Toward Nonbinary Nuance in Research and Care: Mapping Differences in Gender Affirmation and Transgender Congruence in an Online National U.S. Survey

Breslow, Aaron S.; Wojcik, Hailey; Cox, Robert W.; Tran, Nathaniel M.; Brewster, Melanie E.

doi:10.1089/trgh.2020.0038

Cited by 14 publications

(8 citation statements)

References 40 publications

(94 reference statements)

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“…Half of the respondents reported they had not used GAHT as a component of their gender affirmation. Our findings are consistent with prior work that found not all trans adults seek gender affirmation services within formal medical institutions due to a multitude of reasons, including experiences of anti-trans discrimination, administrative burden, legislative state-level restrictions on trans healthcare, refusal of care from medical providers, preference for do-it-yourself hormone management or simply lack of desire to do so [21,[88][89][90][91][92][93]. Importantly, the ability to bundle PrEP-related services with GAHT services was still highly preferred and the second most important attribute assessed in this study.…”

Section: Table 2 Results Of Choice-based Conjoint Analysis Experiment...supporting

confidence: 91%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

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IntroductionCurrent implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States.MethodsBetween April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents’ PrEP status.ResultsThe median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1).ConclusionsParticipants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.

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Section: Table 2 Results Of Choice-based Conjoint Analysis Experiment...supporting

confidence: 91%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

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“…Participants valued feeling as though they had successfully expressed their internally held sense of gender. From gender affirming medical care to experimenting with style and pronouns, findings from our study extend upon previous research demonstrating how such social, and medical gender affirming processes promote wellbeing (Breslow et al, 2020;Hughto et al, 2020). Further, this finding converges with previous research investigating "transgender congruence", which refers to the degree to which TGDN individuals: (a) perceive their appearance to accurately represent their gender identity (appearance congruence), and (b) accept, and feel pride in their gender identity (Kozee et al, 2012).…”

Section: Discussionsupporting

confidence: 82%

Pathways to Euphoria: Deconstructing Gender-Expansive Adults Conceptualizations of Wellbeing

Hall,

Rees,

Newnham

2024

Int J Appl Posit Psychol

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Historically, research has portrayed transgender, gender-diverse, and non-binary (TGDN) individuals through narratives of distress and dysfunction. Through the adoption of a positive psychology lens, the present study sought to refute this dominant deficit model, instead exploring the processes that foster wellbeing among TGDN adults residing in Western Australia. Central to this study was the collaboration between researchers and the TGDN community. Participants comprised twelve adults who self-identified as members of Western Australia’s TGDN community, recruited through TGDN community spaces. In line with the exploratory qualitative design employed in this study, participants took part in face-to-face, semi-structured interviews; with transcripts analysed using thematic analysis. Gender euphoria emerged as the central concept underlying participants’ conceptualizations of wellbeing. Three subsequent themes were identified: (1) achieving gender congruence, (2) collectively healing, and (3) finding gender pride. Each theme illustrates a means through which gender euphoria, and thus wellbeing, was elicited among participants. These findings may inform the development of individualized strategies that clinicians, and institutions serving TGDN individuals, can implement to improve the wellbeing of their clients. Further, this study highlights the need to avoid reconstructing pathologising narratives, and instead adopt participatory, and positive psychology approaches to research with the TGDN community.

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“…One such question is-at what age and under what conditions do children and adolescents who experience gender dysphoria benefit from social gender transition (i.e., living in their affirmed gender rather than their gender assigned at birth, which may involve changing their physical gender markers such as hair and clothing as well as their name and gender pronouns)? 1 Answering this question is of particular urgency, given that children and adolescents who experience gender dysphoria or are otherwise gender variant demonstrate a higher prevalence of mental health difficulties than their cisgender peers (Becerra-Culqui et al, 1 In principle, social gender transition may refer to either a binary social gender transition (in which a person changes gender markers and appearance to live in the gender role "opposite" to that assigned at birth) or non-binary gender transition (in which case the person may aim to defy binary gender-roles in their pronouns and appearance in some instances) (Breslow et al, 2021;Matsuno & Budge, 2017). In the present context, we are confining our discussion to binary social gender transition (birth-assigned males socially transitioning to live as girls and vice versa), which to this point is the more studied phenomenon in paediatric gender services and which may be more likely to be associated with a desire for medical transition (at least among adults) (Breslow et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria?

Morandini

Kelly²,

Graaf

et al. 2023

Arch Sex Behav

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Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4–17 years. We assessed mental health correlates of living in one’s affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.

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Toward Nonbinary Nuance in Research and Care: Mapping Differences in Gender Affirmation and Transgender Congruence in an Online National U.S. Survey

Cited by 14 publications

References 40 publications

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Pathways to Euphoria: Deconstructing Gender-Expansive Adults Conceptualizations of Wellbeing

Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria?

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