Association Between Social Connection and Gender Identity Among Transgender and Gender-Diverse Veterans

Abstract

BackgroundSocial connection plays an important health buffering role in the wellbeing of transgender and gender-diverse (TGD) people. It is not well understood whether social connection differs between binary (transgender men and women) and nonbinary (individuals who do not identity as men or women) TGD individuals. This study compared social connection among binary transgender and nonbinary veterans who had not had but wanted gender- affirming surgery (GAS). Methods Data were drawn from the 2022-2023 cross-sectional Gender-Affirming Care Evaluation (GRACE) study of TGD veterans. Our analytic sample included 3,354 individuals. Generalized linear models with quasi-Poisson distribution were used to calculate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) measuring the relationship between gender identity and social connection. A secondary analysis was conducted to determine whether cost as a barrier to GAS impacted the relationship between gender identity and social connection. Results In adjusted models, the prevalence of low social connection was higher in nonbinary individuals compared to binary transgender individuals for concern about reaction from family and/or friends to GAS (PR 2.13, CI: 1.85 – 2.45), difficulty finding a caretaker for GAS (PR 1.21, CI: 1.05 – 1.39), and feeling unsatisfied with social activities and relationships (PR 1.16, CI 1.06 – 1.27). The prevalences of being unpartnered were similar between nonbinary and binary transgender individuals (PR: 1.08, CI: 0.98 – 1.17). Associations between gender and concern about reaction from friends and/or family to GAS and difficulty finding a caretaker for GAS were stronger when cost was a barrier (p-value for interaction <0.05). Conclusion Nonbinary individuals who have not had but want GAS were less socially connected compared with binary transgender peers. Nonbinary and binary transgender populations may have different experiences of social connection and should not be collapsed into one TGD category in research related to social support.