Ask the Expert: Resilience and Well-being in Transgender and Nonbinary People

Ecological-community psychologist Dr. Jae Puckett is the director of the Transgender Stress and Resilience Research Team (Trans-ilience), a community-engaged research team focused on topics like minority stress, mental health, marginalization, and resilience in trans and nonbinary communities. Currently, they are in the process of a longitudinal mixed methods study on resilience in trans and nonbinary communities. They developed a novel measure of resilience in trans and nonbinary communities that takes into account social context and systems of power and privilege. Their next steps will be following 600 trans and nonbinary people over a 2-year period to learn more about what predicts resilience and how resilience may or may not buffer the effects of minority stressors on various mental health outcomes. 

How does the sociopolitical context that transgender and nonbinary people are living in impact their health and well-being? 

For one, it can impact directly one’s access to resources and protections. If someone is living in a state where, for example, there are attempts to ban access to trans affirming healthcare, this can compromise access to care that could improve health and further exacerbate gender dysphoria and distress. Another way that this impacts health is through exposure to minority stress. Hearing anti-trans rhetoric from politicians, news outlets, and others generally can take a significant toll on trans and nonbinary people’s health and well-being. This can also create an atmosphere where targeting trans and nonbinary people is more accepted and thereby increase exposure to violence, harassment, discrimination, and rejection. Living in hostile contexts can also make it unsafe for trans and nonbinary people to come out, resulting in increased internalized stigma and less access to supportive others and communities.  

Some of your research suggests that legal gender affirmation plays a role in better health outcomes. Can you help explain that? 

Trans and nonbinary people can affirm their gender in a variety of ways, including socially (e.g., changing one’s pronouns, appearance, etc.), medically (e.g., hormones or surgery), and legally (e.g., a legal name and/or gender marker change). There are a lot of barriers to legally affirming a person’s gender, including the costly fees, confusing paperwork, having to interact with the legal system, being required to attend a court hearing, and, in many states, the requirement to publish the notice of your name change in the newspaper. Because of this, many people may not be able to access a legal name change. The process for gender marker changes varies a lot by state, but there can be many barriers as well, such as requirements for certain medical procedures, fees, paperwork, and the lack of nonbinary inclusive gender markers.  

Even with all these barriers, when people are able to and do legally affirm their gender, our research and that of others has shown that this is associated with better health outcomes. One reason that we found for this is that people who have legally affirmed their gender experience less marginalization, specifically less rejection, victimization, and discrimination, than those who have not legally affirmed their gender. Your legal name and gender marker can influence many of your day-to-day interactions with others and prior to a legal gender affirmation, someone may experience more constant misgendering, deadnaming (being called by a given name), and subsequent harassment or mistreatment when their ID and appearance don’t align. Given the findings from this work, we ended up starting the Gender Affirmation Project to help local trans and nonbinary people with their legal name and/or gender marker changes. 

What helps develop resilience in transgender and nonbinary people?  

The literature on resilience for trans and nonbinary people has been minimal relative to other areas. For good reason, a lot of the literature has focused on minority stress and marginalization, given the high rates experienced by trans and nonbinary people and the significant implications for health outcomes. However, this also has resulted in less research on resilience for trans and nonbinary people, meaning that we don’t know as much about resilience for this community.  

Another limitation has been that most research in the area uses a narrow framework developed with cisgender people in mind. Although helpful, there are also unique ways that resilience shows up in trans and nonbinary people’s lives that integrates their gender experience. For example, some trans and nonbinary people have described getting to define their own gender experience as a way that they express their resilience. Experiences like this are overlooked when using general measures of resilience. Those that have been more gender specific have also narrowly measured resilience mostly as being about identity pride and community connectedness. Although two important components, this has limited a fuller understanding of resilience for trans and nonbinary communities. In terms of what helps people to develop resilience, there are a variety of individual and group or community level experiences that can foster resilience for trans and nonbinary people, including experiences like parental or family acceptance, access to resources, having role models, and being engaged in positive social change and advocacy efforts.  

What impact do you hope this work will have? 

I hope that our work will have a few different impacts. For one, I hope that our work can be helpful in advocacy efforts. We have done research documenting the types of minority stressors that trans and nonbinary people experience and the effects on health. In addition, I hope that our work on minority stress and mental health helps to expand existing frameworks and measures to better reflect the community’s experiences. Finally, we frequently take steps to make an impact from our work directly, like starting the Gender Affirmation Project or leading trainings for mental health providers and other examples. I plan for our team to continue this practice so that we can ensure that our work has practical and real-world impacts beyond the research we do. 

What advice do you have for people who want to support the LGBTQ community? 

I would say that we all can make an impact every day in the choices we make and the actions we take. It is important to stay up to date on the current issues that are impacting trans and nonbinary communities, like what legislation is being proposed, and taking action to advocate for more inclusive and affirming policies. We can also advocate for better workplace environments and practices so that trans and nonbinary people experience less marginalization. We also can take steps to ensure better community supports are available and improve access to resources.  

 
For more information about the work the Trans-ilience team is doing, visit the research page of their website.