Comparing the Health of Transgender Women, Transgender Men, and Gender Non-Conforming Individuals Using Population-Level Data

Abstract

Converging evidence indicates transgender and gender non-conforming (TGNC) individuals generally experience poorer health than their cisgender counterparts. Less is known about TGNC health across gender identity subgroups. Extant work has yielded mixed findings, precluding conclusions regarding the comparative health of transgender women, transgender men, and gender non-conforming individuals. Additionally, this work is limited methodologically, e.g., utilizing convenience samples and operationalizing “transgender” differently across studies. This study aims to improve upon these limitations, and more broadly add to the literature on within-group health differences among TGNC individuals. We used 2016 U.S. population-level data (N = 1,117), conducting MANCOVA (multivariate analysis of covariance) and logistic regression to compare the health of transgender women, transgender men, and GNC individuals. Health outcomes of mental and physical health, substance use, and healthcare access/utilization were selected based on empirical and theoretical support for their relevance to TGNC health. We also completed interaction analyses to test the intersectional effects on health of gender identity and emergent sociodemographic variables, e.g. race/ethnicity. Across TGNC subgroups, individuals reported similar alcohol use, mental health, and healthcare access/utilization. Transgender men reported worse physical health than their counterparts, and GNC individuals reported lower smoking prevalence than their counterparts. Interaction analyses by race/ethnicity indicated Hispanic transgender women reported worse physical health than other Hispanic TGNC individuals, while Black transgender men, Multiracial GNC individuals, and Hispanic transgender women reported worse mental health than some of their intra-racial/ethnic TGNC counterparts. Findings add to the growing literature on TGNC health and highlight TGNC subgroups that may be vulnerable regarding mental and physical health.

Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center

“…Non-binary is (commonly and in this paper) used as an umbrella term to describe the diverse and nuanced ways individuals experience and identify their genders outside of/not represented by "man/male" or "woman/female" (cis or trans), including, for example, bigender, agender, genderqueer, genderfluid [10,11]. Recent research indicates that non-binary individuals have higher odds of self-reported poor health due to mental or emotional difficulties and are likely to experience more symptoms and worse mental health outcomes compared to binary transgender (i.e., transgender men and women) and cisgender individuals [8,[12][13][14][15][16]. These findings can be interpreted through the lens of minority stress theory [17,18], which proposes that health disparities result from exposure to unique forms of stress, additive to the stress experienced by the general population.…”

Understanding nonbinary college students’ experiences on college campuses: An exploratory study of mental health, campus involvement, victimization, and safety.

“…Moreover, our work adds important nuance to findings about the mental health of nonbinary people, which tends to be grouped with all TGNC students together and indicates poor mental health outcomes (Budge et al, 2013; Downing & Przedworski, 2018; Jones et al, 2019; Lefevor et al, 2019; Lipson et al, 2019; Marshall et al, 2016; Oswalt & Lederer, 2017; Valente et al, 2020). Some previous work has explored the mental health outcomes of nonbinary adults (Guy et al, 2020; Jones et al, 2019), but less work has explored the mental health of nonbinary emerging adults. Future research should explore mental health longitudinally among nonbinary individuals with special attention to the potential improvement of outcomes as they develop coping mechanisms as they reach early and middle adulthood, as is true of their cisgender peers (Diehl et al, 2014; Leipold et al, 2019).…”

Testing Substance Use as a Mediator of Structural Stigma-Cardiovascular Health Associations in a Large Sample of Gay Men and Lesbian Women

“…64 To control for weighting-related sample inflation and potential weight instability in inferential statistics, we multiplied each case's _LLPCWT value by (Unweighted N/Weighted N) to preserve the original N. This approach aligns with recommendations and previous studies. [77][78][79] Missing Data. We assessed data missingness a priori given evidence for data missingness in related studies.…”

“…We assessed data missingness a priori given evidence for data missingness in related studies. 77,78 Missingness analyses included Little's Test, univariate missingness, and multivariate missingness patterns. 80 Strategies for handling missingness were chosen based on results from the SPSS Missing Values Analysis module and subsequent literature review.…”

“…We controlled for demographic covariates, using previous related research to inform covariate selection. 77,78 We acknowledge that other covariates also reasonably could have been selected, for example, healthcare access or engagement. 108 Additionally, consistent with extant research on mediators of SGM health, this study did not include a heterosexual comparison group.…”