Skip to main content
NCBI home page
Health & Justice logoLink to Health & Justice
. 2025 Nov 19;13:69. doi: 10.1186/s40352-025-00375-z

Identifying racialized administrative and criminal legal burdens for obtaining gender-affirming identification documents among transgender groups: a qualitative analysis

Kathryn Nowotny 1,✉, Callan Hummel 2,✉, Beaux Ramos 3, Jasmine McKenzie 4, Ashley Mayfaire 3, Kim-Phuong Truong-Vu 1, Charlton Copeland 1
PMCID: PMC12628517  PMID: 41258560

Abstract

Background

Identification documents like passports, driver’s licenses, and birth certificates are a cornerstone of citizenship and an important sociolegal determinant of health. Gender-affirming identification is a vital form of gender affirmation for many transgender people, preventing discrimination, stigma, and violence. The objective of this study was to document the administrative and criminal legal burdens for obtaining gender-affirming identification.

Methods

Qualitative trajectories documenting the name change process for 61 transgender people were created via a community-engaged mixed-methods approach. Data were collected in Miami, Florida, USA October 2022 to June 2023 and were analyzed using an inductive analytical approach.

Results

Of the 61 people intending to complete the name change process, 33 successfully filed with the courts and 28 dropped out of the process before filing. People living in poverty, people who were unhoused or unstably housed, and people with criminal legal records were systematically pushed out of the name change process. Among petitioners who file the onerous name change paperwork, discretion at the clerk and judicial level can cause additional administrative burdens.

Conclusions

Barriers to gender-affirming IDs are one critical way transgender people experience intersecting forms of structural oppression and social marginalization. Streamlining the name change process at the local level is one structural intervention that can alleviate discriminatory practices by police, healthcare providers, and others, thereby reducing health inequities.

Keywords: Transgender, Sociolegal determinants, Criminal legal system, Social determinants of health, Discrimination, Stigma

Background

Identification documents like passports, driver’s licenses, and birth certificates (collectively “IDs”) are a cornerstone of citizenship and an important sociolegal determinant of health (Hill, Crosby, Bouris, et al., 2018; Hummel, Velasco-Guachalla, et al., 2025; King & Gamarel, 2021; Restar, Jin, Reisner, et al., 2020; Scheim et al., 2025). IDs are required to access employment, housing, public benefits, and medical care. Several studies document that ID mismatches contribute to risk: Carpenter (2017) shows profiling and increased police encounters for trans women when gender presentation and identity documents diverge. Loza et al. (2021) find that having name/gender marker correction is protective — associated with fewer negative interactions with police, fewer housing difficulties, and less public harassment. Thus, gender affirming IDs (GAIDs) are not only tools of recognition but mechanisms that determine access to safety, services, and protection under the law.

Therefore, GAIDs are vital forms of gender affirmation for many transgender people and are protective against discrimination and violence (Glynn et al., 2016; King & Gamarel 2021; Malta et al., 2020; Puckett et al., 2024; Restar, Jin, Reisner, et al., 2020; Sevelius, 2013; Scheim et al., 2020). A GAID is an ID where a person’s name, gender data/marker, and picture reflect the person’s gender identity. Importantly, the absence of GAIDs does not reflect a lack of initiative by transgender people. Instead, systemic barriers make updating ID information an onerous and often unattainable process (Currah, 2022; Herd & Moynihan, 2019). Hill and colleagues (2018) concluded that GAIDs are an important structural intervention for mitigating social determinants of health after finding that, among transgender women of color, women without GAIDs were more likely to postpone medical care and use nonprescribed hormones than women with GAIDs. Yet, obtaining GAIDs is often a lengthy, expensive, onerous, and dehumanizing process guided by policy that upholds systemic cisgenderism—conceptually adjacent to transphobia (Sell & Krims, 2021)—which confers privileges to those classified as cisgender while penalizing, pathologizing, and erasing transgender populations (Bauer et al., 2009; Lennon & Mistler, 2014; Wesp, Lamcoe, Elliot, & Poteat, 2019).

Preliminary data from the 2022 U.S. Transgender Survey (James, Herman, Durso, Heng-Lehtinen, 2024) finds that about one-quarter of participants reported being verbally harassed, assaulted, asked to leave a location, or denied services when they showed someone an ID that did not match their gender expression. Nearly half of respondents with at least one government issued ID reported that none of their IDs listed their name and 59% said none of their IDs listed their gender. Additionally, Other data confirm that police, employers, landlords, healthcare providers, and other system actors often discriminate against people for not having GAIDs (Currah & Mulqueen, 2011; Gamarel, Hadwin-Cakmak, King, et al., 2023). Thus, barriers to GAIDs are one critical way transgender people experience intersecting forms of structural oppression and social marginalization that contribute to health inequities related to healthcare access, injury from violence, mental illness, and some infectious diseases (Scheim et al., 2022; Wesp, Lamcoe, Elliot, & Poteat, 2019).

From the perspective of the intersectional transgender health justice theory (Wesp, Lamcoe, Elliot, & Poteat, 2019), decisions about IDs are made by government actors working within institutional systems that intersect with polices, regulations, and laws that perform state surveillance and regulation of gender identification (Currah, 2022; Sell & Krims, 2021). State policing of gender results in differential criminal legal system contact, including experiences associated with police contact, judicial decision-making, and incarceration (Jenness & Rowland, 2024; Salisbury & Crawford, 2025). These institutionally produced disparities disproportionately impact transgender people of color; 47% of Black transgender people have been incarcerated (Grant, Mottet, Tanis, et al., 2011). Similarly, the racialized administrative burdens framework (Herd & Moynihan, 2019; Moynihan et al., 2015; Ray et al., 2023) argues that burdens emerge because apparently neutral rules disadvantage or discriminate against racially minoritized groups in practice (Grant, Mottet, Tanis, et al., 2011). Guided by these frameworks, our team used a community-engaged, mixed-methods approach to follow the name change process of 61 transgender people in Florida during 2022 and 2023. Specifically, we collected survey data, field observation data, administrative data, and client case notes to develop qualitative trajectories of participants that follow them through the name change process as part of a larger study on GAIDs as a sociolegal determinant of HIV. In this paper, we document the administrative and criminal legal burdens for obtaining GAID and their relationship to other social determinants of health (e.g., housing) and structures of oppression (e.g., racism). We use the term “transgender” as an umbrella term that refers to a wide range of gender identities and gender minorities who do not identify with their gender assigned at birth, including but not limited to transfeminine, transmasculine, nonbinary, intersex, and genderqueer identities (Ashley, 2022; Harvey, 2024).

Methods

This study is a mixed-methods collaboration between university researchers and activists at two transgender-led organizations in Florida that primarily serve Black and Latinx transgender people: TransSOCIAL and The McKenzie Project. In this study, “we” refers to the authors, including advocacy organization personnel and university researchers representing medical sociology/public health, political science, and law. Four out of seven authors are transgender, across both community and academic settings. We designed the initial study in June 2022 to evaluate the advocacy organizations’ name change programs and document how the legal process does and does not work for transgender people using surveys, field notes, and administrative records. The advocacy organizations are close collaborators and have co-located office and community space. Staff from these organizations managed recruitment and case management for participants, while university researchers secured funding and managed and analyzed data. All team members contributed to the design of the study and interpretation of study findings. Research protocols were approved by university Human Subjects Research Office. This manuscript follows the standards for reporting qualitative research (O’Brien etal., 2014).

Survey

TransSOCIAL had a thorough data collection practice in place at the beginning of the study and had surveyed new clients during intake since 2018 (Hummel et al., 2025a, 2025b; Mayfaire et al., 2021). We added additional questions to the existing survey to better identify potential problems and benefits of the name change process. Survey questions covered topics including demographics, employment and income, access to healthcare, PrEP and HIV status, access to safe housing, political participation, public assistance, contact with police, and experience with discrimination. We pre-tested the survey in 2022 with advocacy organization personnel and volunteers. TransSOCIAL and The McKenzie Project administered the survey online with new clients who agreed to be part of the study from October 2022 to June 2023. Participants were compensated $25 for completing the survey.

Administrative notes

Both advocacy organizations maintain extensive records about clients as they go through the name change process. These records include the clients’ name change petitions as well as documents and spreadsheets that track clients and their cases. Staff keep track of where a person is in the name change process, what documents they have completed, which documents they need, difficulties the person may be facing, dates of contact, and case details. For this paper, staff used case files to add anonymized data to survey responses by coding variables for whether a respondent filed for a name change, the filing date, the assigned judge, the date the name change was granted, any additional barriers or delays the person faced, and if the person reported a criminal record.

Field observation notes

One author from the university team spent one day a week working at the advocacy organizations’ offices from January to June 2023. The researcher spent this time working on study logistics and processes, as well as talking with personnel and clients. They kept detailed field notes about conversations, processes, and barriers. These field notes provided additional context and details around name change processes and the barriers, delays, and frustrations that people face as they go through the process.

Data analysis

We used an inductive analytical approach to analyzing mixed-methods data using a collective instrumental case approach (Hyett et al., 2014). We first developed longitudinal trajectories, or qualitative case summaries, describing the name change process for each participant combining the different data sources (e.g., survey, field notes, case notes, administrative data). This approach allowed us to triangulate and contextualize findings. Qualitative case study methods are appropriate for examining phenomena in real-life contexts to gain a holistic understanding of the perspective of participants and their interactions with other relevant actors (Anthony & Jack, 2009). All participants completed the survey and had case notes available for analysis. We then conducted iterative reading of the case summaries to conduct “within” and “between” person analyses looking for points of convergence and divergence (Horwood, Luthuli, Chiliza, Mapumulo, & Haskins, 2021). Qualitative case summaries included temporality to understand change over time, or the “how and why” the “social world unfolds in varied ways,” allowing us to analyze processes in addition to outcomes (Devonald & Jones, 2023; Thomson, 2007).

Findings

Study sample

Sixty-one transgender adults, aged 18 years or older, enrolled in the study. 63% of people were under 30 years of age (n = 41). The sample is young because clients tend to start a name change in the first few years of their transition. Most older clients requesting services have already completed the name change process. Most participants, 59% (n = 36), reported a feminine gender identity, while 23% (n = 14) reported a masculine gender identity, and 18% (n = 11) identified as nonbinary (do not identify exclusively with feminine/masculine binary). Participants were racially and ethnically diverse, with 43% identifying as Black (n = 26), 27% identifying as Latinx (n = 16), 15% identifying as part of multiple racial and ethnic communities (n = 9), and 10% identifying as White (n = 6).

Most participants (85%; n = 51) had graduated high school or earned a GED, and just under a third had graduated college (28%). Three out of five participants (n = 27) made $1,000 or less income in the previous month. Only 21% were employed full-time (n = 13), while 30% were unemployed (n = 18). Many people in the study reported unemployment, underemployment, and experiences with employment discrimination. As a result, many people tended to work in informal and illegal jobs. Four participants reported that they were currently employed in sex work and 13 others reported informal jobs that were typical in Florida, like house cleaning. Over half the sample (n = 33) had experienced homelessness at some point in their lives, and 20% were unhoused at the time of the study (n = 12). About one-third (36%) did not have health insurance.

Name change trajectories

Of the 61 people who enrolled in the study intending to complete the name change process, 33 successfully filed with the courts for a name change and 28 dropped out of the name change process before filing. 31 people, out of 33 who filed, completed a name change—1 was denied, and 1 was still waiting at the end of the study period. The amount of time that people spent in the name change process varied widely. On average, 64 days passed between filing and a judge granting the name change. The shortest time from filing was 26 days. Eight applicants faced barriers that stretched their name change process into many months, with one waiting 136 days. From this study’s survey data, client notes, and field observation notes, we found several factors affect who files, who drops out of the name change process, and how long the process takes.

Lydia is a Black transgender woman from Miami. She decided to change her name and gender marker on her driver’s license after a wave of laws targeting transgender Floridians passed the state legislature in 2023. During that time, she worked cleaning houses and made about $1,000 a month—far below the city’s per capita income of $75,182 (Federal Reserve Bank of St. Louis, 2025). Lydia worked with advocates to prepare and submit a 6-page petition for a name change, a 5-page notice of related cases form, and an affidavit of indigence to waive the $400 filing fee. Her application to change her name stalled in the county clerk’s office because she had pled guilty to a felony in her early twenties. At the end of the study, over one year later, Lydia was still waiting for a name change. Alex also applied for a name change under similar conditions but had a different experience. Alex is a Latinx nonbinary person who also lives in Miami and makes $500 a month taking whatever work they can get. They also submitted a name change petition and fee waiver with the same advocacy organizations in 2023. Alex was arrested once but never charged with a crime – and Alex’s case was randomly assigned to a judge who works proactively with advocacy organizations. The judge granted Alex’s name change within 2 months of filing. These two cases are illustrative of the varied experiences of obtaining a GAID in Florida. Lydia’s experience of delays and barriers is typical for transgender Floridians with past criminal justice involvement who try to change their names, and several other women in the study had experiences similar to Lydia’s. Alex’s experience is less typical because they were randomly assigned one of the few judges who has worked with advocacy organizations to facilitate name changes. In other words, Alex’s success stemmed from judicial discretion (supportive judge, no felony conviction) versus Lydia’s barriers (felony record, hostile judicial environment), underscoring arbitrariness and systemic bias.

Florida law has two “carve outs” that greatly streamline the time, paperwork, and money involved in name changes. First, married individuals taking a spouse’s last name skip the court process by declaring the new name on the marriage certificate and taking the certificate to the Social Security office and the Department of Motor Vehicles. Second, adoptive parents wanting to change their child’s name can do so during adoption proceedings without initiating a separate court process for a name change. Even though Florida law is facially neutral, the carve outs reduce administrative burdens for many cisgender people while maintaining them for transgender people.

Administrative burdens

Each person who files for a name change completes detailed legal paperwork, including an 8-page document that includes 3 pages of single-spaced instructions. The documents require applicants to list all places in which they have lived since birth, all jobs held over the preceding five years, and all credit judgments issued against the applicant, including case numbers. The name change application asks for more extensive personal and financial information than a standard mortgage application. In Florida, the name change process is very localized since people must petition local county clerks and judges. These local actors serve important functions in determining the speed with which the name change process can go forward.

County clerks and judges have high levels of discretion, which creates disuniformity in the name change process. A small number of judges were known to routinely make name changes more difficult for transgender petitioners compared to cisgender petitioners, and a small number of judges were known to routinely grant name changes without further barriers to transgender petitioners. For example, one judge denied name changes for transgender petitioners explicitly because they were transgender, ultimately deciding to recuse herself from any case with transgender petitioners. Judges frequently rejected paperwork and sometimes dismissed a case if the paperwork did not exactly match the information in a person’s background check. One judge who was active during the study regularly dismissed cases with any paperwork error, resulting in petitioners having to restart the entire process and refile their paperwork with the county clerk. Similarly, county clerks often rejected or delayed applications due to the misinterpretation of the units in which income is listed on forms (e.g., monthly or annually). Petitioners had no control over the clerical or judicial assignment in their case.

Even when applicants successfully obtained a final hearing on their name change application, discretion at the clerk and judicial level can cause additional paperwork burdens. Some judges required additional paperwork from every transgender petitioner they saw while others required none. For example, though there are pre-prepared forms that can be used by the judge in the judge’s final name change order, the instructions indicate that a judge is not obligated to use the forms. This adds additional time burdens for applicants because it requires investigating whether the judge will be using the prepared forms, or whether the applicant must undertake the work of creating new forms.

The burdens imposed by the name change petition process systematically push poor people out of the process. Many of the 28 people who started the process but did not file lived in extreme poverty. The $400 filing fee is a cost to engage with the state that most petitioners cannot afford. People without $400 must spend extra time submitting additional detailed financial paperwork to waive the fee, which is frequently rejected. Some participants dropped out of the process before filing because they did not have regular cellphone or internet access. The petition also requires a permanent address. Twelve people were unhoused when they started the name change process and of those only two went on to file for a name change. The information and resources required are more difficult for unstably housed and unhoused people to collect, such as a state ID, previous addresses, employment information, and detailed financial information.

Research documents that poverty and unstable housing intersect with racism and transphobia (National Low Income Housing Coalition, 2010; Shanna & Begun 2017). Of the 10 unhoused people who started a name change petition but did not file, 8 were Black, 1 was Latinx, and 1 was mixed race. Black transgender people were disproportionately likely to start a petition but drop out of the process before filing: 17 of the 28 people who did not file were Black, and most were transgender women. For example, Kylie—a Black transgender woman in South Florida who was unemployed and living with HIV—contacted an advocacy organization to request help with her name and gender marker change while she was unhoused. Kylie could not file a petition for a name change, even with free legal assistance from the advocacy organization, because she had an open court case and no permanent address. Kylie’s experience was representative of the 10 unhoused people enrolled in the study who started the name change process but did not file. While every petitioner faces the same rules, the administrative burdens of filing for a name change fall disproportionately on Black transgender people who face intersecting forms of oppression related to poverty, housing, and criminal legal system involvement.

Criminal legal burdens

Under Florida law, most people with a criminal record can change their names. Florida restricts name changes if a person has been convicted of certain sex crimes or has an open court case. Nevertheless, a lawyer for one of the advocacy organizations stated that the biggest factor in whether a person faces additional barriers during the court process is whether a person has any criminal record. This is because judges have discretion to deny name changes based on a person’s criminal record beyond the state’s restrictions.

About one-quarter of the 33 people who filed for a name change had an arrest record and/or a misdemeanor or felony conviction. Kylie, introduced previously, could not file because she had an open case. People who had been arrested were typically arrested for crimes related to poverty, such as credit card fraud, petty theft, prostitution, and low-level drug crimes. Many transgender people believe that they cannot change their names if they have a criminal record or expect to experience long delays or rejection if they do apply.

Like other administrative burdens, rules designed to prevent fraud disproportionately affect Black transgender women. Nearly every person with a criminal record in the study was a person of color and most were Black transgender women. Eight of the 33 people or 24% who filed for a name change had a criminal record and six were Black transgender women, one was Latinx and nonbinary, and one was a White transgender woman. Artemis—a Black transgender woman—was the one person who was denied a name change. Artemis had a criminal record from previously pleading guilty to credit card fraud, a common crime related to poverty. At first, she could not file because she had an open case, which she worked to resolve with the help of a local organization for over a year. Once she filed, her petition to change her name was repeatedly thrown out and delayed because she made minor errors on the forms. Then, a judge used her discretion to deny Artemis a name change because her criminal record involved fraud. Two years into the process, Artemis was still trying to change her legal name.

Nearly all people with a criminal record who filed a petition were eventually granted a name change. Still, people with a record faced additional barriers in the name change process including extra paperwork, submissions, and delays. Many people with criminal records never successfully filed a petition even though having a criminal record does not prohibit a person from obtaining a name change. Denying or delaying a name change potentially exposes vulnerable people to discrimination.

Discussion

Our study found that transgender petitioners faced significant administrative burdens when attempting to obtain GAIDs. About half of study participants dropped out of the name change process prior to filing their paperwork, with people living in poverty, people who were unhoused or unstably housed, and people with criminal legal records systematically pushed out of the name change process. This pushout occurred even though Florida has a process for waiving the $400 filing fee and people with a criminal record are not barred from obtaining a name change except in specific circumstances. Among transgender petitioners who file the onerous name change paperwork, discretion at the clerk and judicial level can cause additional administrative burdens, with some judges identified as routinely dismissing cases for minor errors or refusing to grant name changes for any transgender petitioner.

Transgender people experience unstable housing, poverty, policing, and incarceration at much higher rates than cisgender people, due to widespread discrimination, leading to greater burdens among this population (Baćak et al., 2018; Currah & Mulqueen, 2011). This contributes to a vicious cycle of discrimination and poverty. People must present identification when they interact with most social services, government offices, and law enforcement – and transgender people are more likely to interact with social services and law enforcement than cisgender people because of these interlocking vulnerabilities. However, presenting identification with outdated names, gender markers, or photos can out transgender people to anyone who sees that ID and expose them to further harassment. Yet, some of the most vulnerable people—unhoused people and people with criminal records—face the highest barriers to updating their IDs.

The administrative burdens identified in this study are reflective of systemic cisgenderism, where transgender people are penalized in the name change process while cisgender people are privileged despite facially neutral policies. Similarly, the administrative and criminal legal burdens identified in this study are racialized processes: intersecting forms of oppression (racism and transphobia) create conditions in which transgender people of color, particularly Black transgender women, are more likely to have a criminal legal record, to be homeless, and to be living in extreme poverty. These conditions then make it harder to file and obtain a court-ordered name change. We found that Black transgender women are, therefore, systematically pushed out of the name change process at rates higher than other transgender people. Beyond the material barriers we document, transgender people’s very identities are often cast as fraudulent. This reflects persistent cultural tropes of trans people as ‘deceivers,’ which continue to shape how institutions and the law regulate gender (Bettcher, 2007).

The name change process is just one way that gender is controlled by the state (Currah, 2022). Transgender people in Florida have come under further pressure from a state government that is hostile to transgender people. Administrative decisions removed gender-affirming care from Medicaid in 2022, while the state legislature considered 10 antitransgender bills in 2023, up from 4 in 2022 and 2021. There were 14 anti-trans bills proposed in Florida (Restar et al., 2024) in 2024 impacting employment, education, civil rights, incarceration, and healthcare (Trans Legislation Tracker, 2024), as well as barriers to accurate, GAIDs under FL C.S./H.B. 1639. Florida is the only state, at the time of writing, that may criminally charge individuals for using a bathroom that does not correspond with their gender assigned at birth (FL CS/HB 1521, 2023; Movement Advancement Project, 2024). As a result, several organizations have issued “do not travel” warnings for the state, including the NAACP and the Human Rights Campaign (Ebrahimji, 2023).

The data reported in this paper were collected prior to the start of the second Trump administration. Since his first day in office, President Trump has issued numerous Executive Orders and other actions that directly negatively impact the health and wellbeing of transgender people in the U.S. (Dawson & Kates, 2025), including limiting gender-affirming care (Goldman, 2025; Wolf, 2025) and banning federal dollars for research (Reardon, 2025). Perhaps most devastatingly, Executive Order 14,168 states that the U.S. government will only recognize two sexes that are fixed at birth—male and female (The White House, 2025)—which has profound consequences for gender-affirming passports, housing assignment in prisons, and military service, among other domains (Thoreson, 2025). Despite these circumstances, our data collection is ongoing and will continue to document the socio-legal determinants of health for transgender people in the U.S.

Conclusion

GAIDs are a sociolegal determinant of health. Government issued IDs are required for daily living, including accessing healthcare services. Having an ID that does not match a person’s gender identity—incorrect name, gender marker, and/or outdated photo—limits transgender people’s ability to engage with important societal institutions because of widespread discrimination against transgender people. Streamlining the name change process at the local level (e.g., county) to enable transgender people to obtain GAIDs is one structural intervention that has the potential to alleviate discriminatory practices by police, healthcare providers, landlords and others, thereby reducing health inequities.

Acknowledgements

We would like to thank Bridget Daniels and Yaisah Mehu their help implementing this research study.

Authors’ contributions

CH, CC, and KMN analyzed the data. KMN, CH, KTV were major contributors to the writing of the manuscript. All authors contributed to the interpretation of findings and editing of the manuscript. All authors read and approved the final manuscript.

Funding

Research reported in this manuscript was supported by the National Institutes of Health Ending the HIV Epidemic initiative under award number 5P30AI073961-17 and the University of Miami Office of the Vice Provost for Research under the University Laboratory for Integrative Knowledge (U-LINK) initiative. The authors received additional support from the Miami Center for AIDS Research (CFAR; P30AI073961; fiscal years 2024 and 2025) and Center for HIV and Research in Mental Health (CHARM; P30MH116867, P30MH133399). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of the data and the limitations of the informed consent.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the University of Miami (#20220739) on September 15, 2022 consistent with U.S. federal regulations and in accordance with the Declaration of Helsinki. All participants provided informed consent.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Kathryn Nowotny, Email: kathryn.nowotny@miami.edu.

Callan Hummel, Email: callan.hummel@ubc.ca.

References

  1. Anthony, S., & Jack, S. (2009). Qualitative case study methodology in nursing research: An integrative review. Journal of Advanced Nursing,65(6), 1171–1181. [DOI] [PubMed] [Google Scholar]
  2. Ashley F. “’Trans’ Is My Gender Modality: A Modest Terminological Proposal,” in Laura Erickson-Schroth, ed, Trans Bodies, Trans Selves, 2nd ed. New York: Oxford University Press, 2022.
  3. Baćak, V., Thurman, K., Eyer, K., Qureshi, R., Bird, J. D. P., Rivera, L. M., & Kim, S. A. (2018). Incarceration as a health determinant for sexual orientation and gender minority persons. American Journal of Public Health,108(8), 994–999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bauer, G. R., Hammond, R., Travers, R., et al. (2009). ‘“I don’t think this is theoretical; this is our lives”’: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care,20, 348–361. [DOI] [PubMed] [Google Scholar]
  5. Bettcher, T. M. (2007). Evil deceivers and make-believers: On transphobic violence and the politics of illusion. Hypatia,22(3), 43–65. [Google Scholar]
  6. Carpenter, L.F., and R.B. Marshall. Walking While Trans: Profiling of Transgender Women by Law Enforcement, and the Problem of Proof Enforcement. William & Mary Journal of Race, Gender, and Social Justice. 2017;24(3).
  7. Currah P. Sex is as sex does: Governing transgender identity. New York University Press, 2022.
  8. Currah, P., & Mulqueen, T. (2011). Securitizing gender: Identity, biometrics, and transgender bodies at the airport. Social Research,78(2), 557–582. [Google Scholar]
  9. Dawson L, Kates J. Overview of President Trump’s Executive Actions Impacting LGBTQ+ Health. Kaiser Family Foundation, April 15, 2025. Accessed: https://www.kff.org/other/fact-sheet/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/
  10. Devonald, M., & Jones, N. (2023). Analysing adolescent education and health trajectories in crisis contexts: Examples from a multi-year longitudinal cross-country study. International Journal of Qualitative Methods. 10.1177/16094069231153611 [Google Scholar]
  11. Ebrahimji A. The nation’s largest LGBTQ advocacy group joins others in warning people about visiting Florida. CNN, Wednesday 24, 2023. Accessed: https://www.cnn.com/2023/05/24/us/florida-travel-advisory-human-rights-campaign/index.html
  12. Federal Reserve Bank of St. Louis. Per Capita Personal Income in Miami-Dade County, FL. 2025. https://fred.stlouisfed.org/series/PCPI12086. Accessed 4 Mar 2024.
  13. Gamarel, K. E., Jadwin-Cakmak, L., King, W. M., Hughes, L., Abad, J., Trammell, R., Maguire, A., Shackelford, V., Connolly, M., Rescoe, T., Williams, A., & Harper, G. W. (2023). Improving access to legal gender affirmation for transgender women involved in the criminal–legal system. Journal of Correctional Health Care,29(1), 12–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Glynn, T. R., Gamarel, K. E., Kahler, C. W., et al. (2016). The role of gender affirmation in psychological well-being among transgender women. Psychology of Sexual Orientation and Gender Diversity,3(3), 336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Goldman M. Trump administration moves to limit trans care in ACA plans. Axios, April 15, 2025. Accessed: https://www.axios.com/2025/04/15/trump-limit-trans-care-aca-plans-cms
  16. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
  17. Harvey, T. D. (2024). “We’re Here, We’re Queer, Get Used to It”: Advancing LGBTQ+-Inclusive Language in Public Health. American Journal of Public Health,114(2), 170–172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Herd P, Moynihan DP. Administrative burden: Policymaking by other means. Russell Sage Foundation, 2019.
  19. Hill BJ, Crosby R, Bouris A, Brown R, Bak T, Rosentel K. etc. Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color. Sexuality Research and Social Policy. 2018;15:25–33. [DOI] [PMC free article] [PubMed]
  20. Horwood C, Luthuli S, Chiliza J, Mapumulo S, Haskins L. It’s not the Destination it’s the Journey: Lessons From a Longitudinal ‘Mixed’ Mixed-Methods Study Among Female informal Workers in South Africa. International Journal of Qualitative Methods. 2021;21:10.1177/16094069221123718
  21. Hummel, C., Truong-Vu, K. P., Nowotny, K. M., Mayfaire, A., Ramos, B., McKenzie, J., Copeland, C., & Glynn, T. R. (2025a). Antitransgender legislation and needs of transgender Floridians, 2018–2024. American Journal of Public Health,115(10), 1642–1651. 10.2105/AJPH.2025.308171 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hummel, C., V.X. Velasco-Guachalla, L.S. Humerez Aquino, and R. Silvey. "Gender-Affirming identification documents are associated with positive health-related outcomes for transgender people in Bolivia." International Journal of Transgender Health (2025): 1–14.
  23. Hyett, N., Kenny, A., & Dickson-Swift, V. (2014). Methodology or method? A critical review of qualitative case study reports. International Journal of Qualitative Studies on Health and Well-Being. 10.3402/qhw.v9.23606 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. James SE, Herman JL, Durso LE, Heng-Lehtinen R. Early Insights: A Report of the 2022 U.S. Transgender Survey. National Center for Transgender Equality, Washington, DC. 2024.
  25. Jenness, V., & Rowland, A. (2024). The structure and operation of the transgender criminal legal system nexus in the United States: Inequalities, administrative violence, and injustice at every turn. Annual Review of Criminology. 10.1146/annurev-criminol-022222-040947 [Google Scholar]
  26. King, W. M., & Gamarel, K. E. (2021). A scoping review examining social and legal gender affirmation and health among transgender populations. Transgender Health, 6(1), 5–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lennon, E., & Mistler, B. J. (2014). Cisgenderism. TSQ : Transgender Studies Quarterly,1(1–2), 63–64. [Google Scholar]
  28. Loza, O., Beltran, O., Perez, A., & Green, J. (2021). Impact of name change and gender marker correction on identity documents to structural factors and harassment among transgender and gender diverse people in Texas. Sexuality, Gender & Policy,4(2), 76–105. [Google Scholar]
  29. Malta, M., LeGrand, S., Turban, J., Poteat, T., & Whetten, K. (2020). Gender-congruent government identification is crucial for gender affirmation. The Lancet Public Health. 10.1016/S2468-2667(20)30054-2 [DOI] [PubMed] [Google Scholar]
  30. Mayfaire, A., Mayfaire, M., & Glynn, T. (2021). The vital role of trans-led CBOs in public health research and efforts: An example from TransSocial, Inc. HPHR,43, Article 10.54111/0001/QQ. [Google Scholar]
  31. Movement Advancement Project. Equity Maps: Bans on Transgender People Using Public Bathrooms and Facilities According to their Gender Identity. 2024. Accessed 8/22/2024: https://www.mapresearch.org/equality-maps/nondiscrimination/bathroom_bans.
  32. Moynihan, D., Herd, P., & Harvey, H. (2015). Administrative burden: Learning, psychological, and compliance costs in citizen-state interactions. Journal of Public Administration Research and Theory,25(1), 43–69. [Google Scholar]
  33. National Low Income Housing Coalition. Report: Gay and Transgender Youth Disproportionately Homeless. 2010. Accessed: https://nlihc.org/resource/report-gay-and-transgender-youth-disproportionately-homeless
  34. O'Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., Cook, D. A. (2014) Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine, 89(9), 1245-1251. 10.1097/ACM.0000000000000388 [DOI] [PubMed]
  35. Puckett, J. A., Price, S., Dunn, T., et al. (2024). Legal gender affirmation, psychological distress, and physical health issues: Indirect effects via enacted stigma. Sexuality Research & Social Policy,21, 1112–1122. 10.1007/s13178-024-00971-y [Google Scholar]
  36. Ray, V., Herd, P., & Moynihan, D. (2023). Racialized burdens: Applying racialized organization theory to the administrative state. Journal of Public Administration Research and Theory,33(1), 139–152. [Google Scholar]
  37. Reardon, A. New NIH grant terminations target transgender studies—even in mice. Science, March 6, 2025. Accessed: https://www.science.org/content/article/new-nih-grant-terminations-target-transgender-studies-even-mice
  38. Restar, A. J., Layland, A. K., Davis, B., Thompson, H., & Streed, C. (2024). The public health crisis state of transgender health care and policy. American Journal of Public Health,114(2), 161–163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Restar, A., Jin, H., Breslow, A., Reisner, S. L., Mimiaga, M., Cahill, S., & Hughto, J. M. (2020). Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM - Population Health,11, Article 100595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Salisbury, E. J., & Crawford, A. (2025). Gender-responsive treatment to improve outcomes for women and girls in correctional settings: Foundations, limitations and innovations. Health Justice,13, 11. 10.1186/s40352-025-00316-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Scheim, A. I., Baker, K. E., Restar, A. J., & Sell, R. L. (2022). Health and health care among transgender adults in the United States. Annual Review of Public Health,43, 503–523. [DOI] [PubMed] [Google Scholar]
  42. Scheim, A. I., Perez-Brumer, A. G., & Bauer, G. R. (2020). Gender-concordant identity documents and mental health among transgender adults in the USA: A cross-sectional study. The Lancet Public Health,5(4), e196–e203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Scheim, A. I., Restar, A. J., Zubizarreta, D., Lucas, R., Wilson Cole, S., Everhart, A., Baker, K. E., & Rodriguez, M. I. (2025). Legal gender recognition and the health of transgender and gender diverse people: A systematic review and meta-analysis. Social Science & Medicine. 10.1016/j.socscimed.2025.118147 [DOI] [PubMed] [Google Scholar]
  44. Sell, R. L., & Krims, E. I. (2021). Structural transphobia, homophobia, and biphobia in public health practice: The example of COVID-19 surveillance. American Journal of Public Health,111(9), 1620–1626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Sevelius, J. M. (2013). Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles,68, 675–689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Shanna KK, Begun S. On the Margins of Marginalized: Transgender Homelessness and Survival Sex. Affilia. 2017;32(1): 10.1177/0886109916651904.
  47. The White House. Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. January 20, 2025. Accessed: https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/
  48. Thomson, R. (2007). The qualitative longitudinal case history: Practical, methodological and ethical reflections. Social Policy and Society,6(4), 571–582. [Google Scholar]
  49. Thoreson T. Trump Administration Moves to Reject Transgender Identity, Rights. Human Rights Campaign, January 23, 2025. Accessed: https://www.hrw.org/news/2025/01/23/trump-administration-moves-reject-transgender-identity-rights
  50. Trans Legislation Tracker. Florida. 2024. Accessed: https://translegislation.com/bills/2024/FL
  51. Wesp LM, Halinka Malcoe L, Elliot A, Poteat T. Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities. Transgender Health. 2019;4(1):10.1089/trgh.2019.0039. [DOI] [PMC free article] [PubMed]
  52. Wolf B. Background on Trump Executive Order Targeting Health Care for Transgender People Under 19. Human Rights Campaign, January 29, 2025. Accessed: https://www.hrc.org/press-releases/background-on-trump-executive-order-targeting-health-care-for-transgender-people-under-19

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of the data and the limitations of the informed consent.

Articles from Health & Justice are provided here courtesy of BMC

RESOURCES