Stigma, Resilience, and Health Care Use Among Transgender and Other Gender Diverse Youth in the United States

Purpose: To understand the relationships between stigma, resilience, and health care use among transgender and other gender diverse youth (TGDY). Methods: Data include a national sample of 171 TGDY (ages 15-24). Previously developed Gender Minority Stress Theory scales were used to measure experiences of stigma and resilience. Health care use included two outcomes: difficulty accessing care and medical gender affirmation service use (e.g., hormones and surgery). Principal components analysis (PCA) was used to reduce data. Logistic regression was used to test relationships between components and the outcomes; interactions between components were also tested. Results: The PCA determined three components representing (1) enacted stigma, (2) a positive sense of identity, and (3) social support. Two scales (mis-gendering and anticipated stigma) did not fit into any components and were included as separate variables. In the main effects model, none of the minority stress variables were associated with difficulty accessing care. However, an interaction between enacted stigma and a positive sense of identity indicated that having a more positive sense of identity was only associated with reduced difficulty accessing care for participants experiencing less stigma. For medical gender affirmation services, participants who experienced more anticipated stigma were less likely to use these services and participants with a more positive sense of identity were more likely to use them. Conclusions: Findings suggest that stigma and resilience experienced both inside and outside of health care settings can play a role on access to care for TGDY. Interventions should consider how to reduce stigma and promote resilience across multiple contexts.