Experiences Of Transgender People Research Articles

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.

Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

Degendering Menstruation: A Scoping Review Exploring the Experiences of Transgender and Non-Binary People

ABSTRACT Menstruation is a biological process experienced by up to 800 million people on any given day. Historically, menstruation has been studied from the female perspective. However, it should be considered that not all who menstruate are women. Therefore, the purpose of this research was to determine the status of evidence on transgender and non-binary individuals’ experiences with menstruation. Arksey and O’Malley’s (2005) framework for conducting a scoping study was used to guide this review. The authors used five steps of the six-step process to identify the research problem and search strategy, select studies based on defined inclusion and exclusion criteria, extract key information from five selected studies, and chart, summarize, and report the results as themes. The analysis resulted in the identification of four themes: (1) gender dysphoria and the influence on identity; (2) menstrual management and transformation as a turning point; (3) managing menstruation in precarious spaces; and (4) moving toward an open dialogue. Findings suggest a need for awareness of diverse and inclusive menstrual experiences. Inclusive advertising and menstrual products are needed to support transgender and non-binary people and reduce gender dysphoria. Policy initiatives should support the reconceptualization of infrastructure so that bathrooms are safe and comfortable places. Future opportunities for research exploring menstrual management within transgender and non-binary populations with emphasis on global research with diverse cultures and social structures is necessary to address gaps in the existing literature.

A Qualitative Study of Transgender and Nonbinary Perspectives Regarding the Desired Properties of a Peer Support Intervention for the Initiation of Gender-Affirming Hormone Therapy [ID 2683451

INTRODUCTION: Transgender and nonbinary (TNB) people experience significant mental health disparities and challenges accessing gender-affirming care. Peer support interventions have been shown to improve mental health in other populations and contexts but have not been uniquely tailored to the initiation of gender-affirming hormones. This study aims to identify the desired properties of a peer support intervention for TNB people initiating gender-affirming hormones. METHODS: We conducted semistructured interviews with TNB adults who had initiated or attempted to initiate gender-affirming hormones (IRB: HUM00203630: approved/exempt; gender-affirmation: off-label). Participants were selected by snowball and purposive sampling methods. Interview questions focused on the participants' experiences with peer support and their vision for ideal peer support while initiating hormones. Interviews were transcribed and analyzed using reflective thematic analysis with inductive and deductive coding. A TNB community advisory board collaborated in the study design and interviews were conducted by TNB research team members. RESULTS: The ages of the participants ranged from 20 to 52 years (mean=32); 8/18 identified as men or trans men; 4/18 identified as nonbinary; 3/18 identified as women or trans women; 3/18 identified as genderqueer or genderfluid; 10/18 identified as a person of color. Themes include the importance of 1) trans community knowledge in guiding hormone therapy decisions, 2) having support structures attend to intersectional identities, and 3) recognizing barriers to peer engagement, including anxieties about fitting in and internalized transphobia. CONCLUSION: Centering TNB voices is essential in designing a peer support intervention for hormone initiation. Our participants offered nuanced approaches for how to share information about hormones, attend to intersectional identities, and navigate barriers to peer engagement.

Transgender behind bars. The transgender pains of imprisonment in the light of the emerging and advancement of human rights protection for transgender prisoners within the Council of Europe context

Prison systems are traditionally binary systems, as prisoners are either placed in a male or a female prison facility. In the literature, transgender prisoners are identified as a vulnerable group, due to the heightened risk of human rights violations such as violence, abuse, sexual exploitation, stigma and discrimination. Maycock, building upon the theory on the ‘pains of imprisonment’ by Sykes, has identified specific pains of imprisonment to consider the particular deprivations or frustrations that transgender people experience within prison settings. In this article, the central question is whether the human rights framework as developed within the Council of Europe has put forward human rights norms for the placement and treatment of transgender prisoners to deal with these specific pains of imprisonment and to provide protection to transgender prisoners against additional suffering in prison. To ensure safe and humane prison conditions for the vulnerable group of transgender prisoners adequate human rights protection is of the utmost importance. Combining the criminological theory of the transgender pains of imprisonment with the human rights based approach this article makes a novel contribution to the study of transgender people in custody within the Council of Europe context. This approach will shed light on this often overlooked group of vulnerable persons in European prisons. The findings are not only based on theory, but also illuminate current practices in the Council of Europe Member States, as Maycock’s theory of the transgender pains of imprisonment is based on interviews with 13 transgender people in custody in the Scottish penal context and the country reports by the CPT provide evidence of penal policies and practices on the placement and treatment of transgender prisoners in 10 different Council of Europe Member States.

Hospitalizations and transgender patients in the United States.

It is known that transgender people experience health inequalities. Disparities in hospital outcomes impacting transgender individuals have been inadequately explored. We conducted this retrospective cohort study using the National Inpatient Sample (01/2018-12/2019) to compare in-hospital mortality and utilization variables between cisgender and transgender individuals using regression analyses. Approximately two-thirds of hospitalizations for transgender patients (n = 10,245) were for psychiatric diagnoses. Compared to cisgender patients, there were no significant differences in adjusted means differences (aMD) in length of stay (LOS) (aMD = -0.29; p = .16) or total charges (aMD = -$486; p = .56). An additional 4870 transgender patients were admitted for medical diagnoses. Transgender and cisgender individuals had similar adjusted odds ratios (aOR) for in-hospital mortality (aOR = 0.96; p = .88) and total hospital charges (aMD = -$3118; p = .21). However, transgender individuals had longer LOS (aMD = +0.46 days; confidence interval [CI]: 0.15-0.90; p = .04). When comparing mortality and resource utilization between cisgender and transgender individuals, differences were negligible.

Revisiting the Link: A qualitative analysis of the diverse experiences of gender dysphoria as a subset of pervasive social dysphoria co-occurring with autism in Japan.

Studies have suggested that autistic people are more likely to experience gender dysphoria, which refers to the gender-related distress emerging from personal factors and gender norms that some transgender people experience. Transgender people are diverse; some experience gender incongruence (i.e. an incompatibility between a person's gender identity and that expected of them based on their birth-assigned gender), whereas others do not. Therefore, the association of autistic transgender people's gender dysphoria with gender incongruence varies, and the literature has overlooked such diversity. Interviews with 15 Japanese autistic transgender adults revealed diverse gender dysphoria experiences independent of gender incongruence, such as resistance to the societal gender norms themselves, physical dysphoria caused by the imposition of gender, sensory disgust related to autistic sensory sensitivities, uncertainty about the gender norms of the social majority, and the autistic burden of living in a gendered society. Moreover, we found that most participants had not only accumulated distress over gender norms (i.e. gender dysphoria) but also over pervasive social norms, termed Pervasive Social Dysphoria. Our findings suggests that future co-occurrence research and practice must affirm these internal perspectives more, such as by providing support for both gender dysphoria and Pervasive Social Dysphoria, as autistic transgender people may experience gender dysphoria as a subset of Pervasive Social Dysphoria.

Clinically Relevant Laboratory Monitoring of Gender-Affirming Hormone Therapy in Transgender People-Experiences from a Teaching Hospital in the Netherlands.

Transgender care is shifting from academic to nonacademic settings leading to use of common (immunoassay) compared to sophisticated (mass spectrometry) methods to monitor estradiol and testosterone during gender-affirming hormone therapy (GAHT). The type of assay can influence results and have significant implications for clinical decision making. An evidence gap is present in recommendations regarding the assay needed to monitor GAHT. The present study aimed to summarize current evidence and evaluate immunoassay estradiol and testosterone concentrations in transgender people visiting a nonacademic hospital for GAHT. Clinical practice guidelines on GAHT and scientific literature on assay methodologies were screened and summarized. Laboratory and medical data from 252 patients who visited the transgender outpatient clinic of the Maasstad Hospital for GAHT between 2020 and 2022 were retrospectively analyzed. Our research showed that the most used clinical practice guidelines for GAHT provide hormonal target values without recommending a preferred method. A comprehensive literature search on agreement between immunoassay and mass spectrometry showed substantial heterogeneity in results. Retrospective analysis of our immunoassay measured data in transgender people showed hormonal changes during GAHT that are to be expected from the medication used. We demonstrate that laboratory monitoring of GAHT in a nonacademic hospital can be done safely by immunoassay in most cases. Only in cases where clinical observation is discordant with the hormonal results do more sophisticated methods need to be deployed. A best practice model was proposed for transgender care in nonacademic hospitals.

Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people.

This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault. Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.

X Marks Our Spots: Religion and Gender in Transition

Abstract: This article introduces the special section Comparative X: Religious and Gendered Transitions, linking the experiences of religious exes and transgender people through their mutual and different uses of "X" to mark liminal identity and status. Reframing religious disaffiliation through the lens of transition, the article presses on the overlap and intersection of religious and gendered movements to connect these different but related crossings as Xes. Through this crossed and comparative framework, it offers a way of looking at the norming systems of religion and gender together through the movements of those who cross them. Expanding comparative studies in religion through the interfaithless, it introduces comparative ex-religious studies as a new subfield. Drawing on the literature of religious disaffiliation and queer and transgender studies in religion, the article considers how changing the orientation through which we approach religion from its Xes might lead to a better understanding of how the normative structures of "religion" and "gender" shape one another transitively.

Mental health experiences of young gay, bisexual, transgender, two-spirit, queer, and non-binary people in Canada

There is a growing body of research on the disparities, barriers, and inequities experienced by sexual- and gender-minority communities in Canada, particularly in comparison with heterosexual cisgender counterparts. This article examines data from the community-based Canada-wide Sex Now 2018 (in person) and Sex Now 2019 (online) surveys to gauge the mental health, social and community connection, and service needs of young gay, bisexual, transgender, Two-Spirit, and queer (GBT2Q) men and non-binary people. Differences across people of colour, Indigenous, trans, and non-binary sub-populations provide insight for future interventions and targeted programs to support the mental health of GBT2Q young people across Canada.

Effect of an Education Intervention on Nursing Students' Knowledge of and Attitudes Toward Caring for Transgender and Nonbinary People.

Transgender and nonbinary (TGNB) people experience inequities in health care access, quality, and outcomes. Health care professionals' lack of knowledge and biased attitudes toward gender minorities contribute to inequitable care. This study examined the effect of TGNB health education on nursing students' knowledge and attitudes about caring for TGNB clients. A quasi-experimental study using a one-group pretest/posttest design was conducted with 46 nursing students at 2 private baccalaureate nursing programs. A paired-samples t test found a significant increase in knowledge about caring for TGNB clients at posttest (P = .02). Attitudes toward caring for TGNB clients showed a significant improvement in the Sex and Gender Beliefs subscale at posttest (P = .014). The findings suggest that TGNB health education is effective for inclusion in nursing curricula to better prepare nurses to care for gender-diverse clients.

Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19–70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

What is in a chosen name? An exploratory study on the renaming experiences of transgender people

Background: For transgender people, choosing and using a name congruent with their gender identity has been identified as a factor that improved self-esteem and well-being. This study aims to explore their renaming experiences and to identify the functions of chosen names in affirming gender identity and in expressing the need for continuity or rupture with the past. Method: The study was structured in two phases. The first phase, purely inductive, consisted in nine semi-structured interviews. A short version of the interview guide was used with sixteen other participants during the second phase of the study, which was both inductive and deductive, following a non-systematic literature review. Data was analyzed based on a constructivist grounded theory approach. Results: Two categories of functions of the chosen name were identified. The first category consisted of the functions of chosen names regarding the affirmation of gender identity, which were: the classificatory, the identificatory and the symbolic functions. The second category consisted of the functions of chosen names in expressing participants’ needs for continuity or discontinuity with the past, chosen names being experienced as metaphors of a new beginning, supports for continuity through transformation, compromises between family and cultural identifications and disidentifications. Conclusion: Exploring the renaming process and the functions of the chosen names in the clinical setting with transgender people looking for mental health support may help to identify and enhance gender affirming strategies. This may further assist in reducing aspects of gender incongruence and dysphoria through subjectivation and resilience-developing processes.

"Just Because I Don't Conform to Societal Norms": A Qualitative Study of Transgender People's Experiences of Domestic Violence and Coping Methods.

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayıs University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.

Attitudes and Beliefs Towards Transgender Individuals Among Residents of Mashhad, Iran in 2020.

A growing number of studies show that transgender people are at higher risk for psychiatric morbidities. This increased vulnerability can result from the discrimination, violence, and other forms of stigma transgender people experience. Several studies have assessed the stigma by studying the public attitudes and beliefs towards transgender people. Using the Genderism and Transphobia Scale, we evaluated how citizens of a metropolitan city in Iran think and feel about transgender people. A total number of 1202 participants, with a mean age of 41.57 years ± 13.41 (27.4% cisgender men and 72.6% cisgender women), were recruited via a random cluster sampling. Demographic data and socioeconomic status were collected for all the participants. The findings showed a notable level of transphobia. Participants identifying as men, being single, personally acquainted with a transgender individual, possessing a higher education, and having a higher socioeconomic standing displayed significantly more positive views towards transgender people. Iranian transgender people, living under a theocratic state, experience more challenges compared to those live in Western countries. Our findings demonstrate that educational level accounted for much of the variance in transgender attitudes. Therefore, representing transgender issues in social media can educate the general population and positively change attitudes and behaviors.

Transgender and non-binary people’s perception of their healthcare in relation to endometriosis

Background Endometriosis is described as a gynecological disease that can severely impact on people’s quality of life. Much of endometriosis research and literature is focused on cis women, although gender diverse people and cis men have been diagnosed with this disease. Cis women have reported problems in their healthcare for endometriosis due to delays in diagnosis and a lack of support in their treatment. Gender diverse people have reported to experience discrimination in healthcare settings. There is a lack of research on gender diverse people’s experience of living with endometriosis and little is known about their experience of healthcare for endometriosis. Aim Our aim in this article is to report on the healthcare experiences of transgender and non-binary people with endometriosis. Methods We used a phenomenological lens to explore the experiences of transgender and non-binary people with endometriosis’ perceptions of healthcare. Eleven participants were recruited through social media internationally. We recruited participants that identified as transgender and/or non-binary, had suspected/diagnosed endometriosis and were 18 years old or older. Participants took part in three online semi-structured interviews and completed a diary for three months. We used Hermeneutic Analysis to analyze the data via themes. Phenomenology of embodiment was used as a theoretical point of departure in understanding the data. Results From the analysis, the following themes were created that captured participants’ healthcare experiences: (1) Medical Gaslighting of Endometriosis and Gender Diverse Experiences, (2) Misgendering and Gendered Language, (3) Medical Discrimination, and (4) Validating Experiences with Health Care Providers (HCPs) and Recommendations by Participants. The findings revealed that medical gaslighting, misgendering and experiences of discrimination in healthcare settings had a psychological effect on participants, with reports of dysphoria, self-doubt, fear and a trauma response. Discussion Experiences of medical gaslighting, misgendering and discrimination in the healthcare of endometriosis may limit communication between HCPs and patients through limited treatment options being communicated, assumptions in healthcare and participants not feeling safe to disclose their gender identity for a disease that already from cis women’s reports has difficulties in diagnosis and treatment. This highlights additional barriers for gender diverse people to overcome in their healthcare for endometriosis. We recommend that HCPs may benefit from further awareness and training with working with gender diverse people with endometriosis.

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.

Exploring Work Absences and Return to Work During Social Transition and Following Gender-Affirming Care, a Mixed-Methods Approach: 'Bridging Support Actors Through Literacy'.

Research on return to work (RTW) following transition-related gender-affirming care (GAC) is lacking. We aim to study the RTW outcomes and experiences of transgender and gender diverse (TGD) people during social and medical transition to understand their needs better and provide tailored support. In this convergent mixed-methods study, the questionnaires of 125 employed TGD people, who took steps in transition(social and GAC), were analyzed for personal- and work characteristics, medical work absences, RTW, support at work, and health literacy. In-depth interviews were held with twenty TGD people to explore perceived facilitators and barriers to RTW. One hundred and nine participants reported an average of 38 sick days after GAC. The majority (90.2%) resumed their job at the same employer. Although TGD workers felt supported, their health literacy (55.1%) was lower compared to the general population. The qualitative data analysis revealed four major themes: (1) the need and access to information; (2) having multidisciplinary TGD allies; (3) the influence of the occupational position; (4) the precarious balance between work, life, and GAC. Especially participants with a low health literacy level experienced RTW barriers by struggling: (1) to find and/or apply information; (2) to navigate (occupational) health and insurance services. Our research has shown that RTW for TGD individuals is a multifaceted process, affected by personal factors, work-related elements, and the characteristics of the healthcare and social insurance system. Enhancing support for TGD people at work and their RTW requires a high need for centralized information and promoting health literacy while engaging relevant stakeholders, such as prevention services and employers.

SAT393 Resilience And Resistance In The Face Of Stigma And Trauma: A Qualitative Study Of Transgender People’s Reactions To Interactions With The Healthcare System

Abstract Disclosure: D. Stroumsa: None. M. Maksutova: None. G. Indig: None. J.Y. Ballard: None. R. Trammell: None. E.E. Popoff: None. J.P. Wu: None. K. Gamarel: None. IntroductionFor many transgender people, interactions with healthcare, including for initiating gender affirming hormones, can be stigmatizing and traumatic. This study sought to explore how trans people navigate interactions with the healthcare system when accessing gender-affirming hormones. MethodsWe conducted semi-structured interviews with trans adults ages 21 to 54 (mean=31.7) who had initiated gender-affirming hormone therapy (n=21) using purposive and snowball sampling methods. Interviews were transcribed verbatim and de-identified. Interviews were analyzed using a reflective thematic analysis approach in which codes were deductive and inductive in nature. The study was designed in collaboration with a community advisory board. ResultsParticipants included 9 (42.9%) who identified as men or trans men, 9 (42.9)% who identified as women trans women, and 3 (14.3%) who identified as nonbinary; 8 (38%) identified as a person of color, and 8 (38.1%) participants resided in an urban area. Four overarching themes were identified: (1) multi-level minority stress barriers to care; (2) resilience and resistance in response to minority stress; (3) the cost of stigma and discrimination; and (4) recommendations for change. Multilevel minority stressors included internalized, anticipated, and enacted/interpersonal stigma, as well as vicarious trauma in healthcare systems when initiating gender-affirming hormones. In response to stigmatizing and traumatic experiences, participants engaged in a number of resilience and resistance strategies including selective-disclosure, self-advocacy, relying on community support, as well as innovative “workarounds” to overcome the bureaucratic and traumatic hurdles to accessing gender-affirming hormones. These strategies were however not unassailable, and the stigma and discrimination did have negative consequences. Participants described areas for change, which included provider training and addressing the political environment. ConclusionTransgender people encounter stigma when accessing gender-affirming hormones; however, they also engage in a range of resilience strategies. Ensuring access to gender-affirming care necessitates addressing stigma in healthcare systems. Structural interventions addressing root causes of stigma and trauma transgender people experience are needed to complement provider-level interventions. Presentation: Saturday, June 17, 2023

Transgender People's Experiences Sharing Information With Clinicians: A Focus Group-Based Qualitative Study.

Investigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians. This was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing. Four themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems. Transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.