Measurement of Sex and Gender Identity in the Behavioral Risk Factor Surveillance System Survey, 2014 to 2020

Effective measurement of sex and gender identity is challenging. Questions measuring gender identity were added as an optional module of the Behavioral Risk Factor Surveillance System (BRFSS) in 2014 and were modified repeatedly in following years. This study examines BRFSS participant responses to gender identity and sex questions, 2014– 2020. About 70% of participants who identified as transgender male- to-female reported male sex while 30% reported female sex. Participants who identified as transgender female- to-male reported female sex about 65% of the time and reported male sex 35% of the time. Despite changes in sex question wording, these percentages were consistent over time. Reported sex is used in computing health- related variables and in routing participants to questions about birth control, pregnancy, HPV vaccines, and cancer screenings. Without better measurement, it is challenging to assess health and health risks and inform guidelines, programs, and policies protecting the health of transgender people.