Identifying Coping Strategies Used by Transgender Individuals in Response to Stressors during and after Gender-Affirming Treatments—An Explorative Study

Abstract

Background: Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress. Aim: The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health. Methods: Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender. Outcomes: Inductive coding and theory-informed thematic analysis were used to assess stressors (ncodes = 335) and coping strategies (ncodes = 869). Results: Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously. Conclusion: Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.

Exploring Work Absences and Return to Work During Social Transition and Following Gender-Affirming Care, a Mixed-Methods Approach: ‘Bridging Support Actors Through Literacy’

“…Negative worker-employer relations and less favorable coping styles could lead to ‘being the extra-productive worker’ and, due to the repetitiveness of GAC visits and needing time off from work, using personal vacation instead of medically certified leave ending in a strained work-life balance. These findings of stressful GAC management are in line with the literature [ 48 ]. Legislative support, such as medical absences and transition-related paid absence, can therefore inherently be a positive influence on the work-life-GAC balance apart from personal views.…”

“…It is challenging to compare GAC-related work absences due to limited research [ 37 ] and differences in design and gender diversity in an earlier study [ 11 ], while our study had a more balanced sample and reported more detail of GAC. Moreover, as indicated by Oorthuys et al [ 48 ], receiving GAC can be burdensome and can affect the work-life balance, as emphasized by our interviewees, leading to several types of work absences of which our survey only reports sick days. When comparing the latter, TM and GD individuals’ sick leave was similar as their personalized journey did not always include surgery as gender-affirming hormonal therapy was more reported by them.…”

“…While support, a social determinant of health and essential RTW factor [ 28 , 36 ], is often reported in TGD health studies [ 46 – 48 ] as a mediator for work experiences [ 4 , 13 , 49 ] and plays a role in accessing care [ 50 , 51 ], the emphasis is placed upon support received from coworkers, supervisors, family, and friends. The possible contributions of occupational health professionals are seldom mentioned in these TGD (health) studies, and health literacy evaluations are scarce.…”

Pathways to Euphoria: Deconstructing Gender-Expansive Adults Conceptualizations of Wellbeing

“…As illustrated, findings from our study contribute to a growing body of literature, suggesting that achieving gender congruence, engaging in practices that elevate the wider community, and experiencing gender pride, are important processes that promote wellbeing among TGDN individuals (Oorthuys et al, 2023;Valente et al, 2020;van den Brink et al, 2020). While the capacity for these findings to have real world clinical implications depends upon their replication in future studies with larger and more diverse samples, several tentative practical implications are proposed.…”

“…Mentoring programs present one potential avenue through which TGDN individuals can gain access to, or engage as positive role models (Matsuno & Israel, 2018). Family and peer support have been found to foster greater self-acceptance, less psychological distress, and more help-seeking among transgender individuals (Oorthuys et al, 2023;Valente et al, 2020). Similarly, engagement in community activism plays a facilitative coping role and expands access to community connections and services (Budge et al, 2012;Frost et al, 2019;Riggle et al, 2011).…”