How sex and gender are different
For most people, the sex they were assigned at birth aligns with their gender. This means they were assigned male at birth and feel like a man, or female at birth and feel like a woman.
According to analyses conducted by the Pew Research Center in May 2022, over 5% of US adults under 30 say their gender is different from the sex they were assigned at birth.
Sex refers to the biological differences between people who are male, female, or intersex. This includes characteristics such as your:
- reproductive organs
Sex chromosomes determine the biological basis of being male or female. Males usually have 1 X and 1 Y chromosome (XY), and females typically have 2 X chromosomes (XX). These chromosomes influence the development of sexual organs and the production of hormones that contribute to other sexual characteristics.
Still, with over 30 known biological variations that can affect sex development, it is important to recognize that thinking about sex as a binary concept is limited and can exclude people, such as those who are intersex.
Intersex people are born with natural variations in sex characteristics that can include differences in chromosomes and genitalia. Intersex can also be used interchangeably with differences in sex development (DSD).
There is more to biological sex than just being male (XY) or female (XX). Many people are now beginning to realize the complexity and diversity that exists beyond the binary framework.
Gender refers to cultural and societal expectations of roles and attributes based on sex. Gender identity is your internal sense of gender, which exists on a spectrum rather than a strict binary. Your gender expression is how you present yourself through appearance and behavior.
Recent research suggests that social factors and differences in brain structure may influence your gender identity. Gender is an inherent aspect of your identity and how you choose to live in the world.
The majority of the global population identifies as cisgender, meaning their gender identity aligns with the sex assigned to them at birth. But for people who are gender diverse, their gender identity may differ from the one assigned to them at birth.
The term “gender diverse” is used to recognize the wide range of gender identities that exist. This includes people who describe themselves as:
Unfortunately, many people in society still expect you to behave in a particular way when it comes to your sex and gender. This can lead to people who are gender diverse facing discrimination and harassment, which can have a negative effect on their mental and physical health.
Gender dysphoria refers to the emotional distress and psychological challenges that can occur when an individual’s deeply felt sense of their gender identity does not match the sex they were assigned at birth.
If you are experiencing gender dysphoria, various forms of gender affirmation can help. These include:
- Social affirmation: Changing your name and pronouns to align with your gender identity allows others to address and recognize you in a way that reflects who you truly are.
- Legal affirmation: Updating gender markers on official documents to reflect your true gender can help you feel accepted and acknowledged by your community and society.
- Medical affirmation: Options such as hormone therapy can help align your physical attributes with your gender identity and may make you feel more comfortable and authentic in your body.
- Surgical affirmation: Certain surgical procedures can help modify physical features to align with your gender identity. These are known as major interventions and can include:
- Nonmedical affirmation: Changing your clothes and hair, wearing binders, or tucking are ways to try out what feels like you. This can help you decide whether medical or surgical steps are right for you.
Everyone’s gender journey is different, and not everyone who is gender diverse will choose all or any forms of these gender affirmations.
Making gender-affirming changes takes time and may not fully relieve symptoms of gender dysphoria on their own.
Several other options may help, such as:
- finding community support
- engaging in counseling
- considering medication options to help with depression and anxiety
How to find support if you are questioning your gender identity
Consulting with qualified healthcare professionals that specialize in issues related to gender identity can provide you with the most effective support. Examples include:
- primary care doctors
- behavioral health professionals, such as psychologists and counselors
Several ways you can find support include:
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Counseling options for gender diverse individuals include:
- Gender-affirming counseling: This form of counseling provides support and validation for gender identity.
- Individual therapy (various): One-on-one sessions to explore gender identity and address mental health concerns.
- Cognitive behavioral therapy (CBT): CBT can be helpful with:
- addressing negative thoughts
- coping with dysphoria
- building resilience
- managing anxiety
- navigating transitions
- Family therapy: Involves helping family members to improve understanding and their acceptance.
- Group therapy: Offers a supportive environment for connecting with others who share similar experiences.
Healthcare professionals might include several common medications as part of a treatment plan for gender dysphoria.
- Gender-affirming hormone replacement therapy (GA-HRT), such as:
- progesterone (Prometrium)
- Hormone blockers, such as:
- leuprorelin (Lupron)
- histrelin (Supprelin LA)
- Antidepressants, such as:
- sertraline (Zoloft)
It can be helpful to find local organizations that offer support specifically for gender identity issues and resources for finding gender-affirming care.
You can find further support and information here:
- The Trevor Project
- Office on Sexual Orientation and Gender Diversity
- Programs and Projects
- Family Acceptance Project
- Parents, Families, and Friends of Lesbians and Gays (PFLAG) Transgender Network
- World Professional Association for Transgender Health
Sex is based purely on biological attributes, while gender is built on social and personal identity. If you feel that your sex and gender do not match, don’t worry. There is plenty of support available.
It is important to respect and acknowledge people’s self-identified gender, even if it differs from the sex assigned at birth.
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- Brown A. (2022). About 5% of young adults in the U.S. say their gender is different from their sex assigned at birth. https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/
- Griffiths DA. (2018). Shifting syndromes: Sex chromosome variations and intersex classifications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808814/
- Rafferty J, et al. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for
- Ristori J, et al. (2020). Brain sex differences related to gender identity development: Genes or hormones? https://www.mdpi.com/1422-0067/21/6/2123
- Rosenwohl-Mack A, et al. (2020). A national study on the physical and mental health of intersex adults in the U.S. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546494/
- Sex Chromosome. (2023). https://www.genome.gov/genetics-glossary/Sex-Chromosome
- Terminology. (2023). https://www.cdc.gov/healthyyouth/terminology/sexual-and-gender-identity-terms.htm
- Tomlins L. (2019). Prescribing for transgender patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370611/
- What is gender dysphoria? (2022). https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria