Stirling, Morgan2026-07-222026-07-222026-07-202026-07-202026-07-22http://hdl.handle.net/1993/39890Background: Trans* and gender diverse (TGD) people experience persistent inequities across the cancer continuum. These include inequities in access to care, service quality, and health outcomes. Limitations in cancer health services research (HSR) infrastructure, such as inappropriate gender variables and inadequate approaches to conceptualizing and measuring gender diversity, reinforce these inequities. They also prevent cancer HSR from generating evidence that accurately reflects TGD people’s experiences or supports equity-oriented improvements in cancer care. This thesis aimed to identify barriers to including TGD people in cancer HSR and to develop guiding principles to strengthen how gender diversity is conceptualized, measured, and governed within this field. Methods: This mixed-methods, community-engaged study was informed by community-based participatory research principles. It was guided by a Community Advisory Board of nine TGD people. Quantitative data were collected through an online survey of 91 cancer health services researchers. The survey examined current practices, perceived challenges, and capacity related to gender diversity in cancer research. Qualitative data were collected through five focus groups with 21 TGD people across Canada. Focus groups explored community priorities, concerns, and expectations about inclusion in cancer HSR. Quantitative and qualitative findings were integrated to generate metainferences that informed the development of guiding practices. Results: The findings showed that researchers recognized the importance of including TGD people in research. However, there were gaps in their knowledge, confidence, and institutional support. Entrenched research practices, limited data systems, and competing institutional priorities further restricted inclusion. Qualitative findings highlighted how TGD people experience these barriers. They underscored the need for safety, meaningful visibility, and accountability to community priorities. Integrated findings call for prioritizing researcher training, flexible and inclusive measurement, stronger data governance, and sustained community engagement throughout the research lifecycle. Conclusion: This thesis offers guidance for advancing more inclusive, ethical, and relevant cancer HSR, with implications for improving data quality, research utility, and equity across the cancer continuum.engTransgender and gender diverse peopleCancer health services researchMixed methodsHealth EquityCommunity-engaged researchQueer health research