Public bathrooms, of course, are the most intimate places where we regularly meet as strangers. Besides their intended function, they inevitably evoke sexual and other relational associations. Being private, they also have reflected our cultural values on these public settings.
When men comprised the workforce, the public bathrooms that developed were designed for them. When women joined the workforce, separate bathrooms were then established and designated by signage (though given the lines often outside the women's bathroom at events, that evolution is not yet complete).
The Civil Rights era brought an end to separate, and inferior, public bathrooms for Black Americans in the United States. It also led to handicapped stalls and related aids for the disabled.
About 20 years ago, I became a medical director for a clinic that specialized in helping those with gender identity concerns. Located in a business building, the clinic had a single bathroom for those patients to use, but it was hidden and not identified.
Around that same time, in the public community mental health clinic, where I was also a medical director, we had bathrooms for men, women and staff. In retrospect, I should have advocated for a separate private bathroom for anyone to use. Maybe I assumed, erroneously, that the transgendered individuals who came in were rare and could sneak into the bathroom of their choice.
I did have a rather flamboyantly dressed patient who had gender identity concerns along with primary bipolar disorder. To this day, I'm not sure which bathroom that patient used.
In more recent years, I’ve noticed that new restaurants might have non-gender single-stall bathrooms. I don't know if they were set up for those with gender identity concerns, but they seemed successful in that regard.
In many public places, including schools, there seems to be a movement—not without struggle—to establish such bathrooms. Lawsuits for the rights of self-identifying transgender people have occurred. The city of Houston recently voted down such a measure.
Religious organizations also are gradually coming to address the rights of the transgendered. Recently, Reform Judaism, at its biennial national meeting, took the widest step by recommending, though not requiring, congregations to make such accommodations in their buildings.
One of the confusing aspects for the public, especially those without much education on the subject, is that it is not always clear where someone's gender identity exists on a spectrum. Some changes can be identified in the physical appearance, some not.
One can feel since early childhood that he or she might have a brain of one gender, but the body of another. Some can feel in-between. Children often evolve and change in their gender identity. Some adolescents and young adults experiment with gender expression for social, rather than biological, reasons.
Diagnostically, gender identity is now only a DSM-5 diagnosis if it is dysphoric. One of the causes of such dysphoria is a negative social reaction. At its extreme, this may be a major factor in the fact that about 40 percent of the transgendered have significant suicidal ideation and the suicide rate is still rising.
In some societies, historically, the transgendered have been more valued. In some Native-American groups, they are called "two spirit" and thought to have unique insight and wisdom due to their dual gender perspective.