No Child is Born in the Wrong Body … and other thoughts on the concept of gender identity

by William J. Malone, M.D., endocrinologist (Twitter: @will_malone).

with contributions from Colin M. Wright, Ph.D., (Twitter: @SwipeWright), biologist and Eberly Research Fellow at Penn State University;  and Julia D. Robertson (Twitter: JuliaDRobertson), journalist, award-winning author and Senior Editor of The Velvet Chronicle.  

Author’s note, 23 August 2019: This essay has been updated with a new graphical representation of sex-related differences in personality. The original essay had distribution curves showing an 85% overlap of personality traits between males and females. This comparison was based on earlier studies that have been criticized for having design limitations that underestimate sex-related personality differences (link).  More recent studies show the overlap to be more in the 30% range. While the degree of overlap is an area of ongoing debate and study, the consequences for the gender-atypical individuals at the tail ends of the overlapping distributions remain the same. For further reading about sex-related differences and ways to measure them, see the following exchanges between experts in the field: (link) (link) (link).

Many health care professionals and mainstream medical organizations endorse the concept of an innate gender identity.[a]  They define gender identity as the “internal, deeply held” sense of whether one is a man or a woman (boy or girl), both, or neither, and report that it can be reliably articulated by children as young as 3-5 years old.[b]

A growing number of scientists, philosophers, and health care professionals reject this concept or at least the above definition.[c]  Developmental studies show that children have only a superficial understanding of sex and gender at best.  For instance, up until age 7, children often believe that if a boy puts on a dress, he becomes a girl.[d]  This gives us reason to doubt whether a coherent concept of gender identity exists at all in young children.  Additionally, the concept relies on stereotypes that encourage the conflation of gender with sex.

However, starting at a young age, children do tend to exhibit preferences and behaviors that we associate with sex.  For example, male children display more aggressive behavior than female children.[e]  In addition, “cross-sex” behavior, or more accurately cross-sex stereotypical behavior, is often predictive of later same-sex attraction.[f]  Can all of these findings be integrated?

To start, just as sex influences the development of bodies, it also influences brains.  There are in-utero differences in hormone exposures (male testosterone surge at eight weeks gestation for example), and distinct developmental pathways are triggered based on the XX or XY chromosomal make-up of neurons.[g]  The integration of these sex-related processes with environmental pressures gives rise to an individual’s personality and preferences.

It follows then that population-based studies have demonstrated sex-related differences in personality and preferences that are independent of social influences.  When social influences are weakened (in more egalitarian societies), the sex-related differences in personality and preferences increase.[h] [i]  This suggests that as environmental pressures become relaxed, innate sex-specific preferences surface.

A closer look at personality traits shows that when analyzed together as a group, there is a roughly 30% overlap between sexes.[j] [*]  This is graphically represented below.  The consequence of this overlap is that adolescent males who fall on the left end of the male pattern (blue, “masculine”) curve, and adolescent females who fall on the right end of the female pattern (pink “feminine”) curve, are going to have personality traits that are different than the majority of other members of their own sex.  In fact, due to the significant overlap of personality traits between males and females, the personality traits of some females will be more “masculine” than those exhibited by some, or even most males, and vice versa.

Consequently, an adolescent female may find her behavior, personality traits, and preferences more “masculine” than most girls and most boys.  This could lead her to incorrectly conclude that she is the opposite sex.  That child’s parents could become confused as well, noticing how “different” their child’s behavior is from their own, or from that of their peers.  That child simply exists at the end of a behavioral spectrum, and “sex-atypical” behavior is part of the natural variation exhibited both within and between the sexes.  Personality and behavior do not define one’s sex.

There are approximately 40 million children in the United States between the ages of four and fourteen.  The above distribution curves estimate that roughly four million of them have personality profiles that are “sex atypical”, but still part of the natural distribution of personalities within each sex.  Our culture-at-large is incorrectly telling them that they may have been born in the wrong body.  The propagation of this biological falsehood, in addition to other newly identified factors, is likely contributing to the growing number of transgender identifying high school students (now estimated to be 2%), and the rapid rise in adolescents presenting to gender clinics.[k]

There would be less confusion if the distributions wholly overlapped.  It would be the norm that males and females display completely overlapping personality traits.

The broad, but normal distribution of personality traits also explains studies showing a 28% concordance of a transgender identity in twins.[l]  Twins have identical chromosomes, and likely have similar sex-related behaviors as well as environmental influences on their behavior.  Using twin adolescent males as an example: if their behaviors are at the “feminine” end of the male-typical distribution, they could both become confused as to what their behaviors and preferences mean about their sex.  Whether they develop gender dysphoria as a consequence of that is another issue.  If gender dysphoria does develop, 85% of the time it will resolve with uninterrupted puberty.[m]

What is being called “gender identity” is likely an individual’s perception of how their own sex-related and environmentally influenced personality compares to same and opposite sexed people.  Put another way, it’s a self-assessment of one’s stereotypical degree of “masculinity” or “femininity,” and it’s wrongly being conflated with biological sex.  This conflation stems from a cultural failure to understand the broad distribution of personalities and preferences within sexes and the overlap between sexes.

When a girl reports that she “feels like a boy” or “is a boy”, that sentiment may reflect her perception of how her personality and preferences compare to the rest of her peers.  Also, if she has concrete thinking characteristic of an autism spectrum condition, she may not be “sex-atypical” in her behavior but could be falsely perceiving herself to be.  These scenarios don’t apply to all cases of gender dysphoria, as many other triggers are described.[n]  Counseling can help gender dysphoric adolescents resolve any trauma or thought processes that have caused them to desire an opposite sexed body.[o] [p] [q]

To summarize, there is a lack of understanding when it comes to the distribution of sex-related personality and behavioral differences.  This lack of understanding has led to confusion.  That confusion impacts children who fall at the extreme tail-ends of the distribution, who are statistically more likely to grow up to be gay, lesbian, or bisexual adults if allowed to experience uninterrupted puberty.n  Additionally, telling a child that he or she was born in the wrong body pathologizes “gender non-conforming” behavior and makes gender dysphoria less likely to resolve.a

In conclusion, no child is born in the wrong body.  Adults should expand their understanding of what normal male and female behavior and preferences look like.  They should understand that being male and being female both come with a wide range of personalities, preferences, and possibilities.

[*] The first version of this essay used distribution curves showing an 85% overlap of personality traits between males and females.  This comparison was based on earlier studies that have been criticized for having design limitations (looking at one trait at a time, not correcting for measurement error) that underestimate sex-related personality differences (link).  More recent studies show the overlap to be more in the 30% range. While the degree of overlap is an area of ongoing debate and study, the consequences for the gender non-conforming individuals at the tail ends of the overlapping distributions remain the same.  For further reading about sex-related differences and ways to measure them, see the following exchange between experts in the field: (link) (link) (link).


References

[a] Hembree, Wylie, T, P., Louis, Hannema, E, S., . . . G, G. (2017, September 13). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society * Clinical Practice Guideline. Retrieved from https://academic.oup.com/jcem/article/10

[b] Gender identity. (2018, May). Retrieved from https://www.caringforkids.cps.ca/handouts/gender-identity

[c] Byrne, A. (2019, January 10). What Is Gender Identity? Retrieved from https://arcdigital.media/what-is-gender-identity-10ce0da71999

[d] Martin, Carol. “Cognitive Theories of Early Gender Development.” Semantic Scholar, 2002, pdfs.semanticscholar.org/69e9/67157a01cb0af9252650195e7adb99578364.pdf.

[e] Harbin, S. J. (2016). Gender Differences in Rough and Tumble Play Behaviors. International Journal of Undergraduate Research and Creative Activities,8(1). doi:10.7710/2168-0620.1080

[f] Childhood Cross-Gender Behavior and Adult Homosexuality. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.1300/J529v12n01_03

[g] Wheelock, M., Hect, J., Hernandez-Andrade, E., Hassan, S., Romero, R., Eggebrecht, A., & Thomason, M. (2019). Sex differences in functional connectivity during fetal brain development. Developmental Cognitive Neuroscience,36, 100632. doi:10.1016/j.dcn.201

[h] Giolla, E. M., & Kajonius, P. J. (2018). Sex differences in personality are more significant in gender-equal countries: Replicating and extending a surprising finding. International Journal of Psychology. DOI:10.1002/ijop.12529

[i] Archer, J. (2019). The reality and evolutionary significance of human psychological sex differences. Biological Reviews. doi:10.1111/brv.12507

[j] Kaiser, T., Del Giudice, M. D., & Booth, T. (2019). Global sex differences in personality: Replication with an open online dataset. Journal of Personality. doi: 10.1111/jopy.12500

[k] Marchiano, L. (2017). Outbreak: On Transgender Teens and Psychic Epidemics. Psychological Perspectives60(3), 345–366. doi: 10.1080/00332925.2017.1350804

[l] Diamond, M. (2013). Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. International Journal of Transgenderism,14(1), 24-38. doi:10.1080/15532739.2013.750222

[m] Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry,28(1), 13-20. doi:10.3109/09540261.2015.1115754

[n] Gender dysphoria is not one thing. (2017, December 07). Retrieved from https://4thwavenow.com/2017/12/07/gender-dysphoria-is-not-one-thing/

[o] Zucker, Kenneth & Wood, Hayley & Singh, Devita & Bradley, Susan. (2012). A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder. Journal of homosexuality. 59. 369-97. 10.1080/00918369.2012.653309.

[p] Vries, Annelou & Cohen-Kettenis, Peggy. (2012). Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach. Journal of homosexuality. 59. 301-20. 10.1080/00918369.2012.653300.

[q] Clarke, Anna Churcher, and Anastassis Spiliadis. “‘Taking the Lid off the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.” Clinical Child Psychology and Psychiatry, vol. 24, no. 2, 2019, pp. 33

22 thoughts on “No Child is Born in the Wrong Body … and other thoughts on the concept of gender identity

  1. It’s also just thinking that a 30kg prebuscent child has an idea of how they’ll look like when older and NEED to swap it to an hormone-pumped because it’s that version (and not another one) that they absolutely need.

    No way. Our brains adapt as we go (if we get fat or lose an arm, the brain adapts).

    And magically, it’s the medically modified version they want, and not something unrelated (like being a fairy) that we must accept.

  2. I am looking for better understanding on this topic. I have a transgender teen in my life whose pattern fits the ROGD phenomenon discussed on this forum in some ways: it suddenly surfaced with no obvious childhood component, in an already-troubled young teen who likely has ASD, who was surrounded by gender-fluid friends and acquaintances.

    What leads to people who are not on the opposite end of the behavior scale to perceive themselves as transgender? Why would a very girly girl, or a very masculine boy, come to the conclusion that they are really a transgender? And, having come to this realization, why would they continue to act like a very girly girl or very masculine boy while claiming to be the opposite gender – and then have complete meltdowns when people don’t recognize them as their perceived gender? This is what is causing complete chaos with our family’s transgender teen.

    Our family is tolerant and acceptant; we would not be upset about this person’s choices if we felt that this person really was a better fit as the opposite sex, or at least was trying as hard at this transition as the rest of us are expected to. It is literally impossible to see this person as their desired/perceived gender when they act completely opposite of it and do virtually nothing to resemble it. No reasonable stranger, upon meeting our family’s transgender teen, would perceive them to be their preferred gender, and even though we know – because it is pounded into us constantly – what that preferred gender is, it almost feels like a practical joke. It’s almost as if this is really just an excuse to constantly be angry at everyone in the world, and/or to have the power over people to make them pretend that there are five lights when there are only four.

    It would be impossible to ask this person why, if it’s such a life-and-death thing to be the opposite sex (yes, we’ve had the suicide threats and constant reminders about them, should anyone trip up and make a mistake), that they don’t have the remotest interest in living as that sex. But we just don’t get it. It’s torn our family apart.

    • If you haven’t, get a really good therapist for your teen. Not an affirmation only of the perceived gender..but a therapist that will affirm the distress and then dig deep to help them figure out what is really going on. Jungian type therapist, older experienced. Sasha Ayad (Inspired Teen Therapy has some advice to find a good one). Vet them first. I know this phenomenon is so baffling. Good luck and hang in there with your teen to affirm distress and connect with them.

    • My family has a teen like that too. I was always accepting of trans people and believed the ideology until this teen, who has always been very gender-conforming (and remains such), announced themselves to be non-binary. The teen is suspected to have ASD and was always uncomfortable with growing up — not just gendered things like bras but also things that apply to everybody like deodorant — and would refer to themselves as a “little girl.” Yet they also have a number of friends who are trans and seem to subscribe to the ideology that people who are trans are “cooler.” I sincerely think this is a manifestation of their struggle to deal with anxiety about growing up and facing adult responsibilities.

      I’m tempted to second the other commentor’s advice, but based on my experience I doubt that would even work. Even if you could find a therapist who didn’t go the immediate 100% affirmation route, the likelihood of the teen who is so defensive about it actually opening up and considering the perspective of someone who raises the possibility that it might be something other than gender dysphoria is low.

      I feel like all we can do is wait and hope this passes as a phase.

      • I remember back in the late 1970’s, early 1980’s, when all the girls & a few boys were suddenly anorexic/bulimic. My sister fell sick with this. Part of this was my mother’s insistence that we constantly diet. I took the easy route with diet pills but she starved herself. What if she had been told that her anorexia was OK & that we should all go along with it & be supportive of her “choice”? She would be dead. For that matter, if people hadn’t confronted me about me drug use, I might very likely be dead too. These children are being drugged (many of them are already on ADHD drugs, i.e. meth, already) & now that they’re on this trans-train, they’ll be drugged even more & eventually be sterilized & their bodies mutilized … it’s already happening! Wait & hope this passes as a phase but meanwhile, there are children & whole families who are being permanently wrecked by this so-called phase.

    • I would suggest signing up to Sasha Ayed on Patreon, just for a short time, and accessing her videos and articles. She’s a non-affirming counsellor based in the States, her advice is kind and compassionate and includes, for example, how to get hold of therapists and assess their attitude to trans issues.

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  4. Very interesting topic and interesting research indeed . However we can find research that will support just about anything . As much as I do know now and did know our daughter was NOT born in the wrong body , I do think it may be possible someone is . I am not here to walk in someone’s else’s shoes . or to judge someone else. I am staying clear away from any judgment as I do not want to be judged myself as I was by a whole lot of nutty doctors and professionals who “guided” us down the garden path and left us with this “situation”. Again I am finding no balance , even here . To left to the right but nothing in between . Each situation is different and must be treated as such. Trust your gut .

    • When you say, “born in the wrong body,” do you mean that in the figurative sense; i.e. the person dislikes his/her body so intensely that if feels as though it is the wrong body?

      Or do you mean that in the literal sense? So at conception the person’s parents’ genes combined to form the chromosomes of a new human being. These chromosomes act as the DNA blueprint for the new person’s body. Yet somehow the person got a body that belongs to someone else? I can’t think of a way that could happen that doesn’t involve magic.

      I always wonder at a scientific level what the phrase, “born in the wrong body,” means.

    • You said — it may be possible that someone is born in the wrong body. If that is true, then there must be a way to diagnose those who are “legitimately transgender” as opposed to those who are “really not trans”. Ask any mental health or medical professional how to do so. You will hear silence. Ask them why there are detransitioners. You will hear more silence.

      Insisting that our medical procedures should be based on science and evaluated data is not a left/right issue, it is a medical ethics issue. When members of the Kelsey Coalition walked the halls of the House and Senate this year to raise awareness of the ongoing medical malpractice — aimed at children and young people — surrounding “identity medicine”, the response from our politicians was typically, “I’ve never thought about that before”. While in the meantime, huge profits are being made by taking advantage of the most vulnerable — and all while feeling virtuous due to “helping” poor oppressed young people who were “born in the wrong body”.

  5. Unfortunately, the article fails to explain how “masculinity” and “femininity” are measured and to give examples of sex differences in children other than rough and tumble play. What is “Male Mean = 3, Female Mean = 0”? penis size? seconds to react to a shoe ad? The references are all over the place conflating physical, functional and behavioural characteristics, in adults! – i.e. with sex hormones present.

    Furthermore, it conflates sex differences with gender stereotypes (“it’s a self-assessment of one’s stereotypical degree of “masculinity” or “femininity””). You can measure differences in aggression, physical activity, mental rotation skills and sensitivity to pain, but “feeling like a boy/girl” is highly subjective, as much as getting a haircut isn’t about having a “male brain”. Wrongbodyism of kids crossing to the tail on the other side of the curve might’ve existed 10-20 years ago, but the current trend is based on gender stereotypes for kids from the middle 85%. A boy liking pink must be a girl, a girl refusing to wear a dress must be a boy, they are in a wrong body, let’s socially and medically transition them. But I can bet, the researchers didn’t measure brain sex differences against pink and haircuts. Also, the number is supposed to be a sum total of many characteristics. I find it quite surprising how many adult women are ready to denounce their girlhood and claim being gender atypical based on 1-2 superficial aspects like “I didn’t like dresses and makeup”. The most masculine female personality I’ve ever known was my grandma. She wore dresses!

    Finally, ROGD in teens, which is known to be a product of social contagion, isn’t related to sex differences in the brain (unless you’re measuring how social contagion affects females vs males which would be an interesting topic). In a classical gender dysphoria a young child would show a number of patterns typical for the farthest end of the curve for the opposite sex. Then the dysphoria gets resolved (or not) when hormones kick in during puberty. But how do groups of friends or visitors to Tumblr suddenly get the same brains?

    Wrongbodyism rather feels like the tail wagging the dog, where ANY child can be declared to be in a wrong body with ANY excuse, irregardless of any observed or imagined sex differences.

  6. I shared this on my liberal schools page in response to a posting about the genderbread person – it was taken down and i was eventually called out as a ‘terf’ – this is a social contagion

  7. Dear Medical Profession,

    As a parent I never knew I had to protect my child from the medical profession. Creepy soccer coaches, crack houses. a frustrated priest, a mean boyfriend. These are things I was ready for but not Kaiser Permanente, therapists and MD’s. Do us all a favor volunteer and help out the poor and homeless with their health needs, not anxious adolescent girls with their new personalities. Please exit stage right!

    If gender is a “social construct,” what business do you have as a profession getting involved? Gender is not be a “medical construct.” Why are you getting involved? I have come to the conclusion that the APA, AAP and the AMA are in reality cults when it comes to this topic. They are lead by the shrill transgender activists, hyperbole and flawed science all drumming up more business.

    Most young girls are simply self-absorbed and passionate about appearance and fitting in. They know that the world out there is very tough for woman. Hillary’s glass ceiling is not only still there but is made of stainless steel. Girls will need a blowtorch to get through that barrier. Second wave feminism crashed and burned. “Gender Dysphoria” is the ticket for these kids to choose a better gender. That this is covered by insurance is simply strange.

    At some point, the world will wake up to the fact that the medical profession is a predator, preying on adolescent kids. Kamala Harris pointed this out when referring to the present US President. Please notice how you fit this description.

    “The things about predators you should know, they prey on the vulnerable. They prey on those who they do not believe are strong. ” – Kamala Harris

    Please stay away from our daughters!!!

    Paul

  8. Thanks heavens I was born when I was. Before the internet. My parents were not ‘woke’. I was a tomboy who kept their hair short, wore trousers, hated dresses and to this day won’t/hate wearing tights. My mum tried so hard to have her little girl look like a little princess but I wasn’t having any of that. Eventually she gave up and when my sister was born, she was princess-ified from day one! I played cowboys and indians (it was the 60’s – forgive me,) though mainly that involved rolling around in corn fields and making patterns. I climbed trees and threw myself out into the bit pile of corn cuttings gathered underneath. I biked around, pretending my bike was a horse. I even tried using the inside tube of a toilet roll to simulate a penis to see what it felt like to wee standing up…(wet!) Good times. I had nothing in common with other girls. Nowadays I would, without doubt, have transitioned. I grew up a heterosexual woman with two fab kids and a lovely husband. I really worry about children nowadays. What these woke medics are doing is, imo, criminal.

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  12. Dear Sir/Madam,

    Our Dutch organization NPV Care for Life are working on a brochure concerning genderdysphoria.
    We would very much like to use the graph in this article for our brochure. Is there any copy right on this graph? And if you, could you give us permission to use it?

    Thank you very much in anticipation.

    Kind regards,
    Greet Schuurman

    NPV – Care for Life

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