Gender affirming medical care access: The role of healthcare stereotype threat and social support in a national probability sample of transgender adults.

Transgender adults face persistent barriers to gender-affirming medical care (GAC)-medical interventions related to a person's gender expression. Extensive qualitative research suggests that accessing GAC is stressful partly because of anticipated stigma from providers and healthcare systems, but that social support from loved ones helps trans adults persist in seeking care. We know less about how anticipated stigma and social support relate to GAC access at the population level. This study utilizes a nationally representative sample of trans adults who want GAC (N = 204) from the U.S. Transgender Population Health Survey (2016-2018). We ask whether anticipated stigma in healthcare (operationalized as healthcare stereotype threat (HCST), or the worry a person has about being judged, mistreated, or stereotyped by providers because of their gender identity or sexual orientation) and perceived social support are associated with GAC utilization for trans adults. We find a significant positive relationship between GAC utilization and HCST, global social support, and significant other support. We also find a significant interaction between HCST and social support where greater HCST is only associated with greater GAC utilization at high levels of social support. These findings underscore the importance of social relationships like peer advocates and chosen families in supporting necessary medical care for trans adults who want it and the importance of increasing culturally competent care in healthcare settings for gender-diverse people.