Measuring Satisfaction and Comfort with Gender Identity and Gender Expression among Transgender Women: Development and Validation of the Psychological Gender Affirmation Scale

Abstract

Among transgender and gender diverse people, psychological gender affirmation is an internal sense of valuing oneself as a transgender or gender diverse person, being comfortable with one’s gender identity, and feeling satisfied with one’s body and gender expression. Gender affirmation can reduce gender dysphoria and mitigate deleterious health effects of marginalization. We sought to create an instrument to measure psychological gender affirmation among transgender women. Following initial item development using qualitative interviews, we used self-administered survey data from two distinct samples (N1 = 278; N2 = 368) of transgender women living with HIV in the USA. We used data from Study 1 to perform exploratory factor analysis (EFA) and data from Study 2 to perform confirmatory factor analysis (CFA), yielding the five-item single-factor Psychological Gender Affirmation (PGA) scale with high reliability (α = 0.88). This scale is psychometrically sound as demonstrated by its convergent and discriminant validity via correlations with select measures and by its predictive validity through associations in hypothesized directions with measures of mental health and substance use. The PGA scale will aid research on psychological gender affirmation that can in turn inform interventions as well as gender-affirming clinical and social practices to promote the health and well-being of transgender and gender diverse people.

Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV

“…27,28 Gender-affirming interventions should also seek to build psychological gender affirmation, or the internal sense of valuing oneself, being comfortable with one's own gender identity, and having a sense of satisfaction with one's body and gender expression. 29,30 Medical gender affirmation, such as the provision of hormones and other gender-affirming medical care or navigation to such services, is also critical to integrate into interventions for trans and gender diverse people. 28,29 Recent evidence indicates that among trans women of color living with HIV, the implementation of peer-delivered interventions positively affects HIV care visit attendance, receipt of ART prescriptions, and retention in HIV care.…”

“…29,30 Medical gender affirmation, such as the provision of hormones and other gender-affirming medical care or navigation to such services, is also critical to integrate into interventions for trans and gender diverse people. 28,29 Recent evidence indicates that among trans women of color living with HIV, the implementation of peer-delivered interventions positively affects HIV care visit attendance, receipt of ART prescriptions, and retention in HIV care. [31][32][33][34] Interventions that seek to improve health outcomes among trans women living with HIV must specifically address their unique barriers and facilitators to engagement in HIV care.…”

How Transgender Adolescents Experience Expressing Their Gender Identity Around New People: An Interpretative Phenomenological Analysis

“…Gender expression is also important in providing opportunities for affirmation, or social recognition and support, of one’s gender identity. Sevelius’ (2013) gender affirmation framework proposes that social affirmation of gender is important in confirming transgender individuals’ sense of self, and further studies have found affirmation to be related to increased psychological well-being and self-confidence, and reduced dysphoria (Rood et al, 2016; Russell et al, 2018; Sevelius et al, 2021).…”