psychiatric disorders
Gender Incongruence and Gender Dysphoria
Sex, gender, and identity
Sex and gender are not the same thing, and they should be considered clinically as distinct characteristics. Terminology regarding sex and gender includes ( General references ) Sex:Defined by the traits usually used to distinguish between males and females; sex refers especially to the physical and biologic traits that are physically evident at birth and is often captured in the phrases "assigned male at birth" (AMAB) and "assigned female at birth" (AFAB). Gender identity:An internal sense of being male, female, or something else, which may or may not correspond to an individual's sex assigned at birth or sex characteristics. Gender expression:Clothing, physical appearance and other external presentations and behaviors that express aspects of gender identity or role. Gender incongruence:A person’s marked and persistent experience of an incompatibility between that person’s gender identity and the gender expected of them based on their birth-assigned sex. Gender dysphoria:Discomfort or distress related to an incongruence between an individual's gender identity and the sex assigned at birth. Cisgender:Used to describe an individual whose gender identity and gender expression align with the sex assigned at birth. Transgender:An umbrella term encompassing those whose gender identities or gender roles differ from those typically associated with the sex they were assigned at birth. Gender nonconforming:Describes an individual whose gender identity or gender expression differs from the gender norms associated with the sex they were assigned at birth. Genderqueer:Describes an individual whose gender identity does not align with a binary understanding of gender, including those who think of themselves as both male and female, neither, moving between genders, a third gender, or outside of gender altogether. Some refer to themselves as nonbinary with respect to their gender identity and/or role. Gender nonbinary:Includes people whose genders are comprised of more than one gender identity simultaneously or at different times (eg, bigender); who do not have a gender identity or have a neutral gender identity (eg, agender or neutrois); have gender identities that encompass or blend elements of other genders (eg, polygender, demiboy, demigirl); and/or who have a gender that changes over time (eg, genderfluid). Gender binary:The classification of gender into 2 discrete categories of male and female (a paradigm of the past that did not allow for those who do not identify as male or female). Transwomen:People who were assigned male at birth (AMAB) and have adopted a gender identity as a woman, regardless of whether they have undergone any medical gender transition. Transmen:People who were assigned female at birth (AFAB) and have adopted a gender identity as a man, regardless of whether they have undergone any medical gender transition. Eunuch:An individual assigned male at birth whose testicles have been surgically removed or rendered nonfunctional and who identifies as a eunuch. This differs from the standard medical definition by excluding those who do not identify as eunuch. Trans-affirmative:Being aware, respectful, and supportive of the needs of transgender and gender-nonconforming individuals. Sexual orientation:Pattern of emotional, romantic, and/or sexual attractions that people have toward others. It also refers to a person's sense of personal and social identity based on those attractions, related behaviors, and membership in a community of others with similar attractions and behaviors. Sexual identity is different from gender identity. Transgender and gender diverse are the preferred terms to refer to people with gender identities that differ from the gender that is congruent with the sex they were assigned at birth. Transsexualism is an outdated term that is no longer used by experts in gender dysphoria. Gender identities include traditional masculinity or femininity, with a growing cultural recognition that some people do not fit—nor necessarily wish to fit—into the traditional male-female dichotomy (gender binary). These people may refer to themselves as genderqueer, nonbinary, nonconforming, or one of many other terms that have become more commonly used. Moreover, definitions and categorizations of gender role may differ across societies. The term cisgender, which applies to the majority of people, is used to refer to people whose gender identity corresponds to their sex assigned at birth. Many cultures are more tolerant of gender-nonconforming behaviors in young girls (eg, doing activities or wearing clothing that are more typical for boys) than effeminate behaviors in boys. As part of normal development, many boys role-play as girls or mothers, including trying on their sister’s or mother’s clothes or engaging in stereotypical behaviors or expressing interests associated with girls in a given society. Gender incongruence (behavior that significantly differs from cultural norms for a person's birth sex) in children is generally not considered a disorder and usually does not persist into adulthood or lead to gender dysphoria, although persistently gender-incongruent young adolescents may be more likely to identify as homosexual or bisexual as adults ( General references ). Nonbinary gender identity refers to individuals who experience their gender as different from the typical western views of binary gender identity (masculine or feminine). Nonbinary describes people with different types of gender identity, including people who do not identify with any gender, those who identify with multiple genders, and those who may experience different genders over time or in different contexts (gender fluid) ( General references ). Although some nonbinary people identify as transgender, many do not. Nonbinary people may use the pronouns they/them/theirs or newly created pronouns such as ze/zir/hir or e/er/ers, among others. Studies have reported that nonbinary people may constitute 25 to 50% of the gender-diverse community, with the higher percentages seen in adolescents and young adults ( General references ). Currently, a majority of nonbinary people were assigned female at birth. Prior to the 2010s, a majority of patients with gender dysphoria who requested treatment had been assigned male at birth. This has changed, with a substantial increase in the numbers of adolescent patients assigned female at birth coming to clinics worldwide for evaluation and treatment ( General references ). 