Perspectives from Transgender and Gender Diverse People on How to Ask About Gender

Abstract

Purpose: When inquiring about the gender of research participants, most studies use self-generated questions about gender or questions prepared by researchers that have been evaluated for comprehension by transgender and gender diverse (TGD) and cisgender individuals. However, many gaps still exist in this area, including identifying how TGD people would like to see their gender represented in questions about gender identity. To address this issue, we explored the perspectives of TGD people regarding the construction of questions about gender.

Methods: In this online study of 695 TGD people (M_age = 25.52), participants provided written suggestions for how to ask about gender and these responses were analyzed thematically. Data were collected between fall 2015 and summer 2017.

Results: Three broad categories of responses emerged: (1) specific identities to include in response options; (2) specific questions to ask about gender; and (3) qualifiers/nuanced considerations.

Conclusion: Participants provided a variety of suggestions for how to ask about gender and future research is needed to explore the implementation of these suggestions. Recommendations are provided for options that researchers can explore for how to ask about gender. These findings highlight the ways that TGD people would like their gender to be asked about, which is necessary information to ensure that questions about gender reflect TGD people's identities accurately.

Introduction

Research has increasingly focused on the inclusive measurement of transgender and gender diverse (TGD) people's gender identities. Measuring gender has important implications for accurate representation of TGD people, access to resources, and quality of data collection.^1–5 Most research has presented TGD people with questions about gender and asked for their feedback on existing items.^6–12 From this, a two-step method has been frequently suggested,^{2,4,6,11,13–18} entailing asking about both the sex that someone was assigned at birth and their current gender. The wording of these questions and response options has varied across sources. Overall, the two-step method provides a more comprehensive way of asking about gender compared with single question formats that often conflate sex and gender,^15,18 is easily understood by both TGD and cisgender individuals, and produces more reliable data on gender than other methods.^2,6,7,18,19

There is some consensus that a two-step method for asking about gender is preferable to other methods, yet many studies do not include these questions^10,17,20 and some collect information about gender in problematic ways, such as by a person's voice²¹ or through other practices, such as relying on a person's sex assigned at birth. Other specific recommendations for improved measurement of gender include: providing write-in options,^10,14 recognizing that not all TGD people identify with the label of transgender,¹³ enabling multiple response options to be chosen instead of forced choice formats,²² including options for genderqueer and non-binary people,^15,16 and recognizing that regrouping participants or combining participants across response options can be invalidating.^10,19 In addition, there can be legitimate concerns about safety for TGD people who share their identity and individuals should have the option to skip gender questions.^9,11

Some authors have recommended that questions and response options be revised as social shifts in language and understandings of gender continue to happen.²⁰ One change that relates to the frequently suggested two-step method is the increased recognition of individuals who are intersex, including on birth certificates.²³ Many of the existing suggestions were made when states did not issue birth certificates that recognized intersex individuals and as such, their recommendations for asking about sex assigned at birth do not include options for people who are intersex. In addition, there have been other social shifts in language to describe gender and greater recognition of a variety of gender labels that should be considered in response options, such as genderfluid.²⁴ Finally, some areas now allow non-binary options on birth certificates as well and this may influence response options in research questions (e.g., New York City).²⁵

Most of the existing research on the measurement of gender has started with preformed questions and asked TGD people to provide their perspectives on these items, rather than starting by asking TGD people what questions they would like to be asked in the first place. As such, there has been minimal exploration of how TGD people would like to see their gender represented in research studies—an important point to consider to improve accuracy and representation. To add to this literature, we sought to understand how a TGD sample desired their gender to be asked about and represented in research studies.

Methods

Participants and procedures

This online study, conducted between fall 2015 and summer 2017 entailed two sections: (1) a daily diary study for participants who met the following inclusion criteria: identified as trans men, trans women, genderqueer, or non-binary, ages 16–40, had sex in the past 30 days, and either binge drank or used substances in the past 30 days; and (2) a one-time survey for any TGD individuals who were at least 16 years old but did not qualify for the daily diary study (these participants were only required to be at least age 16 or older and could have any TGD identity). The data for the current analyses were drawn from this latter one-time survey. All participants were from the United States. The full procedures for this study are described elsewhere, including information about ensuring the quality of the online data collection.²⁶ The study was approved by the primary investigator's institutions (Northwestern University and the University of South Dakota) with a waiver of parental permission for participants ages 16–17. Participants provided their consent/assent through the online survey. There were 695 participants in the one-time survey.

Measures and open-ended item

Demographics

Participants reported their age, gender, sex assigned at birth, differences of sex development, race/ethnicity, sexual orientation, income, and education (response options are presented in Table 1).

Table 1.

Sample Demographics

Characteristic	n (%)
Race/Ethnicity
White	526 (75.7)
Black/African American	13 (1.9)
American Indian or Alaska Native	1 (0.1)
Native Hawaiian or other Pacific Islander	0
Asian	21 (3)
Latino/a	25 (3.6)
Option not listed	8 (1.2)
Multiracial/Multiethnic	98 (14.1)
Gender Identity
Trans man/Transman	180 (25.9)
Trans woman/Transwoman	105 (15.1)
Woman	10 (1.4)
Man	31 (4.5)
Genderqueer	87 (12.5)
Non-binary	132 (19)
Agender	66 (9.5)
Androgyne	7 (1)
Bigender	22 (3.2)
Option not listed	55 (7.9)
Sex assigned at birth
Female	534 (76.8)
Male	156 (22.4)
Difference of sex development
Unsure	124 (17.8)
Yes	20 (2.9)
No	551 (79.3)
Sexual orientation
Queer	174 (25)
Pansexual	130 (18.7)
Bisexual	106 (15.3)
Gay	62 (8.9)
Asexual	100 (14.4)
Heterosexual/Straight	38 (5.5)
Lesbian	35 (5)
Option not listed	50 (7.2)
Education
Less than high school diploma	91 (13.1)
High school graduate or equivalent	88 (12.7)
Some college education, but have not graduated	228 (32.8)
Associate's degree or technical school degree	52 (7.5)
Bachelor's degree	160 (23)
Master's degree	63 (9.1)
Doctorate or professional degree	13 (1.9)
Income
< $10,000	357 (51.4)
$10–19,999	112 (16.1)
$20–29,999	59 (8.5)
$30–39,999	49 (7.1)
$40–49,999	39 (5.6)
$50–69,999	36 (5.2)
$70–99,999	29 (4.2)
≥ $100,000	11 (1.6)

There were five participants with missing data on the question asking about sex assigned at birth, and three participants with missing data about their race/ethnicity and income. There were no cisgender individuals in the sample, thus the classification of “man” and “woman” refers to trans men and trans women respectively.

Open-ended item

Participants provided suggestions for how gender should be asked about through an open-ended question: “In studies that are for anyone, regardless of gender identity, how would you like to see your gender represented in a question? Keep in mind that without some way of indicating that someone does not identify with their sex assigned at birth, the experiences of trans and gender nonconforming individuals may be overlooked.”

Analyses

Frequencies for demographics and demographic differences in response rates were conducted in SPSS (IBM Corp., Armonk, NY). Qualitative coding was conducted in Dedoose (Los Angeles, CA: SocioCultural Research Consultants). To begin, the first and second authors reviewed all data and developed notes about prominent themes. The second author then developed an initial code list that defined each theme. The codes each represented unique suggestions for how participants believed gender should be asked about. The first author reviewed the list and met with the second author to refine the list and definitions for clarity. The second author then applied the codes and then conducted a review of all the data within each code. After this, the first author reviewed all coding, correcting small changes to align coding with the codebook. Afterward, the third author conducted reliability coding with a random subset of 20% of the data, yielding a Kappa of 0.802 indicating substantial agreement between coders.²⁷

Results

The full sample of 695 participants ranged in age from 16 to 73 years (mean [M] = 25.52; standard deviation [SD] = 9.68) and were primarily White (75.7%). Table 1 includes a full description of the sample. There were 314 participants who responded to the open-ended item and reported suggestions for how to ask about gender. Participants who did not provide a response to the open-ended item were older (M = 26.78, SD = 11.08) than participants who provided recommendations (M = 24.26, SD = 7.81), t (627.67) = 3.48. Participants who identified as either transgender men (participants who indicated a gender of man or trans man/transman) or transgender women (participants who indicated a gender of woman or trans woman/transwoman) were less likely to provide recommendations (44.2%) than all other gender groups combined (54.5%); χ² (1) = 7.35, p < 0.01. There were no significant differences in whether participants responded to the open-ended question based on income [participants earning below $20,000 per year compared with those earning more; χ² (1) = 0.001, p = 0.98] and race/ethnicity [Participants of Color compared with White participants; χ² (1) = 0.95, p = 0.33]. Participants' suggestions fell into three categories: (1) specific identities participants wished were included in gender questions to either capture how they or other TGD people identified; (2) specific questions to ask about gender; (3) qualifiers or nuanced considerations for gender questions. Descriptions of each category and examples are provided. The percentages reported for each category align to the percentage of the subset of participants who provided suggestions.

A total of 226 participants (71.97%) provided suggestions for identities that should be included in gender questions (see Table 2 for a list of responses). Of note, the raw counts of these suggestions must be interpreted in light of the identities of participants in our sample as these likely influenced suggestions. Some labels suggested are infrequently included in gender questions, such as agender, bigender, polygender, and neutrois. Participants also offered nuanced ways of recognizing a TGD experience, such as “man of transgender experience.”

Table 2.

Gender Identity Suggestions

Agender (29)

Androgyne (2)

Bigender (3)

Cassgender (1)

Cis man/Cisgender man (4)

Cis woman/Cisgender woman (3)

Cisgender (1)

Demiboy (2)

Demigirl (1)

Femme nonbinary (1)

Fluid (1)

FtM (5)

Gender nonconforming (10)

Gender neutral (1)

Genderfluid (23)

Genderflux (2)

Genderless (1)

Genderqueer (39)

Man (8)

Man assigned female at birth (1)

Man of transgender experience (3)

Man who has transitioned (1)

Masculine nonbinary (1)

MtF (2)

Multigender (2)

Neither (1)

Neutrois (3)

No gender (1)

Non-binary (94)

Polygender (2)

Trans (8)

Trans feminine (6)

Trans boy (1)

Trans girl (1)

Trans guy (1)

Trans man/Transman /Transgender man (39)

Trans masculine (15)

Trans woman/Transwoman/Transgender woman (20)

Trans* (5)

Transgender (14)

Transsexual Man (1)

Two-spirit (3)

Without-gender (1)

Woman (8)

Values in parentheses represent the number of participants who mentioned this gender identity; participants often made suggestions for multiple identity labels.

In terms of specific questions to ask about gender (n = 44; 14.01%), there were two types of suggestions: (1) separate questions for sex assigned at birth and gender (n = 16; 5.10%); and (2) separate questions for gender and whether participants identified as TGD (n = 28; 8.92%). The first suggestion allows participants to indicate their current gender identity in inclusive ways while also allowing researchers to crossreference this with their sex assigned at birth to determine whether participants who do not report a specific trans identity should be considered TGD (e.g., a participant whose gender identity is woman and who was male assigned at birth). This participant's response exemplifies this suggestion:

Make two separate questions, one just about gender identity, and a separate question about what gender a person was assigned at birth. If you have the question “what is your gender” and two of the options are cis man and trans man, [you're] implying [that] these two groups are different genders, which is transphobic, as they are both men. Basically please don't ask “what is your gender” when you mean “what is you[r] gender and sex.”

Having separate questions for gender and sex assigned at birth ensures that sex and gender are not conflated and that TGD participants are acknowledged appropriately. When researchers do not provide these types of options TGD people may be erased, as this participant noted: “If a study asks me if my gender is ‘male, female, or transgender,’ then I will check the ‘male’ option, since transgender isn't my gender.”

The second option, having a question about gender and about whether participants identify as TGD, allows participants to report their identity without it being compared with their assigned sex. Some participants noted that being asked about their sex assigned at birth was troubling (e.g., “It should ask [if] we are trans, rather than our birth assignment, because having to identify in any way with our sex assigned at birth can be very painful.”). Asking in this way still allows researchers to identify TGD and cisgender participants. Participants suggested a few different ways that the question to indicate being TGD could be worded: (1) using the language of transgender or cisgender experience (“A follow-up question, should someone choose man or woman, is to state, ‘I am a man/woman of…’ transgender experience, cisgender experience, or a preference not to say.”); (2) a yes/no question about identifying as transgender (“I think ‘Are you transgender?’ could be a good follow-up question”); (3) asking if participants are cisgender; (4) asking participants to self-select into being cisgender or transgender (“Fill in the blanks would be lovely, with the possibility for marking trans, cis, or prefer not to answer.”).

Other suggestions related to qualifiers or nuanced considerations. Some participants (n = 50; 15.92%) emphasized the importance of being able to check multiple answers (e.g., “The terms are not mutually exclusive and being asked to pick a single term does not necessarily give the best description of a person's gender identity and presentation; particularly terms like non-binary and genderqueer, which encompass a wide spectrum of identities. I personally identify both with trans masculinity and a non-binary identity.”). Having participants only choose one answer for their gender can result in less accuracy in describing the lived experiences of participants or can be marginalizing to those who identify as genderfluid or other identities that may shift over time (“I identify differently on different days but don't like the term genderfluid for myself, so I prefer to be able to select multiple options”).

Other participants wanted gender to be asked as a fill in the blank question (“In a question about gender identity, I believe the best way to ask would be to just provide a fill in bar so everyone can write individually their own identity without feeling erased.”) or to provide a list of gender options and the ability to write in a response if the others do not fit for participants (n = 56; 17.83%). Some participants noted that just clicking an “other” category felt marginalizing and did not provide them with an opportunity to describe their gender. Alternatives could be to have a “Not Listed” option with a space for participants to write in how they identify if they choose this option, which some participants stated can feel less stigmatizing than the “other” option.

There also are nuances that should be considered in questions about gender (n = 16; 5.10%). Researchers may need to define terms: “And, of course, since many cis folks and some trans folks don't know this language, the terms would have to be defined.” In addition, participants recommended that researchers use “male” and “female” when asking about sex assigned at birth and disentangling this construct from gender, as well as specifying “cis” or “cisgender” when a response option is going to be interpreted as representing people who are cisgender (e.g., when researchers intend “man” to mean cisgender men, they should explicitly state “cisgender man”). Researchers also might consider the order in which response options are listed and not placing cisgender options at the start of the list (“I like having cis-man and cis-woman listed at the end.”).

Some participants (n = 32; 10.19%) indicated that they would like the choice to not indicate that they were TGD and felt that specifying being TGD separated them from the gender with which they identified (“I prefer to just see man for me. I hate the implication that ‘transgender’ is some third gender which others me and bars me from being seen as fully male.”). Similarly, some participants reported that they would like to be able to indicate that they preferred not to answer (n = 9; 2.87%; “I usually select ‘decline [to] answer’ if that is an option.”). Lastly, some participants indicated that their responses to questions about gender depended on the setting and the type of survey (n = 17; 5.41%). For example, one participant responded that:

In studies where my being trans is significant or relevant, like this one, I would prefer to be listed as something like “trans woman” like above, but if that weren't relevant to the study I would probably rather be listed just as “woman” or “female” or [something] like that.

Discussion

Participants reported a range of identities that they would like to see represented in research studies, such as the uncommonly included identities of non-binary, agender, and genderfluid. Including terms that are important to TGD people may result in more accurate reflections of TGD people's identities and experiences and better descriptions of participants. Even so, there is still the issue of cisgender people understanding these terms and concerns about possibly inaccurately classifying individuals as TGD.¹⁶ This is an important consideration because inaccurate classification of cisgender people would result in flawed research and misinformation about TGD people. Future research should examine whether definitional understandings of these gender terms are necessary or if cisgender people are able to correctly classify themselves even if they do not know the specific definitions of these terms. It may be that cisgender people are able to identify that a term does not apply to them even if they cannot provide a specific definition. Otherwise, prioritizing cisgender people's experiences and often limited understandings of gender identities may result in the continued marginalization of TGD people in questions about gender.

Consistent with other recommendations, participants also suggested a two-step method for asking about gender. Typically, this has been presented as inquiring about sex assigned at birth and gender separately,^2,6,14,15 which some participants also suggested. Others indicated that there should be a question about gender followed by a specific question about whether participants were TGD. Many of the additional suggestions reflected nuances that can be considered in future testing of questions about gender, such as disentangling sex and gender, phrasing suggestions, and the ordering of response options.

Other suggestions included allowing multiple responses rather than a forced choice format, providing a fill in the blank, and including a “not listed” option with a text entry field. These recommendations may complicate researchers' use of the data because they may then be faced with uncertainty about how to create subgroups, how to describe their sample, or how to code written responses. Although these suggestions create complexity, they should still be considered. Some recommendations can be more easily implemented than others. For instance, providing a “not listed” option enables participants to write in their gender identity and researchers can then categorize participants as being TGD or into specific gender groups based on those responses. In comparison, check-all formats may be especially challenging to navigate as there can be a variety of unique combinations of identities. To summarize, we have provided a list of potential questions and response options in Table 3 that incorporates the recommendations of our participants along with the existing literature.^2–4,6,7,22 Although not exhaustive, this may provide some avenues for future research to explore.

Table 3.

Recommendations for Gender Questions

Section of gender-related questions	Recommendations
1. Instructions or disclaimers:	• Researchers should state why they are asking about gender in their specific study.
	• Provide definitions that may be needed for interpretation of the question/response options • Provide any disclaimers about choices in wording (e.g., if the survey is just for TGD individuals and there is a response option of “man” researchers can explain that this survey is only for TGD people so they did not include the prefix of cis- or cisgender) • Indicate to participants whether a check-all format or a forced choice format is used in the items.
2. Question about gender	Option 1: “Which of the following labels best describes your current gender identity?” Possible response options:  • Exhaustive list of identities, including cisgender and transgender specific prefixes and labels (see Tables 1 and 2 for some options that could be included), as well as the option of “Not listed” (with a write-in option to specify)  • Brief list of identities for studies that include cisgender and TGD individuals: Transgender Woman, Transgender Man, Cisgender Woman, Cisgender Man, Genderqueer, Non-binary, Agender, Not listed (with a write-in option to specify)  • Brief list of identities for studies that only include TGD individuals: Transgender Woman, Transgender Man, Woman, Man, Genderqueer, Non-binary, Agender, Not listed (with a write-in option to specify)  • Always include the option “Prefer not to answer”  • Future research should examine response options such as “woman of transgender experience” and “man of transgender experience” and similar types of response options Option 1 follow-up question:  • If researchers provided an extensive list of options and a check-all format, this could be followed by a second question that asks TGD participants to self-select into a fewer number of categories to assist with subcategory designation. For instance, in addition to a check-all question with extensive options, researchers could ask: “Recognizing that these are limited options, which of the following categories best describes your current gender identity (please choose one): Trans Woman, Trans Man, Non-binary, I do not feel that my identity fits into one of these categories” Option 2: “What is your gender identity?” with an open-ended response format. Follow-up prompt: “Above you provided your gender identity. To assist us with properly classifying participants, please choose the gender identity label that you feel most closely fits for you.” Response options: I am transgender; I am not transgender; Prefer not to answer Option 2 follow-up questions:  • For participants who indicate that they are not transgender: “Which of the following best describes your gender?” with the following response options: Woman, Man, Prefer not to answer  • For participants who indicate they are transgender: “Which of the following best describes your gender?” with the following response options: Trans Woman, Trans Man, Woman, Man, Non-binary, Genderqueer, Agender, Not listed (with write-in option), Prefer not to answer  • These response options could be shortened to other possible combinations as outlined above
3. Question about either sex assigned at birth or identification as TGD	Option 1: “What sex were you assigned at birth?” Response options: Male Assigned at Birth; Female Assigned at Birth; Intersex Option 2: “I am”: Response options: Cisgender, Transgender, Prefer not to answer Option 3: “Do you identify as transgender?” Response options: Yes, No, Unsure, Prefer not to answer Additional question: “Do you identify as intersex or as having a difference of sex development?” Response options: Yes, No, Unsure, Prefer not to answer

TGD, transgender and gender diverse.

Limitations

Many participants did not respond to the open-ended question and we cannot be sure if this was due to a misunderstanding or other reasons, such as feeling satisfied with the current study's gender question (the open-ended question was directly after our gender question and was optional). Other research indicates that missingness on open-ended questions is not unusual, particularly for online studies.^28–30 In addition, some suggestions conflicted, such as the options of asking about sex assigned at birth and current gender identity, or asking about gender identity only and having a follow-up question about whether the person identifies as transgender, cisgender, or prefers not to say. Future research is needed to test various formats and to identify the method that would result in the most accurate information while also being the most affirming. In addition, our sample was recruited online and findings may differ if conducted in-person, which would also allow follow-up questions to clarify responses. Future research should consider the social shifts that have occurred,²⁰ such as the recognition of intersex and non-binary identities on birth certificates.²⁵ Our sample also was limited in that ∼76% of the sample was White and had a fairly young age. Given that this is common of online studies, future research may increase their racial and ethnic diversity and may have a wider age range by utilizing a variety of recruitment methods and in-person forms of participation.

Conclusion

Improving items about gender is an important step to increasing accurate representation of TGD people in research. Although more research is needed to continue evaluating these suggestions, participants provided some options that may benefit TGD people. With improved measurement of gender, future research will be strengthened and TGD people's experiences will be better reflected.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

The project described herein was supported by a grant from the National Institute on Drug Abuse (1F32DA038557).