Disentangling gender, sex, and biology: a mixed methods study of gender identity data collection tools.

Objectives: We used community-based mixed methods to test whether transgender and gender diverse (TGD) people preferred gender identity questions developed by community members over current questions in use and generate hypotheses about data collection preferences.

Methods: We interviewed twenty TGD adults in English and Spanish, asking them to rate and discuss their responses to questions. We analyzed quantitative data with descriptive statistics and qualitative data with template analysis, then integrated them.

Results: More participants preferred gender identity questions that were currently in use. Themes: 1) TGD participants find questions about "gender" and related terminology unclear because of conflations of sex, gender, and other constructs. 2) TGD participants resist cisgenderism in questions about gender identity. 3) TGD people desire questions that allow for autonomy, privacy, and safety. 4) Contextual factors, particularly safety, influence whether and how TGD people answer questions about gender and sex.

Conclusions: TGD people have varied concepts of sex and gender and preferences about data collection. Future research should investigate the impacts of disentangling gender, sex, and biological factors, which could decrease stigma for TGD people.

Practice Implications: Medical care that disentangles gender, sex, and biological factors could improve data collection effectiveness and the safety of TGD people.