Transgender and Gender-Diverse People's Experiences of Minority Stress, Mental Health, and Resilience in Relation to Perceptions of Sociopolitical Contexts

Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States

The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.

The Often-Circuitous Path to Affirming Mental Health Care for Transgender and Gender-Diverse Adults

PURPOSE OF REVIEW

We describe recent research regarding access to affirming mental health services for transgender and gender-diverse (TGD) adults and explore new resources available for therapists to inform evidence-based practice with TGD clients.

RECENT FINDINGS

Barriers and facilitators at all socioecological levels impact TGD adults' mental health help-seeking. TGD adults often interface with mental health providers while accessing gender-affirming medical care, though new standards of care are likely to alter this typically common path to mental health services. Efforts to improve therapist education, such as therapy manuals, are increasingly available and a necessary step to increase the number of competent, affirming therapists. More work-both advocacy and research-is needed to fully expand accessible, affirming mental health services for TGD adults. Better understanding factors impacting different steps of the mental health help-seeking process and conducting randomized controlled trials of affirming mental health services are important next steps.

Differentiating protective factors for transgender individuals who experience suicidality: The role of optimism as a mediator

As a result of experiencing oppression-based stressors and trauma, suicide rates for lesbian, gay, bisexual and transgender (LGBTQ+) individuals are much higher than in the general population, and for trans and gender non-binary (TGNB) individuals specifically, rates of suicidality are even higher. To best understand how to engage in suicide prevention and intervention efforts for TGNB individuals, it is therefore crucial to understand factors that may mitigate suicidality for TGNB individuals. The purpose of this study was to examine the relationship between protective factors-body acceptance, optimism, social support and pride-and suicidality for TGNB adults. A total of 139 TGNB participants completed an online survey about suicidal behaviours, transgender-specific risk factors and transgender-specific protective factors. High rates of suicidality were observed in our sample. Initial results suggested that only optimism was inversely significantly related to suicidality. Given that optimism, which suggests a belief in a better future, has been found in previous studies to buffer the effects of deleterious stressors, optimism was also examined as a mediator between body acceptance (a key feature of gender dysphoria) and suicidality. Results suggested that optimism did mediate the relationship between body acceptance and suicidality. Optimism appears to be an important protective factor against suicidality for TGNB individuals and thus a potentially important target of intervention.

Trans and Gender Diverse People's Experience Wearing Face Masks During the COVID-19 Pandemic: Findings from Data Across 4 States in the USA

Introduction

Social isolation and reduced access to public life in response to SARS-CoV-2 (COVID-19) challenges health and well-being for many. Marginalized communities, including transgender and gender diverse (TGD) people, have been disproportionally impacted. Experiences of TGD people should be centered in pandemic-related research to better inform policy.

Methods

A diverse sample of TGD people (N = 158) were recruited from Michigan, Nebraska, Oregon, and Tennessee to participate in the Trans Resilience and Health Study. Participants ranged from 19 to 70 years old (M = 33.06; SD = 12.88) with 27.2% identifying as trans men/men, 26% identifying as trans women/women, and remaining identifying with terms like genderqueer and nonbinary. Thirty percent identified as people of color. Participants completed a monthly COVID-19-related questionnaire April 2020-March 2021 including open-ended questions to learn what contributed to resilience during this time. Thematic analyses of responses enabled identification of salient themes.

Results

Analyses revealed pandemic-related changes in social experiences of marginalization and mask-wearing. Twenty-six participants mentioned face masks as contributing to resilience while also elaborating the influence of masks on experiences of misgendering. Participants identifying as trans women reported decreased misgendering while trans men and nonbinary participants reported increased misgendering.

Conclusions and Policy Implications

Mask-wearing helps reduce transmission of COVID-19. For some trans women, masks also reduce the threat of misgendering and possibly other forms of enacted stigma. However, increased risk for misgendering, as noted by trans men in our study, should be considered and increased supports should be provided.