The way others interpret this expression is referred to as “gender perception” ( Table 1). Exploring different ways of expressing gender is common for children and may challenge social expectations. “Gender expression” refers to the wide array of ways people display their gender through clothing, hair styles, mannerisms, or social roles. For some people, gender identity can be fluid, shifting in different contexts. Self-recognition of gender identity develops over time, much the same way as a child’s physical body does. It may be male, female, somewhere in between, a combination of both, or neither (ie, not conforming to a binary conceptualization of gender).

Meanwhile, “gender identity” is one’s internal sense of who one is, which results from a multifaceted interaction of biological traits, developmental influences, and environmental conditions. “Sex,” or “natal gender,” is a label, generally “male” or “female,” that is typically assigned at birth on the basis of genetic and anatomic characteristics, such as genital anatomy, chromosomes, and sex hormone levels.