“The World Is Not Ready for Us Yet” —Gender Minority Stress Experiences Among Nonbinary and Genderqueer Adults Seeking Gender Affirming Medical Care

Mental health disparities among nonbinary and genderqueer (NBGQ) individuals are consistently observed and reflect the impact of intrapersonal and social stressors described by gender minority stress (GMS) theory. This qualitative study extends this framework by exploring how GMS-related stressors are experienced by NBGQ individuals seeking gender-affirming medical care (GAMC). We conducted interviews with 15 participants (aged 18-53) representing diverse nonbinary identities and GAMC pathways. We analyzed the data using thematic analysis and identified key challenges across three contextual layers. At the individual level, participants encountered challenges in exploring and defining their nonbinary identity, due to a lack of nonbinary-sensitive language, representation, and information. Interpersonally, they stressed the continuous pressure to explain and defend their nonbinary identity while facing identity invalidation by others. Systemically, nonbinary individuals faced difficulties navigating societal binary norms, frequently feared for their safety, and were negatively affected by policies and legislation that failed to recognize or protect their identities. Our findings highlight the need for greater attention to NBGQ-specific nuances within existing gender minority stress frameworks, alongside improved NBGQ representation, supportive interpersonal networks, and nonbinary inclusive social structures - all crucial for enhancing mental health and resilience in NBGQ individuals.