Transgender Experience Research Articles

‘Bending’ against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh

BackgroundDespite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative ‘straightening devices’ – mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage – to identify ‘invisible’ structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives.MethodsThis article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author’s doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24.ResultsRespondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity.ConclusionOur study highlighted young people’s everyday experiences of having to ‘bend’ to – and against – heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more ‘barriers’ confronted by sexual and gender diverse young people.

LGBT + academics’ and PhD students’ experiences of visibility in STEM: more than raising the rainbow flag

The experiences of lesbian, gay, bisexual, and transgender (LGBT +) individuals in Science, Technology, Engineering, and Mathematics (STEM) are still understudied and, despite some improvements, are still characterised by patterns of exclusion, disadvantage, and discrimination. In this article, we explore how visibility is perceived and navigated by LGBT + academics and PhD students in STEM, with a focus on the ways that interlocking systems of oppression impact people and groups who are marginalised and historically excluded. This article draws on a broader research project about the experiences of women and LGBT + people in STEM that was conducted between 2019 and 2020 at a UK university and is framed by intersectionality theory. Based on the thematic analysis of interviews and focus groups with 24 LGBT + participants, findings suggest that visibility is still a risk for LGBT + academics and PhD students in STEM. We found that the labour of navigating visibility was perceived as an unfair disadvantage and that the focus on individuals’ visibility in the absence of meaningful and transformative inclusion initiatives by higher education institutions was regarded as tokenistic. The article argues that addressing LGBT + visibility should firstly be an institutional responsibility and not an individual burden and that this work is essential to set the conditions for personal visibility to happen by choice, safely and without retribution.

Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families.

Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss. We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience. The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co-parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity. By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity-based perinatal health outcomes and care experiences among LGBTQ2S+ people.

‘The medical world is very good at cis people, but trans is a specialisation’. Experiences of transgender and non-binary people with accessing primary sexual and reproductive healthcare services in the Netherlands

ABSTRACT Transgender and non-binary (TNB) people are at increased risk of adverse sexual and reproductive health (SRH) outcomes compared to cisgender people. With this qualitative study, we investigated the experiences of TNB people with access to primary SRH care in the Netherlands. We conducted semi-structured, explorative interviews with fourteen TNB individuals. Data were analysed using thematic analysis. We identified three themes: ‘navigating cisgender assumptions’, ‘depending on your healthcare provider’ and ‘access requires labour’. In primary SRH care, respondents felt that healthcare providers made incorrect assumptions about their care needs which required respondents to actively disclose their gender identity or medical history. However, some respondents felt disclosure also exposed them to clinical bias, or reduced them to a medical category ‘transgender’ that their healthcare providers perceived to require specialised knowledge. In this context, respondents felt the onus was on them to ensure their SRH care needs were met. Using the concept of trans erasure, we highlight how TNB people are put at risk of adverse SRH outcomes. Creating equitable care access requires not only that providers are educated on TNB health needs and their own cisnormativity, but also an ongoing, critical reflection on the use of gender- and sex-based categories in medicine.

Reducing Adult Transgender Barriers to Care in the Emergency Department: Strategies to Improve Policies and Practices.

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse (APRN) and the emergency department (ED) registered nurse (RN) and to assist with translating research into practice. In this column, we review a recent qualitative research study by M. Allison, S. Marshall, G. Stewart, M. Joiner, C. Nash, and M. Stewart (2021) titled "Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice" with discussion of how their findings can be applied to inform providers how to deliver appropriate care of transgender patients within the ED.

Abstract 1895: “It’s completely erasure”: A Qualitative Exploration of Experiences of Transgender, Nonbinary, Gender Nonconforming, and Questioning Students in Biology Courses

Abstract 1895: “It’s completely erasure”: A Qualitative Exploration of Experiences of Transgender, Nonbinary, Gender Nonconforming, and Questioning Students in Biology Courses

RECRUITING AND ENGAGING TRANSGENDER, NON-BINARY, AND INTERSEX OLDER ADULTS IN AGING RESEARCH

Abstract Aging research often erases sex and gender variation, thus ignoring the experiences of older transgender, non-binary, and intersex (TNBI) populations. At the same time, researchers have faced unique methodological challenges with recruiting and engaging with TNBI older patient populations in sexual and gender minority (SGM) aging research. Using data from 51 semi-structured individual interviews with TNBI older Americans, I explore methodological approaches for effectively recruiting and engaging TNBI older respondents. I describe the importance of disclosing researcher positionality and understanding community discourse (e.g., intersex status as a sex identity vs. a medical condition) when recruiting and engaging with TNBI older adults. Finally, I share why some traditional recruitment approaches in SGM aging research (e.g., purposive/snowball sampling techniques) may not be as effective towards TNBI older adults while offering some alternative techniques for meaningful recruitment and engagement opportunities.

Conceptualizing transgender and gender-diverse older adults as a vulnerable population: A systematic review

BackgroundWhile extant literature clearly illustrates the negative experiences of transgender and gender-diverse (TGD) people, the intersection between TGD identity and older age in producing vulnerability is poorly understood. The Vulnerable Populations Conceptual Model (VPCM) provides a framework for identifying vulnerable communities. Understanding access to resources, relative risks, and health status experienced by TGD older adults is critical in developing person-centered interventions. MethodsA systematic review using PRISMA guidelines was used. CINAHL, Medline, PubMed, and PsycINFO were searched for studies published from 2017 to 2022. ResultsOf the seventeen articles included, no articles were based from a nursing journal. Synthesis of findings described TGD older adults as a vulnerable population with limited access to resources and several risks leading to poor health status. ConclusionIdentifying TGD older adults as a vulnerable population is critical to understand their unique needs. The findings underline implications in nursing education, practice, and research.

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study.

While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom). This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

A Space of Our Own: Exploring the Relationship Initiation Experiences of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual Dating App Users

This mixed-methods study explores dating app use within the lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) community. LGBTQIA+ dating app users ( N = 231) from across the U.S. were surveyed about their relationship initiation experiences. Thematic analysis was used to identify the benefits and challenges participants faced on dating apps and their motives for adopting (or avoiding) dating apps specifically for the LGBTQIA+ community (e.g., Grindr, Her, Butterfly). Participants described benefitting from dating apps, but also confronting significant challenges such as discrimination and the erasure of identity. Just over half (55.0%) of the sample reported using LGBTQIA+ dating apps, which functioned as safe spaces, reduced uncertainty about others’ identities, and were better adapted to community norms. Multiple logistic regression was also used to test predictions regarding user adoption. Findings have implications for understanding how people in historically thin dating markets are using mobile technology to expand their opportunities for relationship initiation.

"It's completely erasure": A Qualitative Exploration of Experiences of Transgender, Nonbinary, Gender Nonconforming, and Questioning Students in Biology Courses.

Biology is the study of the diversity of life, which includes diversity in sex, gender, and sexual, romantic, and related orientations. However, a small body of literature suggests that undergraduate biology courses focus on only a narrow representation of this diversity (binary sexes, heterosexual orientations, etc.). In this study, we interviewed students with queer genders to understand the messages about sex, gender, and orientation they encountered in biology and the impact of these messages on them. We found five overarching themes in these interviews. Students described two narratives about sex, gender, and orientation in their biology classes that made biology implicitly exclusionary. These narratives harmed students by impacting their sense of belonging, career preparation, and interest in biology content. However, students employed a range of resilience strategies to resist these harms. Finally, students described the currently unrealized potential for biology and biology courses to validate queer identities by representing the diversity in sex and orientation in biology. We provide teaching suggestions derived from student interviews for making biology more queer-inclusive.

Publicizing transgender ballet dancers: a pas de deux of inclusion and reiterative gender norms

ABSTRACT Over the last decade, mainstream media sources from the US and UK have shown an increased interest in topics involving transgender and non-binary populations. Yet, their portrayals of such individuals tend to reaffirm rather than challenge cisnormative ideas surrounding bodies and gender. In this article, we consider this ongoing trend within the highly body-centric, traditionally-gendered artform—classical ballet. With a transgender studies and dance studies lens, we analyze current discourse surrounding the recent move for classical ballet companies and schools to adapt casting and training curricula to better include non-binary dancers. Through these analyses we reveal ways media sensationalizes the transgender body by focusing on information regarding hormone therapy and surgeries, and with the topic of ballet in mind, how this transphobic move becomes intertwined with ballet-specific processes of reshaping the body. We claim that although these popular press pieces contribute to a greater awareness of the lived experiences of transgender and non-binary dancers, they simultaneously reiterate ongoing balletic gender tropes that mark the artform as feminine and designate particular body types and movements to specific binarized genders.

Safe, Seen, and Supported: Navigating Eating Disorders Recovery in the 2SLGBTQ+ Communities.

Purpose: Our purpose was to explore the experiences of self-identifying Two-Spirit, lesbian, gay, bisexual, transgender, and questioning (2SLGBTQ+) Canadians in treatments for their eating disorders (EDs). By knowing more about their experiences, we hoped to better understand how dietitians and ED service providers can better support 2SLGBTQ+ clients.Methods: Ten self-identifying 2SLGBTQ+ individuals reporting concerns regarding body image or eating patterns, as well as accessing support services or treatments, within Canada were recruited through social media platforms. Participants took part in semi-structured interviews. Data were recorded, transcribed, and analyzed using thematic analysis.Results: Four themes are presented: (i) feelings of judgement and otherness, (ii) experiencing shame in EDs and 2SLGBTQ+ identity, (iii) perceiving a lack of understanding and knowledge, and (iv) sharing lived experiences with the care team.Conclusions: Increased focus on trauma-informed approaches to ED treatment in 2SLGBTQ+ populations are indicated so that 2SLGBTQ+ clients feel comfortable to share. Increased education in 2SLGBTQ+ terminology and gender expression is recommended for dietetic professionals. We also recommend increased recruitment efforts for more diverse care teams.

"There's no real roadmap that I know of": Experiences of transgender and nonbinary graduate students in counseling psychology programs.

Minimal research has examined the experiences of transgender and nonbinary (TNB) people in graduate school with no studies to date examining the experiences of TNB students in psychology graduate programs. The purpose of this study was to utilize a critical-ideological paradigm to identify recruitment, retention, and attrition factors for TNB people in counseling psychology (CP) programs with the aim of providing specific recommendations to CP programs. Individual interviews (between 35 and 70 min) were conducted with a sample of 16 TNB graduate students, aged 23-37-years old (M = 26.9, SD = 3.84), in masters (n = 6) and doctoral (n = 10) CP programs. Participants were nonbinary (n = 13) and trans men (n = 3), the majority were White (n = 10), and all were sexual minorities. Participants were recruited online through email listservs and on social media posts on Facebook and Twitter. Reflexive thematic analysis revealed themes related to challenges experienced in CP programs (systemic/structural challenges, interpersonal challenges, individual/internal challenges) and strengths of or recommendations for CP programs (transaffirming resources/policies, supporting TNB competence and expertise, being a TNB accomplice). Several unique subthemes emerged across the seven themes. Findings may be applied by CP programs to more effectively recruit and retain TNB people, and collectively contribute to an increasing number of TNB people within this field. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for “There’s No Real Roadmap That I Know of”: Experiences of Transgender and Nonbinary Graduate Students in Counseling Psychology Programs

Supplemental Material for “There’s No Real Roadmap That I Know of”: Experiences of Transgender and Nonbinary Graduate Students in Counseling Psychology Programs

Review and evaluation of the role of a psychiatric pharmacist on medication management in a gender health program

AbstractIntroductionPeople who identify as transgender experience a significant amount of mental health concerns compared to the general population. Gender health programs offer the opportunity to provide comprehensive care for this highly stigmatized population, with the potential for psychiatric pharmacists to assist other providers and serve this need. This study aimed to evaluate the number and type of interventions made by a psychiatric pharmacist within a gender health program.MethodsA retrospective review of the electronic medical record was conducted analyzing mental health visits completed by psychiatric pharmacists within the Gender Health Program between May 1, 2020 and December 31, 2021. The primary outcome was number and type of interventions, defined as medication adjustments, laboratory monitoring, and completion of prior authorizations. Secondary outcomes included a description of medication regimens, number and type of patient education provided, and referrals to other healthcare professionals. Key subgroup analyses consisted of number of interventions based on gender identity, race identity, and insurance status.ResultsThere were a total of 152 appointments among 93 patients. Sixty‐one patients (66%) received at least one intervention [median (interquartile range, IQR) of 2 (2, 4)], which occurred across 81 pharmacist appointments (53%). Psychotropic medications were adjusted at 79 appointments (97%), with primarily medication initiations. Patient education was completed and documented at 102 appointments with a median (IQR) of 2 (1, 2) topics discussed per appointment. There was a statistically significant difference found between transmen and transwomen on number of interventions [31 (67%) vs 15 (45%), P = 0.048].ConclusionThe pharmacist in this study had the opportunity to bridge gaps in access to care to healthcare providers by initiating and managing medications, providing thorough education, and referring patients to further resources. This study affirms the accessibility and role of a psychiatric pharmacist on the interdisciplinary team caring for lesbian, gay, bisexual, transgender, queer or questioning, and more (LGBTQ+) patients.

The Transgender Experience: Cross-dressing and Sex-change in Virginia Woolf’s Orlando

Virginia Woolf’un beşinci romanı olan Orlando adlı eserindeki transgender başkahramanın potansiyel mevcudiyetiyle yaratılmış olan toplumsal cinsiyet belirsizliğinin ve değişken cinsiyetin önemi bu çalışmanın temel kapsamını oluşturmaktadır. Bu bakımdan, Virginia Woolf’un Orlanda eseri toplumsal cinsiyet kavramının nasıl tekrar biçimlendiğini ve yeniden ifade edildiğini ve hatta bir bedenin nasıl sürekli dönüşüm içinde olduğunu gösterir. Sonrasında, sürekli başkalaşım ve dönüşüm süreci içinde olan, kılıktan kılığa giren cinsiyet edimi kavramının cinsel kimliğin akışkanlığı ve çok katmanlılığı ile bir arada kullanımı romanda rastlanılan ince bir noktadır. Bu bakımdan, başkahraman Orlando hem kadın hem erkek ve aynı zamanda cinsiyetsiz biri olarak ortaya çıkmaktadır. Böylece, eserin başkahramanı Orlando kılıp değiştirip sahte tavırlarla gerçeği gizleyerek cinsel kimliğin akışkanlığını ve belirsizliğini gözler önüne sermiş olur. Bu kapsamda, bu çalışma transgender bir figürün olası varlığı ile toplumsal cinsiyet belirsizliğinin romanda nasıl oluşturulduğunu göstermiş ve bu oluşumun okuyucuların zihnindeki toplumsal cinsiyet algısı dinamiklerini sorgulamalarını ve cinsiyet ve cinsel kimlik kategorileri üzerine tekrar düşünmelerini sağlamıştır.

LGBTQ+ Young People’s Health and Well-being Experiences in Out-of-home Social Care: A scoping review

Background and objectivesThe experiences of lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) youth in foster and residential social care have largely been overlooked in research, practice and policy. This scoping review aims to identify and synthesize the existing empirical research concerning the health and well-being needs of LGBTQ+ youth in care. MethodsFollowing a six-stage approach to scoping reviews, a computerized search was conducted from a total of eight electronic databases: PubMed, Web of Science (Core Collection), Scopus, CINAHL Plus, PsychINFO, Sociological Abstracts, Social Care Online (SCIE), and OpenGrey. Search parameters comprised of three domains (LGBTQ+ status, age, and social care interventions). Data synthesis included thematic analysis, as well as critical appraisal using Critical Appraisal Skills Programme (CASP) criteria. Of the initial 1,962 sources identified, 22 studies met the search and quality criteria and were included in the final review. ResultsOverall, the evidence base is limited with most studies originating from the USA (77 % of included papers). The findings indicate that LGBTQ+ youth experience poorer physical and mental health, and also poorer well-being outcomes compared to non-LGBTQ+ youth while in foster and residential social care. Racial or ethnic minority LGBTQ+ youth, lesbian/bisexual girls, and trans and nonbinary youth face particular challenges, and social care systems appear especially ill-equipped to meet the needs of transgender and nonbinary youth. ConclusionWhile the evidence base continues to grow, there remains a need for high quality research including longitudinal and life course studies in various contexts and countries to generate robust empirical evidence in this area. The implications for practice and policy include policy shifts, mandatory and comprehensive competency-based education and training, as well ongoing coaching regarding anti-LGBTQ+ and heteronormative bias within this system.

Broadening gender self‐categorization development to include transgender identities

AbstractResearch on gender in psychology has increasingly affirmed diversity in gender, with recognition of binary and nonbinary transgender experiences. However, gender has been presumed to be cisgender (congruent with sex) and binary (either male or female) in classical developmental theories. In response, this review engages in a critical analysis of classical gender development theory informed by findings about gender from research on transgender identities. Under analysis was the concept of gender self‐categorization in classical theories of gender development including cognitive developmental theory, developmental gender schema theory, and social cognitive theory. Novel theoretical approaches are then outlined to situate recent advancements alongside classical theory. Conclusions are then drawn with brief recommendations for research methods that aim to include binary and nonbinary transgender participants. Drawing on the findings of this review it has been shown that gender self‐categorization is often implicitly presumed to be cisgender identification. To overcome this bias, it is suggested that greater attention to specific gender self‐categorization mechanisms are needed to open opportunities to include transgender experiences.

Principles of LGBTQ+ Evaluation

AbstractThe time is long overdue for the field of evaluation to critically reckon with how we have failed to appropriately consider the needs and experiences of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people. Perhaps even more importantly, there is a dire need for work that moves us forward in new directions which are more affirming and inclusive of LGBTQ+ people. To achieve this idealistic change in LGBTQ+ Evaluation will require a genuine, transformative paradigm shift within the evaluation field, encompassing everything from pedagogy to practice and all activities in between. As a first step toward a unified paradigm of LGBTQ+ Evaluation, this chapter proposes eight Principles of LGBTQ+ Evaluation to guide evaluators’ work in partnership with and in service of LGBTQ+ communities, organizations, and individuals. Here we are not seeking to provide a script or a rigid framework but rather to create guiding signposts that light the way for evaluators new to LGBTQ+ Evaluation.