FYI: Someone's gender can be different from their sex.

By Leah Groth
August 27, 2020
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When we're first born, the doctor in the hospital normally assigns us a label of male or female, depending on what our bodies look like—either characteristically male or female genitalia.

But sometimes, a person's sexual organs don't align with the gender they were assigned at birth—this is what it means when someone identifies as transgender (or trans, for short). The National Center for Transgender Equality (NCTE) clears it up further: "A transgender woman lives as a woman today, but was thought to be male when she was born. A transgender man lives as a man today, but was thought to be female when he was born."

Additionally, transgender is an umbrella term, and can go further than those assigned male at birth who now identify as female, and vice-versa. Ultimately, "if an individual identifies as transgender, their assigned sex at birth does not align with their internal sense of identity," Christy L. Olezeski, PhD, director of Yale Medicine’s Gender Program, tells Health

Though it's currently unknown just how many transgender people currently live in the US—official records, like the US Census, don't include data on gender identity—Olezeski points to recent estimates suggesting that approximately 1 million Americans identify as transgender, or, 1 in 250 people. The NCTE estimates that number is closer to 1.4 million transgender individuals in the US, with "millions more around the world." 

What's the difference between sex and gender?

So, sex is a term that is used to refer to the biological characteristics of an individual, Olezeski says. That means a person's chromosomes, hormone prevalence, and external and internal anatomy are all indications of a person's sex.

Gender, on the other hand is “one's internal sense of their own identity,” Olezeski says. The American Psychological Association (APA) adds that the term “refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for boys and men or girls and women,” they write on their website. “These influence the ways that people act, interact, and feel about themselves.”

It's equally important here to note that gender identity and sexual orientation are not the same either, per the APA. Sexual orientation refers to someone’s attraction to another person, while gender identity encompasses “one’s internal sense of being male, female, or something else.” Therefore, transgender people can identify as a variety of sexual orientations, including straight, lesbian, gay, bisexual, or asexual, similar to how non-transgender people identify.

What are the transitioning options for someone who is transgender?

Individuals who identify as transgender have a variety of options, to begin transitioning in order to live according to the gender they identify as, instead of the gender they were assigned at birth. “Everyone's gender journey is different and people have different needs to feel most comfortable in their identity,” Olezeski says. 

While gender transition looks different for everyone—and there's "no specific set of steps necessary to 'complete' a transition, per the NCTE—transgender individuals have two main transitioning options.

  • Social transition: This aspect of tradition is non-medical. Examples include using a different name or pronouns or wearing clothing or hair styles that express their affirmed identity.
  • Medical transition: A medical transition usually involves taking hormones that either align with their identity or are more aligned than their endogenous hormones. It can also include speech therapy and hair removal. Medical transition can also involves a surgical intervention, usually chest reconstruction and/or genital affirmation surgery.

What are some of the issues the transgender community faces? 

There is a great deal of discrimination, violence, and even health disparities among the transgender and gender expansive communities, Olezeski says, noting that Black and Indigenous people, and people of color (BIPOC) transgender women are especially targeted. 

Starting at a young age, transgender youth are highly susceptible to discrimination in schools. The National School Climate Survey, a flagship report from the GLSEN, an education organization working to end discrimination based on sexual orientation and sexual identity, revealed that transgender youth are experiencing “extremely hostile” climates in US schools. Nearly 84% of transgender students were bullied or harassed because of their gender, and over 40% face discrimination, including being prevented from using their preferred name or gender and even prevented from using the correct bathroom. 

Another survey, courtesy of NCTE, details the mistreatment of the transgender community in the workforce. “In the year prior to completing the survey, 30% of respondents who had a job reported being fired, denied a promotion, or experiencing some other form of mistreatment in the workplace due to their gender identity or expression, such as being verbally harassed or physically or sexually assaulted at work,” the survey explains.

Regarding physical and sexual assault overall, of all those surveyed, 46% of respondents were verbally harassed and 9% were physically attacked because of being transgender in the year leading up to the survey, with 10% of respondents reporting they were sexually assaulted, and nearly half—47%—noting that they had been sexually assaulted at some point in their lifetime. 

Regarding health issues, the survey also confirmed that the transgender community is more prone to mental health issues, finding that a staggering 39% of respondents experienced serious psychological distress in the month prior to completing the survey—compared with only 5% of the U.S. population. 40% of respondents even admitted to attempting suicide in their lifetime—nearly nine times the attempted suicide rate in the entire U.S. population. The American Medical Student Association (ASMA) also says that "transgender people face numerous health disparities as well as stigma, discrimination, and lack of access to quality care"—those can include an increased risk of HIV infections and a lower likelihood of preventive cancer screenings

How can everyone support the transgender community?

The NCTE points out in their report that governmental and private institutions throughout the United States “should address these disparities and ensure that transgender people are able to live fulfilling lives in an inclusive society” at the institutional level. A few suggestions include improving health care and eliminating barrier for transgender people, ending discrimination in schools, the workplace, and other areas of public life, and “creating systems of support at the municipal, state, and federal levels that meet the needs of transgender people and reduce the hardships they face.”

Olezeski also points out that there are a variety of things that we can do at the personal level to support the trans community: “We can be kind and stand up to violence and discrimination. We can affirm their identities,” she says. “We can learn about local organizations that are supporting and lifting up the community and volunteer with them and/or support them financially. We can look into our own organizations and learn how we can be more inclusive and supportive. We can and have to continue to educate in our own communities.”

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