92,000 Transgender People Took This Survey. Here’s What We Learned

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode! 

Dan Gorenstein (DG): In state capitals around the country, lawmakers are taking aim at the rights of transgender Americans.

News clip: A record number of bills relating to health care, bathrooms…
News clip: The Kentucky general assembly passing a sweeping anti-trans bill.
News clip: Ohio lawmakers just banned trans youth from accessing gender-affirming care.

DG: Twenty-four states have banned or restricted gender-affirming care for kids. Three hundred bills have been introduced just in the last 15 months to restrict trans folks’ ability to get health care. Against this backdrop,  researchers released early findings in February from the largest survey ever of transgender Americans.

Sandy James (SJ): Trans people want to be heard. They want people to be paying attention to what they have to say about their own lives.

DG: Today, lessons from the U.S. Transgender Survey and why hard numbers matter so much in this moment. From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

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DG: Sandy James has spent the last decade using research and data to help the public understand transgender people.

SJ: Very often advocates would go out, and they would try to talk to policymakers or other individuals and they would say, well, this is what’s going on in the trans population. And the reply would be, well, yeah, but who’s that really affecting, or, oh, can you quantify that for us? 

DG: Sandy helped lead the 2015 U.S. Transgender Survey. The survey included more than 300 questions to put cold hard numbers behind stories of discrimination.

SJ: We were hearing from trans people in all walks of life that there were barriers to certain basic needs, whether it was housing, health care, employment. Sometimes people would go into a doctor’s office and be told, well, we don’t treat your kind. And so it was those stories, that anecdotal evidence that was really important for us to try to quantify.

DG: Right these outrageous stories, but were they sort of 1 in 1,000, or were they 1 in 10?

SJ: Exactly, exactly. And it was really important for us to be able to say, oh, it does look like it is indeed 1 in 10, or it does look like it is a third of people who are experiencing this.

DG: Because once you have that, what does that allow you as advocates to be able to do?

SJ: Well, it gives us a starting point. It’s evidence that there is something inhibiting trans people from being able to access things like housing and health care. And then we have to start asking why? Are there policies that are contributing to those percentages?

DG: So the 2015 survey included more than 27,000 responses and highlighted high rates of psychological distress, suicide attempts, health care discrimination. Fast forward to 2022…

News clip: 2022 could be the most anti-trans legislative year in history.

DG: …and we’ve seen transgender rights become a part of the so-called culture wars.

News clip: It is the latest fight over transgender rights, and once again, the epicenter is Texas.

DG: That was the year Texas Gov. Greg Abbott told his state’s child welfare office to investigate gender affirming care as child abuse. 

News clip: Gov. Abbott calls on teachers, doctors and nurses to report if they think these treatments are happening.

DG: How, Sandy, did that climate influence how you put together this 2022 survey?

SJ: So first and foremost, we wanted to see how things might have changed over time. But we also wanted to know how transgender people are being affected by these conversations about them, often happening in ways that people may feel powerless to really combat. And so we wanted to ask trans people directly, how is this affecting you? How has that impacted your day to day? And so we wanted to be able to find out what people were experiencing.

DG: You wanted to give trans people a voice.

SJ: Absolutely. What I have noticed is that there’s a dearth of conversation that actually includes the voices of trans people. And I’m not talking about, you know, in a legislative hearing where people get a minute or two, but actually asking transgender people, as people who are most directly affected by the conversations that are being had, what is it like when you can access health care, and what is it like when you’re being denied access to health care? How might that impact you if your access is revoked? 

DG: You said when you published the 2015 survey, part of the goal was to put some numbers, put some data around the stories. And I’m curious, what were the anecdotes and stories that you were hearing in the run-up to the 2022 survey?

SJ: Well on top of the stories that were similar to those in 2015, we were also hearing more anxiety. We were hearing that people were more fearful. But I think the other thing we wanted to be able to show is that trans people are still getting up, going to work, going out there, doing everything possible just like everybody else. And so I think that’s a big part of the story, too. It’s both how maybe increased anxiety and concern might be impacting trans people, but it’s also about how people are getting up and getting on with it.

DG: When we come back, we’ll dig into some big numbers from the largest survey ever of transgender Americans.

Midroll

DG: Welcome back. We’re talking with Sandy James, the lead researcher of the 2022 U.S. Transgender Survey, which surveyed more than 92,000 trans Americans and released preliminary findings earlier this year. Sandy, I’d like to dive into the findings now. What’s the one number that stands out to you most in this survey?

SJ: I think the thing that stands out the most are the findings around satisfaction. Ninety-eight percent said they were more satisfied with their lives after being able to access hormone therapy, and 97% said they were more satisfied with their lives after receiving gender-affirming surgery. Anytime you do survey research, it’s pretty astounding when you have that sort of consensus around any kind of question. And again it’s important to note here, we surveyed over 92,000 transgender people. And of those people who had access to these types of care, it’s unequivocal: Overwhelmingly people said that they were more satisfied with their lives after being able to access these things.

DG: Sandy, I know that along with the survey, you gave folks the opportunity to share their own stories. Is there one or even a quote you can share to help us understand why getting gender affirming care matters so much to people?

SJ: Absolutely. There was one individual, a woman named Rowan, and she said, “I was once still pinned under the sex I was assigned at birth, burned out and depressed and frustrated. But now I am free, accepted, loved, and as happy as ever as the woman that I am and always was.” When you when you conduct a survey, you’re asking people to answer questions that we’ve crafted very carefully to be able to capture certain data points. But there is something really important about letting people just tell us about their experiences in their own words. And I think that sort of quote really illustrates a finding such as satisfaction with gender transition. You have someone who is saying that they weren’t able to really move forward with life, and without putting words in her mouth, I would say that it looks like she’s on the path to thriving. Of course we want the data points, but when you hear it in Rowan’s own words, you get a real sense of how impactful it is to have access to this kind of care. 

DG: So three numbers caught my eye, Sandy.

One, 44% of people said they experienced serious psychological distress in the last month. Two, 50% of those who sought out medical care in the last year, reported a bad experience. And three, 25% of people said they avoided needed medical care out of fear of mistreatment. All those numbers are higher today than they were back in 2015. What does that tell you?

SJ: We’ve not completed all of our analyses and didn’t draw direct comparisons to the 2015 report. But as you’ve observed, those numbers do appear to be higher. And I think the takeaway from that is that while we might have hoped that we would see drastic shifts in those numbers, we haven’t seen that. So, yeah, I would say there’s still a lot of work to be done. 

DG: Were you surprised?

SJ: Sadly, no. And I think that is because of what we’ve seen in the social and political environment. I think that trans people have been incredibly resilient. I think that there have been improvements here and there. People have been able to access maybe health care that they weren’t able to before. But I had a sense that it would be impacting people in similar ways unfortunately.

DG: As we’ve mentioned, a lot of the anti-trans legislation we’ve seen enacted has been about restricting trans kids from getting gender-affirming care. Almost half of states have now passed these laws. The 2022 survey included 16 and 17 year olds for the first time. What did young people have to say?

SJ: Well, one of the things that was really encouraging to see was the levels of family support. We saw that approximately half of young people, 16 and 17 year olds, said their immediate and their extended families were supportive of them as trans people. And that doesn’t necessarily align with some of the narratives that you’re hearing that are supporting the policies we’re seeing. So I think it’s important to note that there is family support. And that’s really important because we know from what we’ve seen in the 2015 US Trans Survey and in other research that family support was correlated with lower levels of homelessness. We found that it was correlated with lower levels of serious psychological distress and even suicidality. So the importance of family support just cannot be overstated.

DG: I’d like to circle back to this data point: Half of people who sought medical care in the last 12 months reported a negative health care experience – being harassed or being refused care. Tradeoffs is a health policy podcast. You’re not a health care expert. But I’m curious: What would you like hospital administrators, doctors, nurses to take away from that one data point?

SJ: I know this might sound a bit cliché, but I want them to take away that transgender people are people. It’s hard to seek health care. For everyone. And it’s made that much harder when you’re faced with an environment in which people mistreat you simply because of who you are or how you present.

DG: What does that look like, Sandy?  Can you share an example from your own life when you went to get health care and you were treated as a whole person?

SJ: I really am fortunate because the providers from whom I receive care have committed themselves to creating an environment in which transgender people are respected. And so I’m able to go into a place where I can seek health care, and no matter who I’m interacting with, I’m treated with dignity and respect at any stage of the interaction.

DG: What does respectful look like? What does respectful care look like?

SJ: It’s anything as simple as using the correct name, using the correct pronouns. You could have buttons at the reception area to make sure that you’re gendering people correctly. There’s all sorts of things that you might be able to do with your electronic record system, but respectfulness really comes down to treating someone as they wish to be treated, which really is how you would wish to be treated too. Everyone makes mistakes and nobody is perfect. If you make a mistake, it’s important to acknowledge it. It’s a matter of taking that in and processing that and saying, how can we make sure that no one else comes through our doors again and has an experience like that? How can we make sure that people feel seen, heard and respected for who they are.

DG: Sandy, we hear a lot about the lack of health care data on transgender Americans. You got 92,000 people to spend an hour taking a survey. What advice, what guidance do you have for other health services researchers and policymakers about how to get better at including transgender people in their research?

SJ: Well, first and foremost include questions that allow transgender people to be counted. In some of the large scale surveys that we all rely on transgender people are not even included in there in a way that makes them identifiable. Second of all, get to know trans communities. Not just right before you need to collect the data, but spend some time cultivating relationships. And then just let them know that their voices are powerful and that we really do want to hear from them.

DG: Given the amount of fear that’s out there, how hard is it right now if you’re a trans person to trust someone that you don’t know?

SJ: I think it’s harder than it used to be, for sure. You know, the question is, who are you? You’re about to embark on asking me a lot of questions that are in many ways intimate, personal, private. But I think that researchers can work to build that trust. And there are lots of researchers out there who have done a phenomenal job of that. And I think more and more, we just want to be cognizant of people want to know where their data are going to end up. So it’s important to be thoughtful of that.

DG: I asked you this question before about the 2015 survey. Do you feel like you captured most of what you wanted to capture? I guess what I’m really asking you is, are there more questions that need to be asked? And do you have a sense of what those are? 

SJ: I think there’s always an opportunity to ask why, you know, follow up on certain findings and find out more about what is really driving a certain outcome. For example, the satisfaction findings. We want to understand why people were more satisfied and why people are less satisfied. We also want to know more about what I call trans joy. We want to learn more about what does keep people going? What drives them? We often can’t capture things like that in these sorts of surveys, and we want to know more about those aspects of trans lives.

DG: There’s a lot of heavy data in this report. What’s the one finding that gives you the most hope?

SJ: Well, Dan it’s not actually a finding. It is the response that we got to the survey. I’m just astounded that we’d have more than 92,000 people who thought it was well worth their time to complete the survey and contribute to the collective voice of being able to to speak about their experiences. That’s massive. I like to actually visualize 92,000 people gathered in an area, all being able to speak about their own experiences. And that’s what we have here. It’s powerful. It means that in this moment, trans people want to be heard. They want their voices to count. They want people to be paying attention to what they have to say about their own lives. And that gives me a lot of hope for what it means as this collective voice continues to grow and speak.

DG: Sandy, thanks so much for taking the time to talk to us on Tradeoffs.

SJ: Thank you, Dan. It was a pleasure.

DG: I’m Dan Gorenstein, this is Tradeoffs.