Lack of Data Obscures View of Transgender Health Disparities

By Kristin Jones

Courtney Gray attempted suicide three times. Her final attempt was 10 years ago.

Gray, a transgender woman who had begun taking hormones and wearing women’s jeans, was working as a welder and mechanic at the time, building custom cars and trucks. Her co-workers had been cracking jokes and laughing raucously at the expense of another transgender woman—a customer.
    
“In your darker moments, when you’re doubting yourself,” said Gray of her decision to live openly as a woman, “you ask yourself, ‘Why in the hell would you ever sign up for that?’”

Transgender people live in a world that’s ill-prepared to accommodate them. And that takes a toll on their health, both physical and mental.

How much of a toll? That’s a tricky question, complicated by technical, cultural and personal obstacles that prevent a full accounting.

Federal and state agencies don’t routinely collect information on people’s gender identity beyond male or female. Neither do most electronic medical record systems, employers or insurers.

“Data tools in general are very binary. We’re used to sifting data sets into men and women,” says Sara Connell, trans programming coordinator at Out Boulder.

That means systems are frequently ill-equipped to include transgender people who may identify themselves as transgender men, transgender women, gender queer, agender, or simply as men or women.

“And on the personal side,” adds Connell, “a lot of times transgender people survive by not calling attention to ourselves.”  

The Colorado Health Access Survey, a tool funded by The Colorado Trust, doesn’t collect transgender identity information either. Natalie Triedman, research analyst with the Colorado Health Institute, which manages the survey, said the numbers of transgender respondents would be too small to provide a statistically significant sample.

Transgender advocates say research into the health and socio-economic status of transgender Americans is needed to make the case for funding and policy changes.

Among those advocates is Courtney Gray, who survived her final suicide attempt and went on to become the transgender programs coordinator at the GLBT Community Center of Colorado. She was among a group of researchers and advocates who spearheaded a 2014 survey conducted by advocacy group One Colorado that provides one of the few glimpses into transgender health disparities in the state.

Gray was spurred in part by a national survey in which 41 percent of transgender respondents reported having attempted suicide.

“If you look at any other health disparity, you don’t get to 41 percent before it’s considered an epidemic,” says Gray.

One Colorado’s survey found deep and disturbing inequities. Among them:

• 36 percent of transgender Coloradans surveyed had contemplated suicide in the past year, compared with an estimated 4 percent of all Coloradans.
• 44 percent of transgender Coloradans were currently experiencing depression, compared with 7 percent of all Coloradans.
• The transgender Coloradans surveyed were nearly twice as likely as an average Coloradan to have a college degree. But they were also nearly twice as likely to be unemployed, or making less than $25,000 a year.
• 40 percent of those surveyed had delayed accessing health care, compared with 16 percent of all Coloradans. Cost, fear of discrimination and inadequate insurance coverage were the main deterrents.
• 39 percent of transgender Coloradans say they don’t have a doctor or other health care provider who is transgender-inclusive. Without competent and inclusive medical care, people were less likely to have received a physical examination or a cholesterol check in the past year, less likely to report being in good health and more likely to delay care.

 “The data that we do have really shows that transgender people experience some of the greatest health disparities, especially around mental health and access to care,” says Leo Kattari, the health policy manager at One Colorado.

The state-level survey echoed available national data: Transgender people are much more likely than others to live in extreme poverty, to have lost a job due to bias, and to be victims of physical violence or sexual assault, according to a survey conducted by the National LGBTQ Task Force. African-American transgender people fare worse than their peers in almost all respects.

More information is needed, Kattari says. There are still huge gaps in what’s known about the social determinants of health for transgender people in Colorado and across the country, including some that non-transgender people might take for granted: Do they feel safe walking down the street? Do they have access to bathrooms at work or in public?

“Data drives policy, and data drives funding,” he says. “If we want to respond to the transgender community, we need the data to show that the transgender community is suffering, is not experiencing health equity.”

On a more fundamental level, any information that raises the visibility of transgender Americans erodes one of the major barriers to political and personal empowerment, says Connell.

“When we ask for our rights,” she says, “the main pushback is that ‘you don’t exist.’”

Gray, now a mother and a wife, says she hasn’t felt any suicidal thoughts since completing her transition. In her role at the GLBT Community Center of Colorado, she helps usher others through some of the same hardships she experienced.

“I’ve seen [trans people] come in terrified of losing everything in their lives,” says Gray. “To be able to see them flourish has been an amazing experience.”

Another win came this year, when the Colorado Department of Public Health and Environment launched a new question about gender identity on the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, thanks in part to advocacy by Gray and others.

Gray’s happiness about her personal advancement and recent public progress in the visibility of trans people is tempered, she says. For many transgendered Americans, especially African Americans, daily life can still be a struggle against fear of violence and discrimination by family members, employers, schools, doctors and strangers.

“I’m financially privileged, I’m white, I pass, I don’t even remember the last time somebody discriminated against me,” she says. “That’s not playing out across the board.”

Information on health care and support for transgender Coloradans can be found at the website of the GLBT Community Center of Colorado, or at the transgender resource area at Denver PrideFest 2015, happening this weekend, June 20-21.