“Coming home to my body”: A qualitative exploration of gender-affirming care-seeking and mental health

Abstract

Introduction: Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons’ interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals’ self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants’ interest in gender-affirming care and how such interventions impact identity formation.

Method: We conducted semi-structured qualitative interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated.

Results: The most frequently sought gender-affirming care was hormone therapy, followed by chest (“top”) surgery, genital (“bottom”) surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired esthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/ or gender exploration. All who sought gender-affirming care reported improved mental health—including depression, anxiety, dissociation, and eating disorders—and social relationships, though many struggled to find TNG-competent mental health providers.

Conclusion: This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients.

Keywords:

• Gender-affirming care
• transgender
• non-binary
• nonbinary
• access barriers
• mental health

Ethics statement

This Columbia University Irving Medical Center Institutional Review Board approved this protocol prior to subject recruitment.

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

For participant privacy and safety, the complete dataset is not available to external parties. This was stipulated in the IRB forms.

Additional information

Funding

This project was funded by the Friedman Award, Columbia University Vagelos College of Physicians and Surgeons and the author’s time was partially funded by the R25MH119043 at the University of Pennsylvania, Department of Psychiatry.