People sometimes use the terms sex and gender interchangeably, but they aren’t the same. Understanding the difference—and knowing what each term means—is an important aspect of supporting the LGTBQ+ community.
“Biological sex is assigned based upon the appearance of external genitalia at birth,” says Jessica Shill, M.D., an endocrinologist with Henry Ford Health. “Gender identity is how you think about yourself. It's the gender you identify with, which may differ from your sex assigned at birth or your chromosomes.”
It’s often thought that sex and gender are binary, meaning that someone is limited to two options—either male or female. But even from a biological standpoint, that’s not always the case.
When Sex Isn’t Binary
For babies who are intersex or who have ambiguous genitalia, assigning sex based upon the appearance of external genitalia can be flawed. Ambiguous genitalia occurs when there’s a discrepancy between external and internal genitalia, and there are several conditions that can cause this, resulting in inaccurate sex assignment at birth. Someone can have an abnormal number of chromosomes, instead of the usual 46. This abnormality can interfere with normal sexual development and hormone levels.
Rarely, people can be born truly intersex, in that they have both ovarian and testicular tissues, or ovotestis. “We often think of male and female as binary, but there is a spectrum in between,” says Dr. Shill.
Defining Gender Identity
Just as sex isn’t always simply defined as male or female, gender is on a spectrum, as well. “People can identify in a variety of ways,” says Dr. Shill. “They can identify as male, female, a blend of both, neither, or a third gender."
Examples of ways in which people can identify include:
- Cisgender (meaning you identify as the sex that was assigned to you at birth)
- Transgender female (meaning you were assigned male at birth but identify as female)
- Transgender male (meaning you were assigned female at birth but identify as male)
- Gender fluid, queer, non-binary, and non-conforming (meaning you identify somewhere along the spectrum of male or female, or outside of these categories)
The only way to truly know how someone identifies—whether male, female, neither or somewhere in between—is to ask them. He/him, she/her or they/them are the most common pronouns used. And some people are comfortable with more than one type of pronoun. What is evident, however, is that people have a strong sense of identification from an early age.
“Research shows that gender identity forms around 3 to 6 years old and solidifies around 5 to 7 years old,” says Dr. Shill. “However, people may not be able to express their true identity until they’re older, if they aren’t supported by family, friends or their community.”
Ways To Create A Safe, Gender-Affirming Environment
When individuals don’t identify as cisgender and are not supported by friends, family and their community, it can cause significant psychological distress. “These individuals are much more likely to experience homelessness, attempt suicide, or use drugs and alcohol to cope,” says Dr. Shill. “They’re trying to deal with the difficulties and pressures of living in a world where they’re not readily accepted and frequently experience discrimination and violence.
“They can experience problems trying to get healthcare and obtaining insurance. They can be denied hormone therapy or surgery coverage. But medical care to improve someone’s presentation in their affirmed gender can be lifesaving. All major medical associations endorse the medical necessity of gender-affirming treatments.”
As a society, we have a long way to go to truly accepting and including everyone, but there are ways to make a small impact in your daily life. “When you meet someone, ask their preferred name and their preferred pronouns, and give them yours,” says Dr. Shill. “It immediately shows that you are open and supportive, making someone feel seen and accepted. Learning and understanding is so important.”
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To find a doctor at Henry Ford, visit henryford.com or call 1-800-436-7936. While any of our physicians can treat LGBTQ+ patients, certain doctors have expressed interest in LGBTQ+ health. Find a doctor with an LGBTQ+ designation.
Dr. Jessica Shill is an endocrinologist specializing in LGTBQ+ and transgender health. She sees patients at Henry Ford Medical Center – New Center One in midtown Detroit.