https://doi.org/10.4081/qrmh.2023.11485
Seeking gender-affirming medical care: A phenomenological inquiry on skillful coping with transgender and non-binary adults in the United States Midwest
Submitted: 22 May 2023
Accepted: 19 November 2023
Published: 29 December 2023
Accepted: 19 November 2023
Abstract Views: 925
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
This study sought to understand how transgender and gender non-binary (TGNB) individuals skillfully cope with healthcare services and to explore how childhood experiences impact expectations, habits, and meaning-making when utilizing healthcare services. Using an interpretive phenomenological approach, we sampled 17, White TGNB adults in the United States, ages 19 to 57, using semi-structed interviews about childhood experiences with healthcare utilization and adult experiences seeking genderaffirming healthcare. Analysis identified one main theme—Anticipate the worst in healthcare and be pleasantly surprised—and three subthemes: i) contrast between positive childhood and negative adulthood experiences in medical care; ii) coping practices for the worst; and iii) finding your unicorn doctor and medical staff for pleasant experiences. Results indicate participants experienced a disruption and acquisition of new coping practices in healthcare settings and the cultivation of a radical imagination for a more liberated medical world for TGNB people. Implications for providers and medical offices for empowering TGNB adults are described.
Ali, N., Fleisher, W., & Erickson, J. (2016). Psychiatrists’ and psychiatry residents’ attitudes toward transgender people. Academic Psychiatry, 40(2), 268-273.
DOI: https://doi.org/10.1007/s40596-015-0308-y
Baldwin, A., Dodge, B., Schick, V. R., Light, B., Schnarrs, P. W., Herbenick, D., & Fortenberry, J. D. (2018). Transgender and genderqueer individuals' experiences with health care providers: what's working, what's not, and where do we go from here? Journal of Health Care for the Poor and Underserved, 29(4), 1300-1318.
DOI: https://doi.org/10.1353/hpu.2018.0097
Becker, I., Nieder, T. O., Cerwenka, S., Briken, P., Kreukels, B. P., Cohen-Kettenis, P. T., Cuypere, G., Haraldsen, I. R. H., & Richter-Appelt, H. (2016). Body image in young gender dysphoric adults: a European multi-center study. Archives of sexual behavior, 45(3), 559-574.
DOI: https://doi.org/10.1007/s10508-015-0527-z
Benner, P. (1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 99-127). Sage Publications.
DOI: https://doi.org/10.4135/9781452204727.n6
Bhattacharya, N., Budge, S. L., Pantalone, D. W., & Katz-Wise, S. L. (2021). Conceptualizing relationships among transgender and gender diverse youth and their caregivers. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 35(5), 595–605.
DOI: https://doi.org/10.1037/fam0000815
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
DOI: https://doi.org/10.1191/1478088706qp063oa
Brown, H. M., Rostosky, S. S., Reese, R. J., Gunderson, C. J., Kwok, C., & Ryser-Oatman, T. (2020). Blessing or BS? The therapy experiences of transgender and gender nonconforming clients obtaining referral letters for gender affirming medical treatment. Professional Psychology: Research and Practice, 51(6), 571.
DOI: https://doi.org/10.1037/pro0000274
Brown, S., Kucharska, J., & Marczak, M. (2018). Mental health practitioners' attitudes towards transgender people: A systematic review of the literature. International Journal of Transgenderism, 19(1), 4-24.
DOI: https://doi.org/10.1080/15532739.2017.1374227
Budge, S. L., Chin, M. Y., & Minero, L. P. (2017). Trans individuals’ facilitative coping: An analysis of internal and external processes. Journal of counseling psychology, 64(1), 12.
DOI: https://doi.org/10.1037/cou0000178
Budge, S. L., Katz-Wise, S. L., Tebbe, E. N., Howard, K. A., Schneider, C. L., & Rodriguez, A. (2013). Transgender emotional and coping processes: Facilitative and avoidant coping throughout gender transitioning. The Counseling Psychologist, 41(4), 601-647.
DOI: https://doi.org/10.1177/0011000011432753
CDC. (2023). Youth Risk Behavior Survey: Data Summary & Trends Report. Available from: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
Chisolm-Straker, M., Willging, C., Daul, A. D., McNamara, S., Sante, S. C., Shattuck II, D. G., & Crandall, C. S. (2018). Transgender and gender-nonconforming patients in the emergency department: what physicians know, think, and do. Annals of emergency medicine, 71(2), 183-188. e181.
DOI: https://doi.org/10.1016/j.annemergmed.2017.09.042
Coleman, E., Radix, A., Bouman, W., Brown, G., De Vries, A., Deutsch, M., Ettner, R., Fraser, L., Goodman, M., & Green, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(sup1), S1-S259.
DOI: https://doi.org/10.1080/26895269.2022.2125695
Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25.
DOI: https://doi.org/10.1177/1937586715614171
Dreyfus, H. L. (2014). Skillful coping: Essays on the phenomenology of everyday perception and action. OUP Oxford.
DOI: https://doi.org/10.1093/acprof:oso/9780199654703.001.0001
Dreyfus, H. L., & Hubert, L. (1991). Being-in-the-world: A commentary on Heidegger's Being and Time, Division I. Mit Press.
Fix, L., Durden, M., Obedin-Maliver, J., Moseson, H., Hastings, J., Stoeffler, A., & Baum, S. E. (2020). Stakeholder perceptions and experiences Regarding access to contraception and abortion for transgender, non-binary, and gender-expansive individuals assigned female at birth in the US. Archives of sexual behavior, 49, 2683-2702.
DOI: https://doi.org/10.1007/s10508-020-01707-w
Goldenberg, T., Jadwin-Cakmak, L., Popoff, E., Reisner, S. L., Campbell, B. A., & Harper, G. W. (2019). Stigma, gender affirmation, and primary healthcare use among Black transgender youth. Journal of Adolescent Health, 65(4), 483-490.
DOI: https://doi.org/10.1016/j.jadohealth.2019.04.029
Haiven, M., & Khasnabish, A. (2014). The radical imagination: Social movement research in the age of austerity. Fernwood Publishing.
DOI: https://doi.org/10.5040/9781350223462
Heidegger, M. (2002). On time and being. University of Chicago Press.
Heiden-Rootes, K., Meyer, D., Levine, S., Dalton, M., & Rich, Q. (2023). “Testing the Waters” in a “World That Refuses to Make Space”: Development and Coming Out with Transgender and Non-Binary Adults. Journal of Feminist Family Therapy, 1-21.
DOI: https://doi.org/10.1080/08952833.2023.2210344
Hennink, M. M., Kaiser, B. N., & Marconi, V. C. (2017). Code saturation versus meaning saturation: how many interviews are enough? Qualitative health research, 27(4), 591-608.
DOI: https://doi.org/10.1177/1049732316665344
Jaffee, K. D., Shires, D. A., & Stroumsa, D. (2016). Discrimination and delayed health care among transgender women and men. Medical care, 54(11), 1010-1016.
DOI: https://doi.org/10.1097/MLR.0000000000000583
James, S., Herman, J., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. a. (2016). The report of the 2015 US transgender survey. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Johnston, C. D., & Shearer, L. S. (2017). Internal medicine resident attitudes, prior education, comfort, and knowledge regarding delivering comprehensive primary care to transgender patients. Transgend Health, 2(1), 91-95.
DOI: https://doi.org/10.1089/trgh.2017.0007
Korpaisarn, S., & Safer, J. D. (2018). Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons. Reviews in Endocrine and Metabolic Disorders, 19(3), 271-275.
DOI: https://doi.org/10.1007/s11154-018-9452-5
Kraschel, K. L., Chen, A., Turban, J. L., & Cohen, G. (2022). Legislation restricting gender-affirming care for transgender youth: Politics eclipse healthcare. Cell Reports Medicine, 3(8), 100719.
DOI: https://doi.org/10.1016/j.xcrm.2022.100719
Legal, L. (2010). When Health Care Isn’t Caring: Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV. https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring.pdf
Leonard, V. W. (1989). A Heideggerian phenomenologic perspective on the concept of the person. Advances in Nursing Science, 11(4), 40-55.
DOI: https://doi.org/10.1097/00012272-198907000-00008
LeVasseur, J. J. (2003). The problem of bracketing in phenomenology. Qualitative health research, 13(3), 408-420.
DOI: https://doi.org/10.1177/1049732302250337
Levine, S., Heiden-Rootes, K., & Salas, J. (2022). Associations between healthcare experiences, mental health outcomes, and substance use among transgender adults. The Journal of the American Board of Family Medicine, 35(6), 1092-1102.
DOI: https://doi.org/10.3122/jabfm.2022.220186R1
Linsenmeyer, W., Heiden-Rootes, K., Drallmeier, T., Rahman, R., Buxbaum, E., Rosen, W., Gombos, B., & Otte, A. (2023). Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators. Health Promotion Practice, Online. https://doi.org/10.1177/15248399231183643
DOI: https://doi.org/10.1177/15248399231183643
Linsenmeyer, W., Heiden-Rootes, K., Drallmeier, T., Rahman, R., Buxbaum, E., Walcott, K., Rosen, W., & Gombos, B. (2023). The power to help or harm: student perceptions of transgender health education using a qualitative approach. BMC Medical Education, 23(1), 836.
DOI: https://doi.org/10.1186/s12909-023-04761-9
MAP. (2023). Snapshot: LGBTQ Equality by State. Retrieved December 1 from https://www.lgbtmap.org/equality-maps
McGeorge, C. R., Carlson, T. S., & Toomey, R. B. (2014). The intersection of spirituality, religion, sexual orientation, and gender identity in family therapy training: An exploration of students’ beliefs and practices. Contemporary Family Therapy, 36(4), 497-506.
DOI: https://doi.org/10.1007/s10591-014-9312-8
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and implementation (4th ed.). Jossey Bass.
Morse, J. M. (2015). Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry. Qualitative health research, 25(9), 1212-1222.
DOI: https://doi.org/10.1177/1049732315588501
Munro, L., Travers, R., Woodford, M. R. (2019). Overlooked and invisible: Everyday experiences of microaggressions for LGBTQ adolescents. Journal of Homosexuality, 66(10), 1439-1471.
DOI: https://doi.org/10.1080/00918369.2018.1542205
Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D. M., Garcia, G., & Lunn, M. R. (2011). Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education. JAMA, 306(9), 971-977.
DOI: https://doi.org/10.1001/jama.2011.1255
Perone, A. K. (2020). Protecting Health Care for Transgender Older Adults Amidst a Backlash of US Federal Policies. Journal of Gerontological Social Work, 1-10.
DOI: https://doi.org/10.1080/01634372.2020.1808139
Riggs, D. W., Bartholomaeus, C., & Sansfaçon, A. P. (2020). ‘If they didn’t support me, I most likely wouldn’t be here’: Transgender young people and their parents negotiating medical treatment in Australia. International Journal of Transgender Health, 21(1), 3-15.
DOI: https://doi.org/10.1080/15532739.2019.1692751
Riggs, D. W., & Sion, R. (2017). Gender differences in cisgender psychologists’ and trainees’ attitudes toward transgender people. Psychology of Men & Masculinity, 18(2), 187.
DOI: https://doi.org/10.1037/men0000047
Sherman, A. D., Balthazar, M., Klepper, M., Febres-Cordero, S., Valmeekanathan, A., Prakash, D., Cimino, A. N., Wharton, W., Allure, K., & Kelly, U. (2022). Approach and avoidant coping among black transgender women who have experienced violence: A qualitative analysis. Psychological Services, 19(S1), 45.
DOI: https://doi.org/10.1037/ser0000581
Shires, D. A., & Jaffee, K. (2015). Factors associated with health care discrimination experiences among a national sample of female-to-male transgender individuals. Health & social work, 40(2), 134-141.
DOI: https://doi.org/10.1093/hsw/hlv025
Stroumsa, D., Shires, D. A., Richardson, C. R., Jaffee, K. D., & Woodford, M. R. (2019). Transphobia rather than education predicts provider knowledge of transgender health care. Medical education, 53(4), 398-407.
DOI: https://doi.org/10.1111/medu.13796
Van De Grift, T. C., Elaut, E., Cerwenka, S. C., Cohen-Kettenis, P. T., De Cuypere, G., Richter-Appelt, H., & Kreukels, B. P. (2017). Effects of medical interventions on gender dysphoria and body image: a follow-up study. Psychosomatic Medicine, 79(7), 815.
DOI: https://doi.org/10.1097/PSY.0000000000000465
WPATH. (2022). Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People (8th Version). Available from: https://www.wpath.org/soc8
How to Cite
Heiden-Rootes, Katie, Dixie Meyer, Renata Sledge, Bryce K. Davis, Theresa Drallmeier, Whitney Linsenmeyer, Samantha Levine, and Michelle R. Dalton. 2023. “Seeking Gender-Affirming Medical Care: A Phenomenological Inquiry on Skillful Coping With Transgender and Non-Binary Adults in the United States Midwest”. Qualitative Research in Medicine and Healthcare 7 (3). https://doi.org/10.4081/qrmh.2023.11485.
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