Archives of Sexual Behavior

, Volume 43, Issue 8, pp 1503–1514 | Cite as

Using a Two-Step Method to Measure Transgender Identity in Latin America/the Caribbean, Portugal, and Spain

  • Sari L. Reisner
  • Katie Biello
  • Joshua G. Rosenberger
  • S. Bryn Austin
  • Sebastien Haneuse
  • Amaya Perez-Brumer
  • David S. Novak
  • Matthew J. Mimiaga
Original Paper


Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54 %; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.


Transgender Gender identity HIV Health Surveillance 



S. B. Austin is supported by the Maternal and Child Health Bureau, Health Resources and Services Administration, training grants MC00001 and Leadership Education in Adolescent Health Project 6T71-MC00009. The authors wish to thank Sarah MacCarthy, Sc.D., for her assistance with Portuguese translation.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sari L. Reisner
    • 1
    • 2
  • Katie Biello
    • 2
    • 3
  • Joshua G. Rosenberger
    • 4
  • S. Bryn Austin
    • 1
    • 5
    • 6
  • Sebastien Haneuse
    • 7
  • Amaya Perez-Brumer
    • 1
    • 2
  • David S. Novak
    • 8
  • Matthew J. Mimiaga
    • 2
    • 3
    • 9
  1. 1.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  2. 2.The Fenway Institute Fenway HealthBostonUSA
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Department of Global and Community HealthGeorge Mason UniversityFairfaxUSA
  5. 5.Division of Adolescent and Young Adult MedicineChildren’s HospitalBostonUSA
  6. 6.Department of PediatricsHarvard Medical SchoolBostonUSA
  7. 7.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  8. 8.OLB Research InstituteOnline Buddies, Inc.CambridgeUSA
  9. 9.Department of PsychiatryHarvard Medical School/Massachusetts General HospitalBostonUSA

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