The term Sex Assigned at Birth arose in the 1950s around the medical care of intersex infants. In particular, the term arose because physicians thought of intersex variants as harmful to the child and that assigning a child a sex and making sure that parents were not confused about the child's sex would be beneficial to the child. This belief lead to medically unnecessary medical procedures on some infants to bring their genitals or gonads more into alignment with the preceived norm of either male or female genitalia. These surgical procedures have lifelong consequences including sterilization. These surgeries are especially harmful for individuals whose gender identity is inconsistent with the sex they were assigned at birth. Sex Assignment at Birth and surgeries to coercievely assign the sex of intersex infants are still broadly practiced.

History/Presents of Sex Assigned at Birth in Intersex Infants

The term sex assigned at birth is used to describe the legal and medical designation of male or female that is ascribed by doctors to infants at birth based on the presentation of their external genitalia. Assigned Male at Birth (AMAB) and Assigned Female at Birth (AFAB) are used to demark the identification one was give while also being used rhetorically to note the difference between both the sex someone was assigned and what their biological sex is - for instance in the case of intersex individual, and to differentiate between sex and gender identity.

University of Wisconsin - Madison

Price doesn't directly discuss this but another resource individuals often have to use to obtain the biocertification required to get accommodations is social capital is dealing with medical professionals. It is common for disabled individuals to experience medical professionals who are wary of signing paperwork around accommodations out of a belief that accommodations might hem-in or negatively define the capacities of their patient. This experience is felt more keenly by both femme presenting and AFAB patients along with Black, Indigenous, and other patients of color because of histories of medical misogyny and racism that lead to the symptoms of these individuals being downplayed and no believed. Because of this often patients have to leverage social capital - through taking time to prove to their doctor they need medical paperwork signed or through bargainning and framing it as a favour - to obtain paperwork that allows them to get accommodations.

Social Capital as a Resource in Securing Accommodations

Gender identity is an individual's internal, personal sense of being a man, woman, both, or neither. It is a distinct concept from sexual orientation, which relates to attraction, although the two are often mistakenly conflated. While a person's gender identity often corresponds to their sex assigned at birth (based on chromosomes and phenotype), this is not always the case. Gender identity should also not be confused with gender expression, which is the outward presentation of one's gender. It is crucial for clinicians to understand these distinctions and be knowledgeable about gender-affirming care.

Gender Identity

Intersex is a term used to describe when an individual's sex traits, hormones, or reproductive anatomy differ from the two ways humans usually develop. Sometimes intersex is recognized at birth, but it can also show up later in life. Intersex and transgender are terms that are not interchangeable.

Intersex

 Clarke, J. A. (2022). SEX ASSIGNED AT BIRTH. Columbia Law Review, 122(7), 1821–1898. https://doi.org/10.2139/ssrn.4032865


SEX ASSIGNED AT BIRTH

Sex Assigned At Birth

Individuals who experience Gender Dysphoria and feel that their gender identity is incongruent with their sex assigned at birth experience psychological distress due deviation from the societal norm, and Compassion-based Art Therapy combined with mindfulness can help build self-compassion and greater resilience

Mindfulness-Based Art Therapy for Gender- Variant Individuals

Gender dysphoria is a condition listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that is characterized by an individual feeling distress due to their gender identity being different than their sex assigned at birth.

Gender Dysphoria

Cisgender refers to when an individual identify with their sex at birth. "Cis" as a prefix has the meaning of "on the same side."

Cisgender

Though progress is being made, many people still faces hardship, backlash, discrimination, and violence when they vary their gender identity or expression from the traditional gender norms. 

Challenges in Gender Identity Expression

The case of David Reimer began with the 1965 birth of twin boys, Bruce and Brian Reimer, in Winnipeg, Canada. When Bruce was a few months old, his penis was irreparably damaged during a routine circumcision due to faulty medical equipment. This tragic accident led his parents, Janet and Ronald Reimer, to consult with experts, ultimately connecting them with Dr. John Money at Johns Hopkins University. The family's story has since been widely covered in news reports and documentaries, providing further insight into their experiences.

The Case of David Reimer

Sexual orientation and gender identity are frequently confused, but they represent different facets of a person's identity. Gender identity is one's internal sense of their own gender, whereas sexual orientation is a separate, though related, concept concerning one's attractions to others. Recognizing them as two distinct concepts is crucial to avoid common misconceptions.

Distinction Between Sexual Orientation and Gender Identity

The term 'transgender' describes individuals whose personal gender identity does not align with the sex they were assigned at birth. People who are transgender may use a variety of terms to describe themselves, including the abbreviation 'trans' or identifying as 'non-binary'.

Transgender

For some transgender individuals, transitioning is a process of aligning their life with their gender identity, moving away from living in a manner associated with the sex they were assigned at birth. This process is highly individual and can encompass social, legal, or medical changes. However, it is not a required step, and not all transgender people will pursue any or all of these transition types.

Transitioning for Transgender Individuals

Contemporary understanding of gender identity is in a state of continuous evolution, providing more freedom for exploration and expression than in the past. This shift is particularly evident among younger generations like millennials and Gen Z. For instance, research shows a majority of millennials view gender as a spectrum rather than a binary, with 12% identifying as transgender or gender non-conforming. This evolving perspective is reflected in societal changes, such as the increased use of gender-neutral pronouns like 'they/them' and shifts in commercial practices, where retailers are moving away from gender-segregated marketing for items like toys and clothing.

Evolving Understanding and Expression of Gender Identity

While some cultures, such as the United States, have historically been cisnormative and based on a two-gender system classifying individuals as male or female based on their sex at birth, this is not a universal model. Many other cultures recognize more than two gender categories, with some of these identities being integral parts of their societies for centuries. These non-binary identities often predate modern Western definitions of gender and hold deep cultural significance.

Cultural Variations in Gender Systems

An individual named Kai was designated male on their original birth certificate. Kai enjoys wearing tailored suits, is romantically attracted to women, and has a deeply held, internal conviction that they are a woman. Which of these elements best describes Kai's gender identity?

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