Two-Spirit Identity and Traditional Knowledge

Traditional Understandings of Gender Diversity

Gender diversity and equality are important components to First Nations, Inuit, and Métis cultures, yet are understood in different ways across cultures and communities. Further, the specific traditional roles of gender diverse and two spirit people in Indigenous cultures have been impacted by colonization and other social, political, and cultural processes.

The term was first proposed during the 1990 Third Annual Inter-Tribal Native American, First Nations, Gay and Lesbian American Conference in Winnipeg by Elder Myra Laramee.1 Elder Myra was bestowed by Creator the term Anishinaabemowin term niizh manidoowag meaning two spirits. Two-Spirit or 2S folks have always existed in Indigenous Communities. Two-Spirit is an umbrella term used to describe those who are given masculine and feminine spirit by Creator, including people who might be described in western culture as gay, lesbian, bisexual, transgender, genderqueer or who have multiple gender identities.

Historically, two spirit people were seen, loved, and respected as unique individuals in most Indigenous communities. They were gifted with keen insight and the ability to see things through both feminine and masculine eyes (double vision). Many held important roles within their tribes, such as chiefs, medicine people, marriage counsellors, caregivers, protectors, and knowledge keepers.

It is important to think about how Two-Spirit identity will look differently for every community and person. Different communities will have different names with over 155 different words used across communities and languages to describe people with multiple genders 2.

(Cree term, which roughly translates to “neither man nor woman”)

(Ojibwe term, meaning “warrior woman”)

(Ojibwe term, meaning “warrior man”)

(Navaho term, roughly translates to “weaver transformed; that which changes; or he who transforms”)

Dakota/Lakota term, translates to “double woman.” Among the Lakota and Dakota peoples, possessing a wintike name was said to provide spiritual protection for the child, and helped to insure good health and a long life.

(Inuit term, meaning “infant whose sex changes at birth”)

(Mohawk term, which translates into “I have the pattern of two spirits inside my body”)

niizh manidoowag

winkte, Wi’kta, Wingkte’ (would be woman)

nadleeh (He changes) 3

nàdleehé 4

Iskwêw ka napêwayat (a man dressed/living as a woman)

înahpîkasoht (a woman dressed/living as a man)

Katsotse (girl-boy)

Winkte (halfman-halfwoman)

Agookwe (hidden woman) 5

Mixu’ha (instructed by the moon)

He’eman (women/man)


Kwido (old woman/ old man)

Osha’pu (women)


Bote, Bade

Biatti or Miati (woman-compelled)

Being Two-Spirit embodies much more than identity and includes important traditional and sacred roles within Indigenous Communities. Two-Spirit folks were known for their “wisdom, healing, and visions.” 6 In the Mohave creation story it says “ever since the world began, there have been Two Spirit people, and from the beginning of the world, it was meant that there should be Two-Spirit people” 7 Traditional teachings about Two-Spirit folks can be found in Midewiwin creation story of the Anishinaabe 8. In some communities, when a Two-Spirit person reaches puberty, the community would hold a ceremony, placing the Two-Spirit child in a lodge and asking they pick a basket or a bow. Depending on their decision, this meant which path the child was going to be guided by the masculine or feminine. 9 In other communities, vision quests guided Two-Spirit folks to their roles 10 Male-embodying Two-Spirit folks had a wide range of duties including healers, undertakers, and creative work including beading, quillwork, and making regalia for dancing. Many engaged in masculine-centered activities such as sweat lodges but also engaged in domestic responsibilities such as cooking. 11 Female-embodying Two-Spirit folks engaged in duties including chiefs, hunter, fisher, medicine people, and peace keepers. 12


Oral and anthropological research and Inuit testimony suggest that gender in Inuit culture is fluid and does not conform to a traditional binary framework. Historically, Inuit folks have not identified as Two-Spirit as other Indigenous Communities have done. Instead, Inuit folks have a heritage of “third genders” in. A choupan, is a man (or assigned male at birth person*) who expresses feminine gender by wearing women’s clothing. A choupan often becomes a shaman and is responsible for training young, selected individuals to become seers and traditional healers (often young girls). In Inuit culture, gender norms have always been interchangeable and roles responsibilities are given regardless of gender or sexuality.

In some Inuit communities, infants are given names of loved ones who have passed on and may be given and exercise varying gender roles of each. For instance, children assigned female at birth may be named after a passed-on uncle or grandfather (specifically identified as men) but still display gender norms as women, and/or both; this simultaneously is reversed for those assigned male at birth named after female ancestors or relatives. It is believed the infant may display the qualities, knowledge, and spirit of the person they have been named after, regardless of gender.

Not all Inuit practice this tradition: many children are raised to learn both female and male traditional skills, knowledge, and social roles throughout the initial years of life to give them a broader skill set and range of abilities. In recent years, many Inuit 2SLGBTQ+ and gender-diverse women and girls have adopted the word Two-Spirit as a form of decolonization. Using this term also provides an opportunity to identify within the broader 2SLGBTQ+ community. Although some aspects of Inuit culture, gender equality and diversity have been lost due to colonization and Christianization, Inuit women and girls are reclaiming various aspects of sexuality and gender equality through revitalization of language, drum dancing, tattooing, and throat singing. Inuit women and girls are reclaiming their sexuality and identity in evolving and increasingly open ways, illustrating the continuing cultural importance of gender diversity and equality.

*meaning this is the sex they were given at birth based on their bodies alone




The traditional Métis language, Michif, is a unique and complex blend of French and Cree languages. Two-Spirit identities, teachings, roles, and responsibilities in Métis culture are similarly interrelated. For instance, a shared value in Métis and Cree teachings is respecting others and their way of expressing their Two-Spirit identity. Historically, Métis Two-Spirit folks have specific duties and responsibilities including counselling, healing, and serving as visionaries (seers) in accordance with the belief to “respect all life.” Métis core values and beliefs include strength, kindness, courage, tolerance, honesty, love, sharing, caring, balance, patience, and above all, a connection with the Creator and Mother Earth. Métis culture was historically egalitarian: Métis women were the key pillars of their communities and were the providers for their immediate and extended families.

Two-Spirit and gender-diversepeople also held important community roles and positions. As with other Indigenous cultures, colonization deprived Métis Women, Two-Spirit, and Gender-Diverse People from these valued social roles, leading to widespread discrimination and invisibility of diverse genders and sexualities. However, Métis Two-Spirit folks like Gregory Scofield (a Métis poet, artist, and writer) and Cortney Dakin (a Two-Spirit Didikai Métis community organizer) are revitalizing Métis understandings of gender and sexual diversity. In 2019, the Manitoba Métis Federation created a new organization—Two-Spirit Michif—to represent its two spirit and LGBTQ+ citizens. Check out Métis Kitchen Table Teachings where Two-Spirit Métis folks talk about their experiences and this Two-Spirit Métis Awareness Resource.

Algonquin College. (14 June 2019). Frida Facts: Two Spirit. Retrieved from

Arnaquq-Baril, A. (2012). Unikkaat Studios Presents Tunniit: Retracing the Lines of Inuit Tattoos. Retrieved from

Carlson, Mark. (14 October 2016). Two-Spirit Tales: A Berry Curious Raiding Party. Retrieved from

Crass, Barbara A. (1998). Pre-Christian Inuit Mortuary Practices: A Compendium of Archaeological and Ethnographic Sources. Ph.D dissertation, Department of Anthropology, University of Wisconsin, Milwaukee.

OUTSaskatoon. (2020). Two Spirit. Retrieved from

Saladin d’Anglure, B. (1992). Rethinking Inuit Shamanism through the concept of ‘third gender.’ In Northern Religions and Shamanism, edited by Mihály Hoppál and Juha Pentikäinen: 146-150. Akadémiai Kiadó, Budapest.

Scudeler, J. (2016). Oskisihcikêwak / new traditions in Cree two-spirit, gay and queer narratives. PhD dissertation, Department of Indigenous Studies, University of British Columbia, Vancouver, BC. Retrieved from

The Hope for Wellness Help Line (24/7): 1-855-242-3310 or the online chat at\

  • Both telephone and online chat services are available in English and French. Telephone support is also available upon request in: Cree; Ojibway (Anishinaabemowin); Inuktitut. (Note: Supports in Cree, Ojibway, and Inuktitut are not available 24/7, so you may need to call in to find out the next time that a language-speaker will be available.)

NWAC Toll Free Elder Support Hotline (M-F 9:00-12:00 EST and 1:00-4:00 EST)

  • Grandmother Roberta Oshkawbewisens (1-888-664-7808)
  • Elder Esther Ward (1-833-652-1381)
  • Elder Isabelle Meawasige (1-833-652-1382)

Trans Lifeline Call 1 (877) 330-6366

  • LGBTQ Youthlife Call 1-800-268-9688 or Text 647-694-4275
  • Johnny Appleseed. Joshua Whitehead
  • Love After the End: An Anthology of Two-Spirit and Indigiqueer Speculative Fiction Edited by Joshua Whitehead
  • Making Love with the Land by Joshua Whitehead
  • Firesong by Adam Garnet Jones
  • The Cheeroke Rose by Tiya Miles
  • Disintegrate/Disassociate by Arielle Twist
  • Surviving the City by Tasha Spillet-Summer (Graphic Novels)
  • Love Beyong Body, Space & Time edited by Hope Nicholson
  • Two-Spirit Journey: The Autobiography Of A Lesbian Ojibwa-Cree Elder by Ma-Nee Chacaby (Author), Mary Louisa Plummer
  • Spaces between us: Queer settler colonialism and Indigenous decolonization by Scott Lauria Morgensen.

Two-Spirit healthcare is unique to many other forms of healthcare based on their healthcare needs

2SLGBTQQAI+ Gender Affirming Care for HealthCare Providers

What is gender-affirming care?

Gender-Affirming care is the care that supports a client, patient, or service user’s experience that is appropriate for their gender and/or sexual orientation. Having a positive, affirming and respectful experience is important for anyone accessing health or social services, but it is especially important for 2SLGBTQQAI+ individuals accessing health or social services. These experiences have a direct impact on health and wellbeing and if the services will be accessed again. As a healthcare provider, providing gender-affirming care fosters a trusting and inclusive environment. A positive experience means service users are more likely to be open and honest about their experiences and needs. A negative experience’s possible outcome may inhibit an individual from accessing preventative and necessary care. Gender-affirming care is life saving healthcare.

What does this include?

First point of contact employees should have the knowledge and capacity for a positive and affirming experience of 2SLGBTQQAI+ service users. Interactions with employees of these settings at any level can indicate treatment of 2SLGBTQQAI+ individuals. It is imperative that first point of contact employees are able to be respectful of desired pronouns (including use) and personal experiences (that are gendered and related to sexual orientation).

When new service users access health or social services it is important to have intake forms that reflect the diversity of the population. Intake forms are one of the first steps in accessing services. Make space for preferred names and pronouns. Avoid using gendered language and instead use terms like people with a uterus or chest-feeding. Provide options that are outside the gender binary.

A comfortable environment will ease people accessing services. Pride Flags or posters support a safe space for all to access are essential for informing individuals that this is a space that they can use safely. Avoid gendering washrooms or provide an all-genders washroom. Inform new service users or post that there are policies that are enforced to provide a non-discriminatory service and ensure that all staff have applicable knowledge, training, and awareness of policies. Support from families is beneficial but respecting the individual’s choice of this involvement is key.

What should appointments look like?

As a healthcare provider or social service provider you have a duty in your actions to ensure that you are promoting a positive and welcoming space for 2SLGBTQQAI+ individuals accessing services.

  1. Never assume that a person is heterosexual or cisgender, these perceptions can be harmful and invalidating and starts rapport on negative note.
  2. Use open-ended questions to engage and find further information and do not assume experiences. Individuals are the expert on their own bodies and should have autonomy when it comes to disclosure and decisions surrounding their treatment plan.
  3. Be sure to be knowledgeable about the health and social determinants of health that affect 2SLGBTQQAI+ individuals, this will ensure that wrap-around care and a holistic approach is centred to benefit the individual. This also ensures that other intersections of identity is not being overlooked such as age, race, ability and socioeconomic status.
  4. Provide services with a trauma-informed approach by checking in with the individual and making sure that the experience is beneficial for them. Pay attention to the language that is used by the individual describing their body and care that they are receiving and have received.
  5. Take accountability for mistakes and be open to discussion on how to move forward and feelings around this.

What knowledge of practises should you be familiar with?

2SLGBTQQAI+ individuals may seek medical or social assistance in aligning with gender identity. Gender dysphoria is feelings of discomfort or stress related to a person’s gender identity this is because the person’s gender identity does not align with the sex assigned at birth. This may appear at any age or stage in a person’s journey. Individuals may request medical interventions to help with gender affirmation as well as social interventions with care providers that are knowledgeable with education on processes and counselling. An individualized approach is essential in these services. It is important to understand the risks of treatment but also the risks of withholding treatment.

Hormone Replacement Therapy

Hormone Replacement Therapy is a collaborative endeavor that requires a positive relationship with a medical provider. Hormone Replacement Therapy helps with bringing appearance inline with gender identity. This therapy involves taking prescriptions to increase hormones and block other ones such as Testosterone-based hormone therapy and Estrogen-based hormone therapy. Youth are able to access Hormone Replacement Therapy without the consent of caregivers. Assessment is conducted over a couple of visits. Number of visits is determined by physical and mental health of the individual seeking treatment. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

Transition Related Surgeries

There are a number of gender-affirming surgeries that individuals may choose. To access publicly funded surgeries, individuals need to meet WPATH criteria and psychosocial readiness. You must be a qualified provider to assess individuals. Specific training and supervision are required to qualify. Once assessments are completed you are able to refer service user’s for procedures. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

PrEP or PeP

PrEP and PeP are primarily used for the prevention of HIV exposure but there are also other reasons that one might wish to access preventative treatment such as measures to control one’s own sexual health and reduce anxiety about HIV exposure. Pre-Exposure Prophylaxis is a medication routine that is most beneficial when taking the prescription up to 4x a week becoming 99% effective 13. There is public funding for individuals to access PreP. PeP, Post-Exposure Prophylaxis is used when an HIV negative person might have come into contact with HIV. PeP must be taken within 72 hours of exposure and conducted over a period of a few weeks. Some provinces have subsidized cost for these medications and some provinces provide them for free. If you as a healthcare provider are not able to competently support Trans individuals or other gender diverse individuals, please refer to designated specialists.

Along with medical supports, social supports may be needed for Trans and gender diverse individuals. Rainbow Health Ontario provides a directory of listed social service 2SLGBTQQAI+ providers which can be consulted here:

Indigenous Individuals can receive gender-affirming health benefits from the First Nations Health Authority. Many gender-affirming surgeries are covered under these benefits as well as some medical supplies and travel expenses. If an individual is not able to access benefits from the First Nations Health Authority, expenses can be expended through the federal Non-Insured Health Benefits Program. Alternative funding may also be covered through association with Individual Bands. Although these benefits are for Indigenous individuals that have registered status some individuals may meet the criteria to be registered and support could be given to have this. It is important to keep in mind that status has been used as an exclusionary practise historically and criteria has and can change.

For more information as a healthcare provider or social service provider please refer to the following link:

2SLGBTQQAI+ Gender Affirming Care for Service Users

What are the gender-affirming options?

There are a few options to help you with your gender expression and gender identity, if you so choose. Whether you choose to access these options or not is entirely up to you. Your gender identity and gender expression is completely individual. Choosing to not access these options also does not make you any less of the person you are and aspire to be. You are in control of how expressive and visible you choose to be. The following are options that may help with your expression and identity:

Beginning a Medical Transition

You might be aware that there are medical capabilities to help align your gender identity. If this is something that you are interested in then researching and understanding what your desired outcomes are, is your first step in the process. Contact your primary healthcare provider to see how they can support you with a medical transition. If you are comfortable enough to do so, be open and honest about what kind of treatment you are looking for. If you are more comfortable speaking to a specialist or provider with their own lived experience, your primary healthcare provider can refer you to someone else. Everything is assessed on a case-by-case basis and support from your family may be beneficial if that is something that is helpful and healthy for you.

Gender-Affirming Surgery

Surgical care can have benefits for some individuals. Depending on your age and stage of development some surgeries may be better suited for you. Upper body surgeries may be more suitable for youth under the age of majority depending on the length of your transition. No one else can dictate the validity of your transition but assessments and criteria still need to be met for access to surgeries. There will be lots of questions for you to answer but answering as open and truthfully as possible will help the process. If at any time you find that the healthcare provider you have is not adequately supporting your needs and desires, you have the right to ask for a referral or alternative provider that may best suit you through out this process.

Feminizing/Masculinizing Hormone Therapies

You may be familiar with the hormone related therapies such as estrogen-based therapy and testosterone-based therapy. You may also be familiar with puberty suppression medication which is also a prescription-based option. These prescriptions work by increasing certain hormones in the body or blocking them. Depending on assessments, some youth do not need parental permission to access this treatment. In Ontario, physicians can prescribe these therapies to youth. In some cases, hormone therapy is primary health care. These therapies may be beneficial to some individuals but not all.

PrEP or PeP

PrEP and PeP are primarily used for the prevention of HIV exposure but there are also other reasons that one might wish to access preventative treatment such as measures to control one’s own sexual health and reduce anxiety about HIV exposure. If you wish to be preventative and or want more knowledge on HIV and prevention contact your primary healthcare provider. Regardless of sexual partner, HIV is transmitted through bodily fluids. It is important to keep up to date on testing and treatments to best support your health and your sexual partner(s).

What is covered?
Provincial coverage

Depending on your location, your province may have varying levels of coverage for gender affirmation treatment and supports. Most services and treatments should be covered under the provincial coverage granted to inhabitants. For example, in Ontario OHIP covers hormone therapies and some surgeries. British Columbia and the Yukon are known to have some of the best coverage. Check with your Provincial Health Authority website to see what specific gender-affirming care is offered and covered.

First Nations coverage

Indigenous Individuals can receive gender-affirming health benefits from the First Nations Health Authority as well as mental health support. Many gender-affirming surgeries are covered under these benefits as well as some medical supplies and travel expenses. They also can provide gender affirming items such as binders, packers, dialators, breast forms, gaffs etc. Medications including medications for hormone therapy are offered as well. If an individual is not able to access benefits from the First Nations Health Authority, expenses can be expended through the federal Non-Insured Health Benefits Program. Alternative funding may also be covered through association with Individual Bands.

Content for Parents of 2SLGBTQQAI+ youth to support service use

As a parent, you are always wanting whatever makes your child happy and feel like themselves. For some 2SLGBTQQAI+ youth this may included accessing gender-affirming care and other related medical services. This may also include mental health support such as seeing counsellors, therapists, and specialists. An individualized-approach should be centred when youth desire gender-affirming care and with guidance from professionals and in collaboration with family.

Each youth has varying comfort levels. The gender-affirmation process can be an emotionally impactful process. It is imperative to be as supportive and understanding as possible to your child’s wants and needs. They are the leader in this journey and this should be respected and upheld.

Here are some tips that can help you support your child:

  1. Be supportive. Whether this means affirming, understanding and supporting your child’s gender identity or with open ears and silence this is crucial for a positive relationship.
  2. Educate yourself. Browse and research materials that specialize in 2SLGBTQQAI+ youth, gender affirming treatments, 2SLGBTQQAI+ specialists and environments that may be of use through out this journey.
  3. Access therapy and treatments. There are numerous options that your child may wish to pursue or just look into. Therapies and treatments may be important to look into and access. There are always risks but there are risks for withholding these as well.
  4. Ask questions. If you want to know more, just ask. Take interest and understand as best as you can with the answers that you receive. But remember, a quick google search may also help for some things and take some pressure off the 2SLGBTQQAI+ individual.
  5. Advocate if needed. There may be times where you as an ally can step in and advocate for your youth. Your child is taking on a large role as it is, and some times may need your support to publicly and personally create a safe space.

There are a growing number of specialists in the 2SLGBTQQAI+ field and many with their own lived-experience. These individuals have not only been through formal education but also have gone through their own affirming processes. Contacting agencies and services that specialize and provide this treatment may be really helpful and comforting for your child.

Take a look at this service directory: