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I am a boy-girl. … I feel like myself. … I don't feel different from anyone else. …I feel like a girl, as well as a boy. –9-year-old, Hallel1
Nonbinary and genderqueer people experience their sense of gender in expansive and unique ways. Although there is no singular expression of nonbinary gender (just as the categories of man and woman are not monolithic), one common thread among nonbinary and genderqueer people is a sense that the expectations within the gender binary do not adequately reflect their sense of self. Nonbinary youth can have a gender that is neither exclusively boy nor girl, may be composed of elements of boy and girl (eg, Two Spirit—which is used by some Native American communities), moves between genders (eg, genderfluid), is situated beyond the binary (eg, genderqueer), rejects having a gender (eg, agender), or some combination thereof.2 Any of these identities can be consistent or evolving. Nonbinary persons often encompass elements of gender fluidity, whereby their sense of gender embodiment is changing over time, day by day, or sometimes over the course of a day. Gender fluidity can be the dynamic expression of not having a fixed gender, whereby fluidity itself is consistent, or it can be part of a journey of gender exploration which leads to an evolution of gender. Embracing variability in gender identity and embodiment is an important component of supporting youth as they come to understand themselves.
The terms for describing gender beyond the binary continue to evolve and expand, and many people use more than one identifier to describe their experience or identity (Figure 3 we will use the terms non-binary and genderqueer interchangeably in this article to encompass the wide range of gender expansive and/or gender fluid identities. It is important to note that some terms have a history of derogatory usage. Given this history, it is best practice to ask individuals what terms they wish rather than make assumptions about language.
An increasing number of nonbinary young people are presenting to providers for care. In a 2021 publication of high school students from a single urban school district, 9.2% reported a gender diverse identity, which is significantly higher than prior surveys, and one-third of these reported a nonbinary identity.