Gender Affirmation, Quality of Life, and Access to Care: A Mixed-Method Longitudinal Investigation

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PROJECT SUMMARY/ABSTRACT Gender minorities (GM) have gained greater visibility in U.S. society in recent years. However, the physical and mental health of GM individuals remains a critical public health issue. GM face persistent stigma, discrimination, and barriers to services that affect their health and wellbeing over the life course. Gender affirmation is a process of recognizing a person’s gender identity and expression, which may include emotional support as well as social and medical interventions; it has been associated with mental health and wellbeing. Unmet needs for gender affirmation have been linked to greater risk behavior and poorer self-care among GM, particularly related to HIV risk and treatment. Clinicians who are specially trained in providing gender-affirming services may be uniquely positioned to support the emotional needs of GM individuals, with the potential to have a long-term impact on a person’s trust and comfort in interacting with healthcare providers, engagement and retention in care, and self-care behaviors that influence one’s health trajectory over the life course. There is a dearth of evidence on the healthcare needs of GM individuals after surgery, their psychosocial adjustment during this phase of their identity development, their quality of life, and long-term physical and emotional wellbeing. The goal of this prospective, mixed method, longitudinal cohort study is to build a rich evidence base on GM identity development after gender-affirming surgery and the long-term healthcare needs of GM individuals, examining changes in multiple domains of quality of life and their relationships with healthcare providers. Using a combination of quantitative and qualitative methods, our specific aims are to: 1. Document changes over time in GM individuals’ (N = 300 recruited from a gender-affirming, post-surgical home healthcare program) psychosocial development after surgery, including such domains as (i) gender and sexual identity development, (ii) intimacy and relationships, (iii) social and community support, (iv) employment and financial wellbeing, and (v) environmental mastery and purpose in life. 2. Examine changes in GM individuals’ health-related quality of life after surgery, including such domains as (i) physical health, (ii) mental health and social wellbeing, (iii) sexual function, satisfaction and health, (iv) health behaviors and self-care, and (v) engagement and retention in healthcare and relationships with healthcare providers. 3. Identify barriers and facilitators to GM individuals’ engagement with their self-care and engagement and retention in home and subsequent healthcare for both gender-related and other health concerns. The study will address a significant gap in the current evidence on best practices to support GM individuals during a pivotal life course transition, with the potential to improve their engagement in care and mitigate the pervasive disparities in healthcare access, outcomes, and quality of life affecting this population.