Trans* Community Connection, Health, and Wellbeing: A Systematic Review.

Transgender and nonbinary (trans*) people are affected disproportionately by discrimination and violence, contributing to gender minority stress and negative health effects. Transgender community connection (TCC), defined as (i) emotional connectedness (internal sense of belonging) to the trans* community and/or (ii) behavioral participation in the trans* community (observable interaction with other trans* people, in person, online, or through media) may moderate these negative effects on health. This systematic review synthesizes research on links between TCC and health and wellbeing for trans* people. Twenty research articles (3 quantitative, 3 mixed methods, and 14 qualitative) linking TCC to health and wellbeing were identified from systematic searches of PubMed, CINAHL, and PsycINFO. Data regarding TCC were extracted, synthesized, and grouped by (i) gender transitioning, (ii) mental health, (iii) sexual health, and (iv) access to care to illustrate the findings. TCC was linked to several positive outcomes, including improved mental health, increased connection to care, supported exploration of sexual and gender identities, and informed gender transition. For transgender women, especially, TCC was also linked to increased engagement in sex work (as a worker, not a client) and, in some cases, deterred them from getting sexual health testing and treatment due to fear of being observed at specialized clinics and subsequent loss of confidentiality among peers. These findings highlight the overall protective nature of TCC and a need to consider best practices to ensure confidentiality for community members. The findings can be used to inform the development and adaptation of health care interventions aimed at decreasing the harmful effects of gender minority stress for trans* people.