WE traditionally assign ‘sex’ at birth, but is this dependent on the chromosomal sex, XX: female, XY: male; the gonadal sex, determined by the testicular or ovarian tissue present; phenotypic sex, the manifestations of sex as determined by endocrine hormonal influences; or morphological sex, determined by the physical appearance of the external genitals? Not easy, is it?

At birth, people do not always fall clearly into the categories of male and female, and there may be significant overlapping issues, eg XXY chromosomes, undescended testicles, abnormally high hormonal levels influencing sex organ development, or the presence of both types of external genitalia – termed hermaphrodites – thereby confusing the decision-making process.

GENDER ASSIGNMENT

Later on, there may be additional confusion with the matter of gender assignment. Sex and gender are similar, but are not the same. Gender is a social construct in which expectations vary from society to society. It speaks to how a particular society expects us to act based on our perceived biological characteristics. Society then assigns us to ‘gender roles’, where we are expected to act a certain way – boys should not cry too much, are expected to be strong, aggressive, and should not play with dolls; girls should be pretty, soft, and emotional, should not be “tomboys”.

So what does it mean to be a man, and what does it mean to be a woman? Women and men are often described as being at opposite poles. Many people do not realise that these features are societal constricts, and are not products of nature.

DEVELOPING GENDER IDENTITY

Gender identity is the degree to which people develop the internal subjective framework where they identify themselves as male, female, or some combination of both. Over time it determines the way in which individuals experience a sense of being male, female, bi-gendered, or transgender.

People in all four categories are a part of every society, and historically have been, whether they are suppressed or discriminated against.

SEX ROLE AND SEXUAL ORIENTATION

Sometimes people confuse ‘sex roles’ with ‘sexual orientation’. For example, a ‘feminine’ man may be assumed to be homosexual, or a ‘masculine’ female assumed to be a lesbian. Not only may this not be so, but sex roles can change across cultures and across time. What society may be dictating in one country might be different in another, as well as may have varied over time within the same country.

Researchers such as John Money and Simon Rosser outline gender identity as being influenced by genetic, prenatal, hormonal, post-natal, societal, and post-pubertal factors. We are all products of the interaction of chromosomal, gonadal, phenotypic, and morphological sex, and subsequent gender role assignment and evolved gender identity.

Further, we are all a part of human life that exists along a spectrum of continuity of features: being left-handed, right-handed or ambidextrous; a spectrum of mental abilities from imbecile, weak-minded, to brilliant and genius; from non-interest in sex to moderate sex drive to being hyper-sexed; from being sexually attracted to males, females, both, or none.

Where we fall on the spectrum of each continuum often reflects a combination of heredity, hormonal development factors, socialisation, and choice, with some ingredients being more powerful than others.

SEXUAL BEHAVIOUR

We should therefore be very careful when we use the matter of gender to police the boundaries of sexual behaviour. This matter derives from a very complex interplay of many ingredients.

The important issue is that all societies comprise loving, caring people looking for peace, the love of their families, and the ability to access all the services of a society. Society instils in us certain moral judgements, but we should also respect the rights of others to an existence with dignity and peace.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is a member of the Executive Council of RedBioetica UNESCO.