Spilling the T on Trans-Misogyny and Microaggressions: An Intersectional Oppression and Social Process Among Trans Women

A Rapid Review of HIV-Related Stigma-Reduction Randomized Controlled Trials

We conducted a rapid review to identify and describe randomized controlled trials (RCTs) aimed at reducing HIV-related stigma. Using a rapid review design in accordance with PRISMA guidelines, we searched five major databases (PubMed, PsycINFO, OVID/Medline, EMBASE, and Scopus) from July 1981 to June 2023, and analyzed 27 studies from an initial pool of 2,383 articles. Our analysis revealed three primary intervention strategies: (1) alleviating internalized stigma through confidence-building and emotional validation, (2) addressing anticipated and enacted stigma via training and sensitization campaigns, and (3) challenging institutional and cultural beliefs through macro-scale interventions. Community-driven approaches and locally-engaged interventions demonstrated particular promise, especially in resource-constrained settings. While intrapersonal and interpersonal approaches-particularly those involving professional discussions, peer education, and in-person training-showed the most positive outcomes, digital and infotainment interventions yielded mixed results. Our findings highlight the complexity of HIV-related stigma, revealing the importance of holistic strategies that address intersecting psychosocial factors and potential unintended consequences of stigma-reduction efforts. By studying the nuanced landscape of stigma intervention, this review provides insights for developing more comprehensive and contextually sensitive approaches to reducing HIV-related stigma.

Nature and Effects of Climate in 2SLGBTQ+ Leisure Spaces: A Mixed Methods Study

The climate within 2SLGBTQ+ leisure spaces plays a key role in shaping the experiences of diverse individuals who frequent them. Yet, the nature and effects of such spaces remain under-researched. In a mixed methods study, 548 diverse individuals completed a survey, and 22 respondents participated in a follow-up interview. Latent profile analysis of the quantitative data revealed three distinct typologies characterizing the climate of 2SLGBTQ+ leisure spaces: contentious, ambivalent, and welcoming. Notably, the contentious climate was linked to low sense of belonging and satisfaction, whereas the welcoming climate was associated with higher scores across the same outcomes. Additionally, specific social identities were predictive of membership in these climate profiles; individuals identifying as transgender/gender nonconforming and disabled were more likely to encounter contentious and/or ambivalent environments compared to welcoming climates, primarily due to limited options for welcoming climates. Intersectional analysis of the qualitative data illustrated that experiences of discrimination, particularly cisgenderism, racism, and ableism, contributed to poor social outcomes. These findings highlight that 2SLGBTQ+ leisure spaces may not translate into inclusive environments for everyone. The typologies developed could serve as a valuable tool to reflect on the ambiance of 2SLGBTQ+ leisure spaces and work toward welcoming climates.

Examining the Risks of Multiple Types of Interpersonal Victimization for Transgender and Gender Non-Conforming College Students

Recent research has shown that transgender and gender non-conforming (TGNC) individuals are at risk of experiencing interpersonal violence, yet there may be differences within this group and across victimization types. The current study examined rates of seven types of interpersonal victimization based on six gender identities (cisgender women, cisgender men, trans women, trans men, nonbinary, and another identity) among a national study of college students. Data from the Spring 2021 American College Health Association's National College Health Assessment III (ACHA-NCHA III), a national-level study of U.S. college students, were used. We examined the association between gender identity and seven types of interpersonal violence victimization (violent victimization, sexual victimization, intimate partner violence victimization, stalking, bullying, microaggression, and discrimination) that occurred within the past 12 months. Logistic regression analyses were performed to examine if, when controlling for competing factors, gender identity was associated with an increase in the expected odds of victimization for each victimization type. Analyses revealed that TGNC college students reported experiencing a greater amount of all seven types of victimization compared to cisgender college students. These findings corroborate previous research indicating that rates of interpersonal violence are higher among TGNC college students compared to those who identify as cisgender, even after controlling for sexual orientation, related demographic factors, and substance use. Findings from the current study suggest that there are differences within individuals who identify as TGNC in terms of their risk for interpersonal victimization and that rates differ across victimization types. More work is needed to provide tailored prevention programming for TGNC college students.

Gender Differences in Self-assessed Measures of Health: How Does the Structure of Self-rated Health Compare Across Transgender and Cisgender Groups?

Self-rated health (SRH) is consistently related to mortality and morbidity. Yet, health ratings are subjective and reflect an individual's social context. Prior work has found differences in the structure of SRH-that is, in how self-assessments relate to underlying health conditions-across social groups, including by gender. However, prior work has not included transgender adults despite evidence that widespread interpersonal and structural stigma uniquely shapes their subjective experience of health. This study draws on information about 12 health conditions for a sample of transgender men, transgender women, nonbinary adults, cisgender men, and cisgender women. It examines whether the probabilities of reporting poor or fair SRH are similar among those with various underlying health problems. Findings reveal differences by gender identity and age group. For more than half of the examined conditions, self-rated health is poorer among nonbinary adults and younger transgender men than among other gender groups. These differences likely reflect distinct self-assessment processes that consider minority stress and structural stigma, as well as underlying differences in severity and comorbidity that stem from such stigma processes. SRH remains a useful, holistic measure of well-being, including for transgender groups.

Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth

The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.

Recruiting Black and Latina/Hispanic Transgender Women for HIV Research: Implementation of Respondent-Driven Sampling and Factors Associated with Peer Recruitment

Purpose

We aim to examine if respondent-driven sampling (RDS) is a feasible and efficient method to recruit Black and Latina/Hispanic transgender women into HIV research.

Methods

As part of the National HIV Behavioral Surveillance Study among transgender women in New York City in 2019, RDS was implemented with a focus on recruiting Black and Latina/Hispanic transgender women. We identified factors independently associated with (1) peer recruitment and (2) presenting to the study with a photo coupon.

Results

A total of 269 transgender women were enrolled, 94% of whom were Black or Latina/Hispanic. In terms of peer recruitment, 47% recruited at least one eligible peer. Compared with those who were aged 18-29 years, those aged 30-39 years (adjusted prevalence ratio [aPR]: 2.04; 95% confidence interval [CI]: 1.35-3.07) and those aged 50 years or older (aPR: 1.97; 95% CI: 1.32-2.94) were more likely to recruit an eligible peer. Peer recruitment was also associated with utilizing HIV prevention services in the past 12 months (aPR: 1.62; 95% CI: 1.18-2.23). We did not find any differences in presenting the study with a photo recruitment coupon versus a physical recruitment coupon.

Conclusion

RDS was feasible and efficient in recruiting Black and Latina/Hispanic transgender women. Providing gender-affirming environments as well as allowing peer recruitment through photo coupons may have facilitated peer recruitment and study participation. Our findings regarding factors associated with peer recruitment could aid in future study design and may help in addressing the lack of HIV research among Black and Latina/Hispanic transgender women.

Gender identity differences in the experiences of family stressors and violence among transgender and non-binary individuals in China

Emerging research has demonstrated that transgender and non-binary (TNB) individuals face an elevated risk of experiencing family rejection and violence. However, there remains a significant knowledge gap regarding how TNB individuals manage stressors and their gender identity within the family context, particularly in regions where TNB individuals are highly stigmatized and where legal protections against family violence are lacking. The present study represents one of the first pioneering efforts to provide large-scale quantitative data examining the experiences of family stressors, the management of gender identity and expression, and family violence among TNB individuals in China. A national sample of 1063 TNB individuals in China was involved in the study. They completed questionnaires about their experiences of family stressors and violence. The results indicated that 76.0% of TNB individuals reported having encountered at least one form of violence perpetrated by their family members. Transfeminine individuals were more likely to report experiencing emotional and physical abuse, whereas transmasculine individuals were more likely to be subjected to gender identity and/or expression change efforts. Family stressors, including family non-acceptance and the pressure to marry and reproduce, were positively associated with non-disclosure of gender identity, the suppression of gender expression, and family violence. The findings underscore the substantial burden of family violence borne by TNB individuals in China, which warrants immediate legal, institutional, and social responses. Trans-inclusive family violence prevention and intervention are urgently needed, with a focus on Chinese cultural factors and gender identity differences in violence screening and risk assessment.

Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences

Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.

Tucking Practices and Attributed Health Effects in Transfeminine Individuals

Tucking is the gender-affirming practice of putting the penis and scrotum between the buttocks and moving the testes up into the inguinal canals. Our study explores tucking and health effects among transfeminine adults (n=79). Most (74.7%) had practiced tucking and among them, 67.2% had tucked ≥7 years. When tucking, the majority (84.5%) tucked daily and almost half (44.8%) ≥17 h/day. Half (50.0%) reported concern about the health effects of tucking. Itching, rash, and testicular pain were the most commonly reported health effects. Health care providers should use a harm reduction approach in addressing tucking-related concerns and supporting patients who tuck.

Group differences in gender expression discrimination and depressive and anxiety symptoms among transgender and gender-expansive adults: The role of gender identity pride

Despite established associations between discrimination and mental health, little research has focused on gender expression discrimination and integrated individual strengths such as transgender and gender-expansive (TGE) identity pride. This study examined the roles of gender expression discrimination and pride in mental health among TGE adults across gender identity, race, and class. A national sample of TGE adults (N = 212) completed online measures assessing gender identity, race, income, gender expression-related discrimination, TGE identity pride, and depression and anxiety symptoms. Gender expression discrimination was positively associated with depressive and anxiety symptoms. Black, Indigenous, People of Color (BIPOC), higher income, transfeminine participants reported more gender expression discrimination. High TGE identity pride buffered the association between gender expression discrimination and depression-most robustly for BIPOC, lower income, transfeminine participants. TGE identity pride may buffer the effects of gender expression discrimination on depression. Intersectionality in case formulation and treatment planning with TGE individuals is vital.

Differences in Health Care Experiences among Transgender and Gender Diverse Youth by Gender Identity and Race/Ethnicity

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth.

Affirming educational and workplace settings are associated with positive mental health and happiness outcomes for LGBTQA + youth in Australia

BACKGROUND

Affirming socio-cultural settings are essential for protecting the mental health and wellbeing of lesbian, bisexual or pansexual, trans and gender diverse, asexual and queer (LGBTQA +) youth. However, limited research has explored the role of affirming educational and workplace settings, as reported by LGBTQA + youth themselves, with respect to their mental health and wellbeing. Moreover, existing research maintains a focus on mitigating poor mental health outcomes, with little attention to positive wellbeing outcomes among LGBTQA + youth.

METHODS

Using data from the largest national survey of LGBTQA + youth aged 14-21 in Australia, multivariable regression analyses were conducted to explore associations between affirming educational and workplace settings and psychological distress and subjective wellbeing among 4,331 cisgender and 1,537 trans and gender diverse youth. Additionally, a series of multivariable regression analyses were conducted to explore individual sociodemographic traits that are associated with reporting affirming educational or workplace settings.

RESULTS

Both cisgender and trans or gender diverse participants who reported that their education institution or workplace were affirming of their LGBTQA + identity reported lower levels of psychological distress as well as higher levels of subjective happiness. Additionally, affirming environments were not experienced equally across all subsections of LGBTQA + youth, with reporting of an affirming educational or workplace setting differing most noticeably across gender, type of educational institution and residential location.

CONCLUSION

The findings demonstrate that affirming educational and workplace settings can result not only in better mental health, but also greater levels of subjective happiness among LGBTQA + youth. The outcomes illustrate the importance of ensuring all LGBTQA + youth are afforded the opportunity to thrive in environments where they feel validated and confident to express their identities. The findings further highlight a need to target education institutions and workplaces to ensure the implementation of policies and practices that promote not just inclusion of LGBTQA + youth but affirmation of their identities.

Intimate Partner Violence and Mental Health Among Transgender and Gender Diverse Young Adults

Purpose

Research indicates that multiple forms of intimate partner violence (IPV) may be prevalent among transgender and gender diverse (TGD) people, including general forms of IPV (psychological, physical, sexual), as well as identity-specific forms (transgender-related IPV (T-IPV), identity abuse (IA)). Studies also suggest that IPV is associated with negative mental health outcomes in TGD populations, including depression, anxiety, and posttraumatic stress disorder (PTSD). However, little is known about IPV and its association with mental health among TGD young adults. This is noteworthy, as this is a key developmental period for many TGD individuals.

Methods

Thus, the present study sought (1) to estimate the lifetime and past-year prevalence of several forms of general and identity-specific IPV among a sample of (N = 200) TGD young adults in New York City and (2) to assess the associations between IPV with recent symptoms of depression, anxiety, and PTSD. To address the study aims, a cross-sectional quantitative survey was conducted between July 2019 and March 2020.

Results

Regarding lifetime IPV, IA was most prevalent (57.0%), followed by sexual (40.0%), physical (38.5%), T-IPV (35.5%), and psychological IPV (32.5%). Regarding past-year IPV, psychological IPV was most common (29.0%), followed by IA (27.5%), physical (20.0%), T-IPV (14.0%), and sexual IPV (12.5%). Results of hierarchical regression models indicate that lifetime IA was related to depression, anxiety, and PTSD, while past-year T-IPV was only associated with depression.

Conclusions

Taken together, these findings suggest that IPV is highly prevalent among TGD young adults and that IPV - especially identity-specific forms - warrants additional attention from researchers, healthcare professionals, and policymakers, as it may place this population at risk for negative mental health outcomes.

Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame

Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed.

Beyond minority stress: Toward a multidimensional psychology of trans/nonbinary gender

Although research that documents minority stress caused to LGBTQ + people supports needed advocacy, it can concomitantly cause harm to communities by portraying them as depleted and powerless. This review article assesses if and how researchers who study minority stress also center interpersonal functions of gender expression that are agentic for trans/nonbinary (TNB) people. These functions were coded in the qualitative research related to minority stress for TNB people over the last five years. Findings revealed that while most interpersonal functions of gender were described rarely, especially those associated with TNB communities of color, damage-centered perspectives were common. Damage-centered perspectives were common. We charge the field to expand its scope of inquiry, center functionalist and agency-focused research, and to develop a multidimensional psychology of gender.

Transgender theory revisited: Current applications to transgender issues

In addition to social determinants and cognitive constructions of social identities emphasized by earlier theoretical frameworks, transgender theory emphasizes the importance of physical embodiment in gender and sexual identity, as well as the integration of embodied experiences with the self and socially constructed aspects of identity through the lived experiences of those with fluid, often intersecting identities. The present paper considers important recent topics in research on transgender identities through the lens of this theory, including embodiment in understanding fluid gender and sexual identities, the intersectionality of multiple oppressed social identities, barriers to healthcare for transgender individuals, and ethical issues with regard to social policies impacting transgender individuals and with regard to media portrayals of and research on such individuals.

Stress-Related Growth Among Transgender Women: Measurement, Correlates, and Insights for Clinical Interventions

Although transgender women (TGW), and especially TGW of color, are disproportionately exposed to discrimination and violence, many of them experience stress-related growth. However, little is known about the experience of stress-related growth and its correlates among TGW. Using data from a racially-diverse sample of 210 TGW, the short version of the Stress-Related Growth Scale was modified to assess growth as a result of coming to terms with one's transgender identity among TGW. The psychometric properties of the modified scale were examined, along with its associations with various cognitive, emotional, and social factors. A confirmatory factor analysis revealed a unidimensional factor, along with excellent reliability. A stepwise regression revealed that positive reappraisal, internal locus of control, social support, and emotional expression were associated with greater stress-related growth. Findings suggest that cognitive, emotional, and social resources are related to stress-related growth in TGW. Interventions to foster stress-related growth among TGW are discussed.

Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016-2019

PURPOSE

Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals.

METHODS

Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income.

RESULTS

Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride.

CONCLUSIONS

Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.

Disparities in HIV-related risk and socio-economic outcomes among trans women in the sex trade and effects of a targeted, anti-sex-trafficking policy

INTRODUCTION

Marginalization of sex work presents numerous risks for trans women (TW) engaged in the sex trade, including criminalization, traumatization, and contracting HIV. We identified socio-economic and HIV risk disparities among trans women sex workers and others who do sex work (TWSW/OWSW), and evaluated these disparities for TWSW/OWSW compared to TW not engaged in sex work from pre- and post-implementation of the US 2018 "Allow States and Victims to Fight Online Sex Trafficking Act" and "Stop Enabling Sex Traffickers Act" (FOSTA-SESTA).

METHODS

We analyzed 429 trans women (TW) from the Trans*National cohort study (2016-2019). Generalized estimating equations (GEE) characterized differences in socio-economic and HIV risk outcomes for TWSW/OWSW compared to TW not engaged in sex work over the study period. Adjusted, pre-to-post law changes in these outcomes for TWSW/OWSW versus TW not engaged in sex work were compared using difference-in-differences GEE regression analyses.

RESULTS

Over 18 months, TWSW/OWSW had higher adjusted odds of being unstably housed, having income from criminalized sources, experiencing transphobic hate crimes, experiencing discrimination from police/courts, being incarcerated, meeting sex partners in the street/public settings, meeting sex partners on Craigslist or other online forums (except dating apps), or engaging in condomless anal intercourse, (p < 0.01 for all comparisons); TWSW/OWSW also had a higher mean number of income sources (p = 0.03). One difference-in-differences analysis showed additive interaction: the adjusted mean number of income sources reported by TWSW/OWSW compared to those not engaged in sex work decreased from pre-to post-FOSTA-SESTA (from 1.79 to 1.48 for TWSW/OWSW and from 1.52 to 1.47 for TW not engaged in sex work; p = 0.01).

CONCLUSIONS

Disparities in socio-economic and HIV-related risk outcomes exist for TWSW/OWSW in San Francisco. There is an urgent need for comprehensive, long-term follow-up data of TW to accurately analyze policy effects, especially given the recent enactment of a number of other policies targeting TW.

Stigmatization, Resilience, and Mental Health Among a Diverse Community Sample of Transgender and Gender Nonbinary Individuals in the U.S

Transgender and gender nonbinary (TGNB) individuals were recently designated a health disparity population by the U.S. National Institutes of Health. We examined the effect of gender-related discrimination and resilience factors on the mental health of a community sample diverse in gender identity, age, and race/ethnicity. We report on the baseline data of a longitudinal study of transgender identity development across the lifespan with 330 TGNB individuals recruited through venue-based recruitment in three major metropolitan areas in the U.S. Mean age of participants was 34.4 years (SD = 13.7). Structured interviews collected self-report data on sociodemographics, gender-related discrimination, mental health, and resilience. We used hierarchical regression to examine the association between gender-related discrimination and psychological distress (BSI-18) and tested the moderating effect of family support, transgender community connectedness, gender literacy, and transgender activism on this relationship. In adjusted analyses, gender-related discrimination was positively associated with psychological distress. Family support was negatively associated with psychological distress. Contrary to our expectations, gender literacy and transgender activism were positively associated with psychological distress, while no significant relationship was found for transgender community connectedness. Family support, transgender community connectedness, gender literacy, and transgender activism did not moderate the effect of gender-related discrimination on psychological distress. Future mental health interventions should consider leveraging family support among TGNB individuals. Longitudinal studies are needed to better understand the role of gender literacy and activism with respect to mental health and development of identity and resilience among TGNB people.

Demarginalizing Stigmatized Identities of Transgender and Gender Nonconforming Individuals Through Affirmative Group Therapy

Drawing from the existing literature on minority stress and stigma, this article highlights challenges - psychological, social, and interpersonal - confronting transgender and gender nonconforming (TGNC) individuals in relation to their gender identity and expression. TGNC individuals are at risk for poor health due to societal stigma and stressors they face as a gender minority group. Further, TGNC individuals may experience stigma in different shapes and forms; specifically, stigma may occur as enacted, felt, internalized, and anticipated stigma. In maintaining an identity that is socially devalued but often invisible to others, TGNC individuals confront additional challenges in negotiating the risks and benefits of disclosing their stigmatized identity. Affirmative group therapy is proposed as a strength-based and social justice-oriented approach for demarginalizing TGNC individuals' stigmatized identity. Group therapists are called on to address how forms of stigma impact TGNC individuals within and outside of the group, provide validation and space for practicing disclosure, highlight their strengths and resilience, and serve as social justice advocates.

A Decade of Microaggression Research and LGBTQ Communities: An Introduction to the Special Issue

Though the Supreme Court of the U.S. legalized same-sex marriage in 2015, heterosexism and transphobia has continued to manifest through many systems in the US - from lack of federal protection in employment non-discrimination laws to polices that prohibit transgender people from using bathroom and public facilities that match their gender identities. Heterosexist and transphobic discrimination have also persisted through interpersonal interactions - ranging from more overt forms (e.g., hate crimes, bullying) to more subtle forms of discrimination, otherwise known as microaggressions. Since 2008, there have been hundreds of articles written on microaggressions, with dozens focusing specifically on experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. Qualitative and quantitative studies have revealed that LGBTQ people who experience microaggressions have reported negative outcomes like depression, low self-esteem, and trauma. This special issue aims to further Microaggression Theory by providing theoretical and empirical papers that focus on the manifestation and impact of microaggressions on LGBTQ people. Using an interdisciplinary approach, articles range in topic from intersectional identities, to health and psychological outcomes, to advancing research methods. Future studies regarding microaggressions and LGBTQ people are discussed- highlighting the influence of the changing landscape of heterosexism and transphobia within general society, as well as new dynamics that have formed and developed within LGBTQ communities.