Workplace support and affirming behaviors: Moving toward a transgender, gender diverse, and non-binary friendly workplace

The Workplace Experiences of Transgender and Gender Diverse Employees: A Systematic Literature Review Using the Minority Stress Model

Transgender and gender diverse (TGD) employees encounter unique challenges in the workplace that are not shared with the rest of the working population. In this study, we conducted a systematic review of 58 empirical studies on the workplace experiences of TGD individuals published in peer-reviewed journals between 2000 and 2022. Using the Minority Stress Model as a theoretical framework, we classified the literature based on (a) the challenges that TGD employees face when navigating their gender identity at work, (b) the outcomes of minority stress processes, and (c) the mechanisms to ameliorate the impact of minority stressors. Findings suggest that TGD employees are exposed to various distal and proximal stress processes that negatively impact work outcomes and mental health, including discrimination or expectations of rejection. A key protective factor both at the organizational and interpersonal level is support, including inclusive policy development and coworker support. At the intrapersonal level, adaptive coping strategies and an integrated minority identity can countervail the impact of minority stressors. Future research should further examine intrapersonal variables while leveraging broader intersectional and international samples. Practitioners are advised to proactively and continuously review their nondiscrimination policies and practices to promote employee wellbeing and positive work outcomes.

Exploring Work Absences and Return to Work During Social Transition and Following Gender-Affirming Care, a Mixed-Methods Approach: 'Bridging Support Actors Through Literacy'

PURPOSE

Research on return to work (RTW) following transition-related gender-affirming care (GAC) is lacking. We aim to study the RTW outcomes and experiences of transgender and gender diverse (TGD) people during social and medical transition to understand their needs better and provide tailored support.

METHODS

In this convergent mixed-methods study, the questionnaires of 125 employed TGD people, who took steps in transition (social and GAC), were analyzed for personal- and work characteristics, medical work absences, RTW, support at work, and health literacy. In-depth interviews were held with twenty TGD people to explore perceived facilitators and barriers to RTW.

RESULTS

One hundred and nine participants reported an average of 38 sick days after GAC. The majority (90.2%) resumed their job at the same employer. Although TGD workers felt supported, their health literacy (55.1%) was lower compared to the general population. The qualitative data analysis revealed four major themes: (1) the need and access to information; (2) having multidisciplinary TGD allies; (3) the influence of the occupational position; (4) the precarious balance between work, life, and GAC. Especially participants with a low health literacy level experienced RTW barriers by struggling: (1) to find and/or apply information; (2) to navigate (occupational) health and insurance services.

CONCLUSION

Our research has shown that RTW for TGD individuals is a multifaceted process, affected by personal factors, work-related elements, and the characteristics of the healthcare and social insurance system. Enhancing support for TGD people at work and their RTW requires a high need for centralized information and promoting health literacy while engaging relevant stakeholders, such as prevention services and employers.

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.

Exposure to Inclusive Language and Well-Being at Work Among Transgender Employees in Australia, 2020

Objectives. To provide empirical evidence of the positive effects of exposure to inclusive language on trans employees' well-being. Methods. We leveraged unique data from a large Australian national survey of workplace diversity and inclusion (2020 Australian Workplace Equality Index Employee Survey), focusing on a subset of trans respondents (n = 453). We derived self-reported and aggregate-level measures of exposure to trans-inclusive language and created a multidimensional index of employee well-being. We examined their relationships using fully adjusted random-intercept multilevel regression models. Results. We found strong, positive, and statistically significant associations between different indicators of exposure to inclusive language at work and trans employees' well-being. These relationships were large in magnitude and emerged in the presence of an encompassing set of sociodemographic and workplace controls, including other markers of workplace diversity and inclusion (e.g., victimization experiences and identity disclosure). Conclusions. Our results provide robust evidence indicating that efforts to foster inclusive language at work can yield substantial, positive effects on trans people's feelings of belonging and inclusion, thereby contributing to their overall socioeconomic integration. (Am J Public Health. 2022;112(3):482-490. https://doi.org/10.2105/AJPH.2021.306602).