What is a Trans Woman?

16 min readAug 22, 2022

Public Domain Image courtesy of Wikimedia: Estrogen receptor beta complex with DNA

Contents:….
Preface
What is a Trans Woman
— Biological Gender
— Biological Sex
— Assigned Gender
— Social Gender
— Identified Gender
— Emotional Gender
So, What is Transgender, Biologically?
What is Transgender, Socially?
What is Gender Dysphoria & Gender Euphoria?
— Biological Gender Dysphoria
— Social Gender Dysphoria
So why is it important to respect a Transgender person’s name and pronouns?
So why do we let people “choose”, why don’t we have tests?
Sources
FAQ
— what about X/Y?, what about Gender-fluid & neopronouns?

Having been a trans woman with a background in STEM (Science, Technology, Engineering, & Medicine) for awhile, I’ve been asked by cis (non-trans) people various variations of “What is trans?”

Answering that is the point of this article. There will be scientific links and images, so I hope this serves well.

[Note: This article reflects my personal bias as to what is as a trans woman as affected by my history pursuing a bioinformatics’ masters degreee, and is geared towards reading & research I’ve done into trans women. For many things, the process for trans men can be shown as the inverse, or may be different altogether. And as this article should make clear, new research is always refining what we know, and past assumptions can get replaced with modern truths. As always, I suggest additional research.]

So what is a trans woman?

A trans woman is a woman who had developmental defects that initially made her appear to be a man.

At present, about 0.3% of the American population openly admits to being trans, but estimates of those not out put the number as high as 1.4%[3].

Being a trans woman is not exactly the same as intersex, although the two are similar in a number of ways. Our knowledge of both, however, is a result of medical discoveries in two different branches of medicine, the former through psychology and the latter through biology. If they had been discovered by the same pathway, a number of people speculate they likely would have been considered both two variants of some parent condition category.

First off, you’ll hear some people say, “Being trans is a choice, and gender is a social construct.” You’ll hear others say, “Being trans isn’t a choice, and gender is biological.”

Both of these are true. Being trans lies on a lot of edge cases, which I’ll get into. However, when you know the science, you’ll learn gatekeeping is the absolute worst thing you can do to a trans person.

A person’s sexuality & gender is made up of these basic components:

Biological Gender
Biological Sex
Assigned Gender
Social Gender
Identified Gender
Emotional Gender

If any of the gender categories don’t match the biological sex (original OR current), that person falls under the transgender umbrella term.

I’ll address the details of each type of sex/gender in turn.

Biological Gender — Biological gender (also sometimes referred to as Neurological Gender due to the focus on nervous system and brain) is primarely related to the nervous system, and is initially set in the first week of fetal development[1][5], and reinforced (or detracted from) in various ways all up until birth[2][5]. Based off the genes[1][3], the nervous system[1][5], and brain structure [1][2][5], this differentiates to somewhere on the spectrum between male and female with lots of nuance. (Technically genes differentiate first[1][2][3][5], followed by nervous system[5], then biological sex[2], then brain[1][2]). There are over 50 genes that decide biological sex/gender, and most of them will affect the nervous system in some way (at least 19 of which affect the brain directly [2]). This causes the nervous system to create receptors for various gendered hormones (such as testosterone and/or estrogen) and how many receptors. During fetal development, initial hormone production is set as well[1][5]. Biological Gender cannot be changed once set, and generally all attempts to do so have resulted in death. There is also Incidental Biological Gender which is the gender in context of given organ, tissue, etc. in the body. With a transgender person, where their Biological Sex & Gender vary, the gender of various internal organs can be somewhat random. Usually it’s a non-issue, but on rare occasion, it comes up.

With a pre-op trans women, Biological Gender is typically aligned with their “chosen” identity, NOT biological sex.

Biological Sex — Biological sex is initially and specifically related to the sexual organs, and is decided about 7–8 weeks into fetal development. The fetus’s genital ridge will check the body’s testosterone/estrogen levels, and sexually differentiate based on those levels (an error in this process is the most common cause for someone to be transgender, though not the only cause). Afterwards, the sexual organs take over hormone production. This can be changed through extensive use of surgery and hormone supplements. I have heard a few people try change the name to Incidental Biological Gender of the Reproductive System in order to bring it in line with the rest of the terms, but I haven’t seen it gain any traction — possibly because it’s a lot wordier.

It’s worth noting that there are many genes associated with biological sex, and this is not a on/off switch, but more like a sound board with multiple sliders (see previous references). Human genetics “clump” around a few core “settings” on a digital surround system, acting kind of like presets on your sound player mixer (this is where we get the illusion of static male & female), but just like how you can’t guarantee someone didn’t turn up the base in a rental car, you can’t guarantee someone will match those genetic ‘presets’.

Assigned Gender — This is a person’s legal gender, for example found on legal documents such as driver’s licenses and passports. It’s usually first given when a person is born. This has a subcategory of “Assigned Gender at Birth” It’s goal is generally to determine the person’s biological gender, but generally initially established based on a doctor guessing based on biological sex (this “First Draft” is the “Assigned Gender at Birth”). It can sometimes be changed through legal processes, depending on local laws.

Social Gender — This is how society treats a person in a gender-coded way. When people talk about how “gender is a social construct”, this is what they’re talking about. It’s decided when people interact with someone. A lot of our experience of gender comes from how we interact with others and how others interact with us. This is where “passing” and “stealth” are relevant. It can be changed through personal presentation & interaction. This includes both Perceived Gender, and Acknowledged Gender. Perceived Gender is what people will initially think of a person’s gender at a glance. Acknowledged Gender is how the community treats the person generally, including by people they regularly interact with.

Identified Gender — This is how the person self-identifies. This is also known as Chosen Gender. Basically, if they had to put a gender down in their diary, what would they put? It’s usually determined by a combination of Social Gender and Emotional Gender. This generally begins once a person can talk and name things, and it can be changed through life experience or discovering that their emotional gender doesn’t match their assigned gender or biological sex. If someone says, “I am a girl”, then “girl” is their identified gender.

Emotional Gender — Also known as Felt Gender or Real Gender, is how gender is felt. It involves feelings, thoughts, and emotions, how they are formed, imprinted, and experienced. It generally begins at about 2–3 years old, but is almost exclusively (over 90%) determined by Biological Gender. If it is different than biological sex, it may take awhile for it to also become the identified gender. However, once the person “figures it out”, it rarely changes, even if “figured out” at a young age[6]. The main exception is figuring out more details. A person’s emotional gender is generally the same both before and after transition, and is how they’ve always felt.

So, what is transgender, biologically?

Being transgender is when your biological gender and your biological sex initially don’t agree.

This is what “trans” means in science most of the time when you see research papers on the subject. Trans is a prefix which means “to cross from one side to the other”. Alternatively “cis” means “to stay on the same side”. This is why people who aren’t called transgender are called cisgender.

Anyone who has had this difference will be biologically transgender.

So, what is transgender, socially?

Anyone who has a mismatch anywhere between social gender, assigned birth gender, and identified gender is socially transgender.

What is Gender Dysphoria & Gender Euphoria?

When a person’s Biological Gender and Biological Sex don’t match, there are health problems. Specifically, the reproductive organs make a LOT of gendered hormones, usually geared towards one gender. However, if the nervous system’s gender doesn’t match, this means you get a lot of useless hormones flying around, and a shortage of the ones the nervous system expects.

This creates a unique kind of pain called Gender Dysphoria. This comes in two forms, biological gender dysphoria or social gender dysphoria.

Biological gender dysphoria a very intense but also frequently lifelong pain unless treated. The pain is so frequent the nervous system eventually numbs to the actual pain, and instead it is felt as as a kind of an ambiguous anxious or depressive feeling.

Because each body is different in how much hormonal conflict there is, alongside differences in numbing (and other tack-on psychological effects), not every transgender person feels dysphoria.

It’s also possible for cisgender people to feel biological gender dysphoria in certain uncommon circumstances that alter their gendered hormone balances significantly in some way, such as drugs or damage to hormone-producing glands (this wouldn’t make a cis gendered woman feel like a man, but feel like something is harming her femininity. An example is uterus removal due to changes in horomones.)

Social Gender Dysphoria is a feeling of anxiety caused by not fitting in as your chosen gender [it should be noted, some will confuse this with a similar but wholly different issue called dysphasia — although both appear similar, the root causes are vastly different] . (See the following section on why it’s important to respect name and pronouns.) This is a form of social anxiety, which combined with the anxiety from Biological Gender Dysphoria, can often be debilitating.

It’s also possible for cisgender people to feel limited social gender dysphoria as well in certain circumstances as well, such as women suffering female hirsutsim (such as growing prominent hairs on the back, chest, or face.), and she might feel her femininity is in question.

To this end, the more universal experience among transgender people is gender Euphoria. This particular kind of euphoria is the type of pleasure that a person who has been in pain feels when that pain ends. Some people experience a similar form of pain relief after getting a tattoo.

However, like gender dysphoria, gender euphoria also is not guaranteed, even with treatment. As always, experience varies, and bodies differ. That said, it is not normal for a trans person to feel greater gender dysphoria with treatment. This would imply a mistake had been made; such mistakes have been shown to be exceedingly rare, less than .003% of the population.

So why is it important to respect a transgender person’s name and pronouns?

For one, it’s honestly a more accurate way of referring to the person.

If that’s not enough, people should respect other’s identities as a general rule. (If you’re a Tigers fan, you wouldn’t want someone going around telling everyone you’re actually a Dolphin’s fan.)

That said, if these two reasons still aren’t enough for you, there’s another reason.

Imagine you shattered your leg in an accident. That leg has been put in a heavy, sweaty, itchy cast, and your leg constantly hurts. Then, your sibling comes in with a video game. You two start playing, and as time goes on, you completely forget about your leg. You’re mentally lost in just having fun with your sibling, and you’re effectively temporarily free of pain due to being distracted from it.

Then, the Doctor comes in, and says, “Hey there, how’s your broken leg doing? Is it sweaty or itchy? Does it hurt at all?”

All of a sudden, all the pain, the itching, and the discomfort come rushing back. It may not have actually been gone, but your mind was elsewhere, making it tolerable. If the doctor came in and did this every few minutes, it’d be torture.

Language, fashion, culture, and gender roles are a constant reminder of gender. When it doesn’t match emotional gender, it reminds the person of their biological gender dysphoria. When using anything other than the person’s identified gender, it triggers their social gender dysphoria. This means that until their emotional gender and identified gender match, they will suffer some form of dysphoria, regardless. After emotional gender and identified gender match, there is an option that is safe from both types of dysphoria.

This is a big reason why trans people have a high rate of suicide when surrounded by unsupportive family & communities, but those rates drop to about the same as anybody else when they’re in accepting and helpful communities.[4]

So why do we let people “choose”, why don’t we have tests?

First off, “choosing” is politically and technically convenient. It’s usually not actually a choice involved, but the law treating it as a choice makes things easier… usually. It’s easier than reworking the entire legal system to adjust for the complexities of people that don’t fit cleanly into one of two boxes.

The big reason, however, is testing for transness while a person is alive is very difficult and very expensive. The key point is at the sub-microscopic level of the nervous system. You can’t really check it out directly without it being done during an autopsy or permanently damaging the nervous system. So the only way to test for it, biologically, is to test all the causes. And there’s a LOT of potential causes. For about ~90% of cases, a full exome DNA test with analysis can do it [3] (this is about the most expensive DNA test, costing well over $10,000 USD for the test alone, and that’s nothing compared to the cost of the analysis that would need to follow to painstakingly go through an analyze each gene and it’s triggered effects, which could cost millions.) Even charging people over just $10k before a doctor will begin to consider treating a health issue would be a major problem. (Trying to gatekeep on medical tests is what a small group now called truscrum, mediscrum, or transmedicalists did awhile ago, usually to disastrous effect.)

So, research was done to see if there was an easier way to tell. The answer turned out to be: let people “choose” (often with the help of a trained mental health professional). It has been found that by letting people honestly evaluate their emotional gender, their biological gender can be accurately determined 99.998% of the time. This is unsurprising considering its an issue with the nervous system that’s active everyday, by letting a person honestly feel like they are in a safe and supportive environment, they will make decisions that make them more comfortable.

This is what I refer to as a “leg chop choice”. It’s like letting people “choose” whether they want their legs chopped off or not. A normal person wouldn’t ask for their leg to be chopped off, but a person who’s currently snagged by an alligator who is dragging them by a mangled leg into the water will definitely want their leg chopped off to save their life. It’s similar for trans people. Trans people can feel the danger and pain of their situation, and so need to make what feels like a drastic choice to others.

Sources:

[1]: Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders ~ Bao, et. al

[2]: Gene variants provide insight into brain, body incongruence in transgender ~ Baker

[3]: The Use of Whole Exome Sequencing in a Cohort of Transgender Individuals to Identify Rare Genetic Variants ~ Theisen, et. al

[4]: Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt ~ Bailey, et. al

[5]: It is not all hormones: Alternative explanations for sexual
differentiation of the brain ~ Davies, et. al

[6]: Few Transgender Children Change their Minds After 5 Years, Study finds. ~ Ghorayshi

[Note: I will likely be updating this article later with additional research sources. I already have all the ones I’m planning to use, although I’ve been given a few more to add that I’m reading over, but they’re in kind of an unorganized mess of papers, at the moment, and I’d like to share them with links. So if you see this article before part of it has sources, feel free to check back later.]

F.A.Q.

(Note, these are frequently asked questions I’ve been asked in real life and online. If some additional questions arise, I may add them to the list)

Isn’t a person’s sex/gender determined by whether they have an X or Y chromosome?

Short answer: No.

Medium answer: Eh, sometimes, sort of, there’s a sometimes pattern at least?

Long answer: No, and here’s why: Before the completion of the Human Genome Project, we knew our DNA decided most things about us thanks to groups of researchers like Rosalind Franklin, James Watson, & Francis Crick figuring out the structure of DNA; and Alfred Hershey & Martha Chase figuring out that DNA carried biological code. We knew DNA decided stuff about us, and one of the things expected was sex & gender (people didn’t originally know they were separate things). Human DNA is made of 23 pairs of chromosomes, which are gigantic groups of millions of genes. It was found, before the completion of the human genome project, that usually (but not always) that biological sexed males usually (but not always) had an X and a Y chromosome, and biological sexed females usually (but not always) had two X chromosomes. The exceptions were chalked up to faulty equipment (it was REALLY hard to tell all the details back then) and sloppy interpretation of those difficult readings. Thing is… they weren’t mistakes. Those exceptions were actual exceptions. However, people assumed they were errors, and the results were deemed “close enough” and XX vs XY being female vs male entered the textbooks.

However, those exceptions were kind of a big deal. Turns out, chromosomes themselves aren’t THAT big of a deal. They are like big filing cabinets that store genes, but the genes get swapped between filing cabinet frequently. This is called chromosomal recombination, every new person includes multiple instances of Chromosonal Recombination. Anywhere from individual genes to whole chromosonal legs get swapped from one chromosone to another. Like, there may be a tendency for various genes to be in certain chromosomes, but it’s far from guaranteed. When that was discovered, there was kind of a communal freak-out in the science community. Scientists had worked years trying to determine which chromosome various traits were on, and it all went up in smoke in. It was initially discovered as early as 1931, but the big change was discovering it was common (with discoveries to that regard in 1978, 1991, and 2000).

So, we had to re-figure out where sex/gender came from. The first (and easiest to find) target was the SRY gene. It had a high reliability in determining sex/gender, so for a few years, it was mistakenly assumed it was the only sex/gender gene. It was moderately reliable (though not 100%). The idea of a male/female on/off switch was “saved”. Again, errors were chalked up to errors in equipment or to human error of those doing the testing. Except this was before we finished the human genome project — the task to map every single human gene. In the process, we found another sex/gender determining gene. And then another, and another, and another. In the end, over a definite 50 sex/gender determining genes were found, with a lot of others that could have an effect.

The Human genome project started in the 80’s and neared completion (hitting most of the important stuff) in 2003, with final completion in 2022. This is one of the reasons gender & sex are such a hot topic right now (this article is written in 2022), is because we’re in the middle of all those old ideas having to be thrown out the window, and realizing those past “errors” weren’t errors but actual exceptions. It’s a wild time for gender & sex in the science community, so everything changing from what you knew before is totally to be expected.

So what’s the deal with gender fluid and neo pronouns and all that stuff?

As mentioned previously, there’s over 50 different genes that control gender. These aren’t just “+ 1 to Girl” or “+ 1 to Boy” and tally the final score, each one codes for something related to gender, but each one’s different. So like one gene might decide whether there’s testes or ovaries, and another gene might decide if they drop or not (I, for example, am a trans woman who had ovaries, and they dropped. Doctors originally thought they were “oddly shaped testes” They hurt… alot, and all the time.) As a result, technically every combination is a different gender. Considering each gene has two copies, and each copy can be dominant, recessive, or be a variant with duplication, deletion, or transposition, that’s about 10 combinations per gene, which makes it translate nicely into numbers. Basically, you have a 50+ digit number where each number is a different gender. So you have 10,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 possible human biological genders. (For comparison, if every galaxy & star in the sky had a least 5 livable planets per star, and humanity colonized them ALL to the density of where we’ve populated Earth, we MIGHT have one person of each gender.) And some of these variations are affected by horomone levels as they ebb and flow. (Of these theoretical genders, over 120,000 of these variants have already been identified in practice. [2])

And remember, gender can be felt. People will often choose a gender that feels close-enough, but sometimes, none fit, and they need to choose something else to feel right. They may choose something established that feels “close enough” or they may make something up that feels perfect for them (and then have to explain it to everyone they come across, which is their call).

That’s where gender fluid and neopronouns come from. If people are close enough on a major boundary that the change in their horomones can trigger one thing and a different level triggers another, they may fluidly change between multiple emotional genders that in turn they adapt by changing identified genders that are “close enough”. Similarly, neopronouns are used by people who feel that the standard pronouns just aren’t close enough to what they feel. Both are valid.

Why do trans people need to transition, though? Why can’t they just take some pill to adjust the hormone balance?

The thing is, the hormone imbalance is what causes the initial incorrect biological sex. Fixing the hormone imbalance causes transition.