Challenging and understanding gendered narratives: the development and validation of the transnormativity measure (TM).

Background: Transnormativity refers to the accountability structure that regulates the acceptable gender presentations, narratives, and ways of being of trans and nonbinary (TNB) individuals.Aims: The present research extends prior qualitative research on transnormativity to develop and validate the Transnormativity Measure (TM). Methods: The initial developed pool of potential items was presented to a focus groups and three content experts for review. In Study 1 (N = 497), the 69 initial items of the TM hypothesized to underly a six-factor structure were analyzed using Exploratory Factor Analysis (EFA) and construct and discriminant validity were assessed. In Study 2 (N = 540), an independent sample of TNB participants' TM responses were subjected to Confirmatory Factor Analysis (CFA), invariance testing, and construct and predictive validity. Finally, in Study 3 (N = 107), an Interclass Correlation Coefficients 2-way mixed-effects model of the TM was assessed.Results: EFAs conducted in Study 1 revealed a two-factor structure as the best fit with 50 items removed. Conceptually there was considerable overlap in the items comprising the two factors and it was decided that one general factor should be utilized. Study 1 also provided preliminary construct and discriminant validity due to expected relations between the TM and existing measures of heteronormativity and internalized transphobia. In Study 2 findings from correlational tests of the remaining items revealed that four items were highly correlated and were removed. Subsequent CFA indicated that the one factor model fit the data well. Configural invariance was supported however metric noninvariance was found. Additionally, Study 2 results supported construct and predictive validity through correlations between the TM and measures of TNB community belonginess and mental health outcomes. Finally, Study 3 provided support for test-retest reliability. Discussion: Across three studies, the TM was found to be a valid measure of transnormativity.

The Mediating Role of Avoidant and Facilitative Coping on the Relation Between Discrimination and Alcohol Use Among Transgender and Gender-Diverse Individuals.

Purpose: The motivational model of alcohol use indicates that there is a relation between chronic stress and alcohol use, and that this relation is mediated by substance use to cope. However, this model has not been applied to the experiences of transgender and gender-diverse (TGD) individuals. In response, this study investigated whether facilitative (e.g., active and interpersonal coping) and avoidant (e.g., cognitive avoidance and substance use to cope) coping mediate the relation between discrimination and alcohol use. Methods: Participants include 496 TGD individuals (97 trans women, 126 trans men, and 273 nonbinary), 18-68 years of age (mean=32.09 and standard deviation=12.47), who completed a survey about health behaviors and stress. An exploratory factor analysis and confirmatory factor analysis of the Brief Coping Orientation to Problems Experienced (COPE) were conducted to determine the coping patterns of TGD individuals and multiple mediation analyses were conducted to examine whether distinct coping strategies mediated the relation between discrimination and alcohol use. Results: Both facilitative and avoidant coping strategies were significantly related to discrimination; however, only active coping and substance use to cope were related to alcohol use. Mediation results showed that substance use to cope (i.e., an avoidant coping strategy) was the only significant mediator. Descriptive results showed nonsignificant differences between TGD gender identities regarding levels of alcohol use and engagement with coping strategies. Conclusion: The results indicate a clear need for interventions to reduce utilization of avoidant coping strategies among TGD individuals.

Resisting Trans Medicalization: Body Satisfaction and Social Contextual Factors as Predictors of Sexual Experiences among Trans Feminine and Nonbinary Individuals.

Past research has constructed a medicalized model of trans women's sexuality, where trans women are believed to be hyposexual and distressed by their bodies pre-transition, and are cured of their sexual dysfunction as a result of gender affirmative medical procedures. The current study engaged a community sample (N = 169) of trans feminine and nonbinary individuals assigned male at birth (TFNB) to investigate predictors of sexual experiences after addressing methodological biases of prior studies, including body satisfaction (using a modified Body Image Scale) and social contextual factors. Hierarchical regressions were conducted to test the hypothesis that after accounting for demographic variables and social contextual aspects (i.e., body satisfaction, social dysphoria, and fetishization), medical transition (i.e., hormone therapy) would not significantly predict five outcomes of sexual experience (i.e., receptive penetration, insertive penetration, importance of sex, sexual pleasure, and sexual intimacy). Across all models, medical transition was not a significant predictor of sexual experiences; however, sexual orientation, age, body satisfaction, and experiences of fetishization were frequent predictors. Results suggest that the sexual experiences of TFNB individuals do not align with the medicalized model and that demographic and contextual factors play an important role in the sexual outcomes for this population.

Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals.

Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.

"A center for trans women where they help you": Resource needs of the immigrant Latinx transgender community.

Background: Immigrant Latinx transgender people often migrate to the United States because of a desire for increased safety and more opportunities. However, after migrating to the United States, immigrant Latinx transgender people often struggle to access basic needs, including health care, jobs, and stable finances. These struggles are exacerbated for undocumented immigrant Latinx transgender people. There is a gap in the literature regarding needed resources for immigrant Latinx transgender community members living in the United States. Aims: Utilizing a critical intersectionality framework, the aim of the present study was to investigate the resource needs of immigrant Latinx transgender community members living in the United States. Methods: A community sample of 18 immigrant Latinx transgender people living in a large metropolitan city in Florida participated in individual semi-structured interviews to explore their community resource needs. Results: Thematic analysis revealed five themes related to resources that participants needed including: 1) Transgender healthcare/resources, 2) Public education, 3) Financial aid resources, 4) Homelessness resources, and 5) Addictions care. Two resource need-related themes were identified that pertain specifically to undocumented immigrant Latinx transgender people, including: 1) Documentation papers for access, and 2) Legal aid. Conclusions: Findings suggest that immigrant Latinx transgender community members in this study provided guidance about broad resources needed to enhance their wellness and safety, and promote liberation of community members. Participants' resource needs suggest the importance of policy and structural level changes from institutions with power that consider and enhance the wellness of immigrant Latinx transgender people. Findings also suggest the need for more tailored interventions and case work to better support immigrant Latinx transgender people.

Using a Comprehensive Proximal Stress Model to Predict Alcohol Use.

Purpose: The gender minority stress model has been proposed by researchers to explain the high rates of substance use found within transgender communities, but its explanatory power has never been directly tested. Further, qualitative research has noted that premedically transitioned and nonbinary individuals are more likely to engage in avoidant coping such as drinking to cope. As such, the current study tested the relationship between proximal stress (comprised of internalized transphobia, anticipated stigma, concealment, and gender dysphoria), drinking to cope, and problematic alcohol use. Methods: Transgender and nonbinary participants over the age of 18 (N=297) completed an online survey on alcohol use. To test for differences in drinking to cope across gender identity and medical transition, analysis of variance and independent t-tests were conducted. Further, a structural equation model of proximal stress was developed to test whether drinking to cope mediated the relationship between proximal stress and alcohol use. Results: There were no significant differences across gender identity or medical transition status in severity of drinking to cope. Proximal stress was significantly related to problematic alcohol use and the relationship was explained by an indirect relationship with drinking to cope. Conclusion: Findings from this study suggest that drinking to cope is an important aspect of high rates of alcohol use found in the transgender community. Implications for clinical practice with transgender individuals are discussed.

"What American dream is this?": The effect of Trump's presidency on immigrant Latinx transgender people.

Little research has explored how transgender people are impacted by the behaviors, statements, and policies of the Trump administration. To date no scholarship has explored the experiences of immigrant Latinx transgender people during the current political climate. Using a critical intersectional qualitative framework, the present study aimed to investigate how immigrant Latinx transgender people are impacted by Trump's administration. A community sample of 15 immigrant Latinx transgender people from a large metropolitan city in Florida participated in semistructured interviews to explore their experiences since the election of Donald Trump. Thematic analysis revealed seven themes related to experiences of oppression, including: (a) perceived increase in societal discrimination and violence, (b) perception of law enforcement surveillance, discrimination, and violence, (c) mental health toll, (d) decreased access to resources and opportunities, (e) perception of Trump's uninformed, hostile, and aggressive behavior, (f) rollback of discrimination protection, and (g) passing and conforming to norms. In addition, five themes emerged about participants' sources of coping and strength in response to the current political climate, including: (a) pride and resilience, (b) hope for a better future, (c) religion and spirituality, (d) family and community support, and (d) short-term avoidance as a form of resistance. Psychological practices and advocacy efforts such as using evidence-based practices to effectively work with immigrant Latinx transgender people are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"We are our own community": Immigrant Latinx transgender people community experiences.

Little is known about how immigrant Latinx transgender people experience support from their communities in the U.S. and back in their country of origin. The present study aimed to understand how immigrant Latinx transgender people reported support within their communities. A community sample of 18 immigrant Latinx transgender people in a large metropolitan city in Florida participated in semi-structured interviews. Thematic analysis revealed four themes depicting the varying levels of support that participants received within their communities in the U.S., including: (a) neighborhood belonging, (b) organizations as a source of well-being, (c) friends as a source of protection and safety, and (d) supporting undocumented individuals. In addition, three themes emerged about participants' experiences of discrimination and oppression within their communities, including: (a) discrimination and violence, (b) police profiling and restriction of public space, and (c) lack of safety for undocumented individuals. Participants also shared narratives about the perceived level of community support they received in the U.S. versus in their countries of origin. Drawing on gender minority stress and intersectionality, the community experiences of immigrant Latinx transgender people are examined and interpreted to provide important research, advocacy, and practice implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else": Fetishization and Sexualization of Transgender and Nonbinary Individuals.

Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation.

The present study investigated the ways trans masculine and nonbinary individuals describe aspects of their sexual satisfaction. Sexual satisfaction refers to an individual's subjective evaluation of their sexual experiences, and is influenced by relational, contextual, and personal experiences. Prior research with sexual satisfaction among trans individuals utilized quantitative measures, restricting the ability for respondents to describe trans-related aspects. Further, the pervasive focus on the effects of medical transition on binary trans individuals' experiences in prior research limits our understanding of those who do not desire a medical transition or live outside of the gender binary. Participants represented a community sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you satisfied with your sex life?" Thematic analysis revealed eight overarching themes that represented two categories: universal and trans-related. Discussion focuses on the ways in which clinicians and researchers can utilize the current findings to improve the sexual satisfaction of trans masculine and nonbinary individuals.

'None of my providers have the slightest clue what to do with me': Transmasculine individuals' experiences with gynecological healthcare providers.

Background: Transgender individuals experience barriers to accessing healthcare including financial difficulties, lack of insurance, and discrimination and victimization by medical providers. Transmasculine patients face unique challenges and are more at risk for reproductive pathology resulting from a lack of regular gynecological care. Presently, a dearth of research exists on the needs of transmasculine patients in gynecological healthcare settings. While the literature on experiences of transmasculine individuals has focused on physical health and risk factors for this population, this study focuses on the information that transmasculine individuals want their gynecologists to know when working with trans patients. Aim: The aim of the present study was to explore the lived experiences of transmasculine individuals in order to understand what they feel their medical providers need to know about their experiences seeking gynecological care. Method: Participants included 167 adults who identified as masculine of center or trans men ranging in age from 18 - 56 (M = 27.99, SD = 6.06). Participants completed an online survey and responded to open-ended questions about their gynecological healthcare experiences. Qualitative responses were analyzed via thematic analysis. Results: Results revealed four information-salient themes, including: 1) Patient comfort levels; 2) Language; 3) Provider assumptions; and 4) Provider knowledge. Conclusions: Findings suggest that gynecologists are key in both exacerbating barriers and creating more affirming spaces for transmasculine patients. Discussion of the results focuses on the ways that providers can improve the gynecologic healthcare experiences of their transmasculine patients.

"I Use All the Parts I'm Given": A Qualitative Investigation of Trans Masculine and Nonbinary Individuals' Use of Body during Sex.

Objectives: The study investigates how trans masculine and nonbinary individuals describe the use of their bodies during sexual activities. Methods: Three hundred and sixty-one trans masculine and nonbinary individuals were asked to describe their use of body during sex through an online survey. Data were analyzed through thematic analysis. Results: Eleven subthemes emerged that were organized in 4 overarching themes: Relational Factors; Behavioral Factors; Sexual Roles; and Transgender Related Factors. Some differences emerged between trans masculine and nonbinary participants. Conclusions: Although some of our participants described a lack of sexual activity, our participants overall described a wide range of activities.

What Constitutes Sexual Dissatisfaction for Trans Masculine and Nonbinary Individuals: A Qualitative Study.

The present study is aimed at understanding how trans masculine and nonbinary individuals describe aspects of their sexual dissatisfaction. Previous studies on cisgender sexual dissatisfaction have utilized narrow definitions of dissatisfaction, operationalizing it in opposition to sexual satisfaction. Moreover, the pervasive focus on the outcomes of medical intervention steps in prior sexual dissatisfaction research with trans masculine participants ignored the experiences of individuals who do not desire a medical transition or live outside of the gender binary. Participants in the current study represented a non-clinical sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you dissatisfied with your sex life?" Thematic analysis revealed six overarching themes for participant dissatisfaction: 1) difficulty with orgasm, 2) partner dynamics, 3) trauma, 4) desire for different body parts, 5) gender dysphoria, and 6) medical transition. Discussion focuses on the ways in which clinicians can utilize the current findings to decrease the sexual dissatisfaction of trans masculine and nonbinary individuals.