Gender nonconformity is the expression of gender characteristics that are socially and culturally associated with the opposite sex. Gender roles, femininity, and masculinity are concepts that have social and cultural meaning and agreement. Because male gender roles and masculinity are culturally more restrictive than femininity (women can wear pants, but men can't wear skirts) gender nonconformity (femininity) in boys, whether straight or gay, is often treated as more serious and results in stronger rejection compared with gender nonconformity (masculinity) in girls. Gay, Lesbian, bisexual and transgender youth and adults, who express gender-atypical characteristics, are more apt to be targeted for hostility and discrimination.

Compared with gender-conforming men or women, who express strong gender roles, gender identification, including fathering/mothering, and investment in power and social hierarchies, gender-atypical men, women, gays, Lesbians, and especially transgender folk, experience the following:

• More childhood trauma and sexual abuse

• More verbal and physical abuse

• Raped by relatives and/or lovers more frequently

• More experiences with harassment and bi/homo/transophobia

• Higher levels of mental distress

• Higher levels of parental and peer rejection

• Higher levels of fear and attachment anxiety

• Higher risk of eating disorders

• Higher body dissatisfaction

• Higher suicide attempts

• Feeling different, lonely, depressed, stressed, and victimized

• Loss of social support

• Lower self-esteem

To protect themselves, boys, especially, are conditioned and learn to "pass" within the construction of socially defined gender expression. Those who don't "pass" are more likely to be afflicted with parental discouragement, self-esteem issues, social rejection, harassment, hostility, abuse, and even death.

The experience of gender nonconformity, sexism, and homophobia, listed above may result in unresolved trauma, PTSD, generalized anxiety, relationship fears, or ineffective coping mechanisms. In counseling, it is important to pay attention to gender expression and its psychosocial consequences. Childhood gender nonconformity appears to play a role in the long term-mental health issues for men, especially gay men and male-to-female (M-to-F) trangender women. Gender affirming and supportive counseling is an important adjunct to a healthy and positive life.

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