The purpose of this exploratory study was to examine the effects of legal name change on socioeconomic factors, general and transgender-related health care access and utilization, and transgender-related victimization in a sample of young transgender women (transwomen) of color. A cross-sectional group comparison approach was used to assess the potential effects of legal name change. A convenience sample of young transwomen enrolled in a no-cost legal name change clinic were recruited to complete a 30-min interviewer-guided telephone survey including sociodemographic and socioeconomic factors, health and well-being, health care utilization, transgender transition-related health care, and transgender-related victimization. Sixty-five transgender women of color (37 = pre-name change group, 28 = post-name change group) completed the survey. Results indicated that the transwomen in the post-name change group were significantly older than the pre-name change group. In age-adjusted analyses, the post-name change group was significantly more likely to have a higher monthly income and stable housing than the pre-name change group. No significant differences were observed for general health care utilization; however, a significantly greater percentage of transwomen in the pre-name change group reported postponing medical care due to their gender identity. In addition, a significantly larger proportion of transwomen in the pre-name change group reported using non-prescribed hormones injected by friends and experiencing verbal harassment by family and friends compared to transwomen in the post-name change group. Findings suggest that legal name change may be an important structural intervention for low-income transwomen of color, providing increased socioeconomic stability and improved access to primary and transition-related health care.
This is a preview of subscription content,to check access.
Access this article
Similar content being viewed by others
Adimora, A. A., & Auerbach, J. D. (2010). Structural interventions for HIV prevention in the United States. Journal of Acquired Immune Deficiency Syndromes, 55, 132–135.
Agresti, A. (1996). An introduction to categorical data analysis. New York: Wiley.
Auerbach, J. D., Parkhurst, J. O., & Cáceres, C. F. (2011). Addressing social drivers of HIV/AIDS for the long term response: Conceptual and methodological considerations. Global Public Health, 6, 293–309.
Bauer, G. R., Scheim, A. I., Deutsch, M. B., & Massarella, C. (2014). Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: Results from a respondent-driven sampling survey. Annals of Emergency Medicine, 63, 713–720.
Bockting, W. O., Miner, M. H., Romine, R. E. S., Hamilton, A., & Coleman. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951.
Bradford, J., Reisner, S. L., Honnold, J. A., & Xavier, J. (2013). Experiences of transgender related discrimination and implications for health: Results from the Virginia Transgender Health Initiative Study. American Journal of Public Health, 103, 1820–1829.
Brown, T. N. T., & Herman, J. L. (2016). Voter ID laws and their added costs for transgender voters. UCLA School of Law: The Williams Institute.
Card, J. J., Lessard, L., & Benner, T. (2007). PASHA: Facilitating the replication and use of effective adolescent pregnancy and STI/HIV prevention programs. Journal of Adolescent Health, 40, 275.
Centers for Disease Control and Prevention. (2005). Update: Syringe exchange programs—United States, 2002. Morbidity and Mortality Weekly Report, 54, 673–676.
Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69.
Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. (2012). Transgender health in Massachusetts: Results from a household probability sample of adults. American Journal of Public Health, 102, 118–122.
Couch, M., Pitts, M., Croy, S., Mulcare, H., & Mitchell, A. (2008). Transgender people and the amendment of formal documentation: Matters of recognition and citizenship. Health Sociology Review, 17, 280–289.
Crosby, R. A., Salazar, L. F., & Hill, B. J. (2016). Gender affirmation and resiliency among black transgender women with and without HIV infection. Transgender Health, 1, 86–93.
DeNavas-Walt, C., Proctor, B., & Smith, J. (2013). Income, poverty, and health insurance coverage in the United States: 2010. 2011. Washington, DC: US Government Printing Office.
Derogatis, L. R. M. N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13, 595–605.
Garofalo, R., Deleon, J., Osmer, E., Doll, M., & Harper, G. W. (2006). Overlooked, misunderstood and at-risk: Exploring the lives and HIV risk of ethnic minority male-to female transgender youth. Journal of Adolescent Health, 38, 230–236.
Haas, A. P., Eliason, M., & Mays, V. M. (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58, 10–51.
Hill, B. J., Rosentel, K., Bak, T., Silverman, M., Crosby, R., Salazar, L., & Kipke, M. (2017). Exploring individual and structural factors associated with employment among young transgender women of color using a no-cost transgender legal resource center. Transgender Health, 2(1), 29–34.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.
Jordan, W., Edwards, D. G. F., Grace, L., & Reynolds. (2007). Male-to-female transgender and transsexual clients of HIV service programs in Los Angeles County, California. American Journal of Public Health, 97, 1030–1033.
Kim, T. J., & von dem Knesebeck, O. (2015). Is an insecure job better for health than having no job at all? A systematic review of studies investigating the health-related risks of both job insecurity and unemployment. BMC Public Health, 15, 985.
Liebetrau, A. M. (1983). Measures of association. Thousand Oaks: Sage.
McClelland, G. H., & Judd, C. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114, 376.
Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressions toward transgender people: Implications for counseling. Journal of LGBT Issues in Counseling, 6, 55–82.
Namaste, V. K. (1999). HIV/AIDS and female-to-male transsexuals and transvestites: Results from a needs assessment in Quebec. International Journal of Transgenderism, 3, 2.
Nuttbrock, L., Rosenblum, A., & Blumenstein, R. (2002). Transgender identity affirmation and mental health. International Journal of Transgenderism, 6, 97–103.
Reisner, S. L., White, J. M., Bradford, J. B., & Mimiaga, M. J. (2014). Transgender health disparities: Comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health, 1, 177–184.
Rood, B. A., Reisner, S. L., Surace, F. I., Puckett, J. A., Maroney, M. R., & Pantalone, D. W. (2016). Expecting rejection: Understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health, 1, 151–164.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton: Princeton University Press.
Sanchez, N. F., Sanchez, J. P., & Danoff, A. (2009). Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. American Journal of Public Health, 99, 713–719.
Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of US policies and programs. Journal of Adolescent Health, 38, 72–81.
Sevelius, J. M., Patouhas, E., Keatley, J. G., & Johnson, M. O. (2014). Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Annals of Behavioral Medicine, 47, 5–16.
Stroumsa, D. (2014). The state of transgender health care: Policy, law, and medical frameworks. American Journal of Public Health, 104, 31–38.
Su, D., Irwin, J. A., Fisher, C., Ramos, A., Kelley, M., & Mendoza, D. A. R. (2016). Mental health disparities within the LGBT population: A comparison between transgender and nontransgender individuals. Transgender Health, 1, 12–20.
Transgender Legal Defense, & Education Fund. (2014). Name change project overwhelmingly young transgender women of color living in poverty. New York: Transgender Legal Defense & Education Fund.
Wolitski, R. J., Kidder, D. P., Pals, S. L., Royal, S., Aidala, A., & Stall, R. (2010). Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS and Behavior, 14, 493–503.
We would like to acknowledge and thank all of our participants and the staff at the Transgender Legal Defense & Education Fund, Inc. for their dedicated support.
This research was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, grant number UL1-TR000430 and The University of Chicago, Medicine and Biological Sciences Office of Diversity and Inclusion, B.J. Hill & M. Silverman (PIs). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or The University of Chicago Office of Diversity and Inclusion.
Conflict of Interest
The authors declare that they have no conflict of interests.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Hill, B.J., Crosby, R., Bouris, A. et al. Exploring Transgender Legal Name Change as a Potential Structural Intervention for Mitigating Social Determinants of Health Among Transgender Women of Color. Sex Res Soc Policy 15, 25–33 (2018). https://doi.org/10.1007/s13178-017-0289-6