Narratives of Gender, Sexuality, and Community in Three Generations of Genderqueer Sexual Minorities

Abstract

Genderqueer identities—those that challenge a strict binary between woman and man—are increasingly visible within mainstream culture and psychological research. However, little is known about generational differences in the lived experience of genderqueer people. Inductive thematic analysis of interviews with 30 genderqueer sexual minorities of 3 distinct generations living the United States revealed 3 major themes: (a) unintelligibility: genderqueer people face challenges in identifying, naming, and expressing their gender due to the constraints of everyday language and material culture; (b) managing stigma through challenging oppression: genderqueer people manage stigma by naming and challenging the gender binary, often in relation to other forms of oppression; and (c) connection beyond mainstream LGBTQ communities: genderqueer people often find connection outside of mainstream LGBTQ spaces, such as through ethnicity-based or sexual subcommunities (e.g., kink/BDSM, polyamorous). Within these themes, key generational patterns included (a) greater challenges among the middle and older generations in naming and expressing a genderqueer identity, especially in relation to their sexual identity; (b) intensified critique of mainstream LGBTQ politics among the younger generation; and (c) greater challenges in finding and maintaining community among the middle and older generations. Across generations, participants emphasized the need to create more inclusive environments by changing language and social structures to deemphasize the gender binary.

Genderqueer identities are rapidly gaining social and legal recognition, due to social and political advances by lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities and scientific advances in understandings of sex and gender beyond binaries (Barker & Iantaffi, 2019; Hyde, Bigler, Joel, Tate, & van Anders, 2019; Levitt, 2019). Many people are now openly identifying outside of binary gender categories, using terms like agender, androgynous, demi boy/girl, genderfluid, genderqueer, nonbinary, or pangender (Hegarty, Ansara, & Barker, 2018; Steinmetz, 2017). Though language continues to evolve, based on the most common terminology used by members of our sample and within existing research (Thorne, Yip, Bouman, Marshall, & Arcelus, 2019), in this article we use genderqueer as an umbrella term for all gender identities that are not fully captured by the terms woman and man.

Although genderqueer identities are often associated with contemporary youth (Risman, 2018), earlier generations of gender and sexual minorities have also challenged the gender binary and hold genderqueer identities; however, little research investigates how experiences for genderqueer people may differ across generations. Accordingly, it is crucial that psychologists proactively engage with these communities to conduct research that illuminates their experiences and highlights their unique needs. In the remainder of this introduction, we review the limited research on the social and psychological experiences of genderqueer people, divided into three areas: (a) the challenges of identity development as a genderqueer person; (b) the relationship among gender identity, sexual orientation, and other social identities; and (c) experiences of community.

Identity Development and Challenges

Despite the increased visibility of transgender people, genderqueer identities remain largely unrecognized and underresearched. This omission is explained by dickey, Hendricks, and Bockting (2016), who note the influence of medicine on the dominant narrative of transgender identities and experiences that emerged in the middle of the 20th century. These narratives were shaped by the requirement that transgender people adopt a heterosexual identity and traditional gender role following medical transition, which excluded those with alternative experiences from both medical treatment and cultural representations of transgender people. Though medical and legal requirements have changed, this oversimplification still lingers in cultural understandings of gender diversity.

Within this context, many genderqueer people have described challenges in naming and describing their experiences, both internally and externally. Primary challenges include difficulty locating one’s experiences within existing gendered language (Bradford et al., 2019; Saltzburg & Davis, 2010), recognizing genderqueer as a viable identity (Fiani & Han, 2019), and questioning whether to identify under the transgender umbrella (Bradford et al., 2019; Saltzburg & Davis, 2010). These include practical challenges with language such as pronouns, as many genderqueer people use pronouns other than she/her or he/him (Wentling, 2015). In addition, the challenge of whether to identify under the transgender umbrella frequently centers on questions of social and medical transition, as many genderqueer people desire only partial transition procedures (e.g., change of name and/or pronouns, style of dress, hormonal treatment or surgeries) or none at all (Factor & Rothblum, 2008; Risman, 2018). These challenges lead many to feel different not only from cisgender people, but also from most transgender people, thus creating challenges in navigating both cisgender and transgender norms about gender identity (Bradford et al., 2019; Bradford & Syed, 2019).

Despite these challenges, most genderqueer people report feeling (and sometimes expressing) a different gender identity from an early age, even if the recognition of genderqueer as a viable identity and decisions regarding genderqueer expression came later in life (Factor & Rothblum, 2008; Fiani & Han, 2019). Adolescents and young adults who identify as genderqueer describe recognizing and engaging with gender as a multifaceted identity, which involves actively challenging the gendered prescriptions of family and culture (Risman, 2018; Saltzburg & Davis, 2010). In fact, many describe actively challenging the gender binary as a key part of their identity as a genderqueer person (McGuire, Beek, Catalpa, & Steensma, 2019).

Taken together, existing research suggests that genderqueer people face challenges in identity development due to binary conceptions of gender, difficulty arriving at appropriate identity labels and self-presentations, and questioning where they belong socially. However, the contexts of genderqueer identity development differ strongly based on age, geographic location, sex assigned at birth, and other social identities. Additional work is needed to understand how these factors may affect the lived experience of genderqueer people.

The Relationship Among Gender Identity, Sexual Orientation, and Other Social Identities

Many gender minorities report difficulties locating themselves within mainstream sexual orientation labels, because the most well-known labels rely on binary understandings of gender (Galupo, Henise, & Mercer, 2016; Mizock & Hopwood, 2016). For someone whose gender identity falls outside of the woman/man binary, labels such as straight, gay, or lesbian may feel inappropriate, because they imply one’s own gender in addition to that of one’s desired partners (though, interestingly, this problem does not occur with labels such as bisexual, pansexual, or queer). However, categories of gender and sexuality that rely on binary gender are rapidly being challenged, especially in digital spaces, through the creation of new taxonomies that allow for fluidity and nuance in describing identity (Cover, 2019). Though genderqueer people of all ages are engaging with these emerging taxonomies, the impact of adopting a new identity label (especially one that is uncommon) may differ across the life span, particularly in terms of the interplay of gender and sexual identities and how this relates to community belonging for sexual minorities.

Relatedly, a significant challenge facing gender minorities is the conflation of gender identity and sexual orientation in both popular culture and existing research (dickey et al., 2016). However, even while describing a clear distinction between gender identity and sexual orientation, many transgender people describe a complex, interdependent relationship between the two (Galupo et al., 2016; Mizock & Hopwood, 2016). This is especially true for those who understand gender roles as socially constructed and experience their gender identity as fluid (Nagoshi, Brzuzy, & Terrell, 2012). One study found that over half of gender minority participants reported a change in sexual attractions at some point in their lives, with those reporting changes being more likely to hold a genderqueer identity, to hold a plurisexual identity (e.g., bisexual, pansexual, queer), and to be transmasculine (Katz-Wise, Reisner, Hughto, & Keo-Meier, 2016). In addition, many report factors other than gender as central to their sexuality, including polyamory, kink/BDSM, and other factors that challenge dominant understandings of sexual orientation as exclusively based on one’s own gender and that of one’s partners, further indicating that current identity labels are inadequate for assessing the sexual identities of many gender minorities (Galupo et al., 2016).

Because psychological research focusing on transgender and, especially, genderqueer identities is relatively nascent, little research exists that examines the intersections of genderqueer identities and other social identities (Budge, Thai, Tebbe, & Howard, 2016). There is some evidence that genderqueer people have higher levels of educational attainment than transgender people as a whole, despite having lower incomes (Budge et al., 2016). In addition, transgender youth of color describe the simultaneous development of their gender and ethnic/racial identities, along with a difficulty finding affirmation of their intersecting identities (Singh, 2013).

Thus, additional research is needed to understand the lived experience of genderqueer individuals across multiple dimensions of social identity. A nuanced, first-person perspective on genderqueer lives is crucial for understanding how binary gender assumptions and practices differentially impact people across different social locations.

Community Connection and Well-Being

Existing psychological research has established the importance of connection with a community of sexual minorities for lesbian, gay, and bisexual people (e.g., Frost & Meyer, 2012; Meyer, 2003). Though a significant body of psychological research has examined the importance of community connection for well-being among transgender people (e.g., Barr, Budge, & Adelson, 2016), many studies have been unable to analyze specific gender minority identities separately. When distinct gender identities are analyzed separately, studies have found different relationships between community connection and mental health symptoms. For instance, Pflum, Testa, Balsam, Goldblum, and Bongar (2015) found a negative relationship between community connection and well-being for transfeminine spectrum participants (including both transgender women and genderqueer people assigned male at birth). When comparing transgender women, transgender men, and genderqueer individuals with cisgender sexual minorities, Warren, Smalley, and Barefoot (2016) also found that transgender women had the poorest psychological outcomes. However, they found that genderqueer individuals did not differ in outcomes compared to cisgender sexual minorities, despite differing on stressors. Combined with research showing that genderqueer individuals have higher rates of eating disorders (Diemer et al., 2018) and suicidal behavior (Grossman, Park, & Russell, 2016), this suggests that further research is needed on the specific social and community factors that contribute to well-being among genderqueer people.

Binary assumptions about gender identity, expression, and gender transition are key barriers to community connection for genderqueer people. Many face challenges within both cisgender and transgender/LGBT communities, where they encounter resistance to genderqueer identity and expression or experience a general lack of fit with these communities (Beemyn & Rankin, 2011). Genderqueer individuals may face accusations of being “not trans enough,” of “going through a phase,” or of needing to “choose a side” if they do not desire extensive medical or social transition procedures (Beemyn & Rankin, 2011; Bradford & Syed, 2019) or if their gender expression challenges common assumptions (e.g., a transfeminine person who sometimes wears masculine clothing; Diamond, Pardo, & Butterworth, 2011).

Diamond et al. (2011) note that these arguments parallel those leveled against bisexual people, showing how challenges to binary categories of both gender and sexuality are unsettling for many people, even those who are already marginalized by the dominant culture. These findings were echoed in recent work by Bradford and Syed (2019), in which genderqueer people navigated not only dominant cisgender narratives of identity but also dominant narratives of binary transgender identity, underscoring the impact of binary assumptions on both genderqueer identity development and ability to connect with others who understand and support them.

The limited research on the meaning and function of community for genderqueer people suggests complexity and unique challenges. Additional research is needed regarding how genderqueer people can develop meaningful community connections amid widespread misunderstandings of their experiences.

The Current Study

Though research focused on genderqueer identities is expanding, little is known about how gender interacts with other social identities and life experiences—particularly generation—to affect the personal and community experiences of genderqueer people. The current study aimed to address gaps in the literature by focusing specifically on the lived experience of distinct birth cohorts of genderqueer people in relation to gender identity, sexuality and other social identities, and community. Examining the narratives of genderqueer people who also identify as sexual minorities allows for a more nuanced understanding of sexuality in this population, along with how gender and sexuality intersect with other social identities such as race, class, and ability in ways that may be challenging to assess in quantitative research.

Following a theoretical framework that emphasizes the significance of historical events in the shaping of life course development (Elder, 1998), particularly for sexual minorities (Hammack & Cohler, 2009), we sought to interrogate points of distinction in the narratives of genderqueer people who experienced early development at times of divergent discourses about gender and sexuality. In addition, we attended to distinctions in the experiences of participants based on additional social identities such as race, ethnicity, class, and ability, in accordance with an intersectional framework (Moradi & Grzanka, 2017; Wilson & Harper, 2013).

Our participants represent three generational cohorts that experienced adolescence and emerging adulthood during distinct historical eras for sexual minorities in the U.S. The identity formation generation, or “Pride” cohort (ages 52–59 at the start of the study in 2015) came of age shortly after the Stonewall uprising in 1969, during the era of early Gay Pride marches and the shift away from the classification of homosexuality as a mental disorder. The institutional advancement generation, or “Visibility” cohort (ages 34–41) came of age during the height of the HIV/AIDS epidemic, but also when effective treatments first became available for HIV/AIDS and LGBT resources and health centers became established across the country. Finally, the cultural inclusion generation, or “Equality” cohort (ages 18–25) came of age during the debates regarding marriage equality and other major movements toward social inclusion for sexual minorities.

Because younger people tend to be more likely to endorse genderqueer identities in both existing research and popular consciousness (e.g., Cover, 2019; Risman, 2018), an analysis of the meanings of these identities across these generations can help illuminate the historical context of the emergence of genderqueer identities, the relationship between age and genderqueer community, and the intersection of gender with sexuality and other social identities. Accordingly, this study focused on three broad questions: (a) How do genderqueer people of distinct birth cohorts make meaning of their lived experience of gender? (b) How do genderqueer people narrate the intersections of gender, sexuality, and other social identities? (c) How do genderqueer people experience community, both with other gender and sexual minorities and more broadly? These questions were examined through a social constructionist lens, with the understanding that social categories such as gender and sexuality are not static, but rather that their boundaries and meaning depend on time, place and perspective (Wilkins, Mollborn, & Bó, 2014).

Method

Participants

Data for this project were drawn from the Generations Study, a mixed-methods study of identity, stress, and health in three age cohorts of sexual minorities (for more information about the larger study design and methodology, see Frost et al., 2019). As noted above, these three generational cohorts were defined based on the experience of significant historical events (e.g., the Stonewall uprising, the discovery of AIDS, and the marriage equality debates) at critical points in development (e.g., puberty, emerging adulthood).

The qualitative component of the Generations Study included interviews with sexual minorities from each generation (N = 191), drawn from several distinct regions in the U.S. Potential participants completed a demographic screener to assess eligibility. Questions regarding gender, race/ethnicity, and sexual orientation included fixed choices along with a write-in option for identities not listed. Gender was assessed through two questions: (a) sex assigned at birth; and (b) current gender identity (male, female, trans male/trans man, trans female/trans woman, genderqueer/gender nonconforming, or different identity/write-in). Those whose responses indicated a binary transgender identity or history (e.g., selection of trans male/trans man or trans female/trans woman for current gender identity; selection of male for sex assigned at birth and female for current gender identity, or vice versa) were not eligible for the Generations Study, which focused on the experiences of cisgender and genderqueer/gender nonconforming sexual minorities (however, see www.transpop.org for a discussion of a parallel study focusing on the experiences of transgender people).

The present analysis focused on a subsample of participants drawn from this collection of interviews. Participants were included in the present analysis if they either identified as genderqueer/gender nonconforming on the demographic screening form (N = 17) or indicated a genderqueer identity during the interview, despite identifying as male (N = 6) or female (N = 8) on the screening form. One participant was excluded due to indicating a genderqueer identity on the screening form but identifying exclusively as male throughout the interview, leaving a final sample of 30 for the present analysis. In addition to their gender identity as indicated on the screening form, some participants named specific labels during the interview. Of those who did, these labels included agender (two), genderfluid (seven), genderqueer (11), nonbinary (two), trans (five), and two-spirit (three).

The final sample for the current study represented all three generational cohorts, though the younger (17) and middle (11) generations were more heavily represented than the older generation (two). A range of sexual identities was represented, with the majority identifying as queer (10), pansexual (seven), or bisexual (four), and the remainder identifying as gay/lesbian (eight) or two-spirit (two). A majority identified as White (13) or bi/multiracial (six), with the remainder identifying as Hispanic/Latino (four), Asian/Pacific Islander (three), American Indian or Alaska Native (three), and Black/African American (two). The six bi/multiracial participants identified as American Indian and Black (two), American Indian and White (two), American Indian and Hispanic (one), and Asian American/Pacific Islander and Hispanic (one).

Consistent with previous research with genderqueer populations, this sample had a higher average level of education than the general population: All held at least a high school diploma, and 43% held a bachelor’s degree or higher, compared with 88% and 32%, respectively, in the general U.S. population (Ryan & Bauman, 2016). In addition, 13 of the 16 participants with less than a bachelor’s degree were enrolled in a postsecondary institution at the time of the interview, suggesting that their final educational attainment may be higher than represented during this study. All names used are pseudonyms.

Procedure

Participants were recruited via targeted, nonprobability venue-based sampling within 80 miles of four metropolitan areas of the U.S.: Austin, TX; New York, NY; San Francisco, CA; and Tucson, AZ. Venues were selected to ensure a diversity of cultural, political, ethnic, and sexual representation, with a cap of 20% established for respondents from each of the following venue types: (a) bars; (b) nonbar establishments (i.e., coffee shops, gyms, book-stores); (c) outdoors (i.e., parks, streets); (d) groups (i.e., community organizations centered around sports, politics, culture, racial, ethnic, or national interests); (e) events (e.g., Pride); (f) online social media; and (g) other online communities. In addition, recruitment from venues in urban areas was capped at 80% for each site.

Semistructured, one-on-one interviews lasting an average of 2.5–3 hr were conducted between April 2015 and April 2016 by trained interviewers at either university offices or another location of the participants’ choosing (e.g., public library or the participant’s home). Interviews were recorded using a digital audio recording device and transcribed by a professional transcription company. Interviewees received $75 in compensation for their participation, in addition to reimbursement for parking or transit to the interview location.

Nine interviewers of diverse identities in terms of the intersection of gender, race/ethnicity, and sexual identity conducted the interviews. The majority were cisgender (five women, three men), and one was a transgender woman. Interviewers represented a range of sexual identities, including bisexual (three), gay (two), straight (two), lesbian (one), and queer (one). In terms of race, interviewers identified as White (five), Latinx (two), and Black (one). Most fell within the middle generational cohort (six), though the younger (two) and older (one) cohorts were also represented.

Regardless of their personal identities, interviewers were trained to approach the interview as a naive person would and ask questions to elicit the respondent’s narrative, rather than assuming shared experience based on shared identity. Processes of reflexivity were integrated into the research design, during both interviewer training and biweekly videoconferencing calls among interviewers and investigators throughout the data collection period (see Frost et al., 2019). These processes included both written and oral reflections on the interview experience and the way in which the interview encounter was coconstructed.

The interviews were structured according to the following sections: lifeline drawing activity; life story narrative; social identity and communities mapping activity; sex and sexual cultures; challenges, stress, and coping; interpretations of social and historical change; health care utilization; and reflections and goals (for further details, see Frost et al., 2019; see Appendix for the full protocol). The protocol was designed to guide responses from broad, overarching reflections on participants’ individual lives, to social identities and experiences with various communities and their intersections, to reflection on broad cultural changes for LGBT people and, finally, experiences with health care. However, interviewers adjusted the order or inclusion of sections based on the flow of the interview and needs of the participants.

Analysis

We analyzed the transcribed interviews in the Dedoose data-management program using inductive thematic analysis (Braun & Clarke, 2006), in which codes are developed based on repeated readings of the data, rather than a priori. Our analysis included both a semantic and latent focus, in which the explicit meanings of participants’ narratives are considered along with interpretations of underlying meanings based on the sociopolitical context of the interviews. Analysis was conducted by the first and second authors, who met consistently throughout the analytic process to review and refine the emerging thematic codes. This analytic approach is consistent with qualitative research on sexual and gender minority populations (e.g., Galupo et al., 2016). In order to capture all data relevant to the research questions, we included the full interview transcripts in analysis rather than selected sections.

Overall, our analysis proceeded from a constructionist epistemology, in which validity and credibility are established through reflexivity memos and researcher consensus through repeated readings and interpretations of themes across the interviews (see Madill, Jordan, & Shirley, 2000). We further assured trustworthiness and fidelity (Levitt, Motulsky, Wertz, Morrow, & Ponterotto, 2017) through reviewing all aspects of analysis with the remaining authors and the larger team of investigators for the Generations Study, which is diverse in terms of a number of social identities including gender, sexuality, race, and age.

Our constructionist epistemology acknowledges that the positionality of the researchers plays an influential role in the interpretive process, making a description of relevant identities key in a full understanding of the results. The first author falls between the younger and middle generational cohorts and identifies as a White, lesbian/queer, nonbinary transgender person. The second author falls within the middle cohort and identifies as a White, gay/queer, cisgender man. The third author falls between the younger and middle cohorts and identifies as a White, bisexual/queer, nonbinary transgender person. The fourth author falls within the middle cohort and identifies as a Black, biracial, cisgender lesbian woman. The last author falls between the middle and older cohorts and identifies as a White, gay, cisgender male.

Results

Overview

Our inductive thematic analysis generated three major themes: (a) unintelligibility: genderqueer people face challenges in identifying, naming, and expressing their gender due to the constraints of everyday language and material culture; (b) managing stigma through challenging oppression: genderqueer people manage stigma by naming and challenging the gender binary, often in relation to other forms of oppression; and (c) connection beyond mainstream LGBTQ communities: genderqueer people often find connection outside of mainstream LGBTQ spaces, such as through ethnicity-based or sexual subcommunities (e.g., kink/BDSM, polyamorous). For each of these major thematic findings, we begin by discussing generational patterns, followed by a broader discussion of the theme supported by illustrative excerpts. Key generational patterns included (a) greater challenges among the Visibility and Pride generations in naming and expressing a genderqueer identity, especially in terms of how this impacted their sexual identity; (b) intensified critique of mainstream LGBTQ politics among the Equality generation; and (c) greater challenges in finding and maintaining community among the Visibility and Pride generations.

Theme 1: Unintelligibility

Generational patterns.

Across generations, participants described experiences of feeling unintelligible within dominant conceptions of gender, both within LGBTQ communities and more broadly. These experiences manifested in several distinct areas, including language, sexuality, gender presentation, and social structures. However, the timing and impact of these experiences varied, with members of the Visibility and Pride generations discussing the unique challenges of naming and expressing a genderqueer identity later in life, as exemplified by one participant’s discussion of community invalidation when adopting new pronouns during adulthood:

It’s been a lot of years, at least 5 years, 6 years since [I came out as genderqueer]. Still I have like especially my ex, she’s a good friend of mine, she will “she” me ’til the day she dies. I mean, she’ll try not to in public. To her it’s such an important part of her identity that I was female that I think she doesn’t like—she just cannot quite get there … For me I don’t mind so much because I don’t hate the female part of myself. I’m lucky that way … [But] it bugs me because I wish she would just let go of the gender cuz that’s what I did … (Jamie, 40, Visibility cohort, genderqueer, queer, White/American Indian).

As touched on in Jamie’s narrative, participants from the Visibility and Pride cohorts also described greater struggles disentangling gender and sexual orientation, as illustrated by Blake’s discussion of adopting queer and genderqueer as identity labels during adulthood:

When I came out in 1984, I strongly identified as lesbian and dyke, because it was back in the day … Then as my gender identity and really my gender expression moved, the word lesbian didn’t make sense to me, because I don’t think of myself as a woman. Woman didn’t make sense. I also think of queer as very much a political term. Queer takes my gender out of my attraction and also implants my politics … Then I was on a journey of again, like 1995, living as gender queer didn’t exist as a word. Nontransitioning trans people? There was butch, and there was female to male, and I knew that I was not either of those things (Blake, 55, Pride cohort, genderqueer/female, queer, White).

Blake’s narrative reveals the way in which genderqueer people in the Visibility and Pride generations have both created and responded to evolving vocabularies regarding gender and sexuality. As understandings of gender have expanded beyond binary conceptions, so too have possibilities for authentic self-expression for people like Blake. However, these expanded possibilities for gender identification may also destabilize sexual identities that have historically assumed a binary gender, leading to multiple identity shifts across the life span along with expansions in available language. For some, these shifts may bring tension in long-standing personal and community relationships that have not yet embraced genderqueer identities as valid.

Cross-generational results.

Though the Visibility and Pride generations described unique experiences in naming and adopting a genderqueer identity later in life, participants across generations identified language challenges as a key issue in their ability to identify outside the gender binary, as limits of existing language affected both their own identity development processes and the recognition (or lack thereof) of their genderqueer identity by family, friends, and other key communities. These challenges manifested in a sense of being unintelligible within dominant binary frameworks for understanding gender, as described here by two participants from the Equality generation:

[Being genderqueer] is something that people don’t actually understand. They’ve never even heard of [it] sometimes … Then when you do say that, people automatically think that that means you’re trans. You wanna be the opposite gender … [but] I don’t identify as either (Sage, 19, Equality cohort, genderqueer, gay, White).

[I]t’s like a new category … but the category doesn’t exist to some people yet (An, 21, Equality cohort, genderqueer, pansexual, Chinese American).

As these excerpts reveal, the experience of unintelligibility creates distinct challenges in the lived experience of all genderqueer people. Many if not most people they encounter lack the knowledge or vocabulary to understand a genderqueer identity, which creates a constant necessity to explain or educate.

Even when participants were able to access language to describe a genderqueer identity, this often required a further interrogation of language and identity in relationship to sexuality:

Gay’s usually known as same-sex attraction. There’s a difference between sex and gender. How does that work with being genderqueer? Is it still based on sex? Is it based on gender now? Is it a weird combination of both? Is it some random word for it that I don’t know about yet? (Sage, 19, Equality cohort, genderqueer, gay, White).

As Sage discusses, the emergence of new language to describe gender identities other than man or woman (which often relies on a distinction between sex and gender) creates new questions about how to describe sexual orientation.

Unintelligibility could also manifest in choices about gender presentation. Because dominant conceptualizations of gender are binary, participants described having difficulty developing any gender expression that would cause others to recognize them as genderqueer:

I present myself more masculine. I think that’s something that a lot of genderqueer people do … I’ve noticed that a lot of it is you’re gonna present the opposite one, because you want it to kind of be known to people that look at you to be like, “Question?” When people look at you, they might question your gender kind of a thing, which is fun sometimes … When I’m walking down the street, I wonder how people that pass me see me. Because we automatically label things as a man or a woman. I wanna know if they’re confused or if they just automatically label me (Sage, 19, Equality cohort, genderqueer, gay, White).

Sage’s description of choosing a masculine presentation as a way to prompt others to question their gender is similar to how trans men and trans women describe the extreme efforts they must make to “pass” as their gender (Schroeder, 2014). As Sage articulates, however, genderqueer people face an additional challenge, in that most people will never arrive at the correct conclusion about their gender regardless of how they alter their bodies or gender expression, because most people do not recognize the existence of genderqueer identities.

Participants described the psychological and social challenges with being “unreadable” due not only to gender, but also to other social identities. In the excerpt below, a participant from the Visibility generation discusses gender, sexuality, and race as three prominent identities that are often challenging for others to recognize or understand:

I think that these three things in particular are what drive my research, the genderqueer and queer and being Mexinese, as I call it, because I do not fit in a box … These things are constantly reminders from other people’s reactions or paperwork that I have to fill out—they’re constant reminders that I am “other” (Jay, 36, Visibility cohort, genderqueer, queer, Chinese American/Mexican American).

Jay’s experience reflects the challenges of living between or beyond commonly understood social categories, particularly when that ambiguity is visible to others (in this case, regarding both gender expression and a multiracial appearance). In being repeatedly reminded of “otherness” due to language, misidentification, or paperwork, they must constantly navigate the choice between continued invisibility or misidentification on the one hand, and active explanation of these unique identities (with the risk of misunderstanding and invalidation) on the other.

Similarly, many participants described necessary engagement with binary assumptions in daily life, such as this participant’s experience with standard medical forms at the doctor’s office:

Because my driver’s license says M, my insurance says M, but really I was born female. These questions I have to answer about my prostate aren’t useful for us. I’d rather if we could just be honest with each other and talk around the forms (Jamie, 40, Visibility cohort, genderqueer, queer, White/American Indian).

Jamie’s story reveals the challenges of medical visits, identity documents, and navigating nearly universal assumptions of gender as binary and as aligned with birth-assigned sex. Those whose bodies and identity documents do not align as expected by the larger society are rendered unintelligible by social structures that privilege binary and cisgender experiences.

Even within seemingly affirmative contexts, many participants felt the pressure to conform to binary gender expectations. This pressure for conformity occurred both during childhood and adulthood, as illustrated by the following two excerpts:

I just remember it being very painful that the moms in the playground were being told by administration at school, “The boys have to play with the boys. Girls had to play with the girls” ” Basically, all the boys did was play kickball, so I had one option if I was a boy. [Chuckling] To play kickball. I hated kickball (Angel, 40, Visibility cohort, genderqueer, pansexual, Latinx).

[My sister] ended up minoring in LGBT studies … She hinted at the fact that it was because of me that she decided to take that minor. I feel like it’s a hypocritical point, because even though she’s all out in the open about accepting the LGBT community, she always comes back and tells me, “You have to fix yourself. You have to be more feminine.” (Maya, 24, Equality cohort, female, two-spirit, Native American).

Though people of all genders are subject to the pressure of gender conformity, these experiences may be particularly painful and invalidating for genderqueer people, because their very existence is denied by the binary conception of gender that underlies these common practices. Repeated experiences that enforce gender as binary during childhood and adolescence, such as that described by Angel, make self-understanding and recognition by others especially challenging for genderqueer people.

Theme 2: Managing Stigma Through Challenging Oppression

Generational patterns.

Experiences of stigma and harassment were discussed across generations, as was the importance of challenging social structures that reinforce oppression based on gender, sexuality, and other identities. In reflecting on political changes for the LGBTQ community, a common narrative was a desire to focus on issues beyond marriage equality. Interestingly, however, this was especially common in the Equality cohort, many of whom felt that some parts of the LGBTQ community had been left behind in favor of changes that benefitted those with the most privilege:

[T]here’s progress here, but I think it’s the lack of willingness to keep fighting for other people within our alphabet soup … That whole thing that happened with, “I can get married now! I don’t need to fight anymore!” It’s like, trans people do not have any protections federally or for the most part through state regulations and laws to not be discriminated at work (Dominique, 22, Equality cohort, genderqueer, pansexual, American Indian/Black).

The acceptance is more within the White LGBT community, not necessarily them accepting us, but them being accepted by the majority of the population. Because it’s like all the equal rights and marriage equality, all of that is mainly for them. ‘Cause people of color have more issues within the LGBT community. Marriage equality is nothing compared to what can be done (Maya, 24, Equality cohort, female, Two-spirit, American Indian).

In pointing out these intersectional shortcomings of the political movements led by those in the Visibility and Pride cohorts, these participants from the Equality cohort illustrate how social and political progress regarding gender and sexuality must also be understood in relation to other social identities. For genderqueer people, especially those of color, the major changes of recent decades often fall short of meeting individual and community needs.

Cross-generational results.

In defying binary conceptions of gender, many genderqueer people are subject to stigma and harassment. Minority stress processes (Meyer, 2003) were seen in genderqueer participants in ways consistent with existing research regarding LGBTQ communities. One common topic was the fear and actual experience of discrimination based on gender expression. Several participants described experiences of harassment or discrimination based specifically on perceptions of androgyny or gender ambiguity, as illustrated by Kelly’s experience:

I was hugging another very androgynous friend on the street. A car full of men pulled up … One of ‘em completely flipped out and thought we were two gay men and proceeded to try to attack us … I really thought it was about my gender more than anything else. That he couldn’t figure out—he kept screaming “What are you?” Because he couldn’t figure out if we were two gay men or two gay women, or a man and woman (Kelly, 39, Visibility cohort, genderqueer/woman, queer, White).

Examples such as this illustrate not only the risks of gender nonconforming expression, but also the strong reactions encountered when challenging binary social categories. Though similar experiences were reported by many participants, several participants noted the unique challenges surrounding gender expression for those read as male compared with those read as female, and the corresponding caution they must adopt regarding gender expression:

There’s not, in our workspaces and many spaces, there’s not really a place to embrace and safety for people to be fluid and to dress up in the way they want to … [I]f I was assigned at birth a woman, and I was gender fluid, I think there would be less stigma attached because I mean women today could dress masculine and, I don’t know, some people might think it’s weird, but they won’t attack someone as there’s more pressure for men (Chris, 22, Equality cohort, genderfluid, gay, Middle Eastern/Jewish).

I present as a cisgender male just for safety reasons. I mean I live in a rough neighborhood … I would love to dress gender expressively, but I need to be realistic about the world that I live in. It’s like trans people get murdered. Although I identify as genderqueer, I cannot really express it as much just for my own safety, at least not now (Matt, 24, Equality cohort, genderqueer, queer, American Indian/Latinx).

As these narratives illustrate, genderqueer people must contend with expectations of stigma or violence based on gender presentation. These expectations are rooted in both misogyny and the historic privileging of a binary conception of gender, as illustrated by Chris’s fears about being attacked not purely for gender nonconformity, but specifically for being read as a man wearing feminine clothing. Though many of our participants reported harassment or violence based on gender expression, those assigned male at birth face discussed unique challenges due to the policing of masculinity and denigration of feminine gender expression. Experiences such as those described by Kelly, Chris, and Matt demonstrate the role of binary gender ideology in upholding systems of power that privilege men and masculinity, along with the risk of violence for those whose gender expression challenges this ideology.

In addition to gender expression, participants described experiences of oppression when navigating particular social structures, as exemplified by the following discussions regarding health care:

[I]n terms of mental health care, I feel like I have a choice between finding an LGBT supportive or a Muslim supportive therapist, and that those two often do not overlap. If they do, they’re a small handful of people who are probably not in my insurance network (Nour, 24, Equality cohort, genderqueer, bisexual, Arab/White).

Health care’s harder to navigate in many ways. I feel like I end up making choices around what’s good for my [chronic illness]. Then secondary is, “Are they queer friendly?” My GP, not particularly queer friendly. In fact, on my—I can tell that she’s a little horrified that I’m polyamorous on my diagnosis form for my last annual. One of the things she put was “high-risk bisexual activity” as one of my diagnoses. I do not know how you get treated for that, [laughs] but I was pretty horrified, because I’d been with one man my whole life, right? (Kelly, 39, Visibility cohort, genderqueer/woman, queer, White).

Nour and Kelly’s experiences illustrate the challenges of being forced to choose between key identities or needs when seeking necessary services. They also illustrate the need for greater knowledge of the experiences of gender and sexual minorities among health care and other professionals, along with how these experiences differ based on the intersection with other social identities.

In response to experiences of oppression, many participants described the importance of educational and activist spaces in developing their own sense of identity and sociopolitical consciousness around gender, sexuality, and other identities. These spaces provided contexts to name and challenge binary gender ideologies and other forms of oppression:

I’ve recently been involved in a lot of things like the undocuqueer community and how—and fighting for our rights and our right to stay here and stuff like that. They’re very, very protransgender, proexpressive. A lot of the cisgender Browns that are involved in this, they’re some of my biggest supporters when it comes to being gender expressive and stuff like that. It’s really weird. This tiny little niche in all these communities is being the biggest advocates for being gender queer and being trans, and being stuff like that (Matt, 24, Equality cohort, genderqueer, queer, American Indian/Latinx).

I feel like there’s something so beautiful about questioning what we’ve been taught our entire lives. That’s what I’ve been studying for the past three years, questioning authority, and creating an identity of who you are, how you feel, which we can talk about how society influences that, too (Lucian, 23, Equality cohort, genderqueer/trans, lesbian, Latinx).

[O]ne of the things I always say when I give workshops—I just said it yesterday in a workshop or day before. It’s like we’re always talking about gay and lesbian issues. I do not have any issues. I have to deal with other people’s issues, which take my energy. I’m pretty issue-free around my identities (Blake, 55, Pride cohort, genderqueer/female, queer, White).

These excerpts illustrate the importance of sociopolitical consciousness for allowing genderqueer people to combat internalized stigma and work toward social change. For Matt and Lucian, activist and educational settings are key for challenging oppression based on gender, sexuality, and other social identities, whereas for Blake, leading workshops serves as an avenue to locate oppression in external forces and challenge the internalization of negative beliefs.

Theme 3: Connection Beyond Mainstream LGBTQ Communities

Generational patterns.

Across generations, participants described the importance of finding appropriate community spaces that validate not only their genderqueer identity, but their other social identities as well. However, participants from the Visibility and Pride generations described unique experiences of isolation and misunderstanding when seeking community, particularly in terms of the intersection of genderqueer identity, age, and sexuality:

Because I’m genderqueer, here’s the deal: I’m like about 15 years ahead of my time. My community is not my age. The people my age are not my community. That disconnect makes me lonely (Blake, 55, Pride cohort, genderqueer/female, queer, White).

For some, coming out as genderqueer later in life was complicated by membership in communities based on sexual identity:

I had a lot of community … that was attached to my dyke identity, and we were really transphobic for a while. I mean, I was really transphobic for a while. Some of my close friends were against trans men because we were so attached to the dykey-ness and losing our dykes. Like losing our good women, that kind of a thing. It was really challenging for me to get the confidence to come out to them that way (Jamie, 40, Visibility cohort, genderqueer, queer, White/American Indian).

The interplay between gender identity, sexual identity, and community is further described by Angel, who notes the powerful roles of intimate relationships and sexual cultures in shaping identity possibilities across the life span:

Well, I feel like “pansexual” covers me more as a whole person when it comes to my sexual orientation. But I cannot really say I’m not gay because I’ve had so many gay relationships where I feel like in—within my relationship, I’m being identified as a man and I’m identifying the person I’m with as a man. Or male, or somehow within the male spectrum … As genderqueer as I may feel, there’s no getting away from—there’s definitely some maleness going on here … That label was one, the first one probably thrust on me … Lots of times I didn’t want to have it, but I have it … anyway. Apart from just who I am in my relationships, [t]here’s been at least 25 years of being a part of the gay world. The world that identifies as gay or the world that is identified as a gay world or culture. I embrace my gay identity. Even if I am more truly pan (Angel, 40, Visibility cohort, genderqueer, pansexual, Latinx).

These narratives from genderqueer people of the Visibility and Pride generations illustrate the complexity of continually revisiting one’s identity across the life span, especially within times of sociopolitical changes as drastic as those in the past several decades for gender and sexual minorities. Their narratives also reveal the isolation that can occur when contemporary identity categories do not match personal experience during adolescence and emerging adulthood, along with when one’s developing identities feel out of step with one’s generation.

Cross-generational results.

In discussing community, participants described the challenges of navigating inherited communities, such as geographic and faith communities associated with families of origin, along with searching for communities that reflect and affirm their gender, sexual, and other social identities. Though many obtain support from the broader LGBTQ community, they also describe challenges based on specific identity intersections and personal values:

There’s a queer POC scene here … where queer black folks might gravitate toward … [But I’m not] particularly interested in what they’re doing politically, which has become a really important part of how I live my life. Groups that I might be more interested in doing the same kind of work as they are tend to be—there’s lots more white folks, and so I tend not to go to those spaces, or just doesn’t feel as a space that I can connect with … I feel like that’s been stressful for me here, in having to do a lot of explaining on either end (Jade, 22, Equality cohort, genderqueer, queer, Black).

For participants forced to choose between integral aspects of their identity and values, finding a sense of community belonging was exceptionally challenging. Though Jade was still seeking an appropriate community, others described the relief of connecting with culturally specific communities of gender and sexual minorities:

Isolation was the biggest thing, because I felt I couldn’t have my identity as a Native American, and my identity as a gay man … What that looked like when I found the [two-spirit organization] was it was a union of the two, and it was like there’s a coming out, but we have a coming back in, so it was like coming back into the culture, and now you can be both. It’s not like you have to segregate the two, and there’s a way to unite them together, and that identity of two-spirit (Rob, 36, Visibility cohort, male, Two-spirit, American Indian).

For Rob, connecting with a specific identity community facilitated both individual development and community connection. However, even within that community, gender was sometimes understood in binary ways, as illustrated in Rob’s story about meeting a transgender woman at a powwow:

[E]ven some of the new people that come into the two-spirit community have the mentality of the larger LGBT community. I danced at a powwow at a gathering last month, and I wore women’s regalia, and I was the head dancer … She was a trans woman, and … she just saw it as I just want to be a girl, but it’s so much more than just wanting to be a girl. It’s trying to reclaim something that we cannot live in today’s world. [S]he’s missing the spiritual aspect to that part … That’s two-spirit, so it’s different from just male or female (Rob, 36, Visibility cohort, male, two-spirit, American Indian).

As this narrative illustrates, the meaning and possibilities of gender vary considerably even within specific communities. Nevertheless, for individuals trying to reconcile seemingly incompatible aspects of their personal identity, creating community with similar others is a key route to integration.

In addition to ethnicity-based communities, participants identified with specific sexual subcommunities, such as kink/BDSM communities and polyamorous communities. In some cases, these communities allowed for creative gender identification and expression that participants did not find in broader LGBTQ communities, as described by one participant regarding acceptance of their gender fluidity:

It’s fine, at least the people that I hang around with, I mean. I mean, especially since my specific slice of the LGBT pie is also the polyamorous kinky slice, so we’re all getting up a bunch of stuff, so [laughs] I’ve never had to wrestle with anyone not accepting me for who I am or any of that, or any of that sort of stuff. I’ve always been welcomed and accepted (Frankie, 22, Equality cohort, genderqueer, pansexual, White).

For this participant, moving within polyamorous and kinky circles eased the difficulty of challenging the gender binary. Interestingly, however, some participants reported that finding acceptance and belonging within these communities actually made personal authenticity more challenging within mainstream culture:

The group I’m in is very into paganism, gender fluidity, and playfulness, body-based rituals … That actually fits more to describe my gender and my sexual orientation more than anything else. Because there’s sort of some poly in there. There’s some queer in there. There’s some gender queer in there … If your average person on the street, if they ask me what my sexual orientation is, I wouldn’t be like, “Oh, I’m a leather fairy.” [Laughs] … I’d probably say I’m lesbian or I’m queer. Because it’s just what people can understand (Kelly, 39, Visibility cohort, genderqueer/woman, queer, White).

As illustrated by this description, a sense of community belonging for genderqueer people is often found outside of mainstream LGBTQ spaces, especially for genderqueer people who also identify with polyamory, kink/BDSM, or other sexualities that challenge normative understandings of sexual intimacy. However, this also makes recognition and understanding from others outside those communities more difficult.

The stories of participants across these three generations reveal resilience, connection, and creativity, as they all navigate the complexities of gender, sexuality, and other social identities within particular contexts. The importance that most place on community connection for their own identity development, political consciousness, and resilience demonstrates the importance of developing community spaces that acknowledge, affirm, and support genderqueer individuals in terms of not only gender, but their full complexity of social identities.

Discussion

The current study sought to contextualize the experiences of genderqueer people by examining intersections of gender with sexual orientation and other social identities, along with experiences of community. In particular, we were interested in how generational differences might affect genderqueer individuals’ ability to understand their own gender experiences and to find affirming community spaces. Through this generational perspective, we were able to investigate how people engaging with new language of sexual and gender diversity at different points in development can result in distinct experiences across the life course.

Based in binary conceptualizations of gender and cissexism, the unintelligibility of nonbinary gender hindered self-understanding and community connectedness for participants across generations. However, unintelligibility and community disenfranchisement were even more salient for participants from the Visibility and Pride cohorts, who often lacked language to name their experienced gender as adolescents and even well into adulthood. Understanding the self in relation to others is an important part of normative development (Damon & Hart, 1982), and research in other gender and sexual minority populations has demonstrated that the ability to name one’s identity facilitates healthy coping, including positive self-regard and community connectedness (Barr et al., 2016; Dziengel, 2015). Without appropriate language for and societal recognition of their genderqueer identity, study participants did not have access to important resilience strategies and opportunities to fully self-actualize. In addition, because some mainstream identity categories for sexual orientation imply one’s own gender in addition to that of one’s desired partners (e.g., lesbian), participants who adopted genderqueer identity labels later in life faced both personal and community challenges regarding the implications for their sexual identity.

As found in research with other gender and sexual minority groups (e.g., Gordon & Meyer, 2007; Lombardi, Wilchins, Priesing, & Malouf, 2001), participants described how gender nonconformity increased their risk of experiencing victimization and discrimination. Though the term genderqueer is relatively recent (Thorne et al., 2019), sexual minorities have been challenging the gender binary long before terms like genderqueer were recognized (Beemyn & Rankin, 2011). For example, historians have noted gender nonconforming modes of expression as core features of nonheterosexual sexual life in the U.S. since the 1920s (Garber, 1989; Walker, 2001). Knowing the myriad ways genderqueerness has been expressed among people throughout history and across generations, even absent the labeling used in contemporary society, is useful for mapping experiences of this specific gender minority group. In particular, people who are not conforming to the gender binary in expression or appearance are often targets of prejudice and discrimination (Gordon & Meyer, 2007; Miller & Grollman, 2015). We saw evidence of this among participants in this study across generations, and experiences with prejudice were likely to occur regardless of the naming of one’s gender expression and identity.

Our findings suggested that the unintelligibility of genderqueer identities interacted with the threat of gender-based violence in ways unique to genderqueer people. Although cisgender sexual minority people and man/woman-identified transgender people often challenge strict binary conceptualizations of gender, generally they are still recognized within the binary of man or woman. Conversely, there is no way to “pass” as a genderqueer person, because society does not recognize the existence of genders other than woman or man. This tension leaves genderqueer people in a no-win scenario: The closest participants could come to performing a genderqueer identity that would be recognized by others was through ambiguous or androgynous gender expression, but this ambiguous expression then put participants at risk of gender-based violence. It is possible that unintelligibility of genderqueer identity, in combination with experienced discrimination, may explain the significant health disparities of genderqueer people in relation to cisgender sexual minorities and man/woman-identified transgender people, including increased rates of eating disorders (Diemer et al., 2018), nonsuicidal self-injury (dickey, Reisner, & Juntunen, 2015), and suicidal behavior (Grossman et al., 2016).

In addition, our findings regarding sexual subcommunities align with existing research showing that transgender people often describe their sexuality in nonmainstream ways, such as by acknowledging fluidity, diverse partnership styles, kink/BDSM activities, and a separation of sexual and romantic attraction (Galupo et al., 2016). Similar findings have emerged from research with asexual communities (Sloan, 2015; Vares, 2018), in that a focus on consent, direct communication, and the potential for intimacy that does not center genital sexuality make both polyamorous and kink/BDSM communities potential sites of connection for asexual individuals. Some of these factors may also draw genderqueer individuals, who face challenges finding intimacy and community in settings where dominant understandings of bodies, genders, and sexuality go unchallenged.

Overall, our findings highlight the diverse ways contemporary gender and sexual minorities form identities and associated communities, which may have different implications for genderqueer people across generations. For those in the Equality cohort, forming community often centered on challenging oppression based on not only gender and sexuality, but also the reproduction of racism and other forms of oppression within gender and sexual minority communities. This often included offering important critiques of social movements, such as marriage equality, that were spearheaded by the Pride and Visibility generations. In addition, the increased visibility of ethnicity-based and sexual subcommunities, including communities formed online, may offer a greater number of opportunities for community connection for contemporary young adults who identify as genderqueer.

Conversely, those in the Visibility and Pride cohort often discussed challenges remaining connected to the sexual identity communities that were meaningful during adolescence and early adulthood, given their later adoption of a genderqueer identity. In particular, they describe the dual challenges of finding those of similar ages who validate and understand their gender, along with finding genderqueer communities that validate and understand their unique experiences as sexual minorities of earlier generations. Given the increasingly crucial role of online spaces in expanding gender and sexual identity possibilities and forming new communities (Cover, 2019), genderqueer people in middle and later adulthood may face greater challenges in finding appropriate connections, especially if their unique experiences and needs as members of earlier generations of LGBTQ communities are invalidated or misunderstood in these spaces.

Limitations

The current study offers insight into how genderqueer people navigate identity development, stigma, and community; however, results must be considered in light of the study’s limitations. First, the interview protocol and sampling used during data collection were originally designed to investigate topics related to sexual rather than gender identity. Although gender and sexuality are intertwined concepts, there are likely other aspects of genderqueer experience that the protocol used in the present study did not capture. Additionally, the present study may overstate the overlap between sexual minority experiences and genderqueer experiences because of the interview’s primary focus on sexuality. Second, participants in the present study were generally highly educated. Results may be different for genderqueer people with less formal education. In particular, the role of educational spaces for developing vocabulary and sociopolitical consciousness may be less prominent for genderqueer people with different educational experiences. Third, though this sample contained rich narrative data from genderqueer people of three distinct generations, the older generation was less heavily represented than the other two, meaning that there are likely important aspects of the lived experience of older genderqueer people that were not captured in this sample.

Opportunities for Future Research

Future research should continue to investigate how stigma and resilience may manifest differently for genderqueer people as compared with LGBTQ people who identify with a binary gender. For example, a recent study found that genderqueer people reported less social support from family than did either cisgender participants or binary-identified transgender participants (Bradford & Catalpa, 2019). This research will likely necessitate new measure development: Even within transgender studies, many current measures were designed with a binary gender perspective, meaning that they may miss experiences unique to genderqueer people (McGuire et al., 2019).

In addition, the connections between genderqueer identities and forms of intimacy that challenge normativity (e.g., asexual, kink/ BDSM, and polyamory) should be further explored. Evidence is building that established taxonomies fail to capture the full diversity of sex and gender (Cover, 2019; Galupo, Pulice-Farrow, & Ramirez, 2017; Hyde et al., 2019; Levitt, 2019), along with both sexual and nonsexual intimacy (Cover, 2019; Galupo et al., 2016; Hammack, Frost, & Hughes, 2019). To remain relevant, psychological research must not only attend to this emerging diversity, but also explore parallels in how these identities and communities are challenging existing frameworks and addressing unmet needs for gender and sexual minorities.

Finally, future research should examine how the experiences of genderqueer people of distinct generations shift as these identities become more widely recognized. The unique experiences associated with an identity that is frequently unintelligible within both mainstream LGBTQ communities and the wider culture may eventually transform into experiences similar to those of gender and sexual minorities who hold more established identities. However, they may also evolve in unknown ways, making close attention to the lived experiences of genderqueer people essential for understanding individual identity development across the life span, community dynamics among gender and sexual minorities, and contemporary shifts in broader sociocultural understandings of gender and sexuality.

Public Significance Statement.

This study found differences in the experiences of genderqueer people from three distinct generations, with the younger generation expressing greater critiques of mainstream LGBTQ politics and the middle and older generations describing greater challenges in relation to gender identity and community. This suggests that attention to generational cohort is important for understanding the experiences and needs of genderqueer people.

Appendix

Interview Protocol

Identity Stress and Health in Three Cohorts of Lesbians Gay Men and Bisexuals

Protocol for Qualitative Life Story Interview

Note to Interviewer: Interviewer instructions are in [brackets]. All numbered questions should be asked directly to participants. Questions beginning with letters are suggested/optional probes and only need to be asked if the participant’s response to the preceding numbered question is insufficient.

Introduction

[Let Them Know:]

• Start by doing a couple of activities that give life overview

• Activities last about 30–40 minutes

• Questions about communities that you are part of, as well as your sexual experiences and relationships

• Then we’ll talk about challenges and stressors that you may have experienced over your life

• As well as some questions about the social and historical changes that have occurred related to LGB issues

• We’ll end the interview with some questions about your experiences accessing health care.

• We will take a break about midway through the interview, but can also break at any time you need

Part 1. Life Story

Life-Line Drawing [About 10 Minutes]

This first activity is called a life-line. [Hand R lifeline paper and pen] Please draw a line that represents your life. The line should begin when you were born, go to today and then continue into your future. The line should go up when it was a good time in your life and down when it was a bad time in your life. Take a few minutes to think about your life and draw the line, and when you are finished we can discuss it.

Life-Story Narrative and Critical Events [About 15–20 Minutes]

1. Now for the next 15–20 minutes I’d like to go over the line you drew that represents your life and ask you some specific questions about critical life events. First, tell me why you drew the line the way you did. [Probe only for clarification on events; avoid interruptions.]

Now, I’d like us to focus on a few key events that happened to you in your life. For each event, please describe what was happening, where you were, who you were with, and what you were thinking and feeling at the moment.

• 2.Tell me about your first memory, the very first thing you can remember in life.
• 3.Tell me about the time in your life that is really the highest point in your life story, a time when you were just so happy and felt at peace with the world.
• 4.Tell me about the time in your life when you felt the lowest—a time when you felt a lot of negative emotions, like sadness, despair, fear, or anger.
• 5.Now tell me about a turning point in your life. A turning point is a time in which something happened that changed you as a person. Think of a particular event in your life that had this kind of impact on you, when before this event happened, you thought of yourself one way, then the event happened and you thought of yourself in an entirely different way.

Thank you for sharing this overview of your life story. We may come back to some of these events later in the interview.

Part 2. Social Identities And Communities

Identity Map [About 5 Minutes]

For this next activity, please use this page as a starting point for listing the identities and roles that describe who you are. You can write words or phrases that represent different aspects of yourself, these might include social identities or labels related to gender, race, sexuality, class, occupation, different roles in your life, or any words or phrases that describe you. [Hand R the blue colored pencil to fill it in]

Identity Map Narrative [About 25 Minutes]

For the next 25 minutes or so I’d like to go over the words and phrases you used to describe yourself. [If R did not write descriptor for race, gender, and/or sexual orientation, ask why R didn’t. Probe how R identifies in these areas. Write in additions to the identity map in a green colored pencil].

1. In terms of your sexual orientation, you told me that you see yourself as [sexual identity in map]. Tell me about how you came to identify yourself with this sexual identity label and your process of telling others about your identity.

   1. People use a lot of different words to describe their sexual orientation. Tell me about why you think the word you use fits you best?
   2. [Probe for milestones such as specific age of self-awareness, disclosure to others such as friends and family.]

2. [Determine the core social identities—race, sexual, gender-that may intersect; SKIP if R does not seem to have intersectional identities of significance.] I’d like to understand how you see some of these different identities relating. Tell me about your experience of being [SEXUAL IDENTITY] in the [RACE/ETHNICITY/GENDER] community.

Tell me about your experience of being [RACE/ETHNICITY/OTHER] in the [SEXUAL IDENTITY] community.

• 3.
  You said you identify as [GENDER]. What’s it like being a [GENDER] within [RACE/ETHNICITY] LGB communities?

  1. For example, are there ways your experiences might be different if you were NOT [GENDER]?
• 4.
  Do you see yourself as more “masculine” or “feminine”?

  1. What is it like to be [MASC/FEM] in the [SEXUAL IDENTITY] community?
  2. Do you have a label or identity related to how masculine or feminine you see yourself?
• 5.
  Now I’d like to ask you about communities you feel you belong to. Tell me what communities you feel you are a part of, and tell me what those communities look like in terms of who is in them (e.g., the type of people). [Let R define community, if asked.]

  1. In what ways does it feel like a community? Or what makes it a community?
  2. Tell me about the relationships between the different communities you feel a part of. Or how are they related or ever interact? What’s it like to be a part of them at the same time?
  3. [If not already covered] - Tell me about the [SEXUAL IDENTITY] community you are in specifically and how it interacts with other communities

Part 3. Sex And Sexual Cultures

We’re done now with those two exercises and will now move on to discuss your sex life and relationships. This part of the interview will last about 20 minutes, and then we’ll take a break.

1. First, tell me about how you thought about sex and relationships during puberty and adolescence. [Refer to lifeline period on drawing if needed].

   1. How did you approach finding sex and/or romantic partners?
   2. What kinds of things interested you or excited you sexually?
   3. What kinds of things were you worried about?
   4. What was your sex life like back then?
   5. How did you feel about sex back then?
2. And how about today? Tell me about the romantic and/or sexual relationships you are in now.

   1. Are you currently in a relationship or relationships? For how long? Is your relationship or are your relationships monogamous or non-monogamous. [Ask for details, change over time, etc.]
   2. How do you feel about your sex life? Satisfied? Less than Satisfied?
   3. How do you feel about your relationship status?
   4. What kinds of things worry you about sex these days?
   5. [If not mentioned in identity map] – Some people identify with a sex position identity or role, like “top,” “aggressive,” “pillow princess,” “bottom.” Do you use any labels or terms like these to describe yourself?
   6. How does using that label [or not having a label] affect your sex life? Your relationships?
   7. [If not covered in sex roles question] – How does the way you see yourself as masculine and/or feminine relate to your approach your sex life? Relationships?
3. Have the ways you think about and approach sex and relationships changed over the years?

   1. Why do you think this has changed over the years?
   2. Probe for life events and social factors affecting observed differences.
   3. Probe for specific ages at which changes are noted.
4. Looking at your identity map and thinking about the communities and groups you discussed earlier, have you seen changes over the years in how sex and sexual practices are talked about among your friends who are also [sexual identity label]? [Probe for life events and social factors affecting observed differences].

   1. Why do you think some of these changes have happened?
   2. What about availability of different medications for sexually transmitted infections or HIV? Do you see people in your community changing the ways they approach sex because of these?
   3. [MEN ONLY] – More specifically, how has the availability of PrEP, also known as the pre-exposure HIV drug, changed how people you know approach sex and relationships?

[Take a 10 Minute Break]

Part 4. Challenges, Stress, And Coping [About 20 Minutes]

Thank you for sharing all that you have with me so far during the interview. The second half of the interview will ask you specific questions about challenges and stresses in your life and how you coped with them, as well as your experiences with health care services and your impressions of social changes for LGB people and how they have affected your life.

Challenges and Stress

1. Looking back over your life, tell me what you think has been the single greatest challenge you have faced so far in life. [Use lifeline and use as visual aid. If not already on the line, ask participant to mark and label].

2. Tell me how you have handled this challenge, and how you think having to deal with this challenge has impacted you as a person.

   [These questions, #3-4, are about major and minor events and incidents of antigay prejudice, discrimination, and violence].

3. How about any challenges you may have had in your life related to being [LGB term]? Starting when you were an adolescent, were there times when you were treated differently because of your sexual identity and or gender expression?

   [If R asks to explain “difference”, you can add: when you experienced prejudice, stigma, discrimination or violence?] [Refer back to lifeline. Ask if there were specific events or ongoing experiences, for each event or experience ask:]

   1. What happened?
   2. Who was involved?
   3. How did you feel about the experience?
   4. How did you cope with the experience?

4. Were there other times in your life that you were treated differently because of your sexual identity and or gender expression? Has that changed over time?

   [Refer back to lifeline. Ask if there were specific events or ongoing experiences, for each event or experience ask:]

   1. What happened?
   2. Who was involved?
   3. How did you feel about the experience?
   4. How did you cope with the experience?

5. [This question is about self-acceptance vs. internalized homophobia]

   Looking back over your life, were there times that you had an easy or hard time accepting yourself as [LGB term]? Has that change over time? [Explore different time periods related to self-acceptance vs. self rejection (internalized homophobia)].

6. [This question is about concealing LGB identity vs. being out]

   People sometimes need to or feel like they need to hide their LGB identity from others such as family and friends, teachers, colleagues and co-workers, health professionals, etc. Looking back over your life, please tell me about being out vs. not being out about your [LGB identity term]

   [Refer back to lifeline. Ask if there were specific times/contexts when this was an issue and ask:]

   1. When and where did this happen?
   2. Who was involved?
   3. How did you feel about the experience?
   4. How did you cope with the experience?

7. [This question is about expectations of rejection and discrimination vs. acceptance and equality in interactions in society in general]

   In general, in your day-to-day experiences, do you feel that society is accepting of you and other LGB people?

   1. Why or why not?
   2. Has this feeling changed over your lifetime?

Coping and Support

1. What types of things helped you deal with challenges and negative experiences you’ve had related to being [LGB term]?

   1. Have the kinds of resources or supports available to you changed over the years? If yes, how?
   2. Have you gone to an LGBT-specific organization such as LGBT community center?
   3. Have you sought help or advice from an LGBT person or organization online?
   4. Have you sought help or advice from an LGBT person or organization in your community or neighborhood? Did you travel outside of your neighborhood to seek such people or organizations?

Part 5. Social And Historical Moments [About 10 Minutes]

1. I’d like to ask you a few questions about what you remember about what was happening in society at particular moments in your life. First, can you tell me about your memories during puberty and adolescence about what was happening in society with regard to LGBT issues?

   1. What do you remember about how LGBT issues were talked about in the wider society during your childhood and adolescence?
   2. Where and from whom did you hear about these things (e.g., family, school, church, peers)
   3. How did it feel to hear the things you heard discussed?
   4. What did you think about it?
2. And how about today? What do you see as the major issues happening in society with regard to LGBT issues?

   1. How do you feel about the things you hear about these days?
   2. What do you think about the issues or the ways people are talking about them?

Part 6. Healthcare Utilization [About 20 Minutes]

This is the last major section of the interview, and it will last about 20 minutes. Thank you so much for all of the rich information about your life and experiences you’ve provided so far.

I now want to ask you about your physical and mental health and your experiences seeking and receiving care for your health

1. First, can you tell me about when you usually seek care for physical or mental health concerns?

   1. [Probe for the decisions about when to seek care and under what circumstances there is motivation enough to seek care.]
   2. Where do you usually seek care for physical health concerns?
   3. Where do you usually seek care for mental health concerns?
2. Tell me about the last time you sought healthcare for an illness or any physical health problem.

   1. Why did you go?
   2. Where did you go?
   3. Why did you choose that provider?
   4. How was the experience?
3. Tell me about the last time you sought healthcare for your psychological or mental health.

   1. Why did you go?
   2. Where did you go?
   3. Why did you choose that provider?
   4. How was the experience?
4. Tell me about the last time you sought help for psychological or mental health from a spiritual or religious counselor.

   1. Why did you go?
   2. Where did you go?
   3. Why did you choose that provider?
   4. How was the experience?
5. Tell me about the last time you felt you needed healthcare but didn’t seek help.

   1. Why did you not seek care?
6. Have the identities we’ve discussed earlier impacted your seeking and receiving care for your physical and psychological health?

   1. Why do you think those aspects of your identities have/have not impacted your experience with health care?
7. When you talk to a provider about a health concern, how open are you about your sexual identity?

   1. Does it come up?
   2. When?
   3. What situations?
   4. Who brings it up?
   5. If no, why do you think you and your provider haven’t brought it up?
8. Have you ever sought care for reasons related to your sexual identity or gender expression?

   1. How did you find the person?
   2. How did you feel about the experience?
9. Is it important to you to go for healthcare at an LGBT-specific clinic or provider (e.g., an LGBT Center)?

   1. Why or why not?
10. Where do you go for health-related information for physical or psychological concerns?

    1. What specific resources do you seek out? People? Websites? Organizations?
    2. Which resources are best for which concerns?
    3. How important is it for the resource to be LGB-specific?

PART 7: Reflections And Goals [About 5 Minutes]

I have two final questions for you.

1. Life Goals. Looking again at your life-line, tell me about your goals in life with regard to work, relationships, and family life.

2. Finally, looking back over your life, what would you say has been the most positive aspect of being [LGB]?

Those are all of the questions we have for the study. Is there anything that you would like to add now or do you have any questions for me?

Thank you very much for your time.