What determines gender identity?

by Sylvia Sensiper

Current research suggests that our self-identification as either a man or a woman may have as much to do with biology as it does to the way that we are treated as infants and nurtured in our formative years.

How do you define your gender? Do you consider yourself feminine, masculine, or somewhere in the middle? How do you think others see you? What are your earliest memories of being aware that you were a boy or a girl? What if you found out that you were living a life opposite from that for which you were biologically destined?

A recent article in the journal Pediatrics (July 1998) presents the case of a Canadian boy who was "re-assigned" a new gender and raised as a girl after a circumcision accident. An operation at seven months removed the testicles and the remainder of the penis, and the patient was also given female hormones to develop breasts and other female traits. To this day, the subject continues to live as a woman and describes herself as bisexual.

But other cases have not had such "happy endings." In a (much) earlier case remarkably similar to the first one, a boy was reassigned as a girl at 17 months of age. She, however, rejected her female identity at age 14 and began living life as a male. Dr. William Reiner of Johns Hopkins Hospital commented about this case, "Despite everyone telling him constantly that he was a girl, and despite his being treated with female hormones, his brain knew he was a male. It refused to take on what it was being told."

What happened in each of these cases? Why was one girl comfortable with her assigned role and the other one not?

The answer may lie in the way that gender identity is formed. Many experts believe that gender identity is pliable. Some think that before the age of approximately 18 months, babies do not self-identify as either boys or girls. Others think that gender identity remains flexible until puberty.

These experts all claim that the biological differentiation that occurs during these highly formative periods is not what shapes the behavioral characteristics that our society thinks of as primarily female or male.

For example, the aggressive and rough physical play deemed typical of boys is not a natural behavior, but a learned behavior. So too, the nurturing and interpersonal play attributed to girls is something that they learn through external and environmental cues, however subtle.

Within the debate about gender differences, theories of gender identity formation appear to lie along a continuum. At one end are writers and researchers who insist that gender identity emerges naturally as a part of biological development. A mid-point view claims that gender identity is an interaction between biological and cultural factors. At the other end of the spectrum are those researchers who argue that the formation of a gender identity is a cultural process of imitation and improvisation.

It is commonly believed that biological sex is determined at conception. The sex chromosome in women is an "X", whereas the male can carry either an "X" or a "Y." The combination of an "X" and a "Y" normally produces a male, and a combination of two "X" chromosomes normally produces a female. But embryonic sexual development is more than Xs and Ys. It is a complex process that begins from a similar starting point and involves both physical and hormonal changes.

Until the sixth week of development, both XX and XY embryos are anatomically identical. Both embryos have an 'indifferent gonad,' with the potential to develop either male or female internal organs. After the sixth week, hormonal influences induce the development of either male or female organs.

At puberty, the release of growth hormone in the pituitary gland creates complex and very visible hormonal and physical sexual differentiation between males and females. Males develop facial and body hair, deeper voices, and the enlargement of the penis and scrotum. Females begin to develop breasts, body hair, broadening hips, and the onset of menstruation.

These are the 'normal' parameters of biological sexual development. These are the biological milestones that lead us to consciously and unconsciously understand ourselves as male or female.

But it is the unusual situations-ones in which development has gone awry--that have given researchers the richest data on gender identity formation. For example, an infant with the genetically inherited disease called andrenogenital syndrome (AGS) exhibits what appears to be normal male genitalia, but has two X chromosomes, ovaries and oviducts. In another abnormal situation, an XY baby is born with ambiguous female genitalia as well as internal male organs that develop further at puberty. These abnormal cases are estimated to occur in 1/1000 live births.

Researchers that have followed these and other children with atypical sexual development through life have developed theories to account for these anomalies and show how elastic the process of gender differentiation really is.

John Money, a medical psychologist and professor of pediatrics at Johns Hopkins University, has developed a theory that takes into account both genetics and the environment. According to Money, any given embryo has a "genetic program" based on the set of chromosomes it carries, either XX or XY. However, this program can be affected hormonally during the prenatal stage by any one of a variety of factors - a loss or gain of a chromosome, an excess or deficiency of maternal hormone, or a nutrition deficiency. After birth, he feels gender development occurs more through cues and behaviors in the environment, offered predominantly through the infant's primary caregivers, and less through biological means.

Money developed his theory through his extensive work with hermaphrodites, who have both ovarian and testicular tissue. Their complex personal histories often include a re-assignment of sex from that which was assumed at birth. For this reason, Money and his team have encouraged the parents of children with ambiguous genitalia (intersex children) to have the child undergo sexual remodeling and to raise the child accordingly.

Money hypothesizes that sexual identity is like language -- easily acquired, but only in a critical "window" during early childhood. He has modeled his surgical procedures on that theory. His research indicates that gender re-assignments, in which physical features are changed with the help of surgery and parental rearing practices, can occur with some ease until age three. It is difficult after that age, because by that time children have come to think of themselves as either permanently male or permanently female.

Another view on the matter, however, has been developed by Dr. Julianne Imperato-McGinley and her colleagues.

Their research focused on female children in three rural villages in Santo Domingo, all of which seem to produce an unusual number of intersex children. Although raised as girls, the children developed typical male characteristics at puberty. Their voices deepened and they developed adult-sized penises and scrotum. Sixteen out of the eighteen children studied then assumed a male gender role, married, and fathered children. Imperato-McGinley feels that in the absence of sociocultural factors that could interrupt the natural sequence of events, the effect of testosterone predominates the selection of gender identity, overriding the effect of being reared as girls.

Imperato-McGuinley disputes Money's theory. She claims that gender identity "is not unalterably fixed in childhood, but rather is continually evolving."

On the far end of the spectrum is Judith Butler. She believes that the formation of gender identity is a combination of historic, psychoanalytic, and anthropologic concepts. She claims that gender identity is performative--a kind of improvisational theater where identities can be adopted and explored. Her theory takes the physical body into account, but is not constrained by it. Her theories are a way of opening up our traditional categories of female and male to multiple possibilities of human being.

Many popular ideas have been built around the idea of gender difference. The opposite sex is categorized as "alien" or from another planet. But as Anne Fausto-Sterling points out in her book "Myths of Gender," an account of female and male development "might just as easily highlight their similarities, their identical starting points, and minor divergences."

Origins of gender identity and its formation is a complex and highly charged subject. The debate is ongoing, because it touches on some of our most powerful human emotions and experiences. But it is unfair to present the debate without asking one more, very difficult question: when it is in question, do kids have the right to make their own decisions about their very own sexual identity?