. … It is important because it’s how I live my life every day. When I wake up in the morning, I do things as a woman.” – Trans woman, mid-40s

“I feel more strongly connected to my other identities outside of my gender, and I feel like parts of it’s just a more universal thing, like there’s a lot more people in my socioeconomic class and we have much more shared experiences.” – Trans man, late 30s

Some participants spoke about how their gender interacted with other aspects of their identity, such as their race, culture and religion. For some, being transgender or nonbinary can be at odds with other parts of their identity or background. 

“Culturally I’m Dominican and Puerto Rican, a little bit of the macho machismo culture, in my family, and even now, if I’m going to be a man, I’ve got to be a certain type of man. So, I cannot just be who I’m meant to be or who I want myself to be, the human being that I am.” – Trans man, mid-30s

“[Judaism] is a very binary religion. There is a lot of things like for men to do and a lot of things for women to do. … So, it is hard for me now as a gender queer person, right, to connect on some levels with [my] religion … I have just now been exposed to a bunch of trans Jewish spaces online which is amazing.” – Nonbinary person, mid-40s

“Just being Indian American, I identify and love aspects of my culture and ethnicity, and I find them amazing and I identify with that, but it’s kind of separated. So, I identify with the culture, then I identify here in terms of gender and being who I am, but I kind of feel the necessity to separate the two, unfortunately.” – Nonbinary person, mid-30s

“I think it’s really me being a Black woman or a Black man that can sometimes be difficult. And also, my ethnic background too. It’s really rough for me with my family back home and things of that nature.” – Nonbinary person, mid-20s

Navigating gender day-to-day

For some, deciding how open to be about their gender identity can be a constant calculation. Some participants reported that they choose whether or not to disclose that they are trans or nonbinary in a given situation based on how safe or comfortable they feel and whether it’s necessary for other people to know. This also varies depending on whether the participant can easily pass as a cisgender man or woman (that is, they can blend in so that others assume them to be cisgender and don’t recognize that they are trans or nonbinary).

“It just depends on whether I feel like I have the energy to bring it up, or if it feels worth it to me like with doctors and stuff like that. I always bring it up with my therapists, my primary [care doctor], I feel like she would get it. I guess it does vary on the situation and my capacity level.” – Nonbinary person, late 20s

“I decide based on the person and based on the context, like if I feel comfortable enough to share that piece of myself with them, because I do have the privilege of being able to move through the world and be identified as cis[gender] if I want to. But then it is important to me – if you’re important to me, then you will know who I am and how I identify. Otherwise, if I don’t feel comfortable or safe then I might not.” – Nonbinary person, early 30s

“The expression of my gender doesn’t vary. Who I let in to know that I was formerly female – or formerly perceived as female – is kind of on a need to know basis.” – Trans man, 60s

“It’s important to me that people not see me as cis[gender], so I have to come out a lot when I’m around new people, and sometimes that’s challenging. … It’s not information that comes out in a normal conversation. You have to force it and that’s difficult sometimes.” – Trans man, early 40s

Work is one realm where many participants said they choose not to share that they are trans or nonbinary. In some cases, this is because they want to be recognized for their work rather than the fact that they are trans or nonbinary; in others, especially for nonbinary participants, they fear it will be perceived as unprofessional.

“It’s gotten a lot better recently, but I feel like when you’re nonbinary and you use they/them pronouns, it’s just seen as really unprofessional and has been for a lot of my life.” – Nonbinary person, early 30s

“Whether it’s LinkedIn or profiles [that] have been updated, I’ve noticed people’s resumes have their pronouns now. I don’t go that far because I just feel like it’s a professional environment, it’s nobody’s business.” – Nonbinary person, mid-30s

“I don’t necessarily volunteer the information just to make it public; I want to be recognized for my character, my skill set, in my work in other ways.” – Trans man, early 30s

Some focus group participants said they don’t mind answering questions about what it’s like to be trans or nonbinary but were wary of being seen as the token trans or nonbinary person in their workplace or among acquaintances. Whether or not they are comfortable answering these types of questions sometimes depends on who’s asking, why they want to know, and how personal the questions get.

“I’ve talked to [my cousin about being trans] a lot because she has a daughter, and her daughter wants to transition. So, she always will come to me asking questions.” – Trans woman, early 40s

“It is tough being considered the only resource for these topics, right? In my job, I would hate to call myself the token nonbinary, but I was the first nonbinary person that they hired and they were like, ‘Oh, my gosh, let me ask you all the questions as you are obviously the authority on the subject.’ And it is like, ‘No, that is a part of me, but there are so many other great resources.’” – Nonbinary person, late 20s

“I don’t want to be the token. I’m not going to be no spokesperson. If you have questions, I’m the first person you can ask. Absolutely. I don’t mind discussing. Ask me some of the hardest questions, because if you ask somebody else you might get you know your clock cleaned. So, ask me now … so you can be educated properly. Otherwise, I don’t believe it’s anybody’s business.” – Trans woman, early 40s

Most nonbinary participants said they use “they/them” as their pronouns, but some prefer alternatives. These alternatives include a combination of gendered and gender-neutral pronouns (like she/they) or simply preferring that others use one’s names rather than pronouns. 

“If I could, I would just say my name is my pronoun, which I do in some spaces, but it just is not like a larger view. It feels like I’d rather have less labor on me in that regard, so I just say they/them.” – Nonbinary person, late 20s

“For me personally, I don’t get mad if someone calls me ‘he’ because I see what they’re looking at. They look and they see a guy. So, I don’t get upset. I know a few people who do … and they correct you. Me, I’m a little more fluid. So, that’s how it works for me.” – Nonbinary person, mid-30s

“I use they/she pronouns and I put ‘they’ first because that is what I think is most comfortable and it’s what I want to draw people’s attention to, because I’m 5 feet tall and 100 pounds so it’s not like I scream masculine at first sight, so I like putting ‘they’ first because otherwise people always default to ‘she.’ But I have ‘she’ in there, and I don’t know if I’d have ‘she’ in there if I had not had kids.” – Nonbinary person, late 30s

“Why is it so hard for people to think of me as nonbinary? I choose not to use only they/them pronouns because I do sometimes identify with ‘she.’ But I’m like, ‘Do I need to use they/them pronouns to be respected as nonbinary?’ Sometimes I feel like I should do that. But I don’t want to feel like I should do anything. I just want to be myself and have that be accepted and respected.” – Nonbinary person, early 30s

“I have a lot of patience for people, but [once someone in public used] they/them pronouns and I thanked them and they were like, ‘Yeah, I just figure I’d do it when I don’t know [someone’s] pronouns.’ And I’m like, ‘I love it, thank you.’” – Nonbinary person, early 30s

Transgender and nonbinary participants find affirmation of their gender identity and support in various places. Many cited their friends, chosen families (and, less commonly, their relatives), therapists or other health care providers, religion, or LGBTQ+ spaces as sources of support.

“I’m just not close with my family [of origin], but I have a huge chosen family that I love and that fully respects my identity.” – Nonbinary person, early 30s

“Before the pandemic I used to go out to bars a lot; there’s a queer bar in my town and it was a really nice place just being friends with everybody who went and everybody who worked there, it felt really nice you know, and just hearing everybody use the right pronouns for me it just felt really good.” – Nonbinary person, early 30s

“I don’t necessarily go to a lot of dedicated support groups, but I found that there’s kind of a good amount of support in areas or groups or fandoms for things that have a large LGBT population within them. Like certain shows or video games, where it’s just kind of a joke that all the gay people flock to this.”  – Trans woman, late teens

“Being able to practice my religion in a location with a congregation that is just completely chill about it, or so far has been completely chill about it, has been really amazing.” – Nonbinary person, late 30s

Many participants shared specific moments they said were small in the grand scheme of things but made them feel accepted and affirmed. Examples included going on dates, gestures of acceptance by a friend or social group, or simply participating in everyday activities.

“I went on a date with a really good-looking, handsome guy. And he didn’t know that I was trans. But I told him, and we kept talking and hanging out. … That’s not the first time that I felt affirmed or felt like somebody is treating me as I present myself. But … he made me feel wanted and beautiful.” – Trans woman, late 30s

“I play [on a men’s rec league] hockey [team]. … I joined the league like right when I first transitioned and I showed up and I was … nervous with locker rooms and stuff, and they just accepted me as male right away.” – Trans man, late 30s

“I ended up going into a barbershop. … The barber was very welcoming, and talked to me as if I was just a casual customer and there was something that clicked within that moment where, figuring out my gender identity, I just wanted to exist in the world to do these natural things like other boys and men would do. So, there was just something exciting about that. It wasn’t a super macho masculine moment, … he just made me feel like I blended in.” – Trans man, early 30s

Participants also talked about negative experiences, such as being misgendered, either intentionally or unintentionally. For example, some shared instances where they were treated or addressed as a gender other than the gender that they identify as, such as people referring to them as “he” when they go by “she,” or where they were deadnamed, meaning they were called by the name they had before they transitioned. 

“I get misgendered on the phone a lot and that’s really annoying. And then, even after I correct them, they keep doing it, sometimes on purpose and sometimes I think they’re just reading a script or something.” – Trans man, late 30s

“The times that I have been out, presenting femme, there is this very subconscious misgendering that people do and it can be very frustrating. [Once, at a restaurant,] I was dressed in makeup and nails and shoes and everything and still everyone was like, ‘Sir, what would you like?’ … Those little things – those microaggressions – they can really eat away at people.” – Nonbinary person, mid-40s

“People not calling me by the right name. My family is a big problem, they just won’t call me by my name, you know? Except for my nephew, who is of the Millennial generation, so at least he gets it.” – Nonbinary person, 60s

“I’m constantly misgendered when I go out places. I accept this – because of the way I look, people are going to perceive me as a woman and it doesn’t cause me huge dysphoria or anything, it’s just nice that the company that I keep does use the right pronouns.” – Nonbinary person, early 30s

Some participants also shared stories of discrimination, bias, humiliation, and even violence. These experiences ranged from employment discrimination to being outed (that is, someone else disclosing the fact that they are transgender or nonbinary without their permission) without their permission to physical attacks.

“I was on a date with this girl and I had to use the bathroom … and the janitor … wouldn’t let me use the men’s room, and he kept refusing to let me use the men’s room, so essentially, I ended up having to use the same bathroom as my date.” – Trans man, late 30s

“I’ve been denied employment due to my gender identity. I walked into a supermarket looking for jobs. … And they flat out didn’t let me apply. They didn’t even let me apply.” – Trans man, mid-30s

“[In high school,] this group of guys said, ‘[name] is gay.’ I ignored them but they literally threw me and tore my shirt from my back and pushed me to the ground and tried to strip me naked. And I had to fight for myself and use my bag to hit him in the face.” – Trans woman, late 20s

“I took a college course [after] I had my name changed legally and the instructor called me out in front of the class and called me a liar and outed me.” – Trans man, late 30s 

Seeking medical care for gender transitions 

Many, but not all, participants said they have received  medical care , such as surgery or hormone therapy, as part of their gender transition. For those who haven’t undergone a medical transition, the reasons ranged from financial barriers to being nervous about medical procedures in general to simply not feeling that it was the right thing for them.

“For me to really to live my truth and live my identity, I had to have the surgery, which is why I went through it. It doesn’t mean [that others] have to, or that it will make you more or less of a woman because you have it. But for me to be comfortable, … that was a big part of it. And so, that’s why I felt I had to get it.” – Trans woman, early 40s

“I’m older and it’s an operation. … I’m just kind of scared, I guess. I’ve never had an operation. I mean, like any kind of operation. I’ve never been to the hospital or anything like that. So, it [is] just kind of scary. But I mean, I want to. I think about all the time. I guess have got to get the courage up to do it.” – Trans woman, early 40s

“I’ve decided that the dysphoria of a second puberty … would just be too much for me and I’m gender fluid enough where I’m happy, I guess.” – Nonbinary person, early 30s

“I’m too old to change anything, I mean I am what I am. [laughs]” – Nonbinary person, 60s

Many focus group participants who have sought medical treatment for their gender transition faced barriers, although some had positive experiences. For those who said there were barriers, the cost and the struggle to find sympathetic doctors were often cited as challenges. 

“I was flat out turned down by the primary care physician who had to give the go-ahead to give me a referral to an endocrinologist; I was just shut down. That was it, end of story.” – Nonbinary person, 50s

“I have not had surgery, because I can’t access surgery. So unless I get breast cancer and have a double mastectomy, surgery is just not going to happen … because my health insurance wouldn’t cover something like that. … It would be an out-of-pocket plastic surgery expense and I can’t afford that at this time.” – Nonbinary person, 50s

“Why do I need the permission of a therapist to say, ‘This person’s identity is valid,’ before I can get the health care that I need to be me, that is vital for myself and for my way of life?” – Nonbinary person, mid-40s

“[My doctor] is basically the first person that actually embraced me and made me accept [who I am].” – Trans woman, late 20s

Many people who transitioned in previous decades described how access has gotten much easier in recent years. Some described relying on underground networks to learn which doctors would help them obtain medical care or where to obtain hormones illegally. 

“It was hard financially because I started so long ago, just didn’t have access like that. Sometimes you have to try to go to Mexico or learn about someone in Mexico that was a pharmacist, I can remember that. That was a big thing, going through the border to Mexico, that was wild. So, it was just hard financially because they would charge so much for testosterone. And there was the whole bodybuilding community. If you were transitioning, you went to bodybuilders, and they would charge you five times what they got it [for], so it was kind of tough.” – Trans man, early 40s

“It was a lot harder to get a surgeon when I started transitioning; insurance was out of the question, there wasn’t really a national discussion around trans people and their particular medical needs. So, it was challenging having to pay everything out of pocket at a young age.” – Trans man, early 30s

“I guess it was hard for me to access hormones initially just because you had to jump through so many hoops, get letters, and then you had to find a provider that was willing to write it. And now it’s like people are getting it from their primary care doctor, which is great, but a very different experience than I had.” – Trans man, early 40s

Connections with the broader LGBTQ+ community

The discussions also touched on whether the participants feel a connection with a broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community or with other people who are LGBTQ+. Views varied, with some saying they feel an immediate connection with other people who are LGBTQ+, even with those who aren’t trans or nonbinary, and others saying they don’t necessarily feel this way. 

“It’s kind of a recurring joke where you can meet another LGBT person and it is like there is an immediate understanding, and you are basically talking and giving each other emotional support, like you have been friends for 10-plus years.” – Trans woman, late teens 

“I don’t think it’s automatic friendship between queer people, there’s like a kinship, but I don’t think there’s automatic friendship or anything. I think it’s just normal, like, how normal people make friends, just based on common interests.” – Nonbinary person, early 30s 

“I do think of myself as part of the LGBT [community] … I use the resources that are put in place for these communities, whether that’s different health care programs, support groups, they have the community centers. … So, I do consider myself to be part of this community, and I’m able to hopefully take when needed, as well as give back.” – Trans man, mid-30s

“I feel like that’s such an important part of being a part of the [LGBTQ+] alphabet soup community, that process of constantly learning and listening to each other and … growing and developing language together … I love that aspect of creating who we are together, learning and unlearning together, and I feel like that’s a part of at least the queer community spaces that I want to be in. That’s something that’s core to me.” – Nonbinary person, early 30s

“I identify as queer. I feel like I’m a part of the LGBT community. That’s more of a part of my identity than being trans. … Before I came out as trans, I identified as a lesbian. That was also a big part of my identity. So, that may be too why I feel like I’m more part of the LGB community.” – Trans man, early 40s

While many trans and nonbinary participants said they felt accepted by others in the LGBTQ+ community, some participants described their gender identity as a barrier to full acceptance. There was a sense among some participants that cisgender people who are lesbian, gay or bisexual don’t always accept people who are transgender or nonbinary.  

“I would really like to be included in the [LGBTQ+] community. But I have seen some people try to separate the T from LGB … I’ve run into a few situations throughout my time navigating the [LGBTQ+] community where I’ve been perceived – and I just want to say that there’s nothing wrong with this – I’ve been perceived as like a more feminine or gay man in a social setting, even though I’m heterosexual. … But the minute that that person found out that I wasn’t a gay man … and that I was actually a transgender person, they became cold and just distancing themselves. And I’ve been in a lot of those types of circumstances where there’s that divide between the rest of the community.” – Trans man, early 30s

“There are some lesbians who see trans men as being traitors to womanhood. Those are not people that I really identify with or want to be close to.” – Trans man, early 40s 

“It’s only in the past maybe dozen or so years, that an identity like gender fluid or gender queer was acceptable even within the LGBTQ+ community. … I tried to go to certain LGBTQ+ events as a trans man and, you know, I was not allowed in because I looked too female. The gay men would not allow me to participate.” – Nonbinary person, 50s 

“Technically based on the letters [in the acronym LGBTQ+] I am part of that community, but I’ve felt discrimination, it’s very heavily exclusive to people who are either gay or lesbian and I think that’s true … for queer or bisexual or asexual, intersex … anybody who’s not like exclusively hardcore gay or lesbian. It’s very exclusive, like excluding to those people. … I feel like the BTQ is a separate group of people…. So, I identify with the second half of the letters as a separate subset.” – Trans man, late 30s

Policy and social change

When asked to name the most important policy or political issues facing transgender and nonbinary people in the United States today, many participants named basic needs such as housing, employment, and health care. Others cited recent legislation or policies related to people who are transgender that have made national news.

“Housing is a huge issue. Health care might be good in New York, it might be good in California, but … it’s not a national equality for trans folks. Health care is not equal across the states. Housing is not equal across the states. So, I think that the issues right now that we’re all facing is health care and housing. That’s the top, the most important things.” – Trans woman, early 40s 

“Definitely education. I think that’s very important … Whether you identify as trans or not as a young child, it’s good to understand and know the different things under the umbrella, the queer umbrella. And it is also just a respect thing. And also, the violence that happens against trans and nonbinary people. I feel like educating them very young, that kind of helps – well, it is going to help because once you understand what’s going on and you see somebody that doesn’t identify the same as you, you’ll have that respect, or you’ll have that understanding and you’re less likely to be very violent towards them.” – Nonbinary person, mid-20s 

“Employment is a big one. And I know that some areas, more metropolitan progressive-leaning areas, are really on top of this, but they’re trans people everywhere that are still being discriminated against. I think it’s a personal thing for me that goes back to my military service, but still, it’s just unfortunate. It’s an unfortunate reality.” – Trans man, early 30s

“I think just the strong intersectionality of trans people with mental health issues, or even physical health issues. … So in that way, accessing good health care or having good mental health.” – Trans man, late 30s

“I honestly think that the situation in Texas is the most pressing political and policy situation because it is a direct attack on the trans community. … And it is so insidious because it doesn’t just target bathrooms. This is saying that if you provide medical care to trans youth it is tantamount to child abuse. And it is so enraging because it is a known proven fact that access to gender affirming medical care saves lives. It saves the lives of trans youth. And trans youth have the highest suicide rate in the country.” – Nonbinary person, mid-40s 

Participants had different takes on what gets in the way of progress on issues facing transgender and nonbinary people. Some pointed to the lack of knowledge surrounding the history of these issues or not knowing someone who is transgender or nonbinary. Others mentioned misconceptions people might have about transgender and nonbinary people that influence their political and policy perspectives. 

“People who don’t know trans people, honestly … that’s the only barrier I can understand because people fear what they don’t know and then react to it a lot of the time.” – Nonbinary person, early 30s

“Sometimes even if they know someone, they still don’t consider them to be a human being, they are an ‘other,’ they are an ‘it,’ they are a ‘not like me,’ ‘not like my family,’ person and so they are put into a place socially where they can be treated badly.” – Nonbinary person, 50s

“Just the ignorance and misinformation and this quick fake social media fodder, where it encourages people who should not be part of the conversation to spread things that are not true.” – Trans man, late 30s

“Also, the political issues that face nonbinary people, it’s that people think nonbinary is some made-up thing to feel cool. It’s not to feel cool. And if someone does do it to feel cool, maybe they’re just doing that because they don’t feel comfortable within themselves.” – Nonbinary person, mid-30s

“There’s so much fear around it, and misunderstanding, and people thinking that if you’re talking to kids about gender and sexuality, that it’s sexual. And it’s like, we really need to break down that our bodies are not inherently sexual. We need to be able to talk with students and children about their bodies so that they can then feel empowered to understand themselves, advocate for themselves.” – Nonbinary person, early 30s

When asked what makes them hopeful for the future for trans and nonbinary people, some participants pointed to the way things in society have already changed and progress that has been made. For example, some mentioned greater representation and visibility of transgender and nonbinary people in entertainment and other industries, while others focused on changing societal views as things that give them hope for the future. 

“I am hopeful about the future because I see so many of us coming out and being visible and representing and showing folks that we are not to stereotype.” – Trans woman, early 40s

“Also, even though celebrity is annoying, it’s still cool when people like Willow [Smith] or Billie Eilish or all these popstars that the kids really love are like, ‘I’m nonbinary, I’m queer,’ like a lot more progressive. … Even just more visibility in TV shows and movies, the more and more that happens the more it’s like, ‘Oh yeah, we are really here, you can’t not see us.’” – Nonbinary person, late 20s

“We shouldn’t have to look to the entertainment industry for role models, we shouldn’t have to, we should be able to look to our leaders, our political leaders, but I think, that’s what gives me hope. Soon, it’s going to become a nonissue, maybe in my lifetime.” – Trans man, 60s

“I have gotten a little bit into stand-up comedy in the last few weeks, and it is like the jokes that people made ten years ago are resurfacing online and people are enraged about it. They are saying like, ‘Oh, this is totally inappropriate.’ But that comes with the recognition that things have changed, and language has changed, and people are becoming more intolerant of allowing these things to occur. So that is why I am hopeful, is being able to see that progression and hopeful continued improvement on that front.” – Nonbinary person, late 20s

“I think because of the shift of what’s happening, how everything has become so normal, and people are being more open, and within the umbrella of queerness so many different things are happening, I think as we get more comfortable and we progress as a society, it’s just going to be better. So, people don’t have to hide who they are. So, that gives me hope.” – Nonbinary person, mid-20s

For many, young people are a source of hope. Several participants talked about younger generations being more accepting of those who are transgender or nonbinary and also being more accepted by their families if they themselves are trans or nonbinary. 

“And then the other portion that gives me hope are the kids, because I work now with so many kids who are coming out as trans earlier and their families are embracing them and everything. … So I really am trusting in the young generation.” – Nonbinary person, 60s

“I mean kids don’t judge you the same way as adults do about gender, and they’re so expansive and have so much creativity. … So it’s just the kids, Gen Z, and it just makes me feel really, really hopeful.” – Nonbinary person, early 30s

“The youth, the youth. They understand almost intrinsically so much more about these things than I feel like my generation did. They give me so much hope for the future.” – Nonbinary person, early 30s

“I think future generations, just seeing this growing amount of support that they have, that it’s just going to keep improving … there’s an increase in visibility but there’s also an increase in support … like resources for parents where they can see that they don’t have to punish their kids. Their kids can grow up feeling like, ‘This is okay to be this way.’ And I feel like that’s not something that can be stopped.” – Trans man, late 30s

Additional materials

• Acknowledgments
• Methodology

Lead photo: (Angela Weiss/AFP via Getty Images)

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Journal of Unification Studies

Volume XXI - (2020)

Sexual orientation and gender identity issues, and worldview.

• Fleischman, Jinil

Journal of Unification Studies Vol. 21, 2020 - Pages 111-120

Sexual Orientation and Gender Identity (SOGI) issues are one of the most important and contentious social issues in the world today. Beginning in the 1970s, gay activists in the United States have fought against rigid cultural norms and limitations to promote tolerance and acceptance of non-traditional sexual lifestyles and identities. Their ultimate victory was in the landmark Obergefell v. Hodges Supreme Court case in 2015, which guaranteed the constitutional right for same-sex couples to be married in the United States of America.

For most of western history, it has been assumed that there are two genders – men and women – and that the only natural sexual orientation is to be heterosexual, so sexual relations were only socially acceptable between a man and a woman. Anyone who’s lifestyle didn’t conform to those standards was viewed as dysfunctional. These values were informed primarily by Christianity and the Judeo-Christian worldview that was prevalent in the western world. The rise of the LGBT movement coincided with and contributed to many changes in American culture, and was bolstered by the prevalence of new worldviews, notably materialist worldviews like secular humanism and Marxism, as well as postmodernism. The turbulence of today’s America can be traced to the conflict between these different worldviews and the Judeo-Christian worldview. SOGI issues are one of the most important frontiers of this conflict of worldviews.

Different Worldviews

One reason that SOGI issues are so contentious is that they deal with an essential aspect through which people understand and identify themselves, and are thus very personal. Dialogue and debate about SOGI can be taken as personal attacks and intentional efforts to delegitimize LGBT people’s experiences and identity. Any conversation on this topic must be approached with sensitivity and compassion. Worldview can be a powerful lens through which to approach this topic because it encourages us to step back from our deeply held convictions and to examine the assumptions that inform those views. Examining worldview invites healthy reflection and discourse, and hopefully avoids differences of opinions being taken as personal attacks.

The LGBT and Judeo-Christian worldviews are based on assumptions and moral values that differ greatly from each other. The Judeo-Christian worldview believes that there is a God with a divine will and purpose for humanity. That purpose can be understood through knowledge of scripture and through understanding natural law, which is the observable laws of the natural (created) world. Both of these point towards heterosexuality: The Bible teaches that God created humanity as male and female in God’s own image, and reproduction of the human race only occurs through the union of man and woman. Virtue is attributed to that which is within God’s divine purpose; therefore, marriage between man and woman is affirmed, and any other expression of sexual orientation or identity – including adultery, homosexuality, and transgenderism – is viewed as sinful and contrary to God’s purpose.

The LGBT worldview is based upon a materialist and morally relative perspective. It is influenced by postmodern thinkers like Derrida and Foucault towards an orientation that casts serious doubts on claims to absolute truth. Rather, it affirms every person’s unique experience and right to define truth according to their personal experience. Each individual is the expert of their own experience and should have the freedom to live their life according to their judgments of truth, as long as it doesn’t harm others. This includes the right to live as a non-traditional sexual or gender identity. Purpose is not inherent in existence, but each person can define their own purpose for themselves. It views power as being exercised through the domination of language and cultural discourse. Thus, it sees Judeo-Christianity as having maintained a cultural hegemony that reinforces heterosexism, because Judeo-Christianity has set the cultural framework through which discourse and judgments about sex and gender have been made.

Most people of both Judeo-Christian and LGBT worldviews would agree that there are certain undeniable, scientific facts. There is a material reality which can be observed and measured, and about which we can make reasonable assumptions, truth claims, and generalizations. For example, we can say that human beings have two eyes, one nose, and one mouth, even though there are some people who don’t necessarily have all of those features. We can also say that new human beings come into existence through the fertilization of an egg cell by a sperm cell. Scientific facts are value-free. They don’t contain any moral or ethical judgments within themselves, but merely report about what can be observed through the scientific method.

Worldviews are the lenses through which we make judgments about the scientific facts presented to us. A person’s worldview might say that life is meant to be lived joyously by experiencing as much as we can through our five senses. When presented with the scientific reality of a person who is blind, they might see his situation as suboptimal because he cannot experience all that the world has to offer visually, and might think it valuable to conduct scientific research to heal and/or prevent blindness in humans. Another person might have a worldview that uplifts the worth of every person and accepts differences without seeing things as better than or less than. They might emphasize acceptance of people and making society more welcoming of blind people without seeing the need to cure blindness. A third person might have a worldview that sees individuals pitted against each other for survival and might view blind people as weak and as targets to be taken advantage of. All three of them are presented with the same scientific reality, but are led to very different conclusions and actions by their worldview.

The scientific fact related to SOGI issues is that while the majority of human beings fit comfortably within the traditional definitions of heterosexual man and woman, there are people who do not. In the case of gay, lesbian, and bisexual people, they experience sexual attraction to people of the same sex. These are differences of sexual orientation that fall out of the heterosexual norm. Most other identities (the “TQ+” of LGBTQ+) represent variations of gender identity, where people experience their gender identity to be different than the sex that they were assigned at birth. Transgender and transsexual people experience their gender or sex as different than the sex designated by the doctor at their birth. For example, a trans man would have been born with anatomical features of a woman, but at some point in her life felt that she is actually a man. He may now use masculine instead of feminine pronouns, and he may undergo sexual reassignment therapy to change his body to present as a male. Intersex people also fit into those that deal with gender identity issues. Some intersex people were born with ambiguous genitalia that look like something in between male and female genitalia, while others have a different abnormality that produces an ambiguous gender, like a chromosomal or hormonal variation.

It is a scientific reality that there are people who experience the SOGI variations described above, and while they may be a small percentage of the overall US population, they number in the millions. It is a worthwhile endeavor to continue to seek scientific understanding of the cause and nature of these SOGI variations. Because this topic is very politically charged, research may become agenda-driven instead of being impartial and open to unexpected conclusions. As much as possible, such inquiry should be made from a value-neutral perspective. Once the scientific facts are clarified, they are interpreted according to one’s worldview.

Different Responses Based on Worldview

The Christian world and the LGBT world have had very different responses to these SOGI variations. The response of the Judeo-Christian world has often been to reject and persecute LGBT people. Because marriage and sexuality has always been seen as rightfully between a man and a woman, anyone who lived a lifestyle contrary to that was persecuted and judged. Homosexuals had to gather in communities that were secretive and always faced the threat of violence. It was frustration towards this violence that caused the Stonewall Riots in Greenwich Village which sparked the gay rights movement of the 20th century. The Christian response towards the challenges and confusion experienced by LGBT people has been severely inadequate and too often has lacked a demonstration of true brotherly, Christian love.

However, there has been a second narrative that has been growing increasingly, [1] which emphasizes having greater empathy and understand-ing for the situation of LGBT people. They stress the importance of demonstrating compassion for those not living a heterosexual lifestyle. Many denominations (i.e., the United Methodist Church) are facing crises about how to reconcile opposing views about LGBT people, where some say that those lifestyles shouldn’t be condoned by the church and some say that they should be accepted and embraced by the church. Some advocate for the acceptance of LGBT priests, saying that there is much that Christianity can learn from those who practice a queer lifestyle. [2] This response has a different risk than the first: the risk of compromising the most basic tenets of the Judeo-Christian worldview. Christianity believes in a divine Creator who made humankind according to a divine plan, which is revealed specially through scripture. Faith in God and in the Word of God as revealed in the Bible is fundamental to the Christian faith. The Bible has passages that explicitly denounce the practice of homosexuality. Thus, it seems that the answer to the problem of Christian persecution of LGBT people isn’t acceptance and endorsement of LGBT lifestyles.

There are certain assumptions about sexual orientation and gender identity that the LGBT worldview makes in order to support the opinion that variations of SOGIs are equally valid and legitimate lifestyles. One assumption is the belief that the existence of homosexual thoughts and desires, or of gender dysphoric thoughts or feelings, is proof that differences of sexual orientation and gender identity are inherent markers of a person’s identity equivalent to race and other markers of identity. There are many different psychological traits experienced by millions of people but which are outside the norm, many of which can be linked even more strongly to genetic and inherited factors than SOGI variations. Yet, we don’t claim that those traits signify a person’s fundamental identity.

For example, there is a strong genetic link to depression and addiction. Yet, no one would claim either of those two traits as a person’s fundamental identity even though they were born that way. Instead, we advocate for treatment and support so that a person can counter their inherited tendencies. [3] And many people are able to overcome depression and addiction, despite having a genetic predisposition towards them. One reason for this is that depression and addiction detract from a person’s ability to function optimally. A rough comparison can be made between this and SOGI variations.

Evidence of a genetic link does not logically signify a marker of one’s identity. If that were the case, even in terms of sexual orientation, then we would be left to conclude that pedophilia is an equivalent identity marker as homosexuality, and that we should accept those who feel sexual attraction towards children as they are, without helping them to overcome those feelings of attraction. Another assumption of the LGBT worldview is that it is impossible to change a person’s sexual orientation or gender identity if they are any of the LGBTQ+ identities. There has been a crusade to ban any forms of therapy, called conversion therapy, that would help a person to get rid of homosexual attractions and live an exclusively heterosexual lifestyle. It is true that there have been great abuses of individuals through types of conversion therapy, whether through electric shock therapy, aversion therapy in which homoerotic imagery is paired with repulsive sensations, or abusive counselors who denigrate the value of their client because of their homosexual feelings or actions. We need to take a stand against abusive forms of therapy and counselors.

However, the fact that certain forms of conversion therapy are unethical doesn’t mean that the theory behind conversion therapy itself is unethical. In fact, there is evidence that properly conducted conversion therapy (sometimes called reparative therapy) which is grounded in sound psychological theory, can be beneficial to people who desire to eradicate homosexual desires and live as an exclusively heterosexual individual. [4] The existence of such evidence should be reason enough to at least advocate further research and exploration of the possible benefits and risks of such therapy, rather than shutting it down because of individual cases of unethical treatment. But instead of providing clients various options of therapy to choose from that may match their values, they are pushed to accept gay-affirming therapy as the only option.

Also, a person may experience homosexual desires for a number of years of their lives, and then it may go away later in their life. But at the time in their life when they experienced those desires, they would have been told that they are gay, and that it can’t be changed. But the reality is that it wasn’t a fundamental part of their identity. Research is needed to understand why people experience SOGI variations and why they sometimes revert back to a heterosexual orientation and/or a cisgender identity.

Another assumption of the LGBT worldview is that it is possible and fairly easy to tell with absolute certainty when a person has a variant SOGI. Gay affirming counselors and counseling programs teach people that having any homosexual feelings is evidence of being gay, and then guide those people to accept a gay identity, claiming that if they’re not comfortable with that, it is because systemic and internalized homophobia and heterosexism has trained them to revile homosexuality. The reality is that it is not easy to define a person’s sexual orientation. [5]

The first effort to do was the Kinsey scale, whereby a person would be rated on a scale of 0 to 6, 0 meaning exclusively heterosexual and 6 meaning exclusively homosexual. But even with the scale, it’s not clear at which number a person is considered not heterosexual, but having a homosexual or bisexual identity. Is it at 1, when they have incidental homosexual tendencies? At 3, when they have equal homosexual and heterosexual tendencies? Homosexual tendencies can also be measured in very different ways. It could be measured as homosexual thoughts, feelings, fantasies, or actions.

Understanding a person’s sexual orientation or gender identity relies on their own self-report. Unlike other identity markers like race or biological sex, a person’s sexual orientation or gender identity may not be easy to discern upon observation. Also, as mentioned above, SOGI can change over time. It is even more difficult to define a person by any characteristic if it changes over time.

The category of SOGI persons that might be observable is intersex, where a person is born with ambiguous genitalia or has a kind of abnormality, like chromosomal or hormonal, that causes them to have traits that don’t match expectations of the gender binary. However, the existence of intersex people doesn’t mean that the entire system of defining sex and gender as a binary between male and female should be thrown out. There are people born with other physical abnormalities. For example, a person could be born with six fingers. They could live their whole lives with six fingers and function normally and in complete health. However, because the vast majority of people have five fingers, our society is designed for five-fingered people. It would be hard for a six-fingered person to find a glove that fits their hand.

Having an extra finger is not a moral failing, but is a biological condition that they were born with. But still, one might say that it’s best to find a way for people to be born with five fingers instead of six, and/or to find a way to harmlessly remove the extra finger. The same might be said about intersex people. Being intersex isn’t a moral failing. But it could be reasonably said that it is more optimal for people to be born and live with a clear gender and sex. It is true that great harm has been done to intersex people in the past, whether due to discrimination or harmful surgical procedures meant to remove ambiguity about a person’s sex. But just as was mentioned before, the existence of unethical practices doesn’t mean the purpose that was meant to be accomplished through that practice is also unethical.

One of the challenges of both the Judeo-Christian and LGBT world-views is that they lack clarity about the purpose for the gender binary between male and female. The Judeo-Christian perspective acknowledges that it was within God’s design for humankind to be man and woman, that this is the way that we can reflect God’s image. It emphasizes the idea that “form follows function,” [6] meaning that the form of male and female is necessary for the function of reproduction. It seems to imply that deviation from that design is due to the individual’s moral failure. Meanwhile, the LGBT worldview doesn’t believe that there is any purpose to the gender binary, even for reproductive purposes. They propose various, highly intellectual theories to demonstrate that gender is not inherent but is socially instructed. [7] But even feminist theorists criticize those theories of being inadequate to avoid ultimately relying on the division between reproductive roles of the genders. [8]

The LGBT worldview can be interpreted as a reaction to the injustice that people with SOGI variations have experienced historically. It doesn’t strive to find a unifying understanding of truth and reality, but pokes holes in the dominant Judeo-Christian discourse, while trying to affirm the validity of the individual experiences of LGBT people. This comes at the cost of maintaining a rational, coherent, scientific view of reality, as it is not scientific to adjust definitions and procedures that apply to the vast majority of people in order to compensate for outliers at the cost of the majority.

Unification Worldview Towards SOGI Variation

The Unification Worldview provides a clear and more detailed explanation than Christianity for the purpose of gender being binary. First of all, it offers more insights into the scripture that says that man was created male and female in God’s image. It explains that the metaphysics of the universe reflect God’s nature of harmonious interaction between the complementary parts of yang and yin (i.e. masculinity and femininity). Not only is this true in the animal kingdom, but even the molecular harmony between cation and anion and the atomic harmony between proton and electron reflect this dynamic. The conjugal union between man and woman is the pinnacle of this dynamic in the created world.

Secondly, the Unification Worldview highlights the importance of lineage. It explains that the most important thing in life is not money, knowledge, or power, nor is it even to have love or life. The most important thing is lineage. Lineage is the process by which love is multiplied and passed down through the generations. Offspring created through intercourse is the very way by which God is able to multiply His children and Himself. This directly counters the LGBT emphasis that places greatest value on personal satisfaction. According to the Unification Worldview, joy and purpose are greatest not when we live for our own self-centered pleasure, but when we live for a greater purpose like for our spouse, children, and descendants.

Thirdly, the Unification Worldview provides an explanation for the societal, systemic, inherited nature of sin and suffering. The Christian worldview tends to place the fault on individuals who don’t live as monogamous, heterosexual couples for choosing to live sexually deviant lives. It denies the systemic prejudice experienced by those who struggle to live that lifestyle, and it negates the personal experience of individuals who truly feel that they are not heterosexual and/or cisgender. The Unification Worldview explains that our current reality does not reflect the original ideal that God intended for His creation, but rather that sin has corrupted human nature and the natural world. Our personal struggles are not only our shortcomings, but are results of the shortcomings that we have inherited from our ancestors and from the original human ancestors.

Not only that, but the Unification Worldview believes in a spiritual world that can influence the material world. Thus, the spirits of people who have lived in the generations before may be acting out their unresolved issues by trying to influence us living in the physical world currently. Because science has struggled to produce an adequate explanation for the cause of SOGI issues, many Unificationists believe that it could be explained at least in part as the result of the influence of the spirit world. This perspective shifts the blame away from the moral failings of individual people, yet upholds their ability to exercise their free will in their situation.

No matter what perspective or worldview that a person has, when it comes to the issues that human beings face it is important to maintain an attitude of compassion and love. Worldviews have an important role in guiding how we as a society view and deal with issues that we face as a whole; however, too often we lose touch with human compassion in the attempt to convince others of our worldview. The greatest struggles that LGBT people have faced is the treatment that they have experienced from other people. In order to provide them with the best care, we must start by upholding the value and dignity of every human life, regardless of how a person may choose to live their lives. We must start from finding the place in our worldview that acknowledges that basic human value.

[1] Joseph Yi, Gowoon Jung, and Joe Phillips. “Evangelical Christian Discourse in South Korea on the LGBT: The Politics of Cross-Border Learning.” Society 54, no. 1 (March 2017): 32.

[2] Edman, Elizabeth M. Queer Virtue: What LGBTQ People Know about Life and Love and How It Can Revitalize Christianity. Boston: Beacon, 2017.

[3] Ward, Thomas. “Unification Worldview: Formulating a Response to LGBTQ.” Lecture presented for the Unification Worldview class at the Unification Theological Seminary, New York, NY, January 2020a.

[4] Throckmorton, Warren. “Efforts to Modify Sexual Orientation: A Review of Outcome Literature and Ethical Issues.” Journal of Mental Health Counseling 20, no. 4 (October 1998): 283.

[6] Nicoll, Regis. “Don't Make a Right.” Salvo Magazine, 2014. https://salvomag.com/ article/salvo28/dont-make-a-right.

[7] Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 2015.

[8] Hawkesworth, Mary. “Confounding Gender.” Signs: Journal of Women in Culture and Society 22, no. 3 (1997): 649–85.

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Article Contents

1. introduction, 2. gender identity first, 3. the no connection view, 4. contextualism, 5. pluralism, 6. further and future work.

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Recent Work on Gender Identity and Gender

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Rach Cosker-Rowland, Recent Work on Gender Identity and Gender, Analysis , Volume 83, Issue 4, October 2023, Pages 801–820, https://doi.org/10.1093/analys/anad027

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Our gender identity is our sense of ourselves as a woman, a man, as genderqueer or as another gender. Trans people have a gender identity that is different from the gender they were assigned at birth. Some recent work has discussed what it is to have a sense of ourselves as a particular gender, what it is to have a gender identity ( Andler 2017 , Bettcher 2009 , 2017 , Jenkins 2016 , 2018 , McKitrick 2015 ). But beyond the question of how we should understand gender identity is the question of how gender identities relate to genders.

Our gender is the property we have of being a woman, being a man, being non-binary or being another gender. What is the relationship between our gender identity and our gender? According to many people’s conceptions and the standards operative in trans communities, our gender identity always determines our gender. Other people and communities have different views and standards: some hold that our gender is determined by the gender we are socially positioned or classed as, others hold that our gender is determined by whether we have particular biological features, such as the chromosomes we have. If our gender is determined by our gendered social position or whether we have certain biological features, then our gender identity will not determine our gender.

There are several different ways of approaching the question what is the relationship between our gender identity and our gender? We can approach this question as a descriptive or hermeneutical question about our current concepts of gender identity and gender: what is the relationship between our concept of gender identity and our concept of gender? ( Bettcher 2013 , Diaz-Leon 2016 , Laskowski 2020 , McGrath 2021 , Cosker-Rowland forthcoming , Saul 2012 ) Rather than focusing on descriptive questions about our gender concepts, many feminists, such as Sally Haslanger (2000) and Katharine Jenkins (2016) , have proposed ameliorative accounts of the concepts of gender which we should accept; these are gender concepts which they argue that we can use to further the feminist purposes of fights against gender injustice and campaigns for trans rights. We might then ask the ameliorative question, what is the relationship between our gender identity and our gender according to the concepts of gender and gender identity that we should accept? However, some of the most interesting recent work on the relationship between gender identity and gender has focussed on the metaphysical issue of the relationship between being a member of a particular gender kind G (e.g. being a woman) and having gender identity G (e.g. having a female gender identity). As we’ll see, we can answer these different questions in different ways: for instance, we can hold that we should adopt concepts such that someone is a woman iff they have a female gender identity but hold that metaphysically someone is a woman iff they are treated as a woman by their society, that is, iff they are socially positioned as a woman.

Four positions about the relationship between gender identity and gender that give answers to these ameliorative and metaphysical questions have emerged. This article will explain and evaluate these four positions. In order to understand these different views about the relationship between gender identity and gender it will help to have a little understanding of recent work on gender identity. The two most well-known and popular accounts of gender identity in the analytical philosophy literature are the self-identification account and the norm-relevancy account. On the self-identification account, to have a female gender identity is to self-identify as a woman. One way of explaining what it means to self-identify as a woman is to hold that such self-identification consists in a disposition to assert that one is a woman when asked what gender one is. 1 On the norm-relevancy account, to have a female gender identity is to experience the norms associated with women in your social context (e.g. the norm, women should shave their legs) as relevant to you ( Jenkins 2016 , 2018 ).

A first view of the relationship between gender and gender identity is what we can call gender identity first . According to a metaphysical version of gender identity first , what it is to be gender G (e.g. a woman) is to have a G gender identity (e.g. to have a female gender identity). Talia Bettcher (2009 : 112), B.R. George and R.A. Briggs (m.s.: §1.3–4), Iskra Fileva (2020 : esp. 193), and Susan Stryker (2006 : 10) argue for gender identity first or views similar to it. And the view that our gender is always determined by our gender identity is, as Briggs and George discuss, part of the standard view in many trans communities and among activists for trans rights. One key virtue of gender identity first is that it ensures that gender is always consensual: on this view, we can be correctly gendered as gender G (e.g. as a woman) only if we identify as a G , and so we can be correctly gendered as a G only if we consent to be gendered as a G by others ( George and Briggs m.s. : §1.3) ( Figure 1 ). 2

Gender identity first

Elizabeth Barnes (2022 : 2) argues that we should reject gender identity first as both a metaphysical and as an ameliorative view. She argues that

(i) Some severely cognitively disabled people do not have gender identities, but

(ii) These severely cognitively disabled people without gender identities have genders and should be categorized as having genders.

And in this case, although having gender identity G is sufficient for being gender G , it is not necessary for being gender G nor necessary for being categorized as a G according to the concepts of gender that we should accept. So, we should reject gender identity first as both a metaphysical view and as an ameliorative view.

Regarding (i), Barnes argues that gender identity

requires awareness of various social norms and roles (and, moreover an awareness of them as gendered), the ability to articulate one’s own relationship to those norms and roles, and so on. But many cognitively disabled people have little or no access to language. Many tend not to understand social norms, much less to identify those norms as specifically gendered. (6)

The norm-relevancy account of gender identity implies that this is true, since on this view having a gender identity involves taking certain gendered social norms to be relevant to you. And the self-identification account also seems to imply that having a gender identity involves having capacities that many severely cognitively disabled people do not have, since self-identification as a particular gender involves a linguistic capacity to say or be disposed to say that one is, or think of oneself as, a particular gender, and many severely cognitively disabled people do not have these capacities.

Barnes has two arguments for

(ii) Severely cognitively disabled people without gender identities have genders.

First, Barnes argues that severely cognitively disabled people who do not have gender identities nonetheless have genders because they suffer gender-based oppression ( 2022 : 11–12). For instance, severely cognitively disabled women are subject to gendered violence and forced sterilization to a greater degree than severely cognitively disabled men. This argument may seem strongest as an argument for (ii) as a metaphysical claim: the view that severely cognitively disabled people without gender identities have genders is the best explanation of what we find happening in the world.

Second, Barnes argues that holding that some severely cognitively disabled people do not have genders because they do not have gender identities would involve othering, alienating or dehumanizing these severely cognitively disabled people. Gender identity first implies that agender people do not have genders because their gender identity is that they have no gender. But Barnes argues that gender identity first’s implication that severely cognitively disabled people without gender identities lack a gender is more pernicious. Agender people have the capacity to form a gender identity but they opt-out of gender. Gender identity first implies that severely cognitively disabled people without gender identities fail to have genders because they do not have the capacity to form a gender identity. So, it implies that they fail to have a gender in the way that tables and animals fail to have a gender – by failing to have the right capacities to have a gender – rather than in the way that agender people do so; for agender people have these capacities. Therefore, Barnes argues, gender identity first others and alienates severely cognitively disabled people from other humans, since all other humans have the capacity to have a gender and having a gender (or opting out of it) is a central part of human (social life). 3 This second argument seems best understood as an argument that we shouldn’t adopt concepts of gender that imply that one is gender G iff one has gender identity G because there are moral and political costs to adopting such concepts.

A second account of the relationship between gender identity and gender is the opposite view; this view understands gender identity and gender as entirely disconnected. On this no connection view, the fact that a woman has a sense of herself as a woman is never what makes her a woman; other features of her, such as the way that she is socially positioned, the way she was socialized, or her biological features, make her a woman.

Several accounts of gender imply the no connection view, including Haslanger’s (2000) influential account of gender. Haslanger’s account was originally proposed as an ameliorative account of the concepts of gender that we should adopt rather than as a metaphysical account of gender properties. But in later work Haslanger also endorsed her account of gender as a metaphysical account of gender properties ( 2012 : e.g. 133–134). On Haslanger’s account, to be a woman is to be systematically subordinated because one is observed or imagined to have bodily features that are presumed to be evidence of a female’s biological role in reproduction; on Haslanger’s view, women are sexually marked subordinates. This view of what it is to be a woman implies that one’s being a woman is never determined by one’s female gender identity. Since, whether one has a sense of oneself as a woman, is disposed to assert that one is a woman or takes norms associated with women to be relevant to one, is neither necessary nor sufficient for one to be a sexually marked subordinate.

Although our gender is not directly determined by our gender identity on Haslanger’s account, one’s female gender identity can indirectly lead one to be a woman on Haslanger’s account. For instance, a trans woman’s female gender identity may lead her to take estradiol which will make her have female sex characteristics, which may lead to her being assumed to play a female biological role in reproduction, to be oppressed accordingly, and so to be a woman on Haslanger’s account. In this case, on Haslanger’s account, someone’s female gender identity can indirectly lead to their becoming a woman ( Figure 2 ).

The n o connection view

Other accounts of gender similarly imply the no connection view of the relationship between gender identity and gender. According to Bach’s (2012) account of gender, to be a woman one has to have been socialized as a woman. But one can have a sense of oneself as a woman without having been socialized as a woman and one can be socialized as a woman without forming a sense of oneself as a woman. So, having a female gender identity is neither necessary nor sufficient to be a woman on Bach’s account (although it may be more likely that A will have a sense of themself as a woman if A was socialized as a woman). Biological or sex-based accounts of gender on which our genders are determined by our biological features, such as our chromosomes, also imply the no connection view, since to have a female gender identity is neither necessary nor sufficient for having XX chromosomes. 4

The no connection view implies that many trans women are not women. For instance, Haslanger’s version of this view implies that trans women who are not presumed to have female sex characteristics by those in their society are not women; so trans women who are not recognised as women, or who ‘do not pass’, 5 are not women. This is because such trans women are not observed or imagined to have features that are presumed to be evidence of a female’s biological role in reproduction. There are many such trans women. So, no connection views such as Haslanger’s imply that many trans women are not women ( Jenkins 2016 : 398–402). Some have argued that this is an unacceptable result for a metaphysical view about the relationship between gender identity and gender, either because all trans women are women or because this view would marginalize trans women within contemporary feminism ( Mikkola 2016 : 100–102). These implications are even more problematic for ameliorative no connection views, that is, for views of how gender identity and gender are related according to the concepts that we ought to accept. For we should not adopt gender concepts that imply that we should not classify many trans women as women ( Jenkins 2016 ).

Furthermore, trans communities and trans-inclusive communities ascribe gender entirely on the basis of the gender identities people express or which people are presumed to have. Another problem with the no connection view is that it may seem to imply that there are no genders being tracked or ascribed in these communities ( Jenkins 2016 : 400–401; Ásta 2018 : 73–74).

These problems do not establish that Haslanger’s account of gender should be abandoned entirely. Elizabeth Barnes (2020) has recently argued that we can rescue Haslanger’s account of gender from the problem that it excludes trans women by understanding it as an account of what explains our experiences of gender. According to Barnes’ version of Haslanger’s account, our practices of gendering people, and our gender identities, are the product of Haslangerian social practices of subordinating and privileging people on the basis of perceived sex characteristics. Barnes’ version of Haslanger’s account does not imply that one is a woman iff one is systematically subordinated because one is observed or imagined to have bodily features that are presumed to be evidence of one’s playing a female’s biological role in reproduction. This is because Barnes’ account is only an account of what gives rise to our experiences of gender rather than an account of who has what gender properties or of the gender concepts that we should accept. Barnes might rescue a version of Haslanger’s account from the problem that it excludes trans women. But if she does, she does this by revising Haslanger’s account so that it drops the no connection view of the relationship between gender identities and gender; Barnes’ revised version of Haslanger’s account of gender is instead silent on the issue of the relationship between having gender identity G and being a member of gender G . So, Barnes’ rescue of Haslanger’s account of gender does not rescue the no connection view of the relationship between gender identity and gender.

Gender identity first and no connection views such as Haslanger’s are invariantist views of the relationship between gender identity and gender: they hold that the relationship between gender identity and gender does not vary across different contexts. A third account of the relationship between gender identity and gender is the opposite of invariantism, contextualism. According to this view, the features that determine our gender, and so the relationship between gender identity and gender, is different from context to context.

Ásta (2018) and Robin Dembroff (2018) have proposed and/or defended forms of (metaphysical) contextualism. On their views, the gender properties that we have, or the gender kinds that we are members of, are determined by the way that we are treated in particular contexts. We are a member of gender G in virtue of our gender identity G in certain contexts, namely trans-inclusive contexts where people are treated as genders based on their (avowed) gender identities. But in other contexts, we are never a member of gender G in virtue of our gender identity G : in contexts in which people are treated as a gender based on features other than their gender identities – such as traditional or conservative societies – we are not members of genders based on our gender identities. For instance, trans woman Amy is a woman in the context of the support group Trans Leeds – she is a woman (Trans Leeds) – but she is not a women in the context of her conservative parents in Henley who don’t recognize her as a woman and who treat people as women based on the chromosomes that they believe them to have – she is not a woman (family-in-Henley) . And Alex is non-binary in the context of the support group Non-Binary Leeds, where one is conferred a particular gender status based on one’s avowed self-identification – they are non-binary (Non-Binary Leeds) – but Alex is perceived as male in most contexts and is treated as male regardless of their self-identification at school, work and in public, and so Alex is not non-binary in most contexts – e.g. they are not non-binary (Alex’s school) . Importantly, on this view, there is no such thing as being gender G simpliciter , that is, beyond whether one is a G -relative-to-a-certain-context – and the way one is treated or the standards that are operative in that context. So, it is not the case that Alex is non-binary simpliciter or genuinely non-binary; they are merely non-binary relative to one standard or context and not non-binary relative to another.

Contextualism can explain why the way that some people are gendered varies from context to context: in explaining her contextualist view, Ásta (2018 : 73–74) gives an example of a coder who is one of the guys at work, neither a guy nor a girl at the bars they go to after work, and one of the women – and expected to help out like all the other women – at their grandmother’s house (85–86). Contextualism also allows us to explain how sometimes people are gendered on the basis of their perceived biological features and sometimes gendered based on their avowed (or assumed) gender identities. Dembroff argues that a contextualist view is particularly useful in explaining how, in many societies and contexts, trans people are unjustly constrained, or as they put it ‘ontologically oppressed’, by being constructed and categorized as a member of a category with which they do not identify; identifying such ontological oppression is essential to explaining the oppression that trans people face ( Dembroff 2018 : 24–26, Jenkins 2020 ) ( Figure 3 ).

Contextualism

However, there are several problems with contextualism. One problem is that it implies that gender critical feminists are, in a sense, right when they claim that trans women are not women and trans men are not men because trans women are not women according to the standards of many people and of many places: in many places trans women, for instance, are not treated as women, and in many places trans women are not women relative to the dominant standard for who is a woman, which is sex-based or biology-based. So, for instance, when in 2021 the then Tory UK Health Secretary Sajid Javid said that ‘only women have cervixes’, according to contextualism, what he said was true in a sense: only women (dominant UK-standards) have cervixes; and only women (Tory party conference) have cervixes. Even though it is false that only women (Trans Leeds) have cervixes because trans men have cervixes. This conclusion may seem problematic and paralyzing because it implies that Javid’s claim is true in a sense in certain contexts, and we cannot truthfully claim that it is just plain false ( Saul 2012 : 209–210, Diaz-Leon 2016 : 247–248). 6

Ásta (2018 : e.g. 87–88) and Dembroff (2018) argue that we can solve this problem by holding that, although it is true that trans men are not men relative to most dominant UK contexts, we should still treat and classify trans men as men. We should classify trans men as men because facts about how we should classify someone – the gender properties that we should treat them as having – are established by moral and political considerations. But although we should classify trans men as men, they are not – as a matter of social metaphysical fact – men (dominant UK contexts) . So, we should accept contextualism as a metaphysical view about the relationship between gender identity and gender but not as an ameliorative view about the gender concepts we should accept; we can call this combination of views purely metaphysical contextualism.

Dembroff (2018 : 38–48) recognizes that purely metaphysical contextualism may seem to have problematic implications. It may seem to imply that many trans women (for instance) are mistaken when they say that they are women in many contexts, such as dominant UK and US contexts, where there are chromosomes-based or assigned-sex-at-birth-based gender standards. Yet Dembroff argues that purely metaphysical contextualism does not have this problematic implication because trans women are women relative to the gender kinds operative in trans-inclusive contexts.

However, this will not always be a helpful form of correctness. Suppose that Alicia is a trans woman in London in 1840. There are no trans-inclusive societies, communities or contexts that she knows of. But she takes herself to be a woman, and suppose that according to both of the accounts of gender identity that we discussed in §1, Alicia has a female gender identity. We can say that Alicia’s judgement that she is a woman is correct in the sense that it is correct-relative to the gender kinds operative in future contexts and fictional contexts. But any judgment that we might make is true relative to the standards in some future or merely possible context. And we might wonder why it matters that someone’s judgment about their own gender is true relative to the standards operative in some future context that they could not possibly be aware of. This form of truth is not what they want and it’s hard to see why it should be relevant in this context. Furthermore, trans people are widely held to be misguided, mentally unstable, suffering from a delusion or making believe ( Bettcher 2007 , Serano 2016 : ch. 2, Lopez 2018 , Rajunov and Duane 2019 : xxiv). If the only interesting way in which Alicia is correct about her gender is that she is that gender according to standards far in the future that she is not aware of, then it would seem that Alicia is misguided about her gender – given that she could not know about these standards – and that she is in a sense making believe. This seems like an undesirable consequence, especially if we think that Alicia is really a woman, that is, that she is not misguided.

There are two further, more general, problems for contextualism. 7 First, contextualism seems to clash with how many of us think about our own and others’ genders. For instance, many trans men think that they should be classified as men because they are men, and not just because they are men-relative to the standards of trans-inclusive communities and societies ( Saul 2012 : 209–210). 8 Gender critical feminists think that trans women are not women, that standards which align with this view track the standard-independent truth, and standards which don’t align with this view do not.

Second, contextualism seems to be in tension with the idea that many of our disagreements about gender are genuine disagreements. Suppose that contextualism is true and that we (and everyone else) accept it. In this case, it is hard for us to sincerely genuinely disagree with Javid about whether only women have cervixes. Since, when he says that only women have cervixes we know that he means that only those who count as women, relative to the dominant UK standards or relative to the standards operative amongst Tory MPs and members, have cervixes. And we agree with him about this, since we know that according to these standards trans men are women. So, if contextualism is true and we accept it, it is hard for us to genuinely disagree with Javid. Contextualism could be true without our knowing or believing it. In this case, we could genuinely disagree with Javid. But our disagreement here would only be possible because we are significantly mistaken about what kinds of things gender kinds are; we think gender kinds are not all context- or standard-relative but in fact they are. And attributing such a significant mistake to all of us is a significant cost of a metaphysical theory, for other things equal we should accept more charitable theories that do not imply that we are significantly mistaken rather than theories that do imply this ( Olson 2011 : 73–77, McGrath 2021 : 35, 46–48).

These problems with contextualism about the relationship between gender identity and gender are analogues of problems that contextualist views face in other domains such as in metaethics. According to metaethical contextualism, moral claims, their meanings and their truth are always standard-relative. There is no such thing as an act being morally wrong, only its being morally-wrong-relative-to-utilitarianism or morally-wrong-relative-to-the-standards-of-Victorian-England. But metaethical contextualism faces a problem explaining fundamental moral disagreement. Act-utilitarians and Kantians agree that pushing the heavy man off of the bridge in the footbridge trolley case is wrong (Kantianism) and right (act-utilitarianism) but they still disagree and they take themselves to be disagreeing about which of their moral standards is correct, and which standard tracks the truth about which actions are right and wrong simpliciter ( Olson 2011 : 73–77, Cosker-Rowland 2022 : 57–59). If there are no non-context- or standard-relative properties of right and wrong, then although Kantians and Utilitarians do disagree – they think there are such properties – there is in fact nothing for them to disagree about. So, metaethical contextualism seems to be committed to a kind of error theory about morality that, other things equal, we should avoid: Kantians and Utilitarians think that they are talking about which of their moral standards is independently correct, but there is no such standard-independent moral correctness. Contextualists in metaethics have developed several types of resources to mitigate this kind of problem or to enable contextualism to explain what’s happening in these disagreements better. Perhaps these proposals could be used to mitigate the analogous problems with contextualism about the relationship between gender identity and gender. McGrath (2021 : esp. 42–49) considers this possibility and argues that these responses are not plausible, and that they face similar problems to the problems faced by the analogous responses proposed by contextualists in metaethics. 9 More broadly, whether contextualists’ proposals to mitigate these problems for metaethical contextualism do, or could, succeed is contested ( Cosker-Rowland 2022 : 59–64). 10

Contextualism holds that the features that determine our gender vary from context to context and so whether our gender identity determines our gender varies from context to context. Invariantist views such as gender identity first and the no connection view hold that one feature (e.g. gender identity or whether one is a sexually marked subordinate) determines our gender in every context. But we need not adopt such a monist invariantist view; we can instead adopt a pluralist invariantist view that holds that multiple features are relevant to, or determine, our genders across different contexts ( Figure 4 ). A version of pluralism that has been proposed is what we can call the two properties view. According to the two properties view, two and only two properties determine our gender in all contexts: our gender identity and our gendered social position or class. Gender identity first and Haslanger’s no connection view hold that one of these two properties determines our gender in every context; the two properties view holds that both of these properties can make us a particular gender in every context. 11

Views of the relationship between gender identity and gender

Katharine Jenkins (2016) proposes an ameliorative version of the two properties view. She proposes that we accept gender concepts according to which there are two senses of woman . In one sense of woman , to be a woman is to have a female gender identity; in another second sense, to be a woman is to be socially classed as a woman, which we can understand in terms of Haslanger’s account: to be a woman in this second sense is to be a sexually marked subordinate. Jenkins argues that if we accept gender concepts according to which there are two senses of ‘woman’, we do not objectionably exclude trans women, since trans women who are not socially classed as women do have female gender identities and so are still women on this view. So, Jenkins argues that we should accept gender concepts such that A is a woman iff A is socially classed as a woman or has a female gender identity. She then argues that, although we should accept gender concepts on which there are two senses of gender, we should, at least primarily, use ‘woman’ to refer to people with a female gender identity rather than those who are classed as women.

Jenkins’ two properties view avoids the problems with the ameliorative gender identity first and no connection views. It does not imply that severely cognitively disabled women are not women and it does not imply that trans women are not women. Yet if we adopt a concept of ‘woman’ with two senses but use ‘woman’ to refer to people with female gender identities, it still seems that we adopt concepts according to which trans women who are not socially classed as women are not women in an important sense. We may want to avoid this consequence with our ameliorative proposals, since trans women want to be thought of as women, and many trans women want to be thought of as in no way men, rather than merely being referred to as women rather than men (see e.g. Wynn 2018 ). We might also worry that adoption of Jenkins’ view would create a hierarchy of women on which someone who is a woman in both senses is more of a woman than someone who is a woman in only one sense: we might worry that if such concepts of gender were adopted, a trans woman who does not have her womanhood socially recognized would be seen as less of a woman than a trans woman who is socially positioned as a woman. 12

Elizabeth Barnes (2022 : 24–25) briefly articulates a similar metaphysical two properties view. On this view, there are two different properties that one can have that can make it the case that one is gender G : the property of being socially classed as a G and the property of having gender identity G . And the relevant gender identity property takes priority when A is socially classed as a G1 (e.g. as a man) but has gender identity G2 (e.g. a female gender identity): in such a case A is a G2 (a woman) rather than a G1 (a man) ( Figure 5 ).

The two properties view

However, the two properties view needs to explain why our gender identities take precedence over our gendered social position in determining our gender when the two conflict. Without further supplementation the metaphysical two property view does not do this; it does not explain why A is a man when A has a male gender identity but is socially positioned as a woman. If the two properties view does not explain this, it has an explanatory deficiency, and this deficiency gives us reason to accept competing views that do not face this explanatory problem over the two properties view.

One natural way to supplement the two properties view to try to solve this explanatory problem is to hold that moral and political considerations determine that gender identity takes priority over gender class when they conflict. 13 . First, it is controverisal that there is moral encroachment on gender metaphysics, that what's morally best makes a difference to what gender we metaphysically are. For instance, Ásta (2018) , Dembroff (2018) and Jenkins (2020) argue that morality does not encroach on gender metaphysics in this way.

Second, we can think of this as the moral encroachment explanation. However, moral encroachment does not look like a plausible explanation of how, metaphysically, gender identity takes priority over gendered social position in determining our genders. To see this, suppose that Alexa understands herself to be a woman and is treated by those around her as a woman. An evil demon will kill 2000 members of Alexa’s community unless we hold that Alexa is a man, treat Alexa as, think of Alexa as, and assert that Alexa is a man for the next hour. In this case, moral and political considerations establish that we morally ought to treat Alexa as a man for the next hour, but this doesn’t mean that Alexa is in fact a man. 14

It might seem that a nearby view on which moral and political considerations play a smaller role is more plausible. On this view, moral and political considerations only come in to determine whether, metaphysically, A is a member of gender G1 or of gender G2 when A is socially classed as a G1 but has identity G2 . But this view would also generate counterintuitive results. To see this, suppose that Beth has a female gender identity and she was assigned female at birth, but she is socially classed as a man – she doesn’t resist this because of the strong economic advantages she receives, which outweigh the discomfort she feels by being constantly misgendered. Now suppose that an eccentric, very powerful and malevolent millionaire brings these facts to light but will torture everyone in our society unless we continue to classify, think of and refer to Beth as a man. In this case, plausibly, moral and political considerations establish that we should classify Beth as a man, but these facts do not seem to bear on whether Beth is a man or a woman; intuitively Beth is a woman, and intuitively the fact that morally we should think of, treat, and classify Beth as a man does not make it the case that Beth is a man – and really has nothing to do with Beth’s gender in this case. So, if moral and political considerations play this more limited role in determining our genders, they still sometimes generate the wrong result because there are cases in which the social and political considerations side with someone’s gendered social position rather than their gender identity, but in which this does not seem to be relevant to, or establish that, their gender lines up with their gendered social position. So, the moral encroachment explanation does not seem to solve the explanatory problem for the two properties view. 15

These evil millionaire cases may be too fantastical for some. But the same point can be made with real world examples too. Norah Vincent (2006) disguised herself as a man for 18 months so that she could investigate men and their experiences. She became socially positioned as, and treated by others as, a man. While she was effectively disguised as a man, moral and political considerations seem to have established that everyone should treat her as a man: those who didn’t know her real gender had an obligation to take her assertions that she was a man as genuine and those who did know her real gender had an obligation not to blow her cover. But although everyone ought to have treated Vincent as a man, she was not a man: she did not identify as a man at the time, nor prior or subsequent to her journalistic project. Moral and political considerations favoured treating Vincent in line with her social position as a man rather than in line with her female gender identity. But these factors do not establish that she was a man rather than a woman. So, the moral encroachment explanation generates the wrong results in this case too.

One way to respond to this problem for the two properties view is to drop the view that gender identity takes priority. But this would be problematic for then trans women who are socially positioned as men would be both men and women on this view – and not just people with female gender identities who are socially positioned as men. This is implausible. This view is also different from contextualism since contextualism holds that such trans women are women-relative-to-the-standards-of-trans-inclusive-contexts and men-relative-to-other-contexts; a version of the two properties view that drops the priority of gender identity holds that such trans women are both men and women tout court .

In this paper I’ve discussed metaphysical and ameliorative inquiries into the relationship between gender identity and gender. I’ve discussed four different views about this relationship. All four views face problematic objections. Gender identity first seems to objectionably exclude some severely cognitively disabled people from having genders. No connection views seem to be objectionably trans exclusionary. Contextualism seems to be in tension with how we think about gender and implies that trans people are not the genders that line up with their gender identities in many contexts; despite contextualists’ best efforts, these implications still seem problematic. Pluralist views struggle to plausibly explain how their plurality of features interact when they conflict to determine our genders.

One avenue of future research involves examining the extent to which these objections really undermine these different views. For instance, we might question whether Barnes really shows that we should reject gender identity first. Barnes has two arguments for the view that, contra gender identity first, severely cognitively disabled people without gender identities have genders.

The first argument was that, if we reject this view, we cannot explain the gendered oppression that severely cognitively disabled women face. But we might wonder whether this is really true. All we need in order to explain the oppression that severely cognitively disabled women face is the claim that they are socially treated or understood to be women. But we can be socially treated or understood to be a gender other than the gender we are: e.g. many non-binary people who were assigned female at birth (AFAB) are discriminated against because they are understood to be women even though they are not women. We might think that we should explain the gendered oppression that AFAB severely cognitively disabled people without gender identities face and the gendered discrimination that AFAB non-binary people face in the same way: we should say that although they are not women, they are assumed to be women and are treated as women and this is why they face this gendered oppression. Barnes’ second argument was that the view that severely cognitively disabled people without gender identities do not have genders others and alienates these severely cognitively disabled people. However, we might wonder whether this is necessarily true. Perhaps we should think of the capacity to have a gender as inessential to human personhood just as we think of the capacity for membership in other categories as something that is not required for personhood: perhaps we should think that just as some severely cognitively disabled people lack the cognitive capacities to identify as a Christian or as a punk, and so are not Christians or punks, they similarly lack the capacities to identify as a woman and so are not women. If gender need not be central to human life, as religion (or music) need not be, perhaps we might reasonably claim to not other anyone by holding that they could not have a gender.

A second avenue of further work concerns genders beyond the gender category woman . Most of the work on the relationship between gender identity and gender has concerned the relationship between being a woman and having a female gender identity. But views about this may not straightforwardly generalize to provide plausible accounts of other genders such as genderqueer and other non-binary genders. 16 In one of the few published articles in analytic philosophy discussing genders beyond the gender binary, Dembroff (2020) argues that non-binary and genderqueer are critical gender kinds, which should be understood as kinds, membership in which constitutively involves engagement in the collective destabilization of dominant gender ideology. One way to destablize dominant gender ideology is to destabilize the idea that there are two mutually exclusive genders. Such destabilization of the binary gender axis can involve using gender neutral pronouns, cultivating gender non-conforming aesthetics, asserting one’s non-binary gender categorization, queering personal relationships, eschewing sexual binaries and/or switching between male and female coded spaces. Dembroff argues that to be genderqueer is ‘to have a felt or desired gender categorization that conflicts with the binary [gender] axis, and on that basis collectively destabilize this axis’ ( 2020 : 16). This understanding of the category genderqueer does not quite fit into the typology that I’ve explained in this article. For, on this account, a particular kind of non-binary gender identity is necessary but not sufficient for membership in the kind genderqueer .

There are issues with this account. For instance, Matthew Cull (2020 : 162) argues that this account misgenders agender people because many agender people have a felt or desired gender categorization that conflicts with the binary gender axis and are engaged in the collective destabilization of the gender binary but are not genderqueer; they are agender. 17 However, in general, more work is needed on gender kinds beyond the gender binary. This work may also provide new avenues for conceptualizing and/or complicating the relationship between gender identity and gender more generally. 18

See Bettcher (2009) ( 2017 : 396) and Jenkins (2018 : 727). cf. Barnes (2020 : 709).

See also Bornstein (1994 : 111, 123–124).

On the centrality of gender for social life see Witt 2011 .

See Bryne (2020) and Stock (2021 : ch. 2, ch. 6).

There are problems with using this terminology of passing. For instance, we typically think of A as passing as an F only if they are not an F . But if all trans women are women, then there are no ‘non-passing’ trans women. For discussion of issues with the concept of passing see e.g. Serano 2016 : 176–180.

Many gender critical feminists will want to reject contextualism for a similar but opposite reason: they believe that there is no sense in which Javid is mistaken, but contextualism implies that there is a sense in which he is mistaken.

For problems along these lines see McGrath 2021 : esp. 42–49.

Cf. Bettcher 2013 : esp. 242–243.

Cf. Dembroff 2018 : 44–45.

According to Jenkins’ (2023) ontological pluralism, there are a plurality of gender properties. For instance, there is the property of being a woman in the sense of having a female gender identity, and the property of being socially positioned as a woman in a particular context, but there is no further property of being a woman. Ontological pluralism about gender properties is a slightly different view about gender properties from the social position account of gender properties that Ásta and Dembroff propose; see Bettcher 2013 and Jenkins 2023. But ontological pluralism similarly implies that being a woman (social position) is not determined by one’s gender identity but being a woman (gender identity) is; and that there is no such thing as being a woman tout court beyond such a plurality of more specific gender properties. Since it has similar implications about the relationship between gender identity and gender to Ásta and Dembroff's views, it faces similar problems.

Other work on the metaphysics of gender, such as Stoljar’s (1995) nominalism or a view similar to it, could also be understood as a form of pluralist invariantism; although cf. Stoljar 1995 : 283 and Mikkola 2016 : 70.

Cf. Mikkola 2019 : §3.1.2 and Jenkins 2016 : 418–419.

Cf. Jenkins 2016 : 417–418 and Diaz-Leon 2016 .

Cases like this may also cause problems for Ásta’s and Dembroff’s social position accounts of gender.

Heather Logue suggested to me that a more specific form of moral encroachment might solve this problem: our autonomy might establish that our gender identities trump our gendered social positions when they conflict, without establishing that Beth is a man. However, we can imagine a version of this case in which Beth autonomously chooses to waive her right to be treated in line with her gender identity. In such a case Beth is still not a man.

We may also wonder whether this work will generalize to the category man given that human beings are still by default understood to be men in many contexts.

Another worry is that analogous accounts of the kind non-binary will either: (a) make the conditions for engagement in collective resistance too onerous and thereby exclude non-binary people who are not able to engage in this resistance due to oppressive circumstances; or (b) make these conditions too easy to satisfy, in which case it is unclear what work engagement in collective resistance is doing in this account; that is, it is unclear why we should prefer an account of the kind non-binary like this to a gender identity first account of the category non-binary . For work relevant to (a), arguing that trans people in the past who could not express their gender identities or resist the binary gender axis due to hostile circumstances may still be correctly considered to be trans, see Heyam 2022 : ch. 1.

I am grateful to a reviewer, who revealed themself to be Ray Briggs, for wonderful extremely thorough comments on a previous draft of this paper. I would also like to thank an audience of my colleagues at the University of Leeds for comments, thoughts and objections that shaped the final version of this paper.

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MINI REVIEW article

Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems.

• Instituto Universitário de Lisboa ISCTE-IUL, CIS, Lisboa, Portugal

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

Numerous controversies and debates have taken place throughout the history of psychopathology and mental health care with regards to lesbian, gay, bisexual and transgender (LGBT) people. The present paper aims to review relevant concepts in this literature, its historical and current controversies, and their relation to the main psychopathology classification systems.

Concepts and Definitions

Concepts and definitions that refer to sexual orientation and gender identity are an evolving field. Many of the terms used in the past to describe LGBT people, namely in the mental health field, are now considered to be outdated and even offensive.

Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted ( American Psychological Association, 2012 ). Nowadays, the terms ‘lesbian’ and ‘gay’ are used to refer to people who experience attraction to members of the same sex, and the term ‘bisexual’ describe people who experience attraction to members of both sexes. It should be noted that, although these categories continue to be widely used, sexual orientation does not always appear in such definable categories and, instead, occurs on a continuum ( American Psychological Association, 2012 ), and people perceived or described by others as LGB may identify in various ways ( D’Augelli, 1994 ).

The expression gender identity was coined in the middle 1960s, describing one’s persistent inner sense of belonging to either the male and female gender category ( Money, 1994 ). The concept of gender identity evolved over time to include those people who do not identify either as female or male: a “person’s self concept of their gender (regardless of their biological sex) is called their gender identity” ( Lev, 2004 , p. 397). The American Psychological Association (2009a , p. 28) described it as: “the person’s basic sense of being male, female, or of indeterminate sex.” For decades, the term ‘transsexual’ was restricted for individuals who had undergone medical procedures, including genital reassignment surgeries. However, nowadays, ‘transsexual’ refers to anyone who has a gender identity that is incongruent with the sex assigned at birth and therefore is currently, or is working toward, living as a member of the sex other than the one they were assigned at birth, regardless of what medical procedures they may have undergone or may desire in the future (e.g., Serano, 2007 ; American Psychological Association, 2009a ; Coleman et al., 2012 ). In this paper we use the prefix trans when referring to transsexual people.

Since the 1990’s the word transgender has been used primarily as an umbrella term to describe those people who defy societal expectations and assumptions regarding gender (e.g., Lev, 2004 ; American Psychological Association, 2009a ). It includes people who are transsexual and intersex, but also those who identify outside the female/male binary and those whose gender expression and behavior differs from social expectations. As in the case of sexual orientation, people perceived or described by others as transgender – including transsexual men and women – may identify in various ways (e.g., Pinto and Moleiro, 2015 ).

Discrimination and Impact on Mental Health

Lesbian, gay, bisexual and transgender people often suffer from various forms of discrimination, stigma and social exclusion – including physical and psychological abuse, bullying, persecution, or economic alienation ( United Nations, 2011 ; Bostwick et al., 2014 ; European Union Agency for Fundamental Rights, 2014 ). Moreover, experiences of discrimination may occur in various areas, such as employment, education and health care, but also in the context of meaningful interpersonal relationships, including family (e.g., Milburn et al., 2006 ; Feinstein et al., 2014 ; António and Moleiro, 2015 ). Accordingly, several studies strongly suggest that experiences of discrimination and stigmatization place LGBT people at higher risk for mental distress ( Cochran and Mays, 2000 ; Dean et al., 2000 ; Cochran et al., 2003 ; Meyer, 2003 ; Shilo, 2014 ).

For example, LGB populations may be at increased risk for suicide ( Hershberger and D’Augelli, 1995 ; Mustanski and Liu, 2013 ), traumatic stress reactions ( D’Augelli et al., 2002 ), major depression disorders ( Cochran and Mays, 2000 ), generalized anxiety disorders ( Bostwick et al., 2010 ), or substance abuse ( King et al., 2008 ). In addition, transgender people have been identified as being at a greater risk for developing: anxiety disorders ( Hepp et al., 2005 ; Mustanski et al., 2010 ); depression ( Nuttbrock et al., 2010 ; Nemoto et al., 2011 ); social phobia and adjustment disorders ( Gómez-Gil et al., 2009 ); substance abuse ( Lawrence, 2008 ); or eating disorders ( Vocks et al., 2009 ). At the same time, data on suicide ideation and attempts among this population are alarming: Maguen and Shipherd (2010) found the percentage of attempted suicides to be as high as 40% in transsexual men and 20% in transsexual women. Nuttbrock et al. (2010) , using a sample of 500 transgender women, found that around 30% had already attempted suicide, around 35% had planned to do so, and close to half of the participants expressed suicide ideation. In particular, adolescence has been identified as a period of increased risk with regard to the mental health of transgender and transsexual people ( Dean et al., 2000 ).

In sum, research clearly recognizes the role of stigma and discrimination as significant intervening variables in psychopathology among LGBT populations. Nevertheless, the relation between sexual orientation or gender identity and stress may be mediated by several variables, including social and family support, low internalized homophobia, expectations of acceptance vs. rejection, contact with other LGBT people, or religiosity ( Meyer, 2003 ; Shilo and Savaya, 2012 ; António and Moleiro, 2015 ; Snapp et al., 2015 ). Thus, it seems important to focus on subjective distress and in a person-centered experience of psychopathology.

On the History of Homosexuality and Psychiatric Diagnoses

While nowadays we understand that higher rates of psychological distress among LGB people are related to their minority status and to discrimination, by the early 20th century, psychiatrists mostly regarded homosexuality as pathological per se ; and in the mid-20th century psychiatrics, physicians, and psychologists were trying to “cure” and change homosexuality ( Drescher, 2009 ). In 1952, the American Psychiatric Association published its first edition of the Diagnostic and Statistical Manual (DSM-I), in which homosexuality was considered a “sociopathic personality disturbance.” In DSM-II, published in 1968, homosexuality was reclassified as a “sexual deviation.” However, in December 1973, the American Psychiatric Association’s Board of Trustees voted to remove homosexuality from the DSM.

The most significant catalyst to homosexuality’s declassification as a mental illness was lesbian and gay activism, and its advocacy efforts within the American Psychiatric Association ( Drescher, 2009 ). Nevertheless, during the discussion that led to the diagnostic change, APA’s Nomenclature Committee also wrestled with the question of what constitutes a mental disorder. Concluding that “they [mental disorders] all regularly caused subjective distress or were associated with generalized impairment in social effectiveness of functioning” ( Spitzer, 1981 , p. 211), the Committee agreed that homosexuality by itself was not one.

However, the diagnostic change did not immediately end the formal pathologization of some presentations of homosexuality. After the removal of the “homosexuality” diagnosis, the DSM-II contained the diagnosis of “sexual orientation disturbance,” which was replaced by “ego dystonic homosexuality” in the DSM-III, by 1980. These diagnoses served the purpose of legitimizing the practice of sexual “conversion” therapies among those individuals with same-sex attractions who were distressed and reported they wished to change their sexual orientation ( Spitzer, 1981 ; Drescher, 2009 ). Nonetheless, “ego-dystonic homosexuality” was removed from the DSM-III-R in 1987 after several criticisms: as formulated by Drescher (2009 , p. 435): “should people of color unhappy about their race be considered mentally ill?”

The removal from the DSM of psychiatric diagnoses related to sexual orientation led to changes in the broader cultural beliefs about homosexuality and culminated in the contemporary civil rights quest for equality ( Drescher, 2012 ). In contrast, it was only in 1992 that the World Health Organization ( World Health Organization, 1992 ) removed “homosexuality” from the International Classification of Diseases (ICD-10), which still contains a diagnosis similar to “ego-dystonic homosexuality.” However, this is expected to change in the next revision, planned for publication in 2017 ( Cochran et al., 2014 ).

Controversies on Gender Dysphoria and (Trans)Gender Diagnoses

Mental health diagnoses that are specific to transgender and transsexual people have been highly controversial. In this domain, the work of Harry Benjamin was fundamental for trans issues internationally, through the Harry Benjamin International Gender Dysphoria Association (presently, the World Professional Association for Transgender Health, WPATH). In the past few years, there has been a vehement discussion among interested professionals, trans and LGBT activists, and human rights groups concerning the reform or removal of (trans)gender diagnoses from the main health diagnostic tools. However, discourses on this topic have been inconclusive, filled with mixed messages and polarized opinions ( Kamens, 2011 ). Overall, mental health diagnoses which are specific to transgender people have been criticized in large part because they enhance the stigma in a population which is already particularly stigmatized ( Drescher, 2013 ). In fact, it has been suggested that the label “mental disorder” is the main factor underlying prejudice toward trans people ( Winter et al., 2009 ).

The discussion reached a high point during the recent revision process of the DSM-5 ( American Psychiatric Association, 2013 ), in which the diagnosis of “gender identity disorder” was revised into one of “gender dysphoria.” Psychiatric diagnosis was thus limited to those who are, in a certain moment of their lives, distressed about living with a gender assignment they experience as incongruent with their gender identity ( Drescher, 2013 ). The change of criteria and nomenclature “is less pathologizing as it no longer implies that one’s identity is disordered” ( DeCuypere et al., 2010 , p. 119). In fact, gender dysphoria is not a synonym for transsexuality, nor should it be used to describe transgender people in general ( Lev, 2004 ); rather, “[it] is a clinical term used to describe the symptoms of excessive pain, agitation, restless, and malaise that gender-variant people seeking therapy often express” ( Lev, 2004 , p. 910). Although the changes were welcomed (e.g., DeCuypere et al., 2010 ; Lev, 2013 ), there are still voices arguing for the “ultimate removal” ( Lev, 2013 , p. 295) of gender dysphoria from the DSM. Nevertheless, attention is presently turned to the ongoing revision of the ICD. Various proposals concerning the revision of (trans)gender diagnoses within ICD have been made, both originating from transgender and human rights groups (e.g., Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ) and the health profession community (e.g., Drescher et al., 2012 ; World Professional Association for Transgender Health, 2013 ). These include two main changes: the reform of the diagnosis of transsexualism into one of “gender incongruence”; and the change of the diagnosis into a separate chapter from the one on “mental and behavioral disorders.”

Mental Health Care Reflecting Controversies

There is evidence that LGBT persons resort to psychotherapy at higher rates than the non-LGBT population ( Bieschke et al., 2000 ; King et al., 2007 ); hence, they may be exposed to higher risk for harmful or ineffective therapies, not only as a vulnerable group, but also as frequent users.

Recently, there has been a greater concern in the mental health field oriented to the promotion of the well-being among non-heterosexual and transgender people, which has paralleled the diagnostic changes. This is established, for instance, by the amount of literature on gay and lesbian affirmative psychotherapy which has been developed in recent decades (e.g., Davis, 1997 ) and, also, by the fact that major international accrediting bodies in counseling and psychotherapy have identified the need for clinicians to be able to work effectively with minority clients, namely LGBT people. The APA’s guidelines for psychotherapy with lesbian, gay, and bisexual client ( American Psychological Association, 2000 , 2012 ) are a main reference. These ethical guidelines highlight, among several issues, the need for clinicians to recognize that their own attitudes and knowledge about the experiences of sexual minorities are relevant to the therapeutic process with these clients and that, therefore, mental health care providers must look for appropriate literature, training, and supervision.

However, empirical research also reveals that some therapists still pursue less appropriate clinical practices with LGBT clients. In a review of empirical research on the provision of counseling and psychotherapy to LGB clients, Bieschke et al. (2006) encountered an unexpected recent explosion of literature focused on “conversion therapy.” There are, in fact, some mental health professionals that still attempt to help lesbian, gay, and bisexual clients to become heterosexual ( Bartlett et al., 2009 ), despite the fact that a recent systematic review of the peer-reviewed journal literature on sexual orientation change efforts concluded that “efforts to change sexual orientation are unlikely to be successful and involve some risk of harm” ( American Psychological Association, 2009b , p. 1).

Moreover, there is evidence of other forms of inappropriate (while less blatant) clinical practices with LGBT clients (e.g., Garnets et al., 1991 ; Jordan and Deluty, 1995 ; Liddle, 1996 ; Hayes and Erkis, 2000 ). Even those clinicians who intend to be affirmative and supportive of LGBT individuals can reveal subtle heterosexist bias in the work with these clients ( Pachankis and Goldfried, 2004 ). Examples of such micro-aggressions ( Sue, 2010 ) might be automatically assuming that a client is heterosexual, trying to explain the etiology of the client’s homosexuality, or focusing on the sexual orientation of a LGB client despite the fact that this is not an issue at hand (e.g., Shelton and Delgado-Romero, 2011 ). Heterosexual bias in counseling and psychotherapy may manifest itself also in what Brown (2006 , p. 350) calls “sexual orientation blindness,” i.e., struggling for a supposed neutrality and dismissing the specificities related to the minority condition of non-heterosexual clients. This conceptualization of the human experience mostly in heterosexual terms, found in the therapeutic setting, does not seem to be independent of psychotherapist’s basic training and the historical heterosexist in the teaching of medicine and psychology ( Simoni, 1996 ; Alderson, 2004 ).

With regards to the intervention with trans people, for decades the mental health professionals’ job was to sort out the “true” transsexuals from all other transgender people. The former would have access to physical transition, and the later would be denied any medical intervention other than psychotherapy. By doing this, whether deliberately or not, professionals – acting as gatekeepers – pursued to ‘ensure that most people who did transition would not be “gender-ambiguous” in any way’ ( Serano, 2007 , p. 120). Research shows that currently trans people still face serious challenges in accessing health care, including those related to inappropriate gatekeeping ( Bockting et al., 2004 ; Bauer et al., 2009 ). Some mental health professionals still focus on the assessment of attributes related to identity and gender expressions, rather than on the distress with which trans people may struggle with ( Lev, 2004 ; Serano, 2007 ). Hence, trans people may feel the need to express a personal narrative consistent with what they believe the clinicians’ expectations to be, for accessing hormonal or surgical treatments ( Pinto and Moleiro, 2015 ). Thus, despite the revisions of (trans)gender diagnoses within the DSM, more recent diagnoses seem to still be used as if they were identical with the diagnosis of transsexualism – in a search for the “true transsexual” ( Cohen-Kettenis and Pfäfflin, 2010 ). It seems clear that social and cultural biases have significantly influenced – and still do – diagnostic criteria and the access to hormonal and surgical treatments for trans people.

Controversies and debates with regards to medical classification of sexual orientation and gender identity contribute to the reflection on the very concept of mental illness. The agreement that mental disorders cause subjective distress or are associated with impairment in social functioning was essential for the removal of “homosexuality” from the DSM in the 1970s ( Spitzer, 1981 ). Moreover, (trans)gender diagnoses constitute a significant dividing line both within trans related activism (e.g., Vance et al., 2010 ) and the health professionals’ communities (e.g., Ehrbar, 2010 ). The discussion has taken place between two apposite positions: (1) trans(gender) diagnoses should be removed from health classifying systems, because they promote the pathologization and stigmatization of gender diversity and enhance the medical control of trans people’s identities and lives; and (2) trans(gender) diagnoses should be retained in order to ensure access to care, since health care systems rely on diagnoses to justify medical treatment – which many trans people need. In fact, trans people often describe experiences of severe distress and argue for the need for treatments and access to medical care ( Pinto and Moleiro, 2015 ), but at the same time reject the label of mental illness for themselves ( Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ). Thus, it may be important to understand how the debate around (trans)diagnoses may be driven also by a history of undue gatekeeping and by stigma involving mental illness.

The present paper argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

On the one hand, aligned with a position of “transgression” and/or “deviation from a norm,” people who today are described as LGBT were labeled as mentally ill. Inevitably, classification systems reflect(ed) the existing social attitudes and prejudices, as well as the historical and cultural contexts in which they were developed ( Drescher, 2012 ; Kirschner, 2013 ). In that, they often failed to differentiate between mental illness and socially non-conforming behavior or fluidity of gender expressions. This position and the historical roots of this discourse are still reflected in the practices of some clinicians, ranging from “conversion” therapies to micro-aggressions in the daily lives of LGBT people, including those experienced in the care by mental health professionals.

On the other hand, lined up with a position of gender variance and fluidity, changes in the diagnostic systems in the last few decades reflect a broader respect and value of the diversity of human sexuality and of gender expressions. This position recognizes that the discourse and practices coming from the (mental) health field may lead to changes in the broader cultural beliefs ( Drescher, 2012 ). As such, it also recognizes the power of medical classifications, health discourses and clinical practices in translating the responsibility of fighting discrimination and promoting LGBT people’s well-being.

In conclusion, it seems crucial to emphasize the role of specific training and supervision in the development of clinical competence in the work with sexual minorities. Several authors (e.g., Pachankis and Goldfried, 2004 ) have argued for the importance of continuous education and training of practitioners in individual and cultural diversity competences, across professional development. This is in line with APA’s ethical guidelines ( American Psychological Association, 2000 , 2012 ), and it is even more relevant when we acknowledge the significant and recent changes in this field. Furthermore, it is founded on the very notion that LGBT competence assumes clinicians ought to be aware of their own personal values, attitudes and beliefs regarding human sexuality and gender diversity in order to provide appropriate care. These ethical concerns, however, have not been translated into training programs in medicine and psychology in a systematic manner in most European countries, and to the mainstreaming of LGBT issues ( Goldfried, 2001 ) in psychopathology.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords : sexual orientation, gender identity, transgender, discrimination, psychopathology, mental health care

Citation: Moleiro C and Pinto N (2015) Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Front. Psychol. 6:1511. doi: 10.3389/fpsyg.2015.01511

Received: 29 July 2015; Accepted: 18 September 2015; Published: 01 October 2015.

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Copyright © 2015 Moleiro and Pinto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Carla Moleiro, Instituto Universitário de Lisboa ISCTE-IUL, CIS, Avenida das Forças Armadas, 1649-026 Lisbon, Portugal, [email protected]

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Understanding Gender, Sex, and Gender Identity

It's more important than ever to use this terminology correctly..

Posted February 27, 2021 | Reviewed by Kaja Perina

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Representative Marjorie Taylor Greene hung a sign outside her Capitol office door that said “There are TWO genders: MALE & FEMALE. ‘Trust the Science!’” There are many reasons to question hanging such a sign, but given that Rep. Taylor Greene invoked science in making her assertion, I thought it might be helpful to clarify by citing some actual science. Put simply, from a scientific standpoint, Rep. Taylor Greene’s statement is patently wrong. It perpetuates a common error by conflating gender with sex . Allow me to explain how psychologists scientifically operationalize these terms.

According to the American Psychological Association (APA, 2012), sex is rooted in biology. A person’s sex is determined using observable biological criteria such as sex chromosomes, gonads, internal reproductive organs, and external genitalia (APA, 2012). Most people are classified as being either biologically male or female, although the term intersex is reserved for those with atypical combinations of biological features (APA, 2012).

Gender is related to but distinctly different from sex; it is rooted in culture, not biology. The APA (2012) defines gender as “the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex” (p. 11). Gender conformity occurs when people abide by culturally-derived gender roles (APA, 2012). Resisting gender roles (i.e., gender nonconformity ) can have significant social consequences—pro and con, depending on circumstances.

Gender identity refers to how one understands and experiences one’s own gender. It involves a person’s psychological sense of being male, female, or neither (APA, 2012). Those who identify as transgender feel that their gender identity doesn’t match their biological sex or the gender they were assigned at birth; in some cases they don’t feel they fit into into either the male or female gender categories (APA, 2012; Moleiro & Pinto, 2015). How people live out their gender identities in everyday life (in terms of how they dress, behave, and express themselves) constitutes their gender expression (APA, 2012; Drescher, 2014).

“Male” and “female” are the most common gender identities in Western culture; they form a dualistic way of thinking about gender that often informs the identity options that people feel are available to them (Prentice & Carranza, 2002). Anyone, regardless of biological sex, can closely adhere to culturally-constructed notions of “maleness” or “femaleness” by dressing, talking, and taking interest in activities stereotypically associated with traditional male or female gender identities. However, many people think “outside the box” when it comes to gender, constructing identities for themselves that move beyond the male-female binary. For examples, explore lists of famous “gender benders” from Oxygen , Vogue , More , and The Cut (not to mention Mr. and Mrs. Potato Head , whose evolving gender identities made headlines this week).

Whether society approves of these identities or not, the science on whether there are more than two genders is clear; there are as many possible gender identities as there are people psychologically forming identities. Rep. Taylor Greene’s insistence that there are just two genders merely reflects Western culture’s longstanding tradition of only recognizing “male” and “female” gender identities as “normal.” However, if we are to “trust the science” (as Rep. Taylor Greene’s recommends), then the first thing we need to do is stop mixing up biological sex and gender identity. The former may be constrained by biology, but the latter is only constrained by our imaginations.

American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist , 67 (1), 10-42. https://doi.org/10.1037/a0024659

Drescher, J. (2014). Treatment of lesbian, gay, bisexual, and transgender patients. In R. E. Hales, S. C. Yudofsky, & L. W. Roberts (Eds.), The American Psychiatric Publishing textbook of psychiatry (6th ed., pp. 1293-1318). American Psychiatric Publishing.

Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: Review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology , 6 .

Prentice, D. A., & Carranza, E. (2002). What women should be, shouldn't be, are allowed to be, and don't have to be: The contents of prescriptive gender stereotypes. Psychology of Women Quarterly , 26 (4), 269-281. https://doi.org/10.1111/1471-6402.t01-1-00066

Jonathan D. Raskin, Ph.D. , is a professor of psychology and counselor education at the State University of New York at New Paltz.

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15.4: Development of Gender Identity

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From birth, children are assigned a gender and are socialized to conform to certain gender roles based on their biological sex. “ Sex ,” refers to physical or physiological differences between males, females, and intersex persons, including both their primary and secondary sex characteristics. “ Gender ,” on the other hand, refers to social or cultural distinctions associated with a given sex.

When babies are born, they are assigned a gender based on their biological sex—male babies are assigned as boys, female babies are assigned as girls, and intersex babies are born with sex characteristics that do not fit the typical definitions for male or female bodies, and are usually relegated into one gender category or another. Scholars generally regard gender as a social construct , meaning that it doesn’t exist naturally but is instead a concept that is created by cultural and societal norms. From birth, children are socialized to conform to certain gender roles based on their biological sex and the gender to which they are assigned.22

A person’s subjective experience of their own gender and how it develops, or gender identity , is a topic of much debate. It is the extent to which one identifies with a particular gender; it is a person’s individual sense and subjective experience of being a man, a woman, or other gender. It is often shaped early in life and consists primarily of the acceptance (or non-acceptance) of one’s membership into a gender category. In most societies, there is a basic division between gender attributes assigned to males and females. In all societies, however, some individuals do not identify with some (or all) of the aspects of gender that are assigned to their biological sex.

Those that identify with the gender that corresponds to the sex assigned to them at birth (for example, they are assigned female at birth and continue to identify as a girl, and later a woman) are called cisgender . In many Western cultures, individuals who identify with a gender that is different from their biological sex (for example, they are assigned female at birth but feel inwardly that they are a boy or a gender other than a girl) are called transgender . Some transgender individuals, if they have access to resources and medical care, choose to alter their bodies through medical interventions such as surgery and hormonal therapy so that their physical being is better aligned with their gender identity.

Recent terms such as “genderqueer,” “genderfluid,” “gender variant,” “androgynous,” “agender,” and “gender nonconforming” are used by individuals who do not identify within the gender binary as either a man or a woman. Instead they identify as existing somewhere along a spectrum or continuum of genders, or outside of the spectrum altogether, often in a way that is continuously evolving.

The Gender Continuum

Viewing gender as a continuum allows us to perceive the rich diversity of genders, from trans-and cisgender to gender queer and agender. Most Western societies operate on the idea that gender is a binary , that there are essentially only two genders (men and women) based on two sexes (male and female), and that everyone must fit one or the other. This social dichotomy enforces conformance to the ideals of masculinity and femininity in all aspects of gender and sex—gender identity, gender expression, and biological sex.

According to supporters of queer theory , gender identity is not a rigid or static identity but can continue to evolve and change over time. Queer theory developed in response to the perceived limitations of the way in which identities are thought to become consolidated or stabilized (for instance, gay or straight) and theorists constructed queerness in an attempt to resist this. In this way, the theory attempts to maintain a critique rather than define a specific identity. While “queer” defies a simple definition, the term is often used to convey an identity that is not rigidly developed but is instead fluid and changing. 24

The Genderbread Person

In 2012, Sam Killerman created the Genderbread Person as an infographic to break down gender identity, gender expression, biological sex, and sexual orientation. 25 In 2018, he updated it to version 2.0 to be more accurate, and inclusive. 26

Gender Pronouns

Pronouns are a part of language used to refer to someone or something without using proper nouns. In standard English, some singular third-person pronouns are "he" and "she," which are usually seen as gender-specific pronouns, referring to a man and a woman, respectively. A gender-neutral pronoun or gender-inclusive pronoun is one that gives no implications about gender, and could be used for someone of any gender.

Some languages only have gender-neutral pronouns, whereas other languages have difficulty establishing any that aren't gender-specific. People with non-binary gender identities often choose new third-person pronouns for themselves as part of their transition. They often choose gender-neutral pronouns so that others won't see them as female or male. 28

Here is a table based on the Rainbow Coalition of Yellowknife’s Handy Guide to Pronouns:

Factors that Influence Gender Identity

Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. Biological factors that may influence gender identity include pre- and post-natal hormone levels and genetic makeup. Social factors include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in a child’s life. According to social-learning theory, children develop their gender identity through observing and imitating the gender-linked behaviors of others; they are then “rewarded” for imitating the behaviors of people of the same gender and “punished” for imitating the behaviors of another gender. For example, male children will often be rewarded for imitating their father’s love of baseball but punished or redirected in some way if they imitate their older sister’s love of dolls. Children are shaped and molded by the people surrounding them, who they try to imitate and follow.

Gender Roles

The term “gender role” refers to society’s concept of how men and women are expected to act. As we grow, we learn how to behave from those around us. In this socialization process, children are introduced to certain roles that are typically linked to their biological sex. The term “gender role” refers to society’s concept of how men and women are expected to act and behave. Gender roles are based on norms, or standards, created by society. In American culture, masculine roles have traditionally been associated with strength, aggression, and dominance, while feminine roles have traditionally been associated with passivity, nurturing, and subordination.

Gender Socialization

The socialization process in which children learn these gender roles begins at birth. Today, our society is quick to outfit male infants in blue and girls in pink, even applying these color-coded gender labels while a baby is in the womb. It is interesting to note that these color associations with gender have not always been what they are today. Up until the beginning of the 20th century, pink was actually more associated with boys, while blue was more associated with girls—illustrating how socially constructed these associations really are.

Gender socialization occurs through four major agents: family, education, peer groups, and mass media. Each agent reinforces gender roles by creating and maintaining normative expectations for gender-specific behavior. Exposure also occurs through secondary agents, such as religion and the workplace. Repeated exposure to these agents over time leads people into a false sense that they are acting naturally based on their gender rather than following a socially constructed role.

Gender Stereotypes, Sexism, and Gender-Role Enforcement

The attitudes and expectations surrounding gender roles are not typically based on any inherent or natural gender differences, but on gender stereotypes , or oversimplified notions about the attitudes, traits, and behavior patterns of males and females. We engage in gender stereotyping when we do things like making the assumption that a teenage babysitter is female.

While it is somewhat acceptable for women to take on a narrow range of masculine characteristics without repercussions (such as dressing in traditionally male clothing), men are rarely able to take on more feminine characteristics (such as wearing skirts) without the risk of harassment or violence. This threat of punishment for stepping outside of gender norms is especially true for those who do not identify as male or female.

Gender stereotypes form the basis of sexism or the prejudiced beliefs that value males over females. Common forms of sexism in modern society include gender-role expectations, such as expecting women to be the caretakers of the household. Sexism also includes people’s expectations of how members of a gender group should behave. For example, girls and women are expected to be friendly, passive, and nurturing; when she behaves in an unfriendly or assertive manner, she may be disliked or perceived as aggressive because she has violated a gender role (Rudman, 1998). In contrast, a boy or man behaving in a similarly unfriendly or assertive way might be perceived as strong or even gain respect in some circumstances. 31

Contributors and Attributions

24. Boundless Psychology - Gender and Sexuality references Curation and Revision by Boundless Psychology, which is licensed under CC BY-SA 4.0

25. The Genderbread Person by Sam Killermann is in the public domain

26. The Genderbread Person v2.0 by Sam Killermann is in the public domain

28. Pronouns by Nonbinary Wiki is licensed under CC BY-SA 4.0

31. Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

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Guest Essay

The Gender Gap Is Taking Us to Unexpected Places

By Thomas B. Edsall

Mr. Edsall contributes a weekly column from Washington, D.C., on politics, demographics and inequality.

In one of the most revealing studies in recent years, a 2016 survey of 137,456 full-time, first-year students at 184 colleges and universities in the United States, the U.C.L.A. Higher Education Research Institute found “the largest-ever gender gap in terms of political leanings: 41.1 percent of women, an all-time high, identified themselves as liberal or far left, compared to 28.9 percent of men.”

The institute has conducted freshmen surveys every year since 1966. In the early days, until 1980, men were consistently more liberal than women. In the early and mid-1980s, the share of liberals among male and female students was roughly equal, but since 1987, women have been more liberal than men in the first year of college.

While liberal and left identification among female students reached a high in 2016, male students remained far below their 1971 high, which was 44 percent.

Along parallel lines, a Knight Foundation survey in 2017 of 3,014 college students asked: “If you had to choose, which do you think is more important, a diverse and inclusive society or protecting free speech rights.”

Male students preferred protecting free speech over an inclusive and diverse society by a decisive 61 to 39. Female students took the opposite position, favoring an inclusive, diverse society over free speech by 64 to 35.

Majorities of both male and female college students in the Knight survey support the view that the First Amendment should not be used to protect hate speech, but the men were more equivocal, at 56 to 43, than women, at 71 to 29.

The data on college students reflects trends in the electorate at large. The Pew Research Center provided The Times with survey data showing that among all voters, Democrats are 56 percent female and 42 percent male, while Republicans are 52 percent male and 48 percent female, for a combined gender gap of 18 points. Pew found identical gender splits among voters who identify as liberal and those who identify as conservative.

“Significant gender differences in party identification have been evident since the early 1980s,” according to the Rutgers Center for American Women and Politics , which provides data on the partisanship of men and women from 1952 to the present day.

It’s clear from all this that the political engagement of women is having a major impact on the social order, often in ways that are not fully understood.

Take the argument made in the 2018 paper “ The Suffragist Peace ” by Joslyn N. Barnhart of the University of California-Santa Barbara, Allan Dafoe at the Center for the Governance of AI , Elizabeth N. Saunders of Georgetown and Robert F. Trager of U.C.L.A.:

Preferences for conflict and cooperation are systematically different for men and women. At each stage of the escalatory ladder, women prefer more peaceful options. They are less apt to approve of the use of force and the striking of hard bargains internationally, and more apt to approve of substantial concessions to preserve peace. They impose higher audience costs because they are more approving of leaders who simply remain out of conflicts, but they are also more willing to see their leaders back down than engage in wars.

The increasing incorporation of women into “political decision-making over the last century,” Barnhart and her co-authors write, raises “the question of whether these changes have had effects on the conflict behavior of nations.”

Their answer: “We find that the evidence is consistent with the view that the increasing enfranchisement of women, not merely the rise of democracy itself, is the cause of the democratic peace.”

Put another way, “the divergent preferences of the sexes translate into a pacifying effect when women’s influence on national politics grows” and “suffrage plays a direct and important role in generating more peaceful interstate relations by altering the political calculus of democratic leaders.”

Barnhart added by email:

The important thing to remember here is that with any trait, we are talking about averages and distributions and not categorical distinctions. Some men will have lesser preference for the use of force than some women and vice versa. The distribution of traits among the two genders overlaps. So we shouldn’t expect perfect partisan distinction.

Other consequential shifts emerged as women’s views began to change and they became more involved in politics.

Dennis Chong , a political scientist at the University of Southern California, wrote by email that “a gender gap in political tolerance, with women being somewhat more willing to censor controversial and potentially harmful ideas, goes back to the earliest survey research on the subject in the 1950s.”

There are a number of possible explanations, Chong said, including “stronger religious and moral attitudes among women; lesser political involvement resulting in weaker support for democratic norms; social psychological factors such as intolerance of ambiguity and uncertainty which translate to intolerance for political and social nonconformity; and greater susceptibility to feelings of threats posed by unconventional ideas and groups.”

Studies using moral foundations theory , Chong continued, have

found broad value differences between men and women. Women score higher on values defined by care, fairness, benevolence, and protecting the welfare of others, reflecting greater empathy and preference for cooperative social relations. In today’s debates over free speech and cancel culture, these social psychological and value differences between men and women are in line with surveys showing that women are more likely than men to regard hate speech as a form of violence rather than expression, to support laws against divisive hate speech, and to be skeptical that the right to free speech protects the disadvantaged more than the majority.

In addition, Chong said, “Women are also more likely than men to believe that colleges ought to protect students from exposure to controversial speakers whose ideas may create an inhospitable learning environment.”

Steven Pinker , a professor of psychology at Harvard, writes in his book “ The Better Angels of Our Nature ,” that “the most fundamental empirical generalization about violence” is that

it is mainly committed by men. From the time they are boys, males play more violently than females, fantasize more about violence, consume more violent entertainment, commit the lion’s share of violent crimes, take more delight in punishment and revenge, take more foolish risks in aggressive attacks, vote for more warlike policies and leaders, and plan and carry out almost all the wars and genocides.

Pinker continues:

Feminization need not consist of women literally wielding more power in decisions on whether to go to war. It can also consist in a society moving away from a culture of manly honor, with its approval of violent retaliation for insults, toughening of boys through physical punishment, and veneration of martial glory.

In an email, Pinker wrote:

We’re seeing two sets of forces that can pull in opposite directions. One set comprises the common interests of men on the one hand and women on the other. Men tend to be more obsessed with status and dominance and are more willing to take risks to compete for them; women are more likely to prize health and safety and to reduce conflict. The ultimate (evolutionary) explanation is that for much of human prehistory and history successful men and coalitions of men potentially could multiply their mates and offspring, who had some chance of surviving even if they were killed, whereas women’s lifetime reproduction was always capped by the required investment in pregnancy and nursing, and motherless children did not survive.

“ Mapping the Moral Domain ,” a 2011 paper by Jesse Graham , a professor of management at the University of Utah, and five colleagues, found key differences between the values of men and women, especially in the case of the emphasis women place on preventing harm , especially harm to the marginalized and those least equipped to protect themselves.

I asked Jonathan Haidt , a social psychologist at N.Y.U.’s Stern School of Business, about the changing political role of women. He emailed back:

In general, when looking at sex differences in outcomes, it is helpful to remember that differences between men and women on values and cognitive abilities are generally small, while differences between men and women in the activities that interest them, and in their relational styles (especially involving conflict) are often large.

When the academic world opened up to women in the 1970s and 1980s, Haidt continued, “women flooded into some areas but showed less interest in others. In my experience, having entered in the 1990s, the academic culture of predominantly female fields is very different from those that are predominantly male.”

Haidt noted:

Boys and men enjoy direct status competition and confrontation, so the central drama of male-culture disciplines is ‘“Hey, Jones says his theory is better than Smith’s; let’s all gather around and watch them fight it out, in a colloquium or in dueling journal articles.” In fact, I’d say that many of the norms and institutions of the Anglo-American university were originally designed to harness male status-seeking and turn it into scholarly progress.

Women are just as competitive as men, Haidt wrote, “but they do it differently.”

He cited a 2013 paper, “ The development of human female competition: allies and adversaries ,” by Joyce Benenson , of Harvard’s department of human evolutionary biology. In it, Benenson writes:

From early childhood onwards, girls compete using strategies that minimize the risk of retaliation and reduce the strength of other girls. Girls’ competitive strategies include avoiding direct interference with another girl’s goals, disguising competition, competing overtly only from a position of high status in the community, enforcing equality within the female community and socially excluding other girls.

In summary, Benenson wrote:

From early childhood through old age, human females’ reproductive success depends on provisioning, protecting and nurturing first younger siblings, then their own children and grandchildren. To safeguard their health over a lifetime, girls use competitive strategies that reduce the probability of physical retaliation, including avoiding direct interference with another girl’s goals and disguising their striving for physical resources, alliances and status.

In a November 2021 paper, “ Self-Protection as an Adaptive Female Strategy ,” Benenson, Christine E. Webb and Richard W. Wrangham , all of the department of human evolutionary biology, report that they

found consistent support for females’ responding with greater self-protectiveness than males. Females mount stronger immune responses to many pathogens; experience a lower threshold to detect, and lesser tolerance of, pain; awaken more frequently at night; express greater concern about physically dangerous stimuli; exert more effort to avoid social conflicts; exhibit a personality style more focused on life’s dangers; react to threats with greater fear, disgust and sadness; and develop more threat-based clinical conditions than males.

These differences manifest in a number of behaviors and characteristics, Benenson, Webb and Wrangham argue:

We found that females exhibited stronger self-protective reactions than males to important biological and social threats; a personality style more geared to threats; stronger emotional responses to threat; and more threat-related clinical conditions suggestive of heightened self-protectiveness. That females expressed more effective mechanisms for self-protection is consistent with females’ lower mortality and greater investment in child care compared with males.” In addition, “females more than males exhibit a lower threshold for detecting many sensory stimuli; remain closer to home; overestimate the speed of incoming stimuli; discuss threats and vulnerabilities more frequently; find punishment more aversive; demonstrate higher effortful control and experience deeper empathy; express greater concern over friends’ and romantic partners' loyalty; and seek more frequent help.

In an email, Benenson added another dimension to the discussion of sex roles in organizational politics:

From an early age, women clearly dislike group hierarchies of same-sex individuals more than men do. Thus, while boys and men are more willing to compete directly with both higher and lower status individuals, girls and women prefer to interact with same-sex individuals of similar status. This does not mean however that girls and women don’t care about status as much as boys and men do. For both sexes, high status increases the probability that one lives longer and so do one’s children. The result of these two somewhat conflicting motives is that girls and women seek high status but disguise this quest by avoiding direct contests. This gender difference likely impacts how women seek to shape organizational culture.

The strategies Benenson and her colleagues describe, Haidt pointed out,

lead to a different kind of conflict. There is a greater emphasis on what someone said which hurt someone else, even if unintentionally. There is a greater tendency to respond to an offense by mobilizing social resources to ostracize the alleged offender.

In “ Feminist and Anti-Feminist Identification in the 21st Century United States ,” Laurel Elder , Steven Greene and Mary-Kate Lizotte , political scientists at Hartwick College, North Carolina State University and Augusta University, analyzed the responses of those who identified themselves as feminists or anti-feminists in 1992 and 2016.

Based on surveys conducted by American National Election Studies, Elder, Greene and Lizotte found that the total number of voters saying that they were feminists grew from 28 percent to 34 percent over that period. The growth was larger among women, 29 percent to 50 percent, than among men, 18 percent to 25 percent.

Some of the biggest gains were among the young, 18-to-24-year-olds, doubling from 21 percent to 42 percent. Most striking is the data revealing the antithetical trends between women with college degrees, whose self-identification as feminist rose from 34 percent to 61 percent, in contrast to men with college degrees, whose self-identification as feminist fell from 37 percent to 35 percent.

Anti-feminist identity, the authors found,

is not just a mirror image of feminist identity but its own distinctive social identity. A striking difference between feminist and anti-feminist identification is that while gender is a huge driver in feminist identification in 2016, there is essentially no gender gap among anti-feminists. Indeed, bivariate analysis shows that 16 percent of women and 17 percent of men identify as anti-feminists.

In addition, Elder, Greene and Lizotte wrote, “while young people were more likely to identify as feminists than older generations in 2016, young people, particularly young women, also have a higher level of anti-feminist identification compared to older groups.”

The other patterns of anti-feminist identification, according to the authors, are “more the mirror image of feminist identification” with “Republicans being more likely to identify as anti-feminists compared to Democrats, and stay-at-home parents/homemakers, those who identify as born again, and those who attend church frequently being more anti-feminist.”

To provoke further discussion, I will end with the argumentative economist Tyler Cowen , of George Mason University and “ Marginal Revolution .” In December 2019, Cowen wrote a column for Bloomberg, “ Women Dominated the Decade ,” subtitled “The 2010s were pretty thrilling if you liked music, books, TV or movies by or about women.”

Cowen, who acknowledges describing “feminization in not entirely glowing terms ” — indeed one would have to say hostile terms — is also, in other contexts, unequivocally enthusiastic about “what I see as the No. 1. trend of the decade: the increasing influence of women.”

“I had the best of both worlds,” Cowen writes, “namely to grow up in the ‘tougher’ society, but live most of my life in the more feminized society.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here's our email: [email protected] .

Follow The New York Times Opinion section on Facebook , Twitter (@NYTopinion) and Instagram .

Because of an editing error, an earlier version of this article misstated the percentage of women in a Knight Foundation survey who said the First Amendment should not be used to protect hate speech. It was 71 percent, not 7 percent.

How we handle corrections

Thomas B. Edsall has been a contributor to the Times Opinion section since 2011. His column on strategic and demographic trends in American politics appears every Wednesday. He previously covered politics for The Washington Post. @ edsall

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Neurobiology of gender identity and sexual orientation

Sexual identity and sexual orientation are independent components of a person’s sexual identity. These dimensions are most often in harmony with each other and with an individual’s genital sex, although not always. The present review discusses the relationship of sexual identity and sexual orientation to prenatal factors that act to shape the development of the brain and the expression of sexual behaviours in animals and humans. One major influence discussed relates to organisational effects that the early hormone environment exerts on both gender identity and sexual orientation. Evidence that gender identity and sexual orientation are masculinised by prenatal exposure to testosterone and feminised in it absence is drawn from basic research in animals, correlations of biometric indices of androgen exposure and studies of clinical conditions associated with disorders in sexual development. There are, however, important exceptions to this theory that have yet to be resolved. Family and twin studies indicate that genes play a role, although no specific candidate genes have been identified. Evidence that relates to the number of older brothers implicates maternal immune responses as a contributing factor for male sexual orientation. It remains speculative how these influences might relate to each other and interact with postnatal socialisation. Nonetheless, despite the many challenges to research in this area, existing empirical evidence makes it clear that there is a significant biological contribution to the development of an individual’s sexual identity and sexual orientation.

1 |. INTRODUCTION

Gender identity and sexual orientation are fundamental independent characteristics of an individual’s sexual identity. 1 Gender identity refers to a person’s innermost concept of self as male, female or something else and can be the same or different from one’s physical sex. 2 Sexual orientation refers to an enduring pattern of emotional, romantic and/or sexual attractions to men, women or both sexes. 3 Both gender identity and sexual orientation are characterised by obvious sex differences. Most genetic females identify as such and are attracted to males (ie, androphilic) and most genetic males identify as males and are attracted to females (ie, gynophilic). The existence of these dramatic sex differences suggest that gonadal hormones, particularly testosterone, might be involved, given that testosterone plays an important role in the development of most, behavioural sex differences in other species. Here, a review is provided of the evidence that testosterone influences human gender identity and sexual orientation. The review begins by summarising the available information on sex hormones and brain development in other species that forms the underpinnings of the hypothesis suggesting that these human behaviours are programmed by the prenatal hormone environment, and it will also consider contributions from genes. This is followed by a critical evaluation of the evidence in humans and relevant animal models that relates sexual identity and sexual orientation to the influences that genes and hormones have over brain development.

2 |. HORMONES, GENES AND SEXUAL DIFFERENTIATION OF THE BRAIN AND BEHAVIOUR

The empirical basis for hypothesising that gonadal hormones influence gender identity and sexual orientation is based on animal experiments involving manipulations of hormones during prenatal and early neonatal development. It is accepted dogma that testes develop from the embryonic gonad under the influence of a cascade of genes that begins with the expression of the sex-determining gene SRY on the Y chromosome. 4 , 5 Before this time, the embryonic gonad is “indifferent”, meaning that it has the potential to develop into either a testis or an ovary. Likewise, the early embryo has 2 systems of ducts associated with urogenital differentiation, Wolffian and Müllerian ducts, which are capable of developing into the male and female tubular reproductive tracts, respectively. Once the testes develop, they begin producing 2 hormones, testosterone and anti-Müllerian hormone (AMH). In rats, this occurs around day 16–17 of gestation, whereas, in humans, it occurs at about 7–8 weeks of gestation. 6 Testosterone and one of its derivatives, dihydrotestosterone, induce the differentiation of other organs in the male reproductive system, whereas AMH causes the degeneration of the Müllerian ducts. Female ovaries develop under the influence of a competing set of genes that are influenced by expression of DAX1 on the X chromosome and act antagonistically to SRY. The female reproductive tract in the embryo develops in the absence of androgens and later matures under the influence hormones produced by the ovary, in particular oestradiol.

Analogous processes occur during early development for sexual differentiation of the mammalian brain and behaviour. According to the classical or organisational theory, 7 , 8 prenatal and neonatal exposure to testosterone causes male-typical development (masculinisation), whereas female-typical development (feminisation) occurs in the relative absence of testosterone. Masculinisation involves permanent neural changes induced by steroid hormones and differs from the more transient activational effects observed after puberty. These effects typically occur during a brief critical period in development when the brain is most sensitive to testosterone or its metabolite oestradiol. In rats, the formation of oestradiol in the brain by aromatisation of circulating testosterone is the most important mechanism for the masculinisation of the brain; 9 however, as shown below, testosterone probably acts directly without conversion to oestradiol to influence human gender identity and sexual orientation. The times when testosterone triggers brain sexual differentiation in different species correspond to periods when testosterone is most elevated in males compared to females. In rodents and other altricial species, this occurs largely during the first 5 days after birth, whereas, in humans, the elevation in testosterone occurs between months 2 and 6 of pregnancy and then again from 1 to 3 months postnatally. 6 During these times, testosterone levels in the circulation are much higher in males than in females. These foetal and neonatal peaks of testosterone, together with functional steroid receptor activity, are considered to program the male brain both phenotypically and neurologically. In animal models, programming or organising actions are linked to direct effects on the various aspects of neural development that influence cell survival, neuronal connectivity and neurochemical specification. 10 Many of these effects occur well after the initial hormone exposure and have recently been linked to epigenetic mechanisms. 11

The regional brain differences that result from the interaction between hormones and developing brain cells are assumed to be the major basis of sex differences in a wide spectrum of adult behaviours, such as sexual behaviour, aggression and cognition, as well as gender identity and sexual orientation. Factors that interfere with the interactions between hormones and the developing brain systems during gestation may permanently influence later behaviour. Studies in sheep and primates have clearly demonstrated that sexual differentiation of the genitals takes places earlier in development and is separate from sexual differentiation of the brain and behaviour. 12 , 13 In humans, the genitals differentiate in the first trimester of pregnancy, whereas brain differentiation is considered to start in the second trimester. Usually, the processes are coordinated and the sex of the genitals and brain correspond. However, it is hypothetically possible that, in rare cases, these events could be influenced independently of each other and result in people who identify with a gender different from their physical sex. A similar reasoning has been invoked to explain the role of prenatal hormones on sexual orientation.

Although the role of gonadal steroids in the sexual differentiation of reproductive brain function and behaviour is undeniable, males and females also carry a different complement of genes encoded on their sex chromosomes that also influence sexual differentiation of the brain. 14 – 16 As will be discussed, family and twin studies suggest that there is a genetic component to gender identity and sexual orientation at least in some individuals. However, the nature of any genetic predisposition is unknown. The genetic component could be coding directly for these traits or, alternatively, could influence hormonal mechanisms by determining levels of hormones, receptors or enzymes. Genetic factors and hormones could also make separate yet complementary or antagonistic contributions. It should be noted that, although the early hormone environment appears to influence gender identity and sexual orientation, hormone levels in adulthood do not. There are no reports indicating that androgen levels differ as a function of gender identity or sexual orientation or that treatment with exogenous hormones alters these traits in either sex.

3 |. GENDER IDENTITY

The establishment of gender identity is a complex phenomenon and the diversity of gender expression argues against a simple or unitary explanation. For this reason, the extent to which it is determined by social vs biological (ie, genes and hormones) factors continues to be debated vigorously. 17 The biological basis of gender identity cannot be modelled in animals and is best studied in people who identify with a gender that is different from the sex of their genitals, in particular transsexual people. Several extensive reviews by Dick Swaab and coworkers elaborate the current evidence for an array of prenatal factors that influence gender identity, including genes and hormones. 18 – 20

3.1 |. Genes

Evidence of a genetic contribution to transsexuality is very limited. 21 There are few reports of family and twin studies of transsexuals but none offer clear support for the involvement of genetic factors. 22 – 24 Polymorphisms in sex hormone-related genes for synthetic enzymes and receptors have been studied based on the assumption that these may be involved in gender identity development. An increased incidence of an A2 allele polymorphism for CYP17A1 (ie, 17ɑ-hydroxylase/17, 20 lyase, the enzyme catalysing testosterone synthesis) was found in female-to-male (FtM) but not in male-to-female (MtF) transsexuals. 25 No associations were found between a 5ɑ-reductase (ie, the enzyme converting testosterone to the more potent dihydrotestosterone) gene polymorphism in either MtF or FtM transsexuals. 26 There are also conflicting reports of associations between polymorphisms in the androgen receptor, oestrogen receptor β and CYP19 (ie, aromatase, the enzymes catalysing oestradiol synthesis). 27 – 29 A recent study using deep sequencing detected three low allele frequency gene mutants (i.e., FBXO38 [chr5:147774428; T>G], SMOC2 [chr6:169051385; A>G] and TDRP [chr8:442616; A>G]) between monozygotic twins discordant for gender dysphoria. 30 Further investigations including functional analysis and epidemiological analysis are needed to confirm the significance of the mutations found in this study. Overall, these genetic studies are inconclusive and a role for genes in gender identity remains unsettled.

3.2 |. Hormones

The evidence that prenatal hormones affect the development of gender identity is stronger but far from proven. One indication that exposure to prenatal testosterone has permanent effects on gender identity comes from the unfortunate case of David Reimer. 31 As an infant, Reimer underwent a faulty circumcision and was surgically reassigned, given hormone treatments and raised as a girl. He was never happy living as a girl and, years later, when he found out what happened to him, he transitioned to living as a man. However, for at least the first 8 months of life, this child was reared as a boy and it is not possible to know what impact rearing had on his dissatisfaction with a female sex assignment. 1 Other clinical studies have reported that male gender identity emerges in some XY children born with poorly formed or ambiguous genitals as a result of cloacal exstrophy, 5ɑ-reductase or 17β-hydroxysteroid dehydrogenase deficiency and raised as girls from birth. 32 , 33 All of these individuals were exposed to testosterone prenatally emphasising a potential role for androgens in gender development and raising doubts that children are psychosexually neutral at birth. 20 On the other hand, XY individuals born with an androgen receptor mutation causing complete androgen insensitivity are phenotypically female, identify as female and are most often androphilic, indicating that androgens act directly on the brain without the need for aromatisation to oestradiol. 34

3.3 |. Neuroanatomy

Further evidence that the organisational hormone theory applies to development of gender identity comes from observations that structural and functional brain characteristics are more similar between transgender people and control subjects with the same gender identity than between individuals sharing their biological sex. This includes local differences in the number of neurones and volume of subcortical nuclei such as the bed nucleus of the stria terminalis, 35 , 36 numbers of kisspeptin and neurokinin B neurones in the infundibulum, 37 , 38 structural differences of gray 39 , 40 and white matter microstructure, 41 – 43 neural responses to sexually-relevant odours 44 , 45 and visuospatial functioning. 46 However, in some cases, the interpretation of these studies is complicated by hormone treatments, small sample sizes and a failure to disentangle correlates of sexual orientation from gender identity. 47 The fact that these differences extend beyond brain areas and circuits classically associated with sexual and endocrine functions raises the possibility that transsexuality is also associated with changes in cerebral networks involved in self-perception.

4 |. SEXUAL ORIENTATION

Research over several decades has demonstrated that sexual orientation ranges along a continuum, from exclusive attraction to the opposite sex to exclusive attraction to the same sex. 48 However, sexual orientation is usually discussed in terms of 3 categories: heterosexual (having emotional, romantic or sexual attractions to members of the other sex), homosexual (having emotional, romantic or sexual attractions to members of one’s own sex) and bisexual (having emotional, romantic or sexual attractions to both men and women). Most people experience little or no sense of choice about their sexual orientation. There is no scientifically convincing research to show that therapy aimed at changing sexual orientation (ie, reparative or conversion therapy) is safe or effective. 3 The origin of sexual orientation is far from being understood, although there is no proof that it is affected by social factors after birth. On the other hand, a large amount of empirical data suggests that genes and hormones are important regulators of sexual orientation. 49 – 51 Useful animal models and experimental paradigms in animals have helped frame questions and propose hypotheses relevant to human sexual orientation.

4.1 |. Animal studies

Sexual partner preference is one of the most sexually dimorphic behaviours observed in animals and humans. Typically, males choose to mate with females and females choose to mate with males. Sexual partner preferences can be studied in animals by using sexual partner preference tests and recording the amount of time spent alone or interacting with the same or opposite sex stimulus animal. Although imperfect, tests of sexual partner preference or mate choice in animals have been used to model human sexual orientation. As reviewed comprehensively by Adkins-Regan 52 and Henley et al, 53 studies demonstrate that perinatal sex steroids have a large impact on organising mate choice in several species of animals, including birds, mice, rats, hamsters, ferrets and pigs. In particular, perinatal exposure to testosterone or its metabolite oestradiol programs male-typical (ie, gynophilic) partner preferences and neonatal deprivation of testosterone attenuates the preference that adult males show typically. In the absence of high concentrations of sex steroid levels or receptor-mediated activity during development, a female-typical (ie, androphilic) sexual preference for male sex partners develops.

Sexually dimorphic neural groups in the medial preoptic area of rats and ferrets have been associated with sexual partner preferences. In male rats, a positive correlation was demonstrated between the volume of the sexual dimorphic nucleus of the preoptic area (SDN) and the animal’s preference for a receptive female, 54 although this was not replicated in a recent study. 55 Furthermore, in both rats and ferrets, destruction of the SDN caused males to show either neutral or androphilic preferences. 56

Naturally occurring same-sex interactions involving genital arousal have been reported in hundreds of animal species; however, they often appear to be motivated by purposes other than sex and may serve to facilitate other social goals. 57 , 58 Exclusive and enduring same-sex orientation is, however, extremely rare among animals and has only been documented conclusively and studied systematically in certain breeds of domestic sheep. 59 , 60 Approximately 6% to 8% of Western-breed domestic rams choose to exclusively court and mount other rams, but never ewes, when given a choice. No social factors, such as the general practice of rearing in same sex groups or an animal’s dominance rank, were found to affect sexual partner preferences in rams. Consistent with the organisational theory of sexual differentiation, sheep have an ovine sexually dimorphic preoptic nucleus (oSDN) that is larger and contains more neurones in female-oriented (gynophilic) rams than in male-oriented rams (androphilic) and ewes (androphilic). 61 Thus, morphological features of the oSDN correlate with a sheep’s sexual partner preference. The oSDN already exists and is larger in males than in females before sheep are born, suggesting that it could play a causal role in behaviour. 62 The oSDN differentiates under the influence of prenatal testosterone after the male genitals develop, but is unaffected by hormone treatment in adulthood. 63 Appropriately timed experimental exposure of female lamb foetuses to testosterone can alter oSDN size independently of genetic and phenotypic sex. 13 However, males appear to be resistant to suppression of the action of androgen during gestation because the foetal hypothalamic-pituitary-axis is active in the second trimester (term pregnancy approximately 150 days) and mitigates against changes in circulating testosterone that could disrupt brain masculinisation. 64 These data suggest that, in sheep, brain sexual differentiation is initiated during gestation by central mechanisms acting through gonadotrophin-releasing hormone neurones to stimulate and maintain the foetal testicular testosterone synthesis needed to masculinise the oSDN and behaviour. More research is required to understand the parameters of oSDN development and to causally relate its function to sexual partner preferences in sheep. Nonetheless, when considered together, the body of animal research strongly indicates that male-typical partner preferences are controlled at least in part by the neural groups in the preoptic area that differentiate under the influence of pre- and perinatal sex steroids.

4.2 |. Human studies

4.2.1 |. genes.

Evidence from family and twin studies suggests that there is a moderate genetic component to sexual orientation. 50 One recent study estimated that approximately 40% of the variance in sexual orientation in men is controlled by genes, whereas, in women, the estimate is approximately 20%. 65 In 1993, Hamer et al 66 published the first genetic linkage study that suggested a specific stretch of the X chromosome called Xq28 holds a gene or genes that predispose a man to being homosexual. These results were consistent with the observations that, when there is male homosexuality in a family, there is a greater probability of homosexual males on the mother’s side of the family than on the father’s side. The study was criticised for containing only 38 pairs of gay brothers and the original finding was not replicated by an independent group. 67 Larger genome-wide scans support an association with Xq28 and also found associations with chromosome 7 and 8, 68 , 69 although this has also been disputed. 70 Scientists at the personal genomics company 23andme performed the only genome-wide association study of sexual orientation that looked within the general population. 71 The results were presented at the Annual Meeting of the American Society for Human Genetics in 2012, although they have not yet been published in a peer-reviewed journal. Although no genetic loci reaching genome-wide significance for homosexuality among men or women, the genetic marker closest to significance was located in the same region of chromosome 8 in men as that implicated in linkage studies. Other molecular genetic evidence suggests that epigenetic factors could influence male sexual orientation, although this has yet to be demonstrated. 72 , 73

4.2.2 |. Hormones

The leading biological theory of sexual orientation in humans, as in animals, draws on the application of the organisational theory of sexual differentiation. However, this theory cannot be directly tested because it is not ethical to experimentally administer hormones to pregnant women and test their effect on the sexual orientation of their children. Naturally occurring and iatrogenic disorders of sex development that involve dramatic alterations in hormone action or exposure lend some support to a role for prenatal hormones, although these cases are extremely rare and often difficult to interpret. 74 Despite these limitations, two clinical conditions are presented briefly that lend some support for the organisational theory. More comprehensive presentations of the clinical evidence on this topic can be found in several excellent reviews. 74 – 76

Women born with congenital adrenal hyperplasia (CAH) and exposed to abnormally high levels of androgens in utero show masculinised genitals, play behaviour and aggression. 74 , 77 They also are less likely to be exclusively heterosexual and report more same-sex activity than unaffected women, which suggests that typical female sexual development is disrupted. Although it appears plausible that these behavioural traits are mediated through effects of elevated androgens on the brain, it is also possible that the sexuality of CAH women may have also been impacted by the physical and psychological consequences of living with genital anomalies or more nuanced effects of socialisation. 78 There is also evidence for prenatal androgen effects on sexual orientation in XY individuals born with cloacal exstrophy. It was reported originally that a significant number of these individuals eventually adopt a male gender identity even though they had been surgically reassigned and raised as girls. Follow-up studies found that almost all of them were attracted to females (i.e. gynophilic). 33 , 50 The outcomes reported for both of these conditions are consistent with the idea that prenatal testosterone programs male-typical sexual orientation in adults. However, effects on sexual orientation were not observed across the board in all individuals with these conditions, indicating that hormones cannot be the only factor involved.

4.2.3 |. Neuroanatomy

Additional evidence that supports a prenatal organisational theory of sexual orientation is derived from the study of anatomical and physiological traits that are known to be sexually dimorphic in humans and are shown to be similar between individuals sharing the same sexual attraction. Neuroanatomical differences based on sexual orientation in human males have been found. LeVay 79 reported that the third interstitial nucleus of the anterior hypothalamus (INAH3) in homosexual men is smaller than in heterosexual men and has a similar size in homosexual men and women. Based on its position and cytoarchitecture, INAH3 resembles the sheep oSDN, which has similar differences in volume and cell density correlated with sexual partner preference. This similarity suggests that a relevant neural circuit is conserved between species. A recent review and meta-analysis of neuroimaging data from human subjects with diverse sexual interests during sexual stimulation also support the conclusion that elements of the anterior and preoptic area of the hypothalamus is part of a core neural circuit for sexual preferences. 80

Other neural and somatic biomarkers of prenatal androgen exposure have also been investigated. McFadden 81 reported that functional properties of the inner ear, measured as otoacoustic emissions (OAEs), and of the auditory brain circuits, measured as auditory evoked potentials (AEPs), differ between the sexes and between heterosexual and homosexual individuals. OAEs and AEPs are usually stronger in heterosexual women than in heterosexual men and are masculinised in lesbians, consistent with the prenatal hormone theory. However, OAEs were not different in homosexual males and AEPs appear to be hyper-masculinised. The second digit to fourth digit (2D:4D) ratio, which is the length of the second digit (index finger) relative to that of the fourth digit (ring finger), is another measure that has been used as a proxy for prenatal androgen exposure. The 2D:4D ratio is generally smaller in men than in women, 82 , 83 although the validity of this measure as a marker influenced by only prenatal androgen exposure has been questioned. 84 Nonetheless, numerous studies have reported that the 2D:4D ratio is also on average smaller in lesbians than in hetero-sexual women, a finding that has been extensively replicated 85 and suggests the testosterone plays a role in female sexual orientation. Similar to OAEs, digit ratios do not appear to be feminised in homosexual men and, similar to AEPs, may even be hyper-masculinised. The lack of evidence for reduced androgen exposure in homosexual men (based on OAEs, AEPs and digit ratios) led Breedlove 85 to speculate that there may be as yet undiscovered brain-specific reductions in androgen responses in male foetuses that grow up to be homosexual. No variations in the human androgen receptor or the aromatase gene were found that relate to variations in sexual orientation. 86 , 87 However, Balthazart and Court 88 provided suggestions for other genes located in the Xq28 region of the X-chromosome that should be explored and it remains possible that expression levels of steroid hormone response pathway genes could be regulated epigenetically (11).

4.2.4 |. Maternal immune response

Homosexual men have, on average, a greater number of older brothers than do heterosexual men, a well-known finding that has been called the fraternal birth order (FBO) effect. 89 Accordingly, the incidence of homosexuality increases by approximately 33% with each older brother. 90 The FBO effect has been confirmed many times, including by independent investigators and in non-Western sample populations. The leading hypothesis to explain this phenomenon posits that some mothers develop antibodies against a Y-linked factor important for male brain development, and that the response increases incrementally with each male gestation leading, in turn, to the alteration of brain structures underlying sexual orientation in later-born boys. In support of the immune hypothesis, Bogaert et al 91 demonstrated recently that mothers of homosexual sons, particularly those with older brothers, have higher antibody titers to neurolignin 4 (NLGN4Y), an extracellular protein involved in synaptic functioning and presumed to play a role in foetal brain development.

5 |. CONCLUSIONS

The data summarised in the present review suggest that both gender identity and sexual orientation are significantly influenced by events occurring during the early developmental period when the brain is differentiating under the influence of gonadal steroid hormones, genes and maternal factors. However, our current understanding of these factors is far from complete and the results are not always consistent. Animal studies form both the theoretical underpinnings of the prenatal hormone hypothesis and provide causal evidence for the effect of prenatal hormones on sexual orientation as modelled by tests of sexual partner preferences, although they do not translate to gender identity.

Sexual differentiation of the genitals takes place before sexual differentiation of the brain, making it possible that they are not always congruent. Structural and functional differences of hypothalamic nuclei and other brain areas differ in relation to sexual identity and sexual orientation, indicating that these traits develop independently. This may be a result of differing hormone sensitivities and/or separate critical periods, although this remains to be explored. Most findings are consistent with a predisposing influence of hormones or genes, rather than a determining influence. For example, only some people exposed to atypical hormone environments prenatally show altered gender identity or sexual orientation, whereas many do not. Family and twin studies indicate that genes play a role, but no specific candidate genes have been identified. Evidence that relates to the number of older brothers implicates maternal immune responses as a contributing factor for male sexual orientation. All of these mechanisms rely on correlations and our current understanding suffers from many limitations in the data, such as a reliance on retrospective clinical studies of individuals with rare conditions, small study populations sizes, biases in recruiting subjects, too much reliance on studies of male homosexuals, and the assumption that sexuality is easily categorised and binary. Moreover, none of the biological factors identified so far can explain all of the variances in sexual identity or orientation, nor is it known whether or how these factors may interact. Despite these limitations, the existing empirical evidence makes it clear that there is a significant biological contribution to the development of an individual’s sexual identity and sexual orientation.

ACKNOWLEDGEMENTS

I thank Charles Estill, Robert Shapiro and Fred Stormshak for their thoughtful comments on this review. This work was supported by NIH R01OD011047.

Funding information

This work was supported by NIH R01OD011047 (CER)

CONFLICT OF INTERESTS

The author declares that there are no conflicts of interest.

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[DEADLINE EXTENDED TO 15 APRIL] CFP: CURRENT ISSUES IN GENDER STUDIES

Critical Gender Studies Journal (CGSJ)   is an interdisciplinary (also antidisciplinary), transnational and bilingual platform in English and Spanish for all who are interested in exploring how gender and sexuality shape and are shaped by various social, cultural, historical, and political contexts. It also examines the relationships between gender and sexuality and other facets of identity, including nationality, race, class, ethnicity, religion, and disability. It aims to challenge the assumptions and norms that underlie gender and sexual relations and to promote social justice and equality for all people.

Theme: Current Issues in Gender Studies

The inaugural issue of the  CGSJ  invites submissions that explore the emerging issues in gender studies and calls upon authors to engage with the following concerns:

• How do gender relations and identities shape and are shaped by the multiple transformations that characterize our contemporary societies, such as globalization, migration, digitalization, environmental crisis, social movements, and pandemics?
• How do critical gender studies interrogate and challenge the dominant discourses and practices that reproduce and reinforce gender inequalities and oppressions?
• How do critical gender studies envision and enact alternative and emancipatory visions of gender justice and diversity?

We are particularly interested in submissions that address one or more of the following thrust areas:

• Gender and intersectionality : How do gender and other axes of difference and power, such as race, class, sexuality, disability, religion, and nationality, intersect and interact in various contexts and domains?
• Gender and violence : How do gender and violence relate to each other in different forms and settings, such as domestic violence, sexual violence, hate crimes, armed conflicts, and state violence?
• Gender and media : How do gender and media influence each other in terms of representation, production, consumption, and participation, especially in the age of digital and social media?
• Gender and health : How do gender and health intersect and affect each other in terms of access, quality, outcomes, and policies, especially in the context of the COVID-19 pandemic and its aftermath?
• Gender and work : How do gender and work interact and impact each other in terms of labor market, employment, entrepreneurship, care work, and work-life balance, especially in the face of the changing nature and demands of work?
• Gender and education : How do gender and education relate to each other in terms of access, achievement, curriculum, pedagogy, and empowerment, especially in the context of the global education crisis and the shift to online learning?
• Gender and culture : How do gender and culture shape and are shaped by each other in terms of identity, expression, performance, and resistance, especially in the context of global cultural flows and exchanges?

Languages of Publication: We accept papers written in English & Spanish.

Submission Guidelines:  https://cgsjournal.com/guidelines 

Submission Deadline: 31 March 2024.

Free Gender Studies Essay Examples & Topics

A gender studies essay should concentrate on the interaction between gender and other unique identifying features. Along with gender identity and representation, the given field explores race, sexuality, religion, disability, and nationality. Gender is a basic social characteristic that often goes unnoticed.

Some people understand the importance of gender studies only when it relates to women and their issues. However, the concept itself involves basically everyone who lives in a society. The clothes we wear, the jobs we do, the way we act – it’s all gendered. Therefore, gender directly influences our socioeconomic status in everyday life from the moment we become a part of society.

You can explore this subject in detail by reading gender studies essays below. There you will see how the topic was considered and covered by other students. Also, our experts have prepared some valuable tips for writing such papers and have collected gender and sexuality essay topics for you.

Gender Studies Essay: Top Tips

To write a perfect gender studies essay, you need to understand the appropriate structure, style, and ways of developing your thesis and argumentation. Here we will briefly tell you everything you need to know to start and finish such a task.

For a gender roles essay or any gender-related paper, you need to do the following:

• Find a researchable topic of interest. Then, skim through the necessary sources and take notes.
• Do in-depth research. You can find the relevant info in literary works, scientific journals, interviews, popular magazines, etc.
• Organize the information . Create a working outline to make the writing process more manageable and structured.
• Create a hook for an introduction . Write it to engage the reader from the start, then provide background information about the topic.
• Include a thesis statement in your intro . Here you convey your central message to the reader. If you’d like to facilitate the process, let our thesis generator formulate one for you.
• Write body paragraphs . These usually consist of topic sentences, your arguments with proof, and concluding remarks. Organize the supporting evidence in a logical order before listing it in the body.
• Craft your conclusion. It is the most important part of a gender studies essay. You don’t need to write a lot, just a restatement of your thesis and a few strong sentences summarizing the whole piece. You can use our summary generator for this purpose.
• Revise and edit. Check the grammar, punctuation, logical flow of ideas, word choices, spelling. Make sure you’ve used the correct citation style.
• Read the draft aloud. This way, you are more inclined to notice the parts where you must make improvements. Try to exclude such words as “I,” “me,” my,” passive constructions, and verb contractions.

20 Gender Studies Essay Topics

Here we have collected topics that you can use to write your gender equality essay. They are original, so you can practice your writing skills with them or even use them for your homework. Our topic generator can create more ideas for your writing if you need some.

You can try the following ideas:

• Gender studies: what it is, its goal, and development.
• The comparison of gender discrimination laws in different countries.
• Promotion of gender equality in the workplace.
• Gender stereotypes in different aspects of life.
• What are the differences between gender and sexuality?
• How does media influence the breaking of gender role stereotypes?
• Why do women have limited opportunities in sports in comparison to men?
• Gender inequality in American history.
• How can education help solve the problem of inequality?
• In what ways can cities become safer for women to live in?
• How do gender roles influence children’s games?
• Women’s contribution to the world’s economic growth.
• Biological differences between men and women.
• Career growth opportunities for men and women in the military.
• Do feminine and masculine personality traits exist?
• What is a feminist theory in sociology?
• Is there a necessity for men to fight for their rights as women do?
• The differences in salaries between sexes in different countries.
• The main factors of inequality between men and women.
• How gender discrimination influences early childhood development.

Thanks for your attention! Now you can look at the free gender essay examples and write your work with confidence.

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• For Journalists
• News Releases
• Latest Releases
• News Release

Five trans experts are available for media

On Trans Day of Visibility, experts can discuss pressing policy issues facing the transgender and non-binary communities

Media Information

• Release Date: March 28, 2024

Media Contacts

Win Reynolds

• (413) 461-6314

EVANSTON, Ill. --- Trans Day of Visibility is Sunday, March 31, marking a day to celebrate the accomplishments of the transgender and non-binary community and raise awareness of the challenges faced by trans people worldwide.

The American Civil Liberties Union (ACLU) is tracking 479 anti-LGBTQ bills in the U.S. that are in various phases of legislation, including broad-reaching, bundled bill packages proposed in Georgia just days ago that would — among other things — ban trans athlete participation and ban gender nonconforming students from bathrooms aligning with their gender identity.

Faculty from Northwestern University can discuss a variety of topics in the headlines and more. Connect with them directly using the contact information below or reach out to Win Reynolds for assistance.

Marquis Bey (they/them, or any pronoun) Critical gender/race theory

Professor of Black Studies Director of Graduate Studies for Gender and Sexuality Studies

[email protected]

Bey’s research focuses on Blackness and fugitivity, transness and Black feminist theory. Bey has published a monograph, “Black Trans Feminism,” which attempts to theorize the convergence of blackness, transness and Black feminism via the Black Radical Tradition, critical theory, and contemporary literature. They can speak on topics including Black feminism; transgender life; nonnormative genders; race and gender in popular culture; critical gender/race theory; and politics.

TJ Billard (they/them) Media and transgender politics

Assistant Professor in Communication Studies and Sociology (by courtesy)

[email protected]

Billard’s research focuses on the relationship between media and transgender politics in the United States and United Kingdom. Their past research has focused on transgender media visibility, the relationship between mass media and the transgender rights movement, and the role of digital media in transgender activism. Their current research focuses on the weaponization of disinformation to oppose transgender rights, particularly the rights of trans youth. Billard is the author of “Voices for Transgender Equality: Making Change in the Networked Public Sphere,” forthcoming from Oxford University Press. They are also the executive director of the  Center for Applied Transgender Studies and editor-in-chief of the Bulletin of Applied Transgender Studies.

Ricky Hill (they/them) Trans behavioral health

Research Assistant Professor, Institute for Sexual and Gender Minority Health and Wellbeing

[email protected]

Hill’s research centers on behavioral health and wellness in transgender and gender diverse communities, with a current emphasis on transgender men and transmasculine people. Their past research focuses on communication interactions between transgender patients and healthcare providers and relationship education for HIV prevention. They are currently a qualitative methodologist on the  Chicago Area Trans Survey , a collaboration between Northwestern and Chicago-based grassroots organization Brave Space Alliance, whose data will help inform programming, policies and laws to improve the lives of trans Chicagoans. They can speak on topics related to gender affirming care, transgender mental health and wellness, and non-binary gender identities.

Eli Kean (they/them) Gender-affirming education

Assistant Professor of Instruction, Gender & Sexuality Studies

[email protected]

Kean earned their Ph.D. in Curriculum, Instruction & Teacher Education from Michigan State University. Kean's interdisciplinary interests include anti-oppressive education, gender studies and curriculum theory. Their primary goal as an academic is to help shape gendered educational practices in expansive and affirming directions. Kean’s most recent publication, “Advancing a Critical Trans Framework for Education”, is informed by critical trans politics and critical race theory and provides educators with a theoretical framework that centers transgender oppression. They can speak on topics including trans-inclusive curriculum and pedagogy; supporting, mentoring and advising LGBTQ+ undergraduate students; critical trans theory; and other gender-affirming practices in higher education.

alithia zamantakis (she/her) Gender-affirming care and legislation

[email protected]

zamantakis is a writer, sociologist, trans health and implementation scientist, and organizer. She is associate chair for  the division of sexual behavior, politics and communities of the Society for the Study for Social Problems  and chair of the  Sociologists for Trans Justice . zamantakis can cover topics including bans on gender-affirming care, anti-“drag” legislation, trans women and sports, and physical violence against trans women.

Detroit's Catholic archbishop calls trans identity 'gender confusion' in letter

The leader of the Catholic Church in metro Detroit is sounding the alarm about what he calls "gender confusion," critiquing the growing acceptance of transgender identity as a dangerous trend that will harm people.

In a 5,000-word pastoral letter sent recently to Catholic leaders in six counties in southeastern Michigan, Archbishop of Detroit Allen Vigneron wrote on what he called "the challenges of gender identity." Vigneron avoided using the word "transgender" in his letter, instead using the phrase "individuals experiencing gender confusion" to describe people who identify as a different gender from the one they were assigned at birth. In addition to a lengthy letter that touched upon philosophy, theology and sexuality, Vigneron released a 2,000-word FAQ explaining new policies Catholics in metro Detroit are expected to follow.

The new rules for the Archdiocese of Detroit go into effect Aug. 1. They will affect all Catholic schools and parish programs involving youths, such as education programs, youth conferences and other events. Vigneron announced that it will also apply to restrooms and athletic events, among other settings, and dress codes. The policies do not appear to exclude transgender people from activities but prohibit identifying them with a gender different from the one assigned at birth.

"By virtue of each person’s creation in the image and likeness of God as male or female ... all ministers of the Church in the Archdiocese of Detroit (clergy, employees, and volunteers), students, and registered youth program participants shall respect their God-given biological sex regarding (but not limited to) the use of personal pronouns, dress code, bathrooms, and all other facilities," Vigneron wrote. "All documents and records shall reflect the person's God-given biological sex.”

Liberal Catholics who support LGBTQ+ people criticized Vigneron's letter as cruel and unscientific. Under the new policies, family members of trans children are encouraged to join a support group called EnCourage, which LGBTQ+ advocates have criticized. But last week, Vigneron doubled down on his letter in a podcast.

"I think it's a toxin that's been deposited in in our culture," Vigneron said , describing how a dualist vision that divides the body and soul led to transgender identity. "A virus maybe is the better analogy. And it's incubated and it's just continued to grow. In the absence of a Christian culture, it has a lot more scope to to become more virulent. ... The fact that we have technological means to respond in unhealthy ways just aggravates the situation."

The pastoral letter was Vigneron's first since 2017, when he wrote a statement titled "Unleash the Gospel" that spoke about how to evangelize. The new document, released Feb. 26, was Vigneron's fifth pastoral letter since he became archbishop in 2009, titled "The Good News About God’s Plan: A Pastoral Letter on the Challenges of Gender Identity."

Vigneron submitted to the Vatican his resignation letter in October on his 75th birthday, as required under church law, and could be replaced at any time by Pope Francis. There are 907,0000 Catholics in the archdiocese, which includes the counties of Wayne, Oakland, Macomb, Lapeer, Monroe and St. Clair.

Vigneron urged kindness toward transgender people, but he said that kindness should not be accompanied by simply accepting their identity. He compared a transgender person to someone who smokes cigarettes or a woman who drinks alcohol while pregnant.

"Individuals who face the challenge of gender confusion deserve, first and foremost, to receive our love, compassion, and support," Vigneron wrote. "Too often, however, there can be an insistence that compassion and accompaniment mean only that we should stand in solidarity with people and forego lovingly challenging them when their choices conflict with their real good. ... Imagine a cardiologist who seeks to be compassionate by affirming a patient’s smoking, or an obstetrician who avoids telling patients about the dangers of drinking alcohol during pregnancy. Far from being acts of compassion, these would be acts of malpractice. Therefore, we must be no less clear in our proclamation of the good of the human body to those who have been deceived into thinking otherwise."

LGBTQ+ Catholics and others who support them are concerned about the letter.

"When I first saw ... the pastoral letter, I felt sick to my stomach," Carolyn Shalhoub, vice president of Dignity Detroit, a group of LGBTQ Catholics in Michigan, told the Free Press. "As a lifelong Catholic, regular churchgoer, and active member of the Dignity Detroit community, I am saddened by the deliberate embrace of inaccurate and harmful policies that affect children, teachers, staff and parents. We have trans persons in our congregation. They have suffered greatly to get where they are today."

In 2020, the Archdiocese of Detroit kicked out Dignity Detroit and others supportive of LGBTQ+ Catholics as part of an effort to exclude groups Catholic leaders said clashed with their doctrines. In 2013, Vigneron issued a statement urging people who support same-sex marriage to avoid receiving Communion. Liberal Catholics in metro Detroit worry they are being marginalized by church leaders.

"It is really hard to have any respect for the leadership of the Church in our area," Shalhoub said. "Fortunately, it is not like this everywhere in the U.S. There are dioceses which have active LGBTQ+ ministries."

Linda Karle Nelson, of Farmington Hills, a leader with Fortunate Families Detroit, which supports Catholic family members who are LGBTQ+, said she's concerned that the word "transgender" was "not given legitimacy in this letter ... it is never used."

Nelson, who has children who are LGBTQ+, said "although the letter strives to use language that is 'welcoming' and empathetic with the struggles of trans people, the tone of the letter is one that demeans and delegitimizes the self-identity of transgender people."

The Archdiocese did not issue a news release announcing Vingeron's pastoral letter as it has with previous letters, such as the 2017 document. In the podcast, Vigneron said the policy will be carried out with care.

"We will treat them with compassion, but treat them according to their God-given gender," Vigneron said of transgender people. "So things like restrooms, things like athletics, all of the things that make headlines today, for matters of controversy, we're going to (act) with compassion, but act according to the gender with which the child, the young person was conceived and born."

Vigneron's letter has been discussed and promoted at local churches in recent weeks.

"Priests have been sharing it with their parish communities as they deem appropriate," said Holly Fournier, spokesperson for the archdiocese.

The letter was praised during the podcast by the Rev. Stephen Pullis, director of graduate pastoral formation at Sacred Heart Major Seminary in Detroit, who was the former director of the department of evangelization and missionary discipleship in the archdiocese. Pullis said the ideas in Vigneron's letter on gender flow from his earlier letter on Unleashing The Gospel in 2017.

"We're not using the gospel as a weapon to harm people or to ... stick it to people," Pullis said. "We begin with that compassionate love. ... That compassion demands that we treat people according to their God-given biological sex, their God-given gender. So I think on a parish level that gets played out through these conversations with parents or with teachers and coaches and all those who are entrusted ... in leading and forming and shaping young people to help them understand this truth."

Pullis added that this is "not a problem to be solved, but a person to be loved.”

Vigneron's conservative message is in line with some of the guidelines issued last year by the United States Conference of Catholic Bishops (USCCB) for Catholic hospitals that block gender transition care for transgender people, the Associated Press reported. And in 2021, the Marquette Catholic diocese in northern Michigan said LGBTQ+ people who do not repent should not receive Communion and other sacraments.

Marianne Duddy-Burke, executive director of DignityUSA, which works for LGBTQ+ rights in the Catholic Church, said Vigneron's letter caused her "real heartache over the pain that this will cause for so many people in the Archdiocese of Detroit." Duddy-Burke said her transgender son underwent gender transition surgery last week.

"It feels very clear to me that is coming straight from a dogmatic, rather than an experiential position," she said. "It's ... outdated Catholic dogma."

In his letter, Vigneron said parents sometimes are faced with accusations their opposition to gender transition care may lead to suicide.

"They may fear alienating their child if they challenge the identity their child is claiming," Vigneron wrote. "Not infrequently, parents are subject to manipulative claims that if they do not affirm their child’s gender preferences, they risk driving him or her to suicide."

Daddy-Burke said she found "particularly disturbing ... his characterization of the reailty of suicidality among folks with gender dysphoria as a manipulation. That is cruel to use that kind of terminology."

Vigneron said Catholics must stay true to their beliefs regardless of what is considered popular at the moment.

"In contrast to the unitive and Christian vision of the human person as created by God in his image, there is an alternate, 'dualist' vision of mankind, growing in popularity in recent years," he wrote. "This vision sees the human person as inherently divided and separated ... The notion of dividing a person between body and soul — or between mind and matter — is something that Christians have been combating since the early centuries of the Church."

Vigneron added that Catholics should not get drawn into cultural battles while standing firm in their views.

"Our response is not to become 'cultural warriors,' looking for a battle against those with whom we disagree," Vigneron said. "Neither is it to be bullied into silence or cowered by the volume of voices who propose a disjointed view of reality. Rather, we must steadfastly and lovingly proclaim with conviction the Gospel that each and every person’s body, as created, is made in God’s image and likeness, and therefore possesses an inviolable dignity."

Contact Niraj Warikoo: [email protected] or X @nwarikoo .

Below is a copy of the pastoral letter and FAQ on gender identity issued by Archbishop of Detroit Allen Vigneron on Feb. 26, 2024:

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The Trump camp and the White House clash over Biden’s recognition of ‘Transgender Day of Visibility’

President Joe Biden waves as he arrives Air Force One, Tuesday, March 29, 2024, in Hagerstown, Md. Biden is en route to Camp David.(AP Photo/Alex Brandon)

FILE - Republican presidential candidate former President Donald Trump speaks at a campaign rally March 9, 2024, in Rome Ga. (AP Photo/Mike Stewart, File)

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WASHINGTON (AP) — President Joe Biden is facing criticism from Donald Trump’s campaign and religious conservatives for proclaiming March 31 — which corresponds with Easter Sunday this year — as “Transgender Day of Visibility.”

The Democratic president issued the proclamation on Friday, calling on “all Americans to join us in lifting up the lives and voices of transgender people throughout our Nation and to work toward eliminating violence and discrimination based on gender identity.”

But in 2024, the March 31 designation overlaps with Easter, one of Christianity’s holiest celebrations. Trump’s campaign accused Biden, a Roman Catholic, of being insensitive to religion, and fellow Republicans piled on.

“We call on Joe Biden’s failing campaign and White House to issue an apology to the millions of Catholics and Christians across America who believe tomorrow is for one celebration only — the resurrection of Jesus Christ,” said Karoline Leavitt, the Trump campaign’s press secretary. She assailed what she called the Biden administration’s “years-long assault on the Christian faith.”

House Speaker Mike Johnson, R-La., said on social media that the “Biden White House has betrayed the central tenet of Easter” and called the decision “outrageous and abhorrent.”

White House spokesperson Andrew Bates said the Republicans criticizing Biden “are seeking to divide and weaken our country with cruel, hateful and dishonest rhetoric.”

“As a Christian who celebrates Easter with family, President Biden stands for bringing people together and upholding the dignity and freedoms of every American,” Bates said. “President Biden will never abuse his faith for political purposes or for profit.”

The advocacy group GLAAD said in a statement that people can both celebrate Easter and show their support for the trans community.

“The date of Easter moves each year, while Trans Day of Visibility is always recognized on March 31, but this year right-wing politicians and talking heads are using the coincidental timing to overshadow the hope and joy that Easter represents,” said Sarah Kate Ellis, GLAAD president and CEO.

Biden first issued a proclamation on transgender visibility in 2021 . Proclamations are generally statements about public policy by the president. But this year’s overlap with Easter and the heated tensions from the presidential campaign made the latest transgender proclamation a way for many Republicans to question the Democrat’s religious faith.

Biden devoutly attends Mass and considers his Catholic upbringing to be a core part of his morality and identity. In 2021, he met with Pope Francis at the Vatican and afterward told reporters that the pontiff said he was a “good Catholic” who should keep receiving Communion.

But Biden’s political stances on gay marriage and support for women having the right to abortion have put him at odds with many conservative Christians.