research paper on gender identity

MINI REVIEW article

Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems.

• Instituto Universitário de Lisboa ISCTE-IUL, CIS, Lisboa, Portugal

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

Numerous controversies and debates have taken place throughout the history of psychopathology and mental health care with regards to lesbian, gay, bisexual and transgender (LGBT) people. The present paper aims to review relevant concepts in this literature, its historical and current controversies, and their relation to the main psychopathology classification systems.

Concepts and Definitions

Concepts and definitions that refer to sexual orientation and gender identity are an evolving field. Many of the terms used in the past to describe LGBT people, namely in the mental health field, are now considered to be outdated and even offensive.

Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted ( American Psychological Association, 2012 ). Nowadays, the terms ‘lesbian’ and ‘gay’ are used to refer to people who experience attraction to members of the same sex, and the term ‘bisexual’ describe people who experience attraction to members of both sexes. It should be noted that, although these categories continue to be widely used, sexual orientation does not always appear in such definable categories and, instead, occurs on a continuum ( American Psychological Association, 2012 ), and people perceived or described by others as LGB may identify in various ways ( D’Augelli, 1994 ).

The expression gender identity was coined in the middle 1960s, describing one’s persistent inner sense of belonging to either the male and female gender category ( Money, 1994 ). The concept of gender identity evolved over time to include those people who do not identify either as female or male: a “person’s self concept of their gender (regardless of their biological sex) is called their gender identity” ( Lev, 2004 , p. 397). The American Psychological Association (2009a , p. 28) described it as: “the person’s basic sense of being male, female, or of indeterminate sex.” For decades, the term ‘transsexual’ was restricted for individuals who had undergone medical procedures, including genital reassignment surgeries. However, nowadays, ‘transsexual’ refers to anyone who has a gender identity that is incongruent with the sex assigned at birth and therefore is currently, or is working toward, living as a member of the sex other than the one they were assigned at birth, regardless of what medical procedures they may have undergone or may desire in the future (e.g., Serano, 2007 ; American Psychological Association, 2009a ; Coleman et al., 2012 ). In this paper we use the prefix trans when referring to transsexual people.

Since the 1990’s the word transgender has been used primarily as an umbrella term to describe those people who defy societal expectations and assumptions regarding gender (e.g., Lev, 2004 ; American Psychological Association, 2009a ). It includes people who are transsexual and intersex, but also those who identify outside the female/male binary and those whose gender expression and behavior differs from social expectations. As in the case of sexual orientation, people perceived or described by others as transgender – including transsexual men and women – may identify in various ways (e.g., Pinto and Moleiro, 2015 ).

Discrimination and Impact on Mental Health

Lesbian, gay, bisexual and transgender people often suffer from various forms of discrimination, stigma and social exclusion – including physical and psychological abuse, bullying, persecution, or economic alienation ( United Nations, 2011 ; Bostwick et al., 2014 ; European Union Agency for Fundamental Rights, 2014 ). Moreover, experiences of discrimination may occur in various areas, such as employment, education and health care, but also in the context of meaningful interpersonal relationships, including family (e.g., Milburn et al., 2006 ; Feinstein et al., 2014 ; António and Moleiro, 2015 ). Accordingly, several studies strongly suggest that experiences of discrimination and stigmatization place LGBT people at higher risk for mental distress ( Cochran and Mays, 2000 ; Dean et al., 2000 ; Cochran et al., 2003 ; Meyer, 2003 ; Shilo, 2014 ).

For example, LGB populations may be at increased risk for suicide ( Hershberger and D’Augelli, 1995 ; Mustanski and Liu, 2013 ), traumatic stress reactions ( D’Augelli et al., 2002 ), major depression disorders ( Cochran and Mays, 2000 ), generalized anxiety disorders ( Bostwick et al., 2010 ), or substance abuse ( King et al., 2008 ). In addition, transgender people have been identified as being at a greater risk for developing: anxiety disorders ( Hepp et al., 2005 ; Mustanski et al., 2010 ); depression ( Nuttbrock et al., 2010 ; Nemoto et al., 2011 ); social phobia and adjustment disorders ( Gómez-Gil et al., 2009 ); substance abuse ( Lawrence, 2008 ); or eating disorders ( Vocks et al., 2009 ). At the same time, data on suicide ideation and attempts among this population are alarming: Maguen and Shipherd (2010) found the percentage of attempted suicides to be as high as 40% in transsexual men and 20% in transsexual women. Nuttbrock et al. (2010) , using a sample of 500 transgender women, found that around 30% had already attempted suicide, around 35% had planned to do so, and close to half of the participants expressed suicide ideation. In particular, adolescence has been identified as a period of increased risk with regard to the mental health of transgender and transsexual people ( Dean et al., 2000 ).

In sum, research clearly recognizes the role of stigma and discrimination as significant intervening variables in psychopathology among LGBT populations. Nevertheless, the relation between sexual orientation or gender identity and stress may be mediated by several variables, including social and family support, low internalized homophobia, expectations of acceptance vs. rejection, contact with other LGBT people, or religiosity ( Meyer, 2003 ; Shilo and Savaya, 2012 ; António and Moleiro, 2015 ; Snapp et al., 2015 ). Thus, it seems important to focus on subjective distress and in a person-centered experience of psychopathology.

On the History of Homosexuality and Psychiatric Diagnoses

While nowadays we understand that higher rates of psychological distress among LGB people are related to their minority status and to discrimination, by the early 20th century, psychiatrists mostly regarded homosexuality as pathological per se ; and in the mid-20th century psychiatrics, physicians, and psychologists were trying to “cure” and change homosexuality ( Drescher, 2009 ). In 1952, the American Psychiatric Association published its first edition of the Diagnostic and Statistical Manual (DSM-I), in which homosexuality was considered a “sociopathic personality disturbance.” In DSM-II, published in 1968, homosexuality was reclassified as a “sexual deviation.” However, in December 1973, the American Psychiatric Association’s Board of Trustees voted to remove homosexuality from the DSM.

The most significant catalyst to homosexuality’s declassification as a mental illness was lesbian and gay activism, and its advocacy efforts within the American Psychiatric Association ( Drescher, 2009 ). Nevertheless, during the discussion that led to the diagnostic change, APA’s Nomenclature Committee also wrestled with the question of what constitutes a mental disorder. Concluding that “they [mental disorders] all regularly caused subjective distress or were associated with generalized impairment in social effectiveness of functioning” ( Spitzer, 1981 , p. 211), the Committee agreed that homosexuality by itself was not one.

However, the diagnostic change did not immediately end the formal pathologization of some presentations of homosexuality. After the removal of the “homosexuality” diagnosis, the DSM-II contained the diagnosis of “sexual orientation disturbance,” which was replaced by “ego dystonic homosexuality” in the DSM-III, by 1980. These diagnoses served the purpose of legitimizing the practice of sexual “conversion” therapies among those individuals with same-sex attractions who were distressed and reported they wished to change their sexual orientation ( Spitzer, 1981 ; Drescher, 2009 ). Nonetheless, “ego-dystonic homosexuality” was removed from the DSM-III-R in 1987 after several criticisms: as formulated by Drescher (2009 , p. 435): “should people of color unhappy about their race be considered mentally ill?”

The removal from the DSM of psychiatric diagnoses related to sexual orientation led to changes in the broader cultural beliefs about homosexuality and culminated in the contemporary civil rights quest for equality ( Drescher, 2012 ). In contrast, it was only in 1992 that the World Health Organization ( World Health Organization, 1992 ) removed “homosexuality” from the International Classification of Diseases (ICD-10), which still contains a diagnosis similar to “ego-dystonic homosexuality.” However, this is expected to change in the next revision, planned for publication in 2017 ( Cochran et al., 2014 ).

Controversies on Gender Dysphoria and (Trans)Gender Diagnoses

Mental health diagnoses that are specific to transgender and transsexual people have been highly controversial. In this domain, the work of Harry Benjamin was fundamental for trans issues internationally, through the Harry Benjamin International Gender Dysphoria Association (presently, the World Professional Association for Transgender Health, WPATH). In the past few years, there has been a vehement discussion among interested professionals, trans and LGBT activists, and human rights groups concerning the reform or removal of (trans)gender diagnoses from the main health diagnostic tools. However, discourses on this topic have been inconclusive, filled with mixed messages and polarized opinions ( Kamens, 2011 ). Overall, mental health diagnoses which are specific to transgender people have been criticized in large part because they enhance the stigma in a population which is already particularly stigmatized ( Drescher, 2013 ). In fact, it has been suggested that the label “mental disorder” is the main factor underlying prejudice toward trans people ( Winter et al., 2009 ).

The discussion reached a high point during the recent revision process of the DSM-5 ( American Psychiatric Association, 2013 ), in which the diagnosis of “gender identity disorder” was revised into one of “gender dysphoria.” Psychiatric diagnosis was thus limited to those who are, in a certain moment of their lives, distressed about living with a gender assignment they experience as incongruent with their gender identity ( Drescher, 2013 ). The change of criteria and nomenclature “is less pathologizing as it no longer implies that one’s identity is disordered” ( DeCuypere et al., 2010 , p. 119). In fact, gender dysphoria is not a synonym for transsexuality, nor should it be used to describe transgender people in general ( Lev, 2004 ); rather, “[it] is a clinical term used to describe the symptoms of excessive pain, agitation, restless, and malaise that gender-variant people seeking therapy often express” ( Lev, 2004 , p. 910). Although the changes were welcomed (e.g., DeCuypere et al., 2010 ; Lev, 2013 ), there are still voices arguing for the “ultimate removal” ( Lev, 2013 , p. 295) of gender dysphoria from the DSM. Nevertheless, attention is presently turned to the ongoing revision of the ICD. Various proposals concerning the revision of (trans)gender diagnoses within ICD have been made, both originating from transgender and human rights groups (e.g., Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ) and the health profession community (e.g., Drescher et al., 2012 ; World Professional Association for Transgender Health, 2013 ). These include two main changes: the reform of the diagnosis of transsexualism into one of “gender incongruence”; and the change of the diagnosis into a separate chapter from the one on “mental and behavioral disorders.”

Mental Health Care Reflecting Controversies

There is evidence that LGBT persons resort to psychotherapy at higher rates than the non-LGBT population ( Bieschke et al., 2000 ; King et al., 2007 ); hence, they may be exposed to higher risk for harmful or ineffective therapies, not only as a vulnerable group, but also as frequent users.

Recently, there has been a greater concern in the mental health field oriented to the promotion of the well-being among non-heterosexual and transgender people, which has paralleled the diagnostic changes. This is established, for instance, by the amount of literature on gay and lesbian affirmative psychotherapy which has been developed in recent decades (e.g., Davis, 1997 ) and, also, by the fact that major international accrediting bodies in counseling and psychotherapy have identified the need for clinicians to be able to work effectively with minority clients, namely LGBT people. The APA’s guidelines for psychotherapy with lesbian, gay, and bisexual client ( American Psychological Association, 2000 , 2012 ) are a main reference. These ethical guidelines highlight, among several issues, the need for clinicians to recognize that their own attitudes and knowledge about the experiences of sexual minorities are relevant to the therapeutic process with these clients and that, therefore, mental health care providers must look for appropriate literature, training, and supervision.

However, empirical research also reveals that some therapists still pursue less appropriate clinical practices with LGBT clients. In a review of empirical research on the provision of counseling and psychotherapy to LGB clients, Bieschke et al. (2006) encountered an unexpected recent explosion of literature focused on “conversion therapy.” There are, in fact, some mental health professionals that still attempt to help lesbian, gay, and bisexual clients to become heterosexual ( Bartlett et al., 2009 ), despite the fact that a recent systematic review of the peer-reviewed journal literature on sexual orientation change efforts concluded that “efforts to change sexual orientation are unlikely to be successful and involve some risk of harm” ( American Psychological Association, 2009b , p. 1).

Moreover, there is evidence of other forms of inappropriate (while less blatant) clinical practices with LGBT clients (e.g., Garnets et al., 1991 ; Jordan and Deluty, 1995 ; Liddle, 1996 ; Hayes and Erkis, 2000 ). Even those clinicians who intend to be affirmative and supportive of LGBT individuals can reveal subtle heterosexist bias in the work with these clients ( Pachankis and Goldfried, 2004 ). Examples of such micro-aggressions ( Sue, 2010 ) might be automatically assuming that a client is heterosexual, trying to explain the etiology of the client’s homosexuality, or focusing on the sexual orientation of a LGB client despite the fact that this is not an issue at hand (e.g., Shelton and Delgado-Romero, 2011 ). Heterosexual bias in counseling and psychotherapy may manifest itself also in what Brown (2006 , p. 350) calls “sexual orientation blindness,” i.e., struggling for a supposed neutrality and dismissing the specificities related to the minority condition of non-heterosexual clients. This conceptualization of the human experience mostly in heterosexual terms, found in the therapeutic setting, does not seem to be independent of psychotherapist’s basic training and the historical heterosexist in the teaching of medicine and psychology ( Simoni, 1996 ; Alderson, 2004 ).

With regards to the intervention with trans people, for decades the mental health professionals’ job was to sort out the “true” transsexuals from all other transgender people. The former would have access to physical transition, and the later would be denied any medical intervention other than psychotherapy. By doing this, whether deliberately or not, professionals – acting as gatekeepers – pursued to ‘ensure that most people who did transition would not be “gender-ambiguous” in any way’ ( Serano, 2007 , p. 120). Research shows that currently trans people still face serious challenges in accessing health care, including those related to inappropriate gatekeeping ( Bockting et al., 2004 ; Bauer et al., 2009 ). Some mental health professionals still focus on the assessment of attributes related to identity and gender expressions, rather than on the distress with which trans people may struggle with ( Lev, 2004 ; Serano, 2007 ). Hence, trans people may feel the need to express a personal narrative consistent with what they believe the clinicians’ expectations to be, for accessing hormonal or surgical treatments ( Pinto and Moleiro, 2015 ). Thus, despite the revisions of (trans)gender diagnoses within the DSM, more recent diagnoses seem to still be used as if they were identical with the diagnosis of transsexualism – in a search for the “true transsexual” ( Cohen-Kettenis and Pfäfflin, 2010 ). It seems clear that social and cultural biases have significantly influenced – and still do – diagnostic criteria and the access to hormonal and surgical treatments for trans people.

Controversies and debates with regards to medical classification of sexual orientation and gender identity contribute to the reflection on the very concept of mental illness. The agreement that mental disorders cause subjective distress or are associated with impairment in social functioning was essential for the removal of “homosexuality” from the DSM in the 1970s ( Spitzer, 1981 ). Moreover, (trans)gender diagnoses constitute a significant dividing line both within trans related activism (e.g., Vance et al., 2010 ) and the health professionals’ communities (e.g., Ehrbar, 2010 ). The discussion has taken place between two apposite positions: (1) trans(gender) diagnoses should be removed from health classifying systems, because they promote the pathologization and stigmatization of gender diversity and enhance the medical control of trans people’s identities and lives; and (2) trans(gender) diagnoses should be retained in order to ensure access to care, since health care systems rely on diagnoses to justify medical treatment – which many trans people need. In fact, trans people often describe experiences of severe distress and argue for the need for treatments and access to medical care ( Pinto and Moleiro, 2015 ), but at the same time reject the label of mental illness for themselves ( Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ). Thus, it may be important to understand how the debate around (trans)diagnoses may be driven also by a history of undue gatekeeping and by stigma involving mental illness.

The present paper argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

On the one hand, aligned with a position of “transgression” and/or “deviation from a norm,” people who today are described as LGBT were labeled as mentally ill. Inevitably, classification systems reflect(ed) the existing social attitudes and prejudices, as well as the historical and cultural contexts in which they were developed ( Drescher, 2012 ; Kirschner, 2013 ). In that, they often failed to differentiate between mental illness and socially non-conforming behavior or fluidity of gender expressions. This position and the historical roots of this discourse are still reflected in the practices of some clinicians, ranging from “conversion” therapies to micro-aggressions in the daily lives of LGBT people, including those experienced in the care by mental health professionals.

On the other hand, lined up with a position of gender variance and fluidity, changes in the diagnostic systems in the last few decades reflect a broader respect and value of the diversity of human sexuality and of gender expressions. This position recognizes that the discourse and practices coming from the (mental) health field may lead to changes in the broader cultural beliefs ( Drescher, 2012 ). As such, it also recognizes the power of medical classifications, health discourses and clinical practices in translating the responsibility of fighting discrimination and promoting LGBT people’s well-being.

In conclusion, it seems crucial to emphasize the role of specific training and supervision in the development of clinical competence in the work with sexual minorities. Several authors (e.g., Pachankis and Goldfried, 2004 ) have argued for the importance of continuous education and training of practitioners in individual and cultural diversity competences, across professional development. This is in line with APA’s ethical guidelines ( American Psychological Association, 2000 , 2012 ), and it is even more relevant when we acknowledge the significant and recent changes in this field. Furthermore, it is founded on the very notion that LGBT competence assumes clinicians ought to be aware of their own personal values, attitudes and beliefs regarding human sexuality and gender diversity in order to provide appropriate care. These ethical concerns, however, have not been translated into training programs in medicine and psychology in a systematic manner in most European countries, and to the mainstreaming of LGBT issues ( Goldfried, 2001 ) in psychopathology.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords : sexual orientation, gender identity, transgender, discrimination, psychopathology, mental health care

Citation: Moleiro C and Pinto N (2015) Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Front. Psychol. 6:1511. doi: 10.3389/fpsyg.2015.01511

Received: 29 July 2015; Accepted: 18 September 2015; Published: 01 October 2015.

Reviewed by:

Copyright © 2015 Moleiro and Pinto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Carla Moleiro, Instituto Universitário de Lisboa ISCTE-IUL, CIS, Avenida das Forças Armadas, 1649-026 Lisbon, Portugal, [email protected]

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• Published: 01 September 2020

Fluidity of gender identity induced by illusory body-sex change

• Pawel Tacikowski 1 , 2 ,
• Jens Fust   ORCID: orcid.org/0000-0002-4706-092X 1 , 3 &
• H. Henrik Ehrsson   ORCID: orcid.org/0000-0003-2333-345X 1  

Scientific Reports volume  10 , Article number:  14385 ( 2020 ) Cite this article

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• Cognitive neuroscience
• Human behaviour

Gender identity is a collection of thoughts and feelings about one’s own gender, which may or may not correspond to the sex assigned at birth. How this sense is linked to the perception of one’s own masculine or feminine body remains unclear. Here, in a series of three behavioral experiments conducted on a large group of control volunteers (N = 140), we show that a perceptual illusion of having the opposite-sex body is associated with a shift toward a more balanced identification with both genders and less gender-stereotypical beliefs about own personality characteristics, as indicated by subjective reports and implicit behavioral measures. These findings demonstrate that the ongoing perception of one’s own body affects the sense of one’s own gender in a dynamic, robust, and automatic manner.

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Introduction

Gender identity is a collection of thoughts and feelings about one’s own gender, which may or may not correspond to the sex assigned at birth 1 , 2 , 3 , 4 , 5 . This multifaceted, subjective sense of being male, female, both, or neither occurs in our conscious self-awareness, but the associated perceptions and beliefs can also be largely implicit 3 , 4 , 5 . In the past, gender identity was conceptualized as a male–female dichotomy; however, current theories consistently postulate that gender identity is a spectrum of associations with both genders 1 , 3 , 4 , 5 , 6 . There is also a general consensus in the field that gender identity is determined by multiple factors, such as person’s genes, hormones, patterns of behaviors, or social interactions 4 , 5 , 6 , 7 , 8 ; and that the sense of own gender (e.g., “I’m male”) is closely linked to one’s beliefs about males and females in general (e.g., “males are competitive”), as well as to the associated beliefs about own personality (“I am competitive”) 1 , 3 , 6 . The specific content of such beliefs and their strength contribute to what it means for a given person to be male or female in a given sociocultural context, which in some cases hinders the realization of one’s full personal or professional potential. Although gender identity has a profound impact on our lives, little is known about how this sense is formed or maintained. A better understanding of the neurocognitive mechanisms of gender identity is also important in the context of gender dysphoria (DSM-5 9 ; gender incongruence ICD-11 10 ), which is characterized by the prolonged and clinically relevant distress that some transgender individuals experience due to inconsistency between their sex assigned at birth and their subjective sense of gender.

Various observations suggest that gender identity and the perception of one’s own body are tightly connected. For example, people with gender dysphoria (see above) often avoid looking in the mirror, hide their bodies under loose-fitting clothes, and seek hormonal and/or surgical procedures to adjust their physical appearance to meet their subjective sense of own gender 6 , 11 , 12 . Moreover, among individuals whose gender identity matches their sex assigned at birth, mastectomy and androgen deprivation cancer therapies, which both involve changes to one’s feminine or masculine bodily characteristics, are often related to a gender identity crisis 13 , 14 . There are also data suggesting that the mental representation of one’s own body is altered in transgender individuals 15 and that the brain regions involved in this representation are anatomically and functionally different in this group compared to controls 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 . However, the link between own body perception and gender identity remains poorly understood from a behavioral experimental perspective, and we do not know whether, and if so how, the perceived sex of own body influences the sense of own gender in nontransgender individuals.

The full-body ownership illusion 24 is a powerful experimental tool for manipulating the perception of one’s own body 25 , 26 , 27 , 28 , 29 , 30 . During this illusion, the participants wear head-mounted displays (HMDs) and observe a stranger’s body from a first-person perspective. The stranger’s body is continuously stroked with a stick or a brush, and the experimenter applies synchronous touches on the corresponding parts of the participant’s body, which is out of view. Synchronous visuotactile stimulation induces a feeling that the stranger’s body is one’s own, whereas asynchronous stimulation breaks the illusion and serves as a well-matched control condition 24 , 31 , 32 , 33 . The full-body ownership illusion, similar to the rubber hand illusion involving a single limb 34 , 35 , 36 , 37 , occurs when visual, tactile, proprioceptive, and other sensory signals from the body are combined at the central level into a coherent multisensory representation of one’s own body 24 , 25 , 26 , 30 . Body ownership illusions involving limbs 37 and full bodies 31 , 33 , 38 are related to increased neural activity in regions of the frontal and parietal association cortices that are related to multisensory integration, such as the premotor and intraparietal cortices. Because these brain regions contain trimodal neurons that integrate visual, tactile, and proprioceptive signals and because body illusions closely follow the temporal and spatial constraints of multisensory integration, it has been proposed that combining bodily signals from different modalities is a key mechanism for attributing ownership to our bodies 25 , 26 , 27 , 28 , 29 , 30 . The full-body illusion has been replicated in numerous studies 24 , 31 , 32 , 33 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , even with bodies of a sex opposite to that of the participants 24 , 43 , but the cognitive consequences of this transient physical sex change on gender identity have not been assessed.

Here, we conducted three within-subject behavioral experiments on a total of one hundred forty naïve control volunteers to investigate a possible dynamic relationship between the perception of own body and the sense of own gender. In all three experiments, we induced the “body-sex-change illusion”, which is analogous to the standard full-body illusion (see earlier), but in the HMDs, the participants observe the opposite-sex stranger’s body (Movies S1 and S2). Thus, we aimed to experimentally manipulate how the participants perceived the secondary sex characteristics of their own bodies to measure what outcome this manipulation has on different aspects of gender identity. Specifically, in Experiment I, we asked the participants to rate how masculine or feminine they felt after the body-sex-change illusion to assess the subjective and conscious facets of gender identity. Explicit methods such as the one above provide information about participants’ phenomenological experience, but ideally, they should be combined with objective tests to provide more conclusive results. Therefore, in Experiment II, we used a well-controlled behavioral method—the Implicit Association Test (IAT)—to measure the cognitive and implicit aspects of gender identity; this test is largely immune to conscious strategies 46 and has been validated for gender identity research in control 47 , 48 as well as in transgender individuals 48 . Finally, in Experiment III, we tested whether the perception of own body affects gender-related beliefs about own personality (see earlier) by asking the participants to rate after the illusion how much different traits, stereotypically related to males and females, pertain to their own personality. Applying such different measurements aimed to capture the multifaceted character of the sense of own gender (see earlier), while using continuous scales in all experiments addressed gender identity as a spectrum (see earlier). We hypothesized that if own body perception dynamically shapes gender identity, then even a brief transformation of one’s own perceived physical sex during the body-sex-change illusion should shift different aspects of gender identity toward the opposite gender.

Experiment I tested whether the perception of one’s own body dynamically shapes one’s subjective feeling of masculinity/femininity. The experiment comprised a two-by-two factorial design with four conditions (Fig.  1 a): “synchronous opposite sex” (syncO), “synchronous same sex” (syncS), “asynchronous opposite sex” (asyncO), and “asynchronous same sex” (asyncS). This design allowed us to manipulate the sex-related characteristics of the perceived bodily self in the body-sex-change illusion condition (syncO) while controlling for potential confounding factors related to experiencing a full-body ownership illusion itself (syncS) or cognitive biases due to simply looking at a male or female body (asyncS, asyncO). We measured the illusion psychometrically by asking the participants to rate their subjective experience of owning the stranger’s body (Fig.  1 b) and objectively by recording the participants’ physiological fear reactions (skin conductance responses) when the stranger’s body was physically threatened with a knife (Fig.  1 c). Both of these illusion measures should be higher during the synchronous than during the asynchronous conditions 24 , 32 , 38 , 39 , 42 . Importantly, before experiencing any body perception manipulation (baseline) and after every full-body illusion condition, the participants rated how masculine or feminine they felt (Fig.  1 d,e).

Perceptual illusion of having the opposite-sex body modulated the subjective experience of feeling masculine or feminine (Experiment I). ( a ) The participants (N = 32; 15 females) lay on a bed and wore a head-mounted display in which a body of an unknown male or female was shown from a first-person perspective (the participant’s real body was out of view). Video frames illustrate all four conditions for a male participant (top picture). For a female participant, the videos from the lower and upper rows would be swapped. In the synchronous conditions, touches applied to the participant and touches applied to the stranger’s body were matched (see the red triangle), whereas in the asynchronous conditions, touches applied to the participants were delayed by 1 s. We expected to induce the body-sex-change illusion specifically in the syncO condition, and the other conditions served as controls. ( b ) After each condition, the participants rated illusion (I1:I3) and control (C1:C4) statements on a 7-point scale (− 3—“strongly disagree”; + 3— “strongly agree”). The illusion statements assessed the feeling that the stranger’s body is one’s own, whereas the control statements controlled for any potential effects of suggestibility or task compliance. ( c ) Genuine ownership of the stranger’s body should be associated with increased physiological stress responses of the participant when the stranger’s body is physically threatened. Thus, we measured the participants’ skin conductance responses elicited by brief “knife threat” events that occurred in the videos. ( d ) Before the experiment (baseline) and after each condition, the participants rated how feminine or masculine they felt. The upper row shows scale assignment for female participants and the lower row for males. ( e ) The order of conditions was counterbalanced across the participants, and the whole experiment lasted ~ 30 min. ( f ) The illusion ratings and the magnitude of skin conductance responses were significantly higher in the synchronous than in the asynchronous conditions, which shows that the full-body ownership illusion was elicited as expected. ( g ) During syncO, the female participants indicated feeling less feminine, and the male participants indicated feeling less masculine than during other conditions. ( h ) Strong illusory ownership of the opposite-sex body was related to a significant shift toward the opposite gender, specifically in syncO. For clarity of display, only ratings from syncO and asyncO are shown; syncS, asyncS, and baseline are colored in gray for comparison. ( i ) The participants who experienced a strong body-sex-change illusion (above-median I1 ownership ratings: syncO–asyncO; N = 12) indicated feeling more masculine (females) or more feminine (males) during syncO than during other conditions. Plots show means ± SE.

The full-body ownership illusion was induced as expected, that is, “illusion scores” [illusion questionnaire ratings: (I1 + I2 + I3)/3 + (C1 + C2 + C3 + C4)/4] were higher in the synchronous than in the asynchronous conditions, and knife threats during the synchronous conditions triggered stronger skin conductance responses than knife threats during the asynchronous conditions (Fig.  1 f; Table S2 ; main effect of synchrony; illusion scores: F 1,32  = 64.48; P  < 0.005; skin conductance: F 1,27  = 10.98; P  < 0.005; two-sided; N = 32). With regard to our main hypothesis, we found that during syncO, female participants indicated feeling significantly less feminine and male participants significantly less masculine than during the baseline, syncS, and asyncS control conditions; the difference between syncO and asyncO showed a significant trend in the hypothesized direction (Fig.  1 g; Tables S2 and S3 ). Importantly, the shift toward the opposite gender, specifically in the syncO condition, was enhanced by the illusory ownership of the opposite-sex body (Fig.  1 h; Tables S2 and S3 ; synchrony × body × ownership: F 1,32  = 8.05; P  = 0.008; main effect of ownership in syncO: b  = − 0.6; SE  = 0.2; t 30  = − 2.29; P  = 0.022; two-sided; N = 32). Please note that “ownership” in the analysis above corresponds to I1 questionnaire ratings: syncO—asyncO (one value per participant). Moreover, we found that the participants who experienced a strong body-sex-change illusion (N = 12; median-split; see “ Materials and methods ”) indicated feeling more like the opposite gender in syncO compared to the other conditions (Fig.  1 i; Tables S2 and S3 ). Overall, Experiment I shows that the ongoing perception of one’s own body dynamically updates one’s subjective feelings of masculinity or femininity.

Experiment II tested whether the perceived sex of one’s own body also modulates implicit associations between oneself and gender categories. This experiment had the same two-by-two factorial design as Experiment I (Fig.  1 a), but this time, gender identity was measured with the IAT 47 , 48 . During this test, the participants heard words belonging to four semantic categories ( male , female , self , or other ) and sorted these words into just two response categories. In one block, the participants responded with the same key to words from the self and female categories, which made this block congruent for females and incongruent for males. In the other block, the participants responded with the same key to words from the self and male categories, which made this block incongruent for females and congruent for males (Fig.  2 b). Faster responses in the congruent block than in the incongruent block (i.e., congruent block being cognitively less demanding) indicate that a given person associates with the gender that is consistent with his/her sex. In turn, longer reaction times in the congruent block suggest an inclination toward the opposite gender, whereas similar responses in both blocks suggest a balanced gender identity. Thus, the IAT provides a fine-grained behavioral proxy of where a person is located on a gender identity spectrum (see “ Introduction ”). The participants performed the IAT four times, once during each condition, which allowed us to track changes in implicit gender identification across different embodiment contexts (Fig.  2 c).

The body-sex-change illusion balanced implicit associations between the self and both genders (Experiment II). ( a ) This experiment (N = 64; 32 females) comprised the same four conditions as Experiment I (Fig.  1 a), but we used recordings of a different male and female body to enhance the generalizability of our findings. ( b ) The left panel is a schematic representation of the congruent IAT block for the female participants (incongruent for males), as words from the self and female categories are assigned to the same response category (left arrow). The right panel shows the IAT block that is incongruent for the female participants and congruent for males. Please note that exactly the same words are used in both blocks, only the instructions (key assignment) are different. ( c ) During each condition, the participants completed one full IAT (two blocks). The condition order and block order were counterbalanced across participants. The whole experiment lasted ~ 60 min. ( d ) The body-sex-change illusion was successfully induced, as shown by questionnaire data and the magnitude of threat-evoked skin conductance responses. ( e ) In all conditions, reaction times were significantly shorter in the congruent than in the incongruent IAT blocks, which shows that it was generally easier for the participants to associate themselves with the gender consistent with their sex. ( f ) Strong illusory ownership of the opposite-sex body was related to the balancing of implicit associations between the self and both genders, specifically in syncO. For clarity of display, individual data points are not shown (n = 7,290). ( g ) The participants who experienced a strong body-sex-change illusion (above-median I1 ownership ratings: syncO–asyncO; N = 24) responded similarly quickly in the incongruent and congruent IAT blocks during syncO. Bar plots show means ± SE.

The body-sex-change illusion was also successfully induced in Experiment II, as demonstrated by the questionnaire and skin conductance data (Fig.  2 d; Table S4 ; main effect of synchrony; illusion scores: F 1,64  = 125.65; P  < 0.005; skin conductance: F 1,60  = 4.97; P  = 0.03; two-sided; N = 64). In all conditions, it was easier for the participants to associate themselves with the gender consistent with their sex, as indicated by shorter reaction times in the congruent than in the incongruent blocks (Fig.  2 e; Tables S4 and S5 ). More importantly, however, strong illusory ownership of the opposite-sex body was related to a reduced difference between the incongruent and congruent blocks specifically in syncO, which shows that the illusion balanced the strength of implicit associations between the self and both genders (Fig.  2 f; Table S4 ; synchrony × body × congruence × ownership: F 1,28878  = 17.03; P  < 0.005; congruence × ownership in syncO: F 1,7207  = 9.37; P  < 0.005; two-sided; N = 64). Furthermore, the participants who experienced strong illusory ownership of the opposite-sex body (N = 24; median-split; see “ Materials and methods ”) had similar reaction times in the congruent and incongruent IAT blocks during syncO (Fig.  2 g; Tables S4 and S5 ). Thus, the main finding of Experiment II is that the moment-to-moment perception of one’s own body balances the strength of implicit associations between the self and both genders.

Experiment III investigated whether the illusion-induced fluidity of gender identity is generalized to gender-related beliefs about one’s own personality (see “ Introduction ”). This experiment consisted of two conditions (syncO and asyncO); thus, in the HMDs, female participants always observed a male body, and male participants always observed a female body (Fig.  3 a,b). After each condition, the participants filled out a short version of the Bem Sex-Role Inventory (BSRI) 49 , 50 that contained personality characteristics stereotypically associated with males and females (Fig.  3 b,c). The participants’ task was to rate how much they thought each trait refers to their own personality. We found that the body-sex-change illusion was efficiently induced in Experiment III as well (Fig.  3 d; Table S6 ; main effect of synchrony; illusion scores: F 1,44  = 35.88; P  < 0.005; two-sided; N = 44). Ratings of stereotype-congruent traits were generally higher than ratings of stereotype-incongruent traits (Fig.  3 e; Tables S6 and S7 ). Crucially, however, this stereotypical tendency was significantly reduced in the syncO condition by the illusory ownership of the opposite-sex body (Fig.  3 f; Tables S6 and S7 ; synchrony × congruence × ownership: F 1,759  = 5.6; P  = 0.018; congruence × ownership in syncO: F 1,374  = 13.46; P  < 0.005; two-sided; N = 44). The participants who experienced a strong body-sex-change illusion (N = 20; median-split; see “ Materials and methods ”) rated stereotype-congruent and stereotype-incongruent traits during syncO similarly high (Fig.  3 g; Table S7 ). These findings show that the perception of one’s own masculine or feminine physical characteristics flexibly updates gender-stereotypical beliefs about one’s own personality.

Illusory ownership of the opposite-sex body was associated with less gender-stereotypical beliefs about one’s own personality traits (Experiment III). ( a ) Frames from the videos used in this experiment (N = 44; 22 females). ( b ) The experiment consisted of two conditions (syncO and asyncO); thus, in the head-mounted display, the female participants always observed a male body and the male participants a female body that was stroked either synchronously or asynchronously with regard to touches delivered to the participants. The condition order was counterbalanced across the participants, and the whole experiment took ~ 45 min. ( c ) After each condition, the participants rated how well each personality characteristic describes the self (1—“not at all”; 7—“very much”). Each BSRI sublist contained five traits stereotypically related to males (gray) and five traits stereotypically related to females (black). ( d ) The illusion ratings were significantly higher in the syncO condition than in the asyncO condition, which demonstrates that the body-sex-change illusion was efficiently induced. ( e ) Stereotype-congruent personality traits were generally rated higher than stereotype-incongruent traits. ( f ) Strong illusory ownership of the opposite-sex body was associated with less gender-stereotypical beliefs about own personality traits, specifically in the syncO condition. For clarity of display, individual data points are not shown (n = 434). ( g ) The participants who experienced a strong body-sex-change illusion (above-median I1 ownership ratings: syncO–asyncO; N = 20) rated stereotype-congruent and stereotype-incongruent traits similarly high, specifically in the syncO condition. Bar plots show means ± SE.

Finally, to assess the overall robustness of the relationship between own body perception and gender identity, we performed a post hoc meta-analysis of the data from all three experiments combined. We found that strong illusory ownership of the opposite-sex body in syncO was related to increased updating of the sense of own gender (Fig. S1 ; ρ 138  = 0.24; P  < 0.005; Spearman correlation; two-tailed). Control analyses showed that the male and female participants experienced the body-sex-change illusion equally strongly and that there was no consistent significant relationship between the illusion strength and the participants’ age or baseline masculinity/femininity ratings (Fig. S2 ; for analogous evidence regarding syncS, see Fig. S3 ). Moreover, the degree of gender identity updating did not significantly differ between males and females and was not significantly related to the participants’ age or baseline masculinity/femininity ratings (Fig. S4 ). These results are in line with the notion that the full-body illusion is a robust perceptual phenomenon that generally is not affected by high-level cognitive or emotional processes 25 , 30 , which validates the current illusion-based approach to dynamically changing the perceptual basis of the bodily self in a mixed group of male and female subjects.

The present study used the body-sex-change illusion to experimentally investigate the link between own body perception and gender identity. We found that even a brief transformation of one’s own perceived bodily sex dynamically updated the subjective, implicit, and personality-related aspects of the sense of own gender and made these aspects more balanced across male and female categories. This main finding was consistent across three separate experiments conducted on a large group of control volunteers, with the use of subjective and objective behavioral measures. The fluidity of gender identity that we report here extends previous knowledge by demonstrating that the link between own body perception and the sense of own gender is dynamic, robust, and direct. It is dynamic because the effects that we detected occurred after several minutes of the body-sex-change illusion, it is robust because these effects were present at explicit and implicit levels, and it is direct because the changes in gender identity precisely followed our experimental manipulation of perceived own body sex.

By highlighting the role of own body perception in the shaping of the sense of own gender, this study adds a new perspective to existing theories of gender identity development. Specifically, it has been previously proposed that during their first year of life, infants construct presymbolic, perceptual, and unconscious representations of gender, based on patterns of maternal and paternal interactive styles; their touch, activity levels, timbre of voice, affective reactions, etc. 4 , 5 . Around the same age, babies can also detect synchronous visuotactile and synchronous visuomotor information related to their body 51 , 52 , 53 , 54 , which suggests that they have already developed a basic multisensory representation of their own body that continues to mature throughout childhood 55 . Thus, it is possible that during direct interactions with their caregivers, infants experience various degrees of sensory alignment between their own body representation and the perceptual representations of gender; this alignment might be a foundation for what older children and adolescents refine into a conscious sense of own gender 4 , 5 . The present findings fit well with the above idea and offer important new insights by showing that the moment-to-moment perception of one’s own body continues to affect gender identity even in adult participants.

The fluidity of gender identity that we demonstrate here does not deny that most people experience a stable sense of own gender. Instead, our findings indicate that a change is possible if a sufficient modification of own body representation occurs. Thus, the present study is in line with the general notion that gender identity is a “softly assembled, self-organizing system” that involves dynamic coupling between relevant biological, psychological, and sociocultural factors, such as a person’s hormonal and anatomical status, thoughts and feelings about his or her own gender, or perceived societal norms; when all these factors cohere tightly, gender identity remains stable, but when coherence is poor, gender identity is updated accordingly 4 , 5 , 8 . What current results add to this perspective is experimental support that the perception of own secondary sex characteristics is an integral part of the gender identity construction process that can considerably perturb the sense of own gender in nontransgender adults.

A thorough reader might ask how, if the perception of one’s own body is so critical for gender identity, these two aspects can remain in conflict for a prolonged period of time in transgender individuals. First, our results should not be treated as evidence that perceived bodily sex is the only factor that shapes the sense of own gender; this sense is a complex phenomenon that is constructed from multiple factors (see “ Introduction ”). Second, some characteristics of gender dysphoria, such as avoiding looking in the mirror or hiding one’s body under loose-fitting clothes 11 , 12 , suggest that these individuals might actively suppress the link between their own body perception and their subjective sense of gender. Our results contribute to the discussion about the mechanisms of gender identity by suggesting that there is a continuous bottom-up influence from the perceptual body representation on the cognitive, conceptual, and possibly affective representations of gender identity in terms of the body’s secondary sexual characteristics. Future studies should address the important question of how transgender people, with and without gender dysphoria, update their sense of own gender during the body-sex-change illusion and whether the illusion could partly alleviate distress by reducing the incongruence between the body and subjective gender.

Another key finding of the present study is that the body-sex-change illusion reduced gender-stereotypical beliefs about own personality. This result supports the claim that gender identification (e.g., “I’m a male”), gender stereotypes (e.g., “Males are competitive”), and gender-stereotypical beliefs about one’s own personality (e.g., “I’m competitive”) are connected with each other 1 , 3 , 6 , so that a change in one aspect (gender identification), due to the body-sex-change illusion, affects the other aspects (stereotypical self-beliefs). It is worth mentioning that existing programs against gender discrimination, such as media campaigns or educational workshops, mainly target explicit manifestations of gender stereotypes 56 . However, people are often unaware that their way of thinking is biased, and thus, they cannot deliberately change it. Body-oriented techniques, similar to the one used here, could possibly overcome this limitation and target more covert aspects of gender discrimination. Future research is needed to validate this approach.

Previous studies have shown that different versions of the full-body ownership illusion have various cognitive, emotional, and behavioral consequences. For example, attitudes toward other people change after illusory ownership of their bodies 29 , emotional feelings of social fear 42 and body dissatisfaction 32 , 33 can be modulated by the full-body ownership illusion, and the encoding of episodic memories depends on the embodied first-person perspective 57 . Even beliefs about own personality characteristics 58 , the recognition of one’s own face 59 , 60 , 61 , the style of one’s own behavior 62 , and implicit associations with the past-self 45 are flexibly adjusted based on the ongoing perception of one’s own body. With regard to gender, it has been shown that it is possible to induce the body-sex-change illusion 24 , 43 and that female participants who looked at male avatars from a first-person perspective improved their working memory performance during a stereotype-threatening situation 63 ; however, the latter finding needs to be interpreted with caution, as there was no conclusive evidence that the participants felt ownership of the avatar’s body. Our study extends the above literature in three ways: first, by showing that even the supposedly most stable aspects of the psychological sense of self, that is, gender identity, are dynamically updated based on the ongoing perception of one’s own body; second, by demonstrating that this updating affects both implicit and explicit beliefs about the self; and third, by clarifying that the illusory ownership of another person’s body not only modifies attitudes toward that person or toward a social group that he or she is a member of but also modifies beliefs about the self.

With regard to the cognitive mechanisms behind the body-related flexibility of self-concept, there are several possible explanations. Embodied cognition theories propose that all concepts are grounded in sensorimotor and situated representations 64 ; thus, a change in own body representation, for example, during a full-body ownership illusion, affects conceptual knowledge about the self. In turn, predictive processing theories suggest that if the low-level perceptual representation of one’s own body creates a conflict further up in the processing hierarchy, then this conflict is resolved by updating higher-order beliefs about oneself 28 , 65 . Other authors proposed that illusory ownership of someone else’s body (1) involves making inferences about own attitudes, e.g., “I am polite, because the person whose body I have is polite” 62 ; (2) that the illusion allows new associations to be formed within the “self-image network” 66 ; (3) that “owning” another person’s body makes knowledge about that person, or about a social group that this person belongs to, more accessible (i.e., primed) in the conceptual knowledge system 67 ; or (4) that body experiences of this kind increase the perceived physical similarity between the self and the other, which consequently increases the perceived conceptual similarity between the two 29 . What the present study adds to this complex discussion is the demonstration that gender identity updating is not a result of deliberate inference, as the effect occurred for implicit associations measured by the IAT; and this updating could not simply be explained by conceptual priming, because the semantic category of the opposite gender was likely “activated” even by looking at the opposite sex body during asyncO. Moreover, our results suggest that creating new associations within the self-image network is not the only mechanism involved in the updating of self-concept because, at the implicit level, the body-sex-change illusion mainly weakened associations between the self and the preferred gender category (i.e., lengthening reaction times in the congruent IAT block; Fig.  2 f; Table S5 ). Thus, the perceived bodily-sex-change possibly increased a cognitive conflict within the existing beliefs about oneself at the implicit level, which in turn was compensated by revising self-beliefs with new information at the explicit level (i.e., increasing ratings of stereotype-incongruent traits; Fig.  3 f; Table S7 ). Future studies should determine whether the body-related flexibility of self-concept involves different cognitive mechanisms depending on the degree of conscious awareness.

We speculate that at the neural level, the fundamental interplay between the perception of one’s own body and gender identity is implemented by functional interactions between the multisensory frontoparietal areas that represent the bodily self 30 , 31 , 37 , on the one hand, and the medial prefrontal regions that are involved in the self-concept representation 68 , 69 , affective body representations in the insula and anterior cingulate cortex 33 , and higher-order visual representation of the body in the lateral occipital cortex 70 , 71 , on the other. Multisensory representations in the posterior parietal cortex may be particularly important in this respect, as this region is sensitive to the perceived size and shape of one’s own body 33 , 72 , including waist size 72 , which is likely to be important for the identification of the body’s sex based on secondary sex characteristics. Notably, the pattern of resting-state connectivity in the posterior parietal cortex is different in transgender individuals compared to age-matched controls 21 , and a recent study reported that individuals with gender dysphoria display greater cortical thickness of the anterior cingulate cortex and lateral occipital cortex than controls 23 . Interestingly, the lateral occipital cortex, which includes the extrastriate body area—a higher-order visual area that is involved in the processing of images of human body parts 73 —shows increased activation during body ownership illusions 33 , 38 , 70 , 71 . Future neuroimaging studies could use the present body-sex-change illusion to perturb the sense of gender identity experimentally and investigate how the patterns of activity and functional connectivity within the above fronto-parieto-occipital networks change accordingly.

It is noteworthy that our findings are mainly related to balancing the identification with both genders rather than to a “full switch” to the opposite gender. This could be because the perception of one’s own body is not potent enough to completely override the existing sense of own gender or because the body-sex-change illusion in the present study was not induced for long enough. Future studies are needed to reveal the extent to which gender identity could change as a result of modified body representation and the persistence of such changes over time. Another methodological aspect that is noteworthy is that the body-induced fluidity of gender identity showed relatively large interindividual differences. This variability was related mainly to how vividly the participants experienced the body-sex-change illusion, which of course makes sense because if there was no change in the representation of own body, then there was no reason to update one’s gender identity. Individual differences in the strength of body ownership illusions are most likely related to how brains integrate visual, tactile, and proprioceptive signals 30 , 74 and depend on the relative weights assigned to different sensory channels, as well as prior knowledge that varies across subjects 34 , 75 . For example, if more weight is given to vision than to proprioception, the illusion should be stronger, and vice versa. Based on our data, we can conclude that variability in the illusion strength was not significantly related to the participants’ sex, age, or baseline feelings of masculinity/femininity (Figs. S2 and S3 ). Finally, it is worth mentioning that our within-subject experimental design allowed us to demonstrate a particularly strong case of gender identity flexibility that occurred for the same participants across different body perception contexts.

In sum, the present study shows that there exists a dynamic and automatic link between the perception of own body and different aspects of the sense of own gender. This main finding has important bearings on neurocognitive models of gender identity, as well as on clinical psychology and psychiatry. Moreover, the body-sex-change illusion that we report here allows for a manipulation of gender identification in nontransgender participants, which offers an unprecedented opportunity to investigate the sense of own gender in a controlled experimental setting. Importantly, people with gender dysphoria who consider surgical and hormonal procedures to adjust their physical appearance to match their gender identity could perhaps benefit from future iterations of the body-sex-change illusion, which combined with virtual reality and 3D body scanners might alleviate distress and allow these individuals to somewhat experience their own “new body” before undergoing more permanent procedures.

Materials and methods

All participants provided written informed consent before the start of each experiment. The Regional Ethics Review Board of Stockholm approved the studies. All methods were performed in accordance with the approved guidelines. The inclusion criteria were as follows: (1) age between 18 and 65 years old; (2) no history of severe psychiatric illness or neurological disorder; (3) normal or corrected-to-normal vision and hearing; (4) not wearing glasses during the experiment; and (5) understanding English (see below). These criteria were assessed during an initial interview. Sample sizes were based on similar previous studies (see “ Introduction ”) and our counterbalancing schemes. Data collection was finalized when the planned number of participants was reached. At the end of each experiment, the participants were debriefed and received compensation. All measures that were used are reported in the manuscript. Because the participants were of different nationalities, all experiments were conducted in English; the participants followed instructions without problems. The stroking procedure in Experiment I was performed by P.T., and in Experiments II and III, it was performed by J.F.

Experiment I

Participants.

Thirty-three naïve adults participated (age: 25 ± 4; 4 left-handed; 15 females). Data from one participant were excluded due to a procedural error (same condition repeated twice).

The participants first rated how masculine or feminine they felt before experiencing any body perception manipulation (baseline; Fig.  1 d). The main experiment consisted of four conditions: “synchronous opposite sex” (syncO), “synchronous same sex,” (syncS), “asynchronous opposite sex,” (asyncO), and “asynchronous same sex” (asyncS). Each condition lasted 3.5 min. During each condition, the participants lay on a bed with their heads tilted forward (~ 45°) and wore a head-mounted display (HMD; Oculus Rift Development Kit 2, Oculus VR, Menlo Park, CA, USA) so that they could not see their actual body. In the HMD, the participants watched prerecorded 3D videos of a stranger’s body, male or female, that was shown from a first-person perspective. The stranger’s body was continuously stroked on the thighs and abdomen, and the experimenter delivered synchronous (syncO, syncS) or asynchronous (1 s delayed; asyncO, asyncS) touches on the corresponding parts of the participant’s body (Fig.  1 a). During each condition, there were three “knife threats” that occurred 1, 2, and 3 min after the beginning of each video (Fig.  1 c,e). After each condition, the participants took off the HMD, filled out the illusion questionnaire (Fig.  1 b) and rated how masculine or feminine they felt during the preceding session (Fig.  1 d). The order of conditions was counterbalanced across the participants, and the whole experiment lasted ~ 30 min (Fig.  1 e).

Prerecorded videos

During filming, a male and a female lay still on a bed. The experimenter used a 90-cm-long stick with a white plastic ball (diameter 10 cm) attached to its end to deliver strokes to each model’s abdomen, left thigh, or right thigh. The duration of each stroke was 1 s, and each stroke covered ~ 20 cm of the model’s body. The time between the end of one touch and the onset of the next touch ranged between 3 and 5 s. The frequency of strokes was 12 times per minute. The order of strokes was pseudorandom (i.e., no more than two successive strokes of the same body part). Altogether, 36 strokes (12 to each body part) were delivered during each video. The videos were recorded with two identical cameras (GoPro HERO4 Silver, GoPro, Inc., San Mateo, CA, USA) placed parallel to each other (8 cm apart) just above the models’ heads. The recordings from both cameras were combined into a single frame using Final Cut Pro software (version 7, Apple Inc., Cupertino, CA, USA). Two versions of high-quality 3D videos were created: one for the male and one for the female body. Audio cues were then added to each video. These cues were either congruent with touches applied in the videos (same body parts, same onset, same duration) or delayed by 1 s. The experimenter listened to these cues during the experiment and applied touches accordingly. All other aspects were identical in the synchronous and asynchronous videos.

Knife threats

For each of the two videos, we recorded knife-threat events. During these events, a hand holding a knife entered the field of view from above and performed a stabbing movement toward the model’s body (Fig.  1 c). The knife stopped just before hitting the body, changed direction (− 180°), and exited the field of view in the same way that it had entered. The whole event lasted 2 s. Great care was taken to ensure that the knife threats in the male and female versions of the videos looked as similar as possible. Knife threats in the synchronous and asynchronous versions of the same video (male or female) were identical. Subsequent knife threats within a given condition were also identical. After each knife threat, there was a 10 s pause when no strokes were delivered. In line with good ethical practice, before the experiment, we informed the participants about the knife threats in the videos to prevent overly high emotional stress.

Visuotactile stimulation during the experiment

The experimenter listened to audio cues from the videos (see earlier) and accordingly applied touches to the participant’s body. These cues were played via headphones, so the participants could not hear them. The number, order, type, length, velocity, and frequency of strokes during the experiment precisely followed the prerecorded videos (see earlier). To deliver touches, the experimenter used the same white ball attached to a stick that had been used in the video recordings.

Illusion questionnaires

Subjective experience of the full-body ownership illusion was quantified with a questionnaire that began with an open-ended sentence (“During the last session, there were times when…”). This sentence was followed by three illusion statements that quantified the explicit feeling of body ownership (I1; Fig.  1 b) and the sensation of touch directly on the stranger’s body (I2 and I3; Fig.  1 b). Ownership and referral of touch are considered to be the two core elements of the multisensory full-body illusion 25 , 26 . Apart from the illusion statements, the questionnaire included four control statements (C1–C4; Fig.  1 b) that were added to control for potential task compliance or suggestibility effects. The questionnaire administered to the participants had items listed in the following pseudorandom order: C1, I1, C2, I2, C3, C4, I3. The participants marked their responses on a scale from − 3 (“strongly disagree”) to + 3 (“strongly agree”).

Skin conductance responses

The skin conductance response reflects increased sweating attributable to the activation of the autonomic nervous system 76 . When one’s own body is physically threatened, the threat triggers emotional feelings of fear and anticipation of pain that are associated with autonomic arousal. This arousal can be registered as a brief increase in skin conductance a few seconds after the threat event. Increased threat-evoked skin conductance responses, compared to a well-matched control condition, are often used as an index of body ownership in body illusion paradigms 24 , 30 , 38 . In the current experiment, data were recorded continuously with the Biopac system MP150 (Biopac Systems Inc., Goleta, CA, USA) and AcqKnowledge software (version 3.9). The following parameters were used: sampling rate = 100 Hz, low-pass filter = 1 Hz, high-pass filter = DC, gain = 5 μS/V, and CAL2 scale value = 5. Two Ag–AgCl electrodes (model TSD203, Biopac Systems Inc., Goleta, CA, USA) were placed on the volar surfaces of the distal phalanges of the participants’ left index and middle fingers. Isotonic paste (GEL101; Biopac Systems Inc., Goleta, CA, USA) was used to improve the skin contact and recording quality. At the beginning of the experiment, we asked the participants to take the deepest breath possible and hold it for a couple of seconds. In this way, we tested our equipment and established a near maximum response for each participant. The timing of threat events was marked in the recording file by the experimenter by pressing a laptop key immediately after the threat occurred.

Masculinity/femininity ratings

The participants marked their responses on a visual analog scale (Fig.  1 d). Scale assignment was different for the male and female participants (Fig.  1 d). Baseline ratings were generally greater than zero, as expected for a nontransgender group, but showed some degree of variability (mean = 2.22; SD = 0.97; min = − 1; max = 4).

Experiment II

Sixty-four naïve adults participated (age: 27 ± 5; all right-handed; 32 females).

The participants first completed a practice IAT (20 trials). The main study consisted of the same four conditions as those in Experiment I, that is, syncO, asyncO, syncS, and asyncS (Figs.  1 a, 2 a). After the initial phase of just watching the videos and feeling touches (30 s), the participants started the first IAT block (Fig.  2 b,c). IAT stimuli were presented via headphones (Spectrum, Maxell Europe Ltd., Berkshire, UK). The participants used a wireless computer mouse held in the right hand to indicate responses. During each condition, the participants observed two “knife threats” (see further), one in the middle and one at the end of each condition (Fig.  2 c). After each condition, the participants completed the same illusion questionnaire as in Experiment I (Fig.  1 b). The order of the conditions was counterbalanced. The whole study lasted ~ 1 h (Fig.  2 c).

The videos were prepared analogously to those in Experiment I, but a different male and female were filmed to assure that our results were not driven by a certain body type or clothing style of the models (Fig.  2 a). Strokes were applied to three body parts: abdomen, left thigh, and right thigh. The abdomen strokes were either single or double (1 s apart). The duration of each stroke was 1 s, and each stroke covered ~ 20 cm of the model’s body. The time between the offset of one touch and the onset of the next touch ranged from 3 to 6 s. The frequency of strokes was 12 times per minute. The touches were delivered in a pseudorandom sequence, with no more than three successive strokes on the same body part. Altogether, 88 touches (22 on each body part) were applied in each video. The videos were recorded with Infinity cameras (1080p Full HD, CamOneTec, Delbrück, Germany) and prepared in the same way as in Experiment I. In the synchronous videos, audio cues were matched with the touches applied in the videos, whereas in the asynchronous videos, the cues were delayed by 1 s and pertained to different body parts. Altogether, we created four versions (syncO, syncS, asyncO, asyncS) of the high-quality 3D videos, each lasting 7 min 5 s.

We used the auditory version of the brief gender identity IAT 47 , 77 . The instruction for one block was as follows: “The test will start in a few seconds. Please listen to the instructions. Try to go as fast as possible while making as few mistakes as possible. If the word belongs to the categories female or self , press left. If the word does not belong to these categories, press right. The test will begin now.” The instruction for the other block differed only with regard to category assignment: “If the word belongs to the categories male or self , press left. If the word does not belong to these categories, press right.” The key assignment remained the same for a given participant across all conditions but was counterbalanced between the participants. The order of IAT blocks was counterbalanced in the same way. The stimulus set consisted of twenty words (Fig.  2 b) that were read by an English native speaker. The volume of each word sound was adjusted using Audacity software (the “normalize” effect; version 2.1.2, https://www.audacityteam.org ). Each word was edited to have a duration similar to that of other words. Please note that the physical differences between stimuli cannot explain the main IAT results because the congruent and incongruent blocks used exactly the same stimuli. The participants had a maximum of 3 s to provide a response (time from the stimulus onset to the end of each trial). If no key was pressed within this time or the wrong key was pressed, the participants heard a “wrong” feedback beep. Each IAT block consisted of 60 trials (three repetitions of all 20 words) presented in random order. The procedure was self-paced, that is, the next trial started as soon as the participant responded in the previous trial (maximum duration of one block ~ 3 min). Presentation software (Neurobehavioral Systems Inc., Albany, CA, USA) was used to present the stimuli and record responses.

These events were recorded in the same way as in Experiment I (i.e., stabbing movement toward the abdomen; 2 s duration). We used triggers from the Presentation software to automatically flag the onset of the knife threats in the skin conductance recording files.

Experiment III

Forty-five naïve adults participated (age: 26 ± 5; all right-handed; 22 females). One participant was excluded because he did not complete one of the questionnaires.

The study lasted ~ 35 min and comprised two conditions: syncO and asyncO (Fig.  3 a,b). Each condition lasted 14 min 10 s. After each condition, the participants filled out the illusion questionnaire (the same as in Experiments I and II) and the Bem Sex-Role Inventory; BSRI 49 , 50 (see further). The order of conditions was counterbalanced across participants (Fig.  3 b).

The videos were prepared analogously to those in Experiments I and II. Four types of strokes (single abdomen, double abdomen, left thigh, and right thigh) were applied. The duration of each stroke was 1 s, and each stroke covered ~ 20 cm of the model’s body. The time between the offset of one touch and the onset of the next touch ranged from 2 to 10 s. The frequency of strokes was 12 times per minute. Different touches were delivered in a pseudorandom sequence, with no more than three successive strokes on the same body part. Altogether, 160 touches (40 on each body part) were applied in each video. Infinity cameras (1080p Full HD, CamOneTec, Delbrück, Germany) were used to record the videos. Audio cues were matched to touches in the synchronous videos and delayed by 1 s in the asynchronous videos.

After each condition, the participants filled out a version of the BSRI 49 , 50 . The questionnaire contained 5 stereotypically masculine and 5 stereotypically feminine personality traits (Fig.  3 c). Using a 7-point Likert scale (1—“not at all”; 7—“very much”), the participants rated how well each trait described them. Ten traits were rated after the first condition and the other ten after the second condition. The order of BSRI versions was counterbalanced.

Analysis of illusion questionnaires

For each participant and condition, we calculated “illusion scores” as the differences between the average illusion (I1–I3) and the control (C1–C4) ratings. To confirm successful induction of the illusion, we compared these illusion scores between the synchronous and asynchronous conditions. The results for individual questionnaire items are shown in Figs. S5 and S6 . The effect of “ownership” used in the correlation analyses (Figs.  1 h, 2 f, 3 f) was the difference between I1 ownership ratings in syncO–asyncO (one value per participant). The participants who experienced a strong body-sex-change illusion were selected using the median-split method applied to ownership scores (see above). The median-split analyses (Figs.  1 i, 2 g, and 3 g) were performed mainly for display purposes and to complement the main analyses using continuous scores.

Analysis of skin conductance responses

Each response was measured as the difference between the maximum and minimum values during the 0–6 s period after each knife threat. Responses below 0.02 μS were treated as zeroes but were included in the analysis of the magnitude of skin conductance responses 76 . Statistical outliers were identified with the ± 1.5 interquartile criterion and removed from the dataset (16% and 6% of the values in Experiments I and II, respectively). Keeping the outliers did not change the main findings (main effect of synchrony in Experiment I: F 1,31  = 5.76; P  = 0.023; N = 32; Experiment II: F 1,63  = 6.43; P  = 0.014; N = 64; two-sided). We applied a square-root transformation to the skin conductance data 76 . Statistical models included the effect of “repetition”, which indicated how many knife threats had already occurred in the study (max. 12 in Experiment I and max. 8 in Experiment II). The magnitude of the skin conductance responses decreased exponentially with subsequent knife threats (Fig. S7 ). To “linearize” this relationship, we transformed the repetition number (1/repetition), which substantially improved the fit of the linear models to the data (Fig. S7 ; Experiment I: χ 2  = 4.36; P  < 0.005; Experiment II: χ 2  = 37.26; P  < 0.005; two-sided; N = 32 and N = 64, respectively). The effect of repetition (habituation) was highly significant (Tables S2 and S4), which was expected 76 . For the control analyses presented in Figs. S2 and S3 , we (1) calculated residuals from the following model: SCR ~ repetition; (2) averaged them for a given participant and condition; and (3) calculated the difference: syncO–asyncO (Fig. S2 ) or syncS–asyncS (Fig. S3 ). Using the residuals accounted for the habituation effect (see earlier).

Analysis of masculinity/femininity ratings, IAT, and BSRI

Raw masculinity/femininity ratings were analyzed (n = 160; one value per condition). IAT data included only correct trials, in which reaction times were longer than 200 ms and shorter than 1,500 ms (95.5% of all trials; n = 29,147). Reaction times were log-transformed. The BSRI analysis was performed on raw ratings (n = 862; 18 ratings missing). Analyses of IAT and BSRI included random intercepts of “1|Item”, which accounted for possible variability between different words (Tables S4 – S7 ).

Meta-analysis

For each participant in each experiment, we calculated the degree of gender identity updating. In Experiment I, this updating score was calculated as the following difference between the masculinity/femininity ratings: [(syncS + asyncS + asyncO)/3]–syncO. In Experiment II, this score was calculated as the difference between the average reaction times in each IAT block: [(syncS i-c  + asyncS i-c  + asyncO i-c )/3] – syncO i-c , where “i” and “c” denote “incongruent” and “congruent”, respectively. Finally, in Experiment III, the updating was calculated as the difference between average personality ratings from each condition: asyncO c-i –syncO c-i , where “c” and “i” correspond to stereotype-congruent and stereotype-incongruent traits, respectively. Because these scores were on different scales, we standardized them (i.e., from each participant’s score, we subtracted the group mean from the respective experiment and divided the result by the group standard deviation).

General statistical information

All statistical analyses were performed in RStudio and R software (version 3.3.3, The R Foundation for Statistical Computing, https://www.r-project.org ). Linear mixed models were estimated using the “lme4” package. Information regarding model selection is provided in Table S1 . All results are reported in Tables S2 – S7 . The distribution of residuals from each main model are shown in Fig. S8 . P -values for the F-tests were based on Satterthwaite’s approximation to degrees of freedom, as implemented by the “lmerTest” package (Tables S2 , S4 , and S6 ). P -values for effect size coefficients (Tables S3 , S5 , and S6 ) and their 95% confidence intervals were obtained with the bootstrapping method by comparing a given coefficient value to its null distribution derived from resampling the original dataset (“boot” package; 1,000 simulations).

Data availability

We do not have ethics approval to make the raw data from individual subjects publicly available.

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Acknowledgements

This study was funded by the Swedish Research Council, Torsten Söderbergs Stiftelse, Göran Gustafsons Stiftelse, StratNeuro, and the European Commission (MSCA fellowship awarded to P.T.; 750955). We want to thank all the participants and Martti Mercurio for important technical support.

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Tacikowski, P., Fust, J. & Ehrsson, H.H. Fluidity of gender identity induced by illusory body-sex change. Sci Rep 10 , 14385 (2020). https://doi.org/10.1038/s41598-020-71467-z

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Article Contents

1. introduction, 2. gender identity first, 3. the no connection view, 4. contextualism, 5. pluralism, 6. further and future work.

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Recent Work on Gender Identity and Gender

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Rach Cosker-Rowland, Recent Work on Gender Identity and Gender, Analysis , Volume 83, Issue 4, October 2023, Pages 801–820, https://doi.org/10.1093/analys/anad027

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Our gender identity is our sense of ourselves as a woman, a man, as genderqueer or as another gender. Trans people have a gender identity that is different from the gender they were assigned at birth. Some recent work has discussed what it is to have a sense of ourselves as a particular gender, what it is to have a gender identity ( Andler 2017 , Bettcher 2009 , 2017 , Jenkins 2016 , 2018 , McKitrick 2015 ). But beyond the question of how we should understand gender identity is the question of how gender identities relate to genders.

Our gender is the property we have of being a woman, being a man, being non-binary or being another gender. What is the relationship between our gender identity and our gender? According to many people’s conceptions and the standards operative in trans communities, our gender identity always determines our gender. Other people and communities have different views and standards: some hold that our gender is determined by the gender we are socially positioned or classed as, others hold that our gender is determined by whether we have particular biological features, such as the chromosomes we have. If our gender is determined by our gendered social position or whether we have certain biological features, then our gender identity will not determine our gender.

There are several different ways of approaching the question what is the relationship between our gender identity and our gender? We can approach this question as a descriptive or hermeneutical question about our current concepts of gender identity and gender: what is the relationship between our concept of gender identity and our concept of gender? ( Bettcher 2013 , Diaz-Leon 2016 , Laskowski 2020 , McGrath 2021 , Cosker-Rowland forthcoming , Saul 2012 ) Rather than focusing on descriptive questions about our gender concepts, many feminists, such as Sally Haslanger (2000) and Katharine Jenkins (2016) , have proposed ameliorative accounts of the concepts of gender which we should accept; these are gender concepts which they argue that we can use to further the feminist purposes of fights against gender injustice and campaigns for trans rights. We might then ask the ameliorative question, what is the relationship between our gender identity and our gender according to the concepts of gender and gender identity that we should accept? However, some of the most interesting recent work on the relationship between gender identity and gender has focussed on the metaphysical issue of the relationship between being a member of a particular gender kind G (e.g. being a woman) and having gender identity G (e.g. having a female gender identity). As we’ll see, we can answer these different questions in different ways: for instance, we can hold that we should adopt concepts such that someone is a woman iff they have a female gender identity but hold that metaphysically someone is a woman iff they are treated as a woman by their society, that is, iff they are socially positioned as a woman.

Four positions about the relationship between gender identity and gender that give answers to these ameliorative and metaphysical questions have emerged. This article will explain and evaluate these four positions. In order to understand these different views about the relationship between gender identity and gender it will help to have a little understanding of recent work on gender identity. The two most well-known and popular accounts of gender identity in the analytical philosophy literature are the self-identification account and the norm-relevancy account. On the self-identification account, to have a female gender identity is to self-identify as a woman. One way of explaining what it means to self-identify as a woman is to hold that such self-identification consists in a disposition to assert that one is a woman when asked what gender one is. 1 On the norm-relevancy account, to have a female gender identity is to experience the norms associated with women in your social context (e.g. the norm, women should shave their legs) as relevant to you ( Jenkins 2016 , 2018 ).

A first view of the relationship between gender and gender identity is what we can call gender identity first . According to a metaphysical version of gender identity first , what it is to be gender G (e.g. a woman) is to have a G gender identity (e.g. to have a female gender identity). Talia Bettcher (2009 : 112), B.R. George and R.A. Briggs (m.s.: §1.3–4), Iskra Fileva (2020 : esp. 193), and Susan Stryker (2006 : 10) argue for gender identity first or views similar to it. And the view that our gender is always determined by our gender identity is, as Briggs and George discuss, part of the standard view in many trans communities and among activists for trans rights. One key virtue of gender identity first is that it ensures that gender is always consensual: on this view, we can be correctly gendered as gender G (e.g. as a woman) only if we identify as a G , and so we can be correctly gendered as a G only if we consent to be gendered as a G by others ( George and Briggs m.s. : §1.3) ( Figure 1 ). 2

Gender identity first

Elizabeth Barnes (2022 : 2) argues that we should reject gender identity first as both a metaphysical and as an ameliorative view. She argues that

(i) Some severely cognitively disabled people do not have gender identities, but

(ii) These severely cognitively disabled people without gender identities have genders and should be categorized as having genders.

And in this case, although having gender identity G is sufficient for being gender G , it is not necessary for being gender G nor necessary for being categorized as a G according to the concepts of gender that we should accept. So, we should reject gender identity first as both a metaphysical view and as an ameliorative view.

Regarding (i), Barnes argues that gender identity

requires awareness of various social norms and roles (and, moreover an awareness of them as gendered), the ability to articulate one’s own relationship to those norms and roles, and so on. But many cognitively disabled people have little or no access to language. Many tend not to understand social norms, much less to identify those norms as specifically gendered. (6)

The norm-relevancy account of gender identity implies that this is true, since on this view having a gender identity involves taking certain gendered social norms to be relevant to you. And the self-identification account also seems to imply that having a gender identity involves having capacities that many severely cognitively disabled people do not have, since self-identification as a particular gender involves a linguistic capacity to say or be disposed to say that one is, or think of oneself as, a particular gender, and many severely cognitively disabled people do not have these capacities.

Barnes has two arguments for

(ii) Severely cognitively disabled people without gender identities have genders.

First, Barnes argues that severely cognitively disabled people who do not have gender identities nonetheless have genders because they suffer gender-based oppression ( 2022 : 11–12). For instance, severely cognitively disabled women are subject to gendered violence and forced sterilization to a greater degree than severely cognitively disabled men. This argument may seem strongest as an argument for (ii) as a metaphysical claim: the view that severely cognitively disabled people without gender identities have genders is the best explanation of what we find happening in the world.

Second, Barnes argues that holding that some severely cognitively disabled people do not have genders because they do not have gender identities would involve othering, alienating or dehumanizing these severely cognitively disabled people. Gender identity first implies that agender people do not have genders because their gender identity is that they have no gender. But Barnes argues that gender identity first’s implication that severely cognitively disabled people without gender identities lack a gender is more pernicious. Agender people have the capacity to form a gender identity but they opt-out of gender. Gender identity first implies that severely cognitively disabled people without gender identities fail to have genders because they do not have the capacity to form a gender identity. So, it implies that they fail to have a gender in the way that tables and animals fail to have a gender – by failing to have the right capacities to have a gender – rather than in the way that agender people do so; for agender people have these capacities. Therefore, Barnes argues, gender identity first others and alienates severely cognitively disabled people from other humans, since all other humans have the capacity to have a gender and having a gender (or opting out of it) is a central part of human (social life). 3 This second argument seems best understood as an argument that we shouldn’t adopt concepts of gender that imply that one is gender G iff one has gender identity G because there are moral and political costs to adopting such concepts.

A second account of the relationship between gender identity and gender is the opposite view; this view understands gender identity and gender as entirely disconnected. On this no connection view, the fact that a woman has a sense of herself as a woman is never what makes her a woman; other features of her, such as the way that she is socially positioned, the way she was socialized, or her biological features, make her a woman.

Several accounts of gender imply the no connection view, including Haslanger’s (2000) influential account of gender. Haslanger’s account was originally proposed as an ameliorative account of the concepts of gender that we should adopt rather than as a metaphysical account of gender properties. But in later work Haslanger also endorsed her account of gender as a metaphysical account of gender properties ( 2012 : e.g. 133–134). On Haslanger’s account, to be a woman is to be systematically subordinated because one is observed or imagined to have bodily features that are presumed to be evidence of a female’s biological role in reproduction; on Haslanger’s view, women are sexually marked subordinates. This view of what it is to be a woman implies that one’s being a woman is never determined by one’s female gender identity. Since, whether one has a sense of oneself as a woman, is disposed to assert that one is a woman or takes norms associated with women to be relevant to one, is neither necessary nor sufficient for one to be a sexually marked subordinate.

Although our gender is not directly determined by our gender identity on Haslanger’s account, one’s female gender identity can indirectly lead one to be a woman on Haslanger’s account. For instance, a trans woman’s female gender identity may lead her to take estradiol which will make her have female sex characteristics, which may lead to her being assumed to play a female biological role in reproduction, to be oppressed accordingly, and so to be a woman on Haslanger’s account. In this case, on Haslanger’s account, someone’s female gender identity can indirectly lead to their becoming a woman ( Figure 2 ).

The n o connection view

Other accounts of gender similarly imply the no connection view of the relationship between gender identity and gender. According to Bach’s (2012) account of gender, to be a woman one has to have been socialized as a woman. But one can have a sense of oneself as a woman without having been socialized as a woman and one can be socialized as a woman without forming a sense of oneself as a woman. So, having a female gender identity is neither necessary nor sufficient to be a woman on Bach’s account (although it may be more likely that A will have a sense of themself as a woman if A was socialized as a woman). Biological or sex-based accounts of gender on which our genders are determined by our biological features, such as our chromosomes, also imply the no connection view, since to have a female gender identity is neither necessary nor sufficient for having XX chromosomes. 4

The no connection view implies that many trans women are not women. For instance, Haslanger’s version of this view implies that trans women who are not presumed to have female sex characteristics by those in their society are not women; so trans women who are not recognised as women, or who ‘do not pass’, 5 are not women. This is because such trans women are not observed or imagined to have features that are presumed to be evidence of a female’s biological role in reproduction. There are many such trans women. So, no connection views such as Haslanger’s imply that many trans women are not women ( Jenkins 2016 : 398–402). Some have argued that this is an unacceptable result for a metaphysical view about the relationship between gender identity and gender, either because all trans women are women or because this view would marginalize trans women within contemporary feminism ( Mikkola 2016 : 100–102). These implications are even more problematic for ameliorative no connection views, that is, for views of how gender identity and gender are related according to the concepts that we ought to accept. For we should not adopt gender concepts that imply that we should not classify many trans women as women ( Jenkins 2016 ).

Furthermore, trans communities and trans-inclusive communities ascribe gender entirely on the basis of the gender identities people express or which people are presumed to have. Another problem with the no connection view is that it may seem to imply that there are no genders being tracked or ascribed in these communities ( Jenkins 2016 : 400–401; Ásta 2018 : 73–74).

These problems do not establish that Haslanger’s account of gender should be abandoned entirely. Elizabeth Barnes (2020) has recently argued that we can rescue Haslanger’s account of gender from the problem that it excludes trans women by understanding it as an account of what explains our experiences of gender. According to Barnes’ version of Haslanger’s account, our practices of gendering people, and our gender identities, are the product of Haslangerian social practices of subordinating and privileging people on the basis of perceived sex characteristics. Barnes’ version of Haslanger’s account does not imply that one is a woman iff one is systematically subordinated because one is observed or imagined to have bodily features that are presumed to be evidence of one’s playing a female’s biological role in reproduction. This is because Barnes’ account is only an account of what gives rise to our experiences of gender rather than an account of who has what gender properties or of the gender concepts that we should accept. Barnes might rescue a version of Haslanger’s account from the problem that it excludes trans women. But if she does, she does this by revising Haslanger’s account so that it drops the no connection view of the relationship between gender identities and gender; Barnes’ revised version of Haslanger’s account of gender is instead silent on the issue of the relationship between having gender identity G and being a member of gender G . So, Barnes’ rescue of Haslanger’s account of gender does not rescue the no connection view of the relationship between gender identity and gender.

Gender identity first and no connection views such as Haslanger’s are invariantist views of the relationship between gender identity and gender: they hold that the relationship between gender identity and gender does not vary across different contexts. A third account of the relationship between gender identity and gender is the opposite of invariantism, contextualism. According to this view, the features that determine our gender, and so the relationship between gender identity and gender, is different from context to context.

Ásta (2018) and Robin Dembroff (2018) have proposed and/or defended forms of (metaphysical) contextualism. On their views, the gender properties that we have, or the gender kinds that we are members of, are determined by the way that we are treated in particular contexts. We are a member of gender G in virtue of our gender identity G in certain contexts, namely trans-inclusive contexts where people are treated as genders based on their (avowed) gender identities. But in other contexts, we are never a member of gender G in virtue of our gender identity G : in contexts in which people are treated as a gender based on features other than their gender identities – such as traditional or conservative societies – we are not members of genders based on our gender identities. For instance, trans woman Amy is a woman in the context of the support group Trans Leeds – she is a woman (Trans Leeds) – but she is not a women in the context of her conservative parents in Henley who don’t recognize her as a woman and who treat people as women based on the chromosomes that they believe them to have – she is not a woman (family-in-Henley) . And Alex is non-binary in the context of the support group Non-Binary Leeds, where one is conferred a particular gender status based on one’s avowed self-identification – they are non-binary (Non-Binary Leeds) – but Alex is perceived as male in most contexts and is treated as male regardless of their self-identification at school, work and in public, and so Alex is not non-binary in most contexts – e.g. they are not non-binary (Alex’s school) . Importantly, on this view, there is no such thing as being gender G simpliciter , that is, beyond whether one is a G -relative-to-a-certain-context – and the way one is treated or the standards that are operative in that context. So, it is not the case that Alex is non-binary simpliciter or genuinely non-binary; they are merely non-binary relative to one standard or context and not non-binary relative to another.

Contextualism can explain why the way that some people are gendered varies from context to context: in explaining her contextualist view, Ásta (2018 : 73–74) gives an example of a coder who is one of the guys at work, neither a guy nor a girl at the bars they go to after work, and one of the women – and expected to help out like all the other women – at their grandmother’s house (85–86). Contextualism also allows us to explain how sometimes people are gendered on the basis of their perceived biological features and sometimes gendered based on their avowed (or assumed) gender identities. Dembroff argues that a contextualist view is particularly useful in explaining how, in many societies and contexts, trans people are unjustly constrained, or as they put it ‘ontologically oppressed’, by being constructed and categorized as a member of a category with which they do not identify; identifying such ontological oppression is essential to explaining the oppression that trans people face ( Dembroff 2018 : 24–26, Jenkins 2020 ) ( Figure 3 ).

Contextualism

However, there are several problems with contextualism. One problem is that it implies that gender critical feminists are, in a sense, right when they claim that trans women are not women and trans men are not men because trans women are not women according to the standards of many people and of many places: in many places trans women, for instance, are not treated as women, and in many places trans women are not women relative to the dominant standard for who is a woman, which is sex-based or biology-based. So, for instance, when in 2021 the then Tory UK Health Secretary Sajid Javid said that ‘only women have cervixes’, according to contextualism, what he said was true in a sense: only women (dominant UK-standards) have cervixes; and only women (Tory party conference) have cervixes. Even though it is false that only women (Trans Leeds) have cervixes because trans men have cervixes. This conclusion may seem problematic and paralyzing because it implies that Javid’s claim is true in a sense in certain contexts, and we cannot truthfully claim that it is just plain false ( Saul 2012 : 209–210, Diaz-Leon 2016 : 247–248). 6

Ásta (2018 : e.g. 87–88) and Dembroff (2018) argue that we can solve this problem by holding that, although it is true that trans men are not men relative to most dominant UK contexts, we should still treat and classify trans men as men. We should classify trans men as men because facts about how we should classify someone – the gender properties that we should treat them as having – are established by moral and political considerations. But although we should classify trans men as men, they are not – as a matter of social metaphysical fact – men (dominant UK contexts) . So, we should accept contextualism as a metaphysical view about the relationship between gender identity and gender but not as an ameliorative view about the gender concepts we should accept; we can call this combination of views purely metaphysical contextualism.

Dembroff (2018 : 38–48) recognizes that purely metaphysical contextualism may seem to have problematic implications. It may seem to imply that many trans women (for instance) are mistaken when they say that they are women in many contexts, such as dominant UK and US contexts, where there are chromosomes-based or assigned-sex-at-birth-based gender standards. Yet Dembroff argues that purely metaphysical contextualism does not have this problematic implication because trans women are women relative to the gender kinds operative in trans-inclusive contexts.

However, this will not always be a helpful form of correctness. Suppose that Alicia is a trans woman in London in 1840. There are no trans-inclusive societies, communities or contexts that she knows of. But she takes herself to be a woman, and suppose that according to both of the accounts of gender identity that we discussed in §1, Alicia has a female gender identity. We can say that Alicia’s judgement that she is a woman is correct in the sense that it is correct-relative to the gender kinds operative in future contexts and fictional contexts. But any judgment that we might make is true relative to the standards in some future or merely possible context. And we might wonder why it matters that someone’s judgment about their own gender is true relative to the standards operative in some future context that they could not possibly be aware of. This form of truth is not what they want and it’s hard to see why it should be relevant in this context. Furthermore, trans people are widely held to be misguided, mentally unstable, suffering from a delusion or making believe ( Bettcher 2007 , Serano 2016 : ch. 2, Lopez 2018 , Rajunov and Duane 2019 : xxiv). If the only interesting way in which Alicia is correct about her gender is that she is that gender according to standards far in the future that she is not aware of, then it would seem that Alicia is misguided about her gender – given that she could not know about these standards – and that she is in a sense making believe. This seems like an undesirable consequence, especially if we think that Alicia is really a woman, that is, that she is not misguided.

There are two further, more general, problems for contextualism. 7 First, contextualism seems to clash with how many of us think about our own and others’ genders. For instance, many trans men think that they should be classified as men because they are men, and not just because they are men-relative to the standards of trans-inclusive communities and societies ( Saul 2012 : 209–210). 8 Gender critical feminists think that trans women are not women, that standards which align with this view track the standard-independent truth, and standards which don’t align with this view do not.

Second, contextualism seems to be in tension with the idea that many of our disagreements about gender are genuine disagreements. Suppose that contextualism is true and that we (and everyone else) accept it. In this case, it is hard for us to sincerely genuinely disagree with Javid about whether only women have cervixes. Since, when he says that only women have cervixes we know that he means that only those who count as women, relative to the dominant UK standards or relative to the standards operative amongst Tory MPs and members, have cervixes. And we agree with him about this, since we know that according to these standards trans men are women. So, if contextualism is true and we accept it, it is hard for us to genuinely disagree with Javid. Contextualism could be true without our knowing or believing it. In this case, we could genuinely disagree with Javid. But our disagreement here would only be possible because we are significantly mistaken about what kinds of things gender kinds are; we think gender kinds are not all context- or standard-relative but in fact they are. And attributing such a significant mistake to all of us is a significant cost of a metaphysical theory, for other things equal we should accept more charitable theories that do not imply that we are significantly mistaken rather than theories that do imply this ( Olson 2011 : 73–77, McGrath 2021 : 35, 46–48).

These problems with contextualism about the relationship between gender identity and gender are analogues of problems that contextualist views face in other domains such as in metaethics. According to metaethical contextualism, moral claims, their meanings and their truth are always standard-relative. There is no such thing as an act being morally wrong, only its being morally-wrong-relative-to-utilitarianism or morally-wrong-relative-to-the-standards-of-Victorian-England. But metaethical contextualism faces a problem explaining fundamental moral disagreement. Act-utilitarians and Kantians agree that pushing the heavy man off of the bridge in the footbridge trolley case is wrong (Kantianism) and right (act-utilitarianism) but they still disagree and they take themselves to be disagreeing about which of their moral standards is correct, and which standard tracks the truth about which actions are right and wrong simpliciter ( Olson 2011 : 73–77, Cosker-Rowland 2022 : 57–59). If there are no non-context- or standard-relative properties of right and wrong, then although Kantians and Utilitarians do disagree – they think there are such properties – there is in fact nothing for them to disagree about. So, metaethical contextualism seems to be committed to a kind of error theory about morality that, other things equal, we should avoid: Kantians and Utilitarians think that they are talking about which of their moral standards is independently correct, but there is no such standard-independent moral correctness. Contextualists in metaethics have developed several types of resources to mitigate this kind of problem or to enable contextualism to explain what’s happening in these disagreements better. Perhaps these proposals could be used to mitigate the analogous problems with contextualism about the relationship between gender identity and gender. McGrath (2021 : esp. 42–49) considers this possibility and argues that these responses are not plausible, and that they face similar problems to the problems faced by the analogous responses proposed by contextualists in metaethics. 9 More broadly, whether contextualists’ proposals to mitigate these problems for metaethical contextualism do, or could, succeed is contested ( Cosker-Rowland 2022 : 59–64). 10

Contextualism holds that the features that determine our gender vary from context to context and so whether our gender identity determines our gender varies from context to context. Invariantist views such as gender identity first and the no connection view hold that one feature (e.g. gender identity or whether one is a sexually marked subordinate) determines our gender in every context. But we need not adopt such a monist invariantist view; we can instead adopt a pluralist invariantist view that holds that multiple features are relevant to, or determine, our genders across different contexts ( Figure 4 ). A version of pluralism that has been proposed is what we can call the two properties view. According to the two properties view, two and only two properties determine our gender in all contexts: our gender identity and our gendered social position or class. Gender identity first and Haslanger’s no connection view hold that one of these two properties determines our gender in every context; the two properties view holds that both of these properties can make us a particular gender in every context. 11

Views of the relationship between gender identity and gender

Katharine Jenkins (2016) proposes an ameliorative version of the two properties view. She proposes that we accept gender concepts according to which there are two senses of woman . In one sense of woman , to be a woman is to have a female gender identity; in another second sense, to be a woman is to be socially classed as a woman, which we can understand in terms of Haslanger’s account: to be a woman in this second sense is to be a sexually marked subordinate. Jenkins argues that if we accept gender concepts according to which there are two senses of ‘woman’, we do not objectionably exclude trans women, since trans women who are not socially classed as women do have female gender identities and so are still women on this view. So, Jenkins argues that we should accept gender concepts such that A is a woman iff A is socially classed as a woman or has a female gender identity. She then argues that, although we should accept gender concepts on which there are two senses of gender, we should, at least primarily, use ‘woman’ to refer to people with a female gender identity rather than those who are classed as women.

Jenkins’ two properties view avoids the problems with the ameliorative gender identity first and no connection views. It does not imply that severely cognitively disabled women are not women and it does not imply that trans women are not women. Yet if we adopt a concept of ‘woman’ with two senses but use ‘woman’ to refer to people with female gender identities, it still seems that we adopt concepts according to which trans women who are not socially classed as women are not women in an important sense. We may want to avoid this consequence with our ameliorative proposals, since trans women want to be thought of as women, and many trans women want to be thought of as in no way men, rather than merely being referred to as women rather than men (see e.g. Wynn 2018 ). We might also worry that adoption of Jenkins’ view would create a hierarchy of women on which someone who is a woman in both senses is more of a woman than someone who is a woman in only one sense: we might worry that if such concepts of gender were adopted, a trans woman who does not have her womanhood socially recognized would be seen as less of a woman than a trans woman who is socially positioned as a woman. 12

Elizabeth Barnes (2022 : 24–25) briefly articulates a similar metaphysical two properties view. On this view, there are two different properties that one can have that can make it the case that one is gender G : the property of being socially classed as a G and the property of having gender identity G . And the relevant gender identity property takes priority when A is socially classed as a G1 (e.g. as a man) but has gender identity G2 (e.g. a female gender identity): in such a case A is a G2 (a woman) rather than a G1 (a man) ( Figure 5 ).

The two properties view

However, the two properties view needs to explain why our gender identities take precedence over our gendered social position in determining our gender when the two conflict. Without further supplementation the metaphysical two property view does not do this; it does not explain why A is a man when A has a male gender identity but is socially positioned as a woman. If the two properties view does not explain this, it has an explanatory deficiency, and this deficiency gives us reason to accept competing views that do not face this explanatory problem over the two properties view.

One natural way to supplement the two properties view to try to solve this explanatory problem is to hold that moral and political considerations determine that gender identity takes priority over gender class when they conflict. 13 . First, it is controverisal that there is moral encroachment on gender metaphysics, that what's morally best makes a difference to what gender we metaphysically are. For instance, Ásta (2018) , Dembroff (2018) and Jenkins (2020) argue that morality does not encroach on gender metaphysics in this way.

Second, we can think of this as the moral encroachment explanation. However, moral encroachment does not look like a plausible explanation of how, metaphysically, gender identity takes priority over gendered social position in determining our genders. To see this, suppose that Alexa understands herself to be a woman and is treated by those around her as a woman. An evil demon will kill 2000 members of Alexa’s community unless we hold that Alexa is a man, treat Alexa as, think of Alexa as, and assert that Alexa is a man for the next hour. In this case, moral and political considerations establish that we morally ought to treat Alexa as a man for the next hour, but this doesn’t mean that Alexa is in fact a man. 14

It might seem that a nearby view on which moral and political considerations play a smaller role is more plausible. On this view, moral and political considerations only come in to determine whether, metaphysically, A is a member of gender G1 or of gender G2 when A is socially classed as a G1 but has identity G2 . But this view would also generate counterintuitive results. To see this, suppose that Beth has a female gender identity and she was assigned female at birth, but she is socially classed as a man – she doesn’t resist this because of the strong economic advantages she receives, which outweigh the discomfort she feels by being constantly misgendered. Now suppose that an eccentric, very powerful and malevolent millionaire brings these facts to light but will torture everyone in our society unless we continue to classify, think of and refer to Beth as a man. In this case, plausibly, moral and political considerations establish that we should classify Beth as a man, but these facts do not seem to bear on whether Beth is a man or a woman; intuitively Beth is a woman, and intuitively the fact that morally we should think of, treat, and classify Beth as a man does not make it the case that Beth is a man – and really has nothing to do with Beth’s gender in this case. So, if moral and political considerations play this more limited role in determining our genders, they still sometimes generate the wrong result because there are cases in which the social and political considerations side with someone’s gendered social position rather than their gender identity, but in which this does not seem to be relevant to, or establish that, their gender lines up with their gendered social position. So, the moral encroachment explanation does not seem to solve the explanatory problem for the two properties view. 15

These evil millionaire cases may be too fantastical for some. But the same point can be made with real world examples too. Norah Vincent (2006) disguised herself as a man for 18 months so that she could investigate men and their experiences. She became socially positioned as, and treated by others as, a man. While she was effectively disguised as a man, moral and political considerations seem to have established that everyone should treat her as a man: those who didn’t know her real gender had an obligation to take her assertions that she was a man as genuine and those who did know her real gender had an obligation not to blow her cover. But although everyone ought to have treated Vincent as a man, she was not a man: she did not identify as a man at the time, nor prior or subsequent to her journalistic project. Moral and political considerations favoured treating Vincent in line with her social position as a man rather than in line with her female gender identity. But these factors do not establish that she was a man rather than a woman. So, the moral encroachment explanation generates the wrong results in this case too.

One way to respond to this problem for the two properties view is to drop the view that gender identity takes priority. But this would be problematic for then trans women who are socially positioned as men would be both men and women on this view – and not just people with female gender identities who are socially positioned as men. This is implausible. This view is also different from contextualism since contextualism holds that such trans women are women-relative-to-the-standards-of-trans-inclusive-contexts and men-relative-to-other-contexts; a version of the two properties view that drops the priority of gender identity holds that such trans women are both men and women tout court .

In this paper I’ve discussed metaphysical and ameliorative inquiries into the relationship between gender identity and gender. I’ve discussed four different views about this relationship. All four views face problematic objections. Gender identity first seems to objectionably exclude some severely cognitively disabled people from having genders. No connection views seem to be objectionably trans exclusionary. Contextualism seems to be in tension with how we think about gender and implies that trans people are not the genders that line up with their gender identities in many contexts; despite contextualists’ best efforts, these implications still seem problematic. Pluralist views struggle to plausibly explain how their plurality of features interact when they conflict to determine our genders.

One avenue of future research involves examining the extent to which these objections really undermine these different views. For instance, we might question whether Barnes really shows that we should reject gender identity first. Barnes has two arguments for the view that, contra gender identity first, severely cognitively disabled people without gender identities have genders.

The first argument was that, if we reject this view, we cannot explain the gendered oppression that severely cognitively disabled women face. But we might wonder whether this is really true. All we need in order to explain the oppression that severely cognitively disabled women face is the claim that they are socially treated or understood to be women. But we can be socially treated or understood to be a gender other than the gender we are: e.g. many non-binary people who were assigned female at birth (AFAB) are discriminated against because they are understood to be women even though they are not women. We might think that we should explain the gendered oppression that AFAB severely cognitively disabled people without gender identities face and the gendered discrimination that AFAB non-binary people face in the same way: we should say that although they are not women, they are assumed to be women and are treated as women and this is why they face this gendered oppression. Barnes’ second argument was that the view that severely cognitively disabled people without gender identities do not have genders others and alienates these severely cognitively disabled people. However, we might wonder whether this is necessarily true. Perhaps we should think of the capacity to have a gender as inessential to human personhood just as we think of the capacity for membership in other categories as something that is not required for personhood: perhaps we should think that just as some severely cognitively disabled people lack the cognitive capacities to identify as a Christian or as a punk, and so are not Christians or punks, they similarly lack the capacities to identify as a woman and so are not women. If gender need not be central to human life, as religion (or music) need not be, perhaps we might reasonably claim to not other anyone by holding that they could not have a gender.

A second avenue of further work concerns genders beyond the gender category woman . Most of the work on the relationship between gender identity and gender has concerned the relationship between being a woman and having a female gender identity. But views about this may not straightforwardly generalize to provide plausible accounts of other genders such as genderqueer and other non-binary genders. 16 In one of the few published articles in analytic philosophy discussing genders beyond the gender binary, Dembroff (2020) argues that non-binary and genderqueer are critical gender kinds, which should be understood as kinds, membership in which constitutively involves engagement in the collective destabilization of dominant gender ideology. One way to destablize dominant gender ideology is to destabilize the idea that there are two mutually exclusive genders. Such destabilization of the binary gender axis can involve using gender neutral pronouns, cultivating gender non-conforming aesthetics, asserting one’s non-binary gender categorization, queering personal relationships, eschewing sexual binaries and/or switching between male and female coded spaces. Dembroff argues that to be genderqueer is ‘to have a felt or desired gender categorization that conflicts with the binary [gender] axis, and on that basis collectively destabilize this axis’ ( 2020 : 16). This understanding of the category genderqueer does not quite fit into the typology that I’ve explained in this article. For, on this account, a particular kind of non-binary gender identity is necessary but not sufficient for membership in the kind genderqueer .

There are issues with this account. For instance, Matthew Cull (2020 : 162) argues that this account misgenders agender people because many agender people have a felt or desired gender categorization that conflicts with the binary gender axis and are engaged in the collective destabilization of the gender binary but are not genderqueer; they are agender. 17 However, in general, more work is needed on gender kinds beyond the gender binary. This work may also provide new avenues for conceptualizing and/or complicating the relationship between gender identity and gender more generally. 18

See Bettcher (2009) ( 2017 : 396) and Jenkins (2018 : 727). cf. Barnes (2020 : 709).

See also Bornstein (1994 : 111, 123–124).

On the centrality of gender for social life see Witt 2011 .

See Bryne (2020) and Stock (2021 : ch. 2, ch. 6).

There are problems with using this terminology of passing. For instance, we typically think of A as passing as an F only if they are not an F . But if all trans women are women, then there are no ‘non-passing’ trans women. For discussion of issues with the concept of passing see e.g. Serano 2016 : 176–180.

Many gender critical feminists will want to reject contextualism for a similar but opposite reason: they believe that there is no sense in which Javid is mistaken, but contextualism implies that there is a sense in which he is mistaken.

For problems along these lines see McGrath 2021 : esp. 42–49.

Cf. Bettcher 2013 : esp. 242–243.

Cf. Dembroff 2018 : 44–45.

According to Jenkins’ (2023) ontological pluralism, there are a plurality of gender properties. For instance, there is the property of being a woman in the sense of having a female gender identity, and the property of being socially positioned as a woman in a particular context, but there is no further property of being a woman. Ontological pluralism about gender properties is a slightly different view about gender properties from the social position account of gender properties that Ásta and Dembroff propose; see Bettcher 2013 and Jenkins 2023. But ontological pluralism similarly implies that being a woman (social position) is not determined by one’s gender identity but being a woman (gender identity) is; and that there is no such thing as being a woman tout court beyond such a plurality of more specific gender properties. Since it has similar implications about the relationship between gender identity and gender to Ásta and Dembroff's views, it faces similar problems.

Other work on the metaphysics of gender, such as Stoljar’s (1995) nominalism or a view similar to it, could also be understood as a form of pluralist invariantism; although cf. Stoljar 1995 : 283 and Mikkola 2016 : 70.

Cf. Mikkola 2019 : §3.1.2 and Jenkins 2016 : 418–419.

Cf. Jenkins 2016 : 417–418 and Diaz-Leon 2016 .

Cases like this may also cause problems for Ásta’s and Dembroff’s social position accounts of gender.

Heather Logue suggested to me that a more specific form of moral encroachment might solve this problem: our autonomy might establish that our gender identities trump our gendered social positions when they conflict, without establishing that Beth is a man. However, we can imagine a version of this case in which Beth autonomously chooses to waive her right to be treated in line with her gender identity. In such a case Beth is still not a man.

We may also wonder whether this work will generalize to the category man given that human beings are still by default understood to be men in many contexts.

Another worry is that analogous accounts of the kind non-binary will either: (a) make the conditions for engagement in collective resistance too onerous and thereby exclude non-binary people who are not able to engage in this resistance due to oppressive circumstances; or (b) make these conditions too easy to satisfy, in which case it is unclear what work engagement in collective resistance is doing in this account; that is, it is unclear why we should prefer an account of the kind non-binary like this to a gender identity first account of the category non-binary . For work relevant to (a), arguing that trans people in the past who could not express their gender identities or resist the binary gender axis due to hostile circumstances may still be correctly considered to be trans, see Heyam 2022 : ch. 1.

I am grateful to a reviewer, who revealed themself to be Ray Briggs, for wonderful extremely thorough comments on a previous draft of this paper. I would also like to thank an audience of my colleagues at the University of Leeds for comments, thoughts and objections that shaped the final version of this paper.

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Gender identity development in children and young people: A systematic review of longitudinal studies

Affiliations.

• 1 Research and Development Unit, Tavistock and Portman NHS Foundation Trust, London, UK.
• 2 Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK.
• 3 Division of Psychiatry, University College London, UK.
• 4 Research Department of Clinical, Educational and Health Psychology, University College London, UK.
• PMID: 33827265
• DOI: 10.1177/13591045211002620

Background: Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field.

Method: Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included.

Results: Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning.

Conclusions: Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.

Keywords: Gender identity; children and young people; gender dysphoria; longitudinal; outcomes; prospective.

Publication types

• Systematic Review
• Gender Identity*
• Longitudinal Studies
• Netherlands
• Prospective Studies

• Open access
• Published: 04 February 2021

Sexual orientation, gender identity and gender expression-based violence in Catalan universities: qualitative findings from university students and staff

• Elena María Gallardo-Nieto 1 ,
• Aitor Gómez 1 ,
• Regina Gairal-Casadó   ORCID: orcid.org/0000-0003-0093-7912 1 &
• María del Mar Ramis-Salas 2  

Archives of Public Health volume  79 , Article number:  16 ( 2021 ) Cite this article

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Hate crimes have raised in Spain and the gender and sexuality-based conflicts persist worldwide which leads to this problem having an effect on health and wellbeing. Following a focus of transforming Higher Education Institutions, this research analysed the problem that affects undergraduate students in six Spanish universities. The research goal is to improve the life quality of lesbian, gay, bisexual, transgender, queer and intersex university students, breaking the silence that exists around the violence that this group suffer in Catalonia, Spain.

Following the Communicative Methodology, this study has identified violence based on sexual orientation, gender identity or gender expression in the target universities and provided guidelines to improve anti-discrimination protocols. A qualitative method has reached experiences of university students, heads of equality commissions, professors and administrative staff regarding this conflict. Focussing on the qualitative research tools, 30 semi-structured interviews were conducted with university students and staff around issues related to the violence against lesbian, gay, bisexual transgender, queer and intersex students: 1) perception of violence and discrimination, 2) institutional measures, 3) actions against violence. An analysis of exclusionary and transformative dimensions was used to identify emergent themes.

We have identified two dimensions for the analysis given their impact in contributing or overcoming violence: exclusionary and transformative. A wide range of forms of violence on the grounds of sexual orientation, gender identity and gender expression perpetrated at universities have been identified as exclusionary facts and described by participants in the study. Equality commissions have not received reports of violence based on sexual orientation, gender identity or gender expression, and university staff shows certain unfamiliarity regarding the measures and politics to prevent and intervene in cases of violence against the lesbian, gay, bisexual, transgender, queer and intersex community. Among the results identified as transformative are the ways through which actions of lesbian, gay, bisexual, transgender, queer and intersex groups against violence and the professors’ commitment to intervene have a relevant impact on student’s wellbeing. An improvement and implementation of anti-discrimination protocols with mandatory applicability has also been documented.

Conclusions

Findings highlight the need of collecting more evidence that contributes to the improvement of protocols, measures and politics to protect all the members of the university community. A better understanding of violence based on sexual orientation, gender identity and gender expression in HEI’s may guide national and international governments to improve the health and well-being of lesbian, gay, bisexual, transgender, queer and intersex persons.

Peer Review reports

Violence based on sexual orientation, gender identity or gender expression is present in our society and within the university community [ 1 , 2 , 3 ]. Numerous international studies have shown that the lesbian, gay, transgender, queer and intersex (LGBTQI+) community have more risk and probabilities to suffer sexual discrimination or harassment during their university trajectory [ 2 , 3 ]. Furthermore, the risk of being object of violence increases in the case of transgender students [ 4 , 5 , 6 ]. National politics and international agendas have given priority to the legislation and regulation to end with LGBTQI-phobia [ 7 , 8 ], even though the risk of suffering sexual harassment is still higher in the case of sexual minorities [ 1 , 6 , 9 , 10 ]. The case of Spanish universities reflects the international panorama in relation to the LGBTQI+ academic community [ 11 ]. Educating in diversity, tolerance and acceptance towards diversity is crucial, but international reports show that this is still a pending issue in Spain [ 12 ]. The lack of literature and research about how this phenomenon affects Higher Education Institutions (HEI’s) is striking and generates a significant silence towards the situation of the LGBTQI+ community and the consequences of LGBTQI-phobia in their personal, academic and health status. As a response to this reality, the research Uni4freedom seeks to contribute to breaking the silence that goes along the LGBTQI+ community at HEI’s, improving the quality of life of the academic community and the struggle against violence based on sexual orientation, gender identity and gender expression in the Catalan context.

The main challenge when studying the discrimination against the diversity of sexual orientations, gender identities and expressions is the diversity of violence manifestations. A change in the ways violence against the LGBT community is manifested, has been shown in the literature in the last years, shifting towards more subtle and unnoticed manifestations [ 6 ]. Verbal forms of violence [ 9 , 13 , 14 ], homophobic jokes [ 10 , 15 , 16 ], anti-LGBT paintings, graffities and threats [ 3 , 13 ], social distance [ 10 , 15 , 17 ], not-inclusive or acceptance spaces [ 18 ] and possible risk of suffering from unprotected forms of sex and AIDS’ contagion [ 19 ] have been identified as advanced forms of violence based on sexual orientation or gender identity or expression. On the one hand, the case of a hostile environment is conditioning the free expression of the felt gender identity and sexual orientation [ 9 , 18 , 19 , 20 , 21 , 22 ]. On the other hand, all these forms and manifestations of violence can generate a response of internalization and normalization of the homophobic actions, perpetuating the violence and affecting negatively in the life quality and wellbeing of the LGBT+ academic community [ 3 , 16 , 22 , 23 , 24 , 25 ].

According to the findings in the scientific literature, violence and discrimination based on sexual orientation and gender identity and expression, has consequences in three spheres of the LGBT university students’ life. Firstly, it affects the health status, both physically and mentally. It has been shown that LGBT students present higher symptoms of depression and anxiety [ 9 , 13 ] and suffer various forms of physical ache [ 10 , 16 ]. Secondly, it affects their academic performance, presenting a lower grade in average in comparison to hetero-cis students [ 26 ]. This difference of academic results has been analysed as an aftereffect of LGBT stigmatization creating difficulty to focus on their studies [ 19 , 27 ], having further consequences in their future possibilities and academic success [ 24 ]. Thirdly, these realities of LGBT-phobia in HEI’s promote exclusionary climates and negatively affects the cohesion and relationality of sexual minority students [ 22 ]. The seen or suffered experiences of harassment or discrimination can generate a feeling of isolation and exclusion [ 6 , 26 ] which can be reinforced by the institutional invisibility of LGBT perspectives and role models [ 13 ].

Evidence shows six different axes to prevent and intervene in front of violence based on sexual orientation and gender identity and expression within university institutions. Visibility of the LGBTQI+ collective and their situation in the university scope is key to prevent LGBTQI-phobia. Besides, generating profound awareness of university members is necessary to be able to face the problem of LGBT-phobia [ 1 , 28 ]. In order to make this awareness effective and reach the whole academic community, the inclusion of LGBT literature in academic curriculums has the highest impact in the reduction of LGBT-phobia [ 18 , 28 ]. Another protective factor for the prevention and intervention in cases of violence based in sexual orientation, gender identity and gender expression is the explicit institutional support towards the LGBTQI+ community through the implementation of politics and strategies towards the reduction of hetero-sexism [ 6 , 9 , 29 , 30 ].

This article presents qualitative evidence about how to overcome this form of gender inequality in a very relevant social institution. We have chosen a qualitative method in order to delve into the complexities of suffering or witnessing violence at HEI’s and the possibilities of intervention that participants identify in their own interpretation. This methodological choice aims to reinforcing the knowledge and contrasting the depth and complexities of the qualitative findings of the project. Very important issues to be considered when preparing policies for the prevention and intervention of LGBTQI-phobia are thus presented . In conclusion, the study aimed to give visibility to the violence based on sexual orientation, gender identity or expression that takes place in HEI’s, and to identify successful practices and decisions for the eradication of this violence.

This article has been focussed it research methodology for social impact. The voices of the end-users of the research have been incorporated in all phases of the research, in order to contribute to the social impact and social transformation of the conflict [ 31 ]. To make that possible, the methodological design is based on the Communicative Methodology of Research (CMR) [ 32 ], which stands out for its capacity to identify successful actions that contribute to overcoming inequality and to generate social policies based on these actions. CM stands out for generating scientific knowledge through the contrast of the scientific evidence (contributed by the researchers) and the contributions of the social agents’ participants in the research, defined as the world of life [ 33 , 34 , 35 ].

The study was designed to understand how, why, in which forms and circumstances this form of violence in HEI’s take place affecting university students’ life, health status and future. Given the scientific evidence on LGBTQI+ violence prevalence and the aims of the research, the main research objective is to improve the quality of life of LGTBIQ university students, breaking the silence that exists about the violence they suffer.

Following the communicative perspective, Uni4Freedom has implemented mixed-methods research [ 34 ] of which the qualitative techniques’ results are presented in this article. Semi-structured interviews Footnote 1 with communicative orientation have composed the fieldwork of the study taking place in six universities of the Catalan region [ 36 , 37 , 38 ]. The fieldwork has been designed in order to, firstly, make an approach and a diagnose of the reality that the LGBTQI+ community faces at Catalan universities and, secondly, delve into the perspective of university staff and professors, exploring the possibilities to implement and propose transformative actions for the inclusion and non-discrimination. The population target of the study is the academic community enrolled in different disciplines within the project’s six partnering Catalan universities Footnote 2 : students, university professors, administrative staff and heads of equality commissions or units at these institutions.

Communicative organization of the research

In order to ensure the social impact of the research, the voices of the LGBTQI+ community and LGBTQI+ organizations have been included in different forms and phases during the study. Their participation has been indispensable, contributing with reciprocity, advice and follow-up to guarantee that the research objectives are met and ensuring ethics’ standards in the methods. The Advisory Board is a follow-up and supervising body which has been formed by representatives of organizations of reference on LGBTQI+ rights in the territory Footnote 3 . In two different stages of the project and face-to-face meetings in 2018 and 2020, this board has debated and reviewed the methodological plan, research technics, findings and proposals grounding the materials in their experience and expertise in LGBTQI+ rights and reality. Their contribution has contributed to comply with ethical principles as well as to ensure the work and results for the improvement of the situation of the LGBTQI+ community at Catalan HEI’s.

We have conducted 12 semi-structured interviews with communicative orientation to LGBTQI+ university staff from the partner universities of the project. Besides, we have conducted 4 semi-structured interviews with communicative orientation to heads of equality units or commissions from the partner universities of the project. And finally, 12 communicative daily life stories with University students have also been done. These technics have followed the communicative orientation of the methodology by facilitating reflective dialogues between participants and researchers about the incidence of violence due to sexual orientation, identity or gender expression faced in their careers as university professor/staff or student. Proposals to make university a more LGBTQI+ friendly space were also gathered from these qualitative work. The distribution of research tools and participants has been as follows:

Research tools

The guidelines of the interviews have been designed following the communicative perspective, attending to the results of the literature review and contrasted with the Advisory Committee. This combination in the design process has allowed us to develop complex guidelines that enable the identification of situations, characteristics and circumstances that either promote or allows to transform situations of violence based on sexual orientation, gender identity or expression at HEI’s. We have identified three sections that have let us build the data collection process of the interviews. In what follows, the structure of the interview under the three sections and some of the questions of the interview’s guidelines are introduced:

To describe and presentgeneral aspects of the research method, theme, exploring different perspectives and ideas in relation to the reality of the situation of the LGBTQI+ community in University.

To study the experience or perception of violence based on grounds of sexual orientation, gender identity or expression at University or spaces related to the institution according to the results of the literature review. The opening question of this section in the case communicative daily life stories with students was the following:

“If you know of any cases of violence due to sexual orientation, gender identity or gender expression, comment on it:

Do you think that the people who suffer from any of these situations are considered victims of violence because of their sexual orientation, gender identity, or gender expression. Why? Why not?

What was your reaction to the situation of violence? Why?

What was the victim’s reaction to the violence or discrimination? Why?

If it was reported to the university, what was the institution’s response? How did they interpret it? How does the institutional response affect the victim’s decisions and behaviors?

What consequences did the fact of reporting have on the aggressor? And on the victim?

Do you know what has to be done in the case of suffering a situation of violence due to sexual orientatio, gender identity or gender expression?”

To approach the perception of institutional strategies to detect, prevent and intervene in cases of LGBTQI-phobia by the research participants attending to their different roles in the community. Two questions from the semi-structured interviews with university staff from this third section were the followings:

“In the section on harassment and discrimination, the inclusion of sexual orientation and gender identity/expression in anti-discrimination policies and the approval of protocols against LGBTI-phobia is considered. Some universities, such as Oxford, Tuft and UCL, have explicit online policies regarding sexual orientation, and other ones have specific policies concerning the trans* community, as well as policies to ensure inclusive language.

Do you think that this would be convenient at your university? Do you think it would be appropriate? Do you think it would be viable? Why? What benefits would it have and how would students experience it?”

“Finally, on training for members of the university community to detect, prevent and act against LFBTI-phobia. Universities like Pennsylvania and Washington train the community to ensure Safe Zones, zones free of any violence, and others like Cambridge and Oxford train the community in successful actions, such as bystander intervention and providing online resources.

Ethical validation

The study has received the ethical validation of the ethical committees of Girona University and Lleida University in 2019. After submitting a detailed protocol for the fieldwork, containing consent forms and interview guidelines, the Ethics and Biosafety Committee of the University of Girona approved the start of the fieldwork. For the second ethical approval, the Committee for the approval of research studies at the Faculty of Nursing and Physiotherapy of the University of Lleida approved the fieldwork plan, consent forms and guidelines for interviews under the ethical requirements of confidentiality and good praxis without any objections.

Consent forms were systematically signed by all research participants and by the researchers implementing the tools, in order to ensure the former’s rights in the research. These forms helped us to protect their right to confidentiality, anonymity, wilfulness, possibility to stop or leave the study at any moment and receive all necessary information for their involvement by the researcher.

Aside of the institutional validation, the research counted with an Advisory Board which supervised, followed-up and advised the research team in three different phases: approval of the literature review, fieldwork plan and preliminary results of the study. This board was composed by members of the LGBTQI+ community, university students and representatives of active organizations for LGBTQI+ rights of the territory Footnote 4 . Their belonging to the targeted community was due to the need of including the voices of the end-users of the research throughout the whole process of the research. The role of the board has been to relate the theory and scientific evidence to the daily reality of the LGBTQI+ community, reinforcing the transformative role of the research through their very contributions in the study.

Data analysis

The analysis chart has been designed to collect contributions from interviews and communicative daily life stories considering all the dimensions and categories selected (Table  1 – Result analysis chart). Dimensions are located in the rows and refer to the two sorts of results depending on their contribution or transformation of the target conflict, referring to the Communicative Methodology. Categories are the concepts that are being used in the research process to analyse the results of the fieldwork and they are located in the columns (Table 1 – Result analysis chart). The categories have been defined through a deductive method of definition, meaning that they have been determined before fieldwork through the study of scientific literature regarding LGBTQI-phobia in HEI’s. The categories resulting from this study are: LGBTQI-phobic violence, actions against the violence and university politics and measures against the violence.

The research team has processed the qualitative results of the fieldwork ensuring the anonymity of the participants in all the phases of the study. Members of the research team have transcribed the interviews and daily life stories verbatim. Then, the research team has coded the transcription by using the numbers of the designed analysis chart (Table 1 – Result analysis chart), identifying results and matches between the targeted categories and dimensions on the transcriptions. We have not made use of any software or program for the systematization of this process.

In this section, we have made an in depth approach to the research target: studying violence against LGBTQI+ community in HEI’s. On the one hand, we have analysed the results that do not contribute to overcoming the problem of violence based in sexual orientation, gender identity or expression, encompassed within the exclusionary dimension. On the other hand, we have analysed the contributions that have an influence in transforming and overcoming the targeted violence in HEI’s, included in the transformative dimension. All of the results presented belong to the research tools and the research participants already mentioned in the fieldwork subsection (Table 2 - Fieldwork distribution).

Violence’s normalization and internalization

Normalization and internalization of LGBTQI-phobia are the most present consequences of the violence in HEI’s. These results show the need to promote measures of awareness-raising to promote respect to diversity. Under this category, we highlight the normalization of violence in the daily discourses at universities as a consequence of the constant violence against the LGBTQI+ community. The normalization of violence is funded on naturalizing discriminatory comments towards the LGBTQI+ community, which can happen even within classrooms, as stated by a LGBTQI+ university professor in an interview:

Then, inside the class, let me think... at the break and when we leave and so on, I’ve seen someone say to another "hey faggot, you didn't get the work done today!" maybe they said that and, I don't know, I have it so incorporated that I don’t realize either.

In this sense, students have also shared in everyday life stories experiences that prove the naturalization of discriminatory discourses towards the LGBTQI+ community, as stated by a female undergraduate and LGBTQI+ student in a communicative daily life story:

Well, I don’t know, if in class or between classes, we are talking, or they are talking, so in a group, and they want to refer to a boy as being a freak or weaker than the rest they refer to him as a faggot.

The LGBTQI+ participant students in the research have claimed the consequences of the normalization of the violence. Following their discourse, they have found that reproduction of homo and lesbo-phobic comments and the self-internalization of the violence are results of having received a LGBTQI-phobic socialization. As a female and LGBTQI+ student expresses in a communicative daily life story:

Many times, I think they overlook these comments because we are used to them. For me what happens to me is like, if one day I hear someone say butch or something, it's not hard for me to pass but I guess I would think that he’s an asshole, you know? But then I would think that, he’s silly and that's it and I wouldn't take it as something personal, but as something more social that looks normal.

Transgender vulnerability in the conflict

Research has shown that transgender people are the most prone to have difficulties and to suffer violence or discrimination at HEI’s [ 4 , 5 , 6 ]. This form of vulnerability in the university context is even more disturbing when the results show the complexity and accumulation of forms of violence that only transgender students suffer. There can be specific circumstances that transgender students live, such as the social transition and the bodily changes, elements that can make their educational process at university even harder when belonging to the LGBTQI+ community. As a transgender student states in a communicative daily life story regarding the transitioning:

Then I made the transition and it's like that, with the medication and that, I was like super confused with many things, I was relocating mental issues, because in the end I didn't know many things either, because the medication numbed me and I don't know. Of course, I did notice suspicion and misunderstanding and a feeling of being something weird, feelings of disgust, by some colleagues and I realized it but well, as I’m saying I tried to ignore it because I have enough problems.

The exclusionary discourses, looks and refusal perception is clear in the voice of the interviewed people, showing the need of promoting measures of awareness raising that advocate the respect to diversity and differences. In this sense, the need of intervention and respect towards the transgender groups is especially relevant, as it has been shown in the interviews’ fragments.

Unfamiliarity of institutional mechanisms and interventions

Secondly, findings on university policies and measures have indicated the lack of actions, university policies and measures to fight violence and, at the same time, they prove the ignorance of professors and staff about the mechanisms to prevent and intervene in cases of LGBTQI-phobia. Furthermore, the lack of cases of violence due to sexual orientation, gender identity or expression reported at equality offices indicates the complexity of this form of violence and the likely unawareness about violence based on the grounds of sexual orientation, gender identity and gender expression by officials at universities. The fact that some Heads of University Equality Offices claim not to have received complaints regarding violence based on sexual orientation, gender identity or expression is relevant, as one experienced worker on an Equality Office shared regarding the cases of LGBTQI-phobia in an interview:

The truth is that no. I have not dealt with any cases at the observatory, no petitions nor expositions have been received of violence based on gender identity or sexual orientation. We haven’t realized it. For me, it hasn’t come directly to me as a teacher or as a colleague. It hasn’t reached me. I know it’s a college reality, but the truth is I can’t say it’s a reality for me because I haven’t seen it.

The figure ‘0’ of cases of violence based on sexual orientation, gender identity or expression at universities can be explained by the lack of mechanisms and abilities by university professors and staff to identify and detect the violence [ 6 , 39 , 40 ]. Moreover, it could also be justified by the attempts to generate safe and friendly spaces for the LGBTQI+ community to make the process of filing a complaint of LGBTQI-phobia easier. As we can see in the following fragment from a communicative daily life story with a transgender student which has already faced the process of name change, he reflects on other possibilities to it within HEI’s:

I think that a trans person should not go through an equality unit to request a name change, right? But I think that this could already be done in a much easier administrative process of administrative, that is, how you do your... You fill out your application for the first time, that is, in that database, what if there were what is called a chosen name?

The lack of knowledge from university professors, staff and officials about measures, resources and officials of reference in cases of LGBTQI-phobia has been stated in the interviews as a constant reality, as mentioned by a female university professor in an interview: “I’m not responsible. I don’t know if within the management team there is someone in charge of this policies in case there is a problem.”

We have identified other indicators apart from unawareness which could respond to the lack of a support network for victims of LGBTQI-phobic violence within HEI’s. Many university policies and educational protocols for the prevention and intervention in cases of violence based on sexual orientation, gender identity or expression have been developed in the last years from Equality Units and Commissions and other spaces towards equality and against discrimination in HEI’s. The ignorance of the international scientific evidence about the existig policies carries a limitation in the struggle against the violence towards the LGBTQI+ community. This is due to the lack of knowledge and training on the measures and the roots of LGBTQI-phobia for the implementation. In order to understand the notions on institutional measures to intervene in conflicts based on sexual orientation, gender identity or expression, we can see an active LGBTQI+ university professor’s discourse where he discusses the thoughts on the transgender name-change process as it follows a fragment of an interview:

The doubt that I was holding is the legal part. Without a doubt the university has to support straight away and if it is necessary to change, it is changed [referring to the name], if you have special needs, it has to be attended, they have to be listened to and we have to see what can be done, of course. What confuses me a little is the legal issue. (…) To the official lists, they appear with the birth name, but they can be changed, and it seems viable, and they are comparable because at the end, that’s the name that they identify with. “I do not identify myself with Antonio José... I identify myself with Toni.” And it seems very comparable. If this person wants to change the name of Maria to Peter because he identifies himself as Peter, so Peter be it and that’s it. What I find most complicated is at a more internal level, for example in the records, that you have the name changed because there would probably be a conflict of legal identity.

In this sense, students agree in recognizing that ignorance complicates the process of identification and support in particular situations of LGBTQI-phobia at universities. For that reason, training and awareness raising on LGBTQI+ issues are both considered very necessary towards turning all university members into agents of change, whether being or not part of the LGBTQI+ community, as a cis-heterosexual female student points out in a communicative daily life story:

I think so, I have not experienced these situations, and I don’t know these type of situations. I'm sure it happened. I think that it should be known both for those who do not know it and for those who suffer it or have seen it, to know that they are not alone that someone is aware of the issue and that they take measures against these situations and that there are those points of help. There are also people who do not want to come out of the closet and they may have problems but they will not ask for help because they have not yet come out of the closet, so it would be good for them to know that there are actions that can help them without anyone knowing anything and keeping their secret. It is an option for those people to have help.

University as a safe space

Secondly, on the variable LGBTQI+ actions against violence findings point at the existence of three protective factors that lead to overcoming violence and discrimination: HEI’s perceived as safer spaces compared to other places, compromise and predisposition of professors to successfully prevent and intervene in cases of violence and university protocols and measures of intervention including all university community. This is due to the role of Equality Units, their familiarity, respect and openness has an important effect in the prevention and intervention of cases of LGBTQI-phobia. We have identified that HEI’s offer a very wide window of possibilities for intervention, acceptance and respect compared to other spaces, as a LGBTQI+ female student points out in a communicative daily life story:

Sexual diversity is more comfortable at university than in other places and that’s why I also think it’s sometimes easier to make more demands within university, right? Because as there is this freedom or this friendly climate, right? Friendly to make claims, to make demands for improvement, so it’s easy to get it and therefore I think that precisely freedom encourages more freedom of expression, right? And more diversity.

Another protective factor within HEI’s towards the LGBTQI+ community and for the transformation of the violence and discrimination is related to the compromise of professors to prevent and intervene. The alliance between students and professors is especially valuable when having the support of a more powerful group within the educational institution in terms of decision and action. This particular support can be offered for different reasons, firstly for the training, awareness and activism in terms of rights by professors. Next, the importance and urgency of intervening in order to transform and stop the conflict based on gender or sexual diversity is made explicit by one of the LGBTQI+ university professors interviewed:

Having just one victim is enough to talk about it and explain that these things are happening, anonymously. If not, we have to orient ourselves differently, lead it in a way that if things happen socially, we try not to let them happen here. Obviously, they shouldn’t take place anywhere. We protect the space; I think we have to find a balance in that so as not to create an alarm.

The compromise to intervene in cases of violence based on sexual orientation, gender identity or expression has been expressed in different forms in the discourses of LGBTQI+ staff. The following case goes one step further as, aside of an open commitment with LGBTQI+ issues, this social conflict is taken into consideration as part of the very teaching praxis. As a result of this, we see how a safer space in the classrooms can be created, by making sexual and gender diversity an issue in the lectures. A LGBTQI+ male professor - committed to openly talking and discussing about matters of gender, sexuality and diversity in class-, talks about the reaction of his students when addressing these issues:

No! Not in class, maybe that's because we criticize it, and make people think and everything is politically correct...to let them see their experiences based on that and then see how they act...of course, in class I guess that they are aware that it would not look very good for them to do joke about it if we are working for them not to do so in their own environments.

When breaking the silence on the issue of LGBTQI-phobia so that the topic becomes a recurring theme in the classroom, students become active upstanders questioning themselves and intervening in cases of violence [ 41 ]. In this sense, another cis-heterosexual university professor highlighted in the interview the need to break the silence and generate mechanisms facilitating that people dare to complain:

It may also be that things are happening and we don’t know it because there aren’t protocols, so this is also a way to encourage people who are going through things to report it. Because violence is always hidden actions. If this is giving them a little encouragement to report and explain what is happening, even if the violence is not physical, that is verbal, that is behavioural, exclusionary...

The value of receptiveness and alliances

Thirdly, on the variable university policies and measures, we have identified evidence of the openness towards sexual and gender diversity by university professors, also considering the need of prevention and intervention plans and measures of high quality in order to transform the reality. This is the case of protocols and measures of intervention generated by the Equality Units at HEI’s that have been interviewed. They highlight the quality and connection with the reality of the LGBTQI+ community of their regulations and intervention measures in their own Units. This is due to the success of negotiation processes between HEI’s and Equality Units, thanks to the sanctions that exist in case of not implementation and to the inclusion of gender identity and sexual orientation perspectives in the regulations. This is introduced by a long experienced worker on the service of the Head of an Equality Office at one participant university in an interview:

We have a regulation for the prevention of gender violence. The difference between regulation and protocol is that all other universities have protocols, ours has sanctions. The others do not have it typed. Our regulation -which was one of the first to be done, but which had two years of negotiation with the University-, is a comprehensive one because it covers the entire university community (officials, staff, professors, students) and it is also a one that entails penalties that many of the university’s protocols do not have. Then what we have done is the adaptation of it, when we already made the regulation, we put for example everything that was harassment due to sex and sexual orientation, we added all the sexual orientation tag.

The interviewees have shown willingness to learn the measures and implement them in the Catalan University contexts, even though if they have not received any training in LGBTQI+ issues. The following fragment refers to a LGBTQI+ male university professor’s interview referring to the measures of trans-inclusion at their institution:

Of course, as the number does not change, so there is no problem, and everything is linked to the ID number and instead you can change the name. I think it’s ok, if there is a real need for it and it is a request from individuals or the community itself, I do not see it difficult and do not see a problem. I think it would bother me to call this person by the name with which they do not feel identified. If they tell me to change the name, I tell them that way, because otherwise there is not an effective dialogue, so I think that if possible, I think it’s perfect and go ahead.

Predisposition and interest by professors have appeared in the qualitative fieldwork together with the claim of needing scientific evidence as well as the inclusion of voices of the own community and of experts in the field. Then they could advise and orientate regarding measures and politics at HEI’s. A university professor claimed it during the interview as follows:

Totally, but I think that the experts here are somehow the ones who have to take the lead because I do not consider myself an expert on the subject, I am a total ignorant, because I find it hard to find the right words to talk about this community, if we are referring to differentiated groups. Mm, I feel I can talk about certain things, but when I think about it, I think that maybe I had not realized it. My normal life is not affected, but there might be other people’s life who is (…) and then if the need exists and the university has the measures to make it feel normal, so that this becomes of normality, then I will be happy to follow any training that is needed because for me it is also an exciting topic, not morbid-like, but to know. Because it is becoming more and more visible.In the same way that this professor commented, another student also claimed the need of measures and politics to have some support in case of suffering violence based on sexual orientation, gender identity or expression. The following statement is a fragment of LGBTQI+ activities and university student’s communicative daily life story, reflecting clearly on the need of feeling institutional protection in order to feel integrated at University:

That people feel safer, better, that they have a real moral and psychological support because until now, they are not considering themselves part of anywhere. Having such a policy would help us a lot to feel that we belong and that we are considered part of something because, of course, we are having to face these LGTB-phobic behaviours and they have to be counteracted with something, right?

Our study demonstrates the urgency of the conflict taking place at HEI’s on the grounds of sexual orientation, gender identity and gender expression. It has also provided us with the scientific evidence and the protagonists’ discourses by bringing to discussion how both dimensions match and complement each other when facing conflicts, needs and discrimination based on sexual orientation, gender identity and gender expression. Furthermore, the study has added relevant knolwedge to previous research with an evidence-based approach and successful cases to improve protocols and strategies for the struggle against the problem of LGBTQI-phobia taking into account the voices of the university community in the Catalan context. Contributing to the previous research on gender violences at Catalan and Spanish universities [ 31 ], our study has gone further in studying the problem of gender violence against the LGBTQI community in HEI’s for the first time in Catalonia. The complementarity of both the generation of evidence and new proposals of avenues for the improvement of current protocols, policies and measures towards the inclusion of the LGBTQI+ community sets a precedent on how to turn HEI’s into more LGBTQI+ inclusive institutions.

Challenges in identifying violence

There is plenty of evidence about how the conflict of violence based on sexual orientation, gender identity or expression is a current reality, which is visible and has become a relevant subject for the development of international policies and agendas in Europe [ 42 ]. Furthermore, the scientific literature describes how this conflict can permeate social institutions, affecting subjects in different spaces, dimensions and degrees. The main challenge identified in the struggle against this social conflict is its identification and detection in institutions, as it has been mutating and changing its form to avoid being detected [ 6 ].

Our study has, not only proven the existance of a variety of forms of direct violence that take place in HEI’s, but it has also identified more subtle and unnoticed forms of violence. Verbal forms of violence, such as homophobic and transphobic comments and jokes, paintings and non-inclusive spaces and classrooms are just the more apparent forms of violence pointed out in the research [ 9 , 10 , 13 , 14 , 15 , 16 , 18 ]. What has made the situation in the Catalan context more complex is the generalized reaction of internalization shown by LGBTQI+ victims and other agents. As the literature highlights, this response of normalization and naturalization of the violence against sexual or gender diversity contributes in the reproduction of the violence against the LGBTQI+ community [ 3 , 16 , 23 , 24 , 25 ].

Besides the reaction of the victims and the LGBTQI+ community, the responses from the rest of institutional agents facing the conflict are especially significant. As mapped by the research, the role of other students and peers [ 27 ], professors and staff is key when approaching the cases of LGBTQI-phobia at university, as the relationality, authority and influence is compelling [ 8 , 20 , 21 , 22 ]. As the findings have shown, their availability, openness and attitude towards the LGBTQI+ community and sex and gender diversity can have an impact on the perception of classrooms and university campuses as free and safe spaces. Additionally, we have found how previous debates or workshops of LGBTQI+ issues at university classrooms can prevent some forms of LGBTQI-phobia from happening. As well, these previous experiences on discussing gender could facilitate processes of social transition, reception of reports of violence or discrimination, improving the perception of the university as a friendlier and safer space. In addition, the heads of Equality Units’ figure entails two different roles: as social agent and worker as well as a representative in terms of equality and non-discrimination in the institution. In any case, this readiness and preparation does not suffice while numbers show that there are no cases of LGBTQI-phobia arriving to institutional instances in some of the participant HEI’s.

Damage on wellbeing of LGBTQI+ students

Given the findings about the prevalence of violence on the grounds of sexual orientation, gender identity and gender expression in Catalan universities, the negative impact on the well-being and life quality of LGBTQI+ students is a fact. If the existence of violence against sexual and gender diversity in university spaces is a reality, the probability of having students suffering physically and mentally, presenting symptoms of depression, anxiety and various forms of physical ache are a worrying reality for the institution [ 9 , 13 , 16 ]. Furthermore, this difficulty affecting only a group of students would generate a gap in the access, quality and academic success compared to the rest of the community due to their health status [ 25 ]. The lack of social cohesion within the university community and students, has a high impact in the present and future of LGBTQI+ students in Catalonia. LGBTQI+ stigmatization also results in impediments for LGBTQI+ students to reach the same academic level and success than the rest of the students [ 19 , 23 , 43 , 44 ].

The findings about the damage of the LGBTQI+ students at University has given visibility to the risk that the LGBTQI+ community suffers which also affects their wellbeing. This evidence indicates that the generation of successful strategies to prevent, detect and intervene in cases of violence on the grounds of sexual orientation, gender identity and gender expression is urgent. This emergency lies on the institutional duty of offering quality higher education for everyone without of any type of discrimination. In order to eliminate any form of discrimination effective anti-discrimination strategies based on scientific evidence need to be developed.

University policies and measures a the LGBTQI-phobia

Given the results about the implemented strategies to fight and prevent forms of violence on the grounds of sexual orientation, gender identity and gender expression, issues on the evaluation, quality and follow-up of these measures are still pending. The evidence shows that the current strategies to fight, prevent and intervene in cases of LGBTQI+ realities in Catalonia are configured as responses to concrete and specific situations. This conception of the LGBTQI+ reality as a transitory conflict and circumstance implies that the forms of intervention planned only take into account the specific conflict, without paying attention to a reality that is present in all the spheres of the university. This can respond to the lack of continuous and more transversal actions that educational systems implement to carry out more equitable actions for the inclusion of LGBTQI+ realities within HEI’s.

Giving visibility and raising awareness of the LGBTQI+ circumstance is a very pressing issue present both in the literature and in the results of the research, as it can prevent different forms of LGBT-phobia. These actions are identified as protective factors in the prevention and intervention of discrimination and violence on the grounds of sexual orientation, gender identity and gender expression, as well as for generating and imporving the LGBTQI+ students’ feelings of belongingness to HEI’s. More in depth, literature and participants have identified the need of training professors and other university staff about LGBTQI+ perspective [ 1 , 28 ]. This could have an impact on the way conflicts and discrimination on the grounds of sexual orientation, gender identity and gender expression is managed with professionals, ensuring safe follow-up and accompaniment processes by educators and staff -who would be trained on the situation of the LGBTQI+ community through scientific evidence-.

In order to translate this process of making LGBTQI+ issues a closer reality to the university community, the inclusion of literature from a LGBT+ perspective in the academic curriculum has been identified as having the highest impact for the reduction of violence and discrimination on the grounds of sexual orientation, gender identity and gender expression [ 20 , 28 ]. Its implementation would require HEI’s to include LGBTQI+ issues horizontally in all university degrees’ classrooms, considering as an institutional duty the need of ensure freedom of living and expressing sexual and gender diversity. Another way of institutionally protecting the LGBTQI+ community is by explicitly supporting the community as has been informed by the literature [ 6 , 9 , 29 , 30 ]. Lastly, the urgency of addressing the transgender issues at universities is present in both the project’s results and literature [ 45 ], highlighting the need of articulating successful practices and accompanying processes to transgender students for the improvement of their health [ 43 ]. This would require that universities start conceiving the transgender reality as a continuous, individual and changing phenomenon that goes beyond the name and gender change in the identification documents, affecting the live of students with different intensity and in different stages and social circles.

Altogether, the complexity of assessing and reviewing the success and impact of university protocols, measures and strategies to intervene is both a scientific and socio-political issue, attending to the changing political circumstances that affects the European and Spanish context. The research limitations that have affected the study have been closely related to the human interactions during the fieldwork, the protection of the anonymity, the search for gender and sexual minority participants and the issues of visibility and public recognition of participants. For that reason, we have worked very hard in the ethical framework and approval to ensure everyone’s safety, respect, confidentiality and support during and after the fieldwork. Otherwise, the qualitative method and results of the study have also set limits on the applicability and transferability of the findings. Although quality-centred findings do not offer results that can be generalized to the whole Catalan university community, they have allowed us to delve into the reality of the Catalan HEI’s through the discourses of university staff and students.

Following our research goal of improving the quality of life of LGBTQI+ university students, through the CM and breaking the silence that exist about this sort of violence, the study identified protective and exclusionary factors likely to have a high impact in the quality of life of University LGBTQI+ students in the Catalan region. This innovative and transformative focus has provided the dialogue-based methodology on the study of the conflict of gender and sexual diversity in the most relevant educational institution.

The need of studying the conflict of LGBTQI-phobia at universities lies on the importance of higher education in the lives of students and in their future possibilities. It also falls on the strong impact of suffering violence and discrimination for several years while the right of living one’s sexual orientation, gender identity and gender expression freely is not guaranteed. All of this shows how gender and sex norms permeate educational institutions [ 46 , 47 ], making visible the current positioning of Catalan HEI’s against LGBTQI-phobia and towards a more inclusive and diverse university community.

New avenues and research targets on this matter could contribute to identifying other needs and axes of actions that could be essential in the struggle against LGBTQI-phobia. On the one hand, investigating the positioning of professors in the classrooms and their previous training on gender and LGBTQI+ perspective with a base on scientific evidence could open new lines of research for the prevention of violence. Furthermore, the inclusion of LGBTQI+ literature to be addressed in classrooms and the impact of normalizing gender and sex diversity in educational institutions would also be relevant. Our study highlights the importance of the alliance of university professors in the struggle against LGBTQI-phobia as upstanders in the conflict, an issue that must be paramount in new research lines and actions against violence on the grounds of sexual orientation, gender identity and gender expression. On the other hand, studying the case of transgender needs and trajectories in HEI’s is still a pending issue. Tackling the need to underst transgender identities and non-binary gender expressions within the institutional framework would contribute to detect and explain forms of violence yet to be identified as well as the strategies to counter these.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Interviews had an approximate duration of 40 min and the place was chosen by both participant and researcher. Interviews were normally implemented in public spaces which allowed the researcher to generate an atmosphere of trust, such as cafeterias or university offices. The materials result of the interviews were the manual transcriptions made by members of the research team of the Uni4Freedom project. Then, the analysis took place as it follows in the Data Analysis subsection.

The partner universities of Uni4Freedom are: Rovira i Virgili University; University of Barcelona; University of Girona; University of Lleida; Ramón Llull University and University of Vic.

Participant entities and organizations on the Advisory Board:

Col·lectiu H2O · Gais, Lesbianes, Bisexuals i Transsexuals del Camp de Tarragona.

SAI Tarragona - Servei d’Atenció Integral a les Diversitats Sexuals i de Gèneres de Tarragona.

Xarxa Solidària de Vctimes de Violència de Gènere a la Universitat.

Gènere Lliure.

Col·lectiu de gèneres i sexualitats dissidents (GSD).

The participant entities in the Advisory Committee have been:

- Col·lectiu H2O (Gais, Lesbianes, Bisexuals i Transsexuals del Camp de Tarragona).

- SAI Tarragona - Servei d’Atenció Integral a les Diversitats Sexuals i de Gèneres de Tarragona: suport social, informació i atenció piscològica i jurídica.

The participant universities in the study are:

Rovira i Virgili University.

Girona University.

Lleida University.

Vic University.

Barcelona University.

Ramón Llull University.

Abbreviations

Communicative Methodology

Higher Educational Institution

Community of lesbian, gay, bisexual, transgender, queer, intersexual and other groups with non-conforming and dissident identities, orientations or expressions

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Acknowledgements

The authors would like to thank the research participants and collaborators for their important contribution in the study. In particular, we would like to thank to ACUP for their advice and support in all phases of the research. We would also like to acknowledge the support in the data collection to the Advisory Council and all entities participating in it: Col·lectiu H20, SAI Tarragona and Xarxa Solidària de Victimes de Violència de Gènere a la Universitat. We also want to thank the University consortium that enabled the project to take part, formed by Rovira i Virgili University, Lleida University, Girona University, Vic University, Barcelona University and Ramon Llull University. To conclude, we would like to thank all the project collaborators which contribute significantly in data collection and transcription tasks of the fieldwork.

The research leading to these results has received funding from the RecerCaixa program (2017ACUP00235).

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Elena María Gallardo-Nieto, Aitor Gómez & Regina Gairal-Casadó

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The first author EMGN contributed to the data collection and writing of the manuscript along with other project collaborators. The second author AGG contributed with the methodological review of the manuscript. The third author RGC participated in the analysis of the results of the study. The fourth author MMRS contributed to the review of the manuscript offering feedback on editing and stylistic issues. All the authors read and approved the manuscript.

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Correspondence to Regina Gairal-Casadó .

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All study protocols were approved by the Ethics Committee of Girona University on December 19th of 2018 and the Committee for the approval of research studies of the Nursing and Physiotherapy Faculty of Lleida University on May 17th of 2019. As well, all participants gave assent to complete the research tools. Development and monitoring of these protocols involved a study advisory group, which included LGBTQI+ academic community and LGBTQI+ organizations of the local territory.

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Gallardo-Nieto, E.M., Gómez, A., Gairal-Casadó, R. et al. Sexual orientation, gender identity and gender expression-based violence in Catalan universities: qualitative findings from university students and staff. Arch Public Health 79 , 16 (2021). https://doi.org/10.1186/s13690-021-00532-4

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DOI : https://doi.org/10.1186/s13690-021-00532-4

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Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

Concepts and Definitions

Concepts and definitions that refer to sexual orientation and gender identity are an evolving field. Many of the terms used in the past to describe LGBT people, namely in the mental health field, are now considered to be outdated and even offensive.

Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted ( American Psychological Association, 2012 ). Nowadays, the terms ‘lesbian’ and ‘gay’ are used to refer to people who experience attraction to members of the same sex, and the term ‘bisexual’ describe people who experience attraction to members of both sexes. It should be noted that, although these categories continue to be widely used, sexual orientation does not always appear in such definable categories and, instead, occurs on a continuum ( American Psychological Association, 2012 ), and people perceived or described by others as LGB may identify in various ways ( D’Augelli, 1994 ).

The expression gender identity was coined in the middle 1960s, describing one’s persistent inner sense of belonging to either the male and female gender category ( Money, 1994 ). The concept of gender identity evolved over time to include those people who do not identify either as female or male: a “person’s self concept of their gender (regardless of their biological sex) is called their gender identity” ( Lev, 2004 , p. 397). The American Psychological Association (2009a , p. 28) described it as: “the person’s basic sense of being male, female, or of indeterminate sex.” For decades, the term ‘transsexual’ was restricted for individuals who had undergone medical procedures, including genital reassignment surgeries. However, nowadays, ‘transsexual’ refers to anyone who has a gender identity that is incongruent with the sex assigned at birth and therefore is currently, or is working toward, living as a member of the sex other than the one they were assigned at birth, regardless of what medical procedures they may have undergone or may desire in the future (e.g., Serano, 2007 ; American Psychological Association, 2009a ; Coleman et al., 2012 ). In this paper we use the prefix trans when referring to transsexual people.

Since the 1990’s the word transgender has been used primarily as an umbrella term to describe those people who defy societal expectations and assumptions regarding gender (e.g., Lev, 2004 ; American Psychological Association, 2009a ). It includes people who are transsexual and intersex, but also those who identify outside the female/male binary and those whose gender expression and behavior differs from social expectations. As in the case of sexual orientation, people perceived or described by others as transgender – including transsexual men and women – may identify in various ways (e.g., Pinto and Moleiro, 2015 ).

Discrimination and Impact on Mental Health

Lesbian, gay, bisexual and transgender people often suffer from various forms of discrimination, stigma and social exclusion – including physical and psychological abuse, bullying, persecution, or economic alienation ( United Nations, 2011 ; Bostwick et al., 2014 ; European Union Agency for Fundamental Rights, 2014 ). Moreover, experiences of discrimination may occur in various areas, such as employment, education and health care, but also in the context of meaningful interpersonal relationships, including family (e.g., Milburn et al., 2006 ; Feinstein et al., 2014 ; António and Moleiro, 2015 ). Accordingly, several studies strongly suggest that experiences of discrimination and stigmatization place LGBT people at higher risk for mental distress ( Cochran and Mays, 2000 ; Dean et al., 2000 ; Cochran et al., 2003 ; Meyer, 2003 ; Shilo, 2014 ).

For example, LGB populations may be at increased risk for suicide ( Hershberger and D’Augelli, 1995 ; Mustanski and Liu, 2013 ), traumatic stress reactions ( D’Augelli et al., 2002 ), major depression disorders ( Cochran and Mays, 2000 ), generalized anxiety disorders ( Bostwick et al., 2010 ), or substance abuse ( King et al., 2008 ). In addition, transgender people have been identified as being at a greater risk for developing: anxiety disorders ( Hepp et al., 2005 ; Mustanski et al., 2010 ); depression ( Nuttbrock et al., 2010 ; Nemoto et al., 2011 ); social phobia and adjustment disorders ( Gómez-Gil et al., 2009 ); substance abuse ( Lawrence, 2008 ); or eating disorders ( Vocks et al., 2009 ). At the same time, data on suicide ideation and attempts among this population are alarming: Maguen and Shipherd (2010) found the percentage of attempted suicides to be as high as 40% in transsexual men and 20% in transsexual women. Nuttbrock et al. (2010) , using a sample of 500 transgender women, found that around 30% had already attempted suicide, around 35% had planned to do so, and close to half of the participants expressed suicide ideation. In particular, adolescence has been identified as a period of increased risk with regard to the mental health of transgender and transsexual people ( Dean et al., 2000 ).

In sum, research clearly recognizes the role of stigma and discrimination as significant intervening variables in psychopathology among LGBT populations. Nevertheless, the relation between sexual orientation or gender identity and stress may be mediated by several variables, including social and family support, low internalized homophobia, expectations of acceptance vs. rejection, contact with other LGBT people, or religiosity ( Meyer, 2003 ; Shilo and Savaya, 2012 ; António and Moleiro, 2015 ; Snapp et al., 2015 ). Thus, it seems important to focus on subjective distress and in a person-centered experience of psychopathology.

On the History of Homosexuality and Psychiatric Diagnoses

While nowadays we understand that higher rates of psychological distress among LGB people are related to their minority status and to discrimination, by the early 20th century, psychiatrists mostly regarded homosexuality as pathological per se ; and in the mid-20th century psychiatrics, physicians, and psychologists were trying to “cure” and change homosexuality ( Drescher, 2009 ). In 1952, the American Psychiatric Association published its first edition of the Diagnostic and Statistical Manual (DSM-I), in which homosexuality was considered a “sociopathic personality disturbance.” In DSM-II, published in 1968, homosexuality was reclassified as a “sexual deviation.” However, in December 1973, the American Psychiatric Association’s Board of Trustees voted to remove homosexuality from the DSM.

The most significant catalyst to homosexuality’s declassification as a mental illness was lesbian and gay activism, and its advocacy efforts within the American Psychiatric Association ( Drescher, 2009 ). Nevertheless, during the discussion that led to the diagnostic change, APA’s Nomenclature Committee also wrestled with the question of what constitutes a mental disorder. Concluding that “they [mental disorders] all regularly caused subjective distress or were associated with generalized impairment in social effectiveness of functioning” ( Spitzer, 1981 , p. 211), the Committee agreed that homosexuality by itself was not one.

However, the diagnostic change did not immediately end the formal pathologization of some presentations of homosexuality. After the removal of the “homosexuality” diagnosis, the DSM-II contained the diagnosis of “sexual orientation disturbance,” which was replaced by “ego dystonic homosexuality” in the DSM-III, by 1980. These diagnoses served the purpose of legitimizing the practice of sexual “conversion” therapies among those individuals with same-sex attractions who were distressed and reported they wished to change their sexual orientation ( Spitzer, 1981 ; Drescher, 2009 ). Nonetheless, “ego-dystonic homosexuality” was removed from the DSM-III-R in 1987 after several criticisms: as formulated by Drescher (2009 , p. 435): “should people of color unhappy about their race be considered mentally ill?”

The removal from the DSM of psychiatric diagnoses related to sexual orientation led to changes in the broader cultural beliefs about homosexuality and culminated in the contemporary civil rights quest for equality ( Drescher, 2012 ). In contrast, it was only in 1992 that the World Health Organization ( World Health Organization, 1992 ) removed “homosexuality” from the International Classification of Diseases (ICD-10), which still contains a diagnosis similar to “ego-dystonic homosexuality.” However, this is expected to change in the next revision, planned for publication in 2017 ( Cochran et al., 2014 ).

Controversies on Gender Dysphoria and (Trans)Gender Diagnoses

Mental health diagnoses that are specific to transgender and transsexual people have been highly controversial. In this domain, the work of Harry Benjamin was fundamental for trans issues internationally, through the Harry Benjamin International Gender Dysphoria Association (presently, the World Professional Association for Transgender Health, WPATH). In the past few years, there has been a vehement discussion among interested professionals, trans and LGBT activists, and human rights groups concerning the reform or removal of (trans)gender diagnoses from the main health diagnostic tools. However, discourses on this topic have been inconclusive, filled with mixed messages and polarized opinions ( Kamens, 2011 ). Overall, mental health diagnoses which are specific to transgender people have been criticized in large part because they enhance the stigma in a population which is already particularly stigmatized ( Drescher, 2013 ). In fact, it has been suggested that the label “mental disorder” is the main factor underlying prejudice toward trans people ( Winter et al., 2009 ).

The discussion reached a high point during the recent revision process of the DSM-5 ( American Psychiatric Association, 2013 ), in which the diagnosis of “gender identity disorder” was revised into one of “gender dysphoria.” Psychiatric diagnosis was thus limited to those who are, in a certain moment of their lives, distressed about living with a gender assignment they experience as incongruent with their gender identity ( Drescher, 2013 ). The change of criteria and nomenclature “is less pathologizing as it no longer implies that one’s identity is disordered” ( DeCuypere et al., 2010 , p. 119). In fact, gender dysphoria is not a synonym for transsexuality, nor should it be used to describe transgender people in general ( Lev, 2004 ); rather, “[it] is a clinical term used to describe the symptoms of excessive pain, agitation, restless, and malaise that gender-variant people seeking therapy often express” ( Lev, 2004 , p. 910). Although the changes were welcomed (e.g., DeCuypere et al., 2010 ; Lev, 2013 ), there are still voices arguing for the “ultimate removal” ( Lev, 2013 , p. 295) of gender dysphoria from the DSM. Nevertheless, attention is presently turned to the ongoing revision of the ICD. Various proposals concerning the revision of (trans)gender diagnoses within ICD have been made, both originating from transgender and human rights groups (e.g., Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ) and the health profession community (e.g., Drescher et al., 2012 ; World Professional Association for Transgender Health, 2013 ). These include two main changes: the reform of the diagnosis of transsexualism into one of “gender incongruence”; and the change of the diagnosis into a separate chapter from the one on “mental and behavioral disorders.”

Mental Health Care Reflecting Controversies

There is evidence that LGBT persons resort to psychotherapy at higher rates than the non-LGBT population ( Bieschke et al., 2000 ; King et al., 2007 ); hence, they may be exposed to higher risk for harmful or ineffective therapies, not only as a vulnerable group, but also as frequent users.

Recently, there has been a greater concern in the mental health field oriented to the promotion of the well-being among non-heterosexual and transgender people, which has paralleled the diagnostic changes. This is established, for instance, by the amount of literature on gay and lesbian affirmative psychotherapy which has been developed in recent decades (e.g., Davis, 1997 ) and, also, by the fact that major international accrediting bodies in counseling and psychotherapy have identified the need for clinicians to be able to work effectively with minority clients, namely LGBT people. The APA’s guidelines for psychotherapy with lesbian, gay, and bisexual client ( American Psychological Association, 2000 , 2012 ) are a main reference. These ethical guidelines highlight, among several issues, the need for clinicians to recognize that their own attitudes and knowledge about the experiences of sexual minorities are relevant to the therapeutic process with these clients and that, therefore, mental health care providers must look for appropriate literature, training, and supervision.

However, empirical research also reveals that some therapists still pursue less appropriate clinical practices with LGBT clients. In a review of empirical research on the provision of counseling and psychotherapy to LGB clients, Bieschke et al. (2006) encountered an unexpected recent explosion of literature focused on “conversion therapy.” There are, in fact, some mental health professionals that still attempt to help lesbian, gay, and bisexual clients to become heterosexual ( Bartlett et al., 2009 ), despite the fact that a recent systematic review of the peer-reviewed journal literature on sexual orientation change efforts concluded that “efforts to change sexual orientation are unlikely to be successful and involve some risk of harm” ( American Psychological Association, 2009b , p. 1).

Moreover, there is evidence of other forms of inappropriate (while less blatant) clinical practices with LGBT clients (e.g., Garnets et al., 1991 ; Jordan and Deluty, 1995 ; Liddle, 1996 ; Hayes and Erkis, 2000 ). Even those clinicians who intend to be affirmative and supportive of LGBT individuals can reveal subtle heterosexist bias in the work with these clients ( Pachankis and Goldfried, 2004 ). Examples of such micro-aggressions ( Sue, 2010 ) might be automatically assuming that a client is heterosexual, trying to explain the etiology of the client’s homosexuality, or focusing on the sexual orientation of a LGB client despite the fact that this is not an issue at hand (e.g., Shelton and Delgado-Romero, 2011 ). Heterosexual bias in counseling and psychotherapy may manifest itself also in what Brown (2006 , p. 350) calls “sexual orientation blindness,” i.e., struggling for a supposed neutrality and dismissing the specificities related to the minority condition of non-heterosexual clients. This conceptualization of the human experience mostly in heterosexual terms, found in the therapeutic setting, does not seem to be independent of psychotherapist’s basic training and the historical heterosexist in the teaching of medicine and psychology ( Simoni, 1996 ; Alderson, 2004 ).

With regards to the intervention with trans people, for decades the mental health professionals’ job was to sort out the “true” transsexuals from all other transgender people. The former would have access to physical transition, and the later would be denied any medical intervention other than psychotherapy. By doing this, whether deliberately or not, professionals – acting as gatekeepers – pursued to ‘ensure that most people who did transition would not be “gender-ambiguous” in any way’ ( Serano, 2007 , p. 120). Research shows that currently trans people still face serious challenges in accessing health care, including those related to inappropriate gatekeeping ( Bockting et al., 2004 ; Bauer et al., 2009 ). Some mental health professionals still focus on the assessment of attributes related to identity and gender expressions, rather than on the distress with which trans people may struggle with ( Lev, 2004 ; Serano, 2007 ). Hence, trans people may feel the need to express a personal narrative consistent with what they believe the clinicians’ expectations to be, for accessing hormonal or surgical treatments ( Pinto and Moleiro, 2015 ). Thus, despite the revisions of (trans)gender diagnoses within the DSM, more recent diagnoses seem to still be used as if they were identical with the diagnosis of transsexualism – in a search for the “true transsexual” ( Cohen-Kettenis and Pfäfflin, 2010 ). It seems clear that social and cultural biases have significantly influenced – and still do – diagnostic criteria and the access to hormonal and surgical treatments for trans people.

Controversies and debates with regards to medical classification of sexual orientation and gender identity contribute to the reflection on the very concept of mental illness. The agreement that mental disorders cause subjective distress or are associated with impairment in social functioning was essential for the removal of “homosexuality” from the DSM in the 1970s ( Spitzer, 1981 ). Moreover, (trans)gender diagnoses constitute a significant dividing line both within trans related activism (e.g., Vance et al., 2010 ) and the health professionals’ communities (e.g., Ehrbar, 2010 ). The discussion has taken place between two apposite positions: (1) trans(gender) diagnoses should be removed from health classifying systems, because they promote the pathologization and stigmatization of gender diversity and enhance the medical control of trans people’s identities and lives; and (2) trans(gender) diagnoses should be retained in order to ensure access to care, since health care systems rely on diagnoses to justify medical treatment – which many trans people need. In fact, trans people often describe experiences of severe distress and argue for the need for treatments and access to medical care ( Pinto and Moleiro, 2015 ), but at the same time reject the label of mental illness for themselves ( Global Action for Trans ∗ Equality, 2011 ; TGEU, 2013 ). Thus, it may be important to understand how the debate around (trans)diagnoses may be driven also by a history of undue gatekeeping and by stigma involving mental illness.

The present paper argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

On the one hand, aligned with a position of “transgression” and/or “deviation from a norm,” people who today are described as LGBT were labeled as mentally ill. Inevitably, classification systems reflect(ed) the existing social attitudes and prejudices, as well as the historical and cultural contexts in which they were developed ( Drescher, 2012 ; Kirschner, 2013 ). In that, they often failed to differentiate between mental illness and socially non-conforming behavior or fluidity of gender expressions. This position and the historical roots of this discourse are still reflected in the practices of some clinicians, ranging from “conversion” therapies to micro-aggressions in the daily lives of LGBT people, including those experienced in the care by mental health professionals.

On the other hand, lined up with a position of gender variance and fluidity, changes in the diagnostic systems in the last few decades reflect a broader respect and value of the diversity of human sexuality and of gender expressions. This position recognizes that the discourse and practices coming from the (mental) health field may lead to changes in the broader cultural beliefs ( Drescher, 2012 ). As such, it also recognizes the power of medical classifications, health discourses and clinical practices in translating the responsibility of fighting discrimination and promoting LGBT people’s well-being.

In conclusion, it seems crucial to emphasize the role of specific training and supervision in the development of clinical competence in the work with sexual minorities. Several authors (e.g., Pachankis and Goldfried, 2004 ) have argued for the importance of continuous education and training of practitioners in individual and cultural diversity competences, across professional development. This is in line with APA’s ethical guidelines ( American Psychological Association, 2000 , 2012 ), and it is even more relevant when we acknowledge the significant and recent changes in this field. Furthermore, it is founded on the very notion that LGBT competence assumes clinicians ought to be aware of their own personal values, attitudes and beliefs regarding human sexuality and gender diversity in order to provide appropriate care. These ethical concerns, however, have not been translated into training programs in medicine and psychology in a systematic manner in most European countries, and to the mainstreaming of LGBT issues ( Goldfried, 2001 ) in psychopathology.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Regions & Countries

Americans’ complex views on gender identity and transgender issues, most favor protecting trans people from discrimination, but fewer support policies related to medical care for gender transitions; many are uneasy with the pace of change on trans issues.

Pew Research Center conducted this study to better understand Americans’ views about gender identity and people who are transgender or nonbinary. These findings are part of a larger project that includes findings from six focus groups on  the experiences and views of transgender and nonbinary adults  and estimates of the  share of U.S. adults who say their gender is different from the sex they were assigned at birth . 

This analysis is based on a survey of 10,188 U.S. adults. The data was collected as a part of a larger survey conducted May 16-22, 2022. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the  ATP’s methodology . See here to read more about the  questions used for this report and the report’s methodology .

References to White, Black and Asian adults include only those who are not Hispanic and identify as only one race. Hispanics are of any race.

All references to party affiliation include those who lean toward that party. Republicans include those who identify as Republicans and those who say they lean toward the Republican Party. Democrats include those who identify as Democrats and those who say they lean toward the Democratic Party.

References to college graduates or people with a college degree comprise those with a bachelor’s degree or more. “Some college” includes those with an associate degree and those who attended college but did not obtain a degree.

The terms “transgender” and “trans” are used interchangeably throughout this report to refer to people whose gender is different from the sex they were assigned at birth.

As the United States addresses issues of transgender rights and the broader landscape around gender identity continues to shift, the American public holds a complex set of views around these issues, according to a new Pew Research Center survey.

Roughly eight-in-ten U.S. adults say there is at least some discrimination against transgender people in our society, and a majority favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces. At the same time, 60% say a person’s gender is determined by their sex assigned at birth, up from 56% in 2021 and 54% in 2017.

The public is divided over the extent to which our society has accepted people who are transgender: 38% say society has gone too far in accepting them, while a roughly equal share (36%) say society hasn’t gone far enough. About one-in-four say things have been about right. Underscoring the public’s ambivalence around these issues, even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far or been about right in terms of acceptance.

The fundamental belief about whether gender can differ from sex assigned at birth is closely aligned with opinions on transgender issues. Americans who say a person’s gender  can  be different from their sex at birth are more likely than others to see discrimination against trans people and a lack of societal acceptance. They’re also more likely to say that our society hasn’t gone far enough in accepting people who are transgender. But even among those who say a person’s gender is determined by their sex at birth, there is a diversity of viewpoints. Half of this group say they would favor laws that protect trans people from discrimination in certain realms of life. And about one-in-four say forms and online profiles should include options other than “male” or “female” for people who don’t identify as either.   

Related:  The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. adults

When it comes to issues surrounding gender identity, young adults are at the leading edge of change and acceptance. Half of adults ages 18 to 29 say someone can be a man or a woman even if that differs from the sex they were assigned at birth. This compares with about four-in-ten of those ages 30 to 49 and about a third of those 50 and older. Adults younger than 30 are also more likely than older adults to say society hasn’t gone far enough in accepting people who are transgender (47% vs. 39% of 30- to 49-year-olds and 31% of those 50 and older) 

These views differ even more sharply by partisanship. Democrats and those who lean to the Democratic Party are more than four times as likely as Republicans and Republican leaners to say that a person’s gender can be different from the sex they were assigned at birth (61% vs. 13%). Democrats are also much more likely than Republicans to say our society hasn’t gone far enough in accepting people who are transgender (59% vs. 10%). For their part, 66% of Republicans say society has gone  too far  in accepting people who are transgender.

Amid a national conversation over these issues, many states are considering or have put in place  laws or policies  that would directly affect the lives of transgender and nonbinary people – that is, those who don’t identify as a man or a woman. Some of these laws would limit protections for transgender and nonbinary people; others are aimed at safeguarding them. The survey finds that a majority of U.S. adults (64%) say they would favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces such as restaurants and stores. But there is also a fair amount of support for specific proposals that would limit how trans people can participate in certain activities and navigate their day-to-day lives. 

Roughly six-in-ten adults (58%) favor proposals that would require transgender athletes to compete on teams that match the sex they were assigned at birth (17% oppose this, 24% neither favor nor oppose). 1 And 46% favor making it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (31% oppose). The public is more evenly split when it comes to making it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) and investigating parents for child abuse if they help someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Across the board, views on these policies are deeply divided by party. 

When asked what has influenced their views on gender identity – specifically, whether they believe a person can be a different gender than the sex they were assigned at birth – those who believe gender can be different from sex at birth and those who do not point to different factors. For the former group, the most influential factors shaping their views are what they’ve learned from science (40% say this has influenced their views a great deal or a fair amount) and knowing someone who is transgender (38%). Some 46% of those who say gender is determined by sex at birth also point to what they’ve learned from science, but this group is far more likely than those who say a person’s gender can be different from their sex at birth to say their religious beliefs have had at least a fair amount of influence on their opinion (41% vs. 9%).   

The nationally representative survey of 10,188 U.S. adults was conducted May 16-22, 2022.  Previously published findings from the survey  show that 1.6% of U.S. adults are trans or nonbinary, and the share is higher among adults younger than 30. More than four-in-ten U.S. adults know someone who is trans and 20% know someone who is nonbinary. Among the other key findings in this report:

Nearly half of U.S. adults (47%) say it’s extremely or very important to use a person’s new name if they transition to a gender that is different from the sex they were assigned at birth and change their name.  A smaller share (34%) say the same about using someone’s new pronouns (such as “he” instead of “she”). A majority of Democrats (64%) – compared with 28% of Republicans – say it’s at least very important to use someone’s new name if they go through a gender transition and change their name. And while 51% of Democrats say it’s extremely or very important to use someone’s new pronouns, just 14% of Republicans say the same.

Many Americans express discomfort with the pace of change around issues of gender identity.  Some 43% say views on issues related to people who are transgender or nonbinary are changing too quickly, while 26% say things aren’t changing quickly enough and 28% say the pace of change is about right. Adults ages 65 and older are the most likely to say views on these issues are changing too quickly; conversely, those younger than 30 are the most likely to say they’re not changing quickly enough. 

More than four-in-ten (44%) say forms and online profiles that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either.  Some 38% say the same about government documents such as passports and driver’s licenses. Half of adults younger than 30 say government documents that ask about a person’s gender should provide more than two gender options, compared with about four-in-ten or fewer among those in older age groups. Views differ even more widely by party: While majorities of Democrats say forms and online profiles (64%) and government documents (58%) should offer options other than “male” and “female,” about eight-in-ten Republicans say they should  not  (79% say this about forms and online profiles and 83% say this about government documents). 

Democrats and Republicans who agree that a person’s gender is determined by their sex at birth often have different views on transgender issues.  A majority (61%) of Democrats – but just 31% of Republicans – who say a person’s gender is determined by the sex they were assigned at birth say there is at least a fair amount of discrimination against transgender people in our society today. And while 62% of Democrats who say gender is determined by sex at birth say they would favor policies that protect trans individuals against discrimination, fewer than half of their Republican counterparts say the same. 

Democrats’ views on some transgender issues vary by age.  Among Democrats younger than 30, about seven-in-ten (72%) say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, and 66% say society hasn’t gone far enough in accepting people who are transgender. Smaller majorities of Democrats 30 and older express these views. Age is less of a factor among Republicans. In fact, similar shares of Republicans ages 18 to 29 and those 65 and older say a person’s gender is determined by their sex at birth (88% each) and that society has gone too far in accepting people who are transgender (67% of Republicans younger than 30 and 69% of those 65 and older).  

About three-in-ten parents of K-12 students (29%) say at least one of their children has learned about people who are transgender or nonbinary from a teacher or another adult at their school.  Similar shares across regions and in urban, suburban and rural areas say their children have learned about this in school, as do similar shares of Republican and Democratic parents. Views on whether it’s good or bad that their children have or haven’t learned about people who are trans or nonbinary at school vary by party and by children’s age. For example, among parents of children in elementary school, 45% say either that their children  have  learned about this and that’s a  bad  thing or that they  haven’t  learned about it and that’s a  good  thing. A smaller share of parents of middle and high schoolers (34%) say the same. Republican parents are much more likely than Democratic parents to say this, regardless of their child’s age.

A rising share say a person’s gender is determined by their sex at birth

Six-in-ten U.S. adults say that whether a person is a man or a woman is determined by their sex assigned at birth. This is up from 56%  one year ago  and 54% in  2017 . No single demographic group is driving this change, and patterns in who is more likely to say this are similar to what they were in past years.

Today, half or more in all age groups say that gender is determined by sex assigned at birth, but this is a less common view among younger adults. Half of adults younger than 30 say this, lower than the 60% of 30- to 49-year-olds who say the same. Even higher shares of those 50 to 64 (66%) and those 65 and older (64%) say a person’s gender is determined by their sex at birth.

The party gap on this issue remains wide. The vast majority of Republicans and those who lean toward the GOP say gender is determined by sex assigned at birth (86%), compared with 38% of Democrats and Democratic leaners. Most Democrats say that whether a person is a man or a woman can be different from their sex at birth (61% vs. just 13% of Republicans). Liberal Democrats are particularly likely to hold this view – 79% say a person’s gender can be different from sex at birth, compared with 45% of moderate or conservative Democrats. Meanwhile, 92% of conservative Republicans say gender is determined by sex at birth and 74% of moderate or liberal Republicans agree.

Democrats ages 18 to 29 are also substantially more likely than older Democrats to say that someone’s gender can be different from their sex assigned at birth, although majorities of Democrats across age groups share this view. About seven-in-ten Democrats younger than 30 say this (72%), compared with about six-in-ten or fewer in the older age groups. Among Republicans, there is no clear pattern by age. About eight-in-ten or more Republicans across age groups – including 88% each among those ages 18 to 29 and those 65 and older – say a person’s gender is determined by their sex at birth. 

The view that a person’s gender is determined by their sex assigned at birth is more common among those with lower levels of educational attainment and those living in rural areas or in the Midwest or South. This view is also more prevalent among men and Black Americans. 

A solid majority of those who do  not  know a transgender person say that whether a person is a man or a woman is determined by sex assigned at birth (68%), while those who  do  know a trans person are more evenly split. About half say gender is determined by sex assigned at birth (51%), while 48% say gender and sex assigned at birth can be different. 

Though Republicans who know a trans person are more likely than Republicans who don’t to say gender can be different from sex assigned at birth, more than eight-in-ten in both groups (83% and 88%, respectively) say gender is determined by sex at birth. Meanwhile, there are large differences between Democrats who do and do  not  know a transgender person. A majority of Democrats who  do  know a trans person (72%) say someone can be a man or a woman even if that differs from their sex assigned at birth, while those who don’t know anyone who is transgender are about evenly split (48% say gender is determined by sex assigned at birth while 51% say it can be different). 

Many Americans point to science when asked what has influenced their views on whether gender can differ from sex assigned at birth

When asked about factors that have influenced their views about whether someone’s gender can be different from the sex they were assigned at birth, 44% say what they’ve learned from science has had a great deal or a fair amount of influence. About three-in-ten (28%) point to their religious views and about two-in-ten (22%) say knowing someone who is transgender has influenced their views at least a fair amount. Smaller shares say what they’ve heard or read in the news (15%) or on social media (14%) has had a great deal or a fair amount of influence on their views.

The factors people point to on this topic differ by whether or not they say gender is determined by sex at birth. Among those who say that whether someone is a man or a woman is determined by the sex they were assigned at birth, 46% say what they’ve learned from science has influenced their views on this at least a fair amount, while 41% say the same about their religious views. About one-in-ten point to what they’ve heard or read in the news (12%), what they’ve heard or read on social media (11%) or knowing someone who’s transgender (11%). 

Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 40% say their views on this topic have been influenced at least a fair amount by what they’ve learned from science. A similar share say the same about knowing a transgender person (38%). Smaller shares in this group say what they’ve heard or read in the news (19%) or on social media (18%) or their religious views (9%) have had a great deal or a fair amount of influence.

Among those who say gender is determined by sex assigned at birth, adults younger than 30 stand out as being more likely than their older counterparts to say their knowledge of science (60%), what they’ve heard or read on social media (22%) or knowing someone who is trans (17%) influenced this view a great deal or a fair amount. In turn, those ages 65 and older tend to be more likely than younger age groups to cite their religious views (51% in the older group say this has had at least a fair amount of influence). 

Republicans who say gender is determined by sex assigned at birth are more likely than Democrats with the same view to say their knowledge of science (52% vs. 40%) and their religious views (45% vs. 34%) have had at least a fair amount of influence, while Democrats are more likely than Republicans to say the news (17% vs. 10%), social media (16% vs. 10%) and knowing someone who is trans (15% vs. 9%) have influenced them – though the shares are still small among both groups.

On the flip side, among those who say someone’s gender can be  different  from the sex they were assigned at birth, adults younger than 30 are also more likely than older adults to say social media has contributed to this view at least a fair amount (33% vs. 15% or fewer among older age groups). Adults ages 65 and older are more likely than their younger counterparts to say what they’ve learned from science has influenced their view (46% vs. 40% or fewer). 

Democrats who say whether someone is a man or a woman can be different from their sex at birth are more likely than Republicans with the same view to say that what they’ve learned from science (43% vs. 26%) and knowing someone who is transgender (40% vs. 26%) has influenced their view a great deal or a fair amount.

Public sees discrimination against trans people and limited acceptance

Roughly eight-in-ten Americans say transgender people face at least some discrimination, and relatively few believe our society is extremely or very accepting of people who are trans. These views differ widely by partisanship and by beliefs about whether someone’s gender can differ from the sex they were assigned at birth.

Overall, 57% of adults say there is a great deal or a fair amount of discrimination against transgender people in our society today. An additional 21% say there is some discrimination against trans people, and 14% say there is a little or none at all. 

There are modest differences in views on this issue across demographic groups. Women (62%) are more likely than men (52%) to say there is a great deal or a fair amount of discrimination against transgender people, and college graduates (62%) are more likely than those with less education (55%) to say the same. 

There is, however, a wide partisan divide in these views: While 76% of Democrats and those who lean to the Democratic Party say there is a great deal or a fair amount of discrimination against trans people, 35% of Republicans and Republican leaners share that assessment. One-in-four Republicans see little or no discrimination against this group, compared with 5% of Democrats. 

These views are also linked with underlying opinions about whether a person’s gender can be different from their sex assigned at birth. Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 83% say there is a great deal or a fair amount of discrimination against trans people. Even so, some 42% of those who hold the alternative point of view – that gender is determined by sex assigned at birth – also see at least a fair amount of discrimination. Among Democrats who say gender is determined by sex at birth, that share rises to 61%. 

Relatively few adults (14%) say society is extremely or very accepting, while about a third (35%) say it is somewhat accepting. A plurality (44%) says our society is a little or not at all accepting of trans people. 

Again, these views are strongly linked with partisanship. Democrats have a much more negative view than Republicans, with 54% of Democrats saying society is a little accepting or not at all accepting of transgender people, compared with a third of Republicans. 

And, as with views of discrimination, assessments of societal acceptance are linked to underlying views about how gender is determined. Those who say one’s gender can be different from the sex they were assigned at birth see less acceptance: 56% say society is a little accepting or not accepting at all of people who are transgender. This compares with 37% among those who say gender is determined by sex at birth. Republicans who say gender is determined by sex at birth are more likely than Democrats who say the same to believe that society is at least somewhat accepting of people who are transgender (61% vs. 47%).

About four-in-ten say society has gone too far in accepting trans people

While a majority of Americans see at least a fair amount of discrimination against transgender people and relatively few see widespread acceptance, 38% say our society has gone too far in accepting them. Some 36% say society has not gone far enough in accepting people who are trans, and 23% say the level of acceptance has been about right.

These views differ along demographic and partisan lines. Young adults (ages 18 to 29) and those with a bachelor’s degree or more education are among the most likely to say society hasn’t gone far enough in accepting people who are trans. Men, White adults and those without a four-year college degree are among the most likely to say society has gone too far in this regard. 

There is a wide partisan divide as well. Roughly six-in-ten Democrats (59%) say society hasn’t gone far enough in accepting people who are transgender, while 15% say it has gone too far (24% say it’s been about right). Republicans’ views are almost the inverse: 10% say society hasn’t gone far enough and 66% say it’s gone too far (22% say it’s been about right). 

Even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far in accepting trans people or been about right; 44% say society hasn’t gone far enough.

Many say it’s important to use someone’s new name, pronouns when they’ve gone through a gender transition

Nearly half of adults (47%) say it’s extremely or very important that if a person who transitions to a gender that’s different from their sex assigned at birth changes their name, others refer to them by their new name. An additional 22% say this is somewhat important. Three-in-ten say this is a little or not at all important (18%) or that it shouldn’t be done (12%).

Smaller shares say that if a person transitions to a gender that’s different from their sex assigned at birth and starts going by different pronouns (such as “she” instead of “he”), it’s important that others refer to them by their new pronouns. About a third (34%) say this is extremely or very important, and 21% say this is somewhat important. More than four-in-ten say this is a little or not at all important (26%) or it should not be done (18%).

These views differ along many of the same dimensions as other topics asked about. While 80% of those who believe someone’s gender can be different from their sex assigned at birth also say it’s extremely or very important to use a person’s new name when they’ve gone through a gender transition, 27% of those who think gender is determined by one’s sex assigned at birth share this opinion. The pattern is similar when it comes to use of preferred pronouns. 

Democrats are much more likely than Republicans to say it’s extremely or very important to refer to a person using their new name or pronouns. When it comes to pronouns, a majority of Republicans (55%), compared with only 17% of Democrats, say using someone’s new pronouns when they’ve been through a gender transition is not at all important or should not be done.  

There are some demographic differences as well, with women more likely than men and those with a four-year college degree more likely than those with less education to say it’s extremely or very important to use a person’s new name or pronouns when referring to them.

In addition, people who say they know someone who is trans are more likely than those who do not to say this is extremely or very important. Even so, substantial shares of those who don’t know a trans person view this as important. For example, 39% of those who don’t know someone who is transgender say it’s extremely or very important to refer to a person who goes through a gender transition and changes their name by their new name. 

Plurality of adults say views on gender identity issues are changing too quickly

Many Americans are not comfortable with the pace of change that’s occurring around issues involving gender identity. Some 43% say views on issues related to people who are transgender and nonbinary are changing too quickly. About one-in-four (26%) say things are not changing quickly enough, and 28% say they are changing at about the right speed.

Women (30%) are more likely than men (21%) to say views on these issues are not changing quickly enough, and adults younger than 30 are more likely than their older counterparts to say the same. Among those ages 18 to 29, 37% say views on these issues are not changing quickly enough; this compares with 26% of those ages 30 to 49, 22% of those ages 50 to 64 and 19% of those 65 and older. At the same time, White adults (46%) are more likely than Black (34%), Hispanic (39%) or Asian (31%) adults to say views are changing  too quickly .

Opinions also differ sharply by partisanship. Among Democrats, a plurality (42%) say views on issues involving transgender and nonbinary people are not changing fast enough, and 21% say they are changing too quickly. About a third (35%) say the speed is about right. By contrast, 70% of Republicans say views on these issues are changing too quickly, while only 7% say views aren’t changing fast enough. About one-in-five Republicans (21%) say they’re changing at about the right speed. 

Respondents were asked in an open-ended format why they think views are changing too quickly or not quickly enough, when it comes to issues surrounding transgender and nonbinary people. For those who say things are changing too quickly, responses fell into several different categories. Some indicated that new ways of thinking about gender were inconsistent with their religious beliefs. Others expressed concern that the long-term consequences of medical gender transitions are not well-known, or that changing views on gender identity are merely a fad that’s being pushed by the media. Still others said they worry that there’s too much discussion of these issues in schools these days.

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing  too quickly ?

General concerns about the pace of change

“The issue is so new to me I can’t keep up. I don’t know what to think about all of this new information. I’m baffled by so many changes.”

“It takes quite a bit of time for society to accept changes. I have not been aware of this issue for very long. I am relatively conservative and feel that changes need time to be accepted.”

Religious reasons

“People now believe everyone should just forget about their birth identity and just go along with what they think they are. God made us all for a reason and if He intended us to pick our gender then there would be no reason to be born with specific male or female parts .”

“I have a personal religious belief that sex is an essential part of our eternal identity and that identifying as something other than you are … just doesn’t make a lot of sense.”

“I believe GOD created a man and a woman. We have overstepped our bounds in messing with the miracle of life. I side with my creator.”

Concerns about long-term medical consequences

“We do not know the long-term health problems of hormone therapy, especially in young children.”

“More time needs to pass to study mental, physical, emotional ramifications of medications & surgeries, especially when done before puberty and/or adulthood.”

“Accepting gender fluidity, especially for younger children, seems quick. Also, medical treatments related to gender for people under 18 seems to be being accepted without longer term studies.”

It’s a fad/Driven by the media

“I respect people’s views about themselves, and I will refer to them in the way they want to be referred to, but I believe it’s become trendy because it’s being pushed so much in culture, especially for children.”

“News media, social media and entertainment media companies are trying to change, and it seems they have been succeeding in changing public opinion on this issue for many people.”

“It is encouraging kids who are easily influenced to participate in the ‘in’ fad when their brains are not fully developed.”

Concerns about schools

“Elementary school students should not be subjected to instruction on sex identity, any questions the child asks should be referred to a parent.”

“I think that young people are exposed to these issues at too early an age. I believe that it is up to the parents, and I oppose schools that want to include it in the ‘curriculum.’”

“It’s being pushed on society and especially on younger children, confusing them all the more. This is not something that should be taught in schools.”

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing  too slowly ?

Discrimination

“There is far too much discrimination, hate, and violence directed toward people who are brave enough to stand up for who they truly are. We, as a country and as a society, need to respect how people want to identify themselves and be kind toward one another, end of story.”

“Protections for basic rights to self-determination in identity, health care choices, privacy, and consensual relationships should be a bare minimum that our society can provide for everyone – transgender people included . ”

“There’s too much discrimination. People need to quit controlling other people’s private lives. I consider them very brave for having the courage to be who they identify with . ”

“Equal protection has not kept up with trans issues, including trans youth and the right to gender-affirming care.”

Legislative efforts

“Acceptance is not changing quick enough. There remains discrimination and elected officials are passing laws that make it more difficult for transgender individuals in society to live, work and exist.”

“We are going backwards with all the anti-gay & -trans legislation that is being passed.”

“For every step forward, it feels like there are two steps back with reactive conservative laws.”

“These laws are working to restrict the rights of trans and nonbinary people, and also discrimination is still very high which results in elevated rates of suicide, poverty, violence and homelessness especially for people of color.”

“The spate of laws being proposed that would take away the rights of transgender people is evidence that we’re a long way from treating them right.”

Society is not open to change

“Too many people are simply stuck in the binary. We, as a society, need to just accept that someone else’s gender identity is whatever they say it is and it rarely has any bearing on the lives of others.”

“These are people. Who they say they are is all that matters. Society, mostly conservatives, doesn’t understand change in any form. So, they fight it. And they hinder the ability for others to learn about themselves and others, which slows growing as a society to a crawl.” 

“It’s an issue that has been in the closet for centuries. It’s time to acknowledge and accept that gender identity is a spectrum and not binary.” 

“We are not accepting the changes. We refuse to see what is in front of us. We care too much about not changing the status quo as we know it.” 

“Society often views this as a phase or a period of uncertainty in their life. Instead, it’s about a person bringing their gender identity in line with what they have experienced internally all their life.”

Most say they’re not paying close attention to news about bills related to transgender people 

Only about one-in-ten or less across age, racial and ethnic groups, and across levels of educational attainment, say they are following news about bills related to people who are transgender extremely or very closely. Six-in-ten or more across demographic groups say they’re following news about these bills a little closely or not closely at all. 

Liberal Democrats and Democratic-leaning independents (46%) are more likely than moderate and conservative Democrats (29%) to say they are following news about state bills related to people who are transgender at least somewhat closely. Conservative Republicans and Republican leaners (31%) are more likely than their moderate and liberal counterparts (24%) – but less likely than liberal Democrats – to be following news about these bills at least somewhat closely. Still, half or more among each of these groups say they have been following news about this a little or not at all closely. 

About six-in-ten would favor requiring that transgender athletes compete on teams that match their sex at birth

The survey asked respondents how they feel about some current laws and policies that are either in place or being considered across the U.S. related to transgender issues. Only two of seven items are either endorsed or rejected by a majority: 64% say they would favor policies that protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores, and 58% say they would favor policies that require that transgender athletes compete on teams that match the sex they were assigned at birth rather than the gender they identify with. 

Even though there is not a majority consensus on most of these laws or policies, there are gaps of at least 10 percentage points on three items. Some 46% say they would favor making it illegal for health care professionals to provide someone younger than 18 with medical care for gender transitions, and 41% would favor requiring transgender individuals to use public bathrooms that match the sex they were assigned at birth rather than the gender they identify with; 31% say they would oppose each of these. Meanwhile, more say they would  oppose  (44%) than say they would favor (27%) requiring health insurance companies to cover medical care for gender transitions. 

Views are more divided when it comes to laws and policies that would make it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) or that would investigate parents for child abuse if they helped someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Some 21% and 27%, respectively, say they’d neither favor nor oppose these policies. 

Views on many policies related to transgender issues vary by age, party, and race and ethnicity 

Majorities of U.S. adults across age groups express support for laws and policies that would protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores. About seven-in-ten adults ages 18 to 29 (70%) and 30 to 49 (68%) say they favor such protections, as do about six-in-ten adults ages 50 to 64 (60%) and 65 and older (59%). 

But adults younger than 30 are more likely than those in each of the older age groups to say they favor laws or policies that would require health insurance companies to cover medical care for gender transitions (37% among those younger than 30 vs. about a quarter among each of the older age groups). They’re also less likely than older adults to express support for bills and policies that would restrict the rights of people who are transgender or limit what schools teach about gender identity. On most items, those ages 50 to 64 and those 65 and older express similar views. 

Views differ even more widely along party lines. For example, eight-in-ten Democrats say they favor laws or policies that would protect trans individuals from discrimination, compared with 48% of Republicans. Conversely, by margins of about 40 percentage points or more, Republicans are more likely than Democrats to express support for laws or policies that would do each of the following: require trans athletes to compete on teams that match the sex they were assigned at birth (85% of Republicans vs. 37% of Democrats favor); make it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (72% vs. 26%); make it illegal for public school districts to teach about gender identity in elementary schools (69% vs. 18%); require transgender individuals to use public bathrooms that match the sex they were assigned at birth (67% vs. 20%); and investigate parents for child abuse if they help someone younger than 18 get medical care for a gender transition (59% vs. 17%). 

Overall, White adults tend to be more likely than Black, Hispanic and Asian adults to express support for laws and policies that would restrict the rights of transgender people or limit what schools can teach about gender identity. But among Democrats, White adults are often  less  likely than other groups to favor such laws and policies, particularly compared with their Black and Hispanic counterparts. And White Democrats are more likely than Black, Hispanic and Asian Democrats to say they favor protecting trans individuals from discrimination and requiring health insurance companies to cover medical care for gender transitions. 

Sizable shares say forms and government documents should include options other than ‘male’ and ‘female’

About four-in-ten Americans (38%) say government documents such as passports and driver’s licenses that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either; a larger share (44%) say the same about forms and online profiles that ask about a person’s gender.

Half of adults younger than 30 say government documents that ask about gender should include options other than “male” and “female,” compared with 39% of those ages 30 to 49, 35% of those 50 to 64 and 33% of adults 65 and older. When it comes to forms and online profiles, 54% of adults younger than 30 and 47% of those ages 30 to 49 say these forms should include more than two gender options; smaller shares of adults ages 50 to 64 and 65 and older (37% each) say the same. 

Views on this vary considerably by party. A majority of Democrats and Democratic-leaning independents say forms and online profiles (64%) and government documents (58%) that ask about a person’s gender should include options other than “male” and “female.” In contrast, about eight-in-ten or more Republicans and Republican leaners say forms and online profiles (79%) and government documents (83%) should  not  include more than these two gender options. 

Those who say they know someone who is nonbinary are more likely than those who don’t know anyone who’s nonbinary to say forms and government documents should include gender options other than “male” and “female.” Still, 39% of those who don’t know anyone who’s nonbinary say forms and online profiles shouldinclude other gender options, and 33% say the same about government documents that ask about a person’s gender. Conversely, 31% of those who say they know someone who’s nonbinary say forms and online profiles should  not  include options other than “male” and “female,” and 41% say this about government documents. 

About three-in-ten parents of K-12 students say their children have learned about people who are trans or nonbinary at school 

In recent months, lawmakers in several states have introduced legislation that would  prohibit or limit instruction on sexual orientation or gender identity  in schools. The survey asked parents of K-12 students whether any of their children have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school and how they feel about the fact that their children have or have not learned about this.

Some 37% of parents with children in middle or high school say their middle or high schoolers have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school; a much smaller share of parents of elementary school students (16%) say the same. Overall, 29% of parents with children in elementary, middle or high school say at least one of their K-12 children have learned about this at school. 

Similar shares of parents of K-12 students in urban (31%), suburban (27%) and rural (32%) areas – and in the Northeast (34%), Midwest (33%), South (26%) and West (28%) – say their school-age children have learned about people who are transgender or who don’t identify as a boy or a girl. And Republican (27%) and Democratic (31%) parents are also about equally likely to say their children have learned about this in school. None of these differences are statistically significant.

Many parents of K-12 students don’t think it’s good for their children to learn about people who are transgender or nonbinary from their teachers or other adults at school. Among parents of elementary school students, 45% either say their children have learned about people who are trans or nonbinary at school and see this is a  bad  thing or say their children have  not  learned about this and say this is a  good  thing. A far smaller share (13%) say it’s a good thing that their elementary school children have learned about people who are trans or nonbinary or that it’s a bad thing that they  haven’t  learned about this. And about four-in-ten (41%) say it’s neither good nor bad that their elementary school children have or haven’t learned about people who are transgender or nonbinary. 

Among parents with children in middle or high school, 34% say it’s a bad thing that their children have learned about people who are trans or nonbinary at school  or  that it’s a good thing that they haven’t; 14% say it’s good that their middle or high schoolers have learned about this  or  that it’s bad that they haven’t; and 51% say it’s neither good nor bad that their children have or haven’t learned about this in school. 

Republican and Republican-leaning parents with children in elementary, middle and high school are more likely than their Democratic and Democratic-leaning counterparts to say it’s a bad thing that their children have learned about people who are trans or nonbinary at school or that it’s a good thing that they haven’t. In turn, Democratic parents are more likely to say it’s  good  that their children  have  learned about this or  bad  that they  haven’t . They are also more likely to say it’s neither good nor bad that their children have or haven’t learned about people who are trans or nonbinary at school. 

• For each policy item, respondents were also given the option of answering “neither favor nor oppose.”  ↩
• Open-ended responses (quotations) have been lightly edited for clarity and length. ↩
• The shares who say they are following news about this a little or not at all closely do not add up to the combined share shown in the chart due to rounding.  ↩

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About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Free Gender Identity Essay Examples & Topics

Everyone has their own unique gender identity. Whether a person identifies as female, male, or outside the binary, everyone has ways of expressing themselves. This gender expression is then measured against socially established gender roles. If the two concepts clash, this can become a source of internal and external conflict.

In recent years, the definition of gender is beginning to change. We now consider it as a social construct. It is dictated by our behavior, presentation, and cultural norms. The language surrounding this concept is also evolving. Here our experts have explored some terms that will help you understand gender identity.

Cisgender applies to a person whose identity aligns with the sex that they were assigned at birth. In contrast, transgender refers to a person whose gender identity differs from their assigned sex.

Non-binary describes people whose gender identity lies outside the established man/woman dichotomy. This umbrella term covers a broad number of identities, such as genderfluid, genderqueer, agender, etc.

We have collected advice that will help you in writing your gender identity essay. After all, even when writing about a personal experience, you need to approach the subject thoughtfully. We have also created a list of topics. They will help you compose different types of essays about gender identity.

Essay about Gender Identity: 6 Tips

Doesn’t matter whether you are writing a gender expression essay or a paper about identity. You still have to follow a defined structure. Here we have summarized how to organize your work process best and create an effective outline.

You can start with the following tips:

1. Brainstorm. The most critical step in writing a successful essay is to establish what ideas you already have. Perhaps you are thinking about focusing on gender equality? Or maybe about the differences between masculinity and femininity? Jot down your thoughts on paper and see where that takes you.

2. Get a topic. As soon as you have an idea of the direction you’re heading, start thinking about wording. Keep in mind that you have to narrow down from a broad list of potential subjects. The matter of gender identity is infinitely complex, so choose a single aspect to focus on. Try our topic generator so that it can come up with an idea for you.

3. Research your idea. This is perhaps the step that will take you the longest. To successfully write a compelling essay, you should have a large number of credible sources. Most of the information you need will be available online. Yet, try referring to books and journal articles too. Check for the availability of your resources before you settle on a topic.

4. Come up with a thesis. Here is where you might want to look over all the information you have compiled so far. Refer to your chosen topic and create a thesis statement. It is the main argument that you are trying to make in your essay. So, be concise and precise.

5. Outline your paper. From writing down the title to forming your conclusions, everything in your essay should be pre-planned. Start with writing down your introduction using your thesis statement. Afterward, you may want to note down what you will talk about in the body paragraphs. Don’t forget that using statistics, examples, and quotes can make your essay sound more solid. Finally, summarize your findings and restate your thesis in your conclusion. For this, you can use our online summarizer . Now that you have a rough draft, writing will be much easier.

6. Revise & proofread. When you are done writing, it is time for editing. Many students choose to skip over revising and proofreading, believing that it is not necessary. This is not the case. Your true potential opens up only after you edit your paper and compare it to the writing criteria. Make sure to read through your work at least once.

Amazing Gender Identity Essay Topics

After reading our tips, you may still have a vital question. What should be the topic of my essay on gender identity? We are here to help.

Feel free to make use of these 15 gender identity topics:

• What is gender expression, and how does it feed into gender stereotypes?
• The intersection between race and gender identity.
• Why are feminine traits frowned upon while masculine ones are uplifted?
• Gender identity in society today.
• The history of nonbinary gender identities in the West.
• Gender identity development – a psychological study.
• The third gender – a study of nonbinary gender identities of the past.
• Presentation of gender identity in modern media.
• What is gender performativity, and how does it help shape gender identities?
• The contrast between gender identity and gender role.
• Gender as a spectrum: what lies between masculinity and femininity.
• Dysphoria – a gender identity disorder.
• Breaking down the concept of heteronormativity concerning gender.
• The historical evolution of the female gender identity.
• Understanding equality in terms of gender identity.

Thank you for reading! We hope that you found these tips useful, and we wish you the best in your academic work. If you still find yourself at a loss, read through our sample essays on gender identity below.

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