Many people conflate sexual orientation with gender identity because of misconceptions and attitudes that exist about sexuality. In reality, these are two related, but different, aspects of who we are. Gender identity refers to one’s sense of being male, female, neither of these, both of these, or another gender. Generally, our gender identities correspond to our chromosomal and phenotypic sex, but this is not always the case. Transgender people’s gender identity differs from the sex they were assigned at birth. Transgender people may use a range of terms to describe themselves, including abbreviations (e.g. trans) or terms such as non-binary. When individuals do not feel comfortable identifying with the gender associated with their biological sex, then they may experience gender dysphoria. Gender dysphoria is a diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that describes individuals who do not identify as the gender that most people would assume they are. This dysphoria must persist for at least six months and result in significant distress or dysfunction to meet DSM-5 diagnostic criteria. In order for children to be assigned this diagnostic category, they must verbalize their desire to become another gender. It is important to note that not all transgender people experience gender dysphoria, and that its diagnostic categorization is not universally accepted. For example, in 2019, the World Health Organization reclassified “gender identity disorder” as “gender incongruence,” and categorized it under sexual health rather than a mental disorder. However, health and mental health professionals indicate that the presence of the diagnostic category does assist in supporting those who need treatment or help. Some transgender individuals may undertake a process of transition, in which they move from living in a way that is more aligned with the sex assigned at birth to living in a way that is aligned with their gender identity. Transitioning may take the form of social, legal, or medical aspects of someone's life, but not everyone undertakes any or all types of transition. Social transition may involve the person's presentation, name, pronouns, and relationships. Legal transition can include changing their gender on government or other official documents, changing their legal name, and so on. Some people may undergo a physical or medical transition, in which they change their outward, physical, or sexual characteristics in order for their physical being to better align with their gender identity (UCSF Transgender Care 2019). Not all transgender individuals choose to alter their bodies: many will maintain their original anatomy but may present themselves to society as another gender. This is typically done by adopting the dress, hairstyle, mannerisms, or other characteristics typically assigned to another gender. It is important to note that people who cross-dress, or wear clothing that is traditionally assigned to a gender different from their biological sex, are not necessarily transgender. Cross-dressing is typically a form of self-expression or personal style, and it does not indicate a person's gender identity or that they are transgender (TSER 2021). Intersex is a general term used to describe people whose sex traits, reproductive anatomy, hormones, or chromosomes are different from the usual two ways human bodies develop. Some intersex traits are recognized at birth, while others are not recognizable until puberty or later in life (interACT 2021). Intersex and transgender are not interchangeable terms; many transgender people have no intersex traits, and many intersex people do not consider themselves transgender. Those who identify with the sex they were assigned at birth are often referred to as cisgender, utilizing the Latin prefix "cis," which means "on the same side." (The prefix "trans" means "across.") Many cisgender people do not self-identify as such. As with transgender people, the term or usage of cisgender does not indicate a person's sexual orientation, gender, or gender expression (TSER 2021). Our scientific knowledge and general understanding about gender identity continue to evolve, and people today have more opportunity to explore and openly express different ideas about what gender means than previous generations. Recent studies indicate that the majority of millennials (those ages 18–34) regard gender as a spectrum instead of a strict male/female binary, and that 12% identify as transgender or gender non-conforming. Additionally, more people know others who use gender-neutral pronouns (such as they/them) (Kennedy, 2017). This change in language may indicate that millennials and Generation Z people understand the experience of gender itself differently. As young people lead this change, other changes are emerging in a range of spheres, from public bathroom policies to retail organizations. For example, some retailers are starting to change traditional gender-based marketing of products, such as removing “pink and blue” clothing and toy aisles. Even with these changes, those who exist outside of traditional gender norms face difficult challenges. Even people who vary slightly from traditional norms are often the target of discrimination and violence. Figure 10.19 Actress Laverne Cox, who is openly transgender, is the first transgender actress to portray a transgender character on a regular television series. She is also an advocate for LGBTQ+ issues outside of her career, such as in this "Ain't I a Woman?" speaking tour. (credit: modification of work by "KOMUnews_Flickr"/Flickr) Link to Learning Hear firsthand about the transgender experience and overcoming challenges in the face of discrimination and violence. Watch this brief interview with Carmen Carrera and Laverne Cox on Katie Couric's talk show to learn more. This video about transgender immigrants' experiences explains more struggles faced globally by those in the transgender community.