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References to a third sex can be found throughout the texts of India's three ancient spiritual traditions – Hinduism,[125] Jainism[126] and Buddhism[127] – and it can be inferred that Vedic culture recognised three genders. The Vedas (c. 1500 BC–500 BC) describe individuals as belonging to one of three categories, according to one's nature or prakrti. These are also spelled out in the Kama Sutra (c. 4th century AD) and elsewhere as pums-prakrti (male-nature), stri-prakrti (female-nature), and tritiya-prakrti (third-nature).[128] Texts suggest that third sex individuals were well known in premodern India and included male-bodied or female-bodied[129] people as well as intersexuals, and that they can often be recognised from childhood.

Anthropologist and archaeologist Miranda Stockett notes that several writers have felt the need to move beyond a two-gender framework when discussing prehispanic cultures across mesoamerica,[146] and concludes that the Olmec, Aztec and Maya peoples understood "more than two kinds of bodies and more than two kinds of gender." Anthropologist Rosemary Joyce agrees, writing that "gender was a fluid potential, not a fixed category, before the Spaniards came to Mesoamerica. Childhood training and ritual shaped, but did not set, adult gender, which could encompass third genders and alternative sexualities as well as "male" and "female." At the height of the Classic period, Maya rulers presented themselves as embodying the entire range of gender possibilities, from male through female, by wearing blended costumes and playing male and female roles in state ceremonies." Joyce notes that many figures of mesoamerican art are depicted with male genitalia and female breasts, while she suggests that other figures in which chests and waists are exposed but no sexual characteristics (primary or secondary) are marked may represent a third sex, ambiguous gender or androgyny.[147]

Two-spirit individuals are viewed in some tribes as having two identities occupying one body. Their dress is usually a mixture of traditionally male and traditionally female articles, or they may dress as a man one day, and a woman on another. According to Dr. Sabine Lang, a German anthropologist, many tribes have distinct gender and social roles.

Cyrus counts herself among the people who don’t feel they fit in the traditional boxes, saying she doesn’t like the labels boy or girl or even gender fluid, though she’s settled on the latter for now.