Nonbinary Individuals Research Articles

Instruments used to assess gender-affirming healthcare access: a scoping review protocol.

Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field.This paper presents a protocol for a scoping review to map and synthesise the academic and grey literature on instruments used to assess healthcare navigation and access for transgender and non-binary individuals seeking gender-affirming care. This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation will be utilised and reported. The research team will undertake the study as outlined in this protocol and an expert panel of young transgender and non-binary youth will oversee the project through patient and public involvement. Conclusions: This scoping review has the potential to inform policy, practice, and future research through enhanced understanding of the complex interplay of factors that impact healthcare navigation for transgender and non-binary people seeking gender-affirming care. The results from this study will inform further research into healthcare navigation considerations generally and will inform a research project entitled "Navigating access to gender care in Ireland-a mixed-method study on the experiences of transgender and non-binary youth".

Factors affecting communication between transgender and non-binary individuals and general practitioners: Recommendations for inclusive interactions

Research shows that transgender and non-binary (TNB) individuals frequently experience discrimination and mistreatment in health care settings. These negative experiences cause TNB people to underutilize health care and, when they do utilize it, may affect communication of health information. Moving from social cognitive theory (SCT) and theory of planned behavior (TPB), this study investigated what factors influence pre-, during, and post physician visit communication between TNB individuals and general practitioners (GPs) in The Netherlands. Between March and May 2022, fifteen TNB individuals and ten GPs participated in semi-structured interviews and focus groups about their experiences with GP-TNB interactions. The findings suggest that GPs addressing TNB people, GP knowledge and education, GP office procedures and environment, and social environment (in)directly facilitate or hamper communication. These findings support previous ideas about the influence of factors such as knowledge and social environment on one's behavior, as previously described in SCT and TPB. They also add and specify how pre-determined and novel factors affect whether TNB people feel welcome and comfortable at GP offices and if GPs feel equipped to provide TNB people with quality care. More specifically, to facilitate appropriate health communication, GPs are advised to ask patients about their pronouns, adjust intake forms, and put up TNB-specific posters or a Pride flag in their offices. TNB people are advised to make an introductory appointment to discuss their gender identity. Lastly, TNB topics should be included in medical curricula and online GP resources.

Access to healthcare among sexual and gender minority youth at risk for HIV: barriers and experiences of discrimination

ABSTRACT This study examined experiences of healthcare inaccessibility and lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) discrimination among sexual and gender minority youth at elevated risk for HIV in the United States. Participants for this cross-sectional survey study (N = 3330) were cisgender men, transgender men and women, and nonbinary individuals ages 18–34 recruited for a larger study examining HIV risk behavior between December 2017 and December 2019. Results indicated that 41.1% of participants had at least one lifetime experience of LGBTQ + healthcare discrimination, and 44.1% reported past 6-month experiences of discrimination or problems accessing healthcare. Transgender men and women were more likely than cisgender men and nonbinary participants to report experiences of discrimination, and transgender men were more likely to report problems accessing healthcare. A majority of participants (72.8%) reported that their most recent healthcare provider was aware of their sexual or gender identity. These results indicate a high prevalence of structural barriers in healthcare access for sexual and gender minority youth at elevated risk for HIV, including finical and logistical barriers as well as anticipated and experienced discrimination. We discuss these findings and highlight the importance of easily accessible and culturally competent care for this community.

Decision making in metoidioplasty and phalloplasty gender-affirming surgery: a mixed methods study.

Gender-affirming surgical procedures, such as metoidioplasty and phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information. (1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid. This cross-sectional study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework. Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables. We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to "pass" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing. The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty. This mixed methods study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway. This study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution.

A qualitative study of alcohol use disorder psychotherapies for transgender and nonbinary individuals: Opportunities for cultural adaptation

BackgroundTransgender and nonbinary (TGNB) populations experience high rates of hazardous drinking (HD) and alcohol use disorder (AUD) as well as unique treatment barriers. This is due, in-part, to discrimination and stigma within and outside of the healthcare system. Cultural adaptation of clinical interventions can improve outcomes for marginalized populations, but no such adapted interventions exist for AUD among TGNB individuals. This study sought to understand how TGNB individuals perceive currently available AUD psychotherapies and to generate knowledge about potential areas for cultural adaptation. MethodsAs part of a qualitative study of HD among TGNB individuals (N=27), participants were asked to imagine that they were clients in psychotherapy vignettes corresponding to cognitive behavioral therapy, motivational enhancement therapy, and twelve step facilitation. Interviews were audio-recorded and professionally transcribed. A coding team used an iterative codebook to guide coding. Categories emerged from this process that reflected participants’ perceptions and allowed for the identification of potential cultural-adaptation targets. ResultsAcross all three psychotherapies, participants wanted therapists to explicitly discuss gender identity and culturally salient HD risk factors for TGNB individuals (e.g., discrimination, stigma, gender dysphoria). There were also modality-specific recommendations to incorporate principles of trauma-informed care into cognitive behavioral therapy, avoid motivational enhancement therapy exercises that oversimplify decision-making, and recognize that the twelve-step-facilitation concept of “powerlessness” may conflict with how many TGNB people see themselves. ConclusionsThese findings highlight areas for cultural adaptation that can be evaluated in future intervention trials in an effort to improve psychotherapy acceptability and efficacy for TGNB individuals.

A Google Trends Analysis of Interest in Nonbinary Identities.

Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy.

Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

Instruments used to assess gender-affirming healthcare access: a scoping review protocol

Background: Internationally, the demand for gender-affirming care has increased exponentially in recent years. The clinical presentation of those seeking care has changed with an increase in transmasculine and non-binary identities and a decrease in the average age of those seeking care. Healthcare navigation remains complicated for this population and warrants further investigation in light of ongoing changes in the field. This paper presents a protocol for a methodological scoping review that aims to systematically map and synthesise the extent and nature of the peer-reviewed, published academic literature on the instruments used to assess factors relating to healthcare navigation and healthcare access for transgender and non-binary individuals seeking gender-affirming healthcare. Methods: This review will search databases (PsychINFO, CINAHL, Medline, and Embase.) and grey literature sources. In line with the methodological framework for scoping reviews, the following six stages will be undertaken: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarising and reporting results and (6) consultation. The PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation will be utilised and reported. The research team will undertake the study as outlined in this protocol and an expert panel of young transgender and non-binary youth will oversee the project through patient and public involvement. Conclusions: This scoping review has the potential to inform policy, practice, and future research through enhanced understanding of the complex interplay of factors that impact healthcare navigation for transgender and non-binary people seeking gender-affirming care. The results from this study will inform further research into healthcare navigation considerations generally and will inform a research project entitled “Navigating access to gender care in Ireland—a mixed-method study on the experiences of transgender and non-binary youth”.

Improved access yet inequitable experience: gay, bisexual and other men who have sex with men’s views of more inclusive criteria for source plasma donation

BackgroundCanada has incrementally reduced restrictions to blood and plasma donation that impact men who have sex with men, gay, bisexual, and queer men, and some Two Spirit, transgender and non-binary individuals (MSM/2SGBTQ+). Prior to the launch of a pilot program in 2021 enabling some MSM/2SGBTQ + to donate source plasma, we explored the acceptability of the program among individuals who could become eligible to donate in the program.MethodsWe invited men identifying as MSM/2SGBTQ + to participate in two consecutive semi-structured interviews to explore their views on blood and plasma donation policy, plasma donation, and the proposed Canadian plasma donation program. Interview transcripts were analyzed thematically and acceptability-related themes were mapped onto the Theoretical Framework of Acceptability.ResultsTwenty-seven men identifying as having sex with men participated in 53 interviews. Eighteen themes were mapped onto the seven construct domains of the Theoretical Framework of Acceptability. Underlying all aspects of acceptability was a tension between four primary values influencing participants’ views: altruism, equity, supply sufficiency, and evidence-based policy. The program was viewed as welcome progress on a discriminatory policy, with many excited to participate, yet tension with inequitable aspects of the program undermined support for the program and interest to contribute to it. The high demands of the program are unique for MSM/2SGBTQ + and are only tolerable as part of a program that is an incremental and instrumental step to more equitable donation policies.ConclusionFindings highlight past experiences of exclusion in Canada as a unique and critical part of the context of the donation experience among MSM/2SGBTQ+. Despite the program’s goals of greater inclusivity of MSM/2SGBTQ + individuals, the anticipated experience of the program included continued stigmatization and inequities. Future research should seek to understand the experienced views of MSM/2SGBTQ + donors to ensure that as policies change, policies are implemented equitably.

Self-rated health among older adults in India: Gender specific findings from National Sample Survey.

The self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting. We used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults. The overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange. Supporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.

It Depends! Contextual Variability in Feminist Identity Disclosure Among Binary and Nonbinary Individuals

It Depends! Contextual Variability in Feminist Identity Disclosure Among Binary and Nonbinary Individuals

Animal Models of Gender Affirming Hormone Therapy in Translational Research to Support Transgender, Non-binary, and Gender Diverse Individuals

Animal Models of Gender Affirming Hormone Therapy in Translational Research to Support Transgender, Non-binary, and Gender Diverse Individuals

Chest-Binding Practices for Trans and Nonbinary Individuals within Different Spatiotemporalities: Redefining the Meanings of Space, Place, and Time

Styling-fashioning-dressing, which involves embodied and material articulations of style, is one way that trans and nonbinary individuals negotiate, produce, and perform their gender identities. Chest binding is a practice that involves compressing chest tissue to achieve a flattened esthetic. In this paper, we examined the spatiotemporal production of chest binding—that is, we considered bodies, space, and time as mutually constitutive and explored the when and where of why people choose to bind their chest. We created and administered a comprehensive 120-item cross-sectional questionnaire that included demographic, open-ended, closed-ended, Likert-type scale, and multiple-choice questions. In total, 61 usable survey responses were collected and analyzed. The participants’ nuanced experiences offered insight into new ways to conceptualize the public, private, and secret self-model, particularly for trans and nonbinary individuals who are assigned female at birth. We offer a new interpretative model, Dress Snarl, that incorporates different spaces and dress types. Of great importance is the inclusion of garments that continuously cross space, time, and place but remain intimate and typically invisible to the public. It is within this intimate space we theorize and interpret and binder and binding practices.

Predictive Role of Sociodemographic and Health Factors on Psychological Resilience during the COVID-19 Pandemic: A Cross-Sectional Study in Turkey

Recent global changes, including increased health risks and economic instability associated with the coronavirus (COVID-19) pandemic, highlight the need for mental health researchers to regularly and frequently monitor sociodemographic shifts. To minimise the risk of psychological complications arising from adverse events, we need to identify and understand the factors linked to psychological resilience in different populations. To this end, we collected data in Turkey during the third wave of the pandemic (June 2021). The aims were to identify how the level of perceived psychological resilience changed: (1) across sociodemographic groups (age, gender, perceived economic security, caregiver status, perceived socioeconomic status, education level, perceived social isolation, and presence of acquaintances who had contracted COVID-19); (2) across health groups (smoking status, psychological or chronic illness status, and having had COVID-19); and (3) in relation to changes in fear of COVID-19. Regression analyses showed that age, gender, economic security, socioeconomic status, and illness status were factors influencing resilience, and fear of COVID-19 was negatively correlated with resilience. Young adults, females, nonbinary individuals, a low socioeconomic status, and economically insecure groups as well as people with a psychological condition were identified as lower resilience groups. The results provide insights about the predictors of perceived psychological resilience during a global crisis and help identify vulnerable populations.

Leah DeVun. The Shape of Sex: Nonbinary Gender from Genesis to the Renaissance.

Leah DeVun’s latest book, The Shape of Sex: Nonbinary Gender from Genesis to the Renaissance, appears at a pivotal moment in contemporary debates about transgender and intersex embodiment. As many trans antagonistic writers have opted to excise intersex and nonbinary bodies from larger conversations about sex, gender, and identity, The Shape of Sex offers a compelling rebuttal to this erasure, arguing that nonbinary bodies—a term DeVun uses to signal a wide range of bodies that fit uneasily into a premodern male-female binary—have been central to such questions for over two millennia. With careful attention to the complex and shifting ways nonbinary bodies were interpreted during the Middle Ages, DeVun eloquently demonstrates that “although intersex individuals were socially and textually marginalized, ideas about nonbinary sex were central to the fundamental categories that ordered the world” (5). Functioning as an epistemological touchstone, such bodies served divergent purposes in the Middle Ages: sometimes called upon as exemplars of “fluidity and metamorphosis,” and at other times interpreted as “hybrids that constrict and police categories” (6). This diverse history is elaborated through careful attention to the densely populated use of nonbinary figures in medieval discussions among theologians, cartographers, natural philosophers, lawyers, moralists, surgeons, and alchemists as well as through insights from actual nonbinary individuals. The result is a book that is exquisitely nuanced, politically shrewd, and utterly teachable.

‘I don’t want to have to teach every medical provider’: barriers to care among non-binary people in the Canadian healthcare system

It is well-known that trans and non-binary individuals experience worse health outcomes due to experiences of violence and discrimination. For this reason, accessible healthcare for trans and non-binary people is crucial. There is a lack of Canadian literature on the experiences of non-binary people within the healthcare system. This study sought to understand barriers to healthcare among non-binary people living in a mid-sized urban/rural region of Canada. Interviews were conducted between November 2019 to March 2020 with 12 non-binary individuals assigned female at birth, living in Waterloo Region, Ontario, Canada, as a part of a larger qualitative study exploring experiences within the community, healthcare and employment. Three broad themes were developed: erasure, barriers to access to healthcare, and assessing whether (or not) to come out. Sub-themes included institutional erasure, informational erasure, general healthcare barriers, medical transition healthcare barriers, anticipated discrimination, and assessing safety. Policy and institutional changes are needed to increase the safety and accessibility of healthcare services to non-binary individuals.

“I am a binary trans man and I love being pregnant”: Making meaning of pregnancy in seahorse dad narratives

Although there are many ways one might start a family, the culture in the United States considers pregnancy one of a woman’s most important life achievements, privileging biological ties above all else. These cultural assumptions stigmatize seahorse dads, or transmen and nonbinary individuals who become pregnant. Using relational dialectics theory (RDT), this study examined posts on Reddit to highlight how marginalized discourses resist dominant discourses to make meaning of a semantic object. RDT’s corresponding method, contrapuntal analysis, revelated three discourses that competed to make meaning of seahorse dads: the discourse of pregnancy as a woman’s burden (DWB), the discourse of pregnancy as a woman’s privilege (DWP), and the discourse of pregnancy as an independent process (DIP). These discourses interacted through contractive practices (i.e., disqualification, naturalization, and neutralization), synchronic interplay (i.e., entertaining, countering, and negating), and dialogic transformation (i.e., hybridization and an aesthetic moment). Findings revealed theoretical implications and practical applications.

The Vaginal Microbiome of Transgender and Gender Nonbinary Individuals.

The goal of this preliminary study is to describe the vaginal microbiome of transgender and gender nonbinary (TGNB) individuals using nonculture-based techniques. TGNB individuals may undergo gender-affirming surgical procedures, which can include the creation of a neovagina. Little is known about microbial species that comprise this environment in states of health or disease. In this pilot study, vaginal swabs were self-collected from 15 healthy self-identified TGNB participants (age 26-69 years) and 8 cisgender comparator participants (age 27-50 years) between 2017 and 2018. Next-generation 16S ribosomal RNA sequencing was used to profile individual bacterial communities from all study samples. The TGNB cohort demonstrated significantly higher intraindividual (alpha) diversity than the cisgender group (p=0.0003). Microbial species commensal to the gut and skin were identified only in specimens from TGNB participants. Although Lactobacillus species were dominant in all cisgender comparator samples, they were found at low relative abundance (≤3%) in TGNB samples. In this study, specimens collected from neovaginas showed increased alpha diversity and substantially different composition compared with natal vaginas. In contrast to natal vaginas, neovaginas were not dominated by Lactobacillus, but were hosts to many microbial species. Studies that help to improve our understanding of the neovaginal microbiome may enable clinicians to differentiate between healthy and diseased neovaginal states.

Awareness Among Transgender and Nonbinary Adults of the Otolaryngologist's Role in Providing Gender-Affirming Care Services.

To assess transgender and nonbinary adults' awareness of Otolaryngologists' (ENT) and speech-language pathologists' (SLP) ability to perform various face, neck, and voice procedures for gender-affirming purposes. Cross-sectional survey. Online, from February to May 2022. We developed a list of nonsurgical and surgical gender-affirming face, neck, and voice procedures. We asked transgender and nonbinary (TNB) adults which procedures from this list they knew could be performed by specially-trained ENTs or SLPs for gender-affirmation and which listed procedures they knew existed as gender-affirming treatment before the survey. We assessed awareness of ENTs' and SLPs' ability for each procedure across gender identity using Fisher exact tests. We examined if demographic or socioeconomic factors were associated with the total number of gender-affirming procedures participants knew ENTs or SLPs could perform using univariable linear regression. TNB adults (N = 234) generally knew these procedures existed as gender-affirming treatment (64%-93%). However, TNB adults were largely unaware these gender-affirming procedures could be performed by specially-trained ENTs or SLPs (53% or less), especially procedures unrelated to the voice, neck, and nose (26% or less). Knowledge of ENTs' and SLPs' ability was similar across gender identity for most procedures. Total number of procedures known that ENTs or SLPs could perform did not differ by demographic/socioeconomic factors (p > .05). These findings suggest transgender and nonbinary individuals may not know to seek Otolaryngologists or SLP when desiring gender-affirming face, neck, or voice care. Increased efforts are needed to promote awareness of Otolaryngology's role in providing gender-affirming care.

Supplemental Material for Invalidation and Mental Health Among Nonbinary Individuals

Supplemental Material for Invalidation and Mental Health Among Nonbinary Individuals