This practice note is a call to practitioners, researchers, and educators to reconsider how they approach work with trans and nonbinary communities. Drawing on previous work done by Tuck, and shuster and Westbrook, I encourage readers to move from a deficit-based lens to a lens where joy is part of the narrative, an aspect of trans and nonbinary lives that is often missing from much of the research on trans communities. Furthermore, I urge readers to move beyond seeing trans and nonbinary communities as primarily social and political issues to be addressed and to see and embrace the complex and nuanced humanity and lived experiences of trans and nonbinary people.

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients.

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes.

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark’s thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.

Transgender and nonbinary (TNB) individuals experience a variety of systemic barriers that impact their ability to access healthcare, often leading to negative health outcomes. Previous research has suggested that improving health literacy among marginalized communities may help reduce existing health disparities. Yet few studies have examined health literacy among TNB people and how health literacy and healthcare access may differ by urbanicity. Using the capabilities theoretical approach, the current study uses data from six focus groups ( N=40) from metropolitan, urban, and rural areas in Colorado to examine geographic differences in health literacy and healthcare access. Findings show that geographic differences in accessing healthcare include transportation issues, having to travel far distances to access care, finding a TNB-affirming and competent provider, and needing to educate providers and staff. These differences were more prevalent among TNB people living in non-metropolitan areas. Additionally, our findings suggest that TNB individuals have high levels of health literacy due to having to self-educate and exist within a healthcare system that was designed for cisgender people.

Social workers are expected to serve and advocate for marginalized communities, including but not limited to transgender and nonbinary communities (TNB). However, the extent to which social workers meet this expectation is unknown. Using data from a 2019–2020 survey of students who were enrolled in U.S. social work programs (N = 725), this study examined the predictors for engaging in TNB activism, including interaction effects between subdomains of the adapted Ally Identity Measure and students’ personal endorsement of a Critical Orientation to Social Justice. We found that both students identifying as LGBQ and having more TNB people in one’s social network were associated with an increase in engaging with TNB activism. Among our social work educational variables, we found that students who have a mixed micro/macro focus, those who had taken a course on power, privilege, and oppression, and those who had engaged in intergroup dialogue were more likely to engage in TNB activism. Finally, we found that the interaction effects between the Critical Orientation to Social Justice Scale and two of the adapted Ally Identity Measure subdomains were significant.