The Problems with "Gender Identity"

When Colin Wright asked me to turn a slightly ranty tweet thread into an article, I happily complied. But the experience ended up clarifying so much for me about the continued misrepresentations and misinterpretations of ideas that, at one time, helped us understand gender nonconformity. It’s now free on Reality’s Last Stand and I’m reprinting it here for my readers, too.

Photo by davisuko on Unsplash

In 1964, UCLA psychiatrist Robert Stoller published a paper, “A contribution to the study of gender identity.” “Gender identity is the sense of knowing to which sex one belongs, that is, the awareness ‘I am a male’ or ‘I am a female,’” wrote Stoller, who is credited with delineating the split between sex—biology—and gender: masculinity and femininity.

A feminine man might have a male gender identity, Stoller suggested, “although he recognizes his lack of so-called masculinity.” Stoller and his colleague Ralph Greenson speculated that this self-knowledge arose through a combination of genitals, familial and peer influence, and “a biological force, which, though hidden from conscious and preconscious awareness, nonetheless seems to provide some of the drive energy for gender identity.”

That is, by gender identity—later defined by Stoller as “core gender identity”—he meant that we all seem to know our sex. “It’s a fundamental component of human cognitive development,” said Alex Byrne, a professor of philosophy at MIT who has written extensively on gender identity. “Very early on, you come to realize not just that other people are divided into males and females, but that you’re either in one box or the other.” Stoller and others saw this clearly, he said. (Stoller doesn’t note that as toddlers and preschoolers, we understand sex in terms of sex stereotypes. It’s not until about age six or seven that most of us experience “sex constancy”—the realization that our bodies dictate our sex, not our adherence to stereotypes.)

There’s plenty of debate about who used the term gender identity first and what they meant; Byrne and others have been digging and debating and adding to the vault of knowledge in recent publications. Stoller asserted that he and Greenson coined the term after much discussion, though it had been used—if not clearly defined—by sexologists and psychologists like John Money and Evelyn Hooker in various papers and public talks in the years before, and UCLA’s Gender Identity Research Clinic had opened in 1962.

These clinicians were working with similar, small populations: feminine boys; people with intersex conditions (then known as hermaphrodites); and transsexuals, as they were called, who were convinced they should have been, or desperately wanted to be, the opposite sex. They felt extreme distress about their sex, a sense that they were the wrong one, and a sharp aching to be the other: gender dysphoria. But they couldn’t feel that way without knowing which sex they were.

Clincians grasped at other terms to describe these patients’ experiences: “psychosexual identity,” “core sexual identity,” or “gender role and orientation as male or female,” as Money put it, among others. Eventually, Money settled on gender identity as “the private experience of gender role.” Gender role was “the public experience of gender identity.” That is, as definitions progressed, they closed in on themselves—circular, vague, and often contradictory.

The term chugged along into the 21^st century. And, in this era, it morphed into something even more protean and slippery.

---

In 2007, the same year the first pediatric gender clinic opened in the United States, author Cynthia Winfield published Gender Identity: The Ultimate Teen Guide. As far as I know, this could be the first book about gender identity directly marketed to kids.

At birth, Winfield writes, children are “assigned a gender”—a word she doesn’t define and which seems to mean sex, sex-based expectations and gender identity. “For the majority, the gender assigned fits the inner self and the body’s physical appearance.” But there are also those children “whose gender, or biological sex, does not correspond to his or her gender identity.” Rather than knowing one’s sex, and possibly having deep distress about it, children now knew their gender, which was either a synonym of biological sex or identity or some other kind of category or, well, who knows.

By 2013, practitioners were defining gender identity as “the gender the child articulates as being—male, female, or something else,” and this articulated gender could match or mismatch one’s natal sex. The identity was “primarily informed by a child’s cognitions and emotions, rather than by genitalia and observable external sex characteristics.” 

The World Professional Association for Transgender Health’s (WPATH) latest “standards of care,” published in 2022, define gender identity as “a person’s deeply felt, internal, intrinsic sense of their own gender.” (Gender includes “gender identity, gender expression, and/or social gender role, including understandings and expectations culturally tied to people who were assigned male or female at birth,” which doesn’t clarify what it means to have a sense of one’s own.) The advocacy group Human Rights Campaign says it’s “One’s innermost concept of self as male, female, a blend of both or neither—how individuals perceive themselves and what they call themselves.” NPR says it’s “one’s own internal sense of self and their gender.” It’s “a person’s self-identified gender,” per Cornell Law, or “an individual’s self-conception as a man or woman or as a boy or girl or as some combination of man/boy and woman/girl or as someone fluctuating between man/boy and woman/girl or as someone outside those categories altogether,” per Encyclopedia Brittanica. One school presentation defined gender identity as “the self.”

Now, of course, gender identity itself has been “queered,” like so much about gender research. There are tens, maybe hundreds of purported gender identities. Per the powers that be—activist and advocacy groups influencing everything from curricula to medical guidelines—everyone has a gender identity, which is not a sense of sex but of gender. If theirs happens to not match their sex, they should be affirmed as the opposite sex, or both sexes, or neither, or as non-binary or genderless or genderfluid or a demigirl, bigender or trigender or ambigender or genderfuck. Any attempt to reconcile gender identity with sex is now seen as “conversion therapy,” despite the fact that research on conversion therapy only pertained to sexuality, and it’s unclear how you reconcile sex with genderfuck, or change the body to match it.

Kids now learn about gender identity at school, and read books about kids, like Jazz Jennings, who had “a girl brain but a boy body”—this, her autobiographical kids’ picture book explains, is transgender. Gender identity is also a pink or blue brain.

Excerpt from I Am Jazz

Most importantly, the concept of gender identity has become so powerful that it shuts down discussion of where those ideas and feelings originate, and what other issues hide behind them. Rather than helping us to understand young people with gender distress, the term gender identity now terminates inquiry.

---

Gender dysphoria in kids was originally called “gender identity disorder of childhood.” That is, if the child “strongly and persistently” desired to be or insisted they were the opposite sex, along with other criteria, there was a disorder in gender identity. 

There’s no doubt that some young children feel certain that they’re in the wrong category, whether or not they suffer over their bodily differences; from early on, they are typical of the opposite sex in mannerisms and gravitate toward the toys and clothes marketed to that sex. They also gravitate toward members of the opposite sex as playmates. A very experienced clinician once told me that gender identity as a term made sense for this population. Before they’re old enough to understand sex constancy, they may identify themselves as the opposite sex, felling they are or should be in the other category. The term is faulty but utilitarian.

And there’s no doubt that there are adolescents and adults—mostly, but not exclusively, men—who feel a deep desire to be the opposite sex, who see themselves that way, or have erotic fantasies about being women. For eons, they had to keep those desires to themselves because our society had so little tolerance for them. Or they acted on those desires, those visions, and were relegated to the societal margins as transsexuals, sometimes literally: the outer avenues of Manhattan where they sold sex, unable to secure employment elsewhere.

Dr. Ray Blanchard, who saw patients seeking sex-reassignment surgery at a Toronto clinic in the 1980s and 90s, divided these into separate, neutral clinical populations, based on etiology. The first were what he called the “homosexual subtype” of transsexuals. These were often very feminine boys and men (mostly males came to the clinic at the time) who were same-sex attracted. The others were heterosexual and what he called “autogynephilic”—attracted to the idea of themselves as women. Beneath the idea of gender identity were complex overlaps of sexuality and gender. Similar feelings could spring from disparate sources and lead to disparate outcomes. As clinicians would later articulate it: many pathways to gender dysphoria, and thus many pathways from it.

As the diagnosis shifted to “gender incongruence,” it solidified the idea of the simple gender identity/body mismatch as the cause of gender dysphoria. In this framing, etiology becomes moot—dysphoria is a medical problem, rather than a psychologically, socially, or culturally-informed problem. There’s only one pathway to gender dysphoria and, often, a single medical pathway out. “In effect, that just labels the thing to be explained,” says Byrne. “It doesn’t explain it.”

Now there’s a new clinical demographic: teens presenting with these newfangled gender identities, reading books or attending presentations about LGBTQ+ identities and locating their experiences there, recognizing something and claiming it, often passionately. Physician/researcher Dr. Lisa Littman categorized them as having “rapid onset gender dysphoria.”

Many of these kids have other mental health issues and no history of gender problems—an even more complex cohort, the etiology of their distress unknown and, because the term ROGD has become so heavily politicized, almost unknowable. Because their dysphoria is attributed to gender identity, it is seen as the source, rather than a symptom, of their problems. As a result, their mental health comorbidities often go untreated.

Many mental illnesses, like anorexia or self-harm, are expressions of suffering, announcements to the world that something is wrong, and a request for others to bear witness to it. If that’s the case, gender identity wouldn’t be the answer as to why the child is suffering, but a pathway for the expression of it. Sometimes I think this has befallen so many upper middle class white kids because their snowplow parents have obsessively spared them from pain and suffering in childhood, and their minds and bodies need to experience it in order to develop their emotional immune systems. 

But boiling the desire to transition, or gender dysphoria, down to “gender identity,” ignores the relationship between gender dysphoria and cross-sex identities and sexuality. Indeed, gender educators insist that gender and sexuality are completely separate. This mindset ignores that the majority of trans women are autogynephilic—and that acknowledging the relationship to sexuality can help them understand themselves and make decisions about how best to treat their distress. We ignore that many proto-gay kids experience gender dysphoria, and the vast majority are likely to grow out of it—that is, if they aren’t socially transitioned. We ignore that there are rising numbers of ROGD kids claiming identities such as Raccoon gender or Ankylosaurugender or Shrewgender or Lilacgender or Pineapplegender or Gamegender‎ or Gastrogender‎ or Neutroboy or Spacegendervoid.

“The modern conception of gender identity has departed from the original one, at the price of obscurity,” said Byrne. “Gender identity is not simply the sense of yourself as male or female. Now it’s the sense of yourself as being a particular ‘gender’, but what gender is supposed to be is never properly explained.”

Some transsexuals disagree with this new concept of gender identities. They understand the reality of sex because they’ve had to work so hard to change their appearance, to take on the secondary sex characteristics of the opposite sex. Buck Angel, for instance, is well aware that he’s female. Indeed, he’s spent plenty of time trying to educate others about what happens to the female body on testosterone. In the old school sense, Buck would have a female gender identity—an awareness of his sex, but enough distress about it that he chose to transition.

But that understanding is now gone. “This is a postmodernist deconstructionist approach towards language,” said Dana Beyer, a transgender woman and retired doctor, with many decades of trans activism under her belt. “You can make it mean whatever the hell you want at any given time of day.” These days, she notes, gender identity is simultaneously something you’re born with that’s permanent and also something that’s fluid and can shift at any given time. “The inherent contradictions are just stunning,” she said—and if you try to point them out, you’re a bigot.

Yet Beyer believes that she is a woman, that gender identity is a deep sense of one’s sex, and that she’s female. “It's more than a feeling,” she said. “It’s a knowing.” Gender identity is “brain sex,” she said, echoing Jazz, and noting that several studies suggest the brains of transsexuals are different than those of non-transsexuals of the same sex. (There are plenty of objections to those studies, too.)

The fact that gender identity is now vague, unmeasurable, completely subjective, and becomes true by declaration—not by objective evaluation—makes it easier for kids to claim a newfangled gender identity, and perhaps to feel special and seen by doing so. They may find community, solidarity, and social capital—especially those who feel intense pressure not to be part of privileged “oppressor” groups. They can climb the social ladder by claiming to be stranded at the bottom of it. It’s the only identity one can opt into, manifest from magical thinking to reality by way of speaking aloud. Because only the child can know his/her/their/xir gender identity, and all the parent or doctor can do is wait for it to emerge, it’s the ultimate in child-led parenting, in patient-centered care.

If gender identity were a nickname or a look or a movement based on musical choice (Swifties, take note), it would be no big deal. But this vague, subjective and immeasurable idea becomes concretized when declared, and can lead to a cascade of very real and permanent interventions. At the very least, kids may be presented with gender support plans, often without parental knowledge, and have their names and pronouns changed on forms. At the most, they medicalize, assuming that they must change their body to align with their gender identity—that gender identity is fixed and sex is mutable, and nonbinary and genderfluid can somehow be etched onto the body.

The problem with “gender identity” is that it ends inquiry rather than spurring it. It erases questions of etiology, and it privileges the slippery notion of gender over the material reality of sex. But this idea, rather than being questioned, has been institutionalized in medicine, in law, in education, and in the minds of a generation.