A comparative thematic analysis of healthcare experiences and needs among adults with different gender trajectories

Background: Transgender and gender diverse (TGD) individuals, as well as those who have detransitioned (DT), report facing significant challenges in healthcare settings. However, there is a lack of research directly comparing the experiences and needs of these two groups. Aims: This study aimed to explore and compare the perceived needs, experiences, and barriers encountered by TGD and DT participants when accessing gender-related healthcare in a Spanish-speaking context, with the goal of informing and improving care services. Methods: In-depth semi-structured interviews were conducted with 29 TGD participants and 22 DT participants. The data were analyzed using reflexive thematic analysis within an interpretive descriptive framework, employing a comparative strategy to identify shared and distinct patterns of meaning. Results: Our analysis showed a significant convergence of challenges, including a lack of information and guidance, unmet psychological support needs, and systemic barriers such as long waiting lists and rigid care protocols. Interactions with professionals who lacked adequate knowledge, sensitivity, and communication skills were also common to both groups, fostering fear of honest self-disclosure. Key divergences included the absence of information, resources, and support for DT participants’ experiences, and their retrospective critique of the initial transition process, with some feeling it lacked adequate exploration of underlying issues they believed had contributed to it. Conclusions: Our findings emphasize the need for person-centered care models that ethically and effectively support diverse gender trajectories, including detransition, by prioritizing ongoing informed consent and psychological support, a therapeutic alliance based on trust, improved provider training, and more flexible care protocols.