"You Aren't Alone": An Analysis of Trans Latinas' Use of Instagram

Social media platforms, such as Instagram, provide space for marginalized groups to connect, learn about and express themselves, and cultivate community. Trans Latinas, a group target of violence and discrimination, resist by expressing themselves and building community through social media. As cisgender researchers, we explored how trans Latinas use #translatina on Instagram as a shared space to present themselves and their identities, to leverage this knowledge in our fields. We analyzed 134 posts in February and March of 2020 employing basic and interpretive content analyses while considering Goffman's theory of presentation of self. Results showed that trans Latinas mostly presented individually through posed selfies taken near the camera, using a straight camera angle, standing, not smiling, and making eye contact. Most users wore makeup, styled hair, and accessories. Analyzing written captions and photos, four themes were constructed to understand how trans Latinas presented their identities and connected with others: (1) expressions of beauty and femininity, (2) fostering community, (3) commercial or work, and (4) feeling good and confident. These results have implications for mental health and health promotion practices, as social media could serve as affirming spaces for trans Latinas to reinforce their self-determination, maintain a sense of self, and build community.

Religion/Spirituality, Stress, and Resilience Among Sexual and Gender Minorities: The Religious/Spiritual Stress and Resilience Model

Although many sexual and gender minorities (SGMs) consider themselves religious or spiritual, the impact of this religiousness or spirituality (RS) on their health is poorly understood. We introduce the religious/spiritual stress and resilience model (RSSR) to provide a robust framework for understanding the variegated ways that RS influences the health of SGMs. The RSSR bridges existing theorizing on minority stress, structural stigma, and RS-health pathways to articulate the circumstances under which SGMs likely experience RS as health promoting or health damaging. The RSSR makes five key propositions: (a) Minority stress and resilience processes influence health; (b) RS influences general resilience processes; (c) RS influences minority-specific stress and resilience processes; (d) these relationships are moderated by a number of variables uniquely relevant to RS among SGMs, such as congregational stances on same-sex sexual behavior and gender expression or an individual's degree of SGM and RS identity integration; and (e) relationships between minority stress and resilience, RS, and health are bidirectional. In this manuscript, we describe the empirical basis for each of the five propositions focusing on research examining the relationship between RS and health among SGMs. We conclude by describing how the RSSR may inform future research on RS and health among SGMs.

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.

Individuals who are transgender or nonbinary experience a higher prevalence of certain mental health concerns, including depression, anxiety and disordered eating behaviours. In this Review, Tebbe and Budge discuss these disparities along with factors that protect these individuals from negative outcomes and promote well-being.

"Truly Listen to Us": Recommendations for Health Professionals to Bolster Wellbeing of Nonbinary Individuals

Trans-affirming providers play significant roles in the health and wellbeing of nonbinary individuals. Yet, healthcare mistreatment is well-documented among gender-diverse patients, leading to clients withholding information and avoiding care for fear of experiencing bias. Concurrently, healthcare providers report feeling ill-equipped to serve nonbinary patients, often perpetuating cisnormative binary attitudes. The literature has established the challenges to accessing healthcare and the need for gender-affirming care. However, little is known about nonbinary people’s perspectives on how best to deliver gender-affirming care that is inclusive of nonbinary patients. This participatory action PhotoVoice study identified community member recommendations for healthcare providers to bolster the wellbeing of nonbinary individuals through improved access to gender-affirming healthcare. Data were collected through group discussions, photography, and photo-elicitation interviews. Drawing upon research results, the authors identify recommendations for improving interpersonal care, increasing access to gender-affirming care, and advocating for related environmental and policy changes.

The relationship between minority stress factors and suicidal ideation and behaviours amongst transgender and gender non-conforming adults: A systematic review

BACKGROUND

The impact of Minority Stress (MS) upon suicidal ideation and behaviours amongst Transgender and Gender Non-Conforming (TGNC) adults is not sufficiently understood, hence our intervention efforts on an individual and societal level are limited. This review aims to evaluate recent literature that reports on the association between MS and suicidal ideation and behaviours amongst TGNC adults.

METHODS

PsycINFO, Web of Science, MEDLINE, CINAHL and EMBASE were systematically searched for relevant articles. Peer reviewed and grey literature were considered. Included papers reported quantitative analyses on associations between MS factors and suicidal ideation and behaviours amongst TGNC adults. The quality of papers was assessed.

RESULTS

28 papers were identified as eligible. Findings suggested positive associations between external and internal minority stressors and suicidal ideation and behaviour. Dysfunctional individual coping was associated with a greater likelihood of suicide attempts. Community resilience was negatively associated with suicidal outcomes, but did not consistently buffer the effects of minority stress.

LIMITATIONS

Overall quality of included papers was 'poor'. Almost all papers were cross-sectional by design, therefore causality cannot be inferred. Many papers measured variables using non-standardised measures undermining the reliability and validity of reported results.

CONCLUSIONS

Findings offer support to the application of MS theory to the understanding of suicidal ideation and behaviour amongst TGNC. Future research should use standardised measures and longitudinal designs to better support the investigation of directionality and causality. More research is needed to understand the complex interactions between minority stress factors and the role of resilience in this population.

Experiences of Female Partners of People Transitioning Gender: A Feminist Interpretive Metasynthesis

The needs of romantic partners of people transitioning gender remain neglected within academia and gender services. Following a systematic search, nine studies relating to female partners' experiences were subjected to a thematic metasynthesis. Four themes were generated and entitled Changes in sexual relationship; New roles and responsibilities; Identity and belonging; and Transformation and loss Results are considered in relation to the dominance of the gender-affirmation discourse. Limitations of the review and reviewed studies are highlighted. Clinical implications for couples and partners of people transitioning gender are offered.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

Psychological Functioning in Non-binary Identifying Adolescents and Adults

Gender diverse individuals who do not conform to society's binary gender expectations are more likely to experience difficulties in acceptance and in recognition of gender, compared to binary-identifying transgender people. This may accentuate the feeling that their gender identity is not socially recognized or validated. This study aimed to investigate psychological functioning among gender diverse adolescents and adults who identify beyond the binary gender spectrum. In both study populations, 589 clinically-referred gender diverse adolescents from the UK (n = 438 birth-assigned females and n = 151 birth-assigned males), and 632 clinically-referred gender diverse adults from the Netherlands (n = 278 birth-assigned females and n = 354birth-assigned males), we found that a higher degree of psychological problems was predicted by identifying more strongly with a non-binary identity. For adolescents, more psychological problems were related to having a non-binary gender identity and being assigned female at birth. In the adult population, experiencing psychological difficulties was also significantly related to having a stronger non-binary identity and having a younger age. Clinicians working with gender diverse people should be aware that applicants for physical interventions might have a broader range of gender identities than a binary transgender one, and that people with a non-binary gender identity may, for various reasons, be particularly vulnerable to psychological difficulties.

"We're just two people in a relationship": A qualitative exploration of emotional bond and fairness experiences between transgender women and their cisgender partners

Trans-including couples experience systemic marginalization impacting their relationships, yet studies on these relationships or narratives of strength are few. The purpose of this qualitative study was to explore emotional bonding and perceptions of fairness between transgender women and their cisgender partners. Interpretative Phenomenological Analysis was utilized to answer the research question: What are the experiences of emotional bond and fairness between transgender women and their cisgender partners? This research was situated within frameworks of minority stress, romantic attachment, and contextual therapy. Seven couples of transgender women and cisgender partners were interviewed. Three themes emerged: Minority Stress Contexts and Relational Strengths; The Experience of Emotional Bond; and Negotiating Balance. Processes of boundary creation, attunement, affirmations, and balance of care were noted. Findings reframe partner relationships as opportunities to construct transphobia-resistant and resilient narratives. Recommendations for clinicians include prioritizing the couple subsystem as an avenue for building resilience against minority stress.

A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced

There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care.

Tracking trends of transgender health research online: are researchers and the public on the same page?

Altmetric Explorer was searched for the most popular online articles published in Pubmed-indexed journals. The 75 articles with the highest Altmetric Attention Score (AAS) were screened for article information (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). The reviewed articles displayed a mean AAS of 241.52, were broadcast 17.03 times by news agencies, posted on Twitter 101.47 times, downloaded by 67.21 Mendeley readers, and received 62.67 citations. There was intense online interest in the transgender health literature, mainly related to mental health and social well-being. Online visibility of transgender health articles was not significantly correlated with citation counts, implying that the public, likely including transgender persons and allies, may place emphasis on different health issues than scholars. Monitoring altmetrics and interactions on electronic media may help researchers conduct research that is more meaningful to transgender individuals, and to society in general.

Experiences of transgender men in seeking gynecological and reproductive health care: a qualitative systematic review

OBJECTIVE

The objective of this review was to evaluate the experiences of transgender men in seeking gynecological and reproductive health care.

INTRODUCTION

Discrimination has led to barriers in care for the transgender community. This is most evident in gender-based care such as gynecological care. Transgender men may continue to require gynecological and reproductive health care despite having a masculine identity and appearance. It is crucial that transgender men have access to gynecological and reproductive health care that is culturally and clinically competent. This review aimed to identify and synthesize the available qualitative data about their experiences in seeking gynecological care.

INCLUSION CRITERIA

This review considered all studies that included natal females who identified as transgender men, gender non-binary, gender expressive, or gender queer. It included studies that explored the experiences of transgender men seeking gynecological care, obstetrical care, fertility care, or reproductive care in all care environments. As patient experience was the primary focus of the review, only qualitative studies where the data were analyzed into findings and where participant voice was prominent were included.

METHODS

The databases searched included CINAHL Complete (EBSCO), PubMed, PsycINFO (EBSCO), PsycArticles (EBSCO), ScienceDirect All Subscribed Content (Elsevier), and Web of Science. Sources of unpublished studies and gray literature searched included Google Scholar, MedNar, and ProQuest Dissertations and Theses. Databases were searched between November 2018 and January 2019. Searches were limited to studies published in English after 1979.

RESULTS

Twenty-six studies met the inclusion criteria. There was a mix of studies that included only transgender men, as well as studies that included other types of participants. Appraisal of quality was undertaken by two independent reviewers and revealed common concerns found in qualitative reporting. These concerns included the researchers not acknowledging the impact they have on the data and vice versa, as well as not clearly stating the paradigm and methodological underpinnings of the research. All studies that met the inclusion criteria were included in the review regardless of quality appraisal. The 26 included studies comprised 874 participants. They yielded 86 findings and accompanying illustrations. These were categorized into 14 categories and further synthesized into five findings: i) negotiating the binary system, ii) navigating the cis-normative world, iii) healthcare access adaptive behaviors, iv) verbal and nonverbal discrimination, and v) provider knowledge and trustworthiness.

CONCLUSIONS

The findings of this review revealed that transgender men face specific challenges in accessing gynecological and reproductive care. The strictly binary system requires patients to be either male or female, and does not allow for any variation in gender. Gynecological and reproductive spaces and resources are geared exclusively toward heterosexual female clients. Transgender men face discrimination that requires they develop adaptive behaviors. While some of these barriers will not be easily overcome, transgender men feel more comfortable and empowered to seek care when their providers are trusted and knowledgeable about their individualized needs. Recommendations put forth as a result of this review cover policy change, changes to education for staff and providers, changes to academic curricula, and further research.

Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study

While the COVID-19 pandemic in the United States disproportionately impacts marginalized communities, no empiric US-based research has focused specifically on transgender and gender nonbinary (TGNB) people. We examined the pandemic's impact on an established longitudinal cohort of TGNB individuals (N = 208) by administering an online survey between March-June 2020. We used multivariable linear regression to examine reduced LGBTQ/TGNB community support and disruptions in gender-affirming health care as predictors of psychological distress during the pandemic. We found that the pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic. Interruption and/or delay in gender-affirming health care was not associated with increased psychological distress during the pandemic. Special attention is needed to address the unique ways in which TGNB individuals were affected by the COVID-19 pandemic. This includes increasing access to LGBTQ/TGNB community support and addressing long-standing health disparities.

Content analysis of Journal of Genetic Counseling research articles: A multi-year perspective

Content analyses of published papers in journals inform readers, editors, and members of the profession about historical publication patterns and how the journal has represented the field. This study is a content analysis of original research papers published in the Journal of Genetic Counseling from January 2011 through December 2017. This is the first study of its kind for the flagship journal of the National Society of Genetic Counseling. Of 794 papers published in the 7-year period, 428 were original research included in the analysis. Content analysis yielded categories reflecting the types of data analyses, genetic counseling practice specialties, characteristics of the study sample, and major topics/issues investigated in each study. There was an overall positive linear trend in the number of articles published during this period (p = .002). Approximately equal percentages of studies used qualitative (34%), quantitative (31%), and mixed (35%) analyses, and these proportions did not vary significantly across volumes (p = .73). Cancer (27%), prenatal (13.3%), and general genetics (12.6%) were the most prevalent specialties represented. The number of studies about prenatal and pediatrics was less, and the number of studies about neurogenetics was greater than would be expected based on the clinical workforce (p<.001). Patients were the most common sample (55.6%). While there was a significant increase in the number of articles with diverse samples (p = .001), the proportion of such articles did not increase over time (p = .86). The most common content areas were genetic counseling practice (16.8%); attitudes, perceptions, and beliefs about genetics services (16.1%); and decision-making (14.5%). In contrast, relatively few studies focused on laboratory genetic counselor, male, gender non-conforming, and adoptee populations. The trends and gaps highlighted in this content analysis can inform future research endeavors.

Broaching partially-shared identities: Critically interrogating power and intragroup dynamics in counseling practice with trans people of Color

Background: Much of the literature on transgender and nonbinary (TGNB) experiences in counseling focuses on White experiences with few recommendations for trans people of Color (TPOC). Research suggests mental health care providers lack intersectional sensitivity with TPOC, lack knowledge of TGNB issues and engage in microaggressive behaviors, notably with Queer-identified clinicians. Aim: To explore issues of power and privilege in the counseling relationship with Queer-identified clinicians and apply the multidimensional model of broaching behavior with TGNB clients of Color. Method: A critical review of conceptual and empirical literature focusing on the interaction and impact of client and clinician race, gender, and sexual/affectional identities in the counseling relationship is presented. Informed by the authors' counseling experiences and respective positionalities as a Black Queer ciswoman and a White Queer transman, the multidimensional model of broaching behavior is applied to a composite case vignette. Results: The model provides a practical tool to facilitate critical conversations of power, privilege and identity in the counseling relationship. Conclusion: With a dearth of scholarship addressing the role of cisgender or White privilege in the counseling relationship, this article outlines strategies to broach issues partially-shared identities with TGNB clients of Color. Recommendations for culturally informed counseling practice, supervision and research are also provided.

L or G or B or T: Matching Sexual and Gender Minorities with Subpopulation-Specific Interventions

Sexual and gender minorities (SGM) may benefit from psychological interventions tailored to specific subpopulations (e.g., lesbians, gay men, bisexual people, transgender people) given differing experiences with stigma. However, determining the inclusion/exclusion process for subpopulation-specific interventions is challenging and recommendations for this process are scarce. We developed and evaluated a matching procedure to place 1183 SGM participants into four targeted online interventions designed to reduce internalized stigma for lesbian, gay, bisexual, and transgender people. We evaluated participant attrition, efficacy, satisfaction with placement, and qualitative feedback across the four interventions. Results indicated that our matching procedure was time-efficient and largely successful in terms of low attrition, high satisfaction, and reaching segments of the SGM population not usually captured with the LGBT acronym. Based on these findings, we offer six practical guidelines for devising the inclusion/exclusion process or matching procedure for future subpopulation-specific SGM interventions studies.

Growth from adversity in trans and gender diverse people of color

BACKGROUND

Trans-negativity and gender-based discrimination negatively impact on the wellbeing and mental health in transgender (trans) and gender diverse people (TGD). There is limited research on TGD people thriving under adversity, and no research to date has considered TGD people of color in this context.

METHOD

We used the Post-Traumatic Growth Inventory (PTGI-X) to survey 125 TGD people of color and 625 white TGD adults (18 to 68 years old, M = 26.0, SD = 9.2) about their experiences of growth from adversity. Confirmatory factor analysis (CFA), using sub-sampling to compensate for our unequal sample sizes, supported a five-factor structure of the PTGI-X consisting of growth in relating to others, finding new possibilities, personal strength, greater appreciation of life, and spiritual/existential change. Measurement invariance tests confirmed configural, metric, and scalar invariance of this structure across the two TGD subgroups.

RESULTS

A MANOVA revealed that growth from adversity in TGD participants was generally greater than that reported by people who have recently been exposed to a traumatic event. T-tests revealed that TGD people of color experienced more growth in terms of relating to others and more personal strength than white TGD participants. Subsequent hierarchical regressions revealed that race moderated associations between PTGI-X scores and personal well-being, with TGD people of color reporting more benefits (more well-being) at high levels of growth but also more deficits (less well-being) at low levels of growth than the white TGD subgroup.

CONCLUSION

The results support the use of the PTGI-X with TGD populations and across racial TGD subgroups and indicate that growth from adversity is not only prevalent in TGD people but also relevant to positive outcomes, particularly in TGD people of color.

The Presenting Concerns of Transgender and Gender Nonconforming Clients at University Counseling Centers

There is a paucity of research on transgender and gender nonconforming (TGNC) students who present to university counseling centers (UCCs). Using national-level data from the Center for Collegiate Mental Health (2012 to 2015), the current findings indicate that TGNC students seeking services at UCCs are presenting with high acuity and more severe concerns than their cisgender peers. This severity is in nearly every clinical domain including suicidality, history of hospitalization, trauma history, mood disorders, and family distress. Comparing the transgender and gender nonconforming (GNC) collegiate clients, GNC clients have the highest levels of distress and clinical symptoms on nearly every indicator. Overall, these findings for both transgender and GNC clients provide important information for UCCs about treatment and outreach to these high-risk populations. Our findings also mirror the mental health disparities seen in noncollegiate community TGNC samples. We discuss treatment implications, limitations, and suggestions for future research.

Coping with discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals

OBJECTIVES

We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses.

METHOD

This online study included 695 TGD individuals ages 16 years and over (M = 25.52; standard deviation = 9.68).

RESULTS

Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained.

CONCLUSIONS

Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in the internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate possible avenues for interventions to bolster adaptive coping responses for TGD people and highlight that actions to decrease discrimination are urgently needed.

Thinking about ethnicity and gender diversity in children and young people

BACKGROUND

Little is known about how social and cultural variants interact with gender identity development. This article aims to identify the ethnicities of children and young people referred to the United Kingdom's national Gender Identity Development Service (GIDS), and compare the ethnicity data with the UK child population and referrals to Child and Adolescent Mental Health Services (CAMHS).

METHODS

GIDS referrals made between April 2012 and April 2015 for children and young people were retrieved. Ethnicity data were obtained by the '16 + 1' ethnicity list. Chi-square and t-tests were performed on the demographics.

RESULTS

Less than 10% of the 995 referrals at GIDS were from Black and minority ethnic (BME) groups - an underrepresentation as compared with both the national population and CAMHS figures. No significant differences in ethnic representation were found between the demographic birth-assigned sexes, across age groups, or year of referral.

CONCLUSIONS

Hypotheses proposed for this underrepresentation take into account both the potential barriers to accessing services and the possibility of cross-cultural variations in the conceptualisations of gender, gender roles and gender diversity. Ethnicity, culture and religion, and their overlapping relationship with gender need further exploration.

Distress and Therapeutic Outcomes Among Transgender and Gender Nonconforming People of Color

Transgender and gender nonconforming (TGNC) People of Color experience stressors unique to both TGNC and racial and/or ethnic minority communities, resulting in disparities in mental health. Guided by minority stress and intersectionality theories, we examined initial anxiety and depression, as well as changes in symptoms, in 41,691 clients from the Center for Collegiate Mental Health 2012–2016 dataset. We sought to understand disparities that may exist in distress and therapeutic response between TGNC and cisgender clients. We also examined the intersection of gender and racial and/or ethnic identities to examine how these trends differ for TGNC People of Color. Results from hierarchical linear modeling indicated greater symptom severity, but a slower remission of symptoms of depression and anxiety, among TGNC clients. Interaction effects were nonsignificant; however, TGNC Clients of Color experienced more distress than either White TGNC clients or cisgender Clients of Color. On average, TGNC clients, compared to cisgender clients, utilized an additional 2.5 sessions of therapy.

Pretreatment counseling experiences, stressors, and support differences between transgender and cisgender university students seeking mental healthcare

OBJECTIVES

Our aim was to explore rates of prior counseling experiences as well as pretreatment stressors and supports among transgender university students seeking psychotherapy services in university counseling centers.

METHODS

We used regression models to explore relationships between gender identity and prior mental health experiences, risk-related experiences, traumatic experiences, and support among clients (cisgender: n = 162,305; transgender: n = 545) seeking treatment at 136 university counseling centers.

RESULTS

Results demonstrate more previous mental health service utilization and greater frequency of some prior stressors transgender clients. Findings indicate the odds of transgender clients reporting drug and alcohol concerns are lower than the reference group. Additionally, transgender clients report less familial support but more social support than cisgender clients.

CONCLUSION

We discuss the importance of these findings through a more holistic lens that recognizes both stressors as well as positive factors that may more accurately characterize the experiences of transgender clients.

"I love you as both and I love you as neither": Romantic partners' affirmations of nonbinary trans individuals

Background: Transgender microaffirmations are subtle endorsements of a person's gender identity through both verbal acknowledgements and behavioral gestures. Microaffirmations positively impact individuals who identify as transgender by acknowledging their gender identity and by communicating a sense of support and validation. Aims: This study focuses on microaffirmations specifically directed toward nonbinary transgender individuals within romantic relationships. Methods: Participants included 161 adults who identified as nonbinary: 85 who identified as gender nonconforming and 76 who identified as agender. These participants were either currently in a romantic relationship or had been in a romantic relationship within the past 5 years. Participants completed an online survey and provided examples of the microaffirmations they experienced from their romantic partners. Results: Responses were analyzed via thematic analysis, resulting in four overarching themes: (1) Identity Validations, acknowledgement and acceptance of nonbinary identity; (2) Identity Endorsements, active endorsements of nonbinary through language or behavior; (3) Active Learning, self-education about nonbinary identities; and (4) Active Defense, interruptions of others' negative actions directed at nonbinary partners. Discussion: Discussion of the results focuses on understanding how microaffirmations operate to complicate binary notions of gender/sex and positively influence nonbinary transgender individuals in interpersonal relationships.

Psychological Interventions Promoting Resilience Among Transgender Individuals: Transgender Resilience Intervention Model (TRIM)

Transgender people experience disproportionately high mental and physical health risks. Minority stress theory identifies distal and proximal stressors that contribute to negative mental health outcomes for transgender people, and suggests that resilience factors can buffer the negative influence of these stressors. In this article, we aim to synthesize the psychological literature on resilience strategies among transgender people and position it within the minority stress framework and introduce an adapted model called the transgender resilience intervention model (TRIM). The TRIM suggests that social support, community belonging, family acceptance, participating in activism, having positive role models, and being a positive role model are group-level resilience factors. Self-worth, self-acceptance and/or pride, self-definition, hope, and transition are individual-level factors that promote resilience. Community, group, and individual interventions and their potential influence on resilience are discussed. The model calls for the development of additional interventions aimed at increasing resilience for transgender people.

Transactional Pathways of Transgender Identity Development in Transgender and Gender Nonconforming Youth and Caregivers from the Trans Youth Family Study

BACKGROUND

A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using narratives from both transgender and gender nonconforming (TGN) youth and their cisgender (non-transgender) caregivers.

METHODS

The sample included 16 families, with 16 TGN youth, ages 7-18 years, and 29 cisgender caregivers (N = 45 family members). TGN youth represented multiple gender identities, including trans boy (n = 9), trans girl (n = 5), gender fluid boy (n = 1), and girlish boy (n = 1). Caregivers included mothers (n = 17), fathers (n = 11), and one grandmother. Participants were recruited from LGBTQ community organizations and support networks for families with transgender youth in the Midwest, Northeast, and South regions of the United States. Each family member completed a one-time in-person semi-structured qualitative interview that included questions about transgender identity development.

RESULTS

Analyses revealed seven overarching themes of transgender identity development, which were organized into a conceptual model: Trans identity development, sociocultural influences/societal discourse, biological influences, family adjustment/impact, stigma/cisnormativity, support/resources, and gender affirmation/actualization.

CONCLUSIONS

Findings underscore the importance of assessing developmental processes among TGN youth as transactional, impacting both youth and their caregivers.

The Intersection of Race, Sexual Orientation, Socioeconomic Status, Trans Identity, and Mental Health Outcomes

The present study examined patterns in trans individuals’ multiple identities and mental health outcomes. Cluster 1 (socioeconomic and racial privilege; n = 239) was characterized by individuals who identified as trans women or cross-dressers, lesbian, bisexual, or questioning; had associates degrees; reported household incomes of $60,000 or more a year; and were non-Latino White. Cluster 2 (educational privilege; n = 191) was characterized by individuals who identified as trans men or genderqueer, gay, or queer; had a bachelor’s degree; reported household incomes of $10,000 or less a year; and were people of color. There was a pattern of individuals in Cluster 1 who identified with two privileged identities (identifying as White and having higher household incomes), whereas individuals in Cluster 2 identified only formal education as a privilege. Individuals in Cluster 2 reported statistically significant levels of anxiety. Implications of these results for future research and clinical practice are examined.

Major Contribution Reaction

The author of this invited reaction comments on the four articles within the Major Contribution titled “Research on Trans People and Issues.” The Major Contribution authors have successfully met the three goals they set for this work: to (a) review the current state of psychosocial trans scholarship and identify next directions, (b) propose a critical research approach to decision making in trans study activities, and (c) exemplify how this critical research approach may be applied within an empirical study with trans participants. The Major Contribution is a next step in the long history of advocacy for trans researchers to be more attentive to centering the voices of trans people. In this reaction, I enthusiastically support the spirit of the Major Contribution, provide feedback on the articles, and encourage the trans research field to implement the authors’ recommendations and continue to look for ways to reach further toward supporting trans liberation.

Enhancing Scholarship Focused on Trans People and Issues

Scholarship about lesbian, gay, bisexual, and transgender (LGBT) people and issues has been growing. However, trans issues are often overlooked or addressed only nominally in this literature, leading to calls for further focused attention to trans people and issues. In a series of articles, this Major Contribution addresses such calls by (a) providing a content analysis of scholarship about trans people and issues, (b) discussing methodological considerations and strategies for conducting research with trans populations, and (c) presenting an empirical study that addresses how intersecting identities (e.g., ethnicity/race, sexual orientation, socioeconomic status) combine in relation to trans people’s mental health. This article provides a context for the Major Contribution and offers an overview of each of the component articles.