What academic terminology should be used when describing sexual and gender minority patients?
Alice/AdobeStock
SPECIAL REPORT: SEXUAL AND GENDER MINORITIES
In the academic literature the terminology “sexual and gender minority” or SGM is commonplace. That is because SGM helps to succinctly encapsulate a diverse range of people, who often identify with multiple SGM identities. However, it is rare for young people to refer to themselves as SGM, instead (as summarized below) LGBTQ+ terms are more likely to be used.
The Mental Health of SGM Youth: Embracing Affirmation
Jack Turban, MD
Special Considerations for SGM Youth Online
Mathijs F. G. Lucassen, PhD; and Ana M. Ugueto, PhD, ABPP
The Negative Impact of Current Legislation on Gender Diverse Adolescents
Alexis Chavez, MD; and Shervin Shadianloo, MD
Typically, when an individual’s sex assigned at birth differs from their gender identity (ie, how they know themselves to be), they are categorized as transgender or gender diverse.2 Thus, an individual assigned male at birth who identifies as female is frequently described as a trans girl or trans woman (or simply just as a girl or woman).2 Individuals who identify as nonbinary (ie, not exclusively masculine or feminine identified) are also gender diverse, as they fit outside the male/female gender binary. Conversely, a young individual whose sex assigned at birth directly aligns with their gender identity is usually described as cisgender. Based on population-based data and other study estimates, approximately 1% of young individuals are transgender.3,4
It is important to note that LGBTQ+-related labels and terms continue to evolve. For instance, there has been some debate about whether or not the more established sexual identity labels (ie, gay, lesbian, and bisexual) have now lost their meaning and relevance resulting in young people today being post-gay.5 These old labels still appear to be of value for the majority of sexual minority youth,5 alongside the meanings ascribed to more contemporary terms such as “pansexual” (ie, attraction regardless of assigned sex or gender identity), “queer” (a reclaimed word), or developmentally relevant terms such as “questioning.”
Other unique subpopulations, which at times are grouped under the “plus” in LGBTQ+, include asexual and intersex individuals. Asexual individuals are those who lack sexual attractions to others. In the case of adolescents, however, it is important to consider developmental factors. For example, younger teenagers may report being “neither sex attracted.” This does not necessarily mean that they are asexual per se, but rather with age many are likely to start experiencing sexual attractions.6 Intersex individuals are born with biological or physical sex characteristics (eg, sexual anatomy and hormonal variations) that are more diverse than those stereotypically linked to male and female bodies.7 Consequently, they are diverse in terms of their sex.
LGBTQ+ youth are also diverse in terms of other important demographic features, such as being from a racial, ethnic, or religious minority group, having a disability, having an overlapping identity (like being LGB as well as transgender), or any combination of these features.8 Unfortunately, there is still stigma associated with being anything other than exclusively heterosexual and cisgender.8 As a result, LGBTQ+ youth often remain hidden (what is known as “in the closet”) and subsequently can be hard to reach.
Language does matter, and although “sexual and gender minority” terminology is useful, particularly in the academic literature, it tends to be “technical jargon” that is not in common usage. When working with SGM youth, it is therefore important to pay attention to the labels and their associated descriptions, as these are used by the young person. This also extends to using the patient’s correct pronouns (ie, she/her, he/him or they/them), as indicated by the young person.
Dr Lucassen is a researcher and an educator in the Department of Health and Social Care at The Open University (United Kingdom) and an honorary academic in the Department of Psychological Medicine at the University of Auckland (New Zealand). Dr Ugueto is a child psychologist and an assistant professor in the department of Psychiatry and Behavioral Sciences at the University of Texas Health Science Center at Houston. ❒
The rest of the references can be found in the extended article, Special Considerations for SGM Youth Online.
References
2. Turban JL, Ehrensaft D. Research review: gender identity in youth: treatment paradigms and controversies. J Child Psychol Psychiatry. 2018;59(12):1228-1243.
3. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students — 19 states and large urban school districts, 2017. Centers for Disease Control and Prevention. January 25, 2019. Accessed March 19, 2021. https://www.cdc.gov/mmwr/volumes/68/wr/mm6803a3.htm
4. Clark TC, Lucassen MFG, Bullen P, et al. The health and well-being of transgender high school students: Results from the New Zealand Adolescent Health Survey (Youth’12). J Adolesc Health. 2014;55(1):93-99.
5. Russell ST, Clarke TJ, Clary J. Are teens “post-gay”? Contemporary adolescents’ sexual identity labels. J Youth Adolesc. 2009;38(7):884-890.
6. Lucassen MFG, Clark TC, Moselen E, Robinson EM, The Adolescent Health Research Group. Youth’12 the health and wellbeing of secondary school students in New Zealand: Results for young people attracted to the same sex or both sexes. The University of Auckland; 2014.
7. Australian and New Zealand Intersex Organisations. Darlington Statement: A joint statement by the Australia and Aotearoa/New Zealand intersex community organisations and independent advocates. March 2017. Accessed March 17, 2021. https://ihra.org.au/wp-content/uploads/key/Darlington-Statement.pdf
8. Lucassen MFG, Fleming TM, Merry SN. Tips for research recruitment: The views of sexual minority youth. Journal of LGBT Youth. 2017;14(1):16-30.
