transgender research paper outline

Original Article

Trans Research Ethics

Challenges and Recommendations for Change

Zack Marshall , Chris Kaposy , Fern Brunger , Vivian Welch

The field of research that includes transgender, nonbinary, and gender diverse (collectively, trans) people is expanding. In early research, trans people were often the objects of study. As trans studies evolves, community members are turning a critical eye to research practices. In this paper we join others in presenting a call for changes at each stage of the research process. Grounded in specific examples, nine core challenges are identified. Related to research focus and study design there are problems linked to: 1) centering a cisnormative world view, 2) conducting research not identified as a priority by trans communities, and 3) lack of accountability in research design decisions. Regarding data collection and analysis, concerns include: 4) reinforcing gender binaries, 5) collapsing gender and sexual diversity, and 6) misrepresenting trans experiences through data manipulation. In terms of reporting and publishing practices, challenges are identified related to: 7) misgendering, 8) informational erasure in reporting research results, and 9) under-attention to complex informed consent dynamics. Linking the trans research ethics literature with concrete documentation of the ways researchers discuss and represent trans people and their personal information in peer-reviewed publications, this manuscript contributes to new dialogues about improving research processes with communities invested in accountability.

Research with transgender, nonbinary, and gender diverse (collectively, trans) participants is on the rise. As this field of research grows, tensions are also becoming more evident, including questions related to who has the right to conduct research with trans people, the extent of community collaboration, how to carry out ethical recruitment, the protection of participant confidentiality, and how trans people are represented in research findings (Adams et al. 2017; Bouman et al. 2018; Rosenberg and Tilley 2020; Veale 2022; Vincent 2018).

Several groups have started to develop guidelines to help researchers navigate potential ethical challenges in carrying out research with trans people and communicating their results. For example, the European Association for Transgender Health (EPATH) and the World Professional Association for Transgender Health (WPATH) outline recommended linguistic practices for abstract submission to their academic conferences (Bouman et al. 2017). These guidelines include a commitment to “respect, dignity, and equality for transgender, transsexual, and gender variant people in all cultural settings” (Bouman et al. 2017, 2), de-psychopathologization, and specific attention to avoid stigmatizing or pathologizing gender and bodily diversity, misgendering language, and reporting or advocating for clinical practices or interventions that are inconsistent with human rights. In addition, some of the recommendations move beyond discussion of language to address confidentiality, consent, and respect in relation to videos, photos, or other visual representations. WPATH guidelines specifically suggest that researchers should collaborate with trans individuals and communities with regard to selecting “language and terminology that is relevant and meaningful to a target population” (Bouman et al. 2017, 5). The Canadian Professional Association for Transgender Health (CPATH) released a similar set of national guidelines for research involving trans individuals and communities (Bauer et al. 2019).

These new guidelines echo calls for greater attention to sexual and gender diversity in study design, data collection and analysis, and research reporting. As this field evolves, many authors have focused on sampling and measurement, including the development of more inclusive questions and optimal question formats (e.g., Reisner et al. 2016; Saperstein and Westbrook 2021). Others have identified the need for more nuanced approaches to data analysis (Ansara and Hegarty 2014; Lett and Everhart 2022), improved attention to diversity within trans communities (Lett et al. 2022), insider/outsider perspectives (Rosenberg and Tilley 2020; Vincent 2018), and research agendas (Hanssmann 2010; Veale et al. 2022).

In order to understand more about this field of research, our team developed an evidence map of trans research (Marshall et al. 2019). Evidence maps employ systematic review methodologies including systematic searches, screening references on title and abstract, and on full text, using pre-established inclusion and exclusion criteria (Miake-Lye et al. 2016). Each of these steps contributes to increased accountability, replicability, and transparency and this time-consuming process also ensures a full immersion in the data and the ways the research is presented.

One of the key objectives of the evidence map was to explore the behaviors of researchers who study trans individuals and communities, including what topics they tend to study and which research methods they employ. From an initial search that produced 25,230 references, 3,533 references were screened on full-text, including 1,667 studies that included trans people. While reviewing abstracts and articles on full-text, there were many examples of studies that did not seem to adhere to the core principles of research ethics including respect for persons, concern for welfare, and justice (CIHR, NSERC, SSHRC 2018). Linking literature about trans research ethics with concrete documentation of the ways researchers represent trans people in peer-reviewed publications, this manuscript contributes to new dialogues about empirical trans research ethics highlighting challenges and recommendations at each stage of the research process.

Language and Terminology

The concept of gender modality introduced by Ashley (2022) describes, “the correspondence (or lack thereof) between a person’s gender identity and gender assigned at birth” (1). We use the term trans to refer to people whose gender identity and gender assigned at birth are not aligned. The term cisgender refers to people whose gender identity aligns with their birth assigned gender (Schilt and Westbrook 2009). In this paper, we have opted for a broad trans conceptualization (Chen 2018) that incorporates diverse gender identities, expressions, and modalities. This includes trans, nonbinary, and gender diverse people.

Challenges At All Stages of the Research Process

Difficulties accurately reflecting gender identity and expression can be seen at all stages of the research process. In the next three sections we highlight key concerns related to research focus and study design, data collection and analysis, and reporting and publication. Suggestions for addressing these concerns are included at the end of each section. Further reflection on recommendations is contained in the Discussion.

Research Focus and Study Design

Challenges related to research focus and study design include: 1) centering a cisnormative world view, 2) conducting research not identified as a priority by trans people, and 3) lack of accountability in research design decisions.

1) Centering a Cisnormative World View

A cisnormative world view assumes that everyone is cisgender and that variations from the norm do not exist (Ansara and Hegarty 2012; Bauer et al. 2009). From a cisnormative perspective, gender corresponds with the assignment made at birth, and does not change during the life course (Baril 2009). Cisnormative customs and societal structures reflect this belief system and center a “non-trans norm” (Pyne 2011). The existence of trans people, whose gender identities do not necessarily align with their birth assigned gender, challenges a cisnormative world view of sex and gender.

Grounded in cisnormative conceptualizations, psychiatrists, psychologists, and physicians function within a model that typically understands trans experience as a mental illness in need of treatment (MacKinnon 2018; Schwend 2020). Until recently, formal acknowledgment of trans people without pathologization was impossible. That is, in order to be recognized as trans and to gain access to medical transition, it was necessary to be diagnosed with Gender Identity Disorder (APA 1994) and subsequently Gender Dysphoria (APA 2013), disorders identified in the Diagnostic and Statistical Manual of Mental Disorders. A similar practice relates to trans-related codes in the International Statistical Classification of Diseases and Related Health Problems (World Health Organization 2018).

Depending on context, some people still need to obtain a formal diagnosis in order to access gender affirming care, and indeed these mechanisms contribute to beliefs about what it means to be trans, or even “trans enough” (Vincent 2020). The majority of professionals receive no training related to trans experience (MacKinnon et al. 2020). Medical and psychological training that does exist has been shaped by a psychopathologizing framework. Even in cases where professionals purport to recognize that being trans is not a mental illness, simplifications (including false equivalence between “being trans” and “suffering gender dysphoria”) may occur such that trans experience is conceptualized as if pathology. Imagining gender identity as a “disorder” is enacted through societal structures and systems, including the practices of researchers who study trans people. This is also reflected in terms of who is included on research teams and as co-authors, the ways studies are conceived and designed, in the identified objectives and hypotheses, and in the selection of measures and outcomes of interest.

2) Conducting Research Not Identified as a Priority by Trans Communities

Research about trans people typically reflects the interests and needs of researchers, clinicians, and funders. It is unclear how often decisions about research topics, or the identification of research questions, have been informed by the perspectives of trans individuals, communities, or other stakeholders. With the exception of participatory research, typically there is no discussion of connection to communities or their role in determining project focus in peer-reviewed publications. Instead, some authors describe how the purpose of the project relates either to their own learning goals (Kaufmann 2010) or to expanding knowledge in the field as a whole. Similar to other historically marginalized communities, these practices lead to justifiable anger and mistrust towards research and researchers, and require accountability (e.g. Jaiswal and Halkitis 2019; Perez-Brumer et al. 2021; Tagonist 2009).

Current practice supports the increased participation of people with lived experience in research prioritization (Johansson 2014; Staley et al. 2020). The involvement of people whose lives are affected by research or policy decisions contributes in ways that may not have formerly been considered (Brett et al. 2014). Trans-focused community-based research studies in the dataset clearly described how trans community members were involved in the initiation or development of the projects themselves (e.g. Davidmann 2014; Travers et al. 2013). In the context of limited resources to fund research initiatives, centering trans people in identifying research priorities will help to increase the relevance of the information that is produced (Bauer et al. 2019). In addition to considerations related to areas of research priority, there are also implications attached to research design decisions.

3) Lack of Accountability in Research Design Decisions

Recent attention has turned to the importance of reducing research waste and increasing the value of research contributions (Moher et al. 2016). In the dataset, the majority of studies were descriptive, including cross-sectional surveys, exploratory qualitative studies, and clinical case reports (Marshall et al. 2019). There were 21 systematic reviews of descriptive or qualitative research. While we do not intend to reinforce a positivist view that prioritizes randomized controlled trials and meta-analyses, it is important to question what designs are being implemented and who benefits or is harmed by current approaches to study design (Lett et al. 2022).

In some situations, qualitative research provides new insights into specific aspects of trans identities and experience. For example, research conducted by Singh (2013) explores aspects of resilience for young trans women of color who are trauma survivors. In addition to enhancing our understanding of young racialized trans women, these results help to shift the field away from deficits and towards a greater focus on the strengths of members of the population being studied.

The example of case reports is not so clear-cut. Case reports document novel or rare medical circumstances and have traditionally been used for discovery and teaching (Packer et al. 2017). In the case of trans surgeries, there are a limited number of surgeons who conduct gender affirming procedures such as vaginoplasty, facial feminization, chest reconstruction, or phalloplasty. For trans people and their practitioners seeking detailed information about these procedures and potential complications, case reports can be of value. This is particularly true in the absence of clinical trials or other forms of study design. However, these publications also have the potential to augment the reputation of particular surgeons and to draw attention to their areas of expertise, possibly increasing the number of procedures they perform and their personal income. While the contribution of single case reports may benefit trans people in the way they address surgical techniques, side-effects, and complications, their contribution to evidence-informed practice is not always clear. We would argue that the value of case reports depends on how the information is used, whether the publication contributes to increased stigmatization of trans people, and whether researchers use existing case reports to conduct meta-analyses (Vandenbroucke 2001) or to develop more robust research. In order to address these challenges related to study design and research focus, four recommendations are identified below.

Recommendation 1: Adopt an approach to research that centers gender self-determination (Stanley 2014). Integrated this perspective would help to counter systemic cisgender norms that are embedded in typical research processes. A shift towards embracing gender diversity and experience within the context of self-determination would aid in addressing challenges linked to pathologization and the stigmatizing and at times highly disrespectful language used to describe trans bodies and experiences. Recent examples of these changes include a focus on trans joy and gender euphoria (Alutalica 2021; Jacobsen and Devor 2022; Shuster and Westbook 2022). As part of this first step, it is also necessary to acknowledge differences between conceptualizations of gender as binary and biologically based, and a broad diversity of genders determined by multiple factors. Ermine’s (2007) concept of ethical space, developed in relation to research involving Indigenous communities, is helpful in clarifying the need for respectful engagement of difference across thought-worlds. For example, if cisgender experience were de-centered, researchers may be less likely to emphasize biology or genetics in thinking about gender because of the ways trans gender modalities unsettle assumptions about gender identity and gender assigned at birth.

Recommendation 2: Acknowledge the structural implications of study design on trans people. Study design influences the types of questions that can be explored, expectations of participants and research teams, and the potential impact of the project. The time and emotional costs of research participation for trans people and community partner organizations also need to be taken into account in making decisions about study design. Attending to the impact of research fatigue within trans communities is a further consideration (Ashley 2021; Glick et al. 2018). In order to make research more relevant, useful, and accessible, Chalmers and Glasziou (2009) and Moher et al. (2016) underline the importance of: i) public engagement in research prioritization; ii) appropriate research design, conduct, and analysis; and iii) accessible, full research reports.

Recommendation 3: Conduct research identified as a priority by trans communities. There are clear methods for centering communities in research prioritization, including detailed strategies outlined by the James Lind Alliance Guidebook for Priority Setting Partnerships (2021). Taking these steps will make it more likely that research that is funded and carried out is a priority to trans communities, that study designs will include a range of methods, and that research will contribute to transformative change. In considering research that is relevant to trans communities, it is also important to acknowledge diversity within trans communities, and to prioritize the leadership and perspectives of people from multiply marginalized subpopulations (Lett et al. 2022). Decision-making processes which do not account for systemic and structural discrimination will continue to replicate existing power hierarchies (Lett et al. 2022).

Recommendation 4: Establish trans research ethics initiatives in partnership with local communities. In addition to identifying research priorities alongside trans communities, it is recommended that trans communities establish research ethics groups to provide input and oversight into research happening in local communities. There are multiple approaches to organizing community ethics review processes. As documented by Shore et al. (2011) these processes primarily operated through community-based organizations, community-institutional partnerships, community health centers, and tribal organizations. Recent research has highlighted the ways Indigenous communities have established models of accountability that balance individual and collective rights, support ethical principles that are culturally-grounded, and ensure research that is community-driven and self-determined (Hayward et al. 2021). Establishing trans research ethics initiatives, such as committees, boards, or consultation groups will contribute to larger community dialogues and histories, in solidarity with communities who have also been harmed by research and researchers.

Data Collection and Analysis

In this section, we consider the next phase in the research process related to data collection and analysis. Difficulties in this realm include: 4) reinforcing gender binaries, 5) collapsing gender identity and sexual diversity, and 6) misrepresenting trans experiences through data manipulation.

4) Reinforcing Gender Binaries

Aside from being grounded in cisnormative assumptions about sex and gender, research on trans people is also influenced by broader framings of gender binarism, where sex and gender are each classified as “two distinct, opposite, and disconnected forms of masculine and feminine” (Phoenix and Ghul 2016, 200). In contrast to gender binarism, gender can be considered a multiplicity (Linstead and Pullen 2006), one aspect of the diversity of human experience.

Beliefs about gender are concretized in the design of data collection tools, and in the ways data are analyzed (Lindqvist, Sendén, and Renström 2021). There are signs that help the reader to discern whether and to what extent researchers have adopted unproblematized cisnormative and/or binary assumptions about gender. For example, referring to “opposite sexes” or “both men and women” suggests that the writer believes there are only two genders and they may have been less likely to conceptualize their research to be inclusive of people who are nonbinary, or even non-cisgender.

Binarism is also communicated in the ways researchers position trans, nonbinary, and cisgender people in relation to each other. Within a cis-binary world view (Chen 2018), researchers may assume clear distinctions between trans, cisgender, and nonbinary identities. Research design needs to take into account the potential intersections of these experiences in the lives of individual research participants (e.g. Ashley 2022; Puckett et al. 2020; Scheuerman et al. 2021). Failure to acknowledge diversity within trans, nonbinary, and gender diverse communities can be invalidating, but more than this it demonstrates a lack of understanding of lived experience. For example, if a survey asks people to indicate if they are “men,” “women,” or “nonbinary,” this poses a dilemma for trans people who identify as men and/or women and who also want to be visible as trans (and not nonbinary) people. These categories are also not mutually exclusive for many people, and being forced to choose between “men,” “women,” or “nonbinary” can also create limitations related to what the dataset is capable of representing and communicating (Cameron and Stinson 2019; Frohard-Dourlent et al. 2017).

Data based on these types of question mean that participants in the response categories for “men” and “women” will include trans people, cisgender people, and others, and researchers will have no way of clarifying their findings. In this example, if researchers reported that the nonbinary respondents were the only trans participants, this also communicates an underlying belief that trans people cannot be men and/or women. It is important to be aware of additional subtle distinctions in the ways these questions are worded. For example, if cisgender people are asked their gender, and trans people are asked for their gender identity, this reinforces the belief that cisgender people have gender, but trans people have gender identities (Motola 2012; Reed 2014). The different choice of words for cis versus trans people is implicit of a fundamental difference of validity between cis and trans peoples’ genders, where cis peoples’ genders are axiomatic and trans peoples’ genders are suspect.

5) Collapsing Gender and Sexual Diversity

In addition to questions about gender, there are a number of ways researchers group trans people with sexually diverse participants, with particular issues related to data collection and analyses. For example, in some population health studies, participants are asked their gender at the start of the survey with the choice of “male” or “female.” Then later in relation to sexual orientation they are asked, are you “a member of the ‘gay, lesbian, bisexual, or transgendered community’?” (Perrella, Brown, and Kay 2012, 90). When this question is asked with a single “yes” or “no” response option, it is not possible to determine individual numbers of gay, lesbian, bisexual, or trans participants separately. A further difficulty occurs when there is no room for trans people to identify their sexual identities because of the ways the questions are posed. For example, if questions about gender include two response options (woman/man or male/female), and questions about sexual identity include single response options from a list of gay, lesbian, bisexual, transgender, then respondents are not able to identify as both transgender and lesbian (White et al. 2010). These response choices also foreclose experiences at the intersection of gender and sexuality, and do not make room for identity complexity and fluidity (Suen et al. 2020).

6) Misrepresenting Trans Experiences Through Data Manipulation

As researchers become increasingly aware of the existence of trans communities, learn more about how to access trans people through recruitment, and ask questions that are inclusive of trans experiences, trans people’s data become more visible. However, this increased awareness in itself does not guarantee that trans people’s information will be respected during data analysis. Respecting trans people’s data means accurately and sensitively reflecting the diversity of trans people’s lives (Adams et al. 2017).

One of the ways researchers fail trans people is to collect information from participants but to subsequently exclude it from data analysis. For example, in some studies researchers report that due to the small number of trans participants in the overall sample, they are unable to include this data in the analysis. Researchers typically explain this with statements such as, “Individuals who self-identified as transgender ( n = 35) were also excluded from the analytical dataset due to the small sample size and focus on gender comparisons” (Yuan et al. 2014, 10464), “This project incorporated terminology for both queer and trans spectra; however, very few respondents identified along the trans spectrum and therefore were not included in our final subset” (Patridge, Barthelemy, and Rankin 2014, 79), or “… too few clients (<1%) reported their sexual orientation as ‘questioning’ or ’transgender’ to include in the study…” (Lipsky et al. 2012, 403). While some researchers may feel it is methodologically necessary to exclude trans participants from analysis due to small numbers of participants, the implications of these decisions and alternatives require careful consideration (Lett et al. 2022). To convey respect for participants, if trans data will be excluded based on sample size, this possibility should be clarified during recruitment and when obtaining consent in relation to the costs and benefits for trans people.

Another researcher practice when faced with low numbers of trans participants is to combine trans responses with larger subsamples. For example, some researchers explain that in order to include information from trans people they group them together with people from the same birth assigned gender. The emphasis on bio/logics (Van Anders 2014) over gender identity in analyzing and reporting results is most often observed in studies that focus on men who have sex with men (Solomon et al. 2014), but is also reported in other types of studies. For example, as Wells et al. (2013) report, “This coding was based on the assigned sex of the respondents and those to whom they were attracted” (315). Similarly, Newcomb et al. (2014) asked participants to identify their birth sex (options: male or female), sexual identity (options: male, female, male-to-female transgender, or female-to-male transgender), and sexual orientation (options: gay, lesbian, bisexual, questioning/unsure/other). Despite investigator efforts to gain more nuanced information about sexual orientation and gender identity with these questions, they went on to analyze their data according to birth assigned gender as described here,

Our study indicates that LGBT birth sex differences in smoking may be more similar to those found in general populations than was previously believed. However, over time male-born LGBT youth decreased their odds and rate of smoking, while female-born LGBT youth simultaneously escalated their rate of smoking and appeared to catch up to their male-born counterparts. (Newcomb et al. 2014, 562)

This grouping of trans people according to birth assigned gender is a fundamental betrayal. While it may simplify reporting or data analysis, it does so at the expense of participants’ own understandings of their lives and experiences. The classification of trans experiences in these ways reflects an underlying bias against the legitimacy of trans gender identities as valid, a form of epistemic injustice (Fricker 2007) that has implications beyond political correctness.

Recommendation 5: Closer attention to the design of data collection tools to allow for the full participation of all people would also improve data quality and respectful representations of trans experience. Specifically, questions about gender and sexual orientation need to be asked separately . If participants are being asked who they have sexual contact with, or who they want to have sexual contact with, this list needs to include more than standard responses of women or men. An increased diversity of response options would allow participants to more accurately reflect the range of gender and sexual identity (Suen et al. 2020).

Recommendation 6: The development and validation of gender and sexuality measures is a highly active area of research. This includes the multiple studies focused on how best to ask about gender in surveys (Bauer et al. 2017; Broussard, Warner, and Pope 2018; Kosciesza 2022; Lombardi and Banik 2016; Morrison, Dinno, and Salmon, 2021; Reisner et al. 2014; Tate et al. 2013), the development of new measures that more accurately reflect expansive gender and sexual identities (Dockendorff and Heist 2021; Frohard‐Dourlent et al. 2017; Gender Census 2021; Westbrook and Saperstein 2015), critiques of existing measures (e.g. Glick et al. 2018; Katz-Wise et al. 2016; Lett and Everhart 2022; Snyder, Tabler, and Gonzales 2022), and recent research highlighting trans people’s perspectives on existing measures (Puckett et al. 2020; Suen et al. 2020). A number of guidelines have been published related to sexual orientation and gender identity questions in surveys including: Best Practices for Asking Questions to Identify Transgender and Other Gender Minority Respondents in Population-Based Surveys (Badgett et al. 2014), Updates on Terminology of Sexual Orientation and Gender Identity Survey Measures (Morgan et al. 2020), and Measuring Sex, Gender Identity, and Sexual Orientation (National Academies of Sciences, Engineering, and Medicine 2022). With the rapid growth in this field, and the ways language shifts to reflect emerging conceptualizations of sexual and gender diversity, our suggestions focus more on research processes than identifying specific measures or questions. It is recommended that researchers asking questions about sexual and gender diversity remain up-to-date with the most current research, and engage with relevant trans communities in the development of research tools and measures.

Recommendation 7: Potential participants have a right to know how researchers plan to use their information, including whether their data will be excluded in the case of small trans sample sizes, or if the researchers plan to analyze their responses according to birth assigned gender. There are increasing examples of how to do this. Vivienne et al. (2022) and Beischel et al. (2022) have also identified new strategies for categorizing sex and gender during data analysis, including the perspectives of research participants in developing these ideas. During study design, recruitment, and data collection plan for how trans data will be managed and be transparent about this when seeking informed consent. Research documents such as consent forms and data collection tools should make clear the investigator’s plans for data analysis, including whether all trans responses will be grouped together, or if data from trans people will be analyzed according to birth assigned gender. Failure to inform trans participants that their data will be excluded or that it will be analyzed according to birth assigned gender is a misrepresentation of the research process.

Reporting and Publishing Practices

There are multiple challenges related to reporting and publishing practices including: 7) misgendering, 8) informational erasure when describing sample demographics, and 9) under-attention to complex informed consent dynamics.

7) Misgendering

As defined by Ansara and Hegarty (2014, 260), “Misgendering describes the use of gendered language that does not match how people identify themselves.” There are several sites of misgendering within the dataset. In the context of peer-reviewed case reports, authors tend to handle patient pronouns in one of four ways. They either refer to the person by their gender, they refer to them by their birth assigned gender, they refrain from referring to the participant’s gender, or they refer to them by different pronouns before and after gender affirming surgeries. Unless authors explicitly address their choice of pronouns, these decisions can lead to ambiguities, and lack of clarity for the reader. There are many examples of authors who use birth assigned gender pronouns to refer to people who have pursued cross-sex hormones or gender affirming surgeries. For example, in referring to a patient pursuing facial feminization surgery the authors comment, “The case of a 39-year-old male-to-female transgender patient who underwent feminization of his masculine forehead is presented. Surgical techniques to feminize his forehead were as follows” (Cho and Jin 2012, 1207). Similarly, from Rieger et al. (2013), “All implants originated from women, except for two that were removed from men undergoing gender reassignment” (768). While case reports do not provide insights into patient descriptions of their gender, Kapusta (2016) has underlined the moral contestability of misgendering, including the refusal of some clinicians to acknowledge patient authority over their gender.

Another example of misgendering relates to labelling trans women as men who have sex with men (MSM). In some publications, authors describe their sample as MSM but later in a demographics table, results section, or footnote, they identify the number of “trans female” participants. Although there is increasing awareness of the ways it is unacceptable to refer to trans women as men, this practice continues (Parker, Aggleton, and Perez-Brumer 2016). For example, a study by Rhodes et al. (2010), begins with the following statement: “A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA” (797). Subsequently, the authors note “two participants self-identified as male-to-female transgender” (797). As noted by Kaplan, Sevelius, and Ribeiro (2016, 824):

the problematic conflation of trans feminine individuals and MSM in much of the existing HIV literature … has stymied progress in slowing the HIV epidemic in the most at-risk groups, including those who do not fit neatly into binary notions of gender and sex.

Finally, we have examples of misgendering rooted in transmisogyny. For example, in case reports some clinicians describe surgical outcomes in ways that suggest trans (women’s) bodies are not legitimate. For example, Jarolim et al. (2009) state, “… for male transsexuals, surgery can provide a cosmetically acceptable imitation of female genitals” (1643). In other instances, authors highlight the functionality of trans affirming surgeries, particularly as they relate to the sexual experience of partners. One author went so far as to comment, “My responsibility is to make our patients a ’turn on’” (Reed 2011, 172). While on the one hand these comments may speak to priorities identified by surgeons (and some trans people), these statements communicate an underlying transmisogyny and fail to acknowledge the multiple meanings trans people may hold in relation to their bodies and gender affirming surgeries.

8) Informational Erasure in Reporting Research Results

The ways that researchers describe their sample demographics can make it difficult to discern who was involved. For example, some authors identify a certain number of LGBT or LGBTQ participants with no additional information about participant characteristics (Binnie 2014; Das 2012). Sometimes authors explain that this practice is to preserve the anonymity of their sample, which makes sense from one perspective, but this also means that it is not possible to be certain whether trans people participated or in what numbers. This situation is exacerbated when researchers resort to non-specific use of LGBTQI+ acronyms, and when they group results from all trans people together.

Regarding the non-specific use of LGBTQI+ acronyms, one challenge occurs when authors use trans-inclusive acronyms (e.g. LGBTQ or 2SLGBTQ) to refer to their participants but on closer examination of the sample demographics, no trans people (who are not already counted as 2SLGBQ) are included. A further concern relates to the visibility of trans participants at different levels of the publication including title, abstract, and body of the text. Some authors do not mention trans people in the title or abstract, but do identify trans people when describing sample demographics. For example, the title of a study by Stroup, Glass, and Cohn (2014) identifies bisexual, gay, and lesbian students, “The adjustment to U.S. rural college campuses for bisexual students in comparison to gay and lesbian students: An exploratory study,” however 5.3% of the sample is trans. It should be noted that this also happens in relation to bisexual and other sexually diverse participants with identities outside lesbian and gay sexual identity categories. These practices erase (Bauer et al. 2009) trans participants and draw the reader’s attention towards (cisgender) gay and lesbian experiences, reinforcing their centrality. That it also takes more work for the reader to determine whether there are trans participants or not, means that the contribution of these participants is more likely to be overlooked and excluded from knowledge synthesis projects.

A second challenge occurs when researchers group results from all trans people together. Sometimes researchers only document the total number of trans participants, and are unable to distinguish between different groups of trans participants because of the ways that questions are posed. For example, in some surveys participants are asked whether they are “female,” “male,” or “transgender” and asked to select one option (e.g. Sherman et al. 2014). Someone can be both trans and male, or trans and female. Indeed, one can be male and assigned female at birth, female and assigned male at birth, and trans people of the same assignment at birth may select different options when presented with “male” and “female” response options. The benefit of these separate options is that the reader may be able to determine the total number of trans participants, however because of the way the question is asked, it is not possible to identify diversity within the trans sample, including the number of people who identify as trans women, trans men, nonbinary, people of transgender experience, or other genders. These practices may also be echoed when it comes to reporting, when all trans and gender diverse participants are combined, making it unrealistic to decipher the diversity of gender identities within the sample. For example, in McElroy, Everett, and Zaniletti’s (2011) study, “The data were also divided into heterosexual category and SGM [sexual and gender minority] category. Anyone who did not self-define themselves as male or female from the gender question and straight/heterosexual from the sexual orientation question was classified as SGM status” (441).

One of the impacts of these practices of informational erasure (Bauer et al. 2009) is that it becomes very difficult to identify who is impacted by structural forms of oppression including violence, discrimination, and poverty. For example, although trans women (including racialized trans women) are more likely to experience violence and criminalization, current approaches to reporting may lead the reader to erroneously believe that all trans people are equally at risk (Namaste 2011). This has further ramifications in that beliefs about who is affected by oppression and inequities can influence decisions about resource allocation including program and research funding (Tordoff et al. 2022). Apart from the methodological challenges this poses in relation to various forms of knowledge synthesis, reporting information in this format conflates gender and sexual diversity, erases specific aspects of trans and nonbinary experience, and fails to account for potential differences within communities.

9) Under-Attention to Complex Informed Consent Dynamics

In clinical research, it is not uncommon to encounter studies that use clinical assessment data or medical records with no discussion of explicit patient consent. There are multiple studies within the dataset that summarize clinic data from patient medical records (e.g. Anderson 2014; Bucci et al. 2014). The majority discuss enrolling consecutive patients in their studies, but do not elaborate on how informed consent is obtained. It is important to flag the complex dynamics that may influence the process of obtaining informed consent to participate in research from patients who are attempting to simultaneously gain access to gender affirming care (Adams et al. 2017). In these instances, it unlikely that patients who are attempting to navigate access to treatments such as hormones or surgeries would be in a position to decline the request to participate in research carried out within the same service (Denny 1992; Toze 2015).

The requirement for informed consent to analyze de-identified health administrative data varies. In some countries, “‘fair processing notices’ … are sent to data subjects to inform them that personal data are being processed for stated purposes” (Council of Canadian Academies 2015, 132). In others, there is no requirement to inform patients of the use of anonymized health information. Given the challenges presented by trans research in relation to respect for participants and the compromised nature of free and informed consent in the context of trans healthcare (for example, the practice of enrolling consecutive clinic patients in research studies), documentation of clear and transparent informed consent processes should be reported alongside study findings.

Recommendation 8: Use language that respects the lived experience of trans people. Misgendering is only one sign of disrespect, however it is an important one (Kapusta 2016). Referring to people in ways that respect gender necessitates an awareness of the need to ask for this information, and instituting approaches that make room for gender diversity in responses (Bauer et al. 2009; Tordoff et al. 2022). It is recommended that clinicians and researchers have clear mechanisms for gathering information about gender and pronouns in order to accurately reflect (and respect) the self-determination of trans patients and participants.

Recommendation 9: Emphasize transparency and specificity when reporting trans data . For example, if there are only lesbian and gay (LG) participants in the sample, it is detrimental to include a B or a T when describing sample demographics. Researchers should also report disaggregated data and sample demographics (Tordoff et al 2022). If there are 18 Two-Spirit people, 14 nonbinary participants, 55 trans women, and 42 trans men in the study, report this information, not total numbers of trans participants. Researchers need to respect the gender identity of trans women and refrain from grouping these participants together with MSM. As well, when conducting systematic reviews if researchers are describing sample demographics, they should be inclusive of trans experience by documenting trans participants alongside cisgender sample demographics.

Recommendation 10: Require researchers and clinicians to obtain written consent to use trans health information. There are variations in the type of consent required for identifiable and de-identified health information. Given the historical relationship between researchers and trans communities, the level of medicalization experienced by trans people alongside dual clinician-researcher roles, explicit written consent to use trans people’s health information for research purposes should be mandatory (Adams et al. 2017). Documenting informed consent within peer-reviewed publications, as recommended by the Committee on Publication Ethics, would also clarify whether participants have given explicit written consent.

Figure 1. Trans Research Ethics Challenges and Recommendations

In this manuscript, we have highlighted key ethical challenges and recommendations at each stage of the research process with trans people (see Figure 1). Challenges at the level of research focus and study design include: 1) centering a cisnormative world view, 2) conducting research not identified as a priority by trans communities, and 3) lack of accountability in research design decisions. Related to data collection and analysis, there are concerns related to 4) reinforcing gender binaries, 5) collapsing gender and sexual diversity, and 6) misrepresenting trans experiences through data manipulation. In terms of reporting and publishing practices, problems are identified related to 7) misgendering, 8) informational erasure in reporting research results, and 9) under-attention to complex informed consent dynamics.

One of the limitations of this project is that these challenges were identified during a trans research mapping process with publications from 2010-2014. This has allowed us to include very specific illustrations from that period but also helps to explain why some of the examples are not from publications in the last couple of years. Grounding the identification of challenges in this dataset meant that we did not go beyond the scope of the studies we examined. Citations related to specific papers are included to provide concrete examples, with the awareness that the perspectives and practices of researchers and clinicians may have changed over time. This reminds us that research, including the identification of specific challenges and suggestions in the field of trans research, is context dependent.

Ten recommendations were developed in response to these challenges: 1) adopt an approach to research that centers gender self-determination, 2) conduct research identified as a priority by trans communities, 3) acknowledge the structural implications of study design decisions on trans people, 4) establish trans research ethics initiatives in partnership with local communities, 5) ask questions about gender and sexual orientation separately, 6) remain up-to-date with the most current research, and engage with relevant trans communities in the development of research tools and measures, 7) during study design, recruitment, and data collection plan for how trans data will be managed and be transparent about this when seeking informed consent, 8) use language that respects the lived experience of trans people, 9) emphasize transparency and specificity when reporting trans data, and 10) require researchers and clinicians to obtain written consent to use trans health information.

The development of recommendations was complex. We believe that the identification of recommendations should be carried out in collaboration with trans communities. Earlier drafts of this work included fewer suggestions, however through the revision process it became clearer that identifying recommendations based on the existing record of research with trans people might support greater accountability. In the process of summarizing challenges and identifying suggestions, it became clear that many authors, including trans researchers and community members, are calling for change and contributing to this dialogue. Where possible, we have made links to recommendations that others have identified or endorsed. The number of publications in this area is accelerating, and similar to research prioritization, it leads to larger questions about how and who is involved in identifying recommendations for improving trans research processes. As we work towards holding researchers accountable and conducting research with transformative potential, it would be useful to draw together this literature, to synthesize key recommendations, and to engage in a process of review and refinement in partnership with diverse trans communities, with particular attention to communities who have been historically-excluded from research processes (Lett et al. 2022).

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Acknowledgments

This work relies on a body of research that would not exist without trans people. We begin by acknowledging the contributions of trans individuals and communities who knowingly or unknowingly have been a part of research studies. We also sincerely appreciate the anonymous reviewers who provided thoughtful, detailed, and generative feedback.

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Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective

• Sven C. Mueller , Ph.D. ,
• Griet De Cuypere , M.D., Ph.D. ,
• Guy T’Sjoen , M.D.

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Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.

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• Case Report of Transgender Patient with Gonadotropic Dysfunction Secondary to Craniopharyngioma: Toward Improving Understanding of Biopsychosocial Dynamics of Gender Identity in Neurosurgical Care World Neurosurgery, Vol. 145
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• Transgender
• Affective Disorders
• Suicidality
• Gender Dysphoria

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• NEWS FEATURE
• 24 April 2019

The largest study involving transgender people is providing long-sought insights about their health

• Sara Reardon

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Benita Arren wishes that the human body came with instructions. “We have a manual with every little thing we buy, in eight languages, but not for myself,” she says. About a decade ago, Arren was struggling with inner conflict. Designated male at birth, she had secretly dressed up in her mother’s clothes as a child, but she suppressed her feelings for decades. Then in her forties, married with two children and busy with a job in Antwerp, Belgium, she found them resurfacing. The masculine persona in her head — how she had long known herself to be — was falling away, leaving her feeling as though she had no personality at all. “Your consciousness is not fast enough to understand all those emotions,” she says.

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Library Resources for Transgender Topics

Types of resources, scholarly journals, specialized reference books, archives and special collections, datasets and statistics.

Scholarly journals include articles of original research, literature reviews, opinion pieces, book reviews, and more. Usually written by experts in the discipline for an academic audience, they are published periodically ( e.g. , annually, quarterly, or monthly). Scholarly journals are also called serials or periodicals. This list is not comprehensive. One may have to look for other relevant journals in related fields such as women’s studies, history, or psychology.

• International Journal of Transgenderism
• Journal of GLBT Family Studies
• Journal of LGBT Issues in Counseling
• Journal of LGBT Youth
• LGBT Law Notes
• Transgender Health
• Transgender Studies Quarterly

Selected titles include specialized reference works like encyclopedias, handbooks, or bibliographies that primarily focus on transgender topics. This list is not intended to be comprehensive.

• Encyclopedia of Gender and Society
• Handbook of Research with Lesbian, Gay, Bisexual, and Transgender Populations
• The Sage Encyclopedia of LGBTQ Studies
• Sexual orientation, gender identities, and the law: a research bibliography, 2006-2016
• Trans Bodies, Trans Selves: A Resource for the Transgender Community

Bibliographic databases, which are collections of references to published literature, may include journal articles, newspaper articles, conference proceedings, reports, government and legal publications, books, or other types of publications. This list of databases is not exhaustive, but is meant to highlight those most likely to include relevant published materials.

• CINAHL Ultimate (Nursing & Allied Health) Covers nursing and allied health journal articles, book chapters, and dissertations, as well as providing summarized evidence-based resources such as care sheets and quick lessons.
• GenderWatch Search articles from journals, etc. that focus on how gender impacts a broad spectrum of subject areas such as the women's movement, men's studies, the transgender community and the changes in gender roles.
• LGBTQ+ Source LGBTQ+ Source contains indexing, abstracts, amd select full text for LGBTQ+ specific core periodicals. Books, newsletters, case studies, dissertations, and core primary sources are also represented. LGBTQ+ Source content is largely unique from other databases, and it includes indexing from its own LGBTQ+ focused thesaurus.
• Left Index Find left-leaning literature on topics including politics, economics, the labor movement, ecology and environment, women's studies, race and ethnicity, social and cultural theory, sociology, art and aesthetics, philosophy, history, education, law, and globalization.
• MEDLINE (Ovid) Searches MEDLINE, which is the primary source of journal articles for the health sciences (fields of medicine, nursing, dentistry, veterinary medicine, public health, health care systems, and basic sciences). Ovid MEDLINE is optimized for advanced literature searches. Coverage is from the 1940s to the present.
• APA PsycInfo Find articles in thousands of psychology journals, from 1806 to current. View this tutorial to learn how to go from a general idea to a very precise set of results of journal articles and scholarly materials.
• PubMed Searches MEDLINE, which is the primary source of journal articles for the health sciences (fields of medicine, nursing, dentistry, veterinary medicine, public health, health care systems, and basic sciences). Coverage is from the 1940s to the present. View this tutorial to learn how to go from a general idea to a very precise set of results of journal articles and scholarly materials.
• WestlawNext Campus Research (Law) WestlawNext Campus Research provides access to legal materials, including cases, statutes, and regulations of the U.S. government and the various state governments. It includes law journals, the American Jurisprudence encyclopedia, the American Law Reports, and news content.
• Women's Studies International This database is a compilation of ten databases covering journal articles, books, anthology chapters, and reports for feminist writings from 1972 to the present.

Archives and special collections refer to groups of unique or rare materials, often focused around a single topic or from a single source. Items in archives and special collections cannot be borrowed and are viewed instead on site or digitally. In this guide, we include only collections/archives with dedicated focus on transgender topics, or LGBTQIA+ with transgender specific sections (unless a particular general collection/archive has an overwhelming abundance of material, warranting an exception).

• Digital Transgender Archive
• The Labadie Collection's Materials for the Study of Trans History (University of Michigan)
• Lili Elbe Digital Archive
• Louise Lawrence Transgender Archive
• Milwaukee Transgender Oral History Project
• Museum of Trans Hirstory & Art (MOTHA)
• NYC Trans Oral History Project
• The Transgender Oral History Project of Iowa (TOPI)
• Tretter Transgender Oral Histories
• University of Victoria Transgender Archives

It is not entirely possible to separate trans collections from LGBTQIA+ ones. In the following section, you will find more expansive collections that include content relevant to research on trans topics.

• Lavender Legacies Guide: Lesbian and Gay Archives Roundtable Guide to Sources in North America
• The Black Lesbian Gay Bisexual Transgender Cultural Archive
• Duke University Libraries’ LGBT Studies Primary Sources
• Lesbian and Gay Newsmedia Archive (London) Materials in the "transgender topics clippings" subject section
• LGBTQ History Digital Collaboratory
• The Pittsburgh Queer History Project
• The Queer Archive for Memory Reflection (Bangalore, India)
• The Queer Zine Archive Project

Datasets consist of individual data points or input collected ( e.g. , individuals’ reported alcohol use and gender identity). Statistics are the result of analysis done on data or datasets ( e.g. , percentage of transgender teenagers who have high alcohol usage). This list i ncludes datasets/statistics that have specific data about trans populations or transgender topics. There are many other datasets/statistics/surveys ( e.g. , hate crime or homeless populations) that are not trans-specific, but likely contain trans people; these are not listed below but would have relevance to this area. However, we do point to broad repositories and resources that include these types of datasets and statistics.

• 2021 Canadian Census of Population Beginning in 2021, the precision of "at birth" was added to the sex question on the census questionnaire, and a new question on gender was included. As a result, the historical continuity of information on sex was maintained while allowing all cisgender, transgender and non-binary individuals to report their gender.
• Behavioral Risk Factor Surveillance System (BRFSS) Some states collect sexual identity data on the BRFSS at their own expense - you must contact the state coordinator to inquire about the data.
• Minnesota Student Survey This voluntary survey asks students about their activities, opinions, behaviors and experiences, including a few questions related to transgender identity. Students respond to questions on school climate, bullying, out-of-school activities, health and nutrition, emotional and mental health, relationships, substance use and more. Questions about sexual behaviors are asked only of ninth- and 11th-grade students. All responses are anonymous.
• National Transgender Discrimination Survey 2011 precursor to the US Transgender Survey. It was the biggest study of transgender populations at the time it was conducted. Includes interviews with over 6,400 transgender and gender non-conforming people.
• Registry: Clinical Trials with Transgender Persons National Institutes of Health Clinical Trials Registry. This is a curated list of trials with transgender persons.
• Repository: Dryad There are datasets in Dryad tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category. As of Spring 2019, Dryad contains one dataset tagged with the term transgender.
• Repository: FigShare There are many datasets in FigShare tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Repository: Harvard Dataverse There are many datasets in Harvard Dataverse tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Repository: ICPSR There are many datasets in ICPSR tagged with transgender - they may or may not aggregate "transgender" into an "LGBTQIA+" category.
• Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12-Update Data on the number of transgender inmates assaulted in US prisons.
• Social Justice Sexuality Project The Social Justice Sexuality Project is one of the largest ever national surveys of Black, Latinx, and Asian and Pacific Islander, and multiracial LGBTQIA+ people. With over 5,000 respondents, the final sample includes respondents from all 50 states; Washington, DC, and Puerto Rico.
• TransPop The TransPop study (2016-2018) is the first national probability sample of transgender individuals in the United States (it also includes a comparative cisgender sample). A primary goal of this study was to provide researchers with a representative sample of transgender people in the United States. The study examines a variety of health-relevant domains including health outcomes and health behaviors, experiences with interpersonal and institutional discrimination, identity, transition-related experiences, and basic demographic characteristics (age, race/ethnicity, religion, political party affiliation, marital status, employment, income, location, sex, gender, and education).
• U.S. Transgender Survey The 2015 U.S. Transgender Survey (USTS) is the largest survey ever devoted to the lives and experiences of transgender people, with 27,715 respondents across the United States. The USTS was conducted by the National Center for Transgender Equality in the summer of 2015, and the results provide a detailed look at the experiences of transgender people across a wide range of areas, such as education, employment, family life, health, housing, and interactions with police and prisons.
• Unerased: Counting Transgender Lives Database of transgender homicides from 2010-2018. Click on the Database heading and then anywhere on the page to access the database. Mic is a news media company publishing stories focused on millennials and policy analysis.
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LGBTQIA Studies : Research and topic suggestions

Arts & culture.

• queer performance art
• LGBTQIA+ writers
• bullying in schools; opposition to anti-bullying efforts by those who want to maintain traditional gender roles and stereotypes
• gender nonconforming children in schools
• how people who identify as non-binary navigate a world that sees gender in binary terms
• how nonbinary and transgender identities are similar and different
• legal rights of transgender people
• transgender visibility and "passing"
• how sexual orientation (who you're attracted to) differs from gender identity (who you are)
• LGBTQIA+ marches and political movements
• LGBTQIA+ pioneers and activists
• transgender history-- e.g., search transgender history in San Francisco
• lesbian and gay history-- at what point did sexual behavior come to be seen as an identity?
• history of bisexuality-- at what point was it recognized as an identity?
• the influence of cultural norms and attitudes of a specific century or decade, and how/why people hid their feelings of same-sex attraction
• was there a time period and location in which the social climate was more accepting of same-sex attraction and desire?
• biography of a specific person in history whose trans identity or same-sex attraction was known or documented
• Important Legislation for LGBTQIA+ people

International

• contrast how LGBTQIA+ people experience life in other countries outside of the United States
• compare and contrast laws and culture within the Asian continent
• which countries are the most and least accepting of LGBTQIA+ people
• LGBTQIA+ couples of differing nationalities-- can they live in the same country?
• LGBTQIA+ rights worldwide (focusing on the "LGBTQIA+ climate" in a specific country or region)
• how are transgender people transforming the medical establishment?
• sexual orientation-- what does biological research tell us about it?
• LGBTQIA+ mental health; research shows LGBTQIA+ people have higher overall rates of depression, anxiety, and substance abuse disorders
• the diagnosis of "gender dysphoria" and how it has been reframed and is no longer a pathology
• parenting as a trans, nonbinary or gender fluid person
• lesbian and gay parenting and adoption
• new reproductive technologies for LGBTQIA+ people
• the history of how LGBTQIA+ people have or have not been integrated into the priesthood of a particular faith
• what new elements have LGBTQIA+ people brought to a particular faith
• LGBTQIA+ themes in the Bible;
• use of the Bible to justify mistreatment of LGBTQIA people
• What it's like to be gay and Muslim
• Gay and Lesbian - Does God Love you?
• 10 Reasons God Loves Gay Christians

Sexual Orientation

• bisexuality and issues that are unique to bisexual people
• asexuality-- what is means, how it is often misunderstood;
• new efforts at asexual visibility coming out stories/ coming out process;
• challenges to the concept of "coming out"

Society & Politics

• recent backlash against LGBTQIA+ people
• gender identity and America's (or another nation's) changing cultural norms
• opposition to gay rights
• discrimination and treatment in the workplace (search also phrases such as "openly gay teachers")
• violence and bullying of LGBTQIA+ people
• marriage of LGBTQIA+ people to heterosexuals in order to "pass" (especially in traditional cultures)
• queer film festivals as a step toward visibility
• same-sex marriage -- who supports it, who opposes it, and which countries have legalized it
• Rainbow capitalism

Article Databases

Scholarly and nonscholarly articles on LGBTQ topics can be found in the following sources (accessible to current Northeastern affiliates)

For cultural studies, current events, political aspects, and all interdisciplinary topics:

For psychological aspects:, for sociological aspects:, for health aspects:, additional databases.

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The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults

Findings from pew research center focus groups, table of contents, identity and the gender journey, navigating gender day-to-day, seeking medical care for gender transitions , connections with the broader lgbtq+ community, policy and social change.

• Focus groups
• The American Trends Panel survey methodology
• Panel recruitment
• Sample design
• Questionnaire development and testing
• Data collection protocol
• Data quality checks
• Acknowledgments

Introduction

Transgender and nonbinary people have gained visibility in the U.S. in recent years as celebrities from  Laverne Cox  to  Caitlyn Jenner  to  Elliot Page  have spoken openly about their gender transitions. On March 30, 2022, the White House issued a proclamation  recognizing Transgender Day of Visibility , the first time a U.S. president has done so.  

More recently, singer and actor Janelle Monáe  came out as nonbinary , while the U.S. State Department and Social Security Administration announced that Americans  will be allowed to select “X” rather than “male” or “female” for their sex  marker on their passport and Social Security applications. 

At the same time, several states have enacted or are considering legislation that would  limit the rights of transgender and nonbinary people . These include bills requiring people to use public bathrooms that correspond with the sex they were assigned at birth, prohibiting trans athletes from competing on teams that match their gender identity, and restricting the availability of health care to trans youth seeking to medically transition. 

A new Pew Research Center survey finds that 1.6% of U.S. adults are transgender or nonbinary – that is, their gender is different from the sex they were assigned at birth. This includes people who describe themselves as a man, a woman or nonbinary, or who use terms such as gender fluid or agender to describe their gender. While relatively few U.S. adults are transgender, a growing share say they know someone who is (44% today vs.  37% in 2017 ). One-in-five say they know someone who doesn’t identify as a man or woman. 

In order to better understand the experiences of transgender and nonbinary adults at a time when gender identity is at the center of many national debates, Pew Research Center conducted a series of focus groups with trans men, trans women and nonbinary adults on issues ranging from their gender journey, to how they navigate issues of gender in their day-to-day life, to what they see as the most pressing policy issues facing people who are trans or nonbinary. This is part of a larger study that includes a survey of the general public on their attitudes about gender identity and issues related to people who are transgender or nonbinary.

The terms  transgender  and  trans  are used interchangeably throughout this essay to refer to people whose gender is different from the sex they were assigned at birth. This includes, but is not limited to, transgender men (that is, men who were assigned female at birth) and transgender women (women who were assigned male at birth). 

Nonbinary adults  are defined here as those who are neither a man nor a woman or who aren’t strictly one or the other. While some nonbinary focus group participants sometimes use different terms to describe themselves, such as “gender queer,” “gender fluid” or “genderless,” all said the term “nonbinary” describes their gender in the screening questionnaire. Some, but not all, nonbinary participants also consider themselves to be transgender.

References to  gender transitions  relate to the process through which trans and nonbinary people express their gender as different from social expectations associated with the sex they were assigned at birth. This may include social, legal and medical transitions. The social aspect of a gender transition may include going by a new name or using different pronouns, or expressing their gender through their dress, mannerisms, gender roles or other ways. The legal aspect may include legally changing their name or changing their sex or gender designation on legal documents or identification.  Medical care  may include treatments such as hormone therapy, laser hair removal and/or surgery. 

References to  femme  indicate feminine gender expression. This is often in contrast to “masc,” meaning masculine gender expression.

Cisgender  is used to describe people whose gender matches the sex they were assigned at birth and who do not identify as transgender or nonbinary. 

Misgendering  is defined as referring to or addressing a person in ways that do not align with their gender identity, including using incorrect pronouns, titles (such as “sir” or “ma’am”), and other terms (such as “son” or “daughter”) that do not match their gender. 

References to  dysphoria  may include feelings of distress due to the mismatch of one’s gender and sex assigned at birth, as well as a  diagnosis of gender dysphoria , which is sometimes a prerequisite for access to health care and medical transitions.

The acronym  LGBTQ+  refers to lesbian, gay, bisexual, transgender, queer (or, in some cases, questioning), and other sexual orientations or gender identities that are not straight or cisgender, such as intersex, asexual or pansexual. 

Pew Research Center conducted this research to better understand the experiences and views of transgender and nonbinary U.S. adults. Because transgender and nonbinary people make up only about 1.6% of the adult U.S. population, this is a difficult population to reach with a probability-based, nationally representative survey. As an alternative, we conducted a series of focus groups with trans and nonbinary adults covering a variety of topics related to the trans and nonbinary experience. This allows us to go more in-depth on some of these topics than a survey would typically allow, and to share these experiences in the participants’ own words.

For this project, we conducted six online focus groups, with a total of 27 participants (four to five participants in each group), from March 8-10, 2022. Participants were recruited by targeted email outreach among a panel of adults who had previously said on a survey that they were transgender or nonbinary, as well as via connections through professional networks and LGBTQ+ organizations, followed by a screening call. Candidates were eligible if they met the technology requirements to participate in an online focus group and if they either said they consider themselves to be transgender or if they said their gender was nonbinary or another identity other than man or woman (regardless of whether or not they also said they were transgender). For more details, see the  Methodology . 

Participants who qualified were placed in groups as follows: one group of nonbinary adults only (with a nonbinary moderator); one group of trans women only (with a trans woman moderator); one group of trans men only (with a trans man moderator); and three groups with a mix of trans and nonbinary adults (with either a nonbinary moderator or a trans man moderator). All of the moderators had extensive experience facilitating groups, including with transgender and nonbinary participants. 

The participants were a mix of ages, races/ethnicities, and were from all corners of the country. For a detailed breakdown of the participants’ demographic characteristics, see the  Methodology .

The findings are not statistically representative and cannot be extrapolated to wider populations.

Some quotes have been lightly edited for clarity or to remove identifying details. In this essay, participants are identified as trans men, trans women, or nonbinary adults based on their answers to the screening questionnaire. These words don’t necessarily encompass all of the ways in which participants described their gender. Participants’ ages are grouped into the following categories:  late teens; early/mid/late 20s, 30s and 40s; and 50s and 60s (those ages 50 to 69 were grouped into bigger “buckets” to better preserve their anonymity).

These focus groups were not designed to be representative of the entire population of trans and nonbinary U.S. adults, but the participants’ stories provide a glimpse into some of the experiences of people who are transgender and/or nonbinary. The groups included a total of 27 transgender and nonbinary adults from around the U.S. and ranging in age from late teens to mid-60s. Most currently live in an urban area, but about half said they grew up in a suburb. The groups included a mix of White, Black, Hispanic, Asian and multiracial American participants. See  Methodology  for more details.

Most focus group participants said they knew from an early age – many as young as preschool or elementary school – that there was something different about them, even if they didn’t have the words to describe what it was. Some described feeling like they didn’t fit in with other children of their sex but didn’t know exactly why. Others said they felt like they were in the wrong body. 

“I remember preschool, [where] the boys were playing on one side and the girls were playing on the other, and I just had a moment where I realized what side I was supposed to be on and what side people thought I was supposed to be on. … Yeah, I always knew that I was male, since my earliest memories.” – Trans man, late 30s

“As a small child, like around kindergarten [or] first grade … I just was [fascinated] by how some people were small girls, and some people were small boys, and it was on my mind constantly. And I started to feel very uncomfortable, just existing as a young girl.” – Trans man, early 30s

“I was 9 and I was at day camp and I was changing with all the other 9-year-old girls … and I remember looking at everybody’s body around me and at my own body, and even though I was visually seeing the exact shapeless nine-year-old form, I literally thought to myself, ‘oh, maybe I was supposed to be a boy,’ even though I know I wasn’t seeing anything different. … And I remember being so unbothered by the thought, like not a panic, not like, ‘oh man, I’m so different, like everybody here I’m so different and this is terrible,’ I was like, ‘oh, maybe I was supposed to be a boy,’ and for some reason that exact quote really stuck in my memory.” – Nonbinary person, late 30s

“Since I was little, I felt as though I was a man who, when they were passing out bodies, someone made a goof and I got a female body instead of the male body that I should have had. But I was forced by society, especially at that time growing up, to just make my peace with having a female body.” – Nonbinary person, 50s

“I’ve known ever since I was little. I’m not really sure the age, but I just always knew when I put on boy clothes, I just felt so uncomfortable.” – Trans woman, late 30s

“It was probably as early as I can remember that I wasn’t like my brother or my father [and] not exactly like my girl cousins but I was something else, but I didn’t know what it was.” – Nonbinary person, 60s

Many participants were well into adulthood before they found the words to describe their gender. For those focus group participants, the path to self-discovery varied. Some described meeting someone who was transgender and relating to their experience; others described learning about people who are trans or nonbinary in college classes or by doing their own research.  

“I read a Time magazine article … called ‘Homosexuality in America’ … in 1969. … Of course, we didn’t have language like we do now or people were not willing to use it … [but] it was kind of the first word that I had ever heard that resonated with me at all. So, I went to school and I took the magazine, we were doing show-and-tell, and I stood up in front of the class and said, ‘I am a homosexual.’ So that began my journey to figure this stuff out.” – Nonbinary person, 60s

“It wasn’t until maybe I was 20 or so when my friend started his transition where I was like, ‘Wow, that sounds very similar to the emotions and challenges I am going through with my own identity.’ … My whole life from a very young age I was confused, but I didn’t really put a name on it until I was about 20.” – Nonbinary person, late 20s

“I knew about drag queens, but I didn’t know what trans was until I got to college and was exposed to new things, and that was when I had a word for myself for the first time.” – Trans man, early 40s

“I thought that by figuring out that I was interested in women, identifying as lesbian, I thought [my anxiety and sadness] would dissipate in time, and that was me cracking the code. But then, when I got older, I left home for the first time. I started to meet other trans people in the world. That’s when I started to become equipped with the vocabulary. The understanding that this is a concept, and this makes sense. And that’s when I started to understand that I wasn’t cisgender.” – Trans man, early 30s

“When I took a human sexuality class in undergrad and I started learning about gender and different sexualities and things like that, I was like, ‘oh my god. I feel seen.’ So, that’s where I learned about it for the first time and started understanding how I identify.” – Nonbinary person, mid-20s

Focus group participants used a wide range of words to describe how they see their gender. For many nonbinary participants, the term “nonbinary” is more of an umbrella term, but when it comes to how they describe themselves, they tend to use words like “gender queer” or “gender fluid.” The word “queer” came up many times across different groups, often to describe anyone who is not straight or cisgender. Some trans men and women preferred just the terms “man” or “woman,” while some identified strongly with the term “transgender.” The graphic below shows just some of the words the participants used to describe their gender.

The way nonbinary people conceptualize their gender varies. Some said they feel like they’re both a man and a woman – and how much they feel like they are one or the other may change depending on the day or the circumstance. Others said they don’t feel like they are either a man or a woman, or that they don’t have a gender at all. Some, but not all, also identified with the term transgender. 

“I had days where I would go out and just play with the boys and be one of the boys, and then there would be times that I would play with the girls and be one of the girls. And then I just never really knew what I was. I just knew that I would go back and forth.” – Nonbinary person, mid-20s

“Growing up with more of a masculine side or a feminine side, I just never was a fan of the labelling in terms of, ‘oh, this is a bit too masculine, you don’t wear jewelry, you don’t wear makeup, oh you’re not feminine enough.’ … I used to alternate just based on who I felt I was. So, on a certain day if I felt like wearing a dress, or a skirt versus on a different day, I felt like wearing what was considered men’s pants. … So, for me it’s always been both.” – Nonbinary person, mid-30s

“I feel like my gender is so amorphous and hard to hold and describe even. It’s been important to find words for it, to find the outlines of it, to see the shape of it, but it’s not something that I think about as who I am, because I’m more than just that.” – Nonbinary person, early 30s

“What words would I use to describe me? Genderless, if gender wasn’t a thing. … I guess if pronouns didn’t exist and you just called me [by my name]. That’s what my gender is. … And I do use nonbinary also, just because it feels easier, I guess.” – Nonbinary person, late 20s

Some participants said their gender is one of the most important parts of their identity, while others described it as one of many important parts or a small piece of how they see themselves. For some, the focus on gender can get tiring. Those who said gender isn’t a central – or at least not the most central – part of their identity mentioned race, ethnicity, religion and socioeconomic class as important aspects that shape their identity and experiences.

“It is tough because [gender] does affect every factor of your life. If you are doing medical transitioning then you have appointments, you have to pay for the appointments, you have to be working in a job that supports you to pay for those appointments. So, it is definitely integral, and it has a lot of branches. And it deals with how you act, how you relate to friends, you know, I am sure some of us can relate to having to come out multiple times in our lives. That is why sexuality and gender are very integral and I would definitely say I am proud of it. And I think being able to say that I am proud of it, and my gender, I guess is a very important part of my identity.” – Nonbinary person, late 20s

“Sometimes I get tired of thinking about my gender because I am actively [undergoing my medical transition]. So, it is a lot of things on my mind right now, constantly, and it sometimes gets very tiring. I just want to not have to think about it some days. So, I would say it’s, it’s probably in my top three [most important parts of my identity] – parent, Black, queer nonbinary.” – Nonbinary person, mid-40s

“I live in a town with a large queer and trans population and I don’t have to think about my gender most of the time other than having to come out as trans. But I’m poor and that colors everything. It’s not a chosen part of my identity but that part of my identity is a lot more influential than my gender.” – Trans man, early 40s

“My gender is very important to my identity because I feel that they go hand in hand. Now my identity is also broken down into other factors [like] character, personality and other stuff that make up the recipe for my identity. But my gender plays a big part of it. … It is important because it’s how I live my life every day. When I wake up in the morning, I do things as a woman.” – Trans woman, mid-40s

“I feel more strongly connected to my other identities outside of my gender, and I feel like parts of it’s just a more universal thing, like there’s a lot more people in my socioeconomic class and we have much more shared experiences.” – Trans man, late 30s

Some participants spoke about how their gender interacted with other aspects of their identity, such as their race, culture and religion. For some, being transgender or nonbinary can be at odds with other parts of their identity or background. 

“Culturally I’m Dominican and Puerto Rican, a little bit of the macho machismo culture, in my family, and even now, if I’m going to be a man, I’ve got to be a certain type of man. So, I cannot just be who I’m meant to be or who I want myself to be, the human being that I am.” – Trans man, mid-30s

“[Judaism] is a very binary religion. There is a lot of things like for men to do and a lot of things for women to do. … So, it is hard for me now as a gender queer person, right, to connect on some levels with [my] religion … I have just now been exposed to a bunch of trans Jewish spaces online which is amazing.” – Nonbinary person, mid-40s

“Just being Indian American, I identify and love aspects of my culture and ethnicity, and I find them amazing and I identify with that, but it’s kind of separated. So, I identify with the culture, then I identify here in terms of gender and being who I am, but I kind of feel the necessity to separate the two, unfortunately.” – Nonbinary person, mid-30s

“I think it’s really me being a Black woman or a Black man that can sometimes be difficult. And also, my ethnic background too. It’s really rough for me with my family back home and things of that nature.” – Nonbinary person, mid-20s

For some, deciding how open to be about their gender identity can be a constant calculation. Some participants reported that they choose whether or not to disclose that they are trans or nonbinary in a given situation based on how safe or comfortable they feel and whether it’s necessary for other people to know. This also varies depending on whether the participant can easily pass as a cisgender man or woman (that is, they can blend in so that others assume them to be cisgender and don’t recognize that they are trans or nonbinary).

“It just depends on whether I feel like I have the energy to bring it up, or if it feels worth it to me like with doctors and stuff like that. I always bring it up with my therapists, my primary [care doctor], I feel like she would get it. I guess it does vary on the situation and my capacity level.” – Nonbinary person, late 20s

“I decide based on the person and based on the context, like if I feel comfortable enough to share that piece of myself with them, because I do have the privilege of being able to move through the world and be identified as cis[gender] if I want to. But then it is important to me – if you’re important to me, then you will know who I am and how I identify. Otherwise, if I don’t feel comfortable or safe then I might not.” – Nonbinary person, early 30s

“The expression of my gender doesn’t vary. Who I let in to know that I was formerly female – or formerly perceived as female – is kind of on a need to know basis.” – Trans man, 60s

“It’s important to me that people not see me as cis[gender], so I have to come out a lot when I’m around new people, and sometimes that’s challenging. … It’s not information that comes out in a normal conversation. You have to force it and that’s difficult sometimes.” – Trans man, early 40s

Work is one realm where many participants said they choose not to share that they are trans or nonbinary. In some cases, this is because they want to be recognized for their work rather than the fact that they are trans or nonbinary; in others, especially for nonbinary participants, they fear it will be perceived as unprofessional.

“It’s gotten a lot better recently, but I feel like when you’re nonbinary and you use they/them pronouns, it’s just seen as really unprofessional and has been for a lot of my life.” – Nonbinary person, early 30s

“Whether it’s LinkedIn or profiles [that] have been updated, I’ve noticed people’s resumes have their pronouns now. I don’t go that far because I just feel like it’s a professional environment, it’s nobody’s business.” – Nonbinary person, mid-30s

“I don’t necessarily volunteer the information just to make it public; I want to be recognized for my character, my skill set, in my work in other ways.” – Trans man, early 30s

Some focus group participants said they don’t mind answering questions about what it’s like to be trans or nonbinary but were wary of being seen as the token trans or nonbinary person in their workplace or among acquaintances. Whether or not they are comfortable answering these types of questions sometimes depends on who’s asking, why they want to know, and how personal the questions get.

“I’ve talked to [my cousin about being trans] a lot because she has a daughter, and her daughter wants to transition. So, she always will come to me asking questions.” – Trans woman, early 40s

“It is tough being considered the only resource for these topics, right? In my job, I would hate to call myself the token nonbinary, but I was the first nonbinary person that they hired and they were like, ‘Oh, my gosh, let me ask you all the questions as you are obviously the authority on the subject.’ And it is like, ‘No, that is a part of me, but there are so many other great resources.’” – Nonbinary person, late 20s

“I don’t want to be the token. I’m not going to be no spokesperson. If you have questions, I’m the first person you can ask. Absolutely. I don’t mind discussing. Ask me some of the hardest questions, because if you ask somebody else you might get you know your clock cleaned. So, ask me now … so you can be educated properly. Otherwise, I don’t believe it’s anybody’s business.” – Trans woman, early 40s

Most nonbinary participants said they use “they/them” as their pronouns, but some prefer alternatives. These alternatives include a combination of gendered and gender-neutral pronouns (like she/they) or simply preferring that others use one’s names rather than pronouns. 

“If I could, I would just say my name is my pronoun, which I do in some spaces, but it just is not like a larger view. It feels like I’d rather have less labor on me in that regard, so I just say they/them.” – Nonbinary person, late 20s

“For me personally, I don’t get mad if someone calls me ‘he’ because I see what they’re looking at. They look and they see a guy. So, I don’t get upset. I know a few people who do … and they correct you. Me, I’m a little more fluid. So, that’s how it works for me.” – Nonbinary person, mid-30s

“I use they/she pronouns and I put ‘they’ first because that is what I think is most comfortable and it’s what I want to draw people’s attention to, because I’m 5 feet tall and 100 pounds so it’s not like I scream masculine at first sight, so I like putting ‘they’ first because otherwise people always default to ‘she.’ But I have ‘she’ in there, and I don’t know if I’d have ‘she’ in there if I had not had kids.” – Nonbinary person, late 30s

“Why is it so hard for people to think of me as nonbinary? I choose not to use only they/them pronouns because I do sometimes identify with ‘she.’ But I’m like, ‘Do I need to use they/them pronouns to be respected as nonbinary?’ Sometimes I feel like I should do that. But I don’t want to feel like I should do anything. I just want to be myself and have that be accepted and respected.” – Nonbinary person, early 30s

“I have a lot of patience for people, but [once someone in public used] they/them pronouns and I thanked them and they were like, ‘Yeah, I just figure I’d do it when I don’t know [someone’s] pronouns.’ And I’m like, ‘I love it, thank you.’” – Nonbinary person, early 30s

Transgender and nonbinary participants find affirmation of their gender identity and support in various places. Many cited their friends, chosen families (and, less commonly, their relatives), therapists or other health care providers, religion, or LGBTQ+ spaces as sources of support.

“I’m just not close with my family [of origin], but I have a huge chosen family that I love and that fully respects my identity.” – Nonbinary person, early 30s

“Before the pandemic I used to go out to bars a lot; there’s a queer bar in my town and it was a really nice place just being friends with everybody who went and everybody who worked there, it felt really nice you know, and just hearing everybody use the right pronouns for me it just felt really good.” – Nonbinary person, early 30s

“I don’t necessarily go to a lot of dedicated support groups, but I found that there’s kind of a good amount of support in areas or groups or fandoms for things that have a large LGBT population within them. Like certain shows or video games, where it’s just kind of a joke that all the gay people flock to this.”  – Trans woman, late teens

“Being able to practice my religion in a location with a congregation that is just completely chill about it, or so far has been completely chill about it, has been really amazing.” – Nonbinary person, late 30s

Many participants shared specific moments they said were small in the grand scheme of things but made them feel accepted and affirmed. Examples included going on dates, gestures of acceptance by a friend or social group, or simply participating in everyday activities.

“I went on a date with a really good-looking, handsome guy. And he didn’t know that I was trans. But I told him, and we kept talking and hanging out. … That’s not the first time that I felt affirmed or felt like somebody is treating me as I present myself. But … he made me feel wanted and beautiful.” – Trans woman, late 30s

“I play [on a men’s rec league] hockey [team]. … I joined the league like right when I first transitioned and I showed up and I was … nervous with locker rooms and stuff, and they just accepted me as male right away.” – Trans man, late 30s

“I ended up going into a barbershop. … The barber was very welcoming, and talked to me as if I was just a casual customer and there was something that clicked within that moment where, figuring out my gender identity, I just wanted to exist in the world to do these natural things like other boys and men would do. So, there was just something exciting about that. It wasn’t a super macho masculine moment, … he just made me feel like I blended in.” – Trans man, early 30s

Participants also talked about negative experiences, such as being misgendered, either intentionally or unintentionally. For example, some shared instances where they were treated or addressed as a gender other than the gender that they identify as, such as people referring to them as “he” when they go by “she,” or where they were deadnamed, meaning they were called by the name they had before they transitioned. 

“I get misgendered on the phone a lot and that’s really annoying. And then, even after I correct them, they keep doing it, sometimes on purpose and sometimes I think they’re just reading a script or something.” – Trans man, late 30s

“The times that I have been out, presenting femme, there is this very subconscious misgendering that people do and it can be very frustrating. [Once, at a restaurant,] I was dressed in makeup and nails and shoes and everything and still everyone was like, ‘Sir, what would you like?’ … Those little things – those microaggressions – they can really eat away at people.” – Nonbinary person, mid-40s

“People not calling me by the right name. My family is a big problem, they just won’t call me by my name, you know? Except for my nephew, who is of the Millennial generation, so at least he gets it.” – Nonbinary person, 60s

“I’m constantly misgendered when I go out places. I accept this – because of the way I look, people are going to perceive me as a woman and it doesn’t cause me huge dysphoria or anything, it’s just nice that the company that I keep does use the right pronouns.” – Nonbinary person, early 30s

Some participants also shared stories of discrimination, bias, humiliation, and even violence. These experiences ranged from employment discrimination to being outed (that is, someone else disclosing the fact that they are transgender or nonbinary without their permission) without their permission to physical attacks.

“I was on a date with this girl and I had to use the bathroom … and the janitor … wouldn’t let me use the men’s room, and he kept refusing to let me use the men’s room, so essentially, I ended up having to use the same bathroom as my date.” – Trans man, late 30s

“I’ve been denied employment due to my gender identity. I walked into a supermarket looking for jobs. … And they flat out didn’t let me apply. They didn’t even let me apply.” – Trans man, mid-30s

“[In high school,] this group of guys said, ‘[name] is gay.’ I ignored them but they literally threw me and tore my shirt from my back and pushed me to the ground and tried to strip me naked. And I had to fight for myself and use my bag to hit him in the face.” – Trans woman, late 20s

“I took a college course [after] I had my name changed legally and the instructor called me out in front of the class and called me a liar and outed me.” – Trans man, late 30s 

Many, but not all, participants said they have received  medical care , such as surgery or hormone therapy, as part of their gender transition. For those who haven’t undergone a medical transition, the reasons ranged from financial barriers to being nervous about medical procedures in general to simply not feeling that it was the right thing for them.

“For me to really to live my truth and live my identity, I had to have the surgery, which is why I went through it. It doesn’t mean [that others] have to, or that it will make you more or less of a woman because you have it. But for me to be comfortable, … that was a big part of it. And so, that’s why I felt I had to get it.” – Trans woman, early 40s

“I’m older and it’s an operation. … I’m just kind of scared, I guess. I’ve never had an operation. I mean, like any kind of operation. I’ve never been to the hospital or anything like that. So, it [is] just kind of scary. But I mean, I want to. I think about all the time. I guess have got to get the courage up to do it.” – Trans woman, early 40s

“I’ve decided that the dysphoria of a second puberty … would just be too much for me and I’m gender fluid enough where I’m happy, I guess.” – Nonbinary person, early 30s

“I’m too old to change anything, I mean I am what I am. [laughs]” – Nonbinary person, 60s

Many focus group participants who have sought medical treatment for their gender transition faced barriers, although some had positive experiences. For those who said there were barriers, the cost and the struggle to find sympathetic doctors were often cited as challenges. 

“I was flat out turned down by the primary care physician who had to give the go-ahead to give me a referral to an endocrinologist; I was just shut down. That was it, end of story.” – Nonbinary person, 50s

“I have not had surgery, because I can’t access surgery. So unless I get breast cancer and have a double mastectomy, surgery is just not going to happen … because my health insurance wouldn’t cover something like that. … It would be an out-of-pocket plastic surgery expense and I can’t afford that at this time.” – Nonbinary person, 50s

“Why do I need the permission of a therapist to say, ‘This person’s identity is valid,’ before I can get the health care that I need to be me, that is vital for myself and for my way of life?” – Nonbinary person, mid-40s

“[My doctor] is basically the first person that actually embraced me and made me accept [who I am].” – Trans woman, late 20s

Many people who transitioned in previous decades described how access has gotten much easier in recent years. Some described relying on underground networks to learn which doctors would help them obtain medical care or where to obtain hormones illegally. 

“It was hard financially because I started so long ago, just didn’t have access like that. Sometimes you have to try to go to Mexico or learn about someone in Mexico that was a pharmacist, I can remember that. That was a big thing, going through the border to Mexico, that was wild. So, it was just hard financially because they would charge so much for testosterone. And there was the whole bodybuilding community. If you were transitioning, you went to bodybuilders, and they would charge you five times what they got it [for], so it was kind of tough.” – Trans man, early 40s

“It was a lot harder to get a surgeon when I started transitioning; insurance was out of the question, there wasn’t really a national discussion around trans people and their particular medical needs. So, it was challenging having to pay everything out of pocket at a young age.” – Trans man, early 30s

“I guess it was hard for me to access hormones initially just because you had to jump through so many hoops, get letters, and then you had to find a provider that was willing to write it. And now it’s like people are getting it from their primary care doctor, which is great, but a very different experience than I had.” – Trans man, early 40s

The discussions also touched on whether the participants feel a connection with a broader lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community or with other people who are LGBTQ+. Views varied, with some saying they feel an immediate connection with other people who are LGBTQ+, even with those who aren’t trans or nonbinary, and others saying they don’t necessarily feel this way. 

“It’s kind of a recurring joke where you can meet another LGBT person and it is like there is an immediate understanding, and you are basically talking and giving each other emotional support, like you have been friends for 10-plus years.” – Trans woman, late teens 

“I don’t think it’s automatic friendship between queer people, there’s like a kinship, but I don’t think there’s automatic friendship or anything. I think it’s just normal, like, how normal people make friends, just based on common interests.” – Nonbinary person, early 30s 

“I do think of myself as part of the LGBT [community] … I use the resources that are put in place for these communities, whether that’s different health care programs, support groups, they have the community centers. … So, I do consider myself to be part of this community, and I’m able to hopefully take when needed, as well as give back.” – Trans man, mid-30s

“I feel like that’s such an important part of being a part of the [LGBTQ+] alphabet soup community, that process of constantly learning and listening to each other and … growing and developing language together … I love that aspect of creating who we are together, learning and unlearning together, and I feel like that’s a part of at least the queer community spaces that I want to be in. That’s something that’s core to me.” – Nonbinary person, early 30s

“I identify as queer. I feel like I’m a part of the LGBT community. That’s more of a part of my identity than being trans. … Before I came out as trans, I identified as a lesbian. That was also a big part of my identity. So, that may be too why I feel like I’m more part of the LGB community.” – Trans man, early 40s

While many trans and nonbinary participants said they felt accepted by others in the LGBTQ+ community, some participants described their gender identity as a barrier to full acceptance. There was a sense among some participants that cisgender people who are lesbian, gay or bisexual don’t always accept people who are transgender or nonbinary.  

“I would really like to be included in the [LGBTQ+] community. But I have seen some people try to separate the T from LGB … I’ve run into a few situations throughout my time navigating the [LGBTQ+] community where I’ve been perceived – and I just want to say that there’s nothing wrong with this – I’ve been perceived as like a more feminine or gay man in a social setting, even though I’m heterosexual. … But the minute that that person found out that I wasn’t a gay man … and that I was actually a transgender person, they became cold and just distancing themselves. And I’ve been in a lot of those types of circumstances where there’s that divide between the rest of the community.” – Trans man, early 30s

“There are some lesbians who see trans men as being traitors to womanhood. Those are not people that I really identify with or want to be close to.” – Trans man, early 40s 

“It’s only in the past maybe dozen or so years, that an identity like gender fluid or gender queer was acceptable even within the LGBTQ+ community. … I tried to go to certain LGBTQ+ events as a trans man and, you know, I was not allowed in because I looked too female. The gay men would not allow me to participate.” – Nonbinary person, 50s 

“Technically based on the letters [in the acronym LGBTQ+] I am part of that community, but I’ve felt discrimination, it’s very heavily exclusive to people who are either gay or lesbian and I think that’s true … for queer or bisexual or asexual, intersex … anybody who’s not like exclusively hardcore gay or lesbian. It’s very exclusive, like excluding to those people. … I feel like the BTQ is a separate group of people…. So, I identify with the second half of the letters as a separate subset.” – Trans man, late 30s

When asked to name the most important policy or political issues facing transgender and nonbinary people in the United States today, many participants named basic needs such as housing, employment, and health care. Others cited recent legislation or policies related to people who are transgender that have made national news.

“Housing is a huge issue. Health care might be good in New York, it might be good in California, but … it’s not a national equality for trans folks. Health care is not equal across the states. Housing is not equal across the states. So, I think that the issues right now that we’re all facing is health care and housing. That’s the top, the most important things.” – Trans woman, early 40s 

“Definitely education. I think that’s very important … Whether you identify as trans or not as a young child, it’s good to understand and know the different things under the umbrella, the queer umbrella. And it is also just a respect thing. And also, the violence that happens against trans and nonbinary people. I feel like educating them very young, that kind of helps – well, it is going to help because once you understand what’s going on and you see somebody that doesn’t identify the same as you, you’ll have that respect, or you’ll have that understanding and you’re less likely to be very violent towards them.” – Nonbinary person, mid-20s 

“Employment is a big one. And I know that some areas, more metropolitan progressive-leaning areas, are really on top of this, but they’re trans people everywhere that are still being discriminated against. I think it’s a personal thing for me that goes back to my military service, but still, it’s just unfortunate. It’s an unfortunate reality.” – Trans man, early 30s

“I think just the strong intersectionality of trans people with mental health issues, or even physical health issues. … So in that way, accessing good health care or having good mental health.” – Trans man, late 30s

“I honestly think that the situation in Texas is the most pressing political and policy situation because it is a direct attack on the trans community. … And it is so insidious because it doesn’t just target bathrooms. This is saying that if you provide medical care to trans youth it is tantamount to child abuse. And it is so enraging because it is a known proven fact that access to gender affirming medical care saves lives. It saves the lives of trans youth. And trans youth have the highest suicide rate in the country.” – Nonbinary person, mid-40s 

Participants had different takes on what gets in the way of progress on issues facing transgender and nonbinary people. Some pointed to the lack of knowledge surrounding the history of these issues or not knowing someone who is transgender or nonbinary. Others mentioned misconceptions people might have about transgender and nonbinary people that influence their political and policy perspectives. 

“People who don’t know trans people, honestly … that’s the only barrier I can understand because people fear what they don’t know and then react to it a lot of the time.” – Nonbinary person, early 30s

“Sometimes even if they know someone, they still don’t consider them to be a human being, they are an ‘other,’ they are an ‘it,’ they are a ‘not like me,’ ‘not like my family,’ person and so they are put into a place socially where they can be treated badly.” – Nonbinary person, 50s

“Just the ignorance and misinformation and this quick fake social media fodder, where it encourages people who should not be part of the conversation to spread things that are not true.” – Trans man, late 30s

“Also, the political issues that face nonbinary people, it’s that people think nonbinary is some made-up thing to feel cool. It’s not to feel cool. And if someone does do it to feel cool, maybe they’re just doing that because they don’t feel comfortable within themselves.” – Nonbinary person, mid-30s

“There’s so much fear around it, and misunderstanding, and people thinking that if you’re talking to kids about gender and sexuality, that it’s sexual. And it’s like, we really need to break down that our bodies are not inherently sexual. We need to be able to talk with students and children about their bodies so that they can then feel empowered to understand themselves, advocate for themselves.” – Nonbinary person, early 30s

When asked what makes them hopeful for the future for trans and nonbinary people, some participants pointed to the way things in society have already changed and progress that has been made. For example, some mentioned greater representation and visibility of transgender and nonbinary people in entertainment and other industries, while others focused on changing societal views as things that give them hope for the future. 

“I am hopeful about the future because I see so many of us coming out and being visible and representing and showing folks that we are not to stereotype.” – Trans woman, early 40s

“Also, even though celebrity is annoying, it’s still cool when people like Willow [Smith] or Billie Eilish or all these popstars that the kids really love are like, ‘I’m nonbinary, I’m queer,’ like a lot more progressive. … Even just more visibility in TV shows and movies, the more and more that happens the more it’s like, ‘Oh yeah, we are really here, you can’t not see us.’” – Nonbinary person, late 20s

“We shouldn’t have to look to the entertainment industry for role models, we shouldn’t have to, we should be able to look to our leaders, our political leaders, but I think, that’s what gives me hope. Soon, it’s going to become a nonissue, maybe in my lifetime.” – Trans man, 60s

“I have gotten a little bit into stand-up comedy in the last few weeks, and it is like the jokes that people made ten years ago are resurfacing online and people are enraged about it. They are saying like, ‘Oh, this is totally inappropriate.’ But that comes with the recognition that things have changed, and language has changed, and people are becoming more intolerant of allowing these things to occur. So that is why I am hopeful, is being able to see that progression and hopeful continued improvement on that front.” – Nonbinary person, late 20s

“I think because of the shift of what’s happening, how everything has become so normal, and people are being more open, and within the umbrella of queerness so many different things are happening, I think as we get more comfortable and we progress as a society, it’s just going to be better. So, people don’t have to hide who they are. So, that gives me hope.” – Nonbinary person, mid-20s

For many, young people are a source of hope. Several participants talked about younger generations being more accepting of those who are transgender or nonbinary and also being more accepted by their families if they themselves are trans or nonbinary. 

“And then the other portion that gives me hope are the kids, because I work now with so many kids who are coming out as trans earlier and their families are embracing them and everything. … So I really am trusting in the young generation.” – Nonbinary person, 60s

“I mean kids don’t judge you the same way as adults do about gender, and they’re so expansive and have so much creativity. … So it’s just the kids, Gen Z, and it just makes me feel really, really hopeful.” – Nonbinary person, early 30s

“The youth, the youth. They understand almost intrinsically so much more about these things than I feel like my generation did. They give me so much hope for the future.” – Nonbinary person, early 30s

“I think future generations, just seeing this growing amount of support that they have, that it’s just going to keep improving … there’s an increase in visibility but there’s also an increase in support … like resources for parents where they can see that they don’t have to punish their kids. Their kids can grow up feeling like, ‘This is okay to be this way.’ And I feel like that’s not something that can be stopped.” – Trans man, late 30s

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102 Transgender Essay Topics & Research Paper Titles

Are you looking for the best transgender essay topics? On this page, you’ll find a perfect title for your essay or research paper about gender identity, LGBT rights, and other transgender-related issues. Read on to get inspired by research topics on transgender prepared by StudyCorgi!

🏆 Best Transgender Research Paper Topics

🎓 interesting transgender essay topics, 👍 good transgender research topics & essay examples, 🌶️ hot research topics about transgender, 📝 transgender argumentative essay topics, ✒️ more transgender topics for essay.

• Transgender Women in Sports
• Lesbian, Gay, Bisexual, Transgender Activism
• The Issue of Transgender Discrimination
• Transgender People in the Olympic Games
• Transgender People and Healthcare Barriers
• Viviane Namaste and Julia Serano’ Views on Transgenders
• Transgender Offenders in the Criminal Justice System
• Transgender Women Athletes in Professional Sports The inclusivity and legal recognition suggest that transgender athletes are welcome to participate in competitive sport given they meet the established requirements.
• Transgender Issues in Cis- and Trans-Made Movies This paper discusses the implications of transgender and transsexual experience from the outside and from within, particularly how they are represented and how the public sees it.
• Challenges of Transgender Patients Transgender patients have to face a certain amount of resistance and discrimination in society regularly, this group of people has to deal with certain challenges in the health care arena.
• The Fight for $15 Movement vs. the Transgender Law Center For an examination of non-profit organizations, it will be convenient to use case studies. The Fight for $15 movement and the Transgender Law Center will be used as comparisons.
• Health Disparities of Transgender Population The problem is centered around the healthcare inequality experienced by members of the transgender community, where the barriers include financial factors and discrimination.
• Clinically and Culturally Competent Care for Transgender and Non-Binary People The analyzed review can be considered an essential step toward a better understanding of how to work with such groups.
• Transgender People in Prisons: Rights Violations There are many instances of how transgender rights are violated in jails: from misgendering from the staff and other prisoners to isolation and refusal to provide healthcare.
• Transgender People: Prejudice and Discrimination Transgender remains a stereotyped sexual identity, and these individuals face prejudice from critics, religious leaders, and the vast majority of society.
• Transgender Health Disparities and Solutions People who identify as transgender, intersex, gender non-conforming, or gender diverse have exacerbated health disparities compared to other people.
• Mental Healthcare Services for Transgender Individuals This research paper suggests a range of options to treat mental health and related illnesses among the non-binary populations.
• Transgender Prisoners and How They Are Treated According to international studies, transgender persons are a particularly defenseless population in the correctional structure, with their most necessities often being withheld.
• Media Coverage of Transgender Policy in Military This paper aims to provide an annotated bibliography for the ten articles related to the topic of media coverage of transgender policy in the military.
• Transgender Support Group Meeting and Its Importance The transgender support groups allow people to connect and talk about issues that they have faced in their lives.
• Transgender Movement: Overview and Importance Ultimately, policies, guidelines, or steps ensure that the social change that the transgender movement is yearning for can be realized.
• Transgender Health Care in the USA: Then and Now The change of physical appearance or function through clothing, medical, surgical, or other means often becomes part of the personal gender experience of a transgender person.
• Why We Shouldn’t Compare Transracial and Transgender Identities To compare transracial identity with transgender identity is to reduce both to a set of immutable rules, be it rules of biology or society – and this is a very wrong approach.
• Conflict Between Transgender Theory, Ethics, and Scientific Community This essay aims to give answers to questions of ethics within the transgender topic and research fraud based on scholarly articles and presentations by Dr. Q Van Meter.
• The Problem of Lesbian, Gay, Bisexual and Transgender Youth Suicidality Recently, there was a sharp increase in cases of suicides committed by lesbian, gay, bisexual, transgender, and queer youth.
• Transgender Care: Challenges, Implications In a healthcare setting not putting effort into ensuring diverse patient groups are treated with professional finesse with no regard for their differences is a timely issue.
• Critical Thinking and Transgender Ethics Sexual orientation and preference is a debated and complex topic involving biological aspects, including hormones, which can alter and change people’s behavior and feelings.
• Trump Administration and Transgender Discrimination The paper reviews one of the recent issues that caught the public eye and media attention is the Trump administration’s treatment of transgender people’s healthcare rights.
• Gender Non-Conforming or Transgender Children Care The purpose of this paper is to discuss the challenges to be aware of when working with gender non-conforming or transgender children and adolescents.
• Transgender People’s Challenges Within Healthcare This paper aims to discuss the challenges in healthcare that the transgender community faces and how the challenges affect their overall health outcome.
• Transgender Care by Healthcare Professionals Transgender patients require healthcare professionals who are conversant with their experiences and who can treat them with utmost respect and dignity.
• Transgender Bias in News Coverage In the context of increasing LGBTQ activism and recognition, transgenderism faces the greatest controversy and public backlash.
• Transgender Children’s Issues in Society The topic of transgender children in society proves to be divisive and is widely discussed by parents, teachers, clinicians, and politicians.
• Transgender Community and Heterosexism in Language The term “transgender” became commonly used only by the end of the 20th century. Not all transgenders commenced using this and preferred to pass as a different gender.
• Healthcare System: Transgender Patients Discrimination According to the statistics, almost 1 million Americans identifies themselves as transgender, making it a numerous population subgroup that is likely to expand in the future.
• Transgender Patients Problem and the Consequences of Discrimination Transgender patients come across different forms of harassment and do not have the same access to services as other people do.
• Transgender and Gender Non-Conforming Children This paper discusses the issues a psychiatric mental health nurse practitioner should be aware of when interacting with transgender and gender non-conforming children and adolescents.
• Transgender Patients and Health Care Challenges One of the challenges encountered by transgender patients refers to the lack of adequate access to healthcare services.
• Transgender Care and Health Care Professionals Despite the adoption of policies aimed at limiting discrimination, transgender people still face daily challenges in the aspects of employment, education, and healthcare access.
• Transgender Healthcare Barriers in the United States This paper examines central barriers to high-quality health care and includes practices employed to address the issue and some recommendations.
• Transgender Patients: Challenges & Discrimination in Healthcare It is worth noting that the concept of transgenderism implies a state of internal imbalance between the real and desired gender of an individual.
• Healthcare Challenges of Transgender Patients Transgender individuals have health problems common for the whole population and frequently face challenges in healthcare settings related to inadequate healthcare.
• Transgender Patients and Challenges in Health Care The community remains predominantly marginalized, with policies and laws denying them recognition of their gender, making accessing health care very challenging.
• Lesbian, Gay, Bisexual, Transgender Patients’ Therapy The current quality of managing the needs of the representatives of the LGBT community needs a significant improvement.
• Transgender Patients and Nursing Health Management There is a growing recognition today among health care providers and researchers that patients’ transgenderism may become a factor in their care.
• Lesbian, Gay, Bisexual, Transgender in Hospital The paper discusses the cultural competency concept since it appears to be of critical importance for the profound understanding of the problems of the LGBT community.
• Challenges to Transgender Patients Despite the recent attention to the issues of transgender people, the level of discrimination against them is still incredibly high.
• Discrimination Faced by Transgender Patients Contemporary hospitals are not designed for transgender people, therefore, they can have many troubles there ranging from the unfriendly environment of a hospital and doctors.
• Transgender-Associated Stigma in Healthcare Transgender individuals are people who assume a gender definition of identity that differs from gender assigned to them at birth.
• Transgender Disorders and Homosexuality There is a lot of evidence of both the genetic mechanisms’ and surroundings’ influence on people’s sexual preferences. However, the environment is more responsible for such choice.
• Transgender and Problems with Healthcare Services Transgender individuals find it difficult to approach physicians because it is difficult for them to reach needed treatment.
• Transgender People in Healthcare Facilities Gender nonconforming and transgender people face discrimination in almost every sphere of human activity. It has a negative impact on the access of these groups to primary care.
• Transgenders Discrimination from Healthcare Providers The transgender community reports that at the moment, it faces numerous barriers to care because of health workers` inability to consider their specific needs.
• Transgender, Its History and Development Transgender is not a new concept and people have discussed the issues associated with it since the 19th century.
• Problems of Transgender Patients in Health Care A number of transgender patients admit cases of discrimination from the health care workers. From 30% to 60% of the representatives of this group face biased attitude.
• Transgender Discrimination in Health Care This paper investigates the discrimination that transgender persons are subjected to in the health care setting in more detail.
• Transgender Community’s Treatment in Healthcare This paper discusses the transgender community and the discrimination that affects them every day, especially in healthcare, and how we can help stop it.
• Principles of Healthcare for Transgender Patients
• Characteristics of Interpersonal Relationships and the Transgender Community
• Improving Correctional Healthcare Providers’ Ability to Care For Transgender Patient
• Analyzing Transgender Communities Rights
• General Information About Gay, Lesbian, and Transgender Rights Movement
• Transgender Equality and the Progression of the Employment Non-Discriminate
• Beyond Depression and Suicide: The Mental Health of Transgender College Students
• Violence Against Lesbians, Gays, Bisexuals, and Transgender
• Transgender Men and Women Have Been Around for Centuries
• Quality Healthcare for Transgender People
• Role of African American Gay, Bisexual and Transgender Men in Contemporary Society
• Public Bathroom Controversies Due to Transgender Issue in America
• Hate Crimes Against Lesbian, Gay, Bisexual and Transgender
• Empowering and Educating About the Transgender Sodality Through Social Media and Laws
• Transgender Youth Homelessness: Understanding Programmatic Barriers Through the Lens of Cisgenderism
• Policies and Best Practices for Transgender Hiring Organizations in India
• Transgender Rage: The Compton’s Cafeteria Riot of 1966
• The Pros and Cons of Transgender and Gender Nonconforming
• Proper Communication With the Transgender Community
• Gender Dysphoria and the Persecution of Transgender People
• Lesbian, Gay, Bisexual, and Transgender U.S. Legal Questions
• Informal Mentoring for Lesbian, Gay, Bisexual, and Transgender Students
• Transgender Rights Under Bigotry and Ignorance
• Differences Between Gender Feminism and Transgender Activism
• Transgender Rights and Surviving Hate Crimes in the Case of Cece McDonald
• Should transgender adolescents have access to gender-affirming treatments?
• Is transgender representation in media crucial for promoting transgender rights?
• Transgender athletes in competitive sports: equality or unfair advantage?
• Is religious freedom incompatible with protecting transgender rights?
• Transgender parenting rights: why do they deserve equal protection and recognition?
• Transgender people in prisons: how should they be placed and protected?
• Should puberty blockers be banned?
• Should transgender people be disqualified from military service?
• Is it ethical for homeless shelters to discriminate against transgender individuals?
• Should non-binary gender be legally recognized?
• The importance of inclusive terminology for protecting transgender rights.
• Mental health challenges faced by transgender youth.
• The role of transgender activists in driving social change.
• How can religious beliefs help and hinder transgender rights promotion?
• Challenges faced by transgender parents.
• Ways to support transgender youth in schools.
• The relationship between transgender identity and body positivity.
• Comparing transgender rights in different countries.
• Transgender identity and aging: unique challenges.
• The impact of corporate policies on transgender workplace inclusion.

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These essay examples and topics on Transgender were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 9, 2024 .

Gender Research Paper

This sample gender research paper features: 5800 words (approx. 19 pages), an outline, and a bibliography with 134 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Introduction

Theorizing gender, heterosexual normality and biological/social reproduction, bodies, sex, and gender, conclusion: gender and future research.

• Bibliography

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• Women’s and Gender History Research Paper

The use of the concept of gender to explain the social differences between males and females is a fairly recent focus in sociology. This is not to say that differences between the two have been ignored by sociologists but that those differences were understood as immutable biological facts and that the social was, in the last instance, powerless to change. The presumed “natural” binary of sex was taken for granted by nineteenth-century and most twentieth-century theorists, for whom men were the primary focus of sociological interest, with women making an appearance usually in discussions of marriage and the family.

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The relative invisibility of women in the sociological enterprise, as in all Western intellectual traditions, was challenged with the advent of second-wave feminism in the 1960s. The challenge was not confined to the academy. Betty Friedan’s (1963) popular best-seller, The Feminist Mystique, and Kate Millet’s (1970) Sexual Politics critiqued the oppressive nature of male/female relationships, and the numerous consciousness-raising groups as well as feminist groups that emerged from various left and civil rights organizations also mounted trenchant critiques. Central to the critiques was the conviction that the “personal is political,” that feminist scholarship must be allied to feminist activism. In the academy, the marginality of women to the “intellectual, cultural, and political world” (Smith 1987:1) was contested, and vital interdisciplinary exchanges began the process of putting the natural binary under the microscope (Hess and Ferree 1987).

In the early years, research focused on sex roles rather than gender. Sex as well as class and race were “traditional” variables used in social science research, with the assumption that sex, as a biological given, simply meant checking a box for male or female on government or social science survey forms. Using the concept of sex roles was a way of introducing social and cultural factors into the research. The assumption was that socialization into appropriate male/female roles, although resting on a “natural” biological foundation, allowed, in theory at least, some possibility of social change in the unequal relationships between men and women. But the influential work of Talcott Parsons indicated that there were limitations to the use of role theory. Parsons and Bales (1955) linked sex roles to differences in social functions, with males normatively adopting instrumental functions and females expressive functions. These functional social roles were, however, tied to the dictates of a biological binary, and any profound variation in the roles and functions, such as women having careers, was understood to be dysfunctional to the stability of the social system (Parsons [1942] 1954).

Sex-role research was fruitful, however, in producing several empirically based studies on male/female differences (Maccoby and Jacklin 1975), which tended to show that there were no significant differences and that “ women and men are psychologically very similar, as groups” (Connell 2002:42). Later research refined the concept of sex roles as defining “ situated identities —assumed and relinquished as the situation demands—rather than master identities, such as sex category, that cut across situations” (West and Zimmermann 1987:128). It was also pointed out that roles are prescriptive expectations that vary culturally and historically and are not enacted passively; rather, both men and women actively and reflexively shape their sex roles (Connell 1987; Stacy and Thorne 1985). Consequently, the “functional ideas embedded in the concepts of ‘sex role’ and ‘socialization’” were shown to be “inadequate” because people often “do not become what they are expected to be” (Hess and Ferree 1987:14). More significant, critics pointed out that the concept of sex roles could not explain why men were nearly always the more valued members of any social group. In addition, the concept was theoretically problematic because sociologists did not refer to “race roles” or “class roles” (Eichler 1980; Hess and Ferree 1987).

Critiquing the concept of sex roles did not, however, eliminate the problem of the foundational assumption of immutable biological differences, which made the issue of significant change in male/female relationships problematic. In attempting to navigate the nature/nurture binary, Stoller’s (1968) distinction between “sex” as the biological evidence from chromosomes, hormones, and external genitalia and “gender” as the social, psychological, and cultural manifestations was influential. The distinction was initially used in psychoanalytic work on sex and gender “anomalies,” such as hermaphrodites and transsexuals (see Money and Ehrhardt 1972). For feminists, the distinction was a useful way of acknowledging the significance of sex and at the same time freeing them to concentrate on the social elaborations of gender differences. As Dorothy Smith (2002) points out, the distinction was a “political move” because “we had to believe that change was possible, that the repressions to which women were subjected were not the simple effect of biology” (p. ix). For example, Rubin (1975) suggested that the existence of two sexes gave rise to the social organization of gender in kinship systems, which are the “observable and empirical forms of sex/gender systems” (p. 169). Rubin’s analysis retained the assumption of two sexes as foundational, whereas Delphy (1984) maintained that gender precedes sex and that choosing the “bodily type” to explain the hierarchical division of men and women is an arbitrary choice that does not make sense either logically or historically. Biology itself does not necessarily “give birth to gender,” and to assume that it does means that the “existence of genders—of different social positions for men and women—is thus taken as a given and not requiring explanation” (p. 25). It became apparent that the ubiquity of the two-sex model needed to be dismantled if gender was to, as Delphy (p. 24) put it, to “take wing” theoretically.

Before looking at how gender “took wing,” two points need to be made about the following discussion. First, the initial investigations into gender were largely undertaken by feminist researchers. Some male researchers did initiate research on male roles and masculinity, but these discussions were often marginal to the central feminist debates theorizing gender (Brod 1987; David and Brannon 1976; Farrell 1975; Kimmel and Messner 1989; Pleck 1981). The focus of most research, as the subsequent discussion will illustrate, was mainly on the position of women and their experiences, to the extent that it often seemed that men did not “have” gender, that the universal male subject of Western theory remained intact. The second point has to do with the sex/gender distinction, which will loom large in our discussion. As Donna Haraway (1991:127) discovered, when asked to contribute the sex/gender entry to a feminist keywords text, this is a distinction that other languages and other non-English-speaking feminists do not make. The concept of sex/gender remains a problem for cross-cultural feminist debates, exemplified most recently in the responses to Felski’s (1997) article “The Doxa of Difference” and Hawkesworth’s (1997) article “Confounding Gender” and the responses to Hawkesworth’s article. To the extent that the following concentrates largely on the work of Englishspeaking feminists, the somewhat contested epistemological status of the sex/gender distinction should be kept in mind.

By the late 1970s, gender was the central concept for feminist research, although the issue of “sex” in relation to gender remained contentious. For example, sociobiology maintained that women’s reproductive biological destiny invariably results in social, sexual, political, and economic double standards that favor males (Barash 1977; Dawkins 1976; Wilson 1975). The sociobiological position was not uncontested, but sex became the “Achilles’ heel of 1970s feminism” despite its being relegated to the “domain of biology and medicine” (Fausto-Sterling 2005:1493). In general, gender was used to “supplant sex” but “not to replace it” (Nicholson 1994:80).

In the initial forays into gender research, Marx and Freud were the two theorists whose work provided a basis for critique. Marxist analysis, with its focus on oppression and exploitation, seemed to promise an appropriate revolutionary perspective for change. Both Marx and Engels agreed that the first form of class subordination was the subordination of women to men, and for this reason, Engels (1935) maintained that “in any given society the degree of women’s emancipation is the natural measure of the general emancipation” (p. 39). Critiquing Freud’s work was seen as a necessity because it provided the psychological theory that supported the idea of universal patriarchy and offered an explanation for women’s compliance with these arrangements. At the same time, Freud’s assumption of pre-Oedipal bisexuality and a common libido offered the possibility of reconceptualizing the development of sexual difference.

Some of the first approaches concentrated on “documenting gender difference” and understanding “how gender difference is constructed” (Marshall 2000:26). In this context, unpacking the historical and social nature and impact of patriarchy was a central issue. Max Weber ([1925] 1978) had defined patriarchy as the power of “men against women and children; of able-bodied as against those of lesser capability; of the adult against the child; of the old against the young” (p. 359). Following Weber, patriarchy was used as a general term denoting the nearuniversal male domination of women, having its basis in the family and household. Gerda Lerner (1986) pointed out that the foundation for family patriarchy was the control of women’s “sexual and reproductive capacity,” which occurred “ prior to the formation of private property and class society” (p. 8). Women’s subordination preceded the formation of class societies, so class “is not a separate construct from gender; rather, class is expressed in genderic terms” (p. 213).

Although Lerner was at pains to point out that patriarchy was tied to the appropriation of women’s sexual and reproductive capacities, it was class issues filtered through Marx that initially took theoretical precedence in Anglophone sociology. Many feminists pursued the issue of patriarchy through vigorous debates over the connection between patriarchy and capitalism (Barrett 1980; Eisenstein 1979; Firestone 1970; Mitchell 1973; Sargent 1981; Walby 1990). What quickly became clear was that it was not possible to analytically separate the two, that capitalist patriarchy formed a unitary system. The debates produced important work on social class (Acker 1973; Giddens 1973; Kuhn and Wolpe 1978; Sargent 1981); the nature of women’s labor, especially domestic labor (Fox 1980; Luxton 1980; Oakley 1974; Seccombe 1974); and the variable role of the State in the perpetuation of gendered power relations (Balbus 1982; Coontz and Henderson 1986; Coward 1983; Eisenstein 1979; Elshtain 1982; Lowe and Hubbard 1983). In the last context, a considerable amount of work focused on the ways in which gender, class, and race have played out in civic entitlements, especially with respect to welfare benefits (Fraser 1989; Gordon 1994; Marshall 1994; Pateman 1988; Pringle and Watson 1992).

The focus on capitalist patriarchy, however, tended to leave traditional Marxist analyses of productive relations intact and simply added a “separate conception of the relations of gender hierarchy” (Young 1981:49). For example, the domestic labor debates of the 1970s pointed to the usefulness of domestic labor to capital but “became trapped in trying to assess whether housework produced surplus value or was just unproductive labor” (Thistle 2000:286). Furthermore, the dualisms of work/home, public/private appeared not as “mutually dependent but as separate and opposed. It is accordingly, virtually impossible to bring them together within a logically coherent and consistent account of social life” (Yeatman 1986:160). In general, the debates did not displace in practice or in theory what Connell (2002:142) calls the patriarchal dividend. 2 The dividend refers to the very real advantages that men, as a group, derive from the unequal gender order. These advantages operate at all levels, from the local to the global, whatever the cultural, racial, or social differences. Connell concludes that most men have an interest in “sustaining— and, where necessary, defending—the current gender order” (p. 143).

The concern with class and stratification was also critiqued as ignoring race, ethnicity, and sexuality. The assumption seemed to be that the visibility of gender oppression required the invisibility of race, ethnicity, sexual orientation, and even class (Mohanty 1992:75). Many women of color, as well as gays and lesbians, correctly identified the way in which earlier discussions had privileged the position and interests of white, Western, heterosexual women, similar to the way in which “man” had been shorthand for white, Western, heterosexual males in post-Enlightenment sociological discourse (Barrett 1980; Collins 1990; hooks 1981; Rattansi 1995).

At the beginning of the United Nations Decade of Women, 1976, the idea of a “global sisterhood” suffering the same gender oppression came under fire, and it was pointed out that many white, privileged Western women were implicated in the patriarchal dividend enjoyed by their male counterparts (Bhavnani 2001). Critics pointed out that gender is constructed in and through differences of “race and class and vice versa” (Lovell 1996:310) and that race is “integral to white women’s gender identities” (Glenn 1992:35).

But recognizing “race” often resulted in black women, Third World women, and native women becoming the trendy “Other.” Ann duCille (1994) asked, “Why have we—black women—become the subjected subjects of much contemporary investigation, the peasants under the glass of intellectual inquiry in the 1990s?” (p. 592). Gayatri Spivak (1988) also critiqued the privileging of “whiteness” as the natural, normal condition that produced the colonial object on the assumption that race is something that belongs to others. A particularly important observation was that many white, Western, academic feminists were complicit in the “othering” process in using “native” informants to “build their academic careers, while the knowledgeable ‘objects of study’ receive nothing in return” (Mihesuah 2000:1250).

The focus on race was particularly significant to U.S. sociology given its history of race relations. Patricia Hill Collins (1990) conceptualizes the black experience in the United States, in its critical difference from the experiences of “whites,” as embodying an “outsider-within” perspective. She illustrates how African American women have their own take on their oppression and that they are “neither passive victims of nor willing accomplices in their own oppression” (p. xii). Collins points to the significance of everyday practices as the basis for understanding the intersection of race and gender that produces a “Black women’s standpoint,” not a “Black woman’s standpoint,” emphasizing the “collective values in Afrocentric communities” (p. 40, fn. 5).

In Collins’s work and that of others, the key point is that there are multiple and interlocking layers of oppression and domination (see also B. Smith 1983; D. Smith 1987). The “matrix of domination” points to power relations tied to an individual’s location on the interrelated structures of gender, race, class, and sexuality (Collins 1990). A significant part of the matrix was a “heterosexual norm” that produced taken-for-granted assumptions about sex, sexual identity, sexual desire, and sexual practice (Blackwood 1994). Sex and the biological binary, always an undercurrent in any of the debates discussed above, took on greater significance as feminists examined how people “have” and “do” gender and how or if, when considering human reproduction, biological essentialism can be avoided.

Feminists recognized that Freud’s theories provided psychological support to biological assumptions of “natural” sex differences that, in turn, supported the structural subordination of women under patriarchy (Coward 1983; Mitchell 1975). Jacqueline Rose (1986) suggested that Freud’s work gave an “account of patriarchal culture as a trans-historical and cross-cultural force” that “conforms to the feminist demand for a theory which can explain women’s subordination across specific cultures and different historical moments” (p. 90). As Jean Walton (2001) points out, psychoanalysis has always excluded race. The reworking of Freud by Lacan and the comments of other theorists such as Foucault and Derrida provided, and continue to provide, significant contributions to these debates (Braidotti 1991; Butler 1990, 1993; Butler and Scott 1992; Diprose 1994; Irigaray 1974; Kristeva 1986; Rose 1986). A key issue addressed was the presumed inevitability of a tie between biological reproduction and social mothering, which, in turn, was tied to the assumption of heterosexual normality. Chrys Ingram (1994) maintains that the idea that “institutionalized heterosexuality constitutes the standard for legitimate and prescriptive sociosexual arrangements” is one of the “major premises” of sociology in general and of some “feminist sociology” (p. 204). And Rosalind Petchesky (1980) pointed out “women’s reproductive situation is never the result of biology alone, but of biology mediated by social and cultural organization” (p. 667).

The significance of reproduction, reproductive choice, motherhood, and mothering was the focus of what has been called maternal feminist debates. Nancy Chodorow’s (1978) work was important to these debates. She suggested that while there are historical and cross-cultural variations in family and kinship structures, it is generally the case that women mother. This “mother-monopolized childrearing produces women who are able to and will want to mother in their turn” in contrast to men “who have a separate sense of self and who lack the capacity or the desire to nurture others” (Sydie 1987:151). Chodorow’s (1978) object-relations psychoanalytic analysis focuses on the primary, pre-Oedipal identification of both male and female children with the mother and the different ways in which separation occurs for each child. While the son’s identification with the father follows the process described by Freud, that of the daughter is different. Chodorow maintains that the daughter, who shares her sex with her mother, does not completely reject the mother, and in her “personal identification with her mother” she learns “what it is to be womanlike” (pp. 175–76). It is not biological sex as such but the “early social object-relationships” located mainly in the unconscious that determine the development of sexed identities and, in the case of women, produce mothers (p. 54).

Masculinity is thus more difficult to achieve and is largely predicted on distinguishing self from the feminine. Dorothy Dinnerstein (1977), whose work parallels Chodorow’s in many respects, suggested that both sexes have a terror of “sinking back wholly into the helplessness of infancy” so that for “Mother-raised humans, male authority is bound to look like a reasonable refuge from female authority” (pp. 161, 175). According to Dinnerstien, Freud was unable to account for the nearuniversal fear and hatred of women, but she maintains that this stance is the logical result of mother-monopolized child rearing, producing the male need to control women and women’s more or less willing submission. Both Chodorow and Dinnerstein suggest that the solution is to change the nature of parenting to include both men and women.

The accounts by Chodorow and Dinnerstein were criticized on several counts, not the least of which were the implicit Western nuclear family model they assumed and the lack of clarity as to how men might be incorporated into parenting and what happens if this does occur, for the child’s primary identification (Hirsch 1981; Lorber 1981; Spelman 1988). In such a situation, would the identification be bisexual, and if so, what are the consequences? (O’Brien 1981; Sayers 1982). Interestingly, Freud did posit an original bisexuality and common libido in the preOedipal child that the castration fear resolves and that “normally” produces heterosexual gender identities (see Irigaray 1974). In general, it is this assumption of the normality of heterosexuality in these accounts that is a problem. MacKinnon (1982) summarized the heterosexual norm’s effects on women as follows: “Sexuality is to feminism what work is to marxism: that which is most one’s own, yet most taken away” (p. 515).

Adrienne Rich’s (1980) “Compulsory Heterosexuality and Lesbian Existence” was an influential intervention into the sexuality and maternal feminist debates. Rich claimed that heterosexuality, like motherhood, needed to be “recognized and studied as a political institution ” (p. 637). She points out that the structures that maintain heterosexuality and the ideology that claims its normality ensures the compliance of most women in their own subordination. Rich asks “ why in fact women would ever redirect that search ” (p. 637) if women are the primary love object. Her answer is that they are forced to do so because women’s identification with women could make them “indifferent” to men, introducing the possibility that “men could be allowed sexual and emotional—therefore economic—access to women only on women’s terms” (p. 643). Consequently, heterosexuality is something that has to be “imposed, managed, organized, propagandized, and maintained by force,” and lesbian existence and the lesbian continuum of “women-identified experience” throughout women’s lives has to be denied.

Many of the critiques on the hegemony of heterosexuality looked at its manifestations in and on the body, and about the body as a “ text of culture” and a “ practical, direct locus of social control” (Bordo 1989:13). 4 The body as “text” was indebted to Foucault’s concept of bio-power and body aesthetics. Other critiques concentrated on the Western conception of the organically discrete, natural, two-sex human body as a social construction (Laqueur 1990; O’Neill 1985; Schiebinger 1993). Donna Haraway (1991) went further in her claim that the naturalized body was a fiction, that bodies must be understood as “biotechnical-biomedical” bodies in a “semiotic system” that produces the “cyborg” as “our ontology” (pp. 150, 211). While not necessarily producing cyborgs, biotechnological and biomedical interventions in reproduction, such as in vitro fertilization, surrogacy, sex selection, and cloning, have been critiqued as not necessarily producing positive outcomes for women’s health and their social, political, and economic welfare (Overall 1989; Sawicki 1999; Shildrick and Price 1998).

Michel Foucault’s (1976) conceptualization of the body as the site for the exercise of power through “disciplines of the body and the regulation of populations” and his understanding of power as productive as well as prohibitive and punitive provided an initial entry into the conceptualization of the body as the effect of discourse. In addition, Foucault’s demonstration that sexuality has been a “central preoccupation” of modern society that required the confession of a “true” sex identity—male or female, certainly not hermaphrodite—was suggestive. For Foucault, sex was the “naturalised product of a moral code which, through techniques of discipline, surveillance, self-knowledge, and confession organizes social control by stimulation rather than repression” (Foucault 1980:57). But as several feminists pointed out, Foucault’s observation that power is all-pervasive and constituted in the practices of the subjected prompts the question, How is resistance possible? (Diamond and Quinby 1988; Fraser 1989; Ramazanoglu 1993; Sawicki 1991). Further, the relations of power/ knowledge charted by Foucault may change, but they seem to do so by reaffirming “women’s marginal status” (Ricci 1987:24), and there appears to be “no moral high ground where the individual can exercise agency outside of the social codes which constitute desire asymmetrically” (Diprose 1994:24). Foucault himself was not particularly concerned with the gender of dominated subjects of a power/knowledge regime and did not take account of the “relations between masculinist authority” and, therefore, the gendered “language, discourse and reason” (Diamond and Quinby 1988:xv).

Judith Butler (1990), however, found Foucault’s notion of the constructed subject useful. She pointed out that this does not preclude the possibility of the subject’s agency; on the contrary, the construction is the “necessary scene of agency” (p. 147). If subjects are discursive productions and identities unstable fictions, then this allows feminists to “contest the rigid codes of hierarchical binarisms.” The binaries anyway produce “failures”—the assertive female, the effeminate male, the lipstick lesbian, and so on (p. 145). Gender is not simply constructed; it is performed and performed in relation to the sexual obverse—that is, heterosexual and homosexual bodies and practices are interdependent, produced by the regulative norms of compulsory heterosexuality. Furthermore, gender must be continually reproduced; there is no “original.” Nor does anything, performatively, go. In Bodies That Matter, Butler (1993) points out that the construction and performance of gendered bodies does not mean that some constructions are not necessary constructions. For example, Evelyn Fox Keller (1989) suggests that it is the “vital process that issues in the production of new life” that has compelled “people of all kinds throughout history, and across culture, to distinguish some bodies from others” (p. 316). We may play with, perform, and deconstruct sex and gender, but how can we develop “strategies for eliminating (not only resisting) certain kinds of gendered and sexual subordination and violence, precisely those that are not easily subject to resignification” (Brown 2003:368)? And it is reproduction, and its extension mothering, that seems especially resistant to resignification.

The deconstruction of sex and gender and their manifestations in bodies was important in the development of queer theory and for the increasing focus on the “trans”— transgender, transsexual, intersexuality, bisexuality, and various other “transgressions” of sex and gender dimorphisms (Findlay 1995). More specifically, Eva Sedgwick (1990), in her Epistemology of the Closet, claimed that to understand “virtually any aspect of modern Western culture,” it is necessary to “incorporate a critical analysis of modern homo/heterosexual definition” (p. 1).

Queer theory seeks to challenge the “master categories” of heterosexuality and homosexuality as “marking the truth of sexual selves,” by understanding them as “categories of knowledge, a language that frames what we know as bodies, desires, sexualities, identities: . . . a normative language that erects moral boundaries and political hierarchies” (Seidman 1994:174). Queer theory also points to the poverty of sexuality studies in mainstream sociology, which has used labeling theory and/or a deviance perspective to study gay, lesbian, and alternative “subcultures” (Namaste 1994:227), although Epstein (1994:193) claims that the “involvement of sociologists in the study of sexuality” was a significant subset of mainstream sociology, stemming initially from Kinsey’s work, which has diminished only in recent years.

There has been a veritable explosion of research under the general rubric of queer theory, although much of the work also falls under the general rubric of cultural studies rather than sociology (for a general review of the academic history and current status of queer theory, see Marcus 2005). Steven Seidman (1994) states that although queer theory challenges the “regime of sexuality itself” and “aspires to transform homosexual theory into general social theory or one standpoint from which to analyze whole societies,” to date, “queer theory and sociology have barely acknowledged one another” (p. 174).

A critical issue for queer theorists remains the underlying question of how biology figures in these social constructions. Seeing identities as “multiple, unstable, and regulatory” as well as “pragmatic” and relating this to “concerns of situational advantage, political gain, and conceptual utility” may be a laudable standpoint for the contested social and cultural arena of sex/sexuality/gender studies (Seidman 1994:173). Meanwhile biology, especially evolutionary biology, continues to retain a binary take on physical bodies based on the assumption of natural chromosomal, hormonal, and genital binary difference (Haraway 1991).

Ignoring biology and concentrating on social construction seems to be a misguided position for feminists given the focus of some recent medical research. For example, medicine has searched for gay genes and for differences in brain structures between men and women as well as homosexuals and heterosexuals, and in biology, the studied attempts to deny the existence of “homosexuality” as well as the general “plethora of sex diversity” in the nonhuman animal world persists (Hird 2004). Anne Fausto-Sterling (2005) points out that although contemporary biomedical research seems to deal with sex “in the 1970s feminist meaning of the word, sex sometimes strays into arenas that traditional feminists claim for gender” (p. 1497). FaustoSterling concludes with a “call to arms” for feminists to recognize that “culture is a partner in producing body systems commonly referred to as biology” (p. 1516).

Attention to the treatment of the body of the intersexed is one of the ways in which the culture/body relation has been examined in recent years (Heyes 2003; Hird 2000, 2003, 2004; Kessler 1990). According to Hird (2003), the intersexed, defined as “infants born with genitals that are neither clearly ‘female’ nor ‘male,’” (p. 1067) are estimated to comprise up to 2 percent of births. These infants present a “profound challenge to those cultures dependent on a two-gender system,” and intersexed infants are “routinely surgically and hormonally gender reassigned” (p. 1068). The reassignment occurs despite some compelling evidence that for many of these infants, the process is traumatic and often less than successful in producing a stable gender identity in later years (see Hird 2004:135 on the John/Joan case). A critical point in the definition of and treatment of the intersexed is made by Wilchins, who asks, “Why are [intersex] people forced to produce a binary sexed identity? . . . What kinds of categories of analysis would emerge if nontransgendered anthropological bodies were forced to explicate themselves in terms of intersexuality, rather than the other way around?” (quoted in Hird 2003:1068).

Feminist attention to medical treatments of sex identity is more than warranted given the fact that although medicine “requires a biological definition of the intersexual’s ‘sex,’ the surgeons, endocrinologists and psychiatrists themselves clearly employ a social definition” (Hird 2004:136). Kessler (1998) calls medicine’s surgical interventions a “failure of the imagination” in not recognizing that “each of their management decisions is a moment when a specific instance of biological ‘sex’ is transformed into a culturally constructed gender” (p. 32). Furthermore, the insistence on choosing one of two “sexes” is ironic given the fact that the majority of human cells are intersexed, chromosomes have no sex, and there are many species that do not require sex for reproduction. In sum, although the corporeal body in its external fleshy manifestation is important, “beneath the surface of our skin exists an entire world of networks of bacteria, microbes, molecules, and inorganic life,” and they take “little account of ‘sexual difference’” and indeed exist and reproduce without any recourse to what we think of as reproduction” (Hird 2004:142). In addition, the insistence on “identity” as the manifestation of a sovereign “human” subject is compromised by the fact that the Human Genome Diversity Project has shown that humans share the vast majority of their genes with animals, especially with primates. The Genome Project “far from fixing ‘proper’ human identity . . . has shown it to be impure and fluid from the start,” illustrating “profound interconnections and shared genetic identity, with everyone drawing on a common gene pool” (Shildrick 2004:162, 160).

This more recent feminist focus on science, especially biological science, in attempting to sort out sex, sexuality, and gender returns to but confounds the old nature/nurture problem that the sex/gender and biology/social distinctions were to address. The distinctions were initially a fruitful way for feminism to mount important critiques of socialcultural gender inequity, but they were always unstable. Understanding the complexity of our animality is a part of the recognition that dichotomies, in any context, are poor science and poor sociology.

As the discussion above illustrates, the concept of gender has proven to be ambiguous, complex, and contradictory, and this is unlikely to change in the near future. In the midst of the debates, Chafetz’s (1999) point is worth remembering: “All theory pertaining to gender is not feminist, although all feminist theory centers much or all of its attention on gender” (p. 4). There is still a need to unpack the “taken-for-granted assumptions about gender that pervade sociological research, and social life generally” (Ferree, Lorber, and Hess 1999:xii). For example, Stephanie Knaak (2004) points out that when the “standard ‘gender = male/female’ variable” is used in research “as the main proxy for gender,” this superficial assumption threatens the “overall quality of our research” (p. 312).

There are some directions that might be fruitfully explored in the future, although they by no means exhaust all possibilities; others may have quite different ideas of how to go on in the sociological enterprise. One suggestion is to “bring men back in.” Jeff Hearn (2004) suggests that it is

time to go back from masculinity to men, to examine the hegemony of men and about men. The hegemony of men seeks to address the double complexity that men are both a social category formed by the gender system and dominant collective and individual agents of social practices. (P. 59)

Hearn points out that “men” are “ formed in men’s hegemony . . . and form that hegemony” and that the individual as well as the collective hegemony of men is reproduced and contested in all societies “both as a social category and in men’s practices” (p. 61). Tania Modleski (1991), however, registers a caution with respect to scholars who, under the guise of feminist sympathies, appropriate “feminist analysis” to “negate the critiques and undermine the goals of feminism—in effect delivering us back to a prefeminist world” (p. 3).

The second direction to explore in greater depth is the way in which control by bio-power is deployed on a global scale as bio-political power. Rather than the disciplined subject “whose behaviour expresses internalized social norms,” control, according to Clough (2003), “aims at a never-ending modulation of moods, capacities, affects, potentialities, assembled in genetic codes, identification numbers, ratings profiles and preference listings; that is to say, bodies of data and information (including the human body as information and data” (p. 360). If sex and gender are deployed as “natural” binaries in national and global statistical reports about “distributed chances of life and death, health and morbidity, fertility and infertility, happiness and unhappiness, freedom and imprisonment” (p. 361), the use of such information for any emancipatory practices is limited. For this reason, a return to macrolevel stratification theory on the order of Lenski’s application of POET—“population, organization, ecology and technology”—as suggested by Huber (2004:259), could be useful.

Gender theorists still contend with “two powerful, mutually canceling truths in feminism: on the one hand, there is no stable sex or gender and on the other, women too often find themselves unable to escape their gender and the sexual norms governing it” (Brown 2003:366). These two conceptions must also contend with the frequent reports of the “death of feminism,” most particularly from a variety of conservative, often religiously inspired, traditionalists—both male and female (Hawkesworth 2004). The view from the antifeminist or nonfeminist women must not be simplistically dismissed as “false consciousness”; what is needed is to “know how they think as they do, how and in what terms and with what conflicts they experience their femininity” (Scott 1997:701).

Finally, sociologists as gender theorists need to contend with the tendency of the discipline to marginalize or co-opt gender issues, especially when these issues are linked to systems of inequality in the politics of everyday life (Young 1994). This returns us to the initial starting point of feminist appropriation of gender—the recognition that the concept is a political, economic, and social marker of inequality, whatever its theoretical stability. As Nancy Fraser and Nancy A. Naples (2003) contend, some of the debates in recent feminist theory that tended to see inequities as problems of culture left us “defenseless against free-market fundamentalism” and helped to “consolidate a tragic historic disjunction between theory and practice” (p. 1117). This is particularly troubling given the “acceleration of globalization” and the transformation of “circumstances of justice” by undermining the sovereignty of states. The struggle over governance as “representation” must therefore be added to the “(economic) dimension of redistribution and the (cultural) dimension of recognition.”

The above suggestions are but a few that emerge from feminist struggles with the concept of gender. The issues, like all the issues and debates outlined above, are not confined to the disciplinary boundaries of sociology however they may be construed. But if sociology is to have any relevance in the twenty-first century, then gender, as a critical focus of sociological analysis, is important, especially if sociology is to be true to its origins as an engaged political and ethical scientific practice.

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How to Write a Transgender Research Paper Successfully?

Making research papers on transgender is not a simple task, but you can complete it successfully with our effective hints. We know that for many students, writing academic papers seems a nightmare. But it is never late to learn and improve your skills in writing. Read our detailed guide and create an impressive transgender research paper to get a high grade!

Writing about transgender is not so easy because there is a lot of information about this subject, and this subject is surrounded with prejudice, shame to discuss and stigma, as well as misinformation on this topic. In this article, we will give some general tips on writing a research paper on transgender college students may be asked to make.

First of all, you must understand the definition of transgender. This term appeared in the 1960s, and it defines a person’s gender identity. In the 1980s, this term became an umbrella for various terms as crossdressers, transsexuals, transgender, and other people who change their gender. It is important for you to understand the main difference between multiple terms.

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Sometimes transvestites and transsexuals can be defined as transgender, but there is a difference between these terms:

• Transsexuals are those people who have changed their sex to the opposite.
• Transvestites are used to wearing clothing of the opposite sex. These people also can be defined as crossdressers.
• Transgender are heterosexuals, homosexuals, bisexuals or asexuals. Their gender is different from sexual orientation.

Keep reading our article and get more tips on making a successful work without wasting your precious time!

How to Write a Research Paper on Transgender: Guide for Students

If you are assigned to make this paper, prepare to work hard. Follow these six stages on how to write a research paper on transgender, and create a perfect work!

• Brainstorm your ideas. That will help you to get bright ideas for writing your future writing. Take a sheet of paper, sit down in the quiet place, and write down any subjects about transgender that come to mind. That could be discrimination, prejudice, social rights, health insurance, etc. You can get plenty of transgender research paper titles.
• Be sure you have got multiple sources to complete your work. Think about where you can get enough information about the chosen subject. You can use various sources, like articles, statistics, online databases, etc. Remember you should have plenty of data before research.
• Use the information you have found to research on your topic. Define an argument you would like to discuss and make sure you have enough information to support this argument. The argument is a thesis statement (the central idea) of your future work.
• Write a detailed outline. After you have defined a thesis, create a detailed plan for writing your research paper. Feel free to include all important information in the outline, and it will be helpful in writing your document. Some students ignore this step, and they usually appear stuck in the middle of writing. You will find more tips on creating a good outline below.
• Create a rough draft. Follow your outline and write your research paper attentively step by step. Concentrate on your writing and ignore misprints and errors — you will have a chance to correct them later.
• Proofread your paper thoroughly. Take a break after you have finished writing, and then re-read your paper with refreshed eyes to correct mistakes. You can use online software to check grammar. The more time you spend on revising, the higher the grade you will get.

Transgender Research Paper Topics to Emphasize

It is not always easy to select a successful topic for preparing good work. We want to share some interesting transgender research paper topics to give you ideas for creating your own document.

Topics about Transgender Issues in Society

• Analysis of the main reasons why people want to change their sex.
• Can people change their sexual orientation constantly?
• Is it normal for homosexuals to raise children?
• Analysis of themes of homosexuality in the Bible.
• How are transgender people treated by our society?

Transgender Rights Research Paper Topics

• Same-sex marriages: For and against.
• Can lesbians and gays adopt children and be good parents?
• Compare and contrast how transgender people are treated in the USA and in Europe.
• Should transgender people have the same rights as other people?
• What legal rights do transgender people have?

How to Make a Transgender Research Paper Outline?

Preparing an outline is an essential part of your work. Without making a good plan for your future writing, you may find yourself stuck in the very beginning of your paper without any idea what to do next. A transgender research paper outline will be a helpful thing to create well-logical work to impress your readers. Here are the elements of an outline for your research paper:

• Introduction. In this paragraph, you have to represent the subject of your research to the audience and put a thesis statement. We recommend making an introduction for a transgender research paper when you have written all other parts of your work.
• Body part. Here you have to place arguments and support them with strong evidence. We suggest including three paragraphs in this part.
• Conclusion. That is a short paragraph where you should summarize the results of your research and finish your paper logically.

More Useful Tips on Writing a Transgender Research Paper

Transgender is a complex topic to write about, so we recommend using these additional tips to create a good paper:

• Make sure you understand all the terms connected to transgender: confusing definitions is inappropriate for such serious work.
• If you are writing about real stories from life, make sure those people don’t mind releasing it. Try to respect privacy and safety of others.
• Make sure you don’t make transgender people victims in your paper. Keep in mind that your main task is to research, but not judge.

We hope our tips were useful, and wish you good luck in creating a successful transgender research paper!

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Transgender social inclusion and equality: a pivotal path to development

Vivek divan.

1 United Nations Development Programme Consultant, Delhi, India

Clifton Cortez

2 United Nations Development Programme, HIV, Health, and Development Group, New York, NY, USA

Marina Smelyanskaya

3 United Nations Development Programme Consultant, New York, NY, USA

JoAnne Keatley

4 University of California, San Francisco, Center of Excellence for Transgender Health, San Francisco, CA, USA

Introduction

The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished.

The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere.

Conclusions

The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and economic development, and put a stop to untrammelled violence.

Those who have traditionally been marginalized by society and who face extreme vulnerability to HIV find that it is their marginalization – social, legal, and economic – which needs to be addressed as the highest priority if a response to HIV is to be meaningful and effective. Trans people's experiences suggest that although HIV is a serious concern for those who acquire it, the suffering it causes is compounded by the routine indignity, inequity, discrimination, and violence that they encounter. Trans people, and particularly trans women, have articulated this often in the context of HIV [ 1 ].

For a reader who is not trans, imagine a world in which the core of your being goes unrecognized – within the family, if and when you step into school, when you seek employment, or when you need social services such as health and housing. You have no way to easily access any of the institutions and services that others take for granted because of this denial of your existence, worsened by the absence of identity documents required to participate in society. Additionally, because of your outward appearance, you may be subject to discrimination, violence, or the fear of it. In such circumstances, how could you possibly partake in social and economic development? How could your dignity and wellbeing – physical, mental, and emotional – be ensured? And how could you access crucial and appropriate information and services for HIV and other health needs?

Trans people experience these realities every day of their lives. Yet, like all other human beings, trans people have fundamental rights – to life, liberty, equality, health, privacy, speech, and expression [ 2 ], but constantly face denial of these fundamental rights because of the rejection of the trans person's right to their gender identity. In these circumstances, there can be no attainment of the goal of universal equitable development as set out in the 2030 Agenda for Sustainable Development [ 3 ], and no effort to stem the tide of the HIV epidemic among trans people can succeed if their identity and human rights are denied.

The human rights gap – stigma, discrimination, violence

The ways in which marginalization impacts a trans person's life are interconnected; stigma and transphobia drive isolation, poverty, violence, lack of social and economic support systems, and compromised health outcomes. Each circumstance relates to and often exacerbates the other [ 4 ].

Trans people who express their gender identity from an early age are often rejected by their families [ 5 ]. If not cast out from their homes, they are shunned within households resulting in lack of opportunities for education and with no attempts to ensure attention to their mental and physical health needs. Those who express their gender identities later in life often face rejection by mainstream society and social service institutions, as they go about undoing gender socialization [ 6 ]. Hostile environments that fail to understand trans people's needs threaten their safety and are ill-equipped to offer sensitive health and social services.

Such discriminatory and exclusionary environments fuel social vulnerability over a lifetime; trans people have few opportunities to pursue education, and greater odds of being unemployed, thereby experiencing inordinately high levels of homelessness [ 6 ] and poverty [ 7 ]. Trans students experience resentment, prejudice, and threatening environments in schools [ 8 ], which leads to significant drop-out rates, with few trans people advancing to higher education [ 9 ].

Workplace-related research on lesbian, gay, bisexual, and trans (LGBT) individuals reveals that trans workers are the most marginalized and are excluded from gainful employment, with discrimination occurring at all phases of the employment process, including recruitment, training opportunities, employee benefits, and access to job advancement [ 10 ]. This environment inculcates pessimism and internalized transphobia in trans people, discouraging them from applying for jobs [ 11 ]. These extreme limitations in employment can push trans people towards jobs that have limited potential for growth and development, such as beauticians, entertainers or sex workers [ 12 ]. Unemployment and low-paying or high risk and unstable jobs feed into the cycle of poverty and homelessness. When homeless trans people seek shelter, they are housed as per their sex at birth and not their experienced gender, and are subject to abuse and humiliation by staff and residents [ 13 ]. In these environments, many trans people choose not to take shelter [ 14 ].

Legal systems often entrench this marginalization, feed inequality, and perpetuate violence against trans people. All people are entitled to their basic human rights, and nations are obligated to provide for these under international law, including guarantees of non-discrimination and the right to health [ 2 ]; however, trans people are rarely assured of such protection under these State obligations.

Instead, trans people often live in criminalized contexts – under legislation that punishes so-called unnatural sex, sodomy, buggery, homosexual propaganda, and cross-dressing [ 12 ] – making them subject to extortion, abuse, and violence. Laws that criminalize sex work lead to violence and blackmail from the police, impacting trans women involved in this occupation [ 15 ]. Being criminalized, trans people are discouraged from complaining to the police, or seeking justice when facing violence and abuse, and perpetrators are rarely punished. When picked up for any of the aforementioned alleged crimes or under vague “public nuisance” or “vagrancy” laws, their abuse can continue at the hands of the police [ 16 ] or inmates in criminal justice systems that fail to appropriately respond to trans identities.

The transphobia that surrounds trans people's lives fuels violence against them. Documentation over the last decade reveals the disproportionate extent to which trans people are murdered, and the extreme forms of torture and inhuman treatment they are subject to [ 16 – 18 ]. When such atrocities are perpetrated against trans people, governments turn a blind eye. Trans sex workers are particularly vulnerable to brutal police conduct including rape, sometimes being sexually exploited by those who are meant to be protectors of the law [ 15 ]. In these circumstances, options to file complaints are limited and, when legally available channels do exist, trans complainants are often ignored [ 19 ].

These experiences of severe stigma, marginalization, and violence by families, communities, and State actors lead to immense health risks for trans people, including heightened risk for HIV, mental health disparities, and substance abuse [ 20 , 21 ]. However, most health systems struggle to function outside the traditional female/male binary framework, thereby excluding trans people [ 22 ]. Health personnel are often untrained to provide appropriate services on HIV prevention, care, and treatment or information on sexual and reproductive health to trans people [ 20 , 23 ]. HIV voluntary counselling and testing facilities and antiretroviral therapy (ART) sites intimidate trans people due to prior negative experiences with medical staff [ 21 , 24 , 25 ]. Additionally, when trans women test HIV positive, they are wrongly reported as men who have sex with men [ 4 ]. Consequently, testing rates in trans communities are low [ 26 ], which serves to disguise the serious burden of HIV among trans people and perpetuates the lack of investment in developing trans-sensitive health systems. The economic hardships that trans people face due to their inability to participate in the workforce further complicate access to HIV, mental health, and gender-affirming health services. In short, hostile social and legal environments contribute to health gaps, and public health systems that are unresponsive to the needs of trans people.

In addition, understanding of trans people's concerns around stigma, discrimination, and violence, related as they are to gender identity, is often limited due to their being combined with lesbian, gay, and bisexual sexual orientation issues. However, trans people's human rights concerns, grounded in their gender identity, are inherently different and necessitate their own set of approaches.

Imperatives for trans social inclusion

In order to overcome the human rights barriers trans people confront, certain measures are imperative and should be self-evident, given the standards that States are obliged to provide under international law to all human beings. Paying attention to these is key to effectively addressing the systemic marginalization that trans people experience. Such action can have immeasurable benefits, including the full participation of trans people in human development processes as well as positive health and HIV outcomes. For trans people, the change must begin with the most fundamental element – acknowledgement of their gender identity.

The right to gender recognition

For trans people, their very recognition as human beings requires a guarantee of a composite of entitlements that others take for granted – core rights that recognize their legal personhood. As the Global Commission on HIV and the Law pointed out, “In many countries from Mexico to Malaysia, by law or by practice, transgender persons are denied acknowledgment as legal persons. A basic part of their identity – gender – is unrecognized” [ 19 ]. This recognition of their gender is core to having their inherent dignity respected and, among other rights, their right to health including protection from HIV. When denied, trans people face severe impediments in accessing appropriate health information and care.

Recognizing a trans person's gender requires respecting the right of that person to identify – irrespective of the sex assigned to them at birth – as male, female, or a gender that does not fit within the male–female binary, a “third” gender as it were, as has been expressed by many traditionally existing trans communities such as hijras in India [ 27 ]. This is an essential requirement for trans people to attain full personhood and citizenship. The guarantee of gender recognition in official government-issued documents – passports and other identification cards that are required to open bank accounts, apply to educational institutions, enter into housing or other contracts or for jobs, to vote, travel, or receive health services or state subsidies – provides access to a slew of activities that are otherwise denied while being taken for granted by cisgender people. 1 Such recognition results in fuller civic participation of and by trans people. It is a concrete step in ensuring their social integration, economic advancement, and a formal acceptance of their legal equality. It can immeasurably support their empowerment and act as an acknowledgement of their dignity and human worth, changing the way they are perceived by their families, by society in general, and by police, government actors, and healthcare personnel whom they encounter in daily life. UN treaty bodies have acknowledged this vital right of trans people to be recognized. The UN High Commissioner for Human Rights has recommended that States “facilitate legal recognition of the preferred gender of transgender persons and establish arrangements to permit relevant identity documents to be reissued reflecting preferred gender and name, without infringements of other human rights” [ 28 ].

Freedom from violence & discrimination

Systemic strategies to reduce the violence against trans people need to occur at multiple levels, including making perpetrators accountable, facilitating legal and policy reform that removes criminality, and general advocacy to sensitize the ill-informed about trans issues and concerns. Strengthening the capacity of trans collectives and organizations to claim their rights can also act as a counter to the impunity of violence. When trans people are provided legal aid and access to judicial processes, accountability can be enforced against perpetrators. Sensitizing the police to make them partners in this work can be crucial. When political will is absent to support such attempts in highly adverse settings, trans organizations and allies can consider using international human rights mechanisms, such as shadow reports made to UN human rights processes like the Universal Periodic Review, to bring focus to issues of anti-trans violence and other human rights violations against trans people.

Providing equal access to housing, education, public facilities and employment opportunities, and developing and implementing anti-discrimination laws and policies that protect trans people in these contexts, including guaranteeing their safety and security, are essential to ensure that trans individuals are treated as equal human beings.

The right to health

For trans people, their right to health can only be assured if services are provided in a non-stigmatizing, non-discriminatory, and informed environment. This requires working to educate the healthcare sector about gender identity and expression, and zero tolerance for conduct that excludes trans people. Derogatory comments, breaches of confidentiality from providers, and denial of services on the basis of gender identity or HIV status are some of the manifestations of prejudice. The right to non-discrimination that is guaranteed to all human beings under international law must be enforced against actions that violate this principle in the healthcare system. Yet, a multi-pronged approach that supports this affirmation of trans equality together with a sensitized workforce that is capable of delivering gender-affirming surgical and HIV health services is necessary.

Building on the commitments made by the UN General Assembly in response to the HIV epidemic [ 29 ], the World Health Organization (WHO) developed good practice recommendations in relation to stigma and discrimination faced by key populations, including trans people [ 30 ]. These recommendations urge countries to introduce rights-based laws and policies and advise that, “Monitoring and oversight are important to ensure that standards are implemented and maintained.” Additionally, mechanisms should be made available “to anonymously report occurrences of stigma and/or discrimination when [trans people] try to obtain health services” [ 30 ].

Fostering stigma-free environments has been successfully demonstrated – where partnerships between trans individuals and community health nurses have improved HIV-related health outcomes [ 31 ], or where clinical sites welcome trans people and conduct thorough and appropriate physical exams, manage hormones with particular attention to ART, and engage trans individuals in HIV education [ 32 ].

Advancing trans human rights and health

For all the challenges faced by trans people in the context of their human rights and health, promising interventions and policy progress have shown that positive change is possible, although this must be implemented at scale to have significant impact. Change has occurred due to the efforts of trans advocates and human rights champions, often in critical alliances with civil society supporters as well as sensitized judiciaries, legislatures, bureaucrats, and health sector functionaries.

Key strides have been made in the context of gender recognition in some parts of the world. In the legislatures, this trend began in 2012 with Argentina passing the Gender Identity and Health Comprehensive Care for Transgender People Act , which provided gender recognition to trans people without psychiatric, medical, or judicial evaluation, and the right to access free and voluntary transitional healthcare [ 33 , 34 ]. In 2015, Malta passed the Gender Identity, Gender Expression and Sex Characteristics Act , which provides a self-determined, speedy, and accessible gender recognition process. The law protects against discrimination in the government and private sectors. It also de-pathologizes gender identity by stating that people “shall not be required to provide proof of a surgical procedure for total or partial genital reassignment, hormonal therapies or any other psychiatric, psychological or medical treatment.” It presumes the capacity of minors to exercise choice in opting for gender reassignment, while recognizing parental participation and the minor's best interests. It stipulates the establishment of a working group on trans healthcare to research international best practices [ 35 ]. Pursuant to its passing the Maltese Ministry of Education working with activists also developed policy guidelines to accommodate trans, gender variant, and intersex children in the educational system [ 36 ]. Other countries, such as the Republic of Ireland and Poland, have also passed gender identity and gender expression laws, albeit of varying substance but intended to recognize the right of trans people to personhood [ 37 , 38 ]. Denmark passed legislation that eliminated the coercive requirement for sterilization or surgery as a prerequisite to change legal gender identity [ 39 ].

Trans activists and allies have also used the judicial process to claim the right to gender recognition. In South Asia, claims to recognition of a gender beyond the male–female binary have been upheld – in 2007, the Supreme Court of Nepal directed the government to recognize a third gender in citizenship documents in order to vest rights that accrue from citizenship to metis [ 40 ]; in Pakistan, the Supreme Court directed the government to provide a third gender option in national identity cards for trans people to be able to vote [ 41 ]; in 2014, the Indian Supreme Court passed a judgement directing the government to officially recognize trans people as a third gender and to formulate special programmes to support their needs [ 42 ]. These developments in law, while hopeful, are too recent to yet discern any resultant trends in improvements in trans peoples’ lives, more broadly.

More localized innovative efforts have also been made by trans organizations to counter violence, stigma, and discrimination. For instance in South Africa, Gender DynamiX, a non-governmental organization worked with the police to change the South African Police Services’ standard operating procedures in 2013. The procedures are intended to ensure the safety, dignity, and respect of trans people who are in conflict with the law, and prescribe several trans-friendly safeguards – the search of trans people as per the sex on their identity documents, irrespective of genital surgery, and detention of trans people in separate facilities with the ability to report abuse, including removal of wigs and other gender-affirming prosthetics. Provision is made for implementation of the procedures through sensitization workshops with the police [ 43 ]. In Australia, the Transgender Anti-Violence Project was started as a collaboration between the Gender Centre in Sydney and the New South Wales Police Force, the City of Sydney and Inner City Legal Centre in 2011. It provides education, referrals, and advocacy in relation to violence based on gender identity, and support for trans people when reporting violence, assistance in organizing legal aid and appearances in court [ 44 ].

Measures have also been taken to tackle discrimination faced by trans people, in recognition of their human rights – in 2015, Japan's Ministry of Education ordered schools to accept trans students according to their preferred gender identity [ 45 ]; in 2014 in Quezon City, the Philippines the municipal council passed the “Gender Fair City” ordinance to ensure non-discrimination of LGBT people in education, the workplace, media depictions, and political life. This law prohibits bullying and requires gender-neutral bathrooms in public spaces and at work [ 46 ]; in Ecuador, Alfil Association worked on making healthcare accessible to trans people, including training and sensitization meetings for health workers and setting up a provincial health clinic for trans people in collaboration with the Ministry of Health, staffed by government physicians who had undergone the training; and Transbantu Zambia set up a small community house providing temporary shelter for trans people, assisting them in difficult times or while undergoing hormone therapy. Similar housing support has been provided by community organizations with limited resources in Jamaica and Indonesia. 2

Towards sustainable development: time for change

Although there are other examples of human rights progress for trans people, much of this change is isolated, non-systemic, and insufficient. Trans people continue to live in extremely hostile contexts. What is required is change and progress at scale. The international community's recent commitment towards Sustainable Development Goals (SDGs) presents an opportunity to catalyze and expand positive interventions [ 3 ].

Preventing human rights violations and social exclusion is key to sustainable and equitable development. This is true for trans people as much as other human beings, just as the achievement of all 17 SDGs is of paramount importance to all people, including trans people. Of these SDGs, the underpinning support for trans people's health and human rights is contained in SDG 3 –“Ensure healthy lives and promote well-being for all at all ages,” SDG 10 – “Reduce inequality within and among countries,” and SDG 16 – “Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.”

The SDGs are guided by the UN Charter and grounded in the Universal Declaration of Human Rights. They envisage processes that are “people-centered, gender-sensitive, respect human rights and have a particular focus on the poorest, most vulnerable and those furthest behind” and a “just, equitable, tolerant, open and socially inclusive world in which the needs of the most vulnerable are met” [ 3 ]. They reiterate universal respect for human rights and dignity, justice and non-discrimination, and a world of equal opportunity permitting the full realization of human potential for all irrespective of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, disability, or other status . The relationship between the SDGs and trans people's concerns has been robustly articulated in the context of inclusive development [ 47 ].

UN Member States have unequivocally agreed to this new common agenda for the immediate future. The SDGs demand an unambiguous, farsighted, and inclusive demonstration of political will. Their language clearly reflects the most urgent needs of trans people, for whom freedom from violence and discrimination, the right to health and legal gender recognition are inextricably linked.

Specifically in regard to trans people, the SDGs are a call to immediate action on several fronts: governments need to engage with trans people to understand their concerns, unequivocally support the right of trans people to legal gender recognition, support the documentation of human rights violations against them, provide efficient and accountable processes whereby violations can be safely reported and action taken, guarantee the prevention of such violations, and ensure that the whole gamut of robust health and HIV services are made available to trans people. Only then can trans people begin to imagine a world that respects their core personhood, and a world in which dignity, equality, and wellbeing become realities in their lives.

Acknowledgements and funding

The authors are grateful for the work of courageous trans activists around the world who have overcome tremendous challenges and continue to battle disparities as they bring about positive change. Many encouraging examples cited in this manuscript would be impossible without their contribution. The authors also thank Jack Byrne, an expert on trans health and human rights, whose work on the UNDP Discussion Paper on Transgender Health and Human Rights (2013) served as an inspiration for this piece, and JoAnne Keatley's effort to provide writing, editorial comment, and oversight. UNDP staff and consultants, who contributed time to this manuscript, were supported by UNDP.

1 Cisgender people identify and present in a way that is congruent with their birth-assigned sex. Cisgender males are birth-assigned males who identify and present themselves as male.

2 These illustrations are based on information gathered in the process of developing a tool to operationalize the Consolidated Guidelines on HIV prevention, diagnosis, treatment and care for key populations (WHO, 2014), through interviews with and questionnaires sent to trans activists. See also reference 31.

Competing interests

The authors have declared that no competing interests exist.

Authors' contributions

The concept for this manuscript was a result of collaborative work between all four authors. VD provided key ideas for content and led the writing for the manuscript. CC provided thought leadership and contributed writing, particularly on the SDGs, while MS provided writing and editorial input, as well as other support. JK advised on content and provided writing and editorial input and guidance. All authors have read and approved the final version.