Navigating the gap: Unveiling the hidden minority stressors faced by trans and nonbinary clients in gender affirming pathways

Background: Minority Stress Theory (MST) explains health outcome disparities among trans and gender diverse (TGD) individuals as compared to the general population, emphasizing the impact of both distal and proximal stressors on well-being. TGD individuals may encounter additional stressors when seeking access to accessing services for their gender affirming pathway (GAP), particularly in Italy where the pathway maintains a strong gatekeeping approach. Methods: This research explores the experiences of 45 TGD individuals aged between 18 and 38, with the majority identifying as nonbinary (77.8%) and within the context of the institutional Italian GAP. Participants are either currently on a waiting list in an institutional GAP, or they are still questioning if the GAP is suitable for them. Through a semi-structured interview, the study investigates how TGD individuals perceive the institutional GAP and whether it acts as a source of minority stress. The research employs Codebook Thematic Analysis, informed by MST. Results: Findings reveal that the Italian GAP replicate both distal and proximal stressors. Distal stressors encompass manifest aggressions, invalidation, gatekeeping, and burdening, while proximal stressors involve vicarious stress, expectations of rejections, forced concealment, gender dysphoria, and self-gatekeeping. Results indicate a greater difficulty for nonbinary individuals due to the structural negation of their identity within the GAP. Conclusion: The research underlines that the current institutional GAP exacerbates stress rather than promoting well-being. It underscores the necessity for reframing the GAP to provide a tailored and inclusive space to support the many manners of affirming TGD persons without a transnormative approach.