{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:50:57Z","timestamp":1793317857300,"version":"4.5.0"},"reference-count":125,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transgender and gender non-conforming individuals (TGNC) people of color (POC) are exposed to a unique intersection of gender and racial-minority stressors. Distal (external) and proximal (internalized) stressors have been studied within the Gender Minority Stress Model, which outlays the adverse mental\/physical health outcomes that often occur due to gender-minority stress. Few studies have examined the intersectionality of racial-minority related stress, mostly utilizing White TGNC samples, limiting generalizability to TGNC POC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted an online cross-sectional survey (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f149) TGNC POC U.S. adults who answered demographics, questions regarding transition experiences (e.g., gender-affirming care and identification documents), intersectional distal stressors (LGBT People of Color Microaggressions Scale), proximal stressors (The Gender Minority Stress and Resilience Measure), the Gender Congruence and Life Satisfaction Scale (GCLS), the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      91.3% desired a legal name change and a gender marker change (98%). Less than 60% who wanted changes were able to obtain them, reporting negative outcomes using incongruent documents. Additionally, 78.2% of those who wanted gender affirmative hormone therapy were able to obtain it (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f55). A path analysis using structural equation modeling revealed that distal stressors were both directly and indirectly, through proximal stressors, related to anxiety (direct:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.42, 95% CI\u202f=\u202f0.26, 0.58, indirect:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.16, 95% CI\u202f=\u202f0.07, 0.26) and depression (direct:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.43, 95% C I\u202f=\u202f0.26, 0.60, indirect:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.14, 95% CI\u202f=\u202f0.04, 0.23). Intersectional distal stress was not directly related to congruence but was indirectly related through proximal stressors (indirect effect:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.16, 95% CI\u202f=\u202f\u22120.27, \u22120.05); Intersectional distal stress was not directly related to congruence but was indirectly related through proximal stressors (indirect effect:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.16, 95% CI\u202f=\u202f\u22120.27, \u22120.05). Interpretation should be cautioned given low reliability of the GCLS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings emphasize intersectionality and internalization of those stressors on gender congruence, anxiety, and depression, highlighting the importance of culturally humble, accessible services. The high frequency of adverse experiences due to document incongruence highlights the importance of policies that reduce barriers. Future research should strengthen congruence measurement with longitudinal designs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1716010","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:41:49Z","timestamp":1771483309000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Centering transgender and gender nonconforming people of color in the study of minority stress, transition-related factors, and mental health"],"prefix":"10.3389","volume":"14","author":[{"given":"Michelle R.","family":"Dalton","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, Saint Louis University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Secrest","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Saint Louis University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Araujo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Saint Louis University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Nash","sequence":"additional","affiliation":[{"name":"School of Medicine, Saint Louis University School","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Patel","sequence":"additional","affiliation":[{"name":"School of Medicine, Saint Louis University School","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Salas","sequence":"additional","affiliation":[{"name":"Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Paz","family":"Galupo","sequence":"additional","affiliation":[{"name":"Brown School of Social Work, Washington University in St. Louis","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Heiden-Rootes","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Saint Louis University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1037\/a0029597","article-title":"A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model","volume":"43","author":"Hendricks","year":"2012","journal-title":"Prof Psychol Res 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