2025 Theses Doctoral

Personal Healthcare Networks of Transgender and Gender-Diverse Adults After Gender-Affirming Surgery

Gaedecke, Tyler

The purpose of this mixed methods dissertation was to describe access to healthcare among transgender and gender-diverse (TGD) adults in the years following gender-affirming surgery. In particular, these studies aimed to explore what constitutes “appropriate” care as a domain of access (i.e., the degree to which the care meets the needs of patients, and the quality of that care) for TGD adults after gender-affirming surgery and to investigate how it may be associated with their health outcomes. Further, this dissertation proposed and implemented a unique application of social network analysis methods for the characterization of access to healthcare services.

Chapter 1 is an introduction to health and health disparities among TGD people, gender-affirming care (including surgery), theories of access to care, and social network analysis methodologies.

Chapter 2 is an integrative review of 19 studies that utilized social network analysis methods to better understand how they could be applied to our population of interest, ultimately strengthening the concept of a ‘personal healthcare network’ made up of patients’ team of healthcare professionals.

Chapter 3 is a quantitative study analyzing a personal healthcare network dataset of 58 individuals at least one after a gender-affirming surgery and their report of 271 healthcare professionals that they have received care from in the past 12 months. Analysis of inclusive and affirming language use by clinicians in their networks and clinicians’ knowledge of gender-affirming care (as perceived by the patient) revealed a significant association between high network proportion of clinicians with high knowledge of gender-affirming care and participant self-rated physical health. Further, high knowledge of gender-affirming care was associated with significantly higher odds that a patient would intend to return to that provider and that they would consider that provider to be among the most important to their overall care.

Chapter 4 is a qualitative descriptive study with 16 interviews wherein participants described how (de-)humanizing interactions with healthcare professionals appear in their care since surgery, how reciprocal and collaborative relationships help them to feel more seen and empowered in their care, and how their surgery and overall transition affected their outlook on and approach to healthcare services. Lastly, Chapter 5 synthesizes the three studies in this dissertation, ultimately discussing implications for research, practice, and policy.