Background : Despite a growing body of health-related literature, empirically-based knowledge of transgender health lacks understanding of physical health, health-related quality of life, and chronic health conditions. The overall goal of this study was to increase the understanding of transgender health by delineating the health differences among transgender subpopulations (male-to-female/transgender women (MTF), female-to-male/transgender men (FTM), and gender nonconforming (GNC) adults) and in relation to their cisgender male (CGM) and cisgender female (CGF) counterparts, in order to identify transgender groups at greatest risk for poor health outcomes.
Methods : This study used a descriptive, observational, and cross-sectional 1:4 matched-study design to perform a secondary analysis of data from the 2015 Behavioral Risk Factor Surveillance System in order to compare the health status of five study groups (MTF, N=369; FTM, N=239; GNC, N=156; CGM, N=1528; CGF, N=1528). Multivariable logistic regression models were fit to determine the differential effects of individual factors (personal characteristics and socioeconomic position) on health status (fair/poor health, frequent physical and mental unhealthy days, and chronic health conditions) in the five study groups. Adjusted odds ratios (aORs) were estimated by performing a posteriori pairwise contrasts of the study groups when a significant overall study group effect was detected.
Results : Study group was a significant predictor of fair/poor health, frequent physical and mental unhealthy days only. MTFs had a lower odds of fair/poor health relative to FTMs (aOR=0.21) and CGFs (aOR=0.20). When compared to MTF sexual minorities, the estimated odds of fair/poor health among sexual minorities groups were nearly 4.2 times greater in FTM, over 2.5 times higher in GNC, and more than 3.3 times that of CGF. Both MTFs and CGMs had lower odds (aOR=0.67, 0.66, respectively) of frequent physical unhealthy days when compared to CGMs. For frequent mental unhealthy days, FTMs had higher odds compared to GNCs (aOR=1.92) and CGMs (aOR=2.54), and MTFs had lower odds relative to FTMs (aOR=0.62), but higher odds than CGMs (aOR=1.41). When compared to MTF sexual minorities, the estimated odds of fair/poor health among sexual minorities groups were nearly 4.2 times greater in FTM, over 2.5 times higher in GNC, and more than 3.3 times that of CGF. Among those with a high income, the estimated odds of fair/poor health for GNC was more than 2.2 times that of MTF, greater than 2.6 times that of CGM, and 2.0 times higher than CGF.
Conclusions : This study underscores the importance of classifying and examining the health of the transgender population as unique subpopulations versus one homogeneous population, as notable differences in health were discovered. Moreover, by acknowledging the heterogeneity of the transgender population, we fill gaps in knowledge about the health of FTM and GNC adults, two transgender groups that have been underrepresented in contemporary empirical transgender health research. FTM and GNC adults have significant health concerns that require the attention of clinical interventions aimed at promoting health and preventing illness.