Pilipili derives from Akkadian, an extinct East Semitic language spoken in ancient Mesopotamia (Akkad, Assyria, and Babylonia). It refers to a someone who undergoes a gender transition. It involved a purification ceremony that marked significant change in identity, gender, or social status, acknowledging those who did not conform to binary roles. The ritual formally recognised their new identity within the community and was marked by also renaming the individual.