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Definitions of Gender, Sex, and Sexual Orientation and Pronoun Usage

Definitions of Gender, Sex, and Sexual Orientation

Gender has two components:

  1. Gender identity – a person’s basic internal sense of being a man, woman, and/or another gender (e.g., gender queer, gender fluid).
  2. Gender expression – conveyed through appearance (e.g., clothing, make up, physical features), behaviors, and personality styles. These means of expression are often culturally defined as masculine or feminine. The ways in which people express their gender identity are both particular to each individual and variable across cultures.

Sex is often described as a biological construct defined on an anatomical, hormonal, or genetic basis. In the U.S., individuals are assigned a sex at birth based on external genitalia.

Sexual orientation relates both to the types of partners to whom an individual is romantically and/or sexually attracted and also to how one identifies in this regard (e.g., straight, gay, lesbian, bisexual). Sexual orientation and gender identity are distinct constructs. A transgender individual may identify as straight, gay, lesbian, bisexual, or some other sexual orientation entirely.


Pronouns are important and should be addressed with patients at the start of treatment. The following presents recommendations for pronoun use:

  • When a clinician is unsure of someone’s pronouns, it’s appropriate for the clinician to ask and express their own pronoun at the same time.
  • Should a clinician make a mistake in using someone’s pronouns, the clinician should apologize, thank the patient for correcting them, and continue the conversation.

Below is a list of commonly used pronouns that clinicians may hear be mentioned while treating TGNC individuals. Please note that the pronouns they, them, and theirs are frequently used and even encouraged for use as a singular pronoun. For example, instead of saying, “He needs an appointment,” it can can stated, “They need an appointment.”

Subject Object Pronoun Pronunciation
She Her Hers As it looks
He Him His As it looks
They Them Theirs As it looks
Ze Hir Hirs zhee, here, heres
Ze Zir Zirs zhee, zhere, zheres
Xe Xem Xyrs zhee, zhem, zheres

Example Sentences by Pronoun

  • They – “They came into the clinic reporting that their depression had worsened.”
  • Ze – “Could you please tell zir when zirs appointment is?”

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