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Sebastian's Blog

A review of non-pathologizing psychology research that expands our understanding of trans identity, experience, and mental health.


Filtering by Category: Transgender Info/Resource

Dr. Diane Ehrensaft on Trusting Children's Understanding of their Genders

Sebastian Barr

Diane Ehrensaft, Ph.D., is a developmental psychologist and the director of mental health at the Child and Adolescent Gender Center in California. In May, she published a great article titled "We Trust Children to Know What Gender They Are - Until They Go Against the Norm." The article discusses gender identity development in transgender and gender non-conforming children and the approaches to facilitating healthy development. It's brilliant and brief and definitely worth a read:

Those of us who operate within the gender-affirmative model – abiding by the definition of gender health as the child’s opportunity to live in the gender that feels most authentic to them – have developed assessment processes based on the dictum that: “if you listen to the children, you will discover their gender. It is not for us to tell, but for them to say.”

This makes adults nervous, as we were always taught that gender was a bedrock, determined not by the child but by the assessment of the medical professionals delivering the baby: penis for a boy, vagina for a girl. It’s both earthshaking and extremely anxiety provoking to have that trope challenged by young voices who might say to us that we got it wrong. And if the child is wrong and we go along with them, we could make a mess of things by having them bounce back and forth between genders or take the wrong path.

Over the course of time, if we do not impose our own reactions and feelings on the children, like the ones above, and allow a space for their gender narrative to unfold, the gender they know themselves to be will come into clearer focus. From there we can give them the opportunity to transition to the gender that feels most authentic, followed later by the choice to use puberty blockers to put natal puberty on hold and later cross-sex hormones to bring their bodies into better sync with their psyche.

If we do not give them this opportunity, they may feel thwarted, frustrated, despondent, angry, deflated – feelings reflected in the symptoms correlated with being a gender-nonconforming or gender-dysphoric child. The root of these symptoms is not the child’s gender, but rather the environment’s negative reactions to the child’s gender.

Read the full article here, at The Conversation.

Transgender 101

Sebastian Barr

Sex and Gender

I think the difficulty people have in understanding what it means to be transgender comes from the fact that in our society, we often learn about sex and gender in overly simplistic and conflated ways. The first step to understanding the concept of being transgender is to try to understand what sex and gender mean.

There are four main components to sex and gender: sex assigned at birth, biological sex, gender identity, and gender expression. These are separate components and do not necessarily directly influence each other.

Sex assigned at birth is an assignment made at birth, based on doctors’ interpretation of a person’s biology – typically, via examination of external genitalia. In the United States, birth certificates must bear a “male” or “female” sex assignment. Male is assigned when a baby appears to have a penis; female is assigned when a baby appears to have a vulva and vagina.

Biological sex can refer to chromosomes, hormone levels, reproductive anatomy, secondary sex characteristics (e.g., facial hair, breasts), or a combination of all of these things. Unlike assigned sex, biological sex does not fit easily into two discrete categories. Our biological sex is actually very complicated, with a great deal of diversity in chromosomal makeup, hormone levels, reproductive anatomy, and secondary sex characteristics across male-assigned and female-assigned folks. There are multitudes of chromosomal combinations; the two most common (though most of us never have our chromosomes tested) are XX and XY. Typically, people with two X chromosomes have vaginas, wombs and ovaries, are given “female” sex assignments, and have higher levels of progesterone and estrogen after puberty, which lead to menstruation and breast development. Typically people with an X chromosome and a Y chromosome have penises and testes, are given a  “male” sex assignment and have higher levels of testosterone after puberty, which leads to increased body hair, lower vocal ranges, and greater muscle mass.

Gender is a general term referring to social categories based on culturally-specific role expectations that are attached to sex assignments. Gender identity is a person’s internal sense of what gender and/or sex they are and/or how they fit into their society’s gender categories. A person might have an internal sense of being female/woman, male/man, a combination of both, or neither, or may have a fluid internal sense of gender, such that they identify differently at different points in time. There are lots of different possible gender identities and labels outside of man and woman, some of which include genderqueer, non-binary (referring to the fact they do not identify within the binary framework of man vs. woman), genderfluid, and two-spirited (a traditional Native American gender identity).

Gender expression is how a person communicates their gender to the world. Examples of ways we express our gender include the clothing we wear, our hairstyles, and conversation styles. When we use the words masculine and feminine, we tend to be talking about gender expression, for example. Other terms associated with gender expression include femme and butch.

None of these concepts is directly related to sexuality or sexual orientation (e.g., bisexual, lesbian, queer, gay, straight), which involve whom a person is attracted to.

Transgender People, Cisgender People, and Gender Transitions

When we learn about sex and gender, we are usually taught to think about them as a singular concept with two options, when really there are (at least) four components and an infinite possibility of combinations.

People are considered transgender when their particular sex and gender combination includes a gender identity that is different from their sex assigned at birth. For example a person who has a female sex assignment and a genderqueer gender identity is transgender; a person who was female assigned at birth and has a male gender identity is also transgender. People are considered cisgender when their particular sex and gender combination include a gender identity that is the same as their sex assigned at birth (cis is the latin root meaning same). Both cisgender and transgender people have a wide range of biological sex characteristics and gender expressions.

Some transgender people go through gender transitions in order to make their gender identity more visible to the outside world. This can include changes in a person’s gender expression and/or changes in their biological sex to align either or both with their gender identity. For example, a transgender man (a man who was female assigned at birth) may wear more masculine clothes and change his name to a traditionally masculine name in order to communicate his male gender identity; these would be changes in his gender expression. Changes to his biological sex may include hormone replacement or surgeries. Just like there are infinite possible combinations of gender and sex identities, there is not a singular way in which transgender people undergo a gender transition, if they choose to do so.

So, the cheat sheet version of all of this is: gender identity is an internal, psychological sense of how a person fits into gender categories; sex assigned at birth is the label a person was given at birth typically in response to their external genitalia. When these two things differ, a person is considered transgender.

How to Refer to Trans1  People


As I mentioned in my Trans 101 Handout, FTM and MTF are not the best ways to identify a transgender person. Instead, transgender people should be identified using the terminology they use for themselves (for example, a transgender woman should be referred to as a woman if she calls herself that; a genderqueer person should be referred to as genderqueer or using whatever gender label they use for themselves). When using the word transgender as a description for someone,2 include it with the person’s gender identity, not their sex assigned at birth. So a transgender woman is a person who identifies as a woman. When a person’s transgender history is important and needs to be referenced, identify them based on their gender identity and their sex assigned at birth. FAAB and MAAB are acronyms for female-assigned-at-birth and male-assigned-at-birth. For example, a transgender woman is a woman (MAAB) or a woman who was male assigned at birth. Intersex may also be appropriate if a person’s assigned sex and/or biological sex at birth were not discretely male or female. In this case, you might describe someone with a female gender identity as an intersex woman.3  An intersex person may or may not consider themselves transgender.  


Pronouns are the words we use in place of people’s names when referring to them. In English (and many other languages), third person pronouns are gender-specific. He/him/his are typically used for people with male gender identities and she/her/hers are typically used for people with female gender identities. Because pronouns then inherently announce a person’s gender, it is important that we ask others which pronouns they want us to use for them. Many transgender men prefer he/him/his pronouns and many transgender women prefer she/her/hers pronouns, while genderqueer folks and other people with non-binary gender identities may prefer gender-neutral pronouns (e.g., they/them/theirs, ze/hir/hirs). Because we can’t tell a person’s gender identity or pronouns from looking at them, it’s most affirming to ask and use gender-neutral pronouns (or avoid pronouns) until we know which ones to use.

  1. Trans is short for transgender and is sometimes considered to be more inclusive of different sex/gender combinations. While we’re at it, let’s note that cis is short for cisgender. 

  2.  Please note that not everyone considers their transgender identity to be a part of their gender identity, and a transgender person may prefer to be referred to as simply a man or a woman. It is important to ask. Additionally, never disclose a person’s transgender status without their explicit permission to do so.  

  3.  In American society, and some other countries/cultures, intersex people are still assigned a male or female sex at birth. The intersex community refers to this as a coercive sex assignment, and you can use the acronyms CAFAB and CAMAB to mean coercively-assigned-female-at-birth and coercively-assigned-male-at-birth, respectively.