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Beyond the Binary: A More Inclusive Account of Trans Populations

Equity, Inclusion and Social Justice Gender and Sexuality
April 17, 2017 Del Rapier M.A. & Laura Edwards-Leeper, Ph.D. | Pacific University


Trans identities are diverse and complex. Many within the dominant culture view gender through a binary lens; seeing man and woman as the exclusive options. This view is perpetuated within research, in that trans individuals are only recognized when then conform to the same binary system. The research criteria for what it means to be a trans individual is often limited to those who feel they were “born in the wrong body.” This academic perpetuation of binary standards effectively contributes to the erasure of non-binary gender identities.

Literature Review

For some trans individuals, gender is experienced within the binary. For others, such as gender diverse individuals, gender is experienced as fluid and dynamic. Gender fluidity allows for the embracing of limitless possibilities as to how to conduct one’s life as it relates to gender, rather than being bound to binary roles (Ehrensaft, 2012; Stein, 2012). The National Gay and Lesbian Task Force (2011) assert that, “For many gender non-conforming people, transition as a framework has no meaning in expressing their gender — there may be no transition process at all, but rather a recognition of a gender identity that defies convention or conventional categories” (p. 26).

Gender dysphoria refers to the experience of serious distress resulting from one’s own or societal attitudes towards one’s gender variance (American Psychiatric Association, 2000). The latest edition of the Diagnostic and Statistical Manual of Mental Disorders’ (DSM-5) diagnosis of gender dysphoria may reinforce a binary gender system through its assertion of ‘appropriate’ male and female behavior (Rottnek, 1999). Not only does this imply that there are inappropriate ways to be female or male, but it also makes no mention of those with a non-binary gender identity.

Trans, while an umbrella term meant to encapsulate the variety of individuals whose birth sex and gender identity do not conform one to the other, often gets reduced to someone who feels ‘born in the wrong body’ and desires a transition to the ‘other’ binary gender (Vade, 2004). This type of reductionism, however, ignores those whose gender identity does not or cannot be contained within the limitations of a binary gender system. As we come to understand gender diversity as a continuum of normal development, we will recognize the dangers of pathologizing trans individuals, and the benefits of a supportive approach to care (Ehrensaft, 2012; Minter, 2012).


Existing persistence and desistence research on trans populations (on which some prevalence estimates rely), is both narrowly focused and biased toward a body-fixated view of trans persistence. Trans persistence and desistence studies collectively demonstrate a surgical focus as essential criteria for persistence inclusion (Cohen-Ketenis & van Goozen, 1997; de Vries & Cohen-Kettenis, 2012; Drummond, Bradley, Peterson-Badali & Zucker, 2008; Steensma, Biemond, de Boer, & Cohen-Kettenis, 2011; Wallien & Cohen-Ketenis, 2008). Each of these studies concentrate on gender dysphoria and surgical transition procedures as outcome variables. Such criteria uphold a binary perception of gender identity and neglects to consider participants whose trans identity persists into adulthood without a desire for surgical transition. If persistence criteria are based on the conflation of the concepts of gender dysphoria and gender diversity, the likelihood that trans individuals will be excluded from the data of persisters is certain.

While gender variance and gender dysphoria are two distinct concepts, much of the persistence research has historically blurred the lines between the two concepts. Stein (2012) points to Zucker’s (1984; 2005; 2008; 2012) foundational research in which he “seems to inadequately appreciate the ethical difference between gender dysphoria and gender variance. As a result, Zucker and his various coauthors seem to lose sight of the fact that a gender variant child or adolescent can be happy, healthy, and ‘comfortable in one’s skin’” (p. 494). This kind of conflation can lead to the impression that all trans individuals experience gender dysphoria.


This exploratory study offered a critical, social justice approach to understanding trans experience and broadening recognition of diverse trans populations. This study explored the importance of surgical transition procedures to participants’ gender identities. Participants were selected through a snowball sampling approach via various social media platforms. Participants completed an anonymous, online survey. Participants were required to be 18 years old and older, self-identify as trans, live in the United States, and speak English.


Gender Identity and the Value of Gender Affirming Surgeries

Participants were asked the question, “Is access to surgical transition procedures an important aspect of your personal gender identity,” 78.7% of participants responded “yes,” and 21.3% of participants indicated “no.” Crosstabulation with Pearson’s Chi-Square analyses were conducted and standardized residuals were examined to determine if this observed pattern differed from an expected distribution of responses. When comparing importance of access to surgical transition procedures by Gender Identity there were significant differences between the observed and expected distribution of responses for those identifying within the trans masculine spectrum, as well as those identifying as genderqueer/non-gendered. A greater than expected number of individuals within the trans-masculine spectrum responded “no” indicating that surgical procedures were not an important aspect of their gender identity. Further, fewer than expected individuals who identified as genderqueer/non-gendered responded “yes” that this was an important aspect of their identity, and more than expected individuals identifying as genderqueer/non-gendered responded “no.”


Current persistence and desistence research relies heavily upon trans individuals’ desire and ability to access surgical transition procedures to be counted as having persisted, and as a result, included within trans prevalence rates. While it is true that a majority (78.6%) of participants agreed that access to surgical transition procedures was important to their gender identity, a significant minority of trans and gender nonconforming individuals are being left out if this is the only outcome variable used in prevalence research.


Fundamental changes are needed in the way in which prevalence rates are tabulated, specifically in what it means to be trans.  Along with this, increased awareness regarding the gender binary biases we’ve historically held as a field regarding trans experiences would help frame the necessary first steps in the process of recognizing the multitude of trans and gender nonconforming identities.  Gaining support of researchers in these steps could also have positive implications for trans individuals seeking support and services.  

The results of the present study point to the critical need for creating more inclusive methods of collecting trans prevalence information. Further, the results of the present study suggest that researchers may need to educate themselves on the diversity within trans identities, rather than expecting all trans individuals to fit a “born in the wrong body” model.  It is through such knowledge that researchers can become better allies and advocates of trans communities rather than perpetuate the marginalization that continues to exist.


American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Cohen-Kettenis, P. T., & van Goozen, S. H. M. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of American Academy of Child Adolescent Psychiatry, 36(2), 263-271.

de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59(3), 301-320. doi: 10.1080/00918369.2010.653300

Drummond, K. D., Bradley, S. J., Peterson-Badali, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44(1), 34-45. doi: 10.1037/0012-1649.44.1.34

Ehrensaft, D. (2012). From gender identity to gender identity creativity: True gender self-child therapy. Journal of Homosexuality, 59, 337-356.

Minter, S. P. (2012). Supporting transgender children: New legal, social, and medical approaches. Journal of Homosexuality, 59(3), 422-433. doi:10.1080/00918369.2012.653311

National Gay and Lesbian Task Force. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Retrieved from http://www.thetaskforce.org/downloads/reports/ntds_full.pdf

Rottnek, M. (1999). Introduction. In M. Rottnek (Ed.) Sissies and tomboys. Gender nonconformity and homosexual childhood (pp. 1–5). New York: New York University Press.

Steensma, T. D., Biemond, R., de Boer, F., & Cohen-Kettenis, P. T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry, 16(4), 499-516. doi: 10.1177/1359104510378303

Stein, E. (2012). Commentary on the treatment of gender variant and gender dysphoric children and adolescents: Common themes and ethical reflections. Journal of Homosexuality, 59, 480-500. doi: 10.1080/00918369.2012.653316

Vade, D. (2004). Expanding gender and expanding the law: Toward a social and legal conceptualization of gender that is more inclusive of transgender people. Michigan Journal of Gender and Law, 11, 253-316.

Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of American Academy of Child Adolescent Psychiatry, 47(12), 1413-1423.

Zucker, K. J. (2005). Gender Identity Disorder in children and adolescents. Annual Review of Clinical Psychology, 1, 467-492. doi: 10.1146/annurev.clinpsy.1.102803.144050

Zucker, K. J. (2008). Children with gender identity disorder: Is there a best practice? Neuropsychiatre de L’enfance et de L’adoscence, 56, 358–364.

Zucker, K. J., Finegan, J. K., Doering, R. W., & Bradley S. J. (1984). Two sub-groups of gender-problem children. Archives of Sexual Behavior, 13, 27–39.

Zucker, K. J., Wood, H., Singh, D., & Bradley, S. J. (2012). A developmental, biopsychosocial model for the treatment of children with gender identity disorder. Journal of Homosexuality, 59(3), 369-397. doi: 10.1080/00918369.2012.653309