How COVID-19 Affected Trans and Nonbinary People's Health

Many transgender and nonbinary people already face barriers when accessing gender-affirming care. Now, a new study finds that the COVID-19 pandemic only exacerbated these existing challenges.

Researchers from Johns Hopkins University and the University of Michigan conducted a survey between April and August 2020 across the LGBTQ+ social networking and dating apps Hornet and Her. They surveyed 964 individuals from 76 countries, including Turkey and Thailand.

"We saw this in the U.S. with the disproportionate impact COVID-19 had on racialized minorities and economically marginalized people," senior study author S. Wilson Beckham, PhD, an assistant scientist at Johns Hopkins Bloomberg School of Public Health, tells Verywell. "Our study hypothesized that this would be true for transgender and nonbinary people and that the communities’ mental health and access to care—which is already constrained—would be worse."

The study was published in the PLoS One journal in July.

For the study, participants answered questions on how COVID-19 has impacted their access to gender-affirming care. The researchers found that 55% of the trans and nonbinary participants had difficulty accessing one or more of the following resources:

• 35.7% of participants had difficulty getting hormone therapy and/or gender-affirming medications.
• 33.4% of participants had reduced access to surgical aftercare.
• 37.8% of participants had difficulty getting cosmetic supplies and services.
• 42.9% of participants had reduced access to mental health counseling and therapy.
• 36.1% of participants had trouble accessing body modifies like binders.

People's experiences varied slightly based on if they are transmasculine, transfeminine, or nonbinary. This extended to mental health as well. While almost half of the individuals screened positive for anxiety and depression, these rates were higher for transfeminine people. In addition, around 3% or more of transfeminine people noted having increased suicidal ideations in comparison to transmasculine people.

"Even though I know that trans and nonbinary communities faced so many challenges pre-pandemic, I still found our main study findings surprising and heartbreaking," Brooke A. Jarrett, MPH, a corresponding author of the study and global health epidemiologist at Johns Hopkins Bloomberg School of Public Health, tells Verywell.

The Importance of Gender-Affirming Care

Gender-affirming care is crucial for trans and nonbinary people.

"These affirmations are particularly crucial for trans and nonbinary folks, who constantly face discrimination, rejection, and stigma," Jarrett says. "Living in one’s gender with the help of hormone therapy, haircuts, body modifiers like packers, surgery, and other kinds of gender-affirming resources, that can help balance the equation."

It's also not the same for everyone. One trans woman may decide to have hormone treatment and undergo gender confirmation surgery, also known as gender-affirming surgery. Meanwhile, another trans woman may decide that gender confirmation surgery is not right for them.

This care, whatever it best looks like for a given trans or non-binary individual, is important for a person's wellbeing, especially at a young age. One study published in the Pediatrics journal found that children who received gender-affirming care benefited psychologically.

Financial Cost of Gender-Affirming Care

The expensive cost of gender-affirming care can also be a huge barrier for people who are low-income.

"It takes money to express one’s gender, whether that’s hair removal, wigs, binders to flatten chests, new clothes, and hairstyles, or legally changing one’s name and gender marker," Beckham says. "Those types of changes are out-of-pocket, and often out-of-reach for youth or for people who are struggling financially."

The cost of medical procedures and treatment related to gender-affirming care leads to some trans and nonbinary people turning to unregulated treatment, which could be dangerous for their health.

"Trans and nonbinary folks who don’t have financial resources for professional gender-affirming care may also resort to less conventional and unregulated means, like buying hormones on the street, which can be dangerous to one’s physical health," Jarrett says.

The study found that around 15% of trans and nonbinary people lost their jobs, and for a large majority of individuals, this was their only stream of income.

"This study absolutely shows that transgender and nonbinary people have needed, and will likely continue to need, extra support as a result of the COVID-19 pandemic," Jarrett says. "A lot of trans and nonbinary people were already disproportionately affected by issues like homelessness and food insecurity, and COVID-19 really came in and was the last straw."

Delayed Surgeries

Due to the COVID-19 pandemic, many procedures viewed as elective have been delayed, including gender-affirming surgeries.

"For many transgender folks, those surgeries are essential," Angela Kade Goepferd, MD, the chief education officer and vice chief of staff for Children’s Minnesota, the Medical Director of Children’s Minnesota Gender Health Program, tells Verywell. Goepferd emphasizes that gender-affirming surgeries can be "life-saving" for trans and nonbinary people who need them.

Even in non-pandemic times, trans and nonbinary people often have to wait months or even years to get the surgeries that would affirm their gender identity.

"The other thing is that many trans and nonbinary folks have waited months and in some cases years to get the surgeries," Goepferd says. "They have saved the financial resources. They've gone through the hoops that they've needed to do in terms of getting letters from medical and mental healthcare providers."

For trans and nonbinary people who live in the U.S., these waits could also be prolonged by federal policies. In June 2020, the Trump administration initiated policies that rolled back protections preventing providers from refusing care based on someone's gender identity, which the Biden administration reversed in May 2021.

However, according to the American Medical Association, there are 30 states which allow transition-related care to be excluded from insurance coverage.

How to Better Support Trans and Nonbinary People

Cisgender relatives and friends of trans and nonbinary people can help alleviate some of these stressors by making their homes more inclusive.

"Taking the time to ask questions to understand the family member and what's important to them [is important]," Goepferd says. They add that this includes asking someone which pronouns they would like you to use and if it varies per situation, like what they should use in the home versus with an extended relative who may be transphobic.

Human Rights Campaign also recommends that cis people try to do the following in their everyday lives to be a better ally to trans people:

• Familiarize yourself with different pronouns, normalize saying your own, and asking for others
• Practice using inclusive language, like saying "guests" instead of "ladies and gentlemen"
• Be mindful of microaggressions, such as "I could never guess you're trans"