Historically, the gender binary, or the classification of gender into two distinct, opposite forms (masculine and feminine), was the prevailing system of gender classification. However, not everyone identifies as being exclusively male or female, and not everyone’s gender identity matches the sex that they were assigned at birth.

A person may identify as being male, female, a mix of both, or neither. Gender diverse individuals are people whose gender identity falls outside of the gender binary, meaning that they do not identify as solely male or female. Rather, they may identify as mostly male or female, a mix of both, or neither male nor female.

As a minority group, gender diverse people often face discrimination and/or a lack of social acceptance, which is detrimental to psychological and social well-being. What’s more, past research has indicated that these individuals may encounter difficulties in seeking gender affirming care that is not intended for “total masculinization or feminization” (Romani et al., 2021).

To explore the possible differences in psychological well-being between gender diverse and binary transgender individuals, as well as the potential role of perceived social acceptance in these differences, researchers recruited a group of 563 participants from several Italian gender clinics between February 2007 to December 2019.

• Of the 563 participants, 264 (46.89%) were people who were assigned female at birth, and 299 (53.11%) were assigned male at birth.
• The participants were between the ages of 18-70, and all of them experienced gender dysphoria according to the criteria specified by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). (Gender dysphoria is the distress an individual may feel when their gender identity does not match the sex they were assigned at birth. Not all gender diverse individuals experience gender dysphoria.)
• At the start of the study, the participants were asked to describe their gender on a continuum expressed by numbers from 0 to 100, with a rating of 0 indicating full identification with the gender they were assigned at birth and 100 indicating full identification with the opposite gender. Anyone with a score in the middle was considered gender diverse.
• As expected, none of the individuals indicated that they fully identify with the gender they were assigned at birth, but some indicated that they fully identify with the opposite gender. For the purposes of this study, these individuals were considered binary transgender people.

All of the participants were screened for depression and anxiety. They were also asked to complete the gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA), the discrimination and stigma scale (DISC), and the humiliation inventory (HI).

• The authors of this study found that gender diverse individuals had significantly higher depression scores than the binary transgender individuals.
• Gender diverse individuals also showed significantly higher levels of social anxiety (that could lead to the avoidance of ordinary social situations) than the binary transgender people.
• The DISC and HI scores of the gender diverse participants were also higher, indicating more severe experiences of discrimination (due to gender identity) and higher levels of humiliation.
• Regarding gender dysphoria, the gender diverse people had significantly higher GIDYQ-AA scores than the binary transgender people, meaning that the gender diverse participants experienced less intense gender dysphoria than the binary transgender participants.

Social alienation and the fear or experience of discrimination can be very harmful to a person’s overall well-being. When a group of people has been historically marginalized and discriminated against, it is very important for providers to consider how this situation could impact the psychological health of these individuals. Gender diverse individuals seeking gender affirming care should feel empowered to talk to their providers about mental health care resources if they are suffering from discrimination or other psychologically damaging situations.

Resources:

• Romani, A., Mazzoli, F., Ristori, J., Cocchetti, C., Cassioli, E., Castellini, G., Mosconi, M., Meriggiola, M.C., Gualdi, S., Giovanardi, G., Lingiardi, V., Vignozzi, L., Maggi, M., & Fisher, A.D. (2021). Psychological Wellbeing and Perceived Social Acceptance in Gender Diverse Individuals. The Journal of Sexual Medicine, 18(11), 1933-1944. DOI: https://doi.org/10.1016/j.jsxm.2021.08.012