The Psychological Impact of Gender Nonaffirmation

Psychology of Sexual Orientation and Gender Diversity | 2026, Vol. 13, No. 2, p. 248-259

Understanding the Impact of Gender Identity Nonaffirmation: The Mediating Role of Psychological Needs Thwarting

Joda Lloyd; School of Psychology, University of East London

Keely J. Frasca; Birkbeck Business School, Faculty of Business and Law, Birkbeck, University of London

Miles Thompson; School of Social Sciences, University of the West of England (UWE Bristol)

Jay Stewart; Gendered Intelligence, London, United Kingdom

Cara English; Gendered Intelligence, London, United Kingdom

Transgender and gender nonconforming (TGNC) people report high levels of violence, discrimination, and stigma, and this has repeatedly been linked to mental health problems (Testa et al., 2015). However, research examining the general psychological processes underpinning these relationships is in its infancy. Combining understanding from the gender minority stress and resilience model (Testa et al., 2015), Hatzenbuehler’s (2009) integrative mediation framework and basic psychological need theory (Ryan & Deci, 2017), we investigated psychological needs thwarting (i.e., thwarted competence, relatedness, and autonomy) as intermediary variables in the relationship between a specific type of TGNC discrimination —gender identity nonaffirmation—and psychological distress and life satisfaction outcomes. We based this model on a two-wave longitudinal panel design where data were obtained from 454 TGNC people living in England, who participated in surveys on two measurement occasions, 12months apart. Autoregressive analysis revealed that thwarted competence mediated the relationship between gender identity nonaffirmation and depression (β= .05, SE= 0.02, p= .021), stress (β= .05, SE= 0.02, p= .021), and life satisfaction (β=−.05, SE= 0.02, p=.034); thwarted autonomy mediated the relationship between nonaffirmation and depression (β=.03, SE=0.02, p= .049) and life satisfaction (β=−.04, SE= 0.02, p= .049); and thwarted relatedness mediated the relationship between nonaffirmation and depression (β=.05, SE= 0.02, p= .039). We discuss practical and theoretical implications for the fields of gender minority stress, basic psychological need theory, and TGNC mental health.

Transgender and gender nonconforming, gender identity nonaffirmation, needs thwarting, psychological distress, life satisfaction

“Research on the mental health and well-being of TGNC people has revealed disproportionately high rates of psychological distress and poor life satisfaction relative to the general population,” and “central to this literature are the gender-related violence, discrimination, rejection, and stigma experienced by TGNC people.” The authors note that “the impact of distal stressors on mental health may be direct, or indirect via their effect on the minority-specific intermediary proximal processes,” but argue that “the proximal stressors have been criticized as being too restrictive.” Drawing on “Hatzenbuehler’s (2009) integrative mediation framework,” the study focuses on “general, nonminority-specific proximal stressors” and examines “psychological needs thwarting (i.e., thwarted competence, relatedness, and autonomy) as intermediary variables in the relationship between a specific type of TGNC discrimination—gender identity nonaffirmation—and psychological distress and life satisfaction outcomes.” The authors propose that “nonaffirmation of gender identity experiences will be positively associated with psychological needs thwarting,” that “psychological needs thwarting will, in turn, be positively associated with experiences of psychological distress and negatively associated with life satisfaction,” and that “psychological needs thwarting will mediate the association of nonaffirmation of gender identity with psychological distress and life satisfaction” (p. 248-250).

“We adopted a longitudinal panel design where a sample of participants who self-identified as a different gender to their gender assigned at birth was surveyed at two time points, 12 months apart.” The study was based on “the ongoing longitudinal Quality in Life in TGNC People in England study,” and the final sample consisted of “454 respondents.” Participants “ranged from 18 to 82 years old,” and completed measures of “nonaffirmation of gender identity,” “thwarted autonomy,” “thwarted relatedness,” “thwarted competence,” “depression,” “anxiety,” “stress,” and “life satisfaction.” The authors explain that they “adopt[ed] a longitudinal design to assess the indirect effect of nonaffirmation of gender identity on psychological distress and life satisfaction outcomes via psychological needs thwarting,” and fitted “a parsimonious autoregressive model that modeled both T1 and T2 measures of the predictor, mediator, and outcome variables in a single model, capturing both synchronous and lagged effects” (p. 250-254).

The results showed that “nonaffirmation of gender identity was positively related to thwarted autonomy, competence, and relatedness.” Specifically, “T2 nonaffirmation of gender identity was shown to be significantly and positively related to T2 thwarted autonomy,” “T2 thwarted relatedness,” and “T2 thwarted competence,” and therefore “Hypothesis 1 was fully supported.” The authors state that these findings reveal that “the impact of nonaffirmation of gender identity experiences is not confined to reducing levels of one’s needs satisfaction,” but rather that “such experiences result in actively frustrating all three psychological needs in TGNC people.” They further note that “the impact of gender identity nonaffirmation experiences is not confined” to previously identified mechanisms and that “widespread gender nonaffirmation experiences also thwart the primary psychological needs of relatedness, autonomy, and competence, which are essential to our functioning and well-being” (p. 254-256).

Regarding psychological distress and well-being, “thwarted autonomy was positively related to depression and negatively related to life satisfaction,” and “significantly mediated the effects of gender identity nonaffirmation on these outcomes.” “Thwarted relatedness was positively related to depression and significantly mediated the relationship between nonaffirmation of gender identity on this outcome.” Most notably, “thwarted competence was positively related to all three psychological distress outcomes (depression, anxiety, and stress) and negatively related to life satisfaction.” Furthermore, “thwarted competence was also identified as significantly mediating the impact of gender identity nonaffirmation on all outcomes, except for anxiety.” The authors conclude that “the three needs are not equally instrumental in accounting for diverse pathological outcomes in TGNC people; competence is the most pertinent, according to the present findings” (p. 254-256).

The discussion emphasizes that the study “enhances our understanding of the relationships between nonaffirmation of gender identity, psychological distress, and life satisfaction in TGNC people” and that it is “the first study to assess all three of these needs simultaneously in TGNC people: thwarted autonomy, competence, and relatedness.” The findings “contribute to minority stress theory by demonstrating that widespread gender nonaffirmation experiences also thwart the primary psychological needs of relatedness, autonomy, and competence.” The authors further argue that the results provide “partial support for this theoretical proposition” that thwarted needs play “a transdiagnostic role in explaining an array of pathological symptomology.” However, the findings suggest that “depression is exacerbated by the thwarting of all three needs, but stress and anxiety were impacted by thwarted competence, not autonomy and relatedness.” Thus, “these outcomes contribute to BPNT by indicating that the three needs are not equally instrumental in accounting for diverse pathological outcomes in TGNC people; competence is the most pertinent” (p. 256-257).

“Our study outcomes have noteworthy implications for professional bodies, charities, clinicians, and therapists involved in supporting TGNC individuals suffering from psychological distress and poor life satisfaction. Armed with the knowledge from the present study that gender identity nonaffirmation experiences thwart the psychological needs of autonomy, competence, and relatedness, which are crucial for one’s psychological health and well-being, enables such stakeholders to facilitate appropriate interventions for this marginalized group. It is recognized that the needs thwarting–psychopathology relationships may be reciprocal, wherein individuals become trapped in a destructive cycle, thus requiring interventions to prevent and disrupt this cycle.

We appreciate the complexities of ameliorating the underlying origins of psychological needs thwarting, especially instances of prevalent gender nonaffirmation experiences among the TGNC population, as identified in the present research. This would likely entail community-focused interventions that serve to educate the public about the lives of TGNC people and reduce gender-based stigma. There are additional avenues, however, for intervening with the affected TGNC individual directly. Recommendations include aiding the individual in effectively shifting their attention toward the thwarted needs in a way that facilitates an adaptive response to adversity and rebuilds levels of needs satisfaction. Prior evidence has shown that resilient individuals have a more effective attentional bias in this respect. Thus, interventions aimed at enhancing resilience, such as mindfulness-based stress reduction and strengths-based cognitive behavioral therapy, are recommended” (p. 257). 

“When evaluating the study findings, there are several limitations and future research avenues to consider. First, our sample was predominantly White and highly educated. Thus, future research would benefit from recruiting a more diverse sample. Second, our TGNC sample comprised individuals spanning an array of gender identities and expressions. It was not within the scope of our study to examine subgroups of TGNC people, although we recognize that experiences, especially those associated with gender identity invalidations, may be differentially associated with one’s gender identity. Thus, there are opportunities for future studies to examine whether psychological needs thwarting mediate the impact of gender identity affirmation, similarly for all TGNC individuals.

Third, we focused solely on the impact of nonaffirmation of gender identity; we did not examine the other distal stressors of the GMSR model, such as victimization, rejection, and discrimination. Considering prior studies have shown gender nonaffirmation to have as strong, if not stronger, relationships with psychological processes and psychological distress outcomes when modeled with these other stressors, we anticipate our findings to hold even when taking into consideration additional transphobic and stigmatizing experiences. However, we also acknowledge the novelty of our intermediary variables and recommend future research tests an all-encompassing model covering all distal stressors, needs thwarting mechanisms, and outcomes together. As well as considering the comprehensive modelling of all distal stressors suggested by the GMSR model, there are opportunities to examine other proximal variables. Following recent research, future studies may wish to consider the role of gender dysphoria as a proximal stressor. Another potential avenue is to explore any contributing factors from parental and peer acceptance earlier in life, and levels of rejection sensitivity as development progresses.

Fourth, we base our findings on statistical analysis that captured lagged effects over two time points to show evidence of mediation. However, we acknowledge that alternative effects may be possible between our study variables of gender identity nonaffirmation, thwarted psychological needs, and psychological distress and life satisfaction outcomes. Future research may benefit from further analyzing the time-ordered relationships between these variables to establish whether mediation is the best statistical characterization of these effects. Additionally, further research should consider alternative theoretically meaningful mediators that may intervene in conceptual time between nonaffirmation of gender identity and psychological distress and life satisfaction outcomes” (p. 257-258).