What Is… Sex vs. Gender

Gender-related terminology: sex, gender identity, gender expression, sexual orientation

While the terms sex and gender are often used interchangeably, they actually have distinct meanings. The distinction between the two was first proposed by a sexologist in the 1950s, and it’s now widely recognized, including by large organizations such as the World Health Organization. This post will look at what the differences are between the two, as well as the differences between gender identity, gender expression, and sexual orientation.

Sex chromosomes

Sex is based on biology and determined by our genes. Two X chromosomes and you have a female, while an X plus a Y chromosome makes a male. As a side note, this means that the sex of the baby is based on whether the sperm that fertilized the ovum bore an X or a Y chromosome; the maternal contribution is always an X chromosome.

There are a variety of sex chromosome disorders, including those with an extra X chromosome or an extra Y chromosome. Some people with genetic variations in sex chromosomes are born as intersex, with sex characteristics that don’t neatly fit into the male or female norm. This may occur in up to 2% of births in the United States. In the past, the term hermaphrodite was used rather than intersex, but it’s no longer considered acceptable to refer to humans. Its use is limited to biology to describe organisms, such as earthworms and snails, that have both male and female sex organs. 

Intersex humans may have variations in internal and external anatomy as well as sex hormones. Intersex characteristics may be visibly apparent, but in some cases, they can only be identified through genetic testing. At the time of birth, a sex is assigned arbitrarily, and in some cases, surgery will be performed to make the infant/child conform more closely to the assigned sex. These children are typically raised as the gender associated with the assigned sex.

Cultural gender norms

Gender doesn’t refer to biological characteristics; rather, it refers to one’s internal identification in relation to social constructs of “male” or “female”. The World Health Organization defines gender as “the socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. It varies from society to society and can be changed.”

While some may argue that these roles are inherently based in biology, power and control can have a significant impact on the role functions assigned to each gender. This topic is explored further in the post Separating Out Sex/Gender, Biology and Social Construct.

The WHO Europe states that: “The way power is distributed in most societies means that women have less access to and control over resources to protect their health, and are less likely to take part in decision-making.” Our society is highly gendered, and it’s become so normalized that it’s easy to lose sight of the fact that these gender roles are social norms rather than some sort of objective reality.

Gender identities

Some people never have identified with the social gender norms associated with their birth sex. A person who has always identified with the opposite sex’s gender roles may identify as transgender. The term cis-gender describes people whose gender identity matches their biological sex.

While we tend to think of gender as being very binary, i.e. male and female, not everyone fits into those neat little categories. Some people don’t identify with either the male or female box, and they may use terms like gender-queer, gender-fluid, or non-binary to describe themselves. Some cultures have distinct roles for non-binary individuals, sometimes described as a third gender. In Samoan society, faʻafafine are a recognized third gender. Some North American Indigenous groups use the term two-spirit; while the term two-spirit is modern, the concept of a third gender within those cultural groups is not.

Being transgender, or any other non-cis gender is an identity, not a mental illness. However, gender dysphoria is a condition arising from the distress of being in the wrong body in a highly gendered society. That diagnosis isn’t universally accepted as valid, although it is in the DSM-5. A blogger I knew took her own life not all that long ago, and a major contributing factor in the lead-up to her death was the trauma of being frequently misgendered, as she was unable to “pass” as her identified gender.

The fact that gender is a social construct doesn’t mean that we arbitrarily choose the gender we want to be; it’s more a matter of that’s the best fit with who I am rather than ooh, I pick that one!

Gender expression

Gender expression refers to external displays related to gender, and is not necessarily congruent with gender identity. Someone may cross-dress, including as a performance persona (e.g. drag queens), without identifying as the gender they’re dressing as.

Transgender individuals’ gender expression choices may be influenced by the discrimination they expect to face if their gender expression matches their true gender identity rather than their biological sex. If puberty blockers or other forms of hormone therapy aren’t started early, it becomes much harder to “pass” as one’s identified gender, because once secondary sex characteristics of the born-as sex develop, they can’t be undone.


So, sex derives from biology, and gender derives from social constructs. What about sexuality? It sometimes gets mixed in with sex and gender, but it’s a distinct phenomenon. Who a person wants to sleep with doesn’t necessarily have anything to do with their biology or the gender that they identify with. The fact that someone is transgender has no bearing on whether their sexual preference is for men, women, both, or neither.

Are people exposed to this information?

I must admit that I was fairly oblivious to much of this until I started working as a nurse. At that point, I started having contact with a far more diverse range of people. At the same time, though, exposure isn’t always enough. I remember having a conversation with a fellow nurse who couldn’t see the difference between gender identity and sexual orientation. She thought that trans people were just confused gay people, which is absurd.

The key thing, though, is not to assume that we get to decide others’ identities or the terms (including pronouns) that they get to use. Instead of assuming, ask. And even if someone doesn’t fit within your own conception of what gender is (or the Catholic church’s conception, for that matter), that doesn’t mean it’s not valid. Using someone’s identified pronouns is a lot like using their identified name; you might forget it sometimes, but it’s not up to you to decide what their name should be.

Were you aware of some of this terminology related to sex vs. gender?


The Psychology Corner: Insights into psychology and psychological tests

The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.

Ashley L. Peterson headshot

Ashley L. Peterson


Ashley is a former mental health nurse and pharmacist and the author of four books.

16 thoughts on “What Is… Sex vs. Gender”

  1. Thank you. This is an education for me – happily received. I don’t have a lot of exposure to gender-related topics, but one of my daughter’s best friends is now identifying as a boy/young man. I try to be as supportive as possible of this friendship even though I was not raised at a time when gender concerns were part of the social conversation/social fabric. I admit to being very new to the discussion.

    1. I remember around the time that I graduated from high school one of the teachers came out as trans. My dad was a teacher at the same school, and I remember him basically making fun of this trans person. There was definitely a lot less awareness in the past.

  2. We are confused by the terms. You explained them clearly; it’s hard for us to remember them. People label us non-binary, gender fluid, or gender queer. We do not always feel as one or the other binary gender—or we sometimes feel like one and sometimes like the other binary gender, and we do experience conflict about it.

    Before COVID, we use to express in a mixed way that reflected both male and female. We do that less now. Feel constrained. Our plumbing is our birth sex and we are sexually attracted to the other sex’s plumbing. even when we feel like that same gender as Spouse. Does that even make sense?

    Due to sexual abuse, we dislike our plumbing and body much of the time. Still, we are not planning to change it at this time.

  3. I knew all this from some alt dating sites I used to be on. I don’t care what other adults do regarding their gender/sexuality (long as it’s legal and consensual). It’s when we talk about kids that I will probably disagree…

    1. I think parents can certainly do a lot to help kids be safe with their behaviours, but if they’re not prepared to accept who their child is in terms of gender identity or sexual orientation, that has the potential to do a lot of damage.

  4. Clear explanation Ashley and I never even thought about the word ‘gender’ as being one’s internal identification in relation to social constructs of “male” or “female”. I thought, probably like many that it was interchangeable with the word ‘sex’. Hmmm, you learn something new every day. Thank you.

    I’m also with you on explaining the above to children, using age-related language and information.

    1. I think there’s a lot of value in teaching kids that it’s who they are on the inside that counts, whether that be in terms of beauty or various aspects of identity.

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