Gender has been widely viewed as a binary concept in society — a belief that comes from cisnormativity, and one that can affect paradigms about Transgender people themselves.
Transnormativity is an ideology that says the validity of Trans people’ identities is based on their adherence to binary gender norms. For gender non-conforming people, beliefs like these can be alienating.
Even in Queer and Trans-centred research, strict views of binary gender norms have kept the experiences of gender non-conforming people on the backburner. Despite having different lived experiences, non-binary people are sometimes grouped with binary-aligned Trans people in research samples or don’t receive the same focus because they are separate from the gender binary.
While there is overlap between Trans and non-binary experiences, there’s still room for research surrounding their identities individually.
The studies that have focused on non-binary populations outline the variety in Trans experiences. For example, a study by Dr. Stef Murawsky at the University of Cincinnati shows non-binary individuals feel more existential uncertainty in their identities, which can create hesitation and a delay in accessing gender-affirming care.
Standardized gender-affirming care — such as facial feminization or masculinization — is also generally binary, meaning non-binary people will often seek more personalized care. Gender non-conforming people also feel the need to transition in binary ways due to medicalization and other external pressures.
“There’s a lot of non-binary folks under the Trans umbrella who want a more individualized approach,” said Kai Jacobsen, a PhD student in UBC’s Interdisciplinary Studies program, in an interview with The Ubyssey. “Like, ‘I want some changes, but not all the changes that hormones might bring me.’”
“The effects of lower or higher doses of hormones, or particular combinations of medications, or different surgery options — there's a big community demand for having those kinds of more expansive, individualized gender affirming care pathways available.”
Jacobsen has been involved in research showing that non-binary people experience more instances of being misgendered than binary-aligned Trans men and women. As a result, non-binary people also experienced more distress, poor mental health outcomes, gender dysphoria and non-affirmation of identity.
Though there’s a clear difference in experiences, the amount of research on non-binary people still has yet to be expanded.
"Because there wasn't a lot of research literature to draw out, that analysis was really based on our lived experiences to kind of guide how we were analyzing, and interpreting the data we had,” said Jacobsen, referring to their study on misgendering. As a Transgender and non-binary person themselves, their research is focused on the intersection of health-systems, and social and structural factors shaping Queer and Trans health.
A focus on non-binary people is critical for Jacobsen who believes research samples should represent their epistemologies — that is, the priorities and lived experiences of non-binary people themselves. This is critical as it challenges popular assumptions that can illegitimize the experiences of non-binary people, like that they need to experience dysphoria in order for their identities to be valid.
Epistemic justice refers to an equitable and inclusive process of knowledge creation, utilization and dissemination as it calls for a focus on marginalized voices. It is a critical lens Jacobsen aims to integrate in their own research to exemplify epistemic justice for Trans and non-binary people accessing gender affirming care in Canada.
This framework has guided their research to concentrate on understanding the experiences of Trans and non-binary people who have been subjected to skepticism, ignorance and ableism from their care providers.
Jacobsen believes researchers, healthcare providers and other actors in healthcare and medical sciences need to recognize their gaps in understanding, while still being equipped with substantial knowledge about Trans and non-binary people.
The path towards non-binary inclusive research is vulnerable to institutional and societal challenges. Categorization in surveys is one barrier that might make doing statistics easier, but has nuanced implications for non-binary people. “In quantitative research, there’s always this tension between wanting to give folks space to describe their gender in their own words or like, not force them to tick a box,” said Jacobsen.
They believe this is always going to be a work in progress. “How do we produce knowledge that is meaningfully representative of folks' diverse experiences, and also is legible to the government and policy makers, people who really rely on having usually binary, male and female data? … I think it's possible, but hard.”
“As a Trans person in research … people just end up asking you, ‘what's the best way to ask about gender in surveys?’ And I feel like my answer to that changes all the time.”
Jacobsen noted the resourcefulness of the Canadian Gender and Sex Research Equity Toolkit released by the Collaborative for Gender and Sexual Health Equity to help researchers navigate linguistic and methodological limitations to conduct more gender sensitive and inclusive research.
Jacobsen also mentioned co-founding a non-profit organization, the Center for Research, Education and Action for Trans Equity, which aims to contribute to these ongoing efforts by bringing the community needs of Trans, non-binary and Two-Spirit people to the forefront in health research in Canada. As the project is still in early development, they are currently working on a grant application to do community consultations.
The recognition of non-binary experiences as unique and worth accommodating is present in UBC projects like eSense Non-Binary, led by researchers at the Brotto Lab in the Department of Obstetrics and Gynaecology. eSense is an online platform originally geared toward cisgender women facing female sexual interest/arousal disorder, but which is now being adapted to non-binary individuals, widening their access to treatment.
Ultimately, non-binary participation throughout the research process is key to ensuring research seeks not only to advance scientifically, but to improve the lives of Trans and non-binary people. “For a long time, there's been cisgender medical researchers doing research on Trans people that really treats Trans and non-binary folks as the objects of research, rather than active participants of research,” said Jacobsen.
“I think the research is usually better when you have people with lived experience involved in designing it, interpreting the data … It's easier to distribute the findings back to [the] community when [the] community was involved with it from the beginning.”
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