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Many anomalies such as AIS (Androgen Insensitivity Syndrome) can arise causing inconsistent development between the various elements by which we know ourselves to be either a man or a women. Among the larger group embracing all these varieties, there is a small subgroup of individuals who experience gender varience The personal experience of this state is sometimes known as gender dysphoria (dysphoria means ‘unhappiness’). The impact of genetic and/or hormonal factors on their fetal development appears to cause parts of the brain to develop in a way which is inconsistent with their genitalia, gonads and, usually, with their chromosomes. This may give rise to another, rather different, example of XY women, that is, individuals whose visible physical sex appears to be that of a man, but whose brain has some female characteristics and whose gender identification is, therefore, that of a woman. Or, conversely, gender variance may occur the other way round. An individual having XX chromosomes and the visible physical sex of a female, may have some male brain characteristics and therefore, identify as a man. So the issue of one's gender identification, whether as a man or as a woman, or even neither (or both which occurs only rarely), is rooted in the brain, and is regarded by the individuals concerned, and is demonstrated by research, to be largely determined pre-birth and more or less stable thereafter.
Transexualism
Thus the experience of extreme gender variance is increasingly understood in scientific and medical disciplines as having a biological origin. The current medical viewpoint, based on the most up-to-date scientific research, is that this condition, which in its extreme manifestation is known as transexualism is strongly associated with unusual neurodevelopment of the brain at the fetal stage. Small areas of the brain are known to be distinctly different between males and females in the population generally. In those experiencing severe gender variance, some of these areas have been shown to develop in opposition to other sex characteristics and are, therefore, incongruent with the visible sex appearance.
Gender Variant Children
Very rarely, children may express this incongruence between gender identity and the genital sex, but their discomfort is not always easy to identify. Symptoms of unease with the assigned gender role and the visible sex appearance are often only apparent to the individuals concerned and may not be understood even by them. If these children are unable to articulate their unease, their discomfort may grow through adolescence and into adulthood, as their families and society, in ignorance of their underlying gender identity, relentlessly reinforce gender roles in accordance with their physical appearance alone. However, some children are able to express a strong cross-sex identification, and sometimes insist on living in the opposite role. In particular, the increasing disgust with the development of secondary sex characteristics experienced by young people during puberty may be taken as a strong indication that the condition will persist into adulthood as transsexualism. Therefore, in carefully screened individuals, hormone blocking treatment may be given, before pubertal changes become apparent, so that these young people have more time to decide in which gender role they can achieve lasting personal comfort. There is no evidence that raising children in contradiction to their visible sex characteristics causes gender variance, nor can the condition be overridden by raising children in strict accordance with a gender role that is consistent with their visible sex.
Those who are not treated in adolescence may continue to struggle to conform; they may embark on relationships, marriages and parenthood in an attempt to lead ‘normal’ lives by suppressing their core gender identity. Ultimately, however, they may be unable to continue with the charade of presenting themselves as something they know they are not. The artificiality of their situation drives individuals to seek treatment to minimise the mismatch between the brain and the bodily appearance. They experience an overwhelming need to be complete, whole people and to live in accordance with their internal reality. Until this is achieved, the personal discomfort is such that it leads to great unhappiness and sometimes to suicidal feelings.