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
Abstract Views: 918
PDF: 280
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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.

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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.