Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory

Lefevor, G. Tyler; Boyd-Rogers, Caroline C.; Sprague, Brianna M.; Janis, Rebecca A.

doi:10.1037/cou0000339

Cited by 422LGBTQ Health, Identity, and PolicyGender and Feminist StudiesGender Roles and Identity Studies

Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory

Lefevor, G. Tyler, Boyd-Rogers, Caroline C., Sprague, Brianna M., Janis, Rebecca A.·2019·Journal of Counseling Psychology

DOI 10.1037/cou0000339

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Abstract

Interpersonal, social, and structural stressors have been identified as key elements that explain health disparities between transgender and cisgender individuals. However, most of this research has focused on binary transgender individuals or has not differentiated between binary and nonbinary individuals; little research has examined the experiences of minority stress or health of those identifying outside the gender binary. Guided by intersectionality and drawing on a sample of 3,568 college students from the Center for Collegiate Mental Health's 2012-2016 database-of whom 892 identified outside the gender binary-we conducted analyses of demographic and outcome measures administered in participants' 1st counseling appointment, examining differences between cisgender, transgender, and genderqueer individuals. We found that genderqueer individuals were harassed, sexually abused, and subjected to traumatic events at higher rates than were either cisgender or binary transgender individuals, with approximately 50% of genderqueer individuals reporting one of these experiences. We found that genderqueer individuals experienced more anxiety, depression, psychological distress, and eating concerns than did binary transgender and cisgender individuals and more social anxiety than did cisgender individuals. Genderqueer individuals more frequently reported self-harm and suicidality than did any other group, with approximately 2/3 of participants' having contemplated and nearly 50% making a suicide attempt. We extend current theorizing about minority stress (Hendricks & Testa, 2012; Meyer, 2003) to include genderqueer individuals and delineate several structural aspects of genderqueer experiences that may be responsible for these trends, including others' lack of knowledge about genderqueer experiences and pronouns, poor access to legal and medical resources, and systemic discrimination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Both transgender and gender diverse individuals experience pressures attributed to their existence outside cultural gender norms that are heavily based on strict adherence to binary gender roles.
“Both transgender and gender diverse individuals experience pressures attributed to their existence outside cultural gender norms that are heavily based on strict adherence to binary gender roles [6].”
From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [6]
Non-binary gender diverse people may experience even greater levels of gender-based discrimination and negative mental health outcomes than binary transgender individuals.
“non-binary gender diverse people may experience even greater levels of gender-based discrimination and negative mental health outcomes than binary transgender individuals”
From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [6]
TGD individuals experience depression, anxiety, and suicidality at higher rates than cisgender LGB and queer individuals.
“they experience depression, anxiety, and suicidality at higher rates than cisgender lesbian, gay, bisexual (LGB), and queer individuals [6,7,8,15].”
From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [6]
Even within the LGBTQIA+ spectrum, TGD individuals are disproportionately impacted by mental illness.
“Even within the LGBTQIA+ spectrum, TGD individuals are disproportionately impacted by mental illness”
From A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse (2022) · cites this paper as [6]

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“The above-mentioned discrepancies in mental health outcomes between minorities are partially consistent with previous findings [15, 22, 40].”
BackgroundResultInfluential
Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults
Hughto, J. M. W., Restar, A., Wolfe, H. L., Gordon, L. K., Reisner, S. L., Biello, K. B., Cahill, S., & Mimiaga, M. J. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108674 · Cited by 28 · see citing works
Testing the minority stress model across gender identity, race, and ethnicity among U.S. gender minority adolescents.
Jardas, E. S., Ladd, B. A., Maheux, A. J., Choukas‐Bradley, S., Salk, R. H., & Thoma, B. C. (2023) · Journal of Psychopathology and Clinical Science · doi:10.1037/abn0000834 · Cited by 27 · see citing works
An Investigation of the LGBTQ+ Youth Suicide Disparity Using National Violent Death Reporting System Narrative Data
Ream, G. L. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2019.10.027 · Cited by 27 · see citing works
Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations
Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin‐Maliver, J., et al. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00442-4 · Cited by 27 · see citing works
Unheard voices: A qualitative study of LGBT+ older people experiences during the first wave of the COVID‐19 pandemic in the UK
Hafford‐Letchfield, T., Toze, M., & Westwood, S. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13531 · Cited by 27 · see citing works
“…et al., 2019; Westwood et al., 2020), associated with minority stress (Correro et al., 2020; Fredriksen-Goldsen et al., 2020; Frost et al., 2015; Lefevor et al., 2019), the cumulative effects of lifelong exposure to prejudice and discrimination (Fredriksen-Goldsen et al., 2017), and increased…”
Background
Differential Risks for Suicidality and Mental Health Symptoms Among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services
Srivastava, A., Rusow, J. A., & Goldbach, J. T. (2020) · Transgender Health · doi:10.1089/trgh.2020.0034 · Cited by 27 · see citing works
“To date, very few studies have looked at the diversity of gender identities (cisgender, transgender, and nonbinary) among samples of SMY.(8,9) Moreover, studies that have examined gender diversity have generally grouped all gender diverse identities together when comparing against their cisgender counterparts.”
BackgroundResultInfluential
A narrative exploration of the importance of intersectionality in a Black trans woman’s mental health experiences
Shelton, S. A., & Lester, A. O. S. (2020) · International Journal of Transgender Health · doi:10.1080/26895269.2020.1838393 · Cited by 27 · see citing works
Monosexism as an Additional Dimension of Minority Stress Affecting Mental Health among Bisexual and Pansexual Individuals in Hong Kong: The Role of Gender and Sexual Identity Integration
Chan, R. C. H., & Leung, J. S. Y. (2022) · The Journal of Sex Research · doi:10.1080/00224499.2022.2119546 · Cited by 26 · see citing works
“…has indicated that transgender and non-binary individuals are more likely to identify as bisexual and pansexual (Greaves et al., 2019) and experience greater levels of depression and anxiety than cisgender individuals due to gender minority stressors (Lefevor et al., 2019; Rutherford et al., 2021).”
Background
Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults
Kung, K. T. F. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05875-7 · Cited by 27 · see citing works
“…in press; Heylens et al., 2018; Jones et al., 2012; Kung, 2020; Murphy et al., 2020; Nobili et al., 2018; Pasterski et al., 2014; Stagg & Vin-cent, 2019; Vermaat et al., 2018) as well as in mental health (Goldberg et al., 2019; Lefevor et al., 2019; Scandurra et al., 2021; Thorne et al., 2019).”
When the context rows against. Voicing parents of transgender children and teenagers in Italy: A qualitative study
Lorusso, M. M., & Albanesi, C. (2021) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2518 · Cited by 26 · see citing works
Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress
Cusack, C. E., Cooper, M., Libbey, N., & Galupo, M. P. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101544 · Cited by 28 · see citing works
Experience and perpetration of intimate partner violence and abuse by gender of respondent and their current partner before and during COVID-19 restrictions in 2020: a cross-sectional study in 13 countries
Gilchrist, G., Potts, L., Connolly, D. J., Winstock, A., Barratt, M., Ferris, J., Gilchrist, E., & Davies, E. (2023) · BMC Public Health · doi:10.1186/s12889-022-14635-2 · Cited by 26 · see citing works
“Non-binary people experience more stressors than transgender men and women and cis people, including greater rates of trauma and interpersonal violence that may contribute to the higher rates of anxiety, depression and psychological distress reported in our survey and in other studies [56].”
Result
Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals
Skuban-Eiseler, T., Orzechowski, M., & Steger, F. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-02023-0 · Cited by 24 · see citing works
Invalidation and mental health among nonbinary individuals.
Johnson, K. C., LeBlanc, A. J., Dolezal, C. L., Singh, A. A., & Bockting, W. O. (2023) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000621 · Cited by 25 · see citing works
Nonbinary people living in a binary world: Minority stress in public and gendered places
Rosati, F., Lorusso, M. M., Pistella, J., Anzani, A., Giannantonio, B. D., Mirabella, M., & Baiocco, R. (2024) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2338152 · Cited by 24 · see citing works
Mental Health Service Use and Barriers to Accessing Services in a Cohort of Transgender, Gender Diverse, and Non-binary Adults in Australia
Cronin, T. J., Pepping, C. A., & Lyons, A. (2023) · Sexuality Research and Social Policy · doi:10.1007/s13178-023-00866-4 · Cited by 24 · see citing works
“Minority stressors may vary as a function of gender due to the unique experiences of those with transfeminine, transmas-culine, and non-binary genders (Lefevor et al., 2019).”
Beyond Age, BMI , Gender Identity, and Gender Minority Stress, Weight Bias Internalization Is Uniquely Associated With More Eating and Body Image Disturbances and Poor Physical and Mental Health in Chinese Gender‐Diverse Adults
Barnhart, W. R., Xiao, Y., Li, Y., Gaggiano, C. M., Jiang, Z., Wu, S., Cao, H., & He, J. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24278 · Cited by 27 · see citing works
“It's Being Compassionate, Not Making Assumptions”: Transmasculine and Nonbinary Young Adults' Experiences of “Women's” Health Care Settings
Gómez, A. M., Hooker, N., Olip-Booth, R., et al. (2021) · Women s Health Issues · doi:10.1016/j.whi.2021.02.008 · Cited by 21 · see citing works
“It's the Environment, Not Me”: Experiences shared by transgender and gender diverse adults living in Texas
Clary, K. L., Goffnett, J., King, M., Hubbard, T., & Kitchen, R. (2022) · Journal of Community Psychology · doi:10.1002/jcop.22948 · Cited by 21 · see citing works
Risk of suicide attempt with gender diversity and neurodiversity
Polidori, L., Sarli, G., Berardelli, I., Pompili, M., & Baldessarini, R. J. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115632 · Cited by 24 · see citing works
Developing a gender affirming health response for trans and gender diverse Australians: A qualitative study
Windt, I. K., Mullens, A. B., Debattista, J., Stanners, M. N., & Brömdal, A. (2024) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2374007 · Cited by 23 · see citing works
Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study
Kruzan, K. P., Whitlock, J. L., & Bazarova, N. N. (2021) · JMIR Mental Health · doi:10.2196/21854 · Cited by 20 · see citing works
Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals
Riddle, M. C., Robertson, L., Blalock, D. V., Duffy, A., Grange, D. L., Mehler, P. S., Rienecke, R. D., & Joiner, T. E. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23812 · Cited by 20 · see citing works
The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study
Lampis, J., Simone, S. D., Lasio, D., & Serri, F. (2023) · Sexuality Research and Social Policy · doi:10.1007/s13178-023-00817-z · Cited by 25 · see citing works
“…of a relationship of psychological distress with experiences of discrimination, marginalization, and victimization (Hendricks & Testa, 2012; Lefevor et al., 2019; Puckett et al., 2020) and stresses the importance of identifying the needs of transgender individuals in terms of mental health…”
Background
Health Care Avoidance and Delay in the Transgender Population: A Systematic Review Exploring Associations with Minority Stress
Thomas, S. D., Dempsey, M., King, R. J., & Murphy, M. F. (2024) · Transgender Health · doi:10.1089/trgh.2022.0202 · Cited by 20 · see citing works
“11 This model has been utilized by transgender health research to explore observed health disparities, 12 demonstrating minority stress theory as a vital framework to explore health behaviors in this population.”
Social and contextual influences on eating pathology in transgender and nonbinary adults
Urban, B., Knutson, D., Klooster, D., & Soper, J. (2022) · Eating Disorders · doi:10.1080/10640266.2022.2135715 · Cited by 19 · see citing works
“A thorough discussion of this model is beyond the scope of the present paper, but the model provides key evidence that daily distress and discrimination are linked to elevations in mental health concerns such as disordered eating (Lefevor et al., 2019).”
Background
Intimate Partner Violence and Mental Health Among Transgender and Gender Diverse Young Adults
Stults, C. B., Gao, S., Brandt, S. A., Taber, J. L., Lynn, S. G., Kaczetow, W., Lee, G. B., Cruise, A., & Krause, K. D. (2023) · Journal of Family Violence · doi:10.1007/s10896-023-00579-7 · Cited by 20 · see citing works
“For example, one study found that TGD people of color reported higher levels of depression and anxiety than White TGD individuals (Lefevor et al., 2019).”
Exploring the intersectionality of stigma and substance use help-seeking behaviours among lesbian, gay, bisexual, transgender, queer, questioning or otherwise gender or sexuality minority (LGBTQ+) individuals in the United States: A scoping review
Xin, Y., Schwarting, C. M., Wasef, M. R., & Davis, A. K. (2023) · Global Public Health · doi:10.1080/17441692.2023.2277854 · Cited by 21 · see citing works
“Minority Stress Theory (MST; Meyer, 2003) is a widely used theoretical framework that explains the relationship between identity-based stigma, mental health, and well-being among LGBTQ+ individuals (Lefevor et al., 2019; Tebbe & Moradi, 2016).”
Background
Minority stressors and tobacco use among a US sample of sexual and gender minority young adults
Figueroa, W. S., Jankowski, E. E., Curran, H., Ennis, A. C., Poteat, T., Morgan, E., Klein, J., Reczek, C., & Patterson, J. G. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.111356 · Cited by 19 · see citing works
The Conceptualization and Measurement of Sexual Self-Concept and Sexual Self-Schema: A Systematic Literature Review
Astle, S. M., Anders, K. M., McAllister, P., Hanna‐Walker, V. R., & Yelland, E. L. (2023) · The Journal of Sex Research · doi:10.1080/00224499.2023.2244937 · Cited by 18 · see citing works
“…al., 2016), much higher rates of psychological distress, sexual violence, harassment, and physical assault (Grant et al., 2011; James et al., 2016; Lefevor et al., 2019), and often do not receive relevant or affirming sex education (Warwick et al., 2021); these are all things would affect one’s…”
Transphobia in the United Kingdom: a public health crisis
Connolly, D. J., Meads, C., Wurm, A., Brown, C., Bayliss, J., Oakes-Monger, T., & Berner, A. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02509-z · Cited by 20 · see citing works
“…to enacted, anticipated or internalised transphobia brings about a physiological stress response predisposing to or exacerbating physical illness and psychosocial conditions, which are associated with a greater prevalence of mental illness and participation in health risk behaviours [24–26].”
Transgender identity and experiences of sexual harassment in adolescence
Kaltiala‐Heino, R., & Ellonen, N. (2022) · Child Abuse Review · doi:10.1002/car.2748 · Cited by 18 · see citing works
The Face of Nonbinary Beauty Communication on Instagram: A Content Analysis
Wiid, R., Müllern, T., & Berndt, A. D. (2022) · Journal of Current Issues & Research in Advertising · doi:10.1080/10641734.2022.2089786 · Cited by 18 · see citing works
“Lefevor et al. (2019) use genderqueer as an umbrella term for identities that are neither distinctly male nor female in the traditional conceptualization of gender in Western society.”
BackgroundMethodResultInfluential
Minority stressors and their associations with severe psychological distress among gender-diverse people.
Pease, M. V., Williams, N. D., Iwamoto, D. K., & Salerno, J. P. (2022) · American Journal of Orthopsychiatry · doi:10.1037/ort0000635 · Cited by 20 · see citing works
Exploring communication preferences of trans and gender diverse individuals—A qualitative study
von der Warth, R., Metzner, G., Körner, M., & Farin‐Glattacker, E. (2023) · PLoS ONE · doi:10.1371/journal.pone.0284959 · Cited by 19 · see citing works
Transgender and Nonbinary Individuals’ Perceptions Regarding Gender-Affirming Hormone Therapy and Cardiovascular Health: A Qualitative Study
Rytz, C. L., Pattar, B. S. B., Mizen, S. J., Lieb, P., Leigh, J. P., Saad, N., Dumanski, S. M., Beach, L. B., Marshall, Z., Newbert, A. M., et al. (2024) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.124.011024 · Cited by 18 · see citing works
Ketamine use in a large global sample: Characteristics, patterns of use and emergency medical treatment
Barrios, K. P., Connolly, D. J., Ferris, J., Maier, L. J., Barratt, M. J., WINSTOCK, A. R., Puljević, C., & Gilchrist, G. (2024) · Journal of Psychopharmacology · doi:10.1177/02698811241273850 · Cited by 19 · see citing works

Educate your campus about stalking — and follow these best practices for stalking investigations
Sutton, H. (2023) · Campus Security Report · doi:10.1002/casr.31072 · Cited by 1 · see citing works
Toward a Comprehensive Model on Stalking Acknowledgment
Ngo, F. T. (2012) · Crime & Delinquency · doi:10.1177/0011128711428731 · Cited by 26 · see citing works
Raise awareness about stalking, follow key strategies for stalking investigations
Sutton, H. (2023) · Student Affairs Today · doi:10.1002/say.31214
Η «έμμονη παρενοχλητική παρακολούθηση» ("stalking") στον εμπειρικό και τον επιγραμμικό κόσμο
Κατσογιάννου, Μ. (2018) · doi:10.12681/eadd/43271
Mental health in transgender adults: The role of proximal minority stress, community connectedness, and gender nonconformity.
Helsen, V., Enzlin, P., & Gijs, L. A. C. L. (2021) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000530 · Cited by 40 · see citing works

Authors: Lefevor, G. T., Boyd-Rogers, C. C., Sprague, B. M., & Janis, R. A.
ORCID: Lefevor, G. Tyler
Boyd-Rogers, Caroline C.
Janis, Rebecca A.
Venue: Journal of Counseling Psychology
Publisher: American Psychological Association (APA)
Published: 2019-07
Volume: 66
Issue: 4
Pages: 385-395
ISSN: 0022-0167 (ISSN-L)
1939-2168
DOI: 10.1037/cou0000339
OpenAlex: W2922712531
Cited by: 422
References: 0
Citations by year: 2026: 57 · 2025: 66 · 2024: 78 · 2023: 83 · 2022: 59 · 2021: 49 · 2020: 22 · 2019: 7
FWCI: 42.73
Type: journal article
Language: en
Open access: closed
Locations: Journal of Counseling Psychology (publishedVersion)
PubMed (publishedVersion)
Digital Commons - USU (Utah State University) (submittedVersion)
Topics: Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Social Sciences › Gender Studies › Gender and Feminist Studies
Social Sciences › Gender Studies › Gender Roles and Identity Studies
Keywords: transgender people, cisgender individuals, minority stress, health disparities, non-binary gender identity, university students, sexual abuse, harassment, psychological distress, anxiety, depression, eating concerns, social anxiety, self-harm, suicidality, intersectionality, institutional discrimination
MeSH terms: Adult, Anxiety, Depression, Female, Gender Identity, Health Status, Humans, Male, Minority Groups, Sex Offenses, Stress, Psychological, Transsexualism, Sexual Harassment, Transgender Persons

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Health disparities between genderqueer, transgender, and cisgender individuals: An extension of minority stress theory

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