Examining access to gender-affirming surgery: A community-based thematic analysis of structural and systemic barriers and supports

IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

SSM. Qualitative research in health Pub Date : 2025-06-18 DOI:10.1016/j.ssmqr.2025.100589

Braveheart Gillani , Amine Sahmoud , Daniel Hamilton , Erika Kelley , Shubham Gupta , Gulnar Feerasta , Swagata Banik , Rachel Pope

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Abstract

Objectives

To identify and explore the barriers and facilitators to accessing gender-affirming surgery (GAS) for transgender and gender-diverse individuals (TGDI) using a community-based participatory research (CBPR) approach. This study aims to assess the impact of structural, social, and systemic factors on the accessibility of GAS and to highlight key facilitators that improve healthcare access and overall well-being for TGDI individuals.

Methods

Thematic analysis of focus groups was performed to identify barriers and facilitators experienced by the participants in accessing this care.

Results

35 TGDI (9 Trans Women, 8 Trans Men, 5 Non-binary individuals, and one person identifying as other) were included. The primary facilitators of GAS were community support, access to healthcare, and respectful and affirming care providers, while barriers were insurance difficulties, World Professional Association for Transgender Health (WPATH) criteria, medical gatekeeping, negative experiences with medical personnel, and lack of representation.

Conclusion

This study highlights how TGDI face compounded barriers to GAS, including the emotional burden of navigating insurance and WPATH criteria, gatekeeping, and identity erasure. Community networks—especially chosen families and peer knowledge-sharing—emerged as critical facilitators. Beyond increasing representation, findings point to the need for reforming eligibility pathways, provider training in trauma-informed care, and investment in community-based infrastructures that already support access.

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审查获得性别确认手术的机会：基于社区的结构性和系统性障碍和支持的专题分析

目的采用基于社区的参与式研究（CBPR）方法，识别和探索跨性别者和性别多样性个体（TGDI）获得性别确认手术（GAS）的障碍和促进因素。本研究旨在评估结构、社会和系统因素对GAS可及性的影响，并强调改善TGDI个体的医疗保健可及性和整体福祉的关键促进因素。方法对焦点小组进行专题分析，以确定参与者在获得这种护理方面遇到的障碍和促进因素。结果共纳入TGDI 35人，其中跨性别女性9人，跨性别男性8人，非二元性别5人，其他性别1人。GAS的主要促进因素是社区支持、获得医疗保健以及尊重和肯定的护理提供者，而障碍是保险困难、世界跨性别健康专业协会（WPATH）的标准、医疗把关、与医务人员的负面经历以及缺乏代表。本研究强调了TGDI如何面对GAS的复杂障碍，包括导航保险和WPATH标准的情感负担，把关和身份消除。社区网络——尤其是精选的家庭和同侪知识分享——成为关键的推动者。除了增加代表性之外，调查结果还指出，需要改革资格途径，对创伤知情护理提供者进行培训，并投资于已经支持获取的社区基础设施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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