Transgender and gender nonbinary (TGNB) people are diverse and have distinct healthcare needs, yet
demonstrate lower levels of healthcare utilization and greater likelihood of delaying needed care than their
cisgender counterparts. Further, TGNB young adults experience more barriers to healthcare utilization and are
more likely to delay care than TGNB adolescents and older adults. Though limited research indicates
healthcare needs and patterns of healthcare utilization among TGNB people may vary by race/ethnicity and
TGNB identity, little research exists on distinct healthcare needs and utilization patterns based on the
intersection of specific race/ethnicity and TGNB identity among young adults. Further, a gap in the literature
exists regarding nuanced differences in how race/ethnicity intersects with specific TGNB identities to create
barriers to healthcare utilization, including during the COVID-19 pandemic, especially among young adults.
Also, few studies have examined facilitators of healthcare utilization in a nuanced and in-depth way specifically
among racial/ethnic minority TGNB people, particularly during young adulthood. The proposed study will use
an innovative theoretical strategy that examines intersectionality within a leading healthcare utilization model.
To address gaps in the research, we will pursue the following specific aims: (1) Examine the applicability of an
expanded healthcare utilization model that includes specific intersectional factors for each model domain for
racially/ethnically diverse TGNB young adults; and (2) Identify patterns in facilitators of and barriers to
healthcare utilization by the intersection of specific gender identity and race/ethnicity among TGNB young
adults. We will use quota sampling to intentionally recruit 105 TGNB young adults in Florida aged 18 to 26 who
are diverse in terms of intersectional TGNB identity (35% transgender men, 35% transgender women, 35%
nonbinary) and race/ethnicity (30% non-Hispanic Black, 30% Latinx, 30% non-Hispanic White, 15% Asian).
The sample will be recruited mostly through social media platforms, but also Florida community partner
organizations, House and Ballroom communities, Florida university organizations, and snowball sampling.
Participants will complete a telephone survey and an in-depth, semi-structured qualitative interview. We will
use an intersectionality framework in the design of our interview guide, layered thematic coding of qualitative
data, gender identity x race/ethnicity group comparisons, triangulation of quantitative and qualitative data, and
interpretation of the study findings in the context of the healthcare utilization model. The impact of this research
involves evaluating the applicability of an expanded healthcare utilization model to TGNB young adult
experiences and assessing the compatibility of the model with an intersectional approach that considers
experiences of gender and racial/ethnic minority young adults to advance the science on quality healthcare for