Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Chwalisz, Kathleen

Second Advisor

Habib, Reza


Transgender and nonbinary (TNB) people identify with a gender identity that differs from cultural expectations based on sex assigned at birth. Many TNB people pursue social and/or medical transition with the intent of affirming their gender identity to themselves and the world around them. Medical transition describes the process of utilizing one or more forms of gender-affirming medical care (e.g., hormone therapy, gender confirmation surgery, hair removal, breast augmentation, mastectomy) in order to change the physical body such that it is more congruent with an individual’s affirmed gender identity. Researchers suggest that many TNB individuals currently use or desire to use gender-affirming hormone therapy (GAHT), and that some TNB individuals desire or use nontraditional or non-standardized (e.g., low dose) hormone therapy regimens. Unfortunately, many TNB people encounter barriers in the process of accessing gender-affirming healthcare, especially individuals who are nonbinary and/or desire gender transition steps that are nontraditional or non-standardized (e.g., low-dose hormone therapy). In current research literature, little is currently known about the experiences and healthcare needs of TNB people who currently or desire to take nontraditional GAHT. To address this gap in the research literature, the present study was a qualitative study involving semi-structured interviews with 10 TNB people to explore their experiences connected to nontraditional GAHT. The grounded theory analysis revealed a core category: Nontraditional Gender Affirmation Model. The core category is comprised of five axial level categories: Social Processes, Medical Processes, Barriers to Accessing Medical Transition Care, Facilitators to Accessing Medical Transition Care, and Coping with Distress and Barriers. The five axial level categories are comprised of 30 open-coding level categories and 33 open-coding level subcategories. The grounded theory model developed depicts a framework of various phenomena involved in the process of gender affirmation for transgender and nonbinary individuals with nontraditional gender transition needs, including nontraditional approaches to GAHT. Implications for healthcare providers, psychological practice, and future research are discussed.




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