Gender-expansive People Research Articles

Genital Stigma and Sexual Satisfaction Among Queer Women and Gender Expansive Individuals: The Roles of Sexual Communication and Identity Positivity

Under cisheteropatriarchy, women's and gender expansive individuals’ bodies are highly stigmatized. Research finds internalizing stigma about the genitals has negative implications for sexual satisfaction, but this work has predominantly focused on heterosexual cisgender women. We examined associations between genital stigma and partnered sexual satisfaction among Queer (including any minoritized sexual identity) women (cisgender and transgender) and gender expansive people. We also examined whether comfort communicating with a sexual partner mediated the relation between genital stigma and sexual satisfaction, and whether positive LGBTQ+ identity may buffer against internalized genital stigma (i.e., moderate relations between stigma, communication, and sexual satisfaction). We analyzed survey data from 452 Queer women and gender expansive people. We tested a moderated mediation model. Mediation was supported—greater genital stigma was associated with less comfort communicating with a sexual partner, and greater discomfort communicating was associated with lower sexual satisfaction. Moderated mediation was supported, as the negative association between genital stigma and comfort communicating with a partner increased as participants’ LGBTQ+ identity positivity decreased. Our findings offer novel insights into genital stigma and factors that may facilitate and hinder Queer women's and gender expansive individuals’ sexual satisfaction.

Trans Health is Public Health: The Prevalence of HIV Among Trans and Gender Expansive People in Kazakhstan.

Trans and gender expansive (TGE) individuals around the world are at increased risk for contracting HIV and sexually transmitted infections (STIs), yet the combination of stigma, accessibility challenges, and a lack of trans-specific, trans-affirming interventions perpetuates rates of infection. Due to the severe paucity of data on TGE communities and HIV in Central Asia, this study describes HIV infections (both known and newly detected) and STIs among TGE in a multicity Kazakhstan study. This study utilized behavioral and biological assay data collected in a NIDA-funded clinical trial of a behavioral HIV preventive intervention for substance using cis and trans gay and bisexual men who have sex with men (GBMSM) across three Kazakhstan cities (Almaty, Astana, and Shymkent). We specifically focus on HIV infection, as well as three other STIs (chlamydia, gonorrhea, and syphilis), among 68 TGE individuals who participated in the trial from August 2018 to March 2022. Findings reveal that while the majority (69%) of TGE participants have undergone HIV testing in their lifetime-with 32% having completed an HIV test in the prior 6 months-over a third (37%) of participants did not know their current HIV status. Fourteen (21%) of the participants were confirmed to be living with HIV, and 11 (79%) of these confirmed infections were reportedly unknown prior to testing. STI testing revealed that 47% of the TGE sample tested positive for chlamydia, gonorrhea, or syphilis, with almost 10% testing positive for more than one of these STIs. Findings from this study demonstrate high rates of HIV and STIs among TGE individuals in this sample population in Kazakhstan, as well as a discrepancy between HIV status awareness and confirmed HIV diagnosis (with higher rates of confirmed HIV diagnosis). Additionally, the HIV testing rates fall short of the 90-90-90 and 95-95-95 UNAIDS targets for 2020 and 2030, respectively. These results underscore the need for additional research, interventions, and services to address HIV and other STIs and increase testing-concomitantly redressing the conditions leading to marginalization-among TGE in Kazakhstan. NCT02786615.

Critical Feminist Epidemiology in Action: Reflections from a Multidisciplinary Partnership Between Mujeres Unidas y Activas and Academic Researchers.

Critical feminist research addresses social inequities, encourages equitable partnerships between researchers and participants, and acknowledges that research can be inherently political. Building upon critical feminist research practices, community-based participatory research, and social and structural epidemiology, we propose the approach of critical feminist epidemiology. A critical feminist epidemiology approach can study community and population health inequities with an eye towards identifying interventions that reduce inequities, through research processes that center the lived experiences of people from minoritized genders. We describe how our interdisciplinary, community-led team used a critical feminist epidemiology approach for an applied public health research project. Mujeres Unidas y Activas, a community organizing non-profit led by and for Latina and Indigenous immigrant women, partnered with academic researchers to conduct community-led research around how their approach to building community power affected the health and wellbeing of organization members and their families. Critical feminist epidemiology is a promising approach for conducting research that is grounded in and relevant to the lives of women and gender expansive people. Building upon social epidemiology and community-based participatory research, critical feminist epidemiology can be a useful research approach to generate novel evidence to inform action towards health equity for communities and populations.

Learning from Within: Life-Affirming Practices and Third Spaces Created by and for Incarcerated Youth

Grounded in a Black feminist approach (Collins, 2022; Evans-Winters, 2019), in this article, I weave together the personal and professional to share what I have learned as a Black Latina educator, researcher, and abolitionist who for the past twelve years has worked in carceral spaces alongside numerous men, women, youth, and gender expansive people. I bridge what I have learned from theories of the flesh (Madison, 1993; Moraga & Anzaldúa 2021) to what I have learned as a researcher who works with incarcerated youth and use it as a lens to better understand and study youth confinement. Drawing on data from a three-year critical ethnographic study focused on teaching, learning, and identity development in a juvenile detention center, this article explores young people’s experiences living and learning while confined. Using three distinct vignettes, this article touches on the lives of Black and Mexican heritage youth who at the time were detained in a juvenile detention center and the life-affirming practices and spaces they created in response to their dehumanization. Although youth were in a state of unfreedom (Gilmore, 2008), many refused their dehumanization and developed life-affirming strategies and third spaces for themselves and others.

Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people

Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017–2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: ‘low or no risk’, ‘low moderate risk’, ‘high moderate risk’, ‘steep risk increase’, and ‘highest risk’. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the ‘low risk’ category (odds ratios [OR] 1.17–1.33). Internalized stigma was related to ‘high moderate’ and ‘highest risk’ cannabis use (ORs 1.27–1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of ‘low moderate risk’ (ORs 1.61, 1.67) or ‘high moderate risk’ (ORs 2.09, 1.99), and transgender men had higher odds of ‘highest risk’ (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.

Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

The resistance of transgender and gender expansive people: A scoping review.

The resistance of transgender and gender expansive people: A scoping review.

Evaluating the WISE (Women in the South-East) Telehealth Network: A Model of Healthcare and Health Promotion at Rural Libraries.

The purpose of this study was to evaluate the effectiveness of the WISE (Women in the South-East) Telehealth Network. A follow-up survey design was used to determine the impact of the program on access to healthcare. WISE provided preventive care to women and gender expansive people at local libraries and the Mobile Library in the rural South Carolina Lowcountry. In 1year (February 2021-2022), WISE reached 523 individuals with 151 agreeing to participate in the study. Most participants identified as white (66%) or Black (22%). A Community Health Worker provided health education, connection to telehealth services, referrals, and connected individuals with community and social services. The Telehealth Usability Questionnaire (TUQ), changes in knowledge, satisfaction with WISE, Acceptability of Intervention measure (AIM), and sociodemographic characteristics. Participants with a high telehealth usability score were significantly more likely to be under the age of 35 (OR 4.60 [95% CI 1.21-17.52]), married (OR 10.00 [95% CI 2.19-45.64]), or white (OR 4.00 [95% CI 1.06-15.08]). The intervention earned a high acceptability score 4.46 (± .61)/5.0 by helping participants obtain necessary medical care and resources, as well as meeting their educational needs. This study offers practical suggestions to expand the use of telehealth initiatives to improve health outcomes by engaging libraries in rural communities.

Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States

In July 2023, the US Food and Drug Administration approved the first nonprescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no previous research has explored their perspectives on this topic. This study aimed to measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth. We conducted an online, cross-sectional survey from May to September 2019 (before the US Food and Drug Administration approval of a progestin-only pill) among a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth who were aged 18 to 49 years from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We evaluated separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models. Among 1415 participants in our sample (median age, 26 years), 45.0% (636/1415; 95% confidence interval, 42.3-47.6) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18 to 24 years (odds ratio, 1.67; 95% confidence interval, 1.33-2.10; vs those aged 25-34 years), those who were uninsured (adjusted odds ratio, 1.91; 95% confidence interval, 1.24-2.93; vs insured), those who currently used oral contraceptives (adjusted odds ratio, 1.69; 95% confidence interval, 1.17-2.44; vs non-users), had ≤high school degree (adjusted odds ratio, 3.02; 95% confidence interval, 1.94-4.71; vs college degree), had ever used progestin-only pills (adjusted odds ratio, 2.32; 95% confidence interval, 1.70-3.17; vs never users), and who wanted to avoid estrogen generally (adjusted odds ratio, 1.32; 95% confidence interval, 1.04-1.67; vs those who did not want to avoid estrogen generally) or specifically because they viewed it as a feminizing hormone (adjusted odds ratio, 1.72; 95% confidence interval, 1.36-2.19; vs those who did not want to avoid estrogen because they viewed it as a feminizing hormone). There were lower odds of interest among participants with a graduate or professional degree (adjusted odds ratio, 0.70; 95% confidence interval, 0.51-0.96; vs college degree), those who were sterilized (adjusted odds ratio, 0.31; 95% confidence interval, 0.12-0.79; vs not sterilized), and those who had ever used testosterone for gender affirmation (adjusted odds ratio, 0.72; 95% confidence interval, 0.57-0.90; vs never users). Transgender, nonbinary, and gender-expansive individuals were interested in over-the-counter progestin-only pill use, and its availability has the potential to improve contraceptive access for this population.

How Social Discrimination and Housing (Un) Affordability Causes Gender-Expansive Homelessness and Policy Recommendations to Ensure that Everyone is Housed

Transgender, gender non-binary and gender-questioning people (gender-expansive) in the United States are more likely than their cisgender counterparts to experience housing precarity and homelessness. While this results from discrimination that limits our access to economic, social and political capital, it also results from a massive gap in the amount of affordable and adequate permanent housing available to all low-income members of our society.
 When people are inevitably unable to exceed these barriers to rent or own permanent housing, they rely on the emergency shelter system. Despite a diligent and attentive emergency shelter workforce as well as abundant evidence demonstrating that emergency housing can help stabilize mental health, physical health and financial challenges, there is a systemic lack of funding to keep up with the need for emergency shelter beds. Compounded with incomplete antidiscrimination rules, the emergency shelter system does not serve the needs of low-income, gender-expansive people.

Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender.

Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.

Just Another Patient? Student Reflections on Providing Mental Health Care to Transgender and Gender Expansive People During Simulated Encounters.

This study analyzed psychiatric-mental health nurse practitioner (PMHNP) students' reflections following a virtual simulated encounter with a patient who identified as transgender or gender expansive (TGE). To reduce mental health disparities, PMHNP students must be prepared to deliver affirming care. Engaging in and reflecting on simulated encounters with standardized patients can improve PMHNP students' affirming care competency. A thematic analysis process was used to analyze student reflections during simulation debriefings. Five themes emerged: application of affirming care principles, recognizing minority stressors, treating all patients the same, desire to learn more, and valuing authentic practice. PMHNP students' reflections on the experience of providing care to a standardized patient who identified as TGE support the use of virtual simulations to prepare future providers to deliver affirming, person-centered care.

A “hard question”: Gender affirming care and gender distress in a social world

AbstractGender affirming care for youth is currently under political attack across the United States. Critics of affirming care often leverage a biological and fixed notion of gender as assigned at birth, which is at odds with how gender has been theorized academically for decades. Yet for some feminist clinicians, the popularized version of SOCIAL CONSTRUCTION present within rhetoric about the purpose of affirmative intervention also seems to undercut the legitimacy of care. In this article, I track how the difficult problems of the origins of gender itself, problems seemingly exposed by the invocation of the SOCIAL CONSTRUCTION of gender, are managed within the field of gender affirming care. I show how by drawing on the narrative power of very young gender expansive people, and by orienting clinical care away from identity towards DISTRESS, medical providers can align themselves both with feminist desires to change how gender ideology functions in the social world, and with the need to provide interventions that allow youth to embody the gender they desire.

Thematic Analysis of Personal Narratives Spoken by Autistic Adults of Underrepresented Genders

Purpose: Underrepresentation of transgender men and women, gender-expansive people, and cisgender women in autism research has created barriers to appropriate, timely identification and supports that can improve quality of life. To address this need, this study investigated themes in spoken narratives produced by autistic adults whose genders are marginalized and compared them to those of cisgender men. These themes can provide insight into common topics among autistic narrators of diverse genders and dispel stereotypes based on previous research with cisgender men and boys. Method: Twenty autistic adults of diverse genders told stories about their personal experiences. Two stories from each participant were analyzed: (a) Interest, about something the participant really likes to do, and (b) People, about an experience they shared with others. Major themes and subthemes in the narratives were identified using reflexive thematic analysis. Results: Participants of all genders described how their personal interests connect them to other people, even when not explicitly instructed to do so. Major themes in the People narratives included specific places and opportunities to help. Participants shared Interest stories about multiple facets of the arts. Subthemes of nature and history were common in both narrative tasks. Conclusions: Autistic participants, especially women, trans men, and gender-expansive people, consistently emphasized the importance of connecting with other people in their personal narratives. This finding challenges antisocial stereotypes of autistic people. Improved representation of trans and gender-expansive people and cisgender women in research can contribute to better services and supports for autistic people.

Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer.

Approximately 1.6 million people in the US identify as transgender, many of whom undergo gender-affirming medical or surgical therapies. While transgender individuals are diagnosed with cancer at similar rates as those who are cisgender, the impacts of radiation therapy on outcomes of gender-affirming care in transgender, nonbinary, and gender-expansive people with cancer are understudied. We report on the experiences and outcomes of transgender and gender-expansive patients receiving radiation therapy for cancer treatment. This study is a multi-institutional retrospective review of patients evaluated from 2005-2019 identified as transgender or gender-expansive in the medical record and treated with radiation therapy. We identified 23 patients who received radiation to 32 sites, including 12 (38%) to the brain, head, or neck, 8 (25%) to the thorax, and 7 (22%) to the pelvis. Seventeen patients (74%) received gender-affirming hormone therapy and 13 patients (57%) underwent gender-affirming surgery. Four patients had pelvic radiation before or after gender-affirming pelvic surgery, including two trans women who had pelvic radiation after vaginoplasty. Four patients had radiation to the chest or thorax and gender-affirming chest or breast surgery, including two trans men with breast cancer. Two pediatric patients developed hypopituitarism and hypogonadism secondary to radiation therapy and, as adults, changed their hormone replacement therapy to affirm their transgender identities. Transgender people with cancer undergo radiation therapy for a wide range of cancers. Understanding their prior gender-affirming medical or surgical treatments and future gender affirmation goals may identify important considerations for their oncologic care.

Healing the Trauma of Racism and Sexism: Decolonization and Liberation

Gendered racism is a source of stress and, in some cases, traumatic stress for women and girls of color as well as gender expansive people of color. Gendered racism is a form of oppression rooted in both White Supremacy and patriarchy. Along with interpersonal and internalized forms of gendered racism, mental health professionals must attend to systemic forms of gendered racism that manifest in every social system from education to criminal (in)justice. The consequences for women and girls of Color, as well as non-binary persons are multi-layered, including but not limited to physical, psychological, financial, and political. Frameworks that attend to both the context of oppression and the wisdom of women of Color are necessary for individual healing and societal transformation; these frameworks include but are not limited to liberation psychology, womanist psychology, and mujerista psychology. Examples of indigenizing individual, group, and community level programs are provided as well as implications for necessary future directions for advancing anti-oppression interventions, honoring indigenous science, dismantling gendered racism, and birthing liberation for all people. Finally, the author acknowledges racial battle fatigue and patriarchy battle fatigue as well as the necessary care for mental health professionals who are engaged in this sacred work.

Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey.

Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.

Implicit and Explicit Spirituality in the Lives of Transgender and Gender Expansive Older Adults

ABSTRACT Religion and spirituality for transgender and gender expansive people (whom we refer to collectively as trans) are complicated by mainstream religions’ history of stigmatizing and marginalizing sexual and gender minorities. We conducted an interpretive content analysis of biographical interviews with 88 trans older adults from across the United States, applying six tenets of spiritual psychotherapy to their life narratives. Our findings suggest that some trans older adults’ spirituality is experienced both implicitly and explicitly. Implicit spirituality reflects the ways in which meaning, purpose, and connection in one’s life are nurtured with respect to one’s gender identity. Explicit spirituality reflects the process of consciously renegotiating one’s spiritual beliefs and religious practices to validate one’s gender identity and place in society. This knowledge is potentially helpful for gerontological social workers who seek to nurture trans people’s spirituality and well-being as they age.

Patterns of gender identity data within electronic health record databases can be used as a tool for identifying and estimating the prevalence of gender-expansive people.

Electronic health records (EHRs) within the United States increasingly include sexual orientation and gender identity (SOGI) fields. We assess how well SOGI fields, along with International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes and medication records, identify gender-expansive patients. The study used a data set of all patients that had in-person inpatient or outpatient encounters at an academic medical center in a rural state between December 1, 2018 and February 17, 2022. Chart review was performed for all patients meeting at least one of the following criteria: differences between legal sex, sex assigned at birth, and gender identity (excluding blank fields) in the EHR SOGI fields; ICD-10 codes related to gender dysphoria or unspecified endocrine disorder; prescription for estradiol or testosterone suggesting use of gender-affirming hormones. Out of 123 441 total unique patients with in-person encounters, we identified a total of 2236 patients identifying as gender-expansive, with 1506 taking gender-affirming hormones. SOGI field differences or ICD-10 codes related to gender dysphoria or both were found in 2219 of 2236 (99.2%) patients who identify as gender-expansive, and 1500 of 1506 (99.6%) taking gender-affirming hormones. For the gender-expansive population, assigned female at birth was more common in the 12-29 year age range, while assigned male at birth was more common for those 40 years and older. SOGI fields and ICD-10 codes identify a high percentage of gender-expansive patients at an academic medical center.

Differences in Sibilant Perception between Gender Expansive and Cisgender Individuals

Acoustic cues of voice gender influence not only how people perceive the speaker's gender (e.g., whether that person is a man, woman, or non-binary) but also how they perceive certain phonemes produced by that person. One such sociophonetic cue is the [s]/[ʃ] distinction in English; which phoneme is perceived depends on the perceived gender of the speaker. Recent research has shown that gender expansive people differ from cisgender people in their perception of voice gender and thus, this could be reflected in their categorization of sibilants. Despite this, there has been no research to date on how gender expansive people categorize sibilants. Furthermore, while voice gender expression is often discussed within a biological context (e.g., vocal folds), voice extends to those who use other communication methods. The current study fills this gap by explicitly recruiting people of all genders and asking them to perform a sibilant categorization task using synthetic voices. The results show that cisgender and gender expansive people perceive synthetic sibilants differently, especially from a "nonbinary" synthetic voice. These results have implications for developing more inclusive speech technology for gender expansive individuals, in particular for nonbinary people who use speech-generating devices.