Accoding to Teich (2012),
Two-spirit people do not usually directly translate to the Western notion of male-to-female or female-to-male (transitioning from one sex to the other). Oftentimes two-spirit people were and are a blend of gender identities, roles, and expressions. Here is one example from Alaska: "The Chugach Eskimo believed that aranu'tiq were two persons united in one, that they were more gifted than ordinary people, and that they were very lucky, like twins." (p. 73)
Lang (1998) also mentions the belief of Chugach Eskimo (p. 113). According to her book,
"Two-spirit"/"two-spirited" originally referred to (1) those people referred to as "berdaches" in the literature, (2) modern Native Americans who identify with these "alternative" roles and gender statuses, and (3) contemporary Native American lesbians ad gays (p. xiii).
According to Messages for All Voices: Integrating Cultural Competence and Health Literacy in Health Materials, Forms, and Signage (2010) that the Province of Nova Scotia published , Two-spirited refers to:
A term within many First Nations cultures for a person with close ties to the spirit world and who may or may not identify as being lesbian, gay, bisexual, or transgender (two spirits in one person) (p. 43).
Lang, Sabine. (1998). Men as women, women as men: Changing gender in Native American cultures (J. L. Vantine, Trans.). Austin, TX: University of Texas Press.
Province of Nova Scotia. (2010). Messages for All Voices: Integrating Cultural Competence and Health Literacy in Health Materials, Forms, and Signage. Retrieved from http://novascotia.ca/dhw/primaryhealthcare/documents/Messages-for-All-Voices-Full-Length-Tool.pdf
Teich, N. (2012). Transgender 101: A simple guide to a complex issue. New York, NY: Columbia University Press.