The Health Status of Transgender and Gender Nonconforming Adults

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Contemporary, empirically-based knowledge of transgender health is scant and lacks understanding of physical health, health problems or impairments, chronic health conditions, and the impact of individual factors known to affect health outcomes in other vulnerable populations such as socioeconomic position and sexual orientation (Bowleg, 2012; MacCarthy, Reisner, Nunn, Perez-Brumer, & Operario, 2015). Despite a growing body of health-related literature, additional research is needed to advance our understanding of health among transgender subgroups such as male-to-female (MTF, transgender women), female-to-male (FTM, transgender men), and gender nonconforming (GNC) adults. This knowledge will help prioritize health needs and identify pathways to improve the health and reduce the health inequities plaguing the transgender population in the U.S. (Feldman et al., 2016; Institute of Medicine, 2011).

The purpose of this dissertation research was to establish evidence regarding the health of transgender and GNC adults in the United States. Specifically, this dissertation 1) reviewed current literature on the experiences of transgender adults when they access and utilize healthcare, 2) identified and addressed methodological concerns related to conducting transgender health research using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), and 3) explored the health status of three transgender subgroups (MTF, FTM, and GNC adults) and their cisgender male (CGM) and cisgender female (CGF) counterparts. Health status analyses included 1) bivariate logistic regression models and one-way analysis of variance methods to test for study group differences in individual factors and health status, and 2) multivariable logistic regression models to determine the differential effects of individual factors on health status in the five study groups. A posteriori pairwise contrasts of the study groups were conducted when a significant overall study group effect was detected.

The main findings from this dissertation include the following. First, transgender adults experience numerous obstacles accessing healthcare, discrimination from healthcare professionals and clinicians, and barriers to medically necessary care, such as cross-sex hormones, as well as primary and preventative healthcare. Second, the 2015 BRFSS data collection procedures introduced measurement error and sex misclassification that contributed towards problematic BRFSS sampling weights. Third, transgender adults have poorer health than their cisgender counterparts. However, when data are disaggregated into transgender subgroups, notable differences in the health of MTF, FTM, and GNC adults are revealed. Notably, GNC adults have poorer overall health than their transgender and cisgender counterparts.

Overall, the studies from this dissertation provide empirical evidence to inform health promotion and illness prevention in transgender and GNC adults. These findings make significant contributions to the transgender health knowledge base, and advance the field by identifying priority research topics, policy areas, and methodological considerations for public health surveillance and population surveys aimed at improving the health of transgender and gender nonconforming people. Findings also provide the foundation to improve healthcare delivery and educational programs for current and future health professionals. To further advance transgender health knowledge, a more comprehensive understanding of how gender identity and gender expression influence health status and healthcare utilization for transgender and GNC adults is needed.






Cicero, Ethan Collin (2018). The Health Status of Transgender and Gender Nonconforming Adults. Dissertation, Duke University. Retrieved from


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