All studies to date demonstrate a lack of access to care for transgender people. A few educational efforts in providing care to transgender people have been successful. However, one challenge in administering training is that there is almost no research on the need of healthcare providers (HCP) to acquire knowledge, as well as on the effect of training on their level of competence and confidence in working with transgender people. Results from an online survey of a convenience sample of HCP across four different European countries (N = 810) showed that 52.7% reported experiences with some form of training on transgender people. The mean confidence level for all HCP (with or without training) in working with transgender people was 2.63, with a significant effect of training on confidence. 92.4% of HCP believed that training would raise their competence, and this belief was significantly higher among HCP with training experience, HCP working in Serbia and Sweden and/or among those HCP who belong to a sexual minority group. General practitioners had the lowest confidence levels of all professions involved. The study provided strong support for the use of training in improving healthcare conditions for transgender people, not only to raise awareness among HCP, but also to increase knowledge, competence and confidence levels of HCP in working with transgender people.

This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.

Transgender (trans) and gender-diverse (GD) adolescents and young adults have remained largely invisible in health research. Previous research shows worse outcomes in health indicators for trans and GD people, compared to cisgender controls. Research on the impact of sexual violence focuses on mainly cisgender female adult victims. This study assessed the impact of sexual violence on the quality of life (QoL) and mental wellbeing (GHQ-12) among trans and GD adolescents and young adults, while taking into account the possible role of gender nonconformity in sexual violence and mental wellbeing. An online, anonymous survey and interviews/focus groups were conducted between October 2021 and May 2022 in Belgium. Multiple analyses of covariance (ANCOVAs) were used to assess the associations between sexual violence, mental wellbeing, and gender nonconformity, while controlling for different background variables (gender identity, sexual orientation, age, economic vulnerability, etc.). The interviews and focus groups were used to validate associations between variables that were hypothesized as important. The quantitative sample consisted of 110 respondents between 15 and 25 years old, with 30 trans respondents (27.3%) and 80 GD respondents (72.7%). A total of 73.6% reported experiences with sexual violence over the past two years (n = 81). The mean QoL score was 5.3/10, and the mean GHQ-12 score was 6.6/12. Sexual violence was not significantly associated with QoL (p = 0.157) and only marginally significantly associated with GHQ-12 (p = 0.05). Changing one’s physical appearance to conform to gender norms, out of fear of getting attacked, discriminated against, or harassed was significantly associated with QoL (p = 0.009) and GHQ-12 (p = 0.041). The association between sexual violence and changing one’s physical appearance to conform to gender norms was analyzed, to assess a possible mediation effect of sexual violence on mental wellbeing. No significant association was found (p = 0.261). However, the interviews suggest that sexual violence is associated with changing one’s physical appearance, but this association is not limited to only trans and GD victims of sexual violence. Non-victims also adjust their appearance, out of fear of future sexual victimization. Together with the high proportion of sexual violence, as well as the lower average QoL and higher average GHQ-12 scores among trans and GD adolescents and young adults, compared to general population statistics, this highlights the need for policy makers to create more inclusive environments.

Background: Transgender and gender-diverse (TGD) adolescents experience elevated rates of depression, anxiety, and suicidality compared to cisgender peers. These outcomes are largely hypothesized to be linked to social stigma and gender minority stress. Resilience constructs like identity pride and community connectedness may buffer these stressors, but their role, especially in clinical populations, remains underexplored. This study investigates the interplay between gender minority stress, resilience, and mental health in clinic-referred Dutch TGD youth through network analysis. Methods: A sample of 172 Dutch TGD adolescents was assessed using commonly employed measures of gender minority stress, resilience, and mental health. Network analysis was conducted to examine network structure and centrality of these constructs. Among the 172 clinic-referred Dutch participants (mean age = 15.70, SD = 0.79), 86.0% ( n = 148) were assigned female at birth, 14.0% ( n = 24) were assigned male at birth, and 9.9% ( n = 17) of the total sample identified as non-binary and genderqueer (NBGQ). Results: Among the participants, 41.7% scored within the clinical range for internalizing problems, and 32.7% exhibited scores indicative of mild to severe depression. Non-affirmation, an established construct in gender minority stress literature, emerged as the most central construct in the network, with strong associations to internalized transphobia and negative expectations for future events. Distal gender minority stressors, such as gender-related rejection and victimization, were less central within the network, but indirectly influenced mental health via pathways involving the more central stressors. Resilience constructs, specifically pride and community connectedness, showed limited centrality. Conclusions: The findings highlight the substantial psychological vulnerabilities of Dutch TGD adolescents and underscore the importance of addressing non-affirmation, internalized transphobia, and negative expectations for future events in clinical settings to mitigate mental health challenges among TGD youth. The study also emphasizes the necessity of societal-level interventions, such as raising awareness about the value of affirming gender identity. Future research should explore the nuanced distinctions within and between different gender minority stressors and their specific impacts on TGD youth.