In most people, sex and gender identity are the same: such as in a person who is physically male, and considers themselves male. There are other permutations: for example, a pre-op female-to-male transsexual may be physically female, but consider themself male (i.e. having a male gender, or male gender identity).
The study of gender identity has also opened up discussion of sex and gender, with some schools of thought arguing that, in some cultures, sex does not always equal gender. In other words, someone's gender identity is not always determined solely by his or her sex.
Sometimes the line between gender identity and gender role is blurry. For example, is a drag queen acting like a woman (i.e. assuming a female gender identity), or acting like some women act (i.e. assuming a female gender role)? In fact, different drag queens describe themselves differently in this respect: the majority of drag queens have a male gender identity, some have a female gender identity, and a few, such as RuPaul, refuse to be categorised.
Some research has been done that indicates that gender identity is fixed in early childhood and is thereafter static. This research has generally proceeded by talking to transsexuals and asking them at what time they first felt an identity towards the opposite sex. These studies estimate the age at which gender identity is formed at around 2-3.
Critics question this research, claiming that the studies suffer from a sampling bias. The acquisition of hormone replacement therapy and sexual reassignment surgery is generally controlled by doctors. One of the questions some doctors ask to distinguish between "real" transsexuals and others is to ask them when they first felt an attachment to the opposite sex. There is also a possibility of reporting bias, when transsexuals give the "correct" answer in order to increase the chances of obtaining hormones. Pat Califia[?], author of Sex Changes and Public Sex, noted:
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