Health Care Experiences of Transgender Binary and Nonbinary University Students

Abstract

An increasing number of young adults identify with nonbinary gender identities. Yet health providers and therapists often lack understanding of such identities. In this mixed-methods study of 506 transgender undergraduate and graduate students, most of whom (75%) had nonbinary gender identities, we aimed to understand participants’ mental health and health care experiences, and factors related to misgendering and less affirming treatment by providers. Eighty-five percent of participants reported mental health challenges, and named fear of violence and nonsupport as distal stressors. Experiences with therapists and health providers were mixed. Salient features of negative interactions were invalidation, avoidance, or overemphasis in regard to participants’ nonbinary identities. Participants viewed counseling services as more affirming than health services. Nonbinary students reported more misgendering by therapists and health providers, and less trans-affirming care by health service providers, compared to binary students. Undergraduate students reported more misgendering by therapists and health providers than graduate students.

Transgender experiences and transphobia in higher education

“…For nonbinary trans students, who most likely use the gender pronouns they/them/theirs as opposed to he/him/his or she/her/hers (Beemyn, ), university software may not even have the capability of accommodating their pronouns or gender markers. In the classroom, misgendering occurs more frequently for nonbinary students than binary trans students, perhaps because “students with trans nonbinary identities, by definition, do not fit into the binary gender system” (Goldberg, , p. 6). Binary trans students, however, report higher levels of discomfort and distress than nonbinary trans students when they are misgendered (Goldberg, ).…”

“…In the classroom, misgendering occurs more frequently for nonbinary students than binary trans students, perhaps because “students with trans nonbinary identities, by definition, do not fit into the binary gender system” (Goldberg, , p. 6). Binary trans students, however, report higher levels of discomfort and distress than nonbinary trans students when they are misgendered (Goldberg, ). Particularly among binary trans people, there is great variation in the extent to which someone wants to be seen as transgender and, alternatively, the extent to which they may not identify as trans so much as view it as part of their history (Pitcher, ; Serano, ).…”

“…Nicolazzo (), Beemyn (), and Goldberg () argue that nonbinary undergraduate students regularly feel “not trans enough” when it comes to their identities and gender expression. Many nonbinary and genderqueer individuals do not fit the prevailing “born in the wrong body” model of trans‐ness, causing nonbinary students to feel “misunderstood by faculty, staff, and peers” (Goldberg, , p.21).…”

“…Nicolazzo (), Beemyn (), and Goldberg () argue that nonbinary undergraduate students regularly feel “not trans enough” when it comes to their identities and gender expression. Many nonbinary and genderqueer individuals do not fit the prevailing “born in the wrong body” model of trans‐ness, causing nonbinary students to feel “misunderstood by faculty, staff, and peers” (Goldberg, , p.21). In order to “claim public identities,” Garrison () argues that nonbinary people must present themselves as closely to the more dominant “wrong body narrative” as possible, even when “these accounts fail to capture the nuance of their experience” (p. 615).…”

“…Recent work on sexual harassment has exposed the structural vulnerabilities that grad students experience Cantor et al, )—and why, for example, students stay in toxic advising relationships, particularly in STEM fields where their funding is tied to a particular professor or lab. Trans students at the undergraduate and graduate level describe both positive and negative interactions with faculty members, with no substantial difference between binary and nonbinary trans students (Dugan et al, ; Goldberg, ). The only exception was transgender women, whose perceived violations of “masculine gender norms” produce higher social penalties.…”