What is sex? What is gender?

This text is available in German: Was ist Geschlecht? | Please accept my (semi)anonymity.

This is a 101 (= introductory) post on the multiple meanings of the words sex and gender. It is directed at cis (= non-trans) dyadic (= non-intersex) people, as most trans and intersex people probably know everything or almost everything I write here. I learned most things I write here from trans women and trans men and a few things from genderqueer people (= non-binary trans people) and intersex people.

[The cultural context is, for the most part, Europe, North America and similar regions/countries.]

I used to think it was really neat that English had the separate words sex and gender for what is only called Geschlecht in German and has to be clarified regarding what is meant. But by now I think it actually causes more problems than it solves, as it results in people just using sex or gender and thinking their audience / conversation partner will pick up the same meaning as they intended, even though each of these means at least 2 to 4 different things. So, what are the meanings?

(0) Grammatical gender

Some languages have three genders: masculine, feminine, neutral. Some have two: masculine and feminine. Some have two others: masculine+feminine and neutral (okay, kinda, usually the pronouns have three genders anyway). Some don’t have genders. Some languages gender (this is gender as a verb) the pronouns, nouns, articles and adjectives (e.g. German and French), some only gender some of these types of speech, e.g. only the pronouns (for example English).

There are a lot of interesting things that could be said about grammatical genders, but not in this article, otherwise I would not get to write about anything else.

Only so much: The people who say “Words have genders. People have sexes.” clearly come from 1954, as the word gender has been used for people since 1955 (in the “WHO meaning” of the word, see the last of the definitions in this text).

(1) Legal sex/gender

Most, if not all, countries record a legal sex / legal gender on the birth certificate and some other forms of identification. The words sex and gender are used interchangeably for the legal status.

Some countries allow trans people and/or intersex people to change their legal sex/gender, some conservative countries sadly don’t. Few countries so far allow “on demand” changes of the legal sex/gender (e.g. Argentina), some have mild requirements (letter from a therapist or doctor, e.g. in several US states), some have severe requirements (demanding specific kinds of medical treatment e.g. surgeries or infertility [scrapped in many countries including Germany and Sweden because it’s a human rights violation] and/or demanding therapy and/or demanding one or two lengthy and expensive psychological evaluations [e.g. 2 in Germany] – how anyone besides the person zirself is supposed to be able to evaluate zir gender identity is a mystery).

Many trans and some intersex people who have more than one citizenship and/or do not live in the country they were born in (in the case of strongly federally organized countries like the US even if they live in a different state) end up with more than one legal sex/gender. That can have pretty fucked-up results, like not being able to get a divorce or not inheriting from their deceased spouses. (This is of course only one of the ways trans and intersex people are treated in fucked-up ways even in the supposedly most progressive countries.)

Most countries have two legal sexes/genders, male and female. A few have a third, e.g. India – see for example the India Visa Application Form. There the third gender is translated into English as “transgender”, which is a bit problematic as many, possibly most, trans people identify as male or female (not as a third gender) – it’s unclear whether trans women should choose female or transgender, whether trans men should choose male or transgender. [Well actually in this particular case it’s not so unclear, they have to choose whatever their passport says.] However, the in-community term for non-binary people, “genderqueer”, has not yet entered mainstream language, so it’s better than not having a third option at all. Also, in the case of India and other cultures with traditional third genders, “genderqueer” is (usually) not an accurate translation, either – the Indian third gender encompasses intersex people (who were visibly intersex at birth), (some? all?) trans women and (especially in the past) castrated men (“eunuchs”). Some cultures (e.g. some Native American peoples) have four traditional genders, but I don’t know of a country that has four legal sexes/genders, yet.

But to come back to the cultural context of Europe, North America etc., for which this article is written: Germany has introduced a third legal sex/gender this year, intersex children are to be registered with a “blank” sex/gender. Not as good as it may initially sound, intersex organizations oppose this, as it causes mandatory outings and may actually cause parents to go through with surgeries early to be able to register their child as M or F. (Protecting intersex children from surgeries before they are old enough to understand and consent is the number 1 priority of intersex organizations worldwide; in Germany and many other countries this is far from being achieved.)

Let’s talk about passports again: While passports can serve as ID in most countries for most purposes (sometimes additional proof of address may be needed) they are firstly international travel documents and thus have to follow international agreements. They can show the following three sex/gender markers: M, F or X (but most countries do not issue passports with the X marker). Blank sex/gender markers or others (e.g. IS-F and IS-M as suggested by some German intersex organizations) are not possible in passports. (Up to about 10 years ago some countries including Germany issued passports with blank sex/gender markers to transitioning people. Since then rules got a lot stricter; you probably mostly noticed the stricter rules for biometric photos.) Passports do not necessarily have to show the same sex/gender marker as is the legal sex/gender of that person in that country (depending on the laws of the country), e.g. in the UK the requirements for changing the sex/gender marker in the passport are lower than the requirements for changing the legal sex/gender. New Zealand specifically permits passports with sex/gender marker X for people diagnosed with transsexuality/gender identity “disorder”/gender dysphoria based on a letter from the therapist or doctor. (They do not permit X for intersex people, yet, as far as I have followed the news.) Optimally any and all people should be able to get passports with M, F or X according to their choosing – also multiple ones, as entering some countries disclosing trans status (or maybe even intersex status?) can be dangerous. (Having more than one passport for the same country is not unusual, e.g. if you have stamps from Israel passports you will need to get a separate passport for entering many Muslim countries.)

What are the legal consequences of being legally male or female (or other)? Not a lot anymore, in most progressive countries.

  1. Mostly it impacts whether you can get married or only registered as civil union, domestic partnership or a similar legal relationship with lesser rights (in countries where such a distinction is still made).
  2. It may influence whether you can join the army and perform certain roles – women might have only the right to do medical and music services (as in Germany until the year 2000, when German women successfully sued against this limitation at the European Court of Justice), or they might be allowed to perform most roles: usually except fighting directly on the front line. Even the US does not send women to the front line in fighting roles (they have supportive roles near the front line, though, and carry weapons with them). Also, men can get drafted, women cannot in most countries. Israel drafts both men and women, men for 3 years, women for 2 years.
  3. Until 2009 Germany and all other countries bound by an international worker protection agreement from 1935 did not permit women to work in mines under the surface of the earth. The European Court of Justice ordered EU countries to leave the agreement. Other countries may still be bound by it.
  4. In most countries the legal sex/gender will decide which jail/prison, gendered emergency group residence for the homeless or gendered group residence for refugees you will end up in. Needless to say, the result is usually disastrous for trans people who have not been able to change their legal sex/gender, yet. (Trans men are often also in danger in men’s facilities.) Rape is frequent. Abuse by other inmates/residents and by police, prison wards, security people or administrators is frequent. Homeless trans people may not be able to enter either men’s or women’s facilities, no matter which legal sex/gender they have. Trans people in general are often victims of abuse by police even if they successfully changed their legal sex/gender, and treated as members of the sex/gender they were assigned at birth (for example trans women forced to dress or undress in front of or searched by police men).
  5. In most not-Anglosaxon countries the name has to match the legal sex/gender. The effects for trans people may vary. E.g. originally the German legal transitioning process considered a name change near the beginning of the transitioning process, then a period in which name and legal sex/gender did not align (with various situations in which one could lose the name again, e.g. marriage and child birth – most of which have been scrapped by courts in the meantime), and then after “completing” transitioning the change of the legal sex/gender. Since the courts also scrapped surgery requirements for trans women in 2009 (for trans men it was struck down around 2000) this is not the case anymore, name and legal sex/gender can be changed together (requiring, as mentioned, two expensive psychological evaluations).

In more conservative countries the legal consequences can be a lot more, of course (similar to those Europe, North America etc. had let’s say a hundred years ago and in some cases still in the 1950s). Women might not be allowed to vote, work (without the husband’s permission), drive, open bank accounts (without the husband’s co-signature) or sign contracts in general. Men might not be allowed to wear “women’s clothes” and vice versa. By the way, up to the 19th century visibly intersex children (i.e. those with ambiguous genitalia at birth) were generally raised as boys, for the purpose of not depriving a possible boy child of the rights of a man. (Nowadays such intersex children are often raised as girls, because female genital construction surgeries are easier – which are often performed without waiting whether the child develops a male or female (or other) gender identity or whether even a female-identified child or young person is interested in having her genitals altered in this way.)

Arguably in countries were women and men have equal legal rights and the discrimination of same-sex couples (meaning same-legal-sex/gender couples) has been abolished we don’t need a legal sex/gender anymore. But how do we protect the rights of trans people to gender-appropriate jails and group housing if there is no legal sex/gender? I’m not sure. Maybe we should make the legal sex/gender optional.

Damn, I thought the section on legal sex/gender would be like one or two short paragraphs. Now it looks like I could have written an article on this topic alone. Do not despair, let’s go to the next meaning of sex and gender.

(2) Sex/gender assigned at birth

Trans women are female-identified people who were assigned male at birth. Cis women are female-identified people who were assigned female at birth. Trans men are male-identified people who were assigned female at birth. Cis men are male-identified people who were assigned male at birth. Genderqueer (=non-binary) people identify not (or not only) as men and not (or not only) as women and may have been assigned male or female at birth. “Female-identified person” and “female person” and “woman” mean the same; likewise “male-identified person” and “male person” and “man” mean the same. Thus we can also write: Trans women are women who were assigned male at birth. Cis women are women who were assigned female at birth. Trans men are men who were assigned female at birth. Cis men are men who were assigned male at birth. (For young people replace women with girls and men with boys.)

Common abbreviations: FAAB (female assigned at birth), AFAB (assigned female at birth), CAFAB (coercively assigned female at birth, i.e. without asking the child first – which causes considerable harm to children who turn out to be trans). MAAB (male assigned at birth), AMAB (assigned male at birth), CAMAB (coercively assigned male at birth).

Assignment refers to non-surgical assignment, i.e. some or all of the following things (partially depending on the parents): Saying “this is a girl” or “this is a boy” at birth and informing relatives and friends such. Noting it down on the birth certificate. Giving the child a feminine or masculine name. Referring to the child with “she” or “he”. Possibly giving the child “girl toys” or “boy toys” and maybe telling them not to use the other toys. Possibly dressing the child in “girl clothes” or “boy clothes” and maybe telling them they can’t have the other clothes. Enrolling the child in the nursery, preschool, kindergarten or school as a girl or boy. And so on and so on.

What about intersex children (whose intersexuality is visible at birth due to ambiguous genitalia)? In most countries they are also assigned the male or female sex/gender at birth (as mentioned Germany starts to register them without legal sex/gender this year, but they are probably assigned a sex/gender by their parents anyway, i.e. raised as a boy or girl). Some of those intersex people who change their lived/expressed gender and/or their legal sex/gender in the course of their lives identify as trans, some don’t. (The medical definition says that only dyadic (= non-intersex) people can be diagnosed as trans, but the trans and intersex communities and individuals are obviously not bound by what cis dyadic people decided for them in their medical catalogs.)

Why not say “biologically male” or “biologically female”? As we will see further down, neurological sex as well as gender identity are or at least can be partially or fully biological, too. Also: Trans women are female, thus they are not male and therefore also not biologically male, and vice versa for trans men. Genderqueer people are not or not only male and not or not only female, thus they are also not biologically male or female. (A few trans men and trans women and many, especially non-transsexual, genderqueer people might not object to being called biologically male or female – of course they can call themselves whatever they want; this does not give cis people the permission to use these terms on other trans people, not even those with the same gender identity and body configuration as a trans person they know who is okay with it.) Other objections: See anatomically / physically male/female.

Why not say “genetically male” or “genetically female”? Did you get a chromosome test? Are you sure you have exactly two sex chromosomes? Are you sure they are the ones you guess they are? Maybe you have X, XXX, XXXX, XXXXX? XXY, XXXY, XYY? Or mosaic, with some cells with one set of chromosomes and some cells with a different set? (Actually most people with Turner Syndrome (X) and many with Klinefelter Syndrome (XXY, XXXY or XXXXY) know, as there are other noticeable symptoms.) Also: Trans women are female, thus they are not male and therefore also not genetically male. Vice versa for trans men. You can figure it out for genderqueer people by now, I am sure. (Some trans people use genetic men for cis men and genetic women for cis women. Some also use genetically male or female for themselves. Of course they can refer to themselves however they wish – this does not entitle cis people to do the same.)

Why not say “man in a woman’s body” or “woman in a man’s body”? Let’s hear a (generic) trans man about this: “I am a man. This is my body. Therefore it is a man’s body. Which woman’s body could it possibly be, who did I supposedly steal it from?” Analog for trans women.

Why not say “anatomically” or “physically” male or female or “male-bodied” or “female-bodied”? First, you probably don’t know the medical transition status of the trans person – and in the vast majority of cases you have no right to know (and it would be incredibly rude to ask). So, is a trans woman anatomically/physically male / male-bodied even if she has a vagina and vulva and no more penis and testicles? Just because she has a Y chromosome, lacks a uterus (which about a third of all cis women lack by the end of their lives, too) and, if she did not have access to hormone blockers during her first puberty, possibly masculine bone structures? I think most people would not seriously call a post-op trans woman anatomically male, except out of spite (I’m looking at you, TERFs [trans-exclusionary radical fauxminists]). What about pre-op / no-op trans women? Considering the penis-worship in our societies I can see how some cis people would call any person with penis anatomically or physically male or male-bodied. But have a look at a trans woman after taking estrogen and spiro or another androgen-blocker for some time: Is a woman with breasts, fat distributed in a feminine pattern to the hips and butt and softened skin anatomically/physically male / male-bodied, just because she has a penis, which you can’t even see under her clothes in most cases? Similarly for trans men: For example, most trans men get top surgery (mastectomy + shaping of masculine breasts), many have a hysterectomy (removal of uterus and ovaries) and only a relatively low number choose to get any of the various genital surgeries. Is a bearded man with deep voice, male-pattern boldness, masculine facial features, a typically male fat and muscle distribution (with any excess fat migrating to the belly) anatomically/physically female / female-bodied? Where does it start, where does it end, what’s the cut-off point for being biologically/anatomically/physically male or female? Okay, you say, but what about trans people prior to starting transitioning? (Or those who choose not to transition medically.) It varies. Some trans men and FAAB genderqueer people consider their pre-transitioning bodies to be female and some trans women and MAAB genderqueer people consider their pre-transitioning bodies to be male. But some trans men say: Fuck this, I’m male, I have always been male – and so has my body. Likewise for the other groups. The tendency seems to go towards the second approach (especially among female-to-male-spectrum trans people). Obviously, there is nothing wrong with either form of self-attribution, everyone can call their body including their sex characteristics whatever the fuck they want.

Why not say “socialized as male” or “socialized as female”? First, you don’t know that. Some trans people recognize their true gender identity very early, already around the age of 3, when children start figuring out what the words he and she, boy and girl mean. Some parents are very supportive and let their child already transition socially so early that they can even be registered for school as the girl or boy they are. So some trans boys/men have been socialized male after the initial 3 (or however many) years and some trans girls/women female. Second: Girls, or let’s say correctly female-assigned children, are not wrapped in a pink bubble at birth and protected from any masculine influences. Likewise, boys, or more precisely male-assigned children do not grow up in a blue bubble. Gendered social influences come from all directions, not just the parents, but siblings, friends, teachers, books and TV. Little “girls” also learn how boys and men supposedly are to behave. Little “boys” also learn how girls and women are supposed to be. Think about it: Most little “boy” children are not told anymore nowadays that they are not supposed to cry – but seeing an unrelated adult say this to an unrelated (supposed) boy on the playground can be enough to put this into the mind of the witnessing child, of any assigned and actual gender. How much of the socialization for children of their actual gender trans children pick up as part of their view of themselves or their behaviors is hard to say, probably it varies by child and e.g. by how much they are aware of their gender identity already and by how tolerant the parents are of gender-variant behavior. Nevertheless, it hardly needs to be said, if a trans person wants to describe themself as socialized as male or female it’s nobody’s place to tell them they should not. Whatever words they choose to describe themself and their life are correct.

A final note: One can argue both for “sex assigned at birth” (as the assignment is based on the looks of the genitals and, in the case of ambiguity, possibly tests of the cells in the gonads or genetic tests) and for “gender assigned at birth” (as it is the gender in which the parents intend to raise the child). The distinction is not particularly important in this case.

(3) Anatomical or physical sex, sometimes also biological sex, or just sex

Woah, are we at definition 3 already? It’s going so fast *cough cough*.

This is easy right? Penis = anatomically/physically/biologically male, no penis = anatomically/physically/biologically female, right? Pure biology, no problems? Except not.

First, sex is a social construct. Wait, you say, it’s biological, it’s not a social construct! But it is. The individual sex characteristics are biological. Interpreting a set of them as male or female sex or as intersex(ual) is social.

Let’s look at the sex characteristics.

Primary (birth / pre-puberty) sex characteristics that are considered female: ovaries, uterus, vagina, vulva, XX chromosomes (though we already saw that can vary).

Secondary (post-puberty) sex characteristics that are considered female: breasts, no facial hair, high voice, no visible Adam’s apple, little and light, soft hair on arms/legs/chest/belly/back, monthly period, estrogen and progesterone flowing through one’s blood vessels.

Primary sex characteristics that are considered male: testicles, scrotum, penis, XY chromosomes (though we already saw that can vary).

Secondary sex characteristics that are considered male: facial hair, no breasts, deep voice, visible Adam’s apple, a lot and darker, coarser hair at least on arms and legs, often also on chest/belly/back, able to produce sperm, testosterone flowing through the blood vessels.

Primary sex characteristics that are or may be considered an indicator for intersexuality: enlarged clitoris, micropenis (note that clitoris and penis are basically the same organ; whether an organ is an enlarged clitoris or a micropenis can be open to interpretation), partially or fully grown-together labia, partially open (on the under side) penis, hypospadias (urethra opening on the underside of the penis), epispadias (urethra opening on the upper side of the penis), blind-ending vagina, life-threatening problems with the regulation of salt levels in the body (CAH = congenital adrenal hyperplasia), streak gonads (gonad cells have not turned into either ovary cells or testicle cells; both ovary and testicle cells appearing in the same human can only happen in the case of mosaicism), XY chromosomes and female-looking primary sex characteristics (for example partial or complete androgen insensitivity), XX chromosomes and male-looking primary sex characteristics.

X, XXX, XXXX with female appearance and XXY, XXXY, XYY with male appearance are usually not considered intersexuality; however, X-women might show up as male, XXY- or XXXY-men might show up as female in chromosome tests, as these often test for the Barr body, the inactive X (in XX humans one X is active, the other is inactive; in XY humans the X is active; so in typical cases an inactive X indicates femaleness).

Secondary sex characteristics that are or may be considered an indicator for intersexuality: lack of breast development, lack of penis and/or testicle growth, lack of development of pubic hair, lack of menstruation, lack of ejaculation, no sperms in ejaculate, infertility, secondary sex characteristics developing opposite to what was expected.

Let’s ignore intersex people for the rest of this section to keep things a bit simpler.

Think about a woman who has really hairy legs. Would you consider her a man? Certainly not. How about a man who lacks most body hair (except pubic hair) and developed little or no facial hair during puberty? You would probably not even notice. A guy not having a visible Adam’s apple? Still a man. A woman who develops one because of some hormonal or iodine imbalance? Still a woman. What about a man who lost his penis and/or balls in an accident or war? Still a manly man. What about if he never had a penis because his bladder developed outside his body? He might not even be considered intersex if the testes developed normally. What about a woman with size A or below breasts? What about a woman whose uterus is taken out (which happens to about 1/3 of all cis women, as it is the best treatment for many uterus-related problems post-menopause), does she stop being a woman? Hardly. What about menopause itself, no more periods and little estrogen and progesterone in the body – does this make older women neutrums? What about men with moobs (men-boobs) in size A, B or C? You see, the maleness and femaleness of many sex characteristics is not set in stone.

And, as outlined before: A trans man with 100% sex characteristics that are traditionally considered female might still call himself anatomically/physically/biologically male / male-bodied. A trans women with 100% sex characteristics that are traditionally considered male might still coll herself anatomically/physically/biologically female / female-bodied. And there is nothing wrong with that. Nor with those who do it the other way around.

A last word about chromosomes (we stop ignoring intersex people now): Even setting aside XY women with complete androgen insensivity (CAIS) and the SRY gene (sex-determining region of Y gene) breaking off from the Y and translocating to an X, there are about 30 known genes (3 on X, 1 on Y, the others on autosomes = non-sex-chromosomes) that can result in XY women with a typical female phenotype (vulva etc.) or XX men with a typical male phenotype (penis etc.). In extremely rare cases XY women have given birth. So if you ever feel like saying “But $person will always be a man because they have a Y chromosome!” or “But $person will always be a woman because they have no Y chromosome!” just say nothing, kthxbye. That applies to intersex people of any appearance and to trans people.

And a final word about basic politeness: What someone else’s genitals look like is none of your business. That doesn’t change if that person is trans or intersex. So don’t ask.

(4) Neurological sex

Already when we are born our brains know certain things about our bodies. Yes, we have to learn a lot of stuff, like how not to shit our pants and how to walk on two legs, but some things are already there. For example what kind of sexual organs we have and approximately what to do with them. This clearly is a huge evolutionary advantage, species without such knowledge don’t live very long. You think this knowledge is completely learned and comes only during puberty when our levels of sex hormones spike? You are mistaken. If the thought that 3-year old girls and boys masturbate disturbs you, I guess you should never read a book on child development. Sex hormones already flow through our bodies before birth. The wrong amount or the wrong hormone at the wrong time, or let’s better say atypical instead of wrong, can result in (some of the types of) intersexuality, which is well-researched in that regard. (The term Disorders of Sex Development [DSD] is also used. There are pro’s and con’s for using it instead of or in addition to intersexuality, some intersex people reject it, some embrace it. ISNA [Intersex Society of North America] has written two articles about this: DSD But Intersex Too: Shifting Paradigms Without Abandoning Roots and Why is ISNA using “DSD”?. In short they recommend the use of DSD when discussing the treatment of infants – including protection from unwanted surgeries – and the continuation of the use intersex among the organizations where adults organize and as self-description, including possibly for one’s gender identity.) Other atypical hormone levels or timing of hormones in the womb are said to lead to homo-, bi- and asexuality, though there is no scientific proof for this, yet. And similarly likely, but unproven, is that certain atypical hormone levels or timings before birth might be the cause for transsexuality / gender dysphoria.

What is gender dysphoria like? [Trigger warning for the rest of the paragraph for trans people who are triggered by graphic descriptions of gender dysphoria.] Gender dysphoria is knowing you should have a penis, but there is none. Gender dysphoria is not being able to go into the bathroom in your apartment because there is a mirror and you might see your feminine or masculine face. Gender dysphoria is a little trans girl waking up at night, crying and screaming, because she had another nightmare about getting hair all over her body when she grows up. Gender dysphoria is hating your penis so much you might injure yourself if your insurance won’t pay for SRS [Sex Reassignment Surgery]. Gender dysphoria is being depressed because the wrong hormones are flowing through your blood vessels. Gender dysphoria is crying when you shave because there shouldn’t be any hair growing out of your face. Gender dysphoria is hating your breasts with a passion. Gender dysphoria is seeing yourself on a photo or in the mirror and thinking “OMG, I look like a woman|man, I have to throw up!” while everyone else shrugs and says “But you are a woman|man!”. Gender dysphoria is being extremely upset by your erections even if nobody is there who could see them. Gender dysphoria is hating your period not just for the inconveniences or physical pain it causes, but because you just know that you should not be bleeding. Gender dysphoria is feeling during masturbation or sex that something is wrong, and it’s wrong with your body. Gender dysphoria is all kinds of unbearable emotional pain.

Not all trans people experience all forms of dysphoria described here. There are quite a number of trans women who don’t mind their penis (and might or might not mind erections) – that is why it was/is horribly wrong when laws mandate(d) SRS [Sex Reassignment Surgery] as a requirement for being able to change one’s legal sex/gender! Some trans women don’t care overly much that they have to shave every day, or they wouldn’t be bothered except for the reactions they get by cis people (misgendering, i.e. being treated as if they were men). While some trans men want to get rid of their uterus as fast as possible, a few even like to get pregnant (around 5%, informal surveys show … maybe not that much higher than cis men, except those can’t?) – laws that require(d) trans people to be infertile (and in some countries like Sweden even to destroy eggs or sperms that were preserved!) to obtain legal sex/gender changes were/are a human rights violation just like requirements for SRS. Also any other of the examples of gender dysphoria described in the previous paragraph might not be present in an individual trans person – this does not make them less trans, less female or male! Even people who don’t feel any gender dysphoria at all and do not wish any body modifications might be trans women, trans men or genderqueer – because that only depends on the gender identity, to which we will get next. Also, some trans people simply don’t need some of the medical interventions – some trans men have very small breasts that they don’t mind passing off as moobs (men-boobs), some trans women never had any significant amount of facial hair, some look sufficiently (for their own taste and/or for passing) masculine, feminine or androgynous without hormonal intervention.

But the majority of binary trans people (i.e. trans men and trans women) and maybe half (nobody really knows) of genderqueer (= non-binary) trans people do experience gender dysphoria and do wish to modify their bodies so that their anatomies matches what their brains are telling them should be there – and denying them these medical procedures or excluding them from health care coverage is a monstrous human rights violation, too! Note that most changes are achieved by hormones and hormone blockers and work gradually over a period of months and years (the second puberty), it’s not a one-off “sex change operation”, so you (cis people) should remove the words “sex change” from your vocabulary. The hormones are often called HRT for Hormone Replacement Therapy (which, however, is also the term for e.g. cis women after menopause taking estrogen) and sometimes EEI for Exogenous Endocrine Intervention.

Many trans women and some MAAB genderqueer people [with “some” here and in other parts of this text meaning an unknown percentage] do or wish for (some or all of) the following medical interventions:

  • Spironolactone or another androgen blocker to stop the [for them] horrible effects of testosterone: masculinization of the body, hair loss, and direct depression/dysphoria (it’s not completely certain if this is a thing, but because some trans women and MAAB genderqueer people get better within a week after getting spiro and/or estrogen even though the physical effects of hormones and hormone blockers take much longer there are some indications that this could be). When T is blocked, the body becomes significantly less muscular (this can be partially countered by training, if desired; training can also be recommended for preserving bone density).
  • Estrogen (as pills or injection) to grow breasts, get softer/finer skin, slightly less/finer (head/facial/body) hair, redistribute the fat from a masculine pattern at the belly to a feminine pattern at the hips and butt (and to stop the immediate depression/dysphoria, see spiro).
  • In some countries it seems to be common to give trans women and MAAB genderqueer people progesterone and in others this seems to be completely uncommon. Progesterone might increase breast size – or not.
  • Some take separate medication against hair loss.
  • Most want permanent electro or laser hair removal of facial hair and possibly of body hair.
  • Logopedic treatment to exercise speaking in a higher, feminine voice.
  • Orchiectomy, removal of the testes – often done as part of SRS (see next bullet).
  • SRS [Sex Reassignment Surgery], also referred to as Gender Confirmation Surgery or genital surgery: reshaping what previously was the scrotum and penis to a (neo-)vagina, clitoris, labia and short/internalized urethra. (Very little is actually removed [only the testes and the spongy body], so please don’t talk about “cutting off the penis”, this is nonsense.) Sometimes the labia are done in a separate operation. While, as mentioned, not all trans women wish to have SRS, the majority does (and an unknown percentage of MAAB genderqueer people, too).
  • A few have/need/want other surgeries: FFS (facial feminization), breast augmentation, reduction of the size of the Adam’s apple and/or surgeries of the vocal chords (risky).

Many trans men and some FAAB genderqueer people (I am going to use FTM-spectrum trans people for both groups together because this seems to be the common or preferred term, at least in some communities) do or wish for some or all of the following medical interventions:

  • Testosterone (as lotion or injection) to obtain a deep voice, facial and body hair growth, increase the size of clitoris to a micropenis of several centimeters (remember that clitoris and penis are the same organ; erections are possible), redistribute fat from the hips and butt to the belly and make the body more muscular, even with minimal or no training.
  • Estrogen blockers are not necessary for FTM-spectrum trans people that have already completed first puberty (“estrogen poisoning”), as they have already developed breasts (or “bags of fat”, as many like to say) anyway.
  • In some countries it seems to be common to give FTM-spectrum trans people progesterone and in others this seems to be uncommon. Progesterone can be used for stopping periods.
  • “Top surgery”, meaning mastectomy + shaping of masculine breasts, often referred to as simply mastectomy or mastec (which literally is only the removal of the breasts, e.g. what might be done to a person with breast cancer). Before they can access top surgery they wear so-called “binders”, tight, thick, sleeveless shirts that press the breasts close to the body. They can be painful or cause shortness of breath when worn the whole day.
  • Many FTM-spectrum trans people who take T have a hysterectomy (= removal of the uterus, cervix, ovaries and fallopian tubes). Many doctors seem to recommend this because taking T increases the uterus health risks. Some FTM-spectrum trans people people choose to have frequent check-ups instead; others, however, find the check-ups extremely uncomfortable, [TW] as it might be necessary to go to a gynecologist (“women’s doctor”) and for this doctor to put fingers or instruments into a bodily orifice the trans person might not even want to have.
  • “Bottom” or “lower” or genital surgeries: There is not one “sex reassignment surgery”, there are various ones for FTM-spectrum trans people, they might have zero or one or several of them, with some months time for healing in between. They might have lengthening surgery similar to that of their cis male counterparts (e.g. cutting of the ligaments, which increases the visible part of the penis; called metoidioplasty, metaoidioplasty or meta). They might have procedures that form a scrotum (from their labia), in which prosthetic testes are inserted. They might opt for the closing or removal of the vaginal channel. They might have their urethra lengthened. They might have phalloplasty (construction of a penis) where skin is grafted from other body parts. They might choose the implantation of a malleable rod for erections or other supportive prosthetics. (Some of the mentioned procedures can be combined into one surgery.) Currently only a minority of trans men (and FAAB genderqueer people) have any kind of genital surgeries. Reasons include that T alone already produces a penis of several centimeters length, usable for PIV [penis-in-vagina] intercourse, and that the results of the various FTM surgeries are less reliable than those of MTF SRS, more risky regarding complications and nerve damage. On the other hand some trans men have told me that the risks are not that high, but are perpetuated as urban legends in the FTM community/-ies. I cannot estimate the true risks.

In addition, trans people may (or may not) wish psychological therapy to accompany the social changes of transitioning. What they do not wish is therapy to convince them that they are “confused” about their gender identity – they are not confused! Adults and older teens are not in very much danger nowadays to have a therapist that tries to convince them that they are really $assigned_gender, or if they end up with one they can find a better one. Trans children, however, are still in extreme danger of so-called “reparative therapy”! (Also e.g. in Germany 😦 .) Reparative therapy for gay, lesbian and bisexual teens and adults (which tries to make them straight) is not offered anymore nowadays by medical doctors or proper therapists, but only by religious fundamentalist organizations. But “reparative therapy” for trans children exists and is offered by public hospitals: It tries to make trans children (or gendervariant children that appear like they might grow up to be trans) into cis children, i.e. change their gender identity (and typically also their gender presentation and gender expression) to be aligned with their birth-assigned sex/gender. Parents are told they need to prohibit “cross-dressing”, take away toys that do not fit the assigned gender and make the child play with children of the same assigned gender. No matter whether the child is actually trans or just a cis child that likes the clothes or toys considered more suitable for the other gender, I think it can be seen how harmful this is for all of them! Nevertheless parents are still pressured into this. Parents who have lost the rights to decide about medical and psychological treatment for their child for some reason (e.g. after a divorce case) might not even be asked and a court or case worker might order this. Not all is bleak, there are also a lot of therapists and some hospitals that support young trans children to live in their true gender identity and obtain prescriptions for hormone blockers before puberty starts.

So these are treatments trans people require. I mentioned earlier that these necessary treatments are often denied to trans people. This happens by so-called gate keeping. A gatekeeper is someone who stands at a gate (in this case a gate with the proper hormones and surgeries behind it) and asks questions to those who want to come in and prevents most people from entering or delays them a lot. Trans people are made to jump through all kinds of hoops before they are “allowed” to get hormones. They have to “prove” that they are really trans / really the gender they say they are. (“allowed” because nobody [should] need[s] permission for the inalienable right of health care. “prove” because it’s not possible to prove one’s gender identity or what gender dysphoria one experiences.) Depending on the jurisdiction (laws of the country or state) but also depending on the clinic or doctor/therapist these “hoops” vary a lot. They might have to change their name to one matching their gender first – or they might only be allowed to change the name after medical treatment. (You think it’s ridiculous that some countries do it one way and others the other way around? Yes, it is. Just like all gate keeping.) They might have to go through a certain minimum amount of psychological counseling, which could be even a year – or they only get a low maximum amount of counseling sessions even if they want more. They might have to go through a “real life test”, living in their “target gender [role]” for 3 months or 6 months (now common in Germany) or 1 year (e.g. Scotland) or 2 years (e.g. England) or a time that could suddenly change as the therapist sees fit (and they might have to bring a family member or friend that vouches for them that they actually do the real life test and are not lying about it, and hope the person does not slip up and accidentally use the wrong pronoun); for many this is too horrible to face without taking hormones first and – at least somewhat – changing their body’s appearance. They might have to come to the therapist in clothes and make-up that matches their gender – or more precisely matches the therapists often old-fashioned idea of their gender. Trans women have been denied hormones for wearing pants. Trans men have been denied hormones for riding a women’s bicycle. I am not kidding you. Because of the difficulties many trans women and MAAB genderqueer people choose to order spiro and estrogen at internet pharmacies (in countries where this is possible, e.g. the US). This is risky, as high doses of estrogen can result in heart attacks (or even pretty low doses for people who smoke or who have pre-existing medical conditions). Testosterone is not easily available online as it is a controlled substance. In the UK many trans people switch from the free/tax-paid NHS health care to self-paid private health care to avoid or shorten the RLT (real-life test) dramatically.

Enough with the gate keeping, enough with pushing trans people into self-medicating or into paying for health care that should be free, often going into debt! Hormones and surgeries should be available on demand, just based on medical counseling (advise regarding the effects, checks for medical reasons not to go through with them).

Note: Besides the gender dysphoria about one’s body there is social gender dysphoria, the dysphoria about being treated as a man or as a woman when you are not one, i.e. being misgendered – called the wrong name, the wrong pronouns, addressed with Mr., Mrs., Sir, Mam, being told outright “You’re a man/woman/my son/my daughter/…”. Both are bad.

(5) Gender identity

People who consider themselves to be female and prefer female pronouns and being called girl/woman/sister/daughter/… have a female gender identity. “Female-identified”, “female” and “being a woman (or girl)” is the same.

People who consider themselves to be male and prefer male pronouns and being called boy/man/brother/son/… have a male gender identity. “Male-identified”, “male” and “being a man (or boy)” is the same.

“Genderqueer” is a collective term for non-binary gender identities, i.e. people who identify as in between male and female, as both male and female, as neither male nor female, as genderless or third-gender or generally without reference to the binary gender system. Genderqueerness can be separated into three rough groups, for easier understanding:

  1. Androgyne, intergender or genderqueer in the narrow (instead of the umbrella) sense – identifying as on the spectrum in between male and female gender identity. People more or less exactly in the middle most often use the term “androgyne”. People who are somewhere on the female side of the spectrum often use the term “genderqueer woman” and sometimes “female of center” or “on the MTF spectrum” (the latter if they were assigned male at birth; MTF spectrum doesn’t seem to be used a lot). People who are somewhere on the male side of the spectrum may use the term “genderqueer man”, “male of center” or, very often “on the FTM spectrum” (if they were assigned female at birth). [Which terms I perceive as frequent or infrequent is tainted by the US American, British and German trans blogs, forums, tumblrs and twitterers I follow, so I might be off.]
  2. Agender, neutrois, genderneutral, genderless: Some of these people do not have a gender identity, some have one and it is agender/neutrois/neutral, some feel that this doesn’t really make a difference (but for others it makes a difference so don’t assume that it doesn’t – i.e. please offer “none” as an option for gender identities if you make a form where this is queried). I have often read that “neutrois” indicates that one wishes to alter one’s body, i.e. transition medically, while “agender” is the more generic term, encompassing both transsexual/dysphoric people and those who are “only” transgender and not transsexual. I have also read very vehement rejections of the idea that “neutrois” is the transsexual version of “agender”. So this may not be the distinction, or maybe there is none. Some agender people do not consider themselves to be genderqueer (especially considering the more narrow meaning of genderqueer in 1). Some non-transsexual agender people also do not consider themselves to be trans/trans*/transgender (often not wanting to claim a word that might not be theirs to claim).  Note for cis people on agender: Maybe you are thinking now “Hey, I don’t really feel my gender identity either, am I agender?” On the one hand it’s not impossible. On the other hand, as someone described it: When underwear fits, you don’t feel it. Likewise with gender identities, if you are okay with the gender you were assigned, you won’t notice it much.
  3. Bigender (male+female), bigender (two other genders, e.g. male and genderqueer), multigender (three or more genders, obviously), genderfluid (could be varying within minutes, days or months), but also multiple, plural & median (several personalities/personas/head mates/alters with two or more different genders; could be trauma-induced DID [Dissociative Identity Disorder] or a healthy system without any memory loss when switching).

Not exactly a genderqueer identity, but also not binary: Some intersex people who do not identify as (only) male or (only) female but as both, neither or in between, consider their gender identity to be “intersex” (or “intersexual”). (Other intersex people consider intersex to be part of their identity, but not their gender identity. Others only see it as a medical condition, not as part of their identity.)

The genderneutral English pronouns used most in the trans community are on the one hand singular they (with their/them/themself) and on the other hand ze (with either zir/zir/zirzelf or zir/zim/zimself or some variation or combination). Some people use others, e.g. ey/eir/em/emself or even more rare ones. Use whatever pronouns a person prefers. Arguments like “But these are made up!” are invalid.

Important note: In a trans* context “gender identity” is very often referred to with “gender”. Don’t confuse it with (7) Gender below, the WHO or feminist meaning of gender, or how it would be used in a gender studies class in university. In particular do not intentionally confuse the two meanings. (I’m looking at you, TERFs.)

(5a) Innate (“born-with”) gender identity

Some (remember, some means unknown percentage) trans people experience a strong innate (not-learned) knowledge that they are male or female or genderqueer. They would strongly reject the idea that they “want” to be male or female or some other gender. Some of them have tried to suppress or reject their true gender for decades, and only accepted it because of the unbearable pain denying it has caused them. Most would say it has always been there and they only had to uncover, understand or stop suppressing it.

Other trans people feel no such thing. “Wanting to be M/F/X” and “being M/F/X” might be the exact same thing for them. Or they might feel that this is a mostly physical thing (gender dysphoria and its treatment), and their gender identity is closely related to their body [their body as it should have been / as they are making it, so basically to the neurological sex]. Or becoming/living as a woman or a man (or some other gender) might have been a choice for them (while for many it is not a choice).

So maybe there is an innate gender identity or maybe there is not or maybe there is for some people and not for others or maybe it is weaker in some people (so they might have more choices, or it might just mean it’s harder to find out) and stronger in others. And for some a pre-existing gender identity is an undeniable truth and for others it’s actually harmful to try to look for what gender they “really” are (for example a person might feel they want to be a woman and they would be most happy and comfortable as a woman, but they are afraid that they are “really” “only” genderqueer … or the other way around).

The distinction between the internal innate and external/lived gender identity I see is approximately like this: One person might be male-assigned and notice she/ze prefers female pronouns and neutral ones are okay and she/ze needs to get spiro and estrogen and an orchi and facial hair removal to be happy, and she/ze likes to have short hair and hates dresses, and the gender identity she feels best fits her is that of a butch trans woman. And another person might have the same assignment, preferred pronouns, need for medical transitioning and preferred gender presentation, but she/ze feels she is a genderqueer woman. So their internal innate gender identities, if they feel they have such a thing, might be something like “female of center, definitely much more female than I was assigned”, and their neurological sex is “very much on the female side”, and their preferred gender presentation is masculine of center, and all this and possibly other things (maybe even their sexual orientation) together influence what their external/lived/maybe “chosen” gender identity becomes.

Not sure if that actually makes sense. It’s just the impression I got trying to make sense of various trans blogs, chats and forums that at first seemed to contradict each other (“There is no gender identity!” “Yes, there is, I have one!”).

Of course an internal/innate/biological gender identity would not be something exclusive to trans people. Maybe many of the people who live and walk around as cis people are “really” internally / biologically some version of genderqueer, e.g. agender, they just never notice it much, as they don’t feel a strong discomfort with their assigned sex/gender. 

(6a) Gender presentation

Gender presentation is: Our haircuts. Our clothes. Our accessories like handbags. Our make-up and nail polish or lack thereof. Our jewelry.

Gender presentations are on a spectrum: feminine|femme|effeminate — androgynous and genderfuck — masculine|butch|(macho).

Effeminate is only used to describe feminine men and boys. Sometimes it’s considered derogatory, so some men don’t like using it. Some femme trans men prefer it, though, as it avoids confusing them with lesbians or women in general.

Femme and butch were originally used in lesbian community, but they also get used by gay men. And in the end gender presentation has nothing to do with the sexual orientation, so bi, straight and ace (asexual) and any other people can also use the terms. (“Nothing to do” may be a bit strong, there are probably some statistical relationships, there seem to be more femme gay men then femme straight men and more butch lesbian woman than butch straight women … or maybe they are just more likely to go through with the presentation they like, who knows.)

Not only does every sexual orientation go with every gender presentation, obviously also every gender identity goes with every gender presentation. Women can be femme, androgynous, genderfuck or butch (or anything in between or outside of the spectrum). In particular, it seems this needs mentioning, trans women can be butch and this does not make them men, just as it does not make a cis woman a man. Men can present as femme/effeminate, androgynous, genderfuck or butch. And do I need to say that trans men can be any of this, too, and femme trans men are not “regretting they transitioned” or anything? Again, there are statistical relationships. Many women are femme. Men are even more bound to be butch (also because society punishes feminine men), And many genderqueer people present as androgynous (but there are very femme and very butch genderqueer people, too).

(6b) Gender expression (includes 6a gender presentation)

Gender expression includes all of gender presentation and all behaviors that are considered typically masculine or typically feminine in the society one lives in. Our choice of job and hobbies. What books we read, what TV shows we watch and which games we play. How we talk to others. How we decorate our room or home. Whether we have stuffed animals in our bed. For children: what toys they play with.

To say it with the words of PFLAG [Parents, Families, Friends and Allies of LGBT People] in Welcoming Our Trans Family and Friends: Every gender expression is valid.

(6c) Innate preferred gender presentation and/or expression

In her book “Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity” Julia Serano raises (and answers) and interesting question: Why do some men have a strong preference for a feminine gender presentation and expression even though most of them were strictly socialized against it and they receive punishment from society for it, from taunts and being taken less serious to violence? Likewise, why do some women have a strong preference for a butch gender presentation and expression, and this has been so for a long time, also when girls and women were still strongly discouraged from this? Her answer: Probably not just sexual orientation, neurological sex and (internal) gender identity are something we are born with, probably we are also born with a preference for femininity or masculinity. Not in an immediate sense like a preference for e.g. skirts, that would be silly – Scottish men are not on average more feminine than those in other parts of the world. A preference to associate with whatever is considered feminine or masculine in the society one lives in.

(7) WHO or feminist definition of gender (also used in Gender Studies university classes)

The WHO [World Health Organization] writes:

Gender refers to the socially constructed roles, behaviour, activities and attributes that a particular society considers appropriate for men and women.

The distinct roles and behaviour may give rise to gender inequalities, i.e. differences between men and women that systematically favour one group.”

To allow no doubt, in almost all societies/cultures present on our planet today the favored group is men, i.e. they are patriarchies. Very few matriarchies are left.

So when we say “gender is socially constructed” we mean the reason for fewer women in leadership positions, jobs typically performed by women being lower paid, girls continuing to choose these jobs, women being paid less for the same job than men and so on and so on is the society, not biology.

If you use “gender is socially constructed” to try to define trans people into non-existence, please crawl back into the hole you have come out of.

(A) Sexual orientation (not a definition of sex or gender)

Not (8), because it’s not a meaning of sex or gender. I thought I’d include it as most transgender 101s, after going through the definitions of sex and gender, include it, too.

Transsexuality may sound similar to heterosexuality, bisexuality, pansexuality, homosexuality and asexuality, but it has nothing to do with sexual orientation. Transsexual people are those who experience gender dysphoria about their bodies and wish to transition medically. (Intersex people who transition medically may or may not identify as transsexual.) Transgender people, i.e. trans men, trans women and genderqueer people are those who do not identify with the gender they were assigned at birth. (Intersex people who transition socially may or may not identify as transgender.) Trans people, just like cis people, can have any sexual orientation. They do certainly not transition to “become straight”. They also do not transition because of “autogynephilia” or any other such nonsense that claims they want to make their body to that which they sexually desire. A lesbian trans woman is a lesbian woman and not a heterosexual man – should be quite obvious.

For those who are confuzzled about whether a man attracted to a trans woman is gay or straight, let’s go back to the basic definitions:

  • Gay man = a [cis or trans] man attracted to other [cis and/or trans] men and not attracted to women. Not: “A man attracted to penises”.
  • Straight man = a [cis or trans] man attracted to [cis and/or trans] women and not attracted to men. Not: “A man attracted to vulvas/vaginas”.
  • Lesbian woman = a [cis or trans] woman attracted to other [cis and/or trans] women and not attracted to men. Not: “A woman attracted to vulvas/vaginas”.
  • Straight woman = a [cis or trans] woman attracted to [cis and/or trans] men and not attracted to women. Not: “A woman attracted to penises”.
  • Bi/pan cis/trans men/women/genderqueer people are attracted to men and women and (potentially) people of (some or all) other genders.
  • Asexual people do not experience primary sexual attraction to other people.

There is a lot more that could be said about sexual orientation, but this will fill another article.

(B) Alternative views of the definitions of sex and gender identity

I mean alternative (i.e. not (yet?) very widespread) views by trans people (not by people who hate trans people).

Some trans people do not say they have a gender identity but instead use sex to express the same thing. They might say “Trans people get gender identities, cis people get sexes” (in the sense of rejecting that this is so). The idea is that using “sex” to mean the summary of sex characteristics is pretty meaningless. And as “being male” = “identifying as male” and “being female” = “identifying as female” sex is really the better word for what is most of the time called gender identity (or just gender) in a trans* context.

(Be careful if you come across blogs that say “sex not gender” in their headlines or tag lines, they have a >95% chance of being run by someone who hates trans people and wants to deny their existence.)

(C) Other meanings of transgender

I need to mention this quickly: I only focused on one meaning of transgender, “trans-gender-identity”, people who don’t identify with the sex/gender they were assigned at birth (and the subgroup of transsexual/gender-dysphoric people). The transgender umbrella is much wider. It also includes “trans-gender-expression”, i.e. crossdressers and gendervariant/gender-non-conforming [GNC] people.

The end. Oops, this got maybe a teeny-tiny bit too long for a 101 post (15 DIN A4 pages). Maybe it’s more of a 102 or 201 post. (But still, it does not cover everything. E.g. I didn’t even get to guy dykes and girl fags.)

I want to thank all the trans people in my life for being there. I hope I didn’t screw up anything too badly in this post.



3 thoughts on “What is sex? What is gender?

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