According to new research, most transgender adults have been aware of their gender identities since early childhood, even if they didn’t yet have the words to describe the gender dysphoria they were experiencing.

“I’ve always known I was male since my earliest memories,” a transgender man in his late 30s explained. His remarks are part of a larger qualitative essay published Tuesday by the Pew Research Center on the lived experiences of transgender and nonbinary adults in the United States.

Another transgender man in his early thirties remembered having gender dysphoria as early as kindergarten. “I started to feel very uncomfortable just existing as a young girl,” he said.

The essay, which drew on responses from 27 transgender and nonbinary adults from across the country, offers a small, but valuable, glimpse into how adults across the gender spectrum see and experience the world.

According to Pew, only about 1.6 percent of U.S. adults identify as transgender, but a growing proportion of Americans say they know someone who does. According to a Pew Research Center report released in July, 42 percent of adults know someone who identifies as transgender, up from 37 percent in 2017.

According to a 2019 Pew survey, one in every five adults knows someone who does not identify as a man or a woman. According to a recent report published by The Trevor Project, awareness of gender-neutral pronouns such as they/them is growing, particularly among younger adults and Generation Z. According to the same report, nearly half of adults polled said they would be fine if their child started using gender neutral pronouns.

According to the report, the majority of respondents said they were “well into adulthood” before discovering the words to accurately describe their gender identity, though the methods by which they did so varied.

“I knew about drag queens, but I didn’t know what trans was until I got to college and was exposed to new things, and that’s when I finally had a word for myself,” one transgender man said.

Others said sexuality studies classes helped them “feel seen.” One nonbinary person in their early 60s described their journey to self-discovery as starting with a chance encounter with the 1964 LIFE Magazine article “Homosexuality in America.”

“We didn’t have language like we do now,” they said, adding that “homosexuality” was one of the first words “that resonated with me at all.”

Nonbinary respondents perceived the term “nonbinary” to be extremely broad, encompassing multiple gender identities. According to Pew, when asked to describe themselves, the majority said they were “gender queer” or “gender fluid.”

Respondents described how they decide how open to be about their gender identity as a “constant calculation.” Others stated that discussing their gender identity is dependent on the person or situation, with an emphasis on personal safety.

Transgender and nonbinary people face disproportionate levels of violence in the United States, and the Human Rights Campaign has declared 2021 to be the deadliest year on record for transgender and gender nonconforming people in the United States. According to Pew survey respondents, educating people about issues such as gender identity and sexual orientation may help create a more accepting society that is safer for people of all genders.

Many, but not all, Pew survey respondents reported receiving gender-affirming medical care, such as hormone therapy and gender-affirming surgery.

The majority of respondents reported access barriers to gender-affirming care, including the inability to receive treatment at all.

More than a dozen states have considered legislation this year that would limit access to gender-affirming care. Alabama enacted a felony ban on providing gender-affirming care to minors earlier this year, carrying a prison sentence of up to ten years.

Nonetheless, some Pew survey respondents reported having positive experiences seeking gender-affirming medical care.

“[My doctor] is basically the first person who actually embraced me and made me accept [who I am],” a transgender woman in her late twenties said.