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Gender identity and gender expression.

Jama Shelton Jama Shelton Hunter College, City University of New York
https://doi.org/10.1093/acrefore/9780199975839.013.1324
Published online: 21 June 2023

Gender identity and gender expression are aspects of personal identity that impact an individual across multiple social dimensions. As such, it is critical that social workers understand the role of gender identity and gender expression in an individual’s life. Many intersecting factors contribute to an individual’s gender identity development and gender expression, as well as their experiences interacting with individuals, communities, and systems. For instance, an individual’s race, geographic location, disability status, cultural background, religious affiliation, age, economic status, and access to gender-affirming healthcare are some of the factors that may impact experiences of gender identity and gender expression. Gender identity and expression are dimensions of diversity that social workers will interact with at all levels of practice. As such, it is important for social work educational institutions to ensure their students are prepared for practice with people of all gender identities and expression, while also understanding the historical context of the social work profession in relation to transgender populations and the ways in which the profession has reinforced the sex and gender binaries.

gender binary
gender equity
gender identity
gender expression

What Are Gender Identity and Gender Expression?

Every individual has a gender identity, and every individual expresses their gender (see Table 1 ). Gender identity and gender expression are often referenced in relation to transgender, nonbinary, and gender-expansive people, yet one’s gender and the expression of gender are dimensions of identity that every individual possesses. Gender identity can be understood as an individual’s internal sense of self as it relates to gender. One’s gender is a deeply felt, personal sense of self as a girl/woman, boy/man, both a girl/woman and a boy/man, neither a girl/woman nor a boy/man, or a combination of a girl/woman and a boy/man. Additional words people may use to describe their gender include (but are not limited to): nonbinary, gender expansive, agender, multigender, two-spirited, gender-fluid, genderqueer, and muxe. Importantly, there is no external source that can dictate an individual’s gender identity.

Gender expression refers to the ways in which an individual expresses their gender outwardly. Gender expression may include an individual’s dress, hairstyle, mannerisms, and behaviors. These are typically based on stereotypes about gender within a particular cultural context. An individual’s gender expression may or may not conform to social norms that are typically associated with an individual’s gender or with gendered assumptions based on an individual’s assigned sex. Importantly, an individual’s gender presentation may or may not reflect their gender identity. Issues such as personal safety and access to accurately gendered items may impact an individual’s ability to express their gender in a way that aligns with their gender identity.

Table 1. Additional Relevant Terms

The sex and gender binaries.

The terms gender and sex are often used interchangeably. While these terms may be related in some instances, they are not the same. An individual’s sex is connected to their chromosomes, hormones, and anatomy. Typically, an individual is assigned a sex at birth, if not prior to birth. A sex assignment is most often made based on the appearance of a baby’s genitals. The options for sex assignment have historically been either male or female, which is then listed on an individual’s birth certificate. This is still often the case in the United States, even though evidence demonstrates that sex is not a binary construct ( Fausto-Sterling, 2018 ). Some states in the country allow an additional option (X) for the classification of sex on the birth certificate. While it is beyond the scope of this article to examine the category of intersex (discussed in “XXX”), intersex people cannot be overlooked in discussions of sex and gender. The binary construction of sex assumes the existence of only two sexes. This is an inaccurate and limiting construct that ignores human variability. Not only is it inaccurate and limiting, it is also harmful. Intersex babies and children often undergo surgical procedures that they do not consent to, and are required to take hormones in order to make their bodies fit within a binary that their bodies directly challenge.

An individual’s gender is most often presumed based on their sex assignment, and is presumed to fall within the binary gender categories of girl/woman and boy/man. For instance, if a baby is assigned female, the assumption is that the baby is a girl and will grow up to be a woman. With this assumption comes a set of gendered norms and expectations, societally reinforced in myriad ways including options for grooming and dress, presumptions about appropriate behavior and presentation, and even the choice of language used to praise or discipline (“such a pretty girl” or “that’s not ladylike”). However, an individual’s assigned sex does not always predict their gender; gender identity is more strongly linked to an individual’s experience of gender than to assigned sex ( Olson et al., 2015 ). Yet, the connection between an individual’s sex and their gender and the binary constructions of both sex and gender are so widely taught that this misperception is pervasive in the United States and in many Western countries despite the fact that “defining gender as a condition determined strictly by a person’s genitals is based on a notion that doctors and scientists abandoned long ago as oversimplified and often medically meaningless” ( Grady, 2018 ). In addition to the limitations of these binary categories, sex and gender are often viewed as immutable and stable over time. The lived experiences of intersex, nonbinary, transgender, and gender-expansive people demonstrate the inaccuracy of the binary system of sex and gender categorization.

It is important to note that an individual’s identification within the gender binary is not itself problematic. Because many laws and policies in the United States are based on a binary construction of sex and/or gender, it is the classification system itself that is flawed. Binary classifications are problematic when identification with the gender binary and associated gender expressions are required for entry within social and legal systems.

Beyond the Binary: Reconceptualizing Gender Identity and Gender Expression

Some think about gender identity and gender expression as a continuum, with binary classifications marking the endpoints and a range of identities and expressions in between. More contemporary understandings assert that gender identity and gender expression exist more as a “galaxy” rather than a continuum ( Action Canada for Sexual Health and Rights, n.d. ). This thinking is more in alignment with moving beyond binary conceptualizations of gender altogether and situates all gender identities and gender expressions as equally viable, without relying on the containment of binary categories.

Moving beyond the gender binary not only improves the lived experiences of transgender, nonbinary, and gender-expansive people but also opens up possibilities for everyone . The construct of gender carries with it prescribed ways of being ranging from what is “appropriate” physical and behavioral gender expression to what are appropriate fields of study and career choices. Truly moving beyond the gender binary can liberate all people from the constraints inherent in presumptive and prescribed notions of what is deemed socially, culturally, and politically appropriate.

How could moving beyond the gender binary be operationalized within the social work profession? Prior to discussing suggestions for moving beyond the binary in social work education, practice, and research, it is important to first examine the history of the social work profession as it relates to gender identity and gender expression.

Social Work, Gender Identity, and Gender Expression: A Brief History

Historically, the social work profession is rife with demands that nonconforming gender expressions and bodies adapt to mainstream gendered expectations. Examples include the profession’s support for the assimilative Native American Residential Schools, electroconvulsive therapies intended to “cure” homosexuality, and a host of welfare eligibility requirements that serve to police Black families for their deviation from White heteronormative standards ( Bowles & Hopps, 2014 ). Thus, common practices centered around promoting access to resources through acclimating and gaining membership to the status quo. As such, the profession of social work has been complicit in the policing of gender and the maintenance of the gender binary. It is important for the profession to reckon with this disciplinary approach to gender identity and expression in the past, while also developing equitable frameworks for the future.

The primary formal mechanism for the policing of gender and, thus the reification of the gender binary, is the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gender identity disorder was first included in the DSM-III in 1980 , and included the diagnoses “gender identity disorder of childhood” and “transsexualism.” When updated in 1987 , the new DSM-III-R included gender identity disorder of adolescence and adulthood, nontranssexual type ( Drescher, 2009 ). Gender identity disorder of adolescence and adulthood, nontranssexual type, was removed from the DSM-IV and replaced with the category gender identity disorder, a diagnosis encompassing both gender identity disorder of childhood and transsexualism ( Shelton et al., 2019 ). The most recent version of the DSM (the DSM-5) replaced gender identity disorder with gender dysphoria. This shift in diagnostic terminology signifies a change in the understanding of the root causes of the challenges individuals face when their gender identity and gender expression fall outside of the dominant societal norms prescribed to the gender associated with their assigned sex. Namely that societal definitions of and expectations surrounding gender do not accurately reflect people’s lived experience of gender. However, the fact that a mental health diagnosis remains in the DSM is considered problematic by many, as gender related dissonance continues to be constructed as individual pathology.

The DSM solidified the notion of a gendered norm any deviation from which required correction. For decades, the remedy was to fit an individual into a gender that aligned with the expectations associated with their assigned sex. Through modern medicine, a new type of “correction” emerged for those who could gain access, through hormone treatment and affirming surgeries. Though these interventions are medical in nature, the psychiatric diagnoses remain a driving force in accessing these treatments. Further, gender-affirming treatments have reinforced the necessity of binary gender conformity, by supporting an individual in their transition from one gender to the other gender. It is important to note here that these treatments have been and continue to be life-saving for many individuals, and that identifying with the gender binary is not in itself problematic. As already stated, the gender binary is problematic when a binary classification is imposed and/or presumed and is not in alignment with an individual’s stated gender and understanding of their own body ( Ansara & Hegarty, 2012 ), and when identification or categorization within the gender binary is required for entry into and acceptance within social and legal systems ( Shelton et al., 2019 ).

The National Association of Social Workers released a position statement denouncing the continued inclusion of gender identity related diagnoses in the DSM-5, stating that diagnoses such as gender dysphoria should be approached from a medical model rather than a mental health model. Because of the authority that the DSM holds in social work and related professions, the inclusion of gender dysphoria perpetuates the notion that the variability of gender is a psychiatric condition, reinforcing cisnormativity and the binary gender system. Advocacy organizations argue that until gender related diagnoses are removed from the DSM, transgender and gender-expansive people will continue to suffer from stigma, discrimination, and the invalidation of their identities and experiences.

Social workers may find themselves in a gatekeeping role when working with individuals whose gender identity and/or gender expression expand beyond binary classifications or stretch the boundaries of what is typically considered appropriate gendered behavior based on an individual’s sex assignment. For instance, according to the Standards of Care put forth by the World Professional Association for Transgender Health ( WPATH, 2012 ), in order to access gender-affirming care (such as hormone treatment or surgery), an individual must obtain a letter of recommendation from a qualified mental health professional diagnosing their persistent gender dysphoria and indicating their readiness for care ( Coleman et al, 2022 ). Thus, the notion that individuals whose gender identities expand beyond the binary cisgender norm are not only pathologized but also viewed as incapable of owning their own bodily expertise. The same requirements are not expected from cisgender individuals seeking body altering surgeries, such as breast augmentation, hair implants, or facelifts.

Notably, not every nonbinary, gender-expansive, or transgender individual desires gender-affirming medical procedures. There is no single way to be nonbinary, gender expansive, or transgender, just as there is no single way to be a girl, woman, boy, or man. Each individual person experiences and expresses their gender in their own unique way.

Social Work and Gender Equity

Social workers are charged with confronting injustice; social justice is a core value of the profession. In recognition of the social worker’s responsibility to work toward social justice, the Council on Social Work Education (CSWE) (2015 ) generated accreditation standards requiring social workers to understand diversity and difference in the context of privilege, power, oppression, and marginalization to eliminate biases (Competency 2). Because gender identity and gender expression are included as dimensions of diversity that professionals must understand and value, social workers have an ethical commitment to advance gender equity in all professional practice, education, and research activities. The National Association of Social Workers (NASW) Code of Ethics ( 2017 / 1996 ) includes gender identity and gender expression as specific categories to include when confronting discrimination. The Code of Ethics ( 2017 / 1996 , p. 21) states that “social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of ... sexual orientation, gender identity or expression.”

In order to meet CSWE’s Competency 2—that social workers must understand diversity and difference in the context of privilege, power, oppression, and marginalization to eliminate biases—it is important that the profession broadens its analysis from individual and interpersonal acts of discrimination to include social systems and institutions that permit individual and interpersonal acts of discrimination. In other words, the role of structural discrimination in the oppression of people based on their gender identity and/or gender expression must be addressed. Structural discrimination can be understood as “the policies of dominant race/ethnic/gender institutions and the behavior of the individuals who implement these policies and control these institutions, which are race/ethnic/gender neutral in intent but which have a differential and/or harmful effect on minority race/ethnic/gender groups” ( Pincus, 1996 , p. 186).

To engage from within a structural framework would require social workers to address the structural conditions that marginalize people on the basis of their gender identity and/or gender expression. For example, rather than working with people to cope with the gender identity and expression based marginalization they face, social workers would also address the systems and structures that produce and reinforce marginalization. This may include challenging policies and practices within institutions of social work practice and education that rely on a binary classification of gender as a way to organize and categorize people. It may include insisting that all gender restrooms are accessible to all clients in one’s agency, or becoming involved in advocacy efforts aimed at removing gender identity based diagnoses from the DSM.

Social workers can begin to move beyond the gender binary by taking an inventory of the policies and practices within their organizations, critically examining the ways in which they may be inadvertently marginalizing clients and communities based on gender identity and gender expression. By centering transgender and nonbinary people in their examinations of policy and practice, social workers can intentionally assess their inclusion of and impact on transgender, nonbinary, and gender-expansive people. Because societal systems and services were built on the premise of binary sex and gender, they are rooted in the presumption that every individual who comes into contact with them can be categorized within these binary constructions. Public restrooms provide a concrete example. Social norms around restroom use necessitate that males and females are separated in different rooms, even with the physical separation of locked and partitioned stalls. In instances when public restrooms are single occupancy, they are most often still labeled male and female. The rationale for this separation is often safety and privacy. As Davis (2014 , p. 53) asserts, “If privacy and safety are the main reasons for sex-segregated restrooms, then might alternative physical designs such as floor-to-ceiling stall partitions do an even better job of meeting that goal than the current design of most American public restrooms?”

With regard to social work education, Shelton and Dodd (2020 ) outline key strategies for challenging cisnormativity and moving beyond the gender binary, including:

Use all gender pronouns (they and them) when speaking and writing rather than only including she and he or his and hers, an example of binarizing ( Blumer et al., 2013 ).

Examine and review course syllabi for implicit cisnormativity. Include your name and pronouns, ensure gender identity and expression are a part of classroom nondiscrimination standards, avoid binarizing language, and identify any all-gender restrooms available in the building.

Examine and review content on course syllabi. Ensure readings by and about transgender people are included. Transgender topics and authors should appear in a unit on gender identity. When planning a session about parenting, for instance, include a reading about transgender, gender-expansive, genderqueer, or nonbinary parents.

Be intentional when planning classroom introductions. Some students may not use the names indicated on your class roster or on school records. Plan introductions in such a way that enables students to introduce themselves first (before reading names from the provided class roster).

Model the sharing of pronouns and give students the option to include their pronouns when introducing themselves. For example, you could say, “Please share your name and your pronouns if you would like to do so.”

When utilizing case examples in the classroom, make sure transgender people are included/represented.

When including transgender people in case examples, make sure they are included in a way that does not perpetuate negative stereotypes and misinformation. For instance, a case example including a transgender person does not need to be focused solely on gender dysphoria and does not need to be related to their transgender identity.

Engage students in nuanced discussions about the history of the pathologization of gender and sexual minorities and the role of social work in this history.

Social work researchers can concretely work toward gender equity throughout the research process, helping to ensure all gender identities and gender expressions are acknowledged as valid. From the design of demographic questions to the reporting of results, researchers can intentionally include participants with a range of gender identities and expressions. Demographic questions can include additional options for sex and gender beyond the binary categorizations of female/male, woman/man, or girl/boy. When analyzing quantitative data, researchers can opt out of collapsing sex and/or gender into a dichotomous variable. Though this may make the process of analysis less simple, making these variables dichotomous erases the lived experiences of participants. When reporting results, researchers can include the experiences of participants across a range of gender identities and gender expressions. In reporting only statistically significant findings, critical data about frequently marginalized and underrepresented populations is lost. Recruitment strategies should include specific outreach to individuals and communities of diverse gender identities and gender expressions. This will require community engaged research and a willingness to extend recruitment timelines to ensure adequate representation. A 2021 study from the Williams Institute reported that 1.2 million adults in the United States are nonbinary ( Wilson & Meyer, 2021 ). Expanding beyond binary conceptualizations of gender within social work research is imperative in order to address the health and well-being of nonbinary individuals and communities.

In summary, gender identity and gender expression are dimensions of identity that are relevant to and impact all people. Thus, it is important for social workers to understand the ways in which gender identity and gender expression impact the individuals and communities with whom they work, as well as the ways that systems and institutions may perpetuate bias and marginalization based on gender identity and gender expression. Although the profession of social work has a fraught history with regard to policing and pathologizing individuals whose gender identities and expressions exist outside of or in between the gender binary, contemporary practice charges social workers with confronting injustice, including dimensions of diversity such as gender identity and gender expression.

Sexual orientation and gender identity and expression conversion exposure and their correlates among LGBTQI2+ persons in Québec, Canada

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft

* E-mail: [email protected]

Affiliations Research Chair in Sexual Diversity and Gender Plurality, Université du Québec à Montréal, Montréal, Québec, Canada, Département de sexologie, Université du Québec à Montréal, Montréal, Québec, Canada

Roles Writing – original draft

Affiliation Research Chair in Sexual Diversity and Gender Plurality, Université du Québec à Montréal, Montréal, Québec, Canada

Roles Writing – review & editing

Affiliation Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada

Roles Formal analysis, Methodology

Roles Conceptualization, Funding acquisition, Writing – review & editing

Affiliation Département de travail social, Université du Québec en Outaouais, Gatineau, Québec, Canada

Martin Blais,
Fabio Cannas Aghedu,
Florence Ashley,
Mariia Samoilenko,
Line Chamberland,
Isabel Côté

Published: April 6, 2022
https://doi.org/10.1371/journal.pone.0265580
Reader Comments

Despite greater acceptance of sexual and gender diversity and the scientific consensus that same-gender attraction, creative gender expression, and transness are not mental illnesses, LGBTQI2+ persons are still commonly told that they can or should change their sexual orientation, gender identity, or gender expression (SOGIE). The aim of this study was to describe the prevalence of SOGIE conversion efforts, including their sociodemographic correlates, among LGBTQI2+ persons.

Using community-based sampling, we assessed SOGIE conversion attempts and involvement in conversion services of 3,261 LGBTQI2+ persons aged 18 years and older in Quebec, Canada.

A quarter of respondents experienced SOGIE conversion attempts, and fewer than 5% were involved in conversion services. Over half of those who were involved in SOGIE conversion services consented to them, but the services’ goals were made clear and explicit to only 55% and 30% of those who engaged in SO and GIE conversion, respectively. The results also suggest that family plays a key role in SOGIE conversion attempts and services utilization, and that indigenous, intersex, transgender, non-binary, and asexual persons, people of colour, as well as individuals whose sexual orientation is not monosexual (i.e., bisexual, pansexual) were more likely to have been exposed to conversion attempts and involved in conversion services.

Conclusions

This study found that the prevalence of conversion efforts is substantial. Interventions to protect LGBTQI2+ people from such attempts should focus not only on legal bans, but also on supporting families who need to be counseled in accepting sexual and gender diversity. Health professionals need to be adequately trained in LGBTQI2+ affirmative approaches. Religious therapists should consult with colleagues and undergo supervision to ensure that their religious beliefs do not interfere with their practice.

Citation: Blais M, Cannas Aghedu F, Ashley F, Samoilenko M, Chamberland L, Côté I (2022) Sexual orientation and gender identity and expression conversion exposure and their correlates among LGBTQI2+ persons in Québec, Canada. PLoS ONE 17(4): e0265580. https://doi.org/10.1371/journal.pone.0265580

Editor: Stefano Federici, University of Perugia: Universita degli Studi di Perugia, ITALY

Received: September 24, 2021; Accepted: March 7, 2022; Published: April 6, 2022

Copyright: © 2022 Blais et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Since the data contain potentially sensitive information about study participants, the Université du Québec à Montréal’ Human Research Ethics Board has only approved storage of the dataset on secure institutional servers. Any requests to access the data can be made to Université du Québec à Montréal’ Human Research Ethics Board ( [email protected] ; reference Ethics Protocol Number #2020-2218).

Funding: This research is supported by funding from the Social Sciences and Humanities Research Council of Canada. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Despite greater acceptance of sexual and gender diversity and the scientific consensus that same-gender attraction, creative gender expression, and transness are not mental illnesses, lesbian, gay, bisexual, trans, queer, intersex, two-spirit (LGBTQI2+) persons are still commonly told that they can or should change their sexual orientation (SO), gender identity (GI), or gender expression (GE). A recent study revealed that two-thirds of youths aged 13–24 years in the US reported that someone had tried to convince them to change their SOGIE [ 1 ]. Such pressures stem from the belief that it is best to be heterosexual and cisgender (i.e., not transgender) and that people should be changed when they do not conform to cisheterosexist norms. The concept of SOGIE change efforts has been coined to describe any direction or advice that intentionally delays or impedes self-acceptance of one’s sexual orientation, gender identity, or gender expression [ 2 – 4 ]. The 2020 edition of the Canadian Sex Now Survey revealed that about 20% of sexual minority men (gay, bisexual, transgender, Two-Spirit and queer) have been exposed to such efforts [ 5 ]. The US Transgender Survey found that 14% of respondents reported lifetime exposure to gender identity conversion efforts [ 6 ].

Conversion therapy refers to more sustained, structured, specific interventions aiming at changing, discouraging, or repressing SOGIE [ 2 – 4 ]. It relies on various techniques, inspired by psychotherapeutic, medical, or faith-based principles (e.g., talk therapy, aversion therapy, hormonotherapy, spiritual guidance) and takes place in various contexts ranging from private or public settings to “gay conversion camps” or religious institutions. Not only are they inefficient, scientifically unsound, and unethical, but they are also known to have adverse effects on survivors [ 6 – 8 ]. It is thus unsurprising that most psychological, medical, and sexual health professional associations have opposed SO conversion efforts for decades, and most of them are now adopting similar responses to GIE conversion efforts [ 9 ]. In December 2020, a ban on SOGIE conversion therapies has been adopted in Québec. This new law targets practices intended to “induce persons to change their sexual orientation, gender identity or gender expression or to repress non-heterosexual sexual behaviour” and applies regardless of age [ 10 ]. Violations are subject to heavy fines, professional discipline, and/or victim compensation. Federally, a criminal ban has been adopted by the Senate [ 11 ]. According to this new law, anyone who advertises, materially benefits from, or causes a person to undergo SOGIE conversion therapy would be liable to imprisonment for up to five years depending on the offence.

Professional associations’ statements are insufficient, as conversion experiences continue to be reported. In the US, about 4% of youths aged 13–24 years have undergone SOGI conversion therapy [ 7 ]. In Canada, three large, non-probabilistic studies have documented SOGI conversion experiences: the Sex Now survey 2011–2012 (N = 8,388) revealed that about 3.5% of Canadian sexual minority men (i.e., gay, bisexual, transgender, Two-Spirit and queer) experienced SO conversion therapy (4.2% in Quebec; [ 4 ]), the Sex Now survey 2019–2020 (N = 9,214) found that 9.9% of participants were exposed to SOGI conversion therapy [ 3 ]; and the Trans Pulse Canada survey (N = 2033) found that 11% of transgender and non-binary people had experienced conversion therapy [ 12 ].

Survivor characteristics

In Canada, men who have sex with men (MSM) who have been exposed to SO or GI conversion efforts or practices were more likely to be gay (compared to bisexual), transgender and non-binary (compared to cisgender), “out” about their sexual orientation (relative to those who were not), younger, immigrants, and to earn an annual personal income of less than $30,000 (compared to those who earn $60,000 or more [ 3 , 4 ]. The TransPULSE study found increasing rates of conversion therapy experiences with age [ 12 ]. In a US cohort of middle-aged and older MSM, Meanley et al. [ 13 ] found lower exposure to conversion therapy among MSM with any college education, but higher exposure among participants who enrolled in the studies post-2001 (compared to those enrolled pre-1987). Among US youths, Green et al. [ 7 ] found a higher prevalence of conversion experiences among gay and lesbian youths (relative to youths identifying as bisexual or as “something else”) and those from low-income families.

Conversion effort exposure appears to be evenly distributed before and after the age of 18 years. Societal, legal, and cultural homo- or trans-negativity is often endorsed by parents of LGBTQI2+ youths [ 14 , 15 ], leading them to seek conversion efforts for their children. Furthermore, these beliefs may lead LGBTQI2+ child(ren) to believe that they would be more accepted if they were heterosexual and cisgender. Growing up with cultural and parental cisheteronormative values is thus likely to influence LGBTQI2+ persons to initiate, be exposed to, or participate in conversion efforts, whether voluntarily or not.

To explore such societal, legal, or cultural contexts, previous studies have relied on variables such as race/ethnicity, age cohort, religious affiliation, or family’s support of SOGIE. Salway et al. [ 4 ] found greater SO conversion therapy prevalence among Canadian Indigenous individuals and other racial minorities (relative to White men), but no differences were found between age groups. The study found that conversion efforts were far more common among trans respondents (12.1% versus 3.5%). Salway et al. [ 3 ] found that the prevalence of SOGI conversion therapy practices was higher among younger generations, immigrants, and racial/ethnic minorities. Meanley et al. [ 13 ] found a greater prevalence of these practices among US middle-aged and older Black MSM (both non-Hispanic and Hispanic) and those of other racial minority groups (compared to non-Hispanic White men), while Green et al. [ 7 ] found a higher prevalence among Hispanic/Latinx youths. In Ryan et al.’s [ 8 ] sample, respondents who were not born in the US were more likely than those born in the US to report having been taken to a therapist or religious leader by their parents to change their SO. Hypothesizing the role of more conservative values, Flores et al. [ 16 ] found lower support for banning conversion therapy among US racial and cultural minority groups. This conclusion supports the finding that ethnic minority parents report greater levels of homonegativity than ethnic majority parents [ 17 ]. Given the between-country variations in attitudes toward SOGIE, we can expect variations in exposure to conversion efforts depending on the country of birth.

Youth who underwent SO or SOGI conversion therapy are also more likely to come from religious families [ 8 ] or to have heard their parents (or caregivers) use religion to justify saying negative things about LGBTQ individuals [ 7 ]. Adamson et al. [ 18 ] found that, in their worldwide sample, about one-fourth of respondents who have been exposed to conversion efforts indicated that they had sought conversion therapy on their own, while the rest of the sample reported that this decision was beyond their control or made on their behalf by their family, religious leaders or community, school, or employer. They also found that most practitioners who led conversion therapy were mental health providers, followed by religious authorities or their associates.

While LGBTQI2+ people in Canada have been subjected to SOGIE conversion efforts, data are still scarce as most studies are limited to sexual minority men and specifically to SO conversion efforts. In Quebec, the only prevalence estimates available come from the Sex Now survey data, which found conversion therapy rates of 4.2% for SO [ 4 ] and 6.8% for SOGI [ 3 ] among Canadian sexual minority men. While little is known about conversion efforts among other sexual orientation groups (e.g., bisexual and pansexual individuals) and across genders and gender modalities (i.e., cisgender or transgender), rates of conversion efforts appear higher among transgender people [ 3 , 4 , 12 , 19 ]. Moreover, as asexuality has only been recently recognised as different from sexual desire disorders [ 20 ], it is likely that persons describing their sexual orientation as asexual are more likely to have experienced sexual orientation conversion efforts or to have sought services to help them change. Also, to our knowledge, data on intersex persons’ experiences with gender identity assignment or modification are also scarce, though such experiences are likely as intersex variations are treated as a medical condition falling under sex/gender (re)assignment. Relying on a large, province-wide community-based survey, the current study describes the prevalence of SOGIE conversion attempts and involvement in conversion services, as well as their sociodemographic correlates, among LGBTQI2+ persons in Quebec.

Participant recruitment

Data on SOGIE conversion experiences were collected as part of the Understanding the Inclusion and Exclusion of LGBTQ People (UNIE-LGBTQ) research project, which aimed to document events during which LGBTQI2+ people (aged 18 years and older) were demeaned, rejected and belittled, or deprived of the full extent of their rights in important life domains. Participants were recruited from September 2019 to August 2020 (before any legal ban on conversion therapy in Quebec or Canada) through the project’ and community partners’ communication channels (emails, listservs, the project website, Facebook pages and groups, Twitter, and LinkedIn), web and printed media, and word of mouth. The survey was administered online and was available in both French and English. Inclusion criteria were understanding French or English, being at least 18 years old, self-identify as LGBTQI2+, and live in the province of Quebec.

Over 6,000 persons accessed the online questionnaire, of which we retained only those who provided a valid Quebec postal code or whose IP address was located in the province (n = 6,095). Participants who did not provide sufficient data to confirm their eligibility or who did not meet the inclusion criteria were excluded (n = 1,115, of which 11 did not consent, 71 were younger than 18, and 85 were not LGBTQI2+). The final sample was composed of 4,980 participants. The present paper is based on the data of the 3,261 respondents who provided information on their exposure to SOGIE conversion attempts or their involvement in SOGIE conversion services. This study was approved by the Institutional Research Ethics Board of the Université du Québec à Montréal (Québec, Canada) (Protocol #2775).

We assessed lifetime involvement in conversion therapy services and lifetime exposure to conversion attempts. Both were measured separately for SO and GIE, as social attitudes and professional guidelines toward sexual diversity and gender diversity are different. The four items used to assess these constructs, and their response options, are presented in Table 1 . The research team created the survey questions based on the scientific literature and by consulting experts on conversion therapy and key informants from community-based organizations.

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https://doi.org/10.1371/journal.pone.0265580.t001

Questions on lifetime involvement in conversion services were introduced by explicitly stating the aim of such services. Participants were provided with the following instructions: “The next questions ask about the contacts you may have had with services for which your aim was, for instance, [see Table 1 for specific wording of the aim for SO and GIE] . These services may have been provided by health professionals, spiritual or religious guides, or other types of people. These services may go by various names, including therapy or treatment (conversion, reparative, or corrective), special consultations, spiritual processes, healing or deliverance sessions, or other names you may be familiar with. Answer the following questions in relation to all the services you have been in contact with taken together, whether this was on your own initiative or upon someone else’s request (parent, partner, spiritual advisor, etc.)”. Contrary to these organized efforts, conversion attempts refer to any direction or advice to change someone’s SOGIE, make them conform to cisheterosexist norms, or to prevent them from becoming gay, lesbian, bisexual, or transgender.

We asked those who were involved in conversion services to provide information on their most recent experience: their age at the time, and the type of service provider (response options were: a doctor or psychiatrist; a psychologist; a sexologist; another type of therapist or psychotherapist; a member of the clergy, of a religious group, or of a church; no recollection of the person; other). We also inquired about the goals of the services. For SO conversion, the goals were: “to prevent you from being or becoming gay, lesbian, or bisexual”; “to change your sexual orientation (e.g., toward heterosexuality)”; and “to change how you express yourself in your body (your mannerisms, your ways of speaking, moving, walking, dressing, doing your hair, etc.)”. For GIE conversion, the possible goals were: “to prevent you from being or becoming trans”; “to change your gender identity (e.g., to become cisgender)”; and “to change how you express your gender identity with your body (your mannerisms, your ways of speaking, moving, walking, dressing, doing your hair, etc.)”. The four response anchors were dichotomized: not at all (coded 0); a bit (coded 0); somewhat (coded as 1); and a lot (coded as 1). Respondents also indicated whether they themselves, their parents (or their representatives), or someone else consented to these services and whether their conversion purposes were explicit from the beginning (response options: yes; no).

We also explored six potential motivations to seeking conversion services: 1) “I thought it would be easier for me and for my future if I tried”, 2) “I wanted to become [heterosexual, or cisgender] or to avoid becoming [gay, lesbian, or bisexual, or trans]”, 3) I was afraid of negative consequences if I refused to try (e.g., family rejection, refusal of care, termination of treatment), 4) “I felt that my loved ones would be happy if I did it”, 5) “I could not say no to the person or people who suggested it to me”, and 6) “They convinced me it was a good idea to try”. The response options ranged from 0 (Totally false) to 3 (Totally true).

Additional data on year of birth, intersex variation, sexual orientation, gender modality and identity, race/ethnicity, education, place of birth, household income, parents’ religious attendance, and perceived parents’ attributed importance to religious upbringing were also collected.

Data analysis

Descriptive statistics were computed to summarize the sample’s characteristics. Continuous variables were presented as means and standard deviations, or as medians and intervals defined by the first and third quartiles. For dichotomous variables, their prevalence and 95% exact confidence intervals (CI) were calculated [ 21 ]. For categorical variables, we presented the proportion of each category and the corresponding 95% CI were calculated simultaneously for multinomial proportions [ 22 ]. Chi-square or Ficher exact tests were used to compare the distributions of the lifetime exposure to SOGIE conversion attempts and involvement in conversion services between cisgender LGBQ+ and trans participants. Crude Poisson regression with a robust error variance [ 23 ] was applied to assess the associations between lifetime exposure to SOGIE conversion attempts or service involvement and participant’s characteristics on the prevalence ratio (PR) scale. Analyses were performed using STATA 16.1 and SAS 9.4.

Missing data on the outcome variables followed a monotone pattern reflecting sections order in the online questionnaire, ranging from 34.5% (for conversion services involvement) to 39.7% (for conversion attempts). For both outcomes, weak associations [ 24 , 25 ] were found between the presence of missing data and education (Cramer’s V between 0.12 and 0.13), and between the missingness in SOGIE conversion services involvement and birth cohort (Cramer’s V = 0.12), suggesting that missing data on the outcome variables were not completely random. Participants with a university degree and older participants were more likely to have completed the questionnaire. The percentage of missing values in the analytic sample was below 9% for most variables included in the present paper but exceeded 10% for two variables (parental religious attendance and attitudes). Statistical guidelines suggest that bias is negligeable with less than 10% missingness [ 26 ]. Missing values were not replaced. The significance level was set at p < 0.05.

Participants

Table 2 presents the sample’s characteristics. While most participants were born after 1980, multiple birth cohorts were represented. Most participants described their sexual orientation as gay or lesbian (59%), bisexual (17%), or pansexual (10%). Over 80% of the sample was cisgender (43% women, 40% men), and 17% were transgender or non-binary (12% trans men and non-binary assigned female at birth, 5% trans women and non-binary persons assigned male at birth). Fourteen persons reported intersex variations. Most of the sample was white (89%) but included indigenous people (3%) and people of color (8%). Over half of participants reported a college or university degree (56%), most were born in Canada (87%), and were equally distributed across the four assessed household income brackets. About one-third of respondents reported that their parents never attended religious services and did not attribute any importance to religious upbringing.

https://doi.org/10.1371/journal.pone.0265580.t002

Lifetime prevalence of SOGIE conversion attempt exposure and involvement in conversion services

Overall, 26.4% (95% CI, 24.8% to 28.0%) of respondents have experienced lifetime SOGIE conversion attempts or have been involved in conversion services (see Table 3 ). Cisgender sexual minority participants were more likely to have experienced conversion efforts targeting their SO (20.0%, 95% CI, 18.4 to 21.5) than their GIE (6.2%, 95% CI, 5.3 to 7.2), while trans participants were more likely to have been targeted for their GIE (41.9, 37.5 to 46.4) rather than their SO (25.6%, 95% CI, 21.8 to 29.7). Overall, trans participants were more likely to have been exposed to SOGIE conversion attempts and involved in SOGIE conversion services.

https://doi.org/10.1371/journal.pone.0265580.t003

SOGIE conversion attempts

Over two-thirds of respondents identified family members as responsible for the SOGIE conversion attempts (see Table 4 ), followed by friends and acquaintances, members of the clergy, and relationship (ex-)partners. Ten percent or less of participants identified healthcare professionals as responsible for such efforts. Trans participants were more likely than their cisgender LGBQ+ counterparts to have experienced GIE conversion attempts by friends or acquaintances (28.4%, 95% CI: 22.2% to 35.1% vs 15.3%, 95% CI: 9.8% to 22.2%), relationship (ex-)partner(s) (22.9%, 95% CI: 17.3% to 29.3% vs 11.1%, 95% CI: 6.5% to 17.4%), and healthcare professionals (12.9%, 95% CI: 8.6% to 18.4% vs 2.1%, 95% CI: 0.4% to 6.0%).

https://doi.org/10.1371/journal.pone.0265580.t004

Table 5 reports sociodemographic correlates of SO and GIE conversion attempts. SO conversion attempts were more commonly experienced by respondents who were bisexual, pansexual, and asexual (compared to gay/lesbian), transgender (compared to cisgender), indigenous and racialized (compared to white), and those whose parents were more likely to attend religious services (compared to never ) and to at least somewhat value religious upbringing (compared to not at all ). SO conversion attempts were less common among participants who had a college or university education (compared to less than college), who were born in Canada (compared to those born abroad), and who reported an annual household income of over $30,000 CAD (compared to < $30,000 CAD).

https://doi.org/10.1371/journal.pone.0265580.t005

GIE conversion attempts were more commonly experienced by participants who were born in 1981–1990 and after 1990 (compared to those born before 1955), who reported an intersex variation (compared to endosex respondents), who were bisexual, pansexual, queer, and asexual (compared to gay/lesbian), transgender (compared to cisgender), transmasculine and transfeminine (compared to cisgender women), indigenous and racialized (compared to white), and by participants whose parents extremely valued religious upbringing (compared to not at all ). GIE conversion attempts were less commonly experienced by respondents with a college or university education (compared to less than college) and by those who reported an annual household income of over $60,000 CAD (compared to < $30,000 CAD).

Involvement in SOGIE conversion services

Regarding SOGIE conversion services’ involvement (see Table 6 ), respondents born after 1990 reported the lowest prevalence (2.5%, 95% CI 1.8% to 3.4%), with a gradual increase among older cohorts. Participants born before 1955 were the most likely to have been involved in these services (11.7%, 95% CI, 7.7% to 17.2%) compared to other age cohorts, as were transgender participants (PR = 1.59, 95% CI, 1.10 to 2.30), cisgender men (PR = 1.62, 1.12 to 2.36) and transfeminine participants (PR = 3.28, 1.94 to 5.55) compared to cisgender women, indigenous (PR = 2.10, 95% CI, 1.10 to 4.03) and racialized participants (PR = 2.08, 95% CI, 1.33–3.26) compared to white, and those whose parents attended religious services at least 3 times a year, compared to never , and to value religious upbringing at least somewhat , compared to not at all ).

https://doi.org/10.1371/journal.pone.0265580.t006

Regarding the most recent involvement in SOGIE conversion services ( Table 7 ) results show a wide range in terms of the age at which it took place, with as early as 2 years old and as late as almost 60 years old (median age = 18 years). Over half of occurrences occurred after 2000, with trans participants being more likely to have experienced such involvement after 2009 (57.1, 95% CI: 36.8 to 75.3) compared to cisgender ones (24.8, 95% CI: 16.0 to 36.3). Most commonly, the services were provided by healthcare professionals (doctors, psychiatrists, psychologists, or sexologists), a member of the clergy, another type of professional (e.g., counselors, therapists, teachers, etc.) or, less commonly, by a relative or a family friend. Multiple service providers were identified, which suggests that multiple persons provided conversion services, or that some of them occupied multiple functions (e.g., both a healthcare professional and a member of the clergy, both a sexologist and physician, etc.).

https://doi.org/10.1371/journal.pone.0265580.t007

Among cisgender participants, conversion services’ main goals were to make them heterosexual (69.0%) or to prevent them from being gay, lesbian, or bisexual (62.4%). Among trans participants, the most reported goals were to make them heterosexual (83%), change their gender identity (68.2%) or their gender expression (60.0%), or to prevent them from being or becoming transgender (65.2%).

Among respondents who were involved in SO conversion services, about 52% consented themselves, of whom only 55% were clearly aware of the services’ objectives (see Table 8 ). About 48% reported that their parents (or a family member) consented on their behalf, with over 60% of them indicating that the family member(s) did so with clear awareness of the services’ objectives. An additional one-fifth of participants who were involved in SO conversion services reported that someone other than family consented on their behalf, being cognizant of the services’ objectives in over 80% of cases. The most frequently endorsed reasons for using such services were that they thought it would be easier for them and for their future if they tried, and that they could not say no to the person or people who suggested it.

https://doi.org/10.1371/journal.pone.0265580.t008

Approximately 56% of respondents having been involved in GIE conversion services consented themselves, 30% of whom were cognizant of these services’ conversion goals. Forty percent reported that their family consented for them, with clear awareness of the services’ objectives in 40% of cases. One-fifth of the participants who were involved in GIE conversion services reported that someone other than family consented on their behalf (e.g., physician, member of the clergy, psychologist, friends, school staff, etc.), close to 63% of whom were clearly aware of the services’ objectives. The main reasons endorsed for using these services were to make their lives and futures easier, to please their loved ones, and because they feared negative consequences in case of refusal (e.g., family rejection, refusal of care, termination of treatment, etc.).

This study is the first to report data on lifetime exposure to various forms of SOGIE conversion efforts across all gender identities and modalities and sexual orientation groups in Canada. We used data from a large community-based survey to investigate SOGIE prevalence and correlates among LGBTQI2+ people in the province of Quebec. This study revealed that 4.4% of the sample used SOGIE conversion services, with higher prevalence rates among trans participants (PR = 1.59, 95% CI, 1.10 to 2.30). The overall rate of conversion service involvement was close to those reported for Quebecois MSM in the Canadian Sex Now survey (4.2%, [ 4 ]; 6.8%; [ 3 ]). In the current study, conversion services involvement among transgender participants (6.3%) was lower than that reported in the US Transgender Survey (i.e., 14%; [ 6 ]).

SOGIE modification attempts were far more prevalent than conversion services involvement in the current LGBTQI2+ sample (25%), particularly among trans participants who were about 7 times more likely to report so compared to cisgender participants. In comparison, Salway et al. [ 5 ] report a lower prevalence among sexual-minority men (15% in Quebec, 20% across Canada). Disparities in these estimates may reflect variations in the wording of the phenomenon, such as services involvement, sustained efforts [ 5 ], conversion therapy [ 1 , 7 , 13 ], reparative therapy [ 7 ], attempts or efforts [ 3 ], treatment or cure [ 8 ], or sexual repair/reorientation [ 4 ], as well as geographical variations in the conversion services offered and in the societal attitudes toward sexual and gender diversity across the US and Canada, and in Quebec more specifically.

Correlates of conversion services involvement

It should be noted that licensed healthcare providers were responsible for about half of the current sample’s most recent conversion experiences, and members of the clergy or of a religious group, for about one-third. Over half of participants reported having consented to SOGIE conversion services. These services’ objectives, however, were clear to only 55% of those who engaged in SO conversion and to 30% of those who engaged in GIE conversion, which suggests that the goal of conversion became known to these participants only once after being involved in the process. These numbers are higher than those of a previous study that included participants from over 100 countries and showed that only one-fourth of the sample have sought conversion services on their own, while the rest of respondents declared that the decision was largely outside of their control [ 18 ].

The results also show that other persons were also involved to varying degrees in these decisions (parents, extended family, religious congregation members, or school personnel, including private school personnel, which are assumed to be religious), and that these individuals were more likely than the participants to have been aware of the services’ conversion goals. Overall, conversion services involvement among Quebec LGBTQI2+ persons likely resulted from concerted efforts from their immediate environment. Given that the most frequently endorsed reasons to consent to or comply with these services were the wish for a better future and the fear of rejection, it is also likely that these individuals were swayed by ambient hostility toward sexual and gender diversity, leading them to believe that SOGIE conversion was their best option. The results further revealed that a high percentage of participants, parents, and family members were unaware of conversion services’ goals, suggesting that they may involve deception or manipulation, especially in relation to GIE conversion services. To increase power when exploring for correlates, we merged participants who reported having accessed any SO or GIE conversion services. This decision was supported by our finding that response patterns concerning both services were similar. Contrary to Salway et al. [ 3 ] who found a greater exposure to conversion therapy practices among younger generations of Canadian MSM, we observed a birth cohort effect regarding the accessing of conversion services, with older cohorts being more likely than younger ones to report having done so. This pattern may reflect changes in societal attitudes and professional regulations that oppose SO conversion practices, and only more recently, GIE conversion practices.

Accessing SOGIE conversion services was also more commonly reported by indigenous and racialized participants, as well as by those from more religious families. These findings support those of previous studies, and suggests that these groups may endorse more conservative values and stricter sexuality and gender norms (often imported from a colonial past; see Barker [ 27 ]), which contribute to create a hostile climate toward sexual and gender diversity and to increase the likelihood of seeking SOGIE conversion services [ 15 ]. While there were no variations between sexual orientation groups regarding SOGIE conversion services involvement, we found that transgender persons and those assigned male at birth (cisgender, transgender, or non-binary) presented increased risk. This points to a lower threshold for gender (non-)conformity tolerance toward persons assigned male at birth. Contrary to Salway et al. [ 4 ], low-income participants were not more likely to have been involved in SOGIE conversion services than those with higher incomes.

Correlates of conversion attempts

While our findings regarding SOGIE conversion attempts also confirm the role of sociocultural context, differences between SO and GIE conversion attempts are noteworthy. While SO conversion efforts occurred in similar proportions across birth cohorts, GIE attempts were mainly reported by younger generations. This could reflect socially and politically conservative reactions to increased consultations regarding GIE variations among younger generations [ 28 ]. Such conversion attempts could also be due to more recent cohorts of non-binary and transgender persons coming out earlier due to increasing trans visibility, and while still living in their parents’ homes, which can make them more vulnerable to family pressure and other cisnormative influences.

Both SO and GIE conversion attempts were more commonly reported by less educated and lower income participants, while SO conversion attempts more specifically were more common among those who were from more religious households and who were born outside Canada. These results confirm previous findings about the key role of geographical and socioeconomic factors in creating a social or family context that is hostile to sexual and gender diversity. As Salway et al. [ 4 ] suggested, it is possible that the association between ethnicity and racialized status and SO conversion efforts may be at least partially explained by the mediating effect of socioeconomic factors. Yet, as exposure to SOGIE conversion likely happened before the income and education level measured at the time of the study, it is more likely that exposure to SOGIE conversion efforts has negatively impacted the socioeconomic trajectory, a hypothesis that is also suggested by other authors [ 8 ].

That SOGIE conversion attempts were more commonly reported by individuals who identified as other than gay or lesbian can reflect the greater acceptance and recognition of gay and lesbian persons, while other sexual identities remain misunderstood (e.g., bisexuality and pansexuality) or conceptualized as sexual disorders (e.g., asexuality). Results revealed how cisnormativity can also affect intersex persons, who were more likely than their endosex counterparts to have been exposed to GIE, but not SO, conversion attempts. Moreover, our results showed that, compared to their cisgender counterparts, transgender persons were more exposed to both SO and GIE conversion attempts. Their higher exposure to SO conversion efforts might reflect how gender (non)conformity is often taken as a sign of non-heterosexuality. Unlike conversion services, there were no significant differences in the rates of conversion attempts between trans people assigned male and assigned female at birth.

Strengths and limitations

This study is the first to examine exposure to both SO and GIE conversion attempts and conversion services involvement across multiple sexual orientation groups and gender identities and modalities in a large sample. Yet, this work also has some limitations. First, its cross-sectional, retrospective design is subject to recall bias and prevents any causal inferences. Second, as for any self-selected, non-probabilistic sampling, it is likely that the LGBTQI2+ persons who volunteered to participate are different from those who did not. While we used multiple, diversified recruitment strategies, the results cannot be generalized beyond the present sample. Third, as the SOGIE conversion experiences were elicited using non-validated self-reports, our indicators may not have accurately captured their prevalence.

Despite these weaknesses, this study provides a unique overview of Quebec’s LGBTQI2+ populations’ SOGIE conversion experiences, including women’s (cisgender and transgender). The results highlight that while conversion services involvement was more common among older generations, conversion attempts were more common among younger ones. Our findings also show the increased vulnerability to conversion attempts and service involvement among participants with religious upbringing, indigenous persons and people of colour, intersex, transgender, non-binary and asexual persons, as well as those who did not have a monosexual sexual orientation (bisexual, pansexual).

To protect LGBTQI2+ persons from such attempts and practices, legal bans on conversion practices are an important step as they send a strong message about their unethical and harmful nature. However, they will not be insular to faith-based practices and they will be insufficient to eliminate pressures and practices covertly operating under the guise of exploration. Professionals’ ongoing commitment is sorely needed, professional associations must expand their statements regarding sexual orientation and gender identity and expression practices, and healthcare providers need adequate training in LGBTQI2+ affirmative approaches. Religious counselors should also address the religious beliefs and cisheterosexist assumptions underlying their spiritual guidance or clinical practice. Addressing such biases does not imply deconstructing their religious beliefs, but rather exploring how their faith can impact their clinical practice [ 29 , 30 ]. Moreover, as families play a key role in pressuring children into conversion practices, they need to be supported and counseled in the acceptance of their LGBTQIA+ children. More studies are needed to better understand parental and family characteristics associated with heterosexism and cissexism.

Supporting information

S1 file. alternative language abstract..

https://doi.org/10.1371/journal.pone.0265580.s001

Acknowledgments

The Understanding the Inclusion and Exclusion of LGBTQ People research (UNIE-LGBTQ) is a research partnership of universities, public agencies, semi-public and community-based organizations, and private enterprises dedicating their efforts to better understand situations in which LGBTQI2+ people are demeaned, rejected, and belittled, and deprived of the full extent of their rights in important life domains. We extend our thanks to the research partners as well as to the participants who generously shared their experiences with us.

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What Is Gender Expression?

Gender expression refers to the ways that people present their gender identity to the world. This may be through clothing, haircuts, behaviors, and other choices. For many people, there is a "mismatch" between what society expects from their gender and how they choose to present.

Buzz cuts, for example, are seen as masculine hairstyles, while wearing dresses is seen as feminine. This expression may vary from what might be expected of one's gender identity. For example, a cisgender woman may have a very masculine expression but still identify as a woman.

This article looks at how gender expression differs from identity, orientation, and other ways of describing sex and gender. It also looks at discrimination on the basis of gender expression.

The Meaning of Gender Expression

Gender is a concept with many dimensions. When talking about whether people are cisgender or transgender, what is meant is whether a person's gender identity does or does not match their sex assigned at birth.

Gender expression, though, is something else. It refers to how people present themselves, in ways that a wider society may think of as being aligned with one gender or the other. For most people, gender expression affirms their gender identity.

Gender expression usually aligns with a person's gender identity. But it may be different from what the wider culture defines as masculine or feminine behavior.

In other words, people with masculine identities speak, dress, move, or wear their hair in generally "masculine" ways. People with feminine identities make these style and behavior choices in "feminine" ways.

Gender expression is very much a cultural construct. That means there may be a shared social expectation about gender. But it also may mean that the same feminine style of hair or clothing in one setting might be thought masculine in another time or place.

Society will sometimes regulate expression by making women wear certain kinds of clothes, and men other kinds, in order to participate in school, work, and public life. Rules about hair may reflect beliefs about gender too. When cultures enforce gender norms it is known as gender policing, which can range from dress codes to physical and emotional violence. Creating a safe space for all genders requires being aware of these explicit or implicit gender norms so gender policing can be prevented.

Gay men and bisexual cisgender women may be more likely than their straight or lesbian cisgender counterparts to have expression that departs from the expectations about their gender identity.

Research suggests that there are higher rates of discrimination against transgender and gender-nonconforming people compared with the bias against those who are LGBTQ.

Some transgender people use a highly feminine or masculine expression to address their gender dysphoria . This may also lower their chances of being misgendered by others, meaning they are called by a gender or pronoun that does not match their identity.

Gender Expression and Health Care

Gender expression itself does not always need to be addressed by healthcare workers. But it can affect access to and quality of health care. People with an expression that differs from what is expected for their assigned sex at birth may see greater levels of bias and harassment from providers.

This is true for transgender people, but also for lesbian, gay, and bisexual individuals. It's also true for people with a gender expression that is not what their provider expects.

Gender Expression, Pronouns, and Health Care

Gender expression is often what causes a doctor to ask for a patient's pronouns and/or affirmed name, but it is not best practice. In an ideal world, health workers should ask everyone what name they prefer to be called and what pronouns they use.

One approach that may be more affirming is for the doctor to introduce themselves first, using their own pronouns. This simple act invites the patient to share their own without putting anyone on the spot.

In 2020, Lambda Legal released a report about discrimination in health care, called "When Healthcare Isn't Caring." It included those with different gender expressions. Some 30% of respondents feared health workers would treat them differently because of their expression.

The report called for better training for health workers. It also called for broad policies to prohibit discrimination—not just on the basis of sexual orientation and gender identity, but also gender expression.

Blatant discrimination is not the only threat to some patients' gender expression. When doctors and other providers allow their own perceptions and biases around gender to guide their practice, it can create trauma for those in their care. Because medical professionals have authority over their patients, it is especially important that they acknowledge the nuances of gender expression.

Keep in mind that doctors do need to know a person's sex that was assigned at birth. They need to be able to do proper screening tests, such as screening for prostate cancer or cervical cancer.

Discrimination

Minority stress has been shown to play an important role in health disparities. Research suggests that gender expression is a part of the minority stress described by cisgender sexual minorities and gender minorities. This may reflect both a person's expectation that discrimination will happen, as well as the actual bias directed at them.

The effects of gender expression are different depending on a person's sex, gender identity, and the setting they are in. For example, some communities may accept a broader range of gender expressions from people who are seen as female than from those who are viewed as male.

It's a relatively new concept to use human rights law to protect people from discrimination on the basis of gender expression. In 2012, however, Ontario, Canada, passed legislation that forbids discrimination because of it.

A similar law was passed in New York in 2019, and other places have also passed protections. U.S. federal law does not explicitly protect people on the grounds of gender expression, but it does protect against discrimination in health care on the basis of sexual orientation or gender identity. Resources like The National Center for Transgender Equality and the Movement Advancement Project equip people with information about their state's laws and initiatives so they can advocate for themselves and others.

Everyone has a gender expression. If a person's gender expression is what would be expected for their gender identity and/or recorded sex, it would be unusual for anyone to comment on it. But each person chooses how to present themselves to the world, and society views those choices as gendered. Despite growing awareness about gender expression, this still may lead to discrimination in public settings, including health care.

A Word From Verywell

Gender expression is not always static. It can change with time. While some people's gender expression is consistent with society's connotations of masculinity or femininity, others' is more nuanced. This is known as gender fluidity . Some may present as highly masculine one day and highly feminine another. This may or may not have anything to do with their gender identity.

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Sandfort TGM, Bos HMW, Fu T-C (Jane), Herbenick D, Dodge B. Gender expression and its correlates in a nationally representative sample of the U.S. adult population: Findings from the National Survey of Sexual Health and Behavior . The Journal of Sex Research . 2020:1-13. doi:10.1080/00224499.2020.1818178

Kiebel E, Bosson JK, Caswell TA. Essentialist beliefs and sexual prejudice toward feminine gay men . Journal of Homosexuality . 2020;67(8):1097-1117. doi:10.1080/00918369.2019.1603492

Human Rights Watch. "You Don't Want Second Best"—Anti-LGBT Discrimination in US Health Care .

Lambda Legal. When health care isn’t caring: Lambda Legal’s survey of discrimination against LGBT people and people with HIV .

Puckett JA, Maroney MR, Levitt HM, Horne SG. Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men . Psychology of Sexual Orientation and Gender Diversity . 2016;3(4):489-498. doi:10.1037/sgd0000201

Horn SS. Adolescents’ acceptance of same-sex peers based on sexual orientation and gender expression . J Youth Adolescence . 2007;36(3):363-371 doi:10.1007/s10964-006-9111-0

Ross MW, Kashiha J, Mgopa LR. Stigmatization of men who have sex with men in health care settings in East Africa is based more on perceived gender role-inappropriate mannerisms than having sex with men . Global Health Action . 2020;13(1):1816526. doi:10.1080/16549716.2020.1816526

By Elizabeth Boskey, PhD Boskey has a doctorate in biophysics and master's degrees in public health and social work, with expertise in transgender and sexual health.

The Measurement of Sexual Attraction and Gender Expression: Cognitive Interviews with Queer Women

First Online: 24 October 2020

Cite this chapter

Dana Garbarski 3 &
Dana LaVergne 3

Part of the book series: Frontiers in Sociology and Social Research ((FSSR,volume 4))

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Previous research on the survey measurement of sexual orientation and gender identity (SOGI) often focuses on the measurement of gender identity and sexual identity. Comparably little research exists that is focused on gender expression and sexual attraction, which are also each key features gender and sexuality.

The current study seeks to contribute to this line of research, examining what underlies participants’ answers to survey questions on gender expression and sexual attraction. We conducted cognitive interviews with 16 self-identified queer women, expecting participants to show variability and nuance in considering dimensions of gender expression and sexual attraction. We asked best practice versions of survey questions on gender expression and sexual attraction, then followed up with probes to ask what respondents think about when answering each question. We demonstrate how grounded theory methods can be applied to cognitive interview data by developing codes of emergent themes from participants’ responses in an inductive, iterative, and systematic process.

The results of this study indicate various considerations and refinements for measuring gender expression and sexual attraction in surveys, with implications for practitioners and researchers who are interested in measuring gender and sexual orientation holistically in survey research.

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Others have argued (The GenIUSS Group 2014 ; Lowry et al. 2018 ) that this concept may be particularly useful for adolescents and young adults who have not formed an explicit gender identity—although we might argue that young adults are the agents of emergent identity formation and understandings thereof.

Note that distinct perspectives and applications of grounded theory emerged from the work that started with Glaser and Strauss ( 1967 ) then branched to Glaser ( 1978 ) and Strauss and Corbin ( 1998 ), with other distinct applications emerging (e.g., Charmaz 2006 ).

Although some respondents indicated multiple sexual identity categories during the in-depth interview, we categorized them with one group for the purposes of analysis based on information they discussed during the in-depth interview and the cognitive interview. Participant 4 indicated an overarching alignment with the queer community and consistently noted academic considerations of queer politics, thus we placed them with “queer” in categorizing sexual identity. Participants 9, 10, and 16 all noted both queer and bisexual sexual identity. We characterize each as “bisexual” in terms of their sexual identity, as they each seem to use bisexual to specifically refer to their own identity and queer when speaking about community membership. Participant 4 indicated both cisgender and genderqueer identities.

Participants ranged in age from 19 to 35 but were mainly in their twenties, with a median age of 24 and mean age of 24.75.

We do not follow another approach common within grounded theory methodology and the constant comparative method: theoretical sampling, in which participants are purposively selected as indicated by the emerging conceptual codes in the data (Glaser and Strauss 1967 ).With theoretical sampling, data collection and analysis are confounded in that some analysis has occurred that indicates who should be interviewed next (as well as potential revisions to the interview script) (Willis 2015 ); this is not a problem with the method but something to be accounted for in analysis. Since our respondents were interviewed prior to data analysis, we did not follow the theoretical sampling that can be part of the iterative process of sampling and analysis in the grounded theory methodology. In this way, we are similar to other analyses of cognitive interviews that use the constant comparative method for coding but not sampling [see Willis ( 2015 ) for examples].

Gender presentation varies for and is interpreted through the lens of particular audiences and contexts in previous research on sexual minorities. In some cases, certain presentations take on a particular gendered meaning based on the audience and context (Luzzatto and Gvion 2004 ; Moore 2006 ); in others, presentation is used to communicate or disclose one’s sexual identity (Bulgar-Medina 2018 ; Hebl et al. 2002 ). Indeed, distinctive looks to communicate queer identities have increasingly become both more diverse and mainstream.

Sometimes probes were skipped if the interviewer thought the participant had answered the probe in another part of their answer.

Wylie et al. ( 2010 ) propose using the phrase “on average” in gender expression questions to aid in respondents’ cognitive averaging and integration of their perceived gender expression across these different domains. We used the term “overall” so as not to predispose respondents to a particular estimation strategy; another option could be “in general” to be even less specific. Other sorts of response strategies include signaling a modal response, such as “most of the time,” or typicality, such as “on a typical day,” and each of these might lead to different considerations among respondents for whom their appearance varies depending on context, time, or audience.

Although “mostly” and “very” are considered synonyms that indicate a higher values of what is being measured, participants also could have had trouble with the scale because the verbal quantifiers mix dimensions: “mostly” is a quantifier denoting the amount of a whole, whereas “very” is a qualifier denoting value.

The English language has a decided lack of adverbial quantifiers between “somewhat” and “very.” “Pretty” and “quite” are two alternatives, although “pretty” may be complicated given that the question asks about appearance and “quite” sounds formal. Based on theory and research in survey methodology (Kronsick and Presser 2010 ), we do not recommend rating scales with only endpoint labels and numbers for the intermediate response options (c.f. Magliozzi et al. 2016 ; Wilson et al. 2014 ).

One common practice with the bipolar scale is to present the feminine side of the scale first if the respondent is presumed a woman and the masculine side if the respondent is presumed a man. Another practice is to present the same side of the scale to everyone regardless of gender in a paper-administered survey (e.g., Youth Risk Behavior Survey).

Only one participant discussed consciously modifying their mannerisms: Participant 11, a cisgender woman, stated, “um when I was younger I tried to be very masculine and very like sort of aggressive way like masculine in the sense of being uh not just physically aggressive but like like aggressive in the way I talked and uh sort of taking up a lot of space that sort of thing. But at the same time I always sort of walked and moved in a way that a lot of women do and then like actively tried not to and then it’s just a mess I guess.”

We coded for the presence of the following features of the interaction that may indicate various forms of processing and difficulties in answering the survey questions. These each may indicate grappling with the task at hand or the mismatch of the task with one’s lived experience: disfluencies tokens (“um,” “uh”) and markers of uncertainty: mitigating phrases (“probably,” “I think”) and “don’t know” as an answer or mitigating phrase.

The US PATH data uses the response dimensions “mostly to females and at least once to a male” (Federal Interagency Working Group 2016a ). Rust ( 1992 ) measures strength of attraction as a percentage for one gender at the exclusion of others, e.g., 90% for women, 10% for men.

The current practice with the bipolar scale is to present the “only attracted to males” side of the scale first if the respondent is presumed a woman and the reverse if the respondent is presumed a man.

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Garbarski, D., LaVergne, D. (2020). The Measurement of Sexual Attraction and Gender Expression: Cognitive Interviews with Queer Women. In: Brenner, P.S. (eds) Understanding Survey Methodology. Frontiers in Sociology and Social Research, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-030-47256-6_9

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Published: 04 February 2021

Sexual orientation, gender identity and gender expression-based violence in Catalan universities: qualitative findings from university students and staff

Elena María Gallardo-Nieto 1 ,
Aitor Gómez 1 ,
Regina Gairal-Casadó ORCID: orcid.org/0000-0003-0093-7912 1 &
María del Mar Ramis-Salas 2

Archives of Public Health volume 79 , Article number: 16 ( 2021 ) Cite this article

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Hate crimes have raised in Spain and the gender and sexuality-based conflicts persist worldwide which leads to this problem having an effect on health and wellbeing. Following a focus of transforming Higher Education Institutions, this research analysed the problem that affects undergraduate students in six Spanish universities. The research goal is to improve the life quality of lesbian, gay, bisexual, transgender, queer and intersex university students, breaking the silence that exists around the violence that this group suffer in Catalonia, Spain.

Following the Communicative Methodology, this study has identified violence based on sexual orientation, gender identity or gender expression in the target universities and provided guidelines to improve anti-discrimination protocols. A qualitative method has reached experiences of university students, heads of equality commissions, professors and administrative staff regarding this conflict. Focussing on the qualitative research tools, 30 semi-structured interviews were conducted with university students and staff around issues related to the violence against lesbian, gay, bisexual transgender, queer and intersex students: 1) perception of violence and discrimination, 2) institutional measures, 3) actions against violence. An analysis of exclusionary and transformative dimensions was used to identify emergent themes.

We have identified two dimensions for the analysis given their impact in contributing or overcoming violence: exclusionary and transformative. A wide range of forms of violence on the grounds of sexual orientation, gender identity and gender expression perpetrated at universities have been identified as exclusionary facts and described by participants in the study. Equality commissions have not received reports of violence based on sexual orientation, gender identity or gender expression, and university staff shows certain unfamiliarity regarding the measures and politics to prevent and intervene in cases of violence against the lesbian, gay, bisexual, transgender, queer and intersex community. Among the results identified as transformative are the ways through which actions of lesbian, gay, bisexual, transgender, queer and intersex groups against violence and the professors’ commitment to intervene have a relevant impact on student’s wellbeing. An improvement and implementation of anti-discrimination protocols with mandatory applicability has also been documented.

Conclusions

Findings highlight the need of collecting more evidence that contributes to the improvement of protocols, measures and politics to protect all the members of the university community. A better understanding of violence based on sexual orientation, gender identity and gender expression in HEI’s may guide national and international governments to improve the health and well-being of lesbian, gay, bisexual, transgender, queer and intersex persons.

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Violence based on sexual orientation, gender identity or gender expression is present in our society and within the university community [ 1 , 2 , 3 ]. Numerous international studies have shown that the lesbian, gay, transgender, queer and intersex (LGBTQI+) community have more risk and probabilities to suffer sexual discrimination or harassment during their university trajectory [ 2 , 3 ]. Furthermore, the risk of being object of violence increases in the case of transgender students [ 4 , 5 , 6 ]. National politics and international agendas have given priority to the legislation and regulation to end with LGBTQI-phobia [ 7 , 8 ], even though the risk of suffering sexual harassment is still higher in the case of sexual minorities [ 1 , 6 , 9 , 10 ]. The case of Spanish universities reflects the international panorama in relation to the LGBTQI+ academic community [ 11 ]. Educating in diversity, tolerance and acceptance towards diversity is crucial, but international reports show that this is still a pending issue in Spain [ 12 ]. The lack of literature and research about how this phenomenon affects Higher Education Institutions (HEI’s) is striking and generates a significant silence towards the situation of the LGBTQI+ community and the consequences of LGBTQI-phobia in their personal, academic and health status. As a response to this reality, the research Uni4freedom seeks to contribute to breaking the silence that goes along the LGBTQI+ community at HEI’s, improving the quality of life of the academic community and the struggle against violence based on sexual orientation, gender identity and gender expression in the Catalan context.

The main challenge when studying the discrimination against the diversity of sexual orientations, gender identities and expressions is the diversity of violence manifestations. A change in the ways violence against the LGBT community is manifested, has been shown in the literature in the last years, shifting towards more subtle and unnoticed manifestations [ 6 ]. Verbal forms of violence [ 9 , 13 , 14 ], homophobic jokes [ 10 , 15 , 16 ], anti-LGBT paintings, graffities and threats [ 3 , 13 ], social distance [ 10 , 15 , 17 ], not-inclusive or acceptance spaces [ 18 ] and possible risk of suffering from unprotected forms of sex and AIDS’ contagion [ 19 ] have been identified as advanced forms of violence based on sexual orientation or gender identity or expression. On the one hand, the case of a hostile environment is conditioning the free expression of the felt gender identity and sexual orientation [ 9 , 18 , 19 , 20 , 21 , 22 ]. On the other hand, all these forms and manifestations of violence can generate a response of internalization and normalization of the homophobic actions, perpetuating the violence and affecting negatively in the life quality and wellbeing of the LGBT+ academic community [ 3 , 16 , 22 , 23 , 24 , 25 ].

According to the findings in the scientific literature, violence and discrimination based on sexual orientation and gender identity and expression, has consequences in three spheres of the LGBT university students’ life. Firstly, it affects the health status, both physically and mentally. It has been shown that LGBT students present higher symptoms of depression and anxiety [ 9 , 13 ] and suffer various forms of physical ache [ 10 , 16 ]. Secondly, it affects their academic performance, presenting a lower grade in average in comparison to hetero-cis students [ 26 ]. This difference of academic results has been analysed as an aftereffect of LGBT stigmatization creating difficulty to focus on their studies [ 19 , 27 ], having further consequences in their future possibilities and academic success [ 24 ]. Thirdly, these realities of LGBT-phobia in HEI’s promote exclusionary climates and negatively affects the cohesion and relationality of sexual minority students [ 22 ]. The seen or suffered experiences of harassment or discrimination can generate a feeling of isolation and exclusion [ 6 , 26 ] which can be reinforced by the institutional invisibility of LGBT perspectives and role models [ 13 ].

Evidence shows six different axes to prevent and intervene in front of violence based on sexual orientation and gender identity and expression within university institutions. Visibility of the LGBTQI+ collective and their situation in the university scope is key to prevent LGBTQI-phobia. Besides, generating profound awareness of university members is necessary to be able to face the problem of LGBT-phobia [ 1 , 28 ]. In order to make this awareness effective and reach the whole academic community, the inclusion of LGBT literature in academic curriculums has the highest impact in the reduction of LGBT-phobia [ 18 , 28 ]. Another protective factor for the prevention and intervention in cases of violence based in sexual orientation, gender identity and gender expression is the explicit institutional support towards the LGBTQI+ community through the implementation of politics and strategies towards the reduction of hetero-sexism [ 6 , 9 , 29 , 30 ].

This article presents qualitative evidence about how to overcome this form of gender inequality in a very relevant social institution. We have chosen a qualitative method in order to delve into the complexities of suffering or witnessing violence at HEI’s and the possibilities of intervention that participants identify in their own interpretation. This methodological choice aims to reinforcing the knowledge and contrasting the depth and complexities of the qualitative findings of the project. Very important issues to be considered when preparing policies for the prevention and intervention of LGBTQI-phobia are thus presented . In conclusion, the study aimed to give visibility to the violence based on sexual orientation, gender identity or expression that takes place in HEI’s, and to identify successful practices and decisions for the eradication of this violence.

This article has been focussed it research methodology for social impact. The voices of the end-users of the research have been incorporated in all phases of the research, in order to contribute to the social impact and social transformation of the conflict [ 31 ]. To make that possible, the methodological design is based on the Communicative Methodology of Research (CMR) [ 32 ], which stands out for its capacity to identify successful actions that contribute to overcoming inequality and to generate social policies based on these actions. CM stands out for generating scientific knowledge through the contrast of the scientific evidence (contributed by the researchers) and the contributions of the social agents’ participants in the research, defined as the world of life [ 33 , 34 , 35 ].

The study was designed to understand how, why, in which forms and circumstances this form of violence in HEI’s take place affecting university students’ life, health status and future. Given the scientific evidence on LGBTQI+ violence prevalence and the aims of the research, the main research objective is to improve the quality of life of LGTBIQ university students, breaking the silence that exists about the violence they suffer.

Following the communicative perspective, Uni4Freedom has implemented mixed-methods research [ 34 ] of which the qualitative techniques’ results are presented in this article. Semi-structured interviews Footnote 1 with communicative orientation have composed the fieldwork of the study taking place in six universities of the Catalan region [ 36 , 37 , 38 ]. The fieldwork has been designed in order to, firstly, make an approach and a diagnose of the reality that the LGBTQI+ community faces at Catalan universities and, secondly, delve into the perspective of university staff and professors, exploring the possibilities to implement and propose transformative actions for the inclusion and non-discrimination. The population target of the study is the academic community enrolled in different disciplines within the project’s six partnering Catalan universities Footnote 2 : students, university professors, administrative staff and heads of equality commissions or units at these institutions.

Communicative organization of the research

In order to ensure the social impact of the research, the voices of the LGBTQI+ community and LGBTQI+ organizations have been included in different forms and phases during the study. Their participation has been indispensable, contributing with reciprocity, advice and follow-up to guarantee that the research objectives are met and ensuring ethics’ standards in the methods. The Advisory Board is a follow-up and supervising body which has been formed by representatives of organizations of reference on LGBTQI+ rights in the territory Footnote 3 . In two different stages of the project and face-to-face meetings in 2018 and 2020, this board has debated and reviewed the methodological plan, research technics, findings and proposals grounding the materials in their experience and expertise in LGBTQI+ rights and reality. Their contribution has contributed to comply with ethical principles as well as to ensure the work and results for the improvement of the situation of the LGBTQI+ community at Catalan HEI’s.

We have conducted 12 semi-structured interviews with communicative orientation to LGBTQI+ university staff from the partner universities of the project. Besides, we have conducted 4 semi-structured interviews with communicative orientation to heads of equality units or commissions from the partner universities of the project. And finally, 12 communicative daily life stories with University students have also been done. These technics have followed the communicative orientation of the methodology by facilitating reflective dialogues between participants and researchers about the incidence of violence due to sexual orientation, identity or gender expression faced in their careers as university professor/staff or student. Proposals to make university a more LGBTQI+ friendly space were also gathered from these qualitative work. The distribution of research tools and participants has been as follows:

Research tools

The guidelines of the interviews have been designed following the communicative perspective, attending to the results of the literature review and contrasted with the Advisory Committee. This combination in the design process has allowed us to develop complex guidelines that enable the identification of situations, characteristics and circumstances that either promote or allows to transform situations of violence based on sexual orientation, gender identity or expression at HEI’s. We have identified three sections that have let us build the data collection process of the interviews. In what follows, the structure of the interview under the three sections and some of the questions of the interview’s guidelines are introduced:

To describe and presentgeneral aspects of the research method, theme, exploring different perspectives and ideas in relation to the reality of the situation of the LGBTQI+ community in University.

To study the experience or perception of violence based on grounds of sexual orientation, gender identity or expression at University or spaces related to the institution according to the results of the literature review. The opening question of this section in the case communicative daily life stories with students was the following:

“If you know of any cases of violence due to sexual orientation, gender identity or gender expression, comment on it:

Do you think that the people who suffer from any of these situations are considered victims of violence because of their sexual orientation, gender identity, or gender expression. Why? Why not?

What was your reaction to the situation of violence? Why?

What was the victim’s reaction to the violence or discrimination? Why?

If it was reported to the university, what was the institution’s response? How did they interpret it? How does the institutional response affect the victim’s decisions and behaviors?

What consequences did the fact of reporting have on the aggressor? And on the victim?

Do you know what has to be done in the case of suffering a situation of violence due to sexual orientatio, gender identity or gender expression?”

To approach the perception of institutional strategies to detect, prevent and intervene in cases of LGBTQI-phobia by the research participants attending to their different roles in the community. Two questions from the semi-structured interviews with university staff from this third section were the followings:

“In the section on harassment and discrimination, the inclusion of sexual orientation and gender identity/expression in anti-discrimination policies and the approval of protocols against LGBTI-phobia is considered. Some universities, such as Oxford, Tuft and UCL, have explicit online policies regarding sexual orientation, and other ones have specific policies concerning the trans* community, as well as policies to ensure inclusive language.

Do you think that this would be convenient at your university? Do you think it would be appropriate? Do you think it would be viable? Why? What benefits would it have and how would students experience it?”

“Finally, on training for members of the university community to detect, prevent and act against LFBTI-phobia. Universities like Pennsylvania and Washington train the community to ensure Safe Zones, zones free of any violence, and others like Cambridge and Oxford train the community in successful actions, such as bystander intervention and providing online resources.

Ethical validation

The study has received the ethical validation of the ethical committees of Girona University and Lleida University in 2019. After submitting a detailed protocol for the fieldwork, containing consent forms and interview guidelines, the Ethics and Biosafety Committee of the University of Girona approved the start of the fieldwork. For the second ethical approval, the Committee for the approval of research studies at the Faculty of Nursing and Physiotherapy of the University of Lleida approved the fieldwork plan, consent forms and guidelines for interviews under the ethical requirements of confidentiality and good praxis without any objections.

Consent forms were systematically signed by all research participants and by the researchers implementing the tools, in order to ensure the former’s rights in the research. These forms helped us to protect their right to confidentiality, anonymity, wilfulness, possibility to stop or leave the study at any moment and receive all necessary information for their involvement by the researcher.

Aside of the institutional validation, the research counted with an Advisory Board which supervised, followed-up and advised the research team in three different phases: approval of the literature review, fieldwork plan and preliminary results of the study. This board was composed by members of the LGBTQI+ community, university students and representatives of active organizations for LGBTQI+ rights of the territory Footnote 4 . Their belonging to the targeted community was due to the need of including the voices of the end-users of the research throughout the whole process of the research. The role of the board has been to relate the theory and scientific evidence to the daily reality of the LGBTQI+ community, reinforcing the transformative role of the research through their very contributions in the study.

Data analysis

The analysis chart has been designed to collect contributions from interviews and communicative daily life stories considering all the dimensions and categories selected (Table 1 – Result analysis chart). Dimensions are located in the rows and refer to the two sorts of results depending on their contribution or transformation of the target conflict, referring to the Communicative Methodology. Categories are the concepts that are being used in the research process to analyse the results of the fieldwork and they are located in the columns (Table 1 – Result analysis chart). The categories have been defined through a deductive method of definition, meaning that they have been determined before fieldwork through the study of scientific literature regarding LGBTQI-phobia in HEI’s. The categories resulting from this study are: LGBTQI-phobic violence, actions against the violence and university politics and measures against the violence.

The research team has processed the qualitative results of the fieldwork ensuring the anonymity of the participants in all the phases of the study. Members of the research team have transcribed the interviews and daily life stories verbatim. Then, the research team has coded the transcription by using the numbers of the designed analysis chart (Table 1 – Result analysis chart), identifying results and matches between the targeted categories and dimensions on the transcriptions. We have not made use of any software or program for the systematization of this process.

In this section, we have made an in depth approach to the research target: studying violence against LGBTQI+ community in HEI’s. On the one hand, we have analysed the results that do not contribute to overcoming the problem of violence based in sexual orientation, gender identity or expression, encompassed within the exclusionary dimension. On the other hand, we have analysed the contributions that have an influence in transforming and overcoming the targeted violence in HEI’s, included in the transformative dimension. All of the results presented belong to the research tools and the research participants already mentioned in the fieldwork subsection (Table 2 - Fieldwork distribution).

Violence’s normalization and internalization

Normalization and internalization of LGBTQI-phobia are the most present consequences of the violence in HEI’s. These results show the need to promote measures of awareness-raising to promote respect to diversity. Under this category, we highlight the normalization of violence in the daily discourses at universities as a consequence of the constant violence against the LGBTQI+ community. The normalization of violence is funded on naturalizing discriminatory comments towards the LGBTQI+ community, which can happen even within classrooms, as stated by a LGBTQI+ university professor in an interview:

Then, inside the class, let me think... at the break and when we leave and so on, I’ve seen someone say to another "hey faggot, you didn't get the work done today!" maybe they said that and, I don't know, I have it so incorporated that I don’t realize either.

In this sense, students have also shared in everyday life stories experiences that prove the naturalization of discriminatory discourses towards the LGBTQI+ community, as stated by a female undergraduate and LGBTQI+ student in a communicative daily life story:

Well, I don’t know, if in class or between classes, we are talking, or they are talking, so in a group, and they want to refer to a boy as being a freak or weaker than the rest they refer to him as a faggot.

The LGBTQI+ participant students in the research have claimed the consequences of the normalization of the violence. Following their discourse, they have found that reproduction of homo and lesbo-phobic comments and the self-internalization of the violence are results of having received a LGBTQI-phobic socialization. As a female and LGBTQI+ student expresses in a communicative daily life story:

Many times, I think they overlook these comments because we are used to them. For me what happens to me is like, if one day I hear someone say butch or something, it's not hard for me to pass but I guess I would think that he’s an asshole, you know? But then I would think that, he’s silly and that's it and I wouldn't take it as something personal, but as something more social that looks normal.

Transgender vulnerability in the conflict

Research has shown that transgender people are the most prone to have difficulties and to suffer violence or discrimination at HEI’s [ 4 , 5 , 6 ]. This form of vulnerability in the university context is even more disturbing when the results show the complexity and accumulation of forms of violence that only transgender students suffer. There can be specific circumstances that transgender students live, such as the social transition and the bodily changes, elements that can make their educational process at university even harder when belonging to the LGBTQI+ community. As a transgender student states in a communicative daily life story regarding the transitioning:

Then I made the transition and it's like that, with the medication and that, I was like super confused with many things, I was relocating mental issues, because in the end I didn't know many things either, because the medication numbed me and I don't know. Of course, I did notice suspicion and misunderstanding and a feeling of being something weird, feelings of disgust, by some colleagues and I realized it but well, as I’m saying I tried to ignore it because I have enough problems.

The exclusionary discourses, looks and refusal perception is clear in the voice of the interviewed people, showing the need of promoting measures of awareness raising that advocate the respect to diversity and differences. In this sense, the need of intervention and respect towards the transgender groups is especially relevant, as it has been shown in the interviews’ fragments.

Unfamiliarity of institutional mechanisms and interventions

Secondly, findings on university policies and measures have indicated the lack of actions, university policies and measures to fight violence and, at the same time, they prove the ignorance of professors and staff about the mechanisms to prevent and intervene in cases of LGBTQI-phobia. Furthermore, the lack of cases of violence due to sexual orientation, gender identity or expression reported at equality offices indicates the complexity of this form of violence and the likely unawareness about violence based on the grounds of sexual orientation, gender identity and gender expression by officials at universities. The fact that some Heads of University Equality Offices claim not to have received complaints regarding violence based on sexual orientation, gender identity or expression is relevant, as one experienced worker on an Equality Office shared regarding the cases of LGBTQI-phobia in an interview:

The truth is that no. I have not dealt with any cases at the observatory, no petitions nor expositions have been received of violence based on gender identity or sexual orientation. We haven’t realized it. For me, it hasn’t come directly to me as a teacher or as a colleague. It hasn’t reached me. I know it’s a college reality, but the truth is I can’t say it’s a reality for me because I haven’t seen it.

The figure ‘0’ of cases of violence based on sexual orientation, gender identity or expression at universities can be explained by the lack of mechanisms and abilities by university professors and staff to identify and detect the violence [ 6 , 39 , 40 ]. Moreover, it could also be justified by the attempts to generate safe and friendly spaces for the LGBTQI+ community to make the process of filing a complaint of LGBTQI-phobia easier. As we can see in the following fragment from a communicative daily life story with a transgender student which has already faced the process of name change, he reflects on other possibilities to it within HEI’s:

I think that a trans person should not go through an equality unit to request a name change, right? But I think that this could already be done in a much easier administrative process of administrative, that is, how you do your... You fill out your application for the first time, that is, in that database, what if there were what is called a chosen name?

The lack of knowledge from university professors, staff and officials about measures, resources and officials of reference in cases of LGBTQI-phobia has been stated in the interviews as a constant reality, as mentioned by a female university professor in an interview: “I’m not responsible. I don’t know if within the management team there is someone in charge of this policies in case there is a problem.”

We have identified other indicators apart from unawareness which could respond to the lack of a support network for victims of LGBTQI-phobic violence within HEI’s. Many university policies and educational protocols for the prevention and intervention in cases of violence based on sexual orientation, gender identity or expression have been developed in the last years from Equality Units and Commissions and other spaces towards equality and against discrimination in HEI’s. The ignorance of the international scientific evidence about the existig policies carries a limitation in the struggle against the violence towards the LGBTQI+ community. This is due to the lack of knowledge and training on the measures and the roots of LGBTQI-phobia for the implementation. In order to understand the notions on institutional measures to intervene in conflicts based on sexual orientation, gender identity or expression, we can see an active LGBTQI+ university professor’s discourse where he discusses the thoughts on the transgender name-change process as it follows a fragment of an interview:

The doubt that I was holding is the legal part. Without a doubt the university has to support straight away and if it is necessary to change, it is changed [referring to the name], if you have special needs, it has to be attended, they have to be listened to and we have to see what can be done, of course. What confuses me a little is the legal issue. (…) To the official lists, they appear with the birth name, but they can be changed, and it seems viable, and they are comparable because at the end, that’s the name that they identify with. “I do not identify myself with Antonio José... I identify myself with Toni.” And it seems very comparable. If this person wants to change the name of Maria to Peter because he identifies himself as Peter, so Peter be it and that’s it. What I find most complicated is at a more internal level, for example in the records, that you have the name changed because there would probably be a conflict of legal identity.

In this sense, students agree in recognizing that ignorance complicates the process of identification and support in particular situations of LGBTQI-phobia at universities. For that reason, training and awareness raising on LGBTQI+ issues are both considered very necessary towards turning all university members into agents of change, whether being or not part of the LGBTQI+ community, as a cis-heterosexual female student points out in a communicative daily life story:

I think so, I have not experienced these situations, and I don’t know these type of situations. I'm sure it happened. I think that it should be known both for those who do not know it and for those who suffer it or have seen it, to know that they are not alone that someone is aware of the issue and that they take measures against these situations and that there are those points of help. There are also people who do not want to come out of the closet and they may have problems but they will not ask for help because they have not yet come out of the closet, so it would be good for them to know that there are actions that can help them without anyone knowing anything and keeping their secret. It is an option for those people to have help.

University as a safe space

Secondly, on the variable LGBTQI+ actions against violence findings point at the existence of three protective factors that lead to overcoming violence and discrimination: HEI’s perceived as safer spaces compared to other places, compromise and predisposition of professors to successfully prevent and intervene in cases of violence and university protocols and measures of intervention including all university community. This is due to the role of Equality Units, their familiarity, respect and openness has an important effect in the prevention and intervention of cases of LGBTQI-phobia. We have identified that HEI’s offer a very wide window of possibilities for intervention, acceptance and respect compared to other spaces, as a LGBTQI+ female student points out in a communicative daily life story:

Sexual diversity is more comfortable at university than in other places and that’s why I also think it’s sometimes easier to make more demands within university, right? Because as there is this freedom or this friendly climate, right? Friendly to make claims, to make demands for improvement, so it’s easy to get it and therefore I think that precisely freedom encourages more freedom of expression, right? And more diversity.

Another protective factor within HEI’s towards the LGBTQI+ community and for the transformation of the violence and discrimination is related to the compromise of professors to prevent and intervene. The alliance between students and professors is especially valuable when having the support of a more powerful group within the educational institution in terms of decision and action. This particular support can be offered for different reasons, firstly for the training, awareness and activism in terms of rights by professors. Next, the importance and urgency of intervening in order to transform and stop the conflict based on gender or sexual diversity is made explicit by one of the LGBTQI+ university professors interviewed:

Having just one victim is enough to talk about it and explain that these things are happening, anonymously. If not, we have to orient ourselves differently, lead it in a way that if things happen socially, we try not to let them happen here. Obviously, they shouldn’t take place anywhere. We protect the space; I think we have to find a balance in that so as not to create an alarm.

The compromise to intervene in cases of violence based on sexual orientation, gender identity or expression has been expressed in different forms in the discourses of LGBTQI+ staff. The following case goes one step further as, aside of an open commitment with LGBTQI+ issues, this social conflict is taken into consideration as part of the very teaching praxis. As a result of this, we see how a safer space in the classrooms can be created, by making sexual and gender diversity an issue in the lectures. A LGBTQI+ male professor - committed to openly talking and discussing about matters of gender, sexuality and diversity in class-, talks about the reaction of his students when addressing these issues:

No! Not in class, maybe that's because we criticize it, and make people think and everything is politically correct...to let them see their experiences based on that and then see how they act...of course, in class I guess that they are aware that it would not look very good for them to do joke about it if we are working for them not to do so in their own environments.

When breaking the silence on the issue of LGBTQI-phobia so that the topic becomes a recurring theme in the classroom, students become active upstanders questioning themselves and intervening in cases of violence [ 41 ]. In this sense, another cis-heterosexual university professor highlighted in the interview the need to break the silence and generate mechanisms facilitating that people dare to complain:

It may also be that things are happening and we don’t know it because there aren’t protocols, so this is also a way to encourage people who are going through things to report it. Because violence is always hidden actions. If this is giving them a little encouragement to report and explain what is happening, even if the violence is not physical, that is verbal, that is behavioural, exclusionary...

The value of receptiveness and alliances

Thirdly, on the variable university policies and measures, we have identified evidence of the openness towards sexual and gender diversity by university professors, also considering the need of prevention and intervention plans and measures of high quality in order to transform the reality. This is the case of protocols and measures of intervention generated by the Equality Units at HEI’s that have been interviewed. They highlight the quality and connection with the reality of the LGBTQI+ community of their regulations and intervention measures in their own Units. This is due to the success of negotiation processes between HEI’s and Equality Units, thanks to the sanctions that exist in case of not implementation and to the inclusion of gender identity and sexual orientation perspectives in the regulations. This is introduced by a long experienced worker on the service of the Head of an Equality Office at one participant university in an interview:

We have a regulation for the prevention of gender violence. The difference between regulation and protocol is that all other universities have protocols, ours has sanctions. The others do not have it typed. Our regulation -which was one of the first to be done, but which had two years of negotiation with the University-, is a comprehensive one because it covers the entire university community (officials, staff, professors, students) and it is also a one that entails penalties that many of the university’s protocols do not have. Then what we have done is the adaptation of it, when we already made the regulation, we put for example everything that was harassment due to sex and sexual orientation, we added all the sexual orientation tag.

The interviewees have shown willingness to learn the measures and implement them in the Catalan University contexts, even though if they have not received any training in LGBTQI+ issues. The following fragment refers to a LGBTQI+ male university professor’s interview referring to the measures of trans-inclusion at their institution:

Of course, as the number does not change, so there is no problem, and everything is linked to the ID number and instead you can change the name. I think it’s ok, if there is a real need for it and it is a request from individuals or the community itself, I do not see it difficult and do not see a problem. I think it would bother me to call this person by the name with which they do not feel identified. If they tell me to change the name, I tell them that way, because otherwise there is not an effective dialogue, so I think that if possible, I think it’s perfect and go ahead.

Predisposition and interest by professors have appeared in the qualitative fieldwork together with the claim of needing scientific evidence as well as the inclusion of voices of the own community and of experts in the field. Then they could advise and orientate regarding measures and politics at HEI’s. A university professor claimed it during the interview as follows:

Totally, but I think that the experts here are somehow the ones who have to take the lead because I do not consider myself an expert on the subject, I am a total ignorant, because I find it hard to find the right words to talk about this community, if we are referring to differentiated groups. Mm, I feel I can talk about certain things, but when I think about it, I think that maybe I had not realized it. My normal life is not affected, but there might be other people’s life who is (…) and then if the need exists and the university has the measures to make it feel normal, so that this becomes of normality, then I will be happy to follow any training that is needed because for me it is also an exciting topic, not morbid-like, but to know. Because it is becoming more and more visible.In the same way that this professor commented, another student also claimed the need of measures and politics to have some support in case of suffering violence based on sexual orientation, gender identity or expression. The following statement is a fragment of LGBTQI+ activities and university student’s communicative daily life story, reflecting clearly on the need of feeling institutional protection in order to feel integrated at University:

That people feel safer, better, that they have a real moral and psychological support because until now, they are not considering themselves part of anywhere. Having such a policy would help us a lot to feel that we belong and that we are considered part of something because, of course, we are having to face these LGTB-phobic behaviours and they have to be counteracted with something, right?

Our study demonstrates the urgency of the conflict taking place at HEI’s on the grounds of sexual orientation, gender identity and gender expression. It has also provided us with the scientific evidence and the protagonists’ discourses by bringing to discussion how both dimensions match and complement each other when facing conflicts, needs and discrimination based on sexual orientation, gender identity and gender expression. Furthermore, the study has added relevant knolwedge to previous research with an evidence-based approach and successful cases to improve protocols and strategies for the struggle against the problem of LGBTQI-phobia taking into account the voices of the university community in the Catalan context. Contributing to the previous research on gender violences at Catalan and Spanish universities [ 31 ], our study has gone further in studying the problem of gender violence against the LGBTQI community in HEI’s for the first time in Catalonia. The complementarity of both the generation of evidence and new proposals of avenues for the improvement of current protocols, policies and measures towards the inclusion of the LGBTQI+ community sets a precedent on how to turn HEI’s into more LGBTQI+ inclusive institutions.

Challenges in identifying violence

There is plenty of evidence about how the conflict of violence based on sexual orientation, gender identity or expression is a current reality, which is visible and has become a relevant subject for the development of international policies and agendas in Europe [ 42 ]. Furthermore, the scientific literature describes how this conflict can permeate social institutions, affecting subjects in different spaces, dimensions and degrees. The main challenge identified in the struggle against this social conflict is its identification and detection in institutions, as it has been mutating and changing its form to avoid being detected [ 6 ].

Our study has, not only proven the existance of a variety of forms of direct violence that take place in HEI’s, but it has also identified more subtle and unnoticed forms of violence. Verbal forms of violence, such as homophobic and transphobic comments and jokes, paintings and non-inclusive spaces and classrooms are just the more apparent forms of violence pointed out in the research [ 9 , 10 , 13 , 14 , 15 , 16 , 18 ]. What has made the situation in the Catalan context more complex is the generalized reaction of internalization shown by LGBTQI+ victims and other agents. As the literature highlights, this response of normalization and naturalization of the violence against sexual or gender diversity contributes in the reproduction of the violence against the LGBTQI+ community [ 3 , 16 , 23 , 24 , 25 ].

Besides the reaction of the victims and the LGBTQI+ community, the responses from the rest of institutional agents facing the conflict are especially significant. As mapped by the research, the role of other students and peers [ 27 ], professors and staff is key when approaching the cases of LGBTQI-phobia at university, as the relationality, authority and influence is compelling [ 8 , 20 , 21 , 22 ]. As the findings have shown, their availability, openness and attitude towards the LGBTQI+ community and sex and gender diversity can have an impact on the perception of classrooms and university campuses as free and safe spaces. Additionally, we have found how previous debates or workshops of LGBTQI+ issues at university classrooms can prevent some forms of LGBTQI-phobia from happening. As well, these previous experiences on discussing gender could facilitate processes of social transition, reception of reports of violence or discrimination, improving the perception of the university as a friendlier and safer space. In addition, the heads of Equality Units’ figure entails two different roles: as social agent and worker as well as a representative in terms of equality and non-discrimination in the institution. In any case, this readiness and preparation does not suffice while numbers show that there are no cases of LGBTQI-phobia arriving to institutional instances in some of the participant HEI’s.

Damage on wellbeing of LGBTQI+ students

Given the findings about the prevalence of violence on the grounds of sexual orientation, gender identity and gender expression in Catalan universities, the negative impact on the well-being and life quality of LGBTQI+ students is a fact. If the existence of violence against sexual and gender diversity in university spaces is a reality, the probability of having students suffering physically and mentally, presenting symptoms of depression, anxiety and various forms of physical ache are a worrying reality for the institution [ 9 , 13 , 16 ]. Furthermore, this difficulty affecting only a group of students would generate a gap in the access, quality and academic success compared to the rest of the community due to their health status [ 25 ]. The lack of social cohesion within the university community and students, has a high impact in the present and future of LGBTQI+ students in Catalonia. LGBTQI+ stigmatization also results in impediments for LGBTQI+ students to reach the same academic level and success than the rest of the students [ 19 , 23 , 43 , 44 ].

The findings about the damage of the LGBTQI+ students at University has given visibility to the risk that the LGBTQI+ community suffers which also affects their wellbeing. This evidence indicates that the generation of successful strategies to prevent, detect and intervene in cases of violence on the grounds of sexual orientation, gender identity and gender expression is urgent. This emergency lies on the institutional duty of offering quality higher education for everyone without of any type of discrimination. In order to eliminate any form of discrimination effective anti-discrimination strategies based on scientific evidence need to be developed.

University policies and measures a the LGBTQI-phobia

Given the results about the implemented strategies to fight and prevent forms of violence on the grounds of sexual orientation, gender identity and gender expression, issues on the evaluation, quality and follow-up of these measures are still pending. The evidence shows that the current strategies to fight, prevent and intervene in cases of LGBTQI+ realities in Catalonia are configured as responses to concrete and specific situations. This conception of the LGBTQI+ reality as a transitory conflict and circumstance implies that the forms of intervention planned only take into account the specific conflict, without paying attention to a reality that is present in all the spheres of the university. This can respond to the lack of continuous and more transversal actions that educational systems implement to carry out more equitable actions for the inclusion of LGBTQI+ realities within HEI’s.

Giving visibility and raising awareness of the LGBTQI+ circumstance is a very pressing issue present both in the literature and in the results of the research, as it can prevent different forms of LGBT-phobia. These actions are identified as protective factors in the prevention and intervention of discrimination and violence on the grounds of sexual orientation, gender identity and gender expression, as well as for generating and imporving the LGBTQI+ students’ feelings of belongingness to HEI’s. More in depth, literature and participants have identified the need of training professors and other university staff about LGBTQI+ perspective [ 1 , 28 ]. This could have an impact on the way conflicts and discrimination on the grounds of sexual orientation, gender identity and gender expression is managed with professionals, ensuring safe follow-up and accompaniment processes by educators and staff -who would be trained on the situation of the LGBTQI+ community through scientific evidence-.

In order to translate this process of making LGBTQI+ issues a closer reality to the university community, the inclusion of literature from a LGBT+ perspective in the academic curriculum has been identified as having the highest impact for the reduction of violence and discrimination on the grounds of sexual orientation, gender identity and gender expression [ 20 , 28 ]. Its implementation would require HEI’s to include LGBTQI+ issues horizontally in all university degrees’ classrooms, considering as an institutional duty the need of ensure freedom of living and expressing sexual and gender diversity. Another way of institutionally protecting the LGBTQI+ community is by explicitly supporting the community as has been informed by the literature [ 6 , 9 , 29 , 30 ]. Lastly, the urgency of addressing the transgender issues at universities is present in both the project’s results and literature [ 45 ], highlighting the need of articulating successful practices and accompanying processes to transgender students for the improvement of their health [ 43 ]. This would require that universities start conceiving the transgender reality as a continuous, individual and changing phenomenon that goes beyond the name and gender change in the identification documents, affecting the live of students with different intensity and in different stages and social circles.

Altogether, the complexity of assessing and reviewing the success and impact of university protocols, measures and strategies to intervene is both a scientific and socio-political issue, attending to the changing political circumstances that affects the European and Spanish context. The research limitations that have affected the study have been closely related to the human interactions during the fieldwork, the protection of the anonymity, the search for gender and sexual minority participants and the issues of visibility and public recognition of participants. For that reason, we have worked very hard in the ethical framework and approval to ensure everyone’s safety, respect, confidentiality and support during and after the fieldwork. Otherwise, the qualitative method and results of the study have also set limits on the applicability and transferability of the findings. Although quality-centred findings do not offer results that can be generalized to the whole Catalan university community, they have allowed us to delve into the reality of the Catalan HEI’s through the discourses of university staff and students.

Following our research goal of improving the quality of life of LGBTQI+ university students, through the CM and breaking the silence that exist about this sort of violence, the study identified protective and exclusionary factors likely to have a high impact in the quality of life of University LGBTQI+ students in the Catalan region. This innovative and transformative focus has provided the dialogue-based methodology on the study of the conflict of gender and sexual diversity in the most relevant educational institution.

The need of studying the conflict of LGBTQI-phobia at universities lies on the importance of higher education in the lives of students and in their future possibilities. It also falls on the strong impact of suffering violence and discrimination for several years while the right of living one’s sexual orientation, gender identity and gender expression freely is not guaranteed. All of this shows how gender and sex norms permeate educational institutions [ 46 , 47 ], making visible the current positioning of Catalan HEI’s against LGBTQI-phobia and towards a more inclusive and diverse university community.

New avenues and research targets on this matter could contribute to identifying other needs and axes of actions that could be essential in the struggle against LGBTQI-phobia. On the one hand, investigating the positioning of professors in the classrooms and their previous training on gender and LGBTQI+ perspective with a base on scientific evidence could open new lines of research for the prevention of violence. Furthermore, the inclusion of LGBTQI+ literature to be addressed in classrooms and the impact of normalizing gender and sex diversity in educational institutions would also be relevant. Our study highlights the importance of the alliance of university professors in the struggle against LGBTQI-phobia as upstanders in the conflict, an issue that must be paramount in new research lines and actions against violence on the grounds of sexual orientation, gender identity and gender expression. On the other hand, studying the case of transgender needs and trajectories in HEI’s is still a pending issue. Tackling the need to underst transgender identities and non-binary gender expressions within the institutional framework would contribute to detect and explain forms of violence yet to be identified as well as the strategies to counter these.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Interviews had an approximate duration of 40 min and the place was chosen by both participant and researcher. Interviews were normally implemented in public spaces which allowed the researcher to generate an atmosphere of trust, such as cafeterias or university offices. The materials result of the interviews were the manual transcriptions made by members of the research team of the Uni4Freedom project. Then, the analysis took place as it follows in the Data Analysis subsection.

The partner universities of Uni4Freedom are: Rovira i Virgili University; University of Barcelona; University of Girona; University of Lleida; Ramón Llull University and University of Vic.

Participant entities and organizations on the Advisory Board:

Col·lectiu H2O · Gais, Lesbianes, Bisexuals i Transsexuals del Camp de Tarragona.

SAI Tarragona - Servei d’Atenció Integral a les Diversitats Sexuals i de Gèneres de Tarragona.

Xarxa Solidària de Vctimes de Violència de Gènere a la Universitat.

Gènere Lliure.

Col·lectiu de gèneres i sexualitats dissidents (GSD).

The participant entities in the Advisory Committee have been:

- Col·lectiu H2O (Gais, Lesbianes, Bisexuals i Transsexuals del Camp de Tarragona).

- SAI Tarragona - Servei d’Atenció Integral a les Diversitats Sexuals i de Gèneres de Tarragona: suport social, informació i atenció piscològica i jurídica.

The participant universities in the study are:

Rovira i Virgili University.

Girona University.

Lleida University.

Vic University.

Barcelona University.

Ramón Llull University.

Abbreviations

Communicative Methodology

Higher Educational Institution

Community of lesbian, gay, bisexual, transgender, queer, intersexual and other groups with non-conforming and dissident identities, orientations or expressions

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Acknowledgements

The authors would like to thank the research participants and collaborators for their important contribution in the study. In particular, we would like to thank to ACUP for their advice and support in all phases of the research. We would also like to acknowledge the support in the data collection to the Advisory Council and all entities participating in it: Col·lectiu H20, SAI Tarragona and Xarxa Solidària de Victimes de Violència de Gènere a la Universitat. We also want to thank the University consortium that enabled the project to take part, formed by Rovira i Virgili University, Lleida University, Girona University, Vic University, Barcelona University and Ramon Llull University. To conclude, we would like to thank all the project collaborators which contribute significantly in data collection and transcription tasks of the fieldwork.

The research leading to these results has received funding from the RecerCaixa program (2017ACUP00235).

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The first author EMGN contributed to the data collection and writing of the manuscript along with other project collaborators. The second author AGG contributed with the methodological review of the manuscript. The third author RGC participated in the analysis of the results of the study. The fourth author MMRS contributed to the review of the manuscript offering feedback on editing and stylistic issues. All the authors read and approved the manuscript.

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Gallardo-Nieto, E.M., Gómez, A., Gairal-Casadó, R. et al. Sexual orientation, gender identity and gender expression-based violence in Catalan universities: qualitative findings from university students and staff. Arch Public Health 79 , 16 (2021). https://doi.org/10.1186/s13690-021-00532-4

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01 May 2024

We need more-nuanced approaches to exploring sex and gender in research

Stacey A. Ritz 0 &
Lorraine Greaves 1

Stacey A. Ritz is an associate professor in the Department of Pathology & Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

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Lorraine Greaves is a senior investigator in the Centre of Excellence for Women’s Health and a clinical professor in the School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

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Over the past decade, intense and polarizing debates about transgender rights and women’s bodies have escalated worldwide — from politicians being grilled on the definition of a woman to scientific journals being critiqued for the language they use in discussions of women’s health. Meanwhile, studies have accumulated showing that the impacts of sex and gender on human health and behaviour are both far-reaching and complex. This is in part the result of major funding agencies, such as the Canadian Institutes of Health Research and the US National Institutes of Health, as well as various scientific journals 1 , developing guidelines and mandates to encourage scientists to consider sex and gender in their research (see Nature 605 , 396 (2022) ; Nature Commun . 13 , 2845; 2022) .

Given the heightened sociopolitical tensions and a widespread perception that considering sex and gender (terms we define below) will ramp up the complexity and costs of research, many scientists might feel it is prudent to avoid examining them in their work. However, studies that engage critically with sex and gender are urgently needed, both to increase understanding of humans across diverse contexts, and to provide insights for societal discussions — whether on health and disease, education or other topics.

Collection: Sex and gender in science

Clinicians and regulatory agencies still lack knowledge about how factors related to sex and gender, and their interactions, affect the likelihood of being prescribed a drug, of experiencing severe side effects or of receiving an incorrect dose 2 . Similarly, in relation to disaster relief, organizations providing aid to those in need could increase the effectiveness of their efforts if they better understood how sex and gender affect people’s ability to access health services, food or water — in the context of sexualized or gender-based violence, say, or because of gendered stereotypes and roles 3 . To make future products more useful to everyone, many engineering and design fields, from artificial intelligence to robotics, need sex- and gender-informed research. The design of commonly used products , such as seat belts and airbags, needs to take into account factors related to sex and gender to address women’s increased risk of injury and fatality in vehicle crashes 4 . We urge scientists to engage with the concepts and issues surrounding sex and gender, and to consider the relevance of them to their own field. We also entreat them to embrace complexity, and develop deeper, more-nuanced approaches to interrogating sex and gender than are most commonly used today. This means, among other things, engaging deeply with the mechanisms and factors that underlie apparent differences between groups 5 .

Causes of confusion

For most research that considers sex and/or gender, limited information is collected for either attribute. For studies involving humans, participants are typically asked to identify their sex and/or gender category; for those involving non-human animals, individuals are usually assigned to a sex category depending on the appearance of their genital anatomy.

Meanwhile, when it comes to promoting understanding of the concepts of sex and gender and the distinctions between them, a starting point frequently offered — including by major research funders — is that sex is biological and gender is social. In other words, sex is meant to refer to various anatomical and other biological features, whereas gender is associated with social and cultural attributes, opportunities and roles.

Splitting data by sex or gender category can be a useful starting point to help identify sex- and gender-related differences and disparities. Similarly, the ‘sex is biological and gender is social’ framing can offer a valuable initial toehold, because it serves as a reminder that not every difference observed between sex or gender groups is rooted in biology: social and environmental factors are often important, too.

Male–female comparisons are powerful in biomedical research — don’t abandon them

Ultimately, however, both the approaches commonly used to categorize individuals and the way in which many researchers think about sex and gender do not necessarily lead to studies that can adequately address the complexities and diversity of humans. They can even be misleading.

For a start, sex is not a fixed thing. Neither is gender.

For us, the term sex is best understood as both a categorization scheme (in which individuals are typically classed as male, female or intersex) and a complex constellation of traits and factors across several levels of biological organization that show considerable variability between and within individuals. Sex-related factors and traits include anatomical features, hormones, levels of gene expression and physiological, reproductive, metabolic or neurological processes — but no single trait comprehensively defines an individual’s sex. In all animals, including humans, developmental processes that occur during sexual differentiation (during fetal development and after birth) are not determined by single genes. Instead, sex phenotypes emerge from the complex interplay of numerous molecular pathways that can be influenced by environmental experiences through epigenetic, endocrine, neurological and other mechanisms across people’s lifespan 6 .

Similarly, the term gender encompasses much more than people’s sense of self as a gendered individual, or their ‘gender identity’. Gender can be understood as a categorization scheme, in which a person can identify as a man or woman (whether cisgender or trans), as non-binary or with one or more other evolving terms. Gender also encompasses roles, norms, relations and opportunities that vary between cultures and over time , and which affect people’s income, autonomy, domestic and public roles, and their access to power and resources.

Furthermore, sex and gender are not neatly separable.

Why it’s essential to study sex and gender, even as tensions rise

Various studies have shown that environmental and social factors can affect people’s biology in numerous ways. Gendered dressing patterns affect people’s exposure to sunlight 7 , for instance, affecting their levels of vitamin D, which can in turn influence bone density 8 , 9 . In other words, although bone density is affected by levels of oestrogen or testosterone, it should not be understood as solely a sex-related trait, but as something that is shaped by social and environmental factors rooted in gender, too. Similarly, patterns of gendered socialization related to dress, types of play (for example, indoor or outdoor) and vigilance about cleanliness might result in boys and girls having distinct patterns of exposure to microorganisms — which could, in turn, have implications for the maturation of their immune system and susceptibility to developing conditions such as an allergy or autoimmune disorder 10 . Some scholars focusing on issues around sex and gender use the hybrid terms gender/sex or sex/gender in recognition of such entanglement 11 , 12 .

To add to the difficulties, many scientific organizations, journals and researchers fail to clarify what exactly they mean by sex and gender, or they conflate the terms or use them interchangeably. Moreover, patterns of use can differ according to people’s language, discipline or country. For example, the term gender medicine has been used to describe at least three distinct things: a branch of medicine focused on disease-related differences between men and women 13 ; the study of how sex and gender influence an individual’s health 14 , 15 ; and the provision of care for children with differences in sexual development 16 . To help address this confusion, we have mapped the relationships between various areas of science concerned with sex and gender, and policies linked to equity, diversity and inclusion 17 .

Embracing complexity

In our view, continued dialogue between scholars and journal editors will help to clarify and refine terminologies. However, putting aside the problems with how the terms are used and understood, when sex and gender are considered in research at all, the standard approach is to compare female and male individuals. Such comparisons can be useful for flagging characteristics that warrant further investigation. However, in making such comparisons, researchers often overlook the fact that there is substantial heterogeneity in sex/gender categories and substantial overlap between them for many traits. Ultimately, relying too heavily on a binary comparison approach risks describing the realities incorrectly for everyone, not just for women or non-binary people. It also contributes to the marginalization of those with variations in sexual development and people with diverse gender identities.

Take, for example, research on blood donation. In 2017, researchers in Canada published findings that among frequent blood donors, women had low levels of ferritin (a marker of iron levels) more often than did men 18 . The study prompted Canadian Blood Services — the organization that manages most of the country’s blood supply — to alter its policy on donation intervals: for all female donors, it has extended the time between donations from 8 to 12 weeks. (Since January 2023, Canadian Blood Services has also been intermittently testing ferritin levels in donors’ blood, but only in women .)

Indian villagers carrying babies wade through flood waters after collecting relief food

Gendered roles and behaviours affect people’s health and well-being. Credit: Diptendu Dutta/AFP/Getty

By focusing the policy on the sex category of the donor, the organization effectively treats all women as being at the same risk of low iron levels, which is higher than that of men, without attending to the specific factors that are most likely to be mechanistically related to that risk: body size, amount of menstrual blood loss and dietary iron intake. The change to donation interval for women — based on a binary analysis — also glosses over the heterogeneous and overlapping nature of the data, including the fact that the frequent donors also included women who did not have low iron levels, and men who did. A more nuanced interpretation of the findings, along with further research that probed the specific sex- and gender-related factors that increase people’s risk of developing low iron levels, could allow policies to be refined in ways that are better oriented to the mechanistic factors that matter most.

A spokesperson for Canadian Blood Services said that it recognizes that blood donors are a heterogeneous population and that it uses standardized, simple criteria to divide donors into accepted and deferred groups.

Podcast: Sex and gender discussions don't need to be toxic

In practice, each investigator is best placed to work out which sex- and gender-related factors will be most important to assess on the basis of their study system, goals, tools, methods and resources 19 , and — crucially — best placed to justify these decisions. Not every possible variable relating to sex and gender needs to be interrogated in all contexts, and there is no one-size-fits-all approach.

Someone studying a new T-cell therapy for colon cancer, for example, might propose that gonadal hormones could modify the efficacy of the treatment, because T cells possess receptors for both oestrogens and androgens. If that researcher was conducting a study in people with colon cancer, they could evaluate whether correlations exist between the efficacy of the drug and serum concentrations of the relevant hormones (which can be affected by biological, social and environmental factors). If they were working with a mouse model of colon cancer, they might use antagonists or agonists of the relevant hormone receptors or give the animals hormone supplements. A different approach would be needed if the researcher was interested in whether the sex of the T-cell donor changes the efficacy of the treatment depending on the sex of the recipient.

These kinds of analysis could have resource implications: in some cases, different reagents, extra measurements or more animals or participants would be required. In our view, considerable resources should be invested in addressing long-standing gender inequities. Furthermore, researchers do not necessarily need to consider sex and gender in every experiment or study. More important is that they build sufficient skills and understanding to be able to consider the potential impacts of sex and gender and justify their research designs accordingly.

Implicit bias

In addition to considering sex and gender in their work and taking more-nuanced approaches to studying both, it is crucial that researchers explore how the influences of sex and/or gender shape their own research.

The fraught quest to account for sex in biology research

Many phenomena in diverse fields, including medicine, archaeology and history, show that science has never been insulated from social and cultural biases, or from stereotypes and mythologies about sex and gender. Funders and regulators are still trying to remedy the lack of inclusion or under-representation of women in clinical trials of drugs or devices. Such biases lead to common mislabelling such as ‘the male hormone testosterone’ or ‘the female X chromosome’ even though testosterone and X chromosomes are important for normal physiological function in all human bodies. Likewise, many studies assess the effects of androgens in only male participants, for instance, or analyse only women’s child-care responsibilities.

Truly understanding the impacts of sex and gender on human life will require a mix of transdisciplinary, quantitative, qualitative and intersectional analyses — which strive to assess how people’s experiences are shaped by interacting social processes, such as racism, sexism, homophobia, transphobia, ableism and colonialism.

Given the enormous untapped opportunities for developing insights concerning sex and gender across many contexts, it is essential that more scientists lean in with courage and creativity to interrogate the fascinating complexity of sex- and gender-related impacts — to the benefit of all.

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Focus On Ethics: Gender Expression and Identity

On the day his mother was volunteering in the classroom, he walked in and immediately put on a ballerina skirt and sparkly shoes. She firmly told him to take them off and instead put on the firefighter’s hat and boots, try on the cowboy hat, or do “something that boys do.” Michael complied with his mother’s demand but soon left the dramatic play area.

When the children went outside to play, Michael’s mother told Ana, Michael’s teacher, that he consistently plays female roles at home and shows little interest in toys and activities typically associated with boys. She and her husband were very concerned about his behavior, and she asked Ana not to allow Michael to play with any “girl stuff” at school.

Ana also has observed that Michael strongly prefers playing with girls and chooses activities that are stereotypically feminine, like having tea parties and wearing dress-up clothes that have lots of ribbons and sequins. He also frequently tells the other children that he is really a girl and that he wants to be called “Michelle.”

Ana knows that some children begin to persistently identify with a gender different from their assigned sex at a very young age (Ehrensaft 2011; Fox 2015). (See “Glossary of Terms” for definitions of words and phrases used in this column.) She is also aware that the NAEYC Code of Ethical Conduct strongly supports maintaining close, collaborative relationships with families and respecting their child-rearing and cultural preferences. What is her most ethical response?

Responding to the issue

This scenario is similar to the one described in the Focus on Ethics column “Don’t Let My Son Dress Up as a Girl!” in the September 2017 issue of Young Children . In both cases, there is a conflict between a family’s request that its son not be allowed to engage in stereotypically feminine activities in school and a teacher’s belief that it is best for children to be encouraged to choose the activities that are most meaningful to them.

Our role as educators is to create a safe and reflective space for children to develop their identities and to counterbalance gender stereotypes.

Despite the similarities, there are some important differences between these two scenarios. Like Victor (the child described in the September 2017 column), many boys are fascinated by glittery clothing and enjoy playing a variety of roles—including feminine ones—in the dramatic play area. Michael’s interest in “girl stuff,” however, is not limited to playing with clothes and roles. Michael consistently gravitates to female-assigned pursuits, identifies as a girl, and asks to be called by a girl’s name. These are examples of how Michael’s gender expression (how a person shows their gender to the world through external choices) is currently gender nonconforming (it does not follow prevailing cultural and social expectations about what is appropriate for their gender). Michael may be—or ultimately identify as— trans or transgender (a person whose gender identity is different from the sex assigned at birth).

While there is nothing new about gender nonconforming behavior in early childhood settings, advice for how educators can best handle conflicting perspectives has been scarce or absent, and resources to help teachers work with children and their families on this issue have not been readily available (Kilman 2013).

As in previous columns, we will use the process described in Ethics and the Early Childhood Educator (Feeney & Freeman 2018) to systematically apply the NAEYC Code of Ethical Conduct (2011) to this situation. We will then consider the unique challenges presented by this case and explore some resources that might be helpful to teachers and administrators who are working with children like Michael and their families.

Our analysis is informed by contributions from students in the ECE 200, The Professional in Early Childhood Education, class at Portland Community College in Portland, Oregon; participants at the June 2018 NAEYC Professional Learning Institute in Austin, Texas; Briel Schmitz, head of Spruce Street School in Seattle, Washington; and Rabbi Meir Muller, assistant professor of early childhood education at the University of South Carolina and head of Cutler Jewish Day School in Columbia, South Carolina. We thank them for contributing to this analysis.

We begin with the first two steps of the process we use to address a workplace issue.

Identify the problem and determine if it involves ethics

This situation involves ethics because Ana must decide the right course of action to support a gender nonconforming or trans child and the child’s concerned family.

Determine if it is an ethical responsibility or an ethical dilemma

While we noticed similarities between Michael and Victor (from our 2017 column), we came to appreciate that Ana faced a more challenging situation than Victor’s teacher. She needed to respect Michael’s preferences while working effectively and sensitively with his parents.

After presenting the scenario to two groups of early childhood educators and doing some research and reflection, we came to the conclusion that Ana is facing an ethical responsibility (a situation with just one morally justified course of action), not an ethical dilemma (a situation for which there is more than one possible resolution, which can be justified in moral terms). Because we consider it an ethical responsibility to respect children’s gender self-determination, we will refer to Michael using her chosen name, Michelle, and chosen gender pronouns, she/her, for the remainder of the article.

Glossary of Terms

Assigned sex: The label given at birth—usually male or female —based on a variety of factors (usually genitalia, but sometimes also hormones and chromosomes). The term assigned at birth acknowledges that someone (often a doctor) is making a decision but there is far more biological, anatomical, and chromosomal variation than captured by the binary labels of male and female .

Gender: A social construct that categorizes and labels societal and cultural expectations (i.e., gender norms) for how people of different assigned sexes (and thus assigned genders) are supposed to act. Gender varies over time and from place to place.

Gender identity: How a person self-identifies their gender, which may include man , woman , genderqueer , or other gender identities. A person’s understanding of their gender identity can begin as early as age 2.

Gender expression: The way in which a person expresses their gender identity, typically through their appearance, affect, behavior, and activities.

Gender nonconforming: A term to describe a person whose behavior or appearance does not follow prevailing cultural and social expectations about what is appropriate to their assigned gender (and thus assigned sex). Some people who position their gender outside of a man/woman binary describe their gender as gender nonconforming or genderqueer .

Trans or transgender: A self-identification of a person whose gender identity differs from their assigned sex. For example, someone who was assigned female at birth but identifies as male might use the term transman .

Cis or cisgender: A person whose gender identity is the same as their assigned sex. For example, if the doctor said “It’s a boy,” and the child continues to identify as a boy/man, then he is cis or a cisman. People who are not trans are, therefore, cis.

Queer: A term that allows individuals to avoid the rigid categorization of straight and gay , and can indicate an attraction to people of many genders. For some, queer is also a political statement, expressing rejection of binary thinking and asserting that sexual orientation and gender identity are complex and potentially fluid. Although historically a derogatory term, queer has been reclaimed by many communities to have a positive connotation.

Sexuality: Sexuality is not just about sex. It is about individuals’ bodies, genders, feelings, relationships, and ways of experiencing intimacy. In this context, children’s healthy sexual development involves learning about their bodies, feelings, and relationships. Sexuality can also refer to sexual feelings, thoughts, attractions, and preferences. Sexual orientation often refers to whom we are sexually attracted. Some common terms for sexuality include bi (or bisexual ), gay , straight , and queer .

Guidance from the NAEYC Code

Let’s look at the guidance the NAEYC Code provides for this decision.

The groups who discussed this situation both concluded that they could not justify forbidding a child to behave in ways that express her strongly held sense of self and that, therefore, they could not comply with this family’s request to keep her from activities associated with girls or femininity. They agreed that Ana’s primary responsibility was to Michelle, and that she needed to honor Michelle’s ways of expressing her identity. The groups also emphasized the importance of Ana listening carefully to the family’s concerns and treating them with understanding and respect.

Some noted that Ana might feel she lacks the expertise to respond confidently to this situation. They recommended that she work closely with her director and seek out other knowledgeable professionals. Together, they could help her prepare to share information about young children’s developing gender identity with Michelle’s family, helping them understand their child’s request to be identified as a girl and to engage in play that she finds meaningful. For suggestions on how to engage families and respond to some of their concerns, see “ Practical Guidance for Teachers: Supporting the Families of Gender Nonconforming Children ”. It would also be important that Ana and the director work with the program’s other teachers and families to help them accept Michelle’s gender identity with kindness and understanding.

The Code’s Core Values, Ideals, and Principles

Respondents to this case found that the Code’s Core Values, Ideals, and Principles offered guidance that would help Ana address this family’s concerns. They noted, in particular, educators’ responsibilities to children and the importance of nurturing positive relationships with families. The following excerpts from the Code are those most applicable to this situation.

Core Values

Base our work on knowledge of how children develop and learn
Appreciate and support the bond between the child and family
Respect the dignity, worth, and uniqueness of each individual (child, family member, and colleague)
Recognize that children and adults achieve their full potential in the context of relationships that are based on trust and respect

I-1.2 —To base program practices upon current knowledge and research in the field of early childhood education, child development, and related disciplines, as well as on particular knowledge of each child.

I-1.3 —To recognize and respect the unique qualities, abilities, and potential of each child.

I-1.5 —To create and maintain safe and healthy settings that foster children’s social, emotional, cognitive, and physical development and that respect their dignity and their contributions.

I-2.2 —To develop relationships of mutual trust and create partnerships with the families we serve.

I-2.5 —To respect the dignity and preferences of each family and to make an effort to learn about its structure, culture, language, customs, and beliefs.

I-2.6 —To acknowledge families’ childrearing values and their right to make decisions for their children.

I-2.8 —To help family members enhance their understanding of their children . . . and support family members in the continuing development of their skills as parents.

P-1.1—Above all, we shall not harm children. We shall not participate in practices that are emotionally damaging, physically harmful, disrespectful, degrading, dangerous, exploitative, or intimidating to children. This principle has precedence over all others in this Code.

P-1.4 —We shall use two-way communications to involve all those with relevant knowledge (including families and staff) in decisions concerning a

child, as appropriate, ensuring confidentiality of sensitive information.

P-2.4 —We shall ensure that the family is involved in significant decisions affecting their child.

P-2.6 —As families share information with us about their children and families, we shall ensure that families’ input is an important contribution to the planning and implementation of the program.

The Code offers strong justification for a teacher to base her actions on the needs of the child and for honoring the family’s childrearing values and agreeing to their request. However, the Code also points educators toward putting the wellbeing of the child above all other concerns. P-1.1 takes precedence over all other items in the Code and supports Ana’s decision to place the highest priority on the best interests of the child.

Guidance for the director

These items from the Code’s Supplement for Program Administrators (2011) provide additional guidance for the director who is helping Ana address this issue:

P-1.1—We shall place the welfare and safety of children above other obligations (for example, to families, program personnel, employing agency, community). This item takes precedence over all others in this Supplement.

I-2.2 —To serve as a resource for families by providing information and referrals to services in the larger community.

P-2.10 —We shall respond to families’ requests to the extent that the requests are congruent with program philosophy, standards of good practice, and the resources of the program. We shall not honor any request that puts a child in a situation that would create physical or emotional harm. In such instances, we shall communicate with the family the reason(s) why the request was not honored and work toward an alternative solution.

Reflecting on the case

Gender curiosity in children is not a recent phenomenon. Young children have always engaged in various forms of gender play, exploration, and identification. However, in recent years there has been greater recognition of the range of ways that individuals can express their gender identity and significantly more representation of trans people and communities in mainstream media. While this has opened up space for conversations about gender nonconforming and trans-identified children, some adults (including some educators, parents, grandparents) still attempt to stop the behavior (as in the case of Michelle’s parents) or attempt to rigidly categorize the behavior (assuming they can predict the child’s ultimate identity).

It is important to note that in US society today, children who are assigned male at birth receive more intense gender scrutiny than children who are assigned female at birth. For instance, girls are often encouraged by their parents to explore and participate in games traditionally associated with boys. These children are often celebrated as “strong” and “independent.” However, when boys express interests in activities associated with girls, they are typically reprimanded, ostracized, or identified as problematic. This double standard stems from a culture that often demeans behavior associated with women and femininity.

This case warrants particularly careful consideration because of the potential lifelong consequences of respecting or refusing to respect Michelle’s view of herself. It is important that the adults in Michelle’s life be willing to honor who she says she is. Denying children the opportunity to express themselves by forcing them to accept adults’ views of gender-appropriate behavior is likely to damage relationships and the children’s sense of self, in addition to making their lives more difficult.

Teachers working with families who are concerned about how their children are expressing their gender identity need to be flexible and well prepared. It may be helpful to refresh their knowledge of child development, specifically identity development as it relates to concepts of gender. Gender is varied and dynamic. All of us express our gender differently over the course of our lives; children should be encouraged and supported to play, explore, and define the gender that feels right to them at the time (without an expectation of day-to-day or month-to-month consistency). Our role as educators is to create a safe and reflective space for children to develop their interests and identities and to counterbalance pervasive gender stereotypes.

Flexibility and preparation are also essential for supporting families. The most important thing that a teacher or director can do with families is listen carefully and try to understand their concerns. Some families may be worried about their children’s future school experiences during their middle childhood and teen years. They may be seeking assurance that their children will be safe, happy, and well adjusted. Other families may be interested in knowing if there is research that indicates that a transgender child can grow into a confident and well-adjusted adult. Families with strong religious or cultural beliefs that do not support gender nonconformity need to feel that their perspectives are being heard.

Teachers also need to have appropriate resources in mind for families, knowing that different families will be best supported in different ways. Some will be interested in reading scientific literature; others may just need someone to listen to and reassure them. At times, it may be appropriate to refer the family to a community resource person who is skilled in addressing questions of gender and sexual expression.

It may be helpful to remind family members that the ultimate goal is preserving their positive long-term relationships with their child. By sharing current information on child development, teachers may point out that there are things about the child that the family can neither change nor control. While they can’t change their child’s gender identity, they do have the power to strengthen the relationship by being loving and supportive no matter how their child self-identifies. (For more specifics to help you work effectively with families, see pages 91–93.)

As we pointed out in our September 2017 column about a father’s disapproval of his son dressing up in girl’s clothing, many child-rearing values are strongly rooted in families’ cultural beliefs. Sensitive teachers must carefully balance their responsibilities to children and to their families—this can be particularly challenging when working with groups that have strong positions about appropriate gender roles. Additional challenges arise when a child’s gender preference is at odds with their family culture and values. Those situations will call for exceptional cultural navigation skills and, most likely, additional support from experts and organizations in the community. We anticipate that this topic will continue to be addressed in early childhood education.

As a teacher, you have the ability to make the world a better place for children who are gender nonconforming, are gender creative, or identify as trans. One place to start is with an inclusive classroom that supports a variety of gender expressions and avoids perpetuating harmful gender stereotypes. There are simple ways to make classrooms more inclusive, like avoiding consistently dividing children into groups by gender. For example, think about how you call children to the door. Instead of calling boys, then girls, to line up at the door, you might ask children wearing red, then blue, then green, to get ready to go outside. You can incorporate pictures, books, and dress-up materials that avoid gender stereotypes into the classroom. And you can help children move beyond traditional gender roles by encouraging girls to pretend they are firefighters and boys to role-play as nurses. If possible, make your restrooms available to all genders. Respond to children’s fears, teach children to stand up for themselves if teased for their gender expressions, and validate their gender identities as they choose to express them. Strive to help all the children and adults in your program embrace a more inclusive, less restrictive view of gender.

Resources for Teachers and Families

Books and articles for adults.

Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children. Diane Ehrensaft (2011). This developmental and clinical psychologist provides clear advice about supporting children who do not conform to society’s narrowly defined gender categories.

The Transgender Child: A Handbook for Families and Professionals. Stephanie Brill & Rachel Pepper (2008). A comprehensive resource with information to help adults guide gender-variant and transgender children.

This Is How It Always Is: A Novel. Laurie Frankel (2017). A family’s journey of learning and acceptance begins when their 3-year-old son announces that he wants to be a girl when he grows up.

“Tate and the Pink Coat: Exploring Gender and Enacting Anti-Bias Principles.” Janice Kroeger, Abigail E. Recker, and Alexandra C. Gunn. 2019. This article presents current research on the importance of gender inclusivity in early childhood classrooms and offers practical tips to help teachers support children’s explorations of gender. NAEYC.org/resources/pubs/yc/mar2019/exploring-gender-enacting-anti-bias

Gender Spectrum . This website has links to resources that help programs create gender-sensitive and inclusive environments for all children. Includes resources for children, families, and teachers, and training materials addressing a wide range of topics. www.genderspectrum.org

Teaching Tolerance . This website contains resources for educators committed to diversity, equity, and justice, including classroom and professional development materials focused on race and ethnicity, religion, ability, class, immigration, gender and sexual identity, bullying, and bias. www.tolerance.org/topics

Gender Justice in Early Childhood . This website focuses specifically on young children and offers resources and links to help educators consider their language, teaching practices, and programs from a gender justice perspective. www.genderjusticeinearlychildhood.com

Children’s books

The Boy & the Bindi , by Vivek Shraya, illus. by Rajni Perera (2016). (Ages 4–8) A 5 year-old South Asian boy is fascinated with his mother’s bindi, the colored dot commonly worn in the middle of Hindu women’s foreheads. He wants to have one of his own. His mother agrees and teaches him about its cultural significance.

Elena’s Serenade , by Campbell Gleeson (2014). (Ages 3–8) A young Mexican girl admires her father’s glassblowing and wants to follow in his footsteps. However, pointing to her size and gender, he disapproves of her aspirations. She disguises herself as a boy to learn the craft and ultimately changes her father’s views. Told in both English and Spanish, the story explores the limiting nature of gender roles and the power of children to challenge adult thinking.

Introducing Teddy, by Jessica Walton, illus. by Dougal MacPherson (2016). (Ages 3–6) Errol and his teddy bear, Thomas, are best friends who do everything together. One day, Thomas tells Errol, “In my heart, I’ve always known that I’m a girl teddy, not a boy teddy.” Errol replies, “I don’t care if you’re a girl teddy or a boy teddy! What matters is that you are my friend.”

Julián Is a Mermaid , by Jessica Love (2018). (Ages 4–8) Inspired by women he sees on the subway who are colorfully dressed as mermaids, Julián dresses up like a mermaid when he gets home. He worries about how his grandmother will respond, but she celebrates his transformation.

My Princess Boy , by Cheryl Kilodavis, illus. by Suzanne DeSimone (2009). (Ages 4–8) This story is told from the perspective of the mother of a 4-year-old boy who likes to wear dresses and enjoys things that typically appeal to girls.

Sparkle Boy , by Lesléa Newman, illus. by Maria Mola (2017). (Ages 4–8) Casey loves blocks, puzzles, and his dump truck, but he also wants to try out the shimmer skirt, glittery nails, and bracelets his sister and his grandmother wear. The adults in his life support his choices, but he worries when older boys tease him.

Ehrensaft, D. 2011. Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children . New York: The Experiment.

Feeney, S., & N.K. Freeman. 2018. Ethics and the Early Childhood Educator: Using the NAEYC Code , 3rd ed. Washington, DC: NAEYC.

Feeney, S., & N.K. Freeman. 2017. “Don’t Let My Son Dress Up as a Girl! – The Response.” Focus on Ethics. Young Children 72 (4): 90–93.

Fox, R.K. 2015. “Is He a Girl? Meeting the Needs of Children Who Are Gender Fluid.” Chap. 7 in Discussions on Sensitive Issues , ed. J.A. Sutterby, 161–76. Howard House, Wagon Lane, Bingley, UK: Emerald Group Publishing.

Kilman, C. 2013. “The Gender Spectrum: Move Beyond the Pink/ Blue Binary to Support Children Who Don’t Conform to Narrow Gender Norms.” Teaching Tolerance 44. www.tolerance.org/magazine/summer-2013/the-gender-spectrum .

NAEYC (National Association for the Education of Young Children). 2011. “Code of Ethical Conduct and Statement of Commitment.” Position statement. Washington, DC: NAEYC. NAEYC.org/sites/default/files/globally-shared/downloads/PDFs/resources/position-statements/Ethics%20Position%20 Statement2011_09202013update.pdf.

NAEYC. 2011. “Code of Ethical Conduct: Supplement for Early Childhood Program Administrators.” Washington, DC: NAEYC. NAEYC.org/sites/default/files/globally-shared/downloads/PDFs/resources/position-statements/Supplement%20PS2011. pdf.

Stephanie Feeney, PhD, is professor emerita of education at the University of Hawaii at Manoa. She is coauthor of NAEYC’s “Code of Ethical Conduct” and NAEYC’s books about professional ethics. She participated in the development of supplements to the code for adult educators and program administrators and has written extensively about ethics in early care and education. She is the author of numerous articles and books, including Professionalism in Early Childhood Education: Doing Our best for Young Children and coauthor of Who Am I in the Lives of Children ? [email protected]

Nancy K. Freeman, PhD, is professor emerita of education at the University of South Carolina in Columbia, where she was a member of the early childhood faculty. She has served as president of NAECTE and was a member of its board for many years. Nancy has written extensively on professional ethics since the 1990s, and has been involved in the Code’s revisions and in the development of its Supplements for Program Administrators and Adult Educators. [email protected]

Katie Schaffer , BA, is a white, cis, queer woman dedicated to collectively envisioning and implementing liberatory educational practices. For the past six years, Katie has worked at the New York Early Childhood Professional Development Institute. Finding a dearth of teacher education courses or professional development opportunities on gender, sexuality, and LGBTQ families in early childhood settings, Katie has created a training series and built out a facilitation team that has provided support to preschools and child care centers across New York City.

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Americans’ Complex Views on Gender Identity and Transgender Issues

Most favor protecting trans people from discrimination, but fewer support policies related to medical care for gender transitions; many are uneasy with the pace of change on trans issues, table of contents.

A rising share say a person’s gender is determined by their sex at birth
Many Americans point to science when asked what has influenced their views on whether gender can differ from sex assigned at birth
Public sees discrimination against trans people and limited acceptance
About four-in-ten say society has gone too far in accepting trans people
Plurality of adults say views on gender identity issues are changing too quickly
Most say they’re not paying close attention to news about bills related to transgender people
About six-in-ten would favor requiring that transgender athletes compete on teams that match their sex at birth
Views on many policies related to transgender issues vary by age, party, and race and ethnicity
Sizable shares say forms and government documents should include options other than ‘male’ and ‘female’
About three-in-ten parents of K-12 students say their children have learned about people who are trans or nonbinary at school
Acknowledgments
The American Trends Panel survey methodology
Panel recruitment
Sample design
Questionnaire development and testing
Data collection protocol
Data quality checks
Dispositions and response rates
A note about the Asian sample

Pew Research Center conducted this study to better understand Americans’ views about gender identity and people who are transgender or nonbinary. These findings are part of a larger project that includes findings from six focus groups on the experiences and views of transgender and nonbinary adults and estimates of the share of U.S. adults who say their gender is different from the sex they were assigned at birth .

This analysis is based on a survey of 10,188 U.S. adults. The data was collected as a part of a larger survey conducted May 16-22, 2022. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology . See here to read more about the questions used for this report and the report’s methodology .

References to White, Black and Asian adults include only those who are not Hispanic and identify as only one race. Hispanics are of any race.

All references to party affiliation include those who lean toward that party. Republicans include those who identify as Republicans and those who say they lean toward the Republican Party. Democrats include those who identify as Democrats and those who say they lean toward the Democratic Party.

References to college graduates or people with a college degree comprise those with a bachelor’s degree or more. “Some college” includes those with an associate degree and those who attended college but did not obtain a degree.

The terms “transgender” and “trans” are used interchangeably throughout this report to refer to people whose gender is different from the sex they were assigned at birth.

A chart showing Most favor protecting trans people from discrimination, even as growing share say gender is determined by sex at birth

As the United States addresses issues of transgender rights and the broader landscape around gender identity continues to shift, the American public holds a complex set of views around these issues, according to a new Pew Research Center survey.

Roughly eight-in-ten U.S. adults say there is at least some discrimination against transgender people in our society, and a majority favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces. At the same time, 60% say a person’s gender is determined by their sex assigned at birth, up from 56% in 2021 and 54% in 2017.

The public is divided over the extent to which our society has accepted people who are transgender: 38% say society has gone too far in accepting them, while a roughly equal share (36%) say society hasn’t gone far enough. About one-in-four say things have been about right. Underscoring the public’s ambivalence around these issues, even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far or been about right in terms of acceptance.

The fundamental belief about whether gender can differ from sex assigned at birth is closely aligned with opinions on transgender issues. Americans who say a person’s gender can be different from their sex at birth are more likely than others to see discrimination against trans people and a lack of societal acceptance. They’re also more likely to say that our society hasn’t gone far enough in accepting people who are transgender. But even among those who say a person’s gender is determined by their sex at birth, there is a diversity of viewpoints. Half of this group say they would favor laws that protect trans people from discrimination in certain realms of life. And about one-in-four say forms and online profiles should include options other than “male” or “female” for people who don’t identify as either.

Related: The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. adults

Chart showing Young adults, Democrats more likely to say society hasn’t gone far enough in accepting people who are transgender

When it comes to issues surrounding gender identity, young adults are at the leading edge of change and acceptance. Half of adults ages 18 to 29 say someone can be a man or a woman even if that differs from the sex they were assigned at birth. This compares with about four-in-ten of those ages 30 to 49 and about a third of those 50 and older. Adults younger than 30 are also more likely than older adults to say society hasn’t gone far enough in accepting people who are transgender (47% vs. 39% of 30- to 49-year-olds and 31% of those 50 and older)

These views differ even more sharply by partisanship. Democrats and those who lean to the Democratic Party are more than four times as likely as Republicans and Republican leaners to say that a person’s gender can be different from the sex they were assigned at birth (61% vs. 13%). Democrats are also much more likely than Republicans to say our society hasn’t gone far enough in accepting people who are transgender (59% vs. 10%). For their part, 66% of Republicans say society has gone too far in accepting people who are transgender.

Amid a national conversation over these issues, many states are considering or have put in place laws or policies that would directly affect the lives of transgender and nonbinary people – that is, those who don’t identify as a man or a woman. Some of these laws would limit protections for transgender and nonbinary people; others are aimed at safeguarding them. The survey finds that a majority of U.S. adults (64%) say they would favor laws that would protect transgender individuals from discrimination in jobs, housing and public spaces such as restaurants and stores. But there is also a fair amount of support for specific proposals that would limit how trans people can participate in certain activities and navigate their day-to-day lives.

Roughly six-in-ten adults (58%) favor proposals that would require transgender athletes to compete on teams that match the sex they were assigned at birth (17% oppose this, 24% neither favor nor oppose). 1 And 46% favor making it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (31% oppose). The public is more evenly split when it comes to making it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) and investigating parents for child abuse if they help someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Across the board, views on these policies are deeply divided by party.

Views of laws and policies related to transgender issues differ widely by party

When asked what has influenced their views on gender identity – specifically, whether they believe a person can be a different gender than the sex they were assigned at birth – those who believe gender can be different from sex at birth and those who do not point to different factors. For the former group, the most influential factors shaping their views are what they’ve learned from science (40% say this has influenced their views a great deal or a fair amount) and knowing someone who is transgender (38%). Some 46% of those who say gender is determined by sex at birth also point to what they’ve learned from science, but this group is far more likely than those who say a person’s gender can be different from their sex at birth to say their religious beliefs have had at least a fair amount of influence on their opinion (41% vs. 9%).

The nationally representative survey of 10,188 U.S. adults was conducted May 16-22, 2022. Previously published findings from the survey show that 1.6% of U.S. adults are trans or nonbinary, and the share is higher among adults younger than 30. More than four-in-ten U.S. adults know someone who is trans and 20% know someone who is nonbinary. Among the other key findings in this report:

Nearly half of U.S. adults (47%) say it’s extremely or very important to use a person’s new name if they transition to a gender that is different from the sex they were assigned at birth and change their name. A smaller share (34%) say the same about using someone’s new pronouns (such as “he” instead of “she”). A majority of Democrats (64%) – compared with 28% of Republicans – say it’s at least very important to use someone’s new name if they go through a gender transition and change their name. And while 51% of Democrats say it’s extremely or very important to use someone’s new pronouns, just 14% of Republicans say the same.

Many Americans express discomfort with the pace of change around issues of gender identity. Some 43% say views on issues related to people who are transgender or nonbinary are changing too quickly, while 26% say things aren’t changing quickly enough and 28% say the pace of change is about right. Adults ages 65 and older are the most likely to say views on these issues are changing too quickly; conversely, those younger than 30 are the most likely to say they’re not changing quickly enough.

More than four-in-ten (44%) say forms and online profiles that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either. Some 38% say the same about government documents such as passports and driver’s licenses. Half of adults younger than 30 say government documents that ask about a person’s gender should provide more than two gender options, compared with about four-in-ten or fewer among those in older age groups. Views differ even more widely by party: While majorities of Democrats say forms and online profiles (64%) and government documents (58%) should offer options other than “male” and “female,” about eight-in-ten Republicans say they should not (79% say this about forms and online profiles and 83% say this about government documents).

Democrats and Republicans who agree that a person’s gender is determined by their sex at birth often have different views on transgender issues. A majority (61%) of Democrats – but just 31% of Republicans – who say a person’s gender is determined by the sex they were assigned at birth say there is at least a fair amount of discrimination against transgender people in our society today. And while 62% of Democrats who say gender is determined by sex at birth say they would favor policies that protect trans individuals against discrimination, fewer than half of their Republican counterparts say the same.

Democrats’ views on some transgender issues vary by age. Among Democrats younger than 30, about seven-in-ten (72%) say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, and 66% say society hasn’t gone far enough in accepting people who are transgender. Smaller majorities of Democrats 30 and older express these views. Age is less of a factor among Republicans. In fact, similar shares of Republicans ages 18 to 29 and those 65 and older say a person’s gender is determined by their sex at birth (88% each) and that society has gone too far in accepting people who are transgender (67% of Republicans younger than 30 and 69% of those 65 and older).

About three-in-ten parents of K-12 students (29%) say at least one of their children has learned about people who are transgender or nonbinary from a teacher or another adult at their school. Similar shares across regions and in urban, suburban and rural areas say their children have learned about this in school, as do similar shares of Republican and Democratic parents. Views on whether it’s good or bad that their children have or haven’t learned about people who are trans or nonbinary at school vary by party and by children’s age. For example, among parents of children in elementary school, 45% say either that their children have learned about this and that’s a bad thing or that they haven’t learned about it and that’s a good thing. A smaller share of parents of middle and high schoolers (34%) say the same. Republican parents are much more likely than Democratic parents to say this, regardless of their child’s age.

Majority of U.S. adults say gender is determined by sex assigned at birth

Six-in-ten U.S. adults say that whether a person is a man or a woman is determined by their sex assigned at birth. This is up from 56% one year ago and 54% in 2017 . No single demographic group is driving this change, and patterns in who is more likely to say this are similar to what they were in past years.

Today, half or more in all age groups say that gender is determined by sex assigned at birth, but this is a less common view among younger adults. Half of adults younger than 30 say this, lower than the 60% of 30- to 49-year-olds who say the same. Even higher shares of those 50 to 64 (66%) and those 65 and older (64%) say a person’s gender is determined by their sex at birth.

The party gap on this issue remains wide. The vast majority of Republicans and those who lean toward the GOP say gender is determined by sex assigned at birth (86%), compared with 38% of Democrats and Democratic leaners. Most Democrats say that whether a person is a man or a woman can be different from their sex at birth (61% vs. just 13% of Republicans). Liberal Democrats are particularly likely to hold this view – 79% say a person’s gender can be different from sex at birth, compared with 45% of moderate or conservative Democrats. Meanwhile, 92% of conservative Republicans say gender is determined by sex at birth and 74% of moderate or liberal Republicans agree.

Democrats ages 18 to 29 are also substantially more likely than older Democrats to say that someone’s gender can be different from their sex assigned at birth, although majorities of Democrats across age groups share this view. About seven-in-ten Democrats younger than 30 say this (72%), compared with about six-in-ten or fewer in the older age groups. Among Republicans, there is no clear pattern by age. About eight-in-ten or more Republicans across age groups – including 88% each among those ages 18 to 29 and those 65 and older – say a person’s gender is determined by their sex at birth.

The view that a person’s gender is determined by their sex assigned at birth is more common among those with lower levels of educational attainment and those living in rural areas or in the Midwest or South. This view is also more prevalent among men and Black Americans.

A solid majority of those who do not know a transgender person say that whether a person is a man or a woman is determined by sex assigned at birth (68%), while those who do know a trans person are more evenly split. About half say gender is determined by sex assigned at birth (51%), while 48% say gender and sex assigned at birth can be different.

Though Republicans who know a trans person are more likely than Republicans who don’t to say gender can be different from sex assigned at birth, more than eight-in-ten in both groups (83% and 88%, respectively) say gender is determined by sex at birth. Meanwhile, there are large differences between Democrats who do and do not know a transgender person. A majority of Democrats who do know a trans person (72%) say someone can be a man or a woman even if that differs from their sex assigned at birth, while those who don’t know anyone who is transgender are about evenly split (48% say gender is determined by sex assigned at birth while 51% say it can be different).

When asked about factors that have influenced their views about whether someone’s gender can be different from the sex they were assigned at birth, 44% say what they’ve learned from science has had a great deal or a fair amount of influence. About three-in-ten (28%) point to their religious views and about two-in-ten (22%) say knowing someone who is transgender has influenced their views at least a fair amount. Smaller shares say what they’ve heard or read in the news (15%) or on social media (14%) has had a great deal or a fair amount of influence on their views.

Chart showing More than four-in-ten U.S. adults say science has influenced their views of gender and sex at least a fair amount

The factors people point to on this topic differ by whether or not they say gender is determined by sex at birth. Among those who say that whether someone is a man or a woman is determined by the sex they were assigned at birth, 46% say what they’ve learned from science has influenced their views on this at least a fair amount, while 41% say the same about their religious views. About one-in-ten point to what they’ve heard or read in the news (12%), what they’ve heard or read on social media (11%) or knowing someone who’s transgender (11%).

Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 40% say their views on this topic have been influenced at least a fair amount by what they’ve learned from science. A similar share say the same about knowing a transgender person (38%). Smaller shares in this group say what they’ve heard or read in the news (19%) or on social media (18%) or their religious views (9%) have had a great deal or a fair amount of influence.

Among those who say gender is determined by sex assigned at birth, adults younger than 30 stand out as being more likely than their older counterparts to say their knowledge of science (60%), what they’ve heard or read on social media (22%) or knowing someone who is trans (17%) influenced this view a great deal or a fair amount. In turn, those ages 65 and older tend to be more likely than younger age groups to cite their religious views (51% in the older group say this has had at least a fair amount of influence).

Republicans who say gender is determined by sex assigned at birth are more likely than Democrats with the same view to say their knowledge of science (52% vs. 40%) and their religious views (45% vs. 34%) have had at least a fair amount of influence, while Democrats are more likely than Republicans to say the news (17% vs. 10%), social media (16% vs. 10%) and knowing someone who is trans (15% vs. 9%) have influenced them – though the shares are still small among both groups.

U.S. adults with different viewpoints on gender and sex say their opinions have been influenced by different factors

On the flip side, among those who say someone’s gender can be different from the sex they were assigned at birth, adults younger than 30 are also more likely than older adults to say social media has contributed to this view at least a fair amount (33% vs. 15% or fewer among older age groups). Adults ages 65 and older are more likely than their younger counterparts to say what they’ve learned from science has influenced their view (46% vs. 40% or fewer).

Democrats who say whether someone is a man or a woman can be different from their sex at birth are more likely than Republicans with the same view to say that what they’ve learned from science (43% vs. 26%) and knowing someone who is transgender (40% vs. 26%) has influenced their view a great deal or a fair amount.

Roughly eight-in-ten Americans say transgender people face at least some discrimination, and relatively few believe our society is extremely or very accepting of people who are trans. These views differ widely by partisanship and by beliefs about whether someone’s gender can differ from the sex they were assigned at birth.

Overall, 57% of adults say there is a great deal or a fair amount of discrimination against transgender people in our society today. An additional 21% say there is some discrimination against trans people, and 14% say there is a little or none at all.

There are modest differences in views on this issue across demographic groups. Women (62%) are more likely than men (52%) to say there is a great deal or a fair amount of discrimination against transgender people, and college graduates (62%) are more likely than those with less education (55%) to say the same.

Chart showing Most Americans say there is at least some discrimination against trans people in the U.S.

There is, however, a wide partisan divide in these views: While 76% of Democrats and those who lean to the Democratic Party say there is a great deal or a fair amount of discrimination against trans people, 35% of Republicans and Republican leaners share that assessment. One-in-four Republicans see little or no discrimination against this group, compared with 5% of Democrats.

These views are also linked with underlying opinions about whether a person’s gender can be different from their sex assigned at birth. Among those who say someone can be a man or a woman even if that’s different from the sex they were assigned at birth, 83% say there is a great deal or a fair amount of discrimination against trans people. Even so, some 42% of those who hold the alternative point of view – that gender is determined by sex assigned at birth – also see at least a fair amount of discrimination. Among Democrats who say gender is determined by sex at birth, that share rises to 61%.

Relatively few adults (14%) say society is extremely or very accepting, while about a third (35%) say it is somewhat accepting. A plurality (44%) says our society is a little or not at all accepting of trans people.

Chart showing Plurality of Americans say there is little or no societal acceptance of transgender people

Again, these views are strongly linked with partisanship. Democrats have a much more negative view than Republicans, with 54% of Democrats saying society is a little accepting or not at all accepting of transgender people, compared with a third of Republicans.

And, as with views of discrimination, assessments of societal acceptance are linked to underlying views about how gender is determined. Those who say one’s gender can be different from the sex they were assigned at birth see less acceptance: 56% say society is a little accepting or not accepting at all of people who are transgender. This compares with 37% among those who say gender is determined by sex at birth. Republicans who say gender is determined by sex at birth are more likely than Democrats who say the same to believe that society is at least somewhat accepting of people who are transgender (61% vs. 47%).

While a majority of Americans see at least a fair amount of discrimination against transgender people and relatively few see widespread acceptance, 38% say our society has gone too far in accepting them. Some 36% say society has not gone far enough in accepting people who are trans, and 23% say the level of acceptance has been about right.

These views differ along demographic and partisan lines. Young adults (ages 18 to 29) and those with a bachelor’s degree or more education are among the most likely to say society hasn’t gone far enough in accepting people who are trans. Men, White adults and those without a four-year college degree are among the most likely to say society has gone too far in this regard.

Chart showing Public is divided over whether society has gone too far or not far enough in accepting transgender people

There is a wide partisan divide as well. Roughly six-in-ten Democrats (59%) say society hasn’t gone far enough in accepting people who are transgender, while 15% say it has gone too far (24% say it’s been about right). Republicans’ views are almost the inverse: 10% say society hasn’t gone far enough and 66% say it’s gone too far (22% say it’s been about right).

Even among those who see at least some discrimination against trans people, a majority (54%) say society has either gone too far in accepting trans people or been about right; 44% say society hasn’t gone far enough.

Many say it’s important to use someone’s new name, pronouns when they’ve gone through a gender transition

Nearly half of adults say it’s important to use someone’s new name if they change their name as part of a gender transition

Nearly half of adults (47%) say it’s extremely or very important that if a person who transitions to a gender that’s different from their sex assigned at birth changes their name, others refer to them by their new name. An additional 22% say this is somewhat important. Three-in-ten say this is a little or not at all important (18%) or that it shouldn’t be done (12%).

Smaller shares say that if a person transitions to a gender that’s different from their sex assigned at birth and starts going by different pronouns (such as “she” instead of “he”), it’s important that others refer to them by their new pronouns. About a third (34%) say this is extremely or very important, and 21% say this is somewhat important. More than four-in-ten say this is a little or not at all important (26%) or it should not be done (18%).

These views differ along many of the same dimensions as other topics asked about. While 80% of those who believe someone’s gender can be different from their sex assigned at birth also say it’s extremely or very important to use a person’s new name when they’ve gone through a gender transition, 27% of those who think gender is determined by one’s sex assigned at birth share this opinion. The pattern is similar when it comes to use of preferred pronouns.

Democrats are much more likely than Republicans to say it’s extremely or very important to refer to a person using their new name or pronouns. When it comes to pronouns, a majority of Republicans (55%), compared with only 17% of Democrats, say using someone’s new pronouns when they’ve been through a gender transition is not at all important or should not be done.

Chart showing People who know a trans person place more importance on using a person’s new name, pronouns if they transition

There are some demographic differences as well, with women more likely than men and those with a four-year college degree more likely than those with less education to say it’s extremely or very important to use a person’s new name or pronouns when referring to them.

In addition, people who say they know someone who is trans are more likely than those who do not to say this is extremely or very important. Even so, substantial shares of those who don’t know a trans person view this as important. For example, 39% of those who don’t know someone who is transgender say it’s extremely or very important to refer to a person who goes through a gender transition and changes their name by their new name.

Many Americans are not comfortable with the pace of change that’s occurring around issues involving gender identity. Some 43% say views on issues related to people who are transgender and nonbinary are changing too quickly. About one-in-four (26%) say things are not changing quickly enough, and 28% say they are changing at about the right speed.

Women (30%) are more likely than men (21%) to say views on these issues are not changing quickly enough, and adults younger than 30 are more likely than their older counterparts to say the same. Among those ages 18 to 29, 37% say views on these issues are not changing quickly enough; this compares with 26% of those ages 30 to 49, 22% of those ages 50 to 64 and 19% of those 65 and older. At the same time, White adults (46%) are more likely than Black (34%), Hispanic (39%) or Asian (31%) adults to say views are changing too quickly .

Chart showing More than four-in-ten Americans say societal views on gender identity are changing too quickly

Opinions also differ sharply by partisanship. Among Democrats, a plurality (42%) say views on issues involving transgender and nonbinary people are not changing fast enough, and 21% say they are changing too quickly. About a third (35%) say the speed is about right. By contrast, 70% of Republicans say views on these issues are changing too quickly, while only 7% say views aren’t changing fast enough. About one-in-five Republicans (21%) say they’re changing at about the right speed.

Respondents were asked in an open-ended format why they think views are changing too quickly or not quickly enough, when it comes to issues surrounding transgender and nonbinary people. For those who say things are changing too quickly, responses fell into several different categories. Some indicated that new ways of thinking about gender were inconsistent with their religious beliefs. Others expressed concern that the long-term consequences of medical gender transitions are not well-known, or that changing views on gender identity are merely a fad that’s being pushed by the media. Still others said they worry that there’s too much discussion of these issues in schools these days.

For those who say views are not changing quickly enough, some pointed to discrimination and a lack of acceptance of trans and nonbinary people. Others pointed to legislative initiatives in some states aimed at restricting the rights of trans and nonbinary people. Many also said that too many people in our society aren’t open to change when it comes to these issues. 2

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing too quickly ?

General concerns about the pace of change

“The issue is so new to me I can’t keep up. I don’t know what to think about all of this new information. I’m baffled by so many changes.”

“It takes quite a bit of time for society to accept changes. I have not been aware of this issue for very long. I am relatively conservative and feel that changes need time to be accepted.”

Religious reasons

“People now believe everyone should just forget about their birth identity and just go along with what they think they are. God made us all for a reason and if He intended us to pick our gender then there would be no reason to be born with specific male or female parts .”

“I have a personal religious belief that sex is an essential part of our eternal identity and that identifying as something other than you are … just doesn’t make a lot of sense.”

“I believe GOD created a man and a woman. We have overstepped our bounds in messing with the miracle of life. I side with my creator.”

Concerns about long-term medical consequences

“We do not know the long-term health problems of hormone therapy, especially in young children.”

“More time needs to pass to study mental, physical, emotional ramifications of medications & surgeries, especially when done before puberty and/or adulthood.”

“Accepting gender fluidity, especially for younger children, seems quick. Also, medical treatments related to gender for people under 18 seems to be being accepted without longer term studies.”

It’s a fad/Driven by the media

“I respect people’s views about themselves, and I will refer to them in the way they want to be referred to, but I believe it’s become trendy because it’s being pushed so much in culture, especially for children.”

“News media, social media and entertainment media companies are trying to change, and it seems they have been succeeding in changing public opinion on this issue for many people.”

“It is encouraging kids who are easily influenced to participate in the ‘in’ fad when their brains are not fully developed.”

Concerns about schools

“Elementary school students should not be subjected to instruction on sex identity, any questions the child asks should be referred to a parent.”

“I think that young people are exposed to these issues at too early an age. I believe that it is up to the parents, and I oppose schools that want to include it in the ‘curriculum.’”

“It’s being pushed on society and especially on younger children, confusing them all the more. This is not something that should be taught in schools.”

In their own words: Why do some people think views on issues related to transgender people and those who don’t identify as a man or a woman are changing too slowly ?

Discrimination

“There is far too much discrimination, hate, and violence directed toward people who are brave enough to stand up for who they truly are. We, as a country and as a society, need to respect how people want to identify themselves and be kind toward one another, end of story.”

“Protections for basic rights to self-determination in identity, health care choices, privacy, and consensual relationships should be a bare minimum that our society can provide for everyone – transgender people included . ”

“There’s too much discrimination. People need to quit controlling other people’s private lives. I consider them very brave for having the courage to be who they identify with . ”

“Equal protection has not kept up with trans issues, including trans youth and the right to gender-affirming care.”

Legislative efforts

“Acceptance is not changing quick enough. There remains discrimination and elected officials are passing laws that make it more difficult for transgender individuals in society to live, work and exist.”

“We are going backwards with all the anti-gay & -trans legislation that is being passed.”

“For every step forward, it feels like there are two steps back with reactive conservative laws.”

“These laws are working to restrict the rights of trans and nonbinary people, and also discrimination is still very high which results in elevated rates of suicide, poverty, violence and homelessness especially for people of color.”

“The spate of laws being proposed that would take away the rights of transgender people is evidence that we’re a long way from treating them right.”

Society is not open to change

“Too many people are simply stuck in the binary. We, as a society, need to just accept that someone else’s gender identity is whatever they say it is and it rarely has any bearing on the lives of others.”

“These are people. Who they say they are is all that matters. Society, mostly conservatives, doesn’t understand change in any form. So, they fight it. And they hinder the ability for others to learn about themselves and others, which slows growing as a society to a crawl.”

“It’s an issue that has been in the closet for centuries. It’s time to acknowledge and accept that gender identity is a spectrum and not binary.”

“We are not accepting the changes. We refuse to see what is in front of us. We care too much about not changing the status quo as we know it.”

“Society often views this as a phase or a period of uncertainty in their life. Instead, it’s about a person bringing their gender identity in line with what they have experienced internally all their life.”

Chart showing Liberal Democrats are more likely than other groups to be following news about bills related to trans people closely

Many states are considering legislation related to people who are transgender, but a relatively small share of U.S. adults (8%) say they’re following news about these bills extremely or very closely. Another 24% say they’re following this somewhat closely, while about two-thirds say they’re following it either a little closely (23%) or not all closely (44%). 3

Only about one-in-ten or less across age, racial and ethnic groups, and across levels of educational attainment, say they are following news about bills related to people who are transgender extremely or very closely. Six-in-ten or more across demographic groups say they’re following news about these bills a little closely or not closely at all.

Liberal Democrats and Democratic-leaning independents (46%) are more likely than moderate and conservative Democrats (29%) to say they are following news about state bills related to people who are transgender at least somewhat closely. Conservative Republicans and Republican leaners (31%) are more likely than their moderate and liberal counterparts (24%) – but less likely than liberal Democrats – to be following news about these bills at least somewhat closely. Still, half or more among each of these groups say they have been following news about this a little or not at all closely.

The survey asked respondents how they feel about some current laws and policies that are either in place or being considered across the U.S. related to transgender issues. Only two of seven items are either endorsed or rejected by a majority: 64% say they would favor policies that protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores, and 58% say they would favor policies that require that transgender athletes compete on teams that match the sex they were assigned at birth rather than the gender they identify with.

Chart showing Most Americans say they would favor laws that would protect transgender people from discrimination in jobs, housing and public spaces

Even though there is not a majority consensus on most of these laws or policies, there are gaps of at least 10 percentage points on three items. Some 46% say they would favor making it illegal for health care professionals to provide someone younger than 18 with medical care for gender transitions, and 41% would favor requiring transgender individuals to use public bathrooms that match the sex they were assigned at birth rather than the gender they identify with; 31% say they would oppose each of these. Meanwhile, more say they would oppose (44%) than say they would favor (27%) requiring health insurance companies to cover medical care for gender transitions.

Views are more divided when it comes to laws and policies that would make it illegal for public school districts to teach about gender identity in elementary schools (41% favor and 38% oppose) or that would investigate parents for child abuse if they helped someone younger than 18 get medical care for a gender transition (37% favor and 36% oppose). Some 21% and 27%, respectively, say they’d neither favor nor oppose these policies.

Majorities of U.S. adults across age groups express support for laws and policies that would protect transgender individuals from discrimination in jobs, housing, and public spaces such as restaurants and stores. About seven-in-ten adults ages 18 to 29 (70%) and 30 to 49 (68%) say they favor such protections, as do about six-in-ten adults ages 50 to 64 (60%) and 65 and older (59%).

But adults younger than 30 are more likely than those in each of the older age groups to say they favor laws or policies that would require health insurance companies to cover medical care for gender transitions (37% among those younger than 30 vs. about a quarter among each of the older age groups). They’re also less likely than older adults to express support for bills and policies that would restrict the rights of people who are transgender or limit what schools teach about gender identity. On most items, those ages 50 to 64 and those 65 and older express similar views.

Chart showing Views of laws and policies related to transgender issues differ by age

Views differ even more widely along party lines. For example, eight-in-ten Democrats say they favor laws or policies that would protect trans individuals from discrimination, compared with 48% of Republicans. Conversely, by margins of about 40 percentage points or more, Republicans are more likely than Democrats to express support for laws or policies that would do each of the following: require trans athletes to compete on teams that match the sex they were assigned at birth (85% of Republicans vs. 37% of Democrats favor); make it illegal for health care professionals to provide someone younger than 18 with medical care for a gender transition (72% vs. 26%); make it illegal for public school districts to teach about gender identity in elementary schools (69% vs. 18%); require transgender individuals to use public bathrooms that match the sex they were assigned at birth (67% vs. 20%); and investigate parents for child abuse if they help someone younger than 18 get medical care for a gender transition (59% vs. 17%).

Overall, White adults tend to be more likely than Black, Hispanic and Asian adults to express support for laws and policies that would restrict the rights of transgender people or limit what schools can teach about gender identity. But among Democrats, White adults are often less likely than other groups to favor such laws and policies, particularly compared with their Black and Hispanic counterparts. And White Democrats are more likely than Black, Hispanic and Asian Democrats to say they favor protecting trans individuals from discrimination and requiring health insurance companies to cover medical care for gender transitions.

Chart showing About four-in-ten or more say forms and government documents should offer options other than ‘male’ and ‘female’

About four-in-ten Americans (38%) say government documents such as passports and driver’s licenses that ask about a person’s gender should include options other than “male” and “female” for people who don’t identify as either; a larger share (44%) say the same about forms and online profiles that ask about a person’s gender.

Half of adults younger than 30 say government documents that ask about gender should include options other than “male” and “female,” compared with 39% of those ages 30 to 49, 35% of those 50 to 64 and 33% of adults 65 and older. When it comes to forms and online profiles, 54% of adults younger than 30 and 47% of those ages 30 to 49 say these forms should include more than two gender options; smaller shares of adults ages 50 to 64 and 65 and older (37% each) say the same.

Views on this vary considerably by party. A majority of Democrats and Democratic-leaning independents say forms and online profiles (64%) and government documents (58%) that ask about a person’s gender should include options other than “male” and “female.” In contrast, about eight-in-ten or more Republicans and Republican leaners say forms and online profiles (79%) and government documents (83%) should not include more than these two gender options.

Those who say they know someone who is nonbinary are more likely than those who don’t know anyone who’s nonbinary to say forms and government documents should include gender options other than “male” and “female.” Still, 39% of those who don’t know anyone who’s nonbinary say forms and online profiles shouldinclude other gender options, and 33% say the same about government documents that ask about a person’s gender. Conversely, 31% of those who say they know someone who’s nonbinary say forms and online profiles should not include options other than “male” and “female,” and 41% say this about government documents.

In recent months, lawmakers in several states have introduced legislation that would prohibit or limit instruction on sexual orientation or gender identity in schools. The survey asked parents of K-12 students whether any of their children have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school and how they feel about the fact that their children have or have not learned about this.

Some 37% of parents with children in middle or high school say their middle or high schoolers have learned about people who are transgender or who don’t identify as a boy or a girl from a teacher or another adult at their school; a much smaller share of parents of elementary school students (16%) say the same. Overall, 29% of parents with children in elementary, middle or high school say at least one of their K-12 children have learned about this at school.

Similar shares of parents of K-12 students in urban (31%), suburban (27%) and rural (32%) areas – and in the Northeast (34%), Midwest (33%), South (26%) and West (28%) – say their school-age children have learned about people who are transgender or who don’t identify as a boy or a girl. And Republican (27%) and Democratic (31%) parents are also about equally likely to say their children have learned about this in school. None of these differences are statistically significant.

Chart showing Views on children learning about people who are trans or nonbinary at school differ by party, children’s age

Many parents of K-12 students don’t think it’s good for their children to learn about people who are transgender or nonbinary from their teachers or other adults at school. Among parents of elementary school students, 45% either say their children have learned about people who are trans or nonbinary at school and see this is a bad thing or say their children have not learned about this and say this is a good thing. A far smaller share (13%) say it’s a good thing that their elementary school children have learned about people who are trans or nonbinary or that it’s a bad thing that they haven’t learned about this. And about four-in-ten (41%) say it’s neither good nor bad that their elementary school children have or haven’t learned about people who are transgender or nonbinary.

Among parents with children in middle or high school, 34% say it’s a bad thing that their children have learned about people who are trans or nonbinary at school or that it’s a good thing that they haven’t; 14% say it’s good that their middle or high schoolers have learned about this or that it’s bad that they haven’t; and 51% say it’s neither good nor bad that their children have or haven’t learned about this in school.

Republican and Republican-leaning parents with children in elementary, middle and high school are more likely than their Democratic and Democratic-leaning counterparts to say it’s a bad thing that their children have learned about people who are trans or nonbinary at school or that it’s a good thing that they haven’t. In turn, Democratic parents are more likely to say it’s good that their children have learned about this or bad that they haven’t . They are also more likely to say it’s neither good nor bad that their children have or haven’t learned about people who are trans or nonbinary at school.

For each policy item, respondents were also given the option of answering “neither favor nor oppose.” ↩
Open-ended responses (quotations) have been lightly edited for clarity and length. ↩
The shares who say they are following news about this a little or not at all closely do not add up to the combined share shown in the chart due to rounding. ↩

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Research: When Employees Identify with Their Company, They’re Less Likely to Recognize Gender Discrimination

Jamie L. Gloor,
Tyler Okimoto,
Brooke Gazdag,
Michelle Ryan

Beware the “not here” bias.

Identifying as an organizational member — or feeling a strong sense of attachment to the organization — is generally a positive thing for employees and employers. But our research on workplace incivility and mistreatment shows that it can also shape when — and if — employees recognize and respond to subtle forms of discrimination against women at work. Evidence shows that leaders, as well as employees, play a key role in identifying and remedying gender discrimination in all its forms. If the goal is to proactively address gender discrimination in the workplace and encourage leaders and workers to remove their rose-colored glasses, this article offers a few suggestions.

You’re in the elevator of your office building. The doors open and two coworkers — one male and one female — enter the elevator in a heated debate. The female employee is trying to explain an issue on a project she’s leading, but the male employee interrupts her: “ Geez, I’ve heard enough of you and your opinions!” The woman falls silent, clearly upset and shaken by the comment.

JG Jamie L. Gloor is a Swiss National Science Foundation professor of Leadership & Diversity Science at the University of St.Gallen in Switzerland. Her research, teaching, and speaking focus on diversity and inclusion, leadership, humor, and sustainability to craft more equitable, enjoyable, and productive workplaces with positive impact.
TO Tyler Okimoto is a professor of management and academic dean within the faculty of Business, Economics, and Law at the University of Queensland. His research aims to understand the factors that bias employee judgments and lead to discrimination at work, and how organizations can work through biased viewpoints to promote consensus and a greater sense of fairness.

Xinxin Li is an associate professor of management at the Antai College of Economics and Management at the Shanghai Jiao Tong University. Her research focuses on DEI, business ethics, and emotions at work.

BG Brooke Gazdag is an associate professor and academic director of executive education at the Kühne Logistics University in Hamburg, Germany. Through her research and teaching, she seeks to improve employees’ experience at work through leadership, negotiations, and diversity and inclusion.

Michelle Ryan is a professor of social and organizational psychology and the director of the Global Institute for Women’s Leadership at The Australian National University. Her work centers on understanding the psychological processes underlying workplace gender inequality, and designing and implementing innovative and evidence-based interventions to increase gender equality.

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Daily gender expression is associated with psychological ...
This unidimensional scoring approach is consistent with current continuum-based theories of gender identity 2,4, empirical research on gender expression 1,3, and statistical evidence that ...
Gender Identity and Gender Expression
Summary. Gender identity and gender expression are aspects of personal identity that impact an individual across multiple social dimensions. As such, it is critical that social workers understand the role of gender identity and gender expression in an individual's life. Many intersecting factors contribute to an individual's gender identity ...
Sexual orientation and gender identity and expression conversion ...
Background Despite greater acceptance of sexual and gender diversity and the scientific consensus that same-gender attraction, creative gender expression, and transness are not mental illnesses, LGBTQI2+ persons are still commonly told that they can or should change their sexual orientation, gender identity, or gender expression (SOGIE). The aim of this study was to describe the prevalence of ...
Daily gender expression is associated with psychological adjustment for
Although research is limited, there is clearly evidence for both long-term and context-dependent fluctuations in gender expressions. Gender expression and psychological adjustment Generally, individuals who feel typical for their sex (i.e., females with high femininity and males with high masculinity) tend to report better psychological well-being.
How Transgender Adolescents Experience Expressing Their Gender Identity
Prior research suggests that gender expression is key in the development and communication of transgender identity, and that related affirmative and adverse social interactions influence the psychological well-being of transgender individuals. Though these experiences have been explored with transgender adults, qualitative research has yet to ...
Understanding transgender people, gender identity and gender expression
Gender identity refers to a person's internal sense of being male, female or something else; gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or body characteristics. "Trans" is sometimes used as shorthand for "transgender.". While transgender is ...
Gender Expression: Meaning, Health Care, Discrimination
Research suggests that gender expression is a part of the minority stress described by cisgender sexual minorities and gender minorities. This may reflect both a person's expectation that discrimination will happen, as well as the actual bias directed at them.
Self-perceived gender expression, discrimination, and mental health
1. Introduction. While gender is a multifaceted concept including numerous dimensions, such as individual gender identity, gender expression, and dominant gender roles and stereotypes, research exploring gender disparities in mental health is often limited to focused consideration on categorical self-assigned gender identity (or problematically, assumed gender identity based on sex assigned at ...
The Measurement of Sexual Attraction and Gender Expression: Cognitive
Footnote 1 Gender expression has mainly been measured in surveys in terms of how it is perceived by others, although recent research considers one's own perception of their gender expression (Magliozzi et al. 2016; Moore 2006; Smyth and Olson 2020). Overall, although gender expression is a distinct facet of gender, likely useful for ...
Gender expression
Gender expression, or gender presentation, is a person's behavior, mannerisms, and appearance that are socially associated with gender, ... Some research proved a similar idea, showing that homosexual people are generally more gender nonconforming than heterosexual people, and gender nonconformity throughout life can be an indicator of ...
Measurement tools for gender identity, gender expression, and gender
The GIIC 38 also showed adequate psychometric properties 38, 59 and has been widely used across all age groups for the purpose of assessing gender identity and expression. 25, 29, 38, 48, 49, 58, 59 However, GIIC, which was developed in 1993 and has not been revised since then, uses terminology that is non-affirming and outdated (eg, gender ...
Gender and Emotion Expression: A Developmental Contextual Perspective
Several research studies and meta-analyses have shown small but significant gender differences in the expression of emotion in adulthood in the US and some Western European countries, with women showing greater emotion expression overall (Brody & Hall, 1993; Kring & Gordon, 1998), and in particular for positive emotions (LaFrance, Hecht, & Levy Paluck, 2003) and internalizing negative emotions ...
Gender Matters: The Perceived Role of Gender Expression in
Although violation of gender norms has been discussed as a fundamental component of and underlying foundation for anti-queer discrimination, less research has directly attended to how lesbian, gay, bisexual, and queer (LGBQ) individuals interpret the role of gender expression in discriminatory experiences.
Gender stereotypes and biases in early childhood: A systematic review
Include the expression of gender stereotypes or biases as an outcome (measured as an attitude/belief, preference, activity and choice). ... (2010). Gender identity and stereotyping in early and middle childhood. In Handbook of gender research in psychology, Vol: Gender research in general and experimental psychology (pp. 495-525). Springer ...
Sexual orientation, gender identity and gender expression-based
Violence based on sexual orientation, gender identity or gender expression is present in our society and within the university community [1,2,3].Numerous international studies have shown that the lesbian, gay, transgender, queer and intersex (LGBTQI+) community have more risk and probabilities to suffer sexual discrimination or harassment during their university trajectory [2, 3].
We need more-nuanced approaches to exploring sex and gender in research
This is in part the result of major funding agencies, such as the Canadian Institutes of Health Research and the US National Institutes of Health, as well as various scientific journals 1 ...
Gender identity vs. gender expression: Definitions and more
Gender exists on a broad spectrum and encompasses both gender identity and expression, in addition to societal expectations about status, behavior, and characteristics associated with certain sex ...
The measurement of gender expression in survey research
Previous research on the survey measurement of sexual orientation, gender identity, and gender expression (SOGIE) often focuses on the measurement of identity, with comparably little research focused on gender expression as a key feature of how gender is lived and experienced. This study examines the reliability and validity of survey questions about gender expression in a 2-by-5-by-2 ...
Full article: What is gender, anyway: a review of the options for
In the social sciences, many quantitative research findings as well as presentations of demographics are related to participants' gender. Most often, gender is represented by a dichotomous variable with the possible responses of woman/man or female/male, although gender is not a binary variable. It is, however, rarely defined what is meant by ...
Sexual Orientation and Gender Identity/Expression in Adolescent
During the same period, research started to focus on "gender nonconformity," that is a gender expression that does not align with societal expectations based on the assigned sex at birth (deMayo et al., Citation 2022; Martin-Storey & Baams, Citation 2019).
Focus On Ethics: Gender Expression and Identity
Gender varies over time and from place to place. Gender identity: How a person self-identifies their gender, which may include man, woman, genderqueer, or other gender identities. A person's understanding of their gender identity can begin as early as age 2. Gender expression: The way in which a person expresses their gender identity ...
Americans' Complex Views on Gender Identity and ...
Among Democrats, a plurality (42%) say views on issues involving transgender and nonbinary people are not changing fast enough, and 21% say they are changing too quickly. About a third (35%) say the speed is about right. By contrast, 70% of Republicans say views on these issues are changing too quickly, while only 7% say views aren't changing ...
Gender and Emotion Expression: A Developmental Contextual Perspective
Small but significant gender differences in emotion expressions have been reported for adults, with women showing greater emotional expressivity, ... Prior empirical research supporting the model, at least with mostly White middle-class U.S. samples of youth, is presented. Limitations to the extant literature and future directions for research ...
Dancing around gender expression and sex talk: LGBTQ+ asylum policy in
1 One way, among many, to denote groups of individuals who identify as minorities because of their sexual orientation, gender identity, gender expression, and sex characteristics [SOGIESC] (ARC International, International Bar Association's Human Rights Institute, International Lesbian, Gay, Bisexual, Trans & Intersex Association, 2016; International Lesbian, Gay, Bisexual, Trans & Intersex ...
Research: When Employees Identify with Their Company, They're Less
But our research on workplace incivility and mistreatment shows that it can also shape when — and if — employees recognize and respond to subtle forms of discrimination against women at work.
Nutrients
In the context of the increasing number of obese individuals, a major problem is represented by obesity and malnutrition in children. This condition is mainly ascribable to unbalanced diets characterized by high intakes of fat and sugar. Childhood obesity and malnutrition are not only associated with concurrent pathologies but potentially compromise adult life. Considering the strict ...
Relationships Between Dress and Gender Identity: LGBTQIA
Dr. Alyssa Dana Adomaitis is full-time tenured Associate faculty and Director of The BusinessP1 and Technology of Fashion degree program. Her research area of interest is in the social psychology of dress consumer persuasion used marketing and semeiotics.

Article contents

What Are Gender Identity and Gender Expression?

Table 1. Additional Relevant Terms

Beyond the Binary: Reconceptualizing Gender Identity and Gender Expression

Social Work, Gender Identity, and Gender Expression: A Brief History

Social Work and Gender Equity

Further Reading

Related Articles

Sexual orientation and gender identity and expression conversion exposure and their correlates among LGBTQI2+ persons in Québec, Canada

Conclusions

Introduction

Survivor characteristics

Participant recruitment

Data analysis

Participants

Lifetime prevalence of SOGIE conversion attempt exposure and involvement in conversion services

SOGIE conversion attempts

Involvement in SOGIE conversion services

Correlates of conversion services involvement

Correlates of conversion attempts

Strengths and limitations

Supporting information

Acknowledgments

What Is Gender Expression?

The Meaning of Gender Expression

Gender Expression and Health Care

Gender Expression, Pronouns, and Health Care

Discrimination

A Word From Verywell

The Measurement of Sexual Attraction and Gender Expression: Cognitive Interviews with Queer Women

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Sexual orientation, gender identity and gender expression-based violence in Catalan universities: qualitative findings from university students and staff

Conclusions

Communicative organization of the research

Research tools

Ethical validation

Data analysis

Violence’s normalization and internalization

Transgender vulnerability in the conflict

Unfamiliarity of institutional mechanisms and interventions

University as a safe space

The value of receptiveness and alliances

Challenges in identifying violence

Damage on wellbeing of LGBTQI+ students

University policies and measures a the LGBTQI-phobia

Availability of data and materials

Abbreviations

Acknowledgements

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Archives of Public Health

We need more-nuanced approaches to exploring sex and gender in research

Causes of confusion

Embracing complexity

Implicit bias

Competing Interests

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