Abstract
Introduction
Transgender and non-binary (TNB) individuals are at severe risk of adverse mental health outcomes. Transitioning is associated with marked improvements in mental health. Unfortunately, a significant proportion of TNB individuals experience challenges to fully transitioning. In this paper, we examine the mental health status of TNB individuals who have partially transitioned and have expressed a desire to live fully in a gender different from the one assigned at birth and the barriers deterring them from doing so.
Methods
Using the 2015 US Transgender Survey, we estimated generalized ordered logistic models to predict psychological distress using barriers to transitioning as main predictors and accounting for relevant covariates for a subsample of 9242 TNB adults.
Results
Individuals that list structural barriers to transition such as fearing not receiving needed medical care, becoming homeless, and facing violence were significantly more likely to be in moderate and severe, and severe distress compared to individuals who did not report those barriers.
Conclusions
These findings demonstrate the structural nature of barriers to fully transitioning for transgender adults. Although some interpersonal fears were significant, the majority of concerns associated with psychological distress are structural in nature and speak to the institutional barriers TNB people face during the transition process.
Policy Implications
These structural barriers could be ameliorated through social policy in which transgender individuals could access services and are afforded protections to allow for a transition without the fear of negative consequences.
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Data Availability
Restricted data access was granted by the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan where the 2015 USTS is archived (James, SE, Herman, J, Keisling, M, Mottet, L, and Anafi, M. U.S. Transgender Survey USTS; Inter-university Consortium for Political and Social Research [distributor], 2019) (https://doi.org/10.3886/ICPSR37229.v1).
Code Availability
Stata 17 do-file is available by request.
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Acknowledgements
We acknowledge Dr. Mario I. Suárez for his assistance during the data acquisition process.
Funding
This manuscript was completed during GMV’s Career Enhancement Fellowship year with the Institute for Citizens and Scholars (formerly Woodrow Wilson National Fellowship Foundation). GHM is a scholar in the Health Equity Scholars for Action program, supported by the Robert Wood Johnson Foundation. The program exists to challenge biases and conventions in research and academia to be more equitable by funding and supporting early-career researchers from historically underrepresented backgrounds.
Biosocial Research Training, T32 HD091058, Stephanie M. Hernandez, Population Research Infrastructure Program, P2C HD050924, Stephanie M. Hernandez
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All authors contributed to the study conception and design. Data analyses were performed by GMV. The first draft of the manuscript was written by GMV, GHM, SMH, and MM. All authors read and approved the final manuscript.
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Marquez-Velarde, G., Miller, G.H., Hernandez, S.M. et al. Partial Transition and Mental Health: Barriers to a Full Transition. Sex Res Soc Policy 21, 436–445 (2024). https://doi.org/10.1007/s13178-023-00837-9
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DOI: https://doi.org/10.1007/s13178-023-00837-9