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ORIGINAL ARTICLE Open Access
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.
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
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work
is properly credited.
Volume 1.1, 2016
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.
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.
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-
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.
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
SurveyMonkey.com 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.
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
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.)
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.
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
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
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
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
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,
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
4. Negative social messages
5. Intersection of race/ethnicity and gender-related stress
6. General coping with gender-related stress
7. Sources of support
9. Positive message to share with others
Table 3. Categories, Subcategories, Illustrative Core Ideas, and Frequencies Regarding the Expecting Rejection
Domain/category/subcategory Illustrative core idea Frequency
(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
(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
(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
(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
(2) Thoughts and feelings associated with expecting rejection General (30)
(a) Anxious/stressed/nervous Experiencing anxiety/nervous; experiencing general
stress; feeling overwhelmed
(b) Fearful/worried about safety/hyperaware Experiencing fear or terror; worrying about personal
safety or violence; feeling on alert or on guard
(c) Depressed/self-loathing/my fault Experiencing sadness/depression; picking self-apart/
self-denigrating; feeling like a burden/it is my fault
(d) Angry/frustrated with the situation and others Feeling anger/irritability/rage; feeling frustrated; feeling
like it is unfair
(e) Not supported/ignored/rejected Feeling ignored or invisible; thinking about the lack of
support; feeling rejected by others
(f) Physically exhausted by the end of the day Feeling physically exhausted by the end of the day;
feeling tightness in body; feeling shaky
(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
(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
(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
(b) Being White comes with privileges/decreases the expectation
Being White or perceived as White has privileges, and
lowers the expectation of rejection
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,
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-
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,
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
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
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
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-
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,
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
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.
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
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.
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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/
CQR ¼consensual qualitative research
TGNC ¼transgender and gender nonconforming
Appendix: Interview Questions for Expectations
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
[GENDER IDENTITY LABEL].
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
[GENDER IDENTITY LABEL]?
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?
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Rood, et al.; Transgender Health 2016, 1.1