Systematic review of instruments for measuring sex and gender attributes: assessment of measurement properties and utility in research on clinical and functional outcomes.

OBJECTIVES

To identify and synthesize instruments used to assess sex and gender attributes in relation to clinical and functional outcomes in adults.

METHODS

We searched four databases from inception to November 20, 2023, to identify English-language studies on clinical and functional outcomes that used instruments of sex and gender attributes. On July 20, 2025, we searched MEDLINE for studies on the measurement properties of the instruments previously identified. We used Holmbeck and colleagues' evidence-based criteria and rated quality based on measurement properties, including frequency of use by independent researchers, validity and reliability in relevant populations, and sufficiency of information for replication and appraisal.

RESULTS

Of the 12,948 unique records identified through our primary searches, 46 studies met our inclusion criteria. Eighteen of the studies had male-only samples, five had female-only samples, and the remaining included samples featuring both sexes, of which one also featured transgender and nonbinary people. These studies utilized a total of 34 instruments, of which eight assessed sex and 26 assessed gender attributes, of which only one measure, the Gender Self Report, had its scores validated in samples other than binary gender. We assigned high quality ratings to three instruments measuring sex, and three measuring gender attributes, with the remaining instruments classified as moderate or lower based on the predefined rating criteria including measurement properties assessed in relevant populations. Construct validity was the most reported property, and test-retest reliability was the least reported on.

CONCLUSION

The measurement properties of instruments measuring attributes of sex and gender in relevant populations varied. Validation of the scores in non-binary samples is limited. Further validation and application of highly rated instruments in diverse samples is timely for advancing equitable practices and policies.