The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US

Abstract

Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

Piloting a brief intervention to increase positive identity and well-being in transgender and nonbinary individuals.

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Young adult trans and nonbinary (TNB) individuals have heightened risk of health disparities (Burgwal et al, 2019), mental health concerns (McCann, 2015), severe discrimination (Lelutiu-Weinberger et al, 2020), and attempted suicide in their lifetime (Adams & Vincent, 2019). There are also positive aspects associated with TNB identities (Matsuno & Israel, 2018;Riggle et al, 2011), including authenticity, selfawareness, and connection to community (Riggle et al, 2011;Riggle & Mohr, 2015).

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Transgender-specific developmental milestones and associated experiences of violence, discrimination, and stigma among Filipinx transgender women who are sexually active with men

“…For example, experiences of discrimination in health care settings, including provider attitudes towards transgender people, likely prevent trans-WSM from seeking and/or initiating integration of hormone intervention [27,28], and exposure to social or familial reprimands for violating binary gender roles may lead to self-censorship with regard to gender identity exploration and development. Another possible explanation could be that trans-WSM who achieve gender identity milestones relatively early are likely to benefit from gender affirming resources that keep them relatively protected from structural discrimination, stigma, and violence, compared to those who undergo milestones later and do not gain access to gender-affirming resources [29]. Future longitudinal and qualitative work could delineate the directionality of these postulations, including the extent to which structural discrimination, stigma, and violence may inform these trans-specific developmental milestones, and vice versa.…”

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

“…However, the PGA scale is designed to be applicable across populations of transgender women regardless of HIV status or race. Due to its potential ability to mitigate the negative health effects of transphobia, psychological gender affirmation is an important construct to study with people of all genders, regardless of HIV status [4,[7][8][9]50]. Future research should explore applicability of the PGA scale in other groups of transgender and gender diverse people, such as transgender men and gender non-binary people, as well as in other geographic locations globally [51].…”

“…Gender dysphoria is compounded by transphobia-the systemic stigma and discrimination faced by transgender people-which often results in social and economic marginalization as well as violence [1,2]. Experiences of transphobia are also significantly associated with poorer mental health and substance use among transgender and gender diverse people [1,3,4].…”

“…As conceptualized by the Model of Gender Affirmation [5], gender affirmation, whether social, medical, or psychological, has been demonstrated to reduce gender dys-phoria and can mitigate some of the downstream negative health effects of marginalization [4,[6][7][8][9][10][11]. Social gender affirmation is interpersonal recognition and respect for one's gender identity, while medical gender affirmation entails the utilization of gender-affirming medical treatments, such as hormone therapy and/or surgeries.…”