Transition-Related Health Outcomes
Self-reported health and wellbeing status
USTS respondents reported poor outcomes across many domains of health and wellbeing—but crucial factors, like social and medical transition, were associated with better outcomes.
- 66% of 2022 USTS respondents reported they were in “excellent,” “very good,” or “good” health, which was substantially lower than the 81% in the general adult population and the 78% in the 2015 USTS.
- Those who had socially or medically transitioned had a higher prevalence of reporting good health compared to those who had not (67% vs. 61% for social transition; 70% vs. 58% for medical transition).
Mental Health
The impact of social acceptance and discrimination
Adverse mental health indicators, such as depressive symptoms, psychological distress, and suicidality, were elevated among respondents compared to the general U.S. population. However, several factors were associated with better mental health, including support from family members. Discrimination and harassment were associated with worse outcomes.
- The lifetime prevalence of suicidality among 2022 USTS respondents was striking—78% reported lifetime suicidal thoughts and 40% reported lifetime attempts.
- Those with supportive families reported less suicidality compared to those with unsupportive families—78% of respondents with supportive families reported suicidal thoughts compared to 88% of those with unsupportive families.
- 31% of those who experienced no discrimination or harassment reported past-year suicidal thoughts compared to 50% of those who were verbally harassed, 53% of those who were denied equal treatment, and 63% of those who were physically assaulted.
Trans Health and Happiness
Gender transition as a source of happiness
Respondents who reported social or medical transition consistently reported higher happiness, thriving, and satisfaction.
- Those who reported social transition more often reported they were “very to pretty happy” (71% vs.52%), “thriving” (36% vs. 18%), and satisfied with their lives (43% vs. 24%) compared to those who have not socially transitioned.
- We found similar results for medical transition and happiness (72% vs. 55%), reports of thriving (37% vs. 19%), and life satisfaction (43% vs. 27%).
Impact of the COVID-19 Pandemic
Masking and accessing public spaces
Respondents were asked questions about their experiences with the COVID-19 pandemic to determine how it impacted the ways in which they move through the world and interact with others.
- Most respondents reported that, in the last 12 months, they went out in public places (such as a grocery store, restaurant, or shopping mall) less than they did before the COVID-19 pandemic, including 27% who went out “somewhat less” than before, 33% who went out “a lot less” than before, and 1% that did not go out at all. Twenty-seven percent (27%) of respondents went out “about the same amount” as before the pandemic, 7% went out “somewhat more” than before, and 5% went out “a lot more” than before.
- Most respondents wore a mask at least some of the time when out in public in the last 12 months, including 28% who wore a mask “all of the time,” 33% who wore one “most of the time,” and 24% who wore one “some of the time.” Twelve percent (12%) wore a mask “a little of the time,” and 4% wore a mask “none of the time.”
General Health and Experiences with Health Care Providers
Health status and access to care
Stigma and discrimination have a significant impact on the health and wellbeing of many transgender people, and they encounter numerous barriers to the medical and mental health care they need to be healthy.
- Approximately two-thirds of respondents reported that their health status was “good” (36%), “very good” (24%), or “excellent” (6%). One-quarter (25%) rated their health status as “fair,” and 9% said it was “poor.”
- More than one-quarter of respondents (28%) did not see a doctor when they needed to in the last 12 months due to cost.
- Nearly one-quarter of respondents (24%) did not see a doctor when they needed to in the last 12 months due to fear of mistreatment.
- Forty-four percent (44%) of respondents experienced serious psychological distress in the last 30 days (based on the Kessler 6 Psychological Distress Scale).
- Seventy-nine percent (79%) of respondents saw a doctor or health care provider within the last 12 months, and 9% saw a provider between 1 and 2 years ago.
- Of those who saw a health care provider within the last 12 months, nearly one-half (48%) reported having at least one negative experience because they were transgender, such as being refused health care, being misgendered, having a provider use harsh or abusive language when treating them, or having a provider be physically rough or abusive when treating them.
Health Insurance
Coverage and issues with insurance companies
- Eighty-seven (87%) percent of respondents had health insurance coverage.
- Approximately 1 in 4 respondents (26%) had at least one issue with their insurance company in the last 12 months, such as being denied coverage for hormone therapy, surgery, or another type of health care related to their gender identity/transition; gender-specific health care because they were transgender; or routine health care because they were transgender.
Gender Identity and Transition
Satisfaction with hormones, surgery, and gender transition
Satisfaction with life since transitioning gender
Nearly all respondents (94%) who lived at least some of the time in a different gender than the one they were assigned at birth (“gender transition”) reported that they were either “a lot more satisfied” (79%) or “a little more satisfied” (15%) with their life. Three percent (3%) reported that transitioning gender made them “neither more nor less satisfied” with their life, 1% were “a little less satisfied”, and 2% were “a lot less satisfied” with their life.
Satisfaction with life after receiving hormone treatment
Nearly all respondents (98%) who were currently receiving hormone treatment reported that receiving hormones for their gender identity/transition made them either “a lot more satisfied” (84%) or “a little more satisfied” (14%) with their life. One percent (1%) reported that hormones made them “neither more nor less satisfied” with their life, and less than 1% said that they were “a little less satisfied” or “a lot less satisfied” with their lives after receiving hormones.
When I was thinking about transitioning with hormones, I spoke to my gynecologist about it. She was absolutely fabulous with sharing the knowledge that she had about testosterone and providers to avoid, but also was open and willing to discuss information that she was not educated about. She sat with me for another 30 minutes taking notes about how she and her clinic can be more supportive of the trans and queer community. I was overjoyed to see the changes the clinic had made when I returned in the following months.
Ashley
Satisfaction with receiving surgery for gender identity/transition
Nearly all respondents (97%) who had at least one form of surgery for their gender identity/ transition reported that they were either “a lot more satisfied” (88%) or “a little more satisfied” (9%) with their life. One percent (1%) reported that surgery made them “neither more nor less satisfied” with their life, less than 1% were “a little less satisfied”, and 1% were “a lot less satisfied” with their life.
Obtaining hormone therapy through the informed consent model and having access to surgery has definitely changed my life for the better. It certainly didn’t fix all of my problems instantly, but it fixed a lot of problems that my dysphoria caused. Now that I’ve been on HRT and had surgery, I can live my day to day life without pain, dissociation, and misery.
Taylor
