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Summary

The transgender population comprises a diverse group of individuals whose gender identities vary significantly from the sex they were assigned at birth (IOM, 2010). They include transsexual, transgender, and gender nonconforming individuals who experience and express their gender variant identity in different ways, both within and outside of binary conceptualizations of sex/gender as either male or female, man or woman, masculine or feminine.

While visibility of this diversity in gender identity and expression has grown, our understanding of transgender identity and experience remains severely limited by a lack of systematic research beyond the binary "sex change" paradigm popularized since the 1960s. A better understanding of the identity development of transgender individuals is essential to understanding and reducing the health inequities found among this underserved and marginalized population.

Abstract

The transgender population comprises a diverse group of individuals whose gender identity varies significantly from the sex they were assigned at birth (IOM, 2010). They include transsexual, transgender, and gender nonconforming individuals who experience and express their gender variant identity in different ways, both within and outside of binary conceptualizations of sex/gender as either male or female, man or woman, masculine or feminine. While visibility of this diversity in gender identity and expression has grown, our understanding of transgender people's identity and experience remains severely limited by a lack of systematic research beyond the binary "sex change" paradigm popularized since the 1960s. A better understanding of the identity development of transgender individuals is essential to understand and reduce the health inequities found among this underserved and marginalized population.

Previous research with transgender populations in the U.S. has documented health inequities in HIV and, more recently, in mental health. A meta-analysis revealed an HIV-prevalence among transgender women of 12% based on self report and 28% based on HIV testing results (Herbst et al., 2008). Predictors of HIV infection include being African American, high school drop-out, high number of sexual partners, injection drug use, unemployment, and a history of sexual assault. The majority reported gender-related stigma and discrimination (77%), and domestic violence (58%), mental health issues (54% suicidal ideation, 31% suicide attempts), illicit hormone use (34%), a history of incarceration (33%), and homelessness (13%) were common. These findings are limited, however, by the cross-sectional nature of studies to date, primarily consisting of data from small convenience samples of transgender women with a history of sex work (42%) recruited from AIDS and social service agencies. The proposed research will use venue-based sampling in three U.S. sites to recruit a large, diverse community cohort of transgender women and transgender men, enhancing generalizability to the broader transgender population.

The minority stress model (Meyer et al., 2003; Meyer & Frost, 2013) postulates that the health inequities found among the U.S. transgender population are the result of added stress to which transgender individuals are exposed due to the stigma attached to their gender nonconformity (Fig. 1). Minority stress coping can mitigate the negative impact of stigma on health. Indeed, our preliminary research indicated that gender-related discrimination was associated with high levels of psychological distress, and that peer support moderated this relationship (Bockting et al., 2013). Furthermore, family support and identity pride were associated with lower levels of psychological distress. In addition to minority stress processes, other risks (e.g., in family background, hormone therapy) and assets (e.g., in education, income) may affect transgender people's resilience. The proposed research will advance our knowledge of the impact of minority stress processes and other risks and assets on health, psychosocial adjustment, and resilience.

Theories of transgender identity development can be divided into two main categories: (1) typologies and (2) stage models. Typologies differentiate transgender individuals based on age of onset of gender dysphoria (childhood or adolescence/adulthood; Person & Ovesey, 1974a,b), degree of cross-gender identification (partial or complete; Benjamin, 1966; Buhrich & McConaghy, 1977, 1979; Docter, 1988), sexual orientation ("homosexual" or not; Blanchard, 1985, 1989), or childhood gender role nonconformity (enacted or felt stigma; Bockting, 2013). Stage models describe a series of developmental stages (Bockting & Coleman, 2007; Devor, 2004; Gagne, Tewksbury, & McGaughey, 1997; Lev, 2004; Lewins, 1995). For example, based on clinical experience, we adapted a model of gay and lesbian identity development—grounded in Erikson's stages of psychosocial development (Erikson, 1956)—to transgender identity development (Bockting & Coleman, 2007; Fig. 2). These theories are limited by the lack of systematic research and empirical testing, and most were developed a long time ago and hence do not necessarily reflect the experiences of transgender people today. The goal of the proposed research is to develop a contemporary, empirically-based understanding of transgender identity development, and identify periods of acute vulnerability and corresponding intervention strategies to foster resilience, defined as good adaptation (i..e, health and psychosocial adjustment) in the face of adversity (i.e., stigma and minority stress) (Masten et al. 2001, 2009).

The specific aims are:

  • To qualitatively describe the process of transgender identity development, and identify periods of acute vulnerability and characteristics of resilience.
  • To refine a model of minority stress and resilience (Fig. 1) and adapt/develop measures to assess its key constructs (informed by findings from Aim 1);
  • To enroll a cohort of transgender individuals stratified by gender and stage of identity development across three U.S. sites to test the model refined in Aim 2 longitudinally.
  • To translate findings on identity development and minority stress processes into intervention strategies to promote resilience.

Sponsorship

Research Foundation for Mental Hygiene, Inc. – Columbia University – National Institutes of Health subaward
$643,000

Principal Investigator

Anneliese A. Singh
  • Associate Dean for Diversity, Equity, and Inclusion, College of Education

  • Professor, Department of Counseling and Human Development Services (Professional Counseling, Counseling and Student Personnel Services)

  • Affiliated Faculty, Safe and Welcoming Schools

Active Since

September 2014