Transgender And Gender Nonconforming Research Articles

Systematic Review of Gender and Sex Terminology Use in Arthroplasty Research: There is Room for Improvement

There is increasing appreciation of the distinction between gender and sex as well as the importance of accurately reporting these constructs. Given recent attention regarding transgender and gender nonconforming (TGNC) and intersex identities, it is more necessary than ever to understand how to describe these identities in research. This study sought to investigate the use of gender- and sex-based terminology in arthroplasty research. The five leading orthopaedic journals publishing arthroplasty research were reviewed to identify the first twenty primary clinical research articles on an arthroplasty topic published after January 1, 2022. Use of gender- or sex-based terminology, whether use was discriminate, and whether stratification or adjustment based on gender or sex was performed, were recorded. There were 98 of 100 articles that measured a construct of gender or sex. Of these, 15 articles used gender-based terminology, 45 used sex-based terminology, and 38 used a combination of gender- and sex-based terminology. Of the 38 articles using a combination of terminology, none did so discriminately. All articles presented gender and sex as binary variables, and two attempted to explicitly define how gender or sex were defined. Of the 98 articles, 31 used these variables for statistical adjustments, though only six reported stratified results. Arthroplasty articles infrequently describe how gender or sex was measured, and frequently use this terminology interchangeably. Additionally, these articles rarely offer more than two options for capturing variation in sex and gender. Future research should be more precise in the treatment of these variables to improve the quality of results and ensure findings are patient-centered and inclusive.

Enhancing Workplace Inclusivity for TGNC (Transgender/Nonconforming) Communities: “A Path to Psychological-Safety”

Discrimination against transgender and gender nonconforming (TGNC) individuals remains apervasive issue, significantly impacting their psychological safety and overall well-being. This marginalisedcommunity faces an array of challenges, including experiencing homelessness, poverty, and harassment, whichare interconnected and, to a considerable extent, a consequence of systemic discrimination. Studies by Tebbeet al. (2019) reveal that the TGNC community grapples with disproportionately high rates of homelessness,poverty, and harassment, thus highlighting the systemic nature of the challenges they confront. Workplacediscrimination within the TGNC community extends across a spectrum, impacting individuals’ authenticity andpotential for forced engagement in underground economy work to offset poverty, including survival sex workand drug dealing (Par & Howe, 2020). Workplace discrimination is a pivotal determinant of psychological safety and well-being for TGNC individuals.Frazier et al. (2017) emphasise the critical importance of preventing discrimination and conflict in theworkplace, which contributes to negative mental health outcomes. The consequences of discrimination areprofound. A significant portion of the TGNC community reports a history of suicidal ideation, ranging from 45%to 77% (Testa et al., 2017). Promoting psychological safety and well-being for this marginalised community isnot only a moral imperative, but also a pathway to fostering more prosperous and inclusive societies. Thisresearch utilises a qualitative methodology, through semi-structured interviews among diverse genderidentities. By exploring the lived experiences of TGNC individuals in the workplace, this study uncovers theimpact of discrimination on psychological well-being. The results of the findings demonstrate how to improvethe psychological-safety of gender-diverse communities through

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.

White American transgender adults' retrospective reports on the social and contextual aspects of their gender identity development.

A growing body of research has attended to the experiences of transgender and gender non-conforming (TGN) youth's gender identity development. However, practical and ethical concerns have impeded our ability to understand the experiences of TGN youth. Thus, the aim of this study was to utilize one-on-one semi-structured interviews to explore White American TGN adults' (N = 15) retrospective accounts of their gender identity development in childhood and adolescence. Findings demonstrate considerable heterogeneity in TGN adults' retrospective accounts of their gender identity development. However, TGN adults consistently highlighted the role of social (e.g. friends, family and teachers) and contextual (e.g. online, offline, educational and geographical) factors in their gender identity journeys. This study provides new insight into the role of social and contextual factors in TGN adults' retrospective accounts of their gender identity development, demonstrating the importance of continuing to examine these factors in gender diversity research.

Fantasy Worlds, Real-Life Impact: The Benefits of RPGs for Transgender Identity Exploration

ABSTRACT The current research explored the influences of role-playing video games (RPGs) on the development of gender identity among transgender and gender non-conforming (TGNC) individuals. In Study 1 (N = 10), we used a Consensual Qualitative Research approach to interview TGNC individuals and identify common themes regarding the perceived impact of RPGs on gender identity development. TGNC individuals highlighted the influence of character customization, exploration, and the function of RPGs as safe spaces. In Study 2 (N = 100), we quantitatively explored the influence of RPG avatar customization on TGNC gender identity development. Although avatar customization was not associated with gender identity commitment, those playing RPGs with highly customizable avatars were more likely to report an impact of RPGs on their gender identity development. Content analyses reinforced Study 1 findings, indicating that RPGs, especially those with customizable avatars, can shape the gender identity journey for TGNC individuals.

Gender dysphoria and gender-affirming surgery: The New York state experience

Transgender and gender nonconforming (TGNC) individuals experience incongruence between their self-identified gender versus their birth-assigned sex. In some cases, TGNC patients undergo gender-affirming surgical (GAS) procedures. Although GAS is an evolving surgical field, there is currently limited literature documenting patient characteristics and procedures. Addressing this knowledge gap, this retrospective cohort analysis described the characteristics of New York State's TGNC residents with gender dysphoria (GD) diagnosis, including patients undergoing at least one gender-affirming surgical procedure. Using the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2002 to 2018, we identified patients' first-time TCNC records and their risk characteristics. Patients who received GAS procedures were sub-classified as top-only, bottom-only, or combined top/bottom procedures and were compared with TGNC patients who did not receive GAS. Of 24,615 records extracted from TGNC SPARCS database, 11,427 (46.4%) were transmasculine (female-to-male) and 13,188 (53.6%) were transfeminine (male-to-female). Overall, 2.73% of transgender patients received at least one GAS procedure. Of these patients, 78.2% had masculinizing and 21.8% had feminizing surgeries. After a diagnosis of GD, the positive predictors for a GAS-based procedure included female birth sex, pediatric age (<18 years) or older age (60+ years), commercial insurance coverage, and Hispanic race. In contrast, negative GAS predictors included male birth sex and government insurance coverage (i.e., Medicare and Medicaid). Compared with transgender women, transgender men were more likely to receive at least one GAS procedure. Because the race, ethnicity, and payor status of TGNC patients can impact GAS treatment rates, additional research is warranted to examine post-diagnosis GAS treatment disparities among TGNC patients.

Mental health changes in partners of transgender and gender nonconforming individuals as a result of partner gender transition: What about me?

Purpose Research on the psychosocial impact of gender transitioning on partners of transgender and gender nonconforming (TGNC) individuals is scarce in the literature. Here, we assessed mental health in partners of TGNC individuals. Methods Anonymous surveys were administered via Amazon Mturk. Eligible participants were ≥ 18 years with a partner who transitioned genders. Relationship satisfaction and mental health were assessed via perceived changes, Personal Health Questionnaire Depression Scale (PHQ-8), General Anxiety Disorder (GAD-7), Self-Esteem and Relationship Questionnaire (SEAR), Resilience Scale, and Difficulties in Emotion Regulation Scale (DERS-5). Multivariable linear regression assessed associations between relationship satisfaction and type of partner transitioning. Results Of the 337 study respondents, 42.4% were assigned male, 57.6% assigned female (43.9% identify as male; 55.8% as female) and 1.76% nonbinary, with a mean age of 35.8. 44.4% had partners who are transgender women, while a third (36.8%) had partners who are transgender men, 7.7% from assigned male to nonbinary, and 11.2% from assigned female to nonbinary. Most (72.4%) partners underwent surgical transitioning (15.1% top surgery; 5.6% bottom; 51.6% both) versus 27.6% non-surgical transitioning. PHQ-8, SEAR, confidence, self-esteem, relationship satisfaction, and resilience scores were higher among respondents whose partners underwent surgical transitioning (p < 0.001). SEAR scores differed significantly among participants whose partners underwent top only versus bottom only surgery (p = 0.004). Conclusion Partner mental health and relationship satisfaction were most impacted by surgical transitioning of their TGNC partner. Supportive services for partners of TGNC individuals during the transition process to protect these romantic relationships should be considered.

Protective factors for transgender and gender non-conforming youth’s high school experience: a systematic literature review

This systematic review provides an overview of the empirical research relating to protective experiences of transgender and gender non-conforming (TGNC) high school students. 22 studies were identified by online search which included protective high school experiences and TGNC youth. Results revealed an increasing trend of publication in this field after 2010, with the majority of these studies conducted in the U.S. The reviewed studies showed that interpersonal support from friends and educators played a critical role in shaping TGNC students’ affirming school experiences. In addition, TGNC students themselves demonstrated resilience to cope with hostile school experiences and even promoted a more inclusive environment. A safe school environment with accessible resources for TGNC students was also critical for both their mental and academic outcomes. Depending on the context and intersecting identities of TGNC youth, however, protective factors and affirming experiences continue to be rare. The review concludes with recommendations for research and practice.

Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples.

This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs). Participants (ages 13-21years) included TGNC youth from a paediatric gender clinic (N=97), a demographically matched community-based sample of cisgender males (N=97) and cisgender females (N=97), and treatment-seeking patients with EDs (N=112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours. Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35%≥score of 3, 17%≥score of 4), significantly higher than cisgender males (0%≥score of 3, 0%≥score of 4) and females (9%≥score of 3, 3%≥score of 4). Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.

Migration, Exploitation, and Human Trafficking Among High-Risk Transgender and Gender Non-Conforming Individuals in Cape Town: A Case Study

ABSTRACT Transgender and gender non-conforming (TGNC) individuals and migrants are at risk for human trafficking, yet patterns of migration and exploitation among TGNC individuals are not well documented. This case study examined the experiences of migration and exploitation in a subsample of 27 TGNC individuals from a larger study of 665 high-risk adults in Cape Town, South Africa. The main variables of analysis are derived from a version of the Trafficking Victim Identification Tool, which includes quantitative and qualitative responses. Twenty-six participants (96%) reported at least one potential indicator of exploitation in their lifetime. In the past 12 months, ten participants indicated that someone had withheld payments from them or taken the payment they should have been paid. Half (n=13) of the South African born participants discussed internal migration in their qualitative responses without migration specific prompting. Participants described difficult lives that included childhood abuse, unstable housing, economic marginalization, internal migration, and elements of labor and sexual exploitation – much of which was driven by transphobic and intersectional discrimination and stigma. Our findings shed light on the vulnerability of TGNC individuals and emphasize the need to include TGNC voices in all research and interventions addressing human trafficking.

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.

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic.

Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.

Parents Responding to TGNC Children: A Qualitative Metasummary

This article outlines a qualitative metasummary of studies with qualitative findings collected from parents of transgender and gender-nonconforming (TGNC) children. This literature review study describes parents’ experiences of responding to TGNC children. The step of data analysis for this study resulted in a data set of 34 research articles with two primary themes, four subthemes, and 17 findings. The two primary themes represent challenges parents faced and changes they made relating to their TGNC children. We created this report to share with mental health professionals, such as clinical social workers, serving TGNC children and their parents. This metasummary report concludes with recommendations mental health professionals can implement to improve services offered to TGNC child mental health care recipients and their accompanying parents.

Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany

Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11–18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.

Cisnormative symbolic colonization and transgender and gender nonconforming individuals in the workplace

AbstractCisnormativity assumes individual traits and social roles that correspond to one's gender assigned at birth. Cisnormativity in workplace culture sustains the discrimination of transgender and gender nonconforming (TGNC) individuals. Research in the workplace has yet to evaluate strategies that TGNC employees use to attain personal or social goals. In the present study, the term cisnormative symbolic colonization (CSC) incorporates Habermas' theory of communicative action with symbolic interactionism to demonstrate the permeation of cisnormative dominance in workplace culture through symbolic social practices. Interviews with 15 transgender women and gender nonconforming individuals illustrated four strategies used to mitigate CSC in the workplace: bargaining, validating, symbolic‐aligning, and value‐endorsing. The findings demonstrated the dominant impact of CSC in workplace culture and revealed the employment of trans‐symbolism to integrate trans‐inclusive values in the workplace.

Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery.

Literature focused on cancer screening and management is lacking in the transgender population. To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients. We performed a systematic search of PubMed on January 5th, 2022, with the following terms: "TGNC", OR "transgender", OR "gender non-conforming", OR "gender nonbinary" AND "cancer screening", AND "breast cancer", AND "cervical cancer", AND "uterine cancer", AND "ovarian cancer", AND "prostate cancer", AND "testicular cancer", AND "surveillance", AND "follow-up", AND "management". 70 unique publications were used. The findings are discussed under "Screening" and "Management" categories. Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated. When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.

Centering Transgender And Gender Non-conforming Experience, Access, & Safety in Ecological Fieldwork.

Efforts to make ecological sciences more diverse, equitable, and inclusive require us to identify who is being left out and take action to rectify harmful situations. Recruitment of trainees from underrepresented groups alone is insufficient without ensuring a safe and supportive environment where we can flourish. Fieldwork is a critical component and often a requirement for career advancement in ecological sciences, but for transgender and gender non-conforming (TGnC) individuals, it can be disproportionately harmful. TGnC individuals face barriers and gendered violence before, during, and after fieldwork, and our experiences are often lost in current discussions of underrepresented groups in the field. In this article, I discuss the importance of an intersectional framework that focuses on planning, open communication, and trust, to address both the barriers TGnC trainees' experience with travel, accommodations, and access to medical care, along with their experiences of perceived and actual violence by colleagues and strangers. Additionally, I propose direct actions that those in power, such as Principal Investigators, field station managers, and mentors, can take to ensure a safe and welcoming fieldwork environment that supports TGnC trainees' physical, emotional, and professional well-being.

(060) Pilot Student-Led Gender Affirming Care Elective for First- and Second-Year Medical Students

Abstract Introduction In 2022, it is estimated that over 1.6 million adults and young people over 13 years old in the U.S. identify as transgender (UCLA Williams Institute). Members of the transgender and gender non-conforming (TGNC) population face unique health disparities when compared to cisgender individuals, indicating a unique need for medical care. However, there is a dearth of gender-affirming care (GAC) education in undergraduate medical curricula. To address this lack of GAC in medical education, we developed our own curriculum for GAC education utilizing a 7-week student-run elective course for MS1s and MS2s. Objective The objective of this study was to provide a pilot course presenting introductory GAC education to MS1s and MS2s. We sought to assess the efficacy of this course by measuring student engagement with course material and soliciting student feedback in survey form. Methods Classes were held via Zoom on Monday evenings for two hours. Each class structure consisted of a guest speaker and a facilitator-led activity or lecture. Our class topics included terminology, history, and current affairs; intersectionality and healthcare issues pertinent to the LGBTQIA+ population; STIs, sexual health and trauma-informed care; medical specialties and GAC; HRT and surgery; fertility, family planning and intersex care; and provider and patient panels. Students interacted with course material and each other through a variety of platforms, including D2L, PollEverywhere, and Microsoft Whiteboard. Student feedback was gathered using an anonymous Google Forms survey. Questions included short answer, multiple choice, and linear scale prompts. Results There were 32 students who participated in the elective. Upon assessment of student engagement through D2L, we found that 25% (8/32) of the class interacted with 70-100% of the learning materials provided. 90.6% (29/32) of students viewed at least one of the seven learning materials. Upon completion of the course, 34.4% (11/32) of students also completed the feedback survey. 72.7% (8/11) of students surveyed said that student participation was appropriate while 27.3% (3/11) felt that it was too sparse. 81.8% (9/11) of students surveyed felt that time spent hearing from guest speakers was appropriate, while 9.1% (1/11) felt that it was too frequent and 9.1% (1/11) felt that it was too sparse. 100% (11/11) of students surveyed felt that the amount of pre-work was appropriate. Common themes that emerged from student responses were appreciation that most speakers were part of the LGBTQIA+ community and a difference in desired class material; some students thought the class was too introductory while others felt that they learned a lot, indicating differences in student baseline knowledge prior to the course. Common areas for growth that emerged were the need for increased student participation and class discussion and more interaction with pre-work during class. Conclusions This course serves as a blueprint for other medical students who may want to provide information on GAC to their peers. We hope to employ the above areas for growth in next year’s course and have a more diverse group of speakers. In the future, this content could be adopted into the our school's standard curriculum, addressing the gap in coursework on GAC. Disclosure No

Mental Health Disparities Among Cisgender, Transgender, and Gender Nonconforming College Students in the United States

Compared to cisgender men and women, transgender and gender nonconforming (TGNC) individuals receive very littl.e attention on their experiences related to mental health. This study examines gender differences in mental health-related outcomes and their relationship to mental illness diagnoses, psychological service utilization, help-seeking attitudes, and overall health among students attending universities in the United States. A survey of 1,034 college students indicated psychological health significantly varied by gender such that mental health-related outcomes, mental illness diagnoses, and psychological service utilization were worse for TGNC individuals than for cisgender women or men. These healthcare outcomes were also reported to be worse for cisgender women than for cisgender men, except for resilience, loneliness, and overall health, for which TGNC participants reported worse outcomes, but cisgender men and women did not differ. Implications for mental health counselors and recommendations for future research are provided.