PROJECT SUMMARY Candidate: Daphna Stroumsa, MD, MPH, MSc, is an obstetrician-gynecologist and early career health services researcher at the University of Michigan, focused on improving healthcare access and quality for transgender and nonbinary (TGNB) people. Dr. Stroumsa’s long-term career goal is to become an independent physician-researcher leading the development and evaluation of interventions to decrease health disparities affecting gender minorities. Research Context: TGNB people are a highly marginalized population, with unmet gender-affirming needs and staggering mental health disparities. There is a critical need for effective interventions that address this significant burden. Peer support interventions hold immense promise in providing critical gender affirmation and in countering the effects of stigma on health. It is, however, necessary to understand how best to design and deploy such interventions to meet the specific needs of this population. Specific Aims: The overarching goal of this proposal is to adapt and pilot-test a peer support intervention to decrease mental health disparities among TGNB people. The study’s specific aims are to 1) identify the desired properties and structure of a peer support intervention for TGNB people accessing gender affirming hormones (GAH), and how these vary by intersecting gender and racial identities; 2) adapt a peer support intervention to improve mental health among TGNB people presenting for GAH; and 3) evaluate the feasibility and acceptability of the intervention for improving TGNB people’s mental health in a clinical setting. Research Plan: The plan relies on a community-engaged, structured process with 1) interviews with TGNB people and other stakeholders to identify the desired properties of the intervention, 2) An iterative refinement of the intervention with expert feedback, and 3) A six-month pilot RCT to assess feasibility and acceptability. Career Development Plan: To achieve independence, Dr. Stroumsa requires additional training in 1) Community-engaged research, 2) Adaptation of behavioral interventions for marginalized populations, and 3) Conducting and evaluating clinical trials. Dr. Stroumsa’s training will be supported by an interdisciplinary team of NIH-funded mentors. The primary co-mentors, Drs. Paul Pfeiffer and Rob Stephenson, have extensive mentoring experience and expertise designing and evaluating interventions to improve mental health outcomes with gender and sexual minorities, respectively. Drs. Amy Schulz and Kristi Gamarel (co-mentors) are experts in community-based participatory research and peer-delivered behavioral interventions designed with and for TGBN communities, respectively. The training is further supported by regular feedback from advisors, advanced didactic coursework, and participation in workshops/seminars. These will enable Dr. Stroumsa’s seamless transition to becoming an independent researcher, working to improve TGNB people’s health outcomes by developing and testing patient-centered interventions.

PROJECT NARRATIVE Largely due to intersecting forms of stigma and unmet needs for gender affirmation, transgender and nonbinary people have significantly worse mental health outcomes, compared to the general population. Peers have been identified as a critical aspect of gender affirmation, with peer-delivered interventions offering a promising scalable mechanism for addressing mental health disparities. This proposal aims to leverage a community-engaged approach to identify desired elements of peer support interventions, and to develop and test an intervention to improve mental health outcomes among transgender and nonbinary people.