Atypical gender expression
Atypical gender expression refers to behavior that does not match the external sex characteristics that identify an individual as male or female at birth.
Individuals may exhibit gender variance and reject a few traits that are typically expected of their sex while adopting characteristics usually demonstrated by the other sex. For instance, men cross-dressing, showing an interest in domestic chores or cooking, grooming, caring for children, are viewed as instances of male gender non-conformity.
In some cases, the non-conformance may be persistent and include a strong sense of identity with a different gender and a desire to alter one’s physical characteristics to match their sense of identity. The formal diagnosis for such behavior was earlier clinically known as gender identity disorder. However, with increased awareness and understanding of gender identity issues and with a view towards removing the stigma associated with such behavior, it is no longer classified as a disorder. Instead, the discontent experienced by individuals due to gender identity issues, known as gender dysphoria, is recognized as a diagnosis. An individual who feels that his or her body does not match with his or her gender is referred to as a transgender.
The sex of an individual is determined at birth solely on the basis of their external genitalia on the assumption and inference that the individual’s future ‘gender identity’ will be congruent with their external appearance. However, ‘gender identity’ is the psychological experience of identifying oneself as male or female and may not always be a function of one’s external sex characteristics.
Some children, teens and adults may feel that they do not identify with the physical characteristics they possess and instead identify themselves with the other sex. Children demonstrating atypical gender behavior may not participate in or enjoy activities that are typically enjoyed by children of their gender and instead prefer activities or having playmates of the other sex. For instance, boys may enjoy dressing up in girls’ clothing, identify with or pretend to be female characters from movies. Children may also express the desire to get rid of their genitals or to acquire genitals of the gender they identify with. They may consistently state that they belong to a gender different from their physical characteristics. Adolescents may also experience extreme distress as a result of the physical changes occurring in their bodies during puberty.
Research suggests that only a small number of children who exhibit atypical behavior continue to do so in adulthood.
Older children and adults may demonstrate certainty that their bodies do not reflect their identity. Other symptoms include disgust with their genitals and a strong desire to get rid of them.
Children and adults who feel that their bodies do not reflect their true gender may suffer distress, dissatisfaction, anxiety and restlessness. In addition to their own feelings, such individuals are often subjected to teasing and ridicule from their peers, adding to their anxiety and loneliness. Stigma, family distress and their internal conflicts leave them susceptible to developing mental health conditions.
To be diagnosed with gender dysphoria, an individual should demonstrate these signs and symptoms for at least six months.
Gender identity and sexual orientation
Sexual orientation refers to an individual’s emotional and physical attraction to one’s own or the other gender. Gender identity is one’s identification as male, female or some other gender and need not be related to one’s sexual orientation. Persons born with male physical attributes may identify themselves as female but may still be attracted to females.
Although the two are not necessarily related, research suggests that boys demonstrating gender variant behavior in childhood do not exhibit the behavior in adulthood but do identify themselves as homosexuals. This indicates that in some cases, the atypical behavior may be related to sexual orientation. However, this is increasingly being viewed differently and a person’s sexual orientation considered distinct from his or her gender identity and expression.
The objective of the treatment is mainly to assist the person in dealing with the distress associated with gender dysphoria. This may involve counseling to reduce guilt and anxiety, or counseling spouses or family members to help them adjust.
After counseling or psychotherapy, in some cases, individuals may seek medical intervention to match their physical characteristics with the gender they identify with. This could include genital surgery, breast surgery, hormonal treatment, laser hair removal or other sex or gender reconstruction surgeries. It is very important that any such surgery be coupled with psychotherapy to understand and cope with the changes that the individual’s body undergoes.
For those seeking female sex characteristics, the medical treatment could involve estrogen administration, facial hair removal, penectomy (surgical removal of the penis), and vaginoplasty (reconstructive surgery for the vaginal canal and surrounding areas). Those seeking male features could be required to undergo testosterone treatment, mastectomy (surgical removal of breasts), hysterectomy (surgical removal of the uterus), and vaginectomy (surgery to remove all or parts of the vagina).