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Wamsler, Loa Sofie (2020) Understanding the decision making process of beginning hormone therapy for trans individuals: a grounded theory study. Doctoral thesis, London Metropolitan University.
Research indicates the trans population experiences significantly higher levels of mental health difficulties and suicidal ideation compared with the rest of the population. Existing literature relating specifically to psychological therapists is explored and four main gaps identified. These gaps surround lack of support for the trans community, long waiting times, the urgency of need often leading to self-prescription of hormones, and the compromising gate-keeping roles of professionals working with this population. Seven participants, who had all made the decision to take hormones, were interviewed. Semi-structured interviews addressed their help seeking behaviour and decision making process to take hormones, as well as their experiences of the system and the professionals in it. Fewer participants than desired were recruited, and the abbreviated version of grounded theory was therefore implemented. The decision-making behind that and its potential consequences are discussed. Using grounded theory, a stage model of the decision-making process to take hormones was drawn, and four categories and 14 subcategories identified. The categories were "identity frustration", "meeting the gatekept world", "survival mechanisms", and "escalating identity crisis". In discussing these results, the main problems indicated by the results of these findings regarded the mismatch between the urgent need for treatment trans people have, systemic issues of long waiting times, and a general sense of a gap between trans people and the professionals working with them, enforcing gatekeeper roles and feelings of being misunderstood and unsupported. Implications for counselling psychology practice and suggestions for further research are discussed.
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