U.S. society allows for some level of flexibility when it comes to acting out gender roles. To a certain extent, men can assume some feminine roles and women can assume some masculine roles without interfering with their gender identity. Gender identity is a person’s deeply held internal perception of one's gender. Transgender people's sex assigned at birth and their gender identity are not necessarily the same. A transgender woman is a person who was assigned male at birth but who identifies and/or lives as a woman; a transgender man was assigned female at birth but lives as a man. While determining the size of the transgender population is difficult, it is estimated that 1.4 million adults (Herman 2016) and 2 percent of high school students in the U.S. identify as transgender (Johns 2019). The term "transgender" does not indicate sexual orientation or a particular gender expression, and we should avoid making assumptions about people's sexual orientation based on knowledge about their gender identity (GLAAD 2021). Figure 12.5 Actress Laverne Cox is the first openly transgender person to play a transgender character on a major show. She won a producing Emmy and was nominated four times for the Best Actress Emmy. 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) 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 characteristic 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). Figure 12.6 The most widely known transgender pride flag was designed by transgender woman and U.S. Navy veteran Monica Helms. Other designers have different interpretation of the transgender flag, and other groups within the LGBTQ community have their own flags and symbols. Interestingly, Gilbert Baker, the designer of the first widely adopted pride flag, made a point to avoid trademark or other limits on the flag, so that it could be reinterpreted and reused by others. (Credit: crudmucosa/flickr) There is no single, conclusive explanation for why people are transgender. Transgender expressions and experiences are so diverse that it is difficult to identify their origin. Some hypotheses suggest biological factors such as genetics or prenatal hormone levels as well as social and cultural factors such as childhood and adulthood experiences. Most experts believe that all of these factors contribute to a person’s gender identity (APA 2008). 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). While some intersex people have physically recognizable features that are described by specific medical terms, intersex people and newborns are healthy. Most in the medical and intersex community reject unnecessary surgeries intended to make a baby conform to a specific gender assignment; medical ethicists indicate that any surgery to alter intersex characteristics or traits—if desired—should be delayed until an individual can decide for themselves (Behrens 2021). If a physical trait or medical condition prohibits a baby from urinating or performing another bodily function (which is very rare), then a medical procedure such as surgery will be needed; in other cases, hormonal issues related to intersex characteristics may require medical intervention. Intersex and transgender are not interchangeable terms; many transgender people have no intersex traits, and many intersex people do not consider themselves transgender. Some intersex people believe that intersex people should be included within the LGBTQ community, while others do not (Koyama n.d.). 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.") Because they are in the majority and do not have a potential component to transition, 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). And as many societies are heteronormative, they are also cisnormative, which is the assumption or expectation that everyone is cisgender, and that anything other than cisgender is not normal. The language of sexuality, sexual orientation, gender identity, and gender expression is continually changing and evolving. In order to get an overview of some of the most commonly used terms, explore the Trans Student Educational Resources Online Glossary: http://openstax.org/r/tsero 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 the other 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. People become aware that they may be transgender at different ages. Even if someone does not have a full (or even partial) understanding of gender terminology and its implications, they can still develop an awareness that their gender assigned at birth does not align with their gender identity. Society, particularly in the United States, has been reluctant to accept transgender identities at any age, but we have particular difficulty accepting those identities in children. Many people feel that children are too young to understand their feelings, and that they may "grow out of it." And it is true that some children who verbalize their identification or desire to live as another gender may ultimately decide to live in alignment with their assigned gender. But if a child consistently describes themselves as a gender (or as both genders) and/or expresses themselves as that gender over a long period of time, their feelings cannot be attributed to going through a "phase" (Mayo Clinic 2021). Some children, like many transgender people, may feel pressure to conform to social norms, which may lead them to suppress or hide their identity. Experts find evidence of gender dysphoria—the long-term distress associated with gender identification—in children as young as seven (Zaliznyak 2020). Again, most children have a limited understanding of the social and societal impacts of being transgender, but they can feel strongly that they are not aligned with their assigned sex. And considering that many transgender people do not come out or begin to transition until much later in life—well into their twenties—they may live for a long time under that distress. Discrimination Against LGBTQ people Recall from the chapter on Crime and Deviance that the FBI's hate crime data indicates that crimes against LGBTQ people have been increasing, and that those crimes account for nearly one in five hate crimes committed in the United States (FBI 2020). While the disbanding of anti-LGBTQ laws in the United States has reduced government or law enforcement oppression or abuse, it has not eliminated it. In other countries, however, LGBTQ people can face even more danger. Reports from the United Nations, Human Rights Watch, and the International Lesbian, Gay, Trans, and Intersex Association (ILGA) indicate that many countries impose penalties for same-sex relationships, gender noncomformity, and other acts deemed opposed to the cultural or religious observances of the nation. As of 2020, six United Nations members imposed the death penalty for consensual same-sex acts, and another 61 countries penalized same sex acts, through jail time, corporal punishment (such as lashing), or other measures. These countries include prominent United States allies such as the United Arab Emirates and Saudi Arabia (both of which can legally impose the death penalty for same-sex acts). Some nearby nations criminalize same-sex relations: Barbados can impose lifetime imprisonment for same-sex acts, and Jamaica, St. Kitts and Nevis, and Saint Lucia have lesser penalties, though Saint Lucia's government indicates it does not enforce those laws (ILGA 2020). Even when the government criminal code does not formalize anti-LGBTQ penalties, local ordinances or government agents may have wide discretion. For example, many people fleeing Central American countries do so as a result of anti-LGBTQ violence, sometimes at the hands of police (Human Rights Watch 2020). Such severe treatment at the hands of the government is no longer the case in the United States. But until the 1960s and 1970s, every state in the country criminalized same-sex acts, which allowed the military to dishonorably discharge gay veterans (stripping them of all benefits) and law enforcement agencies to investigate and detain people suspected of same-sex acts. Police regularly raided bars and clubs simply for allowing gay and lesbian people to dance together. Public decency laws allowed police to arrest people if they did not wear clothing aligning with the typical dress for their biological sex. Criminalization of same-sex acts began to unravel at the state level in the 1960's and 1970s, and was fully invalidated in a 2003 Supreme Court decision. Hate crimes and anti-LGBTQ legislation are overt types of discrimination, but LGBTQ people are also treated differently from straight and cisgender people in schools, housing, and in healthcare. This can have effects on mental health, employment and financial opportunities, and relationships. For example, more than half of LGBTQ adults and 70 percent of those who are transgender or gender nonconforming report experiencing discrimination from a health care professional; this leads to delays or reluctance in seeking care or preventative visits, which has negative health outcomes (American Heart Association 2020). Similarly, elderly LGBTQ people are far less likely to come out to healthcare professionals than are straight or cisgender people, which may also lead to healthcare issues at an age that is typically highly reliant on medical care (Foglia 2014). Much of this discrimination is based on stereotypes and misinformation. Some is based on heterosexism, which Herek (1990) suggests is both an ideology and a set of institutional practices that privilege straight people and heterosexuality over other sexual orientations. Much like racism and sexism, heterosexism is a systematic disadvantage embedded in our social institutions, offering power to those who conform to heterosexual orientation while simultaneously disadvantaging those who do not. Homophobia, an extreme or irrational aversion to gay, lesbian, bisexual, or all LGBTQ people, which often manifests as prejudice and bias. Transphobia is a fear, hatred, or dislike of transgender people, and/or prejudice and discrimination against them by individuals or institutions. Fighting discrimination and being an ally Figure 12.7 Hashtags, pride parades, and other activism are important elements of supporting LGBTQ people, but most experts and advocates agree that some of the most important steps are ones taken internally to better educate ourselves, and on interpersonal levels with friends, coworkers, and family members. (Credit: Lars Verket/flickr) Major policies to prevent discrimination based on sexual orientation have not come into effect until recent years. In 2011, President Obama overturned “don’t ask, don’t tell,” a controversial policy that required gay and lesbian people in the US military to keep their sexuality undisclosed. In 2015, the Supreme Court ruled in the case of Obgerfell vs. Hodges that the right to civil marriage was guaranteed to same-sex couples. And, as discussed above, in the landmark 2020 Supreme Court decision added sexual orientation and gender identity as categories protected from employment discrimination by the Civil Rights Act. At the same time, laws passed in several states permit some level of discrimination against same-sex couples and other LGBTQ people based on a person's individual religious beliefs or prejudices. Supporting LGTBQ people requires effort to better understand them without making assumptions. Understand people by listening, respecting them, and by remembering that every person—LGBTQ or otherwise— is different. Being gay, lesbian, bisexual, transgender, queer, intersex, or asexual is not a choice, but the way a person expresses or reveals that reality is their choice. Your experience or knowledge of other LGBTQ people (even your own experience if you are LGBTQ) cannot dictate how another person feels or acts. Finally, as discussed in the Race and Ethnicity chapter, intersectionality means that people are defined by more than their gender identity and sexual orientation. People from different age groups, races, abilities, and experiences within the LGTBQ community have different perspectives and needs. While each individual has their own perspective, respecting their feelings and protecting their equality and wellbeing does have some common elements. These include referring to a person as they would like to be referred to, including the avoidance of abbreviations or slang terms unless you are sure they accept them. For example, many people and organizations (including those referenced in this chapter) use the abbreviation "trans" to represent transgender people, but a non-transgender person should not use that abbreviation unless they know the person or subject is comfortable with it. Respect also includes people's right to privacy: One person should never out a person to someone else or assume that someone is publicly out. LGBTQ allies can support everyone's rights to be equal and empowered members of society, including within organizations, institutions, and even individual classrooms. Supporting others may require a change in mindset and practice. For example, if a transgender person wants to be referred to by a different name, or use different pronouns, it might take some getting used to, especially if you have spent years referring to the person by another name or by other pronouns. However, making the change is worthwhile and not overly onerous. You can learn more about being an ally through campus, government, and organizational resources like the Human Rights Campaign's guide https://www.hrc.org/resources/being-an-lgbtq-ally Language is an important part of culture, and it has been evolving to better include and describe people who are not gender-binary. In many languages, including English, pronouns are gendered. That is, pronouns are intended to identify the gender of the individual being referenced. English has traditionally been binary, providing only “he/him/his,” for male subjects and “she/her/hers,” for female subjects. This binary system excludes those who identify as neither male nor female. The word “they,” which was used for hundreds of years as a singular pronoun, is more inclusive. As a result, in fact, Merriam Webster selected this use of “they” as Word of the Year for 2019. “They” and other pronouns are now used to reference those who do not identify as male or female on the spectrum of gender identities. Gender inclusive language has impacts beyond personal references. In biology, anatomy, and healthcare, for example, people commonly refer to organs or processes with gender associations. However, more accurate and inclusive language avoids such associations. For example, women do not produce eggs; ovaries produce eggs. Men are not more likely to be color-blind; those with XY chromosomes are more likely to be color blind (Gender Inclusive Biology 2019). Beyond the language of gender, the language of society and culture itself can be either a barrier or an opening to inclusivity. Societal norms are important sociological concepts, and behaviors outside of those norms can lead to exclusion. By disassociating gender identity, gender expression, and sexual orientation from the concept of norms, we can begin to eliminate the implicit and explicit biases regarding those realities. In everyday terms, this can take the form of avoiding references to what is normal or not normal in regard to sexuality or gender (Canadian Public Health Association 2019).