Foxx is “genderfluid” — one of several relatively new terms to describe people who consider themselves some combination of male and female. “I’m a way better person since I started identifying this way,” said Foxx, who recently moved from Minneapolis to California and is developing a genderfluid clothing line, Label Killer.

Tim/Kimberly Walker, 51, a self-employed engineer in St. Paul, uses a two-sided business card, with one side showing a picture of Tim, a rugged man with a shaved head, and the other side showing Kimberly, a smiling woman with side-swept bangs, a V-necked dress and a chunky necklace.

“I have gone to clients as both,” Walker said. “I enjoy being both, and I took ownership of it.”

Gender is a fixed fact of life for most people, from the moment the doctor says “It’s a boy” or “It’s a girl.” But a small yet increasingly visible segment of the GLBT community is challenging the idea that every person must live as one gender or the other. Instead they’re choosing to live openly — personally and professionally — as both, or somewhere in the middle.

People who experience a blending or alternation of gender states are recognized by the American Psychological Association as a subset under the umbrella term of transgender. But unlike some transgender individuals, such as recent Wikileaks newsmaker Bradley-turned-Chelsea Manning, who seek to transition to the gender that reflects their inner gender identity, some people prefer not to be confined by “binary” gender at all.

“I’m a person in-between,” said Roxanne “Andy” Anderson, 44, co-owner of Cafe Southside in Minneapolis and program director of the Minnesota Transgender Health Coalition. “I can be passable either way.”

Genderfluid people are finding support online, on Facebook groups and blogs targeted to the “genderqueer,” “gender non-conforming,” “bigendered minority” and “gender renegades.”

“It’s becoming more prevalent — with younger people, in particular,” said Lauren Beach, a Minneapolis attorney who organized the academic component of a recent conference on bisexuality at Augsburg College.

“The conversations we’ve been having about sexual orientation are the same conversations we’re having now about gender identity,” said Jason Jackson, assistant director of the GLBTA (gay, lesbian, bisexual, transgender, ally) program at the University of Minnesota, which sees “a lot of people” who describe themselves as genderfluid or genderqueer, according to Jackson.

Less stigma

The American Psychiatric Association (APA) recently updated its Diagnostic and Statistical Manual of Mental Disorders to replace “gender identity disorder” with “gender dysphoria.” The new classification removes the stigma-laden “disorder” in favor of a term to describe those who experience distress over a discrepancy between their biological sex and their experience of gender, according to Ken Zucker, the Toronto psychologist who chaired the APA’s sexual and gender identity disorder work group.

“The primary goal was to make it applicable to people experiencing distress and to keep out of gender preferences,” said Dr. Jack Drescher, a New York City psychiatrist, also a member of the work group. A diagnosis of gender dysphoria maintains access to medical care, including counseling, hormones or surgery, all of which require a diagnosis for insurance coverage.

And gender-related distress is on the rise, according to Zucker. “Gender dysphoria is coming out of the closet. Everybody [clinicians] is experiencing a notable increase in rates of referral.”

Why the increase?

“One hypothesis is that there’s less stigma, so more people are acknowledging their feelings,” Zucker said. “Another is that the Internet allows people to look for information about how they’re feeling. I see a lot of adolescents who say, ‘I didn’t know there was a word labeling what I’m experiencing.’ ”

When Foxx discovered the term genderfluid, “I was so happy — I felt like I was owning myself.” Growing up male, “I never felt like I fit in with boys, playing sports,” Foxx said. “I wanted to dance, do what the girls did. I’m not a typical competitor. I’m more of a creative person. I thought if I’d born female, I’d be happier.” But Foxx wasn’t interested in pursuing a surgical gender transition. “I love my body.”

One morning, “I had an epiphany,” Foxx recalled. “I’m an individual. If you want people to see you as just a person, take away the other stuff.”

Anderson, who grew up female, has been genderfluid “all my life,” she said. As a child, she was considered a tomboy because she liked “boy things: climbing trees, trucks, rebuilding bicycles and getting dirty. The girl stuff wasn’t appealing.” Later, as a young athlete, she successfully petitioned her school to allow her to play on the boys’ softball team. Then at 20, she fell in love and married her college sweetheart, a man to whom she was wed for 10 years, and had a son.

Now in a relationship with a woman, Anderson identifies as “genderqueer. Saying that wraps my sexual identity and gender identity into one word,” Anderson said. “The box of ‘woman’ doesn’t fit me. I don’t look at things the way most of my female-identified friends look at things.”

Melting pot

Like Foxx, Anderson isn’t interested in surgical gender transition. “It doesn’t feel important enough or appealing enough to go through that crap. Transexualism is so medicalized. We haven’t been looking at gender without the medicalization. It’s so new, there’s not a lot of development around it.”

Walker, who grew up male, said he relates more to women and prefers to dress as a woman in some situations. “It’s a social interface I like better,” Walker said. As Kimberly, Walker feels more approachable and less intimidating. “If I’m in my bald head in a bar, I scare people. When I’m Kimberly, I feel more like a mom.”

But Walker prefers to be Tim for certain activities, including dancing, wind-surfing, hard manual labor — and dating, at least initial dates with women. Married to a woman for 11 years, Walker now divides life about 50/50 between being Tim and Kimberly.

“For a lot of people, it’s confusing, but I enjoy being both,” Walker said. “What I am has to be lived publicly, or people won’t know there are people like me and will always have a bias.”

Not all people who experience gender incongruence feel distress over it, and much of the distress that many do feel comes from living in a society that doesn’t accept them, according to transgender health experts.

“We live in a culture that’s pretty gender-binary,” said Katie Spencer, a psychologist and coordinator of the transgender health services program at the University of Minnesota Medical School. “There is a lot of pressure on people to pick a box. Lots of practical things — like restrooms and pronouns — push people to pick one.”

Pronouns get complicated when “he” and “she” aren’t options. Some genderfluid people prefer “they.” Others advocate new neutral pronouns, such as “ze.”

“Just call me Toni,” said Foxx. “People get so caught up on how they’re supposed to respond.”

Some anticipate that gender identity will eventually loosen, similar to the way gender roles have evolved.

“Today, a woman can be a chemist or an airline mechanic or a homemaker, and Dad can stay home, raise the baby and put a mean press on Mom’s suit,” said Anderson. “Gender will become less and less of an issue. Like race. We’re becoming a giant melting pot. I’m guessing gender will become the same thing.”