Espousing diversity

A diverse discourse surrounding gender is one of the most significant shifts brought about by the 21st century and gender identity and nonbinary are terms that are now widely used. We are often given a sex at birth (based on our anatomy) — usually male or female. Differences in Sex Development (DSD) is the term used to describe a subset in which the sex may not be obvious.

Gender identity, or an individual’s innate perception of their gender, is, however, formed during the early stages of development. Gender identity begins to emerge at the age of three and becomes more pronounced by the time a child is six or eight years old. So, preschool-aged youngsters are familiar with concepts like “I’m a girl like my mother” and “he’s a boy,” among others.

Being cisgender refers to the majority of people whose innate sense of gender corresponds with their “assigned sex” at birth.

A subset of people, on the other hand, may not identify with this “assigned gender,” in which case they are considered “transgender” or “genderqueer.”

Now, it’s critical to keep in mind that none of this is related to sexual orientation or desire.

This issue is problematic since gender identity and sexual orientation are sometimes combined under the acronym LGBTQIA (lesbian, gay, bisexual, transgender, intersex, asexual).

A medical term known as DSD is used to describe people whose sexual features are innate and do not conform to the binary definition of gender.

These differences could be caused by hormonal or chromosomal abnormalities. These people might also be referred to as intersex.

Some outdated and stigmatising labels like “hermaphrodites” and “eunuchs” have now been replaced by this new lexicon.

Individuals diagnosed with DSD may identify as either male or female, within or outside of the gender binary.

The understanding of gender in medicine

The recognition of gender-related diversity in modern medicine has been tardy and disrespectful. It was only in 2013 that the American Psychological Association acknowledged that gender identity is not a disorder.

Gender dysphoria

Gender dysphoria (formerly wrongly characterised as Gender Identity Disorder) is the term used to describe an incongruence between assigned sex and experienced gender. Though gender dysphoria in children has been reported to occur as early as age two, it is more frequently observed later in life, particularly as a child approaches puberty.

Individuals with gender dysphoria have a strong desire to be of a different gender than what is assigned to them and often reject gender-stereotypical activities/ dressing. They often describe the feeling of “being trapped” in a male/female body. While the experience of gender dysphoria itself is difficult, a lack of familial and societal understanding and expectation may pose roadblocks for the individuals to resolve the dysphoria and even transition. Unethical practices such as Conversion Therapy (used to attempt to change the gender identity and/or sexual orientation of an individual) were banned by the Madras High Court order only in 2021.

Although gender dysphoria is a challenging experience in and of itself, barriers to overcoming the disorder and even transitioning may arise from a lack of understanding and expectations on the part of family, society, and even the affected persons.

Gender-related nomenclature

These days, the idea that gender is binary — that is, either male or female — is seen as outdated. People whose gender identities fall outside of the gender binary are referred to as nonbinary or genderqueer. People who identify as nonbinary may do one of the following: they may identify as neither a man nor a woman; they may identify as a man or a woman at different times; they may not identify with a gender at all; or they may identify with a gender identity other than that of a man or woman. Gender identity can also evolve over time for a person.

• Transgender: At times used as an umbrella term to refer to all nonbinary persons, it specifically refers to those who identify with a gender (male/female) which is different from the one assigned at birth.

• Cisgender: Individuals whose current gender identity corresponds to the sex assigned at birth. 

• Gender fluid: Individuals who sometimes identify as male and sometimes as female.

• Agender/ Non-
gendered: Those who identify as not having a gender.

• Other/ third gender: People who identify as a separate gender category, outside of the male /female binary.

Pronouns: Typically genderqueer/nonbinary persons tend to be referred to with ‘They/Them’ as their pronouns; Trans persons may specify a preferred pronoun — she/he/they. Mx. may be used instead of the traditional Mr./ Ms./Mrs.

How to be supportive of nonbinary persons
 Understand that a person’s identity is their choice; and that the choice is to be respected!
 Ask about their preferred name/ salutation/ pronoun.
 Open yourself up to understanding their views about life, while respecting their privacy if they so desire.
 Abstain from making fun of/ caricaturing or trivialising gender and sexuality in your daily life.
 Use gender-neutral language, for eg., Good morning to all, rather than Good morning ladies and gentlemen.
 Advocate for the rights of nonbinary and stand against discrimination in workplaces/educational institutions and communities.
 Advocate for breaking gender stereotypes in your home and at work.
 Help nonbinary persons in your community get the right kind of help.
 Educate your children about being respectful
to all.

Role of the medical fraternity

The requirements of nonbinary people are still not being met by the medical establishment. The acceptance of gender sensitivity in healthcare settings and language has been gradual. On the other hand, many nonbinary people exhibit poor healthcare-seeking behaviour as a result of perceived stigma and financial difficulties. Sexually transmitted infections are a major cause for concern, particularly for the hijra community.

Understandably, mental health concerns are widely prevalent, and a lot of nonbinary individuals have high rates of depression, anxiety, substance abuse and suicide. A recent survey among Karnataka’s gender minority population revealed that a resounding majority of participants had considered or even attempted suicide.
But it’s crucial to remember that nonbinary people don’t have a higher risk of developing medical conditions than cisgender people do. Rather, nonbinary people are more vulnerable to the disorders covered above because of their marginalisation and victimisation.

Medical treatments that promote gender equality are nevertheless costly and unaffordable for many members of the gay community. Finally, due to a lack of research in this field, there is a significant gap in the medical literature about nonbinary people. More studies will lead to better knowledge for the general public and medical experts.

(The author is a consultant psychiatrist and can be reached at [e-mail])