# Centering transgender and gender nonconforming people of color in the study of minority stress, transition-related factors, and mental health

## TL;DR

This study explores how transgender and gender nonconforming people of color experience stress from both gender and racial discrimination, and how these stressors affect their mental health.

## Contribution

The study centers transgender and gender nonconforming people of color, addressing gaps in generalizability from predominantly white samples.

## Key findings

- Most participants wanted legal name and gender marker changes but faced barriers, leading to negative outcomes.
- Distal stressors were directly and indirectly linked to higher anxiety and depression.
- Intersectional distal stress indirectly affected gender congruence through proximal stressors.

## Abstract

Transgender and gender non-conforming individuals (TGNC) people of color (POC) are exposed to a unique intersection of gender and racial-minority stressors. Distal (external) and proximal (internalized) stressors have been studied within the Gender Minority Stress Model, which outlays the adverse mental/physical health outcomes that often occur due to gender-minority stress. Few studies have examined the intersectionality of racial-minority related stress, mostly utilizing White TGNC samples, limiting generalizability to TGNC POC.

We conducted an online cross-sectional survey (n = 149) TGNC POC U.S. adults who answered demographics, questions regarding transition experiences (e.g., gender-affirming care and identification documents), intersectional distal stressors (LGBT People of Color Microaggressions Scale), proximal stressors (The Gender Minority Stress and Resilience Measure), the Gender Congruence and Life Satisfaction Scale (GCLS), the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7.

91.3% desired a legal name change and a gender marker change (98%). Less than 60% who wanted changes were able to obtain them, reporting negative outcomes using incongruent documents. Additionally, 78.2% of those who wanted gender affirmative hormone therapy were able to obtain it (n = 55). A path analysis using structural equation modeling revealed that distal stressors were both directly and indirectly, through proximal stressors, related to anxiety (direct: β = 0.42, 95% CI = 0.26, 0.58, indirect: β = 0.16, 95% CI = 0.07, 0.26) and depression (direct: β = 0.43, 95% C I = 0.26, 0.60, indirect: β = 0.14, 95% CI = 0.04, 0.23). Intersectional distal stress was not directly related to congruence but was indirectly related through proximal stressors (indirect effect: β = −0.16, 95% CI = −0.27, −0.05); Intersectional distal stress was not directly related to congruence but was indirectly related through proximal stressors (indirect effect: β = −0.16, 95% CI = −0.27, −0.05). Interpretation should be cautioned given low reliability of the GCLS.

Findings emphasize intersectionality and internalization of those stressors on gender congruence, anxiety, and depression, highlighting the importance of culturally humble, accessible services. The high frequency of adverse experiences due to document incongruence highlights the importance of policies that reduce barriers. Future research should strengthen congruence measurement with longitudinal designs.