Transgender and Gender Diverse Veterans' Access to Gender-Related Health Care Services: The Role of Minority Stress

Impact Statement This manuscript describes the relationship between past experiences of discrimination, perceptions of providers' competence in transgender and gender diverse (TGD) health, and TGD veteran's engagement in gender-related services within the Veterans Health Administration. Additionally, addressing the impacts of discrimination may further enhance engagement. The results have implications for individual clinicians, whose direct work with TGD veterans poses an opportunity to facilitate affirmative (Shipherd et al., 2010) spaces and assess for gender minority risk and resilience. Moreover, these findings emphasize the role of policy makers in creating systems-level safeguards for ensuring TGD-affirmative health care settings. Although Veterans Affairs (VA) directives and initiatives have sought to ensure an affirmative environment for transgender and gender diverse (TGD) veterans, barriers to care persist, including enacted/anticipated stigma as well as providers' lack of knowledge regarding specific health concerns of the TGD community. These barriers are significant in light of prior research, which has demonstrated a relationship between fears of transphobic discrimination and avoiding or delaying health care engagement. The present study seeks to explore the relationship between perceptions of providers' competence with TGD patients, veterans' minority stress, and veterans' treatment engagement in gender-related services. To this end, analyses were performed on data collected from 42 TGD veterans. Results suggest that perceptions of providers' competence are positively correlated with engagement in gender-related services. Global gender minority stress was not related to engagement, but the discrimination subscale was significantly correlated with engagement. When entered into a simultaneous regression, both the discrimination subscale and provider competence significantly predicted engagement. Results require replication in larger, more diverse samples, but suggest improving provider competence may bolster engagement for TGD veterans.