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Gender identity may be affected by a variety of social structures, including the person’s ethnic position, employment status, religion or irreligion, and family.

1 Gender identity - below the surface

In the overwhelming majority of cases there is no difficulty determining sex and gender. The overwhelming majority of human beings are considered to be either men or women. Before the 20th century a person's sex would be determined entirely by the appearance of the genitalia, but as chromosomes and genes came to be understood, these were then used to help determine sex. Most often, men have male genitalia, one X and one Y chromosome; and women female genitalia and have two X chromosomes. However some people consider that they do not fit these categories, and some have ambiguous genitals.

The most easily understood case in which it becomes necessary to distinguish between sex and gender is that in which the external genitalia are removed - when such a thing happens through accident or through deliberate intent, the libido and the ability of express oneself in sexual activity are changed, but the individual does not for that reason cease to regard himself as a boy or a man. One such case is reported in As Nature Made Him by John Colapinto. It details the persistence of a male gender identity and the stubborn adherence to a male gender role of a person whose penis had been totally destroyed shortly after birth as the result of a botched circumcision, and who had subsequently been surgically reassigned by constructing female genitalia. So the term "gender identity" is broader than the sex of the individual as determined by examination of the external genitalia.

2 Formation of gender identity

The formation of a gender identity is a complex process that starts with conception, but which involves critical growth processes during gestation and even learning experiences after birth. There are points of differentiation all along the way, but language and tradition in most societies insist that every individual be categorized as either a man or a woman. When multiplicity is arbitrarily reduced to absolute dichotomy, conflicts are sure to result.

When, for instance, the gender identity of a person makes him a man, but his genitals are female, he may experience what is called gender dysphoria, i.e., a deep unhappiness caused by his experience of himself as a man and his lack of male genitals.

Some research has been done that indicates that gender identity is fixed in early childhood and is thereafter static. This research has generally proceeded by asking transsexuals when they first realized that the gender role that society attempted to place upon them did not match the gender identity that they found in themselves and the gender role that they chose to live out. These studies estimate the age at which gender identity is formed at around 2-3. Such research may be problematical if it made no comparable attempt to discover when non-transsexual people became aware of their own gender identities and choice of gender roles.

Some critics question this research, claiming that the studies suffer from a sampling bias. The acquisition of hormone replacement therapyThis article is about the treatment with sex steroids. For hormone replacement therapy in general, and for other instances in which hormones might be prescribed, see hormone therapy. Hormone replacement therapy (HRT is a system of medical treatment for po and sexual reassignment surgery is generally controlled by doctors. One of the questions some doctors ask to distinguish between "real" transsexuals and others is to ask them when they first felt identification with the opposite sex. The researchers may then be unintentionally eliminating some subjects from consideration when they try to determine a typical time of gender identity formation. There is also a possibility of reporting bias, since transsexuals may feel that must give the "correct" answers to such questions in order to increase the chances of obtaining hormones. Pat Califia, author of Sex Changes and Public Sex, has indicated that this group has a clear awareness of what answers to give to survey questions in order to be considered eligible for hormone replacement therapy and/or sexual reassignment surgery:

"None of the gender scientists seem to realize that they, themselves, are responsible for creating a situation where transsexual people must describe a fixed set of symptoms and recite a history that has been edited in clearly prescribed ways in order to get a doctor's approval for what should be their inalienable right".