As societal understanding of gender evolves, a growing body of research explores the complex interplay of biological and environmental factors that shape our individual identities. This article delves into the latest scientific insights regarding gender identity advancement, beginning even before birth, and examines how early biological markers can influence-but do not entirely determine-how we perceive ourselves and the world around us. Experts at Amsterdam UMC discuss the nuances of sex and gender,and the increasing recognition of gender diversity beyond customary binary classifications.
For many people, understanding their gender feels innate, according to researchers. It’s simply how one feels – a deeply personal sense of self. But when people begin to explore *why* they feel a certain way, the issue becomes far more complex, says Thomas Steensma, a psychologist and researcher at the Knowledge and Care Center for Gender Dysphoria at Amsterdam UMC.
Men may describe feeling masculine through enjoyment of traditionally “masculine” activities like watching sports, driving fast cars, or spending time with friends. Women may connect with their gender through activities like dancing, shopping, or sharing wine with friends. “You quickly arrive at very stereotypical examples,” Steensma notes. This raises important questions about the origins of gender identity and how societal expectations influence our understanding of ourselves.
The process begins even before birth, during an ultrasound. If a sonogram reveals male genitalia, the technician typically identifies the fetus as a boy. If not, a girl. This early assignment of gender raises fundamental questions: Why do most people subsequently identify as male or female? And what explains why some individuals identify as non-binary, falling outside the traditional male/female binary?
Understanding the Terms
It’s important to understand the distinctions between several key terms.
* Sex or Gender is typically determined by chromosomes and external reproductive organs – the presence of a penis or vagina.
* Gender encompasses the characteristics socially or culturally considered masculine or feminine.
* Gender Identity is one’s internal sense of being male, female, or another gender.
* Gender Role Behavior is behavior considered appropriate for a particular gender.
* Gender Dysphoria is the distress caused by a mismatch between one’s gender identity and assigned sex.
* Gender Euphoria is the positive feeling associated with affirming one’s gender identity.
* Gender Diversity acknowledges that gender exists beyond the traditional male/female categories.
* Genderfluid describes a gender identity that varies over time.
* Genderqueer and Non-Binary are umbrella terms for those who do not identify exclusively as male or female.
The Embryo’s Path
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Steensma explains that feeling more male or more female has both biological and social components. “But it starts with biology.”
The developmental process begins even before birth, explains Baudewijntje Kreukels, a professor of medical psychology at Amsterdam UMC who researches gender and sex variations. Typically, gender development follows one of two paths: one involving an X and a Y chromosome, and the other involving two X chromosomes.
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“The Y chromosome contains the SRY gene,” Kreukels explains. “This gene triggers the development of the testes, which then produce testosterone, initiating the male developmental pathway.” In the absence of a Y chromosome and the SRY gene, the testes do not develop, and ovaries and a uterus form. The ultrasound technician then informs expectant parents of the developing fetus’s anatomy, leading them to choose pink or blue for the nursery and a girl’s or boy’s name. Understanding these early biological processes is crucial for comprehending the complexities of gender identity.
Official Documentation
Individuals who do not identify clearly as male or female often face bureaucratic hurdles, says Bodi Huisman. These can include a lengthy process to obtain an “X” marker on their passport instead of “M” or “F.” They may also encounter unnecessary requests for gender information from businesses. Beyond these formal challenges, there are countless subtle interactions with others. “And often people are well-intentioned, but they quickly ask a lot of questions.” Constantly explaining one’s feelings can be exhausting. “The key is to gauge whether such questions are relevant in that moment.”
Testes and Still Female
While it may seem like there are only two options, Kreukels emphasizes that a variety of variations are possible. One example is complete androgen insensitivity syndrome (CAIS). Individuals with CAIS have XY chromosomes, but their bodies do not respond to testosterone produced by testes that develop in the abdomen. As a result, their bodies develop along female lines.
“Sometimes girls are unaware they have the syndrome. They see a doctor because they haven’t started menstruating,” Kreukels says. “Then it’s discovered that they don’t have ovaries in their abdomen, but testicles.” These individuals often identify fully as female, Kreukels adds. “You could say that’s because they’re insensitive to testosterone. But they were also raised as girls.” They presented as female at birth and developed a female gender identity. This demonstrates that sex chromosomes aren’t the sole determinant of gender.
Choice Overload
In the past, gender was often seen as simply male or female. Today, individuals may identify as male, female, or somewhere in between. Or they may not feel at home within the traditional gender framework. Does this increased complexity make it more difficult to be young? “Yes and no,” Steensma suggests. “There have always been people who didn’t feel like they were male or female. For those people, it’s a relief that there appear to be more categories and that they can find a place more quickly.” For young people who clearly identify as male or female, little changes. They still don’t need to search for themselves.
More Testosterone, Rougher Play
Kreukels continues, explaining that individuals with congenital adrenal hyperplasia (CAH) provide another example. Due to a disorder of the adrenal glands, their bodies produce more testosterone. In fetuses with XX chromosomes, this can cause the labia to fuse. “Almost like a scrotum. Or the clitoris can enlarge to resemble a small penis.”
The extent of this growth varies. It may be unclear at birth which sex the doctor should assign, or there may be no external signs of the condition. Kreukels notes, “What you often see with these girls is that they exhibit more behavior considered ‘boyish,’ such as rough play. They prefer boyish toys and later in life have more masculine interests.”
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Gender dysphoria is also more common in these children. “This suggests that exposure to hormones during prenatal development can initiate something.”
Boxes for Everyone
Man, woman, non-binary, and all sorts of other variations: how many genders are there? The International Astronomical Union approves names for stars and planets. There’s no such institution for genders to officially validate a variant.
“It comes from society,” says psychologist Thomas Steensma. “Where you might have said, ‘I’m not a man, so I’m a woman,’ there are now more variants. Apparently, there’s a need for new categories.” There’s also more room for them. “And young people are being encouraged to identify themselves more. They’re expressing themselves and giving it voice.” The number of categories is impossible to say. It’s evolving and will likely continue to do so.
Inherited Feelings
For many people, the X and Y chromosomes determine whether you develop physically as a woman or a man. And whether you also *feel* like a woman or a man. But there are many variations, more than the few you’ve just read about. When it comes to feeling male or female, we learn a lot from people with sex variations, Steensma and Kreukels say. It shows that hormones influence gender development even before birth.
“Genetic factors also play a role,” Kreukels adds. This is evident in twin studies. Identical twins share the same DNA. Fraternal twins do not. Parents of identical twins more often observe that the play behavior of the two children is similar. Both girls, for example, like to play with dolls. Or with cars.
Gender identity is also more often the same. They both feel like men or both feel like women. And it’s also more common for both members of an identical twin pair to experience gender dysphoria. “A review study showed that 30 to 60 percent of gender variation is explained by genetic factors.”
Minority Stress
Non-binary individuals are more likely to experience mental health issues like sadness and anxiety, says psychologist Bodi Huisman of Amsterdam UMC. To explain this, Huisman uses the term “minority stress”: “Like people under the LGBTQ+ umbrella, non-binary people are part of a minority. As a result, they experience structural challenges that others don’t.” They encounter misunderstanding, for example.
“Discrimination occurs, as does exclusion or rejection, when someone says that nothing exists other than man or woman.” Sometimes non-binary people are ashamed of their gender feelings or feel like something is wrong. “Other people in the consultation room say, ‘I’m struggling with my gender, can we figure it out together?’”
Each a Unique Mosaic
There’s also a biological predisposition in the brain for more masculine or feminine development. In a 1995 study, brain researcher Dick Swaab identified an area that is larger in men than in women.
This is the so-called “bed nucleus of the stria terminalis.” In transgender women, who had been assigned male at birth, this area was the size typically found in women. “Our study shows a female brain structure in genetically male transgenders,” the researchers wrote.
Loose Labels
Man, woman, non-binary, agender, demi-boy, demi-girl, pangender, polygender: there are many possibilities. “You don’t have to memorize them all,” Huisman cautions. The precise definitions of the terms aren’t strictly defined. “In lectures, I often get asked what they mean exactly. But that can be different for each person.”
For many gender-diverse people, their gender label is important. It gives them the opportunity to express their feelings in language. Others place less value on it. “In the consultation room, they say, ‘I feel like myself, and how you name it isn’t so important.’”
Meanwhile, we know it’s not that simple. You can’t say there are “male brains in female bodies.” Researchers have found differences in the brains between men and women, Kreukels and Steensma explain. But later brain studies attempting to identify masculine or feminine patterns yielded varying results.
“We now see the brain more as a mosaic,” Steensma explains. “In one area of the brain, a person may show a more feminine pattern, while in another area it looks more masculine.” And these characteristics can vary greatly between individuals.
Words Fell Short
Hormones, genes, brains: “There’s a biological blueprint from which you further develop,” Steensma says. The environment also influences gender identity.
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“Historically, you were told from the outside world that you were male or female. That doesn’t mean there weren’t people who didn’t feel male or female. There just wasn’t a language for it. And there wasn’t space.”
He, She? They, Them
Many men feel it’s important to be addressed as a man. And you say to a woman, “Thank you, madam.” Using the correct pronouns is also important for transgender people. But how does that work if you’re non-binary? Gender-neutral language offers a solution. “Dear travelers,” for example, instead of “Ladies and gentlemen.”
The neutral pronoun “they” can replace “he” and “she.” So you say, “There they come, with their new car.” “Their” and “theirs” can also be used. It takes some getting used to, admits Bodi Huisman, a psychologist at Amsterdam UMC. “Saying it wrong a few times is part of the process. Just say ‘sorry’ and continue the conversation.”
The last ten to fifteen years have allowed us more space to explore ourselves. And words have emerged, such as non-binary and gender-neutral (see the box ‘Boxes for Everyone’). “That’s a recognition for people who have always felt different,” Steensma says. It can be challenging to find where you belong if you don’t feel like you fit the norm of ‘man’ or ‘woman.’ It helps to discover another group that is more like you and to have a word for it.
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It Can Shift
How great is the influence of biology? What does your environment do? We don’t know. It’s a complex interplay, Steensma and Kreukels explain. “There’s no research that looks at the biology, psychology, and social components together,” Steensma says.
Different people also follow different developmental paths. “Some realize it very early on, others don’t experience feeling like they’re not male or female until adolescence or later.” It can also change over time, Kreukels adds. Is gender a spectrum, with woman on one end and man on the other, and everything in between?
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Steensma compares it to a mixing panel, like in a music studio. “With a lot of sliders.” Testosterone can be a slider. And, okay, also that bed nucleus in the stria terminalis.
“Everyone has the sliders set differently.” How exactly? The ultrasound image can indicate a direction. But at birth, it’s not yet certain how gender identity will develop.
