Biological influences

Gender identity (whether you feel male or female) usually coincides with sexual identity indicated by chromosomes, hormones and sexual organs, but this is not always the case. Biological indices can occasionally be abnormal so that gender may be ambiguous or contradictory. Also some women and men feel they are in the wrong biological body (transsexual), and might decide to undergo a sex change operation, which can be very stressful both psychologically, as it affects the notion of identity (who we are) and socially, as it upsets our common-sense notion of gender/sex as a fixed entity.

The sex chromosomes determined at conception, and the subsequent hormonal activity in the fetus, set the pattern for development of the internal and external sex organs and the sexual differentiation of the brain. There are exceptions. For example, abnormal chromosomes may give rise to a definite gender identity, but altered sexual organs and atypical social and sexual behaviour or a fetus with normal chromosomes may be exposed to unusual levels of hormones in utero. Some mothers given progestogens to prevent abortion had daughters who developed genital abnormalities, and atypical sexual and social behaviour.

Cultural factors

During puberty, gender identity becomes linked to sexual activity. There is often a period of sexual experimentation before individuals feel confident of their orientation. In the development of homosexual orientation, there is some evidence for a genetic factor: monozygotic twins show higher concordance than dizygotic twins, but cultural factors and individual learning experiences will also determine attraction to a partner.

Social and cultural influences

Psychological influences on gender start at birth, where in the UK traditionally we dress baby boys in blue and girls in pink. Also our interactions are determined by the perceived sex of the baby, which we often only notice when babies are dressed non-gender-specifically (Fig. 1). We have expectations of boys and girls from a very young age, which may include playing more ‘rough and tumble’ games with boys, and more talking and cuddling with girls. This process quickly extends to peers, school and the media. It is thought that a core gender identity is fixed by about the age of 4 years.

Fig. 1 Girls or boys? Two babies in gender-neutral outfits.

Cultural pressures may delay the acceptance of sexual identity, since in many societies variations from the norm are not accepted. It may take a long period of adjustment and considerable courage to ‘come out’, accepting one’s own sexuality and letting others know. Fear of one’s sexuality being discovered may lead to secretive or reclusive lifestyles, and can be the source of enormous distress. Social norms are changing: witness the changes in the media’s (see pp. 52–53

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Personality and health Depression Cognitive-behavioural therapy Childhood and child health Social class and health Placebo and nocebo effects

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