Embracing Diversity: Recognizing Gender Expression, Discrimination, Victimization, and Mental Health Disparities Among LGB Men and Women

Significance/Purpose. Gender expression is how individuals express their gender, often through feminine and masculine expression. Traditional gender expression expects men to display masculinity and women to embody femininity. Non-traditional gender expression is often defined as having opposite sex's characteristics, such that women being masculine and men being feminine. Non-traditional gender expression in gay and bisexual men has been linked to increased discrimination, victimization, and negative mental health outcomes (SAMHSA, 2023; Sanchez & Vilain, 2012). However, research on non-traditional gender expression in LGB women has not found the same effect. Previous research suggests that non-traditional gender expression in LGB women serves as a protective factor (Craig & LaCroix, 2011), but this has yet to be determined.

The study aimed to examine (1) the association between gender expressions (i.e., traditional vs non-traditional) and discrimination and victimization; and (2) the effect of discrimination and victimization on mental health in LGB men and women. The study hypothesized that non-traditional gender expression will be associated with higher levels of discrimination and victimization. It was also hypothesized that discrimination and victimization experiences will increase risk for mental health problems.

Methods. Utilizing data from the Generations: A Study of the Life and Health of LGB People in a Changing Society study from 2016-2019, the current cross-sectional study used data from Wave 1. Participants were 1,424 LGB individuals ages 18 and over with biological males (n = 674) and females (n = 750). The gender expression manifested in physical appearance and behavioral mannerisms were measured. For each gender expression variable, responses were recoded into three gender expression categories (masculine, feminine, and equally feminine and masculine). All data on variables were collected from self-report measures including discrimination (9 items, alpha = .91), victimization (6 items, alpha = .82), psychological distress (6 items, alpha = .89), suicidal behavior (yes/no), and self-harm (yes/no). All analyses were stratified by biological sex and biologically male and female samples were analyzed separately. A series of one-way ANOVA, multiple linear regression analyses, and binary logistic regression analyses were utilized.

Results. Having non-traditional gender expression in both physical appearance and mannerisms was associated with more discrimination among both men and women. Such that, LGB women with any masculine gender expression and LGB men who present with any feminine gender expression experience higher levels of discrimination. Further, men with equally feminine and masculine gender expression consistently experienced more discrimination. Higher levels of discrimination predicted higher levels of psychological distress, suicidal ideation, and self-harm behaviors in both genders. Additionally, more victimization experiences predicted more suicidal ideation in both genders. However, higher victimization experiences predicted higher levels of psychological distress in men but not in women.

Conclusion and Implications. The study highlights gender disparities in acceptable gender expression and strengthens previous research on discrimination’s impact on mental health outcomes. These findings underscore the importance of acknowledging individual differences within LGB communities to provide gender-affirming healthcare. Healthcare providers should consider non-traditional gender expression’s impact on discrimination and mental health well-being in LGB individuals to address their mental health concerns.