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Gender development and clinical presentation of gender nonconformity in children and adolescents

Michelle Forcier, MD, MPH
Johanna Olson-Kennedy, MD
Section Editors
Diane Blake, MD
David Brent, MD
Mitchell E Geffner, MD
Deputy Editor
Mary M Torchia, MD


Children generally are assigned a gender at birth based upon genital anatomy or chromosomes. For most children, gender assignment correlates with gender identity, which is the innate sense of maleness or femaleness. However, some children have a gender identity that does not correlate with assigned gender. These children are called gender-nonconforming or sometimes transgender. (See 'Terminology' below.)

The trajectory of gender nonconformity in childhood is unpredictable; some children with gender nonconformity will grow up and be transgender adults and some will grow up and be cis-gendered adults (ie, adults in whom gender identity matches genital anatomy). (See 'Trajectory' below.)

This topic will provide an overview of gender development and the clinical presentation of gender nonconformity in children and adolescents. An overview of the management of gender nonconformity in children and adolescents and issues related to gender in children with disorders of sexual development are presented separately. (See "Management of gender nonconformity in children and adolescents" and "Management of the infant with atypical genitalia (disorder of sex development)", section on 'Decisions about sex of rearing and surgery'.)


Cultural differences in concepts of gender, the language used to describe gender, and attitudes toward gender-nonconforming people may affect expressions of gender identity [1,2]. Many Western societies view gender as binary: male or female. This ideology sets an expectation that gender expression must conform to one or the other and may contribute to the pathologization of gender nonconformity [2]. When the gender expression of a child or adolescent does not fit neatly into the societal construct of male or female in congruence with their assigned sex, the child and family may be ostracized or stigmatized.

An alternate perspective views gender as a continuum from male to female, permitting a spectrum of gender identities with varying proportions of maleness and femaleness. Societies that view gender according to this more fluid or developmental perspective may be more accepting of gender variations [1]. Health care provider recognition and validation of the gender continuum and acceptance of individuals no matter where on the spectrum they identify may help to increase tolerance in families and communities [3].

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Literature review current through: Oct 2017. | This topic last updated: May 12, 2017.
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