Gender Affirming Hormone Treatment, Gender Minority Stressors, and protective factors: exploring the factors that impact upon the mental health, wellbeing, and life satisfaction of transgender and gender diverse people

Transgender and Gender Diverse individuals have been identified as a population that reports poorer wellbeing and a greater prevalence of mental health disorders when compared to the general population. A variety of factors have been suggested to play a role in this disparity including experiences of discrimination, victimisation, rejection, and distress over gender incongruence. Factors such as receipt of Gender Affirming Medical Treatment, pride in identity, community connectedness, and social support have been suggested to protect the wellbeing of Transgender and Gender Diverse individuals.

Research suggests that, for those Transgender and Gender Diverse people who require it, Gender Affirming Hormone Treatment may play a role in reducing the prevalence of mental health disorders, such as anxiety and depression. However, gaps in the literature remain as much of this research is cross-sectional and the few longitudinal studies that have been conducted are limited in terms of sample size, follow-up assessment times, and evaluation criteria. Furthermore, little is known about what pre-treatment factors influence the wellbeing outcomes of Gender Affirming Hormone Treatment. With this in mind, the first two studies presented in this thesis aim to address these gaps in the literature by longitudinally examining the mental health outcomes of Gender Affirming Hormone Treatment and pre-treatment predictors. Study 1 examines the influence of pre-treatment factors (pre-treatment levels of anxiety/depression, and social support) on the life satisfaction outcomes of Gender Affirming Hormone Treatment, while Study 2 investigates the impact of Gender Affirming Hormone Treatment on symptoms of anxiety and depression. The findings from these two studies provide strong evidence that mental health symptoms (particularly depression) reduce following 18 months of GAHT, while pre-treatment levels of depression/anxiety and social support do not influence later life satisfaction. With this evidence, it is possible not only to confirm the positive mental health impact that access to Gender Affirming Hormone Treatment can have for Transgender and Gender Diverse individuals, but also to recommend that barriers to accessing Gender Affirming Hormone Treatment based on mental health status are reduced.

As the majority of literature focuses on those earlier in their medical transition (usually between 0-12 months after starting Gender Affirming Hormone Treatment) little is known about factors which impact the wellbeing of those later in their transition. Therefore, Study 3 of this thesis aimed to address this gap in the literature, broadening the scope of the thesis beyond exclusively focusing on Gender Affirming Hormone Treatment. This study qualitatively explored factors impacting the wellbeing of Transgender and Gender Diverse individuals later (5 years post initiation of Gender Affirming Medical Treatment) in their transition. The findings of this study describe that while the impact of experiences of Gender Minority Stress and the influence of protective factors often remain consistent, some - such as gender identity disclosure - may develop additional nuances for those later in their transition. Additionally, a key finding was the duality of the role that social media could play in the wellbeing of participants' lives, both having a positive and negative influence. Building upon the findings from Study 3 and the surrounding literature, Study 4 engaged in a qualitative exploration of the specific role of social media in the lives of Transgender and Gender Diverse people. The findings of this study highlighted how social media can act as a gateway, both facilitating access to communities and exposing individuals to transphobia. These findings provided a deeper understanding of how/why online communities are may be used. For example, access healthcare support from peers due to healthcare professionals’ lack of knowledge. Furthermore, the findings describe additional nuances to online experiences of Gender Minority Stress. For example, exposure to Gender Minority Stress online from within the Transgender and Gender Diverse community, due to sharing of negative information. The findings from Study 3 and 4 not only provide insights which aid in identifying potential sources of Gender Minority Stress but also highlight how some Transgender and Gender Diverse people are already approaching these issues and better facilitate our understanding of how to implement positive change.

The conclusions of this thesis are twofold. The first of which is that Gender Affirming Hormone Treatment has been shown to have a positive impact on the mental health of Transgender and Gender Diverse individuals who require it. Therefore, not only is it vital that Gender Affirming Hormone Treatment is continued to be made more accessible to Transgender and Gender Diverse individuals through improvements in Transgender Health Services, but additionally barriers to accessing this treatment based on the presence of anxiety/depression disorders should be reduced. The second conclusion of this thesis is that specific experiences of Gender Minority Stressors can vary over transition and across different contexts, such as social media or when accessing healthcare. Additionally, the ways through which protective factors are accessed may also expose Transgender and Gender Diverse individuals to Gender Minority Stressors. Therefore, research must continue to explore in what ways Gender Minority Stress and protective factors can impact wellbeing, to provide recommendations to address these issues and provide more comprehensive support.