Table 3.

Definitions of Gender Affirmation Present in Included Studies

Study	Definition
Crosby et al.42	“[Gender affirmation] is described as perceiving validation of one's gender identity and expression, and it may involve having a body image that is concordant with one's gender identity, along with social recognition and legitimacy, and acceptance of the transgender-self.”
Kuper et al.32	“The ability to identity and express one's gender and have this sense of self accurately reflected back by others…”
Glynn et al.21	“…gender affirmation is the process by which transgender individuals have interactions with their environment that recognize and value their gender expression.”
Goldenberg et al.31	“… a dynamic social process through which individuals receive support for their gender identity and expression.”
Menino et al.34	“…the interpersonal, interactive process whereby persons receive social recognition and support for their gender identity and expression.”
Reisner et al.48	“Gender affirmation has been defined as an interpersonal and shared process through which a person's identity is socially recognized. Gender affirmation is thus a dynamic process that can include social (e.g., name, pronoun, and gender expression), medical (e.g., cross-sex hormones and surgery) and/or legal (e.g., legal name change and gender marker change) dimensions. Despite multiple dimensions of gender affirmation, this study conceptualizes social transition (with or without medical and/or legal transition) as the critical gender affirmation component shaping sexual health behaviors…”
Reisner et al.37	“Gender affirmation refers to being recognized or affirmed in one's gender identity or expression.”
Sevelius et al.51	“‘Gender affirmation’ is an interpersonal process in which a person receives validation of their gender identity and expression.”