Associations between social connection and gender identity among transgender and gender diverse U.S. veterans

Purpose To compare social connection among binary transgender (transgender men and transgender women) and nonbinary (individuals who do not identify as men or women) U.S. veterans.Methods We conducted a cross-sectional study of transgender and gender diverse veterans (n = 3,344). Social connection was measured through responses to questions regarding concern about reactions to family and/or friends to gender-affirming surgery (GAS), difficulty finding a caretaker after GAS, feeling unsatisfied with social activities and relationships, and partnership status. Prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between gender identity and social connection were calculated using generalized linear models with quasi-Poisson distributions. We also evaluated whether cost as a barrier to GAS moderated the relationship between gender identity and social connection.Results The prevalence of low social connection was higher in nonbinary compared to binary transgender veterans regarding concern about reaction from family and/or friends to GAS (PR 2.13, 95% CI: 1.85–2.45), difficulty finding a caretaker after GAS (PR 1.21, 95% CI: 1.05–1.39), and feeling unsatisfied with social activities and relationships (PR 1.16, 95% CI 1.06–1.27). Associations between gender and concern about reaction from friends and/or family to GAS and difficulty finding a caretaker for GAS were stronger when cost was a barrier (p-value for interaction <0.05).Conclusion Nonbinary veterans were less socially connected compared to binary transgender veterans. Study findings suggested that especially for nonbinary veterans, important barriers would be present even after removing cost as a barrier to GAS due to deficits in social connection.