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Psychosocial assessment by a qualified mental health provider, colloquially referred to as "getting a letter," is recommended for transgender and gender diverse (TGD) individuals seeking gender-affirming medical care (GAMC). This study used an online survey to examine the logistics and overall affective responses of TGD adults (n = 134) to this process. Findings revealed that, to varying degrees, participants were involved in several steps to obtaining the letter, including seeing the letter before it was sent to medical providers. Overall, participants reported generally positive experiences with the process of "getting a letter" based on the affective measures of empowerment, stigma, helpfulness, and harm, with transgender women feeling more empowered than transgender men in the process. Documenting the lived experiences of TGD adults seeking GAMC is a critical step on the path to realizing health equity. [ABSTRACT FROM AUTHOR]

Background: Veterans Affairs (VA) implemented the Veteran-centered Whole Health System initiative across VA sites with approaches to implementation varying by site. Purpose: Using the Consolidated Framework for Implementation Research (CFIR), we aimed to synthesize systemic barriers and facilitators to Veteran use with the initiative. Relevance to healthcare quality, systematic comparison of implementation procedures across a national healthcare system provides a comprehensive portrait of strengths and opportunities for improvement. Methods: Advanced fellows from 11 VA Quality Scholars sites performed the initial data collection, and the final report includes CFIR-organized results from six sites. Results: Key innovation findings included cost, complexity, offerings, and accessibility. Inner setting barriers and facilitators included relational connections and communication, compatibility, structure and resources, learning centeredness, and information and knowledge access. Finally, results regarding individuals included innovation deliverers, implementation leaders and team, and individual capability, opportunity, and motivation to implement and deliver whole health care. Discussion and implications: Examination of barriers and facilitators suggest that Whole Health coaches are key components of implementation and help to facilitate communication, relationship building, and knowledge access for Veterans and VA employees. Continuous evaluation and improvement of implementation procedures at each site is also recommended. [ABSTRACT FROM AUTHOR]

Introduction: Despite increased attention to transgender and gender diverse (TGD) issues in psychological literature during the past decade, gaps remain for psychometric validation of TGD-specific measures. Kozee et al. (Psychology of Women Quarterly 36(2):179–196, 2012) addressed such gaps by creating the Transgender Congruence Scale (TCS), measuring gender acceptance and feelings of gender congruence between internal and external attributes across a broad range of gender identities. The current study extended Kozee and colleagues' work by further examining the psychometric properties of the TCS. Methods: Between October and November of 2017, 210 transmasculine, transfeminine, and gender diverse adults between ages 19 and 73 completed online surveys containing demographic, gender identity-specific, and well-being measures including the TCS. Results: Results of confirmatory factor analysis replicated the original two-factor model (Appearance Congruence and Gender Identity Acceptance), with the elimination of two poorly loading items, resulting in a 10-item reduced model (TCS-10). Higher scores on TCS-10 were associated with positive scores on gender-related well-being, congruence, and pride, positive affect, and life satisfaction, as well as lower scores on gender-related dysphoria, non-affirmation, internalized transphobia, and marginalization. There were modest but significant associations between Gender Identity Congruence and both depression and negative affect. Conclusions: Despite limitations of sample size and diversity of identities, the study reaffirmed the utility of the TCS as an overall construct of gender identity congruence with a 10-item reduced structure related to other established TGD constructs. Policy Implications: Though socio-political climate is the ultimate domain for alleviating TGD stigma and discrimination, factors such as gender congruence are essential areas of focus to foster resiliency. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Ensuring that mental health professionals are appropriately trained to provide affirming and sensitive care to transgender and gender diverse (TGD) adults is one mechanism that may reduce the marginalization sometimes experienced by TGD adults in mental health contexts. In this study, mental health professionals (n = 142) completed an online survey documenting the sources and types of training received to provide TGD-sensitive care; and, shared a self-assessment of their comfort, competence, and ability to provide TGD-sensitive care. Findings revealed that the majority of the mental health professionals in the study (approximately 81%) received specific training to work with TGD clients from a variety of sources. These mental health professionals also self-reported high levels of comfort, competence, and ability to offer TGD-sensitive care which were statistically significantly associated with the number of hours of TGD-specific training they had received. [ABSTRACT FROM AUTHOR]

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. Summary: 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. [ABSTRACT FROM AUTHOR]

Objective: Transgender and gender diverse (TGD) people face various challenges when seeking therapy. Given this, we wanted to understand more about TGD people's perceptions of providers and how these compare to researcher ratings of providers on metrics of affirming practice. Method: The sample included 158 TGD adults (Mage = 33.06); 57.6% were in therapy. Participants completed measures about mental health, resilience, and therapy. We systematically coded provider websites and intake forms. Results: Participants in therapy were older, had higher depression, and lower resilience than participants not in therapy. Non-binary/genderqueer participants rated providers as less knowledgeable compared to trans feminine participants. Overall, participants appeared satisfied (71.4% extremely satisfied) and viewed providers as at least moderately knowledgeable (89.1%). Provider coding revealed variation across the markers of affirmation; 66.04% identified a TGD-specialty and only 26.42% shared provider pronouns. Higher frequency of inclusivity (via coding) was related to higher ratings of provider knowledge and more of a focus on gender, however, there was not a significant association with satisfaction. Conclusions: Providers who engaged in more affirming practices were more knowledgeable compared to those who engaged in fewer affirming practices. This may influence the content of therapy and whether clients feel comfortable discussing gender. [ABSTRACT FROM AUTHOR]

Recommendations for health care providers working with transgender and gender diverse (TGD) individuals emphasize affirming clients' identities, such as using correct pronouns and name, however, it is unknown how often gender specialists adhere to such recommendations. Websites and intake forms of gender specialists were coded for use of affirming language, asking for pronouns and chosen name, and mention of TGD specialties and resources. Most websites identified the provider's specialty to work with TGD individuals, though much fewer provided additional resources concerning TGD issues and only half of intake forms included affirming language. Given previous research that has demonstrated providers working in states with legal protections for TGD individuals use affirming language more often than providers in locales without protections, association with state legal climate is also examined. [ABSTRACT FROM AUTHOR]

Community-based participatory research (CBPR) represents an important improvement in the integration of marginalized voices into research programs by including community members in the designs, conduct, and dissemination of studies. CBPR often features a social justice component, generating studies designed to reduce societal disparities and improve outcomes for disenfranchised groups. However, the practical implementation of CBPR usually fails to capitalize on this promise, using the same traditional research methodologies, leadership structures, trial designs, and research questions that inculcate researcher bias. In response to the problem, we propose a new solution: Applied critical rhetorical research (ACRR) integrated into the CBPR approach to clinical health research. ACRR research combines critical/cultural studies and rhetorical methods to amplify the figurative voice of marginalized populations. ACRR can expose how majority power (i.e., hegemony) manifests in social institutions like healthcare and government, where its meanings and subjectivities are absorbed. ACRR analyses enhance CBPR by shaping research in directions that reduce stigma, unintended disenfranchisement, and culturally bound bias, increasing the yield from CBPR for researchers and the community. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) individuals face a long-term, multifaceted process if they choose to begin a gender affirmation journey. Decisions to go on hormone therapy and/or have a surgical procedure necessitate the TGD individual to set up an appointment with a health care provider. However, when TGD patients interact with health care practitioners, problems can arise. This article documents and categorizes the types of unmet expectations that are common in the TGD patient–health care provider social dynamic in the Central Great Plains of the United States. Utilizing a community-based participatory research model, qualitative in-depth interviews were conducted with 27 TGD individuals about their health care experiences. From this, the researchers identified four main themes of unmet expectations: probing, gatekeeping, stigmatizing stance, and misgendering/deadnaming. Steps that can be taken by both the health care provider and the TGD individual to have a more successful encounter are discussed. [ABSTRACT FROM AUTHOR]

In recent years, the transgender and gender diverse (TGD) population has gained a stronger voice in the media. Although these voices are being heard, there are limits on the types of TGD representation displayed in media. The current study interviewed 27 TGD individuals. These interviews exposed how participants view the rise of TGD media representation. The main themes that emerged were TGD awareness and TGD identity discovery and role modeling. Clearly, there is a disconnect between transnormativity in the media and transnormativity in reality. [ABSTRACT FROM AUTHOR]

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers. Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if a positive State legal climate for TGNC people was associated with more affirmative provider materials. Methods: Content analysis was used to examine a national sample of websites and intake forms of mental healthcare providers who advertise online as working with TGNC clients. Intake forms were coded for usage of affirmative language in gender/sex questions and including questions for a client's pronouns and preferred name. Websites were coded for mentioning a variety of services or resources for TGNC clients. Results: While provider websites were found through Google searches for a "gender therapist," only 56.6% of websites stated a provider specialty to work with TGNC clients and 32.1% of websites had no mention of services or resources for TGNC people. Additionally, a significantly larger proportion of intake forms from States with legal protections for TGNC people used affirmative language in gender/sex questions and asked for a client's pronouns than intake forms from States without legal protections. Discussion: Barriers to affirmative healthcare for TGNC people within patient and provider interactions have been identified in previous research and these data show TGNC individuals may face enacted stigma even in their search for a provider, particularly those TGNC people living in States without legal protections. [ABSTRACT FROM AUTHOR]