Debra A. Hope’s research while affiliated with University of Nebraska–Lincoln and other places

Introduction One way that transgender and gender diverse (TGD) people may affirm their gender is through a legal name and/or gender marker change. Legal gender affirmation is associated with less psychological distress, but research has yet to expand upon the mechanisms that may help explain this association. We examined associations between legal gender affirmation, psychological distress, and physical health in TGD people, as well as the mediating effect of exposure to enacted stigma. Methods Data are from the baseline portion of a longitudinal mixed-methods study of how sociopolitical contexts influence marginalization, health, and resilience for TGD people. The study included 158 TGD participants from Oregon, Michigan, Nebraska, and Tennessee. Baseline data were collected September 2019–March 2020 (the overall study concluded Fall 2021). Results Latent variable structural equation model analyses revealed that participants who had legally affirmed their gender reported less enacted stigma, which was associated with less psychological distress and physical health issues. There was a significant indirect effect via enacted stigma, such that this variable may partially help explain why legal gender affirmation is associated with better health outcomes. Conclusions Legal gender affirmation is likely to influence TGD people’s health and well-being by shaping exposure to minority stress—specifically, enacted stigma. Our findings demonstrate the importance of sociopolitical factors in health outcomes for TGD people. Policy Implications Given the health benefits of legal gender affirmation and the potential protection from enacted stigma, policies should be revised to make legal name and/or gender marker changes more accessible for TGD people.

Presidential elections have the ability to influence the lives of transgender and gender diverse (TGD) people via their impact on governmental policies, inequalities, discrimination, and stigma. The 2020 U.S. presidential election through which Joe Biden and Kamala Harris were elected signaled a potential turning point following 4 years of increased inequalities harming TGD people during the Donald Trump and Mike Pence administration. This study examined mental health (i.e., anxiety, depression), resilience, and coping among TGD people (N = 158) living in Michigan (n = 39), Nebraska (n = 35), Oregon (n = 45), and Tennessee (n = 39) including baseline data collected Fall 2019–Spring 2020 and 12 monthly surveys spanning April 2020 to March 2021. Using a piecewise plus discontinuous intercept model, we examined changes in dependent variables leading up to the election, shifts in the intercept at the November time point, and changes in dependent variables postelection. Findings indicated that leading up to the 2020 election, participants had increased anxiety and depression and decreased coping and resilience. In November 2020, anxiety and depression decreased and coping improved. Postelection, the overall trajectories of change in anxiety, depression, coping, and resilience did not change significantly. However, trajectories of mental health, coping, and resilience differed based on several individual-level moderating factors, including access to local resources, participant age, experiences of enacted stigma, and levels of social support. These findings highlight the complexity of how societal events can affect the mental health, resilience, and coping of TGD individuals.

We examined transgender and gender-diverse (TGD) people’s reports of their therapy experiences over the course of a year. We explored how participants’ therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients’ internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants’ helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants’ unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients.

Transgender and gender diverse (TGD) individuals often must undergo a psychosocial assessment and receive a letter of support from a mental health care provider to access gender-affirming medical care (GAMC). This study describes TGD individuals' perceptions of barriers and benefits of the assessment process and uses thematic analysis to explore TGD individuals' opinions on how mental health care should or should not be related to gender-affirming medical care. Two hundred and eighteen TGD participants completed an online survey. Participants endorsed benefits and negative impacts associated with the psychosocial assessment and provided qualitative responses to explain their support or opposition to involvement of mental health care and assessment in accessing GAMC. Nearly all participants identified both benefits (e.g., "experienced validation") and barriers (e.g., "experienced an increase in psychological distress") to the psychosocial assessment. Results are considered in the context of the historical marginalization and gatekeeping of TGD people by the medical system.

Experiences of stigma and acceptance profoundly affect the lives of sexual and gender minority (SGM) individuals and are often dependent on context, such as geographic location. Through interviews with twenty sexual and gender minority individuals living in Nebraska, this study aimed to explore participants' experiences of rejection and acceptance in different spheres to better understand how stigma operates. Thematic analysis revealed primary themes of Stigma and Discrimination and Signs of Support. However, reports of stigma and acceptance were often complex and intertwined. For example, participants described that receiving support from others categorized as merely "tolerant" is positive, given their expectations of rejection when living in a politically conservative state. These findings offer a contextualized understanding of how stigma and support affect SGM individuals at individual, interpersonal, community, and political levels in an underserved state.

Purpose Transgender and gender diverse (TGD) individuals who choose to begin a gender affirmation journey often find the experience challenging. This can be a highly stigmatized process, and TGD consumers must strategically interact with brands and products to successfully construct authentic identities. Therefore, the purpose of this study was to obtain a better understanding of the TGD individual’s identity transformation within the consumption context. Design/methodology/approach Interviews were conducted with 27 TGD individuals about their gender affirmation journeys. The process of in vivo coding and thematic coding were applied for inductive analysis. Through subsequent analysis, parities with concepts from stigma management theory and Alvesson’s (2010) self-identity metaphors were identified. Findings The results of this study illustrated seven themes of TGD consumption patterns in relation to the gender affirmation journey. Awakening marks the watershed realization of a TGD identity, a cessation of some consumption habits and an emergence of new ones. Exhibiting is a form of information control and often transpired with new clothing purchases. Shifting one’s name and pronouns on identification documents is a means of covering. Remaking typically involves the procurement of medical services such as hormonal prescriptions and/or surgical procedures. Disclosing to individuals in one’s reference groups is a method of assessing (and maintaining) the wise, the curious and the oblivious. Rebelling against the stereotypes of masculinity and femininity in media portrayals and leisure activities is a technique to express one’s eccentricity and quirkiness. Finally, releasing describes the potentially waning TGD label and a somewhat stabilizing pattern of consumption. A model of TGD consumers is presented, and key assertions are discussed. Originality The variety and complexity of consumer purchases associated with gender affirmation journeys were investigated, and it was revealed that many of these consumption choices aided in the TGD individual’s stigma management as well. The key assertions presented here progress the literature on gender affirmation journeys by predicting patterns of consumption.