We’ll start with “sex.”

OK, so what is “sex”?
When a baby is born, that infant’s birth certificate usually gets marked with a designation of male or female. That designation is determined when nurses or doctor’s look at the baby’s anatomy. But as the GLAAD Media Reference Guide states, “A person’s sex, however, is actually a combination of bodily characteristics including: chromosomes, hormones, internal and external reproductive organs, and secondary sex characteristics.”

Joshua D. Safer, an endocrinologist and executive director of the Center for Transgender Medicine and Surgery at Mount Sinai Health System in New York, told The New York Times that “the idea that a person’s sex is determined by their anatomy at birth is not true, and we’ve known that it’s not true for decades.”

Tell me more.
There are situations that challenge the traditional view of what “sex” means. A recent STAT article by Megan Thielking explained why one’s anatomy alone is not sufficient in the determination of “sex”:

Some babies born with male genitalia have an extra X chromosome, a condition that is known as Klinefelter syndrome. And in androgen insensitivity syndrome, a person has XY chromosomes but does not develop androgen receptors that bind to androgens. A baby with AIS might be born with a short vagina without a cervix, but undescended or partially descended testes.

There are also cases when an individual is “genetically male but physiologically female.” And then there are people who are intersex.

Remind me what “intersex” means?
The GLAAD Media Reference Guide defines intersex as an “umbrella term describing people born with reproductive or sexual anatomy and/or a chromosome pattern that can’t be classified as typically male or female. Those variations are also sometimes referred to as Differences of Sex Development.”

So how is gender defined?
We’ll run through a few definitions. The most straightforward one comes from a 2017 CBS News primer called “The gender identity terms you need to know,” defining gender identity as “a person’s innermost concept of self as man, woman, a blend of both, or neither – how individuals perceive themselves and what they call themselves. Gender identity can be the same or different from one’s sex assigned at birth.”

And is gender identity different from gender?
Some people use it interchangeably, and some don’t. The LGBTQIA+ Resource Center at UC Davis has defined gender separately from gender identity, calling gender “a social construct used to classify a person as a man, woman, or some other identity. Fundamentally different from the sex one is assigned at birth.” But the Reuters’s style guide has used the two terms interchangeably, stating that “people generally have a clear sense of their own gender, sometimes called gender identity, which may conflict with their sex at birth.”

I think I get it?
Here’s how a newsletter from the National Institutes of Health described it in 2016:

Gender is a social or cultural concept. It refers to the roles, behaviors, and identities that society assigns to girls and boys, women and men, and gender-diverse people. Gender is determined by how we see ourselves and each other, and how we act and interact with others. There’s a lot of diversity in how individuals and groups understand, experience, and express gender.

What causes gender identity?
The short answer is that it has not been determined yet. In her article for STAT, Thielking talked with Rachel Levin, a Pomona College neuroscientist who studies the development of sex. Levin said, “There will never be a single answer or a simple answer to gender identity,” in part because . In the New York Times article, Safer said scientist are still studying what specifically determines gender identity:

“We know that there is a significant, durable biological underpinning to gender identity,” Dr. Safer said. “What we don’t know are all of the biological factors at play that explain gender identity. As far as we in the mainstream biological-medical community understand it in 2018, it is hard-wired, it is biological, it is not entirely hormonal, and we do not have identified genes, so we cannot specifically say it is genetic.”

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