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Questions and answers about gender identity

Questions and answers about gender identity


Transgender is a term used for people who do not identify with the sex they were assigned at birth based on their genitalia. They might explain that they feel like a woman trapped in a man’s body, or the opposite. Less than 1 percent of people or about 1 million Americans are believed to be transgender, although the figure is difficult to measure.

The following questions and answers are based on information from the American Psychological Association and studies published by the National Academy of Sciences.

Glossary of terms

Q. What is the difference between gender and sex?

Sex is the assignment of male or female status at birth indicated by biological differences in hormones, chromosomes and anatomy. Gender is the socially constructed standards of behavior and appearance deemed appropriate for men or women. Definitions of gender are more fluid both individually and across cultures.

Q. What is the difference between gender identity and sexual orientation?

Gender identity is a person’s feeling that they are male, female or somewhere in between. Sexual orientation is marked by whom a person is attracted to.

Q. Are transgender people also gay?

Transgender people, like anyone, can be straight, gay or bisexual. People who are transgender are most often attracted to the sex that is opposite from their own that was assigned at birth. A man who transitions to a woman is likely to remain attracted to women.

Q. Are transgender people just confused or experimenting?

No. Nearly all transgender people say they have felt more like the opposite sex for as long as they remember. They may have feelings of shame and dissatisfaction, but their gender identity is not something that can be overcome or changed.

Q. Are people who cross-dress transgender?

Not necessarily. Some people prefer to wear hairstyles and clothing that don’t conform to social norms for gender but that doesn’t mean they feel they are the wrong sex. You can’t tell whether someone is transgender based on their hobbies or activities. For example, a girl is sometimes called a “tomboy” if she prefers toys and clothes that are considered masculine, but that does not mean she feels like she is supposed to be a boy. Most people who cross-dress do not want to change the sex they were born with.

Q. What is the difference between transgender and transsexual?

Generally, transsexual people have changed their bodies to their preferred sex through hormonal and/or surgical treatments. The surgeries can include facial feminizing procedures, breast augmentation or reduction, and genital reassignments.

Q. What causes people to be transgender?

The development of gender identity is highly complex and not well understood. But researchers do not believe that an early childhood trauma or sexual abuse is responsible for a person being transgender. It also does not seem like genetics plays a big role, since a study of transgender people with identical twins showed that only 20 percent were both transgender. More evidence points to biological differences in the brain — that somehow during fetal development the brain did not differentiate its sexual characteristics in alignment with the rest of the body.

Q. Is there a blood test or other physical way to tell if someone is transgender?

There is no blood test to indicate a person is transgender, but brain scans might give some clues. While little research has been done in the area, some small studies have shown differences in the brains of transgender people. The brains of men and women have different structures. One study showed that the brains of transgender people looked more like their preferred gender than their anatomical sex. Transgender men (born female and transitioned to male) had thinner subcortical areas of the brain that would indicate a male structure. And transgender women (male to female) had thinner areas in the right hemisphere of the brain, indicative of a female brain.

In another small study of autopsied brains of transgender women, a section of the hypothalamus thought to influence gender identity was more similar in size to a woman’s than a man’s.

Q. Is being transgender caused by unbalanced hormones?

No. Studies have shown that transgender people have estrogen and testosterone (sex hormones) levels that are consistent with their genitalia at birth. Transgender people who want to transition to the opposite sex take hormone therapy to block their unwanted sexual characteristics.

Q. Is intersex the same as transgender?

No. A variety of rare medical conditions can cause abnormal development of sexual anatomy, known as intersex. For example, some people are born with ambiguous genitals or external and internal genitalia of opposite sexes. The decisions to assign a gender or perform surgery are first made with a goal of preserving fertility. There is no established time frame for treatments unless the condition is harmful to a child’s health. Most people who are born with an intersex condition are satisfied with their assigned sex.

Q. Is being transgender a mental disorder?

No. Mental disorders are defined as causing “significant distress or disability,” according to the American Psychological Association. Many transgender people do not consider themselves distressed by their gender identity, however they do experience problems finding medical and social support. The Diagnostic and Statistical Manual of Mental Disorders was changed in 2012 to describe emotional distress caused by incompatible gender identity from ”gender identity disorder” to “gender dysphoria.” Transgender people do experience higher rates of anxiety, depression and suicidal thoughts.

Q. What is involved in transitioning between sexes?

Transgender people who want to live as their preferred gender generally start the process gradually by changing their clothes and appearance when they feel safe to do so. They may also change their name informally or legally. Before any surgical procedures can be performed, the transgender person must go through a certain amount of counseling and hormone therapy. The process is permanent, and usually ends a person’s fertility, so surgeons want to be sure the decision is right.

“We are altering their body to go along with their brain,” said Dr. Sherman Leis, founder of the Philadelphia Center for Transgender Surgery. “To me it’s a very rewarding field of medicine. We need more doctors of every type to get involved in the care of transgender people to help them get through life in a happier way.”

Q. How can parents support transgender children?

Parents should not look at opposite gender identity as a phase the child will grow out of. Do not force the child into more stereotypical gender behavior. Seek out mental health professionals who are experienced in gender identity issues. They should also talk to the child’s school about safety concerns and other special needs.


The Metro Trans Umbrella Group offers information about support groups, medical care and advocacy for transgender people. For more information:

TransParent is a support group for parents of transgender children that meets monthly at St. Louis Children's Hospital. For more information:

The Transgender Health Network offers lists of medical professionals who work with the transgender community throughout Missouri. For more information:

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