Sex, gender, sexual orientation, and more: Sexual diversity in Alzheimer's research needs a new lens to achieve inclusive research and generalizable results

Abstract

Diversity, Equity, and Inclusion (DEI) efforts in Alzheimer's disease and related dementia (ADRD) research are guiding the adoption of two-step self-report questions that capture research participants’ identity based on categories of sex, sexual orientation, and gender identity. The intent is to facilitate inclusion and representation of sexual and gender minoritized (SGM) communities in ADRD research. The data from using these questions are on a collision course with another National Institute of Aging initiative, which is aimed at understanding sex differences in ADRD mechanisms. Here, we critically analyze the goals and methods of the two initiatives. We propose that, in addition to being SGM focused, DEI efforts are needed to expand how scientists consider and measure sexual diversity itself. Highlights: Sex, sexual orientation, and gender identity (SSOGI) will be asked in ADRD studies. SSOGI data will expand representation of research participant identities. SSOGI data are on a collision course with sex differences research. Both emphasize sexual diversity (SD) largely as SSOGI identity categories. Diversity, Equity, and Inclusion efforts must develop SD methods in ADRD research.