Thinking back to my first pregnancy, I recall going to an ultrasound appointment to look at the infant’s anatomy. The ultra sonographer asked my husband and me if we wanted to know if we were having a girl or a boy. We weren’t even parents yet, but everyone in our social circle was asking if we knew ‘what we were having,’ so we responded ‘yes!’ In our culture, we automatically think about gender in binary terms: girl or boy. This way of thinking is convenient for people whose gender aligns with the sex assigned at birth: it allows grandparents to purchase pink or blue baby clothes and helps parents pick a name. In our culture, identifying your gender  comes up with everything from filling out job applications to choosing which public restroom to use.

But what about those babies who do not have a binary sex assignment (such as those who are intersex)? What about youth who identify as a gender other than what their chromosomes say? What about those people who don’t feel male or female, but identify as somewhere in between? Just because something is ‘convenient’ for the majority doesn’t make it correct.

As a pediatrician who works with teens, I’ve shifted how I think about gender identity. I’ve had the privilege of learning from teens whose gender does not conform to our culture’s limited gender norms that simply calling someone a girl or boy is inadequate and unfair. Consider this analogy. Gender is like the colors in a prism: it is full of a spectrum of amazing colors!

Gender has nothing to do with who an individual is romantically attracted to.

It does not always align with an individual’s chromosomes or anatomy.

Gender is how we perceive ourselves; it is not necessarily the image that the outside world sees, but our own personal sense of self. As a parent, I find myself telling my daughters that it’s what is on the inside that counts! This statement is true for beauty, character, and gender identity.

So in this post, let’s review some definitions of words that may be used when discussing gender identity. Please keep in mind that some terms may change over time. If you or your teen hear a word you’re unfamiliar with, ask the person using it to describe what it means!


Sex – the classification of people as male, female, intersex, or other generally assigned at birth and based on anatomy and/karyotype (chromosomes)

GenderMerriam-Webster’s full definition:

a subclass within a grammatical class (as noun, pronoun, adjective, or verb) of a language that is partly arbitrary but also partly based on distinguishable characteristics (as shape, social rank, manner of existence, or sex) and that determines agreement with and selection of other words or grammatical forms

Note the words ‘arbitrary’ and ‘grammatical subclass ‘in the definition. Some languages do not have gender distinctions.

Gender refers to socially and culturally constructed roles, behaviours, expressions and identities of people. It can vary by culture and can change over time.

Gender identity – this is an individual’s internal sense of gender. It may be binary (male or female) or non-conforming. The most important thing to remember is that it is based on the individual and not anyone else.

Gender Expression – the outward, physical manifestation of gender identity through clothing, hair, body shape, voice, etc.

Cis-gender – this term describes someone whose gender aligns with their sex assigned at birth.

Transgender – this is a broad term used to describe a person whose gender is different than the sex assigned at birth. It may be that a person identifies as the opposite gender (such as identifying as male when their sex assigned at birth was female) or a person may use one of the terms below to describe their gender.

Gender fluid– this term describes people whose identity on the gender spectrum may shift between male or female. For example, they may feel more masculine at one point in time, then feel more female at a different point.

Gender queer – this term may be used by people who do not identify as male or female. They may identify somewhere in between male or female or identify as neither.

Agender – similar to gender queer; this term may be used by people who identify as neither male nor female or by people who identify as both. It may be used by people who do not identify any gender.

In the future, we’ll explore transgender health in more detail, but these few definitions are a place to start.

For more information on gender identity check out these resources:

Trans Student Educational Resources:

Neutrois: Loving my agender child

Gender Diversity:

Transgender Health Information Program: