Gender vs. Sex: Meaning, Differences, Healthcare
Sex is about biology, gender is about identity
Medically reviewed by Renita White, MD
Sex and gender are related to each other, but they are not the same. The difference between them is:
Sex describes biology (chromosomal makeup, hormones, and/or anatomy)
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
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.
Understanding Biological Sex
The biology of sex starts with a discussion of chromosomes, hormones, and anatomy.
The Role of Sex Chromosomes
The two types of sex chromosomes are X and Y.
Most people have two sex chromosomes.
Those with two X chromosomes (XX) are usually assigned female at birth.
Those with an X and a Y (XY) are usually assigned male at birth.
Having two distinct sexes (male and female) creates a binary. When all of an individual's sex characteristics correspond to one biological sex, they are described as endosex.
Chromosomal Variations
However, researchers have learned that biological sex isn't always that simple. Some people:
Have one sex chromosome (X)
Have three sex chromosomes, called trisomy (XXX, XXY, XYY)
Sometimes, these variations lead to unique combinations of biological traits (for example, ovaries and testicles), which is called being intersex. Other times, though, it results in someone who's endosex.
In addition, some people have:
Two sex chromosomes (XX, XY) with unique or dysfunctional genes on one of the chromosomes
That can lead to someone being, for example, a female with XY chromosomes or 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, like testosterone, in their bodies. People assigned female at birth tend to produce more estrogen. However, everyone has both testosterone and estrogen present in their body regardless of their sex assigned at birth.
Exposure to sex hormones helps 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 a penis, 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 a vagina and uterus.
In some cases, a fetus with XY chromosomes is exposed to amounts of testosterone that are too small to cause male structures to develop. That can lead to an intersex baby.
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 identity is 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 are cisgender. If your gender and gender identity do not align with cultural expectations of the sex on your birth certificate, you could possibly be:
Transgender/trans: This term refers to someone whose gender or gender identity does not align with the social and cultural expectations about the sex they were assigned on their birth certificate. It is often used as an umbrella term for all of the below.
Trans man/trans woman: The "man" or "woman" refers to the person's gender; for example, a trans man is someone who lives as a man despite being assigned the female sex at birth.
Transmasculine/transfeminine: These are umbrella terms for trans people who have genders outside of the gender binary. These terms are inclusive of trans men and trans women in addition to people who identify as genderqueer, nonbinary, or a combination of genders. For example, a non-binary person assigned female at birth who is masculine may be considered transmasculine because they are not a trans man.
Gender nonconforming: An umbrella term for people who do not follow gender stereotypes. While some gender-nonconforming people consider themselves transgender, many do not.
Genderfluid/genderflux/genderqueer/bigender: All of these describe a gender that encompasses or fluctuates between multiple genders (it may fluctuate between man and woman, but not always).
Agender: This is the term for someone who doesn't align with any gender.
Nonbinary: This describes someone who doesn't subscribe to the gender binary of man or woman; they may have a gender outside of those two categories or be somewhere between. Nonbinary people may or may not identify as trans. The term is sometimes used interchangeably with genderqueer or other terms.
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 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 were assigned at birth. It's common to see or hear:
Assigned male at birth (AMAB)
Assigned female at birth (AFAB)
Related: 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:
I/me/my/mine
He/him/his
She/her/hers
They/them/their/theirs
We/us/our/ours
You/your/yours
It/its
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.
Using Correct Pronouns and Chosen Names Saves Lives
When a trans person chooses a new name, their former name is referred to as a deadname. Calling or referring to them by that name is called deadnaming.
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 have gender 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:
A cisgender woman with short hair who likes to wear tailored suits is still a woman, though some people may see her presentation as stereotypically masculine
A transgender man who wears makeup is still a man despite presenting in a way that's stereotypically considered feminine
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:
Straight
Gay
Lesbian
Bisexual
Pansexual
Asexual
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.
Related: What Does Heteronormative Mean?
Gender-Affirming Care
Some trans people choose to seek out gender-affirming medical treatment or surgical procedures to further express their true gender.
Gender-affirming care includes a wide variety of interventions that help people align their social, emotional, and/or physical selves with their gender identity. It may include:
Changes in appearance
Hormone therapy
Counseling
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.
Terms like "sex reassignment surgery" and "sex change operation" are outdated.
The goal of gender-affirming care is to relieve gender dysphoria, which is the discomfort caused by a mismatch between someone's body and their true gender.
It's considered inappropriate to ask a trans person whether they've had or plan to have gender confirmation surgery or hormone therapy.
Learn More: Estrogen Therapy for Trans Women
Not Everyone Transitions
Not everyone who's trans makes a medical transition. 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 Care
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.
The child was then generally raised as the gender that culturally aligned with the genitalia chosen by their medical providers and/or parents. The belief was that having clearly male or female genitalia—and a gender expression that matched the genitalia—would lead to an easier and happier life.
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:
Use the names and pronouns they choose for themselves. If you make an occasional mistake, apologize, correct yourself, and move on.
Try not to make assumptions about gender. Remember that identity and expression don't always match. If you're unsure what pronouns to use, ask.
Advocate for trans-friendly policies, such as gender-neutral restrooms or rules allowing them to use whichever they're comfortable with, and choices on forms that go beyond the man-woman gender binary.
Accept that people are what they say they are. Don't reject what they tell you based on their presentation, sexual orientation, or other traits.
Don't ask intrusive questions about their bodies, stage of transition, sexuality, or sexual practices.
Recognize that someone's idea of their gender may evolve over time. Identities and understandings of them can shift.
Put your own pronouns in places like your email signature or name tags—even if you're cis—to normalize the practice.
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.
Related: 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.
Read the original article on Verywell Health.
