Health, economic, and social disparities among transgender women, men, and transgender nonbinary adults: Results from a population-based study (2022)

Karen Fredriksen Goldsen, Meghan Romanelli, Charles Hoy-Ellis, & Hailey Jung

This study is one of the first population-based studies to investigate health, economic, and social disparities among subgroups of transgender men, women, and nonbinary adults. The current study analyzes population-based data to provide new insight into patterns of inequity across transgender subgroups, as well as highlight the need for further research into the disparities in health, economic, and social outcomes that may be observed across the gender spectrum.

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The study included 47,894 individuals who completed the Washington State Behavior Risk Factor Surveillance System (BRFSS) gender identity question. 0.5% (n=181) of those respondents self-identified as transgender.

Economic Risk

Income less or equal to 200% of FPL:

Transgender adults (56.2%)
Cisgender adults (34.1%)

Transgender adults had higher odds than cisgender adults for income at or below 200% of the federal poverty line and education levels of high school or less.

Increased risk for transgender women

Transgender women faced increased odds of socioeconomic risk, including lower income, less education, and lower employment rates. Transgender women were older on average than other transgender subgroups and may be additional affected by ageism.

Income less or equal to 200% of FPL
Education high school or less

Social Disparities

Transgender men were more likely...

to be single than cisgender men and women. Transphobia within both the general population and sexual and gender minority communities may contribute to smaller pools of potential relationship partners for transgender men.

Married or partnered:

Transgender men (24.4%)
Cisgender men (60.1%)
Cisgender women (57.6%)

Transgender women were more likely...

to have fewer children than cisgender men and women and were more likely to live alone than transgender nonbinary and cisgender respondents. Consequences of this social exclusion and isolation may contribute to adverse health outcomes.

Live alone:

Transgender women (35.9%)
Transgender nonbinary (10.9%)
Cisgender adults (16.2%)

Mean number of children:

Transgender women (0.3)
Cisgender women (0.7)
Cisgender men (0.6

Health Risks and Resiliency

Financial access to needed care

Despite a majority receiving healthcare coverage and having a primary care provider, many transgender adults experienced financial barriers to healthcare access.

Received healthcare coverage:
Have a healthcare provider:
Experienced financial barriers to healthcare:

Transgender men at risk for chronic health conditions

Despite a younger average age and engaging in preventative healthcare, transgender men were at higher risk for chronic health conditions than cisgender men and women. Transgender men face discriminatory healthcare practices and a higher likelihood than transgender women and nonbinary adults of interacting with a doctor with low trans-competence, which may contribute to this risk.

Received a routine checkup
Received a flu vaccine in the past year
Had been tested for HIV in their lifetime

Many transgender adults demonstrated resiliency by participating in health-promoting activities at a similar rate as cisgender adults, despite barriers to healthcare access.

This study is one of the first population-based studies to include transgender nonbinary people and investigate differences within the transgender population. However, small samples sizes for each subgroup may make it more difficult to detect significant differences in data. Additionally, data from Washington State may not generalize nationally. Future analysis with larger sample sizes is needed to further investigate significant differences between subgroups.

Recommended citation: Fredriksen Goldsen, K. I., Romanelli, M., Hoy-Ellis, C. P., & Jung, H. (2022). Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study. Preventive medicine, 156, 106988. DOI: 10.1016/j.ypmed.2022.106988

© Goldsen Institute 2023, University of Washington, Seattle, WA.

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