Gender identity and transition in cisnormative society: Decisional conflict about fertility and management of minority stress

Transgender and gender nonconforming (TGNC) people must deal with a cisgender, heteronormative society that assumes people are either men or women and heterosexual. These social constructions can affect the psychosocial aspects of TGNC people’s lives, as individuals and within society. This thesis examines such impacts at these different levels; experiences of coping with minority stress in society, and the influence of psychosocial factors on transmasculine individuals’ decisional conflict over fertility. Together these add to understanding the psychosocial impact of gender identity and transition within cis/heteronormative society.

Systematic literature review

Difficulties experienced by TGNC people can be attributed to minority stressors that they are frequently exposed to. These experiences can decrease gender affirmation and impact psychological and social wellbeing. However, voluntary coping strategies may help protect against this. A systematic search found nine studies that included voluntary coping responses and, through framework synthesis, a new conceptual model of coping responses for TGNC individuals was developed. This included four themes under psychological affirmation and four themes under social affirmation. These provide direction on more active ways of engaging with, or resisting, minority stress and non-affirmative experiences.

Empirical project

Transitioning is typically beneficial to wellbeing, but some gender affirmative treatments may counter this due to increasing the risk of infertility. Despite this, there is low uptake of fertility preservation amongst TGNC people. Research in TGNC fertility, oncology, and decision-making highlight specific psychosocial variables may potentiate decisional conflict about this, particularly for transmasculine individuals. An online questionnaire was completed by 69 participants. Statistical analysis and content analysis explored the prevalence and relationships between variables. Decisional conflict was found to be high overall but none of the variables were significantly associated with it, but additional analyses indicate that psychosocial factors may have some relevance to experiencing decisional conflict about fertility.