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Two-spirit, agender, gender fluid, genderqueer, gender-nonconforming, third sex: whatever the terminology, in many cultures throughout history, some people have identified as neither male nor female, or as “nonbinary.” As our society’s concept of gender evolves, so does the visibility of contemporary nonbinary people. Yet many members of the medical community may not know how to interact with nonbinary patients respectfully or recognize their unique needs and barriers to care.

Nonbinary people’s gender identity lies outside the boundaries of a strict male–female dichotomy. As a gender identity, it is independent of biologic sex (male, female, or intersex) and sexual orientation (heterosexual, homosexual, bisexual, or pansexual). Nonbinary and transgender persons are considered gender minorities, but there may be differences between the two (see Glossary).