Society has a false belief that in nature there are only two sexes or two genders: male or female, man or woman. In truth, nature isn't binary, people are. Gender is a social construct that people use to categorize and organize information. There are many people for whom the binary works and matches. It's important to understand that it does not work for all of us. Gender is a spectrum. There is a greater number people who are both autistic or on the autism spectrum and people who are transgender or gender non-binary.

Gender non-binary people have always existed. What hasn't existed is respectful language, knowledge, and acceptance. Learning to use different language may be a challenge, but it is essential for making space for everyone and to broaden the binary models of gender to make space for all of us. There are new terms that people use to express their own gender identity, words like gender queer, gender fluid, gender creative, gender expansive, neutrois, let people find themselves in language. Having a non-binary means expanding choices for how people may medically transition (or not). The human need for categories effects other areas, like sexual orientation, making language related to sexual orientation problematic for gender non-binary people.

julie graham is the Director of Gender HealthSF, a program in the San Francisco Department of Public Health. Gender HealthSF was the first program in the nation to provide access to gender confirmation surgeries to publi c health consumers. julie is a public health specialist and has trained nationally on healthcare for non-binary, transgender and transsexual people, julie is interested in developing supports to address the realities of healthcare inequities caused by stigma, bias, and discrimination and their impact on health outcomes. Improving the awareness of neurodiversity in the transgender and gender non-binary communities is a particular interest in terms of expanding accessible and relevant services. As curriculum chair of the Global Education Initiative of WPATH, julie assisted in the development of culturally and clinically relevant materials.