Understanding Gender Identity

About 1.6 million people over the age of 13 in the United States identify as transgender, according to a study from the Williams Institute at the UCLA School of Law. While the number of transgender adults has remained steady since 2016, there has been a rise in individuals ages 13 to 17, with nearly one in five teens in that age range identifying as transgender.

“As acceptance and visibility of individuals with diverse gender identities and experiences increase, individuals — particularly young people — may find that they can now imagine a world where they can actualize and share their authentic gender-diverse selves,” says Dr. Kareen Matouk, a psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center and the assistant program director of the Columbia Gender and Sexuality Program. “With the increased awareness, people are finding the language to talk about this, parents have heightened awareness with respect to what may be going on with their children, and overall there’s more acceptance around this subject.”

Gender identity means different things for different people, and a person may make the choice to affirm their gender identity early or late in life. Gender expression can include the use of pronouns (he, she, they, or a blend), gender-affirming care (such as hormone therapy, which can promote masculine or feminine physical traits), and self-expression (the way one dresses, for example).

Gender identity and gender expression are on a spectrum and a person may identify at any point on this spectrum or entirely outside of it. “For those who transition socially and/or physically to affirm their gender identity, this process is highly individualized,” says Dr. Matouk. “There may also be barriers (such as cultural or religious barriers, stigma, and safety) that attribute to someone repressing certain aspects of their identity, not discovering their gender identity sooner, or leading them to choose to transition later in life.”

It’s important to note that gender identity and sexual orientation are not one in the same. Sexual orientation refers to who someone is attracted to or who they have romantic relationships with. Words associated with sexual orientation include queer, lesbian, gay, bisexual, straight, asexual, and pansexual. Meanwhile gender identity refers to the way someone defines and expresses themselves in terms of gender. Words to define gender identity include man, woman, non-binary, genderqueer, and gender non-conforming.

Transgender (or trans) means that your gender is different than the sex you were assigned at birth.

Non-binary, gender non-conforming, and gender queer also mean that your gender is different than the sex you were assigned at birth. These labels might mean that the person’s gender does not fit into the categories of man or woman. All of these terms fall under the umbrella of gender diversity.

You can’t tell a person’s gender just by looking at them, and your body doesn’t determine your gender. Gender expression is in part how you share your gender with the outside world, says Dr. Ani Fredman, a postdoctoral fellow at the Columbia Gender and Sexuality program.

“Those concepts tend to get conflated, though they are very distinct,” says Dr. Fredman. “Whether or not someone is transgender or nonbinary doesn’t tell you anything about their sexual orientation.”

While society has grown more aware of gender diversity, there is still significant stigma, discrimination, and misconception around what it means to be transgender, explains Dr. Matouk. Furthermore, anti-trans laws and policies have severely impacted trans people’s day-to-day lives.

“Trans folks experience discrimination in the form of harassment, denial of benefits, and interpersonal threat and violence,” says Dr. Fredman. “This exposure contributes to poor physical and mental health outcomes for members of marginalized communities. Trans health disparities are particularly exacerbated among trans people of color.”

More than 40% of transgender adults in the U.S. have attempted suicide, and transgender Americans are more likely to experience mental health issues. “It’s critical to have the support of primary care providers and mental health providers who have experience helping patients explore the spectrum of gender-affirming transitions,” says Dr. Matouk.

The Columbia Gender Identity and Sexuality Program was founded in 2018 to provide compassionate, personalized, and expert care to children, adolescents, adults, and families across the gender and sexuality spectrum. Providers support patients as they explore the spectrum of gender identity, gender expression, and gender-affirming transitions. This may include hormone, surgical, non-medical and legal, and social steps to affirm their gender.

“Our mission is to establish a multidisciplinary team that can serve to provide gender- and sexual-diverse folks with all aspects of the care they need,” says Dr, Matouk. “We aim to be a single destination for patients seeking multiple aspects of gender- and sexuality-affirming care — from mental health care to surgery — and we build relationships with clinicians throughout NewYork-Presbyterian so both patients and their families have easier access to coordinated care.”

Another key component to advocating for trans and nonbinary individuals is to work with the family unit, including parents, family members, and partners, who may not always know the best way to provide support for those individuals in their lives,” says Dr. Matouk. “The hope is that through more education, dialogue, and support, we can celebrate every individual and work to a place of universal respect and understanding.”