Examining access to gender-affirming surgery: A community-based thematic analysis of structural and systemic barriers and supports

Objectives: To identify and explore the barriers and facilitators to accessing gender-affirming surgery (GAS) for transgender and gender-diverse individuals (TGDI) using a community-based participatory research (CBPR) approach. This study aims to assess the impact of structural, social, and systemic factors on the accessibility of GAS and to highlight key facilitators that improve healthcare access and overall well-being for TGDI individuals. Methods: Thematic analysis of focus groups was performed to identify barriers and facilitators experienced by the participants in accessing this care. Results: The primary facilitators of GAS were community support, access to healthcare, and respectful and affirming care providers, while barriers were insurance difficulties, World Professional Association for Transgender Health (WPATH) criteria, medical gatekeeping, negative experiences with medical personnel, and lack of representation. Conclusion: This study highlights how TGDI face compounded barriers to GAS, including the emotional burden of navigating insurance and WPATH criteria, gatekeeping, and identity erasure. Community networks-especially chosen families and peer knowledge-sharing-emerged as critical facilitators. Beyond increasing representation, findings point to the need for reforming eligibility pathways, provider training in trauma-informed care, and investment in community-based infrastructures that already support access.