Author ORCID Identifier


Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Eric Benotsch


Transgender individuals face particular challenges when interacting with a cisgender focused medical system. Gender-related medical misattribution and invasive questioning (GRMMIQ), colloquially known by the tongue-in-cheek named “trans broken arm syndrome,” is a form of medical discrimination wherein a healthcare provider assumes that a transgender patient’s medical complaints, regardless of origin, result from their gender identity or medical transition. Previous research has suggested that this, and other forms of identity-related discrimination both in and outside of healthcare, might be understood either using a top-down approach focused on stereotypes founded in schema, or a bottom-up approach examining perceived typicality. One additional theory, the Dynamic Interactive Theory of Person Construal, suggests that top-down and bottom-up processing approaches occur in a rapid and interactive fashion. Exploring GRMMIQIQ through multiple lenses, as through the Dynamic Interactive Theory of Person Construal, might allow for not only a greater understanding of the causal antecedents of GRMMIQIQ experiences, but also a greater understanding of how these theoretical frameworks may function and may be leveraged to understand real world circumstances.

Study 1a used the reverse correlation (RC) technique to generate unique classification images (CIs) reflecting average mental representations of Black and White, transgender and cisgender women. Participants (N=198) completed the RC procedure which was then used to develop CI images for study 1b. In study 1b, CI images were categorized as “cisgender” or “transgender” and rated by US based participants (N = 201) on multiple dimensions. While participants reliably categorized cisgender CIs as “cisgender,” transgender CIs were not reliably categorized as “transgender.”

Study 2 follows this by using a point of subjective equality (PSE) person perception framework to explore how varying degrees of perceived gender atypicality in digitally modified visual stimuli might yield transgender identity status categorization. Participants (N=152) classified 22 digitally morphed images as either cisgender or transgender in a two-interval forced choice task. Images that crossed the PSE threshold (i.e., images that had a greater than 50% likelihood of being classified as “transgender”) and had the highest likelihood of being classified as “transgender” were used as the “perceived transgender” stimuli in study 3, while the corresponding base images were used as the “perceived cisgender” stimuli.

Study 3 recruited students who were in healthcare training programs that could yield a diagnostic professional position (i.e., MD, DO, NP, and PA programs; N=103). Participants were then presented with a standardized acute care vignette reflecting a woman experiencing symptoms consistent with a closed, isolated fracture of the medial malleolus (i.e., a type of ankle fracture), one of the four visual stimuli, and one of two medical histories. In a four-minute period, participants read the scenario, and provided a diagnosis, their perspectives as to the causal antecedents of this diagnosis, and any further questions they might like answered. Medication consistent with hormone replacement therapy (HRT) was listed and standardized in all conditions. Responses were coded for the presence of GRMMIQ as it related to HRT. The impact of target race, visual gender typicality, and explicit gender identity on invasive questioning and medical misattribution was assessed using a multiple linear regression approach. While all overall models were non-significant, several potential explanations, including a lack of power, may have attributed to these findings. Overall, invasive questioning was noted in the responses from 9 participants (8.8%), while potential or explicit medical misattribution related to HRT was noted in in the responses from 20 participants (19.6%). Taken together, results from all three studies suggest that categorization and perception of transgender individuals is significantly more complex and nuanced than categorization of other groups. Future research should extend the results on transgender perception and categorization, while also exploring other potential avenues by which GRMMIQ may occur.


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