The Health Status of Gender Minorities

Duke University, Durham NC

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Abstract

ABSTRACT Background: The transgender (TG) community experience health disparities associated with individual factors, such as gender identity and expression. To date, the majority of TG health-related studies have taken a narrow view of health by focusing on mental health outcomes and cross-sex hormone therapy, and frequently conceptualized health as the absence of engagement in health-harming behaviors. For example, TG adults have an increase in overall mortality, higher levels of psychological distress, substance abuse, and a suicide attempt rate that is nearly ten times higher than the general public. In those few instances where physical health is the focus, it is often examined in relation to gender transition or HIV/AIDS. For instance, TG women of color have a 49 times higher odds of HIV infection compared to cisgender (CG) adults worldwide, and United States TG adults have over four times the national average of HIV infection. Additionally, the use of hormones is associated with an elevated risk for cardiovascular and venous thromboembolic disease, polycythemia, and an increase in insulin resistance and fasting glucose. Findings also indicate that TG adults have unfavorable risk factors and worse health than their CG peers, but this has not been examined among TG subpopulations. Methods: Data from the CDC's 2014 Behavioral Risk Factor Surveillance System, and a modified version of the social ecological model, designed to guide understanding of health and health promotion, will be used to determine the relationships among individual factors and health status for TG subpopulations. The overall goal of this secondary analysis is to increase understanding of the relationships with individual factors (personal characteristics and socioeconomic position) and health status among TG adults to inform the development of clinical interventions and changes in clinical practice and in policy. The specific aims of this study are: Aim 1: Describe and compare the personal characteristics (age, race/ethnicity, geographic classification, and sexual orientation), socioeconomic position (education, employment status, and income), and health status of three TG subpopulations (male-to-female, female-to-male, and gender nonconforming individuals) and a CG comparison group. Aim 2: Determine the relationship between individual factors (personal characteristics and socioeconomic position) and health status in three TG subpopulations and a CG comparison group. Aim 3: Evaluate differences in health status in three TG subpopulations and a CG comparison group while taking into account the influence of individual factors. Significance: Findings will inform the design of future studies by determining the importance of defining and examining TG subpopulations, identify and prioritize health-related needs, and provide the foundation to develop clinical interventions aimed at reducing the burden of illness in TG people.