One person, many changes: a socioecological qualitative analysis of the experiences of transfeminine individuals undergoing feminising gender-affirming hormone therapy.

Stigma operating at multiple socioecological levels created both positive and negative experiences for transfeminine individuals undergoing GAHT.

• Stigma was identified as influencing experiences through the macrosystem, exosystem, and proximal processes of Bronfenbrenner's Socioecological Model.
• This sub-theme captured how broader societal attitudes and institutional-level factors shaped day-to-day GAHT experiences.
• Stigma could produce both negative experiences (discrimination, barriers to care) and positive experiences (community solidarity, affirmation-seeking).
• The sample consisted of 15 Australian transfeminine individuals interviewed via semi-structured interviews in 2022.

Internal changes from GAHT promoted stronger interpersonal relationships for transfeminine individuals.

• This finding emerged as Sub-theme 2, operating at the level of the 'person' and 'proximal processes' within the Socioecological Model.
• Participants described how physical and psychological changes resulting from GAHT contributed to improved closeness and quality of relationships with others.
• This finding highlights a social benefit of GAHT beyond individual-level psychological wellbeing.
• Data were collected through semi-structured interviews with verbatim transcripts analysed using deductive thematic analysis.

Changes experienced during GAHT occurred across time in varied patterns, with some changes being temporary and others being delayed.

• Theme 2 specifically captured the temporal dimension of GAHT-related changes, mapped onto the 'person' and 'time' components of Bronfenbrenner's Socioecological Model.
• Participants reported that not all changes were linear or permanent; some effects emerged only after a delay while others resolved over time.
• This temporal variability has implications for how individuals and clinicians set expectations about the GAHT process.
• The study used Bronfenbrenner's SEM deductively as an analytical framework applied to qualitative interview data.

Physical, psychological, and social changes during GAHT were found to be interconnected rather than isolated phenomena.

• Analyses revealed that changes across domains intersected multiple levels of the Socioecological Model simultaneously.
• The study explicitly challenges the tendency to consider physical, psychological, and social changes in isolation from one another.
• Both identified themes — stigma influences and temporal change patterns — cut across multiple SEM levels, illustrating this interconnectedness.
• Sample comprised 15 Australian transfeminine individuals; interviews were conducted in 2022 and transcripts were analysed using deductive thematic analysis.

Best-practice care for trans people undergoing GAHT was identified as needing to be multi-faceted and holistic, embedding support across different socioecological components.

• The authors concluded that care models must address not only individual-level physical changes but also interpersonal, institutional, and societal factors.
• The socioecological framework revealed that support needs span proximal processes, the exosystem, and the macrosystem.
• The finding of stigma operating at multiple levels underscores the need for interventions beyond the clinical encounter.
• The study was conducted with a qualitative sample of 15 Australian transfeminine individuals, which the authors note as a limitation for generalisability.