Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33 years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.

Keywords:

• Transgender men
• non-binary
• healthcare
• stigma
• resistance

Acknowledgements

We express our appreciation to all of the individuals who participated in the Gender and Health research study and shared their stories. Thank you to Gus Klein for contributing to data analysis and providing feedback on a draft of this paper.

Disclosure statement

The authors declare that they have no conflicts of interest.

Notes

1 These data were collected before the publication of the most recent World Professional Association for Transgender Health’s Standards of Care (version 7), which does not require a patient to obtain a letter from a mental health provider to proceed with hormone therapy.

Additional information

Funding

Funding for this study was provided by the Johns Hopkins Center for Health Disparities Solutions and the Johns Hopkins Center for Public Health and Human Rights. None of the funders played any role in the collection, interpretation, or presentation of the data.