Biological sex, gender identity & sexual orientation

Despite being commonly combined or confused with each other, “biological sex”, “gender identity” and “sexual orientation” are three separate terms that mean different things.

Biological sex

Your biological sex refers to your anatomy, which can be male, female or both (also known as intersex.) This label is assigned to you at birth by a doctor based on certain medical factors such as hormones, chromosomes and reproductive organs. This assignment of biological sex is put on your birth certificate as a gender label.

Gender identity

Your gender identity refers to your internal sense of self as being male, female, both, or neither. Your gender identity is determined by how you feel inside and how you express those feelings. People commonly express their gender identity through their appearance, their clothing, and their general behavior in everyday life. This internal feeling and its expression begin very early in life, for some, even as early as two or three years old. Most cultures have a set of social (and even legal) expectations about gender and what each gender should look like in terms of behavior, appearance, and common characteristics.

Some people feel that their biological sex and gender identity match and are in line with each other. These people are referred to as cisgender. Other people feel that their biological sex and gender identity do not match and are opposite from each other. These people are referred to as transgender. It is important to note that being transgender is not the same thing as being intersex, and that being transgender does not have any implications regarding sexual orientation.

Sexual orientation

Your sexual orientation refers to who you are attracted to. It is characterized by sexual and romantic feelings. Sexual orientation is typically divided into the following categories:

• Homosexuality – attraction to members of the same sex
• Heterosexuality – attraction to members of the opposite sex
• Bisexuality – attraction to members of both sexes
• Asexuality – lack of sexual attraction to others
• Pansexuality – attraction to persons of all sexes and gender identities

Cultural issues

Although a person’s sexual orientation, gender identity, or biological sex may not be a source of psychological distress, some people who identify as lesbian, gay, bisexual, transgender, or queer experience negative mental health outcomes due to harmful cultural stigmas surrounding sex and gender. These stigmas can have a significant effect not only on how others view LGBTQ+ people, but also on how LGBTQ+ people view themselves.

LGBTQ+ people face cultural issues like oppression, discrimination, marginalization, and bullying, all of which can be harmful psychologically. Some mental health outcomes of persistent cultural stigmatization include:

• Depression
• Anxiety
• Identity challenges
• Substance abuse
• Self-harm
• Chronic stress
• Trauma

Gender dysphoria

Incorrect cultural stereotypes and assumptions about gender and sex can be so pervasive and harmful that some LGBTQ+ people develop a psychological condition called gender dysphoria. Gender dysphoria is when the mismatch between your biological sex and your gender identity causes intense distress that can be so severe that it impairs daily functioning. It is defined by continuous feelings of identification with another gender and subsequent discomfort and emotional pain. Gender dysphoria affects children, adolescents and adults, and can manifest differently across age groups.

Gender dysphoria can lead to the following negative mental health outcomes:

• Social isolation
• Low self-esteem
• Preoccupation with appearance
• Anxiety
• Depression

Gender dysphoria can cause significant emotional damage and is especially difficult in cases where an individual’s family members hold stigmatizing views about LGBTQ+ or gender non-conforming individuals.

The following circumstances are known to relieve distress for individuals with gender dysphoria:

• A supportive environment
• The freedom to express their gender identity in the way that’s the most comfortable for them
• Knowledge that there are existing treatments that, if necessary, can help reduce their discomfort

How therapy can help

Treat Seasonal Affective Disorder with psychotherapy 

If you are experiencing psychological symptoms due to issues surrounding sex, gender or sexual orientation, you might benefit from the help of a mental health professional. While cultural progress has been made in terms of the treatment of LGBTQ+ individuals, homophobia still exists and can bring challenges in families, schools, workplaces and friendships. Therapy or counseling can provide and safe and respectful environment for LGBTQ+ individuals to explore their experience and learn to cope with challenges.

Issues related to being LGBTQ+ that can be helpful to address in psychotherapy include:

• Coming out
• Self-acceptance
• Identity
• Discrimination
• Bullying
• Relationships
• Family and extended family
• Workplace prejudice
• Gender-affirming surgery
• Religious identity