Gender and sex are complex.

Gender is not as simple as putting people into neat boxes of “male” or “female.” A useful way to understand gender diversity is the gender health model, which encourages people to fully explore all parts of their gender identity and gender expression. Gender identity is one’s internal sense of self as male, female, both, neither, or something else. Neurologically and philosophically, gender identity is anchored in the brain or mind. But what about sex?

What is “biological sex” anyway? Is it binary?

Sex is much more a spectrum than most people think. Not only is gender and gender identity complex–so is one’s physical/anatomical sex. It might be harder than you think to reduce people down to two categories of “biological sex.” First you’d have to answer the question, what does “biological sex” actually mean? Is “biological sex” based on:

  • Chromosomes (the idea that many people have is XX = “female” and XY = “male”)
  • External body parts (e.g., penis, vagina)
  • Internal body parts (e.g., testes, ovaries)
  • Hormones (the amount of estrogen or testosterone we have in our body)

Some individuals have different experiences of sex development than others. Some people can have missing chromosomes (Turner syndrome), while others can have extra X or Y chromosomes (e.g., Klinefelter’s syndrome). Many people may be surprised to learn that it’s not just chromosomes that determine if your body forms a penis or vagina— hormones, or hormone insensitivity, tell the body what body parts to develop into at around 6 weeks in the womb. An XX chromosome child may have congenital adrenal hyperplasia and develop a penis. Conversely, an XY chromosome child may have androgen insensitivity and never develop a penis.

It soon gets complicated as you can see. Milton Diamond, a world famous sex researcher, suggests that being transgender, itself, is an intersex condition wherein the body does not align with one’s neurological make-up. But not all people even identify with a gender (e.g., agender people).

Being able to talk openly about sex and gender is key to healthy development.

People flourish best when they are allowed to find and explore who they are and are supported in their identities. If your child has a difference of sex development, it is important to talk openly and honestly with your child about their bodily differences. Avoidance or secrecy may perpetuate stigma and cause your child to experience shame. To learn how to support and increase your awareness about intersex people visit InterACT.

When youth identify as transgender or non-binary, it’s usually stressful for both them and their parents. Parents may initially experience confusion or a sense of loss for the child they thought they had. Depending on the age of the youth, they may experience loss of hope and despair if they are not allowed to express themselves or if they can’t get access to gender-affirming medical interventions (e.g., puberty blockers, hormones). The youth and their parents may have to cope with societal stigma and discrimination. While research tells us trans youth are at higher risk for suicide, we know that parent support helps lessen this risk.

All this to say: there is a tremendous amount of sexual and gender diversity. We, as a society, should not be rushing to make others conform to how we believe they should behave or on what we believe they should look like. The simple fact is that there are many legitimate ways of being as it pertains to sex and gender and none should be pathologized.



What Makes Us Unique

Portland Psychotherapy is a clinic, research & training center with a unique business model that funds scientific research. This results in a team of therapists who are exceptionally well-trained and knowledgeable about their areas of specialty.