Abstract
Historically, research has portrayed transgender, gender-diverse, and non-binary (TGDN) individuals through narratives of distress and dysfunction. Through the adoption of a positive psychology lens, the present study sought to refute this dominant deficit model, instead exploring the processes that foster wellbeing among TGDN adults residing in Western Australia. Central to this study was the collaboration between researchers and the TGDN community. Participants comprised twelve adults who self-identified as members of Western Australia’s TGDN community, recruited through TGDN community spaces. In line with the exploratory qualitative design employed in this study, participants took part in face-to-face, semi-structured interviews; with transcripts analysed using thematic analysis. Gender euphoria emerged as the central concept underlying participants’ conceptualizations of wellbeing. Three subsequent themes were identified: (1) achieving gender congruence, (2) collectively healing, and (3) finding gender pride. Each theme illustrates a means through which gender euphoria, and thus wellbeing, was elicited among participants. These findings may inform the development of individualized strategies that clinicians, and institutions serving TGDN individuals, can implement to improve the wellbeing of their clients. Further, this study highlights the need to avoid reconstructing pathologising narratives, and instead adopt participatory, and positive psychology approaches to research with the TGDN community.
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1 The Transgender, Gender-Diverse, and Non-Binary (TGDN) Community
The term transgender describes individuals who self-identify with a gender that does not align with the one assigned to them at birth (Kattari et al., 2020). A wide variance of prevalence estimates exists across studies for the trans population due to inconsistencies in how studies define “transgender” (Collin et al., 2016). While the exact size of the trans population in Australia is unknown (Telethon Kids Institute, 2017), recent estimates in the United States suggest that 0.3–0.5% of adults identify as transgender (Zhang et al., 2020). However, many trans people do not identify as exclusively male or female (Cheung et al., 2020).
The terms gender-diverse and non-binary describe individuals with gender identities beyond the male-female binary (Koehler et al., 2018). Subsumed within these umbrella terms are a variety of gender identities (e.g., androgynous; Richards et al., 2016). Individuals who use labels within this umbrella tend to identify, whether temporarily or permanently, as both male and female, neither male or female, as another gender, or may reject the concept of gender altogether (Valente et al., 2020). Gender-diverse and non-binary people make up between 0.5% and 4.5% of the general population in the US (Zhang et al., 2020). While the definitional distinction between these terms is unclear within the literature, some individuals may feel their identity is better captured through one of these labels but not the other (Thorne et al., 2019). The incorporation of both identities within this study seeks to reflect this reality.
1.1 Issues Facing the TGDN Community
To explore processes contributing to the wellbeing of TGDN individuals, consideration of how distal and proximal stressors influence the wellbeing of these individuals must first occur (Meyer, 2003). Individuals belonging to the TGDN community are exposed to extremely high rates of gender-related discrimination and violence (Bockting et al., 2013). Such discrimination is demonstrated through transphobic public attitudes which manifest in disproportionate incidents of verbal, physical and sexual harassment (Riggle et al., 2014; Tebbe & Moradi, 2012) and through sociostructural inequalities (Stotzer et al., 2013). Experiences of gender-based violence contribute to an increased incidence of adverse mental health outcomes (Hendricks & Testa, 2012; Valente et al., 2020). Findings from Bretherton et al.’s (2021) cross-sectional online survey provided strong evidence supporting the link between adverse mental health outcomes and gender-related violence among 928 Australian TGDN adults. In their study, 63% of participants reported experiencing verbal abuse, while 22% reported having been physically assaulted. Bretherton et al. (2021) found high rates of self-reported mental illness among these individuals, including depression (73%), anxiety (67%) and attempted suicide (43%). These suicidality rates are considerably higher than the prevalence of attempted suicide within Australia’s general adult population, which stands at 3.3% (Slade et al., 2009). For non-binary individuals, rates of depression and anxiety are even higher than their binary trans peers (Cheung et al., 2020). Beyond the adverse mental health outcomes of gender-related violence, discrimination can manifest in sociostructural inequalities which aggravate health disparities more broadly (Frost et al., 2019; Stotzer et al., 2013). Such inequalities are seen in the disproportionate numbers of homeless and unemployed TGDN individuals, as well as the increased instances of discrimination in healthcare settings (Rodriguez et al., 2017). Ultimately, gender-based discrimination is a distal stressor that negatively impacts upon the psychological, physical, and social wellbeing of TGDN individuals (Meyer, 2003).
Proximal stressors describe individual psychological processes resulting from exposure to distal stressors, such as internalized transphobia (Flynn & Bhambhani, 2021). Internalized transphobia describes the state of discomfort TGDN individuals may experience with their own gender identity, as society’s normative, binary-affirming gender attitudes are internalized (Cronin et al., 2019). Internalized transphobia has been associated with poorer mental wellbeing among TGDN individuals, with separate studies indicating that internalized transphobia increases the likelihood of suicide attempts (Perez-Brumer et al., 2015), and depressive and social anxiety symptoms (Testa et al., 2015). Ultimately, the accumulative experiences of distal and proximal stressors produce adverse psychological, social, and physical health outcomes for TGDN individuals (Meyer, 2003).
1.2 Theoretical Framework
1.2.1 Three Pillar Model of Positive Psychology
Positive psychology counters the deficit approaches often adopted in psychological research by concentrating on sources of life satisfaction and wellbeing (Taube & Mussap, 2019). Through the lens of positive psychology, the mechanisms by which life satisfaction and wellbeing manifest in TGDN individuals can be explored (Seligman & Csikszentmihalyi, 2000). As recommended by Vaughan and Rodriguez (2014), the three pillar model of positive psychology functions as the organizing framework through which the wellbeing of TGDN individuals is conceptualized in this research. In this model, wellbeing is considered on three levels: Positive subjective experiences, character strengths, and positive institutions (Seligman & Csikszentmihalyi, 2000). Positive subjective experiences capture a range of inherently valued experiences, from positive affective states to aspects of subjective wellbeing. Character strengths refer to an individual’s positive personal qualities that engender wellbeing and have broad-based cultural value (e.g., bravery; Taube & Mussap, 2019). Finally, positive institutions refer to social institutions that serve as resiliency and support resources e.g., TGDN affirming safe spaces (Lytle et al., 2014). Within this model, these positive institutions are theorized to foster positive subjective experiences (e.g., experiences of affirmation), and contribute to the development of individuals’ character strengths (e.g., pride; Lytle et al., 2014).
1.2.2 The Minority Stress Model
The mechanisms by which strengths manifest in TGDN individuals is a relatively neglected topic of research (Lytle et al., 2014). Meyer’s (2003) Minority Stress Model offers a framework through which a positive psychology approach to research with TGDN populations can be considered (Lytle et al., 2014). Meyer’s (2003) Minority Stress Model proposes that individuals belonging to stigmatized social groups are exposed to additional stressors due to their minority status. These added stressors result in adverse health outcomes in minority populations (Lytle et al., 2014). Meyer’s (2003) Minority Stress Model extends upon its conceptualization of stressors within minority populations, by incorporating commentary on how certain processes can buffer the impact of stress on wellbeing and produce positive health outcomes. These stress-buffering processes are where positive psychology and the Minority Stress Model intersect, providing an integrative framework through which factors contributing to wellbeing in TGDN individuals can be explored.
1.2.3 An Integrative Framework
This study operationalizes “wellbeing” as “a state of physical, psychological, and social health” (Pressman et al., 2013, p. 2047). Within the Minority Stress Model (Meyer, 2003), two distinct sources of resilience that contribute toward wellbeing are described: Individual-based resilience, and community-based resilience. Individual-based resiliency resources comprise those that operate on an individual level that can be drawn on to support wellbeing e.g., personality (Meyer, 2003). Community-based resiliency resources include those that are available to all members of the minority group that support member wellbeing, e.g., gender-affirming spaces (Meyer, 2003). In Seligman and Csikszentmihalyi’s (2000) positive psychology model, individual-based resiliency resources are conceptualized as character strengths and subjective positive experiences, while community-based resiliency resources are conceptualized as positive institutions. The intersection of both models in this way provide an integrative framework through which the wellbeing of TGDN individuals can be explored, as illustrated in Fig. 1.
1.3 TGDN Positive Psychology Literature
To counter the deficit discourse that dominates approaches to research with TGDN individuals, a small but mounting body of research now explores how this population navigates adversity through individual, and community-level resilience processes (Jones & Hillier, 2013). Several resilience-promoting processes at the individual level have been recognized, including perceived acceptance of TGDN identities (Grossman et al., 2011; Simons et al., 2013), the opportunity to describe one’s gender identity with their own words and on their own terms (Matsuno & Israel, 2018; Singh et al., 2014), and self-acceptance (DiFulvio, 2014; Goffnett & Paceley, 2020). Community-level resilience-promoting processes include, engaging in community activism (Asakura, 2016; Craig et al., 2008), involvement in spaces that affirm one’s gender identity (Vijlbrief et al., 2019; Wagaman, 2016), and finding authentic role models (Singh et al., 2011).
1.4 The Current Study
Despite a large number of trans individuals identifying with genders beyond the binary, a relatively low number of trans studies have adequately represented non-binary gender identities (Cosgrove, 2020). While some studies conflate gender identity with sexual orientation (e.g., Asakura, 2016), historically, trans research has omitted non-binary voices all together (Thorne et al., 2019). In doing so, research has assumed binary homogeneity within transgender communities and diluted the nuances of non-binary and gender-diverse individuals’ experiences (Cosgrove, 2020). The explicit inclusion of non-binary and gender-diverse individuals within this research project seeks to challenge this dominant transgender narrative. As the percentage of the general population identifying outside of the gender binary increases, there is an emerging need to expand research to intentionally incorporate this population and in doing so, refute binary conceptualizations of gender (Thorne et al., 2019).
To date, research investigating TGDN health has largely been framed within a deficit model that emphasizes distress and dysfunction among TGDN people (Vaughan & Rodriguez, 2014). As a result, the identity of TGDN individuals is embedded within discourses of mental illness (Asakura et al., 2019). The pathologising of TGDN identities through deficit-oriented research may inadvertently reinforce transphobic attitudes and fuel adverse health outcomes for TGDN individuals (Vaughan et al., 2014). It is therefore important for future research to avoid reconstructing pathologising narratives that are often assigned to members of this community (Jones & Hillier, 2013). Further, given the adverse health outcomes experienced by the TGDN community in Australia (Bretherton et al., 2021), it is important to understand what experiences foster wellbeing in this population (Jones & Hillier, 2013). With this in mind, the present study applied a positive psychology lens to explore the research question: What processes foster wellbeing among TGDN adults residing in Western Australia?
2 Method
2.1 Research Design
This research was conducted from a social constructivist epistemological position, acknowledging that participants’ conceptualizations of the experiences that contribute toward their wellbeing are constructed within their socio-cultural contexts (Else-Quest & Hyde, 2016). In accordance with the principles of social constructivism, this research considered participants’ lived experiences as constituting scientific knowledge (Dickerson, 2010). Collaboration between researchers and participants in this research allowed for the mutual construction of this knowledge (Dickerson, 2010). This epistemological position lends itself to qualitative research methodologies. As such, this study employed a qualitative and exploratory design.
Furthermore, this study utilized patient and public involvement (PPI) methods to establish a forum through which the research question was addressed (Jennings et al., 2018). Collaboration between researchers and members of the TGDN community ensured that this research is framed in ways that are appropriate, accessible, and beneficial to the community, so as to avoid further stigmatization (Frohard-Dourlent et al., 2016). In addition to a supervising researcher, the research team consisted of a Research Advisory Committee made up of two members of the TGDN community who served in a consultation capacity, as defined by Happell and Roper (2007). Both members contributed to various research decisions, including throughout the initial conceptualization of the problem, the recruitment process, the development of the interview schedule and through the member checking and articulation of findings (Jennings et al., 2018). In accordance with Happell and Roper’s (2007) consumer consultation approach to PPI, this study acknowledged the advisors’ lived experience as expertise, consulting with the advisors for specific guidance throughout the research process. A lack of research involving TGDN community members, and the continuing experiences of marginalization faced by this community, justified the use of PPI methods in this research (Asakura et al., 2019).
2.2 Participants
To be eligible for this study participants were required to be over the age of 18, reside in Western Australia, and self-identify as a member of the TGDN community. Given the specificity of the sample population, a combination of venues-based, and snowball sampling was employed to recruit participants, wherein participants selected through community venues were invited to nominate other eligible individuals from the community (Meyer & Wilson, 2009). Ultimately, 12 participants between the ages of 21 and 68 were recruited (M = 33.92, SD = 11.37). Demographic information was collected for all participants and is presented in Table 1.
Malterud et al.’s (2016) information power model was applied to determine an appropriate sample size. This model suggests that through consideration of the study’s aim, the specificity of the sample, its theoretical underpinnings, the quality of the interview dialogue and the proposed data analysis, an adequate sample size can be derived (Malterud et al., 2016). Through an iterative process involving the implementation of the information power model, consultation with an experienced research supervisor, and evaluation of previous research (e.g., Fiani & Han, 2018), a sample of 12 participants was deemed appropriate.
2.3 Interview Guide and Demographic Survey
Preliminary discussions with members of the Research Advisory Committee identified key themes in relation to the research question. An 11 item, semi-structured interview schedule was developed to capture these themes, with previous research further informing the development of specific items (e.g., Riggle et al., 2014). The Research Advisory Committee reviewed draft interview schedules until a comprehensive schedule was finalized (please see Supplementary Materials). The interview broadly sought to explore what experiences fostered wellbeing among participants, and included questions such as, “Describe a situation(s) where you feel like you can be your most genuine self”. In addition, a four-item demographic questionnaire collected information regarding participants’ age, gender-identity(s), relationship status, and level of education. Importantly, participants used their own words to describe their gender-identity(s).
2.4 Procedure
Ethical Approval was obtained from [Blinded] University’s Human Research Ethics Committee (HRE2020-0406). Electronic recruitment flyers were disseminated to community (e.g., TransFolk of WA, the Freedom Centre) and peer-run (e.g. PFLAG) organisations, as recommended by the Research Advisory Committee. Flyers were also shared across several TGDN community groups online via Facebook groups and in physical TGDN-specific spaces. Recruitment was extended via media engagement (e.g. the “All Things Queer” radio program) in an effort to broaden the experiences and insights included in the sample. Interested individuals contacted the researcher via email. After ascertaining eligibility, mutually convenient interview locations and times were negotiated, and participants were emailed a copy of the study’s information sheet and consent form for review. Physical copies of these documents, as well as the demographic questionnaire, were provided to participants on the day of the interview for completion. Interview locations comprised cafes and libraries.
The researcher ensured that participants had read and understood the information sheet, completed the demographic questionnaire, and signed the consent form prior to commencing the interview. Participants were invited to ask any questions, and were notified before audio-recording commenced. Interviews ranged from 46 to 110 min in length, with the average interview lasting 73 min. Interview recordings were transcribed verbatim, and data were de-identified. Participants were provided with a summary of findings from their interviews and were encouraged to provide feedback via email. Five participants responded and expressed their satisfaction with the findings provided.
2.5 Data Analysis
Given the exploratory nature of the study, thematic analysis was considered the most appropriate analytic method as it allowed for the richness and complexity of participants’ experiences to be methodically interpreted (Braun & Clarke, 2006). Following researchers’ familiarization with the data, the analysis commenced with the generation of initial codes. These codes were then displayed on printed cards and discussed in a research meeting to formulate preliminary themes. Each theme was assessed to ensure that they were, (a) relevant to the research question, and (b) conceptually distinct from other themes. This process required the development of theme definitions that captured the essence of each theme, and as such, ensured conceptual clarity. With themes finalized, the analytic narrative was then composed.
2.6 Quality Practices
Various strategies were employed to enhance the quality and rigor of the present study (Creswell, 2014). In acknowledging the lead author’s cisgender positionality, he engaged in reflexive journaling throughout the research process in order to mitigate, and minimize biases in interpretations (Creswell, 2014). A one-page summary of findings pertaining to each participant’s interview was provided to interviewees for member checking. This ensured that the researchers’ interpretations of participants’ experiences were accurate, demonstrating credibility (Creswell, 2014). Five participants responded indicating their satisfaction with the researchers’ interpretations, two of which offered further feedback. No new information was provided. In addition, the use of printed cards within the research team’s discussions not only allowed for the visualization and formulation of preliminary themes, but also enabled deeper recognition of the latent meanings present within each theme. Finally, the Research Advisory Committee reviewed the findings of the research to ensure they were articulated appropriately and were suitable to the research question.
3 Findings
3.1 Gender Euphoria
The overarching core theme gender euphoria reflects the joyful feelings participants experienced when engaging with their internally held sense of gender. Gender euphoria was the common thread that underpinned and united each participant’s experience. Some offered gender euphoria as a counter-narrative to the deficit discourses in which TGDN identities are embedded, “so much of the focus of what it means to be trans is ‘you must have dysphoria and it must be debilitating’ but it’s possible to be trans, not experience dysphoria, but experience gender euphoria” (Ash, 35, Non-binary). While happiness and joy broadly account for participants’ conceptualizations of gender euphoria, there appeared to be a constellation of related emotions associated with the construct. For example, participants described gender euphoria in terms of feelings of confidence, authenticity, rightness, and affirmation. For Kim, gender euphoria was a “kind of giggly or bubbly feeling…it’s this ‘I can’t stop smiling’ feeling and then this feeling of like relief, as if like this is how it’s supposed to be” (Kim, 28, Woman). Gender euphoria was not considered constant or unchanging, and several participants recalled the pain of occasional dysphoria experiences, ‘Sometimes it’s very, very hard. The dysphoria takes over and you think you’re never gonna get anywhere. That’s when it hits. You get depressed and you get anxious and you’re unhappy and you burst into bloody tears. You just can’t do anything about it.’ (Jo, 68, Woman).Most described dysphoria as temporary however, and participants’ reports more frequently reflected experiences of euphoria. The processes that contributed to participants achieving a state of gender euphoria are illustrated by the three additional themes that were uncovered, including (a) achieving gender congruence, (b) collectively healing, and (c) finding gender pride. Figure 2 depicts the centrality of the overarching theme, gender euphoria, along with the subordinate themes previously listed and sub-themes.
3.2 Achieving Gender Congruence
The theme achieving gender congruence refers to participants feeling as though their internal sense of gender has been successfully expressed, whether through their external appearance, or through the language they use to describe themselves. In order to achieve gender congruence, participants first required the freedom to explore and experiment with their gender expression. Having their gender identities then affirmed by members of the public demonstrated to participants that their gender identities were being expressed successfully.
3.2.1 Exploring and Experimenting with Gender Expression
The process to, and experience of, achieving gender congruence, elicited gender euphoria among several participants,
People can take control of their lives in a way that causes them great euphoria and happiness, be that through changing their body, changing their pronouns, their name, you name it…it’s a lesson of like, don’t be afraid to experiment and find what feels really good for you (Ash, 35, Non-binary)
Here, experimentation with one’s gender expression is highlighted as a means through which gender congruence, and subsequent gender euphoria, can be achieved. There were various ways in which participants explored and experimented with their gender expression, from “trying out names and pronouns” (Kai, 31, Genderqueer), to modifying their physical appearance through medical transitions and style. For some, gender congruence was experienced following gender-affirming medical care, “I look in the mirror and I see my skin has gotten really soft, which I’m absolutely happy about, I’ve got no body hair, the anti-androgens have stopped that. It’s just like a normal cis female” (Jo, 68, Woman). Here, Jo identifies the happiness experienced when perceiving herself as a “normal female” following hormone treatment to be an indicator of achieving congruence. It is important to note that for participants identifying as non-binary or genderqueer, the desire to “pass” as a “normal female” or male in some physically congruent way was irrelevant. That’s not to say that all non-binary participants chose not to engage in gender-affirming medical care in order to achieve gender congruence, “getting rid of my breasts was fantastic because that made my body more congruent with how, somewhere abstractly in the back of my head, my brain registered I should exist” (Gabriel, 31,Trans androgyne non-binary).
The subsequent happiness derived from the medical transition experience was mirrored by several other participants, “seeing the physical changes from taking hormones is the most amazing thing ever” (Sky, 30, Male). Hormone treatment is not the only way participants explored their gender identity, however. Experimenting with one’s personal style was particularly important for achieving a sense of gender congruence, and subsequently experiencing gender euphoria,
As I began to try things on, things fit better…the strange thing was, unlike what I expected, which was sexual satisfaction, it was euphoria, just happiness, just the feeling of it all, the freedom of it…it was just gratifying, it felt just correct (Max, 29, Female)
Here, experimenting with style elicited feelings of gender congruence and gender euphoria, as Max reflects on feeling “just correct” and gratified. Others echoed how experimenting with style produced feelings of gender euphoria, “I had always been incredibly bland and bored with my appearance… when I started experimenting with gender my girlfriend said it was like a switch went off and that I was just really happy” (Kim, 28, Woman). Similarly, before Jo transitioned, “it was every time I dressed, it was just a feeling of euphoria” (Jo, 68, Woman). In this way, experimenting with style was at the root of some participants’ experiences of gender euphoria. For other participants however, familial expectations served to limit their freedom of self-expression, “you either present yourself as effeminate, gay or like alt. And if you exist in one of those three categories, you have permission to wear makeup. That wasn’t an option for me. My family would have never allowed that” (Sam, 21, Female).
Style was an important tool participants experimented with to visually communicate their gender identities to the public, “it’s about expressing who you are. It’s not just a superficial thing. It’s very much tied in with wanting people to see you for who you are, not a label or a preconception” (Arlo, 39, Trans non-gendered). While style functions as the medium through which participants could express themselves authentically, it plays an equally important role in ensuring individuals are perceived how they want to be perceived.
For some participants, their membership to alternative communities, such as the goth community, provided them with “lots of space to experiment” (Alex, 39, Genderqueer, gender non-conforming, non-binary, transmasculine). Alex went further to describe how it was the “alternative” nature of such communities, that made it acceptable for them to express their gender freely,
The alternative, the goth punk, all of those sort of crowds, they’re already used to being against the larger concept of what is ‘normal’…so, they’ve already got this like, ‘well, I’m weird for doing stuff, so there’s nothing wrong with other people being weird for doing stuff’ (Alex, 39, Genderqueer, gender non-conforming, non-binary, transmasculine).
In this way, alternative communities function as a medium through which TGDN identities can be freely expressed and affirmed. Further, the ability to express oneself freely within these alternative communities provided participants with a blueprint for expressing themselves freely in terms of their gender, “because you have that sort of supportive feel in that community (goth community), it gives you the ability to branch out and see how you how you can express yourself in other various communities” (Arlo, 39, Trans non-gendered). Arlo describes how developing the confidence to express themself within the goth community helped them to express freely in other contexts (e.g., with gender).
3.2.2 Being Correctly Perceived by the Public
When asked about what experiences evoke gender euphoria, Max explained,
Sometimes finding a new piece of clothing and it looks really good on me and I’m happy with how it looks, that will bring that (gender euphoria). But mostly it comes from being perceived the way I want to be perceived. That’s my driving force (Max, 29, Female)
While the importance of exploring one’s gender expression through style is noted, Max places particular value on being perceived in accordance with her gender identity. Beyond the importance participants ascribed to their support networks in fostering affirmation and wellbeing, participants placed distinct value on being perceived how they wanted to be perceived by members of the public,
If a stranger genders me correctly, it’s really nice, because now I know to them that’s how I’m appearing, and that’s what I want…they’re not simply trying to make you feel better, they’re not honeyed words with no meaning (Ali, 30, Female)
Not all experiences with strangers reflected a sense of gender congruence, and this led to discomfort described by several participants.
I don’t walk into a coffee shop and someone goes ‘that’s a non-binary person’. They would have looked at me and gone ‘woman’…in a day-to-day sense I don’t get read as non-binary, and there is no way currently because there’s just not enough awareness to be read by the average person as non-binary, it’s just not an option. I think that is something that impacts my mental health negatively (Ash, 35, Non-binary)
For all participants, the public’s use of appropriate pronouns and gendered language demonstrated to them that they were being perceived in accordance with their gender identity. When asked about the importance of pronouns, Jay said, “I guess it’s like, people see me the way I want to be seen. So, to the masses, I am being perceived as a guy when they use male pronouns” (Jay, 26, Male). Here, pronouns indicated to Jay that his internally held sense of gender had been successfully represented by his external appearance. In other words, being perceived correctly by the public indicated to Jay that he had achieved gender congruence. Participants reported that on some occasions the use of correct pronouns was viewed as performative rather than authentic, leading to a sense that one’s gender was not perceived appropriately and thus not wholly accepted. However, participants reflected on moments where they were gendered correctly as reminiscent of “euphoria, like absolute elation, or like I just won a gold medal” (Sky, 30, Male). For Ash, it “feels really good when people do use they/them pronouns…that’s euphoric” (Ash, 35, Non-binary). In this way, achieving gender congruence involves two key processes: (a) exploring and experimenting with one’s gender expression, and (b) having that gender expression subsequently affirmed by members of the public. Both processes contribute to participants experiencing gender euphoria.
3.3 Collectively Healing
The theme collectively healing captures participants’ involvement in practices that elevate, and uplift the TGDN community. Participants recognized the systemic inequalities in which the broader TGDN community exists. With reference to their own personal hardships, participants sought to alleviate the suffering endured by this community. This was actioned through generativity, and involvement in various forms of advocacy, as outlined in the sub-theme, Displaying generativity through advocacy. The improved wellbeing participants experienced on account of their involvement in advocacy is detailed in the successive sub-theme, Helping oneself by helping others.
3.3.1 Displaying Generativity Through Advocacy
Advocacy appears to provide participants with a means of resisting transphobic attitudes towards gender-expansive identities, a consequence of the cis-normative context in which they are embedded. An awareness of the systemic inequalities in which the TGDN community exists underscored participants’ motivation for engaging in advocacy,
It’s recognizing that currently I’m living in a space where there is a lot of transphobia and difficulty and struggle, and the best I can do to engage with that and to make that a better place…the more useful I am being to the overall arc of society (Ali, 30, Female)
Activism presented a means through which participants could ensure that subsequent generations of TGDN individuals experienced improved social conditions. Several participants echoed this motive behind engaging in activism, “if I can be loud and vocal about who I am, then the next generation doesn’t have to fight as hard” (Jay, 26, Male). In being vocal about one’s gender, TGDN individuals claim a position within the public sphere and help to increase public awareness, and acceptance of TGDN identities. Contributing to the public’s understanding and awareness of non-binary gender identities was at the core of Gabriel’s motivations for engaging in advocacy,
If I can use myself to broaden the understanding of other people…they may start to have the frameworks and the constructs and the understanding of their existence, then hopefully that makes it so my peers and the non-binary community have an easier time (Gabriel, 31, Transgender androgyne, non-binary).
This extract demonstrates the generativity-oriented motivation for engaging in activism adopted by several participants.
The degree to which participants engaged in collective healing ranged from supporting TGDN peers, to engaging in formal activism. Two participants engaged in activism within formalized contexts, “my choice of activism is research…I do like educational talks with healthcare professionals” (Ash, 35, Non-binary). Some participants adopted role model type positions within the community, others used social media to educate those around them, and some took on leadership roles within their university queer department. For some, their choice of advocacy was more implicit,
I believe that living out as genderless person, that is advocacy…living out, and trying to be as strong of an example of someone that can live without gender, hopefully that at least paves the way for the people that come after me (Arlo, 39, Trans non-gendered).
Regardless of the medium through which participants engaged in advocacy, for many, advocacy involved informally educating the public around gender-related matters, “if I find someone who’s on that, ‘I don’t know where to start, I don’t understand this’ level, I try and teach” (Kai, 31, Genderqueer). In this way, participants cultivated public awareness and understanding of gender-expansive identities through formal, and informal advocacy. While advocacy was conceptualized as a means through which participants could contribute to the wellbeing of future TGDN generations, their participation in advocacy was also personally helpful.
However, not all participants drew strength from activism, and some noted the costs of engagement in social media,
I tend to steer clear of any kind of activism in social media spaces cause the trolls just seem to have endless energy and I don’t, and it really hits me in a personal way that I just don’t feel good (Ash, 35, Non-binary).
Advocacy, both formal and informal, was viewed as an act that required resilience, but could also provide a sense of value, joy and community.
3.3.2 Helping Oneself by Helping Others
Engaging in advocacy was a particularly important coping mechanism for participants who had previously endured hardships on account of their gender identity, “my motivation is to help other people not go through what I went through or not have that much self-hatred and shame and just to let people know that what they’re experiencing is okay, and valid” (Sky, 30, Male). Advocacy helped Sky to find meaning and purpose in his own struggles, and in doing so, seek justice for himself and for the wider TGDN community.
Advocacy not only helped the wider TGDN community, it also helped participants to better understand themselves,
It (advocacy) kind of pushes me to accept myself more, because if I’m going to advocate for my community, you kind of have to have a sense of who you are…that took a long time, to work on myself and overcome my own, like, fears and shame and issues (Sky, 30, Male).
In his actions towards uplifting the TGDN community, Sky ultimately uplifted himself. The capacity for advocacy to help others, and in turn help oneself was echoed by Ali, who said, “I think there’s a lot of self-worth that I’ve derived from feeling like I can do something of value” (Ali, 30, Female). The relative importance that participants assigned to their advocacy work meant that they derived purpose, and self-worth from it,
Just as much as it is exhausting, it’s something I can see importance in, that makes me feel switched on. I can see a purpose in that. And it’s also fun, like, I describe doing lived experience speaking as a hobby. I get the same level of enjoyment out of it as people who get really excited about playing sport (Gabriel, 31, Trans androgyne non-binary).
Others similarly experienced joy from their advocacy work, “I draw lots of joy from seeing someone come out of their shell and become a happier and better person because of it” (Max, 29, Female). Another participant indicated that “just helping people in general makes you feel good, it’s fulfilling” (Arlo, 39, Trans non-gendered). Ultimately, participants experienced improved wellbeing as a by-product of their efforts to improve the wellbeing of their TGDN peers.
Finally, advocacy empowered individuals to take control of the public discourse surrounding their gender, “because of the positioning of non-binary individuals in history at the moment, it’s kind of novel…not a lot of people really understand it, so it’s about being able to take ownership of my story” (Gabriel, 31, Trans androgyne non-binary). Here, advocacy gave Gabriel a platform to be the author of their own existence. In having the power over how their gender identities were to be understood, participants experienced an improved sense of self, “it helps me feel more confident about who I am, the more visible that I am” (Sky, 30, Male).
3.4 Finding Gender Pride
The theme gender pride refers to participants embracing and celebrating their gender identities. Participants demonstrated gender pride through the positive experiences that they ascribed to their gender identity (e.g., happiness and empowerment). Pride was developed following self-acceptance, and through the construction of counternarratives that resisted oppressive cis-normative attitudes and constructs. These processes are represented by the sub-theme, developing pride. In addition to these individual level sources of pride, participants also reflected on the role of support networks, and role models in generating gender pride. For many participants, experiences of pride were juxtaposed with their previously negative self-concepts, “I’ll never ever go back to being the old me. Never. If somebody said to me, I’ll give you a million dollars I wouldn’t take it because I’ve never been so happy” (Jo, 68, Woman). The happiness experienced by Jo as she engaged with her gender identity appears to be synonymous with the experience of gender euphoria.
3.4.1 Developing and Experiencing Pride
Some participants considered the act of realizing their gender identity to have an immediate positive impact on their wellbeing, “there’s been an obvious change since I realized I’m trans. In my wellbeing, on the whole, I’m more happy and excited than I was before” (Kim, 28, Woman). For others however, wellbeing was only achieved after a gradual process of coming to accept their gender identity, “it’s one thing to realize that, but then it’s another thing to actually kind of embrace everything” (Sky, 30, Male). For Sky, moving from denying to embracing his gender identity was met with feelings of “empowerment” and “strength”. Regardless of how participants came to embrace their gender identities, self-acceptance was a necessary prerequisite for experiencing gender pride.
Finding self-acceptance meant countering cis-normative, and transphobic attitudes towards gender-expansive identities. Participants reflected upon the consequences of being embedded within a cis-normative society, “It’s the most common mindset I see…they believe they’re flawed, that they’re a monster, and they’re an abomination” (Max, 29, Female). Here, Max describes the state of discomfort TGDN individuals experience with their own gender identity as society’s cis-normative gender attitudes are internalized. Developing pride in the face of societal transphobia involved participants creating counter-narratives that glorify, rather than vilify, their gender identities,
this is me, and it doesn’t feel like it’s linked to female, it doesn’t feel like it’s linked to femininity or masculinity, I get to look at myself and go, ‘I am the Van Gogh painting’ as opposed to ‘I am pink, or I am blue’ (Kai, 31, Genderqueer).
Here, Kai embraces the complexity inherent in their gender identity and in doing so, transcends dichotomized ideas of femininity and masculinity. This counternarrative gave Kai power and control over their gender identity. Other participants similarly celebrated how their gender identities differed from cisgender identities,
it’s so much better to live in communities that are freed from things like cis-normative ideals. It’s liberating in ways that are hard to describe…cis people live under like cis-normative ideals and I don’t know how they survive. The freedom that comes with not having to subscribe to those things when you exist in like a queer space is…mind numbingly freeing (Sam, 21, Female).
Here, Sam takes pride in the uniqueness, and freedom her gender affords her, rather than being ashamed of it. Counteracting transphobic attitudes by celebrating uniqueness, and the freedom to live authentically, is a central tenant of this theme.
Pride for other participants manifested in experiences of increased confidence and authenticity, as well as improved self-image,
Being trans has improved my self-image immensely…I went from someone who literally didn’t care if I lived or died, to someone who’s actually happy every day and can take a photo of themselves and not despise it (Max, 29, Female).
3.4.2 The Role of Support Networks
Developing pride in one’s gender identity involved participants drawing upon internal resiliency resources, such as self-acceptance, as well as community-level resources, such as support networks. In reflecting upon his gender identity, Sky stated that being trans has “been such a positive thing for me, which is probably due to having that strong support” (Sky, 30, Male). Here, Sky attributes the support he has received as the “driving factor” behind his positive trans experience. Another participant recounted how her friend encouraged her to take pride in her gender identity,
She said, ‘come on, hold your head up just look straight ahead’. I walked into [the supermarket], a few of the staff looked, some smiled, but nobody battered an eye lid. That was a big boost. Being accepted was a big, big thing for me (Jo, 68, Woman).
In this way, support networks play an instrumental role in fostering gender pride among participants. Participants reflected further on the role protective allies play in cultivating confidence in one’s gender identity,
I didn’t really have the confidence to be super open about my transness, which as you kind of get good friends behind you, you build this perception of like ‘if someone says something to me, I have little attack dogs next to me’ (Sam, 21, Female).
Support networks can therefore serve a protective function, buffering TGDN individuals from the effects of potentially harmful social experiences. In doing so, support networks, comprising friends, family, allies, and TGDN-specific groups, provided individuals with the means to develop confidence, and pride in their gender.
3.4.3 Role Models
Participants spoke of the influence TGDN role models had in encouraging them to embrace and celebrate their gender identities. Watching role models “live their best lives” gave participants the optimism, and encouragement to pursue their authentic selves,
One person that I knew…just watching their progress, watching the body transformation and their confidence and sense of self grow was super inspiring to me…it made me realize that that might be a possibility for me, and it wasn’t just a pipe dream (Sky, 30, Male)
Having a peer demonstrate that a positive transition experience was possible, provided Sky with hope and optimism to circumvent his transition related concerns. Similarly, Arlo found assurance of their capacity to thrive after, “seeing other people thrive in the face of adversity. You know, if they can do it, I can do it” (Arlo, 39, Trans non-gendered). In this way, watching TGDN role models thrive appeared to positively influence participants’ self-perception.
For others, role models did not only demonstrate to them that life satisfaction and wellbeing was a possibility for TGDN individuals, they also played important roles in visibility, “I like being able to see more people informing the world that we won’t hide, that we exist, we’re here, acknowledge us. It’s like a belligerent stance towards this desire for us to fade into the background” (Max, 29, Female). Role models are hereby perceived to personify pride, and inspire participants to similarly embrace their gender identities. However, not all visibility was positive, and several participants noted the risks associated with media framing of the transgender community. Ash stated,
The Australian newspaper has it out for transgender kids; everything that’s written is so negative and so misinformed that you’ve got these young trans people or these people trying to work out their gender reading that or seeing that, it’s just like, awful. So that is like this real downside of visibility (Ash, 35, Non-binary).
Despite this, most participants highlighted the sense of solidarity and inspiration that was associated with greater visibility of non-binary and transgender individuals in the community, and opportunity to express their authentic identity.
4 Discussion
Our study explored the sources of wellbeing for individuals belonging to Western Australia’s TGDN community. Participants described the essence of their wellbeing through the positive narratives, and joyful feelings they ascribed to their gender experience. With this, gender euphoria emerged as the central concept underpinning participants’ conceptualizations of wellbeing. While its uptake within psychological research has been rare (Beischel et al., 2021), the term gender euphoria has existed within TGDN community spaces for some time. The reports of gender euphoria offered in this study replicate and extend those offered in previous academic studies (e.g., Beischel et al., 2021) by highlighting the nuanced factors that promote or hinder individuals’ sense of euphoria, authenticity and belonging among gender diverse, non-binary and transgender individuals. The means through which participants achieved a state of gender euphoria, and thus wellbeing, were attributed to their perceived achievement of gender congruence, their engagement in practices that uplifted the TGDN community, and through finding gender pride.
Participants valued feeling as though they had successfully expressed their internally held sense of gender. From gender affirming medical care to experimenting with style and pronouns, findings from our study extend upon previous research demonstrating how such social, and medical gender affirming processes promote wellbeing (Breslow et al., 2020; Hughto et al., 2020). Further, this finding converges with previous research investigating “transgender congruence”, which refers to the degree to which TGDN individuals: (a) perceive their appearance to accurately represent their gender identity (appearance congruence), and (b) accept, and feel pride in their gender identity (Kozee et al., 2012). With particular reference to appearance congruence, a notable limitation of the transgender congruence construct is that it adheres to binary, transition-orientated perspectives of TGDN identities (Kozee et al., 2012). For participants who identified as non-binary, the fluidity implicit in their gender identity rendered the concept of “congruence” irrelevant. For these individuals, the desire to “pass” as male or female in some physically congruent way contradicted what it meant to be non-binary (Breslow et al., 2020). This appeared to underscore some non-binary participants’ indisposition to engage in binary-affirming processes, such as medical transition.
Consistent with previous research (e.g., Sevelius, 2012), participants valued being addressed by members of the public in ways that were congruent with their gender identities. Similarly, participants’ connections with alternative communities that affirm gender-expansive identities, such as the goth community, substantiates findings from Asakura (2016), who found that countercultural communities function as important community-level resiliency resources for trans individuals. Important to note is that variability exists across participants in terms of the importance ascribed to these sources of affirmation. Beyond countercultural communities, separate research has outlined that for TGDN individuals, enhanced relational wellbeing emerges from a unique capacity to transcend gender normative conceptualisations of intimate relationships and family norms, allowing for an increased capacity for sexual, and parenting freedom respectively (Siegel et al., 2022a, b).
The subsequent theme presented in our study, collectively healing, illustrates another source of wellbeing situated at the community level. Participants’ motivation to engage in advocacy appeared consistent with Freire’s (1970) theory of conscientization, wherein the development of critical consciousness regarding systemic inequalities motivates those belonging to stigmatized minorities to pursue liberation. Previous studies (e.g., Asakura, 2016; Craig et al., 2008) corroborated this finding, indicating that oppressive, cis-normative structures provide impetus for TGDN individuals to engage in advocacy. The desire to pursue liberation, and in doing so ensure improved social conditions for future TGDN generations, was actioned by participants through involvement in various forms of advocacy, from formalized activism to role modelling. While generativity typically underscored participants’ motivations behind engaging in advocacy, their participation in advocacy was also personally helpful. Several peer-reviewed studies (e.g., Asakura, 2016; Jones & Hillier, 2013) have similarly concluded that advocacy is an important community-level resource for developing resiliency and wellbeing among TGDN individuals.
Across each theme, the capacity for TGDN individuals to cultivate wellbeing involved disrupting both societal, and internalized transphobia. The final theme, finding gender pride, similarly captured how participants countered negative early life experiences by cultivating pride in their gender identity. In line with research undertaken by Goffnett and Paceley (2020), participants acknowledged self-acceptance as a necessary prerequisite for experiencing gender pride. Furthermore, in developing gender pride, participants emphasized the importance of engaging with resources available at the community-level, from positive role models (Matsuno & Israel, 2018), to affirming support networks (Budge et al., 2013). The process by which participants moved towards gender pride aligns closely with Cass’ (1979) theory of sexual identity formation, which outlines a framework through which sexual minorities begin to accept, and ultimately find pride in their sexuality. Similarly, Cass (1979) highlights self-acceptance, affirmation from peers and the public, activism, and role models, as important mechanisms by which experiences of pride can be fostered. Interestingly, participants’ wellbeing appeared to benefit through both engaging as a role model (as described in the theme, collectively healing), and engaging with positive role models (Moody et al., 2015). Ultimately, these community-level resources emerged as important foundations on which TGDN individuals could begin to develop a sense of pride in their gender (Pflum et al., 2015).
4.1 Theoretical and Practical Implications
As illustrated, findings from our study contribute to a growing body of literature, suggesting that achieving gender congruence, engaging in practices that elevate the wider community, and experiencing gender pride, are important processes that promote wellbeing among TGDN individuals (Oorthuys et al., 2023; Valente et al., 2020; van den Brink et al., 2020). While the capacity for these findings to have real world clinical implications depends upon their replication in future studies with larger and more diverse samples, several tentative practical implications are proposed. Firstly, clinicians may assist TGDN individuals by developing individualized strategies that help clients to cope when they are experiencing gender incongruence (Kozee et al., 2012). For example, higher levels of gender identity acceptance have been shown to be associated with stronger self-esteem, through reduced rumination about gender identity (van den Brink et al., 2020). Prior research indicates that the level of transgender congruence, and therefore wellbeing, experienced by individuals seeking to medically transition considerably improves following gender-affirming medical care (Owen-Smith et al., 2018). Therefore, attending to transgender congruence may also involve supporting clients through the transition process (van den Brink et al., 2020). In addition, given the sense of purpose and self-worth participants derived from their engagement in advocacy and positive role modelling, clinicians and institutions that serve TGDN individuals should be aware of opportunities for clients to engage in activism or volunteering (Singh et al., 2011). Mentoring programs present one potential avenue through which TGDN individuals can gain access to, or engage as positive role models (Matsuno & Israel, 2018). Family and peer support have been found to foster greater self-acceptance, less psychological distress, and more help-seeking among transgender individuals (Oorthuys et al., 2023; Valente et al., 2020). Similarly, engagement in community activism plays a facilitative coping role and expands access to community connections and services (Budge et al., 2012; Frost et al., 2019; Riggle et al., 2011). However, as noted by several participants in the current study, engagement in activism and heightened visibility within the community (both physical and online) is not without risk for gender diverse individuals (Lerner et al., 2020; Valente et al., 2020), and thus fostering greater engagement with gender action must be accompanied by significant social support.
The integration of Meyer’s (2003) Minority Stress Model, and Seligman and Csikszentmihalyi’s (2000) three pillar model of positive psychology was identified as an appropriate theoretical framework through which the wellbeing of TGDN individuals was conceptualized in our study. In many ways, findings from our study support this integrative theoretical framework. Firstly, participants utilized several community-level resources to counteract experiences with minority stressors. For instance, participants reported their affiliations with relational communities (e.g., the goth community) and their interactions with members of the public as fostering positive subjective experiences of affirmation. Similarly, participants’ support networks and role models were considered valuable community-level resources that fostered positive subjective experiences of pride. Participants’ experiences of gender pride appear consistent with the character strengths of integrity (presenting oneself authentically) and vitality (approaching life with enthusiasm) outlined in Seligman and Csikszentmihalyi’s (2000) three pillar model. Furthermore, the character strengths of citizenship and fairness, which concern the development of a positive group identity, involvement with a broader community, and the advancement of equal rights, were displayed by participants through their engagement in practices that uplifted the TGDN community (e.g., advocacy; Vaughan & Rodriguez, 2014).
4.2 Strengths
There were various strengths of the present study. Firstly, the framing of our study through a positive psychology lens actively refuted the deficit model in which TGDN research has largely been conducted. In doing so, our study demonstrated the capacity for TGDN individuals to thrive amidst a body of research that tends to highlight the distress and dysfunction experienced by this community. Secondly, the inclusion of TGDN voices within the research process through the establishment of the Research Advisory Committee ensured that the knowledge produced in our study was appropriate and meaningful. The Research Advisory Committee’s involvement in various research decisions aligned with the principles inherent in participatory research, whereby research transcends the mere production of knowledge, and is instead designed to promote research praxis that contributes to complex social issues (Johnson & Martínez Guzmán, 2012). Finally, through the inclusion of non-binary and gender-diverse participants, our study challenged the binary-trans narrative that dominates TGDN research (Thorne et al., 2019). This allowed for the complexity and nuance that exists within the TGDN community to be captured.
4.3 Limitations and Directions for Future Research
While a major strength of our study concerns the inclusion of a previously neglected population within trans research, the lack of ethnic diversity within this studies population limits the transferability of our findings. In this study, all participants were from the dominant ethnicity, with time restrictions preventing the recruitment of a more diverse sample. Future research should expand upon our study by sampling TGDN individuals with multiple marginalized identities (Asakura, 2016). Despite efforts to broaden sampling through multiple recruitment methods, a strong focus on venues-based sampling may have overrepresented TGDN individuals with deep connections to their community, therefore omitting those who affiliate with their gender community to a lesser extent (Stanton et al., 2016). This is a common criticism within TGDN research (e.g., Goffnett & Paceley, 2020). Future research should employ alternative sampling methods (e.g., snowball sampling), or offer reimbursements to enable participation from the wider TGDN community.
In accordance with the integrative theoretical framework that guided our study, interview questions primarily attended to the individual and community-level resources that contributed to participants’ wellbeing. As a result, knowledge regarding the relative influence of structural-level resources is unknown. While individual and community-level resources assist TGDN individuals to overcome everyday adversities, consideration of structural-level resources is crucial to challenging the marginalization and oppression that prevents TGDN individuals from thriving (Asakura, 2016; Meyer, 2003). Future research should conduct interviews with policymakers, and institutions that serve TGDN individuals to examine structural-level resources that address systemic-inequalities (e.g., TGDN affirming legislation), and ultimately nurture wellbeing.
The contributions made by the Research Advisory Committee in our study highlights the value of participatory approaches to research with TGDN individuals. It would be a major strength for future research to employ similar participatory methods when conducting research with this community. With reference to this study, future research should consider establishing advisory committees that are larger, and represent a more diverse range of TGDN individuals.
4.4 Conclusion
At present, deficit-oriented research has served to perpetuate the stigmatization and oppression of an already marginalized minority. The continued experiences of discrimination and mental health morbidities that follow warrant the employment of positive psychology frameworks in future research with this population. With this, the onus is on researchers to begin to construct positive discourses concerning TGDN individuals, illuminating the ways in which current, and future generations prosper in the face of adversity. In this study, the emergence of gender euphoria clearly demonstrated the capacity for TGDN individuals to not just survive, but to instead, thrive.
Data Availability
The data are confidential and are not publicly available.
Code Availability
Not applicable.
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Hall, T., Rees, C. & Newnham, E. Pathways to Euphoria: Deconstructing Gender-Expansive Adults Conceptualizations of Wellbeing. Int J Appl Posit Psychol 9, 719–745 (2024). https://doi.org/10.1007/s41042-024-00149-2
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DOI: https://doi.org/10.1007/s41042-024-00149-2