Gender dysphoria and effects of gender-affirming medical care on mental health of transgender individuals: a systematic review and meta-synthesis

Background Transgender people experiencing gender dysphoria (GD) often access gender-affirming medical care (GAMC). Accessing GAMC is found to be beneficial for reducing the symptoms of GD. To enhance the well-being of transgender individuals, it is important to explore their lived experiences related to GD and GAMC.Aim To systematically synthesize qualitative literature that explores the experiences of transgender people with GD who have undergone or are at any phase of GAMC through a meta-ethnographic perspective.Method A protocol for this study was registered on PROSPERO. A systematic search was conducted across five databases: PubMed, Web of Science, ScienceDirect, PsycINFO, and Google Scholar. 20 Studies were selected according to the set criteria for final synthesis. The quality assessment of included studies was completed using the Critical Appraisal Skill Program (CASP) checklist. The reporting of synthesis is presented according to Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. The data analysis has been guided by the meta-ethnography approach.Results Using reciprocal transnational analysis, findings were coded under 5 meta-themes and 9 sub-themes.Conclusion This study provides qualitative evidence for poor mental health among transgender individuals who experience GD; however, after accessing GAMC, there is also an increase in their mental health and, in some cases the presence of gender euphoria following GAMC. The analysis indicates that proximal and distal psychosocial factors are important for managing the distress caused by GD. Recommendations are provided to develop tools to enable transgender individuals to arrive at a well-informed decision before accessing GAMC. Pre-intervention and guidance should also be provided to transgender individuals such that it does not promote medical gatekeeping.