Measuring Youth Sexual Orientation and Gender Identity

Despite the tremendous legal and social progress that the LGBTQ movement has achieved in recent decades, LGBTQ people continue to face discrimination, victimization, and disparities in mental health and suicide risk. To confront those disparities, quality data that accurately captures the identities and experiences of LGBTQ people is needed.

EXECUTIVE SUMMARY

Despite the tremendous legal and social progress that the LGBTQ movement has achieved in recent decades, LGBTQ people continue to face discrimination, victimization, and disparities in mental health and suicide risk. To confront those disparities, quality data that accurately captures the identities and experiences of LGBTQ people is needed. While several studies and reports have discussed how to assess adult LGBTQ identities in surveys and large data sets, little has been written about measuring sexual orientation and gender identity (SOGI) among LGBTQ young people. This report examines best practices for measuring sexual orientation and gender identity among youth populations in ways that allow for nuanced individuality while still providing data that is useful for statistical analyses. It shares insights from the research literature, as well as insights and examples from our own surveys of LGBTQ youth. We also offer recommendations for scholars, advocates, and practitioners who wish to improve the assessment of youths’ sexual orientation and gender identity in their surveys and data sets. 

Recommendation Summary

  • Be intentional about item selection. Researchers should consider which aspects of SOGI identity are most meaningful for their work and use survey items closely matched to those categories. 
  • Attend to developmental considerations. Youth are often still exploring their sexual orientation or gender identity. Questions about youths’ sexual orientation and gender identity should reflect this growth. Additionally, youth samples are increasingly more diverse in their sexual and gender identities and endorsing identities outside of the traditional binary understanding of sexuality and gender. This further supports the need to offer a diverse range of options for youth endorsement. 
  • Consider item placement and order. Placing SOGI items within a demographic data section allows youth to express this aspect of their identity in the same way they would their age, race/ethnicity, or geographic location.
  • Balance nuance and analytic utility. Allow youth space to provide descriptions of their sexual orientation and gender identity in addition to categorical descriptors. This can be achieved using open-ended questions or longer lists of identity options.
  • Continue to examine and refine SOGI items for youth. As youth language can quickly change, researchers should be prepared to continue refining and adapting SOGI measures over time to best represent the youth who will be answering them.

The Trevor Project is committed to sharing the voices and experiences of the thousands of LGBTQ youth who participate in our survey research. We share these insights and recommendations in the hope that our colleagues in the research and advocacy communities will continue to work for LGBTQ inclusion in all sectors of society – including data and research. 

BACKGROUND

Despite recent advancements in the fight for equal rights for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) people, many LGBTQ people continue to face discrimination in multiple aspects of their life (Meyer, 2015). In our 2021 National Survey on LGBTQ Youth Mental Health, 75% of LGBTQ youth between the ages of 13-24 reported that they had experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime, and 42% reported that they had seriously considered suicide in the past year. 

As the LGBTQ movement continues to push for an end to discrimination and the inclusion of LGBTQ people in all facets of society, we recognize that this inclusion must extend to research and data. To accurately understand the needs and strengths of LGBTQ youth, sexual orientation and gender identity must be accurately captured in surveys and large data sets. Accurate data about LGBTQ people allows scientists, advocates, and policymakers to pursue evidence-based solutions to the inequalities that LGBTQ people still face. Informed public policy decisions about how to confront violence and discrimination against LGBTQ people cannot be made without data on what that victimization looks like and the settings where it is happening. Neglecting to collect information about LGBTQ identities also contributes to stigma — it sends the message that those identities are shameful or deviant. Mental health practitioners cannot develop effective mental health interventions to decrease disparities in LGBTQ youth mental health without an accurate understanding of which factors are related to the development of mental health symptoms among LGBTQ youth. It is therefore imperative to use survey questions that accurately identify respondents who hold LGBTQ identities. A failure to capture LGBTQ identities in public health data collection can further perpetuate existing inequalities.

The difficulty of capturing LGBTQ youth’s identities in survey questions illustrates a fundamental tension within quantitative research methods: the need to place unique, individualized identities into useful categories in order to use inferential statistics analyses to draw conclusions. This tension requires a balance between allowing individual LGBTQ youth to describe their genders and sexualities with the terms and language that feels most accurate to them, while still creating meaningful categories for analyses. This report examines best practices for measuring sexual orientation and gender identity among youth populations in ways that allow for nuanced individuality while providing data that is useful for statistical analyses.

Although several reports have focused on best practices in sexual orientation and gender identity (SOGI) measurement, there have not been reports focused entirely on SOGI measurement among LGBTQ youth. Adult measurements of SOGI may not only be unsuitable for youth due to age-appropriateness in readability but there may also be concerns with validity when using adult measures. Identity development and formation — the development of a strong and stable sense of self — is particularly salient for youth and is largely considered one of the most important aspects of this period in human development (Erikson, 1994). Furthermore, this period is also one of intense sexual exploration and understanding (Rosario, Schrimshaw, 2013), gender identity development (Katz-Wise et al., 2017), and marked by gender intensification, or increased pressure to conform to culturally sanctioned gender roles (Priess, Lindberg, & Hyde, 2009). The interaction of these different aspects of development occurring simultaneously suggests that many youth are actively in the process of understanding their sexuality and gender and are, in turn, attempting to identify labels that best fit with their understanding. Therefore, it is not surprising that previous research suggests uncertainty about one’s identity can be a common part of identity development (Becht et al., 2016). Due to the explorative nature of this period, the assumption of unidimensionality in sexual orientation and gender is often not true among youth. For example, youth may report incongruencies in their identity (internal and personal) and the behavioral and expression of their identity (social processes), particularly if they are not afforded the opportunity to fully express their identities in their lives (Korchmaros, Powell, & Stevens, 2013). Further, LGBTQ youth may be aware that they are not cisgender or heterosexual, but unsure which identity label may best fit their internal sense of self (Pullen Sansfaçon, et al., 2020; Ybarra et al., 2019). This suggests that measurements of SOGI among youth should take into account how multifaceted these constructs may be for youth and allow for ways to express these complexities. Additionally, youth samples, particularly among Generation Z, are increasingly more diverse in their sexual and gender identities and endorsing identities outside of the traditional binary understanding of sexuality and gender (Boyon, 2021), which further supports the need to offer a diverse range of options for youth endorsement. Findings also show that this diversity in SOGI among youth means that, even if they do not occupy a certain identity, they are likely still aware of it or know someone who does (Parker, Graf, & Igielnik, 2019), and would therefore not be as confused by identity options as some adult samples.

Understanding Sexual Orientation and Gender Identity

The LGBTQ acronym and community includes two main identities: sexual orientation and gender identity. Each person has both a sexual orientation and a gender identity which should be assessed separately. Historically, these two concepts have often been conflated by the media, researchers, and the general public. However, knowing someone’s gender identity (e.g., transgender woman) provides no information about their sexual orientation (e.g., heterosexual, pansexual, lesbian). Similarly knowing someone’s sexual orientation (e.g., bisexual) typically provides no information about their gender identity (e.g., transgender man, nonbinary, cisgender man). 

Sexual Orientation. Scholars generally agree that there are three main components to sexual orientation: sexual identity, sexual behavior, and sexual attraction (Park, 2016; Patterson et al., 2017; Sexual Minority Assessment Research Team, 2009; Wolff et al., 2017). Sexual identity refers to one’s internal sense of their sexuality and the label which they choose to identify with or use to describe themselves. Examples include identifying as “gay,” “straight,” “queer,” or not using a label. Sexual behavior refers to how people experience and express sexuality, including what kinds of sexual acts they engage in and with whom they engage in them. Sexual attraction refers to one’s sense of sexual or romantic desire for contact and connection with people of the same or other genders (Park, 2016; Sexual Minority Assessment Research Team, 2009). 

It is important to note that while for many people these three components of sexual orientation may align (e.g. a man who identifies as gay, is attracted to other men, and has sex with men), there are many people for whom these components may diverge, (e.g. a woman who identifies as a lesbian but is attracted to people of all genders and has sex with men and women) (Wolff et al., 2017). As previously noted, attention to this divergence is particularly relevant for youth and young adults who may be still figuring out their sexual orientation and who may not yet be sexually active. 

Gender Identity. Gender identity is also comprised of multiple components, although there is less consensus in the research literature about what those components are (Federal Interagency Working Group on Improving Measurement of Sexual Orientation and & Gender Identity in Federal Surveys, 2016). The two most commonly researched components are gender identity and sex assigned at birth. Gender identity refers to one’s internal sense of who they are and what gender label (or lack thereof) feels most correct for them. Sex assigned at birth refers to the sex category that a person was assigned when they were born, usually by a doctor or the person’s family (Gender Identity in U.S. Surveillance Group, 2014). Sex assigned at birth is sometimes erroneously referred to as “natal sex” or “biological sex.” Assessing sex assigned at birth on surveys can be especially important for identifying and including transgender survey participants, whose gender identities do not align with the sex category that they were assigned at birth. 

Gender identity can include additional components such as gender expression. Gender expression refers to the myriad ways that one expresses gender both internally and externally to others (Federal Interagency Working Group on Improving Measurement of Sexual Orientation & Gender Identity in Federal Surveys, 2016). Gender expression can include choices about clothes, hairstyle, language, and mannerisms. One prominent component of gender expression is using gendered pronouns to refer to oneself, such as “he,” “she,” or “they.” Gender expression is perhaps the component of gender identity that is most difficult to measure, since it is expansive (including many different forms of self-expression), fluid (subject to change over time), and highly related to culture. 

Historical Approaches to Measuring LGBTQ Youth Identity 

The question of how to capture SOGI in survey data on youth populations has been ongoing for several decades. Survey items about sexual orientation among U.S. high school students were first included on the Minnesota Adolescent Health Survey in 1986 (Remafedi et al., 1992; Sexual Minority Assessment Research Team, 2009). Massachusetts and Seattle followed suit, adding sexual orientation questions to their state Youth Risk Behavior Survey (YRBS) in 1995 (Reis & Saewyc, 1999; Sexual Minority Assessment Research Team, 2009). In 1995 the National Longitudinal Survey of Adolescent Health added questions about youth’s sexual attractions to their Wave 1 survey (Russell & Joyner, 2001; Sexual Minority Assessment Research Team, 2009). In 2015, the Centers for Disease Control and Prevention included sexual orientation measures in their standard YRBS. Although early measures primarily examined sexual attractions and identities in terms of either opposite (heterosexual), same-sex attraction (gay/lesbian identities), or “both sex” attraction (bisexual identities), the 2021 YRBS was updated to include an option for youth who identify with a term outside of these.

CDC’s YRBS Sexual Orientation and Gender Identity ItemsOriginal YRBS Sexual Identity Item (2015, 2017, 2019):
Which of the following best describes you?
-Heterosexual (straight)
-Gay or lesbian
-Bisexual
-Not sure
Current YRBS Sexual Identity Item (2021):
Which of the following best describes you?
-Heterosexual (straight)
-Gay or lesbian
-Bisexual
-I describe my sexual identity some other way
-I am not sure about my sexual identity (questioning)
-I do not know what this question is asking
YRBS Transgender “Pilot” Question (2017, 2019):
Some people describe themselves as transgender when their sex at birth does not match the way they think or feel about their gender. Are you transgender?
-No, I am not transgender
-Yes, I am transgender
-I am not sure if I am transgender
-I do not know what this question is asking

Efforts to include questions about youth gender identity are more recent. The first example was a question asking “Are you transgender?” in the 2006 Boston Youth Survey. Beginning in 2017, the CDC included this question as an optional module on the YRBS. In 2017, 10 states and nine municipalities included the question in their YRBS, and in 2019, 15 states and 15 municipalities included this item in their YRBS. In an effort to expand the identification of youth who are not cisgender, other states and school districts, such as New Mexico, have expanded the question to capture a wider range of gender diversity by asking youth, “Do you consider yourself transgender, genderqueer, or genderfluid?”. 

More broadly, SOGI items are included in only a minority of large public health surveys and data sets in the U.S, particularly in those with youth samples. A small number of surveys include questions about sexual orientation and even fewer include questions about gender designed to identify transgender respondents. A 2017 review of sexual orientation data in surveys administered by the Department of Health and Human Services (HHS) found that only six out of 25 large surveys included measures of sexual orientation, with no review conducted on gender identity questions. Although four of these surveys included data from youth under age 18 in their sample, only two surveys provided asked youth directly about their sexual orientation. The National Survey of Family Growth (NSFG) includes individuals ages 15 and older and the YRBS focuses exclusively on high school students. Both include questions on sexual orientation, with neither yet including a gender identity measure in their standard survey. Other surveys such as the National Survey on Drug Use and Health, which surveys individuals ages 12 and older, only ask questions on sexual orientation to individuals ages 18 and older. 

A separate 2017 literature review found that only 14% of the 43 data sources reviewed asked about all three components of sexual orientation (identity, behavior, attraction), 37% of data sources asked about two of the three components, and 40% asked about one component (Patterson et al., 2017). The most common single component examined was sexual identity and the most common pair of two components was sexual identity and sexual behavior (Patterson et al., 2017). In examining the inclusion of questions on gender identity, this review found that only 19% of the 43 data sources reviewed asked about gender identity, and most did so using a single item (Patterson et al., 2017). For example, the Growing Up Today Study asks young people “How do you describe yourself?” with youth asked to select either 1) Female, 2) Male, 3) Transgender, or 4) Do not identify as female, male, or transgender. Meanwhile, the Behavior Risk Factor Surveillance System asks adults ages 18 and older a more detailed question, “Do you consider yourself to be transgender, 1) Yes, Transgender, male-to-female, 2) Yes, Transgender, female-to-male, 3) Yes, Transgender, gender nonconforming, 4) No, 5) Don’t know / Not sure”. In the National Crime Victimization Survey, adult respondents who indicate a sex assigned at birth that differs from their current gender identity are asked a follow-up question to determine if they meant to report different genders at birth and currently (Truman et al., 2019). While this technique may be effective at minimizing erroneous answers, the act of asking transgender respondents to verify that their self-reported answers about their gender identity were not a mistake can be seen as invalidating or discriminatory.

These reviews indicate that while there has been progress, there is still much work to be done to ensure the widespread inclusion of accurate and appropriate SOGI measures in public health surveys, particularly for youth populations. 

BEST PRACTICES FOR MEASURING LGBTQ IDENTITIES

Best Practices from the Literature

The Trevor Project also reviewed the literature on best practices for measuring sexual orientation and gender identity, primarily examining studies and reports in the United States between 2009 and 2020. Several strong themes emerged regarding LGBTQ inclusion in surveys and large data sets. 

Sexual Orientation

Most authors recommend that multiple components of sexual orientation should be assessed in research studies of LGBTQ identity, as there can be discrepancies between a respondent’s reported sexual identity and their behavior(s) and/or attraction(s) (Sexual Minority Assessment Research Team, 2009; Temkin et al., 2017; Wolff et al., 2017). Authors differ in the language used to describe discrepancies between reported sexual identity and behavior (e.g., a woman who identifies a straight but has sex with women). Most scholars use “concordant” and “discordant” to describe alignment or mismatching between respondents’ identities and behaviors. One study notes that such language could be stigmatizing and instead uses “branched” / “coincident” (Wolff et al., 2017). Several authors had specific recommendations for surveys used with adolescents and youth. Recognizing limitations on survey length, several authors recommend that, depending on the research question and outcome of interest, those surveying adolescents should ask about sexual identity and sexual attraction and not sexual behavior, since many young people have not yet been sexually active (Sexual Minority Assessment Research Team, 2009). 

Gender Identity

Most scholars advocate for a two-item measure of gender identity: 1) sex assigned at birth, and 2) current gender identity (Federal Interagency Working Group on Improving Measurement of Sexual Orientation and & Gender Identity in Federal Surveys, 2016; Gender Identity in U.S. Surveillance Group, 2014; Park, 2016; Temkin et al., 2017; Truman et al., 2019). Authors differed in their exact wording of these concepts (sex assigned at birth was sometimes referred to as “natal sex”) and studies differed in which gender identities they offered as options for respondents to pick from (male, female, transgender, nonbinary, etc.). The strength of a two-item measure is that cross-referencing respondents’ current gender identity with their sex assigned at birth allows researchers to identify transgender respondents who do not primarily identify as transgender or nonbinary and instead select “male” or “female” when asked about their gender identity. Some authors recommend a one-item measure of transgender identity (Do you identify as transgender? Y/N) if there is not enough space for two items. Such a question is most beneficial when used in conjunction with an additional question about respondents’ gender identity since it does not by itself capture current gender identity. While being transgender may be one part of a respondent’s gender identity, additional questions are needed to measure respondents’ current gender identity of male, female, nonbinary, or other identities. 

One study noted anecdotal feedback from transgender people that they are uncomfortable being asked about the sex assigned on their birth certificate, but nothing in the research literature has empirically established this (Federal Interagency Working Group on Improving Measurement of Sexual Orientation and & Gender Identity in Federal Surveys, 2016). Given the large amount of transphobia and invalidation that transgender people experience about their gender identities in all sectors of society, it is understandable that for some transgender people being asked about the sex they were assigned at birth can feel invalidating. Such questions could unintentionally imply to individuals that historical assignment is more important than their gender identity. However, establishing a transgender person’s sex assigned at birth may be important to the research study if the researchers are studying health or social issues which are related to a person’s assigned sex. 

Insights from Trevor’s National Survey on LGBTQ Youth Mental Health

The following data are from The Trevor Project’s National Survey on LGBTQ Youth Mental Health. Survey items and data from our 2019, 2020, and 2021 surveys are discussed. As these data are part of large non-probability samples of LGBTQ youth rather than probability samples of the broader population of youth, additional research is needed to understand how our findings apply to broader populations of youth in the U.S. which include predominantly heterosexual and cisgender identities. 

Sexual Orientation Survey Items

While sexual orientation has multiple components, The Trevor Project uses a survey item about sexual identity to assess respondents’ sexual orientation. This is because many of the youth in our sample are not yet sexually active and because sexual identity can serve as a proxy for sexual orientation. Meyer’s (2003) theory of minority stress also attributes health disparities to stressors that are associated with membership in a stigmatized group, meaning that self-identification can be used in studies of stigma and health disparities. 

In The Trevor Project’s 2019 survey, sexual orientation was assessed using the National Center for Health Statistics’ (Miller & Ryan, 2011) sexual orientation question: “Do you think of yourself as:” with the options 1) gay or lesbian, 2) straight, that is not gay or lesbian, 3) bisexual, 4) something else, and 5) don’t know. There were also multiple follow-up options for youth who selected “something else” as well as a write-in option. While 78% of LGBTQ youth between the ages of 13-24 responded that their sexual orientation was gay, lesbian, or bisexual, a full 21% selected the option for “something else.” 

The vast majority of youth who wrote in a sexual orientation provided a single additional label such as pansexual, queer, asexual, polysexual, abrosexual, graysexual, androsexual, masexual, and omnisexual, among others. A substantial portion of the write-in responses also contained distinctions between sexual and romantic attractions. This was particularly true for youth who identified on the asexual spectrum and used this question as an opportunity to also identify their romantic attractions (e.g., asexual aromantic, asexual panromanic, or asexual homoromantic). There were also youth who provided a combination of two or more sexual orientations (e.g., pansexual and queer) or the combination of a sexual orientation and a relationship type (e.g., pansexual, polyamorous). These various combinations of attraction labels and relationship types suggest that many youth can consider and articulate the different aspects of sexual orientation. In this sense, these write-in responses appear to be an attempt for youth to explain the complexity of sexual orientation in their own words (The Trevor Project, 2020).

In both 2020 and 2021, the Trevor Project used two survey items to measure youth respondents’ sexual orientation in our National Survey on LGBTQ Youth Mental Health. Based on responses to the 2019 survey which indicated that 92% of LGBTQ youth would have been captured if labels of “pansexual” and “queer” were included, compared to 78% using only gay, lesbian, and bisexual, these identities were added to the primary sexual identity item. The first item asks youth to identify the option that best describes their sexual orientation from a list of 7 options: 1) straight or heterosexual, 2) gay or lesbian, 3) bisexual, 4) queer, 5) pansexual, 6) I am not sure, and 7) I don’t know what this question means. In the instructions for this question, youth are informed that in the next question they will have the ability to indicate other identities, but for this question, they are to select the one identity that best describes them. To provide youth with a place to provide greater nuance to their identity, the second item asks youth if they have any other ways of describing their sexual orientation and offers a longer list of over 30 options, including but not limited to asexual, omnisexual, and sapphic. Youth respondents were asked to select any label which they felt described their sexual orientation. A write-in option was also available for this part of the question. Using these two questions allowed youth the ability to provide the nuance of their sexual orientation, while also providing researchers with 1) indicators of terms that may be rising in popularity in the LGBTQ community, and 2) mutually exclusive sexual orientation data from the first question which asked youth to select the identity that best describes them rather than requiring researchers to group youth into the smaller analytic categories that may or may not best describe them to facilitate quantitative analyses (Wilson et. al., 2016; B.D.M. Wilson, personal communication, July 3, 2019). 

Based on data from our 2020 and 2021 surveys, the majority of youth who declined to select a category in the first question, described themselves as asexual or ace spectrum in the second question. As such our 2022 survey provides the label, “asexual” in the mutually exclusive list of sexual identities. Additionally, to allow youth the greatest amount of flexibility in describing their sexual orientation, in 2022 we will first allow youth to use their own words to describe their identity, followed by a request to select the label that best fits them. 

Recommended Survey Questions for Sexual OrientationOpen Response Leading Question Version: 
Sexual orientation is a person’s emotional, romantic, and/or sexual attractions to another person. There are many ways a person can describe their sexual orientation and many labels a person can use. How would you describe your current sexual orientation in your own words? ______________________________________________________________Thank you for telling us about your sexual orientation in your own words. Sometimes we have to create categories to make it easier to understand our findings, and we want to make sure you are represented in the best category.
Which of these options best describes your sexual orientation? We understand that there are many different ways you may identify, please pick the one that best describes you.
-Straight or heterosexual
-Gay
-Lesbian
-Bisexual
-Queer
-Pansexual
-Asexual
-I am not sure
-I don’t know what this question means
-Decline to answer

Single item:Sexual orientation is a person’s emotional, romantic, and/or sexual attractions to another person There are many ways a person can describe their sexual orientation and many labels a person can use. Which of these options best describes your sexual orientation?
-Straight or heterosexual
-Gay
-Lesbian
-Bisexual
-Queer
-Pansexual
-Asexual
-I am not sure
-I don’t know what this question means
-Decline to answer

Abbreviated single item:Sexual orientation is a person’s emotional, romantic, and/or sexual attractions to another person There are many ways a person can describe their sexual orientation and many labels a person can use. Which of these options best describes your sexual orientation?
-Straight or heterosexual
-Gay or lesbian
-Bisexual, pansexual, or queer
-Asexual
-I am not sure
-I don’t know what this question means
-Decline to answer
Gender Identity Survey Items

In our 2019 survey, gender identity was assessed using a two-stage question described by the GenIUSS Group in their 2014 report. The first question asked youth, “What sex were you assigned at birth? (meaning the sex showing on your original birth certificate)” with options of either male or female. The second question asked, “What is your gender identity? Please select all that apply.” Response options included: 1) man; 2) woman; 3) trans male/trans man; 4) trans female/trans woman; 5) genderqueer/gender non-conforming; 6) different identity (please state). Data from this question indicated that the majority of those who selected, “different identity,” indicated that they were nonbinary or genderfluid. Additionally, some transgender youth in our 2019 sample used the “different identity” response as a place to express concern and disappointment that the terms “man” and “woman” were presented separately from “transgender man” and “transgender woman,” implying that transgender men and women are not simply men and women. Additionally, if used in isolation from a sex assigned at birth item, this gender identity item would not provide the level of detail needed to determine which participants were transgender, as those individuals could select either man/woman or trans man/trans woman. Thus, in our 2020 survey we adapted this item to be 1) mutually exclusive to facilitate analyses, 2) to remove differentiation between man/woman and transgender man/woman in the gender identity question, and 3) to include nonbinary and genderfluid identities. Our 2020 and 2021 measures of gender identity, therefore, asked youth to identify the option which best described their gender identity and offered the options: 1) Girl or young woman, 2) Boy or young man, 3) Non-binary, genderfluid, or gender non-conforming, 4) I am not sure or questioning and 5) I don’t know what this question means. Given changes in the frequency of usage for the term “gender non-conforming,” as well as its association with gender expression for both cisgender and transgender individuals, we have replaced “gender non-conforming” with “genderqueer” in our upcoming 2022 survey. 

The 2020 and 2021 surveys also included a question asking youth about their intersex status: “Some people are assigned male or female at birth but are born with sexual anatomy, reproductive organs, and/or chromosome patterns that do not fit the typical definition of male or female. This physical condition is known as intersex. Are you intersex?” 

Recommended Two-Stage Questions for Youth Gender IdentityOpen Response Lead-in Option:Gender identity is how someone feels about their own gender. There are many ways a person can describe their gender identity and many labels a person can use. How would you describe your current gender identity in your own words? ____________________________Thank you for telling us about your gender identity in your own words. Sometimes we have to create categories to make it easier to present our findings and we want to make sure you are represented in the best category. Which of the following terms best describes your current gender identity? We understand that there are many different ways you may identify, please pick the one that best describes you.
-Girl or woman
-Boy or man
-Nonbinary, genderfluid, or genderqueer
-I am not sure or questioning
-I don’t know what this question means
-Decline to answer
AND
What sex were you assigned at birth, on your original birth certificate?
-Male 
-Female
-Decline to answer
OR

Without Open Response Lead-in:Gender identity is how someone feels about their own gender. There are many ways a person can describe their gender identity and many labels a person can use. Which of the following terms best describes your current gender identity?
-Girl or woman
-Boy or man
-Nonbinary, genderfluid, or genderqueer
-I am not sure or questioning
-I don’t know what this question means
-Decline to answer

AND

What sex were you assigned at birth, on your original birth certificate?
-Male 
-Female
-Decline to answer

Order of two-stage question: Several studies in our literature review stated that future research was needed about the order of questions when using a two-item measure of gender identity. Based on the recommendation of a leading SOGI measurement expert (Wilson et al., 2016; B.D.M. Wilson, personal communication, July 3, 2019), we randomized the order of presentation of our two items asking youth respondents about their gender identity in our 2020 National Survey. Half of the respondents were asked about their sex assigned at birth first while the other half were asked about their current gender identity first. 

Our analysis found that the order of questions does not appear to impact the rate of declining to answer the question among transgender and nonbinary respondents. Among transgender and nonbinary identified respondents who were asked first about the sex assigned on their original birth certificate, 1.7% declined to answer the question on sex assigned at birth. Among respondents who were asked about their gender identity first, 1.6% declined to answer the sex assigned at birth question. 

Decline to Answer Rates Based on Two-Stage Gender Identity Question Order from The Trevor Project’s 2020 National Survey on LGBTQ Youth Mental Health
Question Order – Sex Assigned at birth firstDecline to Answer, n (%)
Sex Assigned at Birth 81 (1.7)
Gender Identity7 (0.1)
Question Order – Gender identity first
Gender Identity3 (0.1)
Sex Assigned at Birth76 (1.6)

Transgender and Nonbinary Identity. In addition to the two-item measure of gender identity, we also employed stand-alone questions designed to assess whether or not a youth identifies as transgender or nonbinary. Such questions are useful if researchers do not want to ask about participants’ sex assigned at birth. However, this question provides less detail about a person’s gender identity than the use of a two-stage question. In 2020, we included a single question that combined transgender and nonbinary identities, while in 2021 and 2022 we separated the identities to better understand the relationship between the two and to provide more nuance to the definition of nonbinary. Our item on transgender identity was based on the CDC’s YRBS question, with minor modifications made to the item stem, and with the addition of nonbinary to the single item version to better capture gender identities outside of exclusively cisgender.

Recommended Transgender and Nonbinary Identity QuestionsCombined Single Item:Some people describe themselves as transgender and/or nonbinary when the way they think or feel about their gender is different from their sex assigned at birth. Do you identify as transgender and/or nonbinary?
-No, I am not transgender and/or nonbinary 
-Yes, I am transgender and/or nonbinary
-I am not sure yet or questioning if I am transgender and/or nonbinary
-I don’t know what this question is asking
-Decline to answer

Separate Items: Some people describe themselves as transgender when the way they think or feel about their gender is different from their sex assigned at birth. Do you identify as transgender?
-No, I am not transgender
-Yes, I am transgender
-I am not sure yet or questioning if I am transgender
-I don’t know what this question is asking
-Decline to answer.

Some people describe themselves as nonbinary when the way they think or feel about their gender is beyond exclusively male or exclusively female. This can include, but is not limited to, identifying as having no gender, having a gender somewhere between male and female, having a mix of male and female, identifying outside of male and female gender identities. Do you identify as nonbinary?
-No, I am not nonbinary 
-Yes, I am nonbinary
-I am not sure yet or questioning if I am nonbinary
-I don’t know what this question is asking
-Decline to answer

Data from separate assessments of transgender and nonbinary identity indicate that “transgender” and “nonbinary” are similar identities with much overlap, but they are not synonyms that can be used interchangeably. In 2021, using two separate questions, 3,226 (9.3%) of all LGBTQ youth respondents reported that they identified exclusively transgender, 2,575 (7.4%) reported that they identified exclusively as nonbinary, and 4,386 (12.6%) endorsed both transgender and nonbinary identities. 

There was also overlap in youth who identified as either transgender or nonbinary and were questioning whether or not the other identity felt right for them. Among respondents who identified as transgender, 919 (10.7%) reported that they were questioning or not sure yet if they are nonbinary. Among respondents who identified as nonbinary, 1,823 (20.3%) reported that they were questioning or not sure yet if they are transgender. This suggests that while there is overlap between transgender and nonbinary identities, there are many youth who identify as one but not the other as well as youth who identify with one but are questioning or unsure about identifying with the other. Further research is needed to examine how these groups are similar and different and to determine when a comparison between or among them is analytically useful.

Overlap of Transgender and Nonbinary Identities in The Trevor Project’s 2021 National Survey on LGBTQ Youth Mental Health
Transgender and Nonbinary Identities (n=34,759)Number of Youth, n (%)
Only identify as transgender 3,226 (9.3)
Only identify as nonbinary2,574 (7.4)
Identify as both transgender and nonbinary4,386 (12.6)
Questioning among transgender (n=8,571) and nonbinary (n=8,998) identitiesNumber of Youth, n (%)
Identify as transgender, questioning nonbinary919 (10.7)
Identify as nonbinary, questioning transgender 1,823 (20.3)

Response Rates for SOGI Measures. To address concerns about youth discomfort disclosing sexual orientation and gender identity information with researchers, we examined rates at which youth declined to answer or indicated they didn’t understand these items on our 2020 and 2021 surveys. In particular, it has been anecdotally reported that transgender respondents may skip questions about their sex assigned at birth due to discomfort with being associated with their “former” gender. 

Our questions about respondents’ current gender identity and sexual orientation had very low rates of non-response, ranging from 0.1% to 0.8% who declined to answer and ranging from less than 0.01% to 0.3% who reported they did not understand the question. Our questions on sex assigned at birth and intersex identity did not have an option for “I don’t understand this question,” which did not enable us to separate those who didn’t understand the question from those who declined for other reasons. However, although slightly elevated from other SOGI items, our decline to answer rates for our item on intersex status (1.9% in 2021 and 1.3% in 2020) and sex assigned at birth (1.5% in 2021 and 0.5% in 2020) remained low. Overall, the non-response rates for all sexual orientation and gender identity items were substantially lower than many other survey questions, including questions about respondents’ zip code (33.2% in 2021 and 38.8% in 2020) and financial situation (11.8% in 2021 and 10.7% in 2020). Rates of youth reporting that they did not understand questions about sexual orientation were near zero. Further, less than one percent of youth reported that they did not understand the questions about current gender identity, identifying as transgender, or identifying as nonbinary. This suggests that our sexual orientation and gender identity items were understood by almost all LGBTQ youth ages 13-24 who completed our surveys. 

Sexual Orientation and Gender Identity Item Non-Response Rates from The Trevor Project’s 2020 and 2021 National Survey on LGBTQ Youth Mental Health
2020 National Survey (n=40,001 youth), n(%)2021 National Survey (n=34,759 youth), n(%)
QuestionDecline to answerI do not understand the questionDecline to answerI do not understand the question
Sex Assigned at Birth212 (0.5)514 (1.5)
Gender Identity64 (0.2)34 (0.1)43 (0.1)27 (0.1)
Identify as Transgender207 (0.5)119 (0.3)281 (0.8)112 (0.3)
Identify as Nonbinary143 (0.4)57 (0.2)
Identify as Intersex518 (1.3)660 (1.9)
Sexual Orientation136 (0.3)15 (0.0003)227 (0.7)10 (0.0002)

RECOMMENDATIONS

Based on a combination of our own data collection experiences and our review of the literature on SOGI measurement best practices, we offer the following recommendations for measuring SOGI in youth populations. 

Be Intentional About Item Selection

Researchers should be intentional about which part of a person’s SOGI experience is of interest to them, how they will capture that via survey questions, and how they will construct theoretically comparable groups. There is tremendous diversity of experience within each SOGI identity category. Researchers must be attentive in ensuring that they are creating analytical categories that can be effectively compared to one other in ways that best answer their research questions. Further, as with any research construct, researchers should match the information they gather with the purpose of their research study. Because many LGBTQ people may have experienced intrusive questions about their sexual orientation and gender identity, participants may be put off by survey questions that feel intrusive or are not connected to the research question. Researchers may also consider providing a rationale to participants explaining why they are being asked various questions and how their answers will be used in analysis and study dissemination.

  • Researchers should consider which identity categories (e.g. bisexual vs. bisexual woman) are most meaningful for their work. For example, respondents who identify as bisexual, pansexual, or another multisexual identity often have different experiences and outcomes compared to respondents who identify as gay or lesbian (Price, Green, & Davis, 2021). Further, transgender people who were assigned female at birth may have different experiences from those who were assigned male at birth, particularly related to healthcare and experiences of victimization and discrimination. Researchers should examine existing data and their own hypotheses to determine which categorical labels will be most useful for their study, while also balancing attention to youth desires to express their identity fully.
  • Researchers should consider which components (e.g. sexual behavior vs. sexual identity) of SOGI are most central to their work. There are multiple components to both sexual orientation and gender identity. In most cases, questions on self-reported sexual identity and a two-staged question on gender identity will be the most relevant way to understand the association of sexual orientation and gender identity with youth experiences. Researchers should be intentional about asking youth questions that align with the research they are undertaking. For example, a public health researcher studying the transmission of HIV among LGBTQ youth who engage in sex work may want to ask detailed questions about the participants’ sexual behaviors, asking about the number and genders of youths’ sexual partners, perhaps even asking about specific sexual acts or body parts to accurately determine participants’ risk. This researcher may also want to consider including questions about identity and attractions in addition to behavior if they wanted to draw connections between how these aspects of identity influence transmission risk. Conversely, a researcher studying LGBTQ people’s experiences in the workplace would not need detailed information about a participant’s sexual activities but may be more interested in how respondents express their LGBTQ identity to colleagues and others they interact with in their workplace. For studies that require additional information about sexual behavior, researchers should be very careful to not construct questions based on heteronormative and cisnormative assumptions about body parts or sexual activities. For example, researchers should not assume that sex between men and women automatically includes risk for pregnancy, since one or both partners may be transgender. 

Attend to Developmental Considerations

Our research shows that nearly all LGBTQ youth ages 13-24 were able to understand our questions around sexual orientation and gender identity, and provided additional levels of detail and nuance around their identity. Further, because young people are often not yet sexually active and may still be figuring out their sexual orientation, it is important that researchers understand the ways in which sexual attraction, sexual behaviors, and sexual identity may differ among young people as well as gender expression and gender identity. 

  • Offer questions that allow youth to express a diversity of sexual orientation and gender identity labels. Youth samples, particularly among Generation Z, are increasingly more diverse in their sexual and gender identities and endorsing identities outside of the traditional binary understanding of sexuality and gender. This further supports the need to offer a diverse range of options for youth endorsement. We observe a growing number of youth self-identifying as “queer,” “pansexual,” and “asexual.” Additionally, nonbinary, genderqueer, and genderfluid are often used by youth to describe their gender as something outside of exclusively male or exclusively female. Therefore, we recommend including these identities as options for youth. Some research suggests that adding identity options may decrease non-response rates (Federal Interagency Working Group on Improving Measurement of Sexual Orientation and & Gender Identity in Federal Surveys, 2016; Ridolfo et al., 2012). Adding additional items also improves data quality, since youth who do not see their identity represented in item options may opt to select a category that does not apply to them or “other,” a category often excluded from analytical samples. 
  • In longitudinal studies, consider ways that sexual orientation and gender identity might change over time. Given developmental changes that occur as youth explore and understand their identities, follow-up surveys should continue to include SOGI measurement items to capture changes that may occur over time, rather than assuming a static identity derived from a baseline assessment. 

Consider Item Placement and Order

Based on our review of the literature, we recommend that SOGI questions be included among demographic questions or among other questions about sexual health (Gender Identity in U.S. Surveillance Group, 2014; Sexual Minority Assessment Research Team, 2009). When possible, SOGI questions should be in self-administered sections of surveys or interviews, for maximum privacy. In cases of youth taking paper-and-pencil surveys in community settings, SOGI items should not be located on a page that is easily readable to others, such as the cover page (Gender Identity in U.S. Surveillance Group, 2014; Sexual Minority Assessment Research Team, 2009). Researchers should also consider the ordering of questions in developing their surveys to provide the best survey experience to youth and minimize non-response bias.

  • SOGI items should be situated within other questions about youth identity rather than within potential risk behavior questions. Placing SOGI items within a demographic data section allows youth to express this aspect of their identity in the same way they would their age, race/ethnicity, or geographic location. Surveys that place SOGI items with data on risk behaviors or negative life experiences such as sexual assault or unwanted pregnancies may suggest to youth that their identity is viewed negatively by the researcher. Our own research places SOGI questions immediately after the first questions on age and state, and we have found very low non-response rates for these items.
  • Presentation of questions about sex assigned at birth should consider participant experience along with data quality. Although analysis of our National Survey data shows that there are no significant differences in participant response rates based on the order of the two-stage gender identity items, there is a need for further data on how participants interpret the different ways of ordering this question. For transgender people who have fought to be affirmed in their gender identity, it can feel jarring to be asked about the gender designation that someone else chose for them as a newborn.  To address these feelings, it may be helpful to provide youth with a rationale about why they are being asked these questions and to let them know that they will be given the opportunity to provide both their current gender and sex assigned at birth. 

Balance Nuance and Analytic Utility 

The LGBTQ youth who complete our surveys consistently indicate a desire to express SOGI with a level of detail and nuance that goes beyond the mutually exclusive options which provide the most utility for research practices. To address this tension, we recommend finding ways to allow youth to both describe their identity with the words they use and to self-select into a mutually exclusive category to facilitate quantitative analyses. 

  • Allow youth space to provide descriptions of their sexual orientation and gender identity in addition to a mutually exclusive category. In our most recent survey, we provide an open-ended question first, which allows youth to describe their genders and sexualities with terms and language that feels most authentic to them. We then provide an explanation for a second question requiring them to select a mutually exclusive category to facilitate our research. Oftentimes researchers conduct their own grouping of qualitative labels and data to create meaningful categories, our approach 1) allows youth the ability to self-describe themselves with the best option, and 2) does not require researcher time and effort to categorize the open-end data before beginning analyses.
  • Continue to collect data to inform trends in identity labels used by youth. The use of a longer identity list option or open-ended question can also facilitate the identification of labels that are most representative of the population. For example, our use of write-in options and longer checklists of identity labels have enabled our team to determine that pansexual, queer, and asexual were the most common sexual orientations outside of heterosexual, gay, lesbian, and bisexual and that nonbinary was the overwhelming term used for youth who identified outside of the gender binary. 

Continue to Examine and Refine SOGI Items for Youth

Our data on SOGI measurement are derived from an LGBTQ-identified sample; as such, there is a continued need to examine and test SOGI items with general population samples of youth. Additionally, cognitive testing and continued data collection can facilitate researcher awareness of the ways in which youth of all sexualities and genders understand and discuss these aspects of their identity.

  • Continue to test and refine SOGI items with broader populations of youth in the U.S. and beyond. Although our suggested items have very low non-response rates and rates of not understanding the question, there is still a need for data on how general populations of youth might respond to these items. Evidence suggests that today’s youth are the most aware of expanded sexual orientations and gender identities compared to past generations; however, cognitive testing with samples of non-LGBTQ youth should be conducted to ensure that nearly all youth can understand and accurately answer SOGI questions. Further, the identities shared in this document reflect experiences with English-speaking LGBTQ youth ages 13-24 in the U.S. Given changes in not only linguistic but also cultural uses of these terms, further research should be conducted with other cultures to determine the best approaches for diverse youth.
  • Continue refining and updating measures as youth language often changes over time. Recent data suggests that Generation Z youth are increasingly identifying in ways that are outside of exclusively heterosexual or cisgender. The items suggested in this survey represent our data-informed approaches to inclusive measurement at this point in time. However, given historical and continued trends and changes in the language used to define members of the LGBTQ community, researchers should continue to qualitatively and quantitatively examine the language used by youth to describe their sexual orientation and gender identity. As language can quickly change (e.g., from gender non-conforming to nonbinary as the primary way of describing those who do not identify as exclusively male or female), researchers should be prepared to continue refining and adapting SOGI measures over time to best represent the youth who will be answering them.

CONCLUSION

It is imperative that surveys provide inclusive questions about sexual orientation and gender identity. To continue the fight for LGBTQ inclusion, we need accurate data about who LGBTQ youth are and what kinds of barriers they experience. Asking survey respondents about their LGBTQ identities also destigmatizes conversations about those identities. This report has discussed historical approaches and best practices for measuring sexual orientation and gender identity in survey research, offering insight from our surveys with LGBTQ youth. We encourage all researchers to include both sexual orientation and gender identity among their various measures of demographic characteristics so that we can develop accurate scientific understandings of the experiences and needs of LGBTQ people. Further, in addition to improving the collection of SOGI data in surveys, there is also a need to focus on ways to improve the collection of SOGI data in other areas, such as in reports of violent deaths. The Trevor Project is committed to ensuring LGBTQ inclusion in data collection for better public policy, better mental health assessment and intervention, and better science. We hope that others will join us in the fight for LGBTQ people to be seen and counted as who we are in data collection, analysis, and ultimately, society at large. 

The authors of this report acknowledge and extend our deepest thanks to Dr. Bianca D.M. Wilson for providing guidance on the development of appropriate survey items and methods to ask youth about their sexual orientation and gender identity

ABOUT THE TREVOR PROJECT

The Trevor Project is the world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people. The Trevor Project offers a suite of 24/7 crisis intervention and suicide prevention programs, including TrevorLifelineTrevorText, and TrevorChat as well as the world’s largest safe space social networking site for LGBTQ youth, TrevorSpace. Trevor also operates an education program with resources for youth-serving adults and organizations, an advocacy department fighting for pro-LGBTQ legislation and against anti-LGBTQ rhetoric/policy positions, and a research team to discover the most effective means to help young LGBTQ people in crisis and end suicide. If you or someone you know is feeling hopeless or suicidal, our trained crisis counselors are available 24/7 at 1-866-488-7386 via chat www.TheTrevorProject.org/Help, or by texting START to 678-678.

This report is a collaborative effort from the following individuals at The Trevor Project:

Jonah DeChants, PhD
Research Scientist

Amy E. Green, PhD
Vice President of Research

Myeshia N. Price, PhD
Senior Research Scientist

Carrie Davis, MSW
Chief Community Officer

Recommended Citation: DeChants, J., Green, A.E., Price, M.N, & Davis, C. (2021). Measuring Youth Sexual Orientation and Gender Identity. West Hollywood, CA: The Trevor Project.

Media inquiries:

Kevin Wong
Vice President of Communications
[email protected]
212.695.8650 x407

Research-related inquiries:

Amy Green, PhD
Vice President of Research
[email protected]
310.271.8845 x24

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