Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018)

Abstract

Turban and Ehrensaft (2018) have provided a thoughtful review of transgender identity in children and adolescents, emphasizing the benefits of the affirmative approach in maintaining positive psychological health in transgender individuals. The review reveals significant gaps in our understanding of gender identity regarding its nature, development, plasticity, causes, and links with other aspects of gender, and of the long‐term benefits and costs of childhood social transitions. A full understanding of transgender identity requires studying cisgender identity too, and recognition that gender identity is continuous, develops across time and is not synonymous with gender expression or variations in gender‐typed characteristics. Considerable evidence is needed before we can be confident that we are providing optimal treatment for children who are gender variant.

Commentary: Gender diversity and adolescent mental health – a reflection on Potter et al. (2020)

“…These data support prior remarks by, for example, Berenbaum (2018) that variations in gendered behavior and non‐sex‐typical expression of gender do not necessarily indicate sex‐gender incongruence in the subjective feeling of self. Thus, findings by Potter et al highlight how distinguishing multiple dimensions of gender identity may help to better explain diversity in expression and subjective experience of gender.…”

“…Their study shows that individual differences in gender identity significantly relate to adolescent mental health problems. Moreover, findings of the current study, and future follow‐up assessments of the ABCD cohort, will, hopefully, add important quantitative, empirical data to the controversial discussions on gender identity development and gender diversity in childhood and adolescence (Berenbaum, 2018; Kreukels & Burke, 2020; Steensma & Cohen‐Kettenis, 2018).…”

“…In addition, gender diversity, that is, when expression of gender does not align with one’s birth‐assigned sex, is no longer linked exclusively to transgender individuals. Previously, Berenbaum (2018) noted: ‘atypical gender expression is not an indication of either transgender identity or nonbinary gender identity, […]. Gender‐atypical presentation and activities are found in people with both cisgender [when sex and gender are congruent] and transgender identity’ (p. 1245).…”

Evidence and Implications From a Natural Experiment of Prenatal Androgen Effects on Gendered Behavior

“…In particular, females with C-CAH generally have female-typical gender identity. Although some conversations focus on gender identity as innate and stable, data show that it develops across time and cannot be easily attributed to genes or specific aspects of physiology, including androgens (for discussion, see Berenbaum, 2018). Among females with C-CAH, the vast majority (90%–95%) report female binary identity (when asked to report their identification as either female or male), although the number who express gender dissatisfaction or male identity is greater than in unaffected females; furthermore, girls and women with C-CAH are somewhat less female identified than those without CAH when assessed using continuous measures of gender identity (Berenbaum & Bailey, 2003).…”

Living Up to a Name: Gender Role Behavior Varies With Forename Gender Typicality

“…Choosing a forename to embody gender identity is a common occurrence at birth and described as a fundamental aspect of a transgender individual's transition (VanderSchans, 2015), consistent with our hypothesis that forenames influence the expression of gender-typed behavior because they strengthen or weaken gender identification (i.e., they are an additional condition in the set). It is clear that different pathways to gender identity exist: gender-typed behavior, for example, may be a condition of gender identity, but most individuals who are gender-atypical in behavior are not transgender (Berenbaum, 2018). Significantly, fuzzy-sets allow consideration of combinations of conditions that are sufficient or necessary for varying degrees of membership in a binary category (Pennings, 2003) and have advantages for understanding causality over conventional techniques such as logistic or linear regressions when, for example, different conditions yield the same outcome (Graham et al, 2019).…”