Research examining health disparities among gender minorities (transgender, transsexual, and other gender nonconforming individuals) has reached a stage where population based studies are needed in order to expand upon what smaller, community based studies have found.

However, the diversity of terminology and operationalization of various gender minority groups has made it difficult to identify a measure that can be used globally.

At the same time, it will be necessary to create a measure that can be understood by gender majority populations and correctly differentiate between gender majority and minority populations.

One concept that stands out is gender identity/gender transition.  Gender identity/gender transition is defined by people’s answers to two questions, one asking about one’s sex assigned at birth and another about their current sex or gender.  This “two-step” question is being advocated by the Center of Excellence for Transgender Health.

A preliminary study utilizing the National Transgender Discrimination Survey (NTDS) conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force examined the relationship between gender identity/gender transition and discrimination.  A dichotomous measure was based on two questions:

The measure identified those whose primary gender identity was consistently different from their sex assigned at birth (yes versus no).

Another concept is that of gender nonconformity.  Gender nonconformity was measured by a single question “People can tell I’m transgender/gender non-conforming even if I don’t tell them?”.  The variable ranged from zero (never) to four (always).

Plotting these two variables against people’s experiences with discrimination resulted in the following:

Those who were identified as having a gender different from their assigned sex were found to report more experiences of discrimination; even at higher levels of gender nonconformity.

The above data was found to show that a two-step gender identity question could be useful in identifying those likely to experience greater social disparities among transgender populations.  The next step was to examine whether gender majority individuals can understand and answer these questions in a way that represents their gender majority status.

Another study (funded by the Williams Institute, UCLA) examined gender identity/gender transition measures by conducting cognitive interviews with 50 people (25 gender minority, 25 gender majority).  The interviews asked people to read and answer the questions; afterwards they were interviewed about why they answered the way they did.

The study utilized these questions:

• Male
• Female
• Other: Please specify: _____________________

• Male
• Female
• Unknown or Question Not Asked
• Decline to State

The results show that individuals within the gender majority group consistently answered these questions in a manner that identified their gender majority status.  If they answered male (or female) in the first question, they also answered male (or female) for the second; whereas, individuals within the gender minority group had different answers for both questions, and a small number used the “other” option for the first question.

Overall, the two-step question was effective and easily understood by both groups.

• Individuals within the gender majority group were able to answer the question about sex assigned at birth even though they never heard the phrase before.  They knew what it was referring too.
• Most people in both groups see gender as an identity
• People generally felt these two questions were easy to answer.
• Gender minority group generally saw a difference between the terms sex and gender, but the gender majority group tended to see the terms to be the same.

The next step is to utilize these measures in a quantitative study with gender majority and minority populations to see how effective they are in the field.