Non-binary people

Non-binary people are individuals whose gender identity does not fall exclusively within the category of man or woman. The term “non-binary” (often abbreviated as enby) functions as an umbrella term that encompasses a wide variety of identity experiences. This is not a new phenomenon or a recent trend: gender identities outside the binary have been documented in cultures around the world for centuries [12]. What has changed in recent decades is the availability of language to describe these experiences and growing attention from scientific research.

In this article, we explore what it means to be non-binary, which identities fall under this umbrella term, what science says, how pronouns work, and what daily challenges non-binary people face.

Definition: what it means to be non-binary

Being non-binary means having a gender identity that does not correspond exclusively to the traditional categories of “man” or “woman.” As described by Richards, Bouman, and other researchers in their review published in the International Review of Psychiatry in 2016, non-binary identities (also called genderqueer) represent gender positions that do not align with the male-female binary and that have always existed, although they have often been rendered invisible by medicine and society [1].

This definition covers a broad spectrum of experiences. Some non-binary people feel a combination of masculine and feminine, others do not identify with any gender, and still others experience a gender identity that changes over time. The common thread is that none of these experiences can be reduced to the man-woman dichotomy.

The Standards of Care version 8 (SOC-8) of the World Professional Association for Transgender Health (WPATH), published in 2022, dedicate for the first time a specific chapter to non-binary people, recognizing that these identities require a dedicated clinical approach and that care pathways must be flexible to respond to needs different from those of binary transgender people [2].

The spectrum of non-binary identities

The term “non-binary” functions as an umbrella under which diverse identities are gathered. Knowing the main ones helps in understanding the richness of these experiences.

Genderqueer

The term genderqueer was among the first to emerge, as early as the 1990s, to describe gender identities outside the binary. Some people use it as a synonym for non-binary, while others prefer it for its connection to queer culture and its connotation of challenging traditional gender norms. Richards and colleagues in 2016 described genderqueer identities as positions that “challenge and problematize dominant gender norms” [1].

Genderfluid

Genderfluid people experience a gender identity that changes over time. This fluidity does not necessarily follow a predictable pattern: a genderfluid person may feel more masculine at certain times, more feminine at others, or at a different position on the spectrum. Fluidity is not a sign of confusion or indecision, but a specific way of experiencing gender.

Agender

Agender people do not identify with any gender or feel they do not have a gender identity. Some describe their experience as an absence of gender, others as a neutral identity. The term is also often used by those who feel that the concept of gender itself does not apply to their inner experience.

Bigender and pangender

Bigender people identify with two genders, which may be experienced simultaneously or in alternation. Pangender people identify with all genders or feel their identity encompasses the entire gender spectrum. These identities, while less well known, are documented in the scientific literature and represent authentic and valid experiences [1].

Demiboy and demigirl

Some people identify as demiboy or demigirl, terms indicating partial identification with the male or female gender. For example, a demiboy may feel partly male and partly of a different or absent gender.

Historical and cultural roots

The idea that gender is exclusively binary is not universal. Anthropological and historical research documents the existence of gender identities outside the binary in numerous cultures, often with recognized and respected social roles [12].

Two-Spirit in Native American cultures

The term Two-Spirit (literally “two spirits”) was adopted in 1990 at an intertribal conference in Winnipeg to describe people who in Native American cultures occupy a distinct gender role, neither exclusively masculine nor exclusively feminine. Anthropological research has documented over 150 precolonial North American Native communities that recognized gender identities outside the binary [12]. Two-Spirit people often held important roles as healers, spiritual guides, and mediators. European colonization attempted to erase these traditions, imposing a rigid binary model.

Hijra in the Asian subcontinent

The hijra are people recognized as a third gender in India, Pakistan, Bangladesh, and Nepal for thousands of years, with origins dating back to the sacred texts of Hinduism [12]. The Supreme Court of India officially recognized the hijra as a third gender in 2014, and their history represents one of the oldest documentations of identities outside the binary.

Fa’afafine in Samoa

The fa’afafine (literally “in the manner of a woman”) are people assigned male at birth who assume traditionally feminine roles and behaviors in Samoan culture. They have been recognized and respected in Samoan society for centuries, and their example demonstrates that gender diversity is not a product of contemporary Western culture [12].

Other cultures

Similar examples are found in many other societies: the muxe in Zapotec culture in Mexico, the quariwarmi in the pre-Columbian Andean tradition, the kathoey in Thailand, and the sworn virgins in Albania [12]. This cross-cultural recurrence suggests that gender diversity is a constant aspect of human experience.

What science says

Scientific research on gender as a spectrum, rather than a rigid dichotomy, has expanded significantly in recent years.

Gender as a spectrum: the evidence

In 2015, neuroscientist Daphna Joel and colleagues published a landmark study in PNAS titled Sex beyond the genitalia: The human brain mosaic. Analyzing brain scans of over 1,400 people, the researchers demonstrated that human brains cannot be classified into two distinct categories (“male brain” and “female brain”), but are rather unique mosaics of characteristics, some more common in women, others in men, many shared [4]. This result supports the idea that gender, at a neurological level, is not a binary variable.

Psychologist Janet Shibley Hyde, with her Gender Similarities Hypothesis, demonstrated through a meta-analysis of 46 studies that men and women are similar in the vast majority of psychological variables. Seventy-eight percent of measured gender differences were negligible or small in magnitude, suggesting that gender binary is much less clear-cut than commonly believed [5].

Mental health of non-binary people

A systematic review and meta-analysis published in 2024 in Child and Adolescent Psychiatry and Mental Health specifically analyzed the mental health of non-binary youth. The results show that non-binary youth present higher levels of depressive and anxious symptoms compared to cisgender peers [6]. However, research indicates that this distress is not caused by the non-binary identity itself, but by minority stress: discrimination, lack of recognition, social pressure to conform to the binary, and difficulty accessing appropriate care [6].

The 2024 Trevor Project survey, conducted on over 18,000 LGBTQ+ youth in the United States, found that 46% of transgender and non-binary youth had seriously considered suicide in the past year [3]. At the same time, the data show that social and family support has a significant protective effect: TGNB youth with high levels of family support were 34% less likely to attempt suicide compared to those with low or moderate support [3].

Research in Italy

In Italy, Scandurra and colleagues conducted a 2021 study on Italian binary and non-binary transgender people, examining gender identity milestones, minority stress, and mental health. The results showed that Italian non-binary people tend to reach gender identity milestones (such as the first awareness of their identity) later than binary transgender people, likely due to lower visibility and scarcity of role models [7]. The study also found higher levels of negative expectations and mental health problems in the non-binary group, highlighting the need for targeted interventions [7].

Pronouns and language

The question of pronouns and inclusive language is particularly relevant for non-binary people.

How pronouns work

In English, the most common gender-neutral option is they/them, used as a singular pronoun. The singular “they” has a centuries-long history in English and was named Word of the Year by Merriam-Webster in 2019. Other options include:

• They/them: the most widely used gender-neutral pronoun in English
• Neopronouns: such as ze/hir, xe/xem, or ey/em — used by some non-binary people who find them more fitting
• Using the person’s name: some people prefer to avoid pronouns entirely and use their name instead
• He/him or she/her: some non-binary people are comfortable with traditional pronouns, sometimes alternating between them

The best approach is always to ask directly which pronouns a person uses.

The broader linguistic debate

The push for gender-neutral language extends across many languages. In Italian, solutions such as the schwa and the asterisk have been proposed. A 2023 study published in the Journal of LGBTQ+ Mental Health analyzed the schwa proposal as a non-gender-specific ending in Italian, highlighting its potential as an inclusion tool [8]. In Spanish, the “-e” ending has gained traction. In German, the Gender Star is increasingly common. Each language community is developing its own solutions, reflecting the universal nature of the need for recognition.

Non-binary people and transition

A commonly misunderstood aspect concerns the relationship between non-binary identities and transition. Not all non-binary people desire or undertake medical transition, and there is no single pathway.

Social transition

Many non-binary people undertake a social transition, which may include changing their name, pronouns, gender expression through clothing and appearance, and requesting recognition outside the binary in interpersonal relationships. This form of transition does not require medical interventions.

Medical transition

Some non-binary people choose medical pathways, which may include hormone therapy (sometimes at reduced doses or for limited periods compared to binary transgender people) or surgical procedures. The chapter dedicated to non-binary people in the WPATH SOC-8 emphasizes that care pathways must be personalized and that no standard protocol exists: every person has different needs [2].

No transition

Other non-binary people do not feel the need to modify their body or appearance. The validity of their identity does not depend on any medical intervention or external change. Being non-binary concerns inner identity, not necessarily physical appearance.

Legal recognition

The legal recognition of non-binary identities varies enormously worldwide and represents one of the most significant challenges for this community.

International landscape

Globally, about 17 countries allow the use of an X gender marker on identity documents or passports [9]. These include Australia, Canada, New Zealand, Argentina, Colombia, and, in Europe, Germany, Iceland, and Malta. Germany introduced in 2024 the Self-Determination Act (Selbstbestimmungsgesetz), which allows anyone to register their gender as “diverse” (divers) without medical requirements.

According to the 2024 annual report by ILGA-Europe, in Europe only Germany, Iceland, and Malta offer full legal recognition of non-binary identities, although other countries are considering reforms [11].

The situation in Italy

In Italy, there is currently no legal recognition of non-binary identities. Law 164 of 1982 allows for the rectification of sex on documents, but only from male to female or vice versa. There is no option for a gender different from these two categories. This means Italian non-binary people are forced to choose between two gender markers with neither of which they fully identify, a situation that can generate significant distress in daily life [7].

The United States

In the United States, recognition varies by state. Several states, including Oregon, California, and Washington, allow an X gender marker on driver’s licenses and state IDs. The U.S. passport has offered an X gender marker since 2022. However, not all states provide this option, creating an inconsistent landscape.

Common misconceptions

Non-binary people frequently face prejudices and misunderstandings. Addressing the most common misconceptions is essential for promoting correct understanding.

“It’s just a trend”

This is perhaps the most widespread objection, but also the least founded. As we have seen, gender identities outside the binary have been documented in cultures around the world for centuries or millennia: the hijra in India, Two-Spirit people in Native American cultures, the fa’afafine in Samoa [12]. What is new is not the experience, but the term “non-binary” and the media visibility. The increase in people identifying as non-binary reflects greater availability of language and a (partial) reduction in stigma, not the birth of an unprecedented phenomenon.

“It’s a phase”

Research does not support this claim. Longitudinal studies show that most people who identify as non-binary continue to do so over time. The study by Scandurra and colleagues in Italy showed that non-binary people reach gender identity milestones later, not because their identity is less stable, but because they have fewer role models and take longer to find the words to describe their experience [7].

“It’s an attention-seeking whim”

The mental health data refute this idea. Non-binary people face elevated rates of discrimination, violence, anxiety, and depression [6]. No one would voluntarily choose a condition that exposes them to these difficulties to “get attention.” The 2024 Trevor Project survey shows that fewer than half of transgender and non-binary youth (46%) report that most people in their lives use the correct pronouns [3]: a finding that highlights how the daily experience is often characterized by a lack of recognition, not an excess of attention.

“Non-binary is the same as intersex”

Being non-binary concerns gender identity, meaning the inner sense of one’s own gender. Being intersex concerns the biological characteristics of sex (chromosomes, hormones, anatomy). An intersex person may identify as a man, woman, non-binary, or in any other way. These are distinct dimensions of human experience.

The daily life of non-binary people

Beyond definitions and research, the daily life of non-binary people is made up of concrete challenges that deserve to be understood.

Invisibility and lack of recognition

In a society organized around gender binary, non-binary people often find themselves in a position of invisibility. Bureaucratic forms offer only two options (M or F), public restrooms are divided into two categories, and dress codes in many workplaces presuppose a binary gender. This structural lack of recognition can generate a constant sense of inadequacy and exclusion [7].

Relationships and coming out

Coming out as a non-binary person presents specific challenges. Unlike binary transgender people, non-binary people often have to explain the very meaning of their identity before they can communicate it. In intimate relationships, the lack of understanding from a partner can be a source of tension. At the same time, many non-binary people describe coming out as a liberating experience that finally allows them to live authentically.

Access to healthcare

In many countries, healthcare services are often unprepared to welcome non-binary people. The systematic review by Hibbert and colleagues (2019), published in Frontiers in Psychology, showed that non-binary and genderqueer people face significant barriers in accessing care, partly because existing healthcare pathways are designed for binary transgender people [10]. The WPATH SOC-8 represented a step forward [2], but their practical implementation remains uneven.

Toward a more inclusive society

Understanding non-binary identities does not require abandoning the concept of gender, but recognizing that human experience is more varied than the binary model suggests. Science confirms that gender, at the biological, psychological, and cultural levels, is a spectrum rather than a rigid dichotomy [4][5].

Respect for non-binary people translates into concrete daily practices: using the pronouns and name requested, not making assumptions about gender identity based on physical appearance, and informing oneself with openness and curiosity. It is not necessary to fully understand another person’s experience in order to respect it.

Non-binary people, like all people, ask to be seen for who they are. Recognizing their existence and their dignity takes nothing away from anyone; it enriches, instead, the collective understanding of what it means to be human.