Health and psychosocial differences between binary transgender and nonbinary adults: A national probability sample analysis.

Transgender and gender nonbinary individuals face significant health disparities, but existing research relies on convenience samples or combines gender-diverse individuals without examining subgroup differences. This analysis uses data from two companion national probability samples (Generations and TransPop) to compare health and psychosocial outcomes between binary transgender adults (transgender men and transgender women) (n = 159) and nonbinary adults (n = 164). Multivariable regression models controlling for age, sex assigned at birth, and employment were used to examine differences in health outcomes, victimization, and social support. Among nonbinary individuals, 58.9% (95% CI 49.4-68.4) rated their health as "good" or better, compared to 78.4% (95% CI 69.9-86.8) of binary transgender participants. Functional limitations from physical or emotional problems were reported by 75.0% (95% CI 67.4-82.7) of nonbinary adults versus 41.4% (95% CI 31.6-51.2) of binary transgender adults. Psychological distress levels were comparable between groups. Nonbinary individuals had higher odds of physical or sexual assault (aOR=2.03, 95% CI 1.08-3.81) and partner conflict (aOR=2.74, 95% CI 1.29-5.82). Binary transgender adults more frequently reported unmet desires for parenthood (40.9%, 95% CI 30.9-50.8) than nonbinary adults (18.0%, 95% CI 10.7-25.3). Nonbinary individuals reported poorer future outlook, while life satisfaction was comparable. Friend support was lower among nonbinary individuals, though family support showed no differences. This analysis reveals that despite many similarities, binary transgender and nonbinary individuals face distinct challenges warranting targeted interventions.