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Former US Olympic athlete Bruce Jenner captured the world's attention when he announced that he was a woman trapped in a man's body. The media covered the gruelling transitioning process, and when Bruce emerged as Caitlyn, she was featured on the cover of Vanity Fair magazine.
New research has found that transgender adults struggle more with their health than other people, and researchers say they can't explain away the disparity by blaming poverty or poor lifestyle habits.
The study was published online in the journal JAMA Internal Medicine.
The 'minority stress model'
Lead researcher Dr Carl Streed Jr. suggested 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.
Social rejection and violence are an unavoidable struggle, causing distress and dysfunction for transgender individuals.
A great divide
According to a Health24 article, transgender identity was classified as a mental disorder in both of the world’s main diagnostic manuals, the WHO’s ICD-10 and the American Psychiatric Association’s DSM-5. A major component of the definition of mental disorders is that they are associated with distress and dysfunction.
The findings were not surprising to one transgender health expert.
"Transgender people are still often misunderstood and marginalised," 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 South Africa, there are only two public hospitals where gender reassignment surgery is carried out – Groote Schuur Hospital in Cape Town and the Steve Biko Academic Hospital in Pretoria. South Africa is also the only African country to offer constitutional protection against discrimination based on sex, gender and sexual orientation as stated by the South African Litigation Centre.
Gender identity survey
In the study, Streed's team analysed data compiled by state health departments, in collaboration with the US 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 report feelings of depression.
Outcome-based research
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% of non-transgender respondents had poor or fair health, about 23% 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."
"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 one 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.
Supporting someone who is transgender
It's not always easy for partners, family members or friends to deal with the news that someone close to them is transgender, but you can still maintain a strong relationship with the transgender individual if you:
- Recognise how important your love, acceptance, and support are to them.
- Learn more about their situation and struggles – show that you care enough to make an effort to read, ask questions, and educate yourself.
- Trust that what they are doing is right for them, that they have not made decisions light-heartedly but rather after years of consideration.
- Use their preferred name and pronoun correctly and treat the person in keeping with their gender identity.
- Appreciate that their basic character, temperament, and personality will most likely remain the same as before, with all admirable qualities intact.
Read more:
Chelsea Manning: what is gender identity?
