Sex, Hormones and Identity affect Nociceptive Expression Observed in Non-binary adults (SHINE ON) Project Summary In the clinical population, women are more likely to report chronic pain and greater pain sensitivity than men and this difference has traditionally been reported as a “sex” difference. Too commonly, many conflate “sex” and “gender”, though these terms are not the same, nor are they always congruent. Our previous work showed that transgender women (TW) and cis women (CW) reported similar pain sensitivity that was different from cis men (CM), suggesting that gender identity was more important than sex assigned at birth. Whereas our current project (1R01-NR019417-01) seeks to explore pain sensitivity and immune cell function in cis and trans men and women (CM, CW, TM, TW), no pain-related study to date has included non-binary adults (NB). The current proposal seeks to add 40 NB adults [20 assigned male at birth (AMAB); 20 assigned female at birth, (AFAB)] to the ongoing parent project to investigate the impact of this gender identity category on pain sensitivity and immune cell function. NB adults often face additional stigma and discrimination and are at risk for poor mental health outcomes, making it imperative to include this group in the parent project. The proposed project builds on the ongoing SHINE project (1R01-NR019417-01) in response to the Notice of Special Interest (NOSI: NOT- OD-22-032) and is directly in line with the 2022-2026 NINR Strategic Plan framework and priorities.