The idea that all people have an innate 'gender identity' has recently been supported by many health professionals and leading medical organisations.. This term is commonly used to refer to the an 'inner, deeply rooted' sense of self which tells whether one is a man or a woman (or, in the case of children, a boy or a girl), both or neither. It has become normal to state that this sense of identity can be reliably articulated by children as young as three years old.
Although these claims about gender identity were not initially subject to systematic scrutiny, they have now become object of criticism by a growing number of scientists, philosophers and health professionals. Development studies show that young children have only a superficial understanding of sex and gender (at best). For example up to the age of 7 years many children tend to believe that if a boy wears girl's clothes he becomes a girl. This gives us reason to doubting that a coherent concept of gender identity exists in young children.
To the extent that such an identity can exist, the concept is based on stereotypes that encourage the merging of gender with sex.
However, From an early age children tend to show preferences and behaviours that we associate with the sex (as distinct from the genre ). For example, males show more aggressive behaviour than females. In addition, 'cross-sex' behaviour - or, more precisely, stereotyped cross-sex behaviour - is often predictive of the subsequent same-sex attraction.
Can all these results be integrated? To begin with, just as sex influences the development of bodies, it also influences the brain. There are in-utero differences in hormone exposure (male testosterone peaks at eight weeks gestation, for example) and distinct developmental pathways are activated based on the XX (typically female) or XY (typically male) chromosome composition of the neurons. The integration of these sex-linked and other developmental processes with environmental pressures gives rise to an individual's unique personality and preferences.
It is therefore not surprising that population-based studies have demonstrated personality differences and gender-related preferences independent of social influences. When social influences are weakened (in more egalitarian societies such as the Nordic countries of Europe), sex-related differences in personality and preferences actually increase (the opposite of what one would expect if men and women were wired identically). This suggests that when environmental pressures ease, sex-specific innate preferences emerge.
A closer look at personality traits shows that when the data are analysed in aggregate, there is an overlap of approximately 30% between the sexes, as shown in the attached figure. The consequence of this overlap is that adolescent males who fall at the left end of the male curve (blue 'male') and adolescent females who fall at the right end of the female curve (pink 'female') will exhibit personality traits that diverge from the majority of other members of their own sex. This is because of the overlap in personality traits between males and females, the personality traits of some females will be more 'masculine' than those exhibited by some, or even most, males, and vice versa.
In the case of a teenager whose behaviour, personality traits and preferences are more 'masculine' than most girls and the most of the boys, one might be led to the erroneous conclusion that it is indeed a male, born in the wrong body. The parents of that child may also be confused, noticing how their child's behaviour is 'different' from their own or from that of their peers. In reality, that child is simply at the end of a behavioural spectrum and 'gender-typical' behaviour is part of the natural variation. which manifests itself both within and between the sexes. Personality and behaviour do not define one's sex.
There are about 40 million children in the United States between the ages of four and fourteen. The distribution curve above would suggest that about four million of them have personality profiles that are 'sexually atypical', but are still part of the natural distribution of personalities within each sex.
The wide but normal distribution of personality traits also explains studies showing a 28% concordance of transgender identity in twins. Twins have identical chromosomes and therefore are likely to have similar gender-related behaviours, as well as experience similar environmental influences in relation to those behaviours. Using adolescent male twins as an example: if their behaviours are at the 'female' end of the typical male distribution, both might be confused about what their behaviours and preferences mean about their sex.
In most cases, what is now called 'gender identity'. is probably simply an individual's perception of how his or her gender-related and environmentally influenced personality compares to people of the same and opposite sex. In other words, it is a self-assessment of one's stereotypical degree of 'masculinity' or 'femininity', and is mistakenly confused with biological sex. This merger is the result of acultural incapacity to understand the wide distribution of personalities and preferences within the sexes and the overlap between the sexes.
When a girl reports 'feeling like a boy' or 'being a boy', that feeling may reflect her perception of how her personality and preferences compare with the rest of her peers. If the girl has a autism spectrum disorder, may even perceive 'gender-typical' behaviour that does not actually exist, and therefore self-diagnosing falsely as male even without experiencing any real male personality traits.
It should be noted that these scenarios do not apply to all cases of gender dysphoria, as many other triggering factors are described in the literature. But in most cases, counselling can help gender dysphoric adolescents resolve any trauma or thought processes cthat led them to desire a body of the opposite sex.
Historical data suggest that about 0.5% of children develop gender dysphoria, distress caused by a perceived incongruence between their biological sex and gender presentation. Reinforcing studies in the medical literature show that when children grow up gender dysphoria with infantile onset is resolved (i.e. ends) in most cases. As two authors stated in an article the International Review of Psychiatry in the 2016 , "the conclusion of these studies is that childhood GD [gender dysphoria] is strongly associated with a lesbian, gay or bisexual outcome and that for most children (85.2% ; 270 of 317 [individuals studied]) gender dysphoric feelings regress around or after puberty".
However, instead of offering consultations medical professionals now commonly tell children that they may have been 'born in the wrong body'. This new approach is called 'gender affirmation', makes it less likely that gender dysphoria will resolve itself, pushing children down the path to irreversible medical and surgical interventions. If aggressive transition options are pursued at the onset of puberty, the combination of drugs that block puberty, followed by cross-sex hormones, will result in permanent infertility.
It is estimated that the growing population of high school students who identify as transgender comprises about 2% of all students, a three-fold increase compared to the baseline figure of 0.5% mentioned above. Many adolescents are now presenting to gender clinics, with some clinics seeing a 10-fold increase in new cases. Many of these adolescents have no history of childhood gender dysphoria. Higher rates of autism spectrum disorders have been described in many of these adolescents and the controversial 'affirmation model' is also applied to this unstudied cohort. Not surprisingly, the reports on repentance and de-transition are growing in number (see here).
To summarise, a lack of understanding regarding the distribution of personality and gender-related behavioural differences has led to a confusion impacting on children which fall at the final extreme of the scheme and which would be statistically more likely to become gay, lesbian or bisexual if allowed to experience uninterrupted puberty. In addition, Telling a child that he or she was born in the wrong body pathologises 'gender non-conforming' behaviour and makes resolution of gender dysphoria less likely.
The fact is that no child is really born in the wrong body . Adults should expand their understanding of the behaviour and preferences of males and females, which would lead them to appreciate that being male or female involves a range of personality preferences and wider possibilities than the old stereotypes would have us believe.
William J. Malone (endocrinologist), Colin M. Wright (evolutionary biologist), Julia D. Robertson (journalist). Robertson (journalist)
Here a study by the Endocrinological Society: 'Considering Sex as a Biological Variable in Basic and Clinical Studies'. Interesting for those involved in medicine and science.
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