The meaning of gender incongruence and gender dysphoria

Gender incongruence describes a mismatch between a person's biological sex and their gender identity. This condition can emerge during early childhood and may persist into adulthood.

Gender incongruence

Gender incongruence involves a mismatch between sex and gender where an individual assigned male at birth might identify as female, or vice versa, leading to a sense that their physical body does not align with their internal sense of gender. People with gender incongruence often feel that their assigned sex at birth does not reflect their true gender identity.

Gender dysphoria

Gender dysphoria arises when gender incongruence causes significant emotional distress, such as anxiety. This distress may prompt individuals to seek ways to align their external presentation with their gender identity.

Key features of gender dysphoria:

• Many people pursue gender-affirming treatments, including changes to appearance and behaviour, to live in a manner that matches their identified gender.
• Distress can start in childhood.

Biological explanations for gender incongruence

Biological perspectives suggest that gender incongruence stems from atypical brain development influenced by hormonal factors during prenatal stages. These explanations focus on how differences in brain structure or function may align more closely with the opposite gender.

Role of hormones in brain development

Male and female brains differ due to varying exposure to sex hormones in the womb. Unusual hormone levels during critical development periods could result in brain functioning that is more typical of the other gender. For instance, elevated or reduced testosterone might lead to a brain structure that does not match the individual's biological sex, contributing to gender incongruence.

Research evidence supporting biological explanations

Several studies provide evidence for biological factors in gender incongruence, highlighting differences in brain regions and genetic variations.

Kruijver et al (2000):

• Method - Examined postmortem brain tissue from transgender and cisgender individuals, focusing on the bed nucleus of the stria terminalis (BSTc) region.
• Results - Transgender women had neurone counts in the BSTc similar to cisgender women, approximately half that of cisgender men.
• Conclusions - This supports the idea that brain differences may underlie gender incongruence.

Hare et al (2009):

• Method - Analysed genetic data from transgender women and cisgender men.
• Results - Transgender women were more likely to possess a specific variant of the androgen receptor gene, which affects how male sex hormones (androgens) function.
• Conclusions - Genetic factors influencing hormone sensitivity could contribute to gender incongruence.

Social explanations for gender incongruence

Social explanations emphasise the role of environmental influences and learning processes in shaping gender identity. These views propose that gender incongruence may develop through interactions and reinforcements in a person's surroundings.

Application of social learning theory

According to social learning theory, children may imitate behaviours of role models from the opposite gender. If these behaviours are positively reinforced, it could lead to a gender identity that does not match their biological sex. Rewards for gender-atypical actions or punishments for typical ones might encourage the development of incongruent gender traits.

Research evidence supporting social explanations

Case studies and behavioural interventions have been used to explore how social factors might influence or alter gender incongruence.

Rekers and Lovaas (1974):

• Method - Conducted a case study on a child displaying gender-atypical behaviours, applying behaviour modification techniques.
• Procedure - Reinforced behaviours considered appropriate for the child's biological sex while discouraging others.
• Results - The child's behaviours reportedly shifted towards gender-typical patterns.
• Conclusions - Suggested that gender incongruence could be addressed by reinforcing socially expected behaviours.

Rekers (1977):

• Linked gender identity interventions to broader ideas about 'curing' atypical identities.
• This has since been discredited and criticised for lacking scientific basis and relying on religious views.

Evaluation of explanations for gender incongruence

Explanations for gender incongruence remain debated, with no single theory fully accounting for all cases. Both biological and social perspectives have strengths and limitations, and an interactionist approach may offer the most comprehensive understanding.

Criticisms of biological explanations

• Timing of brain differences - Chung et al (2002) found that sex differences in the BSTc region emerge only in adulthood, suggesting they might result from gender identity development rather than causing it.
• Inconsistent outcomes - Conditions like congenital adrenal hyperplasia (CAH), which involve elevated testosterone, do not typically lead to gender incongruence, indicating hormones alone may not explain the condition.
• Overlooking other influences - Biological views may neglect social and environmental factors that also shape gender identity.

Criticisms of social explanations

• Stigmatisation concerns - Approaches like those from Rekers and Lovaas (1974) have been criticised for pathologising atypical gender identities and attempting to 'change' them to fit societal norms, which lacks social sensitivity.
• Discredited associations - Rekers (1977) connected gender interventions to outdated views on homosexuality as a disorder, drawing criticism for being influenced by personal beliefs rather than empirical evidence.
• Limited generalisability - Case studies, such as Rekers and Lovaas (1974), rely on small samples and may not apply broadly.

Interactionist perspective on explanations

Gender incongruence likely arises from a combination of nature (biological factors like hormones and brain structure) and nurture (social influences like reinforcement). This integrated view accounts for the complexity and variability observed, though ongoing research is needed to clarify the precise interactions.