Gender Identity Questions Research Articles

Disentangling gender, sex, and biology: a mixed methods study of gender identity data collection tools

ObjectivesWe used community-based mixed methods to test whether transgender and gender diverse (TGD) people preferred gender identity questions developed by community members over current questions in use and generate hypotheses about data collection preferences. MethodsWe interviewed twenty TGD adults in English and Spanish, asking them to rate and discuss their responses to questions. We analyzed quantitative data with descriptive statistics and qualitative data with template analysis, then integrated them. ResultsMore participants preferred gender identity questions that were currently in use. Themes: 1) TGD participants find questions about “gender” and related terminology unclear because of conflations of sex, gender, and other constructs. 2) TGD participants resist cisgenderism in questions about gender identity. 3) TGD people desire questions that allow for autonomy, privacy, and safety. 4) Contextual factors, particularly safety, influence whether and how TGD people answer questions about gender and sex. ConclusionsTGD people have varied concepts of sex and gender and preferences about data collection. Future research should investigate the impacts of disentangling gender, sex, and biological factors, which could decrease stigma for TGD people.Practice implicationsMedical care that disentangles gender, sex, and biological factors could improve data collection effectiveness and the safety of TGD people.

Patient comfort with sexual orientation and gender identity questions in adult congenital cardiology clinics.

Lack of sexual orientation and gender identity (SOGI) data creates barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in health care. Barriers to SOGI data collection include physician misperception that patients do not want to answer these questions and discomfort asking SOGI questions. This study aimed to assess patient comfort towards SOGI questions across five quaternary care adult congenital heart disease (ACHD) centres. A survey administered to ACHD patients (≥18 years) asked (1) two-step gender identity and birth sex, (2) acceptance of SOGI data, and (3) the importance for ACHD physicians to know SOGI data. Chi-square tests were used to analyse differences among demographic groups and logistic regression modelled agreement with statement of patient disclosure of SOGI improving patient-physician communication. Among 322 ACHD patients, 82% identified as heterosexual and 16% identified as LGBTQ+, across the age ranges 18-29 years (39.4%), 30-49 years (47.8%), 50-64 years (8.7%), and > 65 years (4.0%). Respondents (90.4%) felt comfortable answering SOGI questions. Respondents with bachelor's/higher education were more likely to "agree" that disclosure of SOGI improves patient-physician communication compared to those with less than bachelor's education (OR = 2.45; 95% CI 1.41, 4.25; p = .0015). These findings suggest that in this largely heterosexual population, SOGI data collection is unlikely to cause patient discomfort. Respondents with higher education were twice as likely to agree that SOGI disclosure improves patient-physician communication. The inclusion of SOGI data in future studies will provide larger samples of underrepresented minorities (e.g. LGBTQ+ population), thereby reducing healthcare disparities within the field of cardiovascular research.

University Student Attitudes Regarding Answering Sex, Sexual Orientation, and Gender Identity Questions on University Application Forms

ABSTRACT A sample of 700 undergraduate university students throughout the US completed an online survey about their attitudes answering questions about their sex, sexual orientation, and gender identity (SSOGI) on their university admission form. This study examined differences between cisgender and transgender and gender diverse students in attitudes related to answering sex assigned at birth and gender identity questions, and between heterosexual students and students of diverse sexual orientations in attitudes related to answering sexual orientation questions. Overall, students indicated positive attitudes about answering SSOGI questions on their university application form, but attitudes toward sexual orientation questions were less positive. Differences were found in question/answer choice understanding (gender identity and sexual orientation), ease of answering (sex assigned at birth), offensiveness in asking (sex assigned at birth), privacy concerns (sex assigned at birth), comfort in answering (sex assigned at birth and sexual orientation), confidentiality concerns (gender identity), and importance of asking (sex assigned at birth and sexual orientation). Findings demonstrate that most respondents held positive attitudes about answering SSOGI questions and that communicating to LGBTQ+ applicants the importance of and privacy protections associated with answering SSOGI questions on university application forms might be important.

Trends in Sexual Orientation and Gender Identity Data Collection.

The aim of this study was to determine response patterns to sexual orientation and gender identity (SOGI) questions in the Behavioral Risk Factor Surveillance System (BRFSS) over time and to assess nonresponse and indeterminate responses by demographic characteristics. This is a secondary data analysis of the SOGI module of the BRFSS. We used data from 46 states and Guam that implemented SOGI questions between 2014 and 2022. We used weighted analyses that accounted for the sampling design, determined SOGI response patterns by year, and assessed nonresponse and indeterminate responses by demographic characteristics. Over time, increasing numbers self-reported as sexual and gender minority respondents, while heterosexual identity declined. Sexual orientation nonresponse and indeterminate responses increased with time, while respondents' reports of not knowing gender identity declined. Hispanic, older, respondents, those with lower education, and those who completed the questionnaire in Spanish had higher SOGI nonresponse and indeterminate responses. The low amount of SOGI nonresponse and indeterminate responses in the BRFSS can be instructive for the implementation of SOGI questions in medical settings. SOGI data collection in all settings requires improving procedures for the groups that have been shown to have elevated nonresponse and indeterminate response.

Identifying 2SLGBTQ+ individuals experiencing homelessness using Point-in-Time counts: Evidence from the 2021 Toronto Street Needs Assessment survey.

The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations.

Just not cricket: Baseball, youth and national identity in late nineteenth-century children’s magazines

In the late nineteenth century, baseball became enshrined as America’s national sport. Across American culture, the game became imbued with a series of values and characteristics that seemed redolent of life in the Gilded Age and beyond. This article explores the ways in which this process played out in the pages of popular magazines directed at the children of the nation’s elite. These neglected resources provide us with an extraordinary lens through which to chart both the changing place of the national game within the lives of American children and the changing meaning of baseball within the life of the nation. In poems, stories, illustrations, editorials and even reader’s letters, children were newly acculturated into the sporting life in ways that had profound implications for wider questions of childhood, gender, race, class and national identity.

Social Support for Rural Gender Diverse Youth Compared to Cisgender Peers

PurposeGender diverse youth (GDY) experience higher rates of mental health concerns than their cisgender peers, but these can be ameliorated by feeling support from family, school, and community. Little is known about how youth perceptions of support vary by gender identity, especially for younger adolescents and those living in rural areas. MethodsYouth ages 12–19 years completed anonymous surveys including measures of perceived support and a two-step gender identity question. GDY (n = 206) were further categorized into binary and nonbinary gender identities. An additional 500 randomly selected cisgender youth were included for comparison. Multivariate analyses of variance with Tukey post hoc tests were employed to test GDY group differences while accounting for the interaction between scaled measures. ResultsCisgender youth had the highest perceived support across all support measures while youth who shared both binary and nonbinary aspects of their gender identity had the lowest rates of perceived support. The F tests for between-subject effects were statistically significant (p <.001) for all six support measures, and multivariate group testing was statistically significant with Wilks' λ 6.38(18,1621.17) = 0.82; p <.001. DiscussionDespite research demonstrating a strong association between perceived support and improved mental health outcomes, GDY in our sample had lower rates of perceived support at the family, school, and community levels. GDY with both binary and nonbinary gender identities had the lowest levels of perceived support. Further research is needed to see if this finding is consistent in other populations and to develop targeted interventions to improve perceived support for this population.

Examining Sexual and Dating Violence by Gender Identity Among High School Students

PurposeThis study examined the reporting of sexual and dating violence among high school students using a standard gender identity question. MethodsUsing data from the 2017 and 2019 Youth Risk Behavior Surveys, multivariable regression models estimated the association between gender identity and four measures of sexual and dating violence, adjusted for confounding by race/ethnicity, grade, and reported sex. ResultsOf the 198,900 teenagers, 1.8% identified as transgender, 1.6% were not sure, and 1.9% responded that they did not know what question was being asked. Across all measures of violence, transgender, “unsure” and “don't understand” students were significantly more likely than cisgender students to report having been victimized. DiscussionStandard analysis practices of eliminating unsure and/or don't understand responses to gender identity questions may underestimate at-risk youth. Researchers seeking to understand disparities in youth violence by gender identity will need to ensure that they employ inclusive measures.

Inclusive Language, Inclusive Practice: American Society of Plastic Surgeons Member Responses to a Gender Identity Question.

Inclusive Language, Inclusive Practice: American Society of Plastic Surgeons Member Responses to a Gender Identity Question.

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity.

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

New research issues in the history of German sexology and sexual medicine

New research questions in the history of German sexology and sexual medicine include anew look at the Imperial and the Weimar Republic periods and Magnus Hirschfeld as aprotagonist, as well as the contemporary history of the discipline in the Federal Republic with the two formative institutes in Frankfurt (Volkmar Sigusch) and Hamburg (Eberhard Schorsch). In the post-war period, the tendency to try to solve social problems through endocrinological and surgical approaches continued. This included the (voluntary) castration of sex offenders, which has been regulated by law in the West Germany since 1969. Questions of gender identity do not only arise in the context of gender reassignment surgery. They also have high social relevance and have become increasingly politicized in recent years. These questions are also persistently relevant for urology and clinical sexual medicine.

Measurement of Sex and Gender Identity in the Behavioral Risk Factor Surveillance System Survey, 2014 to 2020.

Effective measurement of sex and gender identity is challenging. Questions measuring gender identity were added as an optional module of the Behavioral Risk Factor Surveillance System (BRFSS) in 2014 and were modified repeatedly in following years. This study examines BRFSS participant responses to gender identity and sex questions, 2014-2020. About 70% of participants who identified as transgender male-to-female reported male sex while 30% reported female sex. Participants who identified as transgender female-to-male reported female sex about 65% of the time and reported male sex 35% of the time. Despite changes in sex question wording, these percentages were consistent over time. Reported sex is used in computing health-related variables and in routing participants to questions about birth control, pregnancy, HPV vaccines, and cancer screenings. Without better measurement, it is challenging to assess health and health risks and inform guidelines, programs, and policies protecting the health of transgender people.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

State-Level Policies and Health Outcomes in U.S. Transgender Adolescents: Findings from the 2019 Youth Risk Behavior Survey.

Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.

LGBT+ Youth Perspectives on Sexual Orientation and Gender Identity Questions in the Growing Up in Ireland Survey: A Qualitative Study

The increasing importance of identifying lesbian, gay, bisexual and transgender (LGBT+) populations is a key driver in changes to demographic data collection in representative surveys of youth. While such population-based data are rare, Growing Up in Ireland (GUI), an Irish, government-funded, longitudinal survey, includes sexual orientation and gender identity (SOGI) measurements. This qualitative study responds to a query from the GUI study team and aims to identify how best to collect SOGI data in future waves of GUI. A university Human Research Ethics Committee granted approval for online consultations with LGBT+ youth (n = 6) with experiential expertise in policy making. The research is underpinned by rights-based public patient involvement (PPI) with recorded discussions, which were transcribed and imported into NVivo 12, generating the theme “recognition in research, policy and society”. This co-created article, with the LGBT+ young PPI Panel members, commends the inclusion of SOGI data in GUI and recommends changes in question placement and phrasing. Aligning with best practice, the PPI members provide a template for wording on consecutive sex and gender questions, expanded sexual orientation identity categories and maintaining the existing well-phrased transgender question from GUI. This offers potential to improve the quality of the SOGI data collected and the experience of those completing the questionnaire. These findings extend beyond GUI, with relevance for surveys with youth populations. This paper underscores the potential and benefits of participatory approaches to research with youth and views their role beyond simply as sources of data.

Comparison of Transgender and Gender Diverse Demographics in United States Transgender Survey and the Behavioral Risk Factor Surveillance System

Transgender and Gender Diverse (TGD) individuals experience mental and physical health disparities but remain a difficult population to research. TGD scholars encounter barriers to accessing representative probability-based data to investigate prevalence of health issues experienced by TGD individuals. As population-based surveys begin to ask gender identity questions that identify TGD respondents, questions remain regarding representativeness of the actual TGD population. Community-based surveys continue to be the primary way to capture TGD-specific experiences and stressors, but without knowing true prevalence rates, there are challenges in interpreting generalizability. The present research compares demographics and health characteristics found in Behavioral Risk Factor Surveillance System (BRFSS) data from 2015 to 2018 and 2015 United States Transgender Survey (USTS) data, two commonly used probability and community-based datasets. As expected, BRFSS respondents were less likely to see a physician in the last year or be tested for HIV than USTS respondents. USTS respondents were less likely to identify as straight/heterosexual and more likely to report heavy drinking. While representative data of the TGD population continues to be a barrier, comparing characteristics across samples may help contextualize sample limitations.

Adolescent Ruthlessness and the Transitioning Of The Analyst’s Mind

Features of ruthlessness may come into play in the encounter between adolescents who come into the therapeutic space with clear and precise demands to be supported through their gender transition. Winnicott's concept of ruthlessness, extended from the infant-mother matrix to the emotional situation of the clinic, allows a consideration of the conditions under which the analyst can think about adolescent demands. These conditions involve the desire of both patient and analyst for certitude and the analyst's urgency to respond, as well as the adolescent's contradictory desires to both destroy and create gender. The work of Sally Swartz, who brought to Winnicott's conception a notion of ruthlessness in protest, helps us consider the qualities of ruthlessness in constituting gender. A snippet of work with a nonbinary patient shows how questions of gender cannot be understood apart from the intersubjective transferential field. Tying ruthlessness to the enigma of desire illuminates the emotional situation of the clinical encounter between the nonbinary or trans patient and the analyst, a situation that is also libidinal. An analytic move from the question of gender identity to the realm of an emotional situation allows the analyst to meet adolescent ruthlessness. This meeting is an ethical attempt to understand the other, but also reveals one's resistance to giving up something in order to understand.

Characteristics, barriers, and career intentions of a national cohort of LGBTQ+\u2009MD/PhD and DO/PhD trainees

BackgroundLesbian, gay, bisexual, transgender, queer, non-binary, intersex, and/or asexual (LGBTQ+) individuals continue to suffer worse health outcomes compared to the general population. Data on LGBTQ+ individuals in medicine, particularly in medical training, remain sparse. National studies of LGBTQ+ students in MD/PhD and DO/PhD training programs have not been reported.MethodsTrainees pursuing MD, DO, MD/PhD, and DO/PhD degrees at 32 nationally representative institutions completed a 70-item survey about their future career and anticipated challenges using an online survey tool from September 2012 to December 2014. There were 4,433 respondents to the survey. Of those, 2,837 completed the gender identity questions and 2,849 completed the sexual orientation questions. Completion of these questions was required for inclusion. Survey results were analyzed to examine differences between LGBTQ+ and non-LGBTQ+ medical and dual degree trainees.ResultsLGBTQ+ students were underrepresented among MD/PhD and DO/PhD trainees (8.70%) compared to the US population, though their representation was higher than among MD and DO trainees (5.20%). LGBTQ+ dual degree trainees endorsed the greatest interest in pursuing careers involving academic medicine, with varying career focuses including research, clinical duties, education, and advocacy. LGBTQ+ dual degree trainees prioritized opportunities in patient care, work-life balance, and research as the most important factors for their career selection. Importantly, a higher percentage of LGBTQ+ dual degree trainees (15.50%) identified sexual harassment as a past barrier to career advancement compared to their non-LGBTQ+ peers (8.27%). LGBTQ+ dual degree trainees were more likely to report having a mentor who advocated for them.ConclusionsLGBTQ+ physician scientist trainees remain under-represented and under-studied. It is vital that medical institutions devote more time and resources towards identifying and addressing the unique needs of this group in training. Training programs should be aware of the current and prior challenges faced by their LGBTQ+ dual degree trainees, work to overcome the unique barriers they face, highlight the strengths and unique perspectives they bring, and foster their professional growth and goals during and beyond their training.

Alterations in the inferior fronto-occipital fasciculus - a specific neural correlate of gender incongruence?

Increasing numbers of adolescents seek help for gender-identity questions. Consequently, requests for medical treatments, such as puberty suppression, are growing. However, studies investigating the neurobiological substrate of gender incongruence (when birth-assigned sex and gender identity do not align) are scarce, and knowledge about the effects of puberty suppression on the developing brain of transgender youth is limited. Here we cross-sectionally investigated sex and gender differences in regional fractional anisotropy (FA) as measured by diffusion MR imaging, and the impact of puberty on alterations in the white-matter organization of 35 treatment-naive prepubertal children and 41 adolescents with gender incongruence, receiving puberty suppression. The transgender groups were compared with 79 age-matched, treatment-naive cisgender (when sex and gender align) peers. We found that transgender adolescents had lower FA in the bilateral inferior fronto-occipital fasciculus (IFOF), forceps major and corpus callosum than cisgender peers. In addition, average FA values of the right IFOF correlated negatively with adolescents' cumulative dosage of puberty suppressants received. Of note, prepubertal children also showed significant FA group differences in, again, the right IFOF and left cortico-spinal tract, but with the reverse pattern (transgender > cisgender) than was seen in adolescents. Importantly, our results of lower FA (indexing less longitudinal organization, fiber coherence, and myelination) in the IFOF of gender-incongruent adolescents replicate prior findings in transgender adults, suggesting a salient neural correlate of gender incongruence. Findings highlight the complexity with which (pubertal) sex hormones impact white-matter development and add important insight into the neurobiological substrate associated with gender incongruence.

Trans-gendering the Irish Na(rra)tion: Neil Jordan’s Breakfast on Pluto

Occupying a relegated position as it does in Neil Jordan’s filmography, it is my contention that Breakfast on Pluto is one of his most transgressive films. Not only does it cross the most evident boundaries of heteronormative gender roles by giving a transvestite the central position in the story, but also blends film genres as a way of vindicating hybridisation at all levels, challenging other modern categorisations as those informing Irish national identity. Thirteen years after The Crying Game (1992) was released, Irish filmmaker Neil Jordan returns to the intersectional issues of gender and national identity in his adaptation of Patrick McCabe’s novel Breakfast on Pluto (1998). However, apart from the presence of a transvestite and the shadow of sectarian violence looming throughout the narrative, these films have little else in common: the dull, grey atmosphere of an obscure drama involving kidnap and murder by the IRA in The Crying Game contrasts sharply with the bright colours, ironic drive and parody in Breakfast on Pluto, a story about growing up in Ireland as an orphan transvestite who yearns for romantic true love. Moreover, while Jordan’s first feature film was defined as a romantic drama with thriller hues, Breakfast moves between comedy and drama, the bildungsroman and the melodrama. This generic ambivalence goes hand in hand with Jordan’s transgressing approach to the question of gender and national identity as a strategy to challenge fixed understandings of those labels as natural and given and, for that reason, the violence inflicted on the main character (and, by extension, on any Other body that does not fit those categories).