Perspectives on Gender-Affirming Care Among Transgender and Gender-Diverse Members of the United States Ballroom Community

Purpose: We aimed to describe utilization of, perspectives on, and access to gender-affirming care (GAC) in the U.S. Ballroom community, including anticipated and experienced barriers to and facilitators of receiving GAC. Methods: This cross-sectional study utilized an anonymous survey to collect information on types of GAC utilized and desired, satisfaction with GAC, barriers to and facilitators of access among U.S. Ballroom community members, and demographics including race, ethnicity, and gender identity. Responses were collected at a Ball in St. Louis and via word-of-mouth snowball sampling between September and December of 2022. Individuals who self-identified as transgender, gender-nonbinary, genderqueer, or agender were included in analysis. Cisgender-identifying individuals were excluded. Survey responses were described with number and percentage. Results: Seventy-four responses were analyzed per inclusion criteria and losses due to survey incompletion. Ninety-three percent of participants identified as Black or Black and another race/ethnicity. Forty-four participants previously or currently received GAC. Financial difficulties and insurance issues were the most reported barriers to access; insurance coverage, assistance from friends, family, and/or members of their community, and appointment/service availability were the most reported facilitators. Twenty-three of 30 GAC-naïve participants expressed interest in or uncertainty about receiving GAC. Financial difficulties, discrimination, and fear/anxiety were the most anticipated barriers to access; financial assistance and insurance coverage were the most anticipated facilitators. Many participants reported experiencing or anticipating discrimination. Conclusion: These findings, particularly differential experienced and anticipated barriers, offer insights for improving access to GAC that may promote well-being among transgender and gender-diverse people of color.