One Size Does Not Fit All: Differential Transgender Health Experiences By Gender Identity

Background: Transgender and non-binary (trans/NB) individuals experience high rates of health disparities and issues with health care access. These disparities include differential rates of several illnesses and medical conditions, lack of transgender inclusive providers, and fear of discrimination when accessing a provider. Moreover, the majority of research on transgender health either compares rates of issues within the trans/NB community against those of cisgender (non-transgender) people, or explores rates of certain illness, diseases, and risk factors within the transgender community. Few, if any, touch on the differential experiences of trans/NB individuals across gender identities between and within this population. This study poses the questions 1) How do health experiences (such as having medical interventions, having trans inclusive provider, and delaying care due to fear of discrimination) among trans/NB individuals vary across gender identity? and 2) How do other socioeconomic factors such as race, age, income, and education level alter the likelihood of trans/NB young people having these experiences?

Methods: This study was conducted using secondary data analysis of the Colorado Transgender Health Survey (N = 417), co-created by several non-profit and government agencies in Colorado concerned with understanding the health experiences and outcomes of trans/NB individuals. The data analyses used in this paper included descriptive statistics and chi-square tests of independence in order to first determine independence in prevalence of wanting to start or continue hormones/HRT use, having ever used hormones/HRT, and ever having had a gender-affirming surgery across gender identity categories (transfeminine, transmasculine, transgender, and non-binary). Also examined were whether they had a transgender inclusive provider, and whether they had ever delayed care due to fear of discrimination. After this analysis, a binary logistic regression was run for each health experience (trans inclusive provider; any medical intervention; delaying care due to fear of discrimination) to better understand the differential experiences across gender identities, and the role different socioeconomic factors (that were significant at the bivariate level) may play.

Results: The chi-square tests of independence indicated significant differences based on gender identity across the experiences of currently using HRT, wanting to use HRT, having had a gender affirming surgery, having had any medical intervention, having a trans inclusive provider, and having ever delayed care due to fear of discrimination (p < .001 in all categories except having a trans inclusive provider, which was p < .01). The logistic regression models showed significant differential experiences across gender identity, age, education level and sexual orientation. Race, sex assigned at birth, and annual income were not significant and were dropped from the model.

Conclusion/Implications: Given these differences, it’s important for researchers and practioners to not view the transgender and non-binary community as a single unit or identity. Rather, there is a need for both research and practice that reflects the unique experiences across identities within this community, instead of solely in comparison to cisgender individuals. Next steps should include research exploring potential gender identity differences across different mental and physical health outcomes, in hopes of better supporting and treating the needs of this population.