Measuring Sexual 

Orientation and Gender 

Identity

Dr. Kellan Baker, Committee Member

The Committee on Measuring Sex, Gender Identity, and 

Sexual Orientation

The Committee on National Statistics

The Division of Behavioral and Social Sciences and Education
Recommendation 2:

The panel recommends that the National Institutes of Health use the following question 

for assessing sexual orientation identity:

Which of the following best represents how you think of yourself? [Select ONE]:

☐ Lesbian or gay

☐ Straight, that is, not gay or lesbian

☐ Bisexual 

☐ [If respondent is AIAN:] Two-Spirit

☐ I use a different term [free-text]

(Don’t know)

(Prefer not to answer)

2
Sexual Orientation Identity: Measure Characteristics

• Strengths

– Only measures identity

– Allows for enumeration of those who 

use other terms beyond a limited set

– Allows for culturally specific 

identification for American Indian and 

Alaska Native populations

– Tested within a diverse array of 

populations

– Tested within broad age range (ages 

12-85)

3

• Weaknesses

– Response set does not reflect some 

aspects of current culture and 

terminology

– Write-in responses must be cleaned 

and coded

– Does not include response option that 

indicates uncertainty

– Uses negating language for straight 

category that is not conceptually 

accurate

– Response ordering does not reflect 

standard criteria
Sexual Orientation Identity: Topics for Future Research

RECOMMENDATION 3: To further improve the quality and inclusivity of 

current measures of sexual orientation identity, the National Institutes of 

Health should fund and conduct research on the following topics: 

• Alternate wording for the “straight” response option

• The ordering of response categories

• The addition of response options such as “queer,” “questioning,” and “same 

gender loving”

• Guidelines for measuring sexual orientation attraction and behavior

• Best practices for collecting sexual orientation information in adolescent 

populations

• Proxy reporting of sexual orientation identity

4
Sex and Gender Measurement

• Standard binary sex/gender question 

– Male and female answer options only

– Does not:

• Distinguish cisgender and transgender people

• Allow for nonbinary sex or gender

• Identify the concept of interest

• Identifying transgender people

– One-step: Single question asking explicitly whether respondents consider 

themselves transgender (or identify as male, female, or transgender)

– Two-step: Two items used in tandem, usually sex assigned at birth and current 

gender identity

5
Support for a Two-Step Approach

1. Previously recommended by the GeniUSS Group (2014) & the Federal 

Interagency SOGI Working Group (2016)

2. Testing has included feasibility studies, cognitive interviews & behavior coding, 

survey experiments

3. Nonresponse on the order of 1% or less in national surveys, response 

stability/reliability also higher than for other common demographic questions

4. Improves on existing one-step measures:

• Enumerates both cisgender and transgender people

• Accounts for both transgender experience and identity, recognizing that not all 

transgender people identify explicitly as transgender

6
Recommendation 4:

The panel recommends that the National Institutes of Health use the 

following pair of questions assessing sex assigned at birth and gender 

identity:

7

Q1: What sex were you assigned at 

birth, on your original birth 

certificate?

□ Female

□ Male

(Don’t know)

(Prefer not to answer)

Q2: What is your current gender? 

[Mark only one]

□ Female

□ Male

□ Transgender

□ [If respondent is AIAN:] Two-Spirit 

□ I use a different term: [free text]

(Don’t know)

(Prefer not to answer)
Strengths of this Two-Step Measure

• Clearly distinguishes between sex assigned at birth and current gender

• Cross-tabulation allows enumeration of cisgender and transgender people

• Allows for culturally specific identification for Indigenous respondents

• Tested with a diverse array of U.S. populations

– Cisgender and transgender people

– English and Spanish speakers

– Urban and rural residents

– Broad age range (12-85)

8
Cross tabulation of Two-Step Measure

• Cisgender women (female/female)

• Cisgender men (male/male)

• Transgender women (male/female)

• Transgender men (female/male)

• People who can be classified as transgender (trans men, trans 

women, people who identify using the term “transgender”)

• People with nonbinary gender identities (Two-spirit, write-ins)

9
Weaknesses of this Two-Step Measure

• Identity response set is forced choice, but “female,” “male,” & “transgender” 

are not mutually exclusive

• Uses sex terms for gender identity and newer gender terminology (e.g., 

nonbinary) not included

• Write-in responses must be cleaned and coded

• Sex assigned at birth may be sensitive for some and inappropriate to 

include in some circumstances 

• Sex assigned at birth also does not include nonbinary option (because 

framed as “original birth certificate”)

10
Topics for Future Research

RECOMMENDATION 5: To improve the quality and inclusivity of the recommended twostep gender measure—sex assigned at birth and current gender—the National 

Institutes of Health should fund and conduct research on the following topics: 

• Performance of a “select all that apply” approach for current gender

• Replacing or augmenting the gender response option “transgender” with “nonbinary” 

• Categorization of nonbinary people vis-à-vis transgender status or identity

• The need for a “nonbinary” response option for sex assigned at birth

• Stability of responses over time

• Alternative measures that can be used in circumstances in which asking about sex assigned at 

birth is inappropriate 

• Best practices for collecting sex and gender information from youth, people with limited English 

proficiency, and with proxy reporting

11