If you are a mental health clinician, it is important to be aware of the difference between biological sex, gender identity, gender expression, and sexual orientation. It is also important to be familiar with various gender identities. If a client is struggling with their gender identity/expression, and does not feel comfortable discussing this subject with you, you are doing them a disservice as a clinician. In addition, your client should be able to speak about their own individualized gender experiences, and the therapeutic relationship may be strengthened when they have the ability to teach you about their own identity and gender process. However, you should have at least a basic understanding of gender identity and expression, and your client should not have to completely educate you on gender identity and expression.
If you or a loved one is exploring gender, it is also important to understand these differences and become familiar with some gender identities. Through becoming more knowledgeable and opening yourself to more understanding, you can show yourself or your loved one that you are accepting and love them enough to learn more. Please keep an open mind as you read through this article, and understand that this is a very generalized understanding of each of these terms; each person has an individualized experience with their gender.
Many people in our society still conflate gender and sex. However, they are not the same thing. Gender differs from biological sex in that biological sex is associated with one’s primary and secondary sex characteristics, chromosomes, and hormone prevalence. In contrast, gender is a social construct that refers to the roles, behaviors, activities, and attributes that a culture deems appropriate for boys, girls, men, and women. These expectations can impact how a person acts, thinks, feels about themselves, and even how they interact with others . Gender also differs from sexual orientation; gender refers to how you identify and express yourself, while sexual orientation broadly refers to which gender or genders you are attracted to. Sexual orientation will not be addressed in this blog post.
While biological sex is similar across cultures (male, female, intersex), gender varies greatly. Some cultures formally recognize only two genders, while other cultures recognize three, four, or even more genders. Because gender is a social construct, there is no “correct” answer to determine the number of gender identities available. Language around gender identity is constantly changing and being updated, so there are new terms and definitions people are using to label themselves all the time!
However, before getting into these terms and definitions, it is important to note that there still seems to be much confusion about the difference between gender identity and gender expression. The way a person identifies and the way a person expresses themselves are sometimes very different.
Gender Identity is who you feel you are internally. Regardless of your biological sex and your gender expression, your identity is something that you believe about yourself to be true, and it can be whatever makes sense to you at the time. It is deeply rooted, and it can be a very important part of a person’s sense of self .
Gender Expression is what everyone around you can see. It is the way you present yourself and your gender to the world. These cues to others are often expressed through a person’s names, pronouns, haircut, voice, body characteristics, and clothing. These cues are often termed “masculine” or “feminine,” although what is defined as masculinity and femininity can vary from culture to culture, and can also vary across time . The way that someone expresses their gender is not always a clue to how they identify their gender.
Many people’s assigned sex at birth and gender identity match; for example, someone who has the biological sex characteristics of a female, was assigned female at birth, and identifies as a woman, is considered cisgender. This woman may identify as cisgender, but she may express herself in a very masculine way. She may play football, wear only baggy jeans and T-shirts, and crop her hair. Some people may refer to this woman as a “tomboy.”
Some people identify as transgender, when their assigned sex at birth does not match their internal gender identity. Someone who was assigned female at birth, and identifies as a man, is often called a transgender man. Someone who was assigned male at birth, and identifies as a woman, is often called a transgender woman. However, some people may also simply identify as a “man” or “woman,” regardless of the sex they were assigned at birth. Many transgender individuals seek to align their gender expression with their gender identity, although this is not always true. They may do this through hormone replacement therapy (HRT) and/or surgery. However, not all transgender individuals choose to take these steps, or may not be able to take these steps. A transgender identity is not dependent upon physical appearance or medical procedures.
Other people may identify as gender non-conforming. This term may be used by some people whose gender expression is different from the conventional and traditional understanding of masculine or feminine. Gender non-conformity generally refers more to the expression of a person’s gender than their identity. For example, a man who enjoys knitting and wearing mascara may be expressing some gender non-conformity, though they may not identify as gender non-conforming. However, a person can identify as non-conforming as well. Gender non-conforming should only be used if a person self-identifies as such.
Gender non-binary is another term that is becoming more commonly used. This is a person who identifies or expresses their gender in a way that falls outside the categories of man/woman, masculine/feminine. Some people who identify as non-binary may also identify as transgender, but this is not always the case. Again, this term should only be used if a person self-identifies as such. Something to be aware of is the fact that non-binary is also sometimes shortened to enby or NB in safe spaces or inclusive articles.
A person who identifies as genderqueer also identifies or expresses their gender in a way that falls outside the categories of man/woman, masculine/feminine. The terms gender non-binary and genderqueer are sometimes used interchangeably. However, it is important to note that some people in the community can take offense to the term “queer,” while others in the community have embraced it. Yet again, this term should only be used after a person self-identifies as such.
Someone who is genderfluid tends to not confine themselves to one gender, and instead may fluctuate between expressing themselves as more feminine, masculine, both, or neither, depending on how they feel.
An agender person does not identify with any gender, or intentionally does not follow gender expectations. Agender literally means “without gender,” and may sometimes be used interchangeably with “gender neutral.” Other terms that people may use to describe an agender identity are: genderblank, genderfree, genderless, gendervoid, or non-gendered.
This list is not meant to be exhaustive. It is simply meant as a brief beginner’s guide to the difference between biological sex, gender identity, and gender expression. It is also meant to give a brief overview of some of the more common ways people in your life may identify or express their gender. It is my hope that you may now have a better understanding of gender, and will be better able to accept, embrace, and understand yourself or anyone else in your life.
 American Psychological Association (2018). Transgender people, gender identity, and gender expression. Retrieved on October 7, 2018 from https://www.apa.org/topics/lgbt/transgender.aspx
 Reading, W. (2014). Separating out gender identity from gender expression. Retrieved on October 7, 2018 from https://everydayfeminism.com/2014/05/separating-identity-expression/
 Brabaw, K. (2018). 53 gender identity terms every ally should know. Retrieved on October 11, 2018 from https://www.refinery29.com/gender-identity-terms