“They Think Transgender is Like Something on the Side:” Perceptions of Transgender Women of Color of Cisgender Members of the LGBTQIA+ “Community”

Abstract

Due to multiple minority statuses, transgender women of color are exposed to minority stress through distal (external) stressors from society causing proximal (internal) stress, leading to potentially negative physical and mental health outcomes. Often considered allies to the transgender community, cisgender members of the LGBTQIA+ “community” have historically presented different plights resulting in divergent rights, protections, and societal views. Guided by the minority stress framework, a secondary analysis of individual interviews and focus groups (n = 20) with transgender women of color was performed. Participants shared experiences of distal and proximal minority stressors when discussing the cisgender LGBTQIA+ “community” and mitigating resilience factors. Four main themes emerged: 1) preference for cisgender presentation; 2) discrimination and exclusion; 3) mistrust; and 4) resilience. This is the first study to demonstrate direct mental and physical health risks for transgender women of color associated with discrimination and exclusion by members of the cisgender LGBTQIA+ “community.” Negative experiences resulted in health care avoidance, verbal assault, social exclusion, mistrust of providers, and barriers to transgender-affirming care. Future research must consider minority stress to advance the understanding of LGBTQIA+ within-group marginalization and foster equitable opportunities for transgender women of color and other gender minorities.

Introduction

Transphobia is described as negative attitudes, hate, fear, and contempt directed specifically toward transgender people (Bettcher, 2014). This is different from homophobia, negative attitudes, and prejudice toward those who are attracted to members of the same sex (D’Urso & Symonds, 2021). Cisgender people in the lesbian, gay, bisexual, queer/questioning, intersex, and asexual (LGBTQIA+) “community” differ from transgender people in that they live and identify according to their biological sex (Lopez & Rael, 2022). Cisgender normative assumptions adopted by cisgender LGBTQIA+ people can reinforce the notion that all people are cisgender which can influence social activities such as child-rearing, policy, and expectations of normative gender behaviors by ultimately dismissing transgender existence (Bauer et al., 2009). As a result, these assumptions further expose transgender people to structural barriers and social inequities (Bauer et al., 2009; Jefferson et al., 2013). The consequences of the societal, structural, and interpersonal burden caused by expectations of cisgender identity imposed upon transgender people create vulnerability to minority stressors (e.g. internal and distal transphobia, social isolation discrimination, marginality) which can negatively impact physical and mental health outcomes (Lefevor et al., 2019; Meyer & Frost, 2013). Transgender women of color, people not belonging to the dominant, non-Hispanic White society (Alexander-Snow, 2004; R. T. Carter, 2007) in the United States (U.S.), experience unique and elevated stigma and discrimination due to intersecting racial/ethnic and transgender identities resulting in healthcare avoidance, unemployment, poverty, and violence due to discriminatory racial/ethnic and cisgender/heteronormative ideologies (James et al., 2016; Lefevor et al., 2019). The purpose of this study was to examine the perceptions that transgender women of color have regarding LGBTQIA+ “community” members they perceived as cisgender as well as their own previous experiences as cisgender through the lens of the minority stress framework (Meyer, 1995) based on their interactions and experiences with these umbrella “community” members.

There are historical accounts of cisgender members of the LGBTQIA+ “community” creating hostile social environments for transgender women. Shortly after the Stonewall Riots in 1969, transgender people began to be excluded from gay rights activist agendas, despite two transgender women of color leading the earliest days of the Pride movement. During the 1970s feminist movements, transgender women were rejected and attacked by feminist and lesbian groups, excluded from protests and conferences, and characterized as male infiltrators, imposters, and pariahs (Beemyn, 2014); the focus had become the White, upper-middle-class, gay and lesbian cisgender agenda. In the 1980s, gay rights bills sponsored by LGBTQIA+ organizations excluded protections for transgender people (Beemyn, 2014). In San Francisco, separate Pride celebrations were held banning cross-dressing and transgender people from attending (Shepard, 2013). Despite recent media exposure and activism, transgender people continue to report experiencing discrimination, marginalization, and a lack of understanding of their particular needs within lesbian, gay, and bisexual communities (Moolchaem et al., 2015). Within the transgender community, transgender women of color are especially vulnerable to marginalization and violence as a consequence of structural stigma and discrimination (Clark et al., 2018; Sullivan et al., 2015).

Stark differences between transgender people and cisgender members of the LGBTQIA+ “community” in the U.S. are evident in laws, policies, and conventions. Changing federal laws and state-specific protections and restrictions have been indicative of increased stress and burden among transgender people (Hughto et al., 2021). Where legal protections exist based on sexual orientation, the same is not true for gender identity. Thus, many forms of discrimination against transgender people are permissible, such as legal, employment, and education discrimination, discrimination when seeking housing, inequitable access to healthcare coverage, inadequate protection from hate crimes, and a lack of freedom to change gender identity markers (Ferlatte et al., 2020; James et al., 2016). Moreover, limited access to bathrooms because of their transgender identity has reportedly led transgender people to quit their jobs, skip meals, transfer schools, fear violence, and have mental health problems (McGuire et al., 2021). While the 2011 repeal of “Don’t Ask, Don’t Tell” has remained consistent, in recent years identifying as transgender has been regarded as a serious medical condition capable of impacting “unit readiness and combat effectiveness” (Dietert & Dentice, 2022; U.S. Department of Defense, 2019).

Inequities between cisgender and transgender LGBTQIA+ people are also present in psychotherapeutic spaces. Cisgender gay activist protests and panels in the scientific “community” led to a decision in 1973 by the American Psychiatric Association (APA) to remove homosexuality as a psychopathological condition from the second edition of its Diagnostic and Statistical Manual (DSM; Drescher, 2015). Nevertheless, the DSM-III in 1980, maintained gender identity disorder as a psychopathological condition associated with the disparity between anatomical sex and gender identity (American Psychiatric Association [APA], 1980; Drescher, 2015; Koh, 2012). Modifications in subsequent editions of the DSM have led to the replacement of gender identity disorder with gender dysphoria referencing the distress felt due to the incongruence between a person’s expressed gender and one’s biological sex (APA, 2013).

Although identifying as transgender is no longer categorized as a mental disorder, a diagnosis of gender dysphoria is needed to qualify for health-related gender-affirming treatment (APA, 2013; Murariu et al., 2015). This policy situates medical, psychiatric, and mental health professionals in the position of gatekeepers to important healthcare resources (Puckett et al., 2018; Tabaac et al., 2020). Yet, a diagnosis of gender dysphoria may not be appropriate or warranted for some people, however, without this diagnosis, they cannot receive licit and safe gender-affirming medical treatment (Ashley, 2021; Cooper et al., 2020). Lack of access to sanctioned medical treatment has resulted in transgender people seeking illegal medical practices such as injecting liquid silicone into tissues (pumping) under unregulated and potentially unsafe conditions by non-licensed professionals (Clark et al., 2018; Murariu et al., 2015).

Inequities, discrimination, and marginalization of transgender people are further exacerbated and compounded for transgender people of color when considering historical and ongoing treatment of people of color in the U.S. Systemic racism (generational racial differential treatment and discrimination engrained in society through institutional, socially-based, and individual mental structures) sustains disadvantages for people of color in the U.S. which favor those belonging to dominant White societal populations (Banaji et al., 2021). Among the primary drivers of disadvantages impacting people of color is the distribution of wealth and financial opportunity (Beech et al., 2021). These financial disadvantages are attributed to U.S. poverty rates among American Indians and Alaska Natives at 25%, 17.1% among Black/African Americans, and 16.9% among Latine people of color compared to 8.6% non-Hispanic White populations (U.S. Census Bureau, 2023). The consequential impact of poverty and racism experienced by people of color exposes them to historically documented detrimental outcomes including housing discrimination, mental health symptoms, inequities in educational attainment, anti-immigrant sentiments, and community violence (Santiago-Rivera et al., 2016). Further, perpetual racism and socioeconomic inequities foster individual and collective experiences of distrust in governmental, medical, and public health institutions.

Transgender women of color

Transgender women of color have been disproportionately impacted by negative social and health outcomes when compared to other transgender populations (James et al., 2016). Intersecting identities such as race, socioeconomic status, and gender shared by a group of people creates the potential for convergent structural and social oppression (Crenshaw, 1989; Wesp et al., 2019). The minority stress framework helps explain the differential impact of multiple minority identities on transgender women of color (Jefferson et al., 2013; Millar & Brooks, 2022). Transgender women of color experience more verbal harassment, physical attacks, and sexual assault when compared to other LGBTQIA+ people (James et al., 2016). Transgender women of color also report more discrimination when seeking housing (Cyrus et al., 2021), employment in public accommodations, healthcare, and education (James et al., 2016; Jefferson et al., 2013) compared to other members of the LGBTQIA+ “community.” Consequently, more than 35% of transgender women of color report being homeless, which is triple the national poverty rate (James et al., 2016; U.S. Census Bureau, 2023). It should not be surprising then that they are twice as likely to report engaging in underground economic activity, such as survival sex work and illicit drug sales, within their lifetime compared to other transgender people (Fitzgerald et al., 2015; James et al., 2016).

In addition to social injustices, transgender women of color are particularly beset with health disparities unmatched by other sexual or gender minorities (Center for Disease Control and Prevention [CDC], 2021; James et al., 2016). For example, transgender women of color account for 88% of all transgender women living with HIV (CDC, 2023), yet they are reluctant to pursue healthcare due to the risk of medical professionals misgendering, discriminating, and having an overall lack of knowledge about transgender health (James et al., 2016; Maiorana et al., 2021). Due to structural and socioeconomic barriers and gatekeeping practices, transgender women of color report high incidences of mental health problems such as suicidal ideation (Dickey & Budge, 2020), depressive symptomology (Jefferson et al., 2013), and substance use (Hotton et al., 2013), all of which further expose them to HIV risk behaviors (Sullivan et al., 2015). The social consequences associated with identifying as a transgender woman of color increase vulnerability to negative physical and mental health outcomes.

Conceptual framework

Minority stress can be described as the excess stress resulting from the conflict between minority and dominant values within a societal environment leading to negative physical and mental health outcomes among people belonging to one or more minority groups (Meyer, 1995, 2003; Meyer & Frost, 2013; Tan et al., 2020). Distal stressors (e.g., social exclusion, discrimination, racism, homophobia, and transphobia) from members of the dominant society can exacerbate proximal stressors (e.g., social isolation, expectations of rejection, internalized homophobia and transphobia, perceived stigma, and maladaptive emotion regulation, which can contribute to poor physical and mental health outcomes (Meyer, 1995, 2003). Minority stress is unique in that it is additive to general stress, chronic due to the tendency of social and cultural structures to be stable, and socially constructed through institutions (Crenshaw, 1989), social structures, and processes (Crenshaw, 1989; Meyer, 2003).

In recent years the minority stress framework has been adapted to explain social and institutional stigma relevant to transgender people (Frost & Meyer, 2023). Frameworks gauging minority stress among transgender individuals do, however, encounter deficits when evaluating minority stress in the context of intersecting racial/ethnic and cultural minority identities (Tan et al., 2020). Transgender women of color encounter increased exposure to minority stress and discrimination due to intersecting minority identities that may include having a lower socioeconomic status, living the transfeminine experience, belonging to racial/ethnic minorities, having an HIV serostatus (having or not having detectable HIV antibodies, White, 2013), and being an immigrant (Cerezo, 2016; Crenshaw, 1989; Jefferson et al., 2013). While associations have been drawn demonstrating increased psychological distress (Jefferson et al., 2013) and sexual risk (Lett et al., 2022) due to combined racial and transgender-based minority stress when compared separately, much is still unknown regarding how minority stress impacts mental and physical health risks of transgender women of color who hold intersecting minoritized identities (Alizaga et al., 2022; Meza Lazaro & Bacio, 2021).

Resilience at an individual and group level are key features of the minority stress model that can mitigate the negative impact of minority stress (Breslow et al., 2015). Cultivating self-acceptance, gender and/or racial identity pride, personality mastery, self-esteem, and stress management (e.g., emotion-oriented coping) on an individual level can dampen the impact of minority stress (Breslow et al., 2015). On a group level, validation and connection with similar peers can foster a strong within-group identity and serve to protect against future stressors for transgender people (Lefevor et al., 2019). Collective action by members of minority groups (in this case., transgender people) acting as representatives to promote social conditions and improve relationships between majority and minority groups can also serve as a deterrent to minority stress (Glasford & Johnston, 2018; Lefevor et al., 2019).

Social support, providing assistance or support to assist in coping with biological, physical, and social stress responses, can serve as a safeguard against minority stress (McLemore, 2018; Ozbay et al., 2007). Through these supportive relationships, transgender people can have access to consistent emotional, informational, and relational resources to aid in coping with minority stress resulting from discrimination based on one’s transgender identity (McLemore, 2018; Meyer & Frost, 2013). Furthermore, social support has been directly associated with better mental health and decreased suicide risk similarly across transgender subpopulations including transgender women (Tebbe & Moradi, 2016). Organizations and programs such as gay-straight alliances are recommended resources to validate transgender identity and protect against minority stressors among transgender youth and adolescents (Chodzen et al., 2019; Delozier et al., 2020). These findings, however, do not provide context relevant to minority stress youth and adolescents of color nor do they expand on transgender adults or transgender women of color concerning intersecting identities.

Current study

This study explored the experiences and perceptions of transgender women of color in South Florida regarding members of cisgender LGBTQIA+ “community” perceived to be cisgender through the minority stress lens. This study also provides participant experiences as cisgender males compared to their experiences as transgender women leading to perceptions of the cisgender LGBTQIA+ experience. Whether or not transgender women of color view cisgender members of the LGBTQIA+ “community” as allies or contributors to minority stress is not well known. Through qualitative interviews with transgender women of color, the topics of social interactions, healthcare experiences, experiences of discrimination and violence, social cohesion, and support networks were explored. Structural differences between cisgender LGBTQIA+ and transgender women of color in areas such as health equity, employment, and social interactions were also explored.

Statement of significance

Transgender women of color are among the most vulnerable of the lesbian, gay, bisexual, transgender, queer/questioning, and asexual (LGBTQIA+) umbrella community. Due to stigma and discrimination based on multiple marginalized statuses, this hidden and under researched population are beset with a multitude of negative social and health outcomes. This study is among the first of its kind to evaluate whether transgender people, specifically transgender women of color, experience stigma and discrimination from cisgender members of the LGBTQIA+ community utilizing the minority stress framework to understand distal and proximal stressors experienced by these women.

Methods

Procedures and participants

The present study utilized data from a community-engaged research project, To Reach Unrestricted Services for Transgender Women (TRUST) study (PI: Cyrus, 5R00DA046311-04 (Gandy et al., 2021; Morse et al., 2023; Ricks et al., 2022). This study was carried out in collaboration between the research team and a community advisory board (CAB), wherein the CAB was comprised of diverse members belonging to a transgender-founded organization and LGBTQIA±centered organizations (Survivors Pathway and Arianna’s Center) with transgender-specific divisions in South Florida. The goal of the original study was to develop an evidence-based intervention specifically for transgender women. Convenience and snowball sampling procedures were implemented by CAB members and the research team and participants were recruited through social networks, referrals, and a pool of participants from a previous study (Maragh-Bass et al., 2024) who had given documented consent to be contacted for future studies (Maragh-Bass et al., 2024).

South Florida is comprised of a highly concentrated population of people of color, with approximately two-thirds (66.4%) residing in Broward County and 86.4% residing in Miami-Dade County (U.S. Census Bureau, 2021). Additionally, Latine communities in South Florida populate over two-thirds of South Florida communities, of which many are immigrants from Latin American countries. Given that Miami-Dade County is among the highest metropolitan areas in the U.S. newly diagnosed HIV (Rojas et al., 2021), the disproportionate rates of HIV transmission among transgender women of color (CDC, 2021), and difficulties in HIV risk in transgender women of color in South Florida (Holder et al., 2019) qualitative data gathering for methods for HIV behavioral intervention research was warranted. Further, given the syndemic conditions of HIV risk (two or more psychosocial or biological conditions functioning synergistically to exacerbate negative outcomes for either or all conditions related to HIV risk, Pouget, 2017) exploration of data from the primary analysis beyond the scope of HIV behavioral intervention was warranted. These syndemics conditions include, but are not limited to, factors such as mental health (Parsons et al., 2018; Valente et al., 2021), exposure to violence (Bukowski et al., 2019), sexual risk (Arayasirikul et al., 2017), and substance use (Reback et al., 2021).

The interview protocol was adapted from a previous study exploring barriers and facilitators to PrEP use which included Latine, African American, and Haitian cisgender women cisgender women in Miami-Dade County (PI: Dévieux, 5U34AA026219). Data were collected across three focus groups (FG1 included five participants, FG2 included four participants, FG3 included five participants) and eight individual interviews for a total of 20 participants. During the 90-minute focus groups or individual interviews, participants were asked to share their social histories, medical and mental health histories, social relationships, potential substance use, sexual partners, and experiences of violence, trauma, and discrimination. Focus groups and individual interviews were conducted from September to November 2019 based on participant preference. Participants were provided $50 as a cash incentive for their participation. The TRUST Study required and received approval from the Florida International University Institutional Review Board [IRB-18-0046) and informed consent from participants. All focus groups and individual interviews were recorded and transcribed by members of the TRUST research team or through a professional transcription service. To protect participant identities, individual interviewees chose pseudonyms, and participants in focus groups were assigned numbers. Data were managed and stored in encrypted files and folders in SharePoint Online, a platform protected by university online security measures. Participants often mixed the use of English and Spanish. Inclusion criteria incorporated being 18 or older, identifying as a race/ethnicity other than non-Hispanic White, English or Spanish-speaking, a resident of South Florida, and identifying as living the transgender feminine experience, born male at birth, (n = 20, Table 1).

Table 1.

Sociodemographic characteristics for transgender women of color in South Florida.

	Frequency (n = 20)	Percent
Country of Origin
United States	8	40.0
Latin America	12	60.0
Race
Black/African American	2	10.0
White	10	50.0
More than one race	6	30.0
Other	2	10.0
Hispanic/Latina
Yes	16	80.0
No	4	20.0
Employment status
Employed for wages	8	40.0
Self-employed	3	15.0
Unemployed	4	20.0
Retired	4	20
Disabled	1	5
Education
High school or GED	6	30.0
College or university	13	65.0
Other	1	5.0
County
Miami-Dade	13	30%
Broward	6	60%
Other	1	5%
	Mean	SD
Age	44.85	13.57
Monthly Income	1285.60	1289.759

Primary data analytic approach

The purpose of the primary analysis was to develop an intervention that aimed to both increase HIV prevention methods such as Pre-exposure prophylaxis (PrEP) and decrease substance misuse through enhanced access to services and care. Thus, individual interviews capable of extracting a wider scope of discussion topics as well as focus groups effective in eliciting sensitive and personal information were selected for the primary analysis (Guest et al., 2017). Additionally, combining both types of interviews allowed for enhanced description of complex and unique issues impacting access to care for these women through comparison of interview types in addition to increasing trustworthiness through convergence of data (N. Carter et al., 2014; Lambert & Loiselle, 2008). Transgender women living with and without HIV were invited to participate in the interviews and focus groups to gauge experiences and perspectives regarding accessing care and services.

Individual interviews consisted of protocols gauging full life histories beginning with adverse childhood experiences up to current adult experiences as a transgender woman. These experiences also included mental health histories, social support networks, health risks, and access to HIV-preventative or HIV care services. Focus groups concentrated on the lived experiences of the participants as adult transgender women living in South Florida and their experiences accessing HIV preventative and HIV care services. The structural composition for the three focus groups loosely incorporated the following: (1) an introduction of each participant followed by their experiences living in South Florida as transgender women, (2) experiences of trauma and discrimination, (3) discussions concerning mental health and substance use (4) experiences with HIV preventative and HIV care (5) social support networks, (6) suggestions for intervention participant recruitment, and (7) linkage to HIV care and PrEP services.

A previously developed codebook was utilized for the present study created by a coding team that included the first author for the primary analysis. First, the coding team analyzed the transcripts using an open coding approach, utilizing thematic analysis (Braun & Clarke, 2006). Sections of two transcripts were thoroughly open-coded by the members of the coding team using open coding to explore concepts consistent with identified themes (Cascio et al., 2019). After generating codes, potential themes were recognized that informed subsequent codebook development and data coding. These coded transcripts were then used to develop a codebook which also incorporated theoretical codes developed from literature relevant to transgender women’s health and HIV risk as well as preliminary work by the investigators. The two transcripts and the codebook were used to guide the coding team in the completion of the transcripts.

The majority of these codes described transgender women’s lived experiences, with a focus on determining barriers and facilitators of accessing HIV preventive care. Codes were grouped into categories with a description of the code’s intended meaning. For example, within the “Gender-Affirming” category were 9 codes including a code for “role models” with an example stating “Expression or narrative regarding specific empowering role models for trans women and the trans community.” Within the “Discrimination” grouped category was a code for “LGBTQ community” which was described as a “Reported set of beliefs, moral values, traditions, language, and laws (or rules of behavior) commonly held by the LGBTQ community.” Transcripts were divided to between coding members, coded, and then discussed to resolve any questions or discrepancies in coding. While meetings discussing emerging themes, codes, and analysis-specific items occurred weekly to establish investigator triangulation (Korstjens & Moser, 2018), interrater reliability was not applied to the analysis.

Data analytic approach for the present study

The codebook developed for the primary analysis was used to inform the analysis for the present study. During the primary analysis, the first author recognized several references related to interactions between the participants and perceived members of the LGBTQIA+ “community.” Thematic analysis was then incorporated utilizing Braun and Clarke’s (2006) 6-phase structure to examine data from the original transcripts containing references to interactions with gay and lesbian members of the LGBTQIA+ “community.” The analysis included the following: (1) familiarization with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining naming themes, and (6) producing a report. The coding team, led by the first author, reviewed the previously developed codebook (Maragh-Bass et al., 2024) and familiarized themselves with the data by reading the transcripts and listening to recordings of the focus groups and interviews. The previously developed codes provided in the codebook for primary analysis such as “resilience” within a grouped category for “Mental Health” and “Testing” for the grouped category for “HIV” were applied to the transcripts. All members of the coding team were bilingual, and transcripts were left in their original languages, often a combination of English and Spanish. For presentation in this article, Spanish quotations have been translated into English. For rigor, one member of the research team translated Spanish quotations to English, and a second member of the team cross-checked the translation for accuracy. Given the diversity of countries across the Latine sample, bilingual research team members met consistently to develop consensus regarding similarities and differences in vernacular and colloquialisms. To note where quotations have been translated, passages originally in Spanish have been placed in italic text.

In addition to the use of applicable codes provided in the previously developed codebook, the coding team performed open coding on passages of text referencing interactions that transgender women of color had with members of the LGBTQIA+ “community” and health and medical personnel. Checks using the constant comparison method (Dye et al., 2000) and negative case analysis (Patton, 1999) were used during this phase to maintain the accuracy of emerging codes. To search for potential themes, codes were then grouped under higher-order concepts (Braun & Clarke, 2006). While reviewing potential themes to be included in the analysis, higher-order concepts were further developed. Throughout this phase of the analysis, emergent concepts and themes were checked against coded passages of text to ensure their faithfulness to the participants’ perspectives. Themes were then defined and named to produce a report on the analysis. While the use of an intercoder agreement equation was not utilized for the present study, data triangulation procedures were incorporated via bi-weekly meetings to discuss emerging codes, themes, and analysis procedures relevant to the present study (Korstjens & Moser, 2018; Lincoln & Guba, 1986).

Results

Table 1 displays the participant characteristics for the secondary analysis (n = 20). Sixty percent of the participants reported being born in Latin American countries (Cuba, Nicaragua, Honduras, Uruguay, El Salvador, and Peru). Participants’ ages ranged from 20 to 65 years old. Among the predominately Hispanic/Latina identifying participants were 4 non-Hispanic/Latina identifying participants. The participants’ monthly income ranged acutely (0 dollars to $5,416), with the average income at approximately $1,300. Additionally, many of the participants (55%) reported a monthly income of less than $1,000, and only 8 (40%) reported being employed for wages.

During the focus groups and individual interviews, participants described interactions with and perceptions of cisgender members of the LGBTQIA+ “community.” Data for the present study were extracted based on the interview protocol questions that elicited participant reports of life experiences leading to their current experiences as transgender women, discrimination, healthcare access, transgender-affirming services, support networks, and HIV preventative and HIV care access. Most participants reported proximal (e.g., expectations of rejection, concealment of transgender identity) and distal (e.g., social exclusion, verbal assault) stressors associated with minority stress when discussing these interactions. Additionally, participants shared stories of resilience and support strategies that mitigated the deleterious effects of minority stress due to their multiple minoritized identities. Qualitative analysis of participants’ experiences and attitudes regarding cisgender members of the LGBTQIA+ “community” produced four major themes related to minority stress:

1. preference for cisgender presentation;

2. discrimination and exclusion;

3. mistrust;

4. resilience, advocacy, and opportunity

Preference for cisgender presentation

Participants described the same distal stressors as being less intense when they presented as cisgender homosexual men before they presented as transgender women. These experiences led to internalized feelings of societal preferences for cisgender homosexual identity over transgender identity and reports of elevated negative societal and health implications. When asked about her experiences as a transgender woman in South Florida, one participant described this lived experience of differential treatment once she came out as transgender.

When I was working as a gay person there was discrimination, but it was like more tolerated and then I remember one company that I was with for like almost 10 years, in that transition time or that time, um, I started to come out more physically as feminine, as a woman and that’s when I really saw how hard life got for me, and discrimination on so many different levels with housing, health care, and just, you know employment because when I lost my job at this place that I’ve been there for 10 years it was like hell to try to get work and here it is I was this person with all this.

A similar conversation arose regarding distal minority stress by employers through workplace hostility once beginning her transition leading to perceptions of preferential treatment of gay, male, and cisgender people when compared to those who identify as transgender.

It’s better for gays, from before. Before I worked in a sales store for ladies’ clothes. My boss. It … [was] ok when I looked like a man. When I started the transition, my looks changed. My hair, my skin, my body. And my boss was like, “Oh you look like, I don’t like it. You look like different.” And he talked to me angry sometimes.

Another participant described perceived concerns of social rejection and economic loss in her work environment due to intersecting racial/ethnic and gender minority statuses if her transgender identity was exposed.

In certain areas, I dress like a female, and in certain areas, I dress like a boy, I guess. Very, very black clothes and very baggy clothes, and eh, I do all this not because I am ashamed of myself, it’s just because I have to survive. That’s what I have to do, you know? Because, where I work, all they are Republicans, all White, and all are very close-minded. They don’t understand us, so, I don’t want to lose my job, because I’ll lose my food, my rent, and everything … They’re accepting of a gay boy but not …

When asked whether their experience being transgender was negative or positive, one participant had neutral feelings due to the increased discrimination and abuse endured throughout her transition journey.

Before transitioning I was bullied a lot for mostly my gender expression because I first came out as nonbinary. And I would be called gay. I would be walking home with bruises on me because I was beaten. Then once I started transitioning in high school it got somewhat worse because it just escalated [to] more beatings for me, more trash-talking to me. And out of … Over the times of me [sic] transitioning, I started feeling a bit happier because it started dying down but there would be cases where my life would be threatened because of the fact that someone might think I was transgender and that’s why I just usually why I say mine is more of a neutral feeling.

Discrimination and social exclusion

Gauging some of the participants’ perceptions of their place in the LGBTQIA+ “community” was complex. When discussing their identities in the broad LGBTQIA+ “community,” some participants considered themselves as either members or nonmembers. However, several participants (n = 7) considered themselves as members while also describing negative experiences with cisgender members that led them to feel or believe otherwise. During a conversation about her experience living as a transgender woman in Florida, a participant explained her views of how transgender people fit into the larger LGBTQIA+ “community” versus how she perceived they were treated by cisgender members.

It’s very difficult for transgender people, because the gay population, they think transgender is like something on the side or they don’t want to be friends with you. And they discriminate you, including all the gay people. We are in the same boat, but transgenders have to go under. So that’s the experience.

While considering gay cisgender males as members of a broader “community,” when asked about her name change, a participant described being ostracized by a gay cisgender friend once deciding to transition.

It shocked me. A gay person, who belongs to the LGBT “community,” who considers himself gay. He liked the shows of transvestites. From drag queens to transsexuals. When I decided on my transition, he gave me the cold shoulder, and he walked away from me.¹

One participant described discrimination within the LGBTQIA+ “community” by cisgender members despite feelings of within-group membership.

The gay population, our own people, start to discriminate against us because we are not gay. They think we are on the other side, and I still, you know? I try to participate in any research, in any forum, in anything partly because I’m here and here to stay.

Another participant described being publicly ridiculed by cisgender gay males within a neighborhood predominately inhabited by the LGBTQIA+ “community.”

It’s a safe zone. But just walking down the street there was four gay guys. I mean they weren’t dressed up feminine, but one of them had big hoops in their ear, the other one had green hair. I’m walking down the street and then they say, “What the hell is that?” you know, and it’s like, you’re judging me but you’re gay, you’re in the same realm that I am, just that I’m transgender, I mean we’re both like the same sex, so it’s no different.

During a focus group participants were asked if they experienced lost opportunities since living as transgender women. One discussed being fired at the television program by a gay cisgender male after being outed by him.

I was on a big [television] program in Latin America. I wasn’t famous. I was dancing, only dancing. But my history had an impact on the population, and I transformed into a popular person, and, I am famous in the program. The step was when the opportunities opened up, but only in the commercials for entertainment … When I came to work on television, I worked for Telemundo. But one director, a homosexual director, gay, he said no more. Only one season.

Another participant provided a peer’s experience of being outed by gay cisgender men as her rationale for isolating herself from the LGBTQIA+ “community” once she engaged in the transition process.

You changed your sex, now you must change your environment. Yes, you can be with the gays, but I think you need to be in an environment with women. Girls who run around with gays … [transgender women] “A faggot without a penis” … When [name omitted] had the surgery, she became a valuable force. Sabado Gigante hired her, and she was a model for Sabado Gigante. They thought that she was a woman, but she got canned. They [gay men] told Sabado Gigante, Don Francisco, that she was an operated man, and they took her out of her modeling.

Mistrust

LGBTQIA+ “inclusive” organizations

Participants were asked to share their experiences with providers, including services specific to the LGBTQIA+ “community.” Several participants described negative attitudes toward organizations and programs within the “community.” They felt that despite claiming to be LGBTQIA+ inclusive, these organizations and/or providers created barriers to seeking assistance.

I know a lot of girls are very uncomfortable with the LGBT organizations that provide a lot of this … I would say most girls don’t feel safe that I’ve come across in those types of environments because they are spaces which misrepresent an appropriate us more than anyone. And a lot of girls don’t feel welcome, or safe, in a lot of these environments or these spaces which are supposed to be safe for us.

Another participant reported several instances in which umbrella LGBTQIA+ programs lacked adequate knowledge and inclusive practices necessary to meet her trans-specific needs.

People are not being educated properly…and when they’re not being educated properly, they hurt a lot of people’s feelings, when people’s feelings get hurt, you know, we get discouraged to go back to get help or to get reach out for help because we see it’s like a revolving door. Like, everywhere we go, some new program, but still doing the same activity as the next person is doing. We’re not moving on, we’re not giving empowerment to other transgender leaders.

Conversely, another participant reported notable differences between mainstream LGBTQIA+ organizations and a transgender-founded organization.

With Arianna’s center [transgender organization], whatever organization with trans, they help transgender people. With the others, you need to explain all the time. Those in the life (trans) don’t have a hard time explaining too much. That’s what I think.

Cisgender LGBTQIA+ providers

In addition to negative experiences within LGBTQIA+ programs and organizations, many participants expressed mistrust and hesitancy toward cisgender gay and lesbian health service providers. These experiences were illustrated through reports of discrimination, unprofessionalism, lack of knowledge, gatekeeping, and mistrust. One participant described her perceptions of how she believed cisgender LGBTQIA+ mental health professionals regarded transgender identity.

You have a lot of gays and lesbians talking about, and cisgender people talking about the best ways to deal with a child or an adolescent with gender dysphoria. They have no comprehension. They have no experience. They think they do. And I’ve had gay therapists, for instance, who I’ve tried to get on hormones from. A gay therapist. So many of them think, they confuse gender roles with gender. You know what I mean? They think that because they like to do drag or because a lesbian is a bit tom-boyish that gender is performative according to some third-wave feminist ideas on the subject. There’s no voice. We’re completely invisible.

Lack of trust and dissatisfaction with perceived cisgender LGBTQIA+ providers extended around HIV testing. During a focus group, a participant described cisgender gay male testers displaying unprofessional workplace behaviors concerning interactions with the partners of transgender women of color.

I hear a lot of transgenders’ stories. They’re feeling uncomfortable when they’re getting HIV testing from gay guys … When they go get tested with their partners, they [cisgender partners] feel intimidated when they go to a gay tester, because they say the gay testers say “ah you like men.” They’re trying to get; they go over to the partner of the transgender woman. Because, actually, transgender women get really cute guys.

Additionally, a participant reported avoiding HIV screening from perceived cisgender gay male healthcare workers due to witnessing microaggressions toward transgender women. This example highlights the critical health risk that transgender women of color face even when seeking services from a provider within the LGBTQIA+ “community.”

I would go to places to get HIV tested. But if I didn’t see that there was another transgender person that would do it, I would deny it. I always thought, because there is this thing, I always saw that when gay men would do testing on transgender individuals, they would put their business out there. They’ll put her business out there. They would do very ridiculous comments about the transgender individual. The way how she’s dressed, and why she came here, in there to get tested.

Resilience, advocacy, and opportunity

Individual resilience

All participants described resilience and support processes in their lives that have mitigated the negative impact of minority stressors. Positive coping mechanisms came from their lived experiences and in response to negativity surrounding their transition. One participant shared her resilience as an inspiration to support other marginalized transgender people.

I felt happy to finally be who I am, so I decided to tell everyone who I was and not care about what other people would think of me, no matter how bad the backlash was, and I even became like an activist in the school because there was so many discriminations in the school that I could not even handle, especially with some of my teachers who were completely disrespectful. And when I checked the laws of [the] Miami-Dade public schools, they were completely violating them. So, I fought for them to listen and understand, and I became what a lot of my trans friends call me their mother and basically, I decided to stay as coming out as trans because I want to be a role model to some people who are wanting to transition and they’re not able to transition because of what their families think of them.

Similarly, another participant described experiences of abuse and discrimination as the catalysts of resilience and her reason to involve herself in activism.

Yes, I may, I feel like I’ve gotten to the other side, and my activism started because as of me being brutally beaten up, little all over twenty years ago by some guys who targeted me because I’m trans, and they beat me bad, and I laid in my bed, and I was crying and pleading with God and I’m like, “Why am I this way?” like blaming myself, and, I had a moment where I thought my God, if I had died that night, I said, if I had died tonight, would I have died knowing that I tried to do something for me and my people, and that’s when I really started going full force with my activism because I said, you know, you could sit down all day and complain about stuff, or you can get up and try and do something about it.

Within-group resilience

When describing social support, over half of participants (n = 12) shared the positive impact of transgender-centered agencies. Support and organizational engagement were associated with fostering leadership practices, resilience, and activism as well as providing an outlet for the women to share their experiences. One participant described her involvement in transgender support groups and organizational activities as opportunities to share her experiences and occupy her time.

I come here to the group. I go to the club, and when any event comes, I go. I go sometimes with [name omitted]’s organization to places. And with this group Survivors too. I go to some places that we have to go to. We always have activities to go to. Places to go to. To give an experience.

The support, engagement, and social cohesion from a transgender-centered organization were also described by a participant as an opportunity to share her experiences and help others.

And I always thank Survivors [transgender affirming organization] for taking me into consideration, for always taking me into account. That I always tell them that if there is a study or something that is extremely important for me to see the benefit and to see the benefit of others, then I will always be available and that they can call me.

Visibility

Transgender visibility was a widely reported subtheme, as all but one participant (n = 19) emphasized the importance of visibility and social cohesion for the acceptance of transgender women and the transgender community. For example, one participant discussed collective action as an outlet to positively expose society to transgender women and promote tolerance.

There’s strength in groups and even though it might be 100, the next year is 1000. The year after that is 10,000 and it’s going to grow and it’s going to spread. So, it’s really sad that people have to die along the way to create a presence and to create a message. But the great thing is that we’re not going anywhere. We’re going to be and we’re going to exist. And whether you like it or not, you’re going to have to learn to like it because we’re humans and we deserve the same rights as everybody else.

Another participant talked about the obscurity of transgender people and the lack of opportunities in healthcare. Specifically, when asked to speak about experiences with PrEP and HIV prevention practices and education, this participant described the exclusion of people who identify as transgender.

If we try to educate ourselves and try to go as much places as possible, that makes us look visible because we are invisible. And 90%–I’d say 95% we (transgender women) are very educated, we know about PrEP, how to do–we know about medicine for HIV, we are very educated. But they don’t give you the opportunity for us to show what we can do…

Another participant described the need for visibility and opportunity within the workforce to promote better social conditions for transgender women.

Because right now, the trans community is a new minority that’s been neglected somehow. They know they’re there but we try to not mention that they’re there. So we need to empower them in a way that they need to have access–fair access to work. I’m not saying that they should give priority over other people, but just for access, if the person needs to have skills, have ways to train them, enabling them so they could be able to reach.

Discussion

In this study, we explored transgender women of color’s perceptions of cisgender members of the LGBTQIA+ “community” through a minority stress lens. These reports were derived from personal interactions with people perceived as cisgender members of the LGBTQIA+ community as well as their experiences as cisgender gay males and their transgender women identities at the time of data gathering. To our knowledge, this is the first study of its kind to explore minority stressors caused by cisgender members of the LGBTQIA+ “community” experienced by transgender people. Participants shared personal life experiences, both positive and negative. The utilization of thematic analysis highlighted four main themes: preference for cisgender presentation; discrimination and exclusion including multiple episodes of violence; mistrust; and resilience, advocacy, and opportunity.

The first theme to emerge from the data, preference for cisgender presentation, was evidenced by participants expressing that cisgender members of the LGBTQIA+ “community” endured less stigma and discrimination due to their cisgender membership status within society. They used their own experiences from when they presented as cisgender gay men to describe the discrepancy in levels of discrimination they faced compared to when they presented as transgender women. Prior research supports these experiences expressed by the participants. A qualitative study exploring the attitudes of twenty Christian women toward LGBT populations demonstrated a tolerance for cisgender gay and lesbian people while those same women held a disdain for bisexual and transgender people (Mathers et al., 2018). Similarly, in another study, attitudes held by a primarily cisgender sample of people (72.7%) toward transgender people highlighted an implicit and explicit preference for gay identity over transgender identity (Axt et al., 2021). Participant views of societal preferences for cisgender presentation based on lived experiences resulted in reports of non-disclosure of transgender identity, workplace discrimination, and barriers to accessing public accommodations.

Illustrating the second theme, discrimination and exclusion, participants divulged experiences of social exclusion and discrimination by cisgender members of the LGBTQIA+ “community” via direct and indirect violence, aggression, and microaggressions. In support of this finding, Wang-Jones et al. (2018) observed that while cisgender gay people held positive explicit attitudes toward transgender women, they also exhibited a negative implicit bias toward them. Indeed, participants reported being rejected by friends upon coming out as transgender, being verbally assaulted in “gay-friendly” neighborhoods and being labeled as someone “other than.” Upon being outed by a gay cisgender male, one participant reported being removed from a Spanish international television program. Participant experiences further reinforce research demonstrating mainstream media agendas, including cisgender gay and lesbian, that promote gender conformity and disengagement with transgender activism (Rodriguez, 2019). Little is known, however, regarding direct and explicit acts of discrimination by cisgender LTBGQIA+ people toward transgender women of color and other gender minorities. Findings in the current study provide preliminary context and examples of discriminatory and exclusionary actions transgender people face at the hands of cisgender members of the LGBTQIA+ “community.” These negative experiences combined with minority status within queer communities lead to expectations of rejection, verbal assault, public ridicule, loss of employment, and social ostracism for these transgender women of color.

For the third theme, mistrust, several participants expressed negative attitudes and experiences when seeking services from members of the LGBTQIA+ “community.” These experiences left participants feeling mispresented, negatively emotionally impacted, and distrusting of service providers. Other studies have observed the marginalization of transgender people within LGBTQIA+ spaces, the disconnect of the broader “community” to transgender-specific issues, and the lack of provider knowledge (Carmel & Erickson-Schroth, 2016; Moolchaem et al., 2015). The findings of the present study contradict more recent work (Chodzen et al., 2019; Delozier et al., 2020) emphasizing the importance of organizations like gay-straight alliances that espouse support and inclusion of transgender people to mitigate the impact of minority stressors. These findings, however, do not provide context relevant to minority stress youth and adolescents of color nor do they expand on transgender adults or transgender people of color. To the authors’ knowledge, no other study has researched the potential impact of minority stress imposed upon transgender people. Less is known regarding the potential impact of minority stress from cisgender members of the “community” when researching the interactions of transgender women of color who uniquely experience vulnerability to minority stress due to their multiple marginalized minority statuses.

Less is known about the negative health impact that may be related to discriminatory or exclusionary acts by cisgender LGTBQIA+ providers within healthcare settings. As participants in the present study discussed, negative experiences with providers led them and others to avoid HIV testing, be discriminated against in testing centers, and have limited access to trans-affirming care. These experiences are part of a cascade of experiences that may lead to further mental and physical health risks. This is especially concerning given the vulnerability to mental unwellness and the extreme disproportion of transgender women of color living with chronic conditions such as HIV (Sullivan et al., 2015), substance use (Hotton et al., 2013), and mental health disorders (Jefferson et al., 2013).

The fourth theme, resilience, advocacy, and opportunity was comprised of participants sharing experiences and strategies of individual and group resilience that mitigated the impact of minority stressors. Resilience through self-efficacy has been suggested as a buffer to depressive symptoms related to minority stress for transgender women of color (Jefferson et al., 2013). Participants’ responses aligned with findings from previous research as some described instances of activism that led to a stronger sense of self-identity and self-pride. Further, visibility through group participation provided opportunities to improve social conditions for themselves and the transgender “community.” Examples of participation in activism, being and seeking positive role models, feeling a sense of “community,” and developing self-acceptance expressed by participants serve as resilience strategies that can minimize the impact of minority stressors (Matsuno & Israel, 2018). Of significant importance in the present study were the participants’ assertions of having the motivation, knowledge, and desire for both opportunity and inclusion in areas of healthcare, employment, activism, and societal settings. Future advocacy efforts may use these findings as a guide to promote equity across the larger LGBTQIA+ and within society overall.

Limitations

Findings from this study draw from experiences of transgender women of color within South Florida, and may not be indicative of other areas within the U.S. South Florida has a conservative social and political climate regarding LGBTQIA+ people and is unique in its ethnic and racial composition; non-Hispanic White people account for just 13.6% of the population in Miami-Dade County and 33.6% of the Broward County population (U.S. Census Bureau, 2021).

In addition, the current study is a secondary analysis, thus, the interviews from which data were drawn were guided by research aims for a separate study. Respondents might have been prompted to provide even more details in a study created de novo for this study. Fortunately, many of the questions that were asked were related to life experiences, discrimination, and support networks for transgender women of color, or elicited responses that illuminated these issues, allowing for the transferability of data. However, given the nature of secondary analyses, in-depth probing into how intersecting minority statuses (race/ethnicity, HIV serostatus, immigration status, transgender identity) specifically impact the perceptions of transgender women of color were unable to be obtained. The use of secondary data also did not allow for further inquiry into participant interactions with individuals unknown to the participants yet deemed as “gay” and “lesbian.” This limitation did not allow for consideration for other potential cisgender identifying LGBTQIA+ “community” (pansexual, bisexual, queer, etc.). Future studies collecting data relevant to the present study should consider primary data collection strategies that account for both intersecting minority stress and minority identities as well as opportunities for participants to express their perceptions of cisgender individuals beyond the scope of cisgender gay and lesbian presentation.

While using both in-depth interviews and focus groups can increase trustworthiness through data triangulation and provide a deeper exploration of data through comparison of interview types (N. Carter et al., 2014; Korstjens & Moser, 2018), when comparing the two interview types, Guest et al. (2017) have found individual interviews to be more capable of producing a broader scope of discussion items while focus groups were more effective in eliciting sensitive and personal information. Given the diversity of Latin American countries and region-specific vernacular, some of the translations may not fully express the exact meaning of the participant reports (Squires, 2009). Despite these limitations, the present study provides first-hand accounts of transgender women of color expressing marginalization, exclusion, and discrimination by LGBTQIA+ cisgender people. Findings from this study can guide future research, mental and physical health practice, policy, and “community” advocacy when considering equity, visibility, and opportunity for transgender women of color and other gender minorities.

Implications healthcare professionals and LGBTQIA+ organizations

While most members of the LGBTQIA+ “community” experience minority stress based on dominant social and structural factors existing in U.S. society (Meyer, 2015; Meyer & Frost, 2013), transgender women of color may experience unique minority stress from cisgender members within the larger “community.” Moolchaem et al. (2015) provided impactful, yet vague evidence that transgender people seeking services from cisgender LGBTQIA+ spaces do not feel supported. Findings from the present study amplify transgender people’s voices, specifically transgender women of color. Not only did the findings reiterate these women felt unsupported in LGBTQIA+ spaces, but they also reported being verbally assaulted, being denied refusing services and feeling marginalized by cisgender LBGTQIA+ people.

Findings from the present study through the utilization of the minority stress framework as a conceptual theoretical model allowed for an appraisal of stigma and discrimination leading to proximal and distal stress that impacts the transgender women of color participants. This also allowed for a novel understanding of how discrimination and marginalization from cisgender members of the LGBTQIA+ community may contribute to elevated mental and physical health risks. This was demonstrated in the study’s findings through reports of participants avoiding HIV testing and encountering transgender-affirming care from providers perceived as cisgender LGBTQIA+ individuals. Individual resilience strategies were also identified and reported to mitigate minority stressors and discrimination impacting transgender women of color (Frost & Meyer, 2023; Goldenberg et al., 2021; Meyer, 2015). Such strategies included participants becoming activists and role models in their communities to improve conditions in their environments. Health providers and community organizations providing services to these women must be aware of both the discrimination and stigma causing minority stress that increases exposure to health risks along with strategies that promote resilience through individual factors and group-level approaches.

In light of these findings, information related to the intersection of race/ethnicity, culture, and transgender status was relatively absent in the analysis. Theoretical frameworks that combine racial/ethnic factors related to stress and health risk in addition to those that emphasize the impact of cisnormativity and cisgender-based discrimination in study protocols and measures should be implemented to discern multiple and overlapping prejudices impacting transgender people of color (Tan et al., 2020). These frameworks should also incorporate culturally relevant resilience strategies to foster improved health outcomes.

Findings from this study also support research emphasizing the need for healthcare professionals to obtain comprehensive education and gender sensitivity training and interventions specific to transgender people that include gender terminology, health inequalities, transgender issues, and stigma and discrimination (Lindsay et al., 2019). This includes spaces deemed as LGBTQIA+ inclusive as findings from the present study revealed that these spaces employed cisgender LGBTQIA+ individuals who engaged in discriminatory and inappropriate practices or did not accommodate the competence to meet the needs of the participants.

Researchers should be attuned to the minority stress framework when working with LGBTQIA+ populations (Meyer, 1995; Meyer & Frost, 2013), as well as the specific ways in which minority stress impacts the mental and physical health of transgender women of color (Eastwood et al., 2021; Jefferson et al., 2013), and when applying optimal interdisciplinary collaboration. On a micro level, social workers should identify support systems and resilience strategies along with actively seeking, maintaining, and evaluating gender-affirming resources in their communities. Based on the findings of the present study, special attention must be given to factors specific to transgender women of color when considering services claiming to be transgender-inclusive, namely LGBTQIA+ organizations and providers. On a macro level, ensuring transgender women of color have representation within social service organizations, policy advocacy strategies, and research can elevate optimal structural and health equities by acquiring first-hand, relevant information about these women.

Conclusions

To our knowledge, no other studies have identified minority stressors that transgender women of color experience due to prejudice and discrimination by cisgender members of the LGBTQIA+ “community.” Additionally, this is the first study to demonstrate potential health implications as a consequence of social exclusion and discrimination, dominant cisgender membership, and perceived preferences toward cisgender identity existing within the LGBTQIA + and society. The results produced important insights into contributing and mitigating factors to minority stress for one of the most vulnerable populations within the LGBTQIA+ “community” and in the U.S. Similar to previous transgender research, participants in the current study described discrimination, social exclusion, and differences in issues compared to cisgender members of the “community” (Moolchaem et al., 2015). The present study offers insight into these potential issues causing discrepancies existing within the umbrella of the larger “community.” Furthermore, the present study provides context as to the minority stress transgender women of color have experienced by cisgender LGBTQIA+ people and the negative social and health outcomes.

Perhaps most interestingly, these findings suggest that minority stressors may be exacerbated at times when transgender women of color interact with cisgender members of the “community,” even in LGBTQIA+ organizations. This gives important cautions concerning literature suggesting these organizations are important as providers and safe spaces for transgender women of color. Whether or not these organizations are indeed safe and supportive for transgender women of color is not guaranteed; staff may not be particularly knowledgeable or sensitive to transgender issues and may even at times convey discriminatory attitudes. Future research exploring the impact of minority stress must recognize and reevaluate the impact of cisgender privilege and the potential for discrimination among vulnerable populations within the LGBTQIA+ “community.” Visibility and opportunity for transgender women of color within these spaces can be an important way to promote overall health equity. The recommendations provided herein can influence affirming practices and education for cisgender queer health providers, “community” activists, and transgender allies to better support transgender women of color.