Sex versus gender: meaning, medical care, controversy

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Sex and gender are two different things. Sex has to do with human biology. Describe your chromosome makeup, your hormones, and / or your anatomy. Gender, on the other hand, describes a person's understanding of themselves as male, female, or an entirely different gender.

There is a misconception that there are only two genders: male and female. In fact, everything is more complicated. While most people's biology falls into these categories, other people's bodies are in the range between them.

People whose bodies cannot be unequivocally categorized as male or female can be described as intersex, intersex, or sexually differentiated or disabled .

In addition to sexual diversity, there is a growing awareness of gender diversity among people. This reflects the increasing visibility of transgender people , those whose gender identity does not match what is expected of their gender at birth.

Transgender people can be of binary and non-binary sex, and gender, like gender, exists in a wide range. Intersex people can also identify as transgender or of different genders.

Understanding sex

The biology of sex begins with a discussion of chromosomes. There are two types of sex chromosomes: X and Y. Most people have two sex chromosomes, those with two X chromosomes are usually female, and those with X and Y are usually male.

However, some people have one sex chromosome or three sex chromosomes. They can be divided into intersex or endosexual (binary male or female). Also, some people have two chromosomes, but some genes on one of the chromosomes may not work properly. This can lead to someone turning out to be, for example, the XY woman .

The next important aspect of biology that determines a person's sex is their hormones and hormone receptors. Exposure to androgens such as testosterone leads to the development of structures associated with the male sex.

Lack of androgen exposure or ineffective androgen exposure leads to the development of structures associated with the female sex. Androgen ineffectiveness occurs when there is a problem with the proteins (androgen receptors) that respond to the stimulation of these hormones. Lack of androgen exposure occurs when the body does not produce testosterone or DHT .

Finally, it is important to note that the sex recorded on a person's birth certificate is not related to their chromosomes or hormones, but to their anatomy. Although in most cases the human anatomy is a reflection of its chromosomal composition, this is not always true. Sex is harder than just X and Y.

Understanding gender

Gender describes a person's understanding of himself as a man, a woman, or the other gender. Most people's genders match their registered sex at birth, and people for whom this is true are called cisgender . People whose gender does not match their registered sex at birth may be characterized as transgender or of different genders.

As with sex, gender has several components. Most of the time when we talk about gender, we are talking about your gender identity, which is described above. However, in addition to gender identity, people also have gender expression .

Gender expression describes the gender-specific ways that people represent the word. This may or may not be a reflection of your gender identity. For example, a cis woman with short hair who likes to wear a tailored suit is still a woman. A transgender man with long hair is still a man.

Gender expression is deeply culturally constructed. What is understood by male or female presentation depends a lot on the place and the time. There was a time when pink was considered too strong and masculine for women.

Floor to floor

In summary, we can say that sex is a matter of biology and gender is identity. If gender and gender are the same, it is usually not necessary to intervene. In case of gender and gender mismatch, people can ask for help.

Health care when gender is different from gender

Some people whose gender and gender do not match choose to seek gender reassignment treatments or surgical procedures to confirm their gender. The goal of gender validation care is to alleviate gender dysphoria , the discomfort caused by the mismatch between a person's body and their identity.

However, some people conceptualize gender-affirming attention as a way to achieve gender euphoria – feelings of happiness and satisfaction in your gender-sensitive body.

Consent and disagreement about intersex care

Historically, doctors and parents performed early surgery on infants and children with intersex traits to "normalize" the appearance of their genitalia.

This was often not discussed with children even when they were older, and many intersex people were treated without knowledge of their condition or without permission to make informed consent decisions.

It was believed that if a boy's genitalia were made to appear distinctly male or female, it would be easier for them to live as healthy and happy young men or women. However, the foundational work that established this withdrawal pattern later turned out to be highly problematic.

The John / Joan case

In the 1960s, Johns Hopkins University psychologist John Money urged the boy's parents to raise him as a girl after a boy suffered a devastating penile injury during a failed circumcision.

An operation was performed to give the boy female genitalia and during puberty he was given female hormones. The child was never told that he was born a boy.

The early findings of her case have been used to justify hundreds or thousands of unnecessary surgeries to other children with intersex disorders or other genital differences. John Money said his case showed that only parenting affects a person's gender identity, and medical practice has changed accordingly.

Unfortunately, John Money was wrong. In adolescence, the boy abandoned the feminine identity that was assigned to him. Eventually she learned that she was born male and began receiving medical and surgical care to help her body reflect her gender identity and the gender in which she was born.

Unfortunately, he suffered from depression for most of his life and committed suicide in his 30s. Even sadder, it was years before the medical establishment began to believe that genital surgery in boys might not be the best for them.

There is a growing awareness that genital surgery for intersex children is a violation of their human rights, with potentially devastating consequences for their medical, physical and sexual health throughout their lives .

In the United States, prestigious children's hospitals such as Boston Children's Hospital and Lurie Children's Hospital, which historically performed these types of operations, began to stop offering some or all non-medical procedures until patients could participate in self-treatment.

This represents a great step forward in respecting the right of children to a full and happy life, which includes the possibility of healthy sexual function in adulthood.

However, some researchers, doctors, and parents still argue that having binary genitalia is more important to children's lives and well-being than empowering them to make decisions about their care .

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