Persistent, consistent, and insistent: how to tell the difference between gender-expansive and transgender

Many kids who stretch or defy gender norms are doing just that, even if part of the stretching includes changing how they talk about their gender. Some will “settle” into* more typical gender dressing and behaviors, some will forever be “tomboyish” girls or “sensitive” boys, and some will be transgender. How can you tell the difference?  We want do the right parental things: protect kids from preventable harm, prepare them for unavoidable difficulties, support development of noble character, and love them wholly. But how we do those things depends partly on which group we expect the kid to end up in.

Jean Malpas, director of the Ackerman Institute’s Gender and Family Project, offered an elegantly useful explanation in an interview today on NPR’s “Morning Edition,”

Just about all kids explore gender and gender roles, but what’s different, psychologically, for children who come to the conclusion that they’re not comfortable with their biological sex?

Yes, gender fluidity and exploration of gender roles is a normal phase of child development. What’s different for transgender children is that they experience a profound distress about the gender that was assigned to them based on their biological sex. So, we call that gender dysphoria.

And that distress is what we call persistent, consistent and insistent. It’s persistent over time. It’s not something that just shows up for a few weeks and goes away. It’s consistent in different contexts and relationships. And it’s also very insistent. They are very, very passionate about it. It’s not something that they take lightly or that is going to go away again in a few weeks. It is really core to who they are.

* I almost wrote “settle for more typical gender dressing and behaviors.” Surely to some, the settling feels like a choice or need to stop spending the energy required to answer the offensive questions, ignore the hurtful comments and establish credibility in the face of first-impression judgments. This makes me sad to think about. If more of us comfortably cis-gendered people pushed the norm limits once in awhile, would that mean we all had to “settle for” our roles a little less?


Wild Ambassadors for Transpeople

Intersex is not confined to humans. A recent Wall Street Journal feature by Kevin Helliker described “the highlight of anything I will ever do” for North Carolina hunter Chuck Rorie: an 8-point doe. Biologists believe the incidence of intersex deer is “from one in 5,000 to far fewer than one in 10,000,” making them rarer than intersex humans, if both estimates are accurate. But life is hard when you are unusual: “Anecdotal reports suggest that antlered does are outcasts, wary of bucks and ostracized by other does, which tend to run in small packs. ‘The does were running from it, like they thought it was a buck,’ Rorie said of the antlered doe he shot.

2014 saw 4 reports of antlered does taken by hunters, one shot by a 72-year old Arkansas grandmother. (You go, girl.) Her son plans to have the entire specimen preserved as an example of gender diversity in nature. “‘It opens my eyes,” said Byrd, an Arkansas farmer. “If this can happen to an animal, I can’t see why it can’t happen to people as well.’ “

Gender Expression

gender exp

A third spectrum is gender expression, a pattern of behaviors that typically “belong” to males or females in your community. It is heavily, if not altogether, culturally defined, and often situation-specific. Acting aggressively and speaking confrontationally in some circumstances may be “unfeminine,” but in a context of threat to her children might be “normal mama bear” behavior. You can see that studying the incidence of this gets very squishy very fast. In recent decades, the blurring of strict gender roles has made this spectrum more open for everybody, but generally more so for women than men.

Many childhood development experts consider some degree of gender-variant play normal for children. (1) When it comes to pretend, gender seems like a small stretch. Some kids’ games could be described as species-variant (“let’s be ponies”), age-variant (“I’ll be the mommy and you be the little baby”), planet-variant (“let’s go to the moon”), geologic-era-variant (“let’s be dinosaurs”), and of course, reality-variant (cartoon, magical and other characters). Some kids occasionally play at being a different gender, but for others it’s a recurring theme.

So why does frequent or consistent gender-variant play and behaviors cause concern? Parents wonder what conclusions to draw for the future, and protectively fear their child may be teased or worse in the present.

What does it mean for the future? Most studies are small, and tend to focus on the children who exhibit the most gender-variant behaviors.

A small study of boys found that three-quarters of the “feminine boys” were homosexual or bisexual using the Kinsey scale, compared to none of the boys in the “masculine” control group. (2) A longitudinal study followed 54 children who had been referred to a Dutch clinic for Gender Identity Dysphoria over 10 years, and found that “Most children with gender dysphoria will not remain gender dysphoric after puberty…. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.” In their sample, almost all of those whose gender dysphoria persisted through adolescence identified as non-heterosexual, while all the girls and half the boys whose GID diminished with adolescence identified as heterosexual. (3)

An older but larger study found that 5-13% of boys and 20-26% of girls (ages 12-18) reported their own behavior as sometimes cross-gender; significant subsets reported sometimes wanting to be a different gender. (4)  These rates are far higher than the rates of biologically intersex and transgender people, and noticeably higher than estimates of non-heterosexuality.

But for many parents of kids with “nonconforming” gender behavior, the important challenge is separating concern about sexual orientation (maybe to be revealed soon, maybe in the future) from concern about teasing, manipulation and bullying right now. For young kids, the peers in and out of the dressup corner aren’t thinking about sexual activity, even if they use “that’s so gay” as a taunt. They are, in the words of a Japanese proverb, hammering the nail that sticks up. A parent has no influence on whoever it turns out little Michael-as-Glinda or Kayla-as-Batman will be attracted to a decade from now, but quite a lot of influence on how s/he feels about today’s play and the playmates reactions. More about this is in “Bias: Blatent and Latent” (coming soon).

For older kids, the verbal and physical hammering is real much too often.    GLSEN (Gay, Lesbian and Straight Educators’ Network) has been conducting well-regarded broad-scale research into the social climate of schools for LGBT youth since 1999. Comparing the results from 2001 and 2011 (latest available), it’s remarkable how little has changed.

2001-10 bigSadly, although it’s becoming slightly less acceptable to say “that’s so gay,” “fag” and “dyke,”  it’s still ok in too many schools to taunt or slam into lockers someone whose behavior doesn’t match what you think a person of their gender should do. Interestingly, in this same time period the number of LGBT teens who reported hearing sexist remarks frequently or often also fell (85% to 71%) but the number who heard racist remarks frequently or often rose (35% to 42%). (5)

1. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011. 4, page 2 Childhood/Adolescence. Available from:

2. Green R: The “Sissy Boy Syndrome” and the Development of Homosexuality. New Haven, CT, Yale University Press,  1987, as reported in Kenneth J. Zucker, PhD; Susan J. Bradley, MD: Gender Identity and Psychosexual Disorders, FOCUS. 2005;3:598-617.

3. Wallien MS, Cohen-Kettenis PT “Psychosexual outcome of gender-dysphoric children”, J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1413-23.

4. Achenbach T M & Edelbrock C, Manual for the Youth Self-Report and Profile. Burlington VT : U of VT Dept for Psychiatry; 1987, as reported by W J Meyer III  in his commentary in Pediatrics Vol 129 #3” March 2012, p 571.

5. GLSEN, National Schools Climate Survey 2011 and National Schools Climate Survey 2001.

Gender Identity: Who You Believe You Are

gender id

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).


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 NetherlandsActa 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

Two Stories in Honor of Coming Out Week

We still have a long way to go toward equal access:

It looked like Domaine Javier was doing everything right. With an associate’s degree and admission with a scholarship to California Baptist University, her dream of a nursing career seemed to be within reach. On her application to CBU, there were only two boxes for gender, and she checked “female.” CBU rescinded the admissions offer when they became aware of her transgender status, on the grounds that she had misrepresented herself. She could hardly have been said to be hiding her status as a transwoman, having been featured in a documentary series on MTV that spring about the challenges of trans life called “True Life.” And checking “male” would have been a clear misrepresentation; Domaine has been living as a woman since age 13. (More details are here.) But Domaine is still in charge of her life and her dream: she is suing CBU, she started nursing classes at another institution, and she has been cast in a web series called “The Switch,” in which all the trans roles are cast with trans actors.


And stereotypes are still limiting and too pervasive. Why, asks Rebecca Holliman, if we CAN talk more openly about all kinds of sex, do so many people feel we MUST? See her (maybe slightly tongue-in-cheek) essay on the challenges of being a lesbian prude here.