Issue 2 – October 2020 [source: Canadian Institutes of Health Research]

Harlan Pruden (nēhiyo/First Nations Cree) is an Educator at the BC Centre for Disease Control’s Chee Mamuk Program. Travis Salway is an Assistant Professor of Health Sciences at Simon Fraser University. They both work in the Two-Spirit Dry Lab, North America’s first research group/lab that exclusively focuses on Two-Spirit People, communities and/or experiences. They are also principal investigators for a grant funded through the CIHR Indigenous Gender and Wellness Initiative, exploring “Wellness in Two-Spirit Communities across Turtle Island: A Two-Eyed seeing approach to a gender-inclusive community-based 2S research network”.

What is Two-Spirit?

Harlan Pruden (nēhiyo/First Nations Cree) and Travis Salway

Two-Spirit is a term coined by Indigenous lesbian, gay, bisexual, transgender, queer, and/or non-heterosexual (LGBTQ+) leaders at the Third Annual Intertribal Native American/First Nations Gay and Lesbian Conference in Winnipeg in 19901. Two-Spirit is a community organizing strategy or tool and a way to describe one’s self. It is a way to organize the Indigenous Peoples of Turtle Island who embody diverse sexualities, gender identities, roles and/or expressions2. Two-Spirit is meant to facilitate Indigenous Peoples’ connections with Nation-specific expressions and roles of gender and sexual diversity. It is a way for Indigenous Peoples to reconnect with their traditional languages, ways and cultures within a pre-Colonial setting.

Is Two-Spirit a sexual orientation?

It depends on the individual and the context. Two-Spirit can be claimed and used by an Indigenous person who also identifies as an Indigenous LGBTQ+ person in a Western context. However, it can also be viewed as an expression of sexual orientation and as such, may or may not equate to an Indigenous LGBTQ+ person. In this way, Two-Spirit calls into question Western, binary notions of sexual orientation.

Is Two-Spirit a gender then?

This also depends on the individual and the context. Two-Spirit can and may be claimed and used by an Indigenous person as a way to opt out of and/or challenge Western notions of the gender binary (man/woman). Using Two-Spirit in this way is a place-holder and not an identity, as there may be a non-Western, Nation-specific term that is also relevant to their identity. Historically, many First Nations People had more than two genders. Currently, there are around 130 Nation-specific terms within many First Nations languages that name, account and identify these other genders2.

Background: The term Turtle Island originates from some of the First Peoples’ creation stories, including Anishinaabe and Lenape, and is used to name the land that has come to be referred to as the Americas2. Turtle Island is used to reference this land mass while not affirming or recognizing the various nation states that now overlay the First Peoples’ traditional territories and lands.

Sex Gender Sexual Orientation Two-Spirit
What is it? Biological attributes, including physical features, chromosomes, gene expression, hormones and anatomy A composite of socially constructed roles, behaviours, activities and/or attributes that a given society considers appropriate for members of a given sex Description of emotional, romantic or sexual attraction Community organizing tool for Indigenous Peoples of Turtle Island who embody diverse sexualities, gender identities, roles and/or expressions
Who does the term apply to? All people and animals Non-Indigenous people and Indigenous people showing up in the Western world Indigenous Peoples of Turtle Island with diverse sexualities and genders
Examples in Western terms For people: male, female, intersex
For animals: male, female, intersex, hermaphrodite
Man, woman, girl, boy, gender-diverse, non-binary, transgender, queer Heterosexual, gay, lesbian, queer, bisexual, pansexual, asexual Two-Spirit challenges Western terms of gender and sexual orientation. It allows Indigenous Peoples to reconnect with their traditional languages, ways and cultures within a pre-Colonial setting

Can Two-Spirit be considered under the umbrella of LGBTQ+?

The practice of adding Two-Spirit (or 2S) to the end of a LGBTQ+ acronym is problematic because it equates Two-Spirit with Western identities. Furthermore, if there is no substantial investment to engage Two-Spirit individuals in a study, then it would be incorrectly assumed that the conclusions drawn could be extrapolated to Two-Spirit individuals. Alternatively, the acronym LGBTQ/2S can be used to signify that 2S is different from other LGBTQ+ identities.

What can researchers do to recruit Two-Spirit individuals to engage in health research studies, in an ethical and respectful way?

  1. Demonstrate inclusion in a meaningful way. Research teams should include Two-Spirit persons in decision-making roles. Do not rely on one Indigenous person to articulate the experiences of all Indigenous Peoples. Fully listen to the Two-Spirit persons and integrate their voices into the study.
  2. In survey options, list Indigenous terms alongside Western notions, so that Two-Spirit and Indigenous Peoples see themselves within the survey instrument. For example, Indigenous-only options of Elder or Knowledge Keeper could be listed alongside Western terms like psychologist or social worker.
  3. Meet or exceed the spirit of the Tri-Council Policy Statement (TCPS 2, 2018) – Chapter 9: Research Involving the First Nations, Inuit and Métis Peoples of Canada3 and become OCAP® certified (Ownership, Control, Access and Possession)4.
  4. Ensure that recruitment is done by Indigenous Peoples from a particular community, asking their community.
  5. Understand cultural nuances and protocols. For example, it’s important to know when it’s appropriate to approach individuals. This will only be possible when Indigenous Peoples facilitate and help with that process.

How can health researchers collect Two-Spirit data in survey questions?

Two-Spirit is an Indigenous concept, and as such, it should be an option open to Indigenous participants only. For this reason, an option for ‘Two-Spirit’ should be embedded in the race, ethnicity or population groups question and offered only to Indigenous participants. This opens the possibility for Indigenous participants to answer gender and sexual orientation questions as to how they are showing up in the Western or non-Native world while honoring their Indigeneity and/or the use of the term Two-Spirit. A Two-Spirit option should not be included in the gender or sexual orientation questions. Researchers may additionally include a ‘prefer to self-describe’ option in the gender and/or sexual orientation options, so Indigenous participants also have an option to write in ‘Two-Spirit’ if they so choose.

The following is a race survey question, which includes a Two-Spirit measure. The categories are adapted from the Canadian Institute for Health Information5. It is important to specify why the information is being collected and how it will be used.

Which of the following best describes you?
Please select all that apply.

  • Black
  • East/Southeast Asian
  • Indigenous:
    • __First Nations
    • __Métis
    • __Inuit
    • __Prefer to self-describe (please specify)
    • __Prefer not to say
      • Are you Two-Spirit? __Yes __No
  • Latino
  • Middle Eastern
  • South Asian
  • White
  • Another category (please specify)
  • Prefer not to say


When Two-Spirit data is collected in a culturally safe and affirming way, health researchers are given the opportunity to promote rigorous science that considers biological sex and all genders. Research conducted in this way has the potential to expand our understanding of health within a diversity framework that considers how determinants such as ethnicity, race, socioeconomic status, disability, sexual orientation, migration status, age and geography interact with sex and/or gender. By bringing these considerations into focus, they can help formulate health research, policies and programs that are relevant to the diversity of the Canadian population.

The views expressed in this document are those of Harlan Pruden and Travis Salway and do not necessarily reflect those of the CIHR Institute of Gender of Health or the Government of Canada.

Further reading

Walter, M., & Anderson, C. (2013). Indigenous Statistics: A Quantitative Research Methodology. Routledge.


  1. Thomas, W. (1997). Navajo Cultural Constructions of Gender and Sexuality. In Two-Spirit People: Native American Gender Identity, Sexuality, and Spirituality. University of Illinois Press.
  2. Pruden, H. (2019). Two-Spirit Conversations and Work: Subtle and at the Same Time Radically Different. In Transgender: A Reference Handbook (pp. 134–136). ABC-CLIO Greenwood.
  3. Government of Canada, Panel on Research Ethics. TCPS 2 (2018) – Chapter 9: Research Involving the First Nations, Inuit and Métis Peoples of Canada. Accessed on 13th October, 2020.
  4. First Nations Information Governance Centre. (n.d.). The First Nations Principles of OCAP®. Accessed on 13th October, 2020.
  5. Canadian Institute for Health Information. (2020). Proposed Standards for Race-Based and Indigenous Identity Data Collection and Health Reporting in Canada. Accessed on 13th October, 2020.