Trans Health in People of Color

Cartoon of a racially diverse group of young people

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In the United States, individuals who are part of minority groups often experience health disparities. These disparities can be even more profound for individuals with intersectional identities who are part of multiple minority groups.

Transgender people of color, for example, have been shown to be an increased risk of a number of negative health outcomes when compared to their white transgender, or people of color cisgender, counterparts. This reflects discrimination and stigma against transgender people of color as well as longstanding systematic inequities that affect their healthcare access.

Trans, Trans*, or Transgender

Terminology around gender diversity is constantly evolving. Although this is a good thing, it can make it difficult to determine what the most appropriate language is in any given situation. There are legitimate criticisms around the terms trans, trans*, and transgender, and preferences for these terms differ strongly across groups.

Some criticisms that have been applied to each of these terms at various times include:

  • They fail to be inclusive of individuals who fall outside the gender binary.
  • They are only appropriate for individuals who are interested in social, medical, or surgical affirmation.
  • They are not descriptive enough in a given setting.

For the purpose of this article, transgender refers to individuals who identify with a gender other than that which would be expected for someone of their assigned sex at birth.

It will be used as inclusive of individuals with both binary and non-binary genders and those who don't wish to, or can't, access medical or surgical gender affirmation. While recognizing that this is not the term that everyone prefers, it is widely understood and can be interpreted broadly, as long as its limitations are explained.

Health Disparities

Most research on trans people of color focuses on specific racial and ethnic groups rather than transgender people of color more generally. This reflects the highly varied experiences of people from different racial and ethnic groups. The experiences of Black transgender people can be quite different from those of Latinx, Middle Eastern, or Asian transgender people.

Transgender people are known to experience elevated rates of a number of negative health outcomes when compared to cisgender people. These include both mental and physical health outcomes.

These health disparities are thought to largely be the result of minority stress as well as structural and individual concerns around healthcare access rather than any gender or race driven differences in behavior or risk. Social determinants of health have profound effects on transgender people of color, as well as people from other groups.

HIV is one of the most well-studied areas in which transgender people of color are known to be at elevated risk. One large study of transgender people found that Black transgender respondents had HIV rates (6.7%) almost five times those of the overall transgender population (1.4%) and more 20 times that of the general population (0.3%).

Those rates were even higher for Black transgender women (19%). However, transgender people of color have also been found to have higher rates of other conditions such as arthritis, lupus, and asthma, than their White counterparts.

Healthcare Discrimination

The 2015 National Transgender Discrimination Survey (NTDS) is one of the largest, if not the largest, surveys on the health and other life experiences of transgender people in the United States.

According to the NTDS, Black, Latinx, American Indian, and multiracial transgender people were more likely to be uninsured than their white counterparts. Trans people of color were also more likely to avoid going to the doctor for fear of mistreatment.

Transgender people of color have different experiences when accessing healthcare than their White or cisgender counterparts. Research suggests that the combination of racial and gender minority status can complicate healthcare access in a number of ways.

For example, while patients might prefer providers of their own racial or ethnic background to address racial bias, they may have greater fear around disclosing their gender identity to those providers. Some communities of color are less accepting of gender diversity than others.

Individuals who are concerned about healthcare discrimination are more likely to avoid or delay care. This can exacerbate underlying health problems, when people can not engage with preventative treatment. It can also cause long term health problems when people are afraid to access emergency room care after negative previous experiences.

Fears of discrimination are not unfounded, and there is substantial data that transgender individuals experience mistreatment and denial of care by healthcare providers across a variety of settings.

Access to Transgender Healthcare

Not all transgender individuals are interested in medical or surgical gender affirmation. However, medical and surgical gender affirmation are also not equally available to all transgender people.

To the extent that transgender people of color are more likely to be uninsured or underinsured, they may also be less likely to be able to access affordable gender affirming care.

Access to care may also be more difficult for transgender youth from communities of color, if their communities are less accepting of gender diversity or less aware of treatment options. There are limited data suggesting that transgender youth of color are underrepresented in referrals to gender affirming care in both the United States and Britain.

The Transgender Umbrella

In this article, transgender is used as an umbrella term to describe all individuals whose gender identity isn't what would be expected for their recorded sex at birth. Sometimes, instead of using an umbrella term, people will refer to the "trans umbrella" or "transgender umbrella." This phrase is most often used to recognize and support the diversity of transgender and related identities.

A Word From Verywell

There is a growing awareness of the need to do a better job educating healthcare providers about the needs of transgender youth and adults. However, the relative lack of research on the healthcare experiences of transgender people of color, outside the context of HIV, also points to a need for even affirming providers to expand their understanding of transgender health.

Transgender people of color may experience healthcare disparities due to their multiple minority status, but they can also experience extraordinary resilience when supported by their families and communities.

Healthcare providers, and associated personnel, can support the development of that resilience by offering gender affirming care to all patients, and recognizing that the transgender umbrella covers people of all races and ethnicities.

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