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(Reproduced with permission from The Gender Spectrum Collection.)


The new millennium has been accompanied by recognition of a gender revolution. While transgender, nonbinary, and gender diverse (TNG) identities are not new, increasing recognition and acceptance of the full spectrum of healthy and normal gender identities has accompanied increased visibility of TNG populations and more TNG youth seeking clinical care to affirm gender. This chapter aims to prepare those working in pediatric endocrinology to provide affirming, culturally appropriate, and state-of-the-art clinical care.


To provide affirming care for TNG nonconforming youth, all medical providers must have (1) a shared language with clear definitions of terminology related to gender identity; (2) a general understanding of the history of gender care and the challenges that TNG people have faced in health care settings; and (3) a sense of the scope of gender-affirming care, including how interactions in the clinical setting may impact a patient’s feeling of support and safety.

Language and Definitions

As is the case throughout medicine, shared language with clear definitions is central to accurate discussions of gender identity (Table 7-1). Sex is a term that describes the patterns of biological differences between male and female (including sex chromosomes, gonads, internal and external genital structures), though—as noted in Chapter 6—these patterns are not always consistent with medically defined categories of male and female. Gender describes the social expectations based on sex assigned at birth, while gender identity is an internal sense of one’s own gender, which may or may not align with sex assigned at birth. There is compelling evidence that gender is not simply a psychosocial construct, but likely reflects a complex interplay of biological, environmental, and cultural factors.62 Transgender and cisgender are umbrella terms used to describe gender identities: transgender is when gender identity is different from the social expectations for the sex assigned at birth, and cisgender describes when gender identity aligns with the social expectations for the sex assigned at birth.

Table 7-1.Terminology Related to Gender Identity

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