Documenting research with transgender and gender diverse people: protocol for an evidence map and thematic analysis

The aim of this review is to map and describe how transgender, gender diverse, and Two-Spirit (trans) people have been studied and represented within and across research in the fields of social sciences, sciences, humanities, health, education, and business. There is limited information about the scope of research focusing on trans individuals and communities. Because many people are not aware of the amount of research that has been conducted, this leads to misunderstandings and miscommunication. These beliefs are highlighted in statements by researchers such as “Limited empirical data are available regarding the mental health and general well-being of the transgender population” [1], “There is a dearth of health research about transgender people” [2], and “Literature regarding the gender variant population is very limited” [3]. Such misunderstandings may be particularly troublesome if trans community members are unaware of research that can potentially inform questions they have about their lives. Despite the lack of specific information, both researchers and community members have highlighted the links between research and the oppression of trans people [4‐6]. Systematic research documenting the types of studies that have been conducted over time will provide details about the evidence that does exist and will help to identify opportunities for more responsible research [7] with gender diverse individuals and communities.

There are multiple challenges that restrict our ability to conduct reviews in the area of trans research. The first relates to the terminology used to describe transgender, gender diverse, and Two-Spirit people and the ways this influences search strategies. Language used to describe gender diverse people varies across stakeholder communities including medical diagnoses, terms used within or by communities, and phrases used across cultures and linguistic groups. As this terminology evolves over time [8], it adds to the number of terms that should be included in strong search strategies. A second challenge relates to subject headings, both in terms of the ways these headings reflect trans experience and their inability to remain up to date with language related to gender diversity [9]. These complications necessitate searches beyond subject headings, a process that is made more complex because it is difficult to search terms such as “trans” or “gender identity” by themselves due to the lack of specificity of these terms to the target study records and the consequent number of irrelevant results this produces. It is also necessary for search strategies to include both database-specific headings and independent search terms and to include terms such as mastectomy or vaginoplasty that may be relevant to both cisgender and transgender experience. The term cisgender refers to people who identify with the gender they were labelled at birth, also referred to as non-transgender people. Once searches are complete, screening is complicated by difficulties with identifying whether there are trans participants involved in the studies, or whether the articles are trans-focused, due to information that may be incomplete in the title and abstract. For example, these challenges arise when reviewing references that include trans people as part of larger studies with lesbian, gay, bisexual, trans, and queer (LGBTQ) communities, and surgery-related case reports.

Despite these difficulties, some researchers have attempted to raise awareness of the types of trans research available. One of the earliest examples is an annotated bibliography developed by Denny in 1994 [10]. Published in book format, this bibliography includes early articles, books, and community reports. Since then, we have also seen a slow increase in systematic reviews. Primarily focused in the area of trans health [11], researchers have conducted reviews related to gender dysphoria [12], HIV [13], cancer care [14], mental health [15], learning disabilities [16], support experiences and attitudes of parents of gender variant children [17], gender identity disorder in twins [18], and aging [19]. More commonly, we see trans studies included as part of larger reviews focusing on LGBTQ communities, men who have sex with men (MSM), or other marginalized populations (e.g., [20, 21]).

The proposed research, by incorporating an extensive search strategy, text mining, and evidence map, has the potential to build on knowledge in several fields. At this time, there are no evidence maps of trans research. By documenting this broad field of study, this review will increase awareness of existing trans research, identify evidence gaps, and inform strategic research prioritization [22]. Publishing the map online will also improve access to research for key stakeholders including community members, policy makers, and healthcare providers.

The aim of this review is to map and describe how trans people have been studied and represented within and across multiple fields of research. The objectives are to:

As part of the process of developing evidence maps, it is recommended that researchers clarify concepts and engage key stakeholders in considering the potential scope of the review [27]. Accordingly, individual consultations were held with members of trans and cisgender communities to discuss terminology, search scope, and potential uses of an evidence map. Based on the results of consultations and pilot searches, the eligibility criteria were established to include all original research studies of any design, reported in English language peer-reviewed journals, that identifiably included trans people or their information, such as medical or surgical case reports with single participants, trans-focused qualitative or quantitative research, and population survey data that adequately identify trans or gender diverse participation.

Initial identification of potential databases was based on the goal of obtaining the broadest range of studies about trans people from multiple fields including social sciences, sciences, humanities, health, education, and business. A secondary emphasis was to gather research from countries and cultures around the world. For example, in order to properly capture research about gender diverse Indigenous people, three databases focused on Indigenous and First Nations research were included.

Once a draft list had been identified, overlap analysis of potential databases was conducted by a health sciences librarian [28‐30]. Specifically, PubMed was chosen to capture the content not included in MEDLINE through Scopus [28]. Fifteen databases were selected to ensure the identification of diverse study designs [31] including Academic Search Premier, Anthropology Plus, Bibliography of Native North Americans, CINAHL, First Nations Periodical Index, Indigenous Studies Portal, LILACS, ProQuest Social Sciences Premium (contains Sociological Abstracts, ERIC, Social Services Abstracts & Applied Social Sciences Index and Abstracts), PsycINFO, PubMed, SciELO, Scopus, Social Work Abstracts, Web of Science, and Women’s Studies International.

Search terms focus on transgender, gender diverse, and Two-Spirit identities and experiences. The search strategy is provided in Additional file 2. Because there are multiple terms used for (and/or by) trans people, and this language continues to shift over time [8], the full list of search terms is extensive and consists of terms related to gender identity (e.g., “trans woman”), diagnoses (e.g., “gender identity disorder” and “gender dysphoria”), medical and surgical procedures (e.g., vaginoplasty), terms used in a range of countries and cultures (e.g., hijra, waria, travesti), and language used historically (e.g., “transvestite”).

Data extraction will focus on creating an evidence map emphasizing the extent and distribution [34] of trans research studies. The following information will be collected for mapping: study topic; study design, methods, and data sources; recruitment strategies; sample size and demographics (gender identity, sexual identity, race/ethnicity, age, geographic location, education, and income); terminology used to describe trans people; researcher name and affiliation; geographic location of data collection; funding source; and year of publication. Because we do not extract health-related outcomes, this evidence map has not been registered with PROSPERO.