The Health Impacts of Transphobia
A 2021 paper links experiencing deadnaming and misgendering with significantly poorer health.
by Veronica Esposito
Recently, anti-trans extremists have begun arguing for laws that permit, and even in some cases require, misgendering and deadnaming of transgender people. In July, a Florida court ruled that the state’s 2023 “Don’t Say Gay Law” requires that trans algebra teacher Katie Wood be referred to with male pronouns and honorifics while performing her job—even when Wood is referring to herself.
Also in July, a former Bath & Body Works store manager in Utah who was fired after failing to use a trans person’s correct pronouns filed a lawsuit, arguing that misgendering a trans person is constitutionally protected speech.
Typically, reporting on such aggressions against the trans community centers around the “debate” between a trans person’s right to be identified correctly versus a cisgender person’s right to free speech or exercise of religion. Rarely does such reporting attempt to quantify the harm done to trans people when they are forced to inhabit hostile environments that refuse to extend the basic respect of identifying them as they wish to be known.
Research conducted by Jae Sevelius and colleagues has gone some way in quantifying this harm. Studying some 858 transgender women of color living with HIV, Sevelius et al. found that healthcare environments that affirmed these women’s gender compensated for discrimination in other environments to such an extent that there was a noticeable suppression of their HIV viral loads.
Effectively, Sevelius’s work demonstrated that misgendering and deadnaming actively harm the health of transgender people, while affirmation supports their health. This can occur via a variety of pathways—for instance, discrimination against African Americans has been scientifically linked to reduced immune function, and it seems that the same holds for anti-trans discrimination. Furthermore, ongoing stressors like harassment at work and hostile work and living environments can further reduce immune function, while exacerbating chronic health conditions like high blood pressure.
Sevelius and colleagues enrolled participants from 9 healthcare sites in New York, Los Angeles, the San Francisco Bay Area, and Chicago. Using a Likert scale questionnaire (which asks respondents to rate statements based on a range of answers, from “Strongly Agree” to “Strongly Disagree”), they gathered information on these women’s experience with gender affirmation and discrimination in a variety of environments, including while receiving healthcare. They defined “gender affirmation” as “an interpersonal, interactive process whereby a person receives social recognition and support for their gender identity and expression.”
Analyzing this data, Sevelius et al. found that transgender-related discrimination was negatively correlated with HIV viral suppression, and that viral suppression, gender affirmation, and healthcare empowerment were all positively correlated with each other. Essentially, gender affirmation made respondents more able to prevent an HIV infection from developing into AIDS, while discrimination made it more likely that these women would eventually develop AIDS.
This work by Sevelius and colleagues demonstrates that experiences of discrimination can have quantifiable impacts on the health of trans people. As they write:
It has been extensively documented that discrimination in healthcare settings is a major barrier to achieving and maintaining viral suppression among transgender women. In addition, our model provides evidence that discrimination from other sources such as employment, health insurance, and housing also impact viral suppression. The pervasive discrimination that transgender women experience regularly, and from multiple sources, creates intersecting structural barriers that result in persistent health disparities.
This research also builds on existing research demonstrating harm to the mental and physical health of LGB populations due to discriminatory treatment. For instance, a 2010 paper by Mark L. Hatzenbuehler and collegues found a dramatic increase in clinically diagnosable disorders among LGB populations following the enactment of bans on gay marriage during the 2004 and 2005 election cycles. As they wrote:
Psychiatric disorders . . . increased significantly . . . among LGB respondents living in states that banned gay marriage for the following outcomes: any mood disorder (36.6% increase), generalized anxiety disorder (248.2% increase), any alcohol use disorder (41.9% increase), and psychiatric comorbidity (36.3% increase). These psychiatric disorders did not increase significantly among LGB respondents living in states without constitutional amendments.
Among other things, this research indicates the crucial role that healthcare professionals can play in offsetting discrimination at a time of widespread assault on trans rights. Unfortunately, on this count U.S. healthcare providers have sizeable room for improvement. According to the latest U.S. Trans Survey, 48% of trans people “reported having at least one negative experience because they were transgender” while seeing a healthcare provider. Examples of such mistreatment included being refused health care, being misgendered, the use of abusive language, and even physical abuse.
If harm exists in discriminating against trans people, a possible counterargument would be that there is also harm in preventing the exercise of “religious freedom” by preventing individuals from misgendering and deadnaming trans people. Multiple searches conducted by Assigned Media to discover research into quantifiable harms against religious individuals who are compelled to properly identify trans people found no such research. Furthermore, a 2011 report studying the intersection of religious freedom and health described religious practice in terms of things like church attendance, prayer, and meditation—none of the dozens of studies discussed in the literature review included discrimination against marginalized groups as a form of religious practice.
As more Republican-controlled states enact policies that permit or even require discrimination against transgender individuals, we can expect the health of our communities to suffer. It is necessary to find sources of gender affirmation to push back against the deleterious effects of such policies. As ever, coming together to celebrate one another, provide mutual aid, and process the challenges of a harsh world remains essential.
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.