Navigating identity: Experiences of binary and non-binary transgender and gender non-conforming (TGNC) adults

ABSTRACT

Background: Emerging research and colloquial dialogues increasingly point to an uptick in non-binary gender identity endorsement, however research has failed to parallel this increase. For example, existing literature often conflates gender identity with sexual orientation, lumping TGNC people under the LGBTQ umbrella, thus rendering the “T” silent in the process. Further, extant research adheres to a binary (i.e., dichotomous male/female) conceptualization of gender, thus excluding individuals who identify as genderqueer, gender non-conforming, or otherwise non-binary as well as those who do not identify with the construct of gender at all (e.g., agender).

Method: This qualitative investigation utilized individual interviews with 15 TGNC adults. Data analysis employed two data-driven phases, first identifying themes consistent across the 15 transcripts to identify nuances in TGNC identity formation often missed by theory-driven models and second, establishing similarities and differences between binary and non-binary narratives.

Results: Results indicated that various helpful and challenging factors played a stronger role than chronology, physical transition, or activism across all participants which contrasts findings in extant literature. Further, while binary and non-binary narratives were similar in many regards, several noteworthy distinctions emerged. For example, the concepts of “passing or blending”, intersections of gender identity with sexual orientation, and navigating identity presentation and disclosure were described differently for binary and non-binary participants.

Conclusions: Historically, the “T” in “LGBTQ” has often been rendered silent. These results indicate that non-binary narratives have been rendered doubly silent. Given the increasing preponderance of non-binary identifications and the unique needs and experiences of non-binary participants, it is crucial that professional and lay communities alike begin to take two steps moving forward: 1) explicitly acknowledge the existence of non-binary TGNC identities and 2) work to achieve fluency regarding the unique needs and experiences of this population.

In 2014, TIME magazine published “The Transgender Tipping Point”. This article, punctuated by historical data, quality of life statistics, and quotes from Netflix star and transgender advocate Laverne Cox, chronicled the presence of TGNC individuals in American mainstream media (Steinmetz, 2014). Beginning in 1959 with Christine Jorgensen, a transgender World War II veteran, the history of TGNC media presence was repeatedly reshaped as new stories joined this emerging narrative. Over time, this narrative expanded to integrate the voices of Janet Mock, highlighting the role of racial/ethnic intersectionality in TGNC experiences and challenging the misleading ‘girl born in a boy's body’ paradigm (Mock, 2013) and of Caitlyn Jenner, challenging archaic definitions of what makes a “man” a “man” or a “woman” a “woman” through a Vanity Fair exclusive that quickly went viral (Bissinger, 2015). Individuals who identify as non-binary have also emerged into media awareness including singer/songwriter/actress Miley Cyrus who came out as “gender-neutral” in September 2015 (Nichols, 2016) and model/actress/singer/television presenter Ruby Rose who identifies as “gender fluid” (Gray, 2015). While representing only a minute segment of TGNC voices and experiences, these narratives have created a zeitgeist within which society has begun to not only acknowledge TGNC identities, but also to understand their complexities.

Despite increased societal salience, research communities have lagged far behind, often promoting archaic and strictly binary (dichotomous male/female) conceptualizations of gender identity. Considering increasing endorsement of gender identities outside of the traditional gender binary, it is due time that research communities divorce from two trends of the past: 1) assumptions of universal experiences within TGNC communities and 2) pervasive binarism rooted in a false dichotomy of anatomy.

Defining gender identity

Gender and gender identity represent complex constructs which have claimed several conceptualizations over time. For example, Egan and Perry (2001) conceptualized gender at the intersection of social and personal influences—a combination of one's perception of gendered social groups (e.g., male, female, transgender, genderqueer), one's sense of belonging to a specific group (or lack thereof), and one's internal experiences and perceptions of those experiences. Shapiro (2007) further accounted for factors such as availability of gender influences (e.g., role models) and opportunities to explore and express gender.

The term transgender broadly describes individuals who self-identify with a gender other than that assigned to them at birth (APA, 2015; Kaufman, 2008). The term cisgender refers to individuals whose experienced gender identity matches that which they were assigned at birth (i.e., an infant assigned female at birth would grow up and self-identify as female; Tate, Bettergarcia, & Brent, 2015). Additional terms have historically been considered synonymous with transgender and have a complex history of stigmatization and, in some cases, later being reclaimed by TGNC individuals (e.g., MTF or male-to-female, FTM or female-to-male, transvestite, transsexual, and transgendered persons and further more terms continue to be in common use such as transfeminine/transmasculine and transfemale/transmale; Carroll, Gilroy, & Ryan, 2002).

The root word “trans”, meaning “across” often implies that an individual identifies opposite their sex assigned at birth (i.e., an infant assigned male at birth later identifies as female). This definition, deeply rooted in binarism, inadequately represents the vast spectrum of gender identities embraced by individuals. Thus, at least 25–35% of TGNC individuals identify as non-binary or gender non-conforming (GNC), denoting a gender identity outside of the dichotomous male/female binary (James et al., 2016). Notably, research to date consistently suggests that these identities are not inherently pathological, but rather that poor health outcomes emerge from systemic stigmatization, discrimination, and oppression (Currah, 2006; Kaufman, 2008; Meyer & Frost, 2012; Rimes, Goodship, Ussher, Baker, & West, 2017).

Early models of gender identity

One of the earliest investigations of TGNC identity, conducted by Ellis (1945), investigated gaps between socially prescribed gender assignments and experienced gender identity in a sample of intersex individuals (i.e., individuals with atypical presentations in terms of chromosomal configuration, hormones, and/or secondary sex characteristics). Ellis highlighted the importance of both internal and external factors to gender identity and related experiences. The term “gender identity”, however, was not coined until 1968 when Robert Stoller made the powerful claim that individuals experience threats to their gender identity as a threat to their overall sense of self. For more extensive historical overviews, see Frable (1997) or Fagot and Leinbach (1985).

Hill (1997) studied the multidimensional facets of gender identity development. Hill's data challenged contemporary understandings of gender identity as most participants described feeling compelled to select binary categories in daily life (e.g., “male” versus “female” on an application form) while reporting that neither term felt authentic. Hill concluded that a great deal of heterogeneity among TGNC-identified individuals remained unexplored, with detrimental consequences for non-binary identified people.

In 2004, Devor created the first stage model of gender identity formation based upon previous multicultural identity models such as racial/ethnic identity (Cross, 1971; Helms, 1990; Kim, 1981) and lesbian, gay, and bisexual (LGB) identity (Cass, 1984; Fassinger & Miller, 1997; Johns & Probst, 2004; Mohr & Fassinger, 2000). As the first attempt at conceptualizing gender identity as a developmental process rather than a biological or anatomical given, Devor's model took a fundamental step toward understanding TGNC identity development, albeit imperfectly so. For example, its assumptions of anatomical dysphoria and desire for physical “transition” reinforced binary conceptualizations of gender and erroneously assumed that each gender has only one specific physical manifestation, and that identity pride must inevitably involve social activism. Pardo (2008) empirically re-investigated Devor's model, adding non-binary and free-response gender identity options. Like earlier findings of Roen (2002), Pardo obtained 343 non-overlapping gender identifications, opening the doors for inclusive investigations into the full spectrum of gender.

Non-Binary models of gender identity

Dvorsky and Hughes (2008) described historical transgender identity movements as taking on two waves. The first wave epitomized binary gender norms, with MTF individuals adopting socially constructed norms of femininity to the extreme, and FTM adopting masculine norms to the extreme. This first wave echoes the findings of Gagne, Tewksbury, and McGaughey (1997). Dvorsky and Hughes propose that a second wave has emerged more recently, characterized by a tapering from these extremes. What remains is an infinite spectrum of possibility regarding masculinity, femininity, and anything in between. A handful of researchers epitomize this second wave, conceptualizing gender as multiplicity rather than dichotomy. For example, Bilodeau (2005) examined and critiqued the accuracy of binary conceptualizations of gender in his investigation of the identity development of two transgender-identified students. While a sample size of two is hardly generalizable, the frank responses provided by Bilodeau's participants paved the road for research to follow. One participant stated: “I've tried with my identity to not reinforce the gender binary system…the only option is, if you're male, to become female, or vise-versa. Transgender youth have felt that binary gender system is not for them. We want to increase the number of genders” (Bilodeau, 2005, p. 33–34).

Purpose of the study

Considering the aforementioned literature, we set out to center the voices of TGNC individuals and derive from their narratives a nuanced and inclusive conceptualization of gender identity formation. It is our hope and intention that a nuanced conceptualization of gender identity can be applied to improve societal understanding of TGNC identities and experiences which may help to ameliorate disparities in mental health and quality of life among TGNC populations.

The researchers held several a-priori hypotheses prior to conducting this research based upon a combination of extensive literature review and discussions with TGNC-identified individuals and other TGNC researchers: First, that participant narratives would demonstrate a great degree of heterogeneity, particularly during later phases of identity development, than noted within previous gender identity developmental literature; Second, that despite heterogeneity in participant narratives, common themes of risk and resiliency would emerge; and third, that participant identity development would be best conceptualized in terms of a multi-dimensional set of critical processes rather than a linear progression. These hypotheses were tested utilizing a qualitative research methodology, including semi-structured interviews with 15 TGNC adults.

Method

Participants

Participants included 15 adults who self-identified as transgender or gender non-conforming (TGNC). Participants self-selected for participation and were recruited through a series of emails sent to university Listservs and Facebook groups centered on topics of gender identity. Participants self-selected for participation by responding via email to the abovementioned emails and social media posts. Participants age 18 or older who self-identified as transgender or gender non-conforming were included in the study. The only exclusion criteria were an age below adulthood (i.e., younger than 18) and/or explicitly identifying as cisgender.

Participants endorsed a wide range of socio-demographic identities. The average participant age was 32.07 (range 24–53). Over half (60%) of the sample reported being assigned female at birth (N = 9) and the remaining 40% (N = 6) reported being assigned male at birth. Participants reported nine distinct gender identities including “male”, “female”, “genderqueer”, “transgender MtF”, “transgender FtM, and “Transgender non-binary”. For a detailed breakdown of socio-demographic characteristics, see Table 1.

Table 1.

Socio-demographic sample characteristics (N = 15).

Category	Frequency	Valid Percent
Sex Assigned at Birth
Female	9	60
Male	6	40
Intersex	0	0
Gender Identity
Transgender (MtF)	3	20
Transgender (non-binary)	3	20
Transgender (FtM)	2	13.3
Genderqueer	2	13.3
Female	1	6.7
Male	1	6.7
I do not identify with any of these terms. Please specify:	3	20
Gender Identity
I mostly identify with my gender expression, which is generally androgynous. If gender is 0–10 with 0 being 100% masculine and 10 is 100% feminine, I identify as ranging fluidly between 3–6, often slightly masculine. But I count myself as female when asked by government, institutions, etc.	1	6.7
Prefer NOS or non-binary	1	6.7
Race/Ethnicity
White	7	46.7
Mixed race/ ethnicity	3	20
Black or African American	2	13.3
Asian	2	13.3
Hispanic/Latina/o/x	1	6.7
Sexual Orientation
Queer	8	53.3
Pansexual	3	20
Heterosexual (Straight)	2	13.3
Homosexual (Gay/ Lesbian)	2	13.3
Population Density
Major city	13	86.7
Medium-sized town or village	2	13.3
Religion/Spirituality
Spiritual beliefs do not fit a formal religion	7	46.7
Buddhist	3	20
Catholic	1	6.7
Atheist	1	6.7
Jewish	1	6.7
Pagan	1	6.7
None	1	6.7
Not Listed, please specify:	1	6.7
Housing Status
Renting a home	10	66.7
Renting a room	3	20
Living with family	2	13.3
Educational Attainment
Bachelor's Degree	6	40
Advanced Degree (MD, PhD, PsyD, JD, etc)	4	26.7
Associate's Degree	2	13.3
High School Diploma	2	13.3
I did not graduate high school	1	6.7
Income
Under $20,000	6	40
$20,000 – $40,000	5	33.3
$41,000 – $60,000	3	20
Over $100,000	1	6.7
Hormone Therapy
HRT	6	40
None	5	33.3
Both	3	20
Blockers	1	6.7

Measures

Demographic Questionnaire. This questionnaire included 15 items assessing socio-demographic characteristics such as age, birth sex, gender identity, race/ethnicity, sexual orientation, location and population density, religion/spirituality, housing status, employment status, and socio-economic status.

Gender Identity Semi-Structured Interview. The Gender Identity Interview was created by the author for the purposes of this investigation. Adapted from previous identity research (Sophie, 1985; Savin-Williams & Diamond, 2000; Jamil, Harper, & Fernandez, 2009; Shapiro, Rios, & Stewart, 2010), this 21-item interview investigated factors and processes relevant to gender identity development (e.g., self-discovery, self-disclosure, factors of risk and resiliency, and influences of societal perceptions). This interview required approximately 60–90 minutes to complete and utilized a semi-structured format, allowing participant narratives to unfold organically and authentically. Items included in the interview were developed based on extant literature as well as a series of discussions held on the same social networking groups and online forums utilized in participant recruitments wherein group members were asked to share their perceptions on topics that are important for study and/or that have been overlooked/under-studied.

Procedure

This research received IRB approval from the first author's affiliated university on 10/28/2015. After the informed consent process, participants completed individual face-to-face semi-structured interviews with the primary investigator. Lastly, participants received a list of TGNC-affirming counseling resources and $50 (USD) cash compensation.

Analysis

Data analysis utilized the Consensual Qualitative Research (CQR; Hill, Thompson, & Williams, 1997) method. In this data-driven approach, transcribed verbal responses were examined by a team of trained coders, each of whom identified themes and patterns across the transcripts, utilizing the process of memoing (see Birks, Chapman, & Francis, 2008 for a description of memoing and its functions). The team then discussed, iteratively, until reaching consensus regarding themes. Two rounds of analyses were undertaken. First, themes across the 15 transcripts were derived. Second, themes specific to binary (n = 6) and non-binary (n = 9) transcripts were derived for comparison to one another and to the generalized themes. Further description of the coding process is beyond the scope of this paper, but can be found in Hill et al. (1997) and/or Hill, Knox, Thompson, Williams, and Hess (2005).

The coding team consisted of six individual coders and one external auditor. Because personal identities inform world views, members of the coding team anonymously reported their self-identifications and were encouraged to examine the ways in which their various identities might inform their perspectives of the data (see Galupo, 2017 for a poignant review of the implications of researcher identities on the conduct of TGNC-focused research). Coders ranged in age from 20–29 and endorsed gender identities including cisgender male, gender non-conforming (GNC) woman, and non-binary. The external auditor identified as a cisgender male gay Asian American professor.

Results

The following results are organized thematically. In cases where binary narratives differed substantially from non-binary narratives (as determined by the six-person coding team's consensus), areas of divergence are detailed. Refer to Table 3 for an overview of themes and sub-themes with illustrative quotes, as well as a depiction of the salience of each theme within the data overall.

Table 3.

CQR themes and sub-themes.

Themes and Sub-Themes	Summary/Quote	Frequency Category
Developmental Phases
Childhood		General
Early discomfort	“feeling really uncomfortable inside gender identity of male and like the societal expectations”	General
Instinctive identity expression	“[I] did not understand certain differences, like why I had to wear a shirt you know, when it was really hot”	Typical
Adolescence	“When I had puberty, stuff was happening and I was having like panic attacks and freaking out”	General
Early Adulthood	Autonomy, Individuation	General
Adulthood	Transition, Post-Transition, Activism (or not)	Variant
Challenges/Risk Factors
Personal
Lack of information/resources	“no frame of reference for what I'm going through” “I didn't really know that there were other options”	General
Internalized transphobia/trans-negativity	“I actually got like really depressed because of internalized transphobia and all that nonsense of like…I'm this, but this is a terrible thing to be”	Typical
Learning how to perform gender	“I'm always trying to figure out how to woman, like how to do that” “that sort of like male posturing, I feel like maybe one of the biggest challenges is that I don't recognize that are socialized male, I don't understand them”	Typical
Interpersonal
Other-imposed identity	“my ex-partner had this whatever that I'm attracted to women or I'm attracted to you so you must be a woman”	Typical
Exclusion from binary trans* spaces	“I just feel like we stopped when it comes to the ‘T’…we have the ‘T’, but like our ‘T’ is still binary”	Variant
Family tolerating but not accepting	“you can dress however you want but don't be one of those people who like has surgery and takes hormones”	Typical
Romantic relationships	“[my partner], she would you know knock and bash me for who I was”	Typical
Systemic
Systemic bias	“trying to deal with a cis-normative society for sure”	General
Lack of media representation	“It's hard to constantly see images of myself like being punished [on television]”	Typical
Public spaces	Beaches, bathrooms—self-presentation and safety	Typical
Overt discrimination	“call me like a tranny, a dyke, a faggot” “[assumptions that TGNC people] are going to try to kill you, rape you, test you and all this stuff”	Variant
Helpful/Protective Factors
Social Support
Peers	“just having a network of friends who identify as queer” “talking with friends who've had previous experience with thinking about and talking about gender”	General
Family	Supportive, social-justice oriented parents	Typical
Larger communities	“having access to those communities [transmasculine and gender non-conforming communities] has been really huge”	Typical
Partner(s)	“[my partner] she's been amazing and is like ‘wherever you land is fine with me, it's your life, your body, your gender, go for it’”	Typical
Resources
Media and technology	“I typed into Google ‘I think I might be a girl” and thank goodness the search results came up with just all these wonderful transgender stories”	General
Educational resources	Judith Butler books, Philadelphia Transgender Health Conference, Gender Odyssey Conference	Typical
Support groups	“I think it gives a unique, a lot of opportunities for sort of like niche audiences…I'm in a bottom surgery support group for trans masculine people right now”	Variant
Exposure through travel/outreach/etc.	“I have been traveling the world because of my professional work so I have a good understanding of how transgender people are in the rest of countries”	Variant
Creative outlets	“feeling good about my body through dancing…when I'm using my body creatively it's almost like…I'm not gendered in my body anymore, I'm sort of free and powerful”	Variant
Validating Experiences	Being read consistent with gender identity “I knew I was passing because white women were uncomfortable around me” [Black trans man]	Typical
Identity Development Critical Processes
Identity Selection
Not _______.	“I don't think that I'm trans so I'm just trying to figure out something in between”	Variant
Spectrum preferences	“Masculinity is something that I've been less comfortable with than femininity”	Typical
Navigating Names	Pros and cons of name changes	Typical
Reclaiming Self/Body	“it was the process of like internet culture and sort of reclaiming myself, my identity away from society”	Variant
Navigating Disclosure
Comfort in relationships	“socially it's always sort of genderqueer trans-masculine, or the thing that I like to really use with my friends is dude with a vag”	General
Inconsequential contacts	“to the people in the grocery store I identify as male but if I'm like on a panel, I identify as trans-masculine”	General
Interview/occupational	“When I go to a job interview I kind of take it out as an act…[once] I didn't do very well just because the whole time I was in a dress and I wanted to cry”	Typical
Age	“it depends on the audience. With younger people it's much easier”	Variant
Path of least resistance	“I'd just choose the one that I know they want me to say”	Typical
Navigating Self-Presentation
Safety concerns	“When I'm on the bus going through Newark, if I wear eye makeup I wear shades so I don't get called out on the bus”	General
Passing/Blending concerns	“as long as I'm passing within myself, as myself, and feeling true to myself then I'm feeling okay” “It's important, it's not even passing as a guy but passing as someone that's not a woman is what's really important to me”	Typical
Increased Flexibility	“I feel like some of that compensatory bro-ness has eased out, my masculinity is taking on a little bit of a gentler approach”	Variant
Transition Amnesia	“I think that binary trans people if/when they get to the point where they are passing well, there's a kind of amnesia that you forget what it's like”	Variant
Activism (or not)	“when it comes down then we just have to educate people with it” “my friends and I have a phrase: ‘I don't’ have time to teach old white men this stuff, you have the internet’”	Variant

Notes. Participant quotes used when feasible in terms of space, summaries provided otherwise. Frequency categories rather than quantitative frequencies provided per Hill et al. (2005), “General” indicates presence in at least 14 cases, “Typical” indicates 8–13 cases, “Variant” indicates 2–7 cases, no themes derived from single cases.

Growing up TGNC

Participants described their identity development in terms of four developmental phases: childhood, adolescence, early adulthood, and adulthood—each with unique challenges. These themes were consistent across both binary and non-binary transcripts, although non-binary narratives described a later onset of initial gender (identity and/or presentation) exploration—often in early-mid adulthood rather than during adolescence/early adulthood.

Childhood: “A lot of feeling really uncomfortable”. During childhood, participants described two primary themes: 1) Early Discomfort and 2) Instinctive Identity Expression. Early discomforts centered around binary gender norms, to which children are exposed from very young ages, coupled with a lack of resources (personal or otherwise) to conceptualize or manage their discomfort. For example, participants described a generalized sense of discomfort which, in their young age, was not necessarily connected to the construct of gender: “I hated having to wear dresses, but I didn't necessarily connect that with anything like bigger, like any kind of identity”. In addition to generalized early discomforts, participants described the opposite experience: instinctively expressing their experienced gender identity regardless of social norms (e.g., several masculine-identified participants described removing their shirts at the beach or summer camp, instinctively, but much to the surprise (or even chagrin) of those around them).

Adolescence and early adulthood: “Everything started changing”. During adolescence, participants described experiences uniquely related to puberty and its associated physical (e.g., “when I had puberty, stuff was happening and I was having like panic attacks and freaking out, binding down my chest I had no idea what was going on with me”) and social changes (e.g., “I didn't wanna [sic] be seen as like a guy, and I didn't wanna be considered masculine at all. I mostly just hated the performative high fence of what's always expected of you”). During early adulthood, participants described increasing autonomy and individuation following separation from caregivers. Many described this as a crucial turning point as they came to terms with their sense of self, apart from family expectations.

Adulthood: “Digging a little deeper”. The greatest degree of heterogeneity presented during the phase of adulthood, though gender confirmation procedures emerged with consistency. Here, participants described expanding upon the autonomy and individuation of early adulthood, independently exploring and developing an authentic sense of self. For some participants, stepping into adulthood also meant stepping out of a TGNC identity: “I feel like transitioning from one gender to another is something that I don't identify as much with anymore”.

Many participants (especially non-binary identified, though not exclusively so) did not want to pursue hormone therapy or gender-affirming procedures. Such participants challenged the ‘stuck in the wrong body’ narrative, by claiming their bodies and genders as their own, irrespective of social norms. Similarly, while prior models of gender identity formation emphasized the role of activism as indicative of an adaptive gender identity, the importance of such activities were more pronounced among non-binary participants who reported more readily assuming the role of educator and/or activist (though not unanimously so).

Common factors: Challenges and helpful

While binary and non-binary narratives demonstrated far more similarities than differences in terms of challenge and resiliency factors described, divergent themes are described as applicable below.

Challenges. Challenging factors comprised three themes: personal, interpersonal, and systemic.

Personal challenges: “No frame of reference for what I'm going through”. Personal challenges included lack of information/resources, internalized transphobia/trans-negativity, and learning how to perform gender. Participants (binary and non-binary) described grappling with internalized transphobia and/or trans-negativity (e.g., “I think I have this internalized transphobia. I don't really know what this looks like or what other people's experiences are”) and challenges related to the performance of gender (e.g., “I am also always trying to figure out like how to woman, like how to do that”). Lack of information was particularly pronounced in non-binary narratives, whereas binary participants described stigmatizing (rather than absent) resources.

Interpersonal challenges: “It's definitely more about the personal relationships to me”. Interpersonal challenges included: 1) other-imposed identity (e.g., “you are not a boy, you are a girl”), 2) exclusion from binary TGNC communities (e.g., “I just feel like we stopped when it comes to the ‘T’, like we have the T but our T is still binary”), 3) family tolerating but not accepting, and 4) challenges within romantic relationships with partners (e.g., “she said she was accepting, but the tone of her voice or change in speech, her body language told me otherwise”).

Systemic challenges: “Everything is a struggle”. Systemic challenges included four sub-themes: 1) systemic bias, 2) lack of media representation, 3) public spaces, and 4) overt discrimination. Systemic bias encompassed experiences with cis-normativity and anti-TGNC attitudes: “trying to deal with a cisnormative society”. Lack of media representation was particularly pervasive in that it contributed to the unavailability of role models in the media: “I don't have any role models, it's not seeing images of myself” or when a semi-relatable image was projected through the media “it's not a happy life that's transmitted to me…it's hard to constantly see images of myself being punished”.

Public spaces also posed unique systemic challenges. For example, participants frequently mentioned beaches and bathrooms, both complicated in terms of self-presentation, anatomical discomfort/dysphoria, and/or safety. Lastly, participants described overt verbal (e.g., “call me like a tranny, a dyke, a faggot), physical (e.g., “when it comes down to a transgender woman using a female bathroom that person will do something to them), and sexual (e.g., “if I'm dressed feminine I get sexually harassed a lot. If I'm dressed masculine I get really nasty stares”) discrimination. Participants also described more implicit forms of oppression, where they felt dehumanized (e.g., “one set of messages are really like dehumanizing or degrading”) and/or exoticized (e.g., “it just reminds me of the whole like freak-show aspect…it's like tourism that people are like oh, how fascinating”).

In terms of both interpersonal and systemic challenges, some noteworthy distinctions emerged between binary and non-binary narratives. For example, while both groups described both overt and subtle discrimination, fetishization was more common among binary narratives whereas invisibility and boxism (i.e., implicit binarism) were more common among non-binary participants.

Helpful factors: “Thinking and talking about gender”. Participants described three themes which positively impacted their identity development: 1) social support, 2) resources, and 3) validating experiences.

Sources of social support described included peers (both TGNC and cisgender), family, larger communities (e.g., larger LGBTQ or TGNC communities), and partner(s). Social support provided role models and sources of information to support gender exploration. Participants also described five categories of helpful resources: 1) media and technology (e.g., Google), 2) educational resources (e.g., classes, books, conferences), 3) support groups, 4) exposure through travel or outreach, and 5) creative outlets and self-expression (e.g., dance, painting, sketching). Non-binary participants placed much greater emphasis upon a sense of community (i.e., ties to either LGBTQ, TGNC, or to specific non-binary communities) than binary participants, though both groups highlighted peer, family, and formal support groups as integral.

Notably, being read consistent with gender identity formed a large foundation of resiliency among participants, though this validation (i.e., being read as consistent with one's gender identity) was described as unattainable for non-binary participants (e.g., “passing as what? I don't think I'll ever be read as non-binary, people just don't think of it”) and as a double-edged sword at the intersection of gender identity and race/ethnicity (e.g., “I knew I was passing because white women were uncomfortable around me”) or sexism (e.g., “I can generally tell how well I'm passing especially in the warmer months by whether or not people street harass me”).

Critical processes in identity development

Participants also described several critical processes in their gender identity development including: 1) identity selection (for a summary of gender identities described and defined by interview participants, see Table 2), 2) navigating names, 3) reclaiming self/body, 4) navigating disclosure, 5) navigating self-presentation, 6) increased flexibility, 7) transition amnesia, and 8) activism and educating others (or not).

Table 2.

Gender identity self-definitions.

Transcript	Gender Identity	Definition
1	“gender queer”	“it means a little bit of fuck you I don't have to choose” or alternative quote, “I don't think that I'm trans so I'm just trying to figure something out in-between.”
2	“I'm a heterosexual male”	“Me being with women”
3	“gender fluid”	“I go between she, her, hers, to they, them, theirs.”
4	“slightly confused and gender queer”	“I don't really identify with any binary.”
5	“gender non-conforming identity”	“kind of like non-binary but also just kind of like, like I don't mind using trans as an umbrella term”
6	“trans-masculine or FTM”	“generally male, pretty binary”
8	“a being”	“I was born and I'm in this, in whatever body I ended up being inhabiting in the location that I was and all the social stuff that I was already in”
9	“I mostly like don't really identify with anything”	“More androgynous than a specific noun”
10	“female MTF”	“male to female”
11	“transsexual woman”	“somebody who has changed their gender and their sex”
12	“non-binary”	“my internal sense of self and what makes me feel I don't know comfortable… I you know choose things from-from anything that I like appearance wise”
13	“non-binary… if it is left blank, I like to enter NOS”
	“people are people, and not parts”
14	“I'm not entirely sure”	“I've stopped caring about labels”
15	“non-binary”	“I experience my gender as both male, female, and other”
16	“non-binary demi-boy”	“middle of like a male female spectrum, but more like oriented towards masculinity… I think the idea of like, being a boy sometimes, it like, feels right.”

Within the critical process of identity selection, participants described locating and claiming terminology to describe their gender identities. Two sub-themes emerged: identifying as “Not ______” (e.g., “not male”, “not cisgender”, “not transgender”) and spectrum preferences (e.g., “masculinity is something that, like, I've been less comfortable with than femininity”). Both sub-themes were consistent across both binary and non-binary transcripts, though the notion of fluidity across (and at times apart from) the gender spectrum emerged more strongly within non-binary narratives. Additionally, non-binary participants reported their spectrum preferences in comparative terms (e.g., “I'd rather be read as ____ than ____”) whereas binary participants utilized dichotomous descriptions (e.g., passing or blending versus not passing or not blending).

Following selection of a gender identity (often described as an iterative rather than linear process), participants described coping with identity indicators such as their name given at birth. Binary participants who changed their names (legally or socially) to more accurately reflect their sense of self sometimes referred to their name assigned at birth as their “dead name”, whereas non-binary participants more frequently described wanting to reclaim their given names and to change society's perception rather than the name itself: “I kind of just wanted to de-gender my birth name and just, like, take it back or something”.

Like reclaiming their names, participants described a critical process of reclaiming their identities and bodies (e.g., “2014 was this shift toward gender-fluid…I reclaimed my body” and “I think it was the process of like internet culture and sort of reclaiming myself and identity away from society”). Clothing represented one crucial point of divergence between binary and non-binary narratives regarding gender expression, in that non-binary narratives demonstrated earnest attention to the role of clothing in gender presentation and perception by others, whereas binary self-presentation manifested more implicitly in accordance with binary norms.

After settling on an authentic gender identity/expression, many participants described perpetually navigating identity disclosure in terms of five factors: 1) comfort in relationships (i.e., sense of safety and support), 2) inconsequentiality of contacts (i.e., friends compared to coworkers compared to strangers), 3) interview/occupational (i.e., personal versus professional interactions), 4) age (i.e., generational divides), and 5) path of least resistance (i.e., endorsing the identity which will cause the least friction in a given interaction). When navigating such disclosures, two overarching concerns presented throughout all five sub-themes: safety concerns and passing or blending concerns. Of note, some TGNC individuals may experience the term “passing” as stigmatized and as communicating messages regarding an inauthentic identity or presentation. The term “blending” has emerged as an alternative to “passing” for this reason, as to blend communicates the ongoing and societally-enmeshed nature of self-presentation and gender identity. To maximize safety, participants described explicitly modifying their self-presentation within a given context: “If I wear eye makeup I wear shades so I don't get called out on the bus”. Passing/blending concerns often intersected with safety concerns, as participants remarked on reflections such as “for whom do I have to pass?” and non-binary challenges related to passing/blending (e.g., “I don't think I have anything to pass as except for wanting to not be seen as cisgender”.

Lastly, whereas extant literature has highlighted the role of activism in the ‘penultimate’ stages of gender identity development (e.g., Devor, 2004), this theme did not manifest within participant narratives. Instead, participants trended away from the educator/activist role: “I feel like instead of just sitting there educating the person…why don't they go educate themselves on it”. Other participants briefly described numerous instances wherein they were asked to be the spokesperson for gender diversity, in which cases many reported referring the inquirer to the internet and/or to books to answer their question(s) rather than engaging in the demanding emotional labor required by the role of educator and/or activist.

Discussion

Given the fluid nature of gender constructs and of societal perceptions, it is crucial that we as researchers continually evolve our methods and analyses. Our study sought to contribute to this movement and highlight developing nuances to TGNC identities and experiences through explicit inclusion of participants based on gender identity (thus not conflated with sexual orientation), explicit inclusion of non-binary and agender identifications, and through the utilization of a data-driven approach allowing nuances in participant narratives to be captured which would likely be missed by a more theory-driven approach.

All three hypotheses set forth by the researchers were supported by the results, demonstrating greater heterogeneity in identity developmental processes than previously theorized (hypothesis one), the presence of a combination of risk and resiliency factors (hypothesis two), and revealing several non-linear critical processes in gender identity formation (hypothesis three). As such, our results diverge from extant literature at several points. For example, our participants placed much less emphasis upon physical transition and upon social activism than indicated in existing TGNC identity developmental models. We hypothesize that this divergence results from two methodological elements: 1) we had the modern benefit of increased societal awareness and visibility for TGNC populations, and within this widened social lens participants with divergent narratives may have felt more comfortable sharing their experiences and/or 2) we explicitly conceptualized gender inclusively, and all recruitment materials utilized the term “transgender or gender non-conforming”—the latter half of this umbrella term in particular likely drew in participants who might not have participated had the study been advertised for “transgender” volunteers (as are many). Physical transition may not be a crucial stepping stone in one's gender identity development for many non-binary-identified people in comparison to binary-identified people. Notably, the fact that participants did not unanimously shirk activism indicates that the work in educating the public and reducing the impact of systemic biases against TGNC populations is far from complete.

While binary and non-binary narratives addressed many similar themes (e.g., facing oppressive societal norms, concerns regarding safety in self presentation, the challenge of being viewed authentically by others, social support as a source of resiliency), several points of divergence emerged with clinical, policy, and research implications. First, non-binary participants described passing /blending as un-attainable and thus endorsed a sense of learned helplessness wherein they de-emphasized the importance of passing/blending in their lives, instead endorsing preferences for one pole or the other of the gender binary. Second, non-binary participants began identity exploration (in terms of identity labels and self-presentation) and disclosure (i.e., “coming out”) later than binary participants. Many participants attributed their delayed exploration to a lack of information and resources (i.e., societal awareness, role models, supportive spaces, educational materials) regarding non-binary gender. Further, while both binary and non-binary participants described an implicit sense of gender identity, non-binary participants highlighted social pressure to conform and discomfort with traditional gender labeling processes, whereas binary participants described more ease of identifying applicable gender norms (e.g., “I had to learn how to ‘woman’”).

Binary and non-binary narratives also diverged regarding risk and resiliency factors. Consistent with extant literature, social support (e.g., Pflum, Testa, Balsam, Goldblum, & Bongar, 2015) and increased availability of TGNC models in popular culture and the media (e.g., Craig, McInroy, McCreedy, & Alaggia, 2015) were sources of resiliency across both groups. However, non-binary participants more heavily cited the importance of a sense of community as both absent and necessary compared to binary participants, likely due to a comparative dearth of community oriented spaces for non-binary people. Additionally, creative expression was cited as more helpful for non-binary participants, who potentially turned to artistic expression as a venue to explore and articulate their authentically gendered (or a-gendered) selves in the absence of societal salience or community spaces.

While binary and non-binary narratives indicated several similar challenges (e.g., oppressive systemic norms, self-stigmatization, concerns regarding passing/blending and safety, lack of information and role models), the phenomenon of fetishization was more profoundly noted within binary narratives, wherein binary participants described being hyper-sexualized (e.g., facing unwanted sexual advances and/or assumptions that they were sex workers), themes which did not emerge within non-binary narratives.

Clinical implications

Mental healthcare providers are uniquely qualified to alleviate disparities in mental health and quality of life among TGNC populations, as well as being ethically obligated to maximize beneficence and minimize maleficence—particularly among marginalized social groups. This can be accomplished by maintaining awareness of our own biases particularly as they may impact therapeutic alliances with our clients, and to remain insightful to our own limitations—working only within the bounds of our established competencies (APA, 2010). Specifically, psychologists might attend to their beliefs and biases related to gender as a construct. Unfortunately, according to the APA's Task Force on Gender Identity and Gender Variance, fewer than 30% of psychologists report familiarity with TGNC populations (Campbell & Arkles, 2017). This statistic, combined with our results and extant literature, indicates that mental health providers often fall short of their obligations. For example, TGNC people frequently experience microaggressions from mental health providers leading them to avoid seeking help (Lambda Legal, 2010; Nadal, Skolnik, & Wong, 2012; Whitman & Han, 2016) or are outright denied equal treatment due to their gender identity or presentation when they do seek help (Grant et al., 2011). While no data is currently available to this end specifically, it is likely that far fewer psychologists would demonstrate familiarity with non-binary TGNC populations, given the relatively recent emergence of non-binary narratives in the public social sphere.

It is likely that pervasive stereotyping and lack of understanding of TGNC identities, lives, and experiences contribute to these negative mental healthcare experiences, even among the best-intentioned clinicians. For example, many TGNC clients report being misgendered (i.e., referred to as a gender identity with which they do not identify; Ansara & Hegarty, 2014) by clinicians. Misgendering can not only cause direct harm to the mental health of TGNC clients but can also rupture the therapeutic alliance, decreasing treatment efficacy (Johnson, 2014).

Such harmful effects could be mitigated by increased training and education regarding affirmative care for TGNC people which highlights tenets of identity-affirming therapeutic services (Edwards-Leeper, Leibowitz, & Sangganjanavanich, 2016; Perry & Green, 2014) and challenges prevailing stereotypes and myths regarding TGNC identities and experiences (Erickson-Schroth & Jacobs, 2017). Specifically, myths regarding gender as a binary construct and those which draw erroneous correlations between assumptions of dichotomous genetic sex and gender identity. Although the American Psychological Association (APA) provides guidelines for clinical work with TGNC clients, these fundamentally lack “teeth” as mere recommendations without an overseeing entity to uniformly train or uphold them (APA, 2015).

Perpetuating these norms is a great disparity of information and knowledge among therapists regarding TGNC identities and lives (Whitman & Han, 2016). Specifically, curricula in mental health training programs frequently change both within and across programs, thus providing inconsistent information across different disciplines and licensure periods. Further, even if training was standardized, inconsistencies regarding continuing education requirements (both in quantity and quality) prevents efficacy of a career-long competency developmental pipeline for both nascent and seasoned clinicians. At best, courses often include segments on “LGBTQ issues”, within which the “T” is either silent or approached binarily, further perpetuating the marginalization and invisibility of non-binary individuals and their identities.

Research implications

One lesson is quite clear from our findings: there is a significant lack of understanding regarding TGNC people among professionals and lay society alike. Thus, we encourage researchers to expand understanding of TGNC identities and experiences with ardent resolve and renewed fervor, incorporating nuances and changing societal tides. Many limitations within extant literature likely result from readily solvable methodological over-simplifications such as failure to adequately recruit and/or measure the full spectrum of gender variance (e.g., including binaristic conceptualizations of gender or lacking explicit recruitment strategies to promote the inclusion of TGNC volunteers). So long as research methodologies and the minds which construct them remain limited to binaristic, linear, and unidimensional approaches to human identity and gender as a construct, our understanding of the vast spectrum of gender identities and experiences will remain skewed, to the furthered detriment of TGNC populations.

Limitations and future directions

As with any study, the present investigation is not without its limitations. First, interviews took place in New York City, USA, which is a highly urban and liberal space. Though some participants reported growing up in different regions with varying degrees of TGNC visibility, the generalizability of the present results is limited due to its geographic characteristics. For instance, it could be possible that those who live in a much more politically conservative environment may have fewer protective or more risk factors, and/or that these factors may manifest differently in rural compared to urban settings. Future research should examine the relationships of socio-political environment and population density to gender identity.

Relatedly, because social climates change, it is possible that findings from this study may not be generalizable to TGNC people in the future. We are at a nascent stage in which TGNC related issues are gaining more exposure in our society. Many participants' narratives included the role of time in shaping their gender identity development. Future generations' gender identity development may differ vastly from participants in our current study just as the present results differ in many ways from research from decades prior. Thus, no conceptualization of TGNC gender identities (or any identities, for that matter) should be understood as final. Rather, as time progresses so should our investigations, preferably in step with socio-political shifts.

Last, but not least, because the umbrella term of “TGNC” encompasses such a vast spectrum of gender identities, it is possible that this study might have missed subtle differences between various gender identities (e.g., agender, genderqueer, pangender, trans feminine, trans masculine, etc.) Additional research should seek to further explore the possibility of such subtle distinctions through increased sample sizes and diversified methodologies.

Overall, the present investigation highlights the following areas for future research and improvement in practical and applied domains: clinical competencies and implicit biases, training and education (for clinicians, criminal justice personnel, educators, and arguably for any layperson who interacts with other humans on a regular basis). Within the research domain, we must continue to strive toward more inclusive conceptualizations of gender and identity both as distinct and as intersecting constructs. Additionally, we must be intentional in our acknowledgement of intersectionality in the experiences of participants including gender identity, sex assigned at birth, race/ethnicity, spirituality, and socio-economic status. Lastly, a dearth of literature exists regarding specific sub-groups within TGNC populations, thus limiting our understanding of the potentially unique experiences and needs of these populations (e.g., elderly, veterans, and those residing within rural and politically conservative environments).

The present investigation sought to achieve an improved and nuanced understanding of the experiences and identities of adults who identify as TGNC, in pursuit of the overall purpose of reducing disparities in mental health and quality of life faced by TGNC individuals. Our results suggest that archaic assumptions about gender and gender identity (e.g., binarism, linearity) do not adequately represent TGNC experiences. Rather, our findings highlight the importance of heterogeneity and individualism, multi-dimensionality, and intersectionality in participant narratives. As researchers and clinicians, we have clearly fallen short of our duties to TGNC individuals with whom we work, and the perpetuation of these limitations facilitates the systemic oppression of TGNC populations overall. Fortunately, socio-political tides can change, and increasing visibility of TGNC identities, experiences, perspectives, and needs in the mainstream media and among diversity researchers and clinicians indicates that now is the ideal time to begin to push back against archaic narratives founded in stereotypes. It is our hope that future researchers will expand upon our findings and that clinicians will implement those data to the benefit of TGNC populations, so that one day TGNC individuals will not face suicide attempts at nine times the national rate or be two-to-three times (for white and people of color respectively) as likely to live in poverty as cisgender groups (James et al., 2016).

Funding Statement

This work was supported by the Forensic Psychology Research Institute (FPRI) Grant, (N/A). Ohio Psychological Association Michael Sullivan Diversity Scholarship (N/A). This research was supported in part by grants from the Michael Sullivan Diversity Scholarship of the Ohio Psychological Association and the Forensic Psychology Research Institute (FPRI) Grant of John Jay College.

Declaration of conflict of interest

The authors have no conflicts of interest to declare.