ArticlePDF Available

Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals


Abstract and Figures

Purpose: Transgender and gender-nonconforming (TGNC) individuals often are the target of enacted or external (i.e., distal) experiences of stigma, discrimination, and violence, which are linked to adverse health, particularly psychological distress. There is limited research, however, examining felt or internal (i.e., proximal) stressors faced by TGNC individuals. This study sought to examine one type of internal stressor, expecting rejection, and aimed to (1) identify how and to what extent rejection expectations operate day-to-day for TGNC individuals and (2) explore how TGNC individuals respond to expectations of rejection. Methods: In-depth interviews were conducted with 30 participants from 2014 to 2015 who identified as TGNC (mean age=30.4; 60% people of color); data were analyzed using a consensual qualitative research method. Results: Four thematic categories emerged about expecting rejection: (1) where to expect rejection; (2) thoughts and feelings associated with expectations of rejection; (3) coping strategies used to manage the expectation of rejection; and (4) the intersection of race and ethnicity with rejection expectations. Conclusion: Findings from this study suggest that expecting rejection is a frequent and salient internal stressor for TGNC individuals. We discuss the psychological and cumulative potential health impact of minority stress, and the applicability of Meyer's Minority Stress Model. Therapeutic interventions are needed to address the specific cognitive, emotional, and behavioral responses TGNC individuals experience as a result of the stress associated with expecting rejection, including fear, anxiety, and situational avoidance.
Content may be subject to copyright.
Expecting Rejection:
Understanding the Minority Stress Experiences
of Transgender and Gender-Nonconforming Individuals
Brian A. Rood,
*Sari L. Reisner,
Francisco I. Surace,
Jae A. Puckett,
Meredith R. Maroney,
and David W. Pantalone
Purpose: Transgender and gender-nonconforming (TGNC) individuals often are the target of enacted or exter-
nal (i.e., distal) experiences of stigma, discrimination, and violence, which are linked to adverse health, particularly
psychological distress. There is limited research, however, examining felt or internal (i.e., proximal) stressors faced
by TGNC individuals. This study sought to examine one type of internal stressor, expecting rejection, and aimed to
(1) identify how and to what extent rejection expectations operate day-to-day for TGNC individuals and (2) ex-
plore how TGNC individuals respond to expectations of rejection.
Methods: In-depth interviews were conducted with 30 participants from 2014 to 2015 who identified as TGNC
(mean age =30.4; 60% people of color); data were analyzed using a consensual qualitative research method.
Results: Four thematic categories emerged about expecting rejection: (1) where to expect rejection; (2)
thoughts and feelings associated with expectations of rejection; (3) coping strategies used to manage the expec-
tation of rejection; and (4) the intersection of race and ethnicity with rejection expectations.
Conclusion: Findings from this study suggest that expecting rejection is a frequent and salient internal stressor
for TGNC individuals. We discuss the psychological and cumulative potential health impact of minority stress, and
the applicability of Meyer’s Minority Stress Model. Therapeutic interventions are needed to address the specific
cognitive, emotional, and behavioral responses TGNC individuals experience as a result of the stress associated
with expecting rejection, including fear, anxiety, and situational avoidance.
Keywords: expecting rejection; gender; minority stress; stigma; transgender
Transgender and gender nonconforming (TGNC) indi-
viduals have a current gender identity or expression that
differs from their assigned sex at birth. Although re-
search investigations that focus specifically on the health
and well-being of TGNC individuals remain limited,
peer-reviewed published articles have documented the
pervasiveness with which TGNC people face enacted ex-
periences of stigma, discrimination, and victimization.
Prevalence estimates of discrimination among TGNC
individuals are shown to be extraordinarily high, ex-
ceeding 60% in several published studies.
estimates for victimization are commonly greater
than 40% for TGNC people.
Emerging research
also has highlighted an association between enacted
stressors and indicators of negative mental and physi-
cal health. For example, TGNC individuals who
reported having experienced physical or sexual abuse,
Department of Psychology, Augsburg College, Minneapolis, Minnesota.
Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts.
The Fenway Institute, Fenway Health, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Psychology, University of Massachusetts, Boston, Massachusetts.
Department of Psychology, University of South Dakota, Vermillion, South Dakota.
Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts.
*Address correspondence to: Brian Rood, PhD, MPH, Department of Psychology, Augsburg College, 2211 Riverside Avenue, Minneapolis, MN 55454, E-mail:
ªBrian A. Rood et al. 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License
(, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work
is properly credited.
Transgender Health
Volume 1.1, 2016
DOI: 10.1089/trgh.2016.0012
compared to those who did not, are significantly more
likely to report a history of suicidal ideation and suicide
Likewise, experiences of gender-related dis-
crimination are shown to be significantly associated with
elevated levels of psychological distress for TGNC indi-
Thus, enacted stressors appear to be detrimen-
tal to the health of TGNC individuals and continued
and ongoing research, particularly longitudinal studies
examining the relationship of such stressors to health
over time, is needed.
Enacted stressors, however, represent only the external
processes and experiences faced by TGNC individuals.
TGNC individuals likely experience internal stressors
and processes in response to these and other external
stressors. Consistent with the theory and empirical
research underlying Meyer’s Minority Stress Model,
internal or proximal stressors are considered more sub-
jective and related to self-identity.
According to
the model, the three specific proximal stressors recog-
nized are as follows: (1) identity concealment, (2) inter-
nalized stigma, and (3) expectations of rejection.
Expecting rejection—the focus of the present
article—is described in the literature as a form of felt
stigma, which is understood as an individual’s knowl-
edge of society’s stance toward nonmajority individu-
als, and expectations regarding the likelihood of
stigma being enacted in a given situation as a result
of having a minority status, for example, for sexual
and gender minority individuals.
Notably, research
has demonstrated that having a dual minority status
(e.g., being a person of color who is also a sexual minor-
ity) can further complicate and heighten experiences of
enacted stigma, which has implications for expecting
rejection, especially among individuals who represent
more than one marginalized identity.
There is a moderate amount of published data to
show how expecting rejection operates in the lives of
cisgender (i.e., nontransgender or someone whose gen-
der identity matches what is typically associated with
someone of their sex assigned at birth) sexual minority
Yet, published research that demon-
strates how expecting rejection is experienced by
TGNC individuals remains scarce.
Based on a review of the extant literature, only a few
published studies have empirically investigated how
expecting rejection might operate in the lives of TGNC
individuals. Bockting et al. surveyed 1,093 transgender in-
dividuals and found that the expectation of rejection (i.e.,
felt stigma) was positively associated with psychological
distress, and negatively associated with levels of outness.
Gamarel et al. examined relationship stigma—real or
anticipated feelings of negative judgment from others
as a result of one’s romantic relationship being socially
devalued—among couples comprising cisgender men
and transgender women.
They found that higher levels
of reported relationship stigma were associated with in-
creased odds (adjusted odds ratio =1.13) of reporting
clinically significant depressive distress.
Thus, there is support for the notion that TGNC in-
dividuals might expect rejection specific to their gender
identity, and preliminary data appear to support an as-
sociation between expecting rejection and psychologi-
cal distress.
However, the internal experience of
expecting rejection is not well understood. Specifically,
we do not know how TGNC individuals perceive and
assign meaning to this expectation and how they re-
spond emotionally. Examining the internal process
through which TGNC individuals might expect rejec-
tion would offer a more informed perspective regard-
ing the noted association between experiences of
stigma and adverse mental health, including implica-
tions for future points of therapeutic intervention.
Two recently published studies have also investigated
variations of expecting rejection among TGNC individu-
als. In one study, investigators examined specific situa-
tions or environments that TGNC individuals might
avoid, based on the fear of being outed against their
wishes. With a sample of 889 TGNC individuals, 38.8%
reported avoiding public restrooms, 38.4% reported
avoiding gyms, 29.8% reported avoiding clothing shops,
and 24.0% reported avoiding public transportation.
Although these findings are helpful in identifying situa-
tions where TGNC individuals may expect rejection,
they do not describe why or how the expectation
might manifest, or how TGNC individuals may respond
to the perceived threat. Increasing knowledge in this
area would aid researchers in identifying how to target
and effectively address areas perceived as unsafe (e.g.,
through stigma reduction interventions).
In the second study, investigators examined the as-
sociation between employment status, coping strate-
gies, and internalized transphobia and transgender
stigma among 55 TGNC individuals.
The sample
consisted of 24 transgender women (male-to-female),
20 transgender men (female-to-male), seven genderqu-
eer or gender fluid individuals (who do not situate
themselves within the gender binary), and four individ-
uals who were either undecided or did not indicate
their gender. The study demonstrated that higher levels
of effective coping strategies (e.g., coping with work-
Rood, et al.; Transgender Health 2016, 1.1
and mental health-related stigma) were associated with
lower levels of internal and external stigma. This study
provides preliminary information about the role of
coping in managing proximal stressors, particularly
as a moderating variable, which is an important consid-
eration because coping strategies related to proximal
stressors for TGNC individuals are relatively unex-
plored and are a key component of Meyer’s model
that warrants further investigation.
Given the relative lack of investigations specific to
the proximal stress experiences of TGNC individuals,
and expecting rejection in particular, this study sought
to comprehensively understand these experiences for
TGNC individuals through in-depth interviews. Specif-
ically, this study aimed to (1) identify how, and to what
extent, expecting rejection operates day-to-day for
TGNC individuals and (2) explore how TGNC individ-
uals respond to expectations of rejection. Given the
space constraints of a single article, we focus, in this
study, on maladaptive or problematic coping strategies
and experiences reported by the participants; we will
present data on adaptive or resilient coping strategies
in a separate article, to give that aspect of the partici-
pant’s narratives the space they deserve.
Ethical considerations. The Institutional Review
Board at Suffolk University approved the research
study. All participants electronically signed consent
forms before participating. No adverse events were
reported to investigators.
Research team. The research team consisted of six
members: one team member was a postdoctoral re-
searcher (White, genderqueer); two were doctoral stu-
dents in clinical psychology (both Latino, cisgender
men); and two were Master’s-level psychology students
(both White, one a cisgender woman and the other
transmasculine). The team was supervised by a clinical
psychologist and university professor (White, cisgen-
der man) with expertise in sexual and gender minority
health, and experience in qualitative research methods.
Recruiting interviewees. Participants were recruited
through message boards, Listservs, and social network-
ing sites on the Internet. Online recruitment was im-
portant for this study because research suggests that
the Internet is a particularly viable source of network-
ing and information gathering for transgender individ-
Recruitment letters and online flyers were sent
electronically to websites with a predominant transgen-
der audience. The materials contained basic informa-
tion about the nature of the research study, the
investigators, and a link to the web address for the
online study. Study consultants also posted a link to
the online study through private social networking
groups (e.g., in Yahoo! and Facebook).
After reviewing the recruitment materials, interested
potential participants were directed to a secure area of where they could complete the el-
igibility screener. If eligible and willing to participate,
participants then completed an online questionnaire
that included measures of mental and physical health,
health behaviors, and social support. This represented
phase one of the research study. Following the comple-
tion of the questionnaire, participants were asked to in-
dicate if they would like to participate, at a later date, in
an in-depth interview, which represented phase two of
the research study. From the list of individuals willing
to take part in the interview, we randomly selected par-
ticipants and used purposive sampling until we reached
an even number of individuals who were male assigned
and female assigned at birth.
The 30 participants in this study cited the following
sources when asked to specify how they were recruited:
transgender social networking sites (11 participants),
email from a friend/colleague (7 participants), Face-
book group/friends (5 participants), transgender sup-
port websites (4 participants), closed online support
group (1 participant), Tumblr (1 participant), and
online transgender message boards (1 participant).
Eligibility criteria. Eligible participants were individu-
als who (1) resided in the United States; (2) identified
as ‘‘transgender’’ or ‘‘noncisgender/other’’; (3) were be-
tween the ages of 25–40 years; and (4) have begun the
gender affirmation/transition process by dressing
much/most of the time as their identified gender for
at least the past 6 months.
The sample was restricted geographically (U.S.-
based) and with regard to age. The restricted age
range was selected to include individuals who are be-
yond emerging adulthood, yet not quite at midlife.
Limiting the geographic region and ages of participants
was implemented to minimize the presence of life
stressors that are unique to age (e.g., emerging adults
who might be living independently for the first time),
generation (e.g., older adults who lived through periods
of relatively greater social stigma regarding LGBT
Rood, et al.; Transgender Health 2016, 1.1
individuals), or nationality (e.g., U.S. legislation com-
pared with European legislation regarding LGBT rights).
In addition, participants were required to have
affirmed their gender through the way they dressed be-
cause this study assessed ways in which their environ-
ment (e.g., friends, family, and employment/school)
might have enacted stigma in response to their gender
presentation. Therefore, TGNC individuals who were
not affirming their gender identity, particularly in
ways that were not visible to their external environment,
might not have experienced potential stigma/stress and,
thus, were not eligible, given the aims of this study.
The interview. The principal investigator (first author)
developed the interview protocol in collaboration with
several community-based researchers, experts in qualita-
tive methods, and experts in sexual and gender minority
health. Given that this study was designed to more thor-
oughly understand how TGNC individuals experience
proximal stressors, the questions for the interview
were developed to assess for specific constructs repre-
sented in Meyer’s Minority Stress Model.
The inter-
view protocol included questions about, for example,
expectations of rejection, experiences of hypervigilance,
identity concealment, passing, and the intersection of
race/ethnicity with gender identity.
Initial interview questions were more general, in an
effort to establish rapport. Subsequent questions focused
on more sensitive content. Although the interview pro-
tocol consisted of specific questions, discussion of each
content area began with an open-ended question so
that each participant could detail (1) if the experience
was personally relevant, (2) what occurred, (3) what
the associated thoughts and feelings were, and (4) how
they responded to the experience.
The first author (Latino, cisgender man) conducted
all interviews online through Skype. Skype offers en-
cryption for voice conversations and is regarded to be
among the most secure of Voice over Internet Protocol
providers. Each participant was provided access to a par-
ticipant Skype account with a unique password; partici-
pants did not use a personal account that might have
included personal identifiers. Before the start of each in-
terview, the interviewer and participant reviewed the
purpose and voluntary nature of the research study
and the informed consent document the participant
had previously signed electronically.
During the interview, the video option on the inter-
viewer’s Skype account was turned off; therefore, no
video transmission of the participant was received.
The audio, however, was recorded using a digital audio
recorder placed next to the computer speaker. Inter-
views ranged from 37 to 94 min in length (mean 62.2,
standard deviation 11.9). Following the interview, par-
ticipants were provided with a list of transgender re-
sources and sent a $30 gift card electronically.
Data analysis. All interviews were transcribed by un-
dergraduate research assistants and checked for accu-
racy by two independent reviewers. All identifying
information (all proper nouns, such as names and pla-
ces) was removed and identification numbers were
assigned to ensure confidentiality. Audio recordings
were deleted once transcription was finalized.
Data analysis carefully followed the consensual qualita-
tive research (CQR) approach.
To begin coding the data,
the research team first developed a tentative list of do-
mains, based on a review of theliteratureandprimary
questions in the interview protocol. The domains repre-
sent general topic areas that were covered in the interview
guide. The team then took the initial domain list and in-
dependently coded the same four transcripts. In this pro-
cess, the domain list was tested by applying it to the
transcripts to determine how well the domains ‘‘fit’
these data. Consistent with the CQR methodology, the
domain list was independently modified (e.g., adding, re-
moving, or combining domains) based on the topic areas
that emerged from transcripts.
After this process, the
team met to compare notes and discuss changes to the
domains, until a stable list was decided upon.
After developing the consensual domain list, team
members coded the remaining transcripts in pairs. For
each transcript, the two members coded independently
and then met together to compare codes and consensu-
ally assign domains to the data. For each coding pair,
there was a third team member identified to serve as an
auditor. The auditor reviewed the coded transcript pro-
duced by theteam of two, and assisted the pair in reaching
consensus for any disagreements or discrepancies.
After coding all 30 transcripts, the team reviewed each
transcript for core ideas. Core ideas represent clear and
concise summaries of each piece of data (i.e., the partic-
ipant’s narrative). The function of constructing core
ideas is to concisely label each piece of data, which en-
ables more effective comparisons across participants in
the later cross-analysis.
After constructing core ideas
for the transcripts, the team met, discussed the data,
and reviewed the core ideas until we reached consensus.
For the cross-analysis, the team examined the core
ideas represented within each of the domains across all
Rood, et al.; Transgender Health 2016, 1.1
participants. In this stage of analysis, the team consensually
grouped core ideas into common themes and constructed
categories and subcategories within each domain. Consis-
tent with the CQR methodology, categories and subcate-
gories were labeled as general if they applied to 29 to 30
cases (i.e., participants), typical if they applied to 16 to 28
cases, and variant if they applied to 2 to 15 cases.
Through team discussions, consensual revisions were
made to study data until results were finalized.
Demographics. Participants were asked for their U.S.
zip code, sex assigned at birth, gender identity, sexual
orientation, age, relationship status, level of education,
race/ethnicity, and engagement in different gender af-
firmation activities (e.g., Have you dressed much/most
of the time in your identified gender for at least the
past 6 months? Have you disclosed to friends and family
about your gender identity? Have you participated in
hormone therapy?).
Interview guide. The interview guide included ques-
tions to assess the experience of expecting rejection.
For example: ‘‘Have you ever expected that you might
experience discrimination because you identify as
transgender? [If yes] Please tell me about an experience
that stands out to you the most when you expected to
experience discrimination.’’ (See Appendix.)
Sample characteristics
For the total sample, the mean age was 30.4 years and
the majority of participants endorsed a non-White
race/ethnicity (60.0%). The majority of participants
identified as women (26.7%) or as transmen (female-
to-male; 23.3%). Forty-three percent of participants
identified their sexual orientation as queer, and the ma-
jority of participants either graduated from college
(43.3%) or took college-level coursework (26.7%).
Most participants reported engaging in masculinizing
or feminizing hormone therapy (76.6%), considered
some form of gender reassignment surgery (80%),
and told people at work or school about their affirmed
gender (86.7%). Participants resided throughout differ-
ent geographic regions of the United States. Complete
sample characteristics are presented in Table 1.
Qualitative results
Nine domains emerged following the consensual coding
process (Table 2). Within the Expecting Rejection do-
main, there were four distinct categories: (1) where to
expect rejection (with four subcategories); (2) thoughts
and feelings associated with expecting rejection
(with six subcategories); (3) coping strategies used to
manage the expectation of rejection (with three subca-
tegories); and (4) the intersection of race and ethnicity
Table 1. Sample Characteristics
Characteristic n% of sample
Age (M, SD) 30 30.4 years (6.1)
Sex assigned at birth
Female 15 50.0
Male 15 50.0
White 12 40.0
Biracial/multiracial 10 33.3
Asian/Asian American 3 10.0
Black/African American 3 10.0
Latino/Hispanic 2 6.7
Gender identity
Female/woman 8 26.7
Transmale/Transman (FTM) 7 23.3
Transfemale/Transwoman (MTF) 4 13.3
Male/man 4 13.3
Genderqueer 3 10.0
Gender fluid 1 3.3
Masculine 1 3.3
Transboi 1 3.3
Transsexual 1 3.3
Sexual orientation identity
Queer 13 43.3
Lesbian/gay 5 16.7
Heterosexual/straight 4 13.3
Pansexual 4 13.3
Bisexual 3 10.0
Asexual 1 3.3
Relationship status
Single 9 30.0
Partnered 7 23.3
Married 7 23.3
In an open relationship 3 10.0
Engaged 2 6.7
In many open relationships 1 3.3
Nonromantic coparent relationship 1 3.3
Educational attainment
College graduate 13 43.3
Some college 8 26.7
Graduate level education 5 16.7
High school graduate/GED 4 13.3
Have participated in the following gender affirmation activities
Told friends or family about affirmed gender 30 100.0
Told people at work or school about
affirmed gender
26 86.7
Considered some form of GRS 24 80.0
Hormone therapy 23 76.7
Completed some form of GRS 10 33.3
United States geographic region
West 11 36.7
South 9 30.0
Midwest 7 23.3
Northeast 3 10.0
FTM, female-to-male; GED, General Educational Development certifi-
cate; GRS, gender reassignment surgery; MTF, male-to-female.
Rood, et al.; Transgender Health 2016, 1.1
with expecting rejection (with two subcategories).
Categories and subcategories applying to only one
case were excluded from the results. All domain cate-
gories and subcategories are presented in Table 3.
Next, themes are presented and discussed with ac-
companying illustrative quotes, along with self-
reported age, race/ethnicity, and gender identity of
the participant who shared the quote.
Where to expect rejection
Could happen anytime when out in public spaces or when
there is the potential to meet new people. Participants
specified that they expected rejection anytime they left
home and entered a public space. Examples of differ-
ent public spaces included grocery stores, restaurants,
and hotels.
Really, it could be anywhere, you know? Those kinds of situ-
ations pop up where you least expect them. I mean, they’re
going to happen where you do expect them—you know,
when you’re walking out on the street or going to the grocery
store and that mother of four is looking at you like you’re
going to hurt her children just because you dress differently.
But, you know, it could pop up at you and it just snaps you
back to how unusual your situation is, and it takes away
from just living life normally. (27, White, female/woman)
Notably, participants identified spaces that, histor-
ically, are regarded as transphobic, specifically, rural
Table 2. Domain List
1. Expecting rejection
2. Concealing or hiding gender identity
3. Passing
4. Negative social messages
5. Intersection of race/ethnicity and gender-related stress
6. General coping with gender-related stress
7. Sources of support
8. Resilience
9. Positive message to share with others
Table 3. Categories, Subcategories, Illustrative Core Ideas, and Frequencies Regarding the Expecting Rejection
Domain (N=30)
Domain/category/subcategory Illustrative core idea Frequency
Expecting rejection
(1) Where to expect rejection General (30)
(a) Could happen in situations that include gender markers or a clear
gender binary system
Public restrooms; spaces that ask for personal
identification; healthcare settings
General (29)
(b) Could happen anytime when out in public spaces or when there
is the potential to meet new people
Anywhere I go/everyday/it is part of being transgender or
gender nonconforming; when I am around new or
unfamiliar people/environments; when in crowds
Typical (27)
(c) Could happen when around people who know me or with whom
I plan to interact
Employment/work settings; when with family; when
around people who knew me pretransition
Typical (20)
(d) Could happen if/when I do not pass When I was not passing well earlier in my transition;
when I was not on hormone replacement therapy
Variant (5)
(2) Thoughts and feelings associated with expecting rejection General (30)
(a) Anxious/stressed/nervous Experiencing anxiety/nervous; experiencing general
stress; feeling overwhelmed
General (30)
(b) Fearful/worried about safety/hyperaware Experiencing fear or terror; worrying about personal
safety or violence; feeling on alert or on guard
General (29)
(c) Depressed/self-loathing/my fault Experiencing sadness/depression; picking self-apart/
self-denigrating; feeling like a burden/it is my fault
Typical (17)
(d) Angry/frustrated with the situation and others Feeling anger/irritability/rage; feeling frustrated; feeling
like it is unfair
Typical (17)
(e) Not supported/ignored/rejected Feeling ignored or invisible; thinking about the lack of
support; feeling rejected by others
Variant (12)
(f) Physically exhausted by the end of the day Feeling physically exhausted by the end of the day;
feeling tightness in body; feeling shaky
Variant (7)
(3) Coping strategies used to manage the expectation of rejection Typical (26)
(a) Avoidance/escape Avoiding specific situations and people; hiding when in
the situation; escaping the situation
Typical (17)
(b) Substance use Alcohol; smoking cigarettes; Marijuana use Typical (17)
(c) Cognitive/emotional coping strategies Ruminating/thinking about the situation; feeling angry;
minimizing the severity of the situation
Variant (7)
(4) Intersections of race and ethnicity with expecting rejection Typical (20)
(a) Being a person of color increases the expectation of rejection/
helps you to prepare for the rejection
Expect more rejection if you are a person of color; being a
person of color prepares you for the possible rejection;
in addition to my gender, being a person of color makes
me stand out and puts me on guard
Typical (19)
(b) Being White comes with privileges/decreases the expectation
of rejection
Being White or perceived as White has privileges, and
lowers the expectation of rejection
Variant (12)
Rood, et al.; Transgender Health 2016, 1.1
and conservative geographic areas, and religious set-
tings. Yet, participants also explained that transindivid-
uals might expect rejection in LGBTQ-identified spaces.
I would oddly say pride, and events where it’s LGBT run or
friendly. A lot of our gay brothers and sisters do not want to
recognize that we are who we are, and so I choose to be stealth
in those environments. I do notice that I get along with girls,
just because that’s my nature, but the lesbians seem very
stand-offish. They don’t want to make eye contact with me
and I get it, but at the same time it’s like, ‘‘You’re missing
out on the fundamental point here! I’m a part of this commu-
nity and I should feel welcome in this community, but I’m not
sometimes.’’ (34, Black, male/man)
Overall, participants noted that expecting rejection
in most environments is almost inevitable and a funda-
mental part of being TGNC identified.
There is the knowledge that you’re going to walk into places
and you will get treated differently; you will get looked at dif-
ferently. It’s not like it might not happen. It’s not like it might
happen. It’s going to happen at least at some point every day.
(40, White, gender fluid)
Oh, yes! Pretty much every day, every experience I go to, that
[expecting rejection] is a big concern for me. (30, multiracial,
male-to-female [MTF])
Could happen in situations that include gender markers
or a clear gender binary system. Overwhelmingly, par-
ticipants detailed that they expected rejection in spaces
where they must interact with others in a way that
made explicit their gender identity. The most frequently
identified space was public restrooms and, similarly,
locker/fitting rooms and medical visits.
There’s definitely discomfort using public bathrooms.
There’s definitely a lot of anxiety. Sometimes I can just
waltz into whatever bathroom that I want, super confidently,
and then a lot of times I can’t do that. I’ll just be dodging eyes,
not looking at people, so they won’t be confrontational. I’ve
never had any super-confrontational experiences in public
bathrooms but I know a lot of people who have, and I can
still feel looks sometimes, which I think could escalate, and
that’s what I’m worried about. (25, multiracial, genderqueer)
Participants noted specific concerns about using
public restrooms that are associated with the expecta-
tion of rejection.
.and then of course there are always restrooms, which are,
let’s call them, ‘‘nightmarish,’’ for lack of a nicer term. I do ev-
erything possible to avoid using the restroom in public. Going
into the bathroom, you’re always worried that someone’s
gonna harass you or call you out about something, or say
something mean or attack you, or do some other horrible
thing. I’ve personally not been physically attacked ever in a
bathroom but I’ve definitely had people give me weird looks
a lot, and I’ve had people say to me that I was in the wrong
bathroom. Bathrooms are always stressful. I much prefer to
use private bathrooms.because then I don’t have to deal
with someone else coming in, bothering me, and harassing
me. (30, multiracial, MTF)
In addition, participants were outspoken about expe-
riencing stress in situations that required legal identifi-
cation, for example, airport security or being stopped
by the police.
Yeah, so, at the airport, for instance, because my passport and
everything reads female, and my name is obviously female,
immediately I’m nervous about that. When they have to
look at the passport and at your fingerprints, or whatever.
These kinds of situations make me very nervous and I expect
that there will be problems, and that’s what makes me uncom-
fortable. (32, White, female-to-male [FTM])
Could happen when around people who know me or
with whom I plan to interact. Although participants
frequently noted that they could reduce the stress associ-
ated with expecting rejection by avoiding specific places
and contexts, they explained that certain contexts were
not so easily avoided because they had ties to the people
and the place. Most frequently, participants cited work/
employment as a context in which they expect rejection.
It [expecting rejection] is why I am not at all out about my
gender at work.There is no doubt that if I were open
about being gender fluid, it would not only be the end of
my career, but there would be a lot of personal repercussions
as well.There’s a definite fear that I could be found out at
any time, and there’s also anger—because it’s dehumanizing.
(40, White, gender fluid)
In addition, participants noted that family and peo-
ple who knew the participants before they affirmed
their gender were particular sources of internal stress.
Any time I’m in the presence of someone who knew me before—
so, past family members, past friends, anybody like that—it’s al-
most like every muscle in my body is in a heightened state of alert
and my blood pressure, I can almost feel it pumping. Every word
they say, every word they don’t say, every flick of their eyes, ev-
erything they do is something that I’m focusing on and read-
ing.So, constantly, I’m ready for them to say the wrong
pronouns or use the wrong name, or speak to me in some neg-
ative way even if they haven’t done it or aren’t going to. Usually,
by the time that situation is over, whether or not anything bad
happened, I’ll just burst into tears or just decompress emotionally
after it’s done because I’m so ready to be hurt, expecting to be
hurt. (32, White, female/woman)
Could happen if or when I do not ‘‘pass’’ or
‘‘blend.’Although representing a small proportion
of the sample, several participants reported that they
might expect rejection based on how well (or poorly)
Rood, et al.; Transgender Health 2016, 1.1
they ‘‘passed’’ or ‘‘blended’’ while in public. In present-
ing earlier in their gender affirmation process, or with-
out the benefits of masculinizing or feminizing
hormone therapy, participants perceived that others
might react negatively more frequently.
When I first transitioned and didn’t quite pass as well, I was
worried about it [expecting rejection]. (25, Latino, MTF)
Anybody who’s going through the transition, especially during
the early phases, when you’re getting ‘‘ma’am’’ half the time
and ‘‘sir’’ half the time, you definitely notice stares.I don’t
deal with it so much anymore. I’ve been on hormones for
the better part of a decade, so normally I don’t have to
worry about it too much. (31, White, MTF)
Thoughts and feelings associated
with expecting rejection
Fearful, worried about safety, and hypervigilant. Par-
ticipants reported that the expectation of rejection
often is associated with distinct feelings of fear and
worry for their personal safety. Nearly universally, par-
ticipants shared a common concern for the possibility
of being a target for discrimination and victimization
as a result of their gender identity.
I’m hypervigilant constantly. I think it’s impossible really to be
a trans female, and probably to be a trans male as well, and not
be hypervigilant about what’s going on around you—the peo-
ple around you, and how they’re acting and interacting with
you and with each other, because violence creeps up on you
really quickly and people are jerks. They’re just f***ing
a**holes and you never know when something is gonna hap-
pen, and so you always have to just be aware of what’s going
on. And it’s a luxury that I think a lot of my cis friends don’t
realize they have, especially some of my White gay male
friends. They don’t get it that they can just walk around and
not worry about being attacked or harassed. They always
counter with, ‘‘Well, I got called a fag once.’’ And I’m like,
‘‘Okay, yeah, once. Try that every day.’’ (30, multiracial, MTF)
In addition to the fear of violence and discrimination,
participants also reported that they often were on alert
or on guard, and ready to react to threats from others.
To get to work, I have to go to a bus stop that’s a mile away, so I
have to walk a mile alongside the highway. I walk down that every
day, and there’s a stretch where these creepy guys hang out, and
sometimes they’ll yell things at me and I get catcalled a lot, and
that kind of makes me on edge. I think it’s pretty unlikely anything
bad would happen but I think if, say, someone groped me and re-
alized I was transgender, I think that could end pretty badly. So,
I’m a little more hypervigilant in that case. .Usually, [when in
this situation] I’m thinking about how fast I could run and I’ll
play out scenarios in my head. (25, Latino, MTF)
Anxious, stressed, and nervous. Every participant sta-
ted that they, to varying degrees, experienced anxiety
and stress in association with the expectation of rejec-
tion. Participants described the internal stress as over-
whelming, crushing, and awful.
So I recently went to a doctor in [home city] for the first time—
nothing related to my transition at all, just a medical problem
that I was having. Literally four or five hours before I went, I
just felt really nervous or anxious about going there and just
being like, ‘‘What if this happens? What if that happens?’’ Noth-
ing happened. The doctor was reallyunderstanding, but it’s just
that preemptive stress, I guess. (25, multiracial, transsexual)
Physically and mentally exhausted by the end of the
day. A marginal portion of participants shared that
the process of managing the internal stress, over the
course of the day and in different contexts, was physi-
cally and mentally taxing.
Well, there’s definitely stress. Because you’re constantly worried
about everyone else and it’s no wonder you have a hard time
when you’re constantly worried. So, yeah, there’s worry, stress,
and exhaustion. It’s definitely tiring. (25, White, female/woman)
Depressed, self-loathing, and I am at fault. In addition
to fear- and anxiety-based internal processes, partici-
pants also reported mood disturbances associated
with the expectation of rejection. The primary experi-
ence centered on feelings of sadness and depression.
You feel like you’re always on your guard and it’s hard to get
your hopes up about meeting someone new because, a lot of
the time, they’re going to act negatively without even getting
to know you. So, it’s depressing, in a way. And I think a lot
trans people including myself, have dealt with depression, so
it can be a little overwhelming. (31, multiracial, genderqueer)
In addition, participants detailed the ways in which
they experienced feelings of shame and embarrass-
ment, and negative thoughts about themselves.
It [expecting rejection] makes me sad. Like, I’m always going
to be an alien—like an alien amongst friends. It’s a lot of things
like that. I tend to internalize a lot of stress and sadness, and
wonder about myself rather than thinking so much about the
people who stress me out. (32, White, female/woman)
Angry or frustrated with the situation and others. Although
participants described the experience of expecting
rejection generally as stressful and disheartening,
they also voiced strong feelings of anger, frustration,
and disappointment over the idea of expecting rejec-
tion from others.
There’s a lot of anxiety and it’s usually coupled with anger,
which is maybe how I get through it. Like, if I have to use a
public bathroom and I don’t have another choice, I kind of
get a little angry and it helps me to just do what I have to
do. (26, Latino, masculine)
Rood, et al.; Transgender Health 2016, 1.1
Notably, several participants expressed that expecting
rejection, especially in retrospect, was sometimes a con-
fusing process.
I honestly feel sorry for these people, that they can’t just be
open and accepting of everybody around them.I don’t un-
derstand. I don’t get why they feel a need to do this. (30,
White, female/woman)
This was especially apparent when participants felt
threatened or misunderstood by other minority popu-
lations (i.e., cisgender lesbian, gay, and bisexual) that,
as the participants perceived, might experience similar
minority stressors.
The gay community refuses to accept trans men and gender flu-
idity, and the lesbian community will sometimes become vio-
lent against trans women, and then they turn around and
complain about the same things being done to them by the
rest of society. It’s like, ‘‘How can you cry about this when
you’re doing it to the rest of us?’’ (40, White, gender fluid)
Not supported, ignored, and rejected. Finally, partic-
ipants additionally reported that, when experiencing
the expectation of rejection, they sometimes believed
that they were not supported by others and ignored.
I want to be treated like anybody else, so anticipating being an
outsider isn’t a great feeling. It’s pretty upsetting, hoping that
somebody would go up to bat for you, right? .It’s like the
one kid who gets punked on or bullied, and they kind of
know that they’re different, but hopes that other people will
stand up for them, be nice to them, and fight for them, you
know? (28, multiracial, male/man)
Some participants reported that they felt rejected
by society.
I would get people that would look at me and talk to me like, ‘‘Is
this freak really speakingto me?’’ instead of just talking to me like
I’m a normal human being .And I even experience that while
being in the presence of my wife. People would speak to herand
think that it wasn’t important to speak to me, although I’m
standing there next to her. (34, Black, male/man)
Coping strategies used to manage the expectation
of rejection
Avoidance or escape. When expecting rejection and
experiencing intense distress, participants stated that
they frequently responded by engaging in avoidance strat-
egies. Based on the participants’ report, this occurred in
two ways. First, participants reported that, if expecting re-
jection, they would avoid certain situations altogether.
Avoidance is a big thing that I do. I will avoid going to the doc-
tor, even if I need to go to the doctor, or avoid going to the
gym since I don’t want to deal with locker room situations.
(28, multiracial, FTM)
As a second method, participants noted that, if they
did not have the immediate option to avoid the situa-
tion or were already in a potentially threatening setting,
they used developed behavioral routines as a way to
avoid becoming a target.
I usually try to hide in the [restroom] stall. I look around
a lot when I’m inside and, if there’s anyone in there, I try
to hurry so they can’t see me; or, I’ll wait in there until
there’s no one else in the restroom and then rush out
and wash my hands, and then escape. It’s like, ‘‘I don’t
want to deal with this. I just want to go to the bathroom
like a normal person and go on with my day,’’ you know?
(31, multiracial, genderqueer)
When I go to the gym, I always keep earphones in the entire
time because I just don’t want to hear what’s going on around
me. I don’t look up—my eyes are always three feet in front of
my feet—I don’t talk to anyone, and I don’t want to hear the
comments. (40, White, gender fluid)
Substance use. Participants reported that they would
use substances in response to the stress associated with
expecting rejection. Specifically, a third of the total
sample reported alcohol use and smoking cigarettes
as common coping strategies. Participants also men-
tioned marijuana, prescription drugs, and other un-
specified substances used.
There are lots of things that I do that are probably not
healthy for me to deal with the stress of having to navigate
the world as a trans woman. I smoke cigarettes. That’s one
of my big coping mechanisms when I’m out in public. I
don’t really drink but I do smoke a lot of pot. That’s honestly
one of the main ways that I deal with stress that everyone and
everyday life causes me—to escape some of the crap that’s
going on with being trans and escape some of, you know,
the fears and issues that I’m gonna go through. (30, multira-
cial, MTF)
Cognitive or emotional coping strategies. Asmallpro-
portion of participants detailed that they responded to the
stress of expecting rejection by ruminating on what could
occur, or what had already happened in the past.
I might think there’s this tiny chance someone would react vi-
olently if they found out. So, I guess that’s kind of in the back
of my head sometimes.I guess the most unhealthy thing I
did about that was ruminate on it. (25, Latino, MTF)
In addition to rumination, other participants noted that
they might respond by becoming even more infuriated
with the situation.
Whenever I get stressed out [about expecting rejection], I let
go of my stress by being angry. I tend to lash out. .It always
ends up being more harmful right? You always regret that. (28,
multiracial, male/man)
Rood, et al.; Transgender Health 2016, 1.1
Intersections of race and ethnicity
with expecting rejection
Being a person of color increases the expectation
of rejection and helps you to prepare for the
rejection. When asked to consider how the partici-
pant’s race and ethnicity might impact their expecta-
tions of rejection, participants were clear in their
general belief that being a person of color increases
the risk for discrimination and violence. Others of-
fered the notion that experiencing discrimination as
a person of color helps prepare individuals to experi-
ence discrimination as a TGNC person.
There are definitely situations in which I might not even be
thinking about my gender identity, but I’ll expect to experi-
ence some form of discrimination or some sort of danger
just based on my racial identity. (26, Latino, masculine)
I think the experiences that I had when I was young gave me a
little bit of a thicker skin, and already taught me some things
about diversity, and there’s a wide array of responses to diver-
sity. (34, multiracial, FTM)
Although participants of color readily detailed their
own experiences of managing the internal stress asso-
ciated with a dual minority status, White participants,
given the frequency and detail of their responses,
appeared to have little difficulty recognizing and ac-
knowledging these same stressors.
I’m terrified of the threat of violence against me, knowing that
if I’m ever raped that the chances of being beaten or murdered
is way higher for me than others. But also knowing that it’s not
anywhere like it is for other girls who have darker skin than
me. (32, White, female/woman)
Being White comes with privileges and decreases the
expectation of rejection. Participants, quite com-
monly, discussed that being White comes with distinct
social privileges and protections.
Well, I believe that I end up with White female privilege,
which certainly has an advantage over, for example, being a
woman of color. I know that I’ve had probably more opportu-
nities than some women of color, especially some trans
women of color that I know. (28, White, female/woman)
Notably, the notion of ‘‘passing’ as White was salient
to many participants, especially given that a large per-
centage of the sample was multiracial or multiethnic.
Every single trans person I know, who is a trans person of
color, all of them have said that they’re treated worse based
on their race and being trans. So, I can only imagine that if
I actually were perceived more regularly as a person of
color, the discrimination that I would experience would be
more so. (30, multiracial, MTF)
This study aimed to assess the saliency of expecting re-
jection by identifying how, and to what extent, expecting
rejection manifests in TGNC individuals, and further
clarify how they might respond to the expectation of re-
jection. Through in-depth interviews, study findings
offer evidence that proximal stress is a salient experience
for TGNC individuals. Despite the significant heteroge-
neity present in the sample, in terms of the unique
experiences of individuals from different geographical
settings, different racial and ethnic backgrounds, at dif-
ferent points in their gender affirmation process, and at
different ages, study findings converge in a stable narra-
tive. This convergence is quite meaningful and provides
strong support that expecting rejection is a common ex-
perience for TGNC individuals, especially given the fre-
quency with which it was reported. In addition to
frequency, the severity of the experiences that partici-
pants reported was profound.
Qualitatively, participant narratives were punctuated
with a sense of urgency, distress, and resignation. In
other words, they shared stories about expecting rejec-
tion in ways that suggested that the experiences were in-
tense and often life-threatening (e.g., experiencing fear,
anger, and hypervigilance); upsetting and disparaging
(e.g., experiencing frustration, sadness, and shame);
and an expected part of their existence (e.g., thinking
about the possibility of rejection in most contexts and
with most people). Given these findings, it appears
that the proximal stress experiences of TGNC individu-
als are consistent with the expecting rejection construct
represented in Meyer’s Minority Stress Model.
Furthermore, these findings offer evidence regarding
the largely theoretical association between expecting
rejection (or felt stigma) and psychological distress.
Consistent with the few published studies that have
found expecting rejection to be positively associated
with elevated levels of psychological distress,
current qualitative study provides context for why
and how distress might develop. Generally, participants
reported that their proximal stress experiences were
cognitively and emotionally distressing. As the narra-
tives detailed, TGNC participants specifically reported
fear and anxiety, sadness and anger, and mental ex-
haustion, and perceived that they were ignored and
alone in their experiences.
Although qualitative studies are not designed to as-
sess for directionality among constructs (i.e., internal
stigma leading to psychological distress), nearly univer-
sally, the participants in this study reported narratives
Rood, et al.; Transgender Health 2016, 1.1
that offer evidence that proximal stressors appear associ-
ated with health and well-being. Future research using a
quantitative methodology should further explore the as-
sociation of these constructs in a larger sample.
Beyond experiences of depression and anxiety already
reported in the literature (and implicated in this study),
TGNC participants indicated that experiences of fear,
worry, and hypervigilance were highly prevalent. Given
that these fear-based responses are often observed in indi-
viduals with a trauma history, it is important to further as-
sess to what extent proximal stressors might match the
level of severity and impact of distal stressors. Intuitively,
and consistent with published literature, one might as-
sume that distal stressors such as discrimination and
victimization are the primary factors that promote trau-
matic stress in TGNC individuals. Yet, these findings sug-
gest that proximal stressors might operate similarly. In
addition, many participants reported that they heard sto-
ries of violence and discrimination from TGNC peers,
which could be a form of vicarious trauma.
From an intervention perspective, understanding the
impact of internal stressors may inform clinical and
public health approaches to trauma, which extends be-
yond what is happening to TGNC individuals that can
be easily seen and measured (e.g., experiences of vio-
lence and discrimination), and focus on experiences
that might be more covert and internalized (e.g.,
expecting and normalizing violence, or internalizing
messages of shame and embarrassment).
Another consideration noted in the limited published
literature is the use of avoidance strategies by TGNC in-
dividuals as a way to manage the expectation of rejec-
Current findings are consistent with what
has been previously reported. Generally, TGNC partic-
ipants described situations that include gender markers
or a clear gender binary system, that is, sex-segregated
spaces, as being incredibly stressful, especially public
restrooms. Although the fear of being outed was previ-
ously suggested as an indicator for why a TGNC indi-
vidual might avoid situations,
participants in this
study detailed further concerns. Beyond simply being
outed, participants expected confrontation (e.g., asked
invasive questions or told that they were in the wrong
restroom/locker room), harassment (e.g., catcalled or
laughed at), discrimination (e.g., not welcomed at social
events or differential treatment), and violence (e.g., phys-
ical and sexual assault). Therefore, avoidance strategies
(i.e., situational avoidance) might actually represent
an adaptive approach to mitigating proximal stress for
TGNC individuals.
Although previous studies indicated the types of set-
tings that TGNC individuals perceive as threatening,
current study participants identified settings and also de-
tailed ways in which they assessed for potential threats.
Participants stated that they often thought about the
experiences of other TGNC individuals who reported
discrimination or violence specific to a particular context
(e.g., public restrooms, work settings, or bars and clubs).
Based on this information, participants reported that
they would consider the possibility of a similar aversive
experience, were they to be in the same context. Other
participants stated that they often were alert and on
guard in certain situations, paid attention to their sur-
roundings, and actively looked around and assessed
how others were responding. A few participants reported
that they would consider how easily they could escape a
given situation, were there to be a potential threat. Thus,
participants not only assessed for perceived and real
threats to their safety and dignity but also, additionally,
some rehearsed how they might react. Participant narra-
tives, therefore, support Meyer’s model regarding the
manifestation of hypervigilance when expecting rejection
for TGNC individuals.
Participants discussed strategies for managing the ex-
pectation of rejection when they could not avoid certain
settings. Participants detailed routines that they devel-
oped to increase safety, including not making eye contact
with others and remaining in restroom stalls for an ex-
tended period of time if someone was present and quickly
exiting the space when no one was around. Other partic-
ipants noted that they would enter certain settings with
a friend to increase their sense of safety. In sum, the
social interactions of participants appeared thoughtful,
planned, deliberate, and skillful, reflecting the general
stress associated with navigating social spaces as highly
stigmatized and readily targeted individuals.
Notably, participants in this study discussed ways in
which race and ethnicity intersected with the expecta-
tion of rejection. According to minority stress theory,
it is possible for individuals to experience stressors spe-
cific to different minority identities.
Therefore, indi-
viduals with multiple minority identities can, and likely,
experience proximal stressors based on one of the mi-
nority identities or as a combination of several identities.
Accordingly, participants who were people of color
stated that a dual minority status—specifically, being
TGNC identified and a person of color—compounded
the stress associated with expecting rejection. Partici-
pants of color readily discussed their experiences and
perceived that expecting rejection (e.g., with the police,
Rood, et al.; Transgender Health 2016, 1.1
with employers, and when in unknown environments)
was more frequent for them compared to White TGNC
individuals. White participants noted similar discrep-
ancies based on what they had seen and how their
own treatment was differentiated. The reported stress
of a dual minority status described by TGNC partici-
pants warrants further research and evaluation.
In addition, and perhaps as an indication of resilience
(or as an unfortunate form of habituation to discrimina-
tion), participants of color frequently described that
they were prepared for the possibility of gender-related
rejection from others based on previous experiences of dis-
crimination as a result of their race or ethnicity. Con-
versely, participants reported that being White or passing
as White (as stated by several individuals of mixed race/
ethnicity), brought many social privileges that reduced
the expectation of rejection (e.g., being perceived as more
valuable, more trustworthy, and not ‘‘standing out’’ when
in public). Future research would benefit from exploring
how a dual minority status might contribute to potential
protective factors or enhance resilience when faced with
stressful experiences. In addition, there is a need to under-
stand how identity salience, as noted by Meyer,
impact the aforementioned. For example, research might
investigate whether there are differences in the stress asso-
ciated with racism depending on the salience of gender
identity and/or stage of gender affirmation.
This study is not without limitations. The function of
qualitative research is to more thoroughly understand
unique phenomena, and develop theory from the per-
spectives and life experiences of the specific population.
This is especially true for ‘‘hard-to-reach’’ populations,
including TGNC individuals. However, given smaller
sample sizes and methodological focus on reaching the-
matic saturation, qualitative research typically is not gen-
eralizable with any degree of certainty. In addition,
participants’ social desirability and recall bias likely im-
pact the results—which is to be further considered in
the context of any biases brought by investigators (e.g.,
the majority of the research team identifies as cisgender).
Also, participants volunteered to be part of the research
study, which likely contributed to selection bias (e.g., vol-
unteerism). Similar to cross-sectional studies, and as pre-
viously noted, directionality cannot be determined from
these data (e.g., experiencing the proximal stressor leads
to specific thoughts and emotions, which then lead to
specific coping strategies and subsequent mental health
Recruiting participants through the Internet also pres-
ents challenges. Although previous research has outlined
how to effectively recruit transgender participants and
collect valid data through rigorous online methodological
designs, Internet-based studies exclude participants who
do not have access or the necessary resources to be online
and likely represent a more narrowly focused group of
which could include an overrepresentation
of White individuals. The benefits of using the Internet to
recruit participants from geographically diverse locations
are mitigated by the limitations of having a group of par-
ticipants who might have very different and heterogenous
life experiences.
Finally, this study only presents findings about the ways
in which participants coped with expecting rejection,
which were generally ‘‘negative.’’ Participants also noted
many ways that they coped with general stress that demon-
strated resilience in the face of this adversity, which was not
discussed herein (an additional, forthcoming article will
focus on general coping, strengths, and resilience in this
sample—a separate aim of the parent study).
This research represents one of the few studies designed
to qualitatively investigate proximal stressors in TGNC
individuals. These data demonstrate the extent to which
expecting rejection might operate as a pervasive daily ex-
perience in the lives of TGNC individuals. Furthermore,
this study provides evidence regarding the adverse im-
pact of expecting rejection, as shown by the stressful
cognitive and emotional responses reported by partici-
pants. Although emerging research has shown the
deleterious impact of distal stressors (i.e., violence, dis-
crimination, and stigma) on the health of TGNC indi-
viduals, the current finding demonstrate that proximal
stressors likely have a similar devastating impact.
Given the frequency with which proximal stressors
were reported by TGNC participants—and the reported
experiences of fear, hypervigilance, sadness, and anger,
in particular—there is a clear need and urgency to further
evaluate the cumulative impact of the stress over time and
identify future targets to intervene upon to mitigate po-
tential harms. This is especially relevant given the current
cultural climate in which TGNC individuals continue to
remain targets for violence and discrimination—which
has resulted in the murder of countless TGNC individuals
worldwide, and the suicide of individuals who can no lon-
ger withstand the experience. Future research, including
clinical intervention development and testing, should
begin to prioritize the needs of this vulnerable population.
Rood, et al.; Transgender Health 2016, 1.1
Author Disclosure Statement
No competing financial interests exist.
1. Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-
related discrimination and implications for health: results from the Vir-
ginia Transgender Health Initiative Study. Am J Public Health.
2. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender
persons: the influence of gender-based discrimination and victimization.
J Homosex. 2006;51:53–69.
3. Hendricks ML, Testa RJ. A conceptual framework for clinical work
with transgender and gender nonconforming clients: an adapta-
tion of the Minority Stress Model. Prof Psychol Res Pr. 2012;43:460–
4. Nemoto T, Bo
¨deker B, Iwamoto M. Social support, exposure to violence
and transphobia, and correlates of depression among male-to-female
transgender women with a history of sex work. Am J Public Health.
5. Bockting WO, Robinson BE, Forberg J, Scheltema K. Evaluation of a sexual
health approach to reducing HIV/STD risk in the transgender community.
AIDS Care. 2005;17:289–303.
6. Lombardi E. Transgender health: a review and guidance for future re-
search—proceedings from the Summer Institute at the Center for
Research on Health and Sexual Orientation, University of Pittsburgh. Int J
Transgend. 2010;12:211–229.
7. Kenagy GP, Bostwick WB. Health and social service needs of transgender
people in Chicago. Int J Transgend. 2005;8:57–66.
8. Xavier JM, Bobbin M, Singer B, Budd E. A needs assessment of trans-
gendered people of color living in Washington, DC. Int J Transgend.
9. Rood BA, Puckett JA, Pantalone DW, Bradford JB. Predictors of suicidal
ideation in a statewide sample of transgender individuals. LGBT Health.
10. Testa RJ, Sciacca LM, Wang F, et al. Effects of violence on transgender
people. Prof Psychol Res Pr. 2012;43:452–459.
11. Bockting WO, Miner MH, Romine RES, et al. Stigma, mental health, and
resilience in an online sample of the US transgender Population. Am J
Public Health. 2013;103:943–951.
12. Meyer, IH. Minority stress and mental health in gay men. J Health Soc
13. Meyer IH. Minority stress and mental health in gay men. In: Psychological
Perspectives on Lesbian, Gay, and Bisexual Experiences (2nd ed).
(Garnets LD, Kimmel, DC; eds). New York: Columbia University Press,2003, pp.
14. Kobrynowicz D, Branscombe NR. Who considers themselves victims of
discrimination? Psychol Women Q. 1997;21, 347–363.
15. Operario D, Fiske ST. Ethnic identity moderates perceptions of prejudice:
judgments of personal versus group discrimination and subtle versus
blatant bias. Pers Soc Psychol Bull. 2001;27:550–561.
16. Herek GM, Gillis J, Cogan JC. Internalized stigma among sexual minority
adults: insights from a social psychological perspective. J Couns Psychol.
17. Chen Y, Tryon GS. Dual minority stress and Asian American gay men’s
psychological distress. J Commun Psychol. 2012;40:539–554.
18. Feinstein BA, Goldfried MR, Davila J. The relationship between experi-
ences of discrimination and mental health among lesbians and gay men:
an examination of internalized homonegativity and rejection sensitivity
as potential mechanisms. J Consult Clin Psychol. 2012;80:917–927.
19. Kuyper L, Fokkema T. Loneliness among older lesbian, gay, and bisexual
adults: the role of minority stress. Arch Sex Behav. 2010;39:1171–1180.
20. Pachankis JE, Hatzenbuehler ML, Starks TJ. The influence of structural
stigma and rejection sensitivity on young sexual minority men’s daily
tobacco and alcohol use. Soc Sci Med. 2014;103:67–75.
21. Gamarel KE, Reisner SL, Laurenceau JP, et al. Gender minority stress,
mental health, and relationship quality: a dyadic investigation of trans-
gender women and their cisgender male partners. J Fam Psychol.
22. Ellis SJ, McNeil J, Bailey L. Gender, stage of transition and situational
avoidance: a UK study of trans people’s experiences. Sex Marital Ther.
23. Mizock L, Mueser KT. Employment, mental health, internalized stigma,
and coping with transphobia among transgender individuals. Psychol Sex
Orientat Gend Divers. 2014;1:146–158.
24. HorvathKJ, IantaffiA, Grey JA,Bockting W. Areview of the content andformat
of transgender-related webpages. Health Commun. 2012;27:457–466.
25. Hill CE. Consensual Qualitative research: a Practical Resource for Investi-
gating Social Science Phenomena. Washington, DC: American Psycho-
logical Association, 2012.
26. Trippany RL, Kress VEW, Wilcoxon SA. Preventing vicarious trauma: what
counselors should know when working with trauma survivors. J Couns
Dev. 2004;82:31–37.
27. Miner MH, Bockting WO, Romine RS, Raman S. Conducting Internet re-
search with the transgender population: reaching broad samples and
collecting valid data. Soc Sci Comput Rev. 2012;30:202–211.
Cite this article as: Rood BA, Reisner SL, Surace FI, Puckett JA, Mar-
oney MR, Pantalone DW (2016) Expecting rejection: understanding
the minority stress experiences of transgender and gender noncon-
forming individuals, Transgender Health 1:1, 151–164, DOI: 10.1089/
Abbreviations Used
CQR ¼consensual qualitative research
FTM ¼female-to-male
MTF ¼male-to-female
TGNC ¼transgender and gender nonconforming
Appendix: Interview Questions for Expectations
of Rejection
Expectations of Rejection
A lot of trans-identified folks mention that they have
faced discrimination in their lives. Next, I’m going to
ask you some questions about discrimination that
you may have experienced by virtue of identifying as
1. First, I’m wondering: how you would define ‘‘dis-
People can experience discrimination in many
ways and in different contexts. One definition is that dis-
crimination is ‘an event or process in which someone
treats you differently—usually more negatively—
because of the group, class, or category in which you
Whether or not transpeople have experienced discrim-
ination themselves, many report that there are specific
Rood, et al.; Transgender Health 2016, 1.1
places—and interactions with specific types of people—
where they feel certain they’ll face discrimination.
1. Here I’m wondering: have you ever expected that
you might experience discrimination because you iden-
tify as [GENDER IDENTITY LABEL]? For example, in
preparing to go somewhere or to meet with someone,
have you had the experience where you think, ahead of
time, about the possibility of experiencing discrimina-
tion; or when you are out somewhere or with someone,
you are thinking about the possibility of experiencing
Tell me more about an experience that stands out to
you the most when you expected to experience dis-
A lot of people find the expectation of discrimina-
tion to be stressful or upsetting. If this is true for
you, in what ways might that experience have
been stressful or upsetting for you?
BWhat were you thinking or feeling?
BWhen people are stressed about something, they
sometimes try to deal with it in different ways.
We call this ‘‘coping.’’ If this is something you
do when stressed about expecting discrimina-
tion, what are some ways that you coped with
this or a related experience?
That’s interesting. Most of the trans or gender
nonconforming folks I’ve talked with have noted
at least one time when they’ve expected to experi-
ence discrimination. Why do you think this might
not be an experience that some trans or gender
nonconforming folks face?
3. There’s a term called ‘‘hypervigilance,’’ which
means that we’re on alert or on-guard when in certain
situations—or all the time, even—but especially when
we think that something bad could happen to us. Do
you ever find yourself to be hypervigilant in certain situ-
ations, because you identify as [GENDER IDENTITY
Tell me more about that experience and what it
was like for you.
What thoughts or emotions did that bring up for
We talked about coping earlier. What are some
ways that you coped with this or a related experi-
4. Unfortunately, it is common for others—this can
be friends, family, even people we don’t know—to act
or react negatively to people who are different from
themselves in some way. What does it feel like to
know and expect that other people whom you interact
with might react negatively to you simply for being
What emotions come up for you as you think
about the discrimination that you might face?
What types of thoughts come up for you as you
think about this expectation of discrimination?
5. What types of situations [PLACES, PEOPLE,
ACTIVITIES] do you believe might lead transgender peo-
ple to feel stress due to an expectation of discrimination?
Why might that be?
What about situations specific to you?
Publish in Transgender Health
-Immediate, unrestricted online access
-Rigorous peer review
-Compliance with open access mandates
-Authors retain copyright
-Highly indexed
-Targeted email marketing
Rood, et al.; Transgender Health 2016, 1.1
... A semi-structured interview guide was used to direct the flow of the interviews. The discussion guide was developed based on the minority stressors outlined in the minority stress theory, and literature on psychosocial challenges and coping strategies among LGBT individuals (Bockting et al., 2013;Meyer, 2003;Rood et al., 2016). The interviews were conducted in English and covered a wide range of topics, focusing primarily on the participants' lived experiences as sexual or gender minorities in Zambia. ...
... This was not a common finding in many previous studies, an indication that it may be necessary to conduct additional research on the effectiveness of music in assisting LGBT individuals to cope with their challenges. In addition, similar to previous research (Lehavot & Simoni, 2011;Rood et al., 2016), this study also found that sexual and gender minorities used substances to cope with stress. Alcohol abuse was predominantly used to manage negative emotions which may explain why LGBT people are susceptible to substance use. ...
... Published research in Sub Saharan Africa, including Zambia, has shown the negative impact of the HIV pandemic and reduced use of HIV and other STI health services among sexual and gender minorities (Balogun et al., 2020;Gamariel et al., 2020;Magesa et al., 2014;Pilgrim et al., 2019;Wanyenze et al., 2016;Wirtz et al., 2014). Beyond HIV and AIDS, gender minorities continue to experience a variety of sexual/gender identityrelated obstacles, including mental health issues (Bockting et al., 2013;Mustanski et al., 2010;Rood et al., 2016). ...
Background: Sexual and gender minorities face high levels of stigma, discrimination, and violence. In many countries, they are often criminalized and are at risk of mental health challenges. In Zambia, little is known about the psychosocial challenges and coping strategies of sexual and gender minorities. This study sought to explore psychosocial challenges and coping strategies among sexual and gender minority populations in Lusaka, Zambia to inform mental health and human rights promotion for this population. Methods: The study used a qualitative phenomenological study design. Data were collected through in-depth interviews with 16 sexual and gender minority participants (lesbian, gay, bisexual, and transgender) and four key informants. The sexual minorities included four lesbian, five gay, and three bisexual participants while the gender minorities included two transgender men and two transgender women. Interviews with gender and sexual minorities were mostly focused on the lived experiences of participants, while those of key informants focused on their work with sexual and gender minorities. Snowball strategy was used to recruit participants, while purposive sampling was used to select key informants. All interviews were recorded and transcribed verbatim. Thematic analysis was carried out with the aid of Nvivo 12 software. Results: Psychosocial challenges included victimization in the form of threats and physical assault. Stigma and discrimination were experienced in different settings such as healthcare, the workplace, and school. Participants reported having experienced feelings of depression. Rejection from family members was experienced by those who revealed their sexual or gender minority status. Reported coping strategies included social support, self-concealment, listening to music, and substance use. Conclusion: This study suggests that sexual and gender minorities in Zambia experience various psychosocial challenges related to their sexuality and gender identity. To assist them cope better with the obstacles they experience, improved psychosocial counseling and mental health services are needed.
... Proximal processes may include internalized transphobia, feelings of self-loathing, or expectations that others will reject or disapprove of one's gender or sexual identity (Meyer, 2003 (Rood et al., 2016). However, communities of support and relationships that provide encouragement and affirmation for minority identities can promote positive coping, health, and well-being (Meyer, 1995(Meyer, , 2003. ...
We report findings from an interpretative phenomenological analysis (IPA) study of transgender and gender non-conforming (TGNC) participants’ perceptions of their on-campus experiences. Participants reported their lived experiences of campus culture in the Deep South. The data was viewed through a minority stress framework. Four major themes emerged: a) supports for students; b) barriers for students; c) undergoing personal change; and d) influencing systemic change.
... Isso inclui as preocupações com a "passabilidade" (desejo de não parecer ser uma pessoa trans e / ou buscar ter uma expressão de gênero semelhante à de uma pessoa cisgênero), e as experiências com misgendering (quando as pessoas não reconhecem a identidade de gênero das pessoas trans e podem tratá-las com pronomes errados intencionalmente). A combinação desses dois conjuntos de estressores pode levar a resultados psicológicos negativos, que já estão bem documentados na literatura(Rood et al., 2016;Staples, Neilson, Bryan & George, 2018). A forma de aplicação do instrumento pode ser encontrada em: ...
Full-text available
O modelo do Estresse de Minoria (EM) propõe uma explicação de como estressores relacionados ao preconceito levam pessoas lésbicas, gays e bissexuais (LGB) a terem piores desfechos negativos de saúde mental do que pessoas heterossexuais. Os componentes básicos do EM são o preconceito internalizado, preconceito antecipado e preconceito experienciado. O modelo do EM foi desenvolvido primeiramente no campo da sexualidade e hoje tem sido também aplicado no contexto da diversidade de gênero. Ainda não há instrumentos adaptados para sua avaliação no contexto da diversidade de gênero no Brasil. Para esse fim, este estudo objetiva a adaptação transcultural e a investigação de evidências de validade para o contexto brasileiro do “Protocolo para Avaliação do EM em pessoas trans e diversidade de gênero” (PEM-TD-BR). Participaram 455 indivíduos cuja identidade de gênero discordava daquela designada ao nascimento. As análises fatoriais exploratórias e confirmatórias sugerem a estrutura de três fatores do PEM-TD-BR como a mais adequada, fornecendo evidências de validade e fidedignidade para o protocolo no contexto brasileiro.
... More specifically, findings have shown that TGD individuals experience high rates of psychological stress (i.e., anxiety, depression, somatization, suicidal ideation) associated with experiencing stigma, discrimination, and systemic oppression, particularly for individuals with intersecting identities that are marginalized, such as ethnic/racial, gender, and sexual minority statuses (e.g., Bockting, et al., 2013;Valente et al., 2020). TGD individuals experience layers of stress and trauma from bullying, lack of environmental support in school, work and community, as well as policies and legislation that seek to exclude individuals in the community from being able to use public spaces, engage in extracurricular activities, or receive protection from school and workplace harassment and discrimination (Rood et al., 2016). The impact of systemic oppression, gender-based violence, anti-trans legislation efforts, criminalization of healthcare, attack on Title IX protections, and limited providers with knowledge and competence to provide affirming care are all factors posited to contribute to the health inequities experienced by TGD individuals (Lefevor et al., 2019). ...
Full-text available
Purpose There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma. Methods Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing. Results Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation. Conclusion NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.
... Indeed, BIPOC trans persons have been shown to expect to experience greater gender-based rejection, violence, and discrimination than White peers, due to their race (Gately, 2010;Rood et al., 2016;Saffin, 2008), and are disproportionately subjected to incarceration (Saffin, 2008). Recent research surveying more than 600 trans women's experiences with hate crimes also found that Black and Latina trans women were more likely to experience battery with a weapon, compared to White and "other" trans women, who were more likely to experience sexual assault (Gyamerah et al., 2021). ...
Coming out as trans involves the melancholic, ambivalent loss of intentionally forsaken objects and illusions. Creating replacement fantasies for one’s gender expression requires navigating tensions between trying to visualize one’s authentic internal truth in the mirror (self-recognition) and seeking the affirmation and safety associated with external recognition, often referred to as passing. Ascribing to hegemonic binary gender norms can increase one’s legibility, but may impair self-recognition and one’s ability to form intimate connections with others, due to erasure of the authentic self. This can be particularly salient for nonbinary individuals, for whom passing necessitates choosing a least harmful form of misrecognition. I explored these themes in ethnographic interviews with 28 transgender, nonbinary, and/or gender-expansive individuals about their faces. Participants (binary and nonbinary) overwhelmingly fantasized about having facial features more stereotypically incongruent with their assigned-gender-at-birth (e.g., assigned-female-at-birth seeking angular jaw and cheekbones). They found the presence of such elements in their faces affirming or imagined a lack thereof to promote misrecognition. Paradoxically, these same persons were dissatisfied when such hypermasculinity or hyperfemininity was projected onto their faces by digital filters, due to loss of self-recognition.
... Finally, these cissexist conceptualizations of gender often resulted in experiences of double discrimination (Doan Van et al., 2019) when rejected by both cisgender heterosexual and cisgender LGB users, even though LGB users were often assumed to be more understanding due to shared community space (Morrison, 2010). Such rejection has been shown within our sample, and in the broader literature, to decrease transgender individuals' self-esteem and increase negative affect (Rood et al., 2016). This was especially the case when participants were rejected after having expressed significant interest and establishing a good rapport with the other individual before they disclosed transgender status, highlighting that the reason for the rejection was their transgender identity. ...
Dating app use is common and has become particularly relevant for transgender and non-binary people seeking platonic, romantic, and sexual connections with others. In this qualitative study, 15 transgender and non-binary individuals (M = 22.67 years, SD = 3.09 years) were interviewed to explore their experiences using dating apps. Thematic analysis was used to generate themes and subthemes. Six themes were identified: 1) connection to queer community; 2) expression of gender identity on dating apps; 3) fetishization on dating apps; 4) impacts of dating apps on sexual experiences; 5) safety on dating apps; and 6) recommendations for dating app developers. Results show that dating apps are an important tool used by trans/non-binary individuals to connect with others in the queer community and find platonic, romantic, and sexual partners. However, there are concerns about their use such as fears for safety and experiences of fetishization. More research, education, and implementations of app development, including the involvement of trans and non-binary people, are needed to address these concerns.
... The basis of Transcending stems from Beck's cognitive model (i.e., the cognitive triad: negative view of self, world, and future; Beck, 1976) in the context of minority stress. Additionally, the impact of these cognitions on emotions (e.g., fear, sadness, anger, shame) and behavior (e.g., avoidance, hypervigilance) will be contextualized in relation to minority stressors and trauma (Austin & Craig, 2015;Rood et al., 2016). Additional strategies, such as problem solving and radical acceptance will be used to empower TGD individuals by assisting in addressing problems caused by systemic and institutional transphobia. ...
This article describes an innovative, trauma-focused cognitive behavioral protocol, Transcending, to address the effects of minority stress on mental health among transgender and gender diverse individuals. The protocol merges minority stress and cognitive behavioral therapy models to provide a framework for (a) understanding the impact of minority stress (i.e., distal and proximal stressors) and (b) developing skills to address maintenance factors of associated psychological distress. The Transcending protocol is intended to provide a structured approach to filling an important gap in counseling services and increasing therapeutic competence with transgender and gender diverse individuals.
Sexual- and gender-minority (SGM) populations include all individuals of diverse sexualities and genders. As members of stigmatized groups in hierarchy-based societies, SGM individuals are commonly subjected to discrimination and violence and denied access to social resources and opportunities (i.e., minority stress). Such conditions place these individuals at higher risk for mental health difficulties. Additionally, SGM individuals often internalize the stories told to justify inequitable access to social resources, which can compromise their mental health. Self-compassion interventions have potential for buffering the impact of exposure to minority stressors and disrupting internalization processes, thereby promising improvement for the mental health of SGM individuals. This chapter discusses the theoretical underpinnings of self-compassion as it relates to the minority-stress model in SGM populations and discusses extant research on self-compassion in SGM populations.KeywordsSelf-compassionLGBTQSexual minorityGender minorityTransgenderMinority stress
The early months of the SARS-CoV2 pandemic exacerbated health disparities for vulnerable populations, including transgender (trans) communities, creating unique challenges for navigating sex and dating. This paper aims to expand upon the current literature regarding transmasculine populations by capturing their lived experiences during this critical time. We interviewed 20 assigned female sex at birth (AFAB) adults of the transmasculine spectrum - men, nonbinary, and transmasculine individuals - about their social and sexual experiences in the USA in May and June 2020. Transcripts were analysed using an inductive thematic approach. We found that sex drive decreased and uncertainty about health risks increased. Some participants found alternate ways to date and hook-up that reduced their COVID-19 risk, such as engaging in online sex (e.g. sexting, dating apps). Others expressed discomfort using virtual platforms for both personal/work and sexual lives, along with nuanced feelings around being objectified, compared to pornography, and fetishised as trans bodies. COVID-related shutdowns of queer spaces also amplified pre-existing concerns about interpersonal safety and rejection. When seeking new partners, participants sought behavioural characteristics that instilled trust. Future public health communications can take advantage of safety and sexual health strategies already present in trans communities to bolster wellbeing in trans lives.
Objective: Geographic location can affect access to appropriate, affirming mental health care for sexual and gender minority (SGM) individuals, especially for those living in rural settings. Minimal research has examined barriers to mental health care for SGM communities in the southeastern United States. The objective of this study was to identify and characterize perceived barriers to obtaining mental health care for SGM individuals living in an underserved geographic area. Methods: Drawing from a health needs survey of SGM communities in Georgia and South Carolina, 62 participants provided qualitative responses describing barriers they encountered to accessing mental health care when needed in the previous year. Four coders used a grounded theory approach to identify themes and summarize the data. Results: Three themes of barriers to care emerged: personal resource barriers, personal intrinsic factors, and healthcare system barriers. Participants described barriers that can inhibit access to mental health care regardless of one's sexual orientation or gender identity, such as finances or lack of knowledge about services, but several of the identified barriers intersect with SGM-related stigma or may be magnified by participants' location in an underserved region of the southeastern United States. Conclusions: SGM individuals living in Georgia and South Carolina endorsed several barriers to receiving mental health services. Personal resource and intrinsic barriers were the most common, but healthcare system barriers were present as well. Some participants described simultaneously encountering multiple barriers, illustrating that these factors can interact in complex ways to affect SGM individuals' mental health help seeking.
Full-text available
Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one's romantic affiliation) were associated with both partners relationship quality and mental health. Couples (n = 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor-partner interdependence models were conducted to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner's higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partner's greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.
Full-text available
Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer's minority stress model.
Full-text available
Health research on transgender people has been hampered by the challenges inherent in studying a hard-to-reach, relatively small, and geographically dispersed population. The Internet has the potential to facilitate access to transgender samples large enough to permit examination of the diversity and syndemic health disparities found among this population. In this article, we describe the experiences of a team of investigators using the Internet to study HIV risk behaviors of transgender people in the United States. We developed an online instrument, recruited participants exclusively via websites frequented by members of the target population, and collected data using online quantitative survey and qualitative synchronous and asynchronous interview methods. Our experiences indicate that the Internet environment presents the investigator with some unique challenges and that commonly expressed criticisms about Internet research (e.g., lack of generalizable samples, invalid study participants, and multiple participation by the same subject) can be overcome with careful method design, usability testing, and pilot testing. The importance of both usability and pilot testing are described with respect to participant engagement and retention and the quality of data obtained online.
The present study investigated the direct and additive effects of racial minority stress and sexual minority stress on the psychological well-being among a community sample of 139 Asian American gay men. Self-esteem was tested to see whether it moderated or mediated the effects of perceived dual minority stress on psychological distress. Results revealed that sexual minority stress predicted self-esteem and both were predictors of psychological distress. Racial minority stress did not predict psychological distress. Contrary to the minority stress model existing in the current literature, the added disadvantages of racial/ethnic minority status did not increase Asian American gay men's psychological distress. Self-esteem did not mediate or moderate the relationships between minority stresses and psychological distress. These findings highlight the robust effects of stresses related to one'es homosexuality on psychological well-being and suggest that self-esteem may not always protect against multiple discriminations for Asian American gay men. © 2012 Wiley Periodicals, Inc.
Based on data gathered through a household survey of 1,474 urban residents in Beijing, this study examines Chinese help-seeking behaviors in times of psychological distress and perceived barriers to seeking professional help. The results demonstrate that most respondents rely on informal means of seeking help whereas mental health and medical services are underused. The Internet has become a preferred alternative help-seeking approach, particularly among the young educated migrant population. Respondents with higher socioeconomic status are more likely to utilize professional services. The tendency to seek help informally is associated with refusal to recognize the need of professional help, whereas embarrassment and stigma are significant factors in the use of alternative services, particularly the Internet. In addition to showing a general lack of trust in professional mental health services, the more psychologically distressed subgroup also expressed concerns about the affordability of professional treatment.
In the last few years, transgender and gender nonconforming people have become more visible in our society, which has sparked a marked increase in awareness, interest, and attention among psychologists. Questions have emerged about the extent to which psychologists are able to work competently with this population. This article presents a framework for understanding key clinical issues that psychologists who work with transgender and gender nonconforming individuals will likely encounter in their clinical work. This article does not address the knowledge and skills required to provide services related to gender transition, but rather to provide other psychological services that these clients may need, in light of the high levels of gender-related victimization and discrimination to which they are exposed. An adaptation of the Minority Stress Model (Meyer, 2003) is presented and translated to incorporate the unique experiences encountered by transgender and gender nonconforming individuals. In particular, we examine adverse experiences that are closely related to gender identity and expression, resulting expectations for future victimization or rejection, and internalized transphobia. The impact of Minority Stress Model factors on suicide attempts is presented as a detailed example. Mechanisms by which transgender and gender nonconforming persons develop resilience to the negative psychological effects of these adverse experiences are also discussed. Recommendations for clinicians are then made to assist psychologists in developing competence in working with this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Transgender individuals encounter stigma related to nonconforming gender identity, contributing to elevated symptoms of depression, anxiety, and suicidality. Stigma toward transgender individuals (i.e., transphobia) poses significant barriers to employment and other areas of functioning. Transgender individuals with a history of mental health concerns may encounter double stigma. The present 2-part study was conducted to investigate experiences of double stigma, internalized stigma, and coping strategies for dealing with transphobia. In Study 1, quantitative findings with 55 transgender participants indicated that employed participants reported higher levels of stigma (both internalized and external). Higher levels of coping with stigma were associated with lower levels of stigma (both internalized and external). Higher levels of coping were reported by participants utilizing psychiatric medication, with lower levels of coping with mental health stigma in particular found among those receiving outpatient mental health services. In Study 2, a grounded theory analysis was conducted with 45 of these participants to identify coping strategies that transgender individuals use to deal with transphobia. Coping strategies were categorized into individual factors (gender normative coping, self-affirmative coping, emotional regulation coping, cognitive reframe coping); interpersonal factors (social-relational coping, preventative-preparative coping, disengagement coping); and systemic factors (resource access coping, spiritual and religious coping, and political empowerment coping). Findings of Study 2 also revealed the presence of disclosure strategies—decisions to reveal or conceal one’s transgender identity, and anticipatory stigma—expecting and preparing for prejudice and discrimination. Results suggest the need for interventions for transgender individuals to enhance coping with stigma and reduce internalized stigma.
Most societies are heavily organised around a dichotomous model of gender, and individuals are heavily policed on their conformity (or otherwise) to gender norms. This scrutinisation of gender has a profound impact on the identities and lived experiences of trans people, especially for those whose gender identity (or presentation) does not appear to match social expectations for that gender; or where someone's physical body in some way does not match the body conventionally associated with that gender. This might result in trans people avoiding certain situations to reduce the risk of being exposed. Based on a sample of 889 UK-based participants who self-defined as trans, the current paper explores situational avoidance with particular reference to gender identity and stage of transition. A key finding of this study concerned statistically significant associations between group (gender identity and stage of transition) and avoidance (or not) of certain situations, namely clothing shops, gyms, and public toilets. The implications of these findings for supporting trans people through transition – in particular, the real life experience – are also discussed.
Stigma occurs at both individual and structural levels, but existing research tends to examine the effect of individual and structural forms of stigma in isolation, rather than considering potential synergistic effects. To address this gap, our study examined whether stigma at the individual level, namely gay-related rejection sensitivity, interacts with structural stigma to predict substance use among young sexual minority men. Sexual minority (n = 119) participants completed online measures of our constructs (e.g., rejection sensitivity). Participants currently resided across a broad array of geographic areas (i.e., 24 U.S. states), and had attended high school in 28 states, allowing us to capture sufficient variance in current and past forms of structural stigma, defined as (1) a lack of state-level policies providing equal opportunities for heterosexual and sexual minority individuals and (2) negative state-aggregated attitudes toward sexual minorities. To measure daily substance use, we utilized a daily diary approach, whereby all participants were asked to indicate whether they used tobacco or alcohol on nine consecutive days. Results indicated that structural stigma interacted with rejection sensitivity to predict tobacco and alcohol use, and that this relationship depended on the developmental timing of exposure to structural stigma. In contrast, rejection sensitivity did not mediate the relationship between structural stigma and substance use. These results suggest that psychological predispositions, such as rejection sensitivity, interact with features of the social environment, such as structural stigma, to predict important health behaviors among young sexual minority men. These results add to a growing body of research documenting the multiple levels through which stigma interacts to produce negative health outcomes among sexual minority individuals.
We focus on the general issue of how and why individuals might decide if they have been victims of gender discrimination and how social status differences between women and men may change the significance of experiencing gender discrimination. Because both self-protective and situational factors have been found to influence interpretation of prejudicial events, in the present study we explore several individual-difference factors that might differentially predict perceived gender discrimination in women and men. We found that, for men, low self-esteem and high personal assertiveness were related to higher ratings of personal discrimination. Low self-esteem was also related to men's perceptions of discrimination against men as a group. For women, high need for approval was negatively related to perceptions of personal discrimination whereas depression was positively related. Depression was also related to higher ratings of discrimination against women, as was feminism. We argue that perceptions of discrimination serve different purposes for structurally privileged and disadvantaged groups.