Transgender Clients Research Articles

Transgender-Specific Differentiated HIV Service Delivery Models in the South African Public Primary Health Care System (Jabula Uzibone): Protocol for an Implementation Study.

Almost 60% of transgender people in South Africa are living with HIV. Ending the HIV epidemic will require that transgender people successfully access HIV prevention and treatment. However, transgender people often avoid health services due to facility-based stigma and lack of availability of gender-affirming care. Transgender-specific differentiated service delivery (TG-DSD) may improve engagement and facilitate progress toward HIV elimination. Wits RHI, a renowned South African research institute, established 4 TG-DSD demonstration sites in 2019, with funding from the US Agency for International Development. These sites offer unique opportunities to evaluate the implementation of TG-DSD and test their effectiveness. The Jabula Uzibone study seeks to assess the implementation, effectiveness, and cost of TG-DSD for viral suppression and prevention-effective adherence. The Jabula Uzibone study collects baseline and 12-month observation checklists at 8 sites and 6 (12.5%) key informant interviews per site at 4 TG-DSD and 4 standard sites (n=48). We seek to enroll ≥600 transgender clients, 50% at TG-DSD and 50% at standard sites: 67% clients with HIV and 33% clients without HIV per site type. Participants complete interviewer-administered surveys quarterly, and blood is drawn at baseline and 12 months for HIV RNA levels among participants with HIV and tenofovir levels among participants on pre-exposure prophylaxis. A subset of 30 participants per site type will complete in-depth interviews at baseline and 12 months: 15 participants will be living with HIV and 15 participants will be HIV negative. Qualitative analyses will explore aspects of implementation; regression models will compare viral suppression and prevention-effective adherence by site type. Structural equation modeling will test for mediation by stigma and gender affirmation. Microcosting approaches will estimate the cost per service user served and per service user successfully treated at TG-DSD sites relative to standard sites, as well as the budget needed for a broader implementation of TG-DSD. Funded by the US National Institutes of Mental Health in April 2022, the study was approved by the Human Research Ethics Committee at University of Witwatersrand in June 2022 and the Duke University Health System Institutional Review Board in June 2023. Enrollment began in January 2024. As of July 31, 2024, a total of 593 transgender participants have been enrolled: 348 are living with HIV and 245 are HIV negative. We anticipate baseline enrollment will be complete by August 31, 2024, and the final study visit will take place no later than August 2025. Jabula Uzibone will provide data to inform HIV policies and practices in South Africa and generate the first evidence for implementation of TG-DSD in sub-Saharan Africa. Study findings may inform the use of TG-DSD strategies to increase care engagement and advance global progress toward HIV elimination goals. DERR1-10.2196/64373.

Barriers to Healthcare for Transgender Individuals.

Background: Transgender (TG) clients experience provider bias, erasure, refusal to treat, and violence. Objective: The purpose of this article is to identify barriers to healthcare for TG individuals and discuss recommendations for providers treating this population. Methods: Literature review of prime research was conducted using the Whittemore and Knafl methodology (2005). Results: Evidence suggests that barriers to TG healthcare include lack of provider TG knowledge and trans sensitivity, lack of provider communication, and lack of emotional and physical safe healthcare environments. Conclusions: TG clients face barriers to accessing healthcare, and specific recommendations to improve provider practice will decrease these barriers. Implications for Practice: Lack of provider education affects TG individuals accessing quality healthcare. Recommendations to improve provider practice are essential to improve care.

(224) EVALUATION OF ONLINE ADAPTATION OF EDUCATION PROGRAM ON TRANS-INCLUSIVE HEALTHCARE AND GENDER AFFIRMATION FOR MEDICAL PROFESSIONALS IN BOSNIA AND HERZEGOVINA VIA REGIONAL EXPERTS' COOPERATION

Abstract Objectives Sarajevo Open Centre- SOC and a number of medical/mental health experts from Bosnia and Herzegovina, Croatia, and Serbia created an online, video lecture for E-medikacija, BiH online platform for additional education and professional development of MDs (medical doctors). The topic of the education session is Medical Aspects of Trans-Inclusive Health Care/Gender Affirmation. The education is a result of the cooperation between the Federation BiH Medical Chamber, Sarajevo Open Centre (SOC), and medical experts from the region who have extensive expertise working with transgender, intersex, and gender-diverse persons. The need for the education of MDs and mental health professionals in BIH is observed every day when trans persons seek inclusive and specific health care in BiH health institutions/medical facilities, and since BiH does not have educated medical personnel to lead and monitor the process of gender affirmation process, such as MD's, psychologists, endocrinologists, gynecologists, urologists, pediatricians, plastic and reconstructive surgeons, this educations program was essential. Methods The education program for medical workers was adapted to an online version to include a wide range of medical workers and to bridge obstacles of on-site education such as distance, costs, and avoiding attendance because of stigma. Participants fulfilled the online evaluation form and knowledge test. The completed and verified allowed them to get credits to extend their seven-year medical license. Results Out of 2854 registered users, 667 medical professionals visited the webpage where the education was uploaded. 173 users attended the online education in comparison to 7 when it was held onsite. 167 users successfully passed the knowledge test. Conclusions 86% of attendants are very satisfied with the online education program and consider it to improve their knowledge and professional competencies in working with transgender clients. They express their willingness to further participate in educational and collaborative activities with SOC. Conflicts of Interest No.

Pride and body image among transgender and nonbinary adults: the mediating role of body appreciation between gender identity pride and intuitive eating

ABSTRACT Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (M age = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.

Development and validation of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS).

Developing affirming interventions for transgender and nonbinary (TNB) therapy clients requires understanding their experiences with microaggressions in psychotherapy, yet no self-report measure of anti-TNB microaggressions in this context exists. Moreover, few studies have tested the associations between anti-TNB microaggressions and therapy processes. To better address the burden of unmet mental health care needs among TNB people, this three-study investigation designed and tested the psychometric properties of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS), a measure of TNB individuals' encounters with microaggressions in psychotherapy. Study 1 (N = 225) identified a four-factor model, comprising the themes of Educational Burdening, Lack of Affirmation, Inflation, and Invalidation. These subscales exhibited strong internal consistency reliabilities and demonstrated convergent and discriminant validity. The results of Study 2 (N = 435) replicated the four-factor structure through confirmatory factor analysis. However, bifactor analysis revealed that the Educational Burdening, Inflation, and Invalidation subscale scores were mostly accounted by a General Anti-TNB Microaggressions scale score-though Lack of Affirmation showed evidence of its independence. Also in Study 2, both scales were uniquely negatively associated with the working alliance. Study 3 (N = 151) found evidence for the test-retest reliability of GIEMTS scores over a 2-3-week period. Overall, the GIEMTS emerged as a robust and psychometrically sound instrument that captures the experiences of TNB individuals in therapy settings. The study concludes with valuable recommendations for training and clinical practice to bolster TNB mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Microaggression Detection in Psychotherapy: Expanding Affirming Care for Transgender and Nonbinary Clients

Transgender and nonbinary (TGNB) people report experiencing discrimination from therapists. A step to reducing these microaggressions is for therapists to be able to identify them. Psychological trainees and psychologists ( n = 105) were randomly assigned to watch a video vignette therapy session: a session with (a) blatant therapist microaggressions (nonaffirming), (b) therapist-led transition focus (transition affirming), and (c) gender exploration focus (nonbinary affirming). There was no difference in microaggression detection between the two affirming conditions. The microaggression condition of participants had a negative effect on ratings of therapist multicultural orientation (MCO). Additionally, attitudes towards transgender people moderated the relationship between microaggression conditions and ratings of therapist’s cultural humility for the affirming conditions; participants in the nonbinary affirming condition rated the therapist more culturally humble as their positive attitudes towards TGNB people increased, and participants rated the therapist as less culturally humble as TGNB attitudes increased in the transition affirming condition.

Long-term Acoustic Effects of Gender-Affirming Voice Training in Transgender Women

ObjectivesOne role of a speech-language pathologist (SLP) is to help transgender clients in developing a healthy, gender-congruent communication. Transgender women frequently approach SLPs to train their voices to sound more feminine, however, long-term acoustic effects of the training needs to be rigorously examined in effectiveness studies. The aim of this study was to investigate the long-term effects (follow-up 1: 3 months and follow-up 2: 1 year after last session) of gender-affirming voice training for transgender women, in terms of acoustic parameters. Study designThis study was a randomized sham-controlled trial with a cross-over design. Methods26 transgender women were included for follow-up 1 and 18 for follow-up 2. All participants received 14 weeks of gender-affirming voice training (4 weeks sham training, 10 weeks of voice feminization training: 5 weeks pitch elevation training (PET) and 5 weeks articulation-resonance training (ART)), but in a different order. Speech samples were recorded with Praat at 4 different time points (pre, post, follow-up 1, follow-up 2). Acoustic analysis included fo of sustained vowel /a:/, reading and spontaneous speech. Formant frequencies (F1-F2-F3) of vowels /a/, /i/ and /u/ were determined and vowel space was calculated. A linear mixed model was used to compare the acoustic voice measurements between measurements (pre – post, pre – follow-up 1, pre – follow-up 2, post – follow-up 1, post – follow-up 2, follow-up 1 – follow-up 2). ResultsMost of the fo measurements and formant frequencies that increased immediately after the intervention, were stable at both follow-up measurements. The median fo during the sustained vowel, reading and spontaneous speech stayed increased at both follow-ups compared to the pre measurement. However, a decrease of 16 Hz/1.7 ST (reading) and 12 Hz/1.5 ST (spontaneous speech) was detected between the post measurement (169 Hz for reading, 144 Hz for spontaneous speech) and one year after the last session (153 Hz and 132 Hz respectively). The lower limit of fo did not change during reading and spontaneous speech, both directly after the intervention and during both follow-ups. F1-2 of vowel /a/ and the vowel space increased after the intervention and both follow-ups. Individual analyses showed that more aspects should be controlled after the intervention, such as exercises that were performed at home, or the duration of extra gender-affirming voice training sessions. ConclusionsAfter ten sessions of voice feminization training and follow-up measurements after three months and one year, stable increases were found for some formant frequencies and fo measurements, but not all of them. More time should be spent on increasing the fifth percentile of fo, as the lower limit of fo also contributes to the perception of more feminine voice.

"Extremely toxic and evil" reflections on gender identity change efforts by Christian religious leaders: Implications for therapy with transgender and nonbinary clients.

Given the religious groundings that support the practice of gender identity change efforts (GICE), we sought to explore the beliefs of Christian religious leaders about this practice and their understanding of marginalized gender identities. Nineteen religious leaders mainly from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed two themes related to participants' beliefs about transgender and nonbinary identities: (1) Transgender and nonbinary identities are normative and authenticand (2) God created gender diversity. The analyses also highlighted two themes reflecting the pastors' beliefs about GICE: (1) GICE is harmfuland (2) Therapy should affirm transgender and nonbinary identities. Finally, the thematic analysis exploring participants' messages for couple and family therapists could be organized into two themes: (1) Christian religious beliefs do not justify the use of GICE and (2) Therapists should be helpful and not harmful. Implications for couple and family therapists are also discussed.

Prioritizing LGBTQ Clients’ Mental Health: How Christian Therapists Resolve Internal Conflicts to Remain Ethical

This study investigated how Christian therapists are able to resolve any internal conflicts that arise when working with lesbian, gay, bisexual, transgender, and queer (LGBTQ) clients. The study focused on the participants’ internal processes when working with LGBTQ clients, highlighting individual experiences and themes. The study revealed that the more open-minded and self-aware participants were, the more likely they were to have intentional practices to resolve internal conflicts. It also revealed that education, particularly at seminaries, is not adequately preparing therapists to resolve internal conflicts or work with gender and sexual minorities. Ultimately, this research study underscored the importance of therapists being aware of their own beliefs and the impact they may have, as well as being educated on LGBTQ issues, microaggressions, and how to work with gender and sexual minority clients without discrimination and judgment.

Clinical practice with transgender and gender diverse clients: Setting up an inclusive practice and training considerations.

Clinical practice with transgender and gender diverse clients: Setting up an inclusive practice and training considerations.

1848. Barriers and Facilitators to HIV Care in the Transgender Population

Abstract Background Transgender-inclusive healthcare focused on HIV prevention and treatment is a critical component to ending the HIV epidemic. Understanding the needs of this population is essential. Methods Between March – May 2022, surveys were distributed by Arianna’s Center to the transgender community to assess barriers and facilitators related to HIV care services. These results informed a national webinar for healthcare providers (HCPs), who were surveyed before and after the webinar. Results There were 254 individuals who completed the survey (50% transgender female; 20% transgender male; 58% LatinX; 30% African American; 31% living with HIV). The biggest barriers to accessing or staying engaged in HIV prevention/care services were socioeconomic (24%), discrimination/racism/transphobia (15%), and mental health challenges (13%). Over half (52%) felt there were barriers to initiating conversations about sexual health and HIV and 27% reported being denied healthcare services because of their gender and/or sexual orientation. For those taking medication for HIV prevention or treatment (59%, n = 150/254), the biggest adherence facilitator was having a supportive provider knowledgeable about transgender health (56%, n = 84/150). However, there was a disconnect between those who felt highly involved in decisions regarding their sexual/HIV health and those who wanted to be highly involved (Fig. 1). Among those who felt uninvolved in these care decisions (54%, n = 137/254), 39% (n = 53/137) felt too overwhelmed with other things in their lives and 24% (n = 33/137) felt they tried to be involved but their care team did not listen. Most HCPs (55%, N = 98/178) attending the webinar had little to no experience caring for transgender individuals. Only 12% (n = 21/178) of HCPs felt they included their transgender clients extremely well in their HIV care (Fig. 1). Notably, there was improvement in HCPs’ knowledge (p < .001) and confidence in counseling (p < .001) about drug interactions between antiretrovirals and gender-affirming hormone therapy. Conclusion Insights from the transgender community indicate potential areas for improvement in HIV care, and can be leveraged to support HCP education to improve engagement with transgender individuals and promote shared decision-making. Disclosures Dora Martinez, MD, FAAFP, AAHIVS, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria|ViiV Healthcare: As of May 16th will be employed by ViiV, however was not a ViiV employee at time of project Arianna Inurritegui-Lint, -, Gilead Sciences, Inc.: Advisor/Consultant|Human Rights Campaign Foundation: Advisor/Consultant|National Minority AIDS Council: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant

Reframing transgender communication in gender-affirming communication care: Comfort and confidence are the main goals

Purpose To understand the communicative participation experiences of transgender people through a qualitative inquiry, and to address similarities and differences in experiences across genders. Method This study was a secondary analysis of interview data gathered for modifying the Communicative Participation Item Bank for use with transgender populations. Fourteen transgender participants attended individual qualitative interviews. During the interview, participants shared their communication experiences in various situations and the availability of social supports related to communication. Qualitative content analysis was used to develop themes and subthemes from the data. Result Three themes emerged from the data: the participants’ priorities for comfort, safety, and authenticity; the use of an internal “checklist” to optimise their communication; and changes in attitudes towards communication over time. Across themes, participants shared core communication experiences regardless of gender identities. Conclusion The findings support prior research on voice-related communication experiences of transgender people. A key finding is the notion that communication success is influenced by sociocultural contexts and the physical environment beyond their communication presentation. To achieve targeted comfort and satisfaction in communication, healthcare professionals need to consider the transgender client’s communication contexts, and incorporate a life-participation approach to gender-affirming voice and communication training.

A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA.

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.

A preliminary study of intensive transgender-specific cultural competency training: Implications for social workers and psychologists who work with rural transgender clients

Rural transgender individuals face heightened disparities relative to other transgender individuals. However, social workers and psychologists receive minimal training in transgender client care. The current study used one-way repeated measures ANOVAs to investigate the effectiveness of transgender-specific cultural competency training for social workers and psychologists working with rural clients to improve knowledge, awareness, and self-efficacy (i.e., competency) concerning transgender clients’ needs. Results indicated significant differences in the change of competency among participants assigned to a transgender-specific group compared to those assigned to a general multicultural group. Thematic analysis of participants’ responses to course evaluations also supported the course effectiveness.

LGBTQ+ cultural competency of Irish mental health professional students

Introduction The LGBTQ+ community is often discriminated against and stigmatized resulting in greater psychological and emotional stress compared to heterosexual and cisgender people. Consequently, poorer mental health is often observed in this community. To alleviate these disparities, mental health professionals need to be culturally competent. Therefore, LGBTQ+ cultural competency was explored in a sample of Irish mental health professional students. Methods A questionnaire was circulated among Irish students in mental health programmes. Out of approximately 700 students, 66 competed the survey, of which 23 identified as LGBTQ+. Results In terms of cultural competency, participants reported significantly higher attitudinal awareness compared to basic knowledge and clinical preparedness. Further, cultural competency was lower for transgender clients. LGBTQ+ patient education significantly predicted cultural competency when controlling for demographic variables. Three themes were generated from the open answers: experiences of cultural competency training, affirmative but uninformed, and recommendations for implementing training. Conclusion To provide adequate, affirmative care, cultural competency training should be a mandatory component of all mental health professional programmes.

Let me be me: Investigating transgender clients' experiences of their therapeutic relationship with their counsellor

AbstractBackgroundMany transgender individuals experience stigmatisation, victimisation and discrimination and, as a result, have become reliant on counselling services. Previous research indicates that transgender clients have experienced a mixture of negative and positive experiences of counselling and their therapeutic relationships. However, there is limited research that specifically explores the components of therapeutic relationships and transgender clients' experiences of them.AimThis study aimed to investigate how transgender clients experience their therapeutic relationship with their counsellor.MethodThis study used semistructured interviews and interpretative phenomenological analysis (IPA). Three adult participants who identified as transgender and had at least three counselling sessions in the past were recruited.FindingsKey findings indicated positive impacts of the counsellors' congruence, the importance of counsellors having basic knowledge and awareness of the challenges that transgender people may face and how the clients' development of self‐awareness aided their evaluations and re‐evaluations of their experiences of their therapeutic relationships.LimitationsDue to the small sample size, the findings cannot be generalised to the wider transgender population.Implications for PolicyFurther research is needed to support the development of affirmative counselling for transgender clients.Implications for PracticeCounsellors are encouraged to work to respond to the needs of their clients at whatever stage in their process, to acquire basic knowledge and awareness of the challenges that some transgender people may face and to engage with their personal development and reflexivity around gender and identity.ConclusionTransgender clients reported both positive and negative experiences of their therapeutic relationships with reference to their own and their counsellors' contributions. Positive experiences were largely associated with the counsellors' use of congruence and working affirmatively, and negative experiences were largely associated with counsellors working nonaffirmatively.

Transgender and gender diverse clients’ experiences in therapy: Responses to sociopolitical events and helpful and unhelpful experiences.

Transgender and gender diverse clients’ experiences in therapy: Responses to sociopolitical events and helpful and unhelpful experiences.

Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis.

To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.

GenderJourney: Participatory development of an ethics support tool to foster dialogue and reflection on shared decision-making in gender-affirming medical care

ObjectiveTo describe and reflect on the development process of GenderJourney: an ethics support tool that seeks to foster (dialogue and reflection on) shared decision-making (SDM) in gender-affirming medical care (GAMC). MethodsPart of a larger project, this study used a participatory design. We included transgender and gender diverse (TGD) clients and healthcare professionals (HCPs) throughout the study in co-creation workshops. In an iterative process, we (1) established stakeholders’ needs, (2) reached a consensus on the aims, content, and design, (3) developed and tested successive renditions, and (4) presented the final version of the tool. ResultsThe final tool aims to (A) elucidate the client’s care request and corresponding treatment preferences, (B) foster an explicit dialogue between TGD client and HCP about expected/preferred decisional roles and collaboration, (C) stimulate a systematic joint reflection on and handling of SDM-related ethical challenges. ConclusionThe GenderJourney provides non-directive ethics support to jointly reflect on and foster good SDM, including its inherent ethical challenges. Future studies should focus on its implementation and actual contribution to good SDM. Practice implicationsGenderJourney may be used in GAMC to support the dialogue on what good SDM entails and the identification, discussion, and handling of SDM-related ethical challenges.

Models of Gender Dysphoria Using Social Media Data for Use in Technology-Delivered Interventions: Machine Learning and Natural Language Processing Validation Study.

The optimal treatment for gender dysphoria is medical intervention, but many transgender and nonbinary people face significant treatment barriers when seeking help for gender dysphoria. When untreated, gender dysphoria is associated with depression, anxiety, suicidality, and substance misuse. Technology-delivered interventions for transgender and nonbinary people can be used discretely, safely, and flexibly, thereby reducing treatment barriers and increasing access to psychological interventions to manage distress that accompanies gender dysphoria. Technology-delivered interventions are beginning to incorporate machine learning (ML) and natural language processing (NLP) to automate intervention components and tailor intervention content. A critical step in using ML and NLP in technology-delivered interventions is demonstrating how accurately these methods model clinical constructs. This study aimed to determine the preliminary effectiveness of modeling gender dysphoria with ML and NLP, using transgender and nonbinary people's social media data. Overall, 6 ML models and 949 NLP-generated independent variables were used to model gender dysphoria from the text data of 1573 Reddit (Reddit Inc) posts created on transgender- and nonbinary-specific web-based forums. After developing a codebook grounded in clinical science, a research team of clinicians and students experienced in working with transgender and nonbinary clients used qualitative content analysis to determine whether gender dysphoria was present in each Reddit post (ie, the dependent variable). NLP (eg, n-grams, Linguistic Inquiry and Word Count, word embedding, sentiment, and transfer learning) was used to transform the linguistic content of each post into predictors for ML algorithms. A k-fold cross-validation was performed. Hyperparameters were tuned with random search. Feature selection was performed to demonstrate the relative importance of each NLP-generated independent variable in predicting gender dysphoria. Misclassified posts were analyzed to improve future modeling of gender dysphoria. Results indicated that a supervised ML algorithm (ie, optimized extreme gradient boosting [XGBoost]) modeled gender dysphoria with a high degree of accuracy (0.84), precision (0.83), and speed (1.23 seconds). Of the NLP-generated independent variables, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) clinical keywords (eg, dysphoria and disorder) were most predictive of gender dysphoria. Misclassifications of gender dysphoria were common in posts that expressed uncertainty, featured a stressful experience unrelated to gender dysphoria, were incorrectly coded, expressed insufficient linguistic markers of gender dysphoria, described past experiences of gender dysphoria, showed evidence of identity exploration, expressed aspects of human sexuality unrelated to gender dysphoria, described socially based gender dysphoria, expressed strong affective or cognitive reactions unrelated to gender dysphoria, or discussed body image. Findings suggest that ML- and NLP-based models of gender dysphoria have significant potential to be integrated into technology-delivered interventions. The results contribute to the growing evidence on the importance of incorporating ML and NLP designs in clinical science, especially when studying marginalized populations.