Most people’s belief about their gender matches, conveniently, their biological sex, but for some number there is a mismatch. Some psychologists call this Gender Identity Disorder. Note that this is not the same as Disorders of Sex Development. Dr. Jay Hays-Light, director of the UK Intersex Association, makes the distinction this way: “sex is between the legs while gender is between the ears. Most people are ‘hard-wired’ to a gender identity, whether this is male, female or something in between.” (1)

People who change the gender they present to the world to match what they feel about themselves are transgender. (This might or might not include surgery.) Sometimes “transgender” is used to describe behavior outside of gender norms,  for example, a colorfully dressed and made-up man, who considers himself male. (See the post on Gender Expression.) “Gender-bender” is also used in this way, sometimes meaning just dress and behavior, sometimes meaning identity, but this term is offensive to some. This can be confusing!

“Transsexual” is sometimes used as a synonym for transgender, and sometimes to distinguish transgender people who have changed their biology by hormone treatments and/or surgery. Because access to such medical treatment in the US depends on socio-economic factors, some find such distinctions discriminatory and prefer to use “transgender” exclusively, or just “trans.” It might be easier to talk about these matters if the definitions were standardized, but individual experiences and often great pain are behind the various points of view. In the end it can be less awkward just to ask which pronouns to use and how someone identifies, rather than to make assumptions or shrink from the conversation altogether.

“Courage is more exhilarating than fear and in the long run it is easier.” – Eleanor Roosevelt

Happily, some of the language is refreshingly straightforward: the gender label at the end of the word is the target of the transition. A trans-man is a person who has made a transition and is now a man. Also clear are the abbreviations MTF (male to female) and FTM (female to male).

Prevalence

How common is this? The short answer is, we don’t really know. Studies from the last century varied, but all characterized Gender Identity Dysphoria (as clinicians called it) as quite rare. An often cited study in the Netherlands found it to be about 1 in 11,900 for MTF and 1 in 30,400 for MTF , but the researchers were only counting adults who came for hormone treatment and/or surgery. (2)   A questionnaire of mothers showed much higher numbers of children who “wishe[d] to be of opposite sex,” highest in the youngest children studied (4-5 years old) and declining to a couple of percentage points for the 12 and 13 year olds. (3)  But measuring prevalence has many challenges. Most attempts either assess children from a clinical pool (they came to a doctor or therapist for one reason or another), ask parents to report on their children,or ask adults about their childhood experiences. So, the results might vary widely from those you’d get if you randomly sampled all 6th graders, for example. Further, even though gender identity is formed in the preschool years, social pressure prevents many people with gender identity issues from affirming their identities until adolescence or later.

A little development theory for those interested: according to the Kohlberg model (in many psychology textbooks), most children don’t grasp gender constancy until around age 7.  In other words, many children know their gender as toddlers (“Gender Identity”), but aren’t certain that it won’t change as they grow (called “Gender Stability”), or that they can’t change it with behavior or dress (“Gender Constancy”) until later. This seemed to me not to give children enough credit, until I remembered how spotty my own kids’ grasp of various causes and effects were at that time. In those years, what matters in their day-to-day lives about their gender includes who they play with, how they play, and how adults treat them. Gender stereotyping still exists of course, but kids may not feel the limits these stereotypes impose until the end of the dress-up corner. A favorite kindergarten teacher once told me she loved that age because pretend was still so real to 5 and 6 year olds. If it feels real when they “are” dinosaurs, why not also when they “are” the other gender?

1. “The Third Sex: the Truth About Gender Ambiguity,” The Independent,  20 March 2010   

2. Bakker A et al, “The Prevalence of Transsexualism in the Netherlands” Acta Psychiatr Scand. 1993 Apr;87(4):237-8.

3. Achenbach and Edelbrock, 1981 as reported in  Kenneth J. Zucker and Susan J. Bradley, Gender Identity Disorder and Psychosexual Problems in Children and Adolescents (New York: The Guilford Press, 1995) 30