Background: Although many non-binary or genderqueer (NB-GQ) people identify as transgender (trans), their health needs may require expansion of gender-affirming models of care that have historically relied on binary conceptualizations of trans people.

Methods: We conducted a quantitative survey with a sample NB-GQ young adults ages 18-29 (N=80) recruited from the San Francisco Bay Area. We then held 1-hour qualitative interviews with a random subset of participants (n=23) to explore in-depth experiences related to gender and health services. Quantitative survey data was summarized descriptively. Interviews were transcribed verbatim and thematic analyses was used to develop codes and themes.

Results: Participants’ mean age was 24 (SD=3.1) and 62.5% identified as a BIPOC. Common health needs during the past 6 months included counseling/mental health (71.3%), general medical care (56.3%), STI screening (51.3%), and emergency medical care (28.8%). However, 28.8% reported difficulty obtaining services due to gender. Main reasons for avoiding health services included providers’ limited knowledge about NB-GQ issues (32.5%), provider insensitivity to NB-GQ issues (30.0%), and degrading experiences with providers due to being a NB-GQ person (26.3%). In interviews, participants discussed limitations of gender affirming models of care, which influenced their access to hormones, surgeries, and mental health support. Many providers often assumed that participants desired particular aspects of medical transition typically sought by trans men or women, and failed to understand the experiences and needs of patients who resist the gender binary.

Conclusions: Findings highlight the need for gender affirming services to better support the needs of NB-GQ people.

Transgender and Gender-Expansive (TGE) communities routinely face many barriers to healthcare, including challenges in finding healthcare providers who are knowledgeable about and sensitive to TGE health. Healthcare providers receive little training on this patient population, and as a result TGE patients endure negative healthcare encounters including misgendering, deadnaming, and inappropriate questioning. These barriers have been further amplified by the effects of COVID-19 on healthcare systems and TGE communities.

A total of 30 participants who identify as part of TGE communities were purposively sampled from the Greater Los Angeles Area over 6 months during the COVID-19 pandemic. The study team conducted semi-structured video interviews at three-time points to better understand patient experiences during the health encounter.

Findings suggested a lack of cultural competence regarding TGE health which created significant barriers. Qualitative analysis indicated that: (1) TGE patients often engaged with healthcare providers with limited to no cultural competency in TGE health issues; (2) these encounters often resulted in TGE patients educating healthcare providers on the needs of TGE communities; and (3) some patients endured negative or inappropriate lines of questioning unrelated to their immediate health concerns. These outcomes were not new to our TGE participants, but alongside reduced institutional capacities due to COVID-19 precautions, they left participants uncertain of their ability to access essential gender-affirming care. Improving access to and training in TGE health could empower healthcare providers to identify and change systemic barriers to care that contribute to TGE inequity and mistrust of healthcare systems.

Background: Social support is a determinant of health and wellbeing for trans people. Few studies have investigated social support among nonbinary and genderqueer (NB-GQ) people.

Methods: We conducted qualitative in-depth interviews with NB-GQ young adults ages 18-29 in the San Francisco Bay Area (n=23). Semi-structured interviews inquired into sources, types, and consequences of social support that participants considered important to their health. Transcribed interviews were coded and patterns of experience were summarized using the thematic analysis approach.

Results: Findings suggest NB-GQ young adults may have multiple options for social support, including families of origin, families of choice, friends, interest/affinity groups, healthcare providers, and symbolic connections to various queer communities. Participants described certain support systems, especially parents and childhood friendships, as limited, unstable, or stressful due to non-acceptance of their gender identity and/or sexual orientation. They often expressed distress related to past, ongoing, and anticipated non-acceptance from family, even with other social supports available. Participants described stronger social support from siblings and from people with shared socially marginalized identities, including other queer people. These relationships provided gender affirmation, a sense of collective belonging, and support with health and wellbeing. Some participants reported relationships contributing to unhealthy substance use, while others described how relationships supported managing substance use including promoting harm reduction or sobriety.

Conclusions: Programs are needed that build on the identified supportive communities of NB-GQ people, and particular efforts are needed to address unresolved family conflict in order to promote health and wellbeing.