Abstract / Summary
Background Access to gender affirming surgical care is shaped by complex structural, interpersonal, and psychosocial factors, but less is known about how these barriers interact with and influence the care pathway in the Australian healthcare context.Aim To explore the lived experiences of transgender and gender diverse people seeking gender affirming surgical care in Australia, with a focus on structural barriers, psychological burden during waiting, experiences of discrimination and perioperative experiences.Methods A qualitative study was conducted using semi-structured interviews with 60 participants, including 23 transmasculine, 22 transfeminine, and 15 nonbinary individuals. Data were analyzed using Braun and Clarke’s six phase reflexive thematic analysis approach (2006), involving data familiarization, coding, theme development, review, and refinement.Results Five overarching themes were identified. Structural barriers to access included system capacity limitation, financial inaccessibly, gatekeeping, difficulties navigating care pathways, and clinical complexity. Psychological burden of waiting captured distress associated with prolonged delays, uncertainty and loss of control, body and identity incongruence, and internalized stigma. Interpersonal system level discrimination described negative healthcare interactions, marginalization, and perceptions of psychological and physical lack of safety in healthcare and social environments. Preparation for surgery encompasses emotional anticipation, practical and social preparation, and risk benefit decision making process. Surgical experience and outcomes reflected perioperative experiences, recovery and adaptation, and postoperative reflections, including adjustment and challenges during recovery.Conclusions Access to gender-affirming surgical care is shaped by interconnected structural, interpersonal, and psychological factors across the care continuum. Barriers within health systems and experiences of discrimination contribute to cumulative psychological burden while waiting to access care. These findings highlight the need for a more equitable, timely, and affirming surgical pathway in Australia, alongside improved information provision and patient centered care models for transgender and gender diverse individuals.