Table of ContentsView AllTable of ContentsBiological SexGender & IdentityIdentity & OrientationGender-Affirming CareIntersex CareRespect & Support
Table of ContentsView All
View All
Table of Contents
Biological Sex
Gender & Identity
Identity & Orientation
Gender-Affirming Care
Intersex Care
Respect & Support
Sex and gender are related to each other, but they are not the same. The difference between them is:
That’s a good start toward understanding gender vs. sex, but there’s far more to it. The categories “man and woman” and “male and female” do not capture every person. “Masculine and feminine” also fail to describe every person’s gender.
For example, someone’s sex assigned at birth may be “male” while their gender has stereotypically feminine characteristics. Or their sex may be “female” while their gender appears to have a combination of stereotypically masculine and feminine characteristics. Both sex and gender exist on their own spectrum, and the two spectrums don’t always interact in the same way.
This article explores the different aspects of sex and gender, the terminology that’s developed to describe them, how gender relates to sexual orientation, the kinds of medical care available to people who fall outside of the gender binary, and how you can be a good ally.
Gerardo Carnero / Getty Images
Understanding Biological Sex
The biology of sex starts with a discussion ofchromosomes, hormones, and anatomy.
The Role of Sex Chromosomes
The two types of sex chromosomes are X and Y.
Having two distinct sexes (male and female) creates abinary. When all of an individual’s sex characteristics correspond to one biological sex, they are described asendosex.
Chromosomal Variations
However, researchers have learned that biological sex isn’t always that simple. Some people:
Sometimes, these variations lead to unique combinations of biological traits (for example,ovariesandtesticles), which is called beingintersex. Other times, though, it results in someone who’s endosex.
In addition, some people have:
That can lead to someone being, for example, afemale with XY chromosomesor someone with unique sex characteristics in general. Some of these combinations don’t cause medical problems and simply represent normal genetic differences.
Other combinations cause medical problems which are called disorders of sexual differentiation.
The Role of Sex Hormones
The next major aspect of biology that determines sex is hormones and hormone receptors.
Everyone has hormones that are associated with sex characteristics. People assigned male at birth have higher levels of certain hormones, liketestosterone, in their bodies. People assigned female at birth tend to produce moreestrogen. However, everyone has both testosterone and estrogen present in their body regardless of their sex assigned at birth.
Exposure tosex hormoneshelps guide both fetal and adolescent development of sex characteristics.
Exposure to Sex Hormones
A fetus develops physical structures associated with the male sex, such as apenis, when it’s exposed to testosterone.
When a fetus isn’t exposed to testosterone, it develops physical structures associated with the female sex, such as avaginaanduterus.
If someone undergoing pregnancy has high levels of testosterone (due to illness or hormone therapy), their high testosterone may impact the fetus.Researchers have yet to fully understand the effects of this.
The Role of Anatomy
Your anatomy is your bodily structure. That includes your genitalia. The sex noted on your birth certificate is a form of medical classification. It reflects healthcare providers' interpretations of the genitalia they saw when you were born.
In short, a child with male-appearing genitalia will be assigned male at birth, while a child with female-appearing genitalia will be assigned female at birth. This sex would then be reported on the child’s birth certificate.
However, it is important to note anatomical appearance of genitalia does not always reflect the actual chromosomal and hormonal makeup of the child. Karyotype testing determines someone’s true chromosomal makeup.Blood or urine tests are used to detect true hormone levels in the body.
Understanding Gender and Gender Identity
Gender describes social and cultural ideas about the roles, behaviors, expressions, and characteristics people associate with men, women, additional genders, or a mixture of genders. It is separate from biological sex.
Gender identityis someone’s personal understanding and explanation of their gender.
If your gender and gender identity align with cultural expectations associated with the sex on your birth certificate, you arecisgender. If your gender and gender identity do not align with cultural expectations of the sex on your birth certificate, you could possibly be:
Even if you don’t understand the nuances of these terms, it’s important to pay attention to the terms people use to describe themselves. So, if someone tells you they’re genderfluid, it is best practice to refer to them as genderfluid, not necessarily genderqueer or nonbinary.
People who fall into any of these categories may refer to themselves as transgender or trans, as well. However, not all of them do.
Sex Assigned at BirthWhen talking about a trans person’s anatomy, it’s inappropriate to call it their “real” or “original” sex. It is the sex they wereassigned at birth. It’s common to see or hear:Assigned male at birth (AMAB)Assigned female at birth (AFAB)
Sex Assigned at Birth
When talking about a trans person’s anatomy, it’s inappropriate to call it their “real” or “original” sex. It is the sex they wereassigned at birth. It’s common to see or hear:Assigned male at birth (AMAB)Assigned female at birth (AFAB)
When talking about a trans person’s anatomy, it’s inappropriate to call it their “real” or “original” sex. It is the sex they wereassigned at birth. It’s common to see or hear:
Gender Stereotypes and Where They Come From
Pronouns
Everyone, whether transgender or cisgender, has pronouns that are equally deserving of respect. Once someone has made their gender known, you should use the appropriate pronouns. A pronoun is a word used in place of a name or names.
Common pronouns include:
Many trans people have pronouns that align with their gender, not the sex they were assigned at birth (for example, a trans woman who uses “she” and “her” pronouns).
Some have gender-neutral pronouns: they/them/theirs. This is considered grammatically correct as these pronouns have both single and plural usage in the English language.
Some people prefer other pronouns that are considered gender-neutral, such as “hir” or “zie” instead of “him” or “her.”
It is important to use the correct pronouns when addressing trans people because doing so has been shown to lower the chance of negative mental health outcomes.
It is never appropriate to use “it” for a person, regardless of their gender identity unless they explicitly express they are okay being referred to that way. It is also offensive to reduce trans people to the terms “ftm” or “mtf” unless they personally express they are okay being referred to in those ways. Mashed-up terms like “he-she” or “shemale” are highly offensive as well.
A trans person’s chosen name is the correct name to use when referring to them. Using a trans person’s correct name is associated with lower suicidality and depressive symptoms among trans youth.
Using and affirming a trans person’s pronouns has also been shown to decrease suicide attempts in the trans youth population.
What Is Gender Expression?
In addition to gender identity, people also havegender expression. That describes the gendered ways someone presents themselves to the world.
Your gender expression may or may not reflect your gender identity. For example:
Someone can be trans and still present themselves in ways that align with the social, cultural, and behavioral expectations of the sex they were assigned at birth. Many circumstances may prevent someone from presenting in a way that matches their true gender. This includes young people whose parents don’t allow them to express a certain way.
Gender Identity and Sexual Orientation
Gender identity is completely separate from sexual orientation. Like cis people, trans people can be:
How someone describes their orientation generally relates to their gender, not their biology. For instance, a trans woman who is attracted to men is considered straight. A trans man who is attracted to men is considered gay.
People who are nonbinary, genderqueer, a combination of genders, or additional genders may or may not use these terms to describe their sexual orientation.
What Does Heteronormative Mean?
Some trans people choose to seek out gender-affirmingmedical treatmentorsurgical proceduresto further express their true gender.
Gender-affirming careincludes a wide variety of interventions that help people align their social, emotional, and/or physical selves with their gender identity.It may include:
Hormone therapy and gender confirmation surgery alter someone’s appearance and sex characteristics to be more in line with their gender. Hormone therapy may cause a shift in sexual orientation, but this does not always occur. Having breasts added or removed is often referred to as top surgery, whereas a change in genitalia is called bottom surgery.
It’s considered inappropriate to ask a trans person whether they’ve had or plan to have gender confirmation surgery or hormone therapy.
Estrogen Therapy for Trans Women
Not Everyone Transitions
Not everyone who’s trans makes a medicaltransition. Some may wait until they’re old enough, until they can afford it, or for some other milestone to be reached.
Others may never make medical changes to their bodies. This may be due to financial, social, or familial pressures. It could be because they have an external medical issue that is an obstacle to medical transition. Some trans people may not have gender-affirming care accessible to them because they live far from a facility that provides such care or in a region where it is legally prohibited. Others simply don’t feel that medical transition is necessary.
Trans people should not be judged whether they medically transition or not. Lack of medical transition does not invalidate someone’s gender.
Intersex people make up between 0.02% and 1.7% of the population, depending on the definition that’s used.Historically, doctors and parents have opted for controversial early surgeries on intersex infants and young children to make them appear more like they were assigned male or female at birth.
The goal was to “normalize” the appearance of the child’s genitalia. This was often done without the child’s input and/or before the child was old enough to be included in the decision.
However, that has often not been the case, and some of those children have eventually rejected the gender identity that was given to them.
Some parents and healthcare providers still enforce genital surgery, hormones, and attempts to make an intersex child fit into the binary categories of male or female sex assigned at birth.
Beliefs are changing, though, and activists are calling for an end to these practices. They want the medical community to stop treating intersex status as a medical problem and to allow the child to be part of the decision-making process when they’re old enough.
Respecting and Supporting Trans People
Even if you don’t understand someone’s gender identity, or trans identities in general, you can show them that you respect and support them. Ways to do this include:
Restroom SafetyTrans people are more likely to face harassment—and even violence—for using any shared public restroom. Advocate for single-stall, gender-neutral bathrooms to ensure safety for this population.Single-stall bathrooms are also useful to disabled people and parents with children, regardless of whether they are trans or cis.
Restroom Safety
Trans people are more likely to face harassment—and even violence—for using any shared public restroom. Advocate for single-stall, gender-neutral bathrooms to ensure safety for this population.Single-stall bathrooms are also useful to disabled people and parents with children, regardless of whether they are trans or cis.
Trans people are more likely to face harassment—and even violence—for using any shared public restroom. Advocate for single-stall, gender-neutral bathrooms to ensure safety for this population.
Single-stall bathrooms are also useful to disabled people and parents with children, regardless of whether they are trans or cis.
What Is Transphobia?
Summary
Sex is biological and based on chromosomes, hormones, and anatomy. Gender is the social and cultural ideas about the roles, behaviors, expressions, and characteristics people associate with men, women, additional genders, or a mixture of genders.
Gender identity is your personal interpretation of your gender. Gender identity doesn’t dictate sexual orientation.
Gender expression is how you present yourself to the world.
People whose sex and gender do not align with social and cultural norms are transgender. Many terms exist that mean different things about trans identity, including agender, genderfluid, and nonbinary. People whose sex and gender align with social and cultural norms are cisgender.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Berenbaum SA, Beltz AM.How early hormones shape gender development.Curr Opin Behav Sci. 2016;7:53-60. doi:10.1016/j.cobeha.2015.11.011National Human Genome Research Institute.Karyotype.Mount Sinai Health System.Hormone levels.American Psychological Association.Answers to your questions about transgender people, gender identity, and gender expression.Minnesota Department of Health.Using a person’s correct pronouns saves livesRussell ST, Pollitt AM, Li G, Grossman AH.Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth.J Adolesc Health. 2018;63(4):503-505. doi:10.1016/j.jadohealth.2018.02.003Association of American Medical Colleges.What is gender-affirming care? Your questions answered.King DE.The inclusion of sex and gender beyond the binary in toxicology.Front Toxicol. 2022;4:929219. doi:10.3389/ftox.2022.929219National Center for Transgender Equality.Understanding non-binary people: How to be respectful and supportive.Additional ReadingCarpenter M.The human rights of intersex people: addressing harmful practices and rhetoric of change.Reprod Health Matters. 2016;24(47):74-84. doi:10.1016/j.rhm.2016.06.003Griffiths DA.Shifting syndromes: Sex chromosome variations and intersex classifications.Soc Stud Sci. 2018;48(1):125-148. doi:10.1177/0306312718757081PFLAG.PFLAG national glossary of terms.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Berenbaum SA, Beltz AM.How early hormones shape gender development.Curr Opin Behav Sci. 2016;7:53-60. doi:10.1016/j.cobeha.2015.11.011National Human Genome Research Institute.Karyotype.Mount Sinai Health System.Hormone levels.American Psychological Association.Answers to your questions about transgender people, gender identity, and gender expression.Minnesota Department of Health.Using a person’s correct pronouns saves livesRussell ST, Pollitt AM, Li G, Grossman AH.Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth.J Adolesc Health. 2018;63(4):503-505. doi:10.1016/j.jadohealth.2018.02.003Association of American Medical Colleges.What is gender-affirming care? Your questions answered.King DE.The inclusion of sex and gender beyond the binary in toxicology.Front Toxicol. 2022;4:929219. doi:10.3389/ftox.2022.929219National Center for Transgender Equality.Understanding non-binary people: How to be respectful and supportive.Additional ReadingCarpenter M.The human rights of intersex people: addressing harmful practices and rhetoric of change.Reprod Health Matters. 2016;24(47):74-84. doi:10.1016/j.rhm.2016.06.003Griffiths DA.Shifting syndromes: Sex chromosome variations and intersex classifications.Soc Stud Sci. 2018;48(1):125-148. doi:10.1177/0306312718757081PFLAG.PFLAG national glossary of terms.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Berenbaum SA, Beltz AM.How early hormones shape gender development.Curr Opin Behav Sci. 2016;7:53-60. doi:10.1016/j.cobeha.2015.11.011National Human Genome Research Institute.Karyotype.Mount Sinai Health System.Hormone levels.American Psychological Association.Answers to your questions about transgender people, gender identity, and gender expression.Minnesota Department of Health.Using a person’s correct pronouns saves livesRussell ST, Pollitt AM, Li G, Grossman AH.Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth.J Adolesc Health. 2018;63(4):503-505. doi:10.1016/j.jadohealth.2018.02.003Association of American Medical Colleges.What is gender-affirming care? Your questions answered.King DE.The inclusion of sex and gender beyond the binary in toxicology.Front Toxicol. 2022;4:929219. doi:10.3389/ftox.2022.929219National Center for Transgender Equality.Understanding non-binary people: How to be respectful and supportive.
Berenbaum SA, Beltz AM.How early hormones shape gender development.Curr Opin Behav Sci. 2016;7:53-60. doi:10.1016/j.cobeha.2015.11.011
National Human Genome Research Institute.Karyotype.
Mount Sinai Health System.Hormone levels.
American Psychological Association.Answers to your questions about transgender people, gender identity, and gender expression.
Minnesota Department of Health.Using a person’s correct pronouns saves lives
Russell ST, Pollitt AM, Li G, Grossman AH.Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth.J Adolesc Health. 2018;63(4):503-505. doi:10.1016/j.jadohealth.2018.02.003
Association of American Medical Colleges.What is gender-affirming care? Your questions answered.
King DE.The inclusion of sex and gender beyond the binary in toxicology.Front Toxicol. 2022;4:929219. doi:10.3389/ftox.2022.929219
National Center for Transgender Equality.Understanding non-binary people: How to be respectful and supportive.
Carpenter M.The human rights of intersex people: addressing harmful practices and rhetoric of change.Reprod Health Matters. 2016;24(47):74-84. doi:10.1016/j.rhm.2016.06.003Griffiths DA.Shifting syndromes: Sex chromosome variations and intersex classifications.Soc Stud Sci. 2018;48(1):125-148. doi:10.1177/0306312718757081PFLAG.PFLAG national glossary of terms.
Carpenter M.The human rights of intersex people: addressing harmful practices and rhetoric of change.Reprod Health Matters. 2016;24(47):74-84. doi:10.1016/j.rhm.2016.06.003
Griffiths DA.Shifting syndromes: Sex chromosome variations and intersex classifications.Soc Stud Sci. 2018;48(1):125-148. doi:10.1177/0306312718757081
PFLAG.PFLAG national glossary of terms.
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