In the field of health, transgender and gender-diverse individuals (hereafter referred to as transgender people) represent one of the most vulnerable groups in society. Despite progress in understanding and accepting gender diversity, this community continues to face significant challenges that directly impact their physical, psychological, and emotional well-being.
This article aims to examine the current state of transgender health, identify the primary issues faced, and propose evidence-based solutions.
The Current Situation
Recent research highlights alarming disparities in health outcomes between transgender individuals and the general population. A study by Newcomb et al. (2020) revealed significant health disparities for transgender individuals compared to their cisgender counterparts.
Life expectancy, a crucial indicator of a population's health and well-being, demonstrates these disparities starkly. Available data shows that transgender individuals face significantly reduced life expectancy, varying across economic contexts but consistently presenting a tragic outlook for this group.
In high-income countries, despite improvements in recent decades, transgender individuals still experience lower life expectancy. A study in the Netherlands by Wiepjes et al. (2020) found transgender women had a 2.3 times higher mortality risk than cisgender men, and transgender men had a 1.5 times higher risk than cisgender women. These differences were primarily linked to suicide and cardiovascular diseases.
In the United States, while official data on transgender life expectancy is lacking, the Inter-American Commission on Human Rights (2014) estimated a life expectancy of just 35 years for Latina transgender women. This shockingly low figure is attributed to factors such as violence, healthcare discrimination, and high HIV rates.
The situation worsens in low- and middle-income countries. In Brazil, a 2016 study by Transgender Europe estimated a life expectancy of only 35 years for transgender people, less than half the national average of 75 years. This disparity stems largely from pervasive transphobic violence and inadequate access to healthcare.
India offers another stark example. While precise data on transgender life expectancy is unavailable, a study by Shaikh et al. (2016) found significantly higher mortality rates among the Hijra community due to complications from HIV and limited healthcare access.
Mexico presents a particularly concerning scenario regarding violence against transgender individuals. According to the report "Extreme Violence: The Murders of LGBT+ People in Mexico: The Toll of the Six-Year Period (2013–2018)" by the organization Letra S, 473 murders of LGBT+ individuals were recorded in Mexico during that period, 55% of whom were transgender women. These alarming figures place Mexico as the second deadliest country for transgender people in Latin America, second only to Brazil.
The violence manifests not only in homicides but also in physical, verbal, and sexual assaults, as well as systemic discrimination in areas such as employment, education, and healthcare. A 2020 study conducted by the Center for the Support of Trans Identities (CAIT) revealed that 80% of transgender women in Mexico have experienced some form of violence in their lifetime.
This constant violence directly impacts the mental and physical health of transgender people in Mexico, contributing to high levels of chronic stress, depression, and anxiety. Furthermore, fear of violence and discrimination often deters transgender individuals from seeking medical care or reporting abuses, perpetuating a cycle of marginalization and vulnerability.
Contributing Factors
Several factors exacerbate these health disparities:
1. Barriers to Healthcare Access
Many transgender individuals face significant challenges in obtaining affirming healthcare, impeding the prevention, diagnosis, and treatment of illnesses such as HIV and sexually transmitted infections (STIs).
2. High Rates of Violence
Transgender individuals, especially women, experience elevated violence rates that harm physical and mental health, increasing risks of anxiety, depression, and suicide.
3. Chronic Stress from Discrimination
Long-term exposure to discrimination is linked to cardiovascular and other health problems.
These disparities in life expectancy highlight the urgent need for policies and programs aimed at improving the health and well-being of transgender individuals worldwide. This effort must not only enhance access to healthcare but also address the social and economic factors that contribute to these health inequities.
It is crucial to recognize the intrinsic link between the mental and physical health of transgender individuals. Physical health challenges can exacerbate mental health issues, and vice versa.
A study by Veale et al. (2017) found that transgender people face a significantly higher risk of experiencing anxiety and depression compared to their cisgender peers. Specifically, the study observed a 48% prevalence of anxiety and a 50.6% prevalence of depression among transgender individuals—substantially higher rates than those seen in the general population.
Additionally, the risk of suicide among transgender individuals is alarmingly high. According to a study by Turban et al. (2020), 82% of transgender individuals have considered suicide at some point in their lives, and 40% have attempted it. These statistics underscore the urgent need to address the mental health crisis affecting this community.
Proposed Solutions
To address these challenges and improve the health outcomes of transgender individuals, we propose the following evidence-based solutions:
Conclusion
Improving transgender health requires a holistic approach that considers both mental and physical well-being. This involves creating inclusive healthcare environments, training providers on transgender-specific needs, and addressing systemic social and economic inequities.
While the challenges are significant, an integrated strategy—including healthcare improvements, policy changes, education, and community support—can significantly enhance the lives of transgender individuals. It is the responsibility of healthcare professionals, policymakers, and society to work together to foster a more inclusive and supportive environment for this vulnerable group.
References
- Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60(1), 44-49.
- Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2).
- James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
- Klein, A., & Golub, S. A. (2016). Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT health, 3(3), 193-199.
- Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., ... & Baral, S. D. (2016). Global health burden and needs of transgender populations: a review. The Lancet, 388(10042), 412-436.
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- Newcomb, M. E., Hill, R., Buehler, K., Ryan, D. T., Whitton, S. W., & Mustanski, B. (2020). High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Archives of sexual behavior, 49(2), 645-659.
- Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society, 5(4), bvab011.
- Wiepjes, C. M., den Heijer, M., Bremmer, M. A., Nota, N. M., de Blok, C. J. M., Coumou, B. J. G., & Steensma, T. D. (2020). Trends in mortality in adult transgender people receiving hormone treatment: Results from the Amsterdam Cohort of Gender Dysphoria. The Lancet Diabetes & Endocrinology, 8(7), 532-538.
- Inter-American Commission on Human Rights. (2014). An Overview of Violence against LGBTI Persons in the Americas: A Registry Documenting Acts of Violence between January 1, 2013 and March 31, 2014.
- Transgender Europe. (2016). Trans Murder Monitoring Annual Report 2016.
- Shaikh, S., Mburu, G., Arumugam, V., Mattipalli, N., Aher, A., Mehta, S., & Robertson, J. (2016). Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India. Journal of the International AIDS Society, 19, 20809.
- Letra S, Sida, Cultura y Vida Cotidiana A.C. (2019). Violencia extrema. Los asesinatos de personas LGBTTT en México: los saldos del sexenio (2013-2018). Ciudad de México, México.
- Centro de Apoyo a las Identidades Trans (CAIT). (2020). Informe sobre la situación de violencia contra mujeres trans en México. Ciudad de México, México.
