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'{{for|identities defined by to whom one is romantically or sexually attracted|Sexual identity|Sexual orientation}} '''Gender identity''' is the personal sense of one's own [[gender]].<ref name="MorrowMessinger">''Sexual Orientation and Gender Expression in Social Work Practice'', edited by Deana F. Morrow and Lori Messinger (2006, {{ISBN|0231501862}}), page 8: "Gender identity refers to an individual's personal sense of identity as masculine or feminine, or some combination thereof."</ref> Gender identity can correlate with [[assigned sex]] at birth, or can differ from it.<ref>{{cite web|url=http://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions|title=Sexual Orientation and Gender Identity Definitions - Human Rights Campaign|first=Human Rights|last=Campaign|publisher=}}</ref> All societies have a set of gender categories that can serve as the basis of the formation of a person's [[social identity]] in relation to other members of society.<ref>V. M. Moghadam, ''Patriarchy and the politics of gender in modernising societies'', in ''International Sociology'', 1992: "All societies have gender systems."</ref> In most societies, there is a basic division between gender attributes assigned to males and females,<ref name="Carlson">{{citation| last1= Carlson| first1= Neil R.| last2= Heth| first2= C. Donald| contribution= Sensation| editor-last1= Carlson| editor-first1= Neil R. |editor-last2= Heth |editor-first2= C. Donald| title= Psychology: the science of behaviour| pages= 140–141| publisher= Pearson| location= Toronto, Canada| year= 2009| isbn= 9780205645244| edition= 4th |ref= harv| postscript=.}}</ref> a [[gender binary]] to which most people adhere and which includes expectations of [[masculinity]] and [[femininity]] in all aspects of [[sex and gender]]: biological [[sex]], gender identity, and [[gender expression]].<ref>Jack David Eller, ''Culture and Diversity in the United States'' (2015, {{ISBN|1317575784}}), page 137: "most Western societies, including the United States, traditionally operate with a binary notion of sex/gender"</ref> Some people do not identify with some, or all, of the aspects of gender assigned to their biological sex;<ref>For example, "transvestites [who do not identify with the dress assigned to their sex] existed in almost all societies." (G. O. MacKenzie, ''Transgender Nation'' (1994, {{ISBN|0879725966}}), page 43.) — "There are records of males and females crossing over throughout history and in virtually every culture. It is simply a naturally occurring part of all societies." (Charles Zastrow, ''Introduction to Social Work and Social Welfare: Empowering People'' (2013, {{ISBN|128554580X}}), page 234, quoting the North Alabama Gender Center.)</ref> some of those people are [[transgender]], [[Genderqueer|genderqueer or non-binary]]. There are some societies that have [[third gender]] categories. Core gender identity is usually formed by age three.<ref name="Kalbfleisch and Cody">{{cite book|title=Gender, power, and communication in human relationships|publisher=Psychology Press|year=1995|pages=366 pages|accessdate=June 3, 2011|url=https://books.google.com/books?id=LyMo1RUJwj0C&lpg=PR1&dq=Gender%2C%20power%2C%20and%20communication%20in%20human%20relationships&pg=PR1#v=onepage&q=Gender,%20power,%20and%20communication%20in%20human%20relationships&f=false|isbn=0805814043|author1=Pamela J. Kalbfleisch |author2=Michael J. Cody }}</ref><ref name="Gallagher">{{cite book|title =Gender differences in mathematics: An integrative psychological approach|isbn =0-521-82605-5|publisher=[[Cambridge University Press]]|year=2005|page=|author1=Ann M. Gallagher |author2=James C. Kaufman }}</ref> After age three, it is extremely difficult to change,<ref name="Kalbfleisch and Cody"/> and attempts to reassign it can result in [[gender dysphoria]].<ref name="Boles101102"/> Both biological and social factors have been suggested to influence its formation. ==Age of formation== There are several theories about how and when gender identity forms, and studying the subject is difficult because children's [[Language acquisition|lack of language]] requires researchers to make assumptions from indirect evidence.<ref name="Boles101102">Boles, 2013. Pages 101-102.</ref> John Money suggested children might have awareness of, and attach some significance to gender, as early as 18 months to two years; Lawrence Kohlberg argues that gender identity does not form until age three.<ref name="Boles101102"/> It is widely agreed that core gender identity is firmly formed by age three.<ref name="Kalbfleisch and Cody"/><ref name="Gallagher"/><ref name="Boles101102"/><ref>A few authorities say it forms between ages 3-4 rather than precisely at age 3, e.g. George J. Bryjak and Michael P. Soraka, ''Sociology: Cultural Diversity in a Changing World'' (ed. Karen Hanson), Allyn & Bacon, 1997; 209-245</ref> At this point, children can make firm statements about their gender<ref name="Boles101102"/><ref name="Newmann"/> and tend to choose activities and toys which are considered appropriate for their gender<ref name="Boles101102"/> (such as dolls and painting for girls, and tools and rough-housing for boys),<ref>Christopher Bates Doob, ''Social Inequality and Social Stratification in US Society''</ref> although they do not yet fully understand the implications of gender.<ref name="Newmann"/> After age three, core gender identity is extremely difficult to change,<ref name="Kalbfleisch and Cody"/><ref name="Kleeman"/> and attempts to reassign it can result in [[gender dysphoria]].<ref name="Boles101102"/><ref>E. Coleman, ''Developmental stages of the coming out process'', in ''Journal of homosexuality'', 1982: "Core gender and sex-role identities are well-formed by the age of 3 (Money & Ehrhardt, 1972). This is believed because attempts to reassign gender identity after age 3 result in further gender dysphoria."</ref> Gender identity refinement extends into the fourth<ref name="Kleeman">J. A. Kleeman, ''The establishment of core gender identity in normal girls. I.(a) Introduction;(b) Development of the ego capacity to differentiate'', in the ''Archives of Sexual Behavior'', 1971: "Though gender identity formation continues into young adulthood and core gender identity establishment extends into the fourth year and possibly longer, core gender identity is fairly firmly formed by age 3[.]"</ref> to sixth years of age,<ref name="Boles101102"/><ref>Stein MT, Zucker KJ, Dixon SD. December, 1997. "Gender Identity", ''The Nurse Practitioner''. Vo. 22, No. 12, P. 104</ref> and continues into young adulthood.<ref name="Kleeman"/> Martin and Ruble conceptualize this process of development as three stages: (1) as toddlers and preschoolers, children learn about defined characteristics, which are socialized aspects of gender; (2) around the ages of 5–7 years, identity is consolidated and becomes rigid; (3) after this "peak of rigidity," fluidity returns and socially defined gender roles relax somewhat.<ref>{{cite journal | last1 = Martin | first1 = C. | last2 = Ruble | first2 = D. | year = 2004 | title = Children's Search for Gender Cues Cognitive Perspectives on Gender Development | url = | journal = Current Directions in Psychological Science | volume = 13| issue = 2|pages = 67–70 | doi = 10.1111/j.0963-7214.2004.00276.x }}</ref> Barbara Newmann breaks it down into four parts: (1) understanding the concept of gender, (2) learning [[gender role]] standards and stereotypes, (3) identifying with parents, and (4) forming gender preference.<ref name="Newmann">{{cite book|last=Newmann|first=Barbara|title=Development Through Life: A Psychosocial Approach|publisher=Cengage Learning|isbn=9781111344665|page=243|url=https://books.google.com/books?id=oTY_7osGmqUC|date=2012-12-20}}</ref> According to UN agencies, discussions relating to comprehensive sexuality education raise awareness of topics, such as gender and gender identity. <ref>{{Cite book|url=http://unesdoc.unesco.org/images/0026/002607/260770e.pdf|title=International technical guidance on sexuality education: An evidence-informed approach|last=|first=|publisher=UNESCO|year=2018|isbn=978-92-3-100259-5|location=Paris|pages=18}}</ref> ==Factors influencing formation== ===Nature vs. nurture=== {{Main article|Nature versus nurture}} Although the formation of gender identity is not completely understood, many factors have been suggested as influencing its development. In particular, the extent to which it is determined by socialization (environmental factors) versus innate (biological) factors is an ongoing debate in psychology, known as "nature versus nurture". Both factors are thought to play a role. Biological factors that influence gender identity include pre- and post-natal hormone levels.<ref name="ZhongNan">''Effects of male sex hormones on gender identity, sexual behavior, and cognitive function'', ''Zhong Nan Da Xue Xue Bao, Yi Xue Ban'' (''Journal of Central South University, Medical Sciences''), April 2006, 31(2):149-61</ref> While genetic makeup also influences gender identity,<ref>{{Cite journal | last1 = Money | first1 = John | authorlink = John Money | year = 1994 | title = The concept of gender identity disorder in childhood and adolescence after 39 years | url = | journal = Journal of Sex and Marital Therapy | volume = 20 | issue = 3| pages = 163–77 | pmid = 7996589 | doi = 10.1080/00926239408403428 }}</ref> it does not inflexibly determine it.<ref>Susan Golombok, Robyn Fivush, ''Gender Development'' (1994, {{ISBN|0521408628}}), page 44: "When assigned and raised as boys, these genetic girls adopt a male gender identity and role, showing that a Y chromosome is not necessary for gender development to proceed in a male direction."</ref> Social factors which may influence gender identity include ideas regarding gender roles conveyed by family, authority figures, mass media, and other influential people in a child's life.<ref name="Henslin">{{cite book|title=Essentials of Sociology|first=James M.|last=Henslin|publisher=Taylor & Francis|year=2001|pages=65–67, 240|isbn=0-536-94185-8}}</ref> When children are raised by individuals who adhere to stringent gender roles, they are more likely to behave in the same way, matching their gender identity with the corresponding stereotypical gender patterns.<ref>{{cite web|url=https://www.mentalhelp.net/articles/factors-influencing-gender-identity/|title=Factors Influencing Gender Identity|publisher=}}</ref> Language also plays a role: children, while learning a language, learn to separate masculine and feminine characteristics and subconsciously adjust their own behavior to these predetermined roles.<ref>Williams, Michael, "Cultural Identity, Language Identity, Gender Identity", "The English Academy of South Africa", 2011</ref> The [[social learning theory]] posits that children furthermore develop their gender identity through observing and imitating gender-linked behaviors, and then being rewarded or punished for behaving that way,<ref name=myers>Myers, David G. (2008). ''Psychology''. New York: Worth.</ref> thus being shaped by the people surrounding them through trying to imitate and follow them.<ref>{{cite journal | last1 = Martin | first1 = C. L. | last2 = Ruble | first2 = D. N. | last3 = Szkrybalo | first3 = J. | year = 2002 | title = Cognitive theories of early gender development | url = | journal = Psychological Bulletin | volume = 128 | issue = 6| pages = 903–906 | doi = 10.1037/0033-2909.128.6.903 | pmid=12405137}}</ref> A well-known example in the nature versus nurture debate is the case of [[David Reimer]], otherwise known as "John/Joan". As a baby, Reimer went through a faulty circumcision, losing his male genitalia. Psychologist John Money convinced Reimer’s parents to raise him as a girl. Reimer grew up as a girl, dressing in girl clothes and surrounded by girl toys, but did not feel like a girl. After he tried to commit suicide at age 13, he was told that he had been born with male genitalia, which he underwent surgery to reconstruct.<ref>{{cite book|last1=Nolen-Hoeksema|title=Abnormal Psychology|date=2014|publisher=McGraw-Hill|isbn=9781308211503|pages=368|edition=6}}<!--|accessdate=5 December 2014--></ref> This went against Money’s hypothesis that biology had nothing to do with gender identity or human sexual orientation.<ref>{{cite journal|last=Martin|first=Carol |author2=Diane Ruble |author3=Joel Szkrybalo |title=Cognitive Theories of Early Gender Development |journal=Psychological Bulletin|year=2002 |volume=128|issue=6 |pages=903–913|doi= 10.1037/0033-2909.128.6.903 |pmid=12405137}}</ref> ===Biological factors=== Several prenatal, biological factors, including genes and hormones, may affect gender identity.<ref name="ZhongNan"/><ref name="Ghosh">{{cite web|last=Ghosh|first=Shuvo|title=Gender Identity|url=http://emedicine.medscape.com/article/917990-overview|publisher=MedScape|accessdate=October 29, 2012}}</ref> The biochemical theory of gender identity suggests that people acquire gender identities through such factors rather than socialization. Hormonal influences are also complex; [[Sexual differentiation in humans|sex-determining hormones]] are produced at an early stage of foetal development,<ref>Lynda Birke, ''In Pursuit Of Difference, scientific studies of women and men'', in ''The Gender and Science Reader'', page 310</ref> and if prenatal hormone levels are altered, phenotype progression may be altered as well, and the natural predisposition of the brain toward one sex may not match the genetic make-up of the fetus or its external sexual organs.{{citation needed|date=November 2015}}<ref>{{Cite journal|last=Hines|first=Melissa|date=2017-02-02|title=Prenatal endocrine influences on sexual orientation and on sexually differentiated childhood behavior|journal=Frontiers in Neuroendocrinology|volume=32|issue=2|pages=170–182|doi=10.1016/j.yfrne.2011.02.006|issn=0091-3022| pmc=3296090 |pmid=21333673}}</ref> Hormones may affect differences between males' and females' verbal and spatial abilities, memory, and aggression; prenatal hormone exposure affects how the hypothalamus regulates hormone secretion later in life, with "women's sex hormones usually follow[ing] a monthly cycle [while] men’s sex hormones do not follow such a pattern."<ref>Lynda Birke suggests that during the early stage of fetal development, specific hormones will enter the brain and “permanently affect how the hypothalamus works. As before, high levels of hormones known as androgens will stop the hypothalamus from ever organizing hormone cycles. If there are low levels, then it will be cyclic.” This early influence on brain determines the different frequency of hormone secretion later in male or female’s life. “Obviously, women’s sex hormones usually follow a monthly cycle,” while “men’s sex hormones do not follow such a pattern.” {{cite book|last=Birke|first=Lynda|title=The Gender and Science Reader|pages=313}}</ref> ====Intersex people==== {{main article|Intersex}} A survey of the research literature from 1955–2000 suggests that more than one in every hundred individuals may have some [[intersex]] characteristic.<ref>{{Cite journal| doi = 10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F| issn = 1520-6300| volume = 12| issue = 2| pages = 151–166| last1 = Blackless| first1 = Melanie| last2 = Charuvastra| first2 = Anthony| last3 = Derryck| first3 = Amanda| last4 = Fausto-Sterling| first4 = Anne| last5 = Lauzanne| first5 = Karl| last6 = Lee| first6 = Ellen| title = How sexually dimorphic are we? Review and synthesis| journal = American Journal of Human Biology| date = March 2000| url = http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1520-6300(200003/04)12:2%3C151::AID-AJHB1%3E3.0.CO;2-F/abstract| pmid = 11534012}}</ref> An intersex human or other animal is one possessing any of several variations in [[sex]] characteristics including [[chromosome]]s, [[gonad]]s, [[sex hormones]], or [[genital]]s that, according to the UN [[Office of the High Commissioner for Human Rights]], "do not fit typical binary notions of [[male]] or [[female]] bodies".<ref name="unfe-fact">{{Cite web| author=<!--Staff writer(s); no by-line.--> | publisher = United Nations [[Office of the High Commissioner for Human Rights]] | title = Free & Equal Campaign Fact Sheet: Intersex| date = 2015| url = https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf | access-date = 28 March 2016 }}</ref> An intersex variation may complicate initial [[sex assignment]]<ref name="Mieszczak2009">{{cite journal | last1 = Mieszczak | first1 = J | last2 =Houk | first2 = CP | last3 = Lee | first3 = PA | title = Assignment of the sex of rearing in the neonate with a disorder of sex development | journal = Curr Opin Pediatr | date = Aug 2009 | volume = 21 | issue = 4 | pages = 541–7 | pmid = 19444113 | doi=10.1097/mop.0b013e32832c6d2c| pmc = 4104182 }}</ref> and that assignment may not be consistent with the child's future gender identity.<ref name="coe">{{Citation| last1 = [[Council of Europe]]| last2 = Commissioner for Human Rights| title = Human rights and intersex people, Issue Paper| date = April 2015| url = https://wcd.coe.int/ViewDoc.jsp?Ref=CommDH/IssuePaper(2015)1&Language=lanEnglish&Ver=original}}</ref> Reinforcing sex assignments through surgical and hormonal means may violate the individual's [[Intersex human rights|rights]].<ref name="swissnek">{{Cite book| last = Swiss National Advisory Commission on Biomedical Ethics NEK-CNE| title = On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012| location = Berne| series = 2012| date = November 2012| url = http://www.nek-cne.ch/fileadmin/nek-cne-dateien/Themen/Stellungnahmen/en/NEK_Intersexualitaet_En.pdf}}</ref><ref name="who2015">{{Cite book| publisher = World Health Organization| isbn = 9789241564984| last = [[World Health Organization]]| title = Sexual health, human rights and the law| location = Geneva| date = 2015}}</ref> A 2005 study on the gender identity outcomes of female-raised 46,XY persons with [[penile agenesis]], [[cloacal exstrophy]] of the bladder, or penile [[ablation]], found that 78% of the study subjects were living as female, as opposed to 22% who decided to initiate a sex change to male in line with their genetic sex.<ref>{{cite journal |journal=Archives of Sexual Behavior |pmid=16010465 |doi=10.1007/s10508-005-4342-9 |title=Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. |last=Meyer-Bahlburg |first=HF }}</ref> The study concludes: "The findings clearly indicate an increased risk of later patient-initiated gender re-assignment to male after female assignment in infancy or early childhood, but are nevertheless incompatible with the notion of a full determination of core gender identity by prenatal androgens." A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced [[gender dysphoria]].<ref name="furtado">{{cite journal | author = Furtado P. S.| year = 2012 | title = Gender dysphoria associated with disorders of sex development | url = | journal = Nat. Rev. Urol. | volume = 9 | issue = 11| pages = 620–627 | doi = 10.1038/nrurol.2012.182 | pmid = 23045263 |display-authors=etal}}</ref> Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure. At birth, 52% of persons in the study were assigned female, and 41% were assigned male.<ref name="oiijones">{{cite web|url= https://oii.org.au/30313/intersex-stories-statistics-australia/ | title = New publication "Intersex: Stories and Statistics from Australia" | work = [[Organisation Intersex International Australia]] | date = February 3, 2016 | accessdate = 2016-08-18}}</ref><ref name="jones2016">{{Cite book|publisher=Open Book Publishers |isbn=978-1-78374-208-0 |last1=Jones |first1=Tiffany |last2=Hart |first2=Bonnie |last3=Carpenter |first3=Morgan |last4=Ansara |first4=Gavi |last5=Leonard |first5=William |last6=Lucke |first6=Jayne |title=Intersex: Stories and Statistics from Australia |location=Cambridge, UK |date=2016 |accessdate=2 February 2016 |url=http://oii.org.au/wp-content/uploads/key/Intersex-Stories-Statistics-Australia.pdf |deadurl=yes |archiveurl=https://web.archive.org/web/20160914152729/http://oii.org.au/wp-content/uploads/key/Intersex-Stories-Statistics-Australia.pdf |archivedate=14 September 2016 |df= }}</ref> A study by Reiner & Gearhart provides some insight into what can happen when genetically male children with [[cloacal exstrophy]] are sexually assigned female and raised as girls,<ref name="Rosario" /> according to an 'optimal gender policy' developed by [[John Money]]:<ref name="swissnek" /> in a sample of 14 children, follow-up between the ages of 5 to 12 showed that 8 of them identified as boys, and all of the subjects had at least moderately male-typical attitudes and interests,<ref name="Rosario">{{cite web| url=http://www.isna.org/node/564|title=Reiner & Gearhart's NEJM Study on Cloacal Exstrophy – Review by Vernon Rosario, M.D., Ph.D.|work=[[Intersex Society of North America]]|last=Rosario|first=Vernon|authorlink=Vernon Rosario}}</ref> providing support for the argument that genetic variables affect gender identity and behavior independent of socialization. ====Biological causes of transgender and transsexuality==== {{See also|Causes of transsexualism}} Some studies have investigated whether or not there is a link between biological variables and [[transgender]] or [[transsexual]] identity.<ref>E. Vilain, Genetics of intersexuality, J. Gay Lesbian Psychother. 10 (2006) 9–26.</ref><ref>A. Fleming, E. Vilain, The endless quest for sex determination genes, Clin.Genet. 67 (2005) 15–25.</ref><ref>{{cite journal | last1 = Savic | first1 = I. | last2 = Arver | first2 = S. | year = 2011 | title = Sex dimorphism of the brain in male-to-female transsexuals | url = | journal = Cerebral Cortex | volume = 21| issue = 11| pages = 2525–2533| doi = 10.1093/cercor/bhr032 }} Concluded that gynephilic trans women had brains like men's, but in a few areas, trans women's brains were different from both men's and women's brains.</ref> Several studies have shown that sexually dimorphic brain structures in transsexuals are shifted away from what is associated with their birth sex and towards what is associated with their preferred sex.<ref>{{cite journal | last1 = Gizewski | first1 = E. R. | last2 = Krause | first2 = E. | last3 = Schlamann | first3 = M. | last4 = Happich | first4 = F. | last5 = Ladd | first5 = M. E. | last6 = Forsting | first6 = M. | last7 = Senf | first7 = W. | year = 2009 | title = Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: An fMRI study | url = | journal = Journal of Sexual Medicine | volume = 6 | issue = 2| pages = 440–448 | doi=10.1111/j.1743-6109.2008.00981.x}} Found that a sample of androphilic trans women was shifted towards the female direction in brain responses.</ref><ref>{{cite journal | last1 = Rametti | first1 = G. | last2 = Carrillo | first2 = B. | last3 = Gómez-Gil | first3 = E. | last4 = Junque | first4 = C. | last5 = Zubiarre-Elorza | first5 = L. | last6 = Segovia | first6 = S. | last7 = Gomez | first7 = Á | last8 = Guillamon | first8 = A. | year = 2011 | title = White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study | journal = Journal of Psychiatric Research | volume = 45 | issue = 2| pages = 199–204 | doi = 10.1016/j.jpsychires.2010.05.006 | pmid=20562024}} Found that the white matter pattern in gynephilic trans men was shifted in the direction of biological males even before the female-to-male transsexuals started taking male hormones.</ref> In particular, the [[stria terminalis#Bed nucleus of the stria terminalis|bed nucleus of a stria terminalis]] or BSTc (a constituent of the basal ganglia of the brain which is affected by prenatal androgens) of trans women is similar to [[cisgender]] women's and unlike men's.<ref>Psychology The Science Of Behaviour, pg 418, Pearson Education, Neil R.Carlson</ref><ref>{{cite journal | last1 = Zhou | first1 = J.N. | last2 = Hofman | first2 = M.A. | last3 = Gooren | first3 = L.J. | last4 = Swaab | first4 = D.F. | year = 1995 | title = A sex difference in the human brain and its relation to transsexuality | url = | journal = Nature | volume = 378 | issue = 6552| pages = 68–70 | doi=10.1038/378068a0 | pmid=7477289}}</ref> Similar [[Biology and sexual orientation#Studies of brain structure|brain structure differences]] have been noted between gay and heterosexual men, and between lesbian and heterosexual women.<ref name="LeVay 1991">{{Cite journal|author=LeVay S |title=A difference in hypothalamic structure between heterosexual and homosexual men |journal=Science |volume=253 |issue=5023 |pages=1034–7 |date=August 1991 |pmid=1887219 |doi=10.1126/science.1887219 }}</ref><ref name="Byne 2001">{{Cite journal |vauthors=Byne W, Tobet S, Mattiace LA, etal |title=The interstitial nuclei of the human anterior hypothalamus: an investigation of variation with sex, sexual orientation, and HIV status |journal=Horm Behav |volume=40 |issue=2 |pages=86–92 |date=September 2001 |pmid=11534967 |doi=10.1006/hbeh.2001.1680 |url=}}</ref> Another study suggests that transsexuality may have a genetic component.<ref>[http://news.bbc.co.uk/1/hi/health/7689007.stm Male transsexual gene link found] ''[[BBC News]]'' 26 October 2008 (accessed 26 October 2008)</ref> Research suggests that the same hormones that promote differentiation of sex organs in utero also elicit puberty and influence the development of gender identity. Different amounts of these male or female sex hormones within a person can result in behavior and external genitalia that do not match up with the norm of their sex assigned at birth, and in a person acting and looking like their identified gender.<ref name="Oswalt">{{cite web|last=Oswalt |first=Angela |title=Factors Influencing Gender Identity |url=http://www.sevencounties.org/poc/view_doc.php?type=doc&id=37697&cn=1272 |archive-url=https://archive.is/20130415234240/http://www.sevencounties.org/poc/view_doc.php?type=doc&id=37697&cn=1272 |dead-url=yes |archive-date=April 15, 2013 |publisher=Seven Countries Services, Inc. |accessdate=October 29, 2012 }}</ref> ===Social and environmental factors=== {{Refimprove section|date=October 2010}} In 1955, John Money proposed that gender identity was malleable and determined by whether a child was raised as male or female in early childhood.<ref>J. Money, J. G. Hampson, and J. L. Hampson, ''An examination of some basic sexual concepts'', 1955</ref><ref name="GDDSD">A. L. C. de Vries, et al., ''Gender Dysphoria and Disorders of Sex Development'' (2013, {{ISBN|1461474418}})</ref> Money's hypothesis has since been discredited,<ref name="GDDSD"/><ref>Anne Fausto-Sterling, ''Sexing the Body: Gender Politics and the Construct''</ref> but scholars have continued to study the effect of social factors on gender identity formation.<ref name="GDDSD"/> In the 1960s and 1970s, factors such as the absence of a father, a mother's wish for a daughter, or parental reinforcement patterns were suggested as influences; more recent theories suggesting that parental psychopathology might partly influence gender identity formation have received only minimal empirical evidence,<ref name="GDDSD"/> with a 2004 article noting that "solid evidence for the importance of postnatal social factors is lacking."<ref>D. F. Swaab, ''Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation'', in ''Gynecological Endocrinology'', 2004: "...direct effects of testosterone on the developing fetal brain are of major importance for the development of male gender identity and male heterosexual orientation. Solid evidence for the importance of postnatal social factors is lacking."</ref> A 2008 study found that the parents of gender-dysphoric children showed no signs of psychopathological issues aside from mild depression in the mothers.<ref name="GDDSD"/><ref>M. S. C. Wallien, ''Psychosexual outcome of gender-dysphoric children'' (2008)</ref> It has been suggested that the attitudes of the child's parents may affect the child's gender identity, although evidence is minimal.<ref>M Weinraub, LP Clemens, A Sockloff, T Ethridge, ''The development of sex role stereotypes in the third year: relationships to gender labeling, gender identity, sex-types toy preference, and family characteristics'', in ''Child Development'', 1984: "Previous investigators have failed to observe a relationship between parental attitudes and children's early sex role acquisition..."</ref> ====Parental establishment of gender roles==== Parents who do not support gender nonconformity are more likely to have children with firmer and stricter views on gender identity and gender roles.<ref name="Oswalt"/> Recent literature suggests a trend towards less well-defined gender roles and identities, as studies of parental coding of toys as masculine, feminine, or neutral indicate that parents increasingly code kitchens and in some cases dolls as neutral rather than exclusively feminine.<ref name=Kane>{{cite book|last=Spade|first =Joan|title=The Kaleidoscope of Gender|publisher=SAGE|location=London|isbn=978-1-4129-7906-1|pages= 177–184}}</ref> However, Emily Kane found that many parents still showed negative responses to items, activities, or attributes that were considered feminine, such as domestic skills, nurturance, and empathy.<ref name=Kane /> Research has indicated that many parents attempt to define gender for their sons in a manner that distances the sons from femininity,<ref name=Kane /> with Kane stating that “the parental boundary maintenance work evident for sons represents a crucial obstacle limiting boys options, separating boys from girls, devaluing activities marked as feminine for both boys and girls, and thus bolstering gender inequality and heteronormativity.”<ref name=Kane /> Many parents form gendered expectations for their child before it is even born, after determining the child's sex through technology such as [[ultrasound]]. The child thus arrives to a gender-specific name, games, and even ambitions.<ref name="Ghosh"/> Once the child's sex is determined, most children are raised in accordance with it to be a man or a woman, fitting a male or female gender role defined partly by the parents. When considering the parents' social class, lower-class families typically hold traditional gender roles, where the father works and the mother, who may only work out of financial necessity, still takes care of the household. However, middle-class "professional" couples typically negotiate the division of labor and hold an egalitarian ideology. These different views on gender from a child's parents can shape the child's understanding of gender as well as the child's development of gender.<ref name="Halpern" /> Within a study conducted by Hillary Halpern<ref name="Halpern">{{Cite journal|last=Halpern|first=Hillary Paul|title=Parents' Gender Ideology and Gendered Behavior as Predictors of Children's Gender-Role Attitudes: A Longitudinal Exploration|journal=Sex Roles|volume=74|issue=11–12|pages=527|doi=10.1007/s11199-015-0539-0|year=2015}}</ref> it was hypothesized, and proven, that parent behaviors, rather than parent beliefs, regarding gender are better predictors for a child’s attitude on gender. It was concluded that a mother’s behavior was especially influential on a child’s assumptions of the child’s own gender. For example, mothers who practiced more traditional behaviors around their children resulted in the son displaying fewer stereotypes of male roles while the daughter displayed more stereotypes of female roles. No correlation was found between a father’s behavior and his children’s knowledge of stereotypes of their own gender. It was concluded, however, that fathers who held the belief of equality between the sexes had children, especially sons, who displayed fewer preconceptions of their opposite gender. ==Gender variance and non-conformance== {{Main article|Gender variance|Transgender|Transsexual|Genderqueer}} {{See also|Cisgender}} Gender identity can lead to security issues among individuals that do not fit on a binary scale.<ref>{{Cite journal|last=Hoogensen|first=Gunhild|last2=Rottem|first2=Svein Vigeland|date=2016-06-29|title=Gender Identity and the Subject of Security|url=http://journals.sagepub.com/doi/abs/10.1177/0967010604044974|journal=Security Dialogue|language=en|volume=35|issue=2|pages=155–171|doi=10.1177/0967010604044974}}</ref> In some cases, a person's gender identity is inconsistent with their biological sex characteristics (genitals and [[secondary sex characteristics]]), resulting in individuals dressing and/or behaving in a way which is perceived by others as outside cultural gender norms. These gender expressions may be described as [[gender variant]], transgender, or [[genderqueer]]<ref>{{Cite journal |doi=10.1300/J485v09n01_04 |last=Blackless |first=Melanie |author2=Besser, M. |author3=Carr, S. |author4=Cohen-Kettenis, P.T. |author5=Connolly, P. |author6=De Sutter, P. |author7=Diamond, M. |author8=Di Ceglie, D. |author9=Higashi, Y. |author10=Jones, L. |author11=Kruijver. F.P.M. |author12=Martin, J. |author13=Playdon, Z-J. |author14=Ralph, D. |author15=Reed, T. |author16=Reid, R. |author17=Reiner, W.G. |author18=Swaab, D. |author19=Terry, T. |author20=Wilson, P. |author21=Wylie, K. |year=2003 |title=Atypical Gender Development – A Review |journal=International Journal of Transgenderism |volume=9 |pages=29–44 |url=http://www.gires.org.uk/genderdev.php |accessdate=2008-09-28 |deadurl=yes |archiveurl=https://web.archive.org/web/20081007055838/http://www.gires.org.uk/genderdev.php |archivedate=2008-10-07 |df= }}</ref> (there is an emerging vocabulary for those who defy traditional gender identity),<ref>{{cite web|url=https://www.bbc.co.uk/news/world-us-canada-13581835|title=Toronto couple defend move to keep baby's sex secret|date=27 May 2011|publisher=|via=www.bbc.co.uk}}</ref> and people who have such expressions may experience [[#Gender dysphoria and gender identity disorder|gender dysphoria]] (traditionally called Gender Identity Disorder or GID). Transgender individuals are greatly affected by language and gender pronouns before, during, and after their transition.<ref>{{cite web|url=http://www.insightintodiversity.com/words-matter-affirming-gender-identity-through-language/|title=Words Matter: Affirming Gender Identity Through Language|date=18 May 2016|publisher=}}</ref> In recent decades it has become possible to [[sex reassignment surgery|reassign sex surgically]]. Some people who experience gender dysphoria seek such medical intervention to have their physiological sex match their gender identity; others retain the genitalia they were born with (see [[transsexual]] for some of the possible reasons) but adopt a gender role that is consistent with their gender identity. ==History and definitions== ===Definitions=== The terms ''gender identity'' and ''core gender identity'' were first used with their current meaning — one's personal experience of one's own gender<ref name="MorrowMessinger"/><ref name="Boles101">Boles, 2013. Page 101: "Gender identity is the individual's personal and private experience of his/her gender."</ref> — sometime in the 1960s.<ref name=GID>"The term 'gender identity' was used in a press release, November 21, 1966, to announce the new clinic for transsexuals at The Johns Hopkins Hospital. It was disseminated in the media worldwide, and soon entered the vernacular. ... gender identity is your own sense or conviction of maleness or femaleness." {{Cite journal | last1 = Money | first1 = John | authorlink = John Money | year = 1994 | title = 'The concept of gender identity disorder in childhood and adolescence after 39 years' | url = | journal = Journal of Sex and Marital Therapy | volume = 20 | issue = 3| pages = 163–77 | pmid = 7996589 | doi = 10.1080/00926239408403428 }}</ref><ref>''Handbook of the Psychology of Women and Gender'' (2004, {{ISBN|0471653578}}), page 102: "''Gender identity'' was introduced into the professional lexicon by Hooker and Stoller almost simultaneously in the early 1960s (see Money, 1985). For example, Stoller (1964) used the slightly different term ''core gender identity''..."</ref> To this day they are usually used in that sense,<ref name="Carlson"/> though a few scholars additionally use the term to refer to the [[sexual orientation]] and [[sexual identity]] categories ''[[gay]]'', ''[[lesbian]]'' and ''[[Bisexuality|bisexual]]''.<ref>Brym, Roberts, Lie, Rytina. "Sociology". Nelson Education Ltd., 2013.</ref> ===Early medical literature=== In late-19th-century medical literature, women who chose not to conform to their expected gender roles were called "inverts", and they were portrayed as having an interest in knowledge and learning, and a "dislike and sometimes incapacity for needlework". During the mid 1900s, doctors pushed for corrective therapy on such women and children, which meant that gender behaviors that were not part of the norm would be punished and changed. The aim of this therapy was to push children back to their "correct" gender roles and thereby limit the number of children who became transgender.<ref name = Padawer>{{cite news|last=Padawer|first=Ruth|title=What's So Bad About a Boy Who Wants to Wear a Dress?| url = https://www.nytimes.com/2012/08/12/magazine/whats-so-bad-about-a-boy-who-wants-to-wear-a-dress.html?pagewanted=all | accessdate = October 29, 2012|work =[[The New York Times]] }}</ref> ===Freud and Jung's views=== In 1905, [[Sigmund Freud]] presented his theory of [[psychosexual development]] in ''[[Three Essays on the Theory of Sexuality]]'', giving evidence that in the pregenital phase children do not distinguish between sexes, but assume both parents have the same genitalia and reproductive powers. On this basis, he argued that bisexuality was the original sexual orientation and that heterosexuality was resultant of repression during the [[phallic stage]], at which point gender identity became ascertainable. According to Freud, during this stage, children developed an [[Oedipus complex]] where they had sexual fantasies for the parent ascribed the opposite gender and hatred for the parent ascribed the same gender, and this hatred transformed into (unconscious) transference and (conscious) identification with the hated parent who both exemplified a model to appease sexual impulses and threatened to castrate the child's power to appease sexual impulses.<ref name=myers/> In 1913, [[Carl Jung]] proposed the [[Electra complex]] as he both believed that bisexuality did not lie at the origin of psychic life, and that Freud did not give adequate description to the female child (Freud rejected this suggestion).<ref>{{cite journal | last1 = Freud | first1 = Sigmund | year = 1931 | title = Female Sexuality | url = | journal = The Standard Edition of the Complete Psychological Works of Sigmund Freud | volume = 21 | issue = | page = 229 }}</ref> ===1950s and 1960s=== During the 1950s and '60s, psychologists began studying gender development in young children, partially in an effort to understand the origins of [[homosexuality]] (which was viewed as a [[mental disorder]] at the time). In 1958, the Gender Identity Research Project was established at the [[UCLA Medical Center]] for the study of [[intersex]] and transsexual individuals. Psychoanalyst [[Robert Stoller]] generalized many of the findings of the project in his book ''Sex and Gender: On the Development of Masculinity and Femininity'' (1968). He is also credited with introducing the term ''gender identity'' to the International Psychoanalytic Congress in [[Stockholm, Sweden]] in 1963. Behavioral psychologist [[John Money]] was also instrumental in the development of early theories of gender identity. His work at [[Johns Hopkins University|Johns Hopkins Medical School]]'s Gender Identity Clinic (established in 1965) popularized an [[interactionist]] theory of gender identity, suggesting that, up to a certain age, gender identity is relatively fluid and subject to constant negotiation. His book ''Man and Woman, Boy and Girl'' (1972) became widely used as a [[college textbook]], although many of Money's ideas have since been challenged.<ref>{{cite book |last=Haraway |first=Donna |authorlink=Donna Haraway |year=1991 |title=Simians, Cyborgs, and Women: The Reinvention of Nature |page=133 |publisher=[[Free Association Books]] |location=London |isbn=0-415-90386-6}}</ref><ref>[[Fixing Sex|Fixing Sex: Intersex, Medical Authority, and Lived Experience]] by Katrina Karkazis, Duke University Press, November 2008</ref> ===Butler's views=== In the late 1980s, [[Judith Butler]] began lecturing regularly on the topic of gender identity, and in 1990, she published ''[[Gender Trouble|Gender Trouble: Feminism and the Subversion of Identity]]'', introducing the concept of [[gender performativity]] and arguing that both sex and gender are constructed.<ref>{{cite book |last=Butler |first=Judith |authorlink=Judith Butler |year=1990 |title=Gender Trouble: Feminism and the Subversion of Identity |pages=front/backmatter |publisher=[[Routledge Classic]] |location=London |isbn=0415389550}}</ref> ==Present views== {{Refimprove section|date=November 2015}}<!--also needs expansion--> ===Medical field=== {{as of|2018}}, there is some changing of views and new discrepancies about the best way to deal with gender nonconformity. Medical practitioners, as well as an increasing number of parents, generally no longer support or believe in the idea of [[conversion therapy]], <ref name="nymag-7feb2016">{{cite magazine|last1=Singal|first1=Jesse|title=How the Fight Over Transgender Kids Got a Leading Sex Researcher Fired|url=http://nymag.com/scienceofus/2016/02/fight-over-trans-kids-got-a-researcher-fired.html|accessdate=April 25, 2017|magazine=[[New York (magazine)|New York]]|date=February 7, 2016}}</ref> which is now widely discredited as unethical and ineffective.<ref name="The Guardian - prayer and pain">{{cite news |author1=Tom Dart |title=Prayer and pain: why gay conversion therapy is still legal despite dangers |url=https://www.theguardian.com/world/2016/jul/15/gay-conversion-therapy-republican-party-platform |accessdate=9 July 2018 |work=The Guardian |publisher=Guardian Media Group |date=July 15, 2016 |ref=Prayer_and_pain |language=English}}</ref> <ref name="Stonewall - Conversion Therapy">{{cite web |title=Conversion Therapy |url=https://www.stonewall.org.uk/campaign-groups/conversion-therapy |website=Stonewall |publisher=Stonewall |accessdate=9 July 2018 |ref=stonewall_conversion}}</ref> In the UK, all major counselling and psychotherapy bodies, as well as the [[NHS]], have concluded that conversion therapy to 'cure' sexual orientation is dangerous and work is being done to extend this position to include gender identity.<ref name="MOU - Conversion Therapy">{{cite web |title=Memorandum of Understanding on Conversion Therapy in the UK |url=https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdf |website=www.pyschotherapy.org |publisher=UKCP - UK Council for Psychotherapy |accessdate=9 July 2018 |ref=MOU_CT |date=November 2015}}</ref> On the other hand, there are still a number of clinicians who continue to believe that there should be interventions for gender nonconforming children. They believe that stereotypical gender-specific toys and games will encourage children to behave in their traditional gender roles.<ref name="Padawer"/> [[Transsexual]] self-identified people sometimes wish to undergo physical surgery to refashion their [[primary sexual characteristics]], secondary characteristics, or both, because they feel they will be more comfortable with different genitalia. This may involve removal of penis, testicles or breasts, or the fashioning of a penis, vagina or breasts. In the past, sex assignment surgery has been performed on infants who are born with ambiguous genitalia. However, current medical opinion is strongly against this procedure, since many adults have regretted that these decisions were made for them at birth. Today, [[sex reassignment surgery]] is performed on people who choose to have this change so that their anatomical sex will match their gender identity.<ref>{{cite journal|last=Diamond|first=Milton|title=Sex and Gender are Different: Sexual Identity and Gender Identity are Different|journal=Clinical Child Psychology & Psychiatry|year=2002|volume=7|issue=3|url=http://www.hawaii.edu/PCSS/biblio/articles/2000to2004/2002-sex-and-gender.html}}</ref> In the United States, it was decided under the Affordable Care Act that [[health insurance exchange]]s would have the ability to collect demographic information on gender identity and sexual identity through optional questions, to help policymakers better recognize the needs of the [[LGBT]] community.<ref>{{cite web|last=Baker|first=Kellan|title=FAQ: Collecting Sexual Orientation and Gender Identity Data|url=http://www.americanprogress.org/issues/lgbt/report/2012/10/16/41620/faq-collecting-sexual-orientation-and-gender-identity-data/|publisher=Center for American Progress|accessdate=October 29, 2012}}</ref> ===Gender dysphoria and gender identity disorder=== [[Gender dysphoria]] (previously called "gender identity disorder" or GID in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]) is the formal diagnosis of people who experience significant [[dysphoria]] (discontent) with the sex they were assigned at birth and/or the gender roles associated with that sex:<ref>"Gender Identity Disorder | Psychology Today." Psychology Today: Health, Help, Happiness Find a Therapist. Psychology Today, 24 Oct. 2005. Web. 17 Dec. 2010. http://www.psychologytoday.com/conditions/gender-identity-disorder.</ref><ref>[https://web.archive.org/web/20100306075726/http://www.genderdysphoria.org/genderdysphoria_medical.html Gender Dysphoria Organization Research and Education - About Gender Dysphoria<!-- Bot generated title -->]</ref> "In gender identity disorder, there is discordance between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine."<ref name="GID" /> The [[Diagnostic and Statistical Manual of Mental Disorders]] (302.85) has five criteria that must be met before a diagnosis of gender identity disorder can be made, and the disorder is further subdivided into specific diagnoses based on age, for example [[gender identity disorder in children]] (for children who experience gender dysphoria). The concept of gender identity appeared in the [[Diagnostic and Statistical Manual of Mental Disorders]] in its third edition, [[DSM-III]] (1980), in the form of two [[mental disorder|psychiatric diagnoses]] of gender dysphoria: gender identity disorder of childhood (GIDC), and transsexualism (for adolescents and adults). The 1987 revision of the manual, the [[DSM-III-R]], added a third diagnosis: gender identity disorder of adolescence and adulthood, nontranssexual type. This latter diagnosis was removed in the subsequent revision, DSM-IV (1994), which also collapsed GIDC and transsexualism into a new diagnosis of gender identity disorder.<ref name="Historical Note">{{cite journal | last1 = Zucker | first1 = KJ | last2 = Spitzer | first2 = RL |date=Jan–Feb 2005 | title = Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note | url = | journal = Journal of Sex and Marital Therapy | volume = 31 | issue = 1| pages = 31–42 | doi = 10.1080/00926230590475251 | pmid = 15841704 }}</ref> In 2013, the [[DSM-5]] renamed the diagnosis ''gender dysphoria'' and revised its definition.<ref>{{Cite web|first=Wynne|last=Parry|title = DSM-5 Reflects Shift In Perspective On Gender Identity|date=June 4, 2013|url = http://www.huffingtonpost.com/2013/06/04/gender-dysphoria-dsm-5_n_3385287.html|website = The Huffington Post|accessdate = 2015-10-23}}</ref> The authors of a 2005 academic paper questioned the classification of gender identity problems as a [[mental disorder]], speculating that certain DSM revisions may have been made on a tit-for-tat basis when certain groups were pushing for the removal of homosexuality as a disorder. This remains controversial,<ref name="Historical Note"/> although the vast majority of today's mental health professionals follow and agree with the current DSM classifications. ===International human rights law=== [[The Yogyakarta Principles]], a document on the application of [[international human rights law]], provide in the preamble a definition of gender identity as each person's deeply felt internal and individual [[experience]] of gender, which may or may not correspond with the sex assigned at birth, including the person's sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other experience of gender, including dress, speech and mannerism. Principle 3 states that "Each person’s self-defined [...] gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilisation or hormonal therapy, as a requirement for legal recognition of their gender identity."<ref>[[The Yogyakarta Principles]], ''Principle 3. The Right to recognition before the law''</ref> and Principle 18 states that "Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical conditions and are not to be treated, cured or suppressed."<ref>The Yogyakarta Principles, ''Principle 18. Protection from medical abuse''</ref> Relating to this principle, the "Jurisprudential Annotations to the Yogyakarta Principles" observed that "Gender identity differing from that assigned at birth, or socially rejected [[gender expression]], have been treated as a form of [[mental illness]]. The pathologization of difference has led to gender-transgressive children and adolescents being confined in psychiatric institutions, and subjected to aversion techniques — including [[electroshock therapy]] — as a 'cure'."<ref>[https://web.archive.org/web/20101122035344/http://www.yogyakartaprinciples.org/yogyakarta-principles-jurisprudential-annotations.pdf Jurisprudential Annotations to the Yogyakarta Principles, page 43] {{webarchive |url=https://web.archive.org/web/20101122035344/http://www.yogyakartaprinciples.org/yogyakarta-principles-jurisprudential-annotations.pdf |date=November 22, 2010 }}</ref> The "Yogyakarta Principles in Action" says "it is important to note that while 'sexual orientation' has been declassified as a mental illness in many countries, 'gender identity' or 'gender identity disorder' often remains in consideration."<ref>{{cite web|url=http://www.ypinaction.org/wp/wp-content/uploads/2016/10/Activists_Guide_English_nov_14_2010.pdf|title=Activist's Guide to the Yogyakarta Principles, p. 100|publisher=}}</ref> These Principles influenced the [[LGBT rights at the United Nations|UN declaration on sexual orientation and gender identity]] In 2015, gender identity was part of a Supreme Court case in the United States called Obergefell v Hodges in which marriage was no longer restricted between man and woman.<ref>[https://www.supremecourt.gov/opinions/14pdf/14-556_3204.pdf]</ref> ==Non-binary gender identities== {{See also|Third gender|Genderqueer}} ===Fa'afafine=== {{Main article|Fa'afafine}} In some [[Polynesians|Polynesian]] societies, [[fa'afafine]] are considered to be a "[[third gender]]" alongside [[male]] and [[female]]. They are anatomically male, but dress and behave in a manner considered typically female. According to Tamasailau Sua'ali'i (''see references''), fa'afafine in [[Samoa]] at least are often physiologically unable to reproduce. Fa'afafine are accepted as a natural gender, and neither looked down upon nor discriminated against.<ref>Sua'ali'i, Tamasailau, "[[Samoa]]ns and Gender: Some Reflections on Male, Female and Fa'afafine Gender Identities", in: ''Tangata O Te Moana Nui: The Evolving Identities of Pacific Peoples in [[Aotearoa]]/[[New Zealand]]'', Palmerston North (NZ): Dunmore Press, 2001, {{ISBN|0-86469-369-9}}</ref> Fa'afafine also reinforce their femininity with the fact that they are only attracted to and receive sexual attention from straight masculine men. They have been and generally still are initially identified in terms of labour preferences, as they perform typically feminine household tasks.<ref>{{cite journal|last=Schmidt|first=Johanna|title=Paradise Lost? Social Change and Fa'afafine in Samoa|journal=Current Sociology|date=May 2003|issue=3|pages=417–432|doi=10.1177/0011392103051003014|volume=51}}</ref> The [[Prime Minister of Samoa|Samoan Prime Minister]] is patron of the Samoa Fa'afafine Association.<ref name="Stuff.co.nz_5233232">{{cite web |url=http://www.stuff.co.nz/world/south-pacific/5233232/Transsexuals-hailed-by-Samoan-PM |title=Transsexuals hailed by Samoan PM |author=Field, Michael |date=5 July 2011 |work=[[Stuff.co.nz]] |accessdate=1 October 2011}}</ref> Translated literally, fa'afafine means "in the manner of a woman."<ref>Pual L. Vasey, Nancy H. Bartlett, "What Can the Samoan "Fa'afafine" Teach Us About the Western Concept of Gender Identity Disorder in Childhood?", ''Biology and Medicine'', 50.4 (2007) 481-490</ref> ===Hijras=== {{main article|Hijra (South Asia)}} In some cultures of [[Asia]], a [[Hijra (South Asia)|hijra]] is usually considered to be neither a man nor a woman. Most are anatomically [[male]] or [[intersex]], but some are anatomically [[female]]. The hijra form a [[third gender]] role, although they do not enjoy the same acceptance and respect as males and females in their cultures. They can run their own households, and their occupations are singing and dancing, working as cooks or servants, sometimes [[prostitute]]s, or long-term sexual partners with men. Hijras can be compared to [[transvestism|transvestites]] or [[drag queen]]s of contemporary western culture.<ref>Lorber, Judith. Paradoxes of Gender. Yale University Press:Yale, 1994. pp. 92–93.</ref> ===Khanith=== {{main article|Khanith}} The [[khanith]] form an accepted third gender in [[Oman]]. The khanith are [[male]] [[homosexual]] [[prostitute]]s whose dressing is male, featuring pastel colors (rather than white, worn by men), but their mannerisms female. Khanith can mingle with women, and they often do at [[wedding]]s or other formal events. Khaniths have their own households, performing all tasks (both male and female). However, similarly to men in their [[society]], khaniths can marry women, proving their [[masculinity]] by consummating the [[marriage]]. Should a [[divorce]] or death take place, these men can revert to their status as khaniths at the next wedding.<ref>Lorber, Judith. Paradoxes of Gender. Yale University Press:Yale, 1994. pp. 94–95.</ref> ===Two-spirit identities=== {{Main article|Two-Spirit}} <!--section needs slight expansion--> Many [[Indigenous peoples of the Americas|indigenous North American Nations]] had more than two gender roles. Those who belong to the additional gender categories, beyond [[cisgender]] man and woman, are now often collectively termed "two-spirit" or "two-spirited." There are parts of the community that take "two-spirit" as a category over an identity itself, preferring to identify with culture or Nation-specific gender terms.<ref>{{Cite journal|last=Hunt|first=Sarah|year=2016|title=An Introduction to the Health of Two-Spirit People: Historical, contemporary and emergent issues|url=http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/156/2016-05-10-RPT-HealthTwoSpirit-Hunt-EN-Web.pdf|journal=National Collaborative Centre Aboriginal Health|volume=|pages=|via=|deadurl=yes|archiveurl=https://web.archive.org/web/20170202004508/http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/156/2016-05-10-RPT-HealthTwoSpirit-Hunt-EN-Web.pdf|archivedate=2017-02-02|df=}}</ref> ==See also== {{columns-list|colwidth=22em| * [[Eleno de Céspedes]] * [[Gender bias]] * [[Gender differences]] * [[Human sexuality spectrum]] * [[Identity (social science)]] * [[List of transgender-related topics]] * [[Queer studies]] * [[Queer theory]] * [[Sex and gender distinction]] * [[Uranian]] }} {{portal bar|Gender studies|LGBT|Transgender|Sexuality}} ==References== {{Reflist|2}} ==Bibliography== * Boles, Jacqueline, and Tatro, Charlotte, ''Androgyny'' (subsection ''Gender-identity formation''), in ''Men in Transition: Theory and Therapy'', 2013, edited by Kenneth Solomon * Marciano, Avi (2014). [https://onlinelibrary.wiley.com/doi/abs/10.1111/jcc4.12081 Living the VirtuReal: Negotiating Transgender Identity in Cyberspace]. [[Journal of Computer-Mediated Communication]], 19(4), 824-838. ==External links== {{Library resources box|onlinebooks=yes}} * [http://www.britannica.com/EBchecked/topic/228219/gender-identity "Gender identity."] [[Encyclopædia Britannica Online]] * [http://documentarystorm.com/dr-money-and-the-boy-with-no-penis/ Dr. Money And The Boy With No Penis] * [http://www.ifge.org/ International Foundation for Gender Education] * [http://transequality.org National Center for Transgender Equality] * [http://www.ntac.org/ National Transgender Advocacy Coalition] * [https://web.archive.org/web/20110209002411/http://www.gpac.org/ Gender PAC] * [http://www.genderspectrum.org/ Gender Spectrum] * [http://www.transgenderlawcenter.org/ Transgender Law Center] * [https://plus.google.com/b/108155459928759293019/108155459928759293019/posts Gender Issues - Human Rights] * [https://web.archive.org/web/20080517084227/http://www.hrc.org/workplace/transgender Human Rights Campaign Foundation], Transgender Resources for the Workplace * [http://www.wpath.org/ World Professional Association for Transgender Health] * [http://www.genderology.org/ Genderology Directory Project], International listing of service providers for those affected by GID * [http://www.gires.org.uk/ Gender Identity Research and Education Society (GIRES)], British Charity encouraging and reporting on research into gender variance * [http://www.genderanarchyproject.com/ Gender Anarchy Project] * [https://web.archive.org/web/20120318004549/http://www.transfemmebutch.co.uk/forum.php TransFemmeButch] A forum and discussion board for trans men, femmes, and butches * [http://www.ohchr.org/Documents/Publications/BornFreeAndEqualLowRes.pdf Born Free and Equal - Sexual orientation and gender identity in international human rights law] ([[Office of the United Nations High Commissioner for Human Rights|OHCHR]]) {{LGBT}} {{Transgender}} {{Gender and sexual identities}} {{Gender studies}} {{Authority control}} [[Category:Gender]] [[Category:Gender identity]] [[Category:Gender studies]] [[Category:Identity]] [[Category:Self]]'