1. FROM A BLACK AND WHITE
TO A TECHNICOLOR
VIEW OF GENDER:
A DISCUSSION ON GENDER
IDENTITY AND GENDER
VARIANCE
By Aimee Beardslee
Spring 2012

2. TOPICS OF DISCUSSION
 Let‟s talk about sex…versus gender
 What does “Intersex” mean? (It‟s more common than you think!)
 What does “Transgender” mean?
 Hormone Therapy & Sex Reassignment Surgery
 Gender Development Theories
 Gender Variance Across Cultures
 Gender identity development in childhood and adolescence
 DSM-IV Diagnostic Criteria for Gender Identity Disorder &
Proposed Criteria for DSM-V
 Why is studying gender identity and gender variance important?

3. SEX VS. GENDER…
SOME BASICS:
 SEX: a term that typically describes an individual‟s
anatomical structure. “Biology”
 GENDER: a term that describes an imposed or adopted
social and psychological condition. “Culture/Society”
 GENDER ROLE: a term that describes the patterns of
behavior that are learned or “acted” based on one‟s
gender identification.
(Diamond, 2002)
*Gender role scripts, rules, and expectations vary across
cultures…but more on that later!

5. GENDER, AND EVEN SEX, ARE NOT
DICHOTOMOUS CATEGORIES
 Not everyone is born either “male” or “female”.
 Although one‟s sex and gender are expected to be congruent,
not everyone grows up feeling that the two “match”.
 Historically, the concepts of masculinity and femininity have
changed, and how they are defined varies across cultures.
 There are many cultures that accept the existence of more
than two genders-and have for centuries!
 Gender and sexual orientation are NOT the same. Gender
variance should not be conflated with homosexuality.

6. WHAT DOES “INTERSEX” MEAN?
 An intersex person is “born with external
genitalia, chromosomes, or internal reproductive
systems that are not traditionally associated with
either a „standard‟ male or female” (NCTE, 2009).
 Medical experts state that 1 in 1,500 to 1 in 2,000
infants are born with “noticeably atypical” genitalia
(ISNA, 2008).
 However, the actual number is likely to be
significantly higher, because many variations do not
show up until later in life (and some may never be
noticed! ISNA, 2008).

7. HOW COMMON IS INTERSEX? (FROM ISNA)
Not XX and not XY one in 1,666 births
Klinefelter (XXY) one in 1,000 births
Androgen insensitivity syndrome one in 13,000 births
Partial androgen insensitivity
one in 130,000 births
syndrome
Classical congenital adrenal
one in 13,000 births
hyperplasia
Late onset adrenal hyperplasia one in 66 individuals
Vaginal agenesis one in 6,000 births
Ovotestes one in 83,000 births
Idiopathic (no discernable medical
one in 110,000 births
cause)

8. HOW COMMON IS INTERSEX?
(CONT’D)
Iatrogenic (caused by medical treatment,
for instance progestin administered to no estimate
pregnant mother)
5 alpha reductase deficiency no estimate
Mixed gonadal dysgenesis no estimate
Complete gonadal dysgenesis one in 150,000 births
Hypospadias (urethral opening in
one in 2,000 births
perineum or along penile shaft)
Hypospadias (urethral opening between
one in 770 births
corona and tip of glans penis)
Total number of people whose bodies
one in 100 births
differ from standard male or female
Total number of people receiving surgery
one or two in 1,000 births
to “normalize” genital appearance

9. WHAT DOES “TRANSGENDER”
MEAN?
 “An umbrella term for people whose gender
identity, expression, or behavior is different from
those typically associated with their assigned sex at
birth, including but not limited to transexuals, cross-
dressers, androgynous people, genderqueers, and
gender non-conforming people. Transgender is a
broad term and is good for non-transgender people
to use. „Trans‟ is shorthand for „transgender‟”
(NCTE).
 Prevalence of transgenderism varies widely, from 1
in 30,000…to 1 in 5,000…to 1 in 500 (Pleak, 2009).

10. TRANSGENDER TERMINOLOGY
 Transgender man or “transman”: individual born
biologically female who identifies as male. Also
referred to as “FTM” (female-to-male)
 Transgender woman or “transwoman”: individual
born biologically male who identifies as female.
Also referred to as “MTF” (male-to-female)

11. TRANSGENDER HORMONE THERAPY
 Many transgender individuals undergo hormone therapy
to develop secondary sexual characteristics.
Transwomen receive estrogen, and transmen receive
testosterone.
 Some effects of testosterone on secondary sex
characteristics include deepening of the voice, cessation
of ovulation/menstruation, growth of facial and body hair,
enlargement of the clitoris.
 Some effects of estrogen on secondary sex
characteristics include breast growth, redistribution of
body fat (hourglass shape), reduction of musculature,
softening of facial contour.

12. SEX REASSIGNMENT SURGERY
 SRS may also be called gender reassignment surgery, genital
reconstruction surgery, sex affirmation surgery, sex realignment
surgery, or a sex-change operation.
 “Surgery” can include hysterectomy, mastectomy (“top
surgery”), removal of the ovaries, removal of testicles, breast
augmentation, genital reconstruction, and facial plastic surgery.
 “Pre-op”: indicates individuals who have yet to undergo SRS but
desire it.
 “Post-op”: indicates individuals who have undergone SRS.
 “Non-op”: indicates individuals who do not desire to undergo SRS.

13. GENDER DEVELOPMENT THEORIES:
AN OVERVIEW
 Biological theories: posit that gender differences
are “ancestrally programmed” or that hormonal
influences are the basis of gender differences in
social behavior.
 Psychoanalytic theories: posit that identification
with a certain gender is a result of child adopting
characteristics and qualities of the same-sex
parent.

14. GENDER DEVELOPMENT THEORIES
(CONT’D)
 Kohlberg’s Cognitive Developmental Theory: When children
achieve “gender consistency” they place value on their own
gender and seek to act in ways that are consistent with their
gender.
 Kohlberg’s stages of Gender Development:
Gender Identity: Ability to label oneself a boy or girl and others
as boys or girls (usually by age 2).
Gender Stability: Ability to recognize gender remains constant
over time. “I was born a boy and will grow up to be a boy”
(usually by age 4).
Gender Consistency: Understanding that gender is invariant
despite outward changes. “That woman has short hair and is
wearing shorts but is still a woman” (usually by age 6 or 7).

15. GENDER DEVELOPMENT THEORIES
(CONT’D)
 Gender Schema Theory: similar to cognitive-
developmental theory. However, this theory posits
that as soon as a child masters gender identity (“I
am a boy” or “I am a girl”), gender schemas begin
to develop. These schemas expand and grow to
include “knowledge of activities and
interests, personality and social attributes, and
scripts about gender-linked activities” (Bussey &
Bandura, 1999, p. 5).

16. GENDER DEVELOPMENT THEORIES
(CONT’D)
 Social Cognitive Theory: In this theory, “gender
conceptions and roles are the product of a broad
network of social influences operating interdependently
in a variety of societal subsystems. Human evolution
provides bodily structures and biological potentialities
that permit a range of possibilities rather than dictate a
fixed type of gender differentiation” (Bussey & Bandura,
1999, p. 676).
 Basically, biology is not destiny, and multiple factors
(parents, peers, educational institutions, the media,
culture, etc.) interact to determine gender identity.

17. TRANSGENDER DEVELOPMENT
MODELS: ARE THERE ANY?
 Transgender experiences do not readily fit into stage
models, because they do not fit into the traditional
gender binary construction (Bilodeau & Renn, 2005).
 “Mallon argued that it is inappropriate for social service
practitioners to use traditional human development
models, including those of Erikson and Marcia, because
these theorists posit concepts of gender role
identification in traditionally gendered, biologically based
constructions” (Bilodeau & Renn, 2005, p. 33).
 D‟Augelli‟s model has been used to understand
transgender development, but there is a need for the
creation of new models.

18. GENDER VARIANCE ACROSS
CULTURES
 Many North American Indian tribes have a “third
gender”. Called “two-spirit” (formerly “berdache”),
these cross-gender individuals have been
documented in over 150 groups. (Newman, 2002).
 In the Dominican Republic (guevedoche), Papua
New Guinea, and the South Pacific, children with
enzymatic deficiency (who have ambiguous
genitalia) are often raised female, but if virilization
occurs at puberty, the child is allowed to adopt a
male identity and this change is socially accepted
(Newman, 2002).

19. GENDER VARIANCE ACROSS
CULTURES (CONT’D)
 “There is no consensus across world cultures regarding
the appropriate traits, characteristics, and patterns of
behavior that males and females should have” (Langer
& Martin, 2004, p. 13).
 Even within the same country, different cultures and
subcultures have different roles and expectations for
men and women.
 For example, there may be more gender role equality
among African Americans but more rigid gender roles for
Latin American families (Langer & Martin, 2004).

20. GENDER IDENTITY DEVELOPMENT
IN CHILDHOOD
 Some children express feelings of wanting to be the other sex
as young as 1 and a half to 2 years old and pretend to be the
other sex when playing “pretend”.
 Parents may be tolerant of such behavior up until the child
enters school; this is commonly when parents take children to
see psychiatrists.
 Gender variant children may be quite isolated in early school
years. At age 8-10, teasing worsens and they may be targets
of bullying and violence.
 Only a small number of gender variant children will remain
gender variant into adolescence and adulthood.
 Outcomes for gender atypical children: most become gender
typical gay and lesbian adults, some become gender typical
straight adults, and a few will become transgender adults.
(Pleak, 2009)

21. GENDER IDENTITY DEVELOPMENT
IN ADOLESCENCE
 Around age 11 to 13, gender atypicality or gender variance
does not change much going forward.
 Considerable consensus that these young people will
continue to be transgender or transexual as they mature.
(Pleak, 2009)
 Note: individuals may “transition” later in life, which may be
due to the necessity of suppressing their gender variance until
more freedom (or safety) is attained in adulthood.
 Angie, transgender teen, 17 years old, NYC, trans

22. THE GENDER INTENSIFICATION
HYPOTHESIS
 “Hill and Lynch proposed that puberty plays a role in the
differentiation of masculine and feminine characteristics
by serving as a signal to socializing others
(parents, teachers, peers) that the adolescent is
beginning the approach to adulthood and should begin
to act accordingly, that is, in ways that resemble the
stereotypical male or female adult” (Lerner &
Steinberg, 2004, p. 240).
 "Straightlaced (a documentary) unearths how popular
pressures around gender and sexuality are confining
American teens."

23. PEER RESPONSE TO GENDER NON-
CONFORMITY IN ADOLESCENCE
 As Smith and Leaper (2005, p. 102) assert:
“Noting only the relation between gender typicality and
self-worth without considering the social context might
imply that gender typicality per se leads to
adjustment…”
However, “multiple patterns of gender identity and
adjustment exist for adolescents with peer acceptance
being a critical mediator. Importantly, there was no
difference in the self-worth of non-conforming and
conforming adolescents if they felt accepted by their
peers” (emphasis in original).

24. TREATMENT OF TRANSGENDER
ADOLESCENTS
 Option of delaying puberty via hormone therapy: this
allows a transgender adolescent to delay onset of
secondary sex characteristics (Ex/breast growth and
menstruation in females and facial hair growth and voice
deepening in males) so that he or she may have more
time to decide on a gender identity that feels right.
 As mentioned, most adolescents are very aware their
minds and bodies don‟t “match” and have the desire to
make their sex and gender congruent. However, for the
few that may decide against changing their gender, the
treatment can be stopped and genetic puberty will
resume within 6 months.
(Spack, 2009)

25. DIAGNOSTIC CRITERIA FOR GENDER
IDENTITY DISORDER
(DSM-IV-TR)
A. A strong and persistent cross-gender identification (not
merely a desire for any perceived cultural advantages of
being the other sex).
B. Persistent discomfort with his or her sex or sense of
inappropriateness in the gender role of that sex.
C. The disturbance is not concurrent with a physical intersex
condition.
D. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.

26. DIAGNOSTIC CRITERIA FOR GID IN CHILDREN
(DSM-IV-TR)
(Under criterion A) In children, the disturbance is manifested by four (or more) of the
following:
 repeatedly stated desire to be, or insistence that he or she is, the other sex
 in boys, preference for cross-dressing or simulating female attire; in girls, insistence
on wearing only stereotypical masculine clothing
 strong and persistent preferences for cross-sex roles in make-believe play or
persistent fantasies of being the other sex
 intense desire to participate in the stereotypical games and pastimes of the other
sex
 strong preference for playmates of the other sex
In adolescents and adults, the disturbance is manifested by symptoms such as a
stated desire to be the other sex, frequent passing as the other sex, desire to live or
be treated as the other sex, or the conviction that he or she has the typical feelings
and reactions of the other sex.

27. DIAGNOSTIC CRITERIA FOR GID IN CHILDREN
(DSM-IV-TR)
(Under criterion B)
 In children, the disturbance is manifested by any of the
following: in boys, assertion that his penis or testes are
disgusting or will disappear or assertion that it would be better
not to have a penis, or aversion toward rough-and-tumble play
and rejection of male stereotypical toys, games, and activities;
in girls, rejection of urinating in a sitting position, assertion that
she has or will grow a penis, or assertion that she does not
want to grow breasts or menstruate, or marked aversion
toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by
symptoms such as preoccupation with getting rid of primary
and secondary sex characteristics (e.g., request for
hormones, surgery, or other procedures to physically alter
sexual characteristics to simulate the other sex) or belief that
he or she was born the wrong sex.

28. PROPOSED CRITERIA FOR DSM-V
 Would change Gender Identity Disorder to Gender Incongruence
 For Gender Incongruence in Children, children must meet criteria
1: "a strong desire to be of the other gender or an insistence that he
or she is the other gender“
 "This will appropriately prevent children with a gender variant
expression without an incongruence between gender identity and sex
assigned at birth to receive the diagnosis, which was a common
point of critique for DSM IV" (DeCuypere, Knudson, & Bockting,
2010).
 The distress criterion is proposed to be removed, which would make
the diagnostic criteria "so broad that almost any transgender person
could meet criteria for a mental disorder regardless of whether or not
they experience clinically significant distress and desire or need
intervention" (DeCuypere, Knudson, & Bockting, 2010).

29. IS GENDER VARIANCE REALLY A
“MENTAL DISORDER”?
 What it means to be a “man” or a “woman” has changed over
time and is still changing (ex: “stay-at-home dads”).
 Gender roles vary across cultures; some cultures allow for
more than two genders. Also, gender roles vary within
cultures.
 So-called “distress” or “dysphoria” is not inherent in being
gender variant; “incongruence” is not inherently unhealthy.
 There is MUCH controversy over the GID diagnosis and many
argue for its removal; arguments parallel those that eventually
resulted in homosexuality being removed from the DSM in
1973.

30. WHY IS STUDYING GENDER IDENTITY
AND GENDER VARIANCE IMPORTANT IN
OUR FIELDS?
 Our conception of gender influences the questions
we ask in research.
 The lens through which we view gender while
performing research affects the outcome of that
research.
 How we view gender identity influences how we
treat transgender and gender variant
individuals, including children.

31. AWARENESS LEADS TO ACTION!
 Being aware of LGBTQI issues helps us understand struggles
(across the entire lifespan) that are common among these
populations.
 Awareness can also teach us to respond in ways that affirm
individuals with a transgender or gender variant identity,
increasing their chances for healthy outcomes. We can also
develop important interventions, some of which may be literally
life saving.
 For example, the suicide attempt rate for adolescents diagnosed
with GID has been found to be as high as 50 percent (Spack,
2009).
 Other areas of concern are higher incidences of bullying, suicide,
drug abuse, domestic violence, rape, hate crimes, homelessness,
and HIV transmission (Youth Pride, Inc., 2010)

32. GENDER DIVERSITY ACCEPTANCE IS
A SOCIAL JUSTICE ISSUE!
 Both the APA and ACA have ethical principles that
prohibit discrimination based on gender identity
(separate from gender).
 Broadening our view of gender identity impacts
everyone, even “gender congruent” individuals.
 A respect for gender diversity gives all people more
freedom to be themselves!

33. SOME RECOMMENDATIONS FOR FURTHER
LEARNING
 Books:
Stone Butch Blues by Leslie Feinberg (a transgender man)
Gender Outlaw: On Men, Women, and the Rest of Us by Kate Bornstein
(a transgender woman)
Transgender Warriors : Making History from Joan of Arc to Dennis
Rodman by Leslie Feinberg
Middlesex (a novel) by Jeffrey Eugenides
 Films:
Boys Don‟t Cry (based on the true story of Brandon Teena)
Ma Vie en Rose
Transamerica (starring Felicity Huffman)
Southern Comfort (a documentary on the life of Robert Eads, a
transgender man)
Hedwig and the Angry Inch (an entertaining musical/comedy/drama
about a transgender German glam rocker)

34. WEBSITES:
The Trevor Project: The leading national organization providing
crisis intervention and suicide prevention services to
lesbian, gay, bisexual, transgender, and questioning youth.
http://www.thetrevorproject.org/
National Center for Transgender Equality: Non-profit
organization dedicated to advancing the equality of transgender
people through advocacy, collaboration, and empowerment.
http://transequality.org/
Human Rights Campaign (HRC): The largest civil rights
organization working to achieve equality for
lesbian, gay, bisexual, and transgender Americans.
http://www.hrc.org/
National Gay and Lesbian Task Force: Non-profit corporation
that works to build the grassroots political power of the LGBT
community to win complete equality.
http://thetaskforce.org/

35. REFERENCES:
 American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
Author.
 Bilodeau, B. L., & Renn, K. A. (2005). Analysis of LGBT Identity
Development Models and Implications for Practice. New Directions
for Student Services (111), 25-39.
 Bussey, K., & Bandura, A. (1999). Social Cognitive Theory of Gender
Development and Differentiation. Psychological Review, 106, 676-
713.
 DeCuypere, G., Knudson, G., & Bockting, W. (2010, May 25).
Response of the World Professional Association for Transgender
Health to the Proposed DSM 5 Criteria for Gender Incongruence.
Retrieved from World Professional Association for Transgender
Health Web site: www.wpath.org/documents/WPATH Reaction to the
proposed DSM - Final.pdf
 Diamond, M. (2002). Sex and Gender are Different: Sexual Identity
and Gender Identity are Different. Clinical Child Psychology and
Psychiatry, 7 (3), 320-334.

36. REFERENCES
 Intersex Society of North America. (2008). How common is
intersex? Retrieved from Intersex Society of North America
Web site: http://www.isna.org/faq/frequency
 Langer, S. J., & Martin, J. I. (2004). How Dresses Can Make
You Mentally Ill: Examining Gender Identity Disorder in
Children. Child and Adolescent Social Work Journal, 21 (1), 5-
23.
 Lerner, R. M., & Steinberg, L. (2004). Handbook of Adolescent
Psychology. Hoboken: John Wiley and Sons.
 Manners, P. J. (2009). Gender Identity Disorder in
Adolescence: A Review of the Literature. Child and
Adolescent Mental Health, 14 (2), 62-68.
 NCTE. (2009, May). Transgender Terminology. Retrieved from
NCTE Web site:
http://transequality.org/Resources/NCTE_TransTerminology.p
df

37. REFERENCES
 Newman, L. K. (2002). Sex, Gender and Culture: Issues in the
Definition, Assessment and Treatment of Gender Identity
Disorder. Clinical Child Psychology and Psychiatry, 7 (3), 352-
359.
 Pleak, R. R. (2009). Formation of Transgender Identities.
Journal of Gay & Lesbian Mental Health, 13, 282-291.
 Smith, T. E., & Leaper, C. (2005). Self-Perceived Gender
Typicality and the Peer Context During Adolescence. Journal
of Research on Adolescence, 16 (1), 91-103.
 Spack, N. P. (2009). An Endocrine Perspective on the Care of
Transgender Adolescents. Journal of Gay & Lesbian Mental
Health, 13, 309-319.
 Youth Pride, Inc. (2010). Statistics. Retrieved from Youth
Pride, Inc. Web site:
http://www.youthprideri.org/Resources/Statistics/tabid/227/Def
ault.aspx#h

38. FOREST (FTM) TALKS WITH HIS PARENTS
ABOUT GROWING UP TRANS
 Talking With My Parents About Being Transgender
 “This footage is the first time I have EVER talked
openly about being trans with my parents. It was
very hard to do, but the love was strong and I was
impressed. To feel acceptance from family is very
important.”