Lily A. Osmetti

Many gender minorities conceal their identity to escape structural and social stigma and protect their own mental health, yet their concealment strategies remain poorly understood. We argue that gender identity concealment and assigned sex concealment represent discrete concealment pathways with distinct mechanisms and consequences. A convenience sample of 185 transgender and gender diverse Australian adults completed an online survey exploring gender identity concealment and assigned sex concealment. Scores representing active concealment and disclosure were calculated for each concealment pathway. Score distributions and discriminant validity statistics confirmed that gender identity concealment and assigned sex concealment were neither interchangeable nor mutually exclusive. gender identity concealment was associated with decreased social support and assigned sex concealment with increased discrimination. Only gender identity concealment was related to depression—participants who did not attempt to conceal their gender identity at all were significantly less depressed than those who did. Assigned sex concealment was not associated with psychological well-being and was thus preferable as an alternative coping mechanism. Gender identity concealment and assigned sex concealment did not share a correlation on any of the tested variables, suggesting that they produce dissimilar psychological outcomes and that results published in studies conflating the two have been skewed. In the long term, eliminating social stigma against gender minorities may disincentivise gender identity concealment and combat mental health disparities in the trans community. Meanwhile, barriers to assigned sex concealment (e.g., unequal access to gender-affirming healthcare interventions) must be addressed.

Autistic trans and gender diverse (TGD) individuals face unique voice and communication challenges compounded by minority stressors, impacting wellbeing and access to care. Speech pathologists are crucial in providing gender-affirming and neurodiversity-affirming support; however, guidance for working with this intersectional population remains limited. This scoping review mapped current knowledge on voice and communication challenges, identifies available supports, and demonstrates the limitations of existing guidance for speech pathologists. This review draws on 40 sources, including 29 peer-reviewed articles, 8 clinical guidelines, 2 books, and 1 position statement, identified through comprehensive searches of databases such as CINAHL, ERIC, Medline, APA PsycINFO, and grey literature in May 2024. Findings indicated that 96.8% of identified challenges pertained to communication, while fewer (3.2%) focused on voice-specific issues. Similarly, supports primarily addressed communication (91.3%), with 8.7% targeting voice needs. Communication challenges included barriers faced by autistic TGD individuals and those interacting with them, including healthcare professionals, peers, and family. Supports were identified as strategies and resources to enhance service delivery and client wellbeing, such as using visual aids or offering multiple communication options. However, significant gaps remain in addressing the unique voice and communication needs of this population, particularly regarding voice dysphoria, camouflaging versus identity disclosure, and communication within healthcare settings. Autistic TGD individuals represent a unique population whose needs are not sufficiently addressed by current guidance. This review highlights significant gaps in research and clinical practice and calls for improved clinical guidelines and specialized training for speech pathologists to enhance care.

Empirical research indicates that high rates of mental health issues in members of marginalised population groups are predicted in part by their decisions to disclose or conceal their stigmatized identities from others—a field of study known as outness research. Transgender outness research is a nascent branch of this field. It reflects neither the multidimensional view of disclosure and concealment adopted in other branches, nor the ability to address unique aspects of trans outness, such as the practical challenges of concealment and the difference between concealing one’s gender identity and concealing one’s assigned sex. Consequently, prior literature may not accurately represent the effects of transgender identity disclosure and concealment. This scoping review explores the theoretical and operational definitions of trans disclosure and concealment in 46 English-language papers, identified from extensive database searches, addressing relationships between these concepts and mental health factors. Findings indicate that the issues outlined above remain unresolved, even in the widely-used nondisclosure subscale of the Gender Minority Stress and Resilience Measure, and are rarely recognized as a potential source of error. Although small detrimental effects of concealment and beneficial effects of disclosure on mental health were reported in the reviewed studies, reliable conclusions about these relationships and their importance to health and safety in the trans community cannot be drawn while these shortcomings are overlooked. We encourage researchers to address these neglected areas, reevaluate the language used in measurement questions, and conduct longitudinal research to support an accurate understanding of trans outness phenomena.