When conducting studies on the health of sexual and gender minorities, researchers often clump together transgender, gender diverse, and/or gender nonconforming people with lesbian, gay, and bisexual individuals. Such an approach has limited the amount of information available on how discrimination on the basis of gender identity and gender expression uniquely impacts health.
Although in recent years, research with transgender populations has increased, there are still great gaps in knowledge about transgender health when compared to the amount of information available on LGBQ folks.
Most often, studies on trans individuals explore their psychological problems, risk behaviours (often resulting from coping with discrimination) and identity related-topics, such as transitioning or identity development.
There is also a lack of studies on the specific needs of non-binary people, as well as gender non-conforming individuals. As a result, knowledge on their health problems and needs is very scarce.
The available research on transgender people has revealed high rates sexually transmitted infections, mental health problems (i.e., anxiety, depression), and problematic substance use.
In Ontario, Canada, the Trans PULSE Project, a community research initiative, has been collecting information on the health of trans Ontarians for about 10 years. Some of the most relevant findings include a confirmation of high rates of depression in trans men and women, an increased risk of suicidality (particularly in trans youth and those who were experiencing lack of support and transphobia), and a considerably high number of reports of discriminatory experiences in the healthcare setting (and thus avoidance of the healthcare system).
HIV rates are high among transgender women, and both transgender women and transgender men report sexual practices that put them at risk for HIV infection. Transgender men in particular are more likely to not be up-to-date on Pap tests, which increases risk for a variety of problems, including cervical cancer (Edmiston et al., 2016).
Mental health problems and overall quality of life in transgender individuals appear to improve in the long run with the help of treatment, particular access to hormone therapy for transition purposes.
There are also reports that transgender people experience a hard time finding health care providers who are knowledgeable on how to provide specialized services related to transitioning.
Difficulties in accessing regular healthcare services are also common. For example, a recent survey conducted in Ontario showed that transgender people were 2.4 times more likely to have unmet healthcare needs than cisgender heterosexual women, and 1.6 times more likely to have untreated depression. (Giblon & Bauer, 2017).
Moreover, transgender individuals have been found to be more likely to report discrimination than non-transgender LGBQ individuals.
Other reports indicate that transgender individuals may experience sexual assault/rape more than twice as frequently than cisgender LGBQ individuals.
Trans and gender diverse people are more likely to attempt suicide or think about suicide, as well as to having engaged in non-suicidal self-harm or self-injury (i.e., cutting) than non-transgender people in the overall population.
Trans and gender-diverse resiliency
Factors such as social support, personal agency, access to sensitive mental health services, and advocacy, activism, and community participation, among others, have proven to be valuable when coping with a stigmatizing and discriminating environment. The following are personal accounts of resilience of trans and gender-diverse individuals:
“I am me. And it helps me to know who I am. I am not confused about that fact. People thought I was a gay man, but I knew all along I was a lesbian woman. I was in drag all those years I had to wear jeans and T-shirts growing up. Things got better when I acknowledged to myself, ‘Well, I am a woman. And I might be the only one who knows that, and that’s OK.’”
(Singh et al, 2011)
“My resilience is not necessarily about having control, because Lord knows that I don’t control what is going on and I don’t have control of the people around me. If people are yelling nasty insults at me about being trans, then yes—it’s a lot to deal with. But at least I can be assertive about it and speak up for myself and my own worth. And that feels amazing and sustains me.”
(Singh et al, 2011)
“I tend to surround myself with people who are a little more like me in that they don’t judge people for who they are. I don’t let people get close to me who aren’t supportive and “get it” [being trans-positive]. Having a community of people like me [transgender] has saved me after growing up in a world that denies that I exist. I came to realize that I like consistency and structure in my relationships, and understanding, and that is who is in my community.”
(Singh et al, 2011)
“A lot of my activism work since I’ve become an activist has definitely contributed to my resilience because you know that you can work on something and work on something and put your heart and soul into it and then it just doesn’t work, it up and dies on you. And, you know, there’s all these good things and there’s all these bad things that happen. Being an activist is like being on a roller coaster at Six Flags. There’s this major ups and major downs, emotional highs and emotional lows that is just beyond what normal life is about because you’re seeing things happen that are not just important to you, but important to other people that are your friends and people that you don’t even know.”
(Singh et al, 2011)
“I think that there is a high level of survival instinct in trans culture in general. As transgender people, we have to be resilient. We have to be strong. Because when we say, ‘I am going ahead and making this transition,’ well, we know we could lose everything—our family, our children, our friends, our employment, our places of worship, our standing in the community. And even in some cases, we could lose our lives.”
(Singh et al, 2011)
“During a manic period, I don’t dwell on the transgender aspect as much, not more than I normally do. When I’m depressed, I dwell on it. It [bipolar disorder] is one of those things that has a major impact on how I feel at certain times and it’s not something that I forget. I think, in a way, that’s almost been the key to my successes. Even though I’m generally pessimistic, I’m optimistic to know that when I have my depressions, it’s temporary. Keeping my sense of realism has been a key to my success.”
(trans youth) (Singh et al., 2014)
“I don’t have a complication of living in the dorms. I live off campus. I’m still working on some legal issues. I still show up on the roll under my birth name and I have to—I usually—if I haven’t had a professor before I have to e-mail them at the beginning of a semester and let them know please call me this, don’t call me this, call me Jack.”
(trans youth) (Singh et al., 2014)
“When I attempted suicide in 1997 it was because I felt like my life was going nowhere, that I was not living up to my true potential, like I was stuck. I wouldn’t have used words like ‘trans’ at that time. I was all kind of repressed. It was only when my psychiatrist asked me afterward ‘If your life could look any way you wanted it to, what would your life be like?’ And that’s when I knew the answer was ‘I’d be living as a man.’”
(Moody et al., 2015)
“Now that I live full time in my new identity, the joy of being myself outweighs having to deal with little things that can happen once in a while. Nothing will stop me from becoming the woman that I always wanted to be. I am on the right path. . . . Since my first physical changes and the start of my full-time life in my new identity, my suicidal ideation has disappeared. The happiness of being myself outweighs my suicidal thoughts.”
(Moody et al., 2015)
“If I want to kill myself, or whenever I am severely depressed, I kick my own butt, especially if I’m thinking back on the abuse or trans bashings. If I live in fear, pain or equivalent, then the perpetrators may as well still be right there crushing me. I deserve better than just surviving to live trapped in past horror memories. So I find it in me to trust others again, love my family unconditionally (without that costing me self-dignity and respect) and aim for an even better tomorrow.”
(Moody et al., 2015)
