How Sexuality and Gender Unfold from Infancy to Adulthood From a LGBTQ Psychiatrist
Sexuality is often thought of as something that begins in adolescence, when puberty sets in and sexual attraction becomes more visible. But in reality, human sexuality begins in infancy and evolves across the lifespan. It is a dynamic interplay of biology, emotion, culture, and experience. It shapes how we connect with others, understand our bodies, form identity, and express affection or desire.
This blog walks through the developmental course of sexuality from infancy to older adulthood, highlighting how gender identity and gender dysphoria may emerge and shift over time. Understanding this can help reduce stigma, support healthy development, and foster more inclusive families, schools, and communities.
Written by Dr. Soe Thein, an NYC psychiatrist with expertise in LGBT mental health care.
Infancy (0 to 2 years): Sensory Discovery and Attachment
Sexuality in infancy is not about attraction or desire. It is about the earliest experiences of comfort, pleasure, and closeness. Infants are born with a capacity to experience bodily sensations and to form emotional bonds. They discover their bodies through touch and seek soothing through connection with caregivers.
Key developmental themes:
Body exploration: Babies touch all parts of their bodies, including their genitals. This is part of sensory learning and self discovery, not sexual behavior in the adult sense.
Attachment and trust: Consistent, loving care helps babies develop secure attachments. This foundation shapes how they relate to others and experience intimacy throughout life.
Comfort and regulation: Being held, rocked, or spoken to in a soothing voice helps infants regulate emotions and builds the capacity for later emotional intimacy.
Though gender identity does not form this early, infants begin absorbing cues from their environment. The colors they are dressed in, the tone of voice adults use with them, and how people refer to them all contribute to early gender socialization.
Early Childhood (3 to 6 years): Gender Identity and Fantasy Play
This is the stage when most children become aware of their gender identity and begin to assert it. They explore roles and relationships through pretend play, express curiosity about bodies, and ask questions about where babies come from. These are all developmentally appropriate and should be responded to with openness rather than shame.
Key developmental themes:
Gender identity formation: By around age 3, most children have a sense of being a boy, a girl, or another identity. Some children express discomfort with the gender they were assigned at birth, which may be an early sign of gender dysphoria.
Sexual curiosity: Children may engage in exploratory play, touch their genitals for comfort, or ask about body differences. Adults can respond calmly, using simple and respectful language.
Role play and fantasy: Children act out social roles like parent, teacher, or superhero. Some may gravitate toward roles or clothing not typically associated with their assigned gender. This is part of normal identity exploration.
How Gender Dysphoria May Present in Early Childhood
Some children may say things like “I am not a boy” or “I want to be a girl” with clarity and persistence. Others may refuse to wear certain clothes, avoid gendered activities, or show distress about being misgendered. Not all gender diverse children will grow up to be transgender, but their feelings deserve to be respected and explored with curiosity rather than correction.
Middle Childhood (7 to 11 years): Internalization and Social Awareness
During these years, children become more private and less openly curious about sex. They focus more on school, friendships, and moral understanding. Freud called this the latency stage, where sexual energy is redirected into learning and social activities. However, gender identity continues to solidify, and awareness of social norms deepens.
Key developmental themes:
Privacy and modesty: Children may want privacy when changing or using the bathroom and may feel embarrassed by physical affection in public.
Same gender friendships: Friendships often occur within the same gender group and become central for emotional support.
Understanding of norms: Children become more aware of gender expectations and may feel pressure to conform.
Gender Dysphoria in Middle Childhood
If a child has experienced gender dysphoria earlier, these years often bring more intense feelings. The divide between internal identity and social role may widen, especially if adults or peers expect conformity. Some children may begin socially transitioning by changing names, pronouns, or clothing. Others may experience anxiety, sadness, or school avoidance if they cannot express themselves freely.
This is a critical window for affirming a child’s identity and creating a supportive environment. Gender affirming care does not push children toward a specific outcome. It simply allows them to explore who they are with safety and dignity.
Adolescence (12 to 18 years): Puberty and Emerging Identity
Adolescence brings dramatic physical, emotional, and cognitive changes. Sexuality becomes more conscious and relational. Teens explore romantic attraction, sexual orientation, and relationship boundaries. For many, this is also a time when gender dysphoria intensifies.
Key developmental themes:
Physical changes: Puberty involves body hair, menstruation, breast or penile growth, voice changes, and more. These changes can bring excitement or discomfort.
Sexual and romantic identity: Teens may identify as gay, lesbian, bisexual, pansexual, or queer. Others may feel pressure to conform to heterosexual norms.
Autonomy and experimentation: Teens may begin dating, engaging in sexual activity, or questioning long held beliefs about gender and attraction.
Emotional intensity: First love, heartbreak, and sexual shame or confusion are common. Supportive adults can help normalize these feelings.
Gender Dysphoria in Adolescence
Puberty can be a particularly difficult time for transgender and gender diverse youth. The development of secondary sex characteristics may feel foreign or distressing. For example, a trans boy may become distressed by breast development or menstruation, while a trans girl may feel increasingly uncomfortable with facial hair or voice deepening.
Some teens may pursue puberty blockers, which pause physical changes and give time for identity exploration. Others may seek hormone therapy or begin to transition socially. These are personal decisions made in collaboration with medical providers and mental health professionals.
Emerging Adulthood (18 to 25 years): Consolidation and Freedom
In this stage, many individuals move away from their family of origin, explore new relationships, and reflect deeply on identity. Sexual and romantic experiences become more self directed. Some people embrace labels, while others reject them in favor of fluidity.
Key developmental themes:
Sexual agency: Young adults learn to advocate for their needs and preferences, communicate in relationships, and explore boundaries.
Reevaluation: Some people come out for the first time in college or decide to explore a different gender identity than they had in childhood or adolescence.
Intersection with mental health: Identity formation can intersect with depression, anxiety, or trauma, making this a key time for emotional support and affirmation.
This is also when many people seek gender affirming medical care, update legal documents, or build community with others who share their identity. A supportive and informed therapeutic relationship can help navigate all of these transitions.
Adulthood and Older Adulthood (26 and beyond): Lifelong Evolution
While often overlooked, sexuality and gender continue to evolve well into adulthood. Relationships change, desires shift, and life experiences may lead to new understandings of self. Some people come out or transition later in life, while others deepen their sense of identity and connection within long term partnerships.
Key developmental themes:
Intimacy and growth: Adult relationships may emphasize emotional closeness, co parenting, or stability. Others may involve exploration, reinvention, or renewal.
Aging and body image: Menopause, erectile changes, illness, or disability can reshape how people feel about their bodies and sexuality.
Later life identity: Some adults come out as transgender or nonbinary in middle age or beyond, especially if they did not have support earlier in life. Others return to earlier identities they had abandoned under social pressure.
Gender Dysphoria in Adulthood
Gender dysphoria does not expire with age. For some adults, it becomes more pronounced over time as it becomes harder to suppress. Others may feel liberated to express themselves after raising children or retiring. Medical care, peer support, and affirming spaces remain essential for adults navigating gender identity later in life.
Final Thoughts From an LGBTQ Psychiatrist
Sexuality and gender are not one time declarations. They are lifelong processes of discovery, adaptation, and integration. From the bonding of infancy to the transitions of adolescence and the reinventions of older adulthood, our bodies and identities are always in motion.
Understanding how gender dysphoria can emerge at any age, and how to respond with empathy and affirmation, is essential for reducing stigma and fostering mental health. Whether someone transitions at age 5 or 55, the message should be the same: you are not broken, and you are not alone.
About the Author, a NYC Psychiatrist
Dr. Soe Thein is a New York City based psychiatrist with a focus on child, adolescent, and adult mental health, including LGBTQIA+ and gender affirming care. Blending psychodynamic therapy and psychiatric expertise, Dr. Thein provides thoughtful, individualized support for those exploring identity, relationships, and healing.
Are you or a loved one exploring gender identity, navigating gender dysphoria, or seeking affirming care? Our practice offers inclusive psychiatric services for children, teens, and adults in New York and California. Visit our Home, About, or Services page to learn more, or Contact Us today to book a consultation.
We are here to walk with you, every step of the way.
