Measuring Sex, Gender 

Identity, and Sexual 

Orientation

The Committee on Measuring Sex, Gender Identity, and 

Sexual Orientation

The Committee on National Statistics

The Division of Behavioral and Social Sciences and Education

OCTOBER 26, 2022 FCSM RESEARCH CONFERENCE
Developing Standards for the 

Measurement of Sex and Gender: A 

NASEM Consensus Study Report

The Committee on Measuring Sex, 

Gender Identity, and Sexual 

Orientation

Nancy Bates, U.S. Census Bureau (retired)

Co-Chair, Committee on Measuring Sex, Gender Identity, and Sexual Orientation

MAY 12, 2022 AAPOR ANNUAL MEETING
Report Sponsors

• This report was sponsored by the National Institutes of Health (NIH)

– Contract Number: HHSN263201800029I

– Task Order Number: 75N98021F00001 

• 19 entities within NIH provided funding for this project:

3

National Human Genome Research Institute

National Institute on Aging

National Institute of Allergy & Infectious Diseases

Eunice Kennedy Shriver National Institute of Child Health 

& Human Development

National Institute of Environmental Health Sciences

National Institute of Mental Health

National Institute of Minority Health & Health Disparities

National Institute of Neurological Disorders & Stroke

Office of the Director, All of Us

Office of the Director, Chief Officer for Scientific Workforce 

Diversity

Office of the Director, Division of Program Coordination, 

Planning, & Strategic Initiatives:

Office of AIDS Research

Office of Behavioral and Social Sciences Research

Office of Disease Prevention

Office of Research on Women’s Health

Office of Strategic Communication

Sexual & Gender Minority Research Office

Office of the Director, Office of Equity, Diversity, & Inclusion

Office of the Director, Office of Intramural Research, Office 

of Intramural Training and Education
Measuring Sex, Gender Identity and Sexual 

Orientation: A Consensus Study Report

“Data on sexual orientation and gender identity should be collected

in federally funded surveys...”

--- IOM, 2011 The Health of Lesbian, Gay, Bisexual and Transgender People 

“Sexual orientation and gender identity question are presented 

inconsistently across data collection tools” 

“...data on sexual orientation, gender identity and intersex status are 

needed to drive research agendas, monitor population trends...” 

--- NASEM, 2020 Understanding the Well-Being of LGBTQ+ Populations

4
The Committee on Measuring Sex, Gender Identity, 

and Sexual Orientation

• NANCY BATES (Co-chair), U.S. Census Bureau (retired)

• MARSHALL CHIN (Co-chair), University of Chicago

• KELLAN E. BAKER, Whitman-Walker Institute

• JOSÉ A. BAUERMEISTER, University of Pennsylvania

• D’LANE COMPTON, University of New Orleans

• KATHARINE DALKE, Pennsylvania State University

• ALIYA SAPERSTEIN, Stanford University

• KARINA WALTERS, University of Washington

• BIANCA D. M. WILSON, the Williams Institute at UCLA

5
External Peer Reviewers of the Report

• ELIZABETH L. COPE, AcademyHealth

• KARI J. DOCKENDORFF, Colorado State University

• MARGO EDMUNDS, AcademyHealth

• JASON D. FLATT, University of Nevada, Las Vegas

• M. PAZ GALUPO, Towson University

• KIRK GREENWAY, Indian Health Service

• JODY L. HERMAN, Williams Institute at University of California, Los Angeles

• MICHELLE M. JOHNS, NORC at University of Chicago

• CHARLES F. MANSKI, Northwestern University

• KRISTINA OLSON, Princeton University

• TONIA POTEAT, University of North Carolina School of Medicine

• SAMUEL H. PRESTON, University of Pennsylvania

• KRISTEN SCHILT, University of Chicago

• CARL STREED, Boston University School of Medicine

6
Introduction

• Our identities shape opportunities, experiences with discrimination, and outcomes 

through our life course.

• Sex, gender, and sexual orientation are core aspects of identity; therefore, it is crucial 

that measures of these concepts accurately capture their complexity. 

• Current data collection efforts in these areas are not standardized, leading to lack of 

conceptual precision and inability to compare studies. Advances in the conceptualization 

and measurement of sex and gender should be incorporated across scientific fields.

• Better measurement of sex, gender identity, and sexual orientation will also improve the 

ability to identify sexual and gender minority populations and understand the challenges 

they face.

7
1. Review current measures and the methodological issues related to 

measuring sex as a nonbinary construct, gender identity, and sexual 

orientation in surveys and research studies, in administrative settings, 

and in clinical settings.

2. Produce a consensus report with conclusions and recommendations on 

guiding principles for collecting data on sex, gender identity, and sexual 

orientation and recommended measures for these constructs in different 

settings.

Committee Statement of Task

8
Organization of the Report

1. Introduction, Definitions, and Scope of Report

2. Part I: Measurement Principles, Contexts, and Methods

3. Part II: Measure Recommendations

9
Definitions 01

10
Definitions: Sex

• A multidimensional construct based on a cluster of anatomical and 

physiological traits (sex traits)

– Sex traits include: external genitalia, secondary sex characteristics, gonads, 

chromosomes, and hormones

• Characteristics

– Usually assigned as female or male

– Most often defined at birth based on visual inspection of external genitalia

– Sex traits usually assumed to be unambiguous, but may not be

– Sex traits usually assumed to correspond to the same sex, but may not

– Some sex traits can change or be altered over time

11
Definitions: Populations Defined by Sex Traits

• Intersex/Differences in Sex Development (Intersex/DSD)

– People whose sex traits do not all correspond to a single binary sex

12
Definition: Gender

• A multidimensional construct that links gender identity, gender expression, and social and cultural 

expectations about status, characteristics, and behavior that are associated with sex traits

– Identity: A core element of a person's individual sense of self 

– Expression: How an individual signals their gender to others through behavior and appearance

– Social and cultural expectations: Related to social status, characteristics, and behavior that are associated with 

sex traits

• Characteristics

– Often conceptualized as binary (male/female or man/woman) in Western cultures, but also includes categories 

outside this binary

– Often used interchangeably with sex, though it is conceptually distinct

– Often assumed to be determined based on sex assigned at birth but may differ

– Gender identity, expression, and social and cultural expectations may not all correspond to the same gender

– May be temporally and contextually fluid

13
Definitions: Gender Identities

• Transgender: A person whose current gender identity is different from the sex they 

were assigned at birth

– Transgender experience: All people who can be classified as transgender, regardless of whether they identify 

as transgender

– Transgender identity: People who identify as transgender

• Cisgender: A person whose current gender identity corresponds to the sex they were 

assigned at birth

• Nonbinary: An umbrella term for gender identities that lie outside the gender binary

– Genderqueer: A person who does not follow gender norms

– Genderfluid: A person who does not identify with a fixed gender

– Two-Spirit: Placeholder term for specific gender and sexual orientation identities that are centered in 

Indigenous tribal worldviews, practices, and knowledges

14
Definition: Sexual Orientation

• A multidimensional construct encompassing emotional, romantic, and 

sexual attraction, identity, and behavior

– Identity: A person's core internal sense of their sexuality

– Attraction: A multidimensional concept that includes the gender(s) to which a person is 

attracted and the strength of this attraction, including whether a person feels attraction at all

– Behavior: A multidimensional concept that includes the gender(s) of sexual partners, specific 

sexual activities, and frequency of activity

• Characteristics

– Often defined based on the gender(s) of a person's desired or actual partners relative to their 

own gender in Western cultures

– The three dimensions of sexuality—attraction, identity, and behavior—may not correspond to 

the same orientation

15
Definitions: Sexual Orientation Identities

• Straight or heterosexual: Sexually oriented toward people of a different, usually binary, gender

• Gay or homosexual: Sexually oriented toward people of the same, usually binary, gender (Note: 

The term “homosexual” can be considered offensive and outdated)

• Lesbian: Women who are sexually oriented toward other women

• Bisexual: Sexually oriented toward both men and women

• Queer: An umbrella term for belonging to the LGBTQI+ community; also used to refer to a person 

who is sexually oriented toward people of more than one gender

• Pansexual: Sexually oriented toward people of any gender

• Questioning: Uncertain about sexual orientation identity

• Two-Spirit: Placeholder term for specific gender and sexual orientation identities that are centered 

in Indigenous tribal worldviews, practices, and knowledges

• Same Gender Loving: Nonheterosexual sexual orientation identity used by some within African 

American communities as a resistance to Eurocentric language for sexuality

16
Gender Identity and Sexual Orientation in an 

Indigenous Context

• The committee recognizes that the U.S. federal government has a trust 

responsibility to the 574 federally-recognized American Indian and Alaska 

Native tribes

• “Two-Spirit” is an intertribal umbrella term first coined in 1990 that is used as 

a placeholder for tribe-specific gender and sexuality identities

– Many tribes recognize three or more genders

– Within many tribal communities, gender and sexual identity are not easily distinguished and are 

part of an individual’s broader social role within their tribe

– The use of an intertribal term allows these Indigenous identities to be measured and counted in a 

way that individual tribal identities do not

– The term is widely—but not universally—recognized and used within tribal communities

17
Scope of the Report

• Measures than can be used in the general Englishspeaking adult population 

– More detailed response options may be necessary for measures used 

within LGBTQI+ populations

– Modifications to recommendations may be needed if they are used 

within younger populations

– Also prioritized representation of indigenous sexual and gender 

minorities

• Focus on measures of identity that can also be used to 

identify sexual and gender minority populations

18
Part I: Measurement 

Principles, Contexts, 

and Methods

02

19
Data Collection Principles

• Inclusiveness 

– People deserve to count and be counted

• Precision 

– Use precise terminology that reflects the constructs of interest 

• Autonomy 

– Respect individual identity and autonomy

• Parsimony 

– Collect only necessary data

• Privacy 

– Use data in a manner that benefits respondents and respects their privacy and confidentiality 

20
The Importance of Conceptual Clarity: 

Sex and Gender

• Conceptually distinct

• Each comprise multiple dimensions 

• Conflating sex and gender or measuring either concept using a single 

binary measure can lead to mismeasurement or misuse of the data

21
Conclusion 1:

Gender encompasses identity, expression, and social position. A person’s 

gender is associated with but cannot be reduced to either sex assigned at 

birth or specific sex traits. Therefore, data collection efforts should not 

conflate sex as a biological variable with gender or otherwise treat the 

respective concepts as interchangeable. In addition, in many contexts, 

including human subjects research and medical care, collection of data on 

gender is more relevant than collection of data on sex as a 

biological variable, particularly for the purposes of assessing inclusion and 

monitoring discrimination and other forms of disparate treatment.

22
Recommendation 1:

The standard for the National Institutes of Health should be 

to collect data on gender and report it by default. Collection 

of data on sex as a biological variable should be limited to 

circumstances where information about sex traits is relevant, as in 

the provision of clinical preventive screenings or for research 

investigating specific genetic, anatomical, or physiological processes 

and their connections to patterns of health and disease. In human 

populations, collection of data on sex as a biological variable should 

be accompanied by collection of data on gender.

23
Using Context-Specific Measures

• Much of the research is in survey research context 

• Where possible, the panel evaluated measures that have been used in 

clinical and administrative settings

• Panel opted to recommend that the same measures be used within all 

three data collection settings, in absence of clear evidence indicating that 

poor performance or feasibility

27
Panel’s Measure Evaluation Criteria

• Questions

– Consistency with data collection 

principles

– Comprehensible within LGBTQI+ and 

general populations

– Tested within LGBTQI+ and general 

populations

– Consistent estimation across data 

collection contexts

– Tested using multiple administration 

modes 

– Select one response

28

• Response Options

– Terminology is comprehensible within 

both LGBTQI+ and general populations

– Can measure recent trends

– Can track and incorporate changes in 

terminology

– Balances comprehensiveness with 

complexity

– Minimizes need to reclassify respondents

– Ordering follows generally accepted 

practices 
Part II: 

Measure 

Recommendations

03

29