June 30, 2022

Tips for Communicating with and for LGBTQI+ Communities

By Shyam Patel, Communications Director, and Nicole Kazi, Communications Specialist, NIH Sexual & Gender Minority Research Office

When communicating with, about, or for LGBTQI+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and other) communities, it is important to consider the unique needs and barriers these populations encounter. Compared to cisgender and heterosexual people, LGBTQI+ people experience higher rates of discrimination, stigma, and rejection because of their gender identity and sexual orientation. This may affect employment, housing, access to health care, and more. Understanding the history of prejudice and trauma will help to ensure that your communication efforts are respectful, inclusive, and supportive.

Language considerations are especially important when engaging LGBTQI+ communities in health research. Past discrimination, misrepresentation, or erasure have generated mistrust in health research. Too often, the inclusion of LGBTQI+ people in research has been limited or nonexistent. That has left large gaps in our understanding of the health and well-being of these populations.

Though LGBTQI+ is an acronym used to collectively describe non-heterosexual and non-cisgender identities, the terms “sexual and gender minority (SGM)” and “sexual and gender diverse (SGD)” are more commonly used in the context of health research. SGM and SGD are inclusive, umbrella terms to describe LGBTQI+ populations.

SGM populations include but are not limited to, people with same-sex or same-gender attractions or behaviors and those with a difference in sex development. These populations also include those with any non-binary constructs of sexual orientation, gender, and/or sex.

The phrase SGD is used to describe people who exhibit attractions and behaviors that do not align with heterosexual or traditional gender norms. This includes those who identify as lesbian, gay, bisexual, transgender, queer, intersex, and non-binary.

One important consideration is to avoid confusing sex and gender. Frequently, these terms are used interchangeably when, in reality, they are two different concepts.

Biological sex is based on anatomical and physiological traits. These include external genitalia, secondary sex characteristics, gonads, chromosomes, and hormones. A health care provider typically makes the decision about sex based on external-facing genitalia. However, it is important to note that sex can be non-binary, including for individuals who have a difference of sex development and/or identify as intersex, whose sex traits may not all correspond to a singular sex.

Gender, on the other hand, is 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. It is linked to an individual’s innate sense of self and is not always congruous with one’s sex.

The recently published NASEM Consensus Study Report on Measuring Sex, Gender Identity, and Sexual Orientation outlines these distinctions in further detail. It also provides examples of language for researchers to use for data collection purposes.

Gender pronouns are an important consideration when communicating with and about SGM people. By using someone’s correct gender pronouns, you are signaling mutual respect and affirming their identity. Intentionally misgendering a person can cause harm and is tantamount to harassment. Often, when someone’s identity is unknown, it is best to use third-person pronouns (i.e., they/them). The NIH Sexual & Gender Minority Research Office has developed a helpful overview of Gender Pronouns & Their Use in Workplace Communications.

In addition, gendered language, and the context in which it is used, should be evaluated to ensure that SGM populations are not being excluded. For example, when discussing a study that only includes cisgender women, it would be most accurate to use gender-specific language, like “pregnant women.” However, if transgender and nonbinary people are also referenced, phrasing like “women and other pregnant patients” can provide an inclusive alternative to “expecting mothers.”  Or you might use phrases like “pregnant patients” or “pregnant people.”

It is important to stay up-to-date and to avoid using old-fashioned and dated terms that can be offensive to SGM communities. Some common terms to use now are:

• Affirmed gender, not preferred gender or chosen gender or lifestyle
• Transgender, not transgendered, transgenderism, transsexual, or transvestite
• Transition or transitioning, not transgendering, sex change, or sex reassignment surgery

For more tips, see the glossary of terms and definitions developed by the NIH Office of Equity, Diversity, and Inclusion.

Remember, it’s okay to make mistakes. It is more crucial to remain transparent, acknowledge mistakes, and take the necessary steps to ensure they don’t happen again. In order to gain insights on how to better shape an inclusive communication strategy, reach out and establish relationships with partners in the LGBTQI+ community.