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Sex, Gender, and Sexuality

For a thorough list of terminology about sexual and gender minority populations, please reference .

Bisexual, bi+

Bisexual people have the potential to be emotionally, romantically, or sexually attracted to people of the same and different gender—not necessarily at the same time, in the same way, or to the same degree. Commonly referred to as bi.

Bi+ is an umbrella term that is intended to encompass non-monosexual identities, including but not limited to bisexual, pansexual, sexually fluid, and queer.

Cisgender

A cisgender person is someone whose gender identity aligns with the sex assigned to them at birth; sometimes abbreviated as cis. Use cisgender first with cis in parentheses after it if you use the abbreviation in your writing.

Gender

See the NIH Office of Research on Women’s Health’s page on .

Gender is a multidimensional social and cultural construct that includes gender roles, expressions, behaviors, activities, power dynamics, and/or attributes that a given society associates with being a woman, man, girl, or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time.

Gender affirmation, gender confirmation, transition, transitioning

Use the terms above rather than the terms transgendering, sex change, the surgery, or pre-operative/post-operative. Transition refers to the process—social, legal, and/or medical—one goes through to affirm one’s gender identity.  Transition may include changing hair styles, clothing, and other forms of gender expression. It may mean changing names, pronouns, and identification documents. It also encompasses gender-affirming medical care such as taking puberty blockers, taking hormones, and/or having gender-affirming surgeries. There is no one way to transition and the term means something unique to each individual who goes through the process.

Pre-/post-operative may still be used in medical literature but should not be applied to a specific person without the appropriate context as specified by the individual.

Gender expression

Gender expression is how one chooses to convey one’s gender identity through behavior, clothing, and other external characteristics.

Gender identity

An individual’s sense of being a man, woman, boy, girl, genderqueer, nonbinary, etc. This identity is not necessarily visible to others.

Gender non-conforming

A person whose gender expression is not consistent with the societal or cultural norms expected of that gender.

Intersex and variations in sex characteristics

Intersex and people with variations in sex characteristics (VSC) are people born with chromosomal, gonadal, hormonal, and/or anatomical characteristics that may not align with one another and/or fall outside of what is typically classified as male or female. Intersex is more frequently used when describing identity. Not all individuals with VSC identify as intersex as they may not wish to be defined by their biology or biological histories, nor do they think of it as an identity. There are many ways to be born intersex, and having variations in sex characteristics is a natural part of biological diversity.

Differences or disorders in sex development (DSD) may still be used in medical and clinical settings. When communicating with the public, however, VSC and intersex are more appropriate. VSC is a more clinical term and intersex is generally used in the context of identity.

LGBTQI+

LGBTQI+ stands for lesbian, gay, bisexual, transgender, queer, and intersex. The plus sign includes other members of the community, such as asexual, genderfluid, nonbinary, or two-spirit, among others.

Use LGBTQI+ when writing about the community outside of research contexts, e.g., community engagement or Pride month messaging. Use sexual and gender minority (SGM) populations when referring to LGBTQI+ communities as a singular population in the context of health research, related activities, and policy.

Misgender

To misgender is to refer to someone, especially a transgender or gender diverse person, using a word or address that does not correctly reflect their gender identity.

Nonbinary

A nonbinary person identifies outside of a gender binary by seeing themselves as neither a man nor or woman. Nonbinary people are part of the trans community.

Pronouns

Use pronouns that correspond to a person’s gender identity. Because gender identity is an internal characteristic that should not be assumed, asking for a person’s pronouns is the best practice. In addition to the binary English pronouns she/her and he/his, some people may use nonbinary pronouns, including the pronouns they/them used as singular terms, among others. When using the singular they, still conjugate the verb as a plural, as in, “they are gender nonbinary.”

When writing about a hypothetical person, like an anonymous participant in a study enrolling people of all genders, use the singular they rather than he or she.

Please review for a more in-depth discussion.

Queer

The term queer is more fluid and inclusive than traditional categories for sexual orientation and gender identity. Once considered a pejorative term, queer has been reclaimed by some LGBTQIA+ people to describe themselves; however, it is not a universally accepted term even within the LGBTQIA+ community. People who identify as queer may think of their sexual orientation and/or gender identity as characterized by nonbinary constructs of sexual orientation, gender, and/or sex. Queer should only be used to describe members of the community who themselves identify with it.

Sex, sexual

See the NIH Office of Research on Women’s Health’s page on .

Sex is a biological descriptor based on reproductive, hormonal, anatomical, and genetic characteristics. Typical sex categories include male, female, and intersex.

Sex is used when describing anatomical, gonadal, chromosomal, hormonal, cellular, and basic biological phenomena. E.g., sex development, sex hormones, sex characteristics.

Sexual is used when referring to sexual identity, attraction, behavior and associated psychological, social, and behavioral processes and constructs. E.g., sexual orientation, sexual minority, sexual health, sexual behavior.

Sexual and gender diverse

Sexual and gender diverse, abbreviated SGD, describes individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, non-binary, or who exhibit attractions and behaviors that do not align with heterosexual or traditional gender norms.

Sexual and gender minority populations

Sexual and gender minority (SGM) populations include, but are not limited to, individuals who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex. Individuals with same-sex or -gender attractions or behaviors and those with variations in sex characteristics are also included. These populations also encompass those who do not self-identify with one of these terms but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary constructs of sexual orientation, gender, and/or sex.

Use sexual and gender minority (SGM) populations as a broad, umbrella term when referring to LGBTQI+ communities broadly in the context of health research, related activities, and policy.

Use LGBTQI+ when identity is important (e.g., community engagement, Pride messaging). When writing about a specific research project or study, always use the population terms identified and defined by the investigators for that study. For example, a study could be examining outcomes among sexual minority women, while another may look at LGB people. In these instances, using SGM populations or LGBTQI+ would not be appropriate. For more information, see the

Do not use the term sexual and gender minorities. Instead, use sexual and gender minority as a descriptive phrase, e.g., sexual and gender minority communities, populations, groups, etc. This amplifies the fact that SGM communities have been marginalized and not necessarily that they are simply numerical minorities.

Sexual orientation

Sexual orientation describes sexual attraction, behavior, and identity. Use sexual orientation rather than sexual preference. Preference suggests that non-heterosexuality is a choice, a concept often used to discriminate against the LGBTQI+ community. Preference also suggests a selection from two or more choices, excluding bisexual people and pansexual people, among others.

If sexual orientation is a variable under investigation, the specific facet of sexual orientation under investigation should be explicitly named.

Transgender, trans

A transgender person is someone who identifies with a gender other than the one that was assigned to them at birth. Use the term transgender or trans and not transgendered. Transgendered is a dated term that suggests a point in time when a person “became” transgender, which diverges from the lived experiences of most transgender people. Trans is an adjective that helps describe someone's gender identity, and it should be treated like other adjectives (e.g., trans man, trans woman). Merging the adjective and the noun risks suggesting that a trans man or woman is more (or less) than just a man or just a woman, which goes against how many trans people identify themselves.

Two Spirit

Two-Spirit is a culture-specific term for AI/AN communities describing the complex and non-binary nature of gender- and sexuality-related cultural identities, roles, and contributions of AI/AN peoples. ​Due to its specific cultural, spiritual, and historical context, identifying as Two-Spirit is limited to Native Americans. But importantly, not all Native Americans who hold diverse sexual and gender identities consider themselves Two-Spirit; many identify as LGBTQI+. Only use this term if someone has said they identify as such.

Various spellings of Two-Spirit exist, including uppercase, lowercase, and hyphenated or with a number (e.g. 2Spirit, Two Spirit, two-spirit). 2S is the most common abbreviation. Consensus on spelling isn’t set, but for NIH content, use Two-Spirit.