Sexual orientation and gender identity

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In recent years, healthcare centers have started understanding the importance of incorporating Sexual Orientation and Gender Identity, or SOGI, in their medical records.

Traditionally, one’s assigned sex at birth is their biological sex which depends on their sex chromosomes. If they have a Y chromosome, their biological sex is male. If they have 2 X chromosomes, their biological sex is female. However, things aren’t that simple.

For example, a person could have a Y chromosome but they’re missing specific genes that encode for specific male characteristics, so even though they’re chromosomally male, they appear as what is stereotypically described as female.

So you’re thinking biological sex can be linked back to genes, right? Well, things get even more complicated than that. Some genes get expressed at high levels, and others at low levels. So a person may have genes that express a high level of testosterone and little or no estrogen and progesterone, or vice versa.

Finally, hormones like testosterone, estrogen, and progesterone bind to receptors, and some people may have lots of receptors that can easily bind to hormones, whereas others may have very few receptors. In many cases, these people are intersex individuals whose bodies do not fit into the standard definition of male or female.

The bottom line is that biology is messy, and like most things, biological sex exists on a spectrum. Now, separate from the biological construct of sex, is gender identity and gender expression. Gender identity is a person’s own sense of their gender and gender expression is how they present themselves to the world.

Many people identify as either man or woman. But there are also various types of non-binary gender, or gender identities that lie outside of the man-woman dichotomy. For example, someone could identify with multiple genders, such as Native or indigenous Two-Spirits do.

Furthermore, some will identify with a gender that’s neither man nor woman, while others may have a more fluid gender identity. Some individuals identify themselves as transgender, when their gender identity is discordant from the sex assigned at birth. Meanwhile, there are people who don’t feel any of these labels describe them or don’t like the idea of identifying with a specific gender at all.


Sexual orientation refers to whom you are sexually or romantically attracted to, while gender identity is about how you identify yourself, and sex is about biology. Gender identity includes identities such as heterosexual, homosexual, bisexual, and pansexual. Gender identity refers to an individual's internal sense of their own gender, which may or may not align with the sex assigned to them at birth. It's also important to ask someone which pronouns to use when referring to them. Collecting this data is essential to show respect to patients and their families but also to understand the differences individuals with a particular sex and gender identity can have.


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