Gender identity: better understanding to better support

gender is the set of processes and social relationships that serve to categorize humans. This categorization process is part of the cognitive functions that allow our brain to save part of its resources by simplifying the understanding of our environment. Most often, throughout history and cultures, the gender of individuals has been defined based on their sex.

Sex and gender are, however, two separate notions and very different.

Sex is a biological concept. It evolves between two modes (male and female) and is constructed from numerous physiological factors: chromosomes, genes, hormonal production, sexual organs and secondary sexual characteristics, mainly. There are therefore many variations in the biological expression of sex.

Gender is a social and psychological concept that evolves within a broad spectrum. It is mainly composed of four factors:

• Gender identity, that is to say a person's self-identification with one or more genders.
• Gender expression, that is to say the way in which an individual will modify their presentation in order to correspond to their gender. Clothing, haircut, makeup, jewelry, name and pronouns, etc.
• The relationship with the body, because the body we have may not correspond to the body associated with our gender identity, which can cause a very strong feeling of distress.
• Relationships to gender roles, strongly influenced by culture, and most often play a role in the male-female binary.

An individual's gender is often assigned at birth based on sex, but it is a part of identity that evolves enormously over the course of life.

Some of these developments are socially expected. A young boy's gender expression will not be the same as when he was a teenager, which will still be different from his gender expression as an adult.

If an individual's gender identity and gender expression follows the gender assigned at birth (male or female), we will speak of a cisgender person. Cisgender people are comfortable with this identity and their development follows what is expected and socially accepted.

However, for some people, there is a divergence between their gender identity and the gender assigned at birth. We will then speak of a transgender person.

The best known and most represented transidentity and binary transidentity: people assigned male at birth who transition to a female identity, and people assigned female at birth who transition to a male identity.

There is, however, a broader spectrum of gender identity between, and beyond, these two poles.

As we saw previously, the concept of gender is constructed from numerous factors, and as a result, all of these variations make gender a spectral concept.

It is very difficult to represent this gender spectrum, but here is a simplified version:

In this representation, shades of red are feminine, shades of blue are masculine. Shades of pink and purple are therefore at the crossroads between these two genres, in the area of ​​androgyny. Thus, just on this fairly binary aspect, we can observe a first spectrum.

In this representation, however, there are colors belonging neither to the blue family nor to the red family. It will be about non-binarity. non-binary trans people do not identify with traditional genders, and express their gender identity differently from the stereotypes expected of men and women. This expression can be closer to traditional genres, because existing fashion is very largely based on it for example, but these identities remain outside of this binary.

The last term represented in this image is the word “Agender” in the center, on white. In this view of gender, the intensity of color represents the intensity of identification with a gender. The more saturated the color, the stronger the identification. The lighter the color, the less strong the identification. Some people identify with no gender, or very weakly. Gender expression is of little importance to them, and how they are perceived has little importance.

This diagram allows us to understand in a pictorial way that gender is a question of nuances, which varies between each individual, most often in monochromes and rarely on a single color throughout life.

Thanks to a better understanding of transidentity in recent years, it is no longer considered a mental pathology in the major manuals of classification and diagnosis of diseases. However, transidentity can be a source of great suffering, particularly gender dysphoria.

It is an intense discomfort that occurs when gender expression does not correspond to gender identity. Dysphoria can be triggered by body appearance, clothing style, use of wrong pronouns or the wrong first name, anything reminiscent of the gender assigned at birth that does not correspond to the actual gender.

The best way to relieve dysphoria is obviously transition. It can be medical, with surgery, hormones and vocal rehabilitation, but also social, with clothing, the use of the chosen name and appropriate pronouns. It is important to note that transition does not have to be medical and that gender reassignment surgery is not necessary or desired by all transgender people.

Dysphoria is one of the most determining factors in the high rate of suicides and suicide attempts among transgender people. It is therefore important to assess suicidal ideation in patients with strong gender dysphoria.

In addition to supporting your transgender patients in their transition processes, providing them with moments of gender affirmation helps relieve dysphoria. use the right first name and pronouns (do not hesitate to ask for them if necessary) as well as offering them techniques for managing emotions and distress, because transitions are often long processes.

More generally, kindness, listening and acceptance are the key words in caring for a transgender patient. Their identity should not be questioned, nor their suffering. Their lives are often filled with varying degrees of violence, and the therapist must be a safe place to move forward and relieve their discomfort.