ABSTRACT
Efforts to monitor the health of transgender youth, a small but high-risk population, are hindered by a lack of knowledge about how to accurately measure gender identity. Adolescents (n = 30) participated in semistructured qualitative interviews after completing a close-ended transgender-inclusive measure of gender. Interviews explored item comprehension and respondent burden.
Participants, who were diverse in age (range = 15–21), gender identity, sexual orientation, and race–ethnicity, were accurately classified as male, female, or transgender. All youth understood transgender as a difference between the physical body and a person's internal sense of self. Nontransgender youth frequently used an example (a woman in a man's body) in their explanations and were largely supportive of the transgender options. Most transgender youth found a response option that they felt was appropriate.
Transgender response options were added to a gender measure without impacting the accuracy of nontransgender responses or burdening the nontransgender adolescents in our sample. A modified measure (Gender: male; female; transgender, male-to-female; transgender, female-to-male; transgender, do not identify as exclusively male or female) is recommended for testing in samples that vary by age, race–ethnicity, socioeconomic status, language, and geography. Additional suggestions for research in this area are provided.
Acknowledgments
The authors thank the study participants for their thoughtful contributions and the many organizations that assisted with recruitment. The authors also extend thanks to Gunner Scott, for his sound feedback on an earlier version of this article, and to Aarti Patel and Naomi Freedner, members of the research team. K. J. Conron thanks Drs. Steve Gortmaker, Stephen Buka, and Karestan Koenen at the Harvard School of Public Health for comments on an earlier draft of this article.
This study was funded by the Children's Hospital Boston Faculty Research Council and Harvard University Open Gate Fund. K. J. Conron was supported by a grant from the Ford Foundation via The Williams Project, UCLA and the Leopold Schepp Foundation during the research phase of this study and by NIMH grant 5T32-MH15161-26 while revising the manuscript. S. B. Austin was supported by the Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, HRSA grant 6T71-MC00009-16-01.