Health Care and Social Predictors of Gender Positivity and Gender Distress Among Transgender and Nonbinary People in Canada
Abstract
Background: Transgender (trans) health care is focused on gender dysphoria and overlooks the diverse gender experiences of trans and nonbinary (TNB) individuals, especially gender positivity (also known as gender euphoria), a crucial aspect and resilience factor of trans well-being. Existing research on gender positivity is primarily qualitative, lacking quantitative assessment tools. This thesis provides quantitative insights by utilizing new assessment scales to evaluate gender positivity (GP) and gender distress (GD).
Methods: Data (n = 2316) were from Trans PULSE Canada, a 2019 cross-sectional community-based survey of TNB people aged 14+ in Canada. Social and bodily dimensions of gender well-being were measured with the Trans Youth CAN! Gender Positivity Scale and Gender Distress Scale, originally developed using a clinical sample of TNB youth in Canada. This thesis applied confirmatory factor analysis to validate psychometric properties of the two scales, and structural equation modelling to examine health care and social predictors associated with GP and GD.
Results: Correlation analysis demonstrated that GP and GD have a complex relationship instead of being simple opposites. Confirmatory factor analysis supported two-factor (social and body) models for GP and GD, confirming that GP and GD are multi-faceted distinct constructs. Structural equation modelling revealed that gender-affirming medical care was associated with higher GP and lower GD across social and bodily dimensions. However, when barriers impeded accessing ongoing care, these benefits were diminished compared to unobstructed ongoing care or completion of needed care. Possessing government identification with the preferred gender marker was linked to overall gender well-being. The frequency of misgendering emerged as a prominent risk factor, detrimentally impacting both GP and GD across social and body dimensions. Strong parental support was significantly associated with greater GP and less social GD, a link not observed with other familial or romantic partner support.
Conclusion: This study enhances our understanding of TNB gender experiences, underscoring the need for a more balanced and holistic healthcare perspective that promotes gender positivity. The findings suggest that TNB healthcare practices could benefit from incorporating strength- and resilience-based approaches, cultivating gender positivity as a protective factor for the health and well-being of the TNB population.