Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services

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Demand for gender dysphoria (GD) treatment has increased markedly over the past decade. Access to gender-affirming treatments is challenging for most people. For dysphoric individuals, much is at stake. Little is known about the specific needs, challenges, and coping strategies of this hard-to-reach group. We examined the experiences of treatment-seeking adolescents and adults using in-depth unstructured interviews with 26 people attending specialist gender services and 14 transgender people not referred to services. Patients with gender dysphoria distrust clinical services and describe considerable anxiety in sustaining their impression management strategies to obtain treatment. An authentic presentation is regarded by some participants, especially non-binary individuals, as inauthentic and emotionally difficult to maintain. Impression management strategies have partial success in accessing services. The presentation of “idealized” selves may result in unmet mental health needs of patients, and the receipt of interventions incongruent with their authentic selves.

Original languageEnglish
Pages (from-to)3539-3549
Number of pages11
JournalArchives of Sexual Behavior
Issue number8
Early online date5 Nov 2021
Publication statusPublished (in print/issue) - 30 Nov 2021

Bibliographical note

Funding Information:
We wish to thank our experts-by-experience (Adrienne Elson, Jennifer Clifford, and Michael Steven) who have been an integral part of this study throughout. We also want to thank staff members in both specialist gender services and staff and volunteers in the voluntary organizations (Affirm N.I., Belfast Butterfly Club, Belfast Trans Resource Centre, Cara Friend, Common Youth, Focus Trust N.I, Gender Essence, Rainbow Project, and Trans Pride N.I.) for their support of this study and their tireless recruitment of participants. Our biggest thank you goes to all the participants who have generously shared their experiences.

Funding Information:
Katrin Lehmann was supported by the Public Health Agency Northern Ireland 2016 Research & Development Doctoral Fellowship EAT/5219/15 to undertake the GIFTS study.

Publisher Copyright:
© 2021, The Author(s).


  • Service experience
  • Impression management
  • Gender dysphoria
  • Mental health
  • Gender Identity
  • Transsexualism
  • Transgender Persons
  • Attitude
  • Humans
  • Adolescent
  • Adult
  • Gender Dysphoria/therapy


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