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Recent years have seen an unprecedented paradigm shift wherein pathologizing approaches to caring for trans children have been contested by efforts to accept and affirm trans children as their self-determined gender. This has resulted in a mainstreaming of gender affirming and de-pathologizing approaches to caring for trans children. While gender affirming care undoubtedly benefits many trans children, this research analyzes the ways in which practices and delivery of gender affirming care can be exclusionary of children who do not fit within a normative, binary, medicalized, white, and middle-class conceptualization of trans childhood. Applying critical social citizenship as a theoretical framework, this research argues that care for trans children is shaped through a complex interweaving of normative liberal citizenship regimes, professional and social care practices, and relational care practices that seek to recognize and create space for children to belong as their self-determined gender. Using a community-based research methodology to engage with trans youth and supportive parent caregivers around their experiences of care, this study sought to a) better understand how the contested landscape of care impacts the lives of trans children and b) offer possibilities for transforming care for trans children. Centring the voices and experiences of trans youth and parents, this research argues that trans children face exclusions and barriers when accessing care. This research then discusses what relational care practices, as shared in participant narratives, offer for envisioning care possibilities that centre trans children’s agency and gender self-determination. The outcome of this research is a vision of care for trans children that is rearticulated through a critical theorization of trans children’s citizenship. / Graduate

According to the Human Rights Campaign (n.d.), the nation’s largest LGBTQIA+ civil rights organization, there are approximately two million people living within the U.S. who identify as transgender. Gender-affirming healthcare encompasses a variety of services, including hormone therapy, surgical interventions such as genital and top surgery, and mental health services. While surgery may or may not be part of an individual’s personal transition roadmap, research indicates that gender-affirming surgery can significantly improve quality of life (Stroumsa, 2014). However, a study by De Brouwer et al. (2021) found that 65% of transgender individuals reported the desire for increased post-operative care including guidance and education regarding “what are you allowed to do and what not” to do following surgery (p. 1925). The transition process can impact a person’s occupational identity, occupational competence, and overall occupational well-being (Bar et al., 2016). Although deficits in occupational performance and satisfaction have been reported within transgender and gender-diverse (TGD) populations (Swenson et al., 2022), occupational therapy services are not typically provided or included within the gender-affirming care model. Occupational therapy services have the potential to decrease deficits experienced by TGD individuals due to the holistic nature of the profession and its focus on client-centered care. you, AFFIRMED is an innovative program that will provide occupational therapy services pre- and post- gender-affirming top surgery through a six-week program delivered virtually for improved access to healthcare services. you, AFFIRMED aims to improve post-surgical outcomes and general well-being for TGD individuals undergoing gender-affirming top surgery through the provision of individualized occupational therapy services. Furthermore, the program intends to increase the representation of occupational therapy within multidisciplinary gender-affirming healthcare services. Finally, the program intends to further improve access to occupational therapy services through telehealth modalities due to deficits in accessing qualified healthcare professionals and challenges with financial coverage of services.

<p dir="ltr">This thesis outlines a comprehensive training program designed to equip mental health professionals with the knowledge, skills, and cultural competency necessary to provide gender-affirming mental health services to transgender veterans. Included in this training is an overview of the literature documenting the severe mental health disparities experienced by this population through a minority stress framework, unique challenges and needs commonly faced by transgender veterans, and barriers to receiving culturally competent and effective mental health services. Guidelines for the provision of gender affirming therapy for transgender veterans are offered, in addition to opportunities for self-of-therapist reflections, discussions, and activities around these topics.</p>

Transgender and nonbinary (TNB) people identify with a gender identity that differs from cultural expectations based on sex assigned at birth. Many TNB people pursue social and/or medical transition with the intent of affirming their gender identity to themselves and the world around them. Medical transition describes the process of utilizing one or more forms of gender-affirming medical care (e.g., hormone therapy, gender confirmation surgery, hair removal, breast augmentation, mastectomy) in order to change the physical body such that it is more congruent with an individual’s affirmed gender identity. Researchers suggest that many TNB individuals currently use or desire to use gender-affirming hormone therapy (GAHT), and that some TNB individuals desire or use nontraditional or non-standardized (e.g., low dose) hormone therapy regimens. Unfortunately, many TNB people encounter barriers in the process of accessing gender-affirming healthcare, especially individuals who are nonbinary and/or desire gender transition steps that are nontraditional or non-standardized (e.g., low-dose hormone therapy). In current research literature, little is currently known about the experiences and healthcare needs of TNB people who currently or desire to take nontraditional GAHT. To address this gap in the research literature, the present study was a qualitative study involving semi-structured interviews with 10 TNB people to explore their experiences connected to nontraditional GAHT. The grounded theory analysis revealed a core category: Nontraditional Gender Affirmation Model. The core category is comprised of five axial level categories: Social Processes, Medical Processes, Barriers to Accessing Medical Transition Care, Facilitators to Accessing Medical Transition Care, and Coping with Distress and Barriers. The five axial level categories are comprised of 30 open-coding level categories and 33 open-coding level subcategories. The grounded theory model developed depicts a framework of various phenomena involved in the process of gender affirmation for transgender and nonbinary individuals with nontraditional gender transition needs, including nontraditional approaches to GAHT. Implications for healthcare providers, psychological practice, and future research are discussed.

Background: Transgender or nonbinary (TNB) individuals in the United States experience higher rates of sexual and reproductive health disparities when compared to their cisgender counterparts, along with lower access to care. TNB people in the south experience higher rates of disparities. Societal, interpersonal, and individual barriers contribute to these disparities in the TNB population. However, there is a paucity of research examining the sexual and reproductive health experiences of TNB people living in Central Appalachia. Methods: An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in central Appalachia regarding their sexual and reproductive health experiences. Transcribed interviews were analyzed repeatedly by the primary investigator and the study equity committee to identify emergent themes which focused on understanding an individual’s lived experiences through interpretation. Results: Twenty participants from eastern Tennessee and western North Carolina from four Appalachian states within three Appalachian sub-regions participated in this study. Four themes were identified: a) perceptions and/or experiences receiving SRH healthcare shaped the individual’s self-agency regarding accessing and receiving SRH care, along with influencing their sense of self regarding their gender; b) heteronormative expectations within the medical field influenced interactions with providers and the care system; c) community is integral to SRH experiences, and d) policy and laws impact willingness and ability to access SRH care. Discussion: TNB individuals living in central Appalachia experience individual, interpersonal, community, and social factors that impact their sexual and reproductive healthcare experiences. By addressing these factors based on recommendations from participants, public health leaders, policy makers, and providers can improve sexual and reproductive healthcare experiences of TNB people living in central Appalachia.

Dans les dernières années, plusieurs débats autour de la transition sociale à l’enfance ont émergé tant des sphères publiques, cliniques et scientifiques. Or, peu d’écrits mettent en lumière les expériences de transition de jeunes enfants, et plus particulièrement de leur point de vue. Ainsi, ce projet de mémoire vise à explorer les expériences de transition d’enfants trans prépubères ayant accès à des cliniques transaffirmatives au Canada selon leurs perspectives ainsi que celles de leurs parents. À partir de données extraites d’une recherche plus large menée par Annie Pullen Sansfaçon et plusieurs autres co-chercheur·e·s au Canada, nous avons analysé huit (N=8) entretiens qualitatifs semi-dirigés menés auprès de quatre enfants trans prépubères et de leurs parents en contexte clinique transaffirmatif. L’analyse des entretiens s’est appuyée sur la théorie de la reconnaissance d’Axel Honneth et l’analyse thématique (AT). Ainsi, cinq thèmes qui décrivent les expériences de transition des enfants trans prépubères de notre échantillon ont été identifiés : (1) se dévoiler à ses parents en étant simplement soi-même; (2) le processus de transition en dehors de la maison : un processus de négociation et d’accompagnement; (3) l’école comme principal lieu de tensions; (4) s’affirmer à travers le processus de transition : répercussions des obstacles et retombées positives; et (5) se projeter dans l’avenir : la transition médicale. La compréhension de ces expériences de transition permet de mieux cadrer les interventions des professionnel·le·s dans un contexte d’affirmation des identités et des expressions de genre, d’accompagnement des familles et de défense des droits des enfants dans différentes institutions. / In recent years, several debates around social transitions in early childhood have emerged from public, clinical and scientific spheres. However, little has been published about the children’s transition experiences, particularly from their perspectives. Thus, this research project aims to explore the transition experiences of trans prepubertal children who have access to gender- affirming clinics in Canada from their and their parents’ perspectives. Using data extracted from a larger study conducted by Annie Pullen Sansfaçon and several other co-investigators in Canada, we analysed eight (N=8) semi-structured qualitative interviews conducted with four trans prepubertal children and their parents in a gender-affirming clinical setting. Data analysis was based on Axel Honneth’s recognition theory as well as on thematic analysis (TA). We identified five themes that describe the transition experiences of the trans prepubertal children in our sample: (1) revealing oneself to their parents by simply being themselves; (2) the transition process outside of the home: a process of negotiation and accompaniment; (3) school as the main site of tensions; (4) asserting oneself through the transition process: repercussions of obstacles and positive outcomes; and (5) looking ahead into the future: the medical transition. Understanding these transition experiences allows us to better frame the interventions of professionals in a context of affirming gender identities and expressions, accompanying families and defending children’s rights in different institutions.

Le soutien social est communément reconnu comme ayant un effet bénéfique sur la santé et le bien-être alors que les jeunes trans et non binaires (TNB) subissent des expériences de victimisation importantes. Parmi celleux qui sont en processus de débuter ou ont entrepris des traitements médicaux d’affirmation de genre, l’expérience spécifique des adolescent·e·s TNB demeure peu connue. Le présent mémoire a comme objectif de mieux comprendre comment iels rapportent leurs expériences de soutien en examinant les différentes formes d’apport et de tensions émergentes. S’inscrivant dans un projet canadien plus vaste (Pullen Sansfaçon et al., IRSC 2016- 2019), cette étude fait appel à une analyse de données secondaires découlant d’entrevues qualitatives menées auprès de 12 jeunes TNB d’une même clinique Montréalaise. Les données sont analysées selon une formule mixte où une partie des catégories est dérivée de la revue de la littérature alors qu’une autre partie est induite en cours d’analyse. L’utilisation d’une perspective écosystémique permet une vision globale de l’expérience des jeunes, c’est-à-dire où les multiples composantes de l’environnement social sont perçues de façon interactive et intégrée. Les résultats apportent un éclairage sur la variabilité des parcours, mais aussi sur la complexité du soutien social offert aux adolescent·e·s TNB recevant des soins médicaux d’affirmation de genre. Alors que de multiples formes de soutien sont observées à travers l’ensemble des sphères de leur environnement social, une tension générale tourne incontestablement autour de normes traditionnelles de genre et expose des lacunes systémiques qui ont un effet délétère sur les jeunes. / Social support is commonly known for its health and well-being benefits. However, trans and non binary (TNB) youths are confronted to important victimisation experiences and yet little is known about the specific experience of those who are at the process of beginning or have begun medical gender affirming treatments. The objective of this master’s thesis’ is to better understand how these youths relate their social support experiences while examining the different emerging forms of contributions and tensions. Arising from a vaster Canadian project (Pullen Sansfaçon et al., IRSC 2016-2019), this study is a secondary data analysis of qualitative interviews held with 12 TNB youth in a Montreal clinic. The data analysis is conducted following a mixed formula where part of the categories is deriving from the literature review and another is induced while coding. The use of the ecological systems theory contributes to a global perspective of the youths’ experience where the social environment’s multiple components are perceived in an interactive et integrated manner. The results shed light on the variability of pathways, but also on the complexity of the social support offered to TNB adolescents receiving medical gender affirming care. While multiple forms of support are found throughout the different social environmental spheres, a general tension unquestionably emanates from traditional gender norms. This context exposes systemic lacuna and a deleterious effect on TNB youth.

Transpersoner lider en ökad risk jämfört med övrig befolkning att utveckla psykisk och fysisk ohälsa, samt en rejält förhöjd risk för suicid. Trots detta mår många transpersoner bra och är generellt nöjda med sitt liv och sitt mående. Fram till idag har inga svenska studier gjorts kring vad i transidentiteten som gör att många transpersoner också mår bra. Detta arbete har därmed ämnat undersöka positiva aspekter med att vara trans, hur dessa kan ta sig i uttryck och hur deltagarna upplevt dem, i ett försök att konceptualisera begreppet minoritetsglädje. Fem transmän och sex transkvinnor har genom semistrukturerade intervjuer besvarat frågor om vad minoritetsglädje innebär för dem, och med hjälp av en tematisk analys genererades sju teman.  Temana beskriver hur deltagarna upplevt och upplever mycket glädje och lycka tack vare sin identitet, där den mest återkommande glädjen beskrivs i samband med att kunna leva autentiskt för sig själv och omgivningen. Även aspekter som att känna könseufori, att ha tillgång till och kunna bidra till communityt samt att få en ökad insikt och förståelse för samhällsstrukturer och privilegier gav deltagarna en känsla av syfte, och glädje. Precis som minoritetsstress är unika hälsopåfrestningar för minoritetspersoner är minoritetsglädje för dessa deltagare den unika glädjen som bara kan upplevas som minoritet, eller bara som transperson. Resultaten går i linje med tidigare positiva aspekter som framkommit i studier med transpersoner, men arbetet bidrar också med viktig information som aldrig tidigare konceptualiserats på svensk nivå och som kan nyansera såväl den vetenskapliga som den samhälleliga debatten om transpersoners mående.

Transpersoner i Sverige har en ökad risk för psykisk ohälsa, samtidigt som cirka hälften har god livskvalité. Då de positiva hälsofaktorerna för gruppen är underbeforskat, framför allt för ickebinära transpersoner, var studiens syfte att undersöka vilka positiva erfarenheter (minoritetglädje) ickebinära transpersoner har av att tillhöra minoritetsgruppen. En kvalitativ intervjustudie gjordes med åtta deltagare som sedan analyserades med tematisk analys. Det huvudsakliga resultatet visar att minoritetsglädjen främst utgörs av en stark gemenskap med andra transpersoner och att leva ett autentiskt liv i relation till sig själv och omgivningen. Även att utvecklas som person och att transtillhörigheten blir ett verktyg för att förstå världen och andra människor är viktiga fynd. Resultaten går i linje med tidigare forskning om positiva hälsofaktorer för gruppen. Nya fynd är framför allt att upplevelsen av frihet från tvåkönsnormen tycks kunna utgöra en extra stor positiv faktor för den ickebinära gruppen.