Transgender And Gender Nonconforming People Research Articles

Social Work Education on Transgender and Gender Nonconforming People: Application of an Intersectional Feminist Lens and Suggested Classroom Exercises

ABSTRACT This paper argues for the application of Intersectional Feminist theoretical lens to social work pedagogy and provides sample educational activities, from simple to complex, which apply this lens to bachelors, masters, and doctoral social work levels. All social workers must be prepared to work effectively with transgender and gender nonconforming (TGNC) people. This work relies on social workers’ knowledge, skills, and self-awareness. Social workers who lack knowledge, skills, and self-awareness of the dimensions of gender diversity can create barriers to care for TGNC people. Increasingly, research on social work education and professional social work organizations are encouraging and expanding guidelines for effective practices with TGNC people. Much of this guidance stresses discrete practices rather than situating practice within a broader theoretical framework. Rather than adding to general guidance, we advocate for the application of an Intersectional Feminist lens in teaching social workers dimensions of gender diversity. Applying an Intersectional Feminist lens to social work education creates a context to frame educational activities and facilitates students’ self-discovery of personally and socially held conceptions and biases related to gender. We include activities to help those teaching social work infuse this lens into pedagogy across levels of teaching social work.

Rethinking gender diversity: Transgender and gender nonconforming people and gender as constellation

AbstractIn this article, we challenge the mainstream view of gender rooted in binary cisnormativity and suggest that the gender frameworks used to inform organizational research and practice are inadequate with respect to the range of transgender and gender nonconforming (TGNC) identities. We employ Hacking's “dynamic nominalism” to illustrate how evolving classifications of TGNC people operate as a discriminating factor that threatens their lived experiences. As an alternative to the binary cisnormative metaphor of gender as a spectrum, we adopt a more inclusive metaphor of a gender constellation and sketch out its potential conceptualization that promotes multidimensional, non‐hierarchical, and dynamic approaches to gender diversity.

Association Between Perceived Stress and Salivary Biomarkers of Allostatic Load Among Gender Minorities in Chennai: An Observational Cross-Sectional Study.

Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses that necessitate the production of organic chemicals ensuing in the detection of blood serum and saliva.There are currently no laboratory tests that are confirmatory for the diagnosis of stress and facilitate necessary treatment to be carried out in a timely manner. Thus, potential salivary biomarkers could be a helpful tool in overseeing the efficacy of pharmacological treatment prescribed by a psychiatrist. Aim This study aimed to assess the correlation between perceived stress and salivary stress biomarker levels in transgender and gender nonconforming (TGNC) individuals in Chennai, India. Methodology Twenty-two TGNC individuals and 22 age-matched controls in Chennai were administered the Perceived Stress Scale-10 questionnaire. Following this, their saliva samples were collected using the passive drool technique and subjected to sandwich enzyme-linked immunosorbent assay (ELISA) technique for measuring salivary cortisol, salivary tumor necrosis factor-alpha (TNF-alpha), and salivary C-reactive protein (CRP). Independent t-test was used to compare salivary stress biomarker levels between the TGNC and age-matched control groups. Pearson's correlation test was done to correlate perceived stress and salivary stress biomarker levels in the TGNC group. Results Significant difference was seen between the TGNC and control groups with respect to salivary cortisol and salivary TNF-alpha levels, with the levels being higher in the TGNC group. A significant positive correlation was seen between perceived stress and salivary cortisol and between perceived stress and salivary TNF-alpha levels. Conclusion There is a significant correlation between perceived stress and salivary biomarkers of stress among TGNC people in Chennai.

Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample.

Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.

Identity-Related Factors Protect Well-Being Against Stigma for Transgender and Gender Non-Conforming People

Relatively little is known about identity-related resilience factors associated with well-being among transgender and gender non-conforming (TGNC) people. Drawing upon theory on stigma-related stress and resilience and work examining group identification as a buffer against discrimination, the aim of the current study was to model perceived discrimination, transgender identification, and gender identity affirmation as predictors of well-being for TGNC people. We also tested whether the positive association between gender identity affirmation and well-being might be explained by the benefits affirmation has for individual self-concept clarity. Participants were 105 TGNC individuals (42% transgender male, 39% transgender female, 19% other gender non-conforming [e.g., non-binary]) recruited through online forums and support groups in the UK and North America who completed an online survey including self-report measures of key constructs. Results from structural equation models demonstrated that: (1) experiences of discrimination were associated with lower well-being overall, but having a stronger transgender identity moderated this association; (2) after adjustment for discrimination and transgender identification, experiences of gender identity affirmation were independently associated with greater well-being for TGNC people. Secondary analyses demonstrated that gender identity affirmation was linked to well-being through reinforcing a strong, internalized sense of clarity about individual self-concept. Results are discussed in terms of the implications for TGNC health and well-being, particularly with regard to the need for supportive, identity-affirming social environments.

Gender Identity Milestones, Minority Stress and Mental Health in Three Generational Cohorts of Italian Binary and Nonbinary Transgender People.

Transgender and gender nonconforming (TGNC) people experience high rates of minority stress and associated risk for negative health outcomes. However, during the last years, significant positive socio-cultural changes have happened, and younger cohorts of TGNC individuals are having diverse experiences compared to older cohorts. By integrating the minority stress theory and the life course perspective, this cross-sectional, web-based study aimed to explore in 197 Italian TGNC people aged 18 to 54 years (M = 29.82, SD = 9.64) whether the average ages of gender identity milestones (i.e., first insights about being TGNC, self-labeling as a TGNC person, and coming out), minority stress, and mental health vary among three generational cohorts (i.e., Generation Z, Millennials, and Generation X). Compared with older cohorts, younger participants: (a) were more likely to be in the trans-masculine spectrum; (b) self-labeled as TGNC and came out earlier; (c) had more negative expectations and lower levels of disclosure; and (d) had higher levels of mental health problems. No generational differences related to first insights about being TGNC and distal minority stressors were found. Furthermore, compared with binary individuals, participants with a non-binary identity: (a) reported later ages for the gender identity milestones; (b) had higher negative expectations; and (c) had higher levels of mental health problems. Overall, our findings indicated that changes in the social environments have a limited impact on stigmatization processes and mental health of Italian TGNC people.

A thematic analysis of approaches to practice with people who are transgender and gender nonconforming

AbstractPeople who are transgender and gender nonconforming (TGNC) have substantial disparities in mental health and thus rely on mental health practitioners like therapists to help address these disparities. However, little is known about therapist practices with TGNC people, and what research exists is often generalised from broader research on practice with people who are gay and lesbian. Because this research uses broad models to describe practitioner behaviour, it assumes all therapists approach practice with TGNC clients in the same way. The current study explores therapists' self‐reported practices with TGNC people through a structured, qualitative, web‐based survey of 95 practising social workers. From a thematic analysis of responses, five approaches to practice with TGNC people emerged: 1) A Low‐Impact Approach, 2) A Fairness First Approach, 3) A Responsive Approach, 4) A Therapist Responsibility Approach and 5) A Pathological Approach. These approaches vary on three key dimensions: whose responsibility it is to broach client gender identity in treatment (therapist or client), the importance of gender identity (from low to high), and whether a TGNC identity is a disorder (yes, no or not addressed). The breadth of practice behaviours and undergirding assumptions participants described indicates that a single model may not fit practice behaviour with TGNC people. A discussion of the relationship between each approach and existing practice models suggests that the Low‐Impact Approach, Responsive Approach and Therapist Responsibility Approach may be effective with TGNC people and that the Pathological Approach likely represents poor practice.

Supporting Occupational Justice for Transgender and Gender-Nonconforming People Through Narrative-Informed Theater: A Mixed-Methods Feasibility Study.

Societal stigma gravely impedes occupational justice for transgender and gender-nonconforming (TGNC) people, producing vast health disparities for this population. To test the feasibility of an intervention to reduce stigma and improve the well-being of TGNC people. A parallel, mixed-methods design was used to test feasibility in the areas of acceptability, demand, and limited efficacy. Community. Forty-two audience members and 5 TGNC interviewees. Virtual, narrative-informed play reading and moderated discussion about gender diversity and affirmative care. Outcomes and Measures: The valid and reliable Acceptance and Action Questionnaire-Stigma was used to assess stigma beliefs. An open-ended, qualitative question assessed TGNC interviewees' experiences. Recruitment and participant responses to the intervention indicated feasibility in the areas of acceptability, demand, and limited efficacy. However, future efforts at obtaining a diverse TGNC sample are needed. The intervention decreased stigma beliefs in audience members and offered a positive experience for TGNC participants. Feasibility outcomes warrant future efficacy testing. What This Article Adds: This article adds an innovative intervention for promoting occupational justice to support the health and well-being of TGNC people. The community-based intervention facilitates change in societal attitudes and stigmatizing beliefs.

Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review.

In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one's chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.

The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals

Background: According to the minority stress theory, the minority stressors of gender-related discrimination, rejection, and victimization will increase depression in the transgender and gender non-conforming (TGNC) population. However, few studies focused on these relations in the context of mainland China, and the positive perspective of their resilience still remained unstudied.Methods: This cross-sectional study recruited 361 TGNC individuals through the online community of TGNC people. The participants were involved in this study by measuring their experiences of gender-related discrimination, rejection, victimization, resilience, and depression. The SPSS and PROCESS were used to assess the relations of the studied variables.Results: High rates of gender-related discrimination, rejection, and victimization were reported by TGNC participants in this study (80.1%, 98.9%, and 77.0% accordingly). The participants who had experienced gender-related discrimination and victimization showed a significantly higher level of depression than those who never experience such unfair treatments. Besides, gender-related discrimination and resilience significantly contributed to the variance of the depression (R2 adjusted=0.344, F=21.674, p<0.01), and their resilience was found to play a moderating role between discrimination and depression.Limitations: A longitudinal study may need to examine the causal effects, and the limitations of the online data should be noted.Conclusions: The Chinese TGNC people are living in a relatively unfavorable environment with experiencing high rates of gender-related unfair treatments, which can be detrimental to their mental health status. However, their resilience can be a buffer for them in facing adversity. Intervention and educational programs might be developed accordingly.

Provider Recommendations Are Associated with Cancer Screening of Transgender and Gender-Nonconforming People: A Cross-Sectional Urban Survey.

Purpose: This study examined the relationship between clinician recommendation and receipt of cancer screenings among a transgender and gender-nonconforming (TGNC) sample (n=58).Methods: Respondents self-identified as TGNC, age 40+ years, and residents of the Washington, D.C. area. Odds ratios were calculated to compare provider-recommended with received screenings. An open-text question asked for recommendations to improve screening experiences.Results: Provider recommendations were associated with screenings for breast, colorectal, prostate, lung, and anal cancer. Respondents cited interpersonal skills, affirming language, and clear information as important health care provider characteristics.Discussion: Participants reported being more likely to be screened if a provider recommended one regardless of evidence from current published guidelines.Conclusion: Gender identity, anatomy, and hormone exposure are critical elements that should be collected in future cancer screening research to build a stronger evidence base for provider recommendations based on population-level and individual-level risks of TGNC people.

How Are Transgender and Gender Nonconforming Youth Affected by the News? A Qualitative Study

PurposeNews stories about transgender and gender nonconforming (TGNC) people have become more common in recent years and TGNC youth may be disparately affected by this information compared with their cisgender peers. The aim of this study was to understand how TGNC youth react to news stories about TGNC and other gender and sexual minority (GSM) identifying persons. MethodsAs part of a larger study, 23 TGNC youth were recruited from the Seattle Children's Gender Clinic to participate in a semistructured interview. Interviews were audio recorded, transcribed, and thematically analyzed. ResultsParticipating youth ranged in age from 13 to 19 years (mean = 16.9 years). Of the 23 participants, 43% identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Four main themes were identified: (1) news coverage of current political climate affects gender transition; (2) negative news coverage of GSM people contributes to concerns about mental well-being and safety; (3) geographical location affects perception of news; and (4) positive news coverage of TGNC people increases visibility and hope. ConclusionsExposure to negative news about GSM people may contribute to increased levels of stress among TGNC youth. With increased visibility, participants described frustration associated with inaccurate portrayals of the TGNC community in the news; however, with increased visibility, there is also a growing sense of shared community and opportunity for acceptance of TGNC people. Given the scope of responses to negative and positive news on GSM people, TGNC youth may benefit from increased support to promote resilience when interpreting the news.

The manifestation of multilevel stigma in the lived experiences of transgender and gender nonconforming older adults.

Transgender and gender nonconforming (TGNC) people experience disparities in mental health when compared with non-TGNC sexual minorities and the general population. One line of inquiry with respect to these disparities is the examination of stigma and its connection to emotional and psychological well-being. Recent conceptualizations of stigma draw attention to multiple levels-individual, interpersonal, and structural-that are thought to impact well-being for TGNC people. However, little is known about how multilevel stigma is experienced by TGNC older adults, who navigate stigmatizing environments over a lifetime and who may be especially vulnerable to its cumulative effects. We conducted an interpretive content analysis of biographical interviews with 88 TGNC adults aged 50 and older, from across the United States, obtained from the photography and interview project To Survive on This Shore. Our analyses suggest that TGNC older adults' mental health is indeed impacted by multiple levels of stigma. Individual level stigma is experienced as ongoing vigilance about aspects of oneself that break gender norms, often manifesting in internal conflicts. At the interpersonal level, TGNC older adults navigate unpredictable relationships marked by conflicting expressions of love, acceptance, strain, and exclusion. Structural stigma manifests in constraints brought about by transphobic policies and social norms but also sparks intentional action on the part of TGNC older adults to resist and change these social forces. Clinical interventions to combat stigmatization can use life narratives and a focus on consciousness-raising to promote empowerment and well-being for this group of older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

‘Lost in Transition’: Some Preliminary Considerations on Voicing Transgender and Gender Non-Conforming Discrimination in the Workplace

This article proposes a model aimed at considering both voice and inclusion during social and medical transition of transgender and gender non-conforming (TGNC) people in their workplace. A preliminary theoretical framework is focused on voice and inclusion in organisation. The rationale of this article lies in the difficulties expressed in current research in taking into account TGNC issues in organisation due to lack of empirical evidence. The model proposed in the current work intends to add knowledge on the experiences of TGNC people within their workplaces, especially during the transition process.

Psychological processes underlying the impact of gender-related discrimination on psychological distress in transgender and gender nonconforming people.

In this study we combined understanding from the gender minority stress and resilience (GMSR) model (Testa, Habarth, Peta, Balsam, & Bockting, 2015) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999, 2012) to test a theoretically integrated and expansive account of the development of psychological distress in transgender and gender nonconforming (TGNC) people. Specifically, we constructed a parallel multiple mediation model in which we examined the role of psychological processes deriving from the GMSR model (i.e., internalized transphobia and identity nondisclosure) and ACT (i.e., psychological inflexibility) in the relationship between gender-related discrimination and psychological distress (i.e., depression, anxiety, and stress). We based this model upon data from a 2-wave longitudinal panel design in which 358 TGNC people living in England responded to a battery of measures on 2 occasions, 12 months apart (herein, Time 1 and Time 2). Initial tests of model fit and temporal invariance indicated that our proposed measurement model offered an excellent fit to the data and demonstrated equivalence of measurement across the two study timepoints. Autoregressive cross-lagged manifest path analysis indicated that while our hypothesized full structural model offered an excellent fit to the data, psychological inflexibility alone mediated the relationships between gender-related discrimination and depression, anxiety, and stress. Model comparison analysis confirmed the redundancy of internalized transphobia and identity nondisclosure as mediators and ruled out alternative patterns of causality. We discuss theoretical, empirical, and practical implications for the field of TGNC mental health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adherence to Antiretroviral Therapy Among Transgender and Gender Nonconforming People Living with HIV: Findings from the 2015 U.S. Trans Survey.

Purpose: This article includes an analysis of medication adherence among transgender and gender nonconforming (TGNC) people living with HIV (PLWH) from the 2015 U.S. Trans Survey (USTS), the largest survey of TGNC people in the United States.Methods: Using data from the USTS, our analytic sample included 162 TGNC PLWH who had been prescribed antiretroviral (ART). We grouped respondents by adherent/nonadherent and compared demographic characteristics and potential adherence risk factors.Results: Approximately 65.8% of participants reported “taking ART as prescribed” all the time (61.0% trans women and 85.7% of trans men). Black TGNC PLWH were more likely to be nonadherent than whites or Hispanics. Adherent participants reported higher rates of home ownership. Nonadherent PLWH reported higher rates of verbal harassment, sex work, and homelessness in the past year, and lower rates of visiting an HIV doctor for care in the past year.Conclusions: USTS respondents living with HIV reported lower adherence than in other nationally representative studies of this population in medical care. HIV rates are higher among black individuals, and reported adherence is lower, suggesting this is a high-priority population. Findings also suggest that unstable sociostructural conditions (homelessness, sex work, etc.) compromise medication adherence. Future practice directions include integrating HIV treatment plans into larger support services for TGNC PLWH.

A qualitative study on minority stress subjectively experienced by transgender and gender nonconforming people in Italy

Summary A great amount of quantitative research has largely demonstrated that transgender and gender nonconforming (TGNC) people experience high rates of minority stress, against which they are able to exercise resilience and to use adaptive strategies buffering the negative effects of stress on health. Notwithstanding, qualitative investigations on how TGNC people subjectively experience minority stress are still scarce. This study aims at exploring the subjective experiences of minority stress through a focus group with 8 Italian TGNC individuals (5 male-to-female, 2 female-to-male, and 1 genderqueer; M = 25; SD = 5). Narratives were analyzed through the deductive thematic analysis. The analysis generated four main categories: (1) family rejection; (2) visibility of the body; (3) negative effects of family violence on health; and (4) integration of TGNC identity. Results offer an in-depth exploration of minority stress processes in TGNC people, as well as the impact of stress on health and adaptive strategies to face with stigma. Suggestions for clinical practice are discussed.

Food Insecurity Among Transgender and Gender Nonconforming Individuals in the Southeast United States: A Qualitative Study.

Purpose: Transgender and gender nonconforming (TGNC) people experience high rates of poverty, joblessness, and homelessness, which drive risk for food insecurity. TGNC people also face discrimination due to transphobia and cissexism, which may contribute to these drivers. Minimal empirical evidence describes experiences with food insecurity among TGNC people. This project investigated food insecurity among TGNC people and how these experiences relate to their physical and mental health.Methods: Semistructured telephone interviews were conducted with 20 TGNC people residing in the Southeast United States (U.S.), recruited through social media. Interviews were transcribed and qualitatively coded.Results: TGNC people reported living in extreme poverty. They described how the conservative sociopolitical climate of the Southeast United States made it difficult to find and maintain employment, which was a primary driver of food insecurity. Participants experienced discomfort seeking food assistance due to discrimination and concern for reducing emergency food availability for people in greater need. Stress from unemployment and underemployment, inadequate food supplies, and discrimination was reported as a contributor to poor physical and mental health, and weakened support systems.Conclusion: Poverty and food insecurity erode TGNC people's physical and mental health and support systems. TGNC people faced substantial barriers—including unemployment and underemployment and multilevel discrimination—which prevented them from affording adequate food. Public health solutions include implementing employment nondiscrimination policy to protect TGNC people in the workplace and building relationships between local food pantries and LGBT organizations to create safer environments for all persons in need of food assistance.

Distress and Therapeutic Outcomes Among Transgender and Gender Nonconforming People of Color

Transgender and gender nonconforming (TGNC) People of Color experience stressors unique to both TGNC and racial and/or ethnic minority communities, resulting in disparities in mental health. Guided by minority stress and intersectionality theories, we examined initial anxiety and depression, as well as changes in symptoms, in 41,691 clients from the Center for Collegiate Mental Health 2012–2016 dataset. We sought to understand disparities that may exist in distress and therapeutic response between TGNC and cisgender clients. We also examined the intersection of gender and racial and/or ethnic identities to examine how these trends differ for TGNC People of Color. Results from hierarchical linear modeling indicated greater symptom severity, but a slower remission of symptoms of depression and anxiety, among TGNC clients. Interaction effects were nonsignificant; however, TGNC Clients of Color experienced more distress than either White TGNC clients or cisgender Clients of Color. On average, TGNC clients, compared to cisgender clients, utilized an additional 2.5 sessions of therapy.

First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers' online materials in the USA

ABSTRACTBackground: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a “gender therapist,” only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections.