Gender-affirming generally refers to the medical, psychological, and social support provided to individuals who are transgender, non-binary, or gender expansive. to help align their gender identity with their outward appearance and improve their overall well-being.
This type of care can include socially transitioning by changing one’s name, pronouns or way of presenting; puberty blockers; gender-affirming hormone therapy; and gender-affirming surgeries.
At least 30 states have introduced or are considering laws that restrict access to gender-affirming care.
Gender-affirming care has been the subject of much debate in legislatures around the country in recent months, leading to countless misconceptions and myths about what it actually entails and who it’s for.<
According to a report from The Williams Institute, 30 states had introduced or were considering laws to restrict access to gender-affirming care as of March 2023. The result is 146,300 transgender youth who have lost or are at risk of losing access to gender-affirming care. Several bans proposed in 2023 would also limit access to care for those up to age 26.
“Gender-affirming care is considered life-saving,” said Rebecca Minor, MSW, LICSW, a gender specialist and therapist who provides gender-affirming care. “It plays a crucial role in improving the mental health, well-being, and overall quality of life for transgender, non-binary, and gender diverse individuals.”
What Does Gender-Affirming Care Involve?
Gender-affirming care refers to medical, psychological, and social support provided to individuals who are transgender, non-binary, or gender expansive, Minor explained. The goal of gender-affirming care is to assist individuals in aligning their sense of self with their outward appearance and to improve their overall well-being.
“Gender-affirming care means different things for different people,” Uri Belkind, MD, a pediatric medicine specialist who works in adolescent medicine at the New York-based LGBTQ+ health center Callen-Lorde, told Verywell. “It is not a specific process, but rather a collection of tools from which we can select to better fit the individual’s goals and needs.”
One aspect of gender-affirming care requires no medical intervention but instead involves transitioning socially. This may include changing one’s name and pronouns, and dressing or presenting in a way that affirms their gender identity, according to Sean Arayasirikul, PhD, an associate professor in residence of health, society, and behavior at the University of California, Irvine.
Beyond socially transitioning, there are three general medical options available when it comes to gender-affirming care, Belkind said, adding that some people may want or need all of them, while some may find happiness and well-being with only some. These include puberty blockers, gender-affirming hormone therapy, and gender-affirming procedures.
Puberty blockers are for younger patients who are entering puberty and are finding the changes their bodies are going through to be distressing. To access this kind of care, these patients must have shown insistent, persistent, and consistent identification with a gender that is different than their sex assigned at birth.
“This allows us to temporarily ‘pause’ these changes while the young person, with support from their family, further explores their needs and gains a better understanding of what is possible, medically speaking, and what it entails,” Belkind said.
Gender-affirming hormone therapy, on the other hand, refers to the process of using either estrogen or testosterone to promote certain physical changes and to inhibit others, Belkind said.
Gender-affirming procedures, both surgical and non-surgical, change certain physical characteristics that may not otherwise be modified with the use of hormone therapy. Belkind said these may include chest masculinization, facial feminization, permanent hair removal or hair grafting, and genital surgeries such as vaginoplasty or phalloplasty.
“One common misconception is that gender-affirming procedures are regulated only for trans and gender expansive people and that these procedures are experimental, lacking solid medical evidence,” Arayasirikul said.
In reality, cisgender people—or people who are not trans—also choose to undergo gender-affirming procedures to affirm their identity, Arayasirikul explained. This may include a breast augmentation, a mastectomy for gynecomastia, a hair transplant, a rhinoplasty, liposuction, facial fillers, or hormone therapy.
“These procedures and so many more are part of the health care of cisgender people,” Arayasirikul said. “Yet this same care is actively being criminalized for trans and gender-expansive people solely because they are different.”
Can People of All Ages Receive Gender-Affirming Care?
In states where gender-affirming care is not criminalized, trans youth can access puberty blockers to delay the onset of puberty and cross-sex hormones to develop their bodies in ways that align with their gender identity.
“Typically, gender-affirming surgeries are utilized by adults, not children,” Arayasirikul said.
And yet, much of the uproar surrounding gender-affirming care in the U.S. has been surrounding the subject of children undergoing surgery.
According to Belkind, some patients choose to start puberty blockers once puberty begins, while other patients may only begin to seek medical advice after puberty or much later into adulthood.
“It is important to note that, for children who strongly identify with a gender identity that is different from their sex assigned at birth, there are no medical interventions needed before puberty begins and only then do we consider the use of puberty blockers, if needed,” Belkind said.
Medical interventions always happen after a thorough evaluation of the patient’s needs, Belkind added.
Why Gender-Affirming Care Is Necessary
Gender-affirming care helps to reduce gender dysphoria, which is the distress an individual may experience when their gender identity does not align with their assigned sex at birth, Minor said.<
“Gender-affirming care, such as hormone therapy or gender-affirming surgeries, can help alleviate gender dysphoria by allowing individuals to align their physical appearance with their gender identity” she said. “This reduction in distress and discomfort can have a significant positive impact on mental health and overall well-being.”
Trans and gender-diverse individuals often face higher rates of mental health challenges, including depression, anxiety, and suicidal ideation.1 Gender-affirming care, combined with mental health support, can help reduce these risks by providing individuals with the tools, resources, and interventions needed to alleviate distress and promote a positive self-image, Minor said.
According to one recent study, providing trans and non-binary youths aged 13 to 20 years with gender-affirming care, including puberty blockers and gender-affirming hormones, lowered their risk of developing moderate or severe depression by 60% and lowered suicidality by 73% over a 12-month follow-up.2
Another study found that gender-affirming surgeries were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal ideation when compared with transgender and gender-diverse people who had not had gender-affirming surgery but wanted it.3
“Gender-affirming care allows individuals to express their gender identity authentically, promoting self-acceptance and improved self-esteem,” Minor said. “By aligning their physical appearance, social interactions, and personal identity, individuals can develop a stronger sense of identity and self-worth, leading to improved mental health outcomes.”
Additionally, gender-affirming care often includes support groups, peer networks, and counseling services that provide a safe and inclusive environment for individuals to connect, share experiences, and receive emotional support, Minor said. These social support systems, she said, are critical in combating feelings of isolation and promoting healthy relationships.
This kind of care can help combat the societal discrimination, stigma, and marginalization transgender and gender-diverse individuals often face. Minor said gender-affirming care can empower individuals to assert their rights, advocate for themselves, and challenge discriminatory practices.
“By affirming their gender identity, individuals can experience improved resilience, reduced psychological distress, and increased social acceptance,” she said.
The language we use when we’re speaking to and about people is significant. It can impact how we see others, how we see ourselves, and how people are treated in workplaces, social settings, classrooms, places of worship, and just about everywhere else. As we strive for a more inclusive world, one small thing you can do is to try practicing gender-neutral language and using gender-neutral terms.
“Gender-neutral language in and of itself is not a new concept, it has just become more of a topic of conversation as we strive to be more inclusive and accepting of all populations,” explains Jillian Amodio, social worker and founder of Moms for Mental Health.
To use gender-neutral terms is to recognize that “society has a way of gendering just about everything,” as Amodio puts it, and to find alternative ways to say or write things. For example, instead of addressing a group of people as “ladies and gentlemen,” you might try saying “everyone,” “colleagues,” “attendees,” “students,” or another term that makes sense in the context. One big reason for doing this is to ensure that non-binary or gender nonconforming people are recognized and included. You might be familiar with the idea of sharing your pronouns, and using gender neutral terms is another way to be inclusive.
Gender-neutral language can be beneficial for everyone, regardless of how they identify. Here’s everything to know about gender-neutral language and how you can incorporate it in your daily life.
Using gender neutral language is one way to ensure that everyone feels respected.
What are some examples of gendered language and some gender-neutral alternatives?
“Given that our society has for so long been built on gender norms and stereotypes, the division by gender has become ingrained in many aspects of daily living,” notes Amodio. You might find yourself assuming that a teacher, nurse, or daycare provider is female and a mechanic or construction worker is male. But obviously, that’s not always the case. One reason we might associate certain jobs as being “male” is because they often end with “-man,” such as “fireman,” “postman,” “congressman” and so forth. Instead, you could use descriptors that don’t assume gender, such as “firefighter,” “postal worker” or “mail carrier,” and “congressperson” or “member of Congress,” for example.
“When referencing someone or a group of people just ask yourself if there are words you can replace to be more inclusive,” Amodio explains.
Beyond job titles, there are other commonly-used phrases that tend to make assumptions about gender. Here are a few examples, along with gender-neutral terms you could use instead.
Boys and girls — instead, consider using children, kiddos, or everyone
Ladies and gentlemen — instead, consider using folks, everyone, students, or colleagues
Councilman/Councilwoman — instead, consider using councilperson
Husband/wife/boyfriend/girlfriend — instead, consider using partner, significant other, or spouse
Mother or father — instead, consider using parent
Niece or nephew — instead, consider using nibling
Man-made — instead, consider using artificial or machine-made
Pregnant woman or mother-to-be — instead consider pregnant person, expectant person, or birthing parent
Freshman — instead consider first-year student
To be clear, it’s not necessarily insensitive to use a gendered phrase that you feel applies to you, such as “I’m a mother of two” or “My wife and I liked that movie.” However, when you’re speaking to others, particularly in a group, it’s more inclusive to use gender-neutral phrasing like “parents” or “partners” since it doesn’t assume anyone else’s gender identity or sexuality. Plus, using gender-neutral language in reference to yourself and others can also be a way to signify that you are supportive and respectful of all identities.
Why is it important to use gender-neutral language?
“By using gender neutral language we are also not assuming that we know someone’s identity,” says Amodio. “The terms which people use to express their gender and gender identity can vary based on personal preference and what feels right to each individual. Some people are not ‘out’ publicly in terms of how they identify, and gender-neutral language is honestly an easy way to show respect and acceptance to everyone we come into contact with.”
She also notes that in some situations — such as a teacher addressing a new group of students or an employee speaking at a conference or meeting — you may not know the people you’re communicating with. In these cases, “gender-neutral language would be the best option by default,” Amodio says.
You may not always know the gender of who you are communicating with, so gender-neutral language can be the best option.
Should I say something when I hear other people using gendered language?
“We don’t have to be the language police, but if someone uses the wrong pronouns, a gentle correction is perfectly fine,” Amodio says. “If colleagues are addressing people in gendered terms, perhaps suggesting neutral terminology will be of benefit.”
What are some other ways I can support people who have diverse gender identities?
In addition to being thoughtful about the way you speak and write, there are plenty of meaningful ways you can support people who are non-binary, gender nonconforming, or have other gender identities. You can donate to organizations advocating for LGBTQ+ rights, such as The Trevor Project or the Human Rights Campaign. You can also make it a point to shop at businesses owned by LGBTQ+ people and at businesses that donate a certain amount of their profits to LGBTQ+ advocacy organizations. You can also look to local LGBTQ+ organizations and activists in your community and support them by donating, volunteering, spreading the word about their work on your own social media, or finding another way to get involved.
Lastly, don’t underestimate the impact of your words. Using gender-neutral language, sharing your pronouns in a work meeting, and being vocal about your support of LGBTQ+ people are all ways that you can be supportive.
There they are, in their Chevrolet Colorado, five dudes bouncing up and down as the truck grinds through the rugged American high country. Two guys up front, three in the back. Shania Twain is blasting. The fellow in the middle is singing along. “Oh, I want to be free, yeah, to feel the way I feel. Man, I feel like a woman!”
The other guys look deeply worried. But the person in the back just keeps happily singing away, even as the dude next to him moves his leg away. Just to be on the safe side.
This commercial aired back in 2004, and even now it’s not clear to me if it’s offensive or empowering, hilarious or infuriating. Twain says she wrote “Man! I Feel Like a Woman” after working at a resort where some drag queens were performing. “That song started with the title,” she said. “Then it kind of wrote itself.”
It’s a fun tune, and I admit I kind of loved seeing that commercial. But at its heart is an issue central to our current political moment.
When someone says they feel like a woman, what exactly does that mean?
Across the country, conservatives are insisting that — and legislating as if — “feeling” like a woman, or a man, is irrelevant. What matters most, they say, is the immutable truth of biology. Missouri’s attorney general, Andrew Bailey, wants to restrict gender-affirming health care for all transgender people, including adults.A new dress code at the Texas Agriculture Department commands that employees wear clothing “in a manner consistent with their biological gender.” In Florida, a law signed by Gov. Ron DeSantis (R) keeps “biological males” from playing on the women’s sports teams in public schools.
This term, “biological males,” is everywhere now. And it’s not used only by right-wing politicians. People of good faith are also wrestling with the way trans people complicate a world they thought was binary. They’re uncertain about when, and how, sex matters, and just how biological it is. Some want to draw a bright line in areas where maleness and femaleness might matter most — in sports, or locker rooms, or prisons. Others are trying to blur lines that used to be clearer. At Wellesley College last month, for instance, a nonbinding student referendum called for the admission of trans men to a school that traditionally has been a women’s college. The president of the college, Paula Johnson, pushed back.
So what, then, is a biological male, or female? What determines this supposedly simple truth? It’s about chromosomes, right?
Well, not entirely. Because not every person with a Y chromosome is male, and not every person with a double X is female. The world is full of people with other combinations: XXY (or Klinefelter Syndrome), XXX (or Trisomy X), XXXY, and so on. There’s even something called Androgen Insensitivity Syndrome, a condition that keeps the brains of people with a Y from absorbing the information in that chromosome. Most of these people develop as female, and may not even know about their condition until puberty — or even later.
How can this be, if sex is only about a gene?
>Some people respond by saying that sex is about something else, then — ovaries, or testicles (two structures that begin their existence in the womb as the same thing).
What do we do then, with the millions of women who have had hysterectomies? Have they become men? What about women who’ve had mastectomies? Or men with gynecomastia, or enlarged breasts.
Are these people not who they think they are?
It may be that what’s in your pants is less important than what’s between your ears
In the past decade, there has been some fascinating research on the brains of transgender people. What is most remarkable about this work is not that trans women’s brains have been found to resemble those of cisgender women, or that trans men’s brains resemble those of cis men. What the research has found is that the brains of trans people are unique: neither female nor male, exactly, but something distinct.
But what does that mean, a male brain, or a female brain, or even a transgender one? It’s a fraught topic, because brains are a collection of characteristics, rather than a binary classification of either/or. There are researchers who would tell you that brains are not more gendered than, say, kidneys or lungs. Gina Rippon, in her 2019 book “The Gendered Brain,” warns against bunk science that declares brains to be male or female — it’s “neurosexism,” a fancy way of justifying the belief that women’s brains are inferior to men’s.
And yet scientists continue to study the brain in hopes of understanding whether a sense of the gendered self can, at least in part, be the result of neurology.A study described by author Francine Russo in Scientific American examined the brains of 39 prepubertal and 41 adolescent boys and girls with gender dysphoria. The experiment examined how these children responded to androstadienone, a pungent substance similar to pheromones, that is known to cause a different response in the brains of men and women. The study found that adolescent boys and girls who described themselves as trans responded like the peers of their perceived gender. (The results were less clear withprepubescent children.)
This kind of testing is important, said one of the researchers Russo quoted, “because sex differences in responding to odors cannot be influenced by training or environment.” A similar study was done in measuring the responses of trans boys and girls to echolike sounds produced in the inner ear. “Boys with gender dysphoria responded more like typical females, who have a stronger response to these sounds.”
What does it mean, to respond to the world in this way? For me, it has meant having a sense of myself as a woman, a sense that no matter how comfortable I was with the fact of being feminine, I was never at ease with not being female. When I was young, I tried to talk myself out of it, telling myself, in short, to “get over it
But I never got over it.
I compare it to a sense of homesickness for a place you’ve never been. The moment you stepped onto those supposedly unfamiliar shores, though,you’d have a sense of overwhelming gratitude, and solace, and joy. Home, you might think. I’m finally home.
The years to come will, perhaps, continue to shed light on the mysteries of the brain, and to what degree our sense of ourselves as gendered beings has its origins there. But there’s aproblem with using neurology as an argument for trans acceptance — it suggests that, on some level, there is something wrong with transgender people, that we are who we are as a result of a sickness or a biological hiccup.
But trans people are not broken. And, in fact, trying to open people’s hearts by saying “Check out my brain!” can do more harm than good, because this line of argument delegitimizes the experiences of many trans folks. It suggests that there’s only one way to be trans — to feel trapped in the wrong body, to go through transition, and to wind up, when all is said and done, on the opposite-gender pole. It suggests that the quest trans people go on can only be considered successful if it ends with fitting into the very society that rejected us in the first place.
All the science tells us, in the end, is that a biological male — or female — is not any one thing, but a collection of possibilities.
No one who embarks upon a life as a trans person in this country is doing so out of caprice, or a whim, or a delusion. We are living these wondrous and perilous lives for one reason only — because our hearts demand it. Given the tremendous courage it takes to come out, given the fact that even now trans people can still lose everything — family, friends, jobs, even our lives — what we need now is not new legislation to make things harder. What we need now is understanding, not cruelty. What we need now is not hatred, but love.
When the person in that Chevy ad sings, Oh, I want to be free … to feel the way I feel. Man, I feel like a woman!, the important thing is not that they feel like a woman, or a man, or something else. What matters most is the plaintive desire, to be free to feel the way I feel.
Surely this is not a desire unique to trans people. Tell me: Is there anyone who has never struggled to live up to the hard truths of their own heart?
Can a school-based sexual health education program that effectively reduces the risk of unintended pregnancy and STIs also decrease homophobia and transphobia?
That question drove a collaborative effort by researchers conducting a randomized controlled trial of an inclusive comprehensive sex education program—High School FLASH. The study evaluated not just the impact on students’ sexual behaviors and related outcomes but also on their homophobic and transphobic beliefs. Specifically, researchers evaluated High School FLASH in 20 schools in two U.S. regions (Midwest and South). Study findings related to the curriculum’s impact on homophobic and transphobic beliefs are described in the journal Prevention Science.
Young LGBTQ students often endure homophobic and transphobic language at school, experiencing victimization and discrimination based on their sexual orientation and/or gender identity. These students can experience both negative academic consequences (e.g., lower grades, absenteeism, disconnection from school communities) as well as mental health consequences, including depression, anxiety, and lowered self-esteem.
Schools have a critical role to play in combatting discrimination and transphobic violence for LGBTQ students and improving their academic, health and well-being. Along with anti-bullying policies and sponsoring GSA organizations, schools can contribute to safe and affirming environments for all by offering inclusive curricula. Research has shown that LGBTQ students who received inclusive sexual health curricula experienced lower levels of victimization, increased feelings of safety at school, fewer safety-related school absences, better academic performance, and increased feelings of connection to peers.
Inclusivity goal and challenges
Even sexual health curricula that claim to be inclusive do not always affirm all young people’s identities and orientations. Some of the issues identified by LGBTQ youth as contributing to the lack of positive representation in their health curricula include: silences on the part of the teacher or the curriculum about LGBTQ issues/individuals, heterosexist framing of the information presented, and the ongoing pathologizing of LGBTQ individuals or specific sexual practices.
BA Laris, one of the study’s authors, notes that “there is really little to no guidance on how to make a curriculum inclusive.” She observes that quick fixes aren’t the answer. “People will often say ‘just add LGBTQ characters’ or ‘make names gender neutral in scenarios,’ but that is not enough and there is no systematic guidance on how to do it.”
Enter the FLASH program strategy.
FLASH uses a very systematic process to imbue the whole curriculum to be inclusive. In addition to creating a lesson focusing specifically on sexual orientation and gender identity, all of the FLASH lessons:
Provide visibility, depicting young people with a variety of sexual orientations and genders and in diverse contexts (e.g., sexually active, abstinent, partnered, single)
Normalize a wide range of identities
Portray LGBTQ young people in a variety of situations, including caring, satisfying, healthy relationships
Use a nuanced approach to inclusive language, striking a strategic balance between broad inclusion (e.g., the use of neutral language such as “partner” that allows a single sentence or concept to be relevant to a large group) and visibility of specific identities (using specific language such as “boyfriend” or “girlfriend”)
Ensure relevance of content to all. For example, the birth control lesson in High School FLASH starts with the statement “this lesson is for everybody—people who are having vaginal sex now or who will in the future, and teens of all sexual orientations and genders. Even if someone won’t ever need birth control, learning about it now will help them act as health educators for their friends and families on this important topic. Additional inclusivity strategies included in the development of FLASH: a) instructing teachers to use a specially designed protocol to affirm identities in class discussions, when answering questions, along all domains of identity (e.g., sexual orientation, gender, ability, religion, race, ethnicity); b) testing of all curricular messaging with a diverse group of young people, with LGBTQ youth purposefully overrepresented; c) content adjustments according to feedback and re-testing until acceptability was reached; and d) multiple piloting efforts of lessons in public school classrooms to gauge understandability.
Did it work?
In the study, 20 schools drawn from 7 districts in two regions of the South and Midwest were randomly assigned to receive FLASH or a comparison curriculum. A total of 1597 9th and 10th grade students took part in the baseline survey (831 intervention and 766 comparison), representing 92% of the students who had positive parent consent and were eligible for the primary study. Students completed follow-up surveys 3 and 12 months after the instructional period.
Researchers examined changes in homophobic beliefs among straight cisgender young people versus those who identified as not straight or cisgender. FLASH’s positive impact on reducing homophobic and transphobic beliefs was statistically significant for both straight and cisgender youth at both 3- and 12-month follow up timepoints (p<0.01, n=1144 and p+0.05, n+1078, respectively.) For a full study description, see Coyle et al (2021).
As Laris emphasizes, “what this study showed is that the process is effective because all students (both LGBTQ participants and straight and cisgender participants) decreased their homophobic beliefs.” This has different and important implications for each group. A reduction in homophobic and transphobic beliefs among LGBTQ students signals an improvement in how one feels about themselves (a decrease in internalized homophobia and transphobia).
The reduction in homophobic and transphobic beliefs among straight and cisgender students reflects an improvement in how one perceives LGBTQ peers, potentially leading to a reduction in harassment and an improved school climate.
The encouraging take-away here? FLASH is the first evidence-based teen pregnancy prevention program to date to report findings showing it reduces prejudice against people who are LGBTQ.
More information: Kari Kesler et al, High School FLASH Sexual Health Education Curriculum: LGBTQ Inclusivity Strategies Reduce Homophobia and Transphobia, Prevention Science (2023). DOI: 10.1007/s11121-023-01517-1
Decades ago in college, I had a lively discussion with friends about the “Four Food Groups,” a food classification system we had all grown up with in the ‘70s and ‘80s. The so-called “Basic Four” (defined as meats, dairy, fruits/vegetables, and grains) was just one in a series of ever-evolving teaching tools created by the USDA to nudge Americans toward healthier eating habits.
One friend was earnestly critiquing the system. “The Basic Four reflects the outsized influence of the meat and dairy industries,” she said, going on about structures of power in government agencies. “The whole system is wrong,” she exclaimed. “When you look at food in nature, there are actually 12 food groups.”
Another friend sighed. “In nature,” she asserted, “there are no food groups.” Food groups are made-up categorization systems we apply to edible stuff because we find it useful. There are infinite ways we can create food groups (by color, flavor, growing region, plant/animal source, vitamin content, etc.). There could be four, 40, or 400 categories, depending on our goals.
In other words, food groups shouldn’t be mistaken for telling unwavering “truth” about food. They are just convenient systems we use to make meaning from our world. And it doesn’t hurt here to note that the way we choose to group anything usually reflects certain underlying values and assumptions.
Categorizing Sex
Now let’s consider the concept of “sex.” For our purposes, I’m not talking about “sex” as an activity we can enjoy. Rather, I am talking about “sex” as a system that we use to categorize bodies.
In most of our cultural and scientific language, when we refer to the “sex” of humans, we’re usually offered two options, female or male. When we’re taught about sexual anatomy and reproduction in our sex ed classes, we are presented with two sets of drawings to represent genitals and reproductive organs.
The trouble with this system is that the observed reality of natural variations in human bodies isn’t that simple. Yes, we most often observe people who fit common patterns of “male” and “female” in terms of their gonads, genitals, chromosomes, and hormonal levels. But intersex people, who make up about 1.7% of the population, have sex traits or reproductive anatomy that varies from those typical definitions of male or female.
There is no single way to be intersex; it is an umbrella term encompassing a variety of differences in genitalia, hormones, internal anatomy, or chromosomes. Some intersex characteristics can be seen at birth, while others become evident at puberty, when trying to conceive a child, or through genetic testing. There are over 40 known intersex variations, and we’re still learning. The science of sex has become more nuanced in recent decades. Human sexual development is a complex process that involves multiple stages and a cascade of biological processes. Is it really a surprise that folks in our communities reflect natural variations beyond two strict outcomes?
There is no doubt that the categories of female and male can at times be useful. But there are also times when insisting on the rigidity of those categories is limiting and damaging. Serious trouble creeps in when folks insist that female and male are the “only,” “true,” or “natural” options. Our politics is currently rife with such essentialist language, reinforcing the erasure, stigma, and harm that intersex folks are often subjected to in our society.
Unnecessary surgeries on intersex youth
One form of injustice that intersex people have faced for decades is the imposition of binary sex norms by the medical establishment in the form of “normalizing” surgeries. These are non-lifesaving procedures that aim to change natural variations in genital appearance based on ideas about what a “normal” body looks like. Most of these surgeries are done when a child is under 2 years old, denying people important choices about their own bodies—choices that can affect fertility, sexual function, and emotional well-being.
About 1.7 percent of all people are born with intersex characteristics, an umbrella term for sex traits—such as external genitalia, internal reproductive organs, and chromosomal configurations—that don’t line up with society’s artificially tidy binary concepts of male or female bodies. Some of these characteristics are visible at birth: for example, genitals that are notably different from the norms or hard to classify as definitively male or female. Some only make their presence known during puberty, like when people don’t develop in the ways they might’ve expected. Some are so internal and subtle that they’re only identified during an autopsy. In any case, it’s usually impossible to tell if someone has intersex traits just by looking at them in everyday life. Still, living with intersex characteristics can have major impacts on people’s lives—including their sex lives.
To be clear, an intersex characteristic isn’t a medical condition or disability. It’s just one of many natural variations in the way diverse human bodies look and operate. Some factors that lead to intersex variations, like atypical hormone production, can at times also cause serious medical issues that require treatment, but most differences themselves are purely neutral. Yet society’s obsession with categorizing people into one of two binary genders at birth—and with erasing or ignoring anything that complicates the clean (over)simplicity of that binary—means many people with intersex traits grow up with the notion that there is supposedly something wrong with them, but they shouldn’t talk about it. Often, they’re also pressured or forced into “normalizing” themselves to match typical male or female anatomy: Across the world, kids with visible intersex traits are regularly subjected to objectively unnecessary and often harmful surgeries to reshape or remove their genitals, expressly to make them look “normal” and supposedly help them fit into society.
A fair number of people with intersex characteristics don’t feel these traits have much effect, if any, on their sex lives. But several intersex differences can lead to unique experiences of sex and pleasure. And many “normalization” surgeries drastically reduce or eliminate people’s genital sensations, and/or lead to chronic pain and dysfunction in erogenous zones. Thanks to the extreme culture of shame and silence around these traits and experiences, it’s difficult for people with intersex traits—or who are grappling with the effects of unnecessary surgeries—to learn about their bodies, much less articulate and advocate for their sexual wants and needs. Popular misconceptions and stigmas, as well as the risk of someone reacting poorly to diverse genitals or a body that doesn’t work in the ways they’d expect it to, also make it hard for some people with intersex traits to feel comfortable exploring intimacy, or to feel sexy and sexual.
In recent decades, several intersex organizations have formed to push back on pathologization and stigmatization and to help people with intersex characteristics find community and support. But most of their public advocacy and education to date has (understandably) focused on ending unnecessary and harmful surgeries—so there’s still not a tonof publicinformationout there on the issues people with intersex characteristics can face when navigating sex, and how to manage them.
To help bring more visibility to these issues and experiences, VICE reached out to Addy Berry, an intersex woman, and her wife Leea to talk about the ways they’ve approached sex and intimacy. Every intersex experience is unique, so Addy and Leea’s story is hardly universal. But Addy also studies the sexual experiences of people with intersex traits as a PhD candidate and an activist, and shared some of the wider insights she’s gleaned through her research, advocacy, and education work over the years.
This interview has been edited for length and clarity.
Addy: When I was born, my urethra opened on the underside of my phallus, close to the testes. I underwent surgery as a child to reroute it. In medical papers published as late as 2022, doctors have attempted to justify that type of surgery by saying it’s important for boys to be able to pee with their friends—which is a wild justification for a surgery that they perform when no one goes back to see what the long-term effects were on other people. [Editor’s Note: This is one of the most common surgeries performed on infants and toddlers with intersex characteristics.] It’s actually pretty difficult for me to pee anywhere now because there’s a mass of scar tissue within my urethra due to that surgery. So moving my urethra hasn’t done me a whole lot of good.
Doctors insist they can do things like reduce the size of a clitoris—in the past they’d fully remove it—and it’ll all be fine, when there’s no way for them to know that will be the case. Young people I’ve talked to who’ve undergone those surgeries report a lot of pain and also a lot of psychological issues related to the procedures and their long-term effects.
I was also put on hormones pre-puberty, under false pretenses. I didn’t act in accordance with the gender I was assigned—ever—and I got punished for that. Transgender and intersex are not the same thing, but a lot of us were assigned a gender despite uncertainties, and the surgeries done to make us fit that gender then don’t really suit us.
Growing up, my father said things to me like, “You weren’t born with a proper penis,” which is how I knew what my scars were from. And my mother referred to me as an abomination. The effects of all that stigma and shame come up in almost all of the interviews I do—it all has a big effect on your sexuality. I felt the effect on my sense of sexuality pretty early on in life.
Without much sensation in my genitals, likely thanks to that surgery, sex for me was never genital-centric. I could perform penetrative sex, but it doesn’t really do me any good. I was drawn to BDSM, and particularly female domination, from an early age. I’m essentially a masochist. Not everyone in the BDSM community links their involvement back to trauma, but for me I think it’s tied to my history of treatment as an autistic and intersex child who tended to be gender non-conforming and who was raised by a superstitious, sadistic Catholic woman with a lot of issues.
Due to what I was put through in my childhood, I developed into a physically masculine person, and I’d get involved with girls who liked me because of what I looked like—but who’d get angry at me for being feminine even though I was always open about who I am and I didn’t really act masculine. One partner told me that having sex with me was “like having sex with a girl,” and I was like, “Well…” They get angry at you for being the thing you said you were rather than the thing they wanted you to be. There was a lot of incompatibility in my intimate life. And then I found Leea, and there’s been so much compatibility between us that I almost wonder how she’s real. How did we find each other? We should have bought all of the lottery tickets that day. [Laughs.]
Leea: I like to read personal ads because it’s interesting to me to see what people put in them to find a mate. It’s like a love CV or something. I saw this really cute, well-written, dirty Craigslist ad one day, talking about BDSM stuff and with a cute picture, and I said “Oh that’s cool” and moved on. A few days later, I saw the same ad, but all the dirty bits were gone, and I thought that was cute too. I’d never felt inclined to write back to an ad before, but I replied, “Hey, I thought your dirty ad was cuter.” We started texting and then met for a coffee date and really hit it off.
My dad has a cousin who has intersex characteristics. I’m not sure what they are exactly, but as far as I understood it she’d undergone surgery to make her more female, but because of those surgeries she couldn’t have a child, so they adopted. She told my mother about it because they were good friends, and most of my family knew a bit about it, but nobody talked about it or asked questions. It was kind of a family secret. So I knew intersex characteristics existed before I met Addy, but that was about it. Fairly quickly, it became obvious she was trans but not out.
Addy: Because of my kiddos.
Leea: But it took a while to realize, “Oh, Addy’s intersex.”
Addy: Yeah, we talked about the surgeries I went through early on and all of that, but I hadn’t attached intersex language to that yet, for myself even.
Leea: Addy had to do a lot of figuring things out because she always knew she’d had these surgeries but she’d never been told specifically what had happened.
Addy: I’d known other words, and I found intersex later. The modern intersex movement has only existed as long as we’ve been able to find and reach each other online.
“The modern intersex movement has only existed as long as we’ve been able to find and reach each other online.” —Addy
Leea: Still, from early on I understood a lot about Addy—and none of it was an issue for me. We’ve just constantly had discussions about where we are. And Addy likes to talk a lot anyway.
Addy: [Laughs.] It came up early on that you weren’t interested in penetrative sex as well.
Leea: I’d dated a lot of people, and by then I was clear on the sex I wanted to have. I was over men. I don’t give a shit about sex the way a man typically wants to have it. That’s part of why Addy was the one for me. I found someone with whom sex wasn’t centered on the male gaze.
Addy: In the beginning, we also established that I’m not just a submissive but a masochist, and a pretty feminine person. While Leea is pretty feminine physically, she has more traditionally masculine aspects and aptitudes to her. Outside of this relationship, I’m brave, and I take care of tough things. But in this relationship, I find great comfort in being submissive to Leea.
Leea: It’s hard to remember specific conversations from that far back, but we still constantly discuss things, and the BDSM play we have today has evolved from the play we had 5, 10 years ago as we realize we like some things more or less than we did in the past and adjust.
Addy: For example, through exploration, we’ve found that medical play can be pretty cathartic for me—probably because of my history.
I’ve also experienced pretty severe depression for most of my life, and it’s very hard to get mental health help as an intersex person because not many people are qualified to help with the specific type of trauma you’ve been through. I’ve never found a therapist who’s capable of adequately addressing my trauma. But we’ve found that, when I’m in a depressive state, a caning can bring me right out of it. For example, a person I used to work with once asked me—right in front of Leea—“So if I pulled down your pants right now, what would I be looking at?” After that, I was not in a good place. But BDSM lifted up my dopamine or serotonin or something. Whatever it is, I don’t know. If we could get an MRI machine in here, that’d be interesting.
Leea: It’s really exciting as we explore more and more together. We’ve decided to dedicate this year to taking care of us, putting boundaries on who can come over to our place and when, so we can do things like exploring more BDSM play together. We want to go to more dungeons, too.
Ultimately, Addy being intersex doesn’t define anything in our relationship. It’s a part of who she is, and a part of what makes her the person I love. And because she works on intersex issues, it is something we’re always talking about. It plays a role in our life. But it isn’t who she is.
Addy: A lot of the people I’ve talked to who’ve really struggled are straight intersex people who live in a world where sex is all about a penis going into a vagina. A lot of intersex people have small penises, so living in a world full of comments insulting people for having small penises, where they learn that’s inherently bad and shameful, really sucks. For me and a lot of other intersex people who are queer, we’ve been forced to develop a wider vocabulary around sex.
Leea: The fact that we’re a queer couple has also, I think, given us more space to have conversations about things like the different kinds of sex we want to have. I feel really bad for a lot of straight couples because there isn’t a lot of space for conversations around what is good sex, how each partner is feeling, and what works and doesn’t work for them.
Addy: We have had to adapt our sex around the effects of the surgeries, and the effects of the stigma and shame I went through. But personally, I’ve never understood the idea in society that people should be ashamed of differences like this. I didn’t choose to be intersex or to be trans. So why should I be ashamed of those things? Or of being a submissive to, really, a goddess? Or for having done sex work? I don’t harm anyone. I work to make the world a better place.
I think my parents should be ashamed of how they treated me. The medical establishment should be ashamed. Society at large should be ashamed. I don’t see why I should carry shame.
Shedding binaries, shaking off taboos and more – in a year with big events and changes, love and sex looked different, too.
By Jessica Klein
The ways we think about sex and love are always evolving, constantly influenced by cultural, political and global happenings.
This year was no different. Much of that influence particularly spread online, especially in communities by and for those who identify across the LGBTQIA+ spectrum. Meanwhile, ripple effects from the self-reflection undertaken throughout the Covid-19 pandemic continued to rock the wider dating world, resulting in more intentional practices. People thought more about who they wanted to date, and how they wanted to do it.
In 2022, this meant more folks openly moved away from both gender and attraction binaries. We saw people rely even more on the internet to find potential partners, for better and for worse. And daters got increasingly vocal about exploring different types of relationships, from solo polyamory to platonic life partnerships.
People are moving away from long-held binaries
In Western culture, relationships, gender and sexuality have long been defined by binaries. Either a couple is dating or they’re not; a person is attracted to women or men; a person is either a woman or man. Throughout the past several years, however, these binaries have grown steadily less entrenched, as more people are looking at sexual orientations and gender identities in different ways. And this was especially pronounced in 2022.
As far as sexual orientation, a person’s gender has become less relevant for many people when looking for a partner; this is especially the case for many millennials and Gen Zers navigating intimate relationships. For some, it’s even ended up at the “bottom of the list” in terms of what they desire in a partner. That’s particularly true for people who identify as queer or pansexual, meaning their romantic and/or sexual attractions don’t hinge on gender.
As 23-year-old, London-based Ella Deregowska put it, identifying as pansexual has allowed her to “fluidly move and accept each attraction I feel without feeling like I need to reconsider my identity or label in order to explain it”. Experts say the increased openness towards non-binary attractions, in part, is linked to increased representation in popular media – from television shows such as Canada’s Schitt’s Creek, in which Dan Levy plays the pansexual David Rose, to celebrities like Janelle Monae, who’ve identified with pansexuality.
It’s not just sexual orientation that’s felt a shift from binaries this year. More young folk (and celebrities) have also moved away from binaries to describe their gender. Identifying as non-binary or gender fluid lets many people express themselves more genuinely, since that expression may not inhabit one black-or-white category. “One day I wake up and feel more feminine, and maybe I want to wear a crop top and put earrings on. And then there’s times in which I’m like, I need my [chest] binder [to minimise the appearance of my breasts],” says Barcelona-based Carla Hernando, 26.
In 2022, binaries grew less entrenched, as more people looked at sexual orientations and gender
We’re increasingly challenging relationship taboos and traditions
Relationships among young daters have increasingly bucked entrenched norms this year.
Gen Z is has particularly embraced the grey area of dating by purposefully entering into ‘situationships’. These connections satisfy needs for close companionship, intimacy and sex, but don’t necessarily hinge on long-term relationship goals – instead existing somewhere between a relationship and a casual hook-up. Per Elizabeth Armstrong, a sociology professor at the University of Michigan, US, who studies these types of relationships, Gen Zers feel that “the situationship, for whatever reason, works for right now. And for right now, ‘I’m not going to worry about having a thing that is ‘going somewhere’”.
Overall, openness towards many kinds of non-traditional relationships has gained visibility, too. Ethical non-monogamy has been all over TikTok, often in the form of polyamorous relationships, in which more than two committed romantic and sexual partners cohabit. Then there are open relationships, which can look like anything from partners who hook up with other couples together, to those who have separate relationships with others outside their primary partnership. There are also poly people who prefer to live solo, embracing a ‘solo polyamorous’ lifestyle, through which they live alone but engage in multiple, committed relationships. Others to choose to cohabit with platonic partners, forming lasting relationships and even buying homes and planning futures with close friends rather than lovers.
Yet in 2022, we’ve seen solutions for couples teetering on the edge of a break-up. “Life-changing” divorce coaches can help married couples navigate the mental health struggles of their break-ups, from the UK to Canada. These coaches represent a shift towards the normalisation of both seeking therapeutic aid in times of great stress, and of divorce overall. “It is no longer seen as a flaw of character, or a failure in one’s own life to divorce,” says Yasmine Saad, a clinical psychologist and founder of Madison Park Psychological Services in New York City. Hiring a divorce coach, therefore, is as natural as “wanting financial advice before investing your money”.
Or, couples who want to go the distance can try a gap year – an extended break that doesn’t signify the end of their relationships. Relationship therapists report seeing more of this in the wake of the pandemic, as couples who felt cooped up together over the last couple years want to explore life solo without breaking up.
Yet for couples set on splitting, the latest economic downtown has trapped some in joint living situations. Living alone these days, after all, isn’t cheap, and neither is buying an ex-partner out of their share of a joint dwelling. As Chantal Tucker, 37, who co-owns a London property with her ex-partner, put it, “I knew that I would never be able to afford to buy property again, and the prospect of renting in London forever was increasingly unpleasant.”
Some millennials struggled with ‘dead bedrooms’ in 2022
People are trying to make the increasingly bleak world of dating better
For those who are single, meanwhile, navigating the treacherous waters of dating apps has still been hard.
“I feel burnt out sometimes when I feel like I have to swipe through literally 100 people to find someone who I think is moderately interesting,” says Philadelphia, US-based Rosemary Guiser, 32, but it’s almost impossible to avoid using apps to meet someone. “You could compare [their supremacy] a little bit to Amazon or Facebook,” says Nora Padison, a licensed graduate professional counsellor in Baltimore, US.
This year, we learned millennial couples seem to be arriving at sexless relationships faster than their older counterparts – as San Francisco, US-based sex therapist Celeste Hirschman noticed, it used to take her coupled clients around 10 to 15 years to stop having sex with each other. “Now, it’s maybe taking three to five,” she says.
These days, we are involved in a great debate about whether and when we should teach kids about race, gender and sex in our schools.
But here’s the thing: There is no way for teachers to avoid teaching about race and sexuality, even in early grades. The only question is how we do it. To illustrate, let me share a story.
When my daughter was 2, we were visiting my mother in Southern California. We went to the supermarket. My daughter rode in the cart as I pushed through the store collecting items. As we worked our way through the produce section, passing along the lettuces and greens, another Black American woman was shopping just ahead of me. She was a middle-aged woman, dressed simply and sensibly, going about her business in an altogether ordinary way. My daughter watched her, and then looked up at me and said, “Mommy, I think it’s not good to be Black.”
What did I say in the moment? I don’t exactly remember. But probably something like, “Black is beautiful, my love. That woman is beautiful.”
My daughter was a precocious talker, yes. She talked early, though she didn’t talk often. She has always been a quiet and hyperobservant child. One preschool teacher said, “Still waters run deep.” When she had things to say, she said them in complete sentences. And though I think she was 2, she might have been 3 or maybe 3½. It doesn’t really matter. The point is that children learn from the world, and the world provokes questions — and when children ask their questions, their elders teach back.
My daughter’s statement was a question. Its subtext went like this: “I’ve noticed something, Mommy. It seems like it’s not good to Black. But can that be right? You’re Black. I love you. How can these things fit together? And what does this mean for me?” In that moment, I needed to teach my daughter that it is good to be Black. I also needed to teach her that she was accurately observing something about the world — that Blackness is stigmatized. And I needed to give her the capacity to set the stigma apart from the reality.
When I was 7, my father had me read “Uncle Tom’s Cabin.” To many, “Uncle Tom’s Cabin” caricatures Black experience. For my father, it provides a clear statement about the moral agency and equality of Black people — a permanent and visible fact, even in the midst of stigma. In having me read that very long book, he was teaching me.
I was a precocious reader.
But that doesn’t really matter to the story, either. What I can assure you of is that even before any of our kids, of any racial or ethnic background, get to school, every Black family in the United States is having to teach its children about race and the history of enslavement and stories of overcoming that have played out generation after generation. The same must be true for kids raised in LGBTQ families, with regard to the history and contemporary experience of gender and sexuality. I’m sure every family is doing the teaching differently. Some talking, some reading. Some looking at pictures. Some singing songs. But all are teaching.
This means that the only way you can keep knowledge and questions about these histories, experiences and perspectives out of the school curriculum in early grades is to keep Black people or members of LGBTQ families out of schools.
To recognize that fundamental fact is as if to hear a ghost whisper a revelation from a deep and ugly past. The wandering and cold-breathed ghost whispers that our old history of segregation — our now legally abandoned practices — was at some deep and existential level simply a way of evading the truth. The truth of our history and how it has been marred by racial domination. The truth of our present and our continued struggles with race. The truth of our moral responsibility to one another as human beings facing a future together.
To say it again, there is no way for teachers to avoid teaching about race and sexuality. We cannot legislate against children’s questions.
Out of charity, I will assume that the various efforts by state legislators to control when and how teachers engage with these subjects comes from an effort to open a discussion not of whether to teach in response to the questions children have but rather about how to do this. This is a profoundly important topic. And I would agree that some ways are better than others. But I hope we can take this issue of how to teach the histories and presents of race and enslavement, of gender and sexuality, out of the political maelstrom and turn them into a real conversation about how to raise healthy, loving, responsible children with a strong sense of self-confidence, purpose and charity for others in their hearts.
We grown-ups don’t get to decide whether we teach about race, gender and sexuality.
Living in our world as they do, our children have already determined that we will so teach.
Gender identity isn’t a choice — accepting your kid’s gender is the first step to supporting them.
You can also support your kid by using the right pronouns and making your home a safe space.
New clothes, hairstyles, and room decor may also help your kid feel more comfortable as themselves.
It’s natural for kids to explore their identity and sense of self as they grow up. But a child just beginning to question their gender identity may feel alone, uncertain, and scared, especially if they don’t know how you’ll respond.
Transgender and gender non-conforming youth — or kids with a gender identity different from the sex assigned at birth — face plenty of obstacles that can cause emotional distress, including bullying and discrimination, isolation, and a lack of social support.
But evidence overwhelmingly suggests parental support can boost self-esteem, quality of life, and mental health for trans kids — and, most importantly, reduce their risk of suicide.
In short, if your kid knows you have their back, that you’ll love and support them no matter what, this can boost their resilience and help them thrive in the world at large.
Of course, you might feel wholeheartedly committed to accepting and embracing your child unconditionally but have no idea where to start — especially if you haven’t spent much time considering gender yourself.
Below, experts who specialize in gender identity and supporting LGBTQIA+ people share 10 important tips on how to support your child as they begin to discover who they truly are.
Kids begin to develop an understanding of gender between the ages of 18 and 24 months. In other words, they begin to get curious about patterns that help them understand gender.
For instance, boys may lean toward cars and trains, while girls may play with dolls and stuffed animals — especially when parents and siblings encourage these gender norms.
Around the ages of 6 to 8, kids start to become aware of the differences between their gender identity and biological sex.
“Those feelings on gender become more flexible and fluid with regards to likes and preferences,” says Alex Greenwald, a therapist at Empower your Mind Therapy.
So, if your child was assigned male at birth but wants to wear princess dresses and play with dolls at the age of 3, they may simply be trying out something new, or copying a friend or sibling.
But if your school-aged child prefers girls’ clothes and begins to use a female name, you may want to start a conversation about gender identity. You might, for instance:
Ask what they know about gender
Establish that sex and gender are two different concepts
Ask what their gender is
Avoid offering your own opinion on their gender or guiding them toward gender norms
2. Foster gender neutrality at home
Evidence suggests gender stereotypes — pink and dance class for girls, blue and soccer practice for boys, for instance — can limit your child’s development and even lead them to hide their true interests.
Instead of suggesting your kid should play with specific toys or wear certain clothes, Greenwald recommends creating a gender-neutral environment that avoids stereotypes. This means letting them play with whatever toys they like and wear the clothes they prefer — without making comments or criticizing their choices.
3. Establish a safe space for your child
Making your home a safe space can pave the way for open communication within your family, as kids who feel safe are more likely to talk to you honestly and believe you’ll listen without judgment.
Paying attention to your language can make a big difference here. So, you’ll want to steer clear of making comments like “That’s gay,” or “It’s just a phase,” according to Greenwald.
“Rather, encourage their gender exploration. This lets them know you’re there for them and that you support their developing identity,” Greenwald says.
You can affirm and encourage your child by:
Listening to how they’re feeling — without questioning their experiences.
Asking them what you can do to support them.
Making sure they know your family accepts all gender identities and sexual orientations.
Waiting until they come to you instead of pushing them to talk before they feel ready.
These harmful practices aim to “repair” gender identity — but not only do they not change gender, they can also cause lasting, major consequences, such as:
Anxiety
Depression
Substance use disorders
Thoughts of suicide
Damaged family relationships
“Do not push your child to speak to religious leaders (or anyone) who has a fixed mindset about gender. Do not send your child to a camp to ‘change’ them,” says Bethany Cook, a clinical psychologist at Center on Halsted.
Your child may choose a different name and pronoun that better suits their gender.
“Parents should ask, ‘How would you like me to refer to you?’ or ‘What pronouns would you like me to use?’,” says Robert L. Johnson, counselor and director at The Dorm DC.
Just keep in mind it’s important to check with your kid before using these pronouns around extended family, friends, and other people in your life, according to Johnson.
Using the correct pronouns shows you respect your kid and acknowledge their identity — and research suggests trans youth feel both affirmed and validated when their parents use the correct pronouns and their chosen name.
If you happen to misgender them, avoid making excuses or saying things like, “Oh, it’s just so hard to remember” or “You’ll always be my baby girl” or “I just can’t see you as a boy.” Simply apologize and correct yourself with the right pronoun.
Avoid over-apologizing, since this can make them feel uncomfortable and draw unwanted attention in public areas.
If someone else corrects you, avoid getting defensive. Instead, just thank them and then repeat yourself with the correct pronoun.
6. Examine your gender biases
Before talking to a child or teen questioning their gender, it may be worth taking some time to reflect on the gender stereotypes in your social circle.
Stereotypes set a “standard” your child may feel pressured to achieve, which can make it harder for them to show their authentic self.
Expecting girls to be feminine and graceful may discourage them from displaying their strength or participating in sports.
Paying attention to the words you and others assign to describe stereotypical gender roles, like “manly,” “tough,” “weak,” or “gentle” can help you:
Dig deeper into unconscious biases, like the idea that girls should be quiet and calm
Avoid making assumptions about gender
Broaden your understanding about your child’s gender, and gender identity in general
7. Support self-expression
Gender exploration gives your kid a chance to experiment with what makes them feel comfortable.
Trying out new colors and styles, for example, can help them get a sense of their likes and dislikes as they begin to establish their identity.
You can support them by:
Taking them shopping: “Go shopping with them and let them have fun in the dressing room with you trying on whatever they want to,” Cook suggests.
Helping them change up their style: “Ask them if they’d like a haircut. Sometimes a haircut or different style can help in the exploration process,” Cook says.
Offer a room makeover: You can also offer to help them change their room decoration, or switch up accessories like lamps and curtains by letting them buy new items that more accurately represent their gender.
8. Expose them to LGBTQIA+ representation
Positive LGBTQIA+ representation in the media can help your kid find a character they identify with, which may:
Validate their experiences
Foster confidence
Help them realize they belong in society
“Talk openly about TV shows and movies that depict LGBTQIA+ characters. Bring up political and social issues affecting people from different backgrounds, including LGBTQIA+ people,” Erickson-Schroth recommends.
Just keep in mind that a well-represented LGBTQIA+ narrative will avoid tokenization, which happens when a show features LGBTQIA+ characters, like a gay best friend, simply for diversity without fleshing out the character adequately.
Tokenization can do more harm than good when it reinforces negative stereotypes or portrays LGBTQIA+ characters in a negative light.
Real representation, however, embraces a character’s complexity.
A few shows to try with your kid or teen:
She-Ra and the Princesses of Power
The Owl House
I Am Jazz
Star Trek: Prodigy
Kipo and the Age of Wonderbeasts
First Day
9. Connect them to support groups
If your child wants to meet more LGBTQIA+ peers, they might find it helpful to join a youth group.
Erickson-Schroth says you can start by:
Searching for groups in your city
Trying an online group if you can’t find a local in-person option
Ask a therapist or school guidance counselor for a referral
1o. Help them find a supportive mental health professional
You may not feel able to answer every question your child has — but that’s OK.
A therapist who specializes in gender and identity can provide affirmation and space for exploration, along with support helping you and your child prepare for their future, Erickson-Schroth says.
If your child seems reluctant to try therapy, it may help to explain some of the benefits of working with a therapist. For instance, a therapist can:
Offer support for mental health symptoms like anxiety or depression.
Help your child process their experiences and explore any changes they’d like to make to express their gender.
Offer support with finding gender-affirming care if your child chooses to begin social or medical transition.
Helpful resources for finding gender-affirming therapists and organizations include:
As your child begins to explore their gender identity, celebrating them as they are and nurturing them with unconditional love and support can do a lot of good — both for their well-being and your relationship.
Don’t hesitate to seek out helpful resources and connect with other parents for more support. Keep in mind, too, that a therapist can offer more guidance with knowing what to say and processing your own feelings.
“Loving and supporting your child doesn’t mean you can’t grieve any losses you may feel about the change. Just be aware that this is a process for you, not for your child to guide you through,” Cook says.
In 2022, Dictionary.com and the Oxford English Dictionary added 23 words to describe gender and sexuality concepts.
New gender-related words include “enby,” “nounself pronoun,” and “pangender.”
New sex and sexuality words include “throuple,” “sixty nine,” and “simp.”
As people’s understandings of gender and sexuality shift, whether due to cultural changes or scientific findings, so do the words we use to describe them.
This year, Dictionary.com and Oxford English Dictionaryadded new gender and sexuality words and phrases to their pages, giving readers more options to describe who they are, what they desire, and how they show up in the world.
Words that are already popular slang, like “simp,” made the cut, as did the verb form of “sixty nine.”
Oxford English Dictionary additions include ‘TERF,’ ‘stealthing,’ and ‘sixty nine’
Anti-gay (adjective): Opposed or hostile to homosexual people (sometimes specifically gay men) or homosexuality
Condomize (verb): To put on a condom; to use a condom during sexual intercourse, either as a contraceptive or to protect against infections
Demisexual (adjective, noun): Involving ambiguous or amorphous sexual characteristics or activity
Enby (adjective, noun): A person who has a non-binary gender identity; non-binary
Hypersexualize (verb): To make (a person or thing) pervasively, excessively, or inappropriately sexual; to imbue or permeate with intense sexual or erotic
Multisexual (adjective): Characterized by sexual or romantic attraction to, or sexual activity with, people of different sexes or gender identities
Pangender (adjective): Designating a non-binary person whose gender identity encompasses multiple genders, which may be experienced simultaneously or in a fluid way
Sixty nine (verb): To engage with a partner in simultaneous mutual oral stimulation of the genitals for sexual pleasure; to participate in a sixty-nine”
Stealthing (noun): The action or practice of removing one’s condom during sex (or occasionally of intentionally damaging it prior to sex) without the knowledge and consent of a partner
TERF (noun): Transgender-exclusionary radical feminist; typically derogatory term for a feminist whose advocacy of women’s rights excludes (or is thought to exclude) the rights of transgender women
Dictionary.com added ‘simp,’ ‘aromantic,’ and ‘throuple’
Aromantic (adjective): Noting or relating to a person who experiences little or no romantic attraction to other people
Bachelorx party (noun): An inclusive pre-wedding party, often on the night before or in the days leading up to the wedding, and ranging from a night of drinking to a destination vacation (used in contrast to bachelor party and bachelorette party, and intended to be welcoming for wedding participants and guests of any gender)
Demisexual (adjective): Noting or relating to a person who is sexually attracted only to people with whom they already have an emotional bond
Feminine of center (adjective): Noting or relating to a person, especially an LGBTQ+ person, who is more feminine than masculine on a spectrum of gender expression
Hegemonic masculinity (noun): A socially constructed masculine ideal, defined chiefly in contrast to or as the opposite of femininity, and held up as the most prestigious form of manliness in a heteropatriarchy
Heteropatriarchy (noun): A hierarchical society or culture dominated by heterosexual males whose characteristic bias is unfavorable to gay people and females in general
Masculine of center (adjective): Noting or relating to a person, especially an LGBTQ+ person, who is more masculine than feminine on a spectrum of gender expression
Neopronoun (noun): A type of gender-neutral pronoun, coined after 1800, and used especially by nonbinary and genderqueer people, as in English ze/hir/hirs,e/em/eirs, or xe/xem/xyrs
Nounself pronoun (noun): A type of invented gender-neutral pronoun used by some nonbinary and genderqueer people in place of gendered pronouns such as he/himself or she/herself to express a spiritual or personal connection to a specific concept: the nounself pronoun is derived from a word, usually a noun, that is linked to that concept, such as the use of star/starself by people who feel a connection to celestial objects or bun/bunself, derived from bunny, by people who feel a connection to rabbits
Simp (noun, verb): A person, especially a man, who is excessively attentive or submissive to an object of sexual attraction; To be excessively attentive or submissive, especially to an object of sexual attraction
Sologamy (noun): The practice or state of marriage to one’s self
Throuple (noun): Three people who are engaged or married to one another, or involved as romantic partners
Unlabeled (adjective): Noting or relating to a person who does not name their gender or sexuality
As a clinical geneticist, Paul James is accustomed to discussing some of the most delicate issues with his patients. But in early 2010, he found himself having a particularly awkward conversation about sex.
A 46-year-old pregnant woman had visited his clinic at the Royal Melbourne Hospital in Australia to hear the results of an amniocentesis test to screen her baby’s chromosomes for abnormalities. The baby was fine—but follow-up tests had revealed something astonishing about the mother. Her body was built of cells from two individuals, probably from twin embryos that had merged in her own mother’s womb. And there was more. One set of cells carried two X chromosomes, the complement that typically makes a person female; the other had an X and a Y. Halfway through her fifth decade and pregnant with her third child, the woman learned for the first time that a large part of her body was chromosomally male. “That’s kind of science-fiction material for someone who just came in for an amniocentesis,” says James.
Sex can be much more complicated than it at first seems. According to the simple scenario, the presence or absence of a Y chromosome is what counts: with it, you are male, and without it, you are female. But doctors have long known that some people straddle the boundary—their sex chromosomes say one thing, but their gonads (ovaries or testes) or sexual anatomy say another. Parents of children with these kinds of conditions—known as intersex conditions, or differences or disorders of sex development (DSDs)—often face difficult decisions about whether to bring up their child as a boy or a girl. Some researchers now say that as many as 1 person in 100 has some form of DSD.
When genetics is taken into consideration, the boundary between the sexes becomes even blurrier. Scientists have identified many of the genes involved in the main forms of DSD, and have uncovered variations in these genes that have subtle effects on a person’s anatomical or physiological sex. What’s more, new technologies in DNA sequencing and cell biology are revealing that almost everyone is, to varying degrees, a patchwork of genetically distinct cells, some with a sex that might not match that of the rest of their body. Some studies even suggest that the sex of each cell drives its behaviour, through a complicated network of molecular interactions. “I think there’s much greater diversity within male or female, and there is certainly an area of overlap where some people can’t easily define themselves within the binary structure,” says John Achermann, who studies sex development and endocrinology at University College London’s Institute of Child Health.
These discoveries do not sit well in a world in which sex is still defined in binary terms. Few legal systems allow for any ambiguity in biological sex, and a person’s legal rights and social status can be heavily influenced by whether their birth certificate says male or female.
“The main problem with a strong dichotomy is that there are intermediate cases that push the limits and ask us to figure out exactly where the dividing line is between males and females,” says Arthur Arnold at the University of California, Los Angeles, who studies biological sex differences. “And that’s often a very difficult problem, because sex can be defined a number of ways.”
The start of sex
That the two sexes are physically different is obvious, but at the start of life, it is not. Five weeks into development, a human embryo has the potential to form both male and female anatomy. Next to the developing kidneys, two bulges known as the gonadal ridges emerge alongside two pairs of ducts, one of which can form the uterus and Fallopian tubes, and the other the male internal genital plumbing: the epididymes, vas deferentia and seminal vesicles. At six weeks, the gonad switches on the developmental pathway to become an ovary or a testis. If a testis develops, it secretes testosterone, which supports the development of the male ducts. It also makes other hormones that force the presumptive uterus and Fallopian tubes to shrink away. If the gonad becomes an ovary, it makes oestrogen, and the lack of testosterone causes the male plumbing to wither. The sex hormones also dictate the development of the external genitalia, and they come into play once more at puberty, triggering the development of secondary sexual characteristics such as breasts or facial hair.
Changes to any of these processes can have dramatic effects on an individual’s sex. Gene mutations affecting gonad development can result in a person with XY chromosomes developing typically female characteristics, whereas alterations in hormone signalling can cause XX individuals to develop along male lines.
For many years, scientists believed that female development was the default programme, and that male development was actively switched on by the presence of a particular gene on the Y chromosome. In 1990, researchers made headlines when they uncovered the identity of this gene, which they called SRY. Just by itself, this gene can switch the gonad from ovarian to testicular development. For example, XX individuals who carry a fragment of the Y chromosome that contains SRY develop as males.
By the turn of the millennium, however, the idea of femaleness being a passive default option had been toppled by the discovery of genes that actively promote ovarian development and suppress the testicular programme—such as one called WNT4. XY individuals with extra copies of this gene can develop atypical genitals and gonads, and a rudimentary uterus and Fallopian tubes. In 2011, researchers showed that if another key ovarian gene, RSPO1, is not working normally, it causes XX people to develop an ovotestis—a gonad with areas of both ovarian and testicular development.
These discoveries have pointed to a complex process of sex determination, in which the identity of the gonad emerges from a contest between two opposing networks of gene activity. Changes in the activity or amounts of molecules (such as WNT4) in the networks can tip the balance towards or away from the sex seemingly spelled out by the chromosomes. “It has been, in a sense, a philosophical change in our way of looking at sex; that it’s a balance,” says Eric Vilain, a clinician and the director of the Center for Gender-Based Biology at the University of California, Los Angeles. “It’s more of a systems-biology view of the world of sex.”
Battle of the sexes
According to some scientists, that balance can shift long after development is over. Studies in mice suggest that the gonad teeters between being male and female throughout life, its identity requiring constant maintenance. In 2009, researchers reported deactivating an ovarian gene called Foxl2 in adult female mice; they found that the granulosa cells that support the development of eggs transformed into Sertoli cells, which support sperm development. Two years later, a separate team showed the opposite: that inactivating a gene called Dmrt1 could turn adult testicular cells into ovarian ones. “That was the big shock, the fact that it was going on post-natally,” says Vincent Harley, a geneticist who studies gonad development at the MIMR-PHI Institute for Medical Research in Melbourne.
The gonad is not the only source of diversity in sex. A number of DSDs are caused by changes in the machinery that responds to hormonal signals from the gonads and other glands. Complete androgen insensitivity syndrome, or CAIS, for example, arises when a person’s cells are deaf to male sex hormones, usually because the receptors that respond to the hormones are not working. People with CAIS have Y chromosomes and internal testes, but their external genitalia are female, and they develop as females at puberty.
Conditions such as these meet the medical definition of DSDs, in which an individual’s anatomical sex seems to be at odds with their chromosomal or gonadal sex. But they are rare—affecting about 1 in 4,500 people. Some researchers now say that the definition should be widened to include subtle variations of anatomy such as mild hypospadias, in which a man’s urethral opening is on the underside of his penis rather than at the tip. The most inclusive definitions point to the figure of 1 in 100 people having some form of DSD, says Vilain.
But beyond this, there could be even more variation. Since the 1990s, researchers have identified more than 25 genes involved in DSDs, and next-generation DNA sequencing in the past few years has uncovered a wide range of variations in these genes that have mild effects on individuals, rather than causing DSDs. “Biologically, it’s a spectrum,” says Vilain.
A DSD called congenital adrenal hyperplasia (CAH), for example, causes the body to produce excessive amounts of male sex hormones; XX individuals with this condition are born with ambiguous genitalia (an enlarged clitoris and fused labia that resemble a scrotum). It is usually caused by a severe deficiency in an enzyme called 21-hydroxylase. But women carrying mutations that result in a milder deficiency develop a ‘non-classical’ form of CAH, which affects about 1 in 1,000 individuals; they may have male-like facial and body hair, irregular periods or fertility problems—or they might have no obvious symptoms at all. Another gene, NR5A1, is currently fascinating researchers because variations in it cause a wide range of effects, from underdeveloped gonads to mild hypospadias in men, and premature menopause in women.
Many people never discover their condition unless they seek help for infertility, or discover it through some other brush with medicine. Last year, for example, surgeons reported that they had been operating on a hernia in a man, when they discovered that he had a womb. The man was 70, and had fathered four children.
Cellular sex
Studies of DSDs have shown that sex is no simple dichotomy. But things become even more complex when scientists zoom in to look at individual cells. The common assumption that every cell contains the same set of genes is untrue. Some people have mosaicism: they develop from a single fertilized egg but become a patchwork of cells with different genetic make-ups. This can happen when sex chromosomes are doled out unevenly between dividing cells during early embryonic development. For example, an embryo that starts off as XY can lose a Y chromosome from a subset of its cells. If most cells end up as XY, the result is a physically typical male, but if most cells are X, the result is a female with a condition called Turner’s syndrome, which tends to result in restricted height and underdeveloped ovaries. This kind of mosaicism is rare, affecting about 1 in 15,000 people.
The effects of sex-chromosome mosaicism range from the prosaic to the extraordinary. A few cases have been documented in which a mosaic XXY embryo became a mix of two cell types—some with two X chromosomes and some with two Xs and a Y—and then split early in development. This results in ‘identical’ twins of different sexes.
There is a second way in which a person can end up with cells of different chromosomal sexes. James’s patient was a chimaera: a person who develops from a mixture of two fertilized eggs, usually owing to a merger between embryonic twins in the womb. This kind of chimaerism resulting in a DSD is extremely rare, representing about 1% of all DSD cases.
Another form of chimaerism, however, is now known to be widespread. Termed microchimaerism, it happens when stem cells from a fetus cross the placenta into the mother’s body, and vice versa. It was first identified in the early 1970s—but the big surprise came more than two decades later, when researchers discovered how long these crossover cells survive, even though they are foreign tissue that the body should, in theory, reject. A study in 1996 recorded women with fetal cells in their blood as many as 27 years after giving birth; another found that maternal cells remain in children up to adulthood. This type of work has further blurred the sex divide, because it means that men often carry cells from their mothers, and women who have been pregnant with a male fetus can carry a smattering of its discarded cells.
Microchimaeric cells have been found in many tissues. In 2012, for example, immunologist Lee Nelson and her team at the University of Washington in Seattle found XY cells in post-mortem samples of women’s brains. The oldest woman carrying male DNA was 94 years old. Other studies have shown that these immigrant cells are not idle; they integrate into their new environment and acquire specialized functions, including (in mice at least) forming neurons in the brain. But what is not known is how a peppering of male cells in a female, or vice versa, affects the health or characteristics of a tissue—for example, whether it makes the tissue more susceptible to diseases more common in the opposite sex. “I think that’s a great question,” says Nelson, “and it is essentially entirely unaddressed.” In terms of human behaviour, the consensus is that a few male microchimaeric cells in the brain seem unlikely to have a major effect on a woman.
Scientists are now finding that XX and XY cells behave in different ways, and that this can be independent of the action of sex hormones. “To tell you the truth, it’s actually kind of surprising how big an effect of sex chromosomes we’ve been able to see,” says Arnold. He and his colleagues have shown that the dose of X chromosomes in a mouse’s body can affect its metabolism, and studies in a lab dish suggest that XX and XY cells behave differently on a molecular level, for example with different metabolic responses to stress. The next challenge, says Arnold, is to uncover the mechanisms. His team is studying the handful of X-chromosome genes now known to be more active in females than in males. “I actually think that there are more sex differences than we know of,” says Arnold.
Beyond the binary
Biologists may have been building a more nuanced view of sex, but society has yet to catch up. True, more than half a century of activism from members of the lesbian, gay, bisexual and transgender community has softened social attitudes to sexual orientation and gender. Many societies are now comfortable with men and women crossing conventional societal boundaries in their choice of appearance, career and sexual partner. But when it comes to sex, there is still intense social pressure to conform to the binary model.
This pressure has meant that people born with clear DSDs often undergo surgery to ‘normalize’ their genitals. Such surgery is controversial because it is usually performed on babies, who are too young to consent, and risks assigning a sex at odds with the child’s ultimate gender identity—their sense of their own gender. Intersex advocacy groups have therefore argued that doctors and parents should at least wait until a child is old enough to communicate their gender identity, which typically manifests around the age of three, or old enough to decide whether they want surgery at all.
This issue was brought into focus by a lawsuit filed in South Carolina in May 2013 by the adoptive parents of a child known as MC, who was born with ovotesticular DSD, a condition that produces ambiguous genitalia and gonads with both ovarian and testicular tissue. When MC was 16 months old, doctors performed surgery to assign the child as female—but MC, who is now eight years old, went on to develop a male gender identity. Because he was in state care at the time of his treatment, the lawsuit alleged not only that the surgery constituted medical malpractice, but also that the state denied him his constitutional right to bodily integrity and his right to reproduce. Last month, a court decision prevented the federal case from going to trial, but a state case is ongoing.
“This is potentially a critically important decision for children born with intersex traits,” says Julie Greenberg, a specialist in legal issues relating to gender and sex at Thomas Jefferson School of Law in San Diego, California. The suit will hopefully encourage doctors in the United States to refrain from performing operations on infants with DSDs when there are questions about their medical necessity, she says. It could raise awareness about “the emotional and physical struggles intersex people are forced to endure because doctors wanted to ‘help’ us fit in,” says Georgiann Davis, a sociologist who studies issues surrounding intersex traits and gender at the University of Nevada, Las Vegas, who was born with CAIS.
Doctors and scientists are sympathetic to these concerns, but the MC case also makes some uneasy—because they know how much is still to be learned about the biology of sex. They think that changing medical practice by legal ruling is not ideal, and would like to see more data collected on outcomes such as quality of life and sexual function to help decide the best course of action for people with DSDs—something that researchers are starting to do.
Diagnoses of DSDs once relied on hormone tests, anatomical inspections and imaging, followed by painstaking tests of one gene at a time. Now, advances in genetic techniques mean that teams can analyse multiple genes at once, aiming straight for a genetic diagnosis and making the process less stressful for families. Vilain, for example, is using whole-exome sequencing—which sequences the protein-coding regions of a person’s entire genome—on XY people with DSDs. Last year, his team showed that exome sequencing could offer a probable diagnosis in 35% of the study participants whose genetic cause had been unknown.
Vilain, Harley and Achermann say that doctors are taking an increasingly circumspect attitude to genital surgery. Children with DSDs are treated by multidisciplinary teams that aim to tailor management and support to each individual and their family, but this usually involves raising a child as male or female even if no surgery is done. Scientists and advocacy groups mostly agree on this, says Vilain: “It might be difficult for children to be raised in a gender that just does not exist out there.” In most countries, it is legally impossible to be anything but male or female.
Yet if biologists continue to show that sex is a spectrum, then society and state will have to grapple with the consequences, and work out where and how to draw the line. Many transgender and intersex activists dream of a world where a person’s sex or gender is irrelevant. Although some governments are moving in this direction, Greenberg is pessimistic about the prospects of realizing this dream—in the United States, at least. “I think to get rid of gender markers altogether or to allow a third, indeterminate marker, is going to be difficult.”
So if the law requires that a person is male or female, should that sex be assigned by anatomy, hormones, cells or chromosomes, and what should be done if they clash? “My feeling is that since there is not one biological parameter that takes over every other parameter, at the end of the day, gender identity seems to be the most reasonable parameter,” says Vilain. In other words, if you want to know whether someone is male or female, it may be best just to ask.
Gender is a spectrum, so there are a ton of ways you can choose to identify yourself—a.k.a. you’re not limited to just “female” and “male.” In addition to terms like non-binary, genderfluid, and pangender becoming more commonly used, one term you may also have been hearing recently is “bigender.”
In its most basic definition, being bigender means that you identify with having two genders. What those two genders are and how those two genders show up in the way you express yourself is entirely up to you—and isn’t the same from one bigender individual to another. As a gender identity (as opposed to a sexual identity or orientation), the term also doesn’t indicate who someone might be attracted to.
If you’re looking to learn more about the topic, here’s everything you need to know about what it means to be bigender, including how someone might express their bigender identity and how you can support the bigender community, according to expert sources.
What does it mean to be bigender?
Within the definition of bigender, there are many ways to experience the identity, and anyone who identifies as two genders (regardless of what those two genders are) would fall on the bigender spectrum.
“It is important to recognize that just because someone identifies with two genders does not mean those gender identities are man and woman. Being bigender can also include non-binary identities, for example, male and agender, or agender and androgenous, etc.” says Erynn Besser, LCPC and AASECT-certified sex therapist. “There are many different gender identities with which people may identify within the bigender identity.”
The bigender identity is usually grouped under the umbrella of non-binary (more on that later). “To be bigender means having two gender identities that can be experienced and expressed separately, or that can blend and be experienced simultaneously,” explains Paula Leech, LMFT, an AASECT-certified sex therapist. How a person experiences and expresses their two genders can also be dependent on different situations, adds sex therapist Alex Chinks, PsyD.
During times when someone may appear to be expressing one gender exclusively, it’s important to recognize that the second gender doesn’t just disappear from their identity during those times. “You may see a bigender individual who dresses and ‘appears’ completely cis-gendered,” Chinks explains. “That does not mean that their other gender identity is not a part of them and who they are.” Got that down?
What is the difference between bigender, non-binary, genderfluid, pangender, and bisexual?
While these are all terms that you might hear in a similar context as bigender, they are all their own unique identities.
Non-binary: Someone who is non-binary feels their experience of their gender does not feel like an accurate reflection of the gender they were assigned at birth, specifically male or female, says Leech. It is also a larger category of gender identities under which bigender falls.
Genderfluid: Someone who identifies as genderfluid would see gender as more of an expansive, ever-changing concept, Leech explains. For a genderfluid person, gender identity is an idea that is constantly shifting as they grow.
Pangender: While someone who is bigender feels they identify as two genders, someone who is pangender feels they encompass multiple, or even all genders, according to Leech.
Bisexual: A sexual orientation, someone who is bisexual experiences “sexual and/or romantic attraction to people who are of the same gender and people who have a different gender than your own,” Wendasha Jenkins Hall, PhD, a sex educator and researcher based in Atlanta previously told Women’s Health. This means someone could be both bigender and bisexual, but they don’t have to be.
What does being bigender look like?
Because the bigender experience can vary greatly (like all gender identities, TBH), there’s no one way to express being bigender, and you should celebrate your identity in the way that feels best for you.
“It is important to recognize that each person’s expression of their gender identity is unique to them, and there is no ‘right’ way for someone to express their gender identity, including the amount of time one expresses a particular identity,” says Besser. Plus, those who have a bigender identity may express their multiple identities at the same time or separately.
Someone who is bigender may display that identity through dress and use of pronouns, explains Chinks, who also adds that “it is important to remember the fluid nature that can arise with being bigender, meaning that an individual may use one set of pronouns at one point in time or in one situation, and another at another point.”
Simply put, there’s no one set of pronouns that a bigender person typically uses. Instead of guessing based on appearance, your best bet is to ask someone which pronouns they prefer.
Signs that you might be bigender:
While the term is a relatively new way to express gender identity, there are certainly people who have had feelings of being bigender long before there was a word to describe it. The following list includes some (though certainly not all) of the ways you can experience being bigender, if you’re curious:
You move between two distinct ways of expressing yourself. This can be how you display emotionally, psychologically, physically, and/or spiritually, Leech says.
You experience gender dysphoria. Chinks explains the idea of gender dysphoria as the feeling that “the way I feel inside is not aligning with my outward or biologically-assigned gender.” The concept used to be strongly associated with someone who is transgender, Chinks adds, but in terms of the bigender identity, someone might be born male and be comfortable with that male identity, but also feel like there is a feminine side to their gender identity that needs to be honored, too.
You have feelings of gender euphoria. According to Besser, gender euphoria is “a feeling of joy, empowerment, and comfort when your gender identity and expression is affirmed.” For bigender individuals, this could be when you start to display two sides of your gender and it finally feels like something clicks for you.
How to support bigender loved ones and greater community:
No matter your personal gender identity, there are ways that you can do your part to make your communities more inclusive:
Don’t make assumptions. You may have a close friend or family member who is bigender, but that doesn’t mean you know what they’re going through at all times. Leech says that it’s important not to let previous experience or generalizations prevent you from “being curious, really learning about [the identity], and coming to understand the person in front of you and what they uniquely need.”
Ask questions. The best way to find out how you can support someone or what they need from you? Ask. Especially when it comes to which pronouns they prefer. This is much more respectful than assuming you know the answer, Chinks explains.
Learn more. It’s not on someone who is bigender to teach you everything about the identity. “Become an ally by doing your own education in order to avoid education burdening,” says Besser. There are plenty of resources online to get you started. (Like this comprehensive and expert-approved gender identity list on Women’s Health.)
State your pronouns. When you start a Zoom meeting by stating your pronouns or include them in your email signature, you are “opening the door” for those who are bigendered or non-binary to share theirs, Chinks explains. This, in turn, helps to normalize the idea that gender is a spectrum, a spectrum on which everyone is just trying to understand their place.
Does language need to be collectively agreed upon before it’s actually offensive? What about subtler phrasings that unconsciously undermine people, specifically transgender and nonbinary people?
Ignoring what others identify themselves as can actually be alienating and sometimes traumatizing. The misuse of pronouns might seem innocent, but it also puts the speaker’s discomfort and values before the other person’s. In other words, it’s a form of discrimination and harmful to presume someone’s pronouns by looking at them.
Referring to people with terms or phrases that they don’t agree with — like “it’s just a phase” — is a destructive force that implies a sense of doubt, fantasy, or role-play.
Describing someone as a “former man” or “biological man” is demeaning. When you insist on using a former name an individual no longer uses, it symbolizes a preference for your own comfort and can be outright rude, if done intentionally.
In an article for Conscious Style Guide, Steve Bien-Aimé proclaims, “Common language usages should not trample over others who are different.” So why not use the words that have power to validate, acknowledge, and include?
Here at Healthline, we couldn’t agree more. Our most powerful tools on the editorial team are our words. We weigh the words of our content carefully, scanning for issues that could hurt, exclude, or invalidate other human experiences. It’s why we use “they” instead of “he or she” and why we distinguish between gender and sex.
Gender and sex are separate matters. Sex is a word that refers to a person’s biology, including chromosomes, hormones, and organs (and when you take a closer look, it becomes clear that sex isn’t binary, either).
Gender (or gender identity) is the state of being a man, woman, both, neither, or other gender altogether. Gender also includes the roles and expectations society assigns to each person based on their “maleness” or “femaleness.” These expectations can become so ingrained that we may not even recognize when or how we reinforce them.
Gender evolves over time and culture. There was (not too long ago) a time when it was socially unacceptable for women to wear pants. Many of us look back on that now and wonder how it was that way for so long.
Just as we created the space for changes in clothing (which is gender expression) for women, we are learning more space needs to be created in language to affirm and account for the experiences and feelings of transgender people.
Despite being such small words, pronouns hold a lot of significance when it comes to identity. She, he, they — it’s not a matter of grammar. (The Associated Press updated their style guidelines for 2017, allowing for the singular use of “they.”) We use “they” all the time in reference to singular people — just in the introduction above, we used it four times.
If you meet someone new and they haven’t made it clear which pronouns they use, ask. The more we do this as a society, the more natural it’ll become, like asking “How are you?” And honestly, it’ll save you more awkwardness down the line. A simple, “Hey Jay, how do you like to be referred to? What pronouns do you use?” will suffice.
So, whether it’s he, she, they, or something else: When someone lets you know their pronouns, accept them. Using the wrong pronouns (or misgendering) is a sign that you don’t believe someone knows who they are better than you do. It can also be a form of harassment when done intentionally.
Don’t say this: “She’s a former woman who now goes by Michael.”
Say this instead: “That’s Michael. He tells amazing stories! You should meet him sometime.”
It’s unfortunately not uncommon for trans people to still be referred to by their given (as opposed to affirmed) names. This is called deadnaming, and it’s an act of disrespect that can be easily avoided by simply asking, “How do you like to be referred to?”
Many trans people put a lot of time, emotion, and energy into the name they use and it should be respected. The use of any other name can be harmful and should be avoided whenever possible.
A full summary of a transgender person’s gender history and anatomy are usually completely irrelevant. So, when you talk about or with a person, be careful to not prioritize your curiosities. Stick to topics that are relevant to why the person came to see you.
Don’t say this: “Dr. Cyril Brown, named Jessica Brown at birth, made a pivotal discovery in the journey toward curing cancer.”
Say this instead: “Thanks to Dr. Cyril Brown, an amazing scientist, we may now be one step closer to curing cancer.”
Curiosity is a valid feeling, but acting on it isn’t your job. It’s also disrespectful to many trans people. While you may be curious about the details of a person’s gender, body, and anatomy, understand that you don’t have a right to that information. Just like you don’t owe an explanation about your past life, they don’t owe you one, either.
When you meet most other people, you probably don’t inquire about the state of their genitals or their medication regimen. That personal health information is personal, and being trans doesn’t take away that right to privacy.
If you want to understand their experience better, do some research of your own into the different options available to people who identify as transgender, nonbinary or gender nonconforming. But don’t ask an individual about their specific journey unless they’ve given you permission.
Don’t say this: “So, are you ever going to have, you know, the surgery?”
Say this instead: “Hey, what are you up to this weekend?”
To be gender inclusive is to be open to all gender identities and gender expressions in a discussion.
For example, an article may come across our desk that reads “women” when it really means “people who can become pregnant.” For transgender men, menstruation and pregnancy may still be very real issues they experience. Describing the entire group of ovulating people as “women” excludes the experience of some trans men (and women who deal with infertility, but that’s another article).
Words like “real,” “regular,” and “normal” can also be excluding. Comparing trans women against so-called “real” women separates them from their identity and continues the incorrect idea that gender is biological.
Using precise, descriptive language rather than gender buckets isn’t only more inclusive, it’s just clearer.
Don’t say this: “Women and transgender women showed up in huge numbers at the rally.”
Say this instead: “Lots of women showed up at the rally in record numbers.”
Remember, you’re speaking about another person. Another human being. Before you open your mouth, think about what details may be unnecessary, diminish their humanity, or result from your own discomfort.
For example, it’s important to acknowledge that this person is — you guessed it — a person. Referring to members of the trans community as “transgenders” denies their humanity. It’s just like how you wouldn’t say “he’s a black.”
They’re people, and being transgender is just a part of that. Terms like “transgender people” and “the transgender community” are more appropriate. Likewise, many trans people dislike the term “transgendered,” as if trans-ness was something that happened to them.
Rather than coming up with new or shorthand ways to describe trans people, just call them trans people. This way, you avoid accidentally stumbling onto an offensive slur.
Note that even if one person identifies with a term or slur, it doesn’t mean everyone does. It doesn’t make it OK for you to use that term for all the other trans people you meet.
And in most instances, being trans isn’t relevant when interacting with people. Other details that probably aren’t necessary to question are whether the person is “pre-op” or “post-op” and how long ago they started transitioning.
You don’t talk about cis people’s bodies when you introduce them, so extend the same courtesy to trans people.
Don’t say this: “We met a transgender at the bar last night.”
Say this instead: “We met this awesome dancer at the bar last night.”
Navigating new territory can be difficult, we get it. And while these guidelines may be helpful, they’re also just guidelines. People are diverse, and one size will never fit all — especially when it comes to self-reference.
As humans, we’re bound to mess up at some point. Even good intentions may not land appropriately.
How one person feels respected may be different from how another person feels respected. If you flub up, politely correct your mistake and move forward. The important part is to remember to focus on the other’s feelings — not your own.
Don’t say this: “I’m sorry, but it’s just so hard for me to call you Jimmy after I’ve known you as Justine for so long! I don’t know if I’ll ever be able to do it.”
Say this instead: “Hey Just— sorry, Jimmy, do you want to come with us to dinner Friday?”
If you think someone is trans, don’t ask. It doesn’t matter. They’ll tell you if it ever becomes relevant and if they feel comfortable sharing that information with you.
If someone is trans or nonbinary, or if you’re just not sure, it doesn’t hurt to ask how you should address them. Asking shows respect and that you want to validate their identity.
Sexuality is fluid and ever-changing — not something stagnant to be “discovered.”
By Kelly Grace Finney
You’ll hear it all the time: Sexuality is on a spectrum. But what exactly does this mean? And how does it differ from checking off “straight, gay, or bisexual” on an intake form?
In modern psychological research, “sexual orientation” is a term used to describe the overarching umbrella of human sexual preferences. This includes, but is not necessarily limited to, sexual attraction, romantic attraction, sexual behavior and sexual identity. For a lot of folks, these factors all align: For example, a straight woman who is sexually and romantically attracted to men, with a history of sexual relationships with only men. However, these differences are not so clearly defined in a lot of folks’ experiences, which can lead to a lot of shame and confusion.
Sexual fluidity is the concept that sexual orientation can be context-dependant and change over time. You may have heard the term “gay for the stay” to describe incarcerated folks having same-sex relationships in prison when they would otherwise engage in opposite-sex relationships in their communities.
But this isn’t just limited to folks who are removed and isolated from greater society. Even “Saturday Night Live’s” comedy music group The Lonely Island wrote the song “The Golden Rule” as a humorous defense of having three-ways with a member of the same gender. It is also common for folks to engage in sexual relationships with one gender, but fantasize about or watch pornography focused on other genders. And we can’t forget about those who identify as straight but have a habit of kissing or engaging in other sexual behaviors with people of the same gender when under the influence of alcohol or other drugs. If sexual identity, sexual attraction and sexual behavior were all the same, how could we account for these differences in alignment?
This is why it is so important to pay attention to the differences between sexual identity and sexual attraction. A lesbian woman could have a satisfying sexual experience with a man, but that does not necessarily mean that she wants to continue engaging in sex with men, nor does it mean she would want to communicate to others that she is looking for a heterosexual partnership. Therefore, she could still identify as lesbian as a way to tell others that she is looking for partnership with another woman.
Our sexual identities are labels that we use to let ourselves and others know what type of relationships we prefer. However, sexual identity is not the end-all, be-all of relational preferences.
By labeling folks’ sexual fluidity as “confusion,” we are invalidating the very meaningful relationships that others engage in. As Carrie Bradshaw put it on “Sex and the City,” “I’m not even sure bisexuality exists. I think it’s just a layover on the way to Gaytown.”
While this was broadcast in the year 2000, many folks today still struggle to understand anything outside of the gay-straight binary. We often receive cultural messages that bisexual men are really homosexuals testing the waters, while bisexual women engage in same-sex relationships to gain attention from men.
What do these misconceptions have in common? They both rely on the idea that fundamentally, if given the choice, men are ultimately the most desired gender. This patriarchal idea serves the function of categorizing folks in neat, clean boxes as a means to oppress. But, as psychological researchers keep telling us, humans are anything but easily categorized.
Our rigid views around sexuality and sexual identity are part of what fuels violence against transgender and non-binary folk. If society didn’t expect us to “find” and settle on our sexual preferences, there wouldn’t be so much pressure on people, especially straight folk, to defend their sexuality. For example, someone can identify as straight or mostly straight, but have a relationship with someone who is non-binary. This is the key difference between how we identify and who we are attracted to. We should be embracing these gray areas, rather than utilizing shame to discourage exploration.
Sexuality is fluid and ever-changing — not something stagnant to be “discovered.” If we let go of the expectation that we must be “sure” of our sexual preferences, we open up doors to more satisfying sexual and relational experiences.
For parents of neurotypical children and neurodivergent children alike, some things are universal. We all want our kids to be happy, healthy, and loved, and we all worry—a lot.
One of the biggest concerns we may have for our kids can be how they will handle romantic relationships, sex, and the social aspects of dating in general. There is much to think about, but adding autism into the discussion takes it up a notch.
In this article we will take a few minutes to study autism and sexuality. We will find out what we as parents need to know about supporting our kids with autism spectrum disorder (ASD) as they navigate their sexual development, and all that it brings with it.
E – expression
In the grand scheme of things, children, adolescents, and young adults with autism spectrum disorders, need to know the same basic things about sex as their neurotypical peers. Most often, it’s how they process, implement, and express themselves that can be different. It is important to educate our kids.
Relationship education
Relationship education is the base of understanding for:
social skills
sexual well being
Sexual education
Sexual education is the foundation of safety for:
promoting sexual health
prevention of sexual abuse and sexual assault
protection from sexually transmitted infections
sexual function
In order for us to educate our children, we must first educate ourselves. In her paper, titled Sexuality and Adolescents with Autism, Rebecca Koller writes: “Education for caregivers of individuals with autism regarding issues of adolescence and self-pleasuring may help alleviate the anxiety of individuals with autism caused by misinformation or the absence of information. Such education, along with information regarding sexual abuse, should be included in a proactive approach to sexuality training for individuals with autism.”
A child with intellectual disability is going to process the information they need differently, and the most effective way to help them with that is to give them the information at their level.
Social stories are a great way to educate. Hypothetical situations used to illustrate real situations provide an opportunity to walk through topics and allow our child to practice relationship skills in a safe, low pressure way. Sexual education can start with these.
D – desire
According to an article published in the National Library of Medicine, titled Brief Report: Asexuality and Young Women on the Autism Spectrum, studies show that a higher percentage of people with autism spectrum disorders identify as asexual. The presence of sexual attraction will clue us in to what direction we can take with our kids.
As we build our relationship with them, we can learn about what they feel and think about sexual things, and help guide them along the way.
U – understand
Information unlocks many doors. Being misunderstood is one of the largest obstacles for our kids on the spectrum. If we as parents strive to be a constant source of understanding in our kids’ lives, our relationship with them will strengthen, and their ability to take on the world will increase.
We need to help our kids understand that their feelings are normal, and the most appropriate ways to express them. Their understanding of others feelings, desires, and appropriate expression is of utmost importance as well.
How does autism affect intimacy?
In Webster’s dictionary (2022) the word “intimate” is defined as: marked by a warm friendship developing through long association. Our kids’ first intimate relationship is with us; we are the ones they are familiar with.
As they get older that circle widens and more people are allowed in. As they grow and develop, the kind of intimacy with each person in their circle changes.
This can be difficult for children with autism. In order for them to understand appropriate intimacy with others, they need to build their social skills.
Addressing sexuality begins with setting clear and distinct boundaries about what intimacy is, and how it relates to sex and relationships. Then, we need to understand how autism can affect intimacy, and help our child comprehend and prepare for how that can show up in the interactions with others they are close to. They need to know what is appropriate and what isn’t, and from whom.
Helping our child understand sexuality socially, it is important to discuss the way sexuality is expressed. In the interest of educating ourselves first, let’s find out how autism can affect sexual behavior.
Sexual behaviors
As parents we will bring views and emotional “baggage” with us from our own lives that will affect our understanding of our kids. Some of us want to do things opposite to how our parents raised us, others want to preserve the “right” way we learned from our elders. Either way, it is imperative that we see our children clearly and strive to learn from them through a fresh set of eyes, ears, and hearts.
Sexual behavior can be terrifying to address for parents, especially if those behaviors come up at very inopportune times with our kids. Learning as much as we can about sexual behavior and how they can be influenced by autism can really help prepare us to deal with them as they come. Addressing behavior should be done with a calm and understanding approach.
Behavior like:
masturbation
hypersexuality
inappropriate touching
If these behaviors occur at inappropriate times or places because of a lack of understanding of social situations, it can pose a problem for our kids. Teaching them about their bodies early on can go a long way to helping our children know when, where, and with whom they may express themselves sexually.
Koller writes: “Education regarding sexual abuse should be a component of responsible sexuality education. Increased vulnerability among children with disabilities relates to their inability to understand or communicate what has happened or what will happen.
“Two of the most important issues to address in the area of social-sexual relationships are how to teach appropriate behavior and how to balance risk and opportunity. Walcott (1997) reports that ‘without proper education in the areas of sex, health, and physical education, people with moderate and severe disabilities risk exposure to sexual exploitation, poor health, abuse, and neglect.’”
The aspects of romantic relationships are just one of the complexities that our kids with autism may struggle with socially. There is some overlap in the educational needs.For example, teaching our kids about body language is helpful since they may not pick up on those cues on their own. Understanding body language at a young age will help them detect new body language signals or recognize negative ones early, just because they are different to what they already know. This can help protect them from people who may not have their best interest at heart.
Gender identity, sexual orientation, and sexual identity
In a study called: Gender identity and Sexual Orientation in Autism Spectrum Disorder, Rita George and Mark A Stokes comment that “children are generally cognizant of their gender between the ages 18 months and 3 years, and by the beginning of school years, most children will have achieved a sense of their gender identity and a certain degree of gender constancy, at which time children begin to realize that gender is a permanent state that cannot be altered by a change of clothing or activity”.
The same study revealed an increase in the likelihood of individuals with ASD to experience gender identity issues. “When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits.
“Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.”
Children know from such an early age who they are, what they like, and though they may mask their feelings because of social pressures, it doesn’t change who they are.
As parents, looking at the data we can see that we need to be ready to support our child with autism if they come out as part of the LGBTQ+ community, and to recognize the signs, and so that we have a chance to know before they do.
Our treatment of them can either reinforce, or counteract society’s views of them. If they are loved, supported, and educated with us, they will know when to recognize safe people to have relationships with. They will know what healthy looks and feels like, and they will be confident in who they are.
Their mental health is just as important as their sexual health. Safety is the goal. Knowing the increased chances of social misunderstandings, communication is imperative.
C – communicate
As we impart the knowledge we gain to our child, and our relationship with them grows, we can watch them begin to navigate their own relationships in the world. They can learn to communicate with others they are interested in and build healthy intimate relationships.
A – allow
In the world in which we live, so much of what we have discussed above is controversial. We may not agree with the conclusions that our kids come to, the relationships they wish to pursue, or who they know themselves to be. Accepting them for who they are and who they love does not always mean endorsement.
Many parents choose to disassociate from their children when they find out they are not who they thought they were, whether that is their sexual orientation, gender identity, or their sexual choices. This can leave the young adult vulnerable and unsupported.
The goal for parents should be to make sure their child knows what they need to know, is capable of making their own decisions, and to love and accept them regardless. You can disagree without disengaging.
We can allow our children to be who they are, love them, and keep the lines of communication open. We should encourage free and open discussion, foster social interactions, and facilitate relationships with children their same age–mentally, not just in years. An emphasis on gender diversity, as well as children of their own gender identity is important.
T – timeline
You may be thinking, this is too much information to throw at a kid, and I would agree. However, sex education can begin very early. Age appropriate information about their bodies, body parts, and functions, who they belong to, friendships, body language of friends, family, and strangers can all be collected with our kids. All of this being before our kids experience being sexually attracted, sexual activity, sexual experiences, so that when those things do occur, they are ready—even if we are not.
I – Inspiration
How we handle the topics that come up around sexual matters with our kids will inspire them. If we are calm, matter of fact, informative, and set a good example ourselves, they will be inspired to do the same. Their view of themselves, their sexuality, and human connection starts with what they observe in us.
O – Outsource
There are programs to help children and young adults with ASD learn what they need to know socially and how to find romance safely. I want to share with you two resources, both are courses or services run by speakers from the Autism Parenting Summit.
Sexuality is a spectrum. It encompasses much more than the act of intercourse. Understanding your child’s sexualality is important, as it is as unique as they are. EDUCATION is key.
Acceptance and understanding start at home and carry throughout life. Your child needs to know they are loved, and worthy of love. They can grow to be confident individuals who understand their sexuality, express it appropriately, and engage in healthy relationships with others.
References:
Bush, H. H., Williams, L. W., & Mendes, E. (2021). Brief Report: Asexuality and Young Women on the Autism Spectrum. Journal of autism and developmental disorders, 51(2), 725–733. https://doi.org/10.1007/s10803-020-04565-6
George, R., & Stokes, M. A. (2018). Gender identity and sexual orientation in autism spectrum disorder. Autism, 22(8), 970–982. https://doi.org/10.1177/1362361317714587
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