Gender Confirmation Work, Rest, and Symbolic Boundaries in (Trans)Gender Support Groups

Research on transgender identity and community boundaries has developed steadily over the last decade, but many of the inquiries center around personal identity boundaries and development rather than collective boundary drawing. To understand how and why gendered symbolic boundaries are drawn and enforced in shared spaces, I collected and analyzed qualitative data from thirteen in-depth interviews with trans people in gender support groups in the United States. I investigated the symbolic boundaries that members of gender support groups draw around who “counts” as trans, who is welcome in the groups, and factors that influence boundary drawing. I found that trans participants engage in high amounts of emotional work, that I term gender confirmation work, to uphold their gender identities in a cisnormative world. Consequently, gender support groups function as space of rest from work, and boundaries are drawn to ensure rest inside the groups. My study on gender support group membership boundaries advances new terms to describe trans people’s response to gender-based harm. My findings also demonstrate how trans people—a marginalized population—employ group strategies for navigating cisgender-dominant society.

Gender support groups-spaces where people congregate around the common themes of gender identity and expression-are one way that trans people cope with transphobia (Johnson & Rogers, 2020).Gender support groups positively affect transgender people's mental health by normalizing the trans experience, providing social support, and empowering trans people (Johnson & Rogers, 2020).Contact with transgender peers is crucial to enhance resilience in the face of discrimination (Austin & Goodman, 2017;Bariola et al., 2015;Bockting et al., 2013;Schrock et al., 2004).
Transgender support groups exist for transgender people; however, the boundaries of who is considered transgender are contested by the public and by trans people themselves.Today, "transgender" broadly refers to individuals whose gender and/or sex does not align with the gender and/or sex assigned to them at birth.Although "transgender" is often used as an umbrella term (Stotzer, 2009), transgender and non-binary people themselves do not share a unified understanding of whom that umbrella includes (Darwin, 2020;Jacobsen et al., 2022;Sutherland, 2021).Given the contested boundaries of transgender identity and the importance of gender support groups, understanding how transgender identity symbolic boundaries are managed, debated, enacted, and enforced is important for understanding who has access to, and benefits from, gender support groups.
In this study, I interview trans people who participate in gender support groups and investigate the symbolic boundaries they draw to decide who belongs in their groups and why, using the frameworks of symbolic boundaries and gender normativity.Symbolic boundaries are mental parameters drawn to designate who or what belongs in or out of a group or category (Lamont & Molnár, 2002).My research questions are: What are the symbolic boundaries that transgender people construct around who is transgender?What are the symbolic boundaries they construct around who is welcome or unwelcome in gender support groups?What factors shape the symbolic boundaries that participants draw around transgender identity and support group membership?I draw on qualitative data from thirteen indepth interviews I conducted with self-identified transgender adults in the United States who regularly attend a gender support group.
I find that in response to near-constant transphobia, participants modify their emotions and behavior to affirm their identities and maintain safety.All participants engage in this work, which I term gender confirmation work.Gender support groups offer spaces of rest from gender confirmation work, and therefore participants draw boundaries to protect a space of rest inside gender support groups.Participants conceptualize various levels of group welcomeness based on gender confirmation work and rest, which I analytically organize into four distinct categories.
My findings demonstrate the unique ways in which trans people form collective identity using symbolic boundaries.In doing so, I identify a link between trans marginalization and symbolic boundary drawing within trans communities.My conclusions demonstrate that harmful social systems and cultural beliefs about gender affect how transgender people form collective identity and membership boundaries.This reveals that symbolic boundary construction is undertaken as an effort to mitigate gender-based harm.My findings also show that gender support groups can construct counter-narratives to transphobic normative gender systems, which is vitally important for trans people's wellbeing (Bockting et al., 2013).
Transnormativity is another normative gender structure that only acknowledges trans people if they conform to certain ideas of trans identity (Johnson, 2016).Transnormativity supposedly provides validity to transgender experiences-offering an alternative to conforming to cisgender bodies and experiences (cisnormativity).In essence, transnormativity makes transgender people somewhat legitimate to their cisgender counterparts.Some transnormative ideas include knowing you were trans from a very young age, seeing being transgender as a medical issue, and only recognizing binary genders, among others (see Bradford & Syed, 2019).
Transnormativity marginalizes those who are gender non-conforming or otherwise not in line with transnormative ideals (Johnson, 2016).Some trans people invalidate non-normative trans people's identities (Bradford & Syed, 2019).Garrison (2018) and Darwin (2020) find that some transgender and non-binary individuals, especially those who deviate from transnormative ideals, feel excluded from the trans community, or feel trepidation using the term "trans" to describe their identity-a form of marginalization.
Participants must cope with cis-/trans-normative interactions (Mizock & Mueser, 2014).Participants "cope" with cis-/ trans-normativity by doing work to manage their gender and identity (Austin, 2016;Goffnett et al., 2022;Johnson & Rogers, 2020;Mathers, 2017;Schrock et al., 2009;Stallings et al., 2021).Arlie Russell Hochschild (1979) describes how social actors manage their outward presentation and manage internal feelings during social interactions.Hochschild coined the term "emotion work" to describe the work people do to modify their emotions (Hochschild, 1979, p. 561).Discursive aggressioncommunication during social interaction that coerces people into performing social norms (shuster, 2017)-puts pressure on trans people in social situations to do this "emotion work" and regulate how they express and perform their gender: this forces trans people to engage in work out of self-preservation (shuster, 2017).Prior to this study, an umbrella term did not exist to describe the specific types of work transgender, nonbinary, and gender diverse individuals engage in.

Boundary-Drawing
Some trans people rely on normative gender structures (cisnormativity and transnormativity) to determine who is considered trans and welcome in the trans community.Sutherland (2021) finds that on Reddit, about two-thirds of trans participants restrict who can be considered transgender, which Sutherland calls bounded identity.Other research finds a similar phenomenon on Tumblr (Jacobsen et al., 2022).Bounded identity membership strategies include believing a trans person must experience gender dysphoria, must be clinically diagnosed with gender dysphoria, or must desire to have gender-affirming surgeries and take hormones to identify as trans (Sutherland, 2021).Bounded identities closely align with cisnormativity and transnormativity, privileging trans people seeking medical transition and following gender normative narratives.
In some contexts, however, trans people resist both cisnormativity and transnormativity, and instead construct gendered counter narratives (Bamberg & Andrews, 2004) that conceptualize gender in alternative ways (Miller, 2019;Sutherland, 2021).Sutherland (2021) finds that on Reddit, one third of trans participants use an unbounded identity membership strategy to determine whom to consider "trans."Unbounded refers to the "wide and inclusive acknowledgement of all transgender-identities and expressions that may fall under the trans umbrella" (Sutherland, 2021, p. 7), meaning these participants do not restrict who can consider themselves "trans."Jacobsen et al. (2022) also find that on Tumblr, some trans people validate anyone claiming a trans identity, i.e. they are unbounded.Unbounded trans people reject essentialist ideas about gender, therefore rejecting cisnormativity and transnormativity (Sutherland, 2021).Instead, unbounded trans people rely on gendered counter narratives, such as self-identification and non-dysphoric gender transition (Sutherland, 2021).
Recent studies demonstrate increased self-identification of trans identity (Factor & Rothblum, 2008).Jacobsen et al. (2022) and Sutherland (2021) reveal intracommunity discourse in drawing symbolic boundaries of trans identity-there is more than one way that trans people themselves draw trans identity boundaries.Furthermore, bounded and unbounded groups reflect two distinct gender ideologies; the former uses a transnormative medical model of trans identity while the latter constructs counter narratives that resist gender normativity.The work of Garrison (2018), Darwin (2020), Sutherland (2021), andJacobsen et al. (2022) serves as a foundation for understanding trans community boundary drawing and discourse, however, further inquiry is needed to understand the factors that influence boundary drawing, as well as how symbolic boundaries of trans identity may be unique in trans-dominated spaces such as gender support groups.
Understanding boundaries within gender support groups is especially pertinent given that Schrock et al. (2004) finds that groups' goals (namely providing support) are sometimes obscured by identity discourse.There are no studies, to my knowledge, that investigate the membership boundaries, either symbolic or material, that determine who is welcomed into gender support groups.There are also no studies, to my knowledge, that investigate the factors that influence trans membership boundaries.Addressing these gaps in the literature reveals new social phenomena that transgender people engage in (gender confirmation work and rest) and contributes to understanding "transgender" as a social category and community.

Method
I conducted a qualitative study looking at trans adults in the United States who are part of gender support groups.I recruited participants through online outreach, interviewed thirteen participants during Fall of 2021 and Fall of 2022, and then coded and analyzed the data using MaxQDA 2022.

Eligibility Criteria and Recruitment
I recruited interview participants who identified with the label "trans," regardless of their gender identity-meaning I spoke with women, men, and non-binary people.In addition to identifying as trans, all participants had to be over the age of 18, reside in the United States, and attend a synchronous (either in person or over video call) gender support group within the past two years.
This study used purposive sampling to theoretically generalize from the population (Sharma, 2017).I recruited participants through the social media platform Reddit and through gender support group outreach across the U.S. I shared fliers on transgender-related Reddit forums and emailed support groups from major cities asking leaders to share the flier during their support group meeting and/or circulate the flier on their listserv.Most participants came from Reddit rather than direct support group outreach.Potential participants filled out a questionnaire to establish eligibility.I contacted qualified participants for an interview and sent them an electronic consent form.The consent document was reviewed again by me and the interviewee at the beginning of each interview.

Data Collection
This research project is based on approximately sixteen hours of semi-structured, in-depth qualitative interview data from thirteen participants.I use a qualitative approach focusing on the experiences of a small population, and my analysis showed that I likely reached data saturation (Baker & Edwards, 2012) with thirteen interviews.I collected preliminary data in October-November of 2020, and I conducted the subsequent ten interviews the following September of 2021-January of 2022.I held interviews over the video conferencing platform Zoom, and interviews were recorded via Zoom for later transcription.The interview durations ranged from 51-109 minutes, with an average duration of 73 minutes.
Interview questions were open-ended and semi-structured to allow participants to freely share their understanding of trans and cis identity in relation to their support group.The interview guide contained three main sections: personal identity (how one identifies, how one came to understand their gender identity, if/when they came out), general transgender social experiences, and gender support group experiences.These themes sought to capture the experiences of being trans inside and outside of support groups, as well as participants' perspectives on who is welcome.I used broader questions, as well as scripted probing questions, to get at these themes; additionally, I asked unscripted followup questions to increase data richness.
I developed the first iteration of the interview guide in September of 2020.Preliminary data collection suggested additional areas to explore that I didn't originally include, so I modified the guide in August 2021 and again in October 2021.During modification, I consulted with a fellow trans researcher.I followed up with the first two interviewees to seek feedback on the questions.It is also important to note that the interview guide uses gender-inclusive language that avoids putting participants on the defensive; I aimed to create an inclusive, non-judgmental atmosphere.

Participant Demographics
I use pseudonyms to protect the privacy of all interviewees (see Table 1).Five participants identify as "women" and/or "female," one identifies as "binary trans male," two participants identify as "non-binary" or "genderqueer trans masculine," two participants identify as "non-binary trans women," and three participants identify as "non-binary/gender fluid."All participants self-identify as "trans," regardless of their gender identity.Several of the participants use multiple gender identity labels.Ten interviewees identify as white, while the remaining three interviewees identify as Chicano, Black, or Mexican/Latino.Ages range from twenty to fifty-nine years old with most participants in their twenties (n = 7) or thirties (n = 4).All but one participant indicated a queer sexuality label.Participants come from all over the country; however, several of them reside on the West Coast-in California (n = 6), Washington (n = 2), and Oregon (n = 2).The remaining participants (n = 3) reside in New York, Pennsylvania, and Michigan.Most participants identify as middle class, while three participants identify as lower-middle class, poverty level, or low income.Three participants identify as upper middle class, and one remaining participant identifies only as "student." Participants were members of a gender support group at the time of, or within the two years prior to, the interview.Two of the participants were moderators for their groups.All participants were part of a gender support group that welcomed mixed genders (not specifically for trans masculine people, trans women, etc.).Four participants had either been in additional support groups in the past or were currently part of multiple support groups.In these cases, interview questions covered all the support groups that participants were part of, with a focus on the mixed-gender group(s) they were currently active in.
These gender support groups met at least once a month, and sometimes as often as twice a week.Generally, the spaces functioned to provide medical transition support, social support and connectedness, legal documentation support, and emotional support.Group size ranged from several people to several dozen people.All the gender support groups were synchronous, either in-person or over a video platform.

Data Analysis
I analyzed interview data using abductive analysis (Timmermans & Tavory, 2012).Literature review prior to data collection gave me glimpses into potential themes; however, I did not have a formal hypothesis or code system before data analysis.I considered the role of transphobia and cisnormativity in previous research findings on transgender During and after each in-depth interview, I took analytic memos on my initial insights, as well as on similarities between interviews.I began transcribing the interviews using the transcription software Sonix shortly after conducting them, but I did not begin coding analysis until all the interviews were conducted and transcribed.The transcribed interviews were then edited for grammatical clarity.
Once the interview transcriptions were edited, I used MaxQDA 2022 coding software for coding and analysis.I initially used line-by-line open coding, looking for emergent themes and patterns.I reviewed already coded data for each new interview.Through this process I developed a coding tree, at which point I reviewed the codes again and re-coded interviews to include newly developed codes.I wrote analytic memos throughout this process as I developed new insights.As the coding structure became more refined and analytic patterns began to emerge, I wrote analytic summaries of data findings.At this stage, themes of gender confirmation work and rest emerged, and it became clear that these concepts are foundational factors in the symbolic boundaries drawn by gender support group members.

Reflexivity and Social Position
Reflexivity in research accounts for a researcher's position in society and relationship to participants (Finlay, 1998).Studying gender can create potential marginalization and inequality because gender is often an "axis of inequality" (Johnson, 2015).I employ a transfeminist methodology (Johnson, 2015) to minimize unintentional intersectional harm against trans people.My aim is to analyze and report findings in a way that reflects the experiences of the trans participants without relying on cisnormative ideas of gender and sex.I am particularly attentive to ways in which gender support group membership boundaries may uphold or resist gendered narratives such as cisnormativity and transnormativity.I identify as a white, queer, neurodivergent, genderfluid man who is trans.I am educated and come from a middle-class background in a liberal area of the U.S. My interest in this study blossomed out of my own experiences in gender support groups, where I first found a trans community.Through these experiences, I am able to connect with participants about being trans and part of gender support groups.

Results
Gender support group participants draw symbolic boundaries around membership in their gender support groups to avoid doing gender confirmation work, and instead experience rest.Gender confirmation work is gendered emotional and physical work trans people do in response to widespread cisnormativity or transphobia and to affirm their gender identity and/or stay safe.Rest is the feelings of relief, decompression-and sometimes joy-that transgender people experience while engaging in interactions that do not require gender confirmation work.
My participants conceptualize four distinct symbolic membership boundary categories, which I analytically group as the following: unbounded trans and questioning people, unbounded cis exceptions, bounded trans people, and bounded cis people.These categories' welcomeness in support groups depend on if they necessitate gender confirmation work from group members (in which case they would not be welcome) or maintain rest (more likely to be welcome).Although gender support groups' boundaries do not gatekeep transgender identity, they remain restricted spaces that function to facilitate rest.Table 2 presents the major themes.

Gender Confirmation Work and Rest: Factors in Symbolic Boundary Drawing
My findings reveal that participants symbolically draw membership boundaries based on factors of gender confirmation work and rest.Participants recognize that they are oppressed by social structures that privilege cisgender people and punish transgender people (cisnormativity).They engage in gender confirmation work to compensate for harm and loss of identity.Doing work leads to exhaustion, so participants seek spaces of rest from gender confirmation work.Therefore, participants draw support group membership symbolic boundaries based on maintaining rest in their support groups.They deliberate: Who will require us to do work, and who will let us rest?

Gender Confirmation Work
We are modifying how we present ourselves [in order] to meet cisgender norms.Anabel, white non-binary trans woman Participants must cope with cisnormative interactions (Mizock & Mueser, 2014;shuster, 2017), and to do so they engage in multiple types of gendered work, which extend to almost every facet of social life and are unique to the gender-expansive experience.This finding warrants a new term to group the various types of work that trans participants undertake, which I term gender confirmation work.Gender confirmation work is gendered emotional and physical work trans people do in response to widespread cisnormativity and transphobia to affirm their gender identity and stay safe.Gender confirmation work includes any response to An in-depth exploration of all the various types of gender confirmation work is beyond the scope of this article; however, participants' interview responses point towards gender confirmation work in nearly all facets of participants' lives: employment, education, healthcare, public spaces, family, and friends.Gender confirmation work, as seen in my data, includes behaviors such as: hypervigilance and awareness of surroundings and presentation; managing emotions of fear and unease; putting effort into passing; managing trans identity disclosure; explaining their identity to others; and socially isolating.Gender confirmation work includes both emotional work as well as the physical work that trans people undertake.
During employment, Carly, a white trans female participant, explains self-segregating from other women in the women's locker room because she is transgender: When I was [using the women's locker room] … I hadn't changed a whole lot physically … I was here mentally, but physically I was still mostly a guy and using the ladies locker room … [so] I was doing a lot of self segregating, behind a curtain somewhere.
Carly describes physically segregating herself based on her gender, a form of gender confirmation work that protects her from possible harm or negative reactions to being in a women's locker room early in transition.At school, Ezra, a Mexican genderqueer trans man, describes how: I literally have to think about how I'm sitting in a lecture hall because if I sit a certain way, I feel like I'm too feminine.And so there's little bits and pieces of your everyday experience as a trans person that a cis person would never have to think about.
Ezra modifies the way they sit to be perceived in a masculine way and "pass."Out in public, Riley explains how "I'm usually slightly on guard.I just have to self-soothe constantly, and I'm like, this is so much work, I don't want to be doing this all the time … it's just a lot of work."Riley describes how they feel on guard in public and in cisgender-dominated spaces, identifying the need to take measures to stay safe.In response to this need, they engage in gender confirmation work by "selfsoothing," consciously managing their emotions and actions.Riley's statement explicitly mentions the work it takes to be hyper aware of their gender for their own safety.
Athena describes how this work needs to be done to confirm trans people's existence: They see us and say, "Oh, what do you have in your pants?"Fuck you.That's the least interesting part about me … And at the same time, to make any of this better at all, we have to be public.We have to show that we exist and are normal and unremarkable in every meaningful way.We have to find a million different ways to reframe and rephrase our lives and experience so that it fits into other people's metaphors for existence.Cis people's metaphors for existence.We have to strategize about different ways to talk about how we are not mistakes.
Athena explains how trans people must explain their lives and experiences to fit cisnormative expectations.She understands that trans people must publicly explain themselves if they hope to contribute to a better society for trans people to exist in.She implies that since society sees trans people as "mistakes," trans people must counteract the "mistake" narrative by doing gender confirmation work.If they do not engage in gender confirmation work, they risk being seen as "mistakes." Doing gender confirmation work is exhausting.Participants share how they are "tired" and negatively affected by doing gender confirmation work on a regular basis.Riley, a Black genderfluid non-binary trans person, describes how engaging with cis people about their gender is a "shock to [Riley's] system."The words "shock" and "system" allude to bodily harm and illustrate the connection between engaging in gender confirmation work-even purely emotional-type work-and experiencing negative physical effects.Qris, a Chicano trans person, explains how "Trans people have to be ambassadors … [and] I'm tired."Similarly, Sam, a white trans feminine person, explains that having to prove her gender to other people "can get tiring, hard, exhausting."Participants clearly express feelings of harm and exhaustion from doing gender confirmation work; the harm and exhaustion necessitate a space to be able to rest from gender confirmation work.

Rest
When I'm around community, it's golden.

Riley, Black genderfluid trans non-binary person
Trans people join gender support groups for a respite from fear, shame, and stress (Schrock et al., 2004).All my participants view gender support groups as a space of rest from the onslaught of cisnormativity and transphobia, and therefore rest from gender confirmation work.I conceptualize rest as the relief, decompression-and sometimes joy-that transgender people experience while engaging in interactions that do not require gender confirmation work.Rest is the absence of stress from cisnormativity, transnormativity, and resultant gender confirmation work that trans people engage in day-to-day.Rest cannot occur in cisnormative or transnormative interactions.Rest allows people to engage in gendered narrative decompression, or emotional decompression from cisnormativity.
One participant, Qris, explains how in gender support groups he is able to rest from gender confirmation work.In public, around mostly cisgender people, he feels the "internal panic" that comes with being transgender in the U.S.However, in gender support groups: I can unload the [internal panic during social interactions].[I can say] "this is what happened to me today."And everyone will be like "OK, I know, I get it," in a way that you can't really do with cis people unless you explain … they won't get why that was so draining for you.
Qris feels understood instead of needing to explain and work to affirm their gender (gender confirmation work), which brings Qris a sense of relief and decompression.They explain: "it's like how you come home after grocery shopping and you can just drop all your bags on the floor and kick off your shoes and take off your coat and just like, oh, finally."Qris describes this feeling of decompression and rest as the weight of gender confirmation work comes off their shoulders.
Other participants express similar feelings of rest and decompression inside support groups.Anabel, a white trans feminine participant, explains that "there's a sense of being among my people, not having to explain things."Again, Anabel feels the camaraderie with others who do not demand gender confirmation work.Ezra, states: It's so nice, because I don't have to worry about ensuring my voice is deep enough or like presenting "correctly" because they're still going to see me as trans, whether I'm in a dress and talking [in] my high-pitched voice or if I'm working on lowering my voice … and I'm binding that day.I'm still trans no matter what to them.And that just takes a weight off my chest.
Ezra describes the powerful feeling of rest in their gender support group because inside their group, he does not need to engage in the gender confirmation work of modifying his voice or dressing a certain way in order to confirm who he is.
Participants see rest as a major purpose for their groups, and feelings of rest are often achieved in gender support groups (Schrock et al., 2009).Piper explains that the purpose of her group is "for everybody to unload," using "unload" as a synonym for rest.James explains how a goal of his group is to "[try] to make sure everybody's comfortable."Ensuring everyone's comfort provides rest from harms that happen outside of these groups.Riley also articulates that rest is a primary goal of their gender support group: For my gender … I need a space in which I don't need to over explain myself, and I can feel like I can just be along with people of my peers and community without working extra hard.(Riley) Not only does rest happen in the gender support groups; rest is a principal goal.

Symbolic Boundaries: Gender Support Group Membership
Group Boundary Negotiation: Unbounded Trans Identity, Bounded Behavior All participants conceptualize trans identity in an unbounded way.Homogenous unbounded boundary drawing means a priori that participants reject gender normativity: cisnormativity and transnormativity.For participants, the only requirement for being trans is self-identifying as trans.Anabel comments that "you can be trans just by saying 'I'm trans!'"And Adrian believes that "ultimately it's really up to the person" to claim trans identity.Participants rely on self-identification to make sense of who is part of the trans community.This differs from the bounded transgender classifications, in which trans membership necessitates certain requirements to be "truly" trans (Jacobsen et al., 2022;Sutherland, 2021).Because participants are unbounded, the gender support groups I studied do not gatekeep which transgender identities are allowed into gender support groups.Participants, on principle, let those who self-identify as trans into the group, regardless of their gender expression, the terms they use, or their transition plans.
Gender support groups nevertheless maintain membership boundaries, even while keeping trans identity unbounded.Those who require gender confirmation work from participants are unwelcome, while those who uphold rest are welcome, not always aligning with having a trans identity.Since gender confirmation work is a patterned response to cisnormativity and transphobia, those who take intentional steps to break away from cisnormativity and challenge transphobia require less gender confirmation work from trans people.Consequently, those who resist cisnormativity are welcome in gender support groups, while those who are cisnormative are less welcome in gender support groups.Anabel explains how "if you have people who come in [to the group] who are completely normative … you have to treat them with kid gloves because they've got their fragility."If someone who is [cis]normative comes into the group, she, as well as other group members, must engage in gender confirmation work to avoid resultant cisgender fragility, which is, parallel to white fragility (DiAngelo, 2018), defensiveness that cisgender people express in response to non-cisnormative gender experiences or person(s) (Oaster, 2019).Because of this, disengagement from cisnormativity is an important marker for group welcomeness.Bunny, a gender support group member and facilitator, explains how they "don't let anyone who will police other members of the group."Recognizing the goal of rest inside their group, Bunny resists letting people in who would inhibit rest by policing others.
Based on the motive of rest, participants share conceptualizations of whom they welcome into gender support groups.I grouped these conceptualizations into four categories of "welcomeness" using Sutherland's (2021) un/ bounded terms.Each category requires different amounts of gender confirmation work from participants.The more gender confirmation work a potential participant requires from others, the less likely that the individual is welcome into a gender support group.Conversely, the more likely a potential member contributes to rest in a support group, the more likely they are welcome.
Those most welcome in gender support groups are unbounded trans and questioning people.Participants welcome others in this category because they don't require gender confirmation work.Participants also view people in these categories as needing rest: gender support groups are made for them.The second category is bounded cis exceptions, which includes cis people who reject cisnormativity and are therefore allowed into the groups on account of not requiring gender confirmation work as well as not threatening the rest in the support group spaces.Category number three is bounded trans people: trans people who, despite being trans, perpetuate cisnormativity and are therefore not welcome in support group spaces because they necessitate gender confirmation work.The fourth category is bounded cisgender people.This category includes the majority of cisgender people (minus the cis exceptions from category two), and participants identified high levels of gender confirmation work demanded by this group.
Category One: Unbounded Trans and Questioning People Trans and questioning people who are unbounded are most welcome in the support groups.All the study participants belong to this category, and membership in this category is uncontested.Unbounded trans and questioning people are readily welcomed into the support groups for two reasons: not requiring gender confirmation work and needing rest.Bunny explains how their group serves trans people, unless the individual in question would police other unbounded trans group members: "The space is for trans people … anyone who has experienced transphobia in any of its forms … [however] I don't let anyone who will police other members of the group."Being trans/questioning and unbounded functions as the "gold standard" for group membership; there is no membership deliberation for this group.
Unbounded questioning people are also welcome into the support group without contention because participants believe that questioning individuals challenge cisnormativity by virtue of questioning their gender; they are not a threat to maintaining rest.Sam describes how she started to deconstruct cisnormative ideas about gender as soon as they began questioning their gender: "I feel like I've been kind of deconstructing the idea of what passing is in my head ever since I first had questions about gender and what gender means."Deconstructing gender as a once-questioning person was her reason for welcoming in other questioning people; she assumes other questioning people have also attempted to deconstruct (normative) gender ideas.
Category Two: Unbounded Cis Exceptions Participants overwhelmingly do not welcome cisgender people into their support groups.However, unbounded cis exceptions are welcome in gender support groups on a case-by-case basis.This category includes cisgender people who expend significant effort distancing themselves from cisnormativity and do not police participants' trans identities inside the support groups.These cis exceptions always contribute to rest in the gender support groups: they do not require gender confirmation work from participants, and they resist cisnormative ideas about gender.When a cis exception does exhibit cisnormativity or requires gender confirmation work, participants question their inclusion in the group.In this way, participants see those in category two as unlikely exceptions to the symbolic boundaries that typically bar cis people from gender support groups.
When participants allow a cis exception into the group, they always reference rest.Sophie describes why her group includes a cisgender person: The cisgender girlfriend, she's coming there to enable someone, right?… It doesn't feel like she's interloping.She was literally there to help her partner come and show up at all to be supportive, and she didn't talk about herself … it's not a good move to completely bar cisgender people from coming to support group like this.Sophie thinks it is okay for the cis partner to be in the group because she helps the trans participant feel comfortable coming to the group.The cis partner helps achieve rest for the trans partner.Athena explains how the cis exceptions in her group understand the harm induced by discrimination against transgender people.She continues, describing how her trans-cis partner group is a space of rest where trans people are accepted and supported, even by the cis members: We take you as you are.We accept.We support, we love.With cis people doing it too, right alongside.It's proof that this shit can work and work on a bigger scale, that it doesn't have to keep being this way.
Athena explains that in this specific space, if cis people are unbounded, rest is still achieved.She asserts that if cis people were unbounded and stopped being cisnormative, they too would be allowed in the group.This is not to say that trans people would not still want a bounded space, but it shows that the inclusion of cis exceptions is based on their ability to do harm OR maintain rest.
Category Three: Bounded Trans People I don't want people to feel like their identities are invalid.Bunny, white non-binary trans participant Bounded trans people are transgender people who restrict who they consider a valid trans person.Their bounded view of trans identity is cisnormative.My participants give examples of bounded trans people not accepting non-binary trans people, or believing one must want bottom surgery in order to be trans.
The validity of bounded trans people's transness is not questioned by participants-they are seen as unquestionably trans, and their trans validity is not what makes them unwelcome.Bounded trans people are unwelcome in the gender support groups because of their cisnormative and/or transphobic ideologies that then require gender confirmation work from group members.Bunny asks a question before welcoming someone into their support group: One of the most important vetting questions is "is there any demographic as a group who identifies as LGBTQ who you don't believe belongs?"The only acceptable answers would be pedophiles or transmedicalists.If they answer with he/him lesbians 5 , non-binary people, trans people without dysphoria … any kind of exclusionary answer is an immediate red flag.
For Bunny, asking a potential member who belongs in the group is important because it identifies if that potential member might police other LGBTQ identities and therefore require gender confirmation work and not contribute to the space's goal of rest.Athena mentions a fundamental rule of her group: "You are not allowed to use your journey to judge or challenge anyone else's."Athena uses "your journey" as a metaphor for a member's trans identity, which they may not use to police other's trans identities.
Anabel describes how a bounded trans person left the group after being unwilling to change their behavior: We had one person in the group who said some things that were invalidating of non-binary identities, and the group facilitator made it clear … [how] that is not acceptable.We have to enforce these group boundaries in that it needs to be a safe space for people with diverse experiences and people are feeling not valued in that.
Anabel states explicitly that her group boundaries must be enforced to maintain a safe space-a space that allows rest.The person in her group was unwilling to be unbounded, and, because they invalidated certain trans experiences, the support group was not a space of rest with that member present.Jade also describes someone in her group who restricted trans identity: "they were one of those people who were validating certain trans experiences over others … I think they were forced out [of the group].And once they were forced out, the group as a whole was healthier."Describing the group as "healthier," Jade prioritizes rest as a key factor in support group membership boundaries; a group that prioritizes rest does not symbolically (or physically) welcome bounded trans people.
Category Four: Bounded Cis People All the participants resist welcoming bounded cis people in the gender support groups.Bounded cis people include cis people who uphold cisnormativity and/or transnormativity.This category of cisgender people is the vast majority of cis people, and participants categorize these cis people as "the norm" for how they view cisgender people as a whole in relation to group membership.
Bounded cis people are unwelcome in gender support groups based on their ability to cause harm and require gender confirmation work from trans participants.Jade describes her reasoning for excluding cis people: "I guess a lot it is to keep out the people that are threatening."Jade wants to keep cisgender people out of her group because they may disrupt her space of rest.She describes discomfort when cis people are present, and, conversely, feeling comfortable around those who share her experiences: "When they're there, there's almost like a pressure to be accepted."The "pressure to be accepted" is a feeling associated with gender confirmation work.She recognizes that cis people have the power to influence her emotional state.Bunny describes doing gender confirmation work when a cis person is present in their gender support group: "for me, when a cis person is occupying the space, I police myself, and my words.Often not necessarily because I care about their comfort, but because I care about mine."Bunny feels compelled to engage in gender confirmation work because they are protecting themselves from the harms of cisnormativity and transphobia-which Bunny expects cis people to perpetuate.Therefore, they resist allowing bounded cis people into their group.

Discussion
This study demonstrates that the trans community constructs spaces and communities that avoid reproducing cisnormativity and instead construct gendered counter narratives, allowing for rest, in an effort to heal from systems of harm.Therefore, gender normative structures (requiring gender confirmation work), and the relief that comes with the absence of normative structures (rest), are salient factors in support group collective identity formation and symbolic boundary drawing.Enabling trans people to dictate and construct boundaries in order to facilitate rest is critical to fostering community and receiving emotional protection from harm.
My conceptualization of gender confirmation work offers a new layer of analysis with which to understand transgender oppression.Although gender confirmation work describes the unique experiences of transgender and other non-cis individuals, gender confirmation work parallels other marginalized people's experiences of doing work.Black professional women engage in emotion management and survival strategies to cope with gendered racism (Durr & Harvey Wingfield, 2011).Disabled people engage in "hidden labor" while interacting with nondisabled people to increase their autonomy (Scully, 2010).
Gender confirmation work provides a unique analysis of trans-related work done as a response to transgender oppression.Using previous research that describes various forms of work that trans people engage in (Austin, 2016;Goffnett et al., 2022;Johnson & Rogers, 2020;Mathers, 2017;Mizock & Mueser, 2014;Schrock et al., 2009;shuster, 2017;Stallings et al., 2021), gender confirmation work groups these types of work already identified into a broad category, which can be used to understand how work for transgender people is far-reaching and a response to harm.
My conceptualization of rest expands previous understandings of transgender social connectedness (Austin & Goodman, 2017;Bariola et al., 2015;Bockting et al., 2013;Testa et al., 2014) and gender support groups (Barr et al., 2016;Johnson & Rogers, 2020) as important factors in transgender people's wellbeing.Rest may be a protective factor leading towards transgender wellbeing, and it is especially salient in conjunction with trans people's need to do gender confirmation work.Gender confirmation work leads to emotional exhaustion, and so gender support groups provide a space to escape from constant (gender confirmation) work, therefore leading to rest: feelings of relief, decompression, and joy for unbounded trans participants.Rest allows participants to engage in gendered narrative decompression and escape the dominant gender narratives of cis-and trans-normativity.

Limitations and Future Research Directions
My findings may be limited by the racial homogeneity of the people I interviewed.Most of the participants (n = 13) are white, with only three participants identifying as people of color.Gender confirmation work is a response to gender-based harm, so those whose lived experiences include intersections of racism and transphobia likely have additional forms of work unique to their intersecting identities.Two of my white participants mentioned their groups have difficulty attracting people of color, which may indicate racist dynamics within spaces that aim to be spaces of rest for trans people.Future research should pay attention to other forms of exclusion that occur within and outside (trans)gender support groups.
Given that disengagement from cisnormativity and transnormativity (leading to rest) requires one to be unbounded, the fact that my sample consists only of unbounded people is likely representative of general gender support group membership, since rest is the principal goal.Bounded transgender individuals are not welcome because they are unable to facilitate the rest necessary to bolster trans wellbeing.This is significant because bounded trans people, as part of the transgender population, also face high levels of discrimination and mental health issues (James et al., 2016), and not having access to gender support groups may be detrimental to their social and mental health outcomes.Future research should investigate the experiences of bounded trans people, as well as the generalizability of gender support groups being unbounded.How may gender confirmation work, rest, and boundary drawing processes of bounded people differ from those of unbounded trans people?Furthermore, are there gender support groups that are bounded?If so, do membership symbolic boundaries look different?
As gender confirmation work is a new concept in the literature, future research should focus on building out different subtypes of gender confirmation work (which I plan to undertake).Some types of work have been identified, such as explaining work (Austin, 2016), identity management (Goffnett et al., 2022), disengagement coping (Mizock & Mueser, 2014; see also: other types of coping), and selfpolicing (Jauk, 2013).However, my analysis reveals various other types of work and indicates that gender confirmation work extends to virtually every sector of transgender people's social and personal lives.

Practice Implications
My work has important implications for policy and practice.Transgender patients would likely benefit from medical care providers who understand gender confirmation work.Therapists working with trans patients may help trans people heal from the harm and exhaustion of gender confirmation work.
Healthcare workers are often unprepared to provide adequate care to transgender patients-they often require work from trans patients while providing care unrelated to the patient's gender (Newman et al., 2021).Educating healthcare workers on gender confirmation work may help them provide care without necessitating gender confirmation work from transgender patients.

Conclusion
This qualitative study examined how transgender adults in the United States construct membership symbolic boundaries in gender support groups, specifically looking at who is welcome in gender support groups and factors that influence welcomeness.The study aimed to provide a theoretical connection between systems of harm (cisnormativity, transphobia, transnormativity) and trans identity and membership symbolic boundaries, and explore the symbolic boundaries participants draw.My findings demonstrate how transgender identity, gender confirmation work, and rest shape boundary-work.My findings broaden our understanding of transgender community boundary drawing as well as provide new layers of analysis on the responses to gender-based harm in the trans community.

Table 1
Participant DemographicsNote.All demographics are raw data that come directly from participants' self-identification.

Table 2
Summary of Major Themes So that this has been the philosophy since at least since I joined, but we let people decide for themselves if they belong"(James).We do one meeting per quarter where anybody from anywhere of any gender can come, and there are certain things you don't necessarily talk about … We don't talk about "shit, do I need bottom surgery?"Not when it's an open-door meeting.Because so many cis people see us as a spectacle.As strange or deranged or weird" (Athena).92%cisnormativityor transphobia that results in the modification of one's emotions or behaviors with the goal of confirming one's gender identity and/or staying safe from trans-specific violence/discrimination.It is an umbrella term for different facets of trans-specific physical/emotion work that must be done to maintain safety in and/or interact with the larger cisnormative milieu.