Reimagining the Cis-Stem: Exploring Health and Well-Being Among Transgender and Gender Diverse Young Adults

Background and Purpose: Individuals who identify as transgender and gender diverse (TGD) are among the most vulnerable and stigmatized groups in society. In the United States, there are approximately 1.6 million transgender individuals aged 13 years and older. As TGD populations continue to grow there is a greater need to understand the lived experiences of TGD folx, including experiences related to health care services. Addressing challenges related to health care is often complicated due to an overall lack of understanding regarding the health needs of TGD populations and traditional deficit-based health care approaches to TGD health. There is a greater need to understand the lived experiences of TGD folx, specifically as it relates to the nuances associated with how TGD young adults conceptualize health and overall well-being beyond deficit-based models of care. To date, there are no known studies that have adopted an explicitly intersectional strengths-based perspective on examining health and well-being among TGD young adults. This study explores what is working well across multiple domains of TGD young adults’ experiences of health and well-being employing qualitative research methodologies. The following research questions were explored: (1) How do transgender and gender diverse young adults define and understand health and well-being? and (2) What protective factors (i.e., strengths, assets, resources) have contributed to the health and well-being of transgender and gender diverse young adults?

Method: This was an exploratory qualitative study that employed semi-structured interviews among TGD young adults (N=14) aged 19-25 years (M=23, SD=1.8). This study also recruited and paid a Community Advisory Board (CAB), comprised of healthcare professionals and TGD folx, to guide the research process. Data were transcribed verbatim and analyzed using Thematic Analysis.

Results: Analysis revealed that TGD young adults conceptualize health and well-being through two key themes and corresponding sub-themes. Theme one, Separate, but Connected: Perceptions of Health and Well-Being included three subthemes: The Balancing Act of Health and Well-Being; Health and Well-Being are Community; and Experiencing Health and Well-Being Through Multiple Lenses. Theme two, Navigating Gender Pathways Through Health and Well-Being also included three subthemes: Expert Opinion: Me, I’m the Expert, It’s Me; Embracing the Mess of Progress; and Body Neutrality = Wellness Goals. TGD young adults highlighted the positive impact that health care providers had on their gender journeys by providing affirming treatment options, treating them as experts of their gender identity and sexual orientation, and through actionable accountability as they navigated evolving TGD medical landscapes.

Conclusions and Implications: This study provides a rich, detailed analysis of TGD young adults’ health care experiences through a strengths-based and intersectional lens. Addressing TGD young adults’ needs related to health and well-being requires understanding how they experience health and well-being within systems. Systems that are affirming, compassionate, and focused on providing comprehensive trans and gender diverse care are well- positioned to enhance TGD young adults’ overall well-being and improve health outcomes.