Gender Identity Development Among Transgender and Gender Nonconforming Emerging Adults An Intersectional Approach

International Journal of Transgenderism
ISSN: 1553-2739 (Print) 1434-4599 (Online) Journal homepage: https://www.tandfonline.com/loi/wijt20
Gender identity development among transgender

and gender nonconforming emerging adults: An
intersectional approach
L. E. Kuper, L. Wright & B. Mustanski
To cite this article: L. E. Kuper, L. Wright & B. Mustanski (2018) Gender identity development
among transgender and gender nonconforming emerging adults: An intersectional approach,
International Journal of Transgenderism, 19:4, 436-455, DOI: 10.1080/15532739.2018.1443869
To link to this article: https://doi.org/10.1080/15532739.2018.1443869
Published online: 25 Apr 2018.
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INTERNATIONAL JOURNAL OF TRANSGENDERISM
VOL. 19, NO. 4, 436–455
https://doi.org/10.1080/15532739.2018.1443869
Gender identity development among transgender and gender nonconforming

emerging adults: An intersectional approach
L. E. Kupera,b, L. Wrightc, and B. Mustanskid
a
Department of Endocrinology, Children’s Health Texas, Dallas, Texas, USA; bDepartment of Psychiatry, University of Texas Southwestern, Dallas,
Texas, USA; cDepartment of Psychology, City University of New York, New York, USA; dDepartment of Medical Social Sciences, Institute for Sexual
and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
ABSTRACT KEYWORDS
Background: The present study used an intersectional framework to elucidate similarities and Gender development;
differences in the gender-related experiences reported by a diverse sample of transgender and gender identity; identity
gender nonconforming emerging adults (n D 20, age 19–22). The first aim was to identify development;
dimensions of gender-related experience that captured how participants describe, relate to, and intersectionality; sexual
orientation; transgender;
express their gender-related sense of self. The second aim was to identify intrapersonal processes transsexualism
that supported the development of participants’ gender-related sense of self across these
dimensions.
Methods: Semi-structured qualitative interviews were conducted and data was analyzed using an
inductive process of constructivist grounded theory.
Results: Dimensions of gender-related experience included gender identity (e.g., internal sense of
one’s gender, how one wishes others to perceive their gender, gender identity labels), gender
presentation (e.g., clothing, make-up, style), gender expression (e.g., role in relationships and
interactions, interests/activities, personality), and physical self-image (e.g., desired primary and
secondary sex characteristics). Intrapersonal processes included awareness, exploration, meaning
making, and integration. Being able to fully express one’s gender and having this sense of self
accurately reflected back by others was important to all participants. However, much variation
existed in gender-related experience, including how participants described their internal sense of
self, expressed and communicated this sense of self, and related to others of similar and different
genders.
Conclusion: The intersectional approaches of both intercategorical and intracategorical complexity
were useful in conceptualizing these similarities and differences in experience.
Understanding how to best support the healthy particular sex.” The term transgender is typically
development of diverse transgender and gender defined more narrowly to reflect the experience of
nonconforming (TGNC)1 people is critical to the specifically identifying with a gender other than
provision of culturally sensitive healthcare, educa- that associated with one’s assigned sex. As seen in
tion, and other social services (Drescher & Byne, standards of care, treatment guidelines, and educa-
2012). However, research on the development of tional materials, professionals within the field are
TGNC individuals remains limited, particularly in increasingly using the term TGNC to refer to these
its ability to fully account for the diversity of gen- populations as a whole, likely due to the shared
der-related experiences within this population. As experiences of stigma, minority stress, and gender
defined by the World Professional Association for dysphoria (American Psychological Association,
Transgender Health (Coleman et al., 2012), “gender 2015; Coleman et al., 2012; Singh & Dickey, 2017).
nonconformity refers to the extent to which a per- However, little is known regarding the similarities
son’s gender identity, role, or expression differs and differences in how TGNC individuals come to
from the cultural norms prescribed for people of a understand their sense of self in relation to gender,
CONTACT L. E. Kuper laura.kuper@childrens.com 1935 Medical District Drive, Dallas, TX 75235, USA.
1
Gender diverse, gender expansive, and non-binary are increasingly used alternatives to the term gender nonconforming that are preferred due to being less
suggestive of inherent pathology. The term transgender and gender non-conforming (TGNC) was retained in the present manuscript since this was the term
and framework that was used when the study was conducted. Throughout the present manuscript we attempt to be mindful of the potential strengths and
weaknesses of this method of grouping people’s gender-related experiences.
© 2018 Taylor & Francis Group, LLC
INTERNATIONAL JOURNAL OF TRANSGENDERISM 437
or the strengths and weaknesses associated with while witnessing involves having one’s sense of self
grouping these diverse TGNC individuals into a accurately reflected back by others who do not
shared population. share such similarity. This perspective builds of off
Further, a number of social and cultural shifts Nuttbrock, Rosenblum, and Blumenstein (2002)) con-
appear to be influencing the ways that TGNC individ- ceptualization of transgender identity affirmation,
uals understand, experience, and communicate their which also includes the ability to express one’s
gender-related experiences (Bockting, Benner, & gender identity via appearance and adoption of the
Coleman, 2009; Ehrensaft, 2012; Kuper, Nussbaum, & desired gendered social role. Consistent with research
Mustanski, 2012; Meyer, 2012). These shifts are occur- highlighting the effectiveness of gender affirming
ring alongside the lengthening of the developmental medical care including hormones (e.g., testosterone,
periods of adolescence and young adulthood. This estrogen), “top” surgery (e.g., mastectomy, breast aug-
new context of “emerging adulthood” is associated mentation), and “bottom” surgery (e.g., phalloplasty
with a delay in the major commitments of adulthood or vaginoplasty) (Murad et al., 2010), transgender
(e.g., marriage, child rearing, career) and an increase identity development models also emphasize the role
in availability of time and settings (e.g., college, the of medical transition as well as the recalled distress
Internet) to further explore one’s identities, overall associated with pubertal changes. Although widely
sense of self, and worldview (Arnett, 2000, 2014; Mor- cited within the literature, a number of criticisms of
gan, 2013). While previous studies of gender identity stage models have been raised including concern that
development have relied almost exclusively on adult such models obscure generational/cohort, geographi-
samples, research suggests that key aspects of gender cal, and subcultural differences and imply a linear and
identity development and transition (e.g., changing progressive developmental course (Bilodeau & Renn,
name, pronoun, appearance, pursuing gender affirm- 2005; Savin-Williams, 2011).
ing medical care) occur during this period of emerging Narrative perspectives identify making meaning of
adulthood. Results from the largest study of TGNC one’s experience as central to the identity development
individuals to date (U.S. Transgender Survey, n D process. Narratives have been conceptualized as per-
27,715) found that 58% of participants started to dis- sonal frameworks for understanding and communi-
close their gender identities to others between the ages cating one’s experiences in a way that orients and
of 16 and 25 years old and 43% first started taking lends coherence to one’s past, present, and future
steps in transition between the ages of 18 and 24 sense of self (Cohler & Hammack, 2007; Mason-
(James et al., 2016). Schrock, 1996). Self-narratives are thought to develop
through both interactions with others as well as
engagement with larger social narratives that reflect
Gender identity development
common themes about what it means to be a gender
Previous research has utilized both stage and narrative or sexual minority, for example (Hammack, Thomp-
based approaches to conceptualize the development of son, & Pilecki, 2009). While primarily developed in
transgender individuals’ gender-related sense of self reference to sexual orientation identity development,
(e.g., Bolin, 1998; Coleman, 1982; Devor, 2004; Lev, narrative perspectives appear to offer utility in under-
2004; Troiden, 1979). Stage models first emerged to standing the process of gender identity development,
represent the identity development of sexual minority with both gender and sexual minority narratives
(e.g., LGB, lesbian, gay, and bisexual) individuals, but appear to be evolving to reflect greater diversity, fluid-
have since been adapted to incorporate the unique ity, and self-determination (Bornstein & Bergman,
experiences of transgender individuals. Both transgen- 2010; Feinburg, 1999; Mock, 2014). For example, early
der and LGB models reflect intrapersonal processes of perspectives on transsexual identity often reflected a
exploring, affirming, and integrating one’s identity. narrative of being “born in the wrong body” and
Within transgender populations, Devor (2004) identi- viewed hormonal and surgical interventions as neces-
fies additional interpersonal processes of witnessing sary to achieve normalcy and authenticity of one’s
and mirroring that support progression through these “true self” (Bolin, 1998). However, clinicians as well as
stages. Mirroring refers to being seen and feeling vali- transgender activists have argued that this narrative is
dated by others that one considers similar to oneself, overly reductionistic (Bockting, 2009; Serrano, 2007;
438 L. E. KUPER ET AL.
Spade, 2006). Newer research has highlighted the an individual group as well as the experiences of indi-
diversity of gender identities, gender expressions, and viduals whose group membership may be difficult to
desires for gender affirmation procedures within the define. In contrast to anticategorical approaches that
larger TGNC population. In the U.S. Transgender Sur- reject categories altogether, both approaches use cate-
vey (n D 27,715), 35% of respondents reported a gen- gorization strategically while acknowledging that all
der identity that was categorized as non-binary, 21% categories are dynamic as well as socially and cultur-
reported living “as neither a man nor woman” and ally constructed (McCall, 2005).
15% reported living part time as one gender and part Although not specifically conducted from a frame-
time as another (James et al., 2016). In a large study of work of intersectionality, research findings suggest
LGBT youth (n D 10,030), an even greater amount of that both of these intersectional perspectives can assist
TGNC young people wrote in a gender identity other in conceptualizing how TGNC individuals experience
than male, female, or transgender (6%) in comparison their sense of self in relation to gender. Intercategori-
to those who identified as transgender (3.2%) (Baum cal complexity is consistent with the increasingly com-
et al., 2013). mon but relatively recent practice of grouping TGNC
individuals into a larger category that reflects shared
experiences of being a gender minority. This practice
Intersectional framework
is supported by several studies of tomboy and butch
Within the present study we conceptualized gender identified women that suggest overlap with transgen-
development from an intersectional framework and der populations in identity development processes
focused on the ways in which participants describe, associated with challenging social gender norms sur-
relate to, and express their gender-related sense of self rounding desired secondary sex characteristics,
(Warner, 2008; Warner & Shields, 2013). Previous appearance, activities, and gender roles (Carr, 2005;
research by Nagoshi, Brzuzy, and Terrell (2012, 2014) Hiestand & Levitt, 2005). Intercategorical perspectives
and Diamond and Butterworth (2008) have identified can also be useful in elucidating shared experiences
intersectionality as a useful framework for under- within subgroups of the larger TGNC population. For
standing how transgender individuals experience gen- example, genderqueer or non-binary identified indi-
der and sexuality as multifaceted, dynamic, and viduals as a group appear to experience lower desires
mutually informative and have used this framework to for medical transition and more often describe their
explore similarities and differences in how transgen- identities in a social, political, and/or cultural context
der, LGB, and heterosexual people conceptualize gen- of challenging traditional gender norms and expecta-
der and sexuality. De Vries (2012, 2015) also draws on tions (Hansbury, 2005; Sycamore, 2006; Wilchins,
intersectionality to explore how transgender individu- Howell, & Nestle, 2002). Hansbury (2005) contrasts
als’ transition processes interact with self and others’ this subgroup with transsexual individuals who are
perceptions of concurrent identities and social catego- described as the most likely to utilize gender affirming
ries (e.g., race, class). However, we know of no other medical care and least likely to view their history of
study that has utilized an intersectional framework to gender transition as an important aspect of their sense
explore variations in gender-related experience within of self. However, consistent with the perspective of
and across subgroups of TGNC individuals. More spe- intracategorical complexity, researchers’ tendency to
cifically, we used a “both/and strategy” that combined rely on these categorization methods has also been
the intersectional perspectives of both intercategorical criticized as oversimplifying the complexities of gen-
complexity and intracategorical complexity (McCall, der-related experience and marginalizing the experi-
2005; Shields, 2008). This process involved “both com- ences of those who cannot be easily classified within
paring individual identities to each other as well as existing subgroups (Bettcher, 2014; Serano, 2007;
considering intersections and their emergent proper- Spade, 2006).
ties” (Shields, 2008). While intercategorical complex-
ity aims to identify and synthesize differences in
Research questions
experience across groups (e.g., gender non-conform-
ing versus transgender emerging adults), intracategor- While both intracategorical and intercategorical per-
ical complexity focuses on elucidating variation within spectives appear to offer significant utility, research
has yet to examine how they apply to gender identity Hockenberry & Billingham, 1987; Phillips & Over,
development within the TGNC population. Existing 1995) and current gender nonconformity (in reference
studies of TGNC identity development tended to focus to assigned sex) (Patton, 2002). Cutoffs were selected
more narrowly on a specific subgroup of the TGNC to correspond to the response choice indicating
population and the majority have been conducted that gender nonconforming behavior, personality,
with adult samples. The present study aimed to and appearance to others were “often” feminine for
address these gaps by adopting an intersectional those assigned male at birth or “often” masculine for
framework guided by the following research questions: those assigned female. Within this sample, we initially
What similarities and differences exist in the gender- sought out to match ten transgender with ten
related experiences of TGNC emerging adults? What participants of the same sex assigned at birth who did
intrapersonal processes support the development of not identify as transgender at baseline, but scored
TGNC emerging adults’ sense of self in relation to within 1=4 of a standard deviation of transgender par-
these gender-related experiences? We conducted ticipants on these measures (total n D 20). Transgen-
semi-structured qualitative interviews with twenty der participants were initially identified by their
racially diverse emerging adults (age 19–22) who all responses on the parent study’s questions assessing
reported high levels of gender non-conformity in ref- sex assigned at birth and gender identity (e.g., identi-
erence to their sex assigned at birth. We analyzed par- fied as Female-to-Male (FTM) or Male-to-Female
ticipants’ narratives of salient gender-related (MTF), or identified as male or female and noted a dif-
experiences using the inductive process of constructiv- ferent sex assigned at birth). However, some shifts in
ist grounded theory (Charmaz, 2006). Both intracate- identification occurred across the three waves of the
gorical and intercategorical perspectives were used parent study (T5 and N5, T8 and N8, who were
strategically to highlight similarities and differences in matched with each other) and subsequent interview
these gender-related experiences (Warner & Shields, data identified weaknesses in this method of assessing
2013). gender identity (N4, N6, T7, N9, N10), particularly
the lack of non-binary and write in options. Despite
Methods the limitations of this sampling technique, we found
that the selection process still resulted in a sample that
Participants and measures
was diverse in terms of gender identity and sex
Participants were recruited from an existing longitudi- assigned at birth, and thus, was still relevant to our
nal study of a community sample of 246 racially research questions.
diverse LGBT youth, ages 16–20 at baseline (for more Table 1 provides an overview of each participant’s
information on this sample, see Mustanski, Garofalo, pair match along with their responses to questions
& Emerson, 2010). These participants were recruited assessing birth sex, gender identity, gender nonconfor-
using flyers in LGBT youth centers, neighborhoods, mity, sexual orientation, and race/ethnicity. Partici-
and events, e-mail advertisements, and incentivized pants ranged in age from 19 to 22 and self-identified
peer recruitment. At enrollment, 8% of the sample with the following racial/ethnic groups: African Amer-
identified as transgender (n D 20) and all resided in or ican (55%), White (25%), Multi-Racial (15%), and
near the same major Midwestern city in the U.S. Par- Native American (5%). Participants assigned female
ticipants were recruited into the present study approx- were more likely to self identify as white (50% vs.
imately one and a half to two years following their 10%), self-report that their family was “upper class”
initial enrollment in the parent study, at which point (60% vs. 20%), and self-report completing at least
three waves of data collection had occurred with over some college (70% vs. 30%). Drawing on the intracate-
80% of the initial sample retained. No participants gorical and intercategorical framework, relevant com-
declined participation in the present study, but we parisons were made by participants’ affirmed gender,
were unable to contact several potential participants. sex assigned at birth, and self-identification as trans-
Purposeful sampling strategies were used to select gender (e.g., identified as a gender other than or in
participants from this larger sample based on their addition to sex assigned at birth) vs. non-transgender
self-reported experience of both childhood gender (e.g., retained assigned sex as current gender identity).
nonconformity (Boyhood/Girlhood Conformity Scale, References to “transgender men” and “transgender
440
Table 1. Overview of participants’ gender identities, ratings of gender nonconformity, and demographics by pair match.
Transgender participants Matched participants
Assigned Gender Gender Sexual Race/ ID Assigned Gender Gender Sexual Race/
ID Sex Identity1 Nonconformity2 Orientation Ethnicity Sex Identity1 Nonconformity2 Orientation Ethnicity
T1 Female Male, transgender, transsexual Childhood: 4.3 Asexual, other, “still White N1 Female Female Childhood: 4.3 Lesbian White
developing”
Femininity: 1.3 Femininity: 3.3
L. E. KUPER ET AL.
Masculinity: 5.3 Masculinity: 5

T2 Female Male, transgender, female to Childhood: 5.8 Queer White N2 Female “Don’t have a label”, Childhood: 5.5 Lesbian White
male androgynous
Femininity: 2.3 Femininity: 3
Masculinity: 5 Masculinity: 4
T3 Female Stud (“mix between man and Childhood: 5.5 Stud African N3 Female Woman Childhood: 5.5 Stud African
woman”) American American
Femininity: 1 Femininity: 1.7
T4 Female Queer, male Childhood: 6 Queer White N4 Female Female (described period of Childhood: 6 Lesbian Hispanic
considering male identity)
Femininity: 3.3 Femininity: 2
Masculinity: 4.7 Masculinity: 7
T5 Female Female (identified as male in Childhood: 5.5 Lesbian Multiracial N5 Female Female (identified as FTM in Childhood: 5.5 Lesbian, Stud Multiracial
one wave of parent study) one wave of parent study)
Masculinity: 5.7 Masculinity: 5.7
T6 Male Trans, male to female, female Childhood: 4.8 Gay (attracted to males) African N6 Male “Male, unfortunately” (“want to Childhood: 5 Gay African
American be a woman”) American
Masculinity: 1 Masculinity: 2.7
T7 Male Trans, transgender, trans Childhood: 4.8 Gay (attracted to males) African N7 Male Male Childhood: 5 Gay Biracial
woman (“go back and American
forth” with gay male)
T8 Male Woman, transsexual (iden Childhood: 4 Gay (attracted to males) African N8 Male Transgendered, woman Childhood: 4.2 Homosexual (attracted Belizean
tified as male in one wave American (identified as male in two to males)
of parent study) waves of parent study)
T9 Male Male to female transsexual, Childhood: 5.2 Lesbian African N9 Male Male, female, transgender Childhood: 5.6 Homosexual African
transgender American (“depends on the day”) American
T10 Male Transgender, sometimes Childhood: 4 Transgender (both African N10 Male Male (described period of Childhood: 5.2 Gay African
female gender American identifying as transsexual American
and sexual and considering transition)
orientation)
Femininity: 7 Femininity: 7
1
Gender identities reported in the table reflect how participants self-identified during the qualitative interview for the present study (in response to the question: how do you identify in terms of your gender?). Additional
information is included in parentheses.
2
Gender nonconformity scores reflect means of items from a childhood nonconformity measure (in reference to assigned sex; range 1 to 6) as well as a measure of current femininity and masculinity (rage 1 to 7). Participants
T4 and N4 and T8 and N8 were matched because they each varied in how they reported their gender identity during waves of the parent study.
women” reflect participants’ affirmed identities (vs.

assigned sex).
Qualitative interviews
One-on-one interviews were semi-structured and

explored developmental processes related to identity
formation and experiences of gender nonconformity.
Open ended questions covered topics including partic-
ipants’: 1) gender identities 2) childhood and adoles-
cent experiences with gender and sexuality 3)
experiences during puberty 4) coming out and identity
development processes 5) relationships with friends/
peers, family, and other LGBT individuals. Questions
were framed with the goal of being open ended and
non-directive in order to allow the interview to unfold
in accordance with the emphasis and meaning each
individual participant placed on their experiences
within these broad topic areas. Interviews were con-
ducted over a 9-month time period in 2010. All inter-
views were audio recorded, transcribed by study team
members, and subsequently reviewed for accuracy by
the study’s first author. Atlas.ti was used to manage
and code the transcribed interviews.
Qualitative data analysis Figure 1. Overview of themes.
A constructivist grounded theory approach to qualita- gender nonconforming person, interviewed all partici-
tive data analysis was selected as most consistent with pants. While efforts were made to ensure that the
the present study’s intersectional framework of interca- remaining study team members were diverse in terms
tegorial and intracategorical complexity. Both construc- of assigned sex, gender nonconformity, and race/eth-
tivist and intersectional frameworks prioritize nicity, none specifically identified as transgender at
remaining “close” to participant’s own words and per- the time of participation in the research process. Dur-
spectives while also elucidating meaningful shared expe- ing the coding process, study team members regularly
riences (Charmaz, 2006; McCall, 2005). Consistent with met to reflect on the research process and review, dis-
this approach, codes were identified through an iterative cuss, and refine coding categories. During this time,
and inductive coding process where regular team meet- we made efforts to reflect on how our own experiences
ings were held to discuss new interviews within the con- and background may be influencing how we interpret
text of previous interviews and identify and refine these findings. Constructivist techniques were also
coding categories (Charmaz, 2006). This process also used to evaluate the credibility, originality, and reso-
involved creating memos to assist with organizing, syn- nance of our codes and associated analysis (Charmaz,
thesizing, and analyzing excerpts within these coding 2006). This was accomplished through presentations
categories. Concept maps were used to visually repre- and discussions with TGNC community members
sent the data and depict the relationships between cod- and other researchers and clinicians with expertise in
ing categories and the processes associated with these transgender development.
categories (Figure 1 reflects the final concept map).
We recognize that the backgrounds of study team
Results
members likely shaped our interpretations of the
results, and thus should be taken into consideration. Final codes and their relationships are visually
The study’s first author, who identified as a visually depicted in Figure 1. Arrows highlight the interactive,
fluid, and bidirectional relationships that existed Participants varied in the emphasis that they placed
between the dimensions of gender-related experience on each of these identities (e.g., primarily identify as
and intrapersonal developmental processes. Quotes by transgender vs. male/female). At time of interview,
individual participants were identified using the Par- transgender identifying participants described this
ticipant IDs seen in Table 1. identity as a way to represent their transition. Transi-
tion was commonly defined as an individual process
Dimensions of gender-related experience of finding “what fits” for them: “So it’s not so much
you have to get surgery or take hormones, you just
The first aim of the study was to identify dimensions have to work towards being yourself, and embrace the
of gender-related experience relevant to all partici- person that you was supposed to be born, in your own
pants and summarize similarities and differences in eyes (T7).” Another participant described transgender
these experiences within each dimension. These as “the experience of having parents and other people
included: Gender identity, physical self-image, gender expect you to identify with a gender you don’t (T1).”
presentation, and gender expression. While each of In contrast, transsexual was described more narrowly,
these dimensions of experience appeared distinct, they such as “part of having altered my body in someway
were also described as interacting and overlapping. to make it fit more with how I identify (T1).” For
transgender participants, use of their affirmed name
Gender identity and correct pronoun was particularly important and
Experiences coded within this dimension included affirming to their sense of self.
participants’ descriptions of their internal sense of Two participants reported contentment with identi-
gender identity, the perceptions that they desired fying as both male and female. One participant identi-
others to have in reference to their gender identity, fied as both a transgender woman and gay man (T7),
and the identity labels that they associated with these explaining that in general she prefers being transgender
experiences. Gender identity labels reported by partic- full time, but that she also enjoys the versatility of pre-
ipants are listed in Table 1. senting as male at times and does not have a pronoun
When asked “how do you identify your gender” (at preference. The second participant identified as trans-
time of interview), participants varied greatly in how gender, stud, and gay (T3). In contrast to the other stud
they responded. Those that reported identifying as identified participants, she described stud as being a
their sex assigned at birth responded to the question mix between a man and a woman rather than a mascu-
with this identity alone (e.g. “male” or “female”). line female (for a more detailed analysis of stud identifi-
When asked more about what being [male/female] cation among these participants, see Kuper, Wright, &
meant to them, these participants explained that it Mustanski, 2014). She also explained that she tends to
meant that they were not [female/male] or transgen- use she/her pronouns and a masculine chosen name
der, or did not want to be. One participant, who iden- but does not have a strong preference.
tified as both a stud and female, specifically Two additional participants gave responses that
commented that identifying as male “would just make reflected greater ambivalence about their gender iden-
me feel like I’m in denial of my sexuality” (N5). tity at the time of interview, both of whom were
Another participant identified herself as “androgy- assigned male at birth. One specified that he was male,
nous” stated that she “could be considered genderqu- “unfortunately,” explaining that he wants to be a
eer,” but avoids labels and does not think of interests woman and would “switch over” if he has the money,
or personality traits in terms of a gender binary (N2). but that he is not planning on saving to do so, in part
Participants who identified as a gender other than because he viewed the cost and desired results as unat-
their sex assigned at birth responded to this question tainable (N6). Another specified that while he identi-
with a longer identity narrative. For these participants, fies as mostly male, he sometimes also sees himself as
this narrative often referenced an internal sense of self transgender or female: “I have my days like, in my
as male or female (e.g., “I’ve always felt like I am head I’m like two people that lives up there. Like one
female”) along with an identity of transgender, trans- day I’ll feel really masculine, other days I’ll feel really
sexual, female-to-male, or male-to-female (see Table 1 feminine (N9).” This participant struggled with his
for gender identities that participants reported). desire to be both of these aspects of himself, also
commenting: “At the end of the day I know I am a their physical appearance to be more in line with their
man and that’s all I can ever really be.” internal sense of self and desired appearance to others
(T1, T2, T4). These participants also reported a desire
Physical self-image for top surgery, but varied in the extent to which this
Experiences coded within this dimension reflected par- was a priority (particularly given the financial cost). In
ticipants’ relationships to their bodies, including pri- contrast, the transgender and stud identified partici-
mary and secondary sex characteristics as well as pant indicated that she is not “interested in making
overall body size and shape. Participants often any physical changes,” including testosterone as she
described an increasing awareness of their physical self does not want facial hair or anything “extra (T3).”
during puberty, although participants differed both in However, she noted that she “lied about being sexually
the extent of discrepancy they identified between their active” to her healthcare provider so that she could
physical self and gender identity and also in the level of obtain birth control shots to stop her period due to
distress caused by this discrepancy, if present. the distress it caused her. The participant who identi-
Among non-transgender identified participants, fied as a transgender woman and a gay man also
two female participants reported that they did not denied interest in any gender affirming medical care,
think much about the changes associated with puberty but noted that she obtained silicone injections in her
(N2, N3), three reported that they were uncomfortable lips to better match her desired appearance, which
with, or hated their period and/or felt “awkward” was influenced by several African American female
about developing more feminine sex characteristics, celebrities who she strongly identified with (T7). All of
but that this discomfort was not universally linked to the remaining transgender women reported a history
gender (N1, N5, T5). Three also noted their desire to of taking cross-sex hormones and all desired breasts.
have a more masculine body shape and/or smaller Four transgender women specifically discussed
breasts (N4, N5, T5). Three of the non-transgender obtaining hormones from an informal source (e.g.,
identified men did not report puberty to be a particu- “gay mother,” “m,one lady”) (T6, T8, T10, N8).
larly challenging time and did not elaborate much on Desire for “bottom” surgeries was complicated by
their experience (N7, N10). In contrast, the participant high cost, uncertainty regarding outcomes, and con-
who disliked being male but was not planning to tran- cerns regarding impact on sexual functioning/plea-
sition reported that he “felt confined to a body that sure. One transgender woman participant in
was not mine,” like God played a “humiliating joke” particular described feeling extremely detached and
by making him a boy and “ruining his life (N6).” This uncomfortable with her genitalia, but noted that she is
participant described multiple changes that he would hesitant to consider surgery because her male partners
like to make, including removing his Adam’s apple are specifically attracted to her anatomy and tell her
and facial hair and developing a more feminine shape. not to get surgery (T8). Another transgender woman
Reactions to puberty also varied among transgender reported that while she did not initially want bottom
identified participants. One transgender male surgery she now thinks that it will “complete her” and
described puberty as “the worst time of my life” and allow her to be less worried about safety when in pub-
reported frequently crying in the shower (T1), while lic (T10). Two transgender women specifically
another commented “I just looked down and I was like reported being comfortable with their anatomy (T7,
these [breasts] are inconvenient…those were my T9), including the lesbian identified participant who
thoughts. Umm, that was pretty much it (T2).” One explained:
transgender female specifically described feeling posi-
tively about her “girl shape” growing up and being Where I’m from in the hood the lesbian girls they have
the one girl, that you know, uses a device and the other
pleased with her “lower half” in general (T6). However,
girl that doesn’t…I just thought of myself as the lesbian
all transgender men described some level of discomfort that didn’t have to go to the store and buy mine, it was
with breasts, body shape, and menstruation while most already there, it’s like a permanent strap-on.
transgender women expressed discomfort regarding
pubertal changes in voice, body shape, and facial hair. None of the transgender male participants actively
By the time of interview, three transgender men desired bottom surgery, although one participant
were consistently taking testosterone in order to alter reported that while he “definitely wants” a penis and
testes, “whatever I have now works fine and I’m not female section and some make-up (N1). The transgen-
going to mess with it just so you know, what? so I can der and stud identified participant explained that her
have a penis? Like that’s not what being male is about grandparents (primary caretakers) forced her to wear
(T4).” more feminine clothes but that she would change into
Distress over physical characteristics also appeared “male” clothes whenever she left the house (T3). By
to shift over time. Although social and hormonal tran- high school, most had also adopted a short haircut,
sition was generally discussed as reducing gender dys- although two women had long hair at the time of
phoria, two transgender women discussed how their interview and reported that this was not something
lack of breasts became increasingly distressing as they that they desired to change (N1, N4). One participant
started to present as female, which they noted pre- explained that she purposely keeps her hair long so
vented them from wearing some of the feminine that she will not be “mistaken for a man” (N4) while
clothing that they desired (T8, T10). Similarly, one another participant with shorter hair noted that she
transgender male participant reported that he has regularly gets her eyebrows and nails done and hair
grown increasingly frustrated with binding his breasts lined up, which she described as “girl stuff” (N5).
and being unable to swim in public (T2); however, In contrast, most participants assigned male at
another explained that he has gotten used to wearing birth reported wearing mostly “boys’” clothes during
a binder and finds it comforting (T4). Two non-trans- childhood and middle school, although most (n D 8)
gender identified participants (N4, N10) noted that were drawn to tighter fitting clothes and began to
they only desired cross-sex physical features during incorporate clothes from the girls’/women’s section
the time that they actively explored the possibility of into their wardrobe. Most (n D 8) also reported dress-
transition (e.g., “dreamed of having breasts and a ing up in “women’s” clothing as children, commonly
vagina” (N10)). in the bathroom using their mothers’ clothes but never
outside of the home. During these sessions of dressing
Gender presentation up, several transgender women also discussed apply-
The gender-related dimension of gender presentation ing makeup and doing their hair (T7, T8, N8, T10).
reflected participant’s desired clothing as well as other Although these experiences were described as particu-
alterable characteristics of appearance such as hair- larly affirming, transgender women participants did
style, and makeup use. Desire to wear clothing associ- not report “switching over” to wearing “women’s”
ated with the other gender was one of the earliest clothing full-time until they started taking hormones
experiences of gender nonconformity described by during or shortly after high school. At time of inter-
most participants, although participants differed in view, all of the transgender identified women noted
their ability to act on this desire. Participants of both growing their hair out as an important step in transi-
assigned sexes generally described this interest as tion. While non-transgender identified male partici-
being driven what “felt most comfortable.” Manner- pants continued to incorporate more styles perceived
isms were initially included in the dimension of gen- as feminine into their wardrobe, none reported a
der presentation as a gender-related characteristic of desire to consistently wear “women’s” clothes or a
appearance, but they appear potentially less alterable desire for hairstyles commonly associated with
that other characteristics and may be better captured women.
as an aspect of physical self image or gender expres-
sion. Mannerisms were mentioned much less often Gender expression
then other aspects of gender presentation and typically The dimension gender expression included discus-
referenced a way of “carrying oneself.” sions of interests, activities, interactions with others,
All participants assigned female at birth discussed a and personality traits that participants linked to gen-
childhood discomfort with clothes perceived as femi- der. Similar to gender presentation, participants
nine, dresses and “fitted” clothing in particular. By tended to trace their gender nonconforming interests
middle school these participants shifted to wearing and activities back to their earliest memories. How-
primarily clothes from the “boys’ section,” although ever, the meanings they ascribed to these interests and
one non-transgender identified female continued to activities varied and were reported to evolve over time
wear only “comfortable” non-fitted clothes from the as participants described becoming increasingly
cognizant of their larger social meaning through inter- times when I feel more feminine, but I mean I’ll
actions within an expanding range of social contexts always present in a more like masculinish way,
(e.g., peers at school and LGBT community centers). because that’s what I’m comfortable. But in terms of
For non-transgender individuals, gender expression like, just my behavior, I’m not afraid to show more
was conceptualized as distinct from one’s gender iden- femininity (T4).” This perspective of fluidity was also
tity. At the time of interview, two non-transgender echoed by two participants who identified as both
identified women reported seeing themselves as both male and female (T7, N9) as well as the lesbian iden-
“masculine and feminine” and reported that gender tified transgender woman (T9). In contrast, the
does not typically come up in their day-to-day interac- remaining transgender women described themselves
tions (N1, N2). The remaining non-transgender iden- as “feminine” or “very feminine” and “not at all mas-
tified female participants viewed themselves as “very culine” and emphasized their connection with female
masculine,” citing an interest in sports and cars and/ friends. However, the ways in which they described
or disinterest in cleaning as well as making reference their femininity in relation to romantic and sexual
to their perceived masculine clothing and manner- partners varied. For example, when asked what it
isms. These participants were often mistaken for men means to be seen as female by a partner, one trans-
or boys in their day-to-day interactions, but reported gender woman explained: “I have to just, hold the
that this does not bother them so long as others are throne. I’d be the most ladiest of all, the most femi-
not disrespectful. Three specifically commented that nine of all (T10)” while another explained “If we live
their friends or family treat them “like one of the guys together I might do a majority of the cooking and
(N3, N4, N5),” which is what feels most comfortable the cleaning but, you know, I contribute financially. I
to them. These participants also discussed lack of don’t have a problem with working or anything as
interest in interests such as shopping and gossiping long as you respect me as woman, that’s the only
perceived to be female-typical, and two made refer- thing that matters in a relationship to me…I don’t
ence to desired careers that they considered to be think there’s a specific role in any relationship, I
male-typical (e.g., mechanic, cook). A similar spec- really don’t (T6).”
trum existed among non-transgender male partici- As a whole, most participants struggled somewhat
pants with most describing themselves as moderately to explain or describe their gender expression, and
to very “feminine,” three noting that they also have tended to rely on male/female stereotypes when com-
“masculine” characteristics, and one describing him- ing up with specific examples of how they see them-
self as a “tomboy that is a guy (N10).” Although none selves in terms of gender. Roughly half of participants
were mistaken for women in their day to day lives, pointed out that these descriptions were overly sim-
they described a preference for female friends and plistic or limiting, yet had difficulty articulating their
noted ongoing interests such as cosmetology and sense of self without falling back on them. For exam-
dance that they associated with femininity. ple, when asked what influences her view of herself as
In contrast, transgender identified individuals “very masculine,” one participant reported “cause the
tended to discuss their gender expression as develop- certain types of stuff that I do, I like work out and
ing out of or reinforcing their gender identity. When stuff. Well that, that’s not real masculine. Um… you
reflecting on their gender expression, transgender know real female women work out. Um, I dunno, I
men described mostly what they perceived to be just… hmm… I just… you know I watch sports and
male-typical interests and traits. However, they stuff…that was-, that was a catchy question right there
emphasized their masculinity somewhat less than the (N5).” Across participants, most (n D 14) also dis-
“very masculine” female identified participants, per- cussed the importance of “equality” and/or “balance”
haps because they tended to compare themselves to within a relationship, although two non-transgender
other men (versus women) and did not see them- men (N7, N10) and two transgender women (T6, T9)
selves as significantly more masculine than typical discussed difficulty finding partners who also shared
for men. One transgender male specifically com- this value: “It seems that when I find a person to be in
mented that following his social and physical transi- a relationship with, they always throw their role at me
tion, “I just see it [gender expression] as very fluid, and you know, you know what role that is if I’m femi-
there are times when I feel more masculine, there are nine…some people, don’t like a feminine person to be
on top. I guess cause they think that they don’t have were linked to being a tomboy or lesbian rather than
that, um, aggression a little (N7).” to a male identity. In contrast, transgender identified
women typically linked their initial awareness of their
Intrapersonal processes gender identity back to experiences dressing as
women, including doing their hair and make-up. One
The second aim of the study was to identify and participant described it as her “few minutes of bliss”
describe the intrapersonal processes that supported where she was able to look at herself like “I look like a
participants’ development of their sense of self across girl, like this is how I’m supposed to look (T8).” Sev-
all four gender-related dimensions. These processes eral participants assigned male at birth (T8, N8, N10)
included awareness, exploration, meaning-making, recalled becoming aware that they related to or emu-
and integration. While each process appeared distinct, lated female family members, friends, or individuals
they were also often co-occurring, interacting (e.g., in the media, and cited this as their first recognition of
awareness often spurred exploration which subse- feeling different than other men: “I would see some-
quently furthered a deeper awareness and facilitated thing on TV and it would be a heterosexual couple
meaning making) and overlapping (e.g., integration and I always envisioned myself being the woman, it’s
appeared to be a specific but key process of making like, oh my God, look at her hair and look at her-, I
meaning of how one’s gender related sense of self fits was able to point characteristics of women better than
with other aspects of the self and social world). I would men (N10).”
For both male and female transgender identified par-
Awareness ticipants, becoming aware of one’s desired appearance
Exposure to others with similar gender-related experi- and identity to others was often described as another key
ence as well as language surrounding gender identity/ realization, although the timing, progression, and impact
expression was critical to the development of awareness. of the development of awareness varied. One transgender
For example, two transgender men described picturing male participant who was consistently mistaken for a boy
their future physical self-image as more masculine during in childhood described realizing that he was getting a mix
childhood (facial hair, muscular build, pictured self shav- of male and female pronouns on his college campus and
ing their face), but explained that these images were not subsequently reached a “breaking point” where he could
of themselves as “men” as they did not register becoming no longer function as a female: “that’s when I really
male as a possibility (T1, T2). While three transgender freaked out about my gender and realized I can’t live like
women did report identifying as female in childhood, this (T1).” Once deciding to transition, one transgender
they also described lacking an outlet for understanding woman participant described this process as “overnight”
or making changes based on this self-image (T8, T9, and noted becoming impatient with the length of time
T10). Learning about and meeting transgender individu- required to see changes from hormone therapy alone,
als was discussed by many as key to clarifying their identi- explaining that she would not be happy being seen as a
ties and/or desires to transition. One transgender woman “guy wearing women’s clothes (T9).” For these reasons
described seeing a transgender woman on the train for she reported seeking out and receiving free-flowing sili-
the first time: “I was just amazed, I just looked at her, I cone injections in her hips, buttocks, and face. While she
just kept staring at her (N8).” In contrast, one female par- reported that she heard warnings about such injections
ticipant reported that growing up, she “thought I was she commented: “I would pick like-, if it’s a short life
supposed to be a man” but that after “started reading dif- looking the way I want to look, than a long life of being
ferent stuff and watching TV I realized I didn’t feel noth- miserable and unhappy.” In contrast, another transgen-
ing like transgender person saying that they always knew der male described coming to this realization more grad-
that they was this and that they in the wrong body, I ually with the assistance of a therapist who he described
didn’t feel none of that (N3).” as helpful at reflecting back his gender-related experience
While both transgender and non-transgender iden- (T4).
tifying participants assigned female described prefer-
ence for rougher play, interest in male friends, and Exploration
wearing male-typical clothes and hairstyles as an early Both non-transgender and transgender identified par-
marker of being different than same sex peers, these ticipants reported periods of reflecting on and
exploring options associated with identifying and but, for the time being I’m not gunna be a drag queen
expressing their gender. with this walk around and stuff and change my clothes,
but I feel like if I do that, I don’t think it’ll be enough
Several women who did not identify as transgender
cause I have manly features.
at time of interview recalled a period of thinking they
wanted to be or should be male occurring in late child- One additional male participant also reported a
hood (approximately 8 – 12 years old) (N3, N4, T5, brief period of identifying as transsexual and consider-
T6). During this time one explained she would put a ing transition (N10). This participant described a
sock in her pants, draw mustaches on her face, and period where he would frequently dress up “head to
pretend to be her favorite male characters from TV toe” and travel to the gay neighborhood to see what
(N2). These participants also reported questioning reaction he would get or how he felt. He reported that
their gender again in late adolescence. They discussed 50% of his decision not to transition was because of
meeting transgender men at a youth group or the stereotype that all African American transsexual
researching others’ stories online and realizing that women are sex workers, while “25% of it was medical
their interest in transition was not as “serious,” that problems and 25% was probably like just unsure if I
they did not want some of the changes or risk factors would be willing to go that far because once you go
associated with testosterone, or that these changes that far, you can’t really turn back and still be the
were too unclear. Although she commented that it same person that you were.”
was hard to remember what she was thinking at the Before adopting a transgender gender identity or
time, one participant reported that her main motiva- deciding to transition, several transgender identified
tions for exploring transition were to have a “flat participants discussed an initial period of denial or
chest” and be more accepted by her family (N4). How- change attempts, which were often influenced by
ever, her perspective changed after she discussed the interpersonal relationships, namely parents and peers.
process with her aunt, realized how expensive the sur- These included experiences such as joining a sorority
gery was, and found her breasts became smaller when as a “last ditch effort at being a girl (T2),” trying to
she lost weight. None of these three participants “suppress it with religious counseling (T1),” or being
described any current ambivalence, and all presented afraid or embarrassed to think about their desire to
as content with their decision not to transition or transition due to the potential for negative reactions
identify as male. (T1, T6, T8). Several transgender women described
Of the two participants who were ambivalent about briefly considering whether their experiences fit with
their gender identities, one had extensively explored those of drag queens that they met or saw on TV, but
and even temporarily lived “full time” as female (N9). reported that they realized that they were not satisfied
However, these experiences were reflected on with dis- only living as a woman part-time or for entertainment
appointment and embarrassment, particularly given purposes (T6, N8, T10). After deciding to transition,
other TGNC individuals had encouraged him to par- participants also discussed a period of experimenting
ticipate in sex work as a female, which lead to several with their style or way of presenting themselves. In
arrests, mistreatment within jail, and placement in an particular, transgender women often described a pro-
all male alternative school where the bullying and vio- cess of observing other women and adopting traits,
lence against him escalated. In contrast, the second presentations, or mannerisms that they felt would best
participant reported very little exploration of his suit them. During this process, feedback from other
desire to transition, explaining that fear of his moth- transgender peers or potential romantic/sexual part-
er’s reaction and perceived masculine features pre- ners was particularly impactful. Talking with other
vented him from doing so (N6): transgender individuals or reading about their stories
online also helped some to identify the specific types
My mom, she criticize people like, uh they look disgust- of medical interventions that they desired.
ing…if she sees drag queens, she’s like some of ‘em look Both transgender and non-transgender participants
good, she say some people should do it, but some people
described the importance of LGBT affirming settings
shouldn’t do it and when she says stuff like, I’m like oh
God…so if I try this I got too many manly features, but (e.g., school peer groups, LGBT youth spaces). How-
I do want to do it. I always wanted to do somethin’ like ever, competitiveness, fighting, and “drama” occurring
that, if I ever get the big money to do it, I’m gunna do it, within these settings was often identified as a barrier
to exploration. Transgender women in particular dis- lesbian (N1, T4). An additional transgender man dis-
cussed how other transgender women often judge cussed going through a “homophobic and transpho-
each other based on looks and ability to pass. Two bic” period that he described: “[I was] scared of the
specifically reported that they avoid other transgender unknown so I turned that fear into this weird hatred
women and noted that it was too dangerous to associ- (T2).” Prior to coming out to others, most participants
ate with a group of transgender individuals as this discussed developing a sense of self-acceptance or hav-
makes them a target for harassment and violence (T6, ing to be “true to myself” despite the reactions or
T8). In contrast, several participants described college beliefs of others. This process also involved shifting
as a more affirming setting that allowed for explora- the focus of difficulties away from the self and towards
tion without previous barriers such as unsupportive larger gender norms and stereotypes. However, the
parents or bullying at school (T1, T2, N2, T4). effectiveness of this shift appeared to depend on the
degree of affirming interpersonal support: “I just
Meaning making always felt like something was wrong with me like, I
Throughout development, participants described felt like, I’m different…but the thing about me is I
actively striving to make meaning of their gender- didn’t wanna change myself though. I wanted to
related experiences and sense of self. For some this change everybody else. Which I’m still trying- I’m still
was a difficult or ongoing process; whereas, for those battling with that (T7).”
individuals whose gender identities and expressions The process of meaning making also involved artic-
were less called into question or devalued, less of an ulating one’s sense of self in relation to others. When
explicit explanation or narrative was developed. reflecting on their gender identity, two non-transgen-
When reflecting on their childhood most partici- der identified women commented that the term trans-
pants exhibited at least some difficulty explaining their gender would fit with their experiences, but that they
experiences and views of gender due to the develop- were not familiar with the term until recently, do not
mental changes that subsequently occurred in how like the term, or do not want to confuse people who
they understand and relate to gender. For example, would not know what it means (N3, N4). For partici-
one non-transgender identified female participant pants such as the asexual transgender man (T1) and
reported not really identifying as male or female (N2), the lesbian transgender female (T9), a process of over-
while another explained that “maybe I just felt like I coming common stereotypes or narratives associated
was more of a boy growing up (N5)” because of the with being a gender or sexual minority was also
male clothes she would wear, and a third commented reported (e.g., perception that all transgender women
that for several years she would imagine and dream of are very feminine and attracted to men). Four trans-
herself as a man or boy, but that she “just got used to gender women specifically contrasted their experien-
[being female],” but was not sure how (T5). In con- ces with the stereotype that all African American
trast, most transgender participants interpreted child- transgender women are “prostitutes,” often highlight-
hood memories of gender non-conformity as early ing their efforts to finish school and obtain careers
markers of gender identity. For example, one trans- (T6, T7, N8, T10). Two participants specifically noted
gender woman described often fantasizing about being that college classes on gender or women’s studies pro-
married to a man and described a strong desire to be vided helpful concepts or perspectives relevant to their
the “pink Power Ranger [so she could] date the red own experiences of gender (N2, N8). Most transgen-
Power Ranger,” both of which she described as con- der identified participants also referenced the diversity
firming her affirmed childhood identity as female of experiences within this population through com-
(N8). ments such as “gender is a spectrum” and that “trans
Most transgender and several non-transgender people are all different…no one of us is alike.”
identified participants reported periods of internaliz-
ing negative views of transgender and/or LGB identi- Integration
ties. One transgender and one non-transgender In addition to making meaning of one’s gender-
identified participant both discussed experiencing a related experiences, participants’ discussions also
period of depression that lead to a brief psychiatric reflected a process of integrating these meanings into
hospitalization but improved after coming out as a larger sense of self. For transgender participants, this
process was facilitated by physical and/or social The two participants who expressed ambivalence
transition. about their gender identity described difficulty envi-
While two transgender participants described their sioning or expressing an integrated sense of self. One
social and physical transition as occurring “overnight of these participants explained that if he were to take
(T1, T9).” the remainder discussed transition as a pro- hormones, it would “freak him out” to be “female
cess of observing other women/men and improving from the waist up and male from the waist down
one’s appearance over time, often with the help of hor- (N9).” He further explained that he used to picture
mones and the support of similar and/or supportive himself as a “full fledged woman with working vagina,
others. Three described the “second puberty” associ- that wasn’t gonna happen so I’m like forget it,” and
ated with hormone therapy as a confusing, “emotional that now he occasionally wishes he had a “detachable”
rollercoaster (T6, N8).” Two transgender men specifi- female body. This participant also struggled more gen-
cally disliked the initial “awkward” or “androgynous” erally to integrate his feminine and masculine selves,
period where they reported looking like a younger boy noting “one day I’ll feel really masculine, other days
or somewhere in-between genders (T1, T4). Transgen- I’ll feel really feminine…it’s kind of weird to be honest
der men also discussed the social adjustment of learn- with you because, how do I explain it? I don’t want to
ing how to interact in “the boys club” and being say that I’m two people, but that’s what it feels like
treated as male by others. In contrast, transgender sometimes, it’s confusing.” In contrast, descriptions
women tended to focus on the changes in the atten- provided by participants who identified as both male
tion they received from other men and learning how and female (T3, T7) reflected greater integration: “I
to navigate their transgender status within relation- would wanna remain trans for the rest of my life
ships (e.g., when to disclose to potential partners). In because I like the fact that I can go back and forth…it
general, adopting a transgender identity and/or plan- doesn’t make me confused. It just make, it makes me
ning for transition was described as a process of “find- versatile (T7).”
ing oneself,” “being brutally honest,” stopping Barriers to social and medical transition were also
attempts to “compartmentalize” or deny feelings, and associated with integration related difficulties. At the
“adjusting puzzle pieces to figure out what fit best.” time of the interview, two transgender women
Following this adjustment period, transgender par- described consistently “passing” (T9, T10), but one
ticipants reported an increased comfort, confidence, was experiencing daily harassment and fights as a
and self-assuredness. One participant who reported result of her difficulty passing (N8), and one was tem-
making a suicide attempt in childhood commented: “I porarily presenting as male because her financial situ-
do have a lot of worries about my future but I don’t ation forced her to return home to live with her
have so many doubts that there can be a future (T1).” unsupportive family (T6). These participants
Two transgender men specifically discussed becoming expressed distress and described periods where they
more comfortable expressing aspects of themselves or had difficulty envisioning their futures or feeling as if
interests that they perceived to be feminine such as their goals were obtainable (e.g., establishing a career,
cooking or becoming an elementary school teacher finding a partner). Lack of access to gender affirming
(T2, T4). At the time of the interview, all transgender procedures (e.g., top and bottom surgery, electrolysis,
identified men were consistently passing as male in facial feminization) or consistent hormone therapy
their day-to-day lives and explained that their trans- was also a barrier to integration that prevented partici-
gender identities had become less of a focus. One pants from feeling fully comfortable with their physi-
explained: “I’m not like denying my trans roots I guess cal self-image or complete with their transitions.
but I’m just not gonna focus on it as much (T4).” Transgender women also described frustrations with
While one commented that he is “ok” with people physical features such as height and voice that could
assuming his identity because it allows people to see not be changed.
other aspects of himself rather than focusing on his
gender (T1), two described a tension between this per-
Discussion
spective and also wanting to share their history with
others and wanting their queer identity to be more vis- The present study explored the gender-related experi-
ible (T4, T5). ences of a diverse group of TGNC emerging adults
who reported similar experiences of gender noncon- be a certain gender (Bolin, 1998; Devor, 2004). Across
formity in comparison to their sex assigned at birth. all participants, most appeared comfortable openly
Participants discussed experiences within each of the incorporating gender conforming or gender non-spe-
four inductively coded dimensions: Gender identity, cific traits, interests, and activities into their overall
physical self-image, gender presentation, and gender sense of self and/or explicitly objected to viewing these
expression. These dimensions share key similarities in terms of a gender binary.
with previous gender identity frameworks, such as Identity exploration and delays in the commit-
Serano’s (2007, 2010) gender variance model, which ments associated with adulthood have been identified
identifies sex, gender identity, and gender expression as key markers of emerging adulthood. Given these
as distinct yet interactive and often correlated traits larger shifts in both TGNC visibility and the develop-
and Tate (2014); Tate, Youssef, and Bettergarcia mental milestones associated with adulthood, trans-
(2014)) conceptualization of gender-related experi- gender participants within the present study are
ence as a “bundle” of non-binary and dynamic per- members of one of the first generational cohort to
sonality facets (i.e., assigned sex, identity, roles and socially and medically transition prior to establishing
expectations, social presentation). We summarized a career, entering into a committed partnership, and/
the range of experiences described within each of these or starting a family. College, in particular, appeared to
dimensions as well as participants’ descriptions of the afford those participants who attended additional
intrapersonal developmental processes (awareness, opportunities for exposure and support surrounding
exploration, meaning making, integration) that sup- their gender identities while affirming medical pro-
ported their development. Similar developmental pro- viders were also critical to facilitating the achievement
cesses have been described within previous models of of transition related goals. These shifts in timing and
transgender identity development (Devor, 2004; Lev, context are likely to improve the developmental trajec-
2004). Summarizing the similarities and differences in tory of many TGNC individuals. However, earlier ages
gender-related experience within these shared dimen- of coming out in the context of unsupportive settings
sions and across developmental processes highlights can also disrupt family, peer, and romantic relation-
the utility of the intersectional perspectives of both ships and detract from educational and occupational
intercategorical and intracategorical complexity. attainment during a particularly pivotal period
Sociocultural shifts in both the context of emerging (Alanko et al., 2008; Landolt, Bartholomew, Saffrey,
adulthood and the visibility of TGNC experiences Oram, & Perlman, 2004). Unequal access to interper-
were evident within the present study, although these sonal and structural supports (e.g., access to college,
shifts appeared to interact with other factors (e.g., eco- healthcare coverage, occupational opportunities) is
nomic status, geographic location) to differentially likely to further exacerbate the marginalization of
impact participants’ developmental trajectories. In TGNC youth by race/ethnicity and class. Although
comparison to previous studies, participants appeared the present study focused on gender-related experi-
to have greater access to information about being ence at the intrapersonal level, these interpersonal and
TGNC as well as greater contact with both similar and structural supports are also critical to the healthy
different LGBT others, both of which appeared to be development of TGNC emerging adults (Garofalo,
crucial prerequisites of identity development. Particu- Deleon, Osmer, Doll, & Harper, 2006; Hwahng &
larly when coupled with supportive family and peer Nuttbrock, 2007).
contexts, these processes began at earlier ages and pro- Throughout the presentation of results, the inter-
gressed more quickly than has typically been reported sectional perspective of intercategorical complexity
in the literature (Bolin, 1998; Devor, 2004). Given was visible in descriptions and quotes describing over-
these connections were primarily forged among LGBT lapping gender-related experiences of participants
individuals within affirming contexts (e.g., LGBT who shared similar characteristics such as sex assigned
youth groups, gay friendly neighborhoods), these at birth, current gender identity, or transgender status.
evolving ways of making meaning of gender and sexu- While wanting to be seen as more masculine or femi-
ality also reflected an increased recognition of the nine (dimensions of gender presentation and expres-
complexity of gender, sexuality, and identity, and sion) and wanting to be seen as male or female
fewer stereotypes or expectations of what it means to (dimension of gender identity) may appear
conceptually similar, this difference in self concept racial-ethnic minorities) reported obtaining hor-
was critical to distinguishing individuals who self- mones via illicit means, and two also discussed
identified as transgender from those who did not. receiving medically risky silicone injections as a
Consistent with existing research, transgender identi- more accessible and immediate way to achieve their
fied participants discussed an internal, cross-gender or desired physical self (Sevelius, 2013). These partici-
sense of self that was accompanied by a strong desire pants also described the need to contend with addi-
to be seen by others as this gender identity (Bolin, tional stereotypes (e.g., sex workers) and barriers to
1998; Devor, 2004). This dimension of gender identity, community affiliation (e.g., concerns about associ-
termed gender role casting by Nuttbrock and col- ating with each other in public and reported expe-
leagues (2009), was consistent with one’s internal riences of competitiveness among each other that
sense of self, including name and pronoun preferen- appeared linked to previous experiences of victimi-
ces. This sense of self was affirmed, but not deter- zation and social stigma). Previous studies of trans-
mined by, these participants’ gender expression and gender communities of color have noted similar
gender presentation (i.e., ability to express and present stressors and identified further variation in experi-
themselves in ways perceived as consistent with their ence based on age, class, geographic location, and
affirmed gender identity) (Gagne & Tewksbury, 1998; native language (Bith-Melander et al., 2010;
Schrock, Reid, & Boyd, 2005). Dysphoria surrounding Hwahng & Nuttbrock, 2007; Sevelius, 2013). Partic-
one’s physical self image was fairly exclusive to those ipants whose sense of self combined aspects of
who identified or were actively ambivalent about iden- male or female or otherwise challenged the larger
tifying as transgender. At minimum, hormone therapy society’s conflation of sex, gender, and gender
appeared necessary for transgender participants to expression (e.g., the lesbian identified transgender
“pass” as their affirmed gender, and for most partici- woman) also appeared to share similar barriers to
pants, to feel validated in their gender identity. In gender identity development. These participants
contrast to transgender identified participants, partici- appeared to struggle with the lack of available nar-
pants who retained the gender identity associated ratives to make meaning of their experiences and
with their sex assigned at birth did not describe an experienced difficulties effectively integrating their
explicit process of learning to embrace this identity. gender-related experiences into their larger sense of
Consistent with constructivist perspectives of gender self. This is consistent with the research of that
development, this subgroup also did not identify suggests that non-binary identified people are more
an inherent “maleness” or “femaleness” that existed likely to face challenges to the legitimacy of their
beyond physical sex characteristics (Butler, 1990; gender identities, both from within and outside the
Newman, 2002). However, these participants did TGNC population (Galupo, Henise, & Davis, 2014;
describe the importance of being able to be seen and Langer, 2011).
validated in their non-conforming gender presenta- Taken together, these findings highlight the
tion and gender expression and identified similar strategic utility of adopting an intercategorical
underlying processes of development related to their approach to identify the unique experiences and
sense of self in these areas. associated psychosocial needs of such subsets of the
McCall (2005) notes that the perspective of TGNC population. However, as visible in these
intercategorical complexity can be particularly use- examples, the specific categorization strategies of
ful at elucidating the dynamics of inequality pro- utility will vary depending on the aspects of experi-
duced by dominant methods of categorization. ence researchers are seeking to elucidate. Despite
Within the present study, participants assigned these differences in experience, all participants also
male at birth, both transgender and non-transgen- exhibited similarities in the developmental pro-
der, appeared to experience less ability to express cesses (e.g., awareness, exploration, meaning mak-
their femininity or combine their masculinity and ing, integration) that supported the development of
femininity into a cohesive sense of self, both as a their gender-related sense of self. These similarities
result of increased rejection and more narrow gen- across participants highlight the utility of strategi-
der roles (Serano, 2007). Consistent with previous cally conceptualizing participants as part of a larger
research, transgender women (all also identified as TGNC population; an approach that is also
consistent with intercategorical complexity. In com- researchers may contribute to these mechanisms of
parison to stage-based models that do not appear exclusion. For example, participants in the present
to apply to the full range of experience within the study who expressed ambivalence or uncertainty sur-
TGNC population, process-based perspectives such rounding their gender identities, those whose sense of
as the one used in the present study appear more self combined aspects of being “male” and “female,”
broadly applicable. Narrative based approaches also and those who described personal experiences of gen-
appear to offer utility in challenging inequalities der diversity but did not view themselves as part of a
that arise from dominant forms of categorization. larger transgender spectrum are scantily visible within
As described by Wexler, DiFluvio, and Burke the current research on TGNC health and develop-
(2009), collective meaning making within oppressed ment. Newer conceptualizations of gender-related
groups can serve to shift focus away from personal experience appear to be incorporating such concerns,
shortcomings toward an understanding of, and including Tate (2014) and Tate, Youssef, and Better-
mobilization towards, the institutional structures garcia (2014) conceptualization of the gender as a
and practices that maintain oppression. “bundle” of non-binary and dynamic personality fac-
Results also support the utility of the intracate- ets. Within the past decade, use of a “two step”
gorical complexity perspective. This perspective was method of assessing assigned sex and gender identity
visible in descriptions and quotes reflecting differ- has also evolved to capture information about how
ences in experience reported by those with similar groups of people identify their gender in a way that is
characteristics as well as in experiences that pro- inclusive of diverse TGNC people’s experiences (Tate,
blematized categorical distinctions. Much variation Ledbetter, & Youssef, 2013). Using this method, indi-
existed across participants, even among those with viduals are asked to first indicate their gender identity
similar backgrounds or identities. These differences in one question (with non binary and write in options
spanned nearly all areas of gender-related experi- increasingly offered) followed by their sex assigned at
ence (e.g., identity labels, degree of physical dys- birth in a second question. This approach appears to
phoria, desired appearance, preferred interests/ improve ability to make distinctions between sex and
activities) and were also visible across developmen- gender, facilitating many of the strengths associated
tal processes (e.g., differing timelines, sources of with the intercategorical complexity perspective. The
information and support, contexts of exploration, present study recruited from a parent study that used
modes of integration). At the individual level, par- an early version “two step” approach (e.g., asked par-
ticipants also varied in the extent to which they ticipants to separately indicate their sex assigned at
experienced these dimensions as distinct, interac- birth and current gender identity). However, this
tive, and/or dynamic. The perspective of intracate- approach did not allow non-binary or write-in
gorical complexity argues that categorization options, which appeared to limit many participants’
inevitably obscures this diversity of experience, and ability to accurately self-report their gender identities
in doing so, reinforces mechanisms of exclusion (as evidenced by qualitative interview data). (e.g., N2,
and inequality (McCall, 2005; Valentine, 2007). T3, T4, N6, T7, N9, T10). Also of note, changes in
These negative consequences of categorization the gender identity across survey waves were also
appear visible in the resistance efforts that have common (e.g., T5, N5, T7, T8, N8, N9, N10). These
emerged from within TGNC communities sur- weaknesses in the current study design further high-
rounding early conceptualizations that attempted to light the need for research frameworks that acknowl-
assimilate transgender experience into a male- edge gender related experiences as both non-binary
female binary (Bullough & Bullough, 1998), as well and dynamic (e.g., change over time).
as ongoing methods of categorizing transgender Several limitations of the present study are
individuals into subgroups based on sexual orienta- important to consider. Namely, the small sample
tion (Serano, 2010). size likely restricted the range and diversity of
By failing to thoughtfully examine how their meth- experiences present and is not meant to be repre-
ods of conceptualizing TGNC populations may sentative of TGNC populations as a whole. For
exclude or misrepresent certain individuals and example, given participants’ proximity to a large
groups, intracategorical complexity demonstrates how city, they likely experienced greater access to
affirming LGBT services and settings. It was also Declaration of conflict of interest
not possible for interviews to provide an exhaustive
The authors declare that they have no conflict of interest.
discussion of all aspects of one’s gender related
experiences. Further study is necessary to explore
how these gender-related dimensions and associ-
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International Journal of Transgenderism

ISSN: 1553-2739 (Print) 1434-4599 (Online) Journal homepage: https://www.tandfonline.com/loi/wijt20

Gender identity development among transgender

L. E. Kuper, L. Wright & B. Mustanski

To link to this article: https://doi.org/10.1080/15532739.2018.1443869

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Gender identity development among transgender and gender nonconforming

Masculinity: 5.3 Masculinity: 5

women” reﬂect participants’ afﬁrmed identities (vs.

One-on-one interviews were semi-structured and

Qualitative data analysis Figure 1. Overview of themes.

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