Explanations for Gender Incongruence (AQA A Level Psychology): Revision Note

What is gender incongruence?

• The ICD-11 (2022) defines gender incongruence as the feeling of a mismatch between one's assigned biological sex and one's experienced gender, which often leads to a strong desire to ‘transition,' i.e., to be a different gender than the assigned sex

  • E.g., a boy feels like he is a girl and wants to live as a girl, as he experiences distress at living within the assigned sex of male

    • They have a strong desire to change their primary and/or secondary sex characteristics to match the experienced gender

• The ICD-11 distinguishes gender incongruence of childhood (which requires the experience to have persisted for at least two years) from gender incongruence of adolescence and adulthood

  • Certain criteria must be met to ensure that the experience is consistent, persistent, and not temporary

Biological explanations for gender incongruence

• Biological explanations of gender incongruence focus on the influence of genetics, hormones and brain structure differences

Genetic explanation

• Heylens et al. (2012) examined 23 identical (Monozygotic, MZ) and 21 non-identical (Dizygotic, DZ) twin pairs in which one twin had gender incongruence. They saw concordance in 39% of the MZs but in none of the DZs

  • This suggests a genetic component to gender incongruence

• Hare et al. (2009) compared DNA from 112 transgender women with 258 cisgender men and found that the transgender group more often carried a variant of the androgen-receptor gene known to reduce the receptor’s sensitivity to testosterone

  • This suggests that reduced androgen signalling may contribute to gender incongruence

Hormonal explanation

• Berenbaum and Bailey (2003) reviewed cases of congenital adrenal hyperplasia (CAH), a genetic condition where the adrenal glands produce excess androgens in XX foetuses, which can lead to male external genitalia

  • The study found that around 5-10 % later reports significant gender incongruence, far higher than in the general female population.

• Hines (2004) found that XY individuals with complete androgen-insensitivity syndrome (CAIS) exposed to virtually no effective testosterone before birth almost invariably develop a female gender identity despite having XY chromosomes

  • This suggests that atypical levels of prenatal hormones contribute to gender incongruence

Brain structure explanation

• Brain-sex theory proposes that gender incongruence arises when certain sexually dimorphic brain regions develop with the template of the opposite sex

• One such region—the bed nucleus of the stria terminalis (BSTc), typically about 40 % larger in males than in females—illustrates this mismatch

• Postmortem research on six transgender women (male-to-female) showed that their BSTc was the same size as that generally seen in cisgender women (Zhou et al., 1995)

  • A later study confirmed that their BSTc contained an average neuron count within the normal female range (Kruijver et al., 2000)

Social/cultural explanations for gender incongruence

• Social explanations of gender incongruence explain it as a result of learned behaviour, with children gaining positive reinforcement from parents and/or peers for exhibiting behaviour usually associated with the opposite gender

• Just as children are socialised into their assigned gender roles, they may also be socialised into opposite-gender roles, e.g., parents who desired a daughter but had a son may unconsciously reinforce feminine behaviours

  • Over time, the child internalises an opposite-gender identity, which is then expressed as gender incongruence

• Cultural explanations draw on social constructionism, which argues that strict binary gender categories are a cultural product rather than a biological reality

  • This suggests that 'gender incongruence' may only exist as a clinical category in cultures that enforce a rigid male/female binary, rather than being a universal medical condition

• Queer theory frames gender variance as a form of cultural and identity diversity rather than as a clinical disorder, arguing that the very category of 'gender incongruence' reflects Western medicalisation of natural human variation

Social psychological research which investigates gender incongruence

• Littman (2019) conducted interviews with parents of adolescents with gender incongruence and found that parents felt that this was a case of positive reinforcement from peers leading to these young people developing the disorder

Evaluation of the biological and social/cultural explanations of gender incongruence

Strengths

• Postmortem brain research (Zhou et al., 1995; Kruijver et al., 2000) found that the BSTc in transgender women resembled that of cisgender women in both size and neuron count, supporting brain-sex theory

  • This provides evidence that gender incongruence may have a neurological basis, with sexually dimorphic brain regions developing along the template of the experienced gender rather than the assigned sex

• Cross-cultural evidence supports social/cultural explanations, as cultures that recognise third-gender identities (e.g., the Hijra in India, the Bissu in Indonesia) do not pathologise gender variance

  • This suggests that 'gender incongruence' is partly a product of Western binary frameworks rather than a universal medical condition, supporting the social construction of gender

Limitations

• Cause and effect cannot be firmly established in biological explanations, as brain differences may be a consequence rather than a cause of living as the experienced gender

  • E.g. the BSTc research is correlational and post-mortem, so observed differences may reflect lifelong patterns of behaviour, hormone treatment received during transition, or other lifestyle factors rather than innate biological differences present from birth

• There is a lack of empirical evidence for purely social explanations, e.g., Littman's (2019) research on parental influence had to be substantially revised to acknowledge it reflected parental opinion rather than objective evidence about gender incongruence

  • This weakens the social explanation, although ethical constraints make experimental investigation of gender incongruence very difficult

Issues & Debates

• Biological accounts are biologically deterministic, implying individuals have little control over their experienced gender identity due to genetics, hormones or brain structure

  • However, the decision to transition and express gender identity suggests an element of free will and personal agency, especially within supportive cultural contexts

• Most research is Western-centric, which may overlook how different cultures experience or interpret gender

  • For example, third-gender roles (e.g., Hijra in India) suggest that gender diversity is not universally viewed as pathological

  • This highlights a cultural bias in Western diagnostic frameworks like the ICD