SAT393 Resilience And Resistance In The Face Of Stigma And Trauma: A Qualitative Study Of Transgender People’s Reactions To Interactions With The Healthcare System

Disclosure: D. Stroumsa: None. M. Maksutova: None. G. Indig: None. J.Y. Ballard: None. R. Trammell: None. E.E. Popoff: None. J.P. Wu: None. K. Gamarel: None. IntroductionFor many transgender people, interactions with healthcare, including for initiating gender affirming hormones, can be stigmatizing and traumatic. This study sought to explore how trans people navigate interactions with the healthcare system when accessing gender-affirming hormones. MethodsWe conducted semi-structured interviews with trans adults ages 21 to 54 (mean=31.7) who had initiated gender-affirming hormone therapy (n=21) using purposive and snowball sampling methods. Interviews were transcribed verbatim and de-identified. Interviews were analyzed using a reflective thematic analysis approach in which codes were deductive and inductive in nature. The study was designed in collaboration with a community advisory board. ResultsParticipants included 9 (42.9%) who identified as men or trans men, 9 (42.9)% who identified as women trans women, and 3 (14.3%) who identified as nonbinary; 8 (38%) identified as a person of color, and 8 (38.1%) participants resided in an urban area. Four overarching themes were identified: (1) multi-level minority stress barriers to care; (2) resilience and resistance in response to minority stress; (3) the cost of stigma and discrimination; and (4) recommendations for change. Multilevel minority stressors included internalized, anticipated, and enacted/interpersonal stigma, as well as vicarious trauma in healthcare systems when initiating gender-affirming hormones. In response to stigmatizing and traumatic experiences, participants engaged in a number of resilience and resistance strategies including selective-disclosure, self-advocacy, relying on community support, as well as innovative “workarounds” to overcome the bureaucratic and traumatic hurdles to accessing gender-affirming hormones. These strategies were however not unassailable, and the stigma and discrimination did have negative consequences. Participants described areas for change, which included provider training and addressing the political environment. ConclusionTransgender people encounter stigma when accessing gender-affirming hormones; however, they also engage in a range of resilience strategies. Ensuring access to gender-affirming care necessitates addressing stigma in healthcare systems. Structural interventions addressing root causes of stigma and trauma transgender people experience are needed to complement provider-level interventions. Presentation: Saturday, June 17, 2023