Experiences of gender-affirming healthcare among transgender and gender diverse (TGD) people during the COVID-19 pandemic: An explanatory sequential mixed methods study

<b><i>Background:</i></b> Access to timely, gender affirming healthcare (GAH) for transgender and gender diverse (TGD) people is lifesaving. Yet, little is known about the GAH experiences of TGD people during the height of the COVID-19 pandemic. <b><i>Methods:</i></b> Utilizing an explanatory sequential mixed methods design, and applying critical transgender and intersectional theories, we examined baseline survey data (<i>n</i> = 44) and follow-up semi-structured interview data (<i>n</i> = 18 qualitative sub-sample from quantitative participants) with a cohort of TGD persons from a COVID-19 eHealth intervention (#SafeHandsSafeHearts) in Toronto, Canada. <b><i>Results:</i></b> One-sixth (<i>n</i> = 6/39, 15.4%) of the survey sample reported reduced access to GAH because of COVID-19. Qualitative participants described widespread barriers to access and negative mental health impacts given de-prioritization of TGD health during the pandemic. The cessation of gender affirming surgeries, deemed nonessential, was of greatest concern, along with fear that substantial progress made in improving access to GAH was being unraveled. Nevertheless, community resilience was highlighted through discussion of community support, particularly the development of TGD communities of care to compensate for the lack of institutional support. Despite these struggles, participants embodied trans joy, an act of resistance, refusing to be erased by a system that devalues their healthcare needs. <b><i>Conclusions:</i></b> Results inform recommendations for TGD healthcare and improvements that reprioritize TGD community health.