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

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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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“This is particularly problematic to the extent that transgender and gender-diverse youth experience significant mental health and substance use disparities (Lefevor et al., 2019; Price-Feeney et al., 2020).”
Experiences of discrimination in healthcare settings, trust in providers and disordered eating behaviors in LGBTQ+ college students
Henning, T., Weinstock, M., Mazzeo, S. E., & Pham, A. (2024) · Eating Disorders · doi:10.1080/10640266.2024.2416343 · Cited by 2
“First, it utilized a diverse sample of LGBTQ+ individuals, including transgender, nonbinary, and gender queer individuals, groups historically excluded from healthcare research (Lefevor et al., 2019).”
Lifetime Adversity and Risky Substance Use among Transgender Emerging Adults: Selected Interventions and Clinical Social Work Practice
Tubman, J. G., & Galo, G. E. (2024) · Clinical Social Work Journal · doi:10.1007/s10615-024-00967-6 · Cited by 2
“…persons experience particularly burdensome health disparities, including higher prevalence rates for sexually transmitted infections (STIs), psychiatric diagnoses, as well as suicidal thoughts and behaviors compared to cisgender individuals (Lefevor et al., 2019; Reisner et al., 2016a, b).”
Internalized Transnegativity, Self‐Warmth, Self‐Coldness, and Eating Disorder Symptomatology Among Transgender and Nonbinary Adults
McArthur, S., McLaren, S., & Goldie, P. D. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23764 · Cited by 2
“As described, research suggests that unique stressors account for health disparities between TNB and cisgender people (e.g., Bockting et al. 2013; Lefevor et al. 2019).”
Longitudinal Outcomes of an Open Psychotherapy Clinical Trial with Two Spirit, Transgender, and Nonbinary Clients of Color
Budge, S. L., Tebbe, E. A., Lee, J., Lindley, L. M., Domínguez, S., & Matsuno, E. G. (2025) · Transgender Health · doi:10.1089/trgh.2024.0149 · Cited by 2
Empowerment moderates risk for suicide among LGBTQ+ young adults
Muehlenkamp, J. J., & Nagy, L. M. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.05.014 · Cited by 2
Let's Talk About Sex: Understanding Gender Beyond Genetics
McKeague, M., & Terry, S. F. (2019) · Genetic Testing and Molecular Biomarkers · doi:10.1089/gtmb.2019.29048.sjt · Cited by 2
“…causes, including societal pressures to verify their sex, stress surrounding federal and local laws rolling back protections on gender identity, minority stress (Hatzen-buehler and Pachankis, 2016; Lefevor et al. , 2019), and increasing violence toward gender minorities (Testa et al. , 2012).”
Prevalence of self-inflicted injuries among transgender and gender diverse adolescents and young adults compared to their peers: an examination of interaction with mental health morbidity
Pampati, S., Flanders, W. D., Zhang, Q., Ahmedani, B. K., Bhasin, S., Getahun, D., Lash, T. L., McCracken, C., Sandberg, D. E., Silverberg, M. J., et al. (2023) · Annals of Epidemiology · doi:10.1016/j.annepidem.2023.03.003 · Cited by 5
Opportunities for improving abortion care: a key stakeholder analysis of best practices for addressing the needs of transgender, nonbinary, and gender expansive people seeking abortions
Barnett, A. J., Narasimhan, S., Hartwig, S. A., et al. (2024) · Reproductive Health · doi:10.1186/s12978-024-01863-5 · Cited by 2
“TGE patients similarly report high rates of mistreatment in SRH facilities, often heightened through intersections with other experiences of marginalization, particularly related to race, socio-economic, and insurance status [1, 2, 7, 9–11].”
Background
Factors associated with communication preferences in transgender and/or gender-diverse individuals – a survey study
von der Warth, R., Körner, M., & Farin‐Glattacker, E. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108552 · Cited by 2
Experiences and factors associated with transphobic hate crimes among transgender women in the San Francisco Bay Area: comparisons across racePreprint
Gyamerah, A. O., Baguso, G. N., Santiago-Rodríguez, E. I., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-135403/v1 · Cited by 2
Heteronormativity and Counselor Self-Efficacy Working with Sexual and Gender Minority Youth
Moses, K., & Cole, M. J. (2023) · Journal of Child and Adolescent Counseling · doi:10.1080/23727810.2023.2221405 · Cited by 1
“Increased mental health issues (Camp et al., 2020; Lefevor et al., 2019), substance use issues, and suicide rates are realities for many SGM youth (Duncan et al., 2019; Lefevor et al., 2019; The Trevor Project, 2021).”
Background
Capturing the experiences of sexual and gender minorities with migraine headache
Lane, I. A., & Zempsky, W. T. (2023) · Headache The Journal of Head and Face Pain · doi:10.1111/head.14595 · Cited by 1
Understanding and Addressing LGBTQ Health Disparities: A Power and Gender Perspective
Zucker, A. N. (2023) · Springer eBooks · doi:10.1007/978-3-031-41531-9_22 · Cited by 1
A correlational study on the experiences of family members of trans and gender diverse people in Portugal
Gonçalves, B., António, R., & Moleiro, C. (2024) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2379025 · Cited by 1
Peer support workers as a tool to expand access and improve the quality of care for transgender women and travestis in Brazil
Sevelius, J. M., Saggese, G. S. R., Gonzales, J. L. G., de Carvalho, P. G. C., Santos, C. A. D. S., Wanzeller, M. D. M. D. O., Lippman, S. A., & Veras, M. A. D. S. M. (2024) · Epidemiologia e Serviços de Saúde · doi:10.1590/s2237-96222024v33e2024324.especial.en · Cited by 1
Specific reasons for living and suicide resilience mechanisms negatively predict suicide risk among sexual minorities
Zyl, M. V., Brennan, J. M., Parmenter, J. G., Joseph, K., Bongar, B. M., & Goldblum, P. B. (2024) · Frontiers in Social Psychology · doi:10.3389/frsps.2024.1487339 · Cited by 1
Clinicians’ Experiences in Transgender Healthcare: The Impact of Sexology Training on Roles, Challenges, and Solutions
Carvalho, S. A., Forte, T., Manão, A. A., & Pascoal, P. M. (2024) · Gender Issues · doi:10.1007/s12147-024-09347-3 · Cited by 2
“TGD individuals go through more instances of minority stressors than cisgen-der sexual minority individuals (e.g., Borgogna et al., 2019; Lefevor et al., 2019), which contributes to their higher rates of mental health struggles (e.g., Hendricks & Testa, 2012; Su et al., 2016).”
Using the Life History Calendar to Examine Victimization, Mental Health, and Seeking and Attaining Help Among Transgender Women: An Example of a Culturally Relevant Adaptation
Hereth, J. E., Kennedy, A. C., Garthe, R. C., Durand, B., Morein, L., Lunger, L., Smet, L. E. D., Thornton, L. E., Blackburn, A. M., & Saba, J. (2024) · Journal of Interpersonal Violence · doi:10.1177/08862605241308832 · Cited by 3
“Research on minority stress suggests that both general and identity-specific factors are likely to shape the risk for adverse mental health outcomes following victimization (Hendricks & Testa, 2012; Lefevor et al., 2019).”
Influential
Social Support and School Belonging for Gender Diverse Students
Gilbertson, M. L. (2025) · Psychology in the Schools · doi:10.1002/pits.23441 · Cited by 2
“Similarly, classmate support is associated with the psychosocial adjustment of TGD students, with TGD individuals often reporting greater overall social support despite lower perceived family support (Lefevor et al. 2019).”
Improving the Care of Transgender/Gender-Nonconforming Patients in the Emergency Department Through Quality Improvement: An Educational Intervention for Emergency Clinicians
Martinez, B., & Williams, D. A. (2025) · Journal of Emergency Nursing · doi:10.1016/j.jen.2025.02.010 · Cited by 1
Brief Report: Do autistic traits explain lower levels of psychological well-being in non-binary individuals?
Tokarek͐, A., Gąsiorowska, A., & Król, M. E. (2025) · Research in Autism · doi:10.1016/j.reia.2025.202590 · Cited by 1
Minority Stress, General Stress, and Family Support: Associations With Mental Health and Quality of Life in LGBTQ + Young Adults During the Covid‐19 Pandemic
Wurm, M., Bergbom, S., Luigi, G. D., Casa, V. D., & Malmquist, A. (2025) · Scandinavian Journal of Psychology · doi:10.1111/sjop.13122 · Cited by 2
“Here, people with non-binary identities should be included, as they have been shown to experience additional stressors compared to binary-identified trans people (Lefevor et al. 2019; Sotardi and Watson 2019).”
Influential
Structural inequalities and chronic disease health outcomes: Mental health
Bauer, A. G., Dawson, D. N., Bellot, J., & Davidson, T. M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-23750-8.00015-1 · Cited by 1
Collecting patient-reported outcomes data in transgender and gender diverse adults seeking surgery: barriers and facilitators from the patient perspective
Hu, S., Miller, A. S., Parisi, M. N., et al. (2025) · Quality of Life Research · doi:10.1007/s11136-025-04005-x · Cited by 1
The Role of Self-Reassurance in the Relation Between Internalized Gender Stigma, Self-Criticism, and Depression Among Transgender and Nonbinary Patients
Baiocco, R., Gregori, F., Rosati, F., Petrocchi, N., & Pistella, J. (2025) · LGBT Health · doi:10.1177/23258292251371064 · Cited by 1
“We’ve Always Been Here”: Identifying Resilience Factors Among Nonbinary Adults
Matsuno, E. G., Collazo, E. N., Bricker, N. L., & Balsam, K. F. (2025) · Journal of Prevention and Health Promotion · doi:10.1177/26320770251359595 · Cited by 1
“For example, nonbinary people have repeatedly reported greater depressive, anxious, suicidal, disordered eating, and general distress symptoms than cisgender LGBQ + people (Lefevor et al., 2019; Warren et al., 2016).”
“Being Yourself is a Sin”: The Impact of Evangelical Purity Culture on Sexual and Gender Minority People Socialized as Women
Muskrat, T., Porcaro, A. K., Worley, M. G., et al. (2025) · The Counseling Psychologist · doi:10.1177/00110000251352578 · Cited by 1
“Research has begun to explore the speci ﬁ c experiences of gender expansive identities (Lefevor et al., 2019).”
Humility as a Parenting Practice for Promoting the Health and Safety of Transgender and Gender Diverse Youth
Heiden‐Rootes, K. M., Dalton, M. R., & Galupo, M. P. (2025) · Family Process · doi:10.1111/famp.70075 · Cited by 1
A pilot feasibility and acceptability evaluation of Trans Care: A CBPR digital health intervention for transgender and nonbinary adults experiencing gender dysphoria
Lindley, L. M., & Budge, S. L. (2025) · International Journal of Transgender Health · doi:10.1080/26895269.2025.2570422 · Cited by 2
PrEP Intentions, Heavy Substance Use, and Gender Affirmation among Black and Latine Transgender and Gender-Expansive Youth: A Structural Equation Modeling Analysis
Cluesman, S. R., Gwadz, M. V., & Cleland, C. M. (2025) · AIDS and Behavior · doi:10.1007/s10461-025-04897-3 · Cited by 1
“Although many gender expansive Black and Latine YEA may not identify with trans binary identities, they are often engaging in similar risk factors (i.e., unprotected anal sex) typically associated with identified priority populations, such as men who have sex with men or trans-women [28, 150].”
The Bright Side of Gender Nonconformity Among Chinese Cisgender LGQ Individuals: Life Satisfaction, Positive Sexual Identity, and Interpersonal Resources
Pu, Y., Budge, S. L., & Xu, W. (2025) · International Journal of Sexual Health · doi:10.1080/19317611.2025.2577731 · Cited by 2
“…identity development, and well-being beyond cisgender sexual minority individuals is needed, as individuals with gender-diverse and/or other sexual identities often experience poorer mental health and may undergo unique minority stress and identity development processes (Lefevor et al., 2019).”
Intimate Partner Violence and HIV Prevention Among Transgender and Nonbinary Persons: Protocol for a Prospective Mixed Methods Cohort Study
Storholm, E. D., Horvath, K. J., Ogunbajo, A., Scheim, A. I., Restar, A., Lucas, R., Lee, S. D., Choo, S., Jensen, B., Randazzo, J., et al. (2025) · JMIR Research Protocols · doi:10.2196/82090 · Cited by 1
Attending to transgender health dilemmas: Practical and strategic nursing actions toward gender justice for health
Cleofas, J. V., & Abesamis, L. E. A. (2025) · Nursing Outlook · doi:10.1016/j.outlook.2025.102593 · Cited by 1
Queering Puberty Research Among LGBTQIA+ Populations: A Scoping Review
Gaunson, T., Warton, W., Thomas, J., Stills‐Blott, S., Hughes, A., Choong, J. X., Jobson, L., & Byrne, M. L. (2025) · Journal of Adolescence · doi:10.1002/jad.70078 · Cited by 1
Understanding LGBTQ+ Students Seeking Therapy at College Counseling Centers: Treatment Utilization, Presenting Distress, and Relational Support
Davis, K. A., Janis, R. A., Lefevor, G. T., & Scofield, B. E. (2025) · Journal of College Student Mental Health · doi:10.1080/28367138.2025.2577635 · Cited by 1
“There are also persistent disparities in the emotional health and well-being between LGBTQ+ individuals relative to heterosexual and cisgen-der individuals (Bränström et al., 2024; Lefevor, et al., 2019).”
Self-citation

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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