Health Equality and Diversity Within the Transgender

As a research team focused on vulnerable youth, we increasingly need to find ways to acknowledge non-binary genders in health research. Youth have become more vocal about expanding notions of gender beyond traditional categories of boy/man and girl/woman. Integrating non-binary identities into established research processes is a complex undertaking in a culture that often assumes gender is a binary variable. In this article, we present the challenges at every stage of the research process and questions we have asked ourselves to consider non-binary genders in our work. As researchers, how do we interrogate the assumptions that have made non-binary lives invisible? What challenges arise when attempting to transform research practices to incorporate non-binary genders? Why is it crucial that researchers consider these questions at each step of the research process? We draw on our own research experiences to highlight points of tensions and possibilities for change. Improving access to inclusive health-care for non-binary people, and non-binary youth in particular, is part of creating a more equitable healthcare system. We argue that increased and improved access to inclusive health-care can be supported by research that acknowledges and includes people of all genders. K E Y W O R D S gender, gender-and sex-based analysis, gender identity, health research, non-binary gender, population health, research methodology, transgender, youth In March 2015, our research team went to a Vancouver high school to administer an annual questionnaire in a longitudinal study on student wellness. We had arranged to visit all of the classrooms–sur-veying nearly 1400 students—over 2 weeks. On Friday morning, a student asked why there were only two options describing sex (male and female), rather than a range of options for gender (e.g., girl, boy, genderqueer). We explained that while it was not ideal, we had chosen to limit the options to male and female because in past school-based surveys, providing a write-in option for gender identity in addition to sex has led to measurement error. Some youth do not understand questions about gender identity, or they treat the question as a joke. We encouraged the student, and the entire class, to use the comments section to express their opinion about the question. We said we would investigate other options for the survey next year. Over the next week, a student in every classroom we visited asked us a similar question.