Transgender and gender diverse (TGD) individuals experience violence to a greater extent compared to their cisgender counterparts, including hate crimes, physical violence, and sexual and psychological abuse (Stotzer, 2009; Flores et al, 2022). For example, transgender individuals are over twice as likely to experience physical and sexual intimate partner violence compared to cisgender people (Peitzmeier et al, 2020).
There are many potential consequences of violence, both in the short and long terms. These include physical effects, such as injuries and transmission of sexually transmitted infections or diseases, and psychological effects, such as anxiety, depression, and suicidality (Rivara et al, 2019). The health sector is therefore essential in the treatment of physical injuries or symptoms as well as treatment and prevention of mental health deterioration. However, TGD individuals face several challenges when trying to access quality health services, such as care refusals and further victimisation by health professionals (Cicero et al, 2019; Strauss et al, 2020 – blogged here by Dr. Talen Wright).
It is in this context that Kaptchuk and colleagues (2025) conducted a review summarising the findings from previous research on aspects and practices of health services that are preferred and valued by TGD individuals and health providers serving them.
The health sector response to violence against transgender and gender diverse individuals plays a key role in decreasing post-violence mortality.
Methods
Kaptchuk and colleagues (2025) carried out a comprehensive search in order to identify publications looking at the characteristics that TGD adults and health providers supporting TGD individuals would like to find in health services when accessing them after experiencing interpersonal violence. The search included six online databases, secondary references, and grey literature, such as conference abstracts and publications on websites of relevant organisations. Eligible studies included only TGD adults (18 or older) and/or health providers serving TGD adults, or a more general population but where data on TGD adults only were reported. Any method was included, as long as it presented primary data collection, as well as any language and geographical region.
Three reviewers completed the screening process, extracted, and analysed the data using inductive thematic analysis, which is a research approach according to which the researcher identifies recurring patterns in the data without any pre-established categorisation. Rigor of the identified themes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE), while overall confidence in the results was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach.
Results
The review included 16 studies carried out in ten different countries, allowing for the representation of various populations and health services. The themes emerged from the analysis were:
- Health provider education
Participants discussed the importance of providing education in health services in relation to the different forms of violence that are specific to TGD individuals, as well as the various factors that make TGD individuals more vulnerable to violence, such as social norms and the intersection of gender identity and race. Such education would allow health professionals and volunteers to provide support that meets the needs of TGD individuals.
- Quality of care
TGD-individuals-specific quality of care include safe, empowering, supportive, and respectful services and interactions between patients and health providers. This includes using the patient’s preferred pronouns, carrying out physical examinations in a gender-affirming way, and using a trauma-informed, victim-centred approach.
- Inclusive advertising
TGD individuals often feel they are not welcome in post-violence health services, and they are not aware of what services are available to them. For this reason, post-violence health services’ advertising should be more inclusive, for example by targeting TGD populations, using inclusive language, and by explicitly stating whether TGD people are served there.
- TGD-inclusive policies and service environments
Both TGD individuals and health providers expressed that policies should be developed to create a safe and inclusive service environment in order to remove barriers to accessing post-violence support. Suggestions included displaying TGD-affirming stickers, providing gender-inclusive facilities, and developing an explicit plan on how to support TGD individuals who experienced violence or discrimination.
- Representation and role of TGD individuals within staff, programme development, and advocacy roles
Participants reported that TGD individuals had a more positive experience accessing services when there were TGD representation or someone with violence lived experience among the service staff members. However, one study in the review reported that some TGD participants feared that TGD staff members would disclose the client’s private information to other members of the trans community.
- Dedicated services for TGD individuals
Some participants highlighted the value of specialised services in order to provide the appropriate support to TGD individuals who were victims of violence, meeting their unique needs.
- Provide health navigation, coordination, and linkage to services
In order to access adequate and timely care and support, patient navigation models should be developed. Additionally, participants felt that referrals to gender-affirming services should be facilitated via enhanced communication between services’ staff members.
- Incorporate mental health support
Participants suggested that mental health support should be integrated in post-violence services, where health professionals are trained and aware of TGD-specific violence and broader socio-structural experiences.
- Accessibility of post-violence healthcare locations
One study in the review identified barriers in relation to the location of gender-based violence services, which are at long distances from participants.
Staff training provision, transgender and gender diverse (TGD) representation, and TGD-inclusive policies are all aspects of post-violence services valued by TGD adults and health providers serving them.
Conclusions
This study by Kaptchuk and colleagues (2025) highlights that there are several areas where improvement is needed in order to provide safe and affirming services to TGD communities following a violence experience. As health providers’ education alone is not enough, a multilevel response is therefore called for, involving changes at both the societal and structural levels.
A multilevel response is necessary for transgender and gender diverse individuals to access quality post-violence services.
Strengths and limitations
The findings of this study provide useful insights on how to improve post-violence services in order to better support TGD populations, who face a great burden of violence. The study was conceptualised and designed alongside an individual with related lived experience, ensuring that the focus of the research remained relevant to TGD individuals. The search strategy was sound and comprehensive, leading to both peer-reviewed articles and grey literature being included in the analyses. Additionally, the reviewers assessed rigor and overall confidence in the synthesised themes, which are noteworthy in the interpretation of the results.
However, some limitations need to be considered:
- Only a few studies included in the review directly investigated the preferences and values for post-violence services, while others focused on violence experiences and care-access barriers for TGD populations.
- Most participants were transgender women, highlighting the need for further examination on transgender men and gender diverse individuals’ views.
- Although there is evidence suggesting that transgender and gender diverse youth face a great level of violence (Goldenberg et al, 2018; Norris et al, 2020) as well as barriers to affirming-care access (Inward-Breland et al., 2021), only adult participants were included in the review. The inclusion of TGD individuals younger than 18 in future studies might provide additional perspectives on values and preferences regarding post-violence services.
This study has effectively synthesised the current knowledge on the values and preferences of TGD communities in relation to health services responding to interpersonal violence.
Implications for practice
The findings of this study’s value mainly lies with the implications for practice. The views of TGD populations and health providers serving TGD individuals reported in the review can inform post-violence health services and providers as well as clinical guidelines. In light of the current findings, health services may introduce new policies and practices specific to the response to interpersonal violence against TGD individuals.
For example, care providers should receive training on the unique experience of violence against the trans community, understanding the interlocking system of oppression at the base of such violence. Care providers should also be required to provide respectful and gender-affirming care. Services’ advertisements and public health programmes should also move towards using more inclusive language, allowing TGD individuals to know that high quality support is available to them.
TGD populations will only be able to access safe, empowering, and affirming post-violence support through multilevel changes informed by TGD’s own voices and perspectives.
Transgender and gender diverse voices need to be heard to be able to provide them with the kind of support that meets their unique needs.
Statement of interests
None.
Links
Primary paper
Kaptchuk P R, Kennedy K S, Wong B W. et al (2025) Values and preferences regarding the health sector response to interpersonal violence against transgender and gender-diverse individuals: A systematic review. Lancet Psychiatry. 2025, 12(7)524-534.
Other references
Breland-Inwards D J, Karrington B, & Sequeira G. (2021) Access to care for transgender and nonbinary youth: Ponder this, innumerable barriers exist. Jama Pediatrics 2021 175(11) 1112-1114.
Cicero E, Reisner S R, Silva S G. et al (2019) Healthcare experiences of transgender adults: An integrated mixed research literature review. Advances in Nursing Science 2019 42(2) 123-138.
Flores A R, Stotzer R L, Meyer I H. et al (2022) Hate crimes against LGBT people: National crime victimization survey, 2017-2019. PLoS ONE 2022 17(12).
Goldenberg T, Jadwin-Cakmak L J, & Harper G W. (2018) Intimate partner violence among transgender youth: Associations with intrapersonal and structural factors. Violence and Gender 2018 5(1).
Norris A L, & Orchowski L M. (2020) Peer victimization of sexual minority and transgender youth: A cross-sectional study of high school students. Psychology of Violence 10(2) 201-211.
Peitzmeier S M, Malik M, Kattari S K. et al (2020) Intimate partner violence in transgender populations: Systematic review and meta-analysis of prevalence and correlates. American Journal of Public Health 2020 110(9), e1-e14.
Rivara F, Adhia A, Lyons V. et al (2019) The effects of violence on health. Health Affairs. 2019 38(10) 1622-1629.
Stotzer R L. (2009) Violence against transgender people: A review of United States data. Aggression and Violent Behaviour 2009 14(3) 170-179.
Strauss P, Lin A, Winter S. et al (2020) Options and realities for trans and gender diverse young people receiving care in Australia’s mental health system: findings from Trans Pathways. Australian & New Zealand Journal of Psychiatry 2020 55(4).
