Many societies construct additional categories between male and female to accommodate people who do not fit into a binary gender system. The term multiple gender indicates a gender system that goes beyond male and female, adding one or more categories of variant gender to accommodate more sex/gender diversity. A variant gender is an added version of male or female that accommodates those who were not assigned to that category at birth but adopt that identity during the course of their lives. A person whose biology, identity, or sexual orientation contradicts their assigned sex/gender role can adopt a variant-gender identity. For instance, a person might be considered female at birth but later transition to a masculine version of female—what anthropologists term female variant. Cultural anthropologist Serena Nanda (2000) has studied variant-gender categories in many societies, including Native North American societies and peoples in Brazil, India, Polynesia, Thailand, and the Philippines. The widespread practice of multiple gender indicates a common cultural need to accommodate the complexities of human sex/gender and sexuality. In contrast, European and Euro-American societies have inherited a rigid two-gender system that stigmatizes people who do not conform to the gender identity assigned to them at birth. Activists pressing for more gender flexibility can be inspired by examples of alternative gender in many non-European cultures. When Spanish explorers first came to North America, they were astonished to find men in Native American societies who dressed as women, did the work of women, and had sexual relationships with men. Later, anthropologists who studied Native American groups discovered that some groups, including the Crow and the Navajo, had categories of variant male (assigned a male identity at birth but adopting a feminine identity later on) and variant female (assigned female at birth but adopting a masculine identity later on). Note that people in variant categories did not fully transition to the opposite gender but rather took on a masculine or feminine variant of the sex assigned at birth. Ignoring the Native American terms for variant gender, early European explorers referred to variant males as berdache, a Portuguese term that indicated a male prostitute—though that is not what they were at all. In 1990, as Native American LGBTQ people sought to resurrect their heritage of variant gender, they coined the pan-Indian term two-spirit people, meaning people with both male and female spirits. Two-spirit people were highly valued and esteemed in Native cultures. Rather than facing stigma or rejection, their alternate gender identity was thought to give them special talents and spiritual powers. In many Native American societies, two-spirit people often became healers and spiritual leaders. They were typically very successful at performing the work of the opposite gender. Male-variant people were known for their excellent cooking and needlework, and many female-variant people were great hunters and warriors. Two-spirit people were also called upon to act as intermediaries between genders, such as in marriage arrangements. Like gender-nonconforming people in many societies, two-spirit people began to realize their variant identities in childhood, rejecting the activities associated with their assigned gender. A boy might want to cook or weave, or a girl might prefer to hunt and play with the boys. If there were not enough boys to hunt, a family might even encourage a girl to develop a variant identity so that she could help provide meat to the family. Sometimes, children would experience visions or dreams guiding them to the tools associated with the opposite gender. Generally speaking, people of variant gender had sexual relationships with people of the gender opposite their lived identity. So if a person took on the clothing and work of a woman, they would be expected to have intimate relationships with men, and people who lived as men would have relationships with women. Neither two-spirit people nor their opposite-gender partners were considered lesbian or gay. With European colonization of North America came a much more restrictive system of gender categories and sexualities. As Euro-Americans expanded into Native American territories, Native Americans were pressured to assimilate to Euro-American norms. From 1860 to 1978, children were removed from their families and sent to assimilationist schools, where they were taught that Native cultures were backward and variant genders were sinful and deviant. By the 1930s, variant-gender practices had largely disappeared. However, with the rise of the American LGBTQ movement, many Native Americans have rediscovered the more flexible and tolerant gender system of their ancestors.

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