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Gender and sexuality

Gender and sexuality are related but distinct concepts. Sexual orientation refers to whom one is attracted to and has a demonstrable biological component that is laid down early in development. 'Gender identity' refers to an inner sense of whether one feels male, female or something else; this is a theoretical construct whose scientific basis is much weaker. It is important not to confuse the two – not only to avoid confusion, but also because current practice in youth gender care disproportionately affects homosexual young people.

The distinction between gender and sexuality

Sexual orientation (straight, gay, bisexual) describes a pattern of attraction and has, as far as science reaches, a substantial biological basis: twin studies, prenatal-hormone research and persistent patterns through history all point to this. Homosexuality is not a choice or an identity-in-the-sense-of-a-feeling; it is a persistent trait.

'Gender identity' is a much younger and contested concept (see Gender identity and gender expression). It is not objectively measurable and rests on self-report. Anyone placing the two concepts on the same plane as if they were of the same nature suggests a scientific equivalence that does not exist.

Historical conflation of gender and sexuality

In the nineteenth century, homosexuality and gender variation were indeed confused, in the so-called 'inversion' theory: a gay man was supposed to have 'a female soul in a male body'. Sexology gradually unpicked that conflation in the twentieth century: homosexuality is not a gender question but a question of sexual orientation.

Ironically, the contemporary 'gender-affirmative' discourse brings back something that strongly resembles the old inversion theory. When a masculine girl or a feminine boy is automatically interpreted as 'really trans', the old wrong schema – namely, that 'inappropriate' gender expression points to a 'wrong' bodily sex – is reactivated, now with medical intervention added. LGB activists such as Bev Jackson and organisations such as the LGB Alliance have protested sharply against this.

Sexuality and trans identification

The relationship between sexual orientation and trans identification is known from the clinical literature. The classic study by Steensma et al. (2013) showed that a large majority of children with gender variation, left undisturbed, do not become trans but develop into homosexual or bisexual adults. Comparable findings come from earlier studies by Zucker, Bailey and others.

This is of great practical importance. A 'gender-affirmative' pathway for pre-pubertal children with gender variation – social transition followed by puberty blockers – has as its statistically expected outcome that a substantial part of what would have been gay youth is instead medicalised into a sterilised 'cross-sex' person. Clinicians such as Susan Bradley, Kenneth Zucker and Hilary Cass have pointed to the iatrogenic gay-conversion component of this practice.

In adult males who transition, there is a second pattern documented in the science: autogynephilia, a sexual orientation in which a man is attracted to the idea of himself as a woman (Ray Blanchard, Anne Lawrence, J. Michael Bailey). This hypothesis is extremely contested within activist discourse and is often suppressed, but is broadly recognised in the clinical literature as a real phenomenon.

LGBTIQ+ and the relation to gender

The coupling of transgender activism with the gay-rights movement under the umbrella 'LGBTIQ+' is being viewed critically by a growing number of LGB people. The arguments for gay rights (equality based on an innate orientation, the right to enter relationships with whom one chooses) differ fundamentally from the arguments in trans activism (a duty on society to recognise subjective gender identifications, including the medical bodily adjustment to them). A growing number of LGB organisations, notably the LGB Alliance in the United Kingdom, have split off for this very reason.

Another point of tension concerns 'cotton-ceiling' rhetoric and social pressure within LGB communities to accept transgender people as sexual partners, regardless of biological sex. Lesbians in particular have reported being pressured to revise their attraction to women – defined on biological grounds – on pain of being labelled 'transphobic'. This touches on fundamental rights to sexual self-determination.