Felt Dylan, Beach Lauren B, Ashley Florence, Phillips Gregory
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
University of Toronto Faculty of Law and Joint Centre for Bioethics, Toronto, Ontario, Canada.
Transgend Health. 2025 Apr 11;10(2):210-219. doi: 10.1089/trgh.2023.0010. eCollection 2025 Apr.
This study compares and evaluates two distinct two-step approaches to identifying transgender people in survey datasets. Traditional two-step methods using sex assigned at birth (SAB) and current gender identity remain dominant. However, they have notable limitations. Gender modality, or the relationship between SAB and current gender identity (e.g., cisgender, transgender, or something else), presents an important alternative item to consider.
Using an online, cross-sectional survey of 952 sexual and gender minority adults in the United States, we conducted an exploratory analysis of categorization divergence/convergence using two approaches: (1) a modified traditional two-step (SAB + current gender identity) and (2) an alternative two-step (current gender identity + modality).
Convergence between approaches was 95%. Rates of refusal for all questions were low, although slightly higher for gender modality. Divergence fell into three categories: (1) individuals grouped as "Questioning" by Approach #2, but not #1 (=21; 44.7% of divergences); (2) individuals categorizable by one approach, but not the other (=13; 27.6% of divergences); and (3) individuals whose gender modality differed between approaches (=13; 27.6% of divergences).
We found preliminary evidence for the utility of an alternative two-step approach, particularly when within-group differences among transgender populations are relevant. Both the traditional two-step model and the alternative we tested have limitations which should be ameliorated through future research. Cognitive testing is necessary to evaluate explanations of divergences. We identify priorities to expand on the relative strengths of our alternative approach and address the remaining limitations and areas of uncertainty it highlights.
本研究比较并评估了在调查数据集中识别跨性别者的两种不同的两步法。使用出生时指定的性别（SAB）和当前性别认同的传统两步法仍然占主导地位。然而，它们有显著的局限性。性别模式，即SAB与当前性别认同之间的关系（例如，顺性别、跨性别或其他情况），是一个需要考虑的重要替代项目。
通过对952名美国性取向和性别少数群体成年人进行在线横断面调查，我们使用两种方法对分类差异/趋同进行了探索性分析：（1）改良的传统两步法（SAB+当前性别认同）和（2）替代两步法（当前性别认同+模式）。
两种方法之间的趋同率为95%。所有问题的拒绝率都很低，尽管性别模式问题的拒绝率略高。差异分为三类：（1）被方法2归类为“存疑”但未被方法1归类的个体（=21；占差异的44.7%）；（2）可被一种方法归类但不能被另一种方法归类的个体（=13；占差异的27.6%）；（3）两种方法之间性别模式不同的个体（=13；占差异的27.6%）。
我们发现了替代两步法有用性的初步证据，特别是当跨性别群体内部差异相关时。我们测试的传统两步模型和替代模型都有局限性，应通过未来的研究加以改进。需要进行认知测试以评估差异的解释。我们确定了优先事项，以扩展我们替代方法的相对优势，并解决它所突出的剩余局限性和不确定性领域。
