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Discrimination and violence targeting people perceived as gender nonconforming have been linked to a range of negative health outcomes, and large-scale representative data are needed to begin population surveillance of associated health disparities. A brief self-report measure of gender expression as perceived by others was tested using cognitive interviewing methods in a diverse sample of 82 young adults aged 18–30 years, recruited from the New England region in the U.S. Results identified themes related to item clarity, gender expression variation, undesirability of highest or lowest ends of item range, and tension between self and others’ perceptions. The item performed as expected and is recommended for use on studies of health disparities, including statewide and national public health surveillance tools.