Key TakeawaysA new study found that COVID-19 impacted transgender and nonbinary people’s access to gender-affirming care, their mental health, and their economic stability.Gender-affirming care is crucial for trans and nonbinary people, and failing to receive it can negatively impact their mental health.During the pandemic, many people haven’t been able to afford the cost of this care and surgeries have been delayed.
Key Takeaways
A new study found that COVID-19 impacted transgender and nonbinary people’s access to gender-affirming care, their mental health, and their economic stability.Gender-affirming care is crucial for trans and nonbinary people, and failing to receive it can negatively impact their mental health.During the pandemic, many people haven’t been able to afford the cost of this care and surgeries have been delayed.
Many transgender and nonbinary people already face barriers when accessing gender-affirming care. Now, a new study finds that the COVID-19 pandemic only exacerbated these existing challenges.
Researchers from Johns Hopkins University and the University of Michigan conducted a survey between April and August 2020 across the LGBTQ+ social networking and dating apps Hornet and Her. They surveyed 964 individuals from 76 countries, including Turkey and Thailand.
“We saw this in the U.S. with the disproportionate impact COVID-19 had on racialized minorities and economically marginalized people,” senior study authorS. Wilson Beckham, PhD, an assistant scientist at Johns Hopkins Bloomberg School of Public Health, tells Verywell. “Our study hypothesized that this would be true for transgender and nonbinary people and that the communities’ mental health and access to care—which is already constrained—would be worse.”
The study was published in thePLoS Onejournal in July.
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For the study, participants answered questions on how COVID-19 has impacted their access to gender-affirming care. The researchers found that 55% of the trans and nonbinary participants had difficulty accessing one or more of the following resources:
People’s experiences varied slightly based on if they are transmasculine, transfeminine, or nonbinary. This extended to mental health as well. While almost half of the individuals screened positive for anxiety and depression, these rates were higher for transfeminine people. In addition, around 3% or more of transfeminine people noted having increased suicidal ideations in comparison to transmasculine people.
“Even though I know that trans and nonbinary communities faced so many challenges pre-pandemic, I still found our main study findings surprising and heartbreaking,” Brooke A. Jarrett, MPH, a corresponding author of the study and global health epidemiologist at Johns Hopkins Bloomberg School of Public Health, tells Verywell.
The Importance of Gender-Affirming Care
Gender-affirming care is crucial for trans and nonbinary people.
“These affirmations are particularly crucial for trans and nonbinary folks, who constantly face discrimination, rejection, and stigma,” Jarrett says. “Living in one’s gender with the help of hormone therapy, haircuts, body modifiers like packers, surgery, and other kinds of gender-affirming resources, that can help balance the equation.”
It’s also not the same for everyone. One trans woman may decide to have hormone treatment and undergogender confirmation surgery, also known as gender-affirming surgery. Meanwhile, another trans woman may decide that gender confirmation surgery is not right for them.
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This care, whatever it best looks like for a given trans or non-binary individual, is important for a person’s wellbeing, especially at a young age. One study published in thePediatricsjournal found that children who received gender-affirming care benefited psychologically.
Financial Cost of Gender-Affirming Care
The expensive cost of gender-affirming care can also be a huge barrier for people who are low-income.
“It takes money to express one’s gender, whether that’s hair removal, wigs, binders to flatten chests, new clothes, and hairstyles, or legally changing one’s name and gender marker,” Beckham says. “Those types of changes are out-of-pocket, and often out-of-reach for youth or for people who are struggling financially.”
The cost of medical procedures and treatment related to gender-affirming care leads to some trans and nonbinary people turning to unregulated treatment, which could be dangerous for their health.
“Trans and nonbinary folks who don’t have financial resources for professional gender-affirming care may also resort to less conventional and unregulated means, like buying hormones on the street, which can be dangerous to one’s physical health,” Jarrett says.
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The study found that around 15% of trans and nonbinary people lost their jobs, and for a large majority of individuals, this was their only stream of income.
What This Means For YouIf you or someone you know has struggled to access gender-affirming health care, resources like the Fenway Institute, the Johns Hopkins Center for Transgender Health, and theNational Queer & Trans Therapists of Color Networkcan help you find appropriate care.
What This Means For You
If you or someone you know has struggled to access gender-affirming health care, resources like the Fenway Institute, the Johns Hopkins Center for Transgender Health, and theNational Queer & Trans Therapists of Color Networkcan help you find appropriate care.
Delayed Surgeries
Due to the COVID-19 pandemic, many procedures viewed as elective have been delayed, including gender-affirming surgeries.
“For many transgender folks, those surgeries are essential,” Angela Kade Goepferd, MD,the chief education officer and vice chief of staff for Children’s Minnesota, the Medical Director of Children’s Minnesota Gender Health Program, tells Verywell. Goepferd emphasizes that gender-affirming surgeries can be “life-saving” for trans and nonbinary people who need them.
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Even in non-pandemic times, trans and nonbinary people often have to wait months or even years to get the surgeries that would affirm their gender identity.
“The other thing is that many trans and nonbinary folks have waited months and in some cases years to get the surgeries,” Goepferd says. “They have saved the financial resources. They’ve gone through the hoops that they’ve needed to do in terms of getting letters from medical and mental healthcare providers.”
However, according to the American Medical Association, there are 30 states which allow transition-related care to be excluded from insurance coverage.
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“Taking the time to ask questions to understand the family member and what’s important to them [is important],” Goepferd says. They add that this includes asking someone which pronouns they would like you to use and if it varies per situation, like what they should use in the home versus with an extended relative who may be transphobic.
Human Rights Campaign also recommends that cis people try to do the following in their everyday lives to be a better ally to trans people:
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Jarrett B, Peitzmeier S, Restar A et al.Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people.PLoS One. 2021;16(7):e0254215. doi:10.1371/journal.pone.0254215
Sorbara J, Chiniara L, Thompson S, Palmert M.Mental Health and Timing of Gender-Affirming Care.Pediatrics. 2020;146(4):e20193600. doi:10.1542/peds.2019-3600
- Fish J, McInroy L, Paceley M et al.“I’m Kinda Stuck at Home With Unsupportive Parents Right Now”: LGBTQ Youths' Experiences With COVID-19 and the Importance of Online Support.Journal of Adolescent Health. 2020;67(3):450-452. doi:10.1016/j.jadohealth.2020.06.002
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