IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v373y2025ics0277953625003442.html
   My bibliography  Save this article

Gender affirming medical care access: The role of healthcare stereotype threat and social support in a national probability sample of transgender adults

Author

Listed:
  • Smith-Johnson, Madeline
  • Alexander, Katherine

Abstract

Transgender adults face persistent barriers to gender-affirming medical care (GAC)—medical interventions related to a person's gender expression. Extensive qualitative research suggests that accessing GAC is stressful partly because of anticipated stigma from providers and healthcare systems, but that social support from loved ones helps trans adults persist in seeking care. We know less about how anticipated stigma and social support relate to GAC access at the population level. This study utilizes a nationally representative sample of trans adults who want GAC (N = 204) from the U.S. Transgender Population Health Survey (2016–2018). We ask whether anticipated stigma in healthcare (operationalized as healthcare stereotype threat (HCST), or the worry a person has about being judged, mistreated, or stereotyped by providers because of their gender identity or sexual orientation) and perceived social support are associated with GAC utilization for trans adults. We find a significant positive relationship between GAC utilization and HCST, global social support, and significant other support. We also find a significant interaction between HCST and social support where greater HCST is only associated with greater GAC utilization at high levels of social support. These findings underscore the importance of social relationships like peer advocates and chosen families in supporting necessary medical care for trans adults who want it and the importance of increasing culturally competent care in healthcare settings for gender-diverse people.

Suggested Citation

  • Smith-Johnson, Madeline & Alexander, Katherine, 2025. "Gender affirming medical care access: The role of healthcare stereotype threat and social support in a national probability sample of transgender adults," Social Science & Medicine, Elsevier, vol. 373(C).
  • Handle: RePEc:eee:socmed:v:373:y:2025:i:c:s0277953625003442
    DOI: 10.1016/j.socscimed.2025.118014
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953625003442
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2025.118014?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Poteat, Tonia & German, Danielle & Kerrigan, Deanna, 2013. "Managing uncertainty: A grounded theory of stigma in transgender health care encounters," Social Science & Medicine, Elsevier, vol. 84(C), pages 22-29.
    2. King, Wesley M. & Hughto, Jaclyn M.W. & Operario, Don, 2020. "Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research," Social Science & Medicine, Elsevier, vol. 250(C).
    3. Bockting, W.O. & Miner, M.H. & Swinburne Romine, R.E. & Hamilton, A. & Coleman, E., 2013. "Stigma, mental health, and resilience in an online sample of the US transgender population," American Journal of Public Health, American Public Health Association, vol. 103(5), pages 943-951.
    4. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
    5. Sorhaindo, Annik Mahalia & Lavelanet, Antonella Francheska, 2022. "Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care," Social Science & Medicine, Elsevier, vol. 311(C).
    6. Kia, Hannah & Kenney, K.A. & Abramovich, Alex & Ferlatte, Olivier & MacKinnon, Kinnon Ross & Knight, Rod, 2023. "“Nowhere else to be found”: Drawing on peer support experiences among transgender and gender-diverse people to substantiate community-driven gender-affirming care," Social Science & Medicine, Elsevier, vol. 339(C).
    7. Whitley, Rob & Kirmayer, Laurence J., 2008. "Perceived stigmatisation of young mothers: An exploratory study of psychological and social experience," Social Science & Medicine, Elsevier, vol. 66(2), pages 339-348, January.
    8. Wall, Catherine S.J. & Patev, Alison J. & Benotsch, Eric G., 2023. "Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning," Social Science & Medicine, Elsevier, vol. 320(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jordan, Sid P., 2024. "Compelling care: A grounded theory of transmasculine self-defense and collective protection at the clinic," Social Science & Medicine, Elsevier, vol. 345(C).
    2. Speechley, Molly & Stuart, Jaimee & Scott, Riley A. & Barber, Bonnie L. & Zimmer-Gembeck, Melanie J., 2024. "Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients," Social Science & Medicine, Elsevier, vol. 348(C).
    3. Hughto, Jaclyn M.W. & Wolfe, Hill L. & Adrian, Haley & Operario, Don & Hughes, Landon D. & Fernández, Yohansa & Briody, Victoria & Matthews, Paige & Kelly, Patrick J.A. & Collins, Alexandra B., 2024. "Understanding the delivery of substance use treatment services to transgender and gender-diverse people: Findings from a mixed-methods study of healthcare professionals," Social Science & Medicine, Elsevier, vol. 343(C).
    4. Kia, Hannah & MacKinnon, Kinnon Ross & Abramovich, Alex & Bonato, Sarah, 2021. "Peer support as a protective factor against suicide in trans populations: A scoping review," Social Science & Medicine, Elsevier, vol. 279(C).
    5. Bhattacharya, Shamayeta & Ghosh, Debarchana, 2020. "Studying physical and mental health status among hijra, kothi and transgender community in Kolkata, India," Social Science & Medicine, Elsevier, vol. 265(C).
    6. King, Wesley M. & Hughto, Jaclyn M.W. & Operario, Don, 2020. "Transgender stigma: A critical scoping review of definitions, domains, and measures used in empirical research," Social Science & Medicine, Elsevier, vol. 250(C).
    7. Hannah Van Borm & Marlot Dhoop & Allien Van Acker & Stijn Baert, 2020. "What does someone's gender identity signal to employers?," International Journal of Manpower, Emerald Group Publishing Limited, vol. 41(6), pages 753-777, March.
    8. Vaitses Fontanari, Anna Martha & Zanella, Gabriel Ibarra & Feijó, Marina & Churchill, Siobhan & Rodrigues Lobato, Maria Inês & Costa, Angelo Brandelli, 2019. "HIV-related care for transgender people: A systematic review of studies from around the world," Social Science & Medicine, Elsevier, vol. 230(C), pages 280-294.
    9. White Hughto, Jaclyn M. & Reisner, Sari L. & Pachankis, John E., 2015. "Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions," Social Science & Medicine, Elsevier, vol. 147(C), pages 222-231.
    10. Danya Lagos, 2018. "Looking at Population Health Beyond “Male” and “Female”: Implications of Transgender Identity and Gender Nonconformity for Population Health," Demography, Springer;Population Association of America (PAA), vol. 55(6), pages 2097-2117, December.
    11. shuster, stef m., 2019. "Performing informed consent in transgender medicine," Social Science & Medicine, Elsevier, vol. 226(C), pages 190-197.
    12. Ahmad, Husnain F & Banuri, Sheheryar & Bokhari, Farasat, 2024. "Discrimination in healthcare: A field experiment with Pakistan's transgender community," Labour Economics, Elsevier, vol. 87(C).
    13. Sari L Reisner & Jaclyn M W Hughto, 2019. "Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    14. Lewis, Tom & Doyle, David Matthew & Barreto, Manuela & Jackson, Debby, 2021. "Social relationship experiences of transgender people and their relational partners: A meta-synthesis," Social Science & Medicine, Elsevier, vol. 282(C).
    15. Ethan C Cicero & Sari L Reisner & Elizabeth I Merwin & Janice C Humphreys & Susan G Silva, 2020. "The health status of transgender and gender nonbinary adults in the United States," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-20, February.
    16. Cristiano Scandurra & Vincenzo Bochicchio & Anna Lisa Amodeo & Concetta Esposito & Paolo Valerio & Nelson Mauro Maldonato & Dario Bacchini & Roberto Vitelli, 2018. "Internalized Transphobia, Resilience, and Mental Health: Applying the Psychological Mediation Framework to Italian Transgender Individuals," IJERPH, MDPI, vol. 15(3), pages 1-19, March.
    17. Paine, Emily Allen, 2018. "Embodied disruption: “Sorting out” gender and nonconformity in the doctor's office," Social Science & Medicine, Elsevier, vol. 211(C), pages 352-358.
    18. Willging, Cathleen & Gunderson, Lara & Shattuck, Daniel & Sturm, Robert & Lawyer, Adrien & Crandall, Cameron, 2019. "Structural competency in emergency medicine services for transgender and gender non-conforming patients," Social Science & Medicine, Elsevier, vol. 222(C), pages 67-75.
    19. Davide Costa, 2023. "Transgender Health between Barriers: A Scoping Review and Integrated Strategies," Societies, MDPI, vol. 13(5), pages 1-29, May.
    20. Ajay Keshav Pandey & Kristie Seelman, 2022. "History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults," IJERPH, MDPI, vol. 19(23), pages 1-16, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:373:y:2025:i:c:s0277953625003442. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.