Understanding sustainable return to work during gender transition, a (mixed method) diary-based single-case study of...

Psychosocial obstacles have been recognized as a significant factor in the return to work (RTW) for cisgender individuals with various health issues. RTW and sustained work participation of transgender and gender diverse (TGD) people during socio-medical transition have been sparsely investigated. Transgender women face multifaceted challenges in the workplace, in life, in social relations, and regarding their gender-affirming healthcare.

To better understand sustainable RTW during socio-medical transition, we aimed to analyze the evolution of emotional-, psychosocial-, and RTW measures and chronological experiences during twelve months following (genital) gender-affirming surgery. Data from a mixed-method diary-based critical case study of a trans woman undergoing socio-medical transition was analyzed using a reflexive thematic analysis.

Four themes were integrated with longitudinal quantitative results of positive and negative affect, gender-affirmation, and work rehabilitation measures. Results show a fluctuating course of emotions, expectations, and confronting reality (and workability), which gravely impacted self-esteem and overcompensation behaviors. They show social isolation in an uphill fight against stereotypes and power dynamics in information flow whilst insecurely navigating the cisnormative work environment and healthcare. RTW sustainability seems to adhere firmly to gender affirmation, gender comfort, and individualized, dynamic, holistic support from several stakeholders. By integrating longitudinal quantitative and qualitative data, a patterned meaning analysis of lived experiences and reflections was found.

This study sheds light on the fluctuating dynamics of social relations and gender (dis)comfort at work and helps us better understand psychosocial obstacles in sustainable (return to) work and creating a person-centered environment sensitive to these challenges. Occupational health professionals should thus educate themselves on gender-inclusive care, address barriers to access, and empower TGD workers in a tailored manner while involving the immediate work environment and striving for diversity and inclusion among all workers.