The author of this document has limited its availability to on-campus or logged-in CSUSB users only.

Off-campus CSUSB users: To download restricted items, please log in to our proxy server with your MyCoyote username and password.

Date of Award


Document Type

Restricted Project: Campus only access

Degree Name

Master of Social Work


School of Social Work

First Reader/Committee Chair

Schott, Erik


The relationship between the benefits of gender-affirming care (GAC) and improved mental health outcomes among transgender individuals has been well documented. However, literature on the association of a delay or denial of medically necessary GAC and mental health outcomes is limited. This mixed-methods study was guided by the Health Equity Promotion Model to explore the association of GAC denial and new or worsened mental health outcomes among transgender individuals. Both qualitative and quantitative data were collected from a sample of 94 transgender individuals (N = 94) via Qualtrics. The findings suggested that denial of GAC was associated with more frequent experience of stress, trauma, other mental health issues (depression, anxiety, etc.), self-harm, maladaptive coping strategies and risky behaviors and increased mental health symptoms or diagnosis among this sample. Research and policy implications of these findings were discussed. Further research is necessary to provide insight on the importance of GAC access, as a lack thereof may contribute to worsened mental health outcomes within a population that already presents with disproportionately higher adverse mental health as compared to the general population.