Gender health & development

Gender 101

While the two terms are often used interchangeably, gender and sex are different. 

Sex refers to biological traits. These include chromosomes, hormones and sexual anatomy (which includes body parts such as a penis An erogenous and erectile organ located between the legs that consists of spongy tissue that can fill up with blood and may become firmer with sexual arousal. It is also a means for urination. A person may be born with a penis or have one surgically created. When referring to genitals, the Trans Care BC website uses "erogenous tissue (penis)" for trans people assigned male at birth (AMAB) and "penis" for trans people assigned female at birth (AFAB), but there are many different terms that individuals may use. or vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. ). Sex is a label, usually assigned when a person is born, based on body characteristics. 

Gender is shaped by social factors. Gender roles, expressions and identities vary across cultures. Around the world, people have different ideas and expectations related to gender. These social and cultural understandings of gender can change over time. 

Gender is about how people feel on the inside. Sometimes, a person's gender matches what is expected of them based on their sex, and sometimes it does not. When there is a match, this experience is called cisgender Refers to people who are non-trans, i.e. whose gender matches their assigned sex at birth. . When there is a difference between a person’s gender and what is expected based on their sex, terms like transgender (trans) may describe this experience. 

Our Understanding Gender page provides some key definitions that we use to help explain the differences between things like: 

• Sex and gender
• Gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) and gender expression How a person outwardly communicates their gender, including name and pronoun choice, style of dress, and voice modulation. (Source: QMUNITY)  
   

Talking about gender diversity

When discussing gender diversity in children, we may use many terms. 

• Gender creative A term that refers to children who identify and express their gender in ways that differ from societal and cultural expectations. Some gender creative children grow up to be trans and some do not. describes children who identify and express their gender in ways that differ from social and cultural expectations. Some of these children may be transgender, and some may not. Each person’s gender journey is different, and the terms a person and their family use will be specific to their experience and culture and may change over time. 
• Affirmation The ways a person can be supported in expressing their self-identified gender. This may involve supporting social transition steps or changes in gender expression. describes the ways a person can be supported in expressing their self-identified gender. For some children, affirmation may require social transition Non-medical changes a person may make as part of their gender journey. This journey is different for every person. steps or changes in gender expression How a person outwardly communicates their gender, including name and pronoun choice, style of dress, and voice modulation. (Source: QMUNITY) ; however, for many others, affirmation may simply mean supporting them for who they are and how they express their gender. 

To help explain specific terms on the Trans Care BC website, we have a Glossary with over 100 definitions for words or phrases related to gender. 
 

Beyond the gender binary

You may have heard about the gender binary A view that there are only two genders (girls/women and boys/men) and that these genders are fixed, separate and unchanging. . It’s the idea that there are only two genders, such as boy and girl or man and woman. 

Many people fit within this gender binary, but others identify outside of it. A person may have no gender (agender Refers to people with no or limited personal connection to gender, or who identify as existing without gender , for example), more than one gender (such as bigender Refers to someone who has two genders. ) or a gender other than man or woman (genderqueer A person who does not conform to society’s expectations for their gender roles or gender expression. , for instance). Non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. is an umbrella term that refers to people whose gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) does not fall within (or exclusively within) the binary gender system of girl or boy.

For some, their gender may not have a label or name. As an example, some children may be ambivalent about gender, and others may have an explanation of how their gender feels but perhaps no term that feels like it fits. 

Exploring Gender Diversity (a gender diagram) is a helpful visual framework for discussing gender diversity. 

Supporting gender development

All children have different journeys and timelines for when and how they share their gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) and expression. Research helps us understand how gender develops in children.

What do we know?

We know that gender identity evolves over a young person’s life. The Canadian Paediatric Society’s 2023 position statement provides a good overview of gender development and affirming care from a medical perspective. 

During preschool, a child can develop an understanding of gender. However, preschoolers do not typically recognize gender as an identity but rather as a way people look. At this age, children often can be seen playing with and engaging with all types of activities, clothes, colours and ways of expressing themselves. Families are encouraged to support the exploration of various toys and behaviours and not make assumptions about their future gender. 

According to the Canadian Paediatric Society's guide on gender development in children, most children have a strong sense of their gender by the time they are four (but it may not be permanent). By age 6–7, children begin to appreciate gender as an identity that becomes more sophisticated through adolescence.

Children are getting to know themselves

It is common for children to express their gender in different ways. Gender journeys and timelines are different for everyone. When gender creative A term that refers to children who identify and express their gender in ways that differ from societal and cultural expectations. Some gender creative children grow up to be trans and some do not. , trans and Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) children are given space and support, they're more likely to express their gender in a way that feels right for them. This may simply mean sharing their gender diversity and authentic self with friends and family. Over time, they may want to explore other steps, such as changing their pronouns. As a parent, it's important to listen, make space and follow your child's lead.

Diversity of gender creative children

Each child is unique, and so is their gender. 

Gender involves two important parts: identity and expression. 

• Gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) is who the child feels they are. It is their internal and individual experience of gender. Some possible gender identities include boy, girl, gender creative A term that refers to children who identify and express their gender in ways that differ from societal and cultural expectations. Some gender creative children grow up to be trans and some do not. , non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. and genderfluid.
• Gender expression How a person outwardly communicates their gender, including name and pronoun choice, style of dress, and voice modulation. (Source: QMUNITY) refers to how a person communicates their gender through their behaviour and appearance. 

Gender creativity in children may show up in different ways:

• Some gender creative children’s gender expression does not conform to rigid gender norms, but they still identify with the gender they were assigned. 
• Some children do not identify as being a boy or a girl while others may be fluid in their identity and expression. 
• Other children consistently express that their gender is not the same as their sex assigned at birth. They may be frustrated or even distressed with the bodies that they were born with.

All of these ways of experiencing and expressing gender are healthy. However, if your child is expressing distress or asking for help with gender concerns, it is important to identify ways to relieve distress. Finding a counsellor or supportive health care provider could be helpful.

Good gender health comes from being able to freely express one’s authentic gender. By paying attention to children's gender expressions and what they tell you about their identity, you can learn how to support them best.
 

Gender health

What is gender health?

In recent years, experts specializing in care for gender creative A term that refers to children who identify and express their gender in ways that differ from societal and cultural expectations. Some gender creative children grow up to be trans and some do not. and trans children have talked about the idea of gender health. Supporting gender health means helping a child live in their authentic gender and express it freely.

What does authentic gender mean?

Authentic gender refers to a core part of our identity. It is the gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) and gender expression How a person outwardly communicates their gender, including name and pronoun choice, style of dress, and voice modulation. (Source: QMUNITY) that feels the most real and comfortable. A person’s authentic gender can only be described by them.

Supporting a child's authentic gender self

Many gender creative and trans children are supported in identifying and expressing their authentic gender selves. Their families, friends, teachers, communities and other important people play a crucial role in honouring and celebrating who they truly are. 

These young people may face challenges in the world due to the ways that rigid gender norms are often reinforced. But with access to safe spaces and lots of love and support, they can develop the resilience and confidence needed to express their authentic gender selves. With support, these children have the same chances as cisgender Refers to people who are non-trans, i.e. whose gender matches their assigned sex at birth. peers to become happy, healthy, confident people who thrive.

The gender affirmative model of care

Gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. promotes gender health in children and youth. There is a growing body of evidence that shows when children are supported in their gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) , it helps their mental health and enables them to engage more fully in the world around them.

Trying to change a child's gender or preventing them from expressing their gender freely may lead them to feel confusion or shame. This can contribute to mental health challenges like depression. 

The gender affirmative model is based on the following ideas:

• Gender variations are not disorders; they are identities.
• Gender variations are healthy expressions.
• Gender presentations are diverse and varied across cultures.
• Gender involves an interweaving of nature, nurture and culture.
• A person's gender may be binary, non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. , fluid or multiple and may change over time. 
• Distress related to gender most often comes from negative reactions from others.

Gender is complex, and gender diversity is a natural part of human diversity. Understanding this is important in learning how to support a gender creative A term that refers to children who identify and express their gender in ways that differ from societal and cultural expectations. Some gender creative children grow up to be trans and some do not. child. 

[Adapted from The Gender Affirmative Model (Keo-Meier and Ehrensaft, 2018)]