Conceptualizing transgender experiences in psychology: Do we have a 'true' gender?

Psychological research has acknowledged that the commonly accepted definitions of 'transgender', 'sex' and 'gender' within psychological research have resulted in limitations in accounting for the lived realities of transgender individuals. Such limitations include, but are not limited to, the continued pathologization of transgender experiences through idealizing sex and gender congruence and incapacity to account for non-normative and non-binary transition pathways. This paper provides a review of these limitations to first demonstrate how the incongruence definition of 'transgender' is reliant on the idea of a 'true' gender, and next suggest that problematising the idea of a 'true' gender allows new conceptions of transgender experiences to be advanced. To undertake this problematization, the work of Judith Butler and Sara Ahmed is used to consider how gender could be conceptualized otherwise in psychology and then applied to transgender experiences. In all, this paper theorizes transgender experiences without a reliance on the assertion of a true gender, to suggest instead a focus on contextualized transgender experiences. Last, the limitations and implications of this definition of transgender are briefly discussed. Overall, transgender experiences are conceptualized as those experiences that run counter to the dominant (re)production of binary sexed gender.

Gender identity importance in cisgender and gender diverse adolescents in the US and Canada

Transgender adolescents often categorize themselves in the same way that cisgender adolescents do-that is, as girls/women and boys/men. Potential differences in the extent to which these self-categorizations matter to transgender and cisgender adolescents, however, have yet to be explored, as has the relative importance transgender adolescents place on their gender compared to their transgender self-categorization. In the current study, we explored self-reported identity importance in a sample of 392 primarily White (70%) and multiracial/ethnic (20%) 12-18-year-old (M = 15.02) binary transgender (n = 130), binary cisgender (n = 236), and nonbinary (n = 26) adolescents in the United States and Canada. Results revealed that binary transgender adolescents considered their gender self-categorization to be more important to them than both binary cisgender and nonbinary adolescents did. Most binary transgender adolescents rated their gender self-categorization as maximally important to them. Additionally, transgender adolescents considered their gender self-categorization to be more important to them than their transgender self-categorization (that is, their identification with the label "transgender"). These findings demonstrate that the identities that are often denied to binary transgender adolescents may be the very identities that are most important to them. Results also suggest that gender diverse adolescents with different gender identities may differ in the importance they place on these identities.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Fluidity in Gender Identity and Sexual Orientation Identity in Transgender and Nonbinary Youth

Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.

How Cisgender People Define "Transgender" Is Associated with Attitudes Toward Transgender People

Prior work suggests that some cisgender people do not consider gender identity when thinking about what being transgender means, and that exposure to a definition of transgender can reduce negative attitudes toward transgender people. In two studies, we sought to integrate these lines of research by examining whether anti-transgender attitudes are associated with how cisgender people define the term transgender. In Study 1, 293 participants (132 female and 157 male; four participants did not report their sex/gender) recruited via Mechanical Turk were randomly assigned to one of two conditions. Participants in one condition first read a definition of "transgender" that referred to gender identity and then reported their attitudes toward transgender people. Participants in the other condition did not read the definition and instead simply reported their attitudes toward transgender people. Contrary to predictions, exposure (vs. lack thereof) to the definition did not affect attitudes. However, participants who identified gender identity as a central component of the definition of transgender on a manipulation check endorsed more positive attitudes. In Study 2, 295 cisgender participants (165 women and 130 men; recruited via Mechanical Turk) wrote down their own definitions of transgender. Participants who spontaneously included (vs. did not include) gender identity in their definitions reported distinctively positive attitudes. Observed effects held over and above individual differences in cognitive style, gender identification, contact with transgender people, and participant gender. How cisgender people think about gender identity may thus index their attitudes toward transgender people.

Gender Development in Gender Diverse Children

Within "mainstream" developmental science, gender researchers largely study the developmental trajectory of children considered to be "gender-typical", while research housed primarily in psychiatry and clinical psychology often documents the trajectories of gender diverse children. This article aims to bridge the studies of gender diversity and "mainstream" gender development. First, we review literature on the development of four commonly studied subgroups of gender diverse children - children referred to medical clinics because of their gender identity and expression, transgender children, female children with congenital adrenal hyperplasia, and tomboys - highlighting how these gender trajectories do or do not align with modal developmental patterns. We then describe social, cognitive, and biological determinants of gender in light of their implications for understanding diverse gender development. Finally, we note methodological suggestions for future research, with an eye toward better integrating research on gender diversity into "mainstream" gender development research.

Few Differences in Sexual Talk by Gender/Sex and Dyad Type: A Retrospective and Daily Diary Study with Couples

Sexual talk is a type of verbal communication that occurs exclusively during sexual activity and that is specific to the sexual activity itself. Previous research has identified two types of sexual talk: individualistic (i.e., self-focused) and mutualistic (i.e., sharing/partner-focused), which have generally been linked to greater sexual and relationship well-being. Whether sexual talk use varies by gender/sex (i.e., men, women, gender/sex diverse individuals; GSD) or dyad type (i.e., same- vs. mixed-gender/sex) has not been examined. Given initial evidence that the types of sexual talk may contribute differently to sexual and relationship well-being, it is important to identify factors (e.g., gender/sex) that may be associated with the amount of sexual talk used. We examined differences by gender/sex and dyad type in the average sexual talk use among long-term couples (N = 229; 69 same-gender/sex) using retrospective cross-sectional dyadic data. We also examined these differences in the same sample (N = 217) using a 35-day dyadic daily diary study. Retrospectively, but not daily, women reported using more mutualistic talk than men, especially when partnered with a woman. There were no significant gender/sex or dyad type differences in use of individualistic talk retrospectively or daily. Exploratory analyses with the GSD couples suggested that there may be gender/sex and dyad type differences retrospectively and daily, for individualistic and not mutualistic talk; however, these analyses must be interpreted with caution due to the small subsample size of GSD couples.

Differentiating Gender and Sex in Dental Research: A Narrative Review

While in humans the term “sex” refers to the biological attributes that distinguish subjects as male, female, and intersex, the term “gender” refers to psychological, social, and cultural factors that strongly influence attitudes, behaviors, and relationships of individuals. Recently, it has been emphasized how the integration of these two terms in the design of the research can improve the methodology of the research itself. However, in dental research, the influence of gender has not gained enough consideration and it is often used indiscriminately as a synonym for sex. This narrative review discusses the usefulness of considering gender and sex in dental research, whose guidelines have been provided so far on this topic, and whether the top 20 dental scientific journals promote the analysis of sex and gender in their guidelines. Sex and gender analysis in dental research could be important both for analyzing biological differences such as those in the immune or neuro-immune system, cardiovascular physiology, developmental anomalies or deformities, and psychosocial differences such as lifestyle, pain experience and prevalence of chronic pain, eating behavior, and access to healthcare services. As for the specific policies for sex and gender analysis and reporting, only five out of 20 biomedical journals have included them in their editorial policy, which refers mainly to the correct use of the terms “sex” and “gender.” In conclusion, we found that no specific and differentiated sex and gender analysis and reporting are required in dental journals. Their integration, which is still not routinely applied, may be improved in the future by updating editorial guidelines and developing more specific methodological recommendations.

“I Think It’s Too Early to Know”: Gender Identity Labels and Gender Expression of Young Children With Nonbinary or Binary Transgender Parents

Little is known about gender expression among children with transgender parents. In the United States, we surveyed 64 nonbinary or binary transgender parents of children aged 18 to 71 months. Most parents reported a marginalized sexual identity and a White racial identity. Many declined to label their child’s gender identity, and this was particularly true among those with younger children. Scores indicated that, on average, children’s play was conventionally gendered. However, scores indicated significantly more gender-expansive play in the present sample than in normed samples, particularly among children assigned male at birth. Findings support transfamily theory (McGuire et al., 2016) and illustrate differences among families with nonbinary and binary transgender parents.

"He Helped Me in Discovering Myself." Rethinking and Exploring Sexual and Gender Identity in Trans-Inclusive Relationships

This qualitative study explores the effects of being in a relationship with a transgender or non-binary (TGNB) person on an individual's sexual and/or gender identity. To this aim, the responses of 107 partners of TGNB individuals to the following open-ended question were collected: "What effect, if any, has having a relationship with a transgender person had on your gender and/or sexual identity?." Through thematic analysis, 4 overarching themes emerged from the participants' responses: 1) No reason to change; 2) Exploration and changes; 3) New perspective; and 4) Negative effects and confusion. Overall, this study suggests that being in a relationship with a TGNB person may prompt a reflection on the concept of sexual and gender identity, and an exploration of one's own identity, which is usually experienced as positive, but may also be a source of distress for the individual and/or the couple. Also, in many other cases, the relationship has been observed to have no effect on the partner's identity, due to a number of reasons. These findings constitute a relevant addition to the understanding of couple's dynamics in trans-including couples.

‘I Can Construct it in My Own Way’: A Critical Qualitative Examination of Gender Self-Categorisation Processes

Gender self-categorisation is used to communicate a gender group membership in daily life and is recognised across research as an important facet of an individual’s identity. However, understandings of the psychological processes associated with gender self-categorisation have, historically, been restricted by binary, cisgender assumptions. This study qualitatively examined the processes associated with gender self-categorisation in a sample of transgender (binary and nonbinary, n = 15) individuals alongside a negative case analysis of one cisgender woman. Reflexive thematic analysis was used to construct a map of components which interacted to inform participants’ gender self-categorisation. Participants reported that their self-categorisation was reciprocally informed by their internal sense of gendered self, their gendered attributes and by other people’s perceptions. Further, participants’ knowledge and understanding of gender in the world more broadly provided context for this reciprocal process. The process of gender self-categorisation mapped in this study has important implications for researchers regarding theory and methods, for educators and parents regarding how children might be taught about gender and for clinicians regarding how to talk with clients about gender outside of a diagnostic framework.

Effects of Including Gender Pronoun Questions in Surveys

This research examines whether the mere presence of asking about gender pronouns (e.g., she/her, he/him, they/them, and ze/zir) in a survey enhances participants’ attitudes and satisfaction of answering the questions. A large sample (N = 1,511) of heterosexual, cisgender, and LGBTQIA+ participants across the United States (US) were surveyed an online “personality test” (as a deception), with the real purpose of examining whether asking a pronoun question enhanced their perceptions of the survey. Three demographic groups were included: (i) heterosexual–cisgender (n = 503), (ii) gay–cisgender (n = 509), and (iii) genderqueer (trans, non-conforming, other, n = 499). Half of each group were randomly given either a survey that included a gender pronoun question (test) or not (control), and then all rated their perceptions of the survey questions. For participants who identified as heterosexual or gay, no major differences were found between survey conditions. However, participants who identified as genderqueer experienced significant increases of satisfaction, comfort level, and perceived relevance of the questions when given a survey that asked their gender pronouns versus the survey that did not. These findings have implications for any surveys that ask about personal demographics, and suggest that any form of written communication should include clarity about gender pronouns.

A Scoping Review of Gender, Sex and Sexuality Differences in Polysubstance Use in Adolescents and Adults

BACKGROUND

Polysubstance use is a common, problematic behavior that increases risk of harm to self and others. Research suggests that rates may vary based on gender, sex and sexuality. Understanding the current state of this literature may inform prevention and treatment of polysubstance use, leading to reduced public health burden.

OBJECTIVES

This review aimed to synthesize research on gender, sex and sexuality differences in polysubstance use in adults and adolescents.

METHODS

A scoping review was conducted using all EBSCO databases, PubMed and Google Scholar to identify articles examining the effects of gender, sex and sexuality on polysubstance use. Polysubstance use was defined broadly as the use of any combination of substances over any time period and included licit (alcohol, tobacco) and illicit substances, concurrent and simultaneous use, from lifetime to daily use and use at any frequency. Studies were considered if they were published in peer-reviewed journals between January 1990 and October 2020 and were written in English. Publicly available data sources were also utilized to fully capture prevalence data that has not been published elsewhere.

RESULTS

Findings were mostly inconsistent and often conflicting. Only two findings were generally consistent: adult men were overall more likely to report polysubstance use than adult women, and sexual and gender minorities report more frequent polysubstance use than non-minorities.

CONCLUSIONS

Research has been unable to clearly elucidate differences in polysubstance use prevalence and patterns according to gender, sex and sexuality. Several recommendations are offered to advance future research and address limitations of current research.

Sex and Gender Related Differences in Diabetic Kidney Disease

Diversity in sex and gender are important considerations in the pathogenesis, prognostication, research, and management of diabetic kidney disease (DKD). Sex and gender differences in the disease risk, disease-specific mechanisms, and outcomes in DKD may be attributed to biological differences between males and females at the cellular and tissue level, inconsistencies in the diagnostic and assessment tools used in chronic kidney disease and DKD, as well societal differences in the way men, women, and gender-diverse individuals self-manage and interact with health care systems. This review outlines key considerations related to the impact of sex on DKD, specifically elaborating on how they contribute to observed differences in disease epidemiology, pathogenesis, and treatment strategies. We also highlight the effect of gender on DKD progression and care.

Transgender data collection in the electronic health record: Current concepts and issues

There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.

"Having a non-normative body for me is about survival": Androgynous body ideal among trans and nonbinary individuals

The present study focused on trans and nonbinary (TNB) individuals who have an androgynous or non-stereotypical body ideal, with attention to how their body ideal is conceptualized and maintained. Data were collected online from 76 TNB individuals. Based on responses to two open-ended prompts, a two-tiered analysis was conducted. First, thematic analysis was used to develop four central themes describing the way TNB individuals conceptualized their androgynous body ideal: 1) Attaining Neutrality and De-Categorizing Gender; 2) Disaggregating Gender Expression; 3) Managing Gender Dysphoria; and 4) Achieving Authenticity. Second, content analysis was used to document 12 behaviors engaged in or actions taken for the purpose of approaching or maintaining an androgynous or non-stereotypical body ideal. These were grouped into 3 main categories: gender expression (clothes, hair, make-up, body modifications), body shape (weight, muscularity, eating/diet), and sex characteristics (hormone therapy, body hair, vocal, chest, genitals). Results of the present study expand the current body ideal literature by including TNB narratives and by focusing specifically on the ways an androgynous body ideal is conceptualized and maintained. Research and clinical implications are discussed.

Is lesbian identity obsolete? Some (limited) answers and further questions from a unique philology of human behavioral science perspective

Many scholarly disciplines focusing exclusively on human behavior can and do approach philology in some form in the conduct of their analyses, especially implicitly. "Philology" is generally understood to mean a study of oral and written records, particularly in their original form to determine either their authenticity and/or their original meaning-especially at the time of their development and delivery. This present article sketches a philology of human behavioral science perspective to make explicit what is largely implicit in the conduct of the science (most notably in psychological science) to answer the provocative question of this special issue ("Is lesbian identity obsolete?"). From this new perspective, I ask and answer (to the extent possible) three interrelated questions about the current or future obsolescence of the concept "lesbian identity." The first question is whether lesbian identity like predecessor terms for the larger concept will become obsolete in the future. A second question is whether lesbian identity should become obsolete based on its potentially less inclusive meaning-either (a) from the origin terms that comprise it or (b) in comparison to other terms in the lexicon at present. A third question concerns whether lesbian identity may wane now (at the time of this writing) and then wax again in the future (some decade[s] later from this writing).

Integrating Sex/Gender into Environmental Health Research: Development of a Conceptual Framework

There is a growing awareness about the need to comprehensively integrate sex and gender into health research in order to enhance the validity and significance of research results. An in-depth consideration of differential exposures and vulnerability is lacking, especially within environmental risk assessment. Thus, the interdisciplinary team of the collaborative research project INGER (integrating gender into environmental health research) aimed to develop a multidimensional sex/gender concept as a theoretically grounded starting point for the operationalization of sex and gender in quantitative (environmental) health research. The iterative development process was based on gender theoretical and health science approaches and was inspired by previously published concepts or models of sex- and gender-related dimensions. The INGER sex/gender concept fulfills the four theoretically established prerequisites for comprehensively investigating sex and gender aspects in population health research: multidimensionality, variety, embodiment, and intersectionality. The theoretical foundation of INGER's multidimensional sex/gender concept will be laid out, as well as recent sex/gender conceptualization developments in health sciences. In conclusion, by building upon the latest state of research of several disciplines, the conceptual framework will significantly contribute to integrating gender theoretical concepts into (environmental) health research, improving the validity of research and, thus, supporting the promotion of health equity in the long term.

Self-Compassion and Reactions to a Recalled Exercise Lapse: The Moderating Role of Gender-Role Schemas

Exercise is good for health and well-being, yet people experience lapses when trying to adhere to exercise. Self-compassion may help people cope with exercise lapses. Most research on self-compassion and exercise has been conducted with women; men may also benefit from self-compassion. No research has examined whether gender-role schema influences responses to exercise lapses. The authors examined both male and female adult exercisers (N = 220) who reported their self-compassion, recalled an exercise lapse, their reactions to the lapse, and their self-identification of masculinity and femininity. After controlling for self-esteem, age, and lapse importance, self-compassion negatively related to emotional responses (p < .001), rumination (p < .001), extrinsic motivation (p = .004), and positively related to intrinsic motivation (p < .001). Masculinity moderated the relationships between self-compassion and amotivation (p = .006), and identified regulation (p = .01). Self-compassion may be an effective resource for exercisers, especially those who identify as highly masculine.

Multidimensional and Intersectional Gender Identity and Sexual Attraction Patterns of Adolescents for Quantitative Research

To identify and compare gender identity and sexual attraction (GISA) patterns using a latent class analysis (LCA), questionnaire data from a cross-sectional study on social resilience in adolescence was conducted in 2020, using a sample of 785 Swiss seventh grade high school students. Following McCall’s complex intersectionality approach, we applied an intracategorical and intersectional approach to reshape, differentiate, and critique the existing binary, heteronormative GISA categorization. To empirically validate the detected classes according to content, we measured the participants’ psychological characteristics with measures of self-esteem, social competence, symptoms of anxiety and depression, dissociation, social desirability, and emotional styles, and related these measures to the respective GISA patterns the LCA detected. The results of our multistep LCA endorsed that heteronormatively binary gender identities are far too simplistic to fully illustrate adolescents’ differences and similarities where gender is concerned. Out of the subsample of n = 785 adolescents (375 identified as “assigned females” and 410 “assigned males”), three significant subgroups of multidimensional GISA patterns emerged for both assigned females and males where differences within the identified GISA groups were larger than those between traditional “boys” and “girls” overall. The LCA demonstrated that the six classes with GISA indicators could be described as low GISA diverse (cis/heterosexual), intermediate GISA diverse (gender identity diverse and/or sexual diverse), high GISA diverse (gender diverse/sexual diverse) for both assigned males and females thus showing that GISA and the psychological state according to gender variance is greater within groups of assigned females and assigned males than between these groups.

Comparing conceptions of gender, sexuality and lesbian identity between baby boomers and millennials

To answer this special issue provocation, Is Lesbian Identity Obsolete? we analyzed interviews with people who had identified at some point in their lives as lesbians, or as women/femmes who were attracted to women - some of them part of the Baby Boomer generation and some part of the Millennial generation. Participants from both generations rejected the gender binary. Nevertheless, we found a shift away from understanding gender as an oppressive category to an understanding of gender as a proliferating identity in which one may play with gender in an intentional and creative manner. It appears that participants across generations articulated their sexual identities strategically to express not only a sexual orientation but more importantly political and community alliances. For Baby Boomer lesbians, lesbian identity connoted an alliance with feminism, and for Millennials their sexual identity indicated a political alliance with queer and trans* movements. In order to sustain solidarity between lesbians of different generations, we suggest that narratives about gender should include both intrinsic and extrinsic components. We further suggest that the political project of ending the oppression of all lesbians/women who love women is fraught, but essential in a world that hates women.

Sex-differences in symptoms and functioning in >5000 cancer survivors: Results from the PROFILES registry

BACKGROUND

Previous reports highlight the greater number of side effects that women experience during cancer treatment, but little is known about sex differences in symptoms and functioning in long-term survivors.

METHODS

We investigated sex differences in the prevalence of physical (EORTC QLQ-C30) and emotional symptoms (Hospital Anxiety and Depression Scale) and loss of functioning (EORTC QLQ-C30) in 5339 cancer survivors (55% males). General linear models were computed to assess the differences in symptoms and functioning between female and male cancer survivors and between survivors and an age-matched reference population.

RESULTS

The direct comparison between female and male cancer survivors identified more symptoms, such as nausea and vomiting (M = 5.0 versus. 3.2), insomnia (M = 26.1 versus. 15.9), anxiety (M = 5.2 versus. 4.2), and lower physical (M = 77.5 versus. 82.5) and emotional functioning (M = 83.4 versus. 86.3), in female survivors. However, comparison with an age-matched reference population demonstrated that several symptoms, such as fatigue, dyspnea, anxiety and depression, appeared to be more frequent in male patients. The investigation of functioning domains - compared with a reference population - highlighted further sex-specific differences. Female survivors experienced a moderate net loss in physical and cognitive functioning (-6.1 [95% CI = -8.1; -4,1] and -5.2 respectively [95% CI = -7; -3.5]), whereas male survivors displayed a significant net loss in role and social functioning compared to the reference population (-9.9 [95% CI = -11.2; -8.6] and -7.7 [95% CI = -9.6; -7.6] respectively).

CONCLUSION

To adequately capture sex differences in symptoms and functioning in long-term cancer survivors, a comparison with a reference population should always be considered. In our study population, this adjustment highlighted a significant and unexpected long-term impact on male patients. Role and social functioning were especially impacted in male patients, emphasizing the need to further investigate these gendered domains.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

Gender Diversity in Peer Relations: Best Research Practices and Marshalling Peer Influence

Young people are challenging gender to expand beyond a male/female binary, yet research practices still lag behind these conceptions. This call-to-action paper will review the traditional conceptualizations of gender as prevalent in peer relations research, contrasted with modern approaches from scholars studying gender and sexual orientation diversity, and outline how youth are challenging binary conceptualizations. We provide recommended best practices to sensitively bridge this gap, including: using open responses where possible, and two-step closed-ended question formats where necessary, to measure gender identity; considering the context and role that gender identity and each of its facets might play in the research design; and preserving underrepresented groups even though they may be small. We close by exploring the ways in which the power of peer socialization can be (and likely currently are being) harnessed to support the ever-changing, diverse gender identities emergent in today's youth, and provide questions for future research.

Gender Categories as Dual-Character Concepts?

Seminal work by Knobe, Prasada, and Newman (2013) distinguished a set of concepts, which they named "dual-character concepts." Unlike traditional concepts, they require two distinct criteria for determining category membership. For example, the prototypical dual-character concept "artist" has both a concrete dimension of artistic skills, and an abstract dimension of aesthetic sensibility and values. Therefore, someone can be a good artist on the concrete dimension but not truly an artist on the abstract dimension. Does this analysis capture people's understanding of cornerstone social categories, such as gender, around which society and everyday life have traditionally been organized? Gender, too, may be conceived as having not only a concrete dimension but also a distinct dimension of abstract norms and values. As with dual-character concepts, violations of abstract norms and values may result in someone being judged as not truly a man/woman. Here, we provide the first empirical assessment of applying the dual-character framework to people's conception of gender. We found that, on some measures that primarily relied on metalinguistic cues, gender concepts did indeed resemble dual-character concepts. However, on other measures that depicted transgressions of traditional gender norms, neither "man" nor "woman" appeared dual-character-like, in that participants did not disqualify people from being truly a man or truly a woman. In a series of follow-up studies, we examined whether moral norms have come to replace gender role norms for the abstract dimension. Implications for the evolution of concepts and categories are explored.

"A little shiny gender breakthrough": Community understandings of gender euphoria

BACKGROUND

Gender euphoria is an important experience and concept for many, especially transgender and/or nonbinary individuals, but has not received much attention from psychological and clinical research. In contrast to gender dysphoria, which originates in psychiatry, the term "gender euphoria" has been mobilized by some LGBTQ people to describe the powerfully positive emotions that can come from one's gender/sex. As such, researchers and clinicians may benefit from conceptual clarity as to what gender euphoria is and what kinds of experiences might result in gender euphoria.

AIM

We aimed to better understand how trans community members and others conceptualize the term "gender euphoria," including its relationship to gender dysphoria, as well as the contexts and behaviors that elicit gender euphoria.

METHOD

We administered an online qualitative survey to participants (N = 47) of diverse sexualities and gender/sexes (including transgender, cisgender, and/or nonbinary participants) who had heard of or used the term "gender euphoria." Participants answered open-ended questions about where they had heard the term being used, how they would define gender euphoria and gender dysphoria, the relation between these terms, and their gender euphoric experiences.

RESULTS

Analyses resulted in five themes: (1) gender euphoria describes a joyful feeling of rightness in one's gender/sex, (2) gender euphoric experiences can be external, internal, and/or social, (3) "gender euphoria" originated in and circulates in online and in-person gender/sex minority communities, (4) dysphoria describes a negative feeling of conflict between gender/sexed aspects of one's self, and (5) the relationship between euphoria and dysphoria is complex.

DISCUSSION

These results can inform qualitative and quantitative research, gender affirmative clinical practice, political fights for transgender rights, and understandings of gendered experiences for people of all identities.

"There Is Nothing to Do About It": Nonbinary Individuals' Experience of Gender Dysphoria

Purpose: Clinical definitions of gender dysphoria have primarily centered on a binary conceptualization of gender. This study aimed to understand nonbinary transindividuals' experiences of gender dysphoria. Methods: Data were collected online from a nonclinical sample comprised of 205 nonbinary and agender participants. Analysis focused on answers to a single open-ended question prompting participants to describe their gender dysphoria as it relates to their body and/or appearance. Results: First, content analysis was used to document 11 contextual elements in which participants described their dysphoria with regard to three overarching categories, including no gender dysphoria (no issues with body, no dysphoria), aspects of gender/sex (naming gender identity, naming assigned sex, gender role, or expression), and aspects of body (body shape, genitals, chest, secondary sex characteristics, hormones, reproductive capability). Second, thematic analysis revealed six central themes describing the unique way gender dysphoria is experienced by nonbinary individuals: (1) Androgyny or Fluidity, (2) Feminine and Masculine Traits, (3) Dysphoria vs. Expression or Appearance, (4) Varying or Shifting Dysphoria, (5) No Solution, and (6) Trade-off/Loss. Conclusion: Results of this study suggest that nonbinary transindividuals experience gender dysphoria in unique ways. These findings highlight the need to develop clinical assessments of gender dysphoria that reflect nonbinary experience, and to outline explicit medical protocols for interventions tailored to achieve a desired outcome of physical androgyny.

'None of my providers have the slightest clue what to do with me': Transmasculine individuals' experiences with gynecological healthcare providers

Background: Transgender individuals experience barriers to accessing healthcare including financial difficulties, lack of insurance, and discrimination and victimization by medical providers. Transmasculine patients face unique challenges and are more at risk for reproductive pathology resulting from a lack of regular gynecological care. Presently, a dearth of research exists on the needs of transmasculine patients in gynecological healthcare settings. While the literature on experiences of transmasculine individuals has focused on physical health and risk factors for this population, this study focuses on the information that transmasculine individuals want their gynecologists to know when working with trans patients. Aim: The aim of the present study was to explore the lived experiences of transmasculine individuals in order to understand what they feel their medical providers need to know about their experiences seeking gynecological care. Method: Participants included 167 adults who identified as masculine of center or trans men ranging in age from 18 - 56 (M = 27.99, SD = 6.06). Participants completed an online survey and responded to open-ended questions about their gynecological healthcare experiences. Qualitative responses were analyzed via thematic analysis. Results: Results revealed four information-salient themes, including: 1) Patient comfort levels; 2) Language; 3) Provider assumptions; and 4) Provider knowledge. Conclusions: Findings suggest that gynecologists are key in both exacerbating barriers and creating more affirming spaces for transmasculine patients. Discussion of the results focuses on the ways that providers can improve the gynecologic healthcare experiences of their transmasculine patients.

Fluidity of gender identity induced by illusory body-sex change

Gender identity is a collection of thoughts and feelings about one’s own gender, which may or may not correspond to the sex assigned at birth. How this sense is linked to the perception of one’s own masculine or feminine body remains unclear. Here, in a series of three behavioral experiments conducted on a large group of control volunteers (N = 140), we show that a perceptual illusion of having the opposite-sex body is associated with a shift toward a more balanced identification with both genders and less gender-stereotypical beliefs about own personality characteristics, as indicated by subjective reports and implicit behavioral measures. These findings demonstrate that the ongoing perception of one’s own body affects the sense of one’s own gender in a dynamic, robust, and automatic manner.

Methods and strategies for effectively surveying the LGBTQ+ population

The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population is at a substantially elevated risk for myriad health complications, due in large part to structural and social inequities. As such, the LGBTQ population is an important demographic to survey regarding their health. As with many populations facing inequality, the LGBTQ population is often hard to sample. In light of this challenge, several approaches may be required in order to effectively surveying this population. Specifically, advances in sampling methodologies, leveraging community partnerships, and culturally aware question design appear to increase the likelihood of a successful LGBTQ-focused health survey. The Southern LGBTQ Health Study is examined as a case study in effectively conducting a large, multi-state LBTQ health survey. They used a simple snowball sampling strategy where their online health survey was distributed through a wide network of community organizations across several states. They also employed members of the LGBTQ community as "Survey Ambassadors" to help recruit their peers to participate in the study. This case study demonstrated several successful methods. Their combined sampling methodology resulted in almost 6000 respondents. Their question for sexual orientation ("Check all that apply") resulted in rich, easy to interpret data and was well received by the participants. However, this case study also provided valuable learning opportunities. Had they used a more formalized approach to their sampling, they would have had greater generalizability to their target population. Also, the use of an open-ended question regarding gender identity generated data that was not conducive to formal analysis without significant resources dedicated to cleaning the data.

Qualitative Study of the Processes of Transgender-Men Identity Development

OBJECTIVE

Describe and analyze the mental health service and medical needs of a group of transgender men from the point when they changed their gender identity to male.

MATERIAL AND METHOD

Transgender men volunteers who attended a specialized care center in Mexico City answered a qualitative semi-structured interview to explore their needs as well as the adversities they unnecessarily face due to the lack of information and care for their condition. Interviews were audio-recorded and transcribed for thematic analysis.

RESULTS

Respondents began to develop their transgender identity in childhood; however, during that time, almost none of them had any helpful contact with a health professional. Those who did receive some form of care received mistreatment rather than positive feedback. It was not until adulthood that they obtained facts about a specialized care center.

CONCLUSION

It is necessary for health professionals to have information about sexual diversity and be trained to meet the needs of transgender children, in order to have information on places and professionals who accompany them and advise on available treatments such as hormone blockers or treatments. The study includes a small but important sample. However, the currently hostile, discriminatory environment, significantly exposes transgender people to developing mental health problems.

Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals

The present research explored transgender individuals' subjective ratings of two clinical measures of gender dysphoria: the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) and the Utrecht Gender Dysphoria Scale (UGDS). Participants read each scale and provided a global rating regarding how well they captured their experiences of gender dysphoria. Participants included 622 transgender individuals who identified as transfeminine (n = 221), transmasculine (n = 206), and non-binary/agender (n = 195). Findings indicated clear patterns of responses across gender identity and assigned sex, but not clinical diagnosis. For the GIDYQ-AA, transfeminine and transmasculine individuals rated the scales more positively than did non-binary/agender individuals. In addition, participants who were assigned male rated the scale to be a more accurate measure of their dysphoria than did participants who were assigned female. For the UGDS, transfeminine individuals rated the scale most positively, followed by transmasculine individuals, and then non-binary/agender individuals. All pairwise comparisons were significant. Likewise, participants who were assigned male rated the scale to be a more accurate measure than did those who were assigned female. It is important to note that subjective ratings were relatively low (M = 3.40, SD = 1.09 for GIDYQ-AA; M = 3.43, SD = 1.22 for UGDS on a 5-point scale) where little more than half of the participants (52.5% GIDYQ-AA; 54% UGDS) agreed or strongly agreed that the scales captured their experience. Discussion focused on the implications for using these measures of gender dysphoria in both clinical and research settings.

Sexual and Gender Diversity Among Sexual and Gender/Sex Majorities: Insights via Sexual Configurations Theory

Recent research on gender and sexual majority individuals suggests that their attractions, identities, and experiences may not be as homogenous or easily generalizable as is often assumed. Sexual configurations theory (SCT; van Anders, 2015) is a framework for conceptualizing individuals' partnered sexualities and gender/sexes with a focus on gender/sex and sexual diversity. SCT has been successfully used in recent empirical work with gender and sexual minority individuals (Schudson, Manley, Diamond, & van Anders, 2018), but it has not yet been tested with heterosexual, cisgender individuals. In the present study, we tested the use of SCT in qualitative interviews with 26 gender and sexual majority participants to address the following research questions: What are the strengths and weaknesses of SCT for representing heterosexual, cisgender individuals' gender/sexes and partnered sexualities? How do gender and sexual majority individuals use SCT to express their gender/sexes and partnered sexualities? And, what insights about sexual and gender diversity can be gained from using SCT with a gender and sexual majority sample? Using thematic analysis, we evaluated how participants interacted with SCT and the SCT diagrams. Results showed that our participants used components of SCT to convey comprehensive and nuanced interests, which included gender/sex and sexual diversity outside of what is typically expected in research on heterosexual, cisgender individuals. We discuss findings and challenges specific to working with majority participants and offer implications for future work on gender/sex and sexual majorities and on gender/sex and sexual diversity in general.

Gender/Sex, Sexual Orientation, and Identity Are in the Body: How Did They Get There?

In this review, I explore theoretical and empirical approaches to the development of gender/sex and sexual orientation (SO). Leaving behind the nature versus nurture opposition, I look at both identities as deeply embodied. My approach intertwines sex, gender, orientation, bodies, and cultures without a demand to choose one over the other. First, I introduce basic definitions, focusing on how intertwined the concepts of sex and gender really are. I affirm recent trends to consider a new term-gender/sex-as the best way to think about these deeply interwoven bodily traits. I introduce several literatures, each of which considers the processes by which traits become embodied. These points of view offer a basis for future work on identity development. Specifically, and selectively, I provide insights from the fields of phenomenology, dyadic interaction and the formation of presymbolic representations in infancy, and dynamic systems in infant development. I consider how thinking about embodied cognition helps to address intersubjectivity and the emergence of subjective identity. Next, I review what we currently know about the development of complex sexual systems in infancy and toddlerhood. Finally, I discuss the few existing theories of SO development that consider the events of infancy and childhood.

Queer Intimacies: A New Paradigm for the Study of Relationship Diversity

Recognition of sexual and gender diversity in the 21st century challenges normative assumptions of intimacy that privilege heterosexual monogamy and the biological family unit, presume binary cisgender identities, essentialize binary sexual identities, and view sexual or romantic desire as necessary. We propose a queer paradigm to study relationship diversity grounded in seven axioms: intimacy may occur (1) within relationships featuring any combination of cisgender, transgender, or nonbinary identities; (2) with people of multiple gender identities across the life course; (3) in multiple relationships simultaneously with consent; (4) within relationships characterized by consensual asymmetry, power exchange, or role-play; (5) in the absence or limited experience of sexual or romantic desire; (6) in the context of a chosen rather than biological family; and (7) in other possible forms yet unknown. We review research on queer relational forms, including same-sex relationships; relationships in which one or more partners identify as transgender, gender nonbinary, bisexual, pansexual, sexually fluid, "mostly" straight, asexual, or aromantic; polyamory and other forms of consensual nonmonogamy; kink/fetish relationships; and chosen families. We argue that a queer paradigm shifts the dominant scientific conception of relationships away from the confines of normativity toward an embrace of diversity, fluidity, and possibility.

"I love you as both and I love you as neither": Romantic partners' affirmations of nonbinary trans individuals

Background: Transgender microaffirmations are subtle endorsements of a person's gender identity through both verbal acknowledgements and behavioral gestures. Microaffirmations positively impact individuals who identify as transgender by acknowledging their gender identity and by communicating a sense of support and validation. Aims: This study focuses on microaffirmations specifically directed toward nonbinary transgender individuals within romantic relationships. Methods: Participants included 161 adults who identified as nonbinary: 85 who identified as gender nonconforming and 76 who identified as agender. These participants were either currently in a romantic relationship or had been in a romantic relationship within the past 5 years. Participants completed an online survey and provided examples of the microaffirmations they experienced from their romantic partners. Results: Responses were analyzed via thematic analysis, resulting in four overarching themes: (1) Identity Validations, acknowledgement and acceptance of nonbinary identity; (2) Identity Endorsements, active endorsements of nonbinary through language or behavior; (3) Active Learning, self-education about nonbinary identities; and (4) Active Defense, interruptions of others' negative actions directed at nonbinary partners. Discussion: Discussion of the results focuses on understanding how microaffirmations operate to complicate binary notions of gender/sex and positively influence nonbinary transgender individuals in interpersonal relationships.

How Gender Identity and Transgender Status Affect Perceptions of Attractiveness

Can a perceiver’s belief about a target’s transgender status (distinct from gender nonconforming appearance) affect perceptions of the target’s attractiveness? Cisgender, heterosexual men and women ( N = 319) received randomly assigned labels (cisgender cross-gender, transgender man, transgender woman, or nonbinary) paired with 48 cross-sex targets represented by photos and rated the attractiveness and related characteristics of those targets. The gender identity labels had a strong, pervasive effect on ratings of attraction. Nonbinary and especially transgender targets were perceived as less attractive than cisgender targets. The effect was particularly strong for male perceivers, and for women with traditional gender attitudes. Sexual and romantic attraction are not driven solely by sexed appearance; information about gender identity and transgender status also influences these assessments. These results have important implications for theoretical models of sexual orientation and for the dating lives of transgender people.