Chapter 1 10 and characteristics generally associated with a individuals’ gender identity (gender dimensions). This includes a focus on gender identities, gender expressions, gender roles and norms, and gender relations (Box 1).8 From this perspective, gender identities can match or differ from people’s sex assigned at birth. Box 1. Gender dimensions and descriptions Gender dimension Description Gender identity Refers to and individual’s sense of self (i.e. identifying as a woman, man, non-binary person etc.) Gender expression Refers to the way an individual presents themselves to the world (i.e. how people present their body and identity through self-expression in e.g. clothing, hair, make-up, body language) Gender roles and norms Refer to social expectations associated with being a man, woman or non-binary person in a given society (i.e. societal structures that lead to shared ideas about what constitute e.g. masculinity and femininity) Gender relations Refers to ways in which power, authority and resources are distributed between sexes in a given society (the impact of gender on e.g. power dynamics in relationships) Investigating gender in medical research Researchers in social sciences already differentiated between the concepts of sex and gender in health in the 1970s. The constructivist perspective in social sciences holds the view that sex characteristics have a biological basis whereas gender dimensions are socially constructed and not natural phenomena. This position arose from the women’s movement of the 1960’s, when feminists argued that socially constructed gender differences have historically been mobilised to create and enforce inequalities between men and women in society and that these gender norms can be redefined to equalise the sexes. The constructivist perspective includes both ‘sex as biological variables’ (SABV) and ‘gender as sociocultural variables’ (GASV) paradigm in SGSM research.11 Currently, both the Canadian Institute of Health Research (2010) and the European Commission (2014) have endorsed the inclusion of both SABV and GASV in biomedical research, whereas the US National Institute of Health (2016) tends to focus more on the inclusion of SABV.12–14
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