Terminology
Terminology
‘Gender identity’ refers to one’s internal sense of self and is being increasingly acknowledged as including a wider range of possibilities than the socially organising categories of ‘man’ and ‘woman’.
‘Gender non-conformity’ refers to certain behaviours and/or presentations, (e.g.: the use of clothing, hairstyle, etc) that challenge expected gendered behaviour. Not all gender non-conforming individuals are trans; they simply express their gender in an unconventional way.
Gender identity is not the same as ‘sexual orientation’ (sexual attraction, sexual behaviour, sexual identity).
‘Cisgender’ (commonly shortened to ‘cis’) has its meaning derived from the Latin prefix cis- meaning ‘this side of’ and refers to individuals whose sense of their gender corresponds to that assigned to them at birth.
‘Trans’ (an abbreviation of ‘transgender’) is a commonly used umbrella term to capture a broad range of gender identities and experiences that are other than cis. It is a widely used and accepted term in the UK.
Some people prefer to be regarded simply as a ‘man’ or ‘woman’ and not as (or ‘identifying as’) a ‘trans woman’ or ‘trans man’. For a variety of reasons, some people choose to keep their trans history private and allow others to assume that they are cis (sometimes referred to as ‘stealth’). Degrees of privacy around trans status/history varies between different people – some may be comfortable sharing with acquaintances, others only with close friends, and others with no-one unless unavoidable. The latter situation can present clinical challenges, particularly when coupled with a request to delete prior medical records or when the need to share information pertaining to birth-assignation is central to the provision of good medical care.
‘Gender incongruence of adolescents and adults’ is a diagnosis of the ICD-11 (WHO 2019) and is defined as a discrepancy experienced between a person’s gender identity and the assignation made at birth.2
‘Gender Dysphoria’ is a diagnosis of the DSM-5 (APA, 2013) and gender dysphoria (not capitalised) the term used by individuals to describe the clinically significant distress that gender incongruence can cause some people to experience.3 It can relate to physical attributes (often, but not exclusively, sex characteristics), and/or social interactions. Someone is misgendered when they are referred to using a salutation, pronoun, name, or title that does not correctly reflect their gender (for example, masculine titles or pronouns for a trans woman). This can generate significant psychological distress, and for some, severely restricts psychosocial functioning.
‘Transsexual’ is an older term that some trans individuals identify with and use, while others consider it outdated or experience it as offensive with pathologizing implications. Practitioners should establish what language a trans person uses to describe themselves and apply this in context without universalising to other patients. As a diagnostic term, ‘Transsexualism’ (ICD-10) is depreciated. Its replacement, ‘Gender Incongruence’ is more inclusive of those with non-binary genders and does not position trans status as inherently pathological.
‘Transvestism’ denotes a preference for cross-dressing as opposed to living permanently as a gender different to that assigned at birth. As with ‘transsexual’, some individuals will identify with the term, while others reject its use as out-dated and pathologizing. ‘Cross-dressing’ (or cross-dresser) is commonly preferable.
‘Intersex’ is an umbrella term used to describe a range of diverse variations in sex characteristics. Intersex people do of course have a gender identity, but it is best practice among trans and intersex groups to understand trans and intersex as distinct and distinguishable phenomena, with different barriers and experiences within healthcare. As most intersex people are ultimately assigned male or female at birth it is possible for an intersex person to also be trans, however being trans does not inherently mean someone is intersex.
Lastly, it is important to consider the cultural context of trans and gender diverse groups, regarding how a person might experience living authentically and the challenges or possible risk involved in doing so.
Practical Tip
Never assume. If you’re not sure, ask your patient how they best describe their gender identity. The same is true for gender pronouns. Using the right pronoun avoids misgendering and signals that you have an inclusive approach. If you make a mistake, the best approach is to acknowledge it and move on.
“You probably aren’t an expert in trans issues—that’s OK. You don’t need to be an expert to treat me with kindness and compassion: something as simple as the name you call me makes a huge difference”. I am your trans patient, BMJ 2017