Breaking the Binary: Expanding Gender Identity and Expression

April 1, 2022

This week we celebrated Transgender Day of Visibility, a day that recognizes the important role that trans and gender diverse people play in our lives and communities, and that celebrates the courage it takes for many trans and gender diverse folks to live in the world as their authentic selves. On this episode, we interview Nick Alm (they/them), who lives boldly as a non-binary person, and who is the founder of Mossier, a company that works with organizations to develop LGBTQ employment equity. Join this conversation with Nick as we explore non-binary identities, gender-neutral pronouns and what gender expansive kids and colleagues need to thrive in all areas of their lives.


Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas, and practical tips will surprise, challenge, and perhaps change how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. Thursday, March 31st was International Transgender Day of Visibility, a time to celebrate trans people around the world and the courage it takes to live openly and authentically while also raising awareness about the discrimination that transgender people still face today. Many transgender non-binary and gender expansive kids, teens, and adults continue to struggle to find safe spaces, to fully express and embody their true identities. Whether we are allies to the trans community or consider ourselves part of the gender diverse spectrum, our work today and every day is to continue to create spaces and a culture where everyone feels seen and safe.

On this episode of Talking Pediatrics, we will dissect the gender binary diving into what it means to be male or female, or something in between, and discuss the importance of expanding gender expression so that we can all find the version of ourselves that feels most like home. I am thrilled to have with me on the show today, Nick Alm, who identifies as non-binary, uses they, them pronouns, and is the founder of Mossier, an organization that collaborates with companies to develop LGBTQ inclusive workspaces, and also helps LGBTQ folks find ways to be themselves at work. Nick, welcome to Talking Pediatrics.

Nick Alm: Hey, Dr. Goepferd. So good to be here.

Dr. Angela Kade Goepferd: We were commenting on the way in, we have actually never seen each other in-person, we’ve only seen each other in virtual space. So the first thing I said to Nick was, Nick, you’re so tall. And the first thing Nick said to me was you’re so short, both remain true.

Nick Alm: Yes.

Dr. Angela Kade Goepferd: There is so much for us to talk about today. I wanted to take some time at the start of the show to just explore non-binary identities in particular, and help folks understand how they can create more inclusive workspaces for their colleagues, but also welcoming environments for patients. So let’s learn a little bit more about you. Let’s talk about Mossier. So what led you to launch this company? And what’s the vision that you had going into this work?

Nick Alm: What led me to start Mossier was a few different things. If we want to go all the way back, I was the gender nonconforming child who forced my mom to be a witch for Halloween three years in a row.

Dr. Angela Kade Goepferd: Now, your mom was the witch or you were the witch?

Nick Alm: I was the witch.

Dr. Angela Kade Goepferd: Okay. Okay.

Nick Alm: And it doesn’t support this whole narrative that queer people are doing witchcraft, but yeah, I wanted to be this witch. I was the kid who in elementary school, I did the talent show. I moderated this fashion show I did with my friends as Mr. Mrs., he, she, and this dress and high heels. And it was just always out there, I guess. And you go back into the closet when you hit puberty, because you start to realize that there are some really strict gender rules in this world, which we can talk about. I ended up going to business school where those gender rules, those conformity principles were really strong. And I was forced to choose between being an entrepreneur and being LGBTQ.

And I was like, you know what? No, we’re just not going to do that. You’re not going to force me into some box. And I started the LGBTQ student organization there. This is at the University of Minnesota. And then all these companies started coming forward like, wow, Nick, will you help us recruit? Will you help us with our employee resource group, our trans-inclusive healthcare benefits? I had no clue what to do about any of that, but I said, let’s figure it out. And that was how Mossier got started, I got incorporated probably about a year and a half after starting that student group.

Dr. Angela Kade Goepferd: It’s great work that’s really needed. And I’ve participated in some Mossier events with you. And every time I’ve been involved, it feels like folks are really hungry for that information. They want to know how to do better and how to be more inclusive, but often feel like they’re a little lost on how to get there.

Nick Alm: The thing that we do really well is we create a space for people to color outside the lines. And you saw that last week on our event, people feel really constricted by their workplaces, I think in general.

Dr. Angela Kade Goepferd: Sure.

Nick Alm: And so we create the space where it’s like, you can come at any level, any identity, we have every generation represented and we’re going to learn together and realize that this isn’t about one singular person becoming woke. This is about us collectively finding solutions. And I think that’s what resonates with people.

Dr. Angela Kade Goepferd: And I do a lot of training in healthcare spaces around how to be more inclusive for LGBTQ patients. And the one thing I find people are really hungry for is just a safe space to ask some questions and recognize that we’re all learning together. And I think that’s something really beautiful that you’ve created with Mossier. Tell me about your gender identity and your pronouns and what being non-binary means to you?

Nick Alm: I’ve been non-binary for as long as I can remember, even though that term was new to me until a few years ago.

Dr. Angela Kade Goepferd: Sure.

Nick Alm: When I would walk into a department store as a kid, I was always so confused why there was this men’s section over here and this women’s section. I was like, well, I like some of the stuff in the women’s section, but I like the men’s section too. But where is this third option for me? And again, as you get older, as a child I felt like people maybe encouraged me a little more to step outside of those gender lines, because it was cute. It was just me having fun, being a witch for Halloween or whatever it was. And then you get to this certain point where people start to say, all right, pack it up.

Dr. Angela Kade Goepferd: The cuteness is over.

Nick Alm: It’s over.

Dr. Angela Kade Goepferd: Yeah.

Nick Alm: You got to get a girlfriend, you got to butch it up. You got to figure this out. That was 12 years old to really about 18, 19, was this stuffing away. And that caused a lot of suffering for me. There was no language for it. There was no one to talk to. There was no school counselor. There was no mention of LGBTQ, anything in all of my advanced placement social studies classes. And this was only about 10 years ago. There was nothing available. So I get to college and then I developed this persona. This again, that my Mr., Mrs. he, she persona going out on the weekends, wearing makeup and wearing dresses and all these things. And I just thought, that’s this thing I do. This is like this little character. And then as time went on though, it became more clear that no, this isn’t a character. This is really something that feels fundamental to who I am and not being able to express this day to day really, again, it really hurts.

Dr. Angela Kade Goepferd: When I’m working with kids in clinic there’s, as you know, so any different terms people use to describe their gender identities. And one question that I often ask kids when they share their identity with me is what does that mean to you? So the question I would ask you, Nick, is what does being non-binary mean to you when you use that term to describe yourself, how would you describe that to someone else?

Nick Alm: I use non-binary in a technical sense to simply say that I am not a man, I’m not a woman. I channel a little bit of both sometimes, sometimes neither. Non-binary I think it’s a more mainstream label to use these days. So it gets people, at least part of the way there. I feel deep down that I’m gender expansive. To me, non-binary isn’t a reduction or minimization of gender, it is an expansion of gender, coloring outside the lines. It’s just a belief that there’s more to this world than this and that, and us and them. Non-binary is a way of seeing the world as more than just two things that were put in front of us.

Dr. Angela Kade Goepferd: I think a lot of folks, when we talk about Transgender Day of Visibility, or being transgender, still continue to think about transgender identities in the binary sense, someone was assigned male at birth, and now they’re identifying as female, or vice versa. As someone who identifies as non-binary and gender expansive, what’s been the biggest challenge for you about occupying that space and being in that non-binary gender expansive category?

Nick Alm: I’ve always felt as a non-binary person that I’ve had to earn it, to earn that label. If I wear boy clothes one day, I’m not earning my non-binary. If I don’t wear makeup today, I’m not earning it. If I don’t get on hormones or do some kind of surgery, I haven’t earned my right to be a part of this conversation. So, that’s really tough, because that’s a lot of pressure that you put on yourself. And at the same time, I don’t want to take away space from that binary trans story. It’s so important. The world just, unfortunately doesn’t really have the space right now to hold all of these different things together. So it is, it’s been a very, I would describe it as an awkward choreography of, do I speak up? Do I listen? But I find that there are so many parallels and complimentary struggles and experiences in both conversations. And so I’m about how do we find ways to amplify each other, even though maybe we didn’t follow the exact same path?

Dr. Angela Kade Goepferd: That pressure that you talk about of performing being non-binary is one that I experience as a non-binary person, but I also hear and see that playing out with the kids that I take care of, where there’s an expectation that you’re either going to occupy an androgynous gender expression, or if you’re someone assigned male at birth, more of a feminine gender expression. And that’s where my work with families, I really try to hone in on the difference between gender identity and gender expression, that someone’s identity, who they see themselves as transgender or non-binary, or whatever the label is that they’re picking gender fluid, is different than the way they choose to walk out the door on a day to day basis. And that gender expression can be really fluid, can be both masculine and feminine. There’s no one way to be any one gender identity. Let’s talk about pronouns. You use they them pronouns. And that’s often a place where I get questions. People seem really challenged by the, they them pronoun conversation. How have you navigated pronouns and how do you have that conversation with people who have a hard time understanding?

Nick Alm: Yeah, this is another area where I faced this really tough tension of, I need to use they them pronouns, because that’s what feels right, and that’s what feels good, and that’s who I am. And then this other tension of, well, I don’t want to make things complicated for other people. And I know that the pronoun thing, because of the way we taught English, because of the way we see the world, it doesn’t click for a lot of people. So I’m like, do I want to experience the authenticity of who I am, or do I want to make other people comfortable? And that has been the pronoun tension for me, people will say, oh, people who use they, them pronouns are just attention seeking, they just want some kind of extra special something. And I really bought into that for a long, long time because it does get you a lot attention. When I make a post on LinkedIn about being non-binary and using they, them pronouns people tune in.

I’ve had to think about, again, what is the intention behind this? Those messages that people put out there are really tough. So for people who are trying to expand their thinking, the best thing I can say is even as somebody who uses they, them pronouns, it took me years. I had people in my life before me who use they, them pronouns, I didn’t get it, I didn’t get it right away. I didn’t understand why it was so important and affirming to them. They downplayed it. I downplayed it for years. So I never really got a sense of, oh no, no, no. This is the equivalent of me calling you John right now, that is out of left field. That is not who you are Angela. So in the beginning you just have to trust that we’re telling the truth. And give us enough to time to walk that path with you. And in time, I think you’ll see what a positive, loving thing it is to do to use somebody’s correct pronouns.

Dr. Angela Kade Goepferd: So we’ve seen that using the correct name and pronouns for teenagers dramatically decreases their suicidality, for example. So real life outcomes of trying to get our brains to do something that might be challenging at first. I’d love to talk a little bit more, you’ve been so generous with sharing your story about growing up. And you’ve talked a lot about that switch that has happened for you as you’ve gone through your development, not only as a child, but as a professional. And I’d love to talk a little bit about both, but a lot of our audience are caring for kids and caring for teenagers. And I wonder what would’ve been helpful for you as that 12 year old, who was figuring out that it wasn’t cute anymore and trying to navigate the authenticity of your expression in a world that wasn’t quite made for it. Did you have anyone who helped you if you didn’t, what would’ve been helpful at the time?

Nick Alm: I faced the issue that I called the pervasive silence issue. And I think this is the case in a lot of situations where there was nobody in my life who was against LGBTQ anything, but there just wasn’t anybody in my life who was for LGBTQ anything. And so I’m going to school, I’m getting bullied for having a high voice, feminine mannerisms for being gay. And all I really got from people was, oh, just don’t pay attention to those people, put your head down and keep going. And that’s what I did. I was the high achieving type. That was my drug of choice to get through that. I had a teacher, Mr. Tash, probably the most supportive, even though we never talked about gender specifically, we never talked about being LGBTQ, because I was in fifth and sixth grade.

I was a weird kid. I was fundamentally just a weird person. And he wanted me to be weird. He supported me every step of the way to be weird through the presentations I did in class, through the group projects I did, through whatever it was, just somebody who I felt so safe to be like, oh, I can just really be weird. That was transformative, but that was all I had. What I needed, again, I probably needed professional help. I really did probably. I would love to think my parents could have been on that level to support me the way I needed them to. They just weren’t going to be able to do that for me. There was no LGBTQ student organization in junior high, or high school, I needed community. I was one of two openly gay kids in a class of 700.

Dr. Angela Kade Goepferd: Wow.

Nick Alm: So that’s why it’s really freaky to me that we are actively trying to remove that conversation from schools, because school was the safe place, the sort of safe place.

Dr. Angela Kade Goepferd: And school is such a huge part of kids’ worlds. I just dropped my own kids off at school prior to this conversation and that’s where they’re spending the majority of their time. So kids have to be able to explore who they are in the context of school, because it’s so much of their world. And I really appreciate the call outs that you identified around having peer groups, having those unique adults who are positive forces in kids’ lives, and having spaces to have the conversation rather than that silence around, we’re not going to say anything negative, but we’re also not going to help you or encourage you through this process.

Let’s talk about that transition into professional life, because I think the other thing that I think is really important when we talk about trans visibility and expanding the binary is how we look out for our colleagues and those who we work with as well. And you mentioned being in business school and really feeling like it was just extra binary and extra needing to fit into a box. So tell me a little bit more about that experience and what you think we can do to be more supportive of those folks we work with.

Nick Alm: I defected from the traditional workplace. I chose entrepreneurship because I was like, I’m just not going to fit in over here with this thing that’s going on. And I don’t regret it, but I’m really grateful I get to be a part of creating spaces where trans and non-binary people can thrive. And I think part of the ways we support our colleagues who have those identities and the way we support each other, when we say psychological safety for trans and non-binary people, when we say inclusion, we say equities, there’s all these buzz words that we’re thrown out. I think one, the workplace needs to be a place where people can experiment with their gender freely. I need to be able to go to my manager and say, hey, I know I have these customer relationships and I know they know me as one thing or they see me as one thing, but this is going to be evolving and changing. Do you have my back if I run into an issue?

Dr. Angela Kade Goepferd: Yeah.

Nick Alm: And hopefully I don’t even have to ask that, hopefully that manager is right there saying that. When hiring managers sit down to talk about a slate of candidates, who’s in the room challenging that person who says that the man in the dress doesn’t have the right fit for our organization? Those disruptions, those small, I always say allyship is just these very small moments. Right now trans and non-binary people they’re bearing the brunt, carrying all the weight of disrupting workplaces. And we just need allies to step in a little more and say, hey, give me some of that. I’ll call that out. I’ll ask that question. I’ll use my pronouns in that meeting so that, you know what? Maybe you don’t feel as pressured to represent the entire movement.

Dr. Angela Kade Goepferd: One thing that I experienced and I wonder if you have experienced this or continue to experience this, is what we consider to be professional in the workplace. So I know I had a hard time understanding as someone who doesn’t fit the gender binary, how I could show up in a way that would read as professional, but not feminine because that was not something that I was comfortable expressing. And I remember the first conversation I had with my boss at the time actually were, it was one of the first days I had worn a bow tie to work and we were in the elevator together. And he said to me, that bow tie looks great on you. I think that’d be a great look for you. And that was so validating for me. It was such a small comment, but it was so validating. I wonder what your experience has been like trying to navigate that what is professional? When so much of what we consider to be professional is binary in terms of gender expression.

Nick Alm: Not a lot of affirmation in this space. If you’ve ever felt like the word professional was coded language for act White, act straight, et cetera, et cetera. You’re very much onto something. The professionalism word is the dog whistle for how we say things that, if we said them out loud in a real sense you could maybe get sued or… I’ve had to push the boundaries on my own. People look at me and they’re like, Nick, you’re so fabulous. I love your makeup. Oh my gosh, I just feel this pressure to look good and have great clothes and great makeup, because some people think I’m amazing. Alok Vaid-Menon who’s a really great speaker, thinker in this space, they said people always run up to me and say how fabulous I am, but they never ask how I’m getting to my car after the event.

And I feel like I experience that all the time. Thank God for this virtual environment, because I’ve been able to explore so much more, do so much more because I’ve had the protection of being behind a screen. I don’t need to go leave my house. So it’s weird. I get affirmed in the sense that people think I’m fabulous, but that’s not what I need at the end of the day. Being fabulous doesn’t make me feel safer. It’s this armor I present to the world because it just makes it easier to exist. And I think that is the one thing to be aware of is that trans and non-binary people, again, back to the pressure that’s on us, we have to create those affirmations ourselves. I can’t rely on other people to do it for me. I just can’t.

Dr. Angela Kade Goepferd: And I think it really speaks to, we all want to be our full selves at work. And I’m a huge LGBTQ advocate here at Children’s Minnesota and out in the world. But I’m so much more than that as well. I’m also a leader. I’m also someone who runs a education team. I’m someone who’s a parent. I’m someone who is a pediatrician in the room with kids. And I want to be able to be all of those things and not just be put in the one box. And I want for you and for all of the trans and non-binary and gender diverse folks in the world and for the kids that we’re helping pave the way for them to feel like their gender identity is an important part of who they are, but it is also one part of what makes them amazing.

Nick, I just can’t thank you enough for joining me today. This has been a great conversation. I feel like we could have talked for another hour about all of this, but I appreciate you. I appreciate your vulnerability. I appreciate you being who you are in the world and thank you so much.

Nick Alm: Likewise. Thanks Dr. Goepferd.

Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Lexi Dingman is our marketing representative. For more information and additional episodes, visit us at, and to rate and review our show, please go to