Safe, age-appropriate, and affordable gender-affirming medical care is crucial for transgender and nonbinary folks. Affirming care can be a number of things, ranging from a medical professional supporting the use of pronouns to prescribing hormonal treatments to surgery. Sometimes trial and error are involved to find the best fit, and sometimes people pause and restart treatment over the course of a lifetime. All of that is normal and valid.
Sadly, however, it’s considerably difficult for trans folks in the United States to access gender-affirming care to begin with, and according to a new survey published in PLoS One journal in July, as covered by Julia Métraux at VeryWell Health, during the COVID-19 pandemic, many trans and nonbinary folks struggled to find affirming care and services. Some reported having to delay treatment because of finances and 15% reported losing their job due to the pandemic. Researchers suggest reductions in gender-affirming care may have increased mental health symptoms, including anxiety and depression, as reported in their sample. Let’s check out more findings below—and go over how to help.
Before we get into more numbers, here’s some background on the survey: Between April 16 and Aug. 3, 2020, researchers from Johns Hopkins University and the University of Michigan conducted an online survey via LGBTQ+ apps (Hornet and Her) in which they connected with 964 adults from 76 countries. Just over 50% of respondents were between 18 and 29 and just over 40% reported having at least a university degree. Less than 13% said they ever lacked a face mask during the pandemic, and more than three-quarters said their country issued some degree of a “stay-at-home” order because of the virus.
More than one-third of respondents reported having difficulty accessing hormonal therapy and/or related gender-affirming medications, while a similar number reported having difficulty accessing cosmetic supplies and services, like wigs, makeup, and hair removal. Some 36% of respondents said they faced barriers trying to get body modifiers, including, for example, binders and packers.
In terms of mental health, nearly 43% of respondents said they faced a reduced level of access to therapy. While 12% of respondents said their suicidal ideation decreased during the pandemic, 10% said theirs increased. Transfeminine folks were less likely to agree with statements about having sources of comfort or hope and were more likely to report increases in suicidal ideation. More than three-quarters of folks said they anticipated having their income cut during the pandemic, with more than 50% saying they were not able to access financial assistance in spite of need. Of the respondents, 17% reported expecting to lose their health insurance.
In a press release, Brooke Jarret of the John Hopkins Bloomberg School of Public Health summed up why these results are so important in the big picture, saying, “Transgender communities, who already face a myriad of health inequities, experienced even further health burdens due to restrictions imposed during COVID, like reduced access to gender-affirming treatments and mental health resources.”
Even without considering job loss and unemployment rates amid the pandemic, we know that trans folks report facing discrimination while interviewing for jobs, at jobs, when it comes to finding housing, and, disturbingly, even while seeking medical care. Low-income trans folks may not be able to afford (or access) certain services—whether that’s a prescription for hormones or a custom wig fitting—and may seek them out through other routes, which can be dangerous for one’s health and safety.
And if you’re thinking, “Well, I couldn’t get a haircut, either, so what’s the big deal?” Just remember that for trans folks, gender-affirming care and treatments can have a huge impact on mental health and that for trans folks, not “passing” in a cis, heteronormative world can be legitimately dangerous.
With this framing in mind, nearly 40% of respondents said the pandemic reduced or completely eliminated their ability to live in accordance with their gender. A full 43% of transfeminine folks said this, while 36% of nonbinary folks felt the same, and 28% of transmasculine folks agreed.
If you’re reading these responses and feel overwhelmed or at a loss for how to help, remember that just being a supportive, affirming ally is already a big step. Part of being a good ally is, of course, using the correct pronouns (including gender-neutral pronouns, like they/them), centering trans and nonbinary voices, and supporting trans and queer creators, like when it comes to the movies you watch, books you buy, and content you stream. We also have a roundup of simple ways you can show up for the trans folks in your life, including some free mental health resources you can pass along or use yourself!
People can reach the National Suicide Prevention Lifeline at 1-800-273-8255 24/7. The Trans LifeLine offers free support at 1-877-565-8860.
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