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It is possible to define gender as interchangeable with “sex,” indicating that the term can be used when differentiating male creatures from female ones biologically. However, the concept of gender, a word primarily applied to human beings, has additional connotations having to do with general behavior, social interactions, and most importantly, one's fundamental sense of self. People increasingly recognize that a complex spectrum between male and female exists not only mentally, psychologically, and behaviorally, but also anatomically—there have always been intersex people. The conflation of gender with sex, though historically common, is now often criticized because it is seen by some to be insensitive or dehumanizing. People who do not question their assigned gender are usually referred to as cisgender, or just ������— as in a cis male or a cis female. Using cis is a way to refer to these individuals without implying that cisgender people are the only norm. Those who don't identify with the gender assigned to them at birth are often referred to using the umbrella term transgender, though not everyone labeled in this way accepts the designation. The term transgender includes both binary trans people and those who are outside of the male–female binary in some way, including nonbinary and genderqueer people. After realizing their gender, many transgender people may change the way they dress, speak, or otherwise present themselves. Some may transition medically through surgery, hormone replacement therapy, and other procedures. Some may want to change the language people use to refer to them, including things like given name and pronouns as well as gender labels. This array of life experiences has resulted in a veritable explosion of new, or newly adapted, vocabulary.