Challenging Norms: The Impact of Transgender and Gender-Diverse Realities on Work and School Participation

Abstract Importance: Disruption in school and the workplace are health concerns for transgender people. Objective: To evaluate transgender individuals’ thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school. Design: Cross-sectional survey. Participants: Survey respondents older than age 18 yr from the Study of Transition, Outcomes n = 350 assigned male at birth, n = 346 assigned female at birth AFAB). Outcomes and Measures: Ever “out” to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses. Results: Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio OR = 0.57, 95% confidence interval CI 0.38, 0.86). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI 0.20, 0.97). Conclusions and Relevance: Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.