Transgender adults struggle more with their health, and researchers say they can’t explain away the disparity by pointing to poverty or poor lifestyle habits.
But lead researcher Dr. Carl Streed Jr. did suggest that a theory known as the “minority stress model” might explain the differences.
“The idea is that any population that has experienced stigma and discrimination has that negative experience reflecting in their health” and how they perceive it, Streed explained. He is a postdoctoral fellow at Brigham and Women’s Hospital in Boston.
The findings were not surprising to one transgender health expert.
“Transgender people are still often misunderstood and marginalized,” said Dr. Stephen Rosenthal, medical director of the Benioff Children’s Hospital Child and Adolescent Gender Center at the University of California, San Francisco.
“When I look back over the last eight and a half years I have been involved in this work, I see things moving in the right direction, but there is still a lot to be done,” Rosenthal added.
In the study, Streed’s team analyzed data compiled by state health departments, in collaboration with the U.S. Centers for Disease Control and Prevention.
Since 2014, this surveillance system has included a gender identity question. The researchers looked at the more than 315,000 people who answered the gender identity question in 2014 and 2015. Of that total, about 1,400 identified as transgender.
When Streed’s team compared the two groups, they found transgender people were younger, and less likely to be white, married, cohabitating, have a minor child in the house or be English speakers.
Transgender people were also more likely to be lower-income, unemployed, uninsured and to have unmet medical needs due to costs. They were also more likely to be overweight and to report feelings of depression.
The researchers looked at three outcomes, including self-reports of overall health, limitations due to physical or other problems and issues with concentrating and decision-making. The association with poorer health held even after taking into account factors known to affect health, such as alcohol and cigarette use and whatever health issues the study participants might have already had.
For instance, while 17 percent of non-transgender respondents had poor or fair health, about 23 percent of the transgender people did.
However, Streed said, this is only an association. “Given that our study is a cross section of where this population is now, we cannot definitely say that it is a cause-and-effect outcome based on this data,” he said.
“Other studies have found the same kind of disparities,” Streed said, but the numbers in those studies were smaller and tended to be from one facility, while his team gathered data from many states.
One thing is clear, Streed said. Additional studies are needed to find out more about the disparities. All states and territories should gather the data, he said.
The numbers that Streed’s team found identifying as transgender — about 1 in 300 of the respondents — is consistent with other surveys and statistics, Rosenthal added.
Another transgender expert agreed.
“These findings correspond to our 2015 transgender survey,” said Harper Jean Tobin, director of policy for the National Center for Transgender Equality.
As for Streed’s suggestion that more states should add the gender question to their health surveys, Tobin said, “We strongly support that.”
The study was published online May 30 in the journal JAMA Internal Medicine.
For more on transgender issues, see U.S. National Center for Transgender Equality.