“I don't think I have been out of fight or flight. Ever.” Transgender people's experiences in inpatient psychiatric treatment

Inpatient psychiatric treatment reinforces gender essentialism, subjecting transgender patients to stigma and mistreatment. Participants described experiences of frequent misgendering, dismissal of gender-affirming needs, and emotional strain from navigating a system designed for non-transgender patients, leading to worse mental health symptoms, including gender dysphoria, and feelings of powerlessness. Healthcare professionals reinforce these harmful systems deliberately or unintentionally. However, instances of disruption by healthcare professionals and transgender participants were observed leading to the creation of affirming experiences despite the prevailing gender essentialism. Future opportunities to disrupt these structures include advocating for systemic change, engaging in patient-centered care, and developing inclusive policies. By creating inpatient psychiatric environments that accommodate gender diversity, healthcare providers could allow transgender patients to focus on their mental health and recovery, rather than combating stigma. Inclusive care can shift the focus from navigating systemic transphobia to healing.