Beyond Dysphoria: A Model of Gender Fulfilment and Frustration for Transgender and Gender-Nonconforming People 

Background

Gender euphoria describes the positive emotional state associated with one's gender identity, which may be triggered by internal validation and external affirmation (correct pronouns). Although research links gender euphoria to well-being of transgender and gender nonconforming (TGNC) people, research on theory in this area is often derived from a deficits-based model of gender dysphoria, which is disempowering, characterizes gender identity as an endpoint, and has limited interpretive value

Methods

This research uses Grounded Theory to develop a theory of gender fulfilment from participant experiences. To explore the experiences of gender euphoria and fulfilment among TGNC people, this research employed a multi-study design with three interlinked qualitative studies, enabling the team to apply an iterative approach to data analysis. In total, 35 semi-structured Zoom interviews were conducted, each lasting 60-90 minutes. The first two groups consisted of 24 TGNC people who shared their experiences of health, mental health, gender euphoria, and fulfilment. The second group comprised 11 mental health providers who work with TGNC clients. These interviews explored the providers' experiences and practices related to supporting gender euphoria, joy, and fulfilment within their TGNC clients. Insights from earlier interviews with TGNC people about healthcare experiences informed subsequent interview questions with mental health providers about practices. To ensure rigor, a three-person research team triangulated data analysis; this team included members with lived experience outside the gender binary and expertise in mental health research.

Findings

Data analysis yielded a four-phase cycle of TGNC Gender Fulfilment and Gender Frustration: Phase 1: Identity Assessment: Due to feelings of frustration, people assess the fit between their assigned gender at birth (AGAB) and their internal sense of self. This phase involves internal affirmation (thoughts, feelings, bodily sensations) and external affirmation (perceived expectations of society, the TGNC community, and other salient identities) and is mediated by anticipated acceptance and perceived cultural norms. Phase 2: Identity Commitment: This phase marks a turning point where the person commits to a non-cisgender identity, acknowledging a non-cisgender experience. Phase 3: Identity Enactment: People take steps to express their gender identity authentically via both physical and social transitions. Physical and social transitions can influence each other, and both are continuous, potentially shifting as the person seeks greater authenticity. These transitions are fully mediated by the context of barriers like cost, time, and safety. Importantly, even if barriers prevent physical or social changes, the individual's TGNC identity continues to be internally experienced rather than let go, referred to as "The Fallacy of Gender Abandonment." Phase 4: Re-assessment: People reassess their feelings about identity, evaluating identity on two concurrent continuums: identity fulfilment and identity frustration, potentially leading to identity refinement.

Conclusion and Implications

This novel cyclical model of identity exploration for TGNC people highlights the interplay between internal and external affirmation and the continuous nature of identity expression. Importantly, the model emphasizes that a lack of physical or social transition does not negate a person's TGNC identity. Social workers can apply this model to understand TGNC people through a positive identity framework.