Gender: introduction

Concepts of gender and sex

The concepts of gender and sex are distinct but connected.

Sex: Each person’s physical characteristics relating to sex, including chromosomes, gonads, sex hormones, genitals and secondary physical features emerging from puberty. In Britain, the terms ‘male’ and ‘female’ are used in birth certificates to denote the sex of children. Harassment and discrimination based on sex are illegal in the Equality Act 2010.

Gender:  Refers to each person’s deeply felt internal and individual experience of gender, which may or may not correspond to the sex they were assigned at birth or the gender attributed to them by society. Gender identity includes the personal sense of the body, which may or may not involve a desire for modification of appearance or function of the body by medical, surgical or other means. A person’s gender identity is distinct from their sexual orientation. A non-binary person does not identify as a man or a woman but has a gender identity. A transgender person’s gender identity does not correspond with the sex shown on their original birth certificate.

Sex and gender, and the terms, 'male/female’ and ‘man/woman’ are often used and understood interchangeably. However, in the research literature, sex and gender are considered separately. These definitions are taken from the Equality and Human Rights Commission's publication Collecting information on gender identity (230kB).

Gender norms are learned and are not fixed; they evolve and change over time and space. The roles, behaviours or activities accepted as ‘normal’ can differ between societies. Societies vary in how rigidly they apply gender norms, and the amount of flexibility they allow individuals in interpreting their own gender identity. Unless challenged, gender norms can be formed and reinforced very early in a child's life (see: Zero Tolerance's training resources on gender equality in the early years). Unquestioned social acceptance of gender norms implies more limited opportunities for individuals, and physical and mental health risks if they do not comply with those norms.

Biological sex does not only consist of the simple binaries of male and female (UNHCR, 2021 (189KB); Sen et al, 2007 (734KB)). Just as people can  choose their gender, including non-binary gender identities, sex can also be changed in both a physical and a legal sense. The challenge to heterosexual norms by the LGBTQ+ (Lesbian, Gay, Bisexual and Transgender) movement goes beyond biological sex to reflect how sexuality and gender are defined and expressed.

Sex, gender and health

Sex differences and gender norms can condition behaviours and opportunities and therefore also affect health risks. Differences in health between men and women can result from biological differences, from gendered social determinants, or a combination of both.

Sex affects health at the individual level through specific differences which may be related to anatomy (e.g., cervical cancer is exclusive to females and prostate cancer to males), or the result of physiological or genetic susceptibilities. Gender affects health at a social level, through norms and expectations, access to resources and power, and differentials in roles and responsibilities. The social determinants of health, including income, employment, education, transport and housing are influenced by gender expectations and discrimination.

Sex and gender therefore interact with other factors that influence health to create conditions and problems that are unique, more prevalent, more serious or different with respect to the risk factors or effective interventions between genders.

Gender inequality may be experienced by women in relation to the pay gap, occupational segregation, primary caring responsibilities for children/family, gender-based violence and less economic and political power, all of which can contribute to poor health.

Although gender confers many privileges on men, a significant number of health outcomes are worse amongst men. The reasons for this are not completely understood but may relate to direct exposure to more hazardous environments (e.g. through occupational exposures), gender-influenced behaviours (e.g. substance misuse (see our alcohol and drugs pages)) or differences in service use. 

In relation to mental health, differences between genders become apparent in adolescence with young women at greater risk of reporting and being diagnosed with depression, anxiety and eating disorders while young men experience a higher prevalence of hyperactivity disorders, drug and alcohol problems, suicide and violence (Tod et al, 2013). Experience of gender-based violence is strongly associated with higher levels of mental health problems. Trans people are disproportionately affected by mental health difficulties and experience higher levels of mental health problems, suicide, and violence (Stonewall, 2018).

Intersections between gender and other social hierarchies

Health inequalities by sex and gender differ by age, ethnicity, disability, religion, sexual orientation, and transgender status. Relative inequality between socio-economic groups in health status by gender can be different within each of these equality strata (Millard et al, 2015).  For example, inequalities in cause of death show different patterns for females and males by age range (see our Older people: inequalities pages).