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This concept is intimately related to the concept of gender role, which is defined as the outward manifestations of personality that reflect the gender identity. Gender identity, in nearly all instances, is self-identified, as a result of a combination of inherent and extrinsic or environmental factors; gender role, on the other hand, is manifested within society by observable factors such as behavior and appearance.

For example, if a person considers himself a male and is most comfortable referring to his personal gender in masculine terms, then his gender identity is male. Thus, gender role is often an outward expression of gender identity, but not necessarily so. In most individuals, gender identity and gender role are congruous. Assessing the acquisition of this congruity, or recognizing incongruity resulting in gender-variant behavioris important in the developing.

It is important also to note that cultural differences abound in the expression of one's gender role, and, in certain societies, such nuances in accepted gender norms can also play some part in the definition of gender identity. In order to understand gender identity development and related issues, definitions must be emphasized for clarity. The topic of gender identity is often discussed merely in terms of dysfunction, and the diagnosis of gender identity disorder is a known phenomenon in both children and adults.

In the realm of pediatrics, recognition of gender identity is a process rather than a particular milestone, and variance from societal norms can cause distress to both the child and the child's family. It is necessary to understand the varied pathways that lead to a mature and congruent gender role in order to fully assess a person's behavioral health. In the English language, the terms sex and gender are often used interchangeably in the vernacular. However, in a medical and technically scientific sense, these words are not synonymous. Increasingly, the term gender is being accepted to define psychophysiologic processes involved in identity and social role.

Therefore, it is not uncommon to hear references to "gender" by professionals from numerous disciplines, including medicine, psychology, anthropology, and social science. Gender comes from the Latin word genus, meaning kind or race. It is defined by one's own identification as male, female, or intersex; gender may also be based on legal status, social interactions, public persona, personal experiences, and psychologic setting.

Sex, from the Latin word sexus, is defined by the gon, or potential gon, either phenotypically or genotypically. It Sex with male looking for f or fm generally ased at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status.

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When an intersex condition is noted in a newborn, one sex is often chosen with the intention of simplifying social interactions and rearing. A person's sex is a primary state of anatomic or physiologic parameters. A person's gender is a conclusion reached in a broad sense when individual gender identity and gender role are expressed.

An often-used phrase to point out the difference, while an oversimplification, has some merit when dealing with these definitions: Sexual identity is in the perineum; gender identity is in the cerebrum. In instances when a discrepancy exists between sex and gender, compassion and empathy are essential to foster better understanding and an appropriate relationship between the physician and the patient. Conceptually, professionals dealing with development may fairly state that sex is biologically determined, whereas gender is culturally determined.

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Note that just as gender and sex are not interchangeable terms, neither are gender development and sexual development interchangeable. Physiologic sexual development progresses through distinct stages from the neonatal period through infancy, childhood, puberty and adolescence, and adulthood. Such physiologic change is distinguishable from gender-related behaviors during each of these stages.

The sexual identity that emerges beyond childhood is very clearly a separate entity from gender identity. Aspects of physical sexual growth, eroticism, and eventual sexuality, although closely related to gender, should not necessarily be used to draw conclusions about a patient's gender definitions. 's gender development, meaning maturation of gender identity, clearly begins in the intrauterine stage. Hormone-induced sexual dimorphism in the growing fetus probably plays a primary role.

This is apparent in the fact that, most commonly, female sex corresponds with female gender, just as male sex and male gender are commonly linked. Initially, all human fetuses are primed to have a female sex, in that the default pathway for development is toward female anatomy. During the eighth week of gestation, fetuses with a Y chromosome and a functional locus for the SRY gene product, also called the testes determining factor TDFundergo testicular development.

This process converts the inherently female fetus into a male one, as a steadily increasing surge of testosterone is then produced by the testes. Much of the testosterone is converted to dihydrotestosterone, which is the key virilizing hormone during gestation.

Along the biochemical pathway of hormone production, other recently identified gene products likely play an additional role in the masculinization of the fetus. The fetal brain is also affected by this process.

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MRI studies in human and animal models reveal that the corpus callosum, amygdala, cerebellum, and portions of the preoptic area of the hypothalamus are larger in brains exposed to intrauterine testosterone. Corresponding parts of the brain are smaller in female, or testosterone-deprived, fetuses. Indeed, in the absence of testosterone, the fetus continues its progression in the female state. Development of the ovaries and the female genital tract is likely triggered by follicle-stimulating hormone FSHwhich is present in both male and female fetuses, but whose effect is superseded by the testosterone surge in males.

The gender identity of a fetus, and later of an infant, is still incomplete by definition. Until a self-conceptualization of such an identity can take place, it remains in flux. At the same time, current research indicates that, because of the expected hormonal exposure secondary to genetic sex, all newborns probably have a certain gender bias toward a particular gender identity. Predicting this based on external anatomy or on other factors is not completely accurate because no specific means exist to verify the presupposition. In a small minority of newborns, it is also possible that the gender bias is neutral, in which case it may remain so or may be modified via environmental and epigenetic or other gene-influencing mechanisms.

Rudimentary gender identity at birth, although incomplete, is an important determinant in gender development. The dimorphism of the brain itself suggests a strong biologic underpinning to eventual gender development in the vast majority of individuals. Nevertheless, variations may occur when endogenous or exogenous factors create a fetal environment in which hormone levels do not follow the genetically predetermined pattern. In such situations, the gender bias of these infants may be tilted away from one that correlates with the genotype.

Such variations are discussed below.

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The environment in which a baby is reared with respect to gender begins to take shape prior to birth. Prenatal ultrasonography now allows the sex of a fetus to be determined quite accurately by the second semester of gestation. Families who receive knowledge of the child's biological sex often use this information to tailor parental planning and reactions. Thus, a preformed idea of the child's preferences is in place even before the child is delivered.

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Upon asment of sex at birth, a ificant environmental role begins in gender development, as the parents usually rear the child as either male of female, with all of the associated social interactions. In recent years, the prevailing notion once fostered by John Money of Johns Hopkins University, that gender identity is malleable during the first years of life, after which it becomes irreversible, has been challenged. Whether particular gender identity is truly an inborn characteristic, or even if it remains unchangeable through the course of an individual's lifetime, has not yet been determined.

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Several studies by Milton Diamond of the University of Hawai'i indicate that gender development reaches a critical point during childhood, after which it becomes extremely difficult to modify in most individuals. While there may be a of children who do not clearly fit into a neat binary model of gender in which the polar extremes of behavior are reserved for those with clear sex and gender congruence, it is increasingly clear that gender identity is at the very least an intrinsic characteristic that emerges during early development.

For the moment, a of proposed theories appear to have some validity. Note that these theories are neither mutually exclusive nor universally applicable, given the latest evidence. An epidemiologic approach to the human population as a whole cannot be reconciled with the very personal, and often unique, experience of gender development. As such, the current state of knowledge remains somewhat incomplete. Quite possibly, the multifactorial nature of mammalian development allows the inherent brain bias toward a particular gender identity to be molded during the first few years and, in some cases, perhaps even in later years.

Clearly though, as gender development progresses in children, an acceptance and personal expression of a gender identity occurs. Traditionally, this has been called the core gender identity. Evidence suggests that this expression usually takes place by age years.

The gender role may not necessarily be well defined until age 5 years, although, in some cases, it is evident earlier. Although this concept and these reference-age ranges have been accepted for several decades, the full plasticity of gender identity has not yet been fully elucidated. Whether an absolute final point truly exists after which a gender identity is irrevocably fixed is still unproven.

During infancy, gender identity probably remains in the same incomplete stage in which it exists at birth. At this point, the parents create the gender role, and parental decisions play the largest part in determining environmental influences. Theories of social learning describe differing types of reinforcement in families. Opportunities to experience Sex with male looking for f or fm variety of activities or restriction to sex-stereotypical ones may have some effect on gender development.

Scientific evidence describes behavioral changes that occur when parents of either sex interact with male babies versus female babies. Females are touched and cuddled more; males are encouraged to play assertively with toys and balls. The disparity seems to be greater with fathers than with mothers. Eventually, the concept of gender constancy develops in the growing.

This refers to the ability of to concretely differentiate between the genders, frequently occurring by age 2 years, at which time the first expressions of gender identity are commonly made. Gender constancy is thought to be achieved by age 6 years in nearly all children, barring those with specific variations from the usual pattern. Throughout the rest of childhood and school years, 's gender identity is typically reinforced by gender role. A preference for same-sex playmates usually manifests by age years, and the gender role is better defined by subsequent interactions.

A general assumption has been that boys typically prefer more rough-and-tumble activities, often involving physical aggression. Conversely, girls have been thought to prefer quieter activities, with greater reliance on fantasy and imagined situations.

Research by Money, among others, seems to indicate that these assumptions are largely true in the examination of school-aged children. The school environment often serves as a model for society, and ascription to either a male or a female gender role is often presented there, as well as at home.

In recent years, ificant strides have been made in the awareness of gender-variant behaviors in both boys male anatomic sex and girls female anatomic sex. Typically, female gender variance has been well-tolerated in Western society, with "tomboys" faring reasonably well in school activities. However, male gender variance "sissy boys" have not been looked upon favorably by families or society and have been more easily recognized. That such gender variance is biologically equivalent in boys and girls, and that it is not necessarily an indicator of gender identity disorder in childhood, is growing clearer.

However, the converse is also true; insofar as such behaviors have associations with confusion or incongruence of gender identity, both girls and boys may experience such symptoms. In adolescence, the influential factors of sexuality, personality traits or disorders, peer interaction, and anxieties are most important in gender development.

The nascent gender identity, fostered from infancy to childhood by parents, is first strengthened by playmates, schoolmates, and others.

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It is usually enhanced by the pubertal development of who progresses into adolescence, with its accompanying physical confirmation of the internal self-image. Although many believe that gender identity is fixed in early childhood, it is more certain that, by late adolescence and early adulthood, an established gender identity is unquestionably in place. In the usual case, an accompanying gender role is well defined, and gender identity in the context of one's sexual identity is also clear. Changes to the usual process of fetal development cause numerous differences in the resulting fetus.

When levels of prenatal hormones are altered, phenotypic progression is also altered. The inherent brain bias toward one sex may be discordant with the genetic makeup of a fetus, or even with its external anatomic presentation. Other variations lead to psychologic stressors in later development but have their origin in the prenatal stage. A of such conditions may ultimately affect 's gender identity. Two very well-described syndromes involving sex and gender, Turner syndrome and Klinefelter syndrome, result from chromosomal abnormalities.

In Turner syndrome, one sex chromosome is missing, causing a single X karyotype a solo Y chromosome is not compatible with life. Little evidence exists to suggest that hormone levels in utero are markedly lower than in the case of XX fetuses. The resultant XO individual is born with female external genitalia; however, in many such individuals, ovarian development is anomalous.

Other characteristics usually include short statureneck and chest anomalies, and cardiac defects. A ificant percentage of individuals with Turner syndrome have varying levels of mental retardation. This is clearly not true for all XO individuals. Many XO physicians practice in the United States. Female secondary sex characteristics often do not occur, and patients require exogenous estrogen intervention at the time of puberty. The vast majority of individuals with Turner syndrome are infertile.

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Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire