Factors influencing overdose and misuse of gender-affirming medication in Chinese transgender and gender diverse individuals: a qualitative study of experience and perspectives

Abstract

Background The overdose and misuse (ODM) of gender-affirming hormone treatment (GAHT) medications is common among the Chinese transgender and gender diverse (TGD) population due to a unique sociocultural and healthcare basis. However, there is no existing publication providing descriptions and interpretations of this situation among Chinese TGD people. Aims To investigate related factors, probable triggers, and causes of GAHT ODM among Chinese TGD people on a qualitative basis, and develop a corresponding framework for further studies. Methods We used an expert panel to draw up the criteria of ODM and semi-structured interviews to collect data. TGD people from mainland China were recruited online for interviews. An inductive thematic analysis was conducted using a framework method. A working analytical framework was developed based on the coding of nine randomly selected transcripts and the researchers’ discussion and experience. The framework was continuously refined and applied to code and chart all transcripts into the framework matrix. We examined all potential experiences and perspectives of participants on GAHT ODM. Results Twenty-one Chinese TGD youths (mean age 21.6, SD 3.65) with GAHT experience in the past 12 months completed eligible interviews, of whom eight were trans women, eight were trans men and five identified themselves as genderqueer or non-binary. Ten of them reported ODM according to the criteria derived from an expert panel. We extracted five domains consisting of 14 topics related to their GAHT medication behaviors, i.e. accessibility of healthcare resources, gender minority stress, online TGD communities and drug sellers, gender dysphoria and mental distress, and knowledge deficit. Conclusion This study firstly used qualitative methods to investigate GAHT ODM among Chinese TGD people, providing a framework to identify probable causes and triggers for further studies. Practitioners or psychologists can take this framework as a reference when evaluating TGD clients in order to better understand their behaviors.