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Assigned sex, gender and the spectrum of gender identities

While both terms are related, sex and gender have different meanings—and some gender identities have overlapping definitions. Keep reading to learn the differences and how specialized LGBTQ+ care can improve health outcomes.

What is assigned sex?

Your assigned sex is a biological label – male or female – you’re born with based on hormones, chromosomes (genes) and reproductive organs (genitals). Most are assigned female at birth (AFAB) or assigned male at birth (AMAB).

Some are born intersex, meaning they have male and female traits, such as genitals and hormones. Some people don’t know they’re intersex until puberty, while others never find out.

What is gender?

Gender describes your identity through behaviors and societal expectations of masculinity and femininity. Perceptions of gender identities vary from person to person because everyone is shaped by unique beliefs, experiences, upbringings and culture. Every community’s perception of gender evolves over time.

Gender identity and gender expression

Gender identity describes how you see yourself. Gender identity doesn’t always align with one’s sex assigned at birth.

Gender expression is how you express your gender through appearance, behavior and voice. For example, your clothes, hair and makeup. Gender expressions exist on a spectrum of masculinity and femininity. However, it’s OK if you don’t align with traditional gender expressions.

Name in use and personal pronouns

A name in use and personal pronouns describe what someone wants to be called. Misgendering means referring to someone using a name or pronoun that doesn’t align with their gender identity. Misgendering often affects mental health because it makes people feel less valued, disrespected and underrepresented.

Pronouns can be confusing, and it’s OK to make mistakes. If you accidentally misgender someone, acknowledging your mistake can help them feel accepted. Be brief and avoid focusing on yourself to avoid making them feel uncomfortable.

Which pronouns should I use?

If you don’t know someone’s pronoun, you can ask about their pronouns in private. Some people don’t use pronouns and may prefer being referred to as their name instead.

Common pronouns include:

  • She/her/hers are feminine pronouns.
  • He/him/his are masculine pronouns.
  • They/them/theirs are gender-neutral/non-binary pronouns.
  • Ze/Zir/Zirs replaces she/he/they.

What are the types of gender identities?

Gender identities go beyond male and female. You may use many terms to describe yourself. Your “label” isn’t permanent, and it can change at any time. You may identify as nonbinary and later identify as gender fluid, genderqueer or another term to better affirm your identity.


Cisgender describes someone whose gender identity matches his or her assigned sex – male, female or intersex. Cisgender doesn’t describe one’s romantic or sexual attractions.


Transgender, or trans, is an umbrella term describing people with a different gender identity than their sex assigned at birth.

Not all transgender people medically transition to an identified gender through hormone therapy or gender affirmation surgery. Some choose to transition socially instead. A social transition can include changing your name and pronouns, how you dress and wearing a different hairstyle to express your authentic gender identity.


Nonbinary is an umbrella term for people who don’t identify as male or female. Nonbinary looks different from person to person. They can identify as a man and a woman, neither or another gender. Other nonbinary identities include agender, bigender, gender fluid and genderqueer.


Agender refers to someone without a gender identity. While the terms overlap, not all nonbinary people are agender.


Bigender people can be two gender identities at the same time. For example, they can switch from feminine to masculine or identify as both. A bigender person can also be two nonbinary gender identities, like agender and gender fluid.


Genderqueer describes someone who doesn’t conform to binary gender norms. Some genderqueer people have multiple identities – transgender, binary or both. Genderqueer is an umbrella term for LGBTQ+ identities outside of the gender binary. They can be agender, bigender, genderfluid, pangender or another gender identity.

Gender fluid

Gender fluid refers to people who change their gender over time. A gender-fluid person identifies as one gender at a time.


The term refers to someone whose identity includes all genders. A pangender person may identify with multiple genders at the same time.

Gender-affirming care

Everyone deserves exceptional care without discrimination. Many people in the LGBTQ+ community delay care because they fear judgment because of their differences. When you share your gender identity and sexual orientation, your health care provider can better address all of your unique needs.

Allina Health offers inclusive care in a welcoming environment so you can be your best.

Personalized health care options include:


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