Sex and Gender Identity: Part 2, Gender Identity and Gender Dysphoria

Last time we discussed the complexity of what defines male and female in terms of physical sex. This time, I am going to attempt to give a little information around the much more nuanced issue of gender identity.

Gender identity is, in short, how one perceives oneself to be. This doesn’t directly map to the societal concept of a gender role–though it is in some ways related–but more broadly represents how the person models themselves internally. Where sex is mostly about one’s exterior state, gender operates on a less easily measured level.

It is important to note that this is not a binary, either-or situation. This is more a two dimensional system, since people may end up perceiving themselves as:

  • Male
  • Female
  • Both male and female (sometimes called bigendered or androgyne, depending on the model)
  • Neither male nor female (sometimes called nongendered)

With various degrees in-between. So someone may perceive themselves to be male, but only weakly. Or they may perceive themselves as being both strongly male and strongly female. This is extremely difficult to successfully model, and even more difficult to measure, but is an important part of personal identity.

For our purposes here we are going to focus on male and female and gender dysphoria, as opposed to the concepts of strongly or weakly gendered or the spectrum of possible gender identities. The reason for this is not because those issues aren’t important, but because for the purpose of this discussion we can address the dyadic case without getting into the deeper ramifications.

Biology of Gender Identity

For many, this implies that somehow gender identity isn’t real or that it isn’t biological in the way that sex clearly is. Under this model, gender–especially gender as it is variant from absolute male-or-female sex–is something imprinted by society or something that people choose to be. However, it appears that there is a fairly significant biological basis for gender identity.

One of the first signs of this is that Male-to-Female transsexuals have brain structures that more closely resemble that of women than that of men, and that there is a genetic correlation with male-to-female transsexualism:

One can see that the research is still very young, but there is also a clear pattern emerging that there are significant biological components to gender identity.

There is still a significant debate on the question of nature versus nurture and such studies cannot currently cleanly model groups that view themselves as variant from strictly male or female, but in the US the current standard of care for Gender Identity Disorder is, if the situation calls for it, to help the individual transition so that they can live entirely as their identified gender. There are some significant and deep flaws with the way we handle this, but the underlying message is clear: it is easier to change someone’s outside to more closely correlate with their internal state than it is to change someone’s ingrained self perception at this level.

Gender Dysphoria’s Manifestations

There are a few key manifestations of gender identity. The exact ones vary depending on who you ask, but a good starting point is to look at what is variant for various classifications of Gender Identity Disorder.

In the draft of the DSM-V, Gender Dysphoria in adults is defined by the following:

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2* or more of the following indicators: [2, 3, 4]**

  1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]
  2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]
  3. a strong desire for the primary and/or secondary sex characteristics of the other gender
  4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
  5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
  6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability

The first thing to note is that if it is not impairing your life, it is not a disorder as defined above, and the coping strategies may look quite different. More on this–and the meaning of the word disorder–at a later point.

The next component to note is that these are pretty much all reflective of the internal state of the individual. The individual simply does not see themselves as their birth-assigned gender, and frequently has negative reactions to being classified as their birth-assigned gender. In adults, it impacts significantly more than whether they prefer to do things that are stereotypically male or female and goes to the heart of how an individual sees themselves, and that being at odds with their birth-assigned gender.


Gender dysphoria isn’t a choice, it isn’t an attempt by men to steal or otherwise infiltrate into women’s mysteries. They are people who happen to see themselves in a way that does not fit with their outer presentation and assignment, and who undergo a great deal of difficulty in trying to reconcile these. Pre-transition suicide rates among those with gender dysphoria are often reported to be 20% or higher, and violent crime victimhood is also proportionately higher.

This doesn’t mean anyone should or shouldn’t run a ritual for ciswomen only. Or that I am telling people they need to include intersex or transgendered individuals. My point is closer to that, as Raven Kaldera said about intersex: whenever a line is drawn, it passes through someone’s flesh. You can choose to include or exclude those people who will be cut by the lines, especially given that these are communities that see significant cross-over, but I do ask that people be aware of the consequences of where these lines fall.

I’ll write more on the matter of language in a future installment.

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2 Responses to Sex and Gender Identity: Part 2, Gender Identity and Gender Dysphoria

  1. A Thakkar says:

    I have read this so many times, on so many different mediums. I know my gender identity has to be decided by me, but I’m not able to decide.
    Not conforming to a gender is twisting me into many knots and is not letting me live my life normally.
    I’ve tried so many psychiatrists… I don’t even know why I am ranting here, but I’m desperately looking for some kind of help, perhaps a miracle, so that I can move on and find my basic piece of identity and leave peacefully with it….

  2. Jay Ford says:

    I think this a great essay and it makes a lot of good points. But, as a transmasculine person, I think one edit should be made. The pre-transition suicide rate of transgender people is actually between 50-60%. Transfeminine people fall more to the 60% whereas transmasculine people and androgynous people fall more towards the 50%.

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