Date of Award


Degree Name

Doctor of Philosophy


Counselor Education and Counseling Psychology

First Advisor

Dr. Mary Z. Anderson

Second Advisor

Dr. Eric Sauer

Third Advisor

Dr. Gary Bischof


Transgender, social support, quality of life, well being, affirmation, non-affirmation


This research builds upon scholarship exploring the quality of life of transgender populations. Knowledge on quality-of-life (QOL) for transgender populations has been limited due to the fact that most studies have focused on gender affirming medical procedures as interventions (Nobili et al., 2018). Other protective factors, such as social support, have been identified in the literature but have been defined in broad terms. The purpose of the study was to better understand additional factors that promote QOL and psychological well-being, specifically social support. It is unclear how non-affirmation of gender identity affects the protective effects of social support for QOL. The study investigated if non-affirmation of gender identity acted as a moderator for social support and QOL. Online survey data was collected from 167 transgender/gender-nonconforming participants living in the U.S. QOL was measured using the World Health Organization Quality of Life Brief (WHOQOLBREF; WHO, 1998) scale. Psychological well-being was also measured using the short version of the Depression, Anxiety, and Stress scale (DASS-21; Lovibond & Lovibond, 1995). Non-affirmation was measured using the Non-Affirmation of Gender Identity subscale from the Gender Minority Stress and Resilience (GMSR) measure (Testa et al., 2015. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988).

Non-affirmation of Gender Identity did not moderate the positive relationship between the social support and the quality of life domains. The results indicated mixed support for Non-affirmation of Gender Identity moderating the negative relationship between social support and psychological well-being. The study also explored how type and source of social support may predict different domains of QOL and psychological well-being. The study also explored gender identity and transition by examining the ways in which participants described their gender. The Transgender Congruence Scale (TCS) was used to understand how participants’ perceived congruence between their appearance and their gender identity reflected their perceived attitudes towards medically affirming treatments, such as hormone treatment and sexual reassignment surgery. The study serves to provide new insight in understanding quality of life for transgender populations by investigating specific sources and types of social support and affirmation. The study also offers additional insight in understanding gender identity and transition by highlighting the diversity of gender identities in the sample, making recommendations for research that allows flexible methods for participants to indicate gender identity. By understanding gender identity as fluid instead of a fixed category, the findings of this study offer additional insight in evaluating the role medically affirmative treatment has in the quality of life for transgender populations.

Access Setting

Dissertation-Open Access