A qualitative study of <scp>US</scp> ‐based transgender, nonbinary, and gender diverse individuals' perspectives on preconception and prenatal genetic testing for nonmedical sex selection

Nonmedical sex selection has become increasingly common due to advancements in genetic testing and increased consumer demand. There is growing concern that the current practices of sex chromosome screening and result disclosure contribute to public misinformation about sex and gender, disproportionately harming the transgender, nonbinary, and gender diverse (TNGD) community. This qualitative study explores United States-based TNGD individuals' perspectives on the use of nonmedical sex selection and identifies recommendations of best practices for healthcare professionals (HCPs) when discussing these genetic tests. Semi-structured interviews were conducted with 13 TNGD individuals. Data were analyzed using reflexive thematic analysis and guided by queer theory. Three themes were developed: (1) "there are probably good reasons and bad reasons": drawing moral boundaries around nonmedical sex selection while preserving patient autonomy, (2) trapped in rigidity: gender essentialism reinforced by nonmedical sex selection harms TNGD people, and (3) laying the foundation: HCPs' role in patient education. Participants emphasized the responsibility of HCPs to educate patients on the differences between sex chromosomes, sex, and gender, as well as promoting open-ended discussions to encourage critical reflection on the motivations behind nonmedical sex selection. The results of this study illuminate how HCPs, including genetic counselors, and organizations can tailor the protocols and counseling about nonmedical sex selection to facilitate a more ethical decision-making process and foster inclusivity of the TNGD community.