Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Bauer, Greta R.


University of Minnesota


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.

Summary for Lay Audience

This thesis investigates the health care and social factors that influence the gender well-being of transgender and nonbinary (TNB) people in Canada. Traditionally, transgender healthcare has focused on gender dysphoria and overlooked the diverse gender experiences of TNB individuals, particularly gender positivity (also known as gender euphoria) – the positive, empowering feelings related to one’s gender. There is a dearth of quantitative research or assessment tools on gender positivity. To address this gap, we used two new psychological scales to measure gender-related positivity and distress in both the social and body dimensions. These scales capture broader manifestations of TNB gender feelings without pathologizing them, viewing TNB people as a community rather than a patient group.

Applying advanced statistical analyses on the data of 2316 TNB individuals aged 14+ from a 2019 Canadian community survey (Trans PULSE Canada), this thesis study reveals a complex relationship between gender positivity and distress, challenging the notion that they are simple opposites. Furthermore, we found a significant association between gender-affirming medical treatments and higher gender positivity, as well as lower gender distress, in both social and body dimensions. However, when individuals faced barriers to accessing such care, these improvements were diminished compared to when they had unobstructed ongoing care or completed needed care. Possessing a government-issued identification document with the preferred gender designation is also linked to improved gender well-being overall. Notably, misgendering stands out as a prominent risk factor, negatively impacting both social and body gender well-being. In addition, strong parental support plays a uniquely crucial role in fostering gender positivity and reducing social distress among TNB individuals.

These findings expand the dysphoria-centered viewpoint to a community-informed, holistic, and more balanced understanding of TNB gender experiences. This multidimensional understanding can inform future research, gender-affirming healthcare practices, policies, and societal representations. Transgender healthcare can benefit from resilience- and strength-based approaches that foster gender positivity as a protective factor for the health and well-being of TNB individuals.

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Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.