Abstract
In this interview-based study, we investigated the common social experiences and minority stressors related to being transgender. It is one of two articles that resulted from a grounded theory analysis of interviews with 17 participants who claimed a variety of transgender identities (e.g., cross-dresser, transman, transwoman, butch lesbian) and were from different regions in the United States. The interview was centered on how participants’ identities influenced their lives across different interpersonal contexts. Participants described developing a more complex understanding of gender because of the effect of their transgender status on others and the need to modify their gender presentation at times to secure their safety. In the workplace, their gender could overshadow their competence and, in the age of social media, was always at risk of becoming public. Seeking social support could be dangerous, and the process of transitioning was found to make safe spaces especially elusive. Also, open communication about sex and gender was found to be particularly important within successful intimate relationships. Our findings emphasized the tensions between a need to be respected and valued for oneself and one’s abilities with a need to mitigate the very real dangers of being visible or out as transgender in different contexts. Our research can be used to enhance health professionals’ understandings of transgender people’s life experiences, to identify salient minority stressors for further research exploration, and to advance advocacy.
Keywords
In our study, we explore the challenges and struggles that transgender people meet across different interpersonal contexts, as well as the forms of resilience and support that they find helpful. Transgender is an umbrella term that refers to any individual whose gender does not fit into the widely accepted binary of male and female genders—a powerful framework that structures social roles, behaviors, and expectations (Denny, Green, & Cole, 2007). Some transgender people live as people of their nonbirth gender identity on a full-time basis; they may undergo physical surgeries, typically to align their physical sex with their internal sense of gender. Some seek a full transition, whereas others may opt only to take hormones or to surgically alter some sex characteristics. Other transgender people have fluid gender identities and may not align themselves with one gender or may change between gender expressions (Dean et al., 2000).
What follows is a grounded theory analysis of interviews with transgender people in the United States focused upon how they enact their gender within different interpersonal contexts, including the challenges they face and the ways they often surmount them. Whereas a set of findings focused upon participants’ transgender identity development is described in a separate article (Levitt & Ippolito, in press), the current article is focused on how participants sought to represent their gender authentically while coping with substantial and systemic minority stressors. Minority stress theory provides a framework for studying the effects of the additional stress that minority groups experience in addition to routine stress of majority groups (Meyer, 2003). Developing an understanding of minority stressors and the ways minority groups experience and cope with these stressors is important for both advocacy and for furthering the resilience of these groups (Meyer, 2010). In the present article, minority stressors specific to transgender identities are explored as they unfold across different social contexts.
In order to discuss transgender experience, we must first distinguish the terms sex and gender. Sex refers to a person’s biological characteristics (e.g., genitalia, hormone levels, chromosomal makeup), and most cultures recognize two sex categories: male and female (West & Fenstermaker, 1995). Gender, on the other hand, is a construct based on socially accepted standards of behavior and appearance for males and females (Unger & Crawford, 1993). Most cultures endorse two gender categories, masculine and feminine, and assume that they emerge naturally from binary sex categories, male and female. Although sex and gender exist independently of each other, often the terms are used interchangeably (Cole, Denny, Eyler, & Samons, 2000). Similarly, sexual orientation, one’s patterns of romantic and sexual attraction, is independent of both sex and gender identity, yet these terms are often confounded (e.g., transgender women assumed to be attracted only to men; Denny, 2007). Our article builds upon a program of qualitative and quantitative research conducted by Levitt and colleagues (Hiestand, Horne, & Levitt, 2008; Hiestand & Levitt, 2005; Levitt, 2006; Levitt, Gerrish, & Hiestand, 2003; Levitt & Hiestand, 2004, 2005; Levitt, Puckett, Ippolito, & Horne, 2012; Manley, Levitt, & Mosher, 2007; Mosher, Levitt, & Manely, 2006) that studies gender identities rooted in lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities in terms of their development, distinct meanings, and functions.
Those who challenge gender norms challenge one of the most fundamental bases of power in Western society. When one person cannot confidently identify another’s gender, he or she lacks information about that person’s social status, which can cause confusion about how to interact with that person (Griggs, 1998; Prosser, 1998) and how to judge that person’s behavior (West & Fenstermaker, 1995). Therefore, transgender people can feel great social pressure to conform to one side of the gender binary paradigm (Bornstein, 1994; Griggs, 1998). In the following sections, we review the literature on the challenges faced by transgender people across the contexts of society in general, employment, support networks, and intimate relationships.
Gender Variance and Threats to Safety
Because legal documents are marked with one’s birth sex, transgender people can be unwillingly “outed” and thus are vulnerable to discrimination in situations where they must present identification (Griggs, 1998; Taylor, 2007). U.S. federal law allows the gender on passports and social security records to be amended only after sex reassignment surgery (Taylor, 2007)—which may be neither desirable nor affordable by all transgender people, with the laws regarding the modification of other legal documents varying by state.
The ability to pass as a person of a different gender can be vital to transgender individuals’ safety because transphobia or genderism, defined as negative attitudes toward individuals with nontraditional gender presentations (Bettcher, 2007), is commonplace in the United States. As a result, people may display a marked sense of discomfort when interacting with transgender people (Schilt & Connell, 2007), or worse, they might inflict harm through verbal abuse, physical assault, or sexual harassment (Bettcher, 2007; Halberstam, 2005). Therefore, transgender people must constantly evaluate the safety of their environment, and they may need to quickly adjust their gender presentation when in a threatening environment in order to avoid being identified as transgender (“Gay vs. trans,” 2007; Griggs, 1998). After reviewing data from self-report surveys and needs assessments, hotline and social service records, and police reports, Stotzer (2009) concluded that all these sources indicated a higher risk of multiple forms of violence (particularly sexual violence) running throughout the lives of transgender people.
In fall of 2009, new U.S. federal legislation extended the definition of hate crimes to include violent crimes committed against people on the basis of their gender, gender identity, or sexual orientation (Stout, 2009), so national documentation on transgender hate crimes should be forthcoming. According to the National Coalition of Anti-Violence Programs’ (2011) analysis of data from 17 antiviolence organizations across the United States, transgender women face particular risk within LGBT populations. Although transgender women composed only 8.6% of these LGBTQ communities, they made up 44% of the total number of murder victims in these communities in 2010 yet they accounted for only 10% of the police reports—likely because transgender victims lack social support or access to legal services (Dean et al., 2000) and are frightened of poor treatment by authorities. Furthermore, they were twice as likely to experience discrimination as cisgender heterosexual White people. For transgender people who were also people of color, this figure rose to 2.5 times (National Coalition of Anti-Violence Programs, 2011). Notably, hate-crimes legislation generally does not apply to verbal insults and threats and may not protect against more routine experiences of harassment.
Although it might seem easier to maintain discretion about their gender identities to avoid these perils, living a closeted life can exacerbate emotional stress as they then must hide significant parts of their histories (Cole et al., 2000) and the pressure to pass can be both a cause and a result of the obscurity of transgender issues on a public level. Furthermore, in a study of suicide, researchers found that experiences of gender discrimination and physical assault related to gender expression were significant predictors of suicide attempts among transgender participants (Clements-Nolle, Marx, & Katz, 2006). These experiences predicted suicide attempts over and above the influence of those risk factors that were common in the general population (e.g., previous suicide attempts). In 2010, the National Center for Transgender Equality and the National Gay and Lesbian Task Force issued a report based upon a survey of over 7,000 transgender participants in which they noted that 41% of respondents reported attempting suicide (compared to 1.6% of the general population), with a history of bullying, harassment, expulsion, or sexual/physical assault raising this risk significantly to 51%.
Occupational and Financial Challenges
Being unable to change the sex listed on their legal documents can be especially risky in seeking employment because transgender people are afforded no explicit protection against employment discrimination within U.S. federal law. According to the Human Rights Campaign (2012), only 16 states (and DC) had laws protecting transgender individuals from employment discrimination. Drawing on data from convenience samples, a William Institute report found that 15–57% of transgender people reported experiences of workplace discrimination, 6–60% reported being unemployed, and 22–64% of those employed earned under US$25,000 per year (Badgett, Lau, Sears, & Ho, 2007).
A report from the Transgender Law Center (2009) indicated that 23% of transgender people in California were living under the poverty line (US$10,400/year)—twice as many as nontransgender people—and one fifth of the respondents (n = 646) reported becoming homeless once they began to identify as transgender. Additionally, 70% reported experiencing workplace harassment related to their gender identity. A second large survey of demographics among 1,229 transgender respondents indicated that this population is more highly educated than the general population but with a lower income, particularly for female-to-male (FtM) participants (Rosser, Oakes, Bockting, & Miner, 2007).
Furthermore, employment has been related to suicide attempts. The National Center for Transgender Equality and the National Gay and Lesbian Task Force’s (2010) report on health and health care found that the percentage of respondents who had attempted suicide rose from 37% among those who were employed to 51% among those who were unemployed at the time of the study. Annual income also was related to suicide attempts with fewer of those earning over US$100,000 (26%) having attempted suicide than those earning under US$10,001 (54%). In the face of the myriad threats and lack of protections described in the preceding two sections, an analysis of how transgender people experience and cope with interpersonal challenges can be important for the purposes of both support and advocacy.
Educational, Heath, and Interpersonal Supports
The term transgender applies to a wide variety of people, and the important influences of race, SES, physical ability, and other identities cannot be ignored (Halberstam, 2005; Juang, 2006). For example, transgender people of color experience the layering of multiple forms of discrimination (Bettcher, 2007; Dacumos, 2006). Although transgender middle-class individuals may have trouble financing medical procedures or legal recourse against an act of discrimination, transgender individuals of a lower economic standing may not have the luxury of even considering medical procedures or legal defense (Beam, 2007; Hale, 2007). Transgender people who can afford housing may safeguard themselves, but transgender teens living on the street after being expelled from their families’ houses are especially vulnerable to violence (Beam, 2007). A common thread throughout the experiences of most transgender people is that they must negotiate their gender identities within their ethnic, professional, and various other identities (Feinberg, 1996; Halberstam, 2005). A transgender person may not have the support of a local transgender community (Dacumos, 2006; Halberstam, 2005) and may have to struggle through gender issues in isolation or within a community (e.g., ethnic, gay, or lesbian) that is unsupportive.
Transgender people are marginalized not only within the dominant sexist and heterosexist society, but sometimes in gay and lesbian communities as well (Bornstein, 1994). For example, individuals transitioning from female-identified to male-identified genders are sometimes dismissed as individuals attempting to gain male privilege or reifying gender roles (Jeffreys, 1997). Transmen are sometimes criticized for being butch women who have “gone too far” (Dacumos, 2006) or “sold out” (Denny, 2006). Because they identify as men instead of as masculine women, transmen are accused of being ashamed of their bodies (Dacumos, 2006) and therefore enslaved by male-dominated society (Jeffreys, 1997).
Challenges to those moving from male-to-female (MtF) identities can take on multiple forms as well. For example, Jeffreys (1997) criticized MtF transsexuals for enacting hyperfeminine behaviors and thus perpetuating traditional notions of femininity. In addition, sometimes transwomen are regarded as men who are trying to infiltrate women’s spaces. Other times, transwomen are construed as men enacting fetishist desires (“Gay vs. trans,” 2007; Jeffreys, 1997). And yet another source of conflict can be found within the transgender community when drag queens, cross-dressers, and transsexuals devalue each other’s motives for enacting femininity (Tewksbury & Gagne, 1996). Given these social and interpersonal stressors, social support and community may be particularly important. For instance, social support has been associated with decreased depression in transwomen with a history of sex work in California (Nemoto, Bödecker, & Iwamoto, 2012). Given the high risk of suicide attempts in this community, the provision of adequate mental health treatment can be important as well.
The American Psychiatric Association (APA, 2013) has recently released the fifth edition Diagnostic and Statistical Manual of Mental Disorders (DSM). There are multiple disorders that are relevant to gender, but in this discussion, we will focus upon what was termed gender identity disorder in DSM-IV (APA, 2000). In the DSM-V, the title of this disorder was changed to “gender dysphoria,” positioning the concern within one’s emotional reaction and coping with one’s gender rather than within identity (De Cuypere, Knudson, & Bockting, 2011). Also, it generated separate criteria for gender dysphoria in children than for adolescents and adults, creating a disorder that is more developmentally appropriate (e.g., gender play and fantasy are not indicators for adults and children are expected to have a lesser ability for insight and self-expression). The revisions initially proposed did not require distress or dysfunction, but these amendments were added in response to public comment. However, the requirement of clinical levels of distress and functional impairment are no longer necessary; rather, just the risk of distress or disability can be sufficient for diagnosis—despite the recommendation of the World Professional Association of Transgender Health to have the diagnoses based only upon the experience of a clinical level of distress (De Cuypere, Knudson, & Bockting, 2010; De Cuypere et al., 2011). As well, the names of the disorders were altered in response to comment so they now locate the pathology in relation to emotional distress rather than to identity.
There has been great outcry around these proposed disorders since their inclusion in the DSM, and transgender communities themselves have been divided on whether there should be diagnoses based upon gender at all (Knudson, De Cuypere, & Bockting, 2010; Vance et al., 2010). The dominant concerns include the pathologizing of gender and stigmatizing of transgender people, as well as the concern that labeling gender variance as mental illness may cost them legal rights and social status. In contrast, there is a competing need to maintain health insurance for those who are seeking medical or mental health treatments and a concern that removing the diagnosis would lead to compromised care (Corneil, Eisfelt, & Botzer, 2010). Other gender-related disorders have been altered along similar lines to focus upon distress rather than identity or behavior (e.g., transvestic disorder; Knudson, De Cuypere, & Bockting, 2011).
Developing a professional understanding of transgender issues is particularly important because this population relies heavily upon psychological services to deal with psychological distress. In the 2010 report on Transgender Health and Health care, 75% of participants received counseling at the time of the survey (and only 11% of the sample reported not wanting counseling), yet 11% also reported being denied equal treatment at mental health clinics because of their gender (National Center for Transgender Equality & National Gay and Lesbian Task Force, 2010).
Intimate Relationships
There has been less research on intimate relationships of transgender people. Qualitative research on the experiences of partners of transgender men has shown that their transitions had major impacts upon their partner’s sense of identity (e.g., being in a lesbian vs. heterosexual relationship), community, and mental health (Joslin-Roher & Wheeler, 2009). Partners felt that it was difficult to communicate to others the ways they were changing in the face of their partners’ more dramatic transitions. Their sense of isolation might be increased further if they felt that they could no longer be part of lesbian communities where they previously found support. They had to reconcile their need to deal with the pain of their own transitions with their desire to support their partner.
In contrast to the research on same-sex couples, research on women in relationships with transgender men has shown that they tend not to have an egalitarian division of labor but a more idiosyncratic division based upon partners’ skills, interests, and priorities (Pfeffer, 2010). Although they seemed satisfied with this division in household labor, the women described having to do much of the emotional work within relationships and around managing their partners’ health care. Some saw this added responsibility as linked with their partners’ male privilege and were less pleased with this aspect of their relationship.
In contrast, Devor’s (1997) research documented the changes in intimate relationships from the perspective of FtM transsexuals. Approximately half (55%) of his 38 participants experimented with heterosexual relationships unsatisfactorily and then most (80%) experimented with lesbian relationships as butch women before deciding that these identities did not fit them because their partner related to them as women when they did not feel woman-identified. Although there are case studies of transgender people’s intimate relationships (e.g., Hines, 2006), more research is needed to document the commonalities across transgender people’s relationships—in particular the experiences of transwomen.
The Present Study
In a context where transgender people rarely are provided with the same legal protections as others, they face threats of harassment and violence; economic and vocational vulnerability; challenges finding health care, educational, and social supports; and challenges in their intimate relationships. In the current research, we investigated how transgender people describe enacting their genders within these different interpersonal contexts and in the face of corresponding minority stressors. Our work contributes an understanding of the internal experiences of transgender people while confronting these challenges and identifies commonalities in people with a range of transgender identities.
Often in qualitative research, the data gathered are so rich that findings need to be divided into multiple chapters or articles, organized thematically, so that their content can be adequately explored (e.g., Fassinger, 2005). The present article derived from a project that was focused on the experience of being transgender across the life span. It is a companion to another article, which focused on participants’ gender identity development—involving childhood experiences, the development of language to describe one’s gender, and decision making around transitioning (Levitt & Ippolito, in press). In contrast, the current article contains four main findings that describe being a person with a transgender identity and facing different sets of minority stressors. These findings capture challenges of understanding gender differently than most others, vocational and economic challenges, social support challenges, and challenges within intimate relationships.
Method
Participants
Although 18 people were interviewed for our study, one interview was lost due to a malfunctioning digital voice recorder so that our final sample included 17 self-identified transgender participants. Their mean age was 42 (SD = 11.97, range = 18–63), and they were from different regions of the United States, including urban (13), smaller city/towns (3), and a rural setting (1). Most of the participants were White (12), four were African American, and one was Biracial. Please see Table 1 for the detailed demographic information, including employment information that can serve as a proxy for class and income and that suggested a range. Although Table 1 provides information on the names of the cities for participants in urban locations, to conceal identifying information about the participants, only the name of the state was provided for participants in smaller cities, towns, or rural settings. We also used generic terms to describe their professions for this same reason.
Each Participant’s Demographic Information.
Note. FtM = female-to-male; MtF = male-to-female.
Participants claimed a variety of different sex and gender identities as well as a transgender identity (nine transmen/FtM/men, five transwomen/MtF/women, and three who each identified differently as gender queer, butch, and cross-dressing). Two of these participants also described being intersex (one MtF and one FtM). All of them indicated a sense of gender difference from childhood but described this sense using other terms of identity before adopting their current transgender identity (e.g., identifying as being “like a girl” or as a lesbian). Sexual orientation was challenging to describe: 12 participants reported changes in their sexual orientation associated with changes in their transgender identity. That being said, we included heterosexual, bisexual, and gay and lesbian participants, as well as participants who were unsure of their sexual orientation.
Procedure
Recruitment
Advertisements for interviewees were circulated to two national support websites for transgender people of color as well as to local transgender groups. One participant also posted the online advertisement to additional transgender community websites, and two interviewees were recruited through contacts of the first interviewer within the LGBT community and were interviewed by her. They had no external pressures to participate and neither indicated any discomfort or effect on their interview from being recruited in this manner within the credibility checks in the interview process. Interviewees were required to be over 18 years old and identify as transgender. They received US$20 in return for their participation. As is typical in grounded theory studies, a process of theoretical sampling was used in which recruitment efforts centered on obtaining participants with a range of gender identities and experiences. The project was approved by an Institutional Review Board and the researchers followed the American Psychological Association’s (2010) ethical guidelines in the treatment of participants.
Interviews
Nine interviews were conducted by phone, and eight were conducted in person at an agreed-upon location (depending upon whether or not the participant was local). The researchers asked the participants about their experience of their interviews and did not notice any systematic difference in the responses of those participants who were interviewed by phone or in person; all seemed comfortable talking with us. A semistructured interview protocol was developed around the central question: “What does gender (and transgender) mean to you?” The domains of the interview protocol included the influence of being transgender within: (a) heterosexual contexts, including self-presentation, employment, health care, and advocacy; (b) romantic relationships, including intimacy and sexuality; and (c) friendship and community relationships, including heterosexual and gay and lesbian communities. Questions were refined as the interviews continued, as is typical in grounded theory studies.
Grounded Theory Analysis
Grounded theory analysis is a method of study designed to develop, rather than validate, a theory—that is, to develop an understanding of a phenomenon rather than an explanation for it (Glaser & Strauss, 1967). There are many different variations of this method being employed (Fassinger, 2005). In the current study, researchers used an approach to method and epistemology based upon the work of Rennie, Philips, and Quataro (1987). Our theoretical position is constructivist in that we are interested in the ways by which our participants create the meanings that influence their experience of gender, and it is located within methodical hermeneutic and feminist frameworks (see Levitt, in press; Rennie, 2012). Our methodical hermeneutic perspective situates grounded theory as a synthesis of relative and realist epistemologies—as an interpretive analysis (a relativist aspect) of empirical participants’ reports of their experiences in the world (which are seen as constructed as well but with a grounding in real experiences in the world). It positions grounded theory as using a hermeneutic circle in an understanding a specific aspect of experience that then is used to inform the understanding of the whole, which in turn influences the understanding of aspects.
We use a feminist epistemology in that we approach our analysis with the awareness that experiences in the world, and the process of inquiry itself, can be fundamentally influenced by social biases that can marginalize the experiences of minorities or the oppressed (Fine, 2012; Harding, 1986). As a result, we recognize that context is very influential in processes of understanding, and we prioritized the development of deep understanding in shaping categories that are highly attuned to participants’ experiences—for instance, by seeking consensus between two researchers who were deeply engaged in the research over an extended period of time rather than agreement by an external auditor or team of auditors.
The transcribed interviews were divided into units of text called meaning units (Giorgi, 1985) that each conveyed one main idea related to the experience of gender. In this process, researchers draw from an experientially based understanding of a unit of text to come to an interpretation of its essential meaning and assigned a corresponding label (Rennie, 2012). These unit labels then were compared to one another and organized into descriptive categories to reflect similarities in their meanings, using the process of constant comparison. Each category was given a label that reflected the commonalities within the experiences contained within it. These initial categories then were compared to one another, according to their common meanings, and grouped into higher order categories. Through this process, the commonalities and differences identified through the inductive analysis may lead the researchers to support, revise, or abandon a category title (Rennie, 2012). In this way, a hierarchy of categories was developed, culminating in one core category that reflected the central meaning in the analysis (Glaser & Strauss, 1967). This process is continued as new units are added to the analysis until the point at which incoming data no longer seem to lead to new understandings. Data collection continued until saturation was reached, with saturation defined as the point where new data appeared to be redundant and no new categories were emerging from the inclusion of additional data. The last two interviews did not result in new meanings in our analysis so saturation occurred after the 15th interview.
Researchers
Using a process called memoing in grounded theory method, the researchers kept a record of their beliefs and perceptions, as well as method-related and coding decisions. This process aids the researchers in assessing and limiting their influence on the data collection and analysis by creating a forum in which they explicitly acknowledge their biases and address them when able. The first researcher was a White, Jewish, femme-identified, cisgender, lesbian clinical psychologist and the second was a White Italian American, bisexual, cisgender, graduate student in psychology. The first researcher has a history of researching LGBTQ communities and gender identities and has methodological expertise in grounded theory having led professional trainings and taught graduate courses on this method. The second researcher has been involved in LGBTQ advocacy and completed a certificate in women’s studies.
Credibility Checks
To assess the thoroughness of the interviews and analysis, three credibility checks were used. (a) Interviewees were asked at the end of each interview to share any thoughts about their experience of gender that were not discussed in the interview. This query acted as a check that the data collection was complete. Also, participants were asked about their comfort level in interviewing with the interviewer, who was not transgender-identified. They all conveyed comfort with the process, and three noted that they thought their explanations might have been less in depth with a transgender interviewer because they would have assumed they had common experiences. (b) Consensus between the two investigators provided evidence that the interpretations of data are evident to more than one person. For a period of approximately 2 years, the two investigators met together weekly to discuss the development of the units and hierarchy. They sought to develop category titles that capture the complexity within commonalities and to represent when there are patterns within participants’ experiences. (c) Finally, the participants provided feedback on the results. Nine interviewees who responded had a phone conversation with one of the investigators in which a summary of the findings (a description of the clusters and categories therein) was presented. Participants rated how well each cluster represented the experience of being transgender on a Likert-type scale from 1 (not at all) to 7 (very well). Also, participants were asked to share any thoughts they may have had about experiences that needed to be more or less stressed.
Nine participants provided feedback; the other eight could not be reached for comment. Because the time it took to conduct this intensive analysis was lengthy and because some of the participants had many stressors in their own lives, resided in other locations, or were students or unemployed and may have moved in the interim, we considered the response rate of 53% to be good. Also, the very positive responses from those who responded were affirming. When the interviewees were asked if the findings overall represented the experiences discussed in their interview, they gave an average rating of 6.6 (SD = 0.7, range = 5–7) on a 7-point scale. Also, when asked if the findings contradicted the experiences discussed in their interview, they gave an average rating of 1.5 (SD = 0.7, range = 1–3) on the same scale, suggesting minimal contradiction. When appropriate, feedback specific to categories is discussed in the following section.
Results
The hierarchy that resulted in analysis included 1,275 meaning units from 17 interviews and had eight levels. The top levels of the hierarchy are described in the current article because they represent the main findings of our study. These levels are labeled as follows: (a) the core category is the uppermost level and represents the central idea uncovered in the analysis, (b) seven clusters represent the level below the core category, and (c) categories refer to the third level of the hierarchy. In our article, the top levels of the hierarchy are described because they contain the theoretically important findings developed from the analysis of lower levels of data. Four of the clusters are described, followed by a description of the core category. A listing of these core category, cluster, and category titles can be found in Table 2. Throughout these descriptions, the number of participants whose units contributed to a given category or cluster is presented.
Core Category, Cluster, Category Titles, and Number of Participants Contributing Meaning Units to Each.
Note. LGBTQ = lesbian, gay, bisexual, transgender, and queer.
To describe how many participants contributed to a particular idea, the following terminology is used: most indicates that all but one or two participants (15–16) endorsed an idea, many indicates that more than half the participants (9–14) endorsed an idea, some indicates that 5–8 participants endorsed an idea, and few indicates that 2–4 participants endorsed an idea. In accordance with a semistructured interview, the participants were not each asked to provide an opinion on all the thoughts that emerged for other participants; rather, they described issues that were salient for them within their own experience of being transgender. These numbers are best understood as an assessment of how many participants spontaneously referred to a specific experience as a significant or important given the general prompt to describe their experience of gender across interpersonal contexts.
Cluster 1: Challenges of Understanding Gender Differently
Our full title for this cluster was “Experiencing multiple gender identities facilitates a deep understanding of systemic gender complexity.” Participants were asked how they experienced their gender in society in general. All 17 described a more acute awareness of the role that gender played in society as a consequence of navigating it with the lens of a nontraditionally gendered person. As empowering as this knowledge was, it also created a deeper division between the participants and others because these new concepts often were not recognized within mainstream discourse.
Category 1.1: Gender as Protection
The 16 participants represented in this category, which we labeled “Developing empathic gender enactment responses for self-protection,” reflected upon how their experiences of oppression necessitated a heightened awareness of their surroundings and their self-presentation. Many participants (n = 11) spoke of constantly monitoring their behavior in order to minimize the possibility of experiencing rejection or violence from others. Participants explained how they were sensitive to uncomfortable reactions to their presence, especially early in transition when they were less confident in their gender presentation. Also, some (n = 5) explained that, through intense social observation, they learned highly nuanced gender mannerisms (e.g., cisgender men pick up objects with their palms vs. fingertips), as well as contextual factors that could influence how others perceived their gender (e.g., transmen were more often perceived as female in lesbian spaces).
Participants who did not attempt to pass, but still expressed themselves in a manner more typical of the other sex (n = 2), developed different strategies for protecting themselves from potential discrimination. For example, a butch-identified participant described responding to biological males who saw her as a threat: I’m not going to swagger around a whole bunch of insecure macho ass dudes who have something to prove…. I just know how to pull it [my masculine demeanor] in and know to [say to them], “You the one! You the man!” you know and um—I know how to survive. (P #18)
Category 1.2: Acquiring or Losing Power
Within this category, “Becoming the oppressor? Responses to rapidly acquiring or losing power in shifting gender,” 12 participants discussed how they had accrued insight into the workings of patriarchy. Many participants (n = 11) acknowledged that having formative experiences that differed from their current gender experiences helped them to see how the sexes were treated differently. Also, the five participants who were born female and now pass as male described an ongoing struggle to make sense of their new social position and reported ambivalence in deciding to adopt this identity. These participants, who were self-identified feminists, explained how, on one hand, being male-identified fit their own sense of their gender but, on the other hand, they were disturbed by their entry into the position of power they had struggled against as women. A few (n = 4) even sensed that, by transitioning, they were turning their backs on a community of women that had nurtured them. One male-identified participant recounted discussing the merits of Hilary Rodham Clinton as a presidential candidate with two men who opposed her candidacy: The fact that I was perceived as male meant that these people, who didn’t even know me, stopped and listened and considered what I had to say! It, it was a startling experience for me, because all of a sudden I’m perceived in the gender that has power. And, while I appreciated that, it infuriated me that all of the years that I was not perceived that way, that what I had to say meant nothing!…It’s [my newfound power is]…stretching me emotionally and mentally in ways that I did not an, anticipate. (P #10)
Another insight resulted from having the experience of embodying both sexes. A few male-identified participants (n = 3) said that they had not understood how intensely hormones could affect sex drive and emotions until they began treatment. Also, a few participants (n = 3) noted that FtM participants generally pass with greater ease than MtF participants because FtM individuals could navigate public spaces with less risk of detection or violence.
Category 1.3: LGBTQ Communities
This category, “LGBTQ communities restructuring traditional sex/gender standards is empowering but also frustrating,” included data from all 17 participants and referred to their concerns about society’s definitions of sex and gender. Many participants (n = 13) reported a profound appreciation for the complexity of gender and sex because they continually examined these constructs to understand their own experiences. On one hand, this insight was described by a few (n = 4) as being empowering because it alleviated the pressure to conform to traditional genders. For example, one participant enthusiastically referred to herself as a freak and said: A freak is anything that, that society can’t manage…And—so yeah, I think, there’s like a positive way of identifying as a freak and, understanding that—that you, you do stand out…and there’s no, there’s no sense in saying, “I wanna be acceptable”…. It’s just, well the sense of empowerment is just to me, for me, is like a sense of like, this is who I am and I don’t have to adopt…a socially played out script. (P #02)
On the other hand, this acute insight typically came with frustration as well because it was difficult to communicate about sex and gender with most people outside transgender communities. Many interviewees (n = 13) wished they could live like everyone else, without the burden of oppression or constantly having to serve as a spokesperson for transgender issues. For example, one participant said: Society is organized around men and women…not around transgendered men and transgendered women…. It’s [the existence of transgender people is] not on most people’s radar…. I just don’t see the utility of making that um [being transgender] such a prominent part of my [public] identity. (P #11)
Cluster Feedback
Nine participants gave this cluster an average rating of 6.5 (SD = 0.6, range = 5.5–7.0) on a scale of 1 (not at all) to 7 (very well), suggesting strong endorsement. In offering feedback, three participants described how their motivation to educate others over time had become less focused on challenging mainstream notions of sex and gender because it seemed futile or overwhelming. Also, one participant noted class differences, stating that lower SES transgender people might be too concerned with survival to focus on educating others.
Cluster 2: Vocational and Economic Challenges
This cluster included data from 15 participants and was titled, “Gender overshadows both ability and opportunity.” They discussed the challenges of finding and maintaining work. Experiences of discrimination varied in degree, from pressure to adopt a more traditional gender presentation to employment termination.
Category 2.1: Fewer Job Prospects
The title that was developed to capture the commonality within the data contained in this category was “Fewer job prospects: Coming out can be damning but it may be impossible to remain closeted.” Participants (n = 9) described how being transgender interacted with race in presenting challenges in securing employment. One genderqueer participant with an advanced graduate degree described his experience: People hire people who are like them or who they want to be like…. Fairly masculine White males do great! They can even be kinda lazy…and get really good jobs…. If I feel, start feeling like I have to act…act like a woman [to get hired] then I get…insecure. It makes it really hard to—to try to figure out how to be, or how to get anywhere. If I’d been a guy, then I would’ve been one of ’em. I would’ve gotten a great job, right out of my residency because of hard work and good attention to detail….But not, you know, not when what they see most is, is someone who is differently gendered. (P #06)
For those participants who identified as the other sex but were prevented by law from changing the sex marked on their identification documents (e.g., birth certificate), it was impossible to conceal the fact that they were transgender from potential employers, rendering them vulnerable to discrimination. A few participants (n = 2) were able to avoid this disclosure by changing the sex listed on their official documents, but then lost their job history until that point and lacked the references and experience needed to find work. Furthermore, some participants (n = 5) worried that employers would eventually discover their transgender status on various Internet sites. One participant spoke in detail about the danger of the Internet: “No matter how far we go to change our ID card, birth certificate, all stuff like that…everybody goes on the Internet. If you have a Myspace page, you know, they [potential employers] look at all that stuff!” (P #08). Even well-intentioned acquaintances could post information that revealed a transgender person’s gender status inadvertently.
Category 2.2: Remaining Closeted at Work
In this category, “It may be necessary to remain closeted at work because of others’ biases, although it can strain relationships and hurt job performance,” 13 participants spoke of how their nontraditional gender presentation often eclipsed job performance. This meant that being out at work often meant that they could not be evaluated fairly by employers or clients. For example, some interviewees (n = 7) were denied jobs for which they were qualified on the basis of their gender presentation or were fired from their jobs upon starting to adopt a nontraditional gender presentation. One intersex transwoman described: My work performance was such that they had wanted me to enter manager training….But when—when it became known by HR [human resources that I was transitioning]…my job performance, although it didn’t change, people’s attitudes towards me changed. I got accused of, accused of sexually harassing some of, one of my female co-worker’s boyfriends. I was—every little thing I said and done was [scrutinized], which, most of which would have been completely overlooked had, had I just—played the game, and did the boy thing. It, it never would’ve become an issue. (P #13)
In order to protect themselves from harassment or dismissal, many participants (n = 11) remained closeted at a previous or current workplace (either by maintaining a traditional gender presentation according to their assigned birth sex or by passing as the other sex). At the same time, a few participants (n = 3) reported that being closeted at work was draining because they had to hide a significant part of themselves and, in rare cases, this stress, in turn, negatively affected their job performance and their relationships (both personal and professional).
Cluster Feedback
This cluster was supported by the nine participants who gave it an average rating of 6.1 (SD = 0.8, range = 3–7) on a scale of 1 (not at all) to 7 (very well). This feedback suggested that the findings were aligned with their experience of being transgender. Participants noted, however, that if they could find a work environment where they could be out about their gender history, these worries decreased.
Cluster 3: Social Support Challenges
All 17 participants contributed to this cluster, called “Navigating treacherous waters: Safe spaces are elusive, especially when transitioning,” that resulted from questions about the process of developing support networks. They experienced marginalization from mainstream society as well as from many ethnic and sexual minority subcultures. Participants discussed both social and political repercussions of this widespread disregard of their experiences and needs.
Category 3.1: Educational, Health, and Social Supports
Data from all 17 interviewees were included in this category, “Accessibility of educational, health, and social supports is limited by time and in conservative or non-urban locations,” which addressed variability in transgender people’s experiences with regard to finding education, medical care, and social support. Most participants (n = 15) described the limited availability of affirmative medical and mental health care providers as something that could be stressful. Participants sometimes had to search extensively and endure uncomfortable experiences before finding a competent health care provider—a search that tended to be more problematic for participants outside large cities. Those participants in smaller towns or conservative cultures (e.g., the Bible Belt) often endured, at best, having to educate their doctors on transgender issues and, at worst, being refused health care. Furthermore, a few participants (n = 3) described an intense fear of needing emergency medical assistance because they could not control who treated them.
Some participants (n = 8) described experiences with mental health professionals who were unsupportive of gender exploration, oblivious to transgender issues, or denied participants’ claims of gender incongruence and insisted that they were struggling with sexual orientation issues. One participant described a particularly disturbing therapy relationship: She [therapist] wanted me to go back [to] living as a man. I tried it. I can’t…. I think it really offended her [that I didn’t go back]…. She had told me that I’m too ugly to be a woman. I said…“I wanna get my face lifted, and the only reason I don’t is that I don’t have the money!” I mean, if I had the money…I would get fixed up!…I said, “Why am I coming here for?…I don’t think I’m a deviant. I’m not a freak, I’m not a hybrid. I’m just trying to be as much as a woman as I can!” She was of the opinion that my genital surgery would be mutilation. (P #05)
The lack of resources in smaller, more conservative locations extended to education and mentorship resources as well, and some participants (n = 7) spoke of how fundamental it was (or how helpful it would have been) to have a transgender role model as they struggled with their gender. These participants expressed concern for transgender children and teens who were vulnerable to the kinds of traumatic pressures that they had endured in childhood. These locations often were described as lacking a local LGBTQ community or safe spaces for LGBTQ social gatherings apart from gay bars, which could be dangerous because they created an atmosphere where participants were encouraged to use unhealthy coping mechanisms to escape from their gender struggles. One participant explained: That’s all there is…there was nothing for anybody who was gay or anything [there]. There were bars downtown and that’s all there was. So that’s what I did I went to the bar. What do you do when you’re in a bar? You drink, you take drugs. (P #04)
Category 3.2: Rejection and Denied Protection
Within this category, “Always risking rejection when coming out or read as transgender—and may be denied protections,” 13 interviewees spoke of how rejection from others always was a threat when coming out. Some participants (n = 9) stressed the impossibility of knowing how somebody would react because some people in presumably supportive populations (e.g., gay and lesbian) did not accept them and some people in presumably unsupportive populations (e.g., Christian) defended them.
A few participants (n = 2) relayed frightening experiences from those who were professionally obligated to protect them from unfair treatment. One participant described being confronted by a police officer because he brought his dog along while studying at university. Not taking the incident seriously, the participant got in his vehicle while the police officer was shouting at him about the dog: So he pounds on the truck…and I’m thinking, “He’s really lost it!” And then he tries to grab my throat. So when he grabs for my throat I stepped on the accelerator, to back away. I didn’t do it fast but I did it fast enough to get his arm off my throat, and he fell. (P #06)
Within their families as well, some participants (n = 9) spoke of mixed support. Whereas some family members accepted them (either immediately or with time), others did not—which led to strained or estranged family relations. Also, a few participants (n = 2) discussed how their access to support systems shifted with their gender identity. For example, one transman said: As I pass more, like now I have a beard and I have a little bit of mustache—uh, my voice is deeper, um and so when I talked about, you know, about having safe spaces or having queer spaces, those spaces are not as um, they won’t be as safe anymore. Um, and so, but it doesn’t mean that straight spaces are, are safe, are completely safe [either]. (P #15)
Category 3.3: Diversity and Legitimacy
The 14 participants in this category, “Diversity within sexual or racial minority groups creates conflicting claims for legitimacy,” described how various parts of their identity complicated their ability to fit into various communities. For example, a few participants (n = 4) explained how their racial background influenced their gender formation because racial communities have different standards for gendered behavior. Also, they explained that race was inseparable from gender in determining how they were perceived. For example, Black interviewee described reactions as he moved from a butch to a transman identity: I think as I become a Black man, I think it’s a very different type of fight…. Now as a Black man if I’m too aggressive then I’m just violent. So, you know, whereas if I was too aggressive then [as a butch] I was just an angry Black woman, but you know…as an angry Black woman…they probably wouldn’t call the cops but as an angry Black man…you know, I’m [seen as] a threat. (P #15)
Many interviews (n = 12) included a description of how, as one participant said, “the oppressed become oppressors” (P #08) or, more specifically, how some gay and lesbian communities or communities of color discriminate against transgender people. Rejection from these populations felt most hurtful for some participants (n = 10) because they believed that, being already under siege and struggling for political and social equality within mainstream society, these populations should be more sensitive to transgender oppression. Some participants (n = 8) saw these prejudices between and among sexual and racial minority groups as costly to struggles for social equality when certain groups (e.g., transgender, low SES) repeatedly were thrown under the bus during political struggles. For example, one participant said: This man [Barney Frank] stood in front of all, all those [transgender] people and swore that he would keep working to make sure that, ya know, we were included [in the ENDA bill]…and when the proposed bill came out we were nowhere to be found. Ya know, and that was a very, very hurtful, ya know, situation, very hurtful…There were [transgender] people that were working with him, trusting that he was telling them the truth, and taking a lot of heat from other [transgender] people that knew that he was lying…. And then it split our community…. It was very hurtful to sit back and watch…people, ya know, beating up on each other. (P #08)
Cluster Feedback
Nine participants gave this cluster an average score of 6.7 (SD = 0.4, range = 6.5–7.0) on a scale of 1 (not at all) to 7 (very well) when asked to rate how well it represented the experience of being transgender. It appeared to resonate strongly.
Cluster 4: Challenges Within Intimate Relationships
When participants were asked about being transgender within intimate relationships, both romantic and familial relationships caused grave concern. This cluster contained meaning units from 16 of the 17 participants. It was titled, “Intimate relationships require open communication about sex and gender because their repression leads to emotional and sexual distance.” The following two categories described processes that could strengthen or weaken these relationships.
Category 4.1: Finding Intimacy
Within this category, “Sexual intimacy must be gender affirming and requires partners to be open to redefining forms of physical intimacy,” 12 participants spoke about challenges in finding affirming romantic partners. Many (n = 9) told of how they needed sexual partners to treat their bodies in a gender affirming manner in order to avoid invalidating their identity. For example, a female-identified participant stated: I’ve had sex with a woman once [since transition] and—I’m really conflicted about that—because it was, um, well it was a, it was a lesbian encounter I suppose but, still the sex we were having was undeniably heterosexual sex and I, and I was the male…It was certainly a revival of my dysphoria because I, I don’t really want to be in a, in, a male position or in a male role anymore. (P #11)
Category 4.2: Stress in Relationships
The 15 participants in this category described the effects of the repression of their true gender or the process of transition (either physical transition or transition in gender presentation or identity) within close relationships. We titled it, “The urgency to alleviate gender repression and the changes gender and sex can impose stress on intimate relationships and provoke partners’ fears.” Partners and family members could be influenced as well as the participants. Partners reportedly were frightened for the participants’ health, as well as shifts in their own identities (e.g., Am I still lesbian?).
On one hand, a few participants (n = 3) described how repressing their gender struggle led to emotional distance from their romantic partners, leading to failed relationships. In recalling a series of romantic relationships before coming out as butch, one participant said: I mean on every level, not just [my] gender identity but the sexuality [aspect as well]…the whole entire thing, was profoundly painful. The depth of denial, and you know, looking back at it now I can see how all that denial impacted all those relationships that I was in…I was always anxious. I was freaked out [that my gender feelings would be discovered]…you know, my girlfriends were so tired of me. (P #18)
On the other hand, periods of gender exploration affected relationships as well, and some participants (n = 7) described this as a time of fluctuation that loved ones had to endure with them due to either hormonal changes or emotional reactions to gender shifts. In addition, some participants (n = 7) described how their loved ones’ fears needed to be addressed during times of transition. For example, a few participants (n = 2) had to address the concern that a shift in their gender identity may necessitate a shift in their partners’ role or identity (e.g., from a lesbian to a heterosexual woman) that he or she might not wish to make. Also, sometimes loved ones needed time to understand and accept participants’ changing gender presentation or were resistant to supporting physical transition because they perceived it to be a rushed or drastic decision. One participant described opposition from his father to his seeking hormone treatment: Well he [my dad] seems to think that, you know, I only make this decision—spontaneously…and he thinks that I’m going to change my mind after I, you know, do something irreversible…. I can’t really blame him, I’ve known this about myself [my gender], my whole life, he only figured it out a couple years ago. (P #01)
Cluster Feedback
In rating how well this cluster represented the experience of being transgender on a scale of 1 (not at all) to 7 (very well), nine participants gave an average score of 6.2 (SD = 0.9; range = 5–7). Feedback from participants suggested that partners’ comfort and understanding of transgender issues often increased with the duration of the relationship so that communication about these issues had become less necessary over time.
Core Category
The core category in our study was given the following category with three subcomponents: “The struggle to develop color vision in a monochromatic world: The experience of being transgender entails (a) developing constructs to represent one’s gender authentically, (b) finding ways to communicate one’s gender to others and be seen, and (c) balancing these needs with a need to survive under discriminatory political, social and economic conditions.” By depicting transgender as an experience like attempting to describe a vividly colorful landscape in a world void of color, we sought to represent the gulf in experience between our participants and others in their social contexts. This gulf made it challenging to conceptualize and communicate their own experience as well as to be understood by others. We developed this metaphor to represent how their sense of gender was an embodied experience but pervaded much of their sense of self and created structural and communicative barriers.
The first segment of the core category related to participants’ process of understanding and identifying their gender as transgender and finding language to describe their identities (see Levitt & Ippolito, in press, for a description of transgender identity development). The processes of self-identification and communication often were eye-opening, as participants developed a profound knowledge of the social and cultural mechanisms behind the shame that had been imposed on them and began healing from their pain and learning to deal with this oppression. As they developed transgender identities, however, participants attempted to communicate their experiences of their gender and identities to others (see Levitt & Ippolito, in press). Some became motivated to raise societal awareness of transgender issues to bridge the gaps in understanding, however, there were both risks and benefits involved in taking on this educator role—particularly for those facing socioeconomic challenges with few supports of their own.
The lack of transgender awareness in mainstream society had a number of consequences for participants’ social relations (see Clusters 3 and 4). When their transgender status did become known, others often viewed participants with great curiosity or contempt, forgetting that they were multifaceted human beings. This treatment posed a challenge for participants as they navigated their environments in search of employment and social communities in which they would be treated fairly and find companionship (e.g., ethnic, LGBTQ, or artistic communities). The participants had to balance their needs for an authentic sense of self in relationships with others with their need for safety under very discriminatory conditions. At times, they were compelled to make decisions not to select an identity, vocational choice, social network, or relationship that they might desire because the conditions seemed too dangerous.
Participants’ reactions to the core category generally were positive. When asked to rate how well the core category represented the experience of being transgender on a scale of 1 (not at all) to 7 (very well), nine participants gave it an average rating of 6.4 (SD = 0.9, range = 5–7). Feedback suggested that the challenges around living with a new sex or gender identity often lessened over time and as posttransition relationships solidified.
Discussion
The current analysis suggests that living comfortably with a nontraditional gender requires more than just finding and claiming new gender options. It requires ongoing communication with those who do not share the same language, a frank evaluation of the risks and benefits of changing gender across multiple contexts, and an extended negotiation of the consequences of being transgender. Despite a desire to have authentic self-presentation and communication across contexts, participants had to decide at times whether or not to adapt their gender expression to limit minority stressors that might ensue or exacerbate, such as social rejection or unemployment.
Although our clusters focused upon separate contexts, the challenges described may not only converge but create interacting stressors (Devor, 2004; Sánchez & Vilain, 2009). A strength of our research is its inclusion of transgender participants who transitioned between gender identities (Devor, 2004) with those who do not seek to alter their gender and instead desired to live between binary gender categories (Diamond, Pardo, & Butterworth, 2011; Levitt & Hiestand, 2004) because there is little research examining the commonalities across these groups. There are some commonalities that transgender people might share with other marginalized people who face systematic oppression—for instance, employment discrimination or social prejudices. At the same time, there are distinct transgender minority stressors as well that our research has highlighted. These include: (a) coming to terms with the loss or gain of gender-related power as individuals alter their gender expressions or identities, (b) a greater vulnerability to job discrimination—in part because of fewer legal protections nationally than afforded many minority groups (e.g., Human Rights Campaign, 2012), (c) difficulty hiding their gender minority status (if they wish to remain closeted) because their identifying documentation may reveal their gender history—as could their employment histories pretransition, (d) challenges in forging sexually intimate relationships because of prejudices and because their bodies are sites of their oppression and sexual intimacy has to be redefined to respect their gender identities, and (e) difficulty finding a safe community—especially given potential rejection from lesbian, gay, and bisexual (LGB) communities (usually places where sexual minorities can find support), racial/ethnic groups (usually a place where racial/ethnic minorities can find support), and their families of origin (usually places where racial/ethnic minorities can find support). Additionally, finding community can be especially challenging for transgender people of color or of other marginalized identities who also may face rejection from the dominant transgender community.
The findings of our study contribute to a program of research (Levitt, 2006; Levitt et al., 2012) on gender within different LGBTQ communities. This research had generated a theory of gender with one structural and three functional components (see Levitt, 2006): (a) Gender as both essential and constructed, (b) gender as instrumental communication, (c) gender as a way to express needs or values, and (d) gender as an eroticization of values, respectively. Whereas the first article from our research focused upon the structure and formation of gender identity (Levitt & Ippolito, in press), the present findings contribute more to the understanding of the last three functional components, which we review in the following sections.
Gender as Instrumental Communication
Much like a painting is interpreted by all those who view it in addition to the painter, participants’ gender expressions were constantly interpreted by others. Therefore, participants described learning to communicate their gender to others in an effective way. Considering gender as instrumental does not imply a malicious manipulation of others but rather a process of learning to cope while being denied privileges that are automatically credited to cisgender people. Given the risks of violence, as well as employment and health care biases, it can be essential for transgender people to consider how to safely communicate gender.
This issue was complicated by functioning within multiple cultures that have different gender referents, such as mainstream society, LGB culture, transgender culture, and sometimes ethnic/racial cultures as well. One way of understanding their experience is as a form of bicultural competence—a term that originates in the racial minority identity development literature (LaFromboise, Coleman, & Gerton, 1993). Individuals who display bicultural competence learn to communicate with those in the dominant culture (in the case of transgender people, the gender normative population) yet to navigate the social and institutional structures of a minority culture as well (e.g., queer communities). For example, one participant described functioning in mainstream society as male, but as a transman within queer communities. The development of this competence becomes even more complex with transgender ethnic/racial minorities—perhaps demanding tri- or quadcultural competence (Erich, Tittsworth, Colton Meier, & Lerman, 2010). Future research is warranted on this process.
Expressing Needs and Upholding Values
Participants did not make decisions about their gender presentation or identities based only upon their social power within different contexts, however. They also had a strong internal sense of their gender, values about how they wanted to live, and resource limits with which to contend.
Power, Belonging, and Authenticity
Participants who decided to pass as their nonassigned birth sex were thrust into a position of greater or lesser power as determined by their perceived maleness or femaleness and their gender normativity (Connell, 1987). Being perceived as transgender, however, was not necessarily an indication of a failure. For some participants, communicating their gender genuinely meant retaining a nontraditional gender expression (e.g., butch, genderqueer)—their valuing of authenticity was more important than the power to be gained by passing.
Often when participants’ identities moved from a place of less to more societal power (e.g., FtM, queer-to-gender normative), they gained privilege in mainstream society but lost a nurturing community (e.g., queer/lesbian community) on account of that privilege. And, like in other research on LGBTQ gender (Levitt & Hiestand, 2004), participants made context-bound decisions about how to portray and communicate their gender in relation to their own needs (e.g., employment, health care), values (e.g., authenticity, education of others), and the safety of their context. For instance, those who passed as their nonassigned birth sex sometimes disclosed their histories to develop a more intimate relationship, to educate others, or because they had no choice (e.g., having to surrender identification documents that indicated their birth sex).
Our core category stressed learning not only to communicate one’s gender across context but also to survive in a world rich in prejudices and hostility. It reflected the body of research documenting serious economic challenges for this group (Budge, Tebbe, & Howard, 2010; Transgender Law Center, 2009). For example, in our study, two White participants reported that transitions to a male identity were financially advantageous. However, three of the four MtF participants described a loss of economic stability as they fell further from their workplace ideals. Economic resources were critical if participants desired to change their genders or sexes because surgeries were expensive, participants may be unable to work during parts of the process, and they risked losing employment due to bias as well. And, participants who could not afford to make changes that allowed them to pass or who chose genderqueer gender presentations faced extended employment discrimination, which sometimes could be circumvented by individuals who were self-employed or in supportive workplaces.
Furthermore, participants’ perceived sex and gender were linked inextricably to other parts of their identity (e.g., race and SES; see Diamond & Butterworth, 2008, regarding intersectionality in violence against transgender people). Expectations of men of color and Caucasian men, for instance, could carry with them quite different social standings and privileges. Being from a lower socioeconomic bracket could prohibit medical treatments as well as safer gender expression. And job-related challenges and medical expenses, in turn, could cause transgender people to fall into a lower socioeconomic bracket.
Power and Empathy in Subidentities
When beginning our study, we were uncertain if transgender identities could be analyzed together. We found, however, that most responses converged across subgroups and that differences tended to be due to the distinct challenges that subgroups faced, rather than different reactions to shared experiences (e.g., reactions to hormones were described only by those who used them). After completion, we reviewed the hierarchy for trends based upon the participants’ gender identities (e.g., MtF, butch), assigned birth sex (i.e., male, female, or intersex), or desire to transition.
Almost all our data cut across these categories. One trend though was that the 10 participants who transitioned from a feminine to a masculine gender described concerns around entering a male identity that had been seen as oppressive. Six of them felt more empathy toward men adopting attitudes of privilege after experiencing themselves how insidious this bias was. Three of the FtM participants conveyed that being transgender inspired them to help oppressed people through activism or ministry. The participants who transitioned to becoming female-identified did not tend to describe their transitions in these terms (although one did). Future research would be helpful to shed light on the functions of gender (Kozee, Tylka, & Bauerband, 2012).
Eroticization of Values
For the transgender participants, communication about gender often was necessary within intimate relationships, requiring explicit discussion around their gender identity and how they preferred to be treated both emotionally and physically. Some of the research on LGBTQ gender identities (Levitt, 2006) has suggested that gender expressions can be an eroticization of symbols representing values and needs that have been culturally oppressed. For instance, gay men, who were systematically given the message that being gay denies them a male identity, were found to eroticize symbols of masculinity within leather communities (Mosher et al., 2006). In our study, participants related to the parts of their body that were experienced as incongruent with their authentic selves and values (e.g., having/not having a penis/breasts) with attitudes that ranged from acceptance to disgust, and parts that were congruent were more desirable and eroticized. Different transgender communities might form different collective aesthetics with symbols that represented their unique experiences of value oppression.
The process of developing a gender-based aesthetic was more complicated for our sample than for other LGBTQ identities studied, however, for two reasons. First, transitions in gender might require partners to reevaluate their own sexual orientation and sexuality in relation to their loved one’s new gender identity or expression (Findlay, 1998). Second, many participants (n = 12) reported that their sexual attractions shifted after adopting a more genuine gender. Changes in sexual attraction patterns also were found in qualitative studies by Bockting, Benner, and Colman (2009) and Jacob, Tram, and Wolmark (2009). These authors hypothesized that changes in the way transgender people related to the world, and vice versa, after transitioning might lead to changes in their sexual attractions. Our participants described that having their gender accepted in relationship allowed their sexuality to develop. Being accepted could allow them to embody new sets of values (e.g., genders) and enter cultures that ascribed status to them—facilitating clarity in sexual orientation and sexual desire.
Practice Implications
Our findings suggest that transgender people experience multiple gender identities that provide them a deep understanding of the systemic ways that genders are oppressed and privileged. This awareness could be socially isolating and could easily be replicated within therapy with ill-informed therapists. In addition to the challenges that transgender people experience in mainstream society, according to participants in our study as well as previous literature (Denny et al., 2007; “Gay vs. trans,” 2007), many therapists lack knowledge of transgender issues and their intersecting identities (Lev, 2004). Transgender people need improved resources and better access to treatments, particularly given the disproportionately high levels of poverty and unemployment in this group (National Center for Transgender Equality & National Gay and Lesbian Task Force, 2010). Acceptance of a binary gender system is so pervasive that many physicians and psychologists still consider nontraditional gender as pathological—generating a fear in this population that health professionals will directly attribute any problems to their gender identities (Dean et al., 2000; Denny et al., 2007; Hiestand et al., 2008).
Supportive mental health care services are important for transgender individuals who may be required to seek therapy prior to surgery or hormone treatment (Bess & Stabb, 2009). Requiring psychotherapy before physical transition has been criticized because it (a) pathologizes transgender people (Dean et al., 2000); (b) adds to the expense of transition; (c) places mental health professionals in a “gate-keeping role” (Beam, 2007; Flynn, 2006), thus minimizing the autonomy of a legally competent adult patient (Hale, 2007); and (d) distorts the power between the client and therapist, potentially threatening their alliance (Denny et al., 2007). The American Counseling Association (Burnes et al., 2010) and the World Professional Association for Transgender Health (Coleman et al., 2011) have developed guidelines for the competent treatment of transgender clients that can assist in training and practice.
In addition, practitioners treating transgender clients should be aware that the minority stressors (Meyer, 2003) that are unique to transgender people exist across contexts and may be hard to predict. Employment and economic security may be threatened continually by a client’s transgender status being revealed via slips in conversation, social media, or medical and employment records. Social support can be difficult to find and may not feel trustworthy when past communities of support have been rejecting. Clients may need to find ways to express to their partner how they can be emotionally and sexually intimate while being true to their sense of gender. Therapy can be helpful for clients who wish to develop strategies to help them cope with these pressures while still realizing that minority stressors are socially based, chronic stressors that are externally and systemically based.
The findings of our study can be used for advocacy and to increase awareness of challenges that transgender people face in social, educational, and health care contexts. In particular, the need for legal protections for employment, housing, and services for transgender people is dire. This situation is especially severe for transgender people of color who may face overwhelming and intersecting minority stressors (Singh & McKleroy, 2011).
Limitations and Strengths
Although we sought out demographic differences, there was limited diversity in racial and religious backgrounds of participants and so readers may wish to generalize from the current findings with caution. Our analysis is based exclusively on a sample from the United States and, as such, represents only a segment of transgender identities and experiences worldwide. At the same time, the use of multiple credibility checks ensured that data collection and analytic procedures were thorough and minimized the involvement of personal bias. Also, our hierarchy reached saturation at the 15th interview, indicating that our analysis was comprehensive.
Conclusion
Our study adds to the literature by providing an intimate examination of the process of negotiating transgender across interpersonal contexts, which can increase sensitivity and awareness of transgender experience for clinicians and researchers. In particular, it highlighted the ongoing social challenges transgender people face across multiple transgender identities. Participants described unexpected stressful issues arising both before and after adopting their current gender identity (e.g., employment issues; shifts in power position and sexual orientation). In guiding clients to create and exist within their own vivid landscapes, therapists need not only to help clients form this landscape but also to evaluate risks and benefits around its creation and develop their sense of agency to make decisions that will work in their own lives.
Footnotes
Acknowledgment
The authors would like to thank Drs. Robert Neimeyer and Linda Sagrestano for their helpful suggestions in shaping our research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.