Everything should be made as simple as possible – but no simpler.
 Albert Einstein

I am a man and have never had any doubt about this fact, but I would find it very difficult to say what it feels like to be a man. I would have to compare it to some other state of being, such as that, say, of a cat. Sometimes I wonder what it’s like to be a cat, but since I’m not a cat it’s impossible for me to say what that’s like.

Similarly, if I were asked to state my gender identity, this would sound rather odd. What does gender identity mean?

Since there is some confusion these days in discussions about sex, gender, and transgenderism, I have attempted to clarify the matter by offering the following really simple definitions:

Sex
The state of being male or female as determined by genital anatomy and chromosomes. Anatomy is obvious, and in every cell of the body an XY or XX chromosome will be found in a male or female person, respectively. There are, therefore, only two sexes, so by definition sex is binary.

(In about 1:5,500 or 0.018 per cent of live births, babies are born with ambiguous genitalia. These rare abnormalities are called disorders of sexual differentiation which I do not discuss here.)

Gender
A euphemism for sex as when filling in forms: ‘State your gender: male or female.’ Used in expressions such as ‘gender pay-gap’ and ‘gender roles’.

Also, recently has been appropriated by transgenderists to refer to how people ‘identify’, as in the expression ‘gender identity’. This is because, when a baby is born, nearly always the first thing that the midwife or midhusband says to the birthing person is, ‘Here’s your baby. What gender would you like to assign to them?’

Gender may thus be assigned, designated, or labelled and therefore can be reassigned, re-designated, or re-labelled.

Gender identity
A person’s deep internal, individual, unique sense, feeling, belief, fantasy, or delusion that he or she is really of the opposite sex, both sexes, neither sex, something in between, or something that changes from time to time (‘gender fluid’).

Transgender (‘trans’ for short)
Noun and adjective: someone whose gender identity (see above) or gender expression (see below) differs from their sex.

Gender dysphoria
A state of unease, dissatisfaction, or distress, especially clinically significant distress, due to incongruence between one’s gender identity and one’s sex. Like Schrödinger’s cat – cats again! – it’s a mental disorder and it’s not a mental disorder:

A diagnosis for gender dysphoria is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…published by the American Psychiatric Association. The diagnosis was created to help people with gender dysphoria get access to necessary health care and effective treatment. (Mayo Clinic, 2023.)

Gender dysphoria is not a mental illnes. (NHS, 2023.)

Gender expression or presentation
A person’s appearance, clothing, behaviour, mannerisms, and interests that are conventionally associated with being male or female; the appearance, clothing, behaviour, etc., of different types of transgender people.

Treatment for the created diagnosis of gender dysphoria
This is called affirmative care and means, for people of the female sex, any or all of the following (incomplete list):

  • Puberty blocker (if pre-pubertal) – an experimental treatment that may impair bone development and have adverse effects on the brain
  • Testosterone (male hormone) by injection or skin patch, indefinitely
  • ‘Chest binding’ with special garment to flatten the breasts
  • Bilateral mastectomy (surgical removal of the breasts)
  • Hysterectomy and bilateral salpingo-oophorectomy (removal of womb, ovaries, and Fallopinan tubes)
  • Wearing prosthesis to immitate the ‘crotch bulge’ of male genitalia
  • Surgical creation of scrotum with insertion of testicular prostheses
  • Construction of a ‘neo penis’ – a complicated plastic surgery procedure

Result: partial imitation of the external appearance of a man; zero sexual function; permanent sterility; need for regular prescriptions and medical supervision for side effects of treatment; possible regret for the rest of one’s life.

For people of the male sex, any or all of the following (incomplete list):

  • Puberty blocker (if pre-pubertal) – an experimental treatment that may impair bone development and have adverse effects on the brain
  • Oestrogen (female hormone) by mouth, indefinitely
  • Aumentation of breast size by silicone implants
  • Development of female fat distribution
  • Failure to develop beard or cessation of beard growth
  • Removal of testes (castration)
  • Refashioning scrotum in imitation of a vulva
  • Refashioning the penis and making a surgical wound to create a faux vagina in front of the rectum
  • Reducing and repositioning the glans to make a clitoris look-alike

Result: partial imitation of the external appearance of a woman; little or no sexual function; permanent sterility; need for regular prescriptions and medical supervision for side effects of treatment; possible regret for the rest of one’s life.

Treatment for the symptoms of the non-disease of gender dysphoria
If desired, psychotherapy (not be confused with conversion therapy) to explore the cause(s) of the person’s distress, including family background and relationships, history of the development of feelings of gender dysphoria, etc., with a view to helping the person accept or come to terms with his or her physical reality.

Text © Gabriel Symonds

Picture credit: Zoe Gayah Jonker on Unsplash