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A Study of Transgender Adults and Their Non-Transgender Siblings on Demographic Characteristics, Social Support, and Experiences of Violence

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A national sample of 295 transgender adults and their nontransgender siblings were surveyed about demographics, perceptions of social support, and violence, harassment, and discrimination. Transwomen were older than the other 4 groups. Transwomen, transmen, and genderqueers were more highly educated than nontransgender sisters and nontransgender brothers, but did not have a corresponding higher income. Other demographic differences between groups were found in religion, geographic mobility, relationship status, and sexual orientation. Transgender people were more likely to experience harassment and discrimination than nontransgender sisters and nontransgender brothers. All transgender people perceived less social support from family than nontransgender sisters. This is the first study to compare trans people to nontrans siblings as a comparison group.
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A Study of Transgender Adults and Their Non-Transgender
Siblings on Demographic Characteristics, Social Support,
and Experiences of Violence
Rhonda J. Factor
Esther D. Rothblum
ABSTRACT. A national sample of 295 transgender adults and their nontransgender siblings were
surveyed about demographics, perceptions of social support, and violence, harassment, and discrim-
ination. Transwomen were older than the other 4 groups. Transwomen, transmen, and genderqueers
were more highly educated than nontransgender sisters and nontransgender brothers, but did not have a
corresponding higher income. Other demographic differences between groups were found in religion,
geographic mobility, relationship status, and sexual orientation. Transgender people were more likely
to experience harassment and discrimination than nontransgender sisters and nontransgender brothers.
All transgender people perceived less social support from family than nontransgender sisters. This is
the first study to compare trans people to nontrans siblings as a comparison group.
KEYWORDS. Transgender, genderqueer, transman, transwoman
Traditional ways of thinking about sex and
gender have limited the ability of mental health
professionals to understand the ways in which
people with atypical gender expression expe-
rience themselves and negotiate their lives in
the dominant culture’s rigid binary gender sys-
tem. The various editions of the Diagnostic and
Statistical Manual (DSM) have included trans-
sexualism (American Psychological Association
[APA], 1980, 1987) and gender identity disorder
(GID; APA, 1980, 1987, 1994). as categories
of mental health disorders. Nearly 1000 arti-
cles have been published in the mental health
literature about transsexualism and gender iden-
tity disorder beginning in the 1950s. Given the
conceptualizations in the DSM, psychological
research has largely focused on assessment, eti-
Rhonda J. Factor, PhD, is affiliated with Counseling Services, The New School, 135 East 12th Street, 2nd
Floor, New York, NY 10003 (E-mail: factorr@newschool.edu).
Esther D. Rothblum, PhD, is affiliated with Women’s Studies Department, San Diego State University,
5500 Campanile Drive, San Diego, CA 92182 (E-mail: erothblu@mail.sdsu.edu).
Address correspondence to: Rhonda J. Factor, PhD, or Esther D. Rothblum, PhD, at the above address.
ology, and treatment of individuals with these
“disorders.” Although individuals assigned male
at birth who identify as female have histori-
cally been referred to as transsexual men in
the psychological literature, we refer to these
individuals as transwomen or male-to-female
(MTF), terms more consistent with how these in-
dividuals experience themselves. Similarly, we
refer to individuals assigned female at birth
who experience themselves as male as trans-
men or female-to-male (FTM), though histori-
cally they have been referred to as “transsexual
women.”
Over the past 15 years, a growing number
of individuals have begun to identify as trans-
gender. These individuals do not identify fully
with the sex and/or gender to which they were
Journal of LGBT Health Research, Vol. 3(3) 2007
Available online at http://jlhr.haworthpress.com
C
2007 by The Haworth Press. All rights reserved.
doi: 10.1080/15574090802092879 11
12 JOURNAL OF LGBT HEALTH RESEARCH
assigned at birth. During the 1990s, several
personal narratives, historical documentations,
and constructionist theoretical critiques have
brought the voices and experiences of contempo-
rary transgender individuals to larger segments
of the population (Bornstein, 1994; Feinberg,
1996; Wilchins, 1997). The title of Bornstein’s
work, Gender Outlaw: On Men, Women, and the
Rest of Us, expresses two major themes com-
mon throughout these texts. One theme is the
existence of a small, yet vocal, minority of the
transgender population who experience them-
selves outside the binary categories of male and
female. Another major theme is that transgender
individuals are largely living outside the law. Be-
cause of the lack of legal recognition accorded
to trans people, discrimination, harassment, and
violence are not uncommon.
Despite little knowledge and insight into the
experiences of trans individuals, mental health
professionals continue to provide psychotherapy
to this population. In addition to the numerous
psychological challenges faced by the general
population, these individuals must confront the
stresses of living in a transphobic culture, a cul-
ture hostile to their self-expression. Not enough
is known about these additional stresses, their
effects, and how trans people cope with these
stresses.
TERMINOLOGY
To center transgender people’s experiences,
moving them from object to subject, we used
the terms that transgender people use to describe
themselves. The term transgender or trans is
an umbrella term referring to a heterogeneous
group of individuals who do not identify com-
pletely with the sex and/or gender to which they
were assigned at birth. These individuals may
or may not have used hormonal and/or surgical
interventions to alter their physical presentation.
They may identify as male, female, both, or nei-
ther. They may or may not experience distress
related to their gender identity. And, they may or
may not have been born intersexed, that is, with
physical, hormonal, and/or chromosomal char-
acteristics that do not fit into the categories of
male and female.
The term transmen is used to refer to indi-
viduals assigned to the female sex at birth but
who experience themselves as men. These in-
dividuals have often been referred to as trans-
sexual women in the psychological literature,
although this is not how they experience them-
selves. Transwomen are individuals assigned to
the male sex at birth who experience themselves
as women, often referred to as transsexual men
in the psychological literature.
A greater difficulty is to come up with a term
for individuals who do not identify fully with the
concept of binary gender. A number of terms are
used by trans individuals who do not feel that
male or female, man or woman, is a complete or
accurate description of their gender and/or sex.
Based on a choice of 36 descriptors ( e.g., fem
male, gender blender, sex radical, omnisexual,
butch, etc.) in which participants could circle as
many terms as applied to them, the term gen-
derqueer was endorsed most frequently (62.5%
of the sample; Factor & Rothblum, in press)
Thus, we have used this term to describe our third
group of participants, although we acknowledge
that it is not everyone’s preferred term.
AIMS OF THIS STUDY
Previous findings from mental health research
with transsexuals may not apply to all groups
of contemporary transgender individuals. Fur-
thermore, much prior research included very
small samples, was often limited to transsex-
uals in clinical or surgical settings, and fo-
cused overwhelmingly on MTF individuals.
Few of the studies had adequate comparison
groups of nontransgendered individuals. This
study was planned as a large, national sample of
transwomen, transmen, genderqueers, and non-
transgendered brothers and sisters.
Using Siblings as a Comparison Group
This study used a sibling methodology. This
is similar to that used in studies of lesbians,
gay men, and bisexuals (LGBs) and their
heterosexual siblings (Rothblum, Balsam, &;
Mickey, 2004; Rothblum & Factor, 2001), which
found that siblings are comparable on parental
Rhonda J. Factor and Esther D. Rothblum 13
socioeconomic status, race, and religion while
growing up, and age cohort. Thus, regardless of
the representativeness of the transgender sam-
ple, inclusion of their nontransgender siblings
ensures a meaningful comparison group. It is a
useful methodology when studying a minority
group that has siblings who are members of the
dominant group. There has been little research
comparing trans individuals with nontrans indi-
viduals, and none using siblings as a comparison
group.
Demographic Information
This study compared demographic informa-
tion among three groups of trans people and their
nontrans male and female siblings. This allowed
comparison of siblings who had grown up in
the same families and thus were comparable,
at one time, in parental socioeconomic status
and parental educational background. We were
particularly interested in the variables of educa-
tion, income, and employment. Given that trans
people are a stigmatized group, we predicted
that they would not obtain the educational level,
income, and occupational status of their non-
trans siblings. Furthermore, given that income
and employment are linked to gender, how does
this affect trans individuals?
Gagne and Tewksbury (1996, 1998) found
that many MTF individuals who disclosed their
gender identity at work were fired, demoted,
pressured to quit, and subject to harassment
by coworkers. If they remained on a job dur-
ing a transition, they were pressured to have a
rapid, complete, and convincing feminine pre-
sentation. They also found that MTF people
who lived full-time as women were vastly under-
employed. Clements-Nolle, Marx, Guzman, and
Katz (2001) found that FTMs had more educa-
tion and a higher income than MTFs. Eighty-one
percent of FTMs had obtained money in the past
6 months from part- or full-time employment,
but only 40% of MTFs had obtained money that
way.
Social Support
Gagne and Tewksbury (1998) found that most
MTF individuals were rejected by their families
of origin and created families of choice. Many
were rejected by friends and/or experienced a
decrease in intimacy in interpersonal relation-
ships. In Lombardi’s study (1999), trans peo-
ple who had a higher proportion of trans people
and relatives among their close confidantes had
fewer depressive symptoms than trans people
with smaller proportions of trans people and rel-
atives among their close confidantes. Lombardi
compared these findings about the close confi-
dantes of trans people with results from the 1985
General Social Survey of the general popula-
tion and found a smaller proportion of relatives
among close confidantes for trans people than
for nontransgender people. Another finding was
that trans people tended to have a higher num-
ber of close confidantes than nontransgender
people.
The little research that exists in this area
suggests that trans people receive less support
from their families than do nontrans people. This
study utilized the same measures to assess lev-
els of perceived social support from friends and
levels of perceived social support from family
across groups. It was hypothesized that non-
transgender siblings perceive more social sup-
port from family than trans people.
Along with perceived social support, we were
also interested in demographic variables that
were related to social support. One set of vari-
ables focused on intimate relationships, includ-
ing whether or not people were living alone
or with others, whether they were in intimate
spousal or partnered relationships, and how long
they had been in spousal/partnered relation-
ships. Another set of variables focused on reli-
gion/spirituality and its importance in the lives of
trans and nontrans people. A third set identified
geographical mobility—the size of the location
in which participants were living, how long they
had lived there, and how far they lived from their
mother and father. Prior research with LGBs and
heterosexual siblings (Rothblum et al., 2004;
Rothblum & Factor, 2001) has found that LGBs
are less religious than heterosexuals, have less
contact with family of origin, perceive less so-
cial support from family of origin, and, in the
case of lesbians, live further from their parents
and went to a college that was further from home
than heterosexuals.
14 JOURNAL OF LGBT HEALTH RESEARCH
Violence, Harassment, Discrimination
Lombardi, Wilchins, Priesing, and Malouf
(2001) found that approximately 60% of the
transgender individuals in their study experi-
enced some form of harassment or violence, and
26% experienced a violent incident. In addition,
37% reported experiencing economic discrimi-
nation. Gagne and Tewksbury (1998) found that
trans people on the FTM continuum living out-
side the gender binary, those who were unable
or uninterested in passing, were more likely to
experience harassment, threats, and physical at-
tacks. However, their results also indicated that
the more MTFs were able to pass convincingly as
women, the greater their fears of being assaulted
as women.
There is no research that compares these
groups with a comparable nontransgender con-
trol group. It was hypothesized that the three
trans groups experience more violence, harass-
ment, and discrimination than their nontransgen-
der siblings.
In sum, there have been no large-scale, na-
tional surveys of trans people that compare
them with comparable nontrans people on demo-
graphics, social support, and experiences of vio-
lence. In this study, we wanted to see how gender
identity and nonconformity to traditional gender
expressions are associated with these variables.
METHODS
Participants
Participants were 18 years of age or older.
They were recruited from three populations:
transwomen, transmen, and genderqueers. These
individuals then recruited a nontransgender sib-
ling. Transgender individuals did not need be
“out” to their sibling to participate: The study’s
focus on gender identity was not indicated in the
directions or items of the sibling questionnaire.
Indeed, the sibling questionnaire only asked
about sex in the conventional way, whether the
respondent was “male” or “female.
Trans groups were determined by trans re-
spondents’ answers to three questions on the
trans survey. If an individual was assigned the
male sex at birth, felt most comfortable with
the pronoun she, and felt “very” or “extremely”
comfortable with the pronoun she; this individ-
ual was categorized as a transwoman. If an in-
dividual was assigned the female sex at birth,
felt most comfortable with the pronoun he,and
felt “very” or “extremely” comfortable with the
pronoun he; this individual was categorized as a
transman. All other trans respondents were cat-
egorized as genderqueers. Assigned sex at birth
of genderqueers was 28.1% male, 70.3% female,
1.6% unknown, and 1.6% intersexed.
The study yielded a total of 295 completed
questionnaires. This included 50 transwomen,
52 transmen, 64 genderqueers, 88 nontrans sis-
ters, and 41 nontrans brothers. More detailed
information about the response rate is presented
in the Results section.
Procedure
The first author attended numerous transgen-
der political (e.g., GenderPAC, aka the Gen-
der Public Advocacy Coalition), social (e.g.,
Southern Comfort), cultural (e.g., True Spirit
Conference), academic (e.g., Transecting the
Academy), and health conferences (Philadel-
phia Transgender Health Conference); she also
attended transgender film showings, events,
and benefit performances. At these events, she
handed out paper flyers, left stacks of fly-
ers in well-trafficked areas, and gathered e-
mail addresses. She approached more than 1200
transgender individuals for potential participa-
tion. Despite obtaining well over 600 e-mail ad-
dresses from enthusiastic potential respondents,
fewer than half of these ultimately provided the
information necessary to send the survey(s) to
them (and their sibling). It is not possible to know
how many flyers were not picked up by potential
participants or how many e-mails were incorrect.
Furthermore, some participants e-mailed to say
that they would have participated in the study
except for the fact that they did not want to con-
tact their siblings or were no longer in touch
with their siblings. We do not know how many
participants ended up not participating for this
reason.
The calls for participants sought transgender
individuals 18 and over to participate in a study
Rhonda J. Factor and Esther D. Rothblum 15
to illustrate the various ways we experience
and express our gender identities. . . [and]
to explore ...similarities and differences
[with individuals who identify fully with
the sex/gender to which they were as-
signed at birth] by comparing our expe-
riences with those of our “conventionally
gendered” siblings.
Individuals interested in participating in the
study contacted the first author to request sur-
veys for themselves and their siblings. If the
individual had more than one sibling likely to
participate, they were asked to choose the one
closest in age and provided the name of another
potential sibling if the first did not complete and
return a survey. (Only one survey was sent to a
second sibling, but this sibling did not return the
survey.)
As per the request of the respondent, both sur-
veys were either sent to the respondent or one
was sent to the respondent and one directly to the
sibling. Surveys from siblings in the same family
had the same number but were distinguished by a
different letter (e.g., 37A and 37B). This allowed
data to be entered anonymously while still keep-
ing track of siblings. The sibling survey was not
identified as specifically comparing groups by
gender identity to ensure the confidentiality of
those transgender participants who may not be
“out” to their siblings. The transgender question-
naire had additional questions specific to trans
experiences (not described or analyzed here).
Measures
The sibling questionnaire for the nontrans-
gender siblings was entitled “The Family
Project.” The transgender questionnaire was
called “The Trans Project, Exploring Gender Di-
versity: Comparing Siblings.” It included every-
thing in the sibling questionnaire, in addition to
measures specifically about transgender experi-
ences. The wording of questions about gender
and sexuality differed from the sibling question-
naire by including terms and concepts specific
to particular trans subcultures.
Demographic Information. General demo-
graphic questions focused on age, ethnicity, re-
ligion in childhood and adulthood, educational
level, current employment status, and individ-
ual and household income. Participants wrote
in their occupation, and occupational status was
coded based on the Hollingshead index of social
status (Achenbach, 1998). Items related to geo-
graphic mobility included population density of
current location, years in current location, miles
from prior location, distance from mother and
father, and distance from childhood home to col-
lege. Relationship status variables included sex-
ual orientation; presence of children; number of
children; with whom participants were currently
living; marital status; relationship status; years
in relationship; and the sex, age, and ethnicity of
spouse/partner.
Perceived Social Support. Social support was
assessed using the Perceived Social Support
from Friends and Family questionnaires (PSS-
FR; PSS-FA; Procidiano & Heller, 1983). These
scales measure the extent to which people be-
lieve that friends and family, respectively, meet
their needs for support, information, and feed-
back. The PSS-FR and the PSS-FA each contain
20 questions that are answered yes,no,ordon’t
know (e.g., “My friends give me the moral sup-
port I need”). Directions of the questions vary:
the yes or no indicating support is scored as 1 and
the other is scored as 0. Don’t know responses are
scored as 0. Thus, high scores indicate high lev-
els of perceived social support. These measures
are negatively correlated with psychological dis-
tress (Procidano & Heller, 1983) and have been
found to correlate with ratings made by friends
and coworkers (Miller, Rothblum, Brand, & Fe-
licio, 1995).
Violence, Harassment, and Discrimination.
Victimization and discrimination were as-
sessed using Balsam’s (Balsam, Rothblum, &
Beauchaine, 2005) criminal victimization ques-
tions, with additional questions added regarding
discrimination. Participants were asked whether
they have ever been discriminated against or
harassed by different individuals, specifically
co-workers, work supervisors, fellow students,
teachers, strangers, members and leaders of re-
ligious communities, members and leaders of
ethnic communities, healthcare providers, and
acquaintances. They were asked if they have
ever been verbally harassed, verbally threat-
ened, stalked or followed, beaten up, mugged,
16 JOURNAL OF LGBT HEALTH RESEARCH
burglarized, raped or sexually assaulted, or wit-
nessed a friend or relative being murdered. They
were also asked if they believed that these events
occurred as a result of their actual or per-
ceived race/ethnicity, gender, sexual orientation,
or “other” attribute. A total score was calculated
based on the number of events an individual ex-
perienced.
RESULTS
Response Rate
A total of 242 transgender individuals re-
quested surveys for themselves and a nontrans-
gender sibling. In one case, when one sibling
who had been mailed a survey did not return it,
a survey was mailed to a different sibling. Thus,
surveys were mailed to 485 potential respon-
dents. Of these potential respondents, 295 com-
pleted and returned a survey yielding an over-
all response rate of 60.8%. The response rate
of transgender participants was 68.6%. The first
names of siblings suggested that 144 surveys
were mailed to sisters, whereas only 84 surveys
were mailed to brothers. It was not possible to
determine the gender of 15 of the siblings who
did not return surveys. Thus, response rates for
siblings were 55.3% for sisters and 41.4% for
brothers.
The 295 participants consisted of 50
transwomen (16.9% of participants), 52 trans-
men (17.6%), 64 genderqueers (21.7%), 88 non-
trans sisters (29.8%), and 41 nontrans brothers
(13.9%). There were 120 pairs in which both
the trans participant, as well as their sibling, re-
turned the survey. The siblings of transmen had a
return rate of 84.6%; the siblings of transwomen
and genderqueers had return rates of 64.0% and
68.8%, respectively. Thus, fewer transmen are
unpaired respondents (8) than transwomen (18)
and genderqueers (20). Six nontrans sisters and
3 nontrans brothers returned surveys, but their
trans sibling did not.
The majority of transgender respondents
(55.4%) heard about the study electronically, ei-
ther through a listserv, Web site, or chat room.
Learning about the study through attending a
trans conference was also common. Indeed,
34.4% of genderqueers, 23.1% of transmen, and
14.0% of transwomen learned about the study
at a conference. The third largest source for
trans participants was hearing about the sur-
vey from a friend, which ranged from 10.0%
for transwomen to 9.6% for transmen and 7.8%
for gender-queers.
Between 60% and 80% of participants in each
trans group told their sibling that the study in-
volved a comparison of trans people and their
nontrans siblings. The extent to which nontrans
siblings knew that gender identity was a primary
variable in the study did not differ significantly
between groups, X2(2, N=159) =3.41, p>
.05.
This study compared five groups (trans-
women, transmen, genderqueers, and non-
transgendered brothers and sisters) and included
all participants that returned surveys. Our prior
research on lesbians and their heterosexual sis-
ters (Rothblum & Factor, 2001) and lesbian, gay
male, bisexual, and heterosexual siblings (Roth-
blum, Balsam, & Mickey, 2004) demonstrated
similar results when paired comparisons were
made between sibling pairs and when all re-
spondents (including those whose siblings had
not responded and those where multiple siblings
returned questionnaires) were included in the
analyses.
Demographics
Participants were assigned to one of the five
groups based on the previously-defined criteria.
Analyses of variance were used for continuous
variables and chi square tests were used for cate-
gorical variables. Table 1. shows comparisons of
demographic characteristics of the five groups.
Respondents reported living in 40 U.S. states,
as well as the District of Columbia and Canada.
Although surveys were only mailed to locations
in the United States and Canada, siblings living
in the United Kingdom, Cyprus, and Brazil also
returned surveys.
Age. The average age of all participants was
35.6 years (SD =12.25) with a range of 18 to 72
years. However, the transwomen in this sample
were significantly older than respondents in each
of the other groups. Their average age was 44.6
TABLE 1. Demographic Information and Social Support of Trans and Nontrans Groups
Nontrans Nontrans
Transwomen Transmen Genderqueers Sisters Brothers
Characteristic
N
=50
N
=52
N
=64
N
=88
N
= 41 Statistic
Age 44.6
a
(11.7) 31.4
b
(9.2) 33.8
b
(11.3) 33.6
b
(11.6) 37.4
b
(13.9)
F
(4, 290) =10.77****
18–30 12.0% 59.6% 50.0% 47.7% 31.7%
31–40 28.0% 25.0% 21.9% 22.8% 31.7%
41–50 20.0% 11.6% 18.7% 22.7% 12.2%
51 and older 40.0% 3.8% 9.4% 6.8% 24.4%
Race/Ethnicity
X
2(24,
N
=291) =20.1
White/Caucasian 88.0% 86.3% 95.1% 87.5% 92.7%
African American/Black 0 0 3.3% 2.3% 0
Latino, Latina, Hispanic 4.0% 2.0% 0 2.3% 4.9%
Native American 0 2.0% 0 0 0
Asian American /Pacific Islander 4.0% 2.0% 0 2.3% 2.4%
Multiracial 2.0% 5.9% 1.6 3.4% 0
Other 2.0% 2.0% 0 2.3% 0
Religion in childhood χ2(28, N =294) =24.99
Catholic 38.0% 32.7% 29.7% 31.8% 35.0%
Jewish 4.0% 13.5% 9.4% 9.1% 7.5%
Protestant 52.0% 38.5% 34.4% 38.6% 42.5%
Buddhist 0 1.9% 0 0 2.5%
None 2.0% 7.7% 15.6% 12.5% 7.5%
Pagan 0 0 1.6% 0 0
Spiritual/no formal religion 4.0% 5.8% 6.3% 6.8% 5.0%
Other 0 0 3.1% 1.1% 0
Religion Now
X
2(28,
N
=291) =46.39*
Catholic 6.0% 5.9% 8.1% 18.2% 20.0%
Jewish 2.0% 9.8% 4.8% 4.5% 7.5%
Protestant 26.0% 13.7% 4.8% 26.1% 27.5%
Buddhist 0 2.0% 1.6% 2.3% 0
None 24.0% 15.7% 30.6% 21.6% 15.0%
Pagan 6.0% 7.8% 1.6% 0 0
Spiritual/no formal religion 34.0% 43.1% 45.2% 27.3% 25.0%
Other 2.0% 2.0% 3.2% 0 2.5%
Religion/Spirituality
Importance
a
3.30 (1.53) 3.48 (1.35) 3.06 (1.44) 3.36 (1.46) 2.93 (1.39)
F
(4, 287) =1.26
Frequency of attending services
b
4.32 (1.93) 4.48 (1.74) 5.08
a
(1.40) 4.27
b
(1.94) 4.78 (1.37)
F
(4, 290) =2.48*
17
TABLE 1 (continued)
Population density of current location χ2(20, N =293) =25.24
Large city 18.4% 25.0% 32.8% 27.6% 22.0%
Medium-sized city 14.3% 34.6% 20.3% 23.0% 26.8%
Small city or town 24.5% 25.0% 25.0% 25.3% 26.8%
Suburb 18.4% 7.7% 12.5% 14.9% 17.1%
Rural 24.5% 5.8% 9.4% 9.2% 7.3%
Other 0 1.9% 0 0 0
Years in current location 12.70
a
(13.51) 6.62
b
(8.68) 6.84
b
(7.43) 9.01 (10.72) 11.51 (11.03)
F
(4, 289) =3.56**
Miles from prior location
c
3.02 (1.71) 3.52
a
(1.67) 3.06 (1.70) 2.80 (1.74) 2.48
b
(1.66)
F
(4, 283) =2.47*
Distance live from
Mother 807 (1185) 1042
a
(1275) 638 (949) 447
b
(945) 386 (733)
F
(4, 230) =2.95*
Father
d
541 (740) 1034 (1211) 794 (10.48) 477 (887) 409 (750)
F
(4, 184) =2.63*
Other parental figure 1102 (1138) 862 (1111) 793 (1127) 652 (1140) 554 (833)
F
(4, 36) =.22
Distance between childhood home and college
c
3.07 (1.42) 3.00 (1.51) 3.39 (1.44) 2.92 (1.51) 3.03 (1.61)
F
(4, 261) =.93
Educational level
d
,
f
4.32 (1.30) 4.19 (1.14) 4.22 (1.16) 3.89 (1.38) 3.61 (1.58)
F
(4, 290) =2.45*
Current employment status
e
Student 16.0% 38.5% 28.1% 26.1% 19.5% χ2(4, N =295) =7.82
Employed full-time 66.0% 48.1% 56.3% 60.2% 65.9% χ2(4, N =295) =4.63
Employed part-time 12.0% 28.8% 23.4% 21.6% 12.2% χ2(4, N =295) =6.61
Homemaker 16.0% 0 0 18.2% 4.9% χ2(4, N =295) =24.83****
Retired 16.0% 0 1.6% 1.1% 2.4% χ2(4, N =295) =25.66****
Unemployed 8.0% 11.5% 12.5% 2.3% 12.2% χ2(4, N =295) =7.08
Other 0 0 0 0 0
Occupational status
g
67.86 (14.57) 61.77 (19.77) 60.33 (19.56) 62.98 (17.45) 59.22 (20.95)
F
(4, 208) =1.34
Individual yearly income
h
4.44 (3.22) 3.16 (2.08) 3.41 (2.60) 3.90 (2.92) 4.58 (3.08)
F
(4, 279) =2.34
Individual yearly income for full-time workers only
h
4.94 (3.10) 4.46 (2.09) 4.31 (2.51) 4.87 (2.76) 5.48 (2.68)
F
(4, 167) =.85
Household yearly income for those with partner/spouse only
h
6.53 (3.22) 5.48
a
(2.52) 6.05 (2.26) 7.83
b
(2.95) 7.64 (2.95)
F
(4, 136) =4.15***
Have children 44.0% 7.7% 20.3% 45.5% 36.6% χ2(4, N =295) =29.23****
Number of children 2.18 (1.01) 1.75 (.96) 2.15 (1.46) 1.83 (.813) 2.20 (1.21)
F
(4, 89) =.72
Currently living with
e
No one 38.0% 28.8% 23.4% 12.5% 9.8% χ2(4, N =295) =17.32***
Male spouse/partner 8.0% 3.8% 1.6% 56.8% 4.9% χ2(4, N =295) =107.00****
Female spouse/partner 28.0% 38.5% 26.6% 3.4% 51.2% χ2(4, N =295) =41.76****
Trans spouse/partner
i
4.0% 7.7% 6.3% χ2(4, N =295) =.62
Roommate(s)/housemate(s) 10.0% 25.0% 32.8% 6.8% 12.2% χ2(4, N =295) =22.63****
Parent(s) 10.0% 9.6% 4.7% 18.2% 17.1% χ2(4, N =295) =7.77
Child(ren) 10.0% 3.8% 4.7% 31.8% 26.8% χ2(4, N =295) =32.05****
Other family member(s) 0 7.7% 10.9% 11.4% 12.2% χ2(4, N =295) =6.57
Other 0 0 0 0 0
18
Marital status
Currently married 28.0% 5.8% 10.9% 46.6% 46.3% χ2(4, N =295) =43.44****
Married in past 50.0% 11.5% 15.6% 19.3% 14.6% χ2(4, N =295) =29.62****
Never legally married 30.0% 82.7% 78.1% 44.3% 43.9% χ2(4, N =295) =48.76****
Currently in relationship 56.0% 59.6% 51.6% 76.1% 65.9% χ2(4, N =295) =11.56*
Spouse/partner’s sex χ2(4, N =184) =115.26****
Female 53.6% 74.2% 66.7% 7.7% 85.2%
Male 25.0% 12.9% 9.1% 90.8% 14.8%
Spouse/partner’s sex
Trans
i
10.7% 9.7% 18.2% 1.5%
Other
i
10.7% 3.2% 6.1%
# Years in relationship
j
7.25 (6.70) 3.68
a
(3.07) 5.18
a
(8.10) 9.29
ab
(8.38) 11.69
b
(10.53)
F
(4, 175) = 5.28****
Spouse/partner age 40.50
a
(9.23) 30.58
b
(8.82) 34.61 (11.19) 36.50 (11.38) 42.72
a
(13.79)
F
(4, 172) = 5.40****
Spouse/partner race/ethnicity
X
2(24,
N
=186) =33.09
White/Caucasian 100.00% 83.9% 84.8% 83.6% 85.2%
African American/Black 0% 3.2% 0% 6.0% 0%
Latino, Latina, Hispanic 0% 0% 0% 6.0% 7.4%
Native American 0% 3.2% 6.1% 0% 0%
Asian American/Pacific Islander 0% 0% 0% 0% 3.7%
Multiracial 0% 6.5% 9.1% 4.5% 0%
Other 0% 0% 0% 0% 3.7%
Sexual orientation
e
,
k
Heterosexual 27.1% 33.3% 21.0% 83.7% 77.5%
X
2(4,
N
=287) =87.81****
Bisexual 43.8% 17.6% 29.0% 12.8% 7.5%
X
2(4,
N
=287) =25.03****
Lesbian/Gay 35.4% 21.6% 35.5% 3.5% 15.0%
X
2(4,
N
=287) =31.08****
Social support from friends 14.10 (5.11) 15.63 (4.81) 14.67 (5.19) 14.30 (5.19) 12.33 (5.19)
F
(4, 273) =2.40
Social support from family 9.74
a
(6.59) 10.00
a
(6.73) 9.59
a
(6.23) 14.07
b
(5.56) 11.53 (6.30)
F
(4, 266) =6.50****
Note.
Percentages are given for categorical variables. Means, with standard deviations in parentheses, are given for continuous variables. Means having the same subscript are not significantly different
at
p
< .05 in the Bonferroni test.
a
1 = not at all important, 3 = moderately important, 5 = very important.
b
1 = weekly, 2 = more than once a month, 3 = about once a month, 4 = several times a year, 5 = rarely, 6 = never.
c
1 = 0–20 miles, 2 = 21–50 miles, 3 = 51–100 miles, 4 = 101–500 miles, 5 = over 500 miles.
d
Although the
F
statistic is significant at the .05 level, there are no significant simple effects.
e
Categories are not mutually exclusive; percentages may add up to more than 100%.
f
1 = some or no high school; 2 = high school degree; 3 = some college; 4 = college degree; 5 = some graduate/professional school; 6 = graduate/professional degree.
g
Occupational level rated on 10 (lowest-status occupation) to 90 scale (highest-status occupation).
h
1 = $10,000 or less per year; 2 = $10,000–19,000; 3 = $20,000–29000; 4 = $30,000–39,000; 5 = $40,000–49,000; 6 = $50,000–59,000; 7 = $60,000–69,000; 8 = $70,000–79,000; 9 = $80–89,000; 10
= $90–99,000; 11 = $100,000 or more.
i
Response of “transpartner” for living with and “trans” and “other” for spouse/partner’s sex/gender was included only on trans questionnaires to avoid “outing” trans participants to siblings.
j
Nonrans sisters differ from transmen but not genderqueers, transwomen, or nontrans brothers.
k
Trans surveys also included other options.
p
< .05. **
p
< .01 ***
p
< .005. ****
p
< .001.
19
20 JOURNAL OF LGBT HEALTH RESEARCH
years and the average age of the four other groups
ranged from 31.4 to 37.4 years.
Given this significant age difference, analyses
of covariance controlling for age were performed
on all subsequent continuous variables. Results
of these analyses are presented in the text after
the results of the analyses of variance.
Race/ethnicity. The vast majority of re-
spondents in the study identified as White
(88.5%). Multiracial participants constituted
2.7% of the sample, Latinos were 2.4%,
Asian Americans/Pacific Islanders were 2.0%,
African Americans/Blacks were 1.4%, Native
American/American Indians were 0.3% and
8.0% identified as “Other” or did not answer this
question. There were no significant differences
in race/ethnicity based on group.
Religion. Although respondents’ religion in
childhood was similar across groups, there was
a significant effect for current religion. Less
than 10% of transgender participants still iden-
tified as Catholic, compared with 18% of non-
trans sisters and 20% of nontrans brothers. In
addition, over 25% of nontrans sisters, non-
trans brothers, and transwomen identified as
Protestant, whereas this was true for only 14%
of transmen and 5% of genderqueers. Further-
more, only 25% and 27% of nontrans broth-
ers and sisters, respectively, identified as be-
ing spiritual but having no formal religion;
34% of transwomen, 43% of transmen, and
45% of genderqueers identified this way. There
were no significant differences across groups in
terms of the importance of religion/spirituality.
However, genderqueers attended services sig-
nificantly less frequently (“rarely,” on aver-
age) than nontrans sisters (approximately sev-
eral times per year, on average). Analyses of
covariance controlling for age did not change
the significance level of importance of reli-
gion, F(4,286) =1.74, p> .05, or frequency
of attending religious services, F(4,289) =
2.58, p<.05.
Geographic Location and Mobility. There
were no statistically significant differences
across groups in the population density of partic-
ipants’ current residence. Table 1 indicates that
sizable percentages of each group reported living
in large cities, medium-sized cities, small cities
or towns, suburbs, and in rural areas.
However, there were differences in geo-
graphic mobility. Transwomen reported living
in their current residence significantly longer
than both transmen and genderqueers. Transmen
moved significantly further from their previous
location than did nontrans brothers. Transmen
also lived significantly further away from their
mothers than did nontrans sisters. Groups also
showed a significant effect for the distance they
lived from their father. Transmen reported living
more than 1000 miles from their fathers, on av-
erage, yet nontrans brothers reported living less
than 500 miles from their fathers.
However, some of the differences in geo-
graphic mobility were attributable to age. When
age was controlled for, differences were not
significant in the number of years participants
lived in their current location, F(4, 288) =
1.24, p> .05, or the distance they moved from
their prior location, F(4, 288) =2.28, p> .05.
However, differences remained significant in
the distance participants lived from mothers,
F(4, 228) =2.88, p< .05, and fathers, F(4,
183) =2.68, p< .05.
Education, Employment, and Income. Dif-
ferences in educational level were significant.
All trans groups had more education than non-
trans groups. Transwomen, transmen, and gen-
derqueers had an average of a college degree, in
addition to some graduate or professional train-
ing. Nontrans sisters and brothers, on average,
had less education than a college degree. Even
when age was used as a covariate, educational
level remained significant, F(4, 289) =2.60,
p<.05.
There were some differences in employment
status. Similar percentages of each group were
likely to be students, employed full-time, em-
ployed part-time, and to be unemployed. How-
ever, no transmen or genderqueers were home-
makers, as compared to 16.0% of transwomen,
4.9% of nontrans brothers, and 18.2% of non-
trans sisters. In addition, 16.0% of transwomen
were retired; this was true for only 1.1% of non-
trans sisters, 2.4% of nontrans brothers, 1.6% of
genderqueers, and no transmen.
Groups were similar in occupational status
and individual income. Analyses of individual
yearly income, both among all participants as
well as among only those working full-time,
Rhonda J. Factor and Esther D. Rothblum 21
did not reveal any differences that were signif-
icant. Controlling for age, occupational status
showed no significant variation across groups,
F(4, 207) =.92, p>.05. Similarly, when age
was controlled for, neither individual yearly in-
come for all respondents, F(4, 278) =1.20,
p>.05 nor individual income for full-time
workers only, F(4, 166) =.61, p>.05, was
significant.
On the other hand, there were significant dif-
ferences in household income. When the annual
household income of those with partners was
compared across groups, there was a statistically
significant difference between the household in-
come of transmen and nontrans sisters. Nontrans
sisters’ household income was between $60,000
and $79,000; the household income of transmen
was between $40,000 and $59,000. Even when
age was taken into account, differences in house-
hold income remained significant, F(4, 135) =
2.89, p< .05.
Children. There was a significant difference
in having children. Between one-third and one-
half of nontrans sisters, nontrans brothers, and
transwomen reported having children, but only
one-fifth of genderqueers and less than one-tenth
of transmen reported having children. However,
the difference was not significant in the number
of children respondents reported having. This
remained the case even when age was used as a
covariate, F(4, 88) =.30, p> .05.
Household Composition. There were many
differences in household composition across
groups. Over 25% of all trans people lived alone,
as compared to less than 12% of all nontrans peo-
ple. Although 57% of nontrans sisters reported
living with a male partner, less than 9% of every
other group reported this. Over half of nontrans
brothers and approximately one-third of all trans
groups reported living with a female partner, yet
this was true for less than 4% of nontrans sisters.
Only trans groups were asked if they lived with a
trans partner and a small percentage of each trans
group responded in the affirmative. Nonetheless,
the overall effect was not significant.
Differences in living with children were sig-
nificant. More than one-quarter of nontrans
sisters and nontrans brothers lived with chil-
dren, compared to one-tenth of transwomen and
less than one-twentieth of transmen and gen-
derqueers. Differences in living with parents or
other family members were not significant.
Marriage, Relationships, and Sexual Orien-
tation. Differences in marital status were statis-
tically significant. Over 45% of nontrans par-
ticipants were currently married, but 28% of
transwomen and less than 11% of transmen
and genderqueers were married. Fifty percent of
transwomen had been married previously; this
was true for less than 20% of each of the other
groups. The difference in never having been
legally married was also significant. Over 75% of
transmen and genderqueers reported never hav-
ing been married, whereas 44% of nontrans sib-
lings reported this and only 30% of trans women
reported never having been legally married.
The difference for currently being in a rela-
tionship was also significant. Seventy-three per-
cent of non-trans sisters and brothers compared
to 55% of trans people reported currently being
in a relationship. There was also a significant
difference for partner’s sex. More than half of
all groups, except nontrans sisters, had female
partners. In addition, a number of trans people
reported being involved with a trans person and
a number of trans people reported their partner’s
sex as “other.”
Further, the difference in length of relation-
ships was significant as well. Nontrans broth-
ers reported being in their current relationship
longer than transmen and genderqueers. When
age was taken into account, groups continued
to vary significantly in length of current re-
lationship, F(4, 174) =4.79, p< .005. The
difference in partner ethnicity was not signif-
icant. The vast majority of participants (87%)
reported having a White partner. Other eth-
nicities of partners included African Ameri-
can, Latino, Native American, Asian American,
Multiracial, and “Other.
Differences in sexual orientation were signif-
icant. Over 75% of nontrans sisters and brothers
identified as heterosexual, but this was true for
less than 35% of each trans group. Over 40% of
transwomen identified as bisexual and just less
than 30% of genderqueers identified this way.
Less than 20% of transmen, nontrans sisters,
and nontrans brothers identified as bisexual. In
addition, 35% of transwomen and genderqueers
identified as lesbian/gay; this was true for 22% of
TABLE 2. Comparison of Transwomen, Transmen, Genderqueers, Nontrans Sisters, and Nontrans Brothers on Violence, Harassment, and
Discrimination
Nontrans Nontrans
Transwomen Transmen Genderqueers Sisters Brothers
Characteristic
N
=50
N
=52
N
=64
N
=88
N
= 41 Statistic
Any harassment or discrimination 90.0% 92.3% 92.2% 79.5% 63.4%
X
2(4,
N
= 295) = 21.50****
Harassment or discrimination by
Coworkers 44.0% 46.2% 54.7% 43.2% 19.5%
X
2(4,
N
= 295) = 13.02*
Work supervisors 40.0% 44.2% 51.6% 36.4% 22.0%
X
2(4,
N
= 295) = 10.02*
Fellow students 30.0% 50.0% 46.9% 39.8% 29.3%
X
2(4,
N
= 295) = 7.48
Teachers 12.0% 28.8% 26.6% 25.0% 22.0%
X
2(4,
N
= 295) = 5.02
Strangers 60.0% 76.9% 73.4% 48.9% 34.1%
X
2(4,
N
= 295) = 26.65****
Members of religious community 18.0% 32.7% 26.6% 13.6% 2.4%
X
2(4,
N
= 295) = 17.71***
Leaders of religious community 16.0% 23.1% 20.3% 11.4% 2.4%
X
2(4,
N
= 295) = 10.15*
Members of ethnic community 14.0% 28.8% 23.4% 12.5% 14.6%
X
2(4,
N
= 295) = 7.96
Leaders of ethnic community 10.0% 21.2% 14.1% 4.5% 4.9%
X
(4,
N
= 295)2= 11.85*
Harassment or discrimination by
Healthcare provider 28.0% 50.0% 26.6% 8.0% 2.4%
X
2(4,
N
= 295) = 44.79****
Casual functional acquaintance 42.0% 53.8% 53.1% 38.6% 19.5%
X
2(4,
N
= 295) = 15.11***
Pervasiveness of harassment or discrimination
a
3.14 (2.19) 4.56
a
(3.32) 4.17
a
(3.09) 2.82
b
(2.31) 1.73
b
(1.95)
F
(4, 290) = 9.11****
Threatened or actually attacked 64.0% 71.2% 56.3% 64.8% 61.0%
X
2(4,
N
= 295) = 2.94
Threatened with physical violence 42.0% 50.0% 43.8% 30.7% 46.3%
X
2(4,
N
= 295) = 6.32
Verbally harassed or verbally attacked 70.0% 86.5% 85.9% 58.0% 53.7%
X
2(4,
N
= 295) = 26.03****
Chased, followed, or stalked 32.0% 48.1% 28.1% 33.0% 22.0%
X
2(4,
N
= 295) = 8.33
Property purposely damaged or vandalized 34.0% 34.6% 18.8% 18.2% 24.4%
X
2(4,
N
= 295) = 8.29
Property stolen (break-in burglary or theft) 20.0% 23.1% 15.6% 28.4% 39.0%
X
2(4,
N
= 295) = 8.66
Robbed (holdup or mugging) 4.0% 11.5% 3.1% 5.7% 17.1%
X
2(4,
N
= 295) = 9.76*
Punched, hit, kicked, or beaten 30.0% 38.5% 20.3% 19.3% 39.0%
X
2(4,
N
= 295) = 10.65*
Assaulted with a weapon 2.0% 15.4% 3.1% 3.4% 12.2%
X
2(4,
N
= 295) = 13.30*
Raped or sexually assaulted 18.0% 21.2% 10.9% 27.3% 4.9%
X
2(4,
N
= 295) = 12.44*
Crime Victimization Total
b
2.52 (2.22) 3.29 (2.41) 2.30 (1.96) 2.24 (1.95) 2.59 (2.51)
F
(4, 290) = 2.18
Note.
Percentages are given for categorical variables. Means, with standard deviations in parentheses, are given for continuous variables. Means having the same subscript are not significantly different
at
p
< .05 in the Bonferroni test.
a
Number of different types of interactions in which harassment and/or discrimination (based on 11 types listed; range =0–11).
b
Number of different types of violent threats and violent attacks (based on 9 types listed; range =0–9).
p
< .05. **
p
< .01. ***
p
< .005. ****
p
< .001.
22
Rhonda J. Factor and Esther D. Rothblum 23
transmen, 15% of non-trans brothers, and 3.5%
of non-trans sisters.
Perceived Social Support
Results of perceived social support from
friends and family are presented in Table 1.
The difference in perceived social support from
friends was not significant. However, the dif-
ference in perceived social support from family
was statistically significant. Nontrans sisters ex-
perienced the most support from family. This
was significantly greater than the support expe-
rienced by each of the trans groups. When age
was used as a covariate, the difference in sup-
port from friends continued not to be significant,
F(4, 272) =2.08, p> .05, but the difference in
support from family continued to be significant,
F(4, 265) =6.23, p< .001.
Violence, Harassment, and Discrimination
Comparisons of all five groups on harass-
ment, discrimination, and violence are displayed
in Table 2. Analyses revealed significant differ-
ences for many types of harassment and dis-
crimination. There was a significant difference
for the overall item of experiencing “any type of
harassment or discrimination.” Over 90% of all
trans people reported experiencing harassment
or discrimination, compared to 80% of nontrans
sisters and 63% of nontrans brothers. In addition,
there were significant effects for harassment
or discrimination by coworkers, work supervi-
sors, strangers, members of religious communi-
ties, leaders of religious communities, leaders of
ethnic communities, healthcare providers, and
casual acquaintances. Generally, the rates of ha-
rassment or discrimination reported by the trans
groups was higher than those reported by non-
trans brothers or sisters. In addition, groups dif-
fered in the pervasiveness of harassment and
discrimination. Transmen and genderqueers re-
ported experiencing harassment and/or discrimi-
nation in significantly more types of interactions
than did nontrans people. The difference re-
mained significant when age was used as a co-
variate, F(4, 289) =8.52, p<.001.
The difference across groups in threats of at-
tacks and actual attack was not significant. The
difference was also not significant for threats of
physical violence. However, there was a signifi-
cant difference for being verbally attacked. Over
85% of transmen and genderqueers reported be-
ing verbally attacked; this was reported by 70%
of transwomen, 58% of nontrans sisters, and
54% of nontrans brothers. The difference for be-
ing chased, followed, or stalked was not signifi-
cant. Further, there was no significant difference
for property being damaged or stolen.
There was a significant difference in hav-
ing been robbed. Seventeen percent of non-
trans brothers reported being robbed, as did 12%
of transmen and less than 6% of each of the
other groups. The difference for having been
punched, hit, kicked, or beaten was also signif-
icant. Thirty-nine percent of nontrans brothers
and transmen reported being physically attacked
in this way. Thirty percent of transwomen, 20%
of genderqueers, and 19% of nontrans sisters re-
ported being punched, hit, kicked, or beaten. As-
sault with a weapon differed significantly across
groups. This was reported by 15% of transmen,
12% of nontrans brothers, 3% of nontrans sisters
and genderqueers, and 2% of transwomen.
The difference in rape and sexual assault was
significant across groups. Rape or sexual assault
was reported by 27% of nontrans sisters, 21%
of transmen, 18% of transwomen, 11% of gen-
derqueers, and 5% of nontrans brothers. The
group difference in crime victimization total,
the number of different types of threatened or
actual attacks, was not significant. When crime
victimization was analyzed using age as a co-
variate, the difference was still not significant,
F(4,289) =2.14,p>.05.
DISCUSSION
Response Rate
The methods of recruitment, as well as the
study procedures, meant that participants were
drawn from a particular population of transgen-
der individuals. This population has easy access
to a computer, a permanent residence, a sibling
with a permanent residence, and enough con-
tact with a sibling to know his/her address. Con-
sequently, this population differs a great deal
24 JOURNAL OF LGBT HEALTH RESEARCH
from the trans populations in much of the prior
research.
Transgender participants were much more
likely to send a survey to a sister rather than
a brother. In a study using a comparable sibling
methodology, Rothblum et al. (2004) also found
that gay men, lesbians, and bisexual women and
men were more likely to send a survey to a sis-
ter. This may be because trans people, as well
as LGB people, feel more accepted by their sis-
ters than by their brothers. It may also be that
respondents thought that their sisters would be
more likely to complete and return the survey.
Indeed, sisters were, in fact, more likely to com-
plete and return the survey when compared with
brothers. The tendency to recruit sisters rather
than brothers, and brothers’ lower rates of sur-
vey return, made it extremely difficult to recruit
a large number of nontransgender brothers and
resulted in more than twice as many sisters as
brothers.
Demographics
Age. What could account for the significant
age difference between transwomen and the
other groups? Much of the prior research on
transsexuals focused on MTF individuals, so per-
haps there was more public awareness of trans
issues for transwomen earlier on. It may be that
individuals who experience their gender in ways
similar to transmen and genderqueers were un-
likely to identify as transgender before the rel-
atively recent emergence of a vocal transgen-
der community in the past 15 years. Many have
argued that those who previously would have
identified as “butch” lesbians are currently iden-
tifying as trans (e.g., Crawley, 2002). This would
result in those who identify as transmen and gen-
derqueer being younger.
The effects of age have been parceled out
when possible through analyses of covariance,
and controlling for age rarely changed the signif-
icance level of results. Nevertheless, these anal-
yses do not take into account the extent to which
historical changes in trans communities differ-
entiate older cohorts from younger ones. Further
research is needed to understand historical dif-
ferences among trans groups.
Race and Ethnicity. Previous research has
identified a population of transwomen who are
largely people of color. These women tend to live
in urban areas, are relatively young, have little
education, have difficulty finding legal employ-
ment, have difficulty finding safe and permanent
housing, and live in poverty. Among this popula-
tion, there are extremely high rates of violence,
rape, unclean needle use for hormone injections,
HIV and AIDS, and suicide. The sibling method-
ology is limited to recruitment of large numbers
of participants who are educated, have a perma-
nent residence, have access to a computer, and
are in contact with siblings.
It is clear that findings from this study regard-
ing transwomen are more accurately described
as findings that reflect the experiences of white
transwomen over 30. Findings regarding trans-
men and genderqueers are more accurately de-
scribed as findings reflecting the experiences of
white transmen and white genderqueers.
Religion. Although a large majority of par-
ticipants in each group was raised with a formal
religion, the number of individuals continuing to
identify with a religion in adulthood decreased
in each of the five groups. However, trans peo-
ple were much less likely than their nontrans
siblings to identify with a formal religion as
adults. The exception to this finding was that
transwomen had similar rates of identification as
Protestant as their nontrans siblings. Although it
is not surprising that trans people eschew reli-
gions that denigrate their identity, it is unclear
why many transwomen embrace Protestantism.
This difference may be associated with age.
Although there were no differences in the im-
portance of religion/spirituality between groups
when age was controlled for, being a member
of a formal religious group may become more
important as one ages. In addition, it may be
that transwomen, as opposed to transmen and
genderqueers, experience Protestantism as less
alienating and/or demeaning. Further, perhaps
transwomen’s greater likelihood of having chil-
dren means they are more likely to be a member
of a formal religion to provide children with a
religious community.
Despite trans people’s lesser tendency to iden-
tify with a formal religion than nontrans people,
spirituality held a similar level of importance
Rhonda J. Factor and Esther D. Rothblum 25
in their lives. Indeed, many embraced a spiritu-
ality outside of formal Western religions. It is,
thus, surprising that even though trans people
are less affiliated with religion, transwomen and
transmen attended religious services to a similar
extent as nontrans women and men. Therefore,
the tendency not to identify with a formal reli-
gion may reflect an affirmation of one’s own dig-
nity that these religions fail to honor, an expres-
sion of protest against certain religious tenets,
and/or a refusal to align oneself with institu-
tions contributing to the marginalization of gen-
der and sexual minorities. The difference in re-
ligious identification appears to reflect thoughts
and feelings toward religious institutions more
so than it does spiritual behavior or beliefs.
Education, Employment, and Income
We had hypothesized that trans people, as a
stigmatized group, would not have obtained the
educational level, income, and occupational sta-
tus of their non-trans siblings. This hypothesis
was partially supported. The trans people in this
study were extremely well-educated: On aver-
age, they had a college degree in addition to some
graduate or professional education. In contrast
to the trans people in this study, their nontrans
siblings averaged less than a college degree.
However, despite having more education,
trans people did not have a correspondingly
higher occupational status, nor a higher annual
income. This was true even when only full-time
workers were compared and the effects of age
were controlled.
There are a number of reasons that might ac-
count for this. It may be related to the types
of jobs that trans people choose. Transgender
people may not prioritize income to the same
extent as nontransgender people. For example,
they may place a higher priority on whether gen-
der expression and/or gender identity is included
in a company’s antidiscrimination policy. In ad-
dition, it is possible that, as members of a stig-
matized minority group, trans people are more
likely to have jobs aimed at creating a more just
and equitable society. These jobs are more likely
to be in nonprofit organizations or governmental
agencies that would pay less than similar jobs in
the private sector.
Another possibility to account for the failure
of trans people to earn an income commensurate
with their education is workplace discrimina-
tion. Indeed, 15% of individuals in one study
reported losing a job due to discrimination from
being transgendered (Xavier, 2000). In another
study, 37.1% of individuals reported some form
of economic discrimination due to being trans-
gendered: being fired, not being hired, demoted,
losing promotions, or being unfairly disciplined
(Lombardi et al., 2001). Although rates of un-
employment in this study did not differ across
groups, it is, nonetheless, possible that work-
place firings led to underemployment.
In terms of household income among those
who were married or partnered, nontrans sisters
had a higher household income than transmen.
This is not surprising, given that, of all groups,
nontrans sisters were most likely to partner with
men and transmen were most likely to part-
ner with women. According to the most recent
available data on the gender wage gap, women
earn 77% of men’s earnings for the same work
(National Committee on Pay Equity, 2006).
Social Support
We had hypothesized that trans people would
perceive less social support from their families
of origin, and this hypothesis was confirmed.
There was no difference in the degree to which
the five groups experienced social support from
their friends. However, there was a strong ef-
fect for social support from family. Each of
the trans groups experienced less social support
from their family than their nontrans sisters. The
lack of social support for trans people by fam-
ilies of origin is in line with previous findings.
Bockting, Huang, Ding, Robinson, and Rosser
(2005) found that a combined group of MTFs
and FTMs had lower levels of social support than
the two other groups with whom they were com-
pared: men who have sex with men and women
who have sex with women and men. In Xavier’s
(2000) study, 27% of a combined group of MTFs
and FTMs reported that estrangement from their
birth family limited their access to safe hous-
ing. There has been much anecdotal evidence
suggesting that trans people are less likely to re-
ceive support from their families of origin, but
26 JOURNAL OF LGBT HEALTH RESEARCH
this is the first study to systematically compare
social support across trans and nontrans groups.
In addition, some of the findings from related
demographic variables, described in the follow-
ing sections, also point to increased distance to
family of origin as well as isolation from others.
Geographic Location and Mobility. Signifi-
cant percentages of trans people, as well as
nontrans people, in this study lived in medium-
sized cities, small cities, suburbs, and rural areas.
Transmen tended to live further from their moth-
ers and fathers than members of other groups.
It is understandable that trans people would live
further away from their parents, from whom they
were less likely to feel support, and often where
they had previously been known as a gender with
which they do not currently identify. Transmen’s
tendency to live further away than transwomen
or genderqueers, even after the effects of age
were taken into account, may be related to ideals
of masculinity. Perhaps it is important for trans-
men to assert their independence and experience
themselves as self-reliant.
Marriage, Relationships, and Sexual Orienta-
tion. Transwomen were the most likely to ever
have been married, but less likely than their non-
trans siblings to currently be married. This is
likely a combination of the effects of cohort,
gender, and the legal system. As discussed, the
recent increase in trans visibility may mean that
the transwomen in this study, who are older than
the transmen and genderqueers, saw fewer op-
tions for themselves upon entering adulthood.
The intense societal denigration of femininity,
particularly when expressed in those appear-
ing male, may also have made it more likely
for transwomen to attempt gender, sexual, and
lifestyle conformity relative to transmen.
Although many transwomen are currently
married, they are also the most likely group to
have divorced. There is a great deal of diver-
sity in the responses of female spouses to learn-
ing of and living with a partner’s transgender
identity and/or desire to expand their transgen-
der expression (Cole, Denny, Eyler, & Samons,
2000). However, many spouses choose to end
the marriage.
A smaller percentage of trans people were
in primary relationships compared to their non-
trans siblings. Although there are little data
on the relationship rates of trans people in
large studies, the data that exist suggest these
rates are relatively low. In a Washington, DC,
study, 31% of a combined group of transmen
and transwomen had primary partners (Xavier,
2000); in a Minnesota study, 48% had primary
partners (Bockting et al., 2005). Thus, the per-
centage of trans people in our study in primary
sexual relationships is higher than that found in
other studies, although lower than that of non-
trans people.
There are a number of reasons that may ac-
count for lower rates of relationships in trans
people. It may be more difficult for trans people
to find individuals who are open to a primary
relationship with a trans person. It is also likely
that some partners of trans people ended rela-
tionships due to transgender issues. Fears of re-
jection by a potential partner may inhibit trans
people’s dating activity.
About one-third of transwomen and gen-
derqueers identified as lesbians, as well as one-
fifth of transmen. All three trans groups were
much more likely to be involved with women
than with men. Although there are a diversity of
ways in which trans people use terms to describe
their sexual orientation ( e.g., a transwoman at-
tracted to men may identify herself as “gay” as
opposed to “heterosexual”), it appears that ei-
ther bisexual trans people tend to be involved
with women and/or those who are attracted to
women are more likely to be in primary relation-
ships. There is some evidence, albeit scant, that
supports the latter. In one study of 43 MTF trans-
sexuals, Lewins (as cited in Lawrence, 2005)
found that 71% of those who identified as les-
bian were in a stable relationship, as opposed to
only 27% of those who were sexually attracted
to men.
Children. Almost half of the transwomen in
the study had children, similar to the percent-
ages of nontrans siblings who had children and
far greater than the percentages of transmen and
genderqueers who had children. One explana-
tion relates to cohort effects. It may be that
when the transwomen in this study were in their
20s, between 1981 and 1990 on average, there
was more pressure to conform to societal expec-
tations regarding gender, sexuality, and child-
rearing. The transmen and genderqueers in the
Rhonda J. Factor and Esther D. Rothblum 27
study were in their 20s between 1995 and 2004,
on average, and may not have experienced soci-
etal pressure to the same extent.
Another aspect of the extent to which indi-
viduals experienced societal pressure relates to
the cultural denigration of femininity. There is
a considerably greater range of gender expres-
sion for those who appear to be women than for
those who appear to be men (e.g., Devor, 2004) .
Cross-sexed expressions of femininity are much
more highly censured than cross-sexed expres-
sions of masculinity. Thus, it may be that trans-
men felt less societal pressure to distance them-
selves from their internal gender experience, but
transwomen may have had greater motivation to
attempt gender, sexuality, and child-rearing con-
formity.
Finally, transwomen may be more likely to
have children than transmen and genderqueers as
a result of being more likely to be able to create a
child through sex with their partner. The major-
ity of transwomen, transmen, and genderqueers
in this study were in relationships with women.
Thus, regardless of current surgical and/or hor-
monal use, transwomen were most likely to be
able to procreate with their partner. Although in-
dividuals certainly have children by other meth-
ods, those methods require a great deal more
deliberation, time, money, and effort.
Household Composition. Household compo-
sition varied a great deal across groups. Trans
people were more likely to live alone than non-
trans people. Part of this difference is attributable
to trans people being less likely than nontrans
people to be in a primary relationship. Another
contributor is trans people receiving less sup-
port from parents than their nontrans sisters and
therefore being less likely to live with parents.
Interestingly, all trans groups were much more
likely to live with a female partner than a male
partner, and in this way were similar to nontrans
brothers. Indeed, this is consistent with the sex-
ual orientation reported by trans participants.
Although transwomen were just as likely
to have children as nontrans women and men,
they were significantly less likely to live with
children. There is very little information about
transwomen as parents. Many courts have ruled
against the custodial rights of transwomen
(Minter & Daley, 2003), and the publicity—as
well as financial and emotional costs—are
likely to be deterrents. On the other hand, it may
be that transwomen sought freedom to explore
and enact their gender identity and expression.
This is an important area to study further.
Violence, Harassment,
and Discrimination
As hypothesized, trans people were much
more likely to experience harassment and dis-
crimination than nontrans sisters and nontrans
brothers. They reported more harassment or
discrimination by coworkers, work supervisors,
strangers, members and leaders of the religious
community, leaders of the ethnic community,
healthcare providers, and casual acquaintances.
The rates for nontrans brothers were the lowest
for the types of harassment in which the differ-
ence was significant, with one exception. The
rate of harassment by leaders of ethnic commu-
nity, however, was higher for nontrans brothers
than it was for nontrans sisters. In addition, rates
of harassment for transmen were consistently
higher than rates of harassment for transwomen.
Harassment rates were also higher for transmen
than rates for genderqueers, with the two excep-
tions of coworkers and work supervisors. The
reason for higher rates of harassment and dis-
crimination of transmen relative to transwomen
and genderqueers is unclear. It is possible that
the differences in rates between transmen and
transwomen are related to differences in the age
of first presenting as one’s subjectively expe-
rienced gender identity. Perhaps individuals are
more likely to harass and/or discriminate against
younger people. Perhaps younger people are in
situations in which harassment and/or discrimi-
nation is more likely to arise.
Another possibility is that, regardless of age,
transmen tend to be in situations that are more
likely to lead to harassment or discrimination.
Further, perhaps transmen experience a false
sense of safety when presenting as men. They
may feel less vulnerable than when they had
presented as women. Perhaps this false sense
of safety, a desire to experience themselves as
strong and independent, and/or a desire to be per-
ceived as strong and independent may lead them
to be less cautious than transwomen. It may also
28 JOURNAL OF LGBT HEALTH RESEARCH
be that transmen’s relative youth is associated
with decreased caution as well. Finally, it may
be that perpetrators are more threatened and,
therefore, more likely to harass or discriminate
against transmen, as opposed to transwomen or
genderqueers.
Comparisons of violent crime victimization
yielded very different results than did com-
parisons of verbal harassment and discrimina-
tion. Nontrans brothers reported the highest rates
of robbery, whereas genderqueers reported the
lowest. Both transmen and nontrans brothers
had similarly high rates of being punched, hit,
kicked, or beaten, although transwomen had
high rates of this as well. Transmen and nontrans
brothers had the highest rates of assault with
a weapon, whereas transwomen had the lowest
rate. Finally, nontrans sisters had the highest rate
of rape or sexual assault followed by transmen
and then transwomen.
National violent crime victimization data
show that men are much more likely to be vic-
tims of violent crimes than women, except in
the cases of rape and sexual assault (Depart-
ment of Justice, 2005) and this was borne out
in this study. What is also evident in the current
study is that transmen, like nontrans men, are
subject to high rates of violent crimes in addi-
tion to high rates of rape and sexual assault. The
transwomen in the study were subject to high
rates of being punched, hit, kicked, or beaten
but not the other violent crimes. Their rates of
rape and sexual assault were similar to transmen
but lower than nontrans women. It appears that
rape and sexual assault victimization may be as-
sociated with length of time one is perceived as
a woman. Other possibilities are those identified
previously to account for differential rates of ha-
rassment and discrimination: transmen’s earlier
age of presenting as their subjectively experi-
enced gender, a false sense of security deriving
from physiological changes in the body, a false
sense of security deriving from being perceived
socially as a man, and decreased caution and in-
creased risk taking associated with masculinity
and/or youth.
Comparisons of rates of violence and harass-
ment across studies are complicated by differ-
ently worded questions, different ways of gath-
ering data, and including different populations.
For example, Kenagy (2005) reported combined
findings for MTFs and FTMs, some of whom
answered a written survey and others who were
interviewed face-to-face, about whether they had
ever been forced to have sex. Of the individuals
who answered the question, 53.8 reported that
they had. Lombardi et al. (2001), also with a
combined sample of MTFs and FTMs, found
that 14% of respondents had been the victim
of rape or attempted rape. In our study, 18%
of transwomen, 21% of transmen, and 27.3%
of nontrans women had been raped or sexually
assaulted. Thus, including a meaningful compar-
ison group is essential.
It is also essential to reiterate the demograph-
ics of the participants in this study. These are the
“thrivers” in the transgender population. They
are largely White, extremely well-educated, em-
ployed, and live in urban, suburban, and rural en-
vironments. The transwomen in this population
tend to be over 30 and, on average, have lived
in their current home for 12 years. These are the
most financially secure trans people, the individ-
uals who have the most control over situations.
Thus, the rates of verbal harassment, assault, and
rape found in this population likely represent the
low end of harassment and violence against trans
people. Nevertheless, comparison with their
nontrans brother and sisters yields extremely
high rates of assault and rape, respectively.
Strengths and Limitations
The biggest strength of this study is its recruit-
ment of groups of transwomen, transmen, gen-
derqueers, nontrans sisters, and nontrans broth-
ers using the same methodology. There has
never been a study that compared transgen-
der individuals with nontrans people recruited
from their siblings. The fact that siblings share
the race/ethnicity, childhood socioeconomic sta-
tus, religion, and childhood geographic location
means that, regardless of how representative the
trans samples are, their siblings serve as a mean-
ingful comparison group. Differences between
groups can thus be attributed to gender identity.
Another major strength of the study is
its comparable sample sizes of transmen and
transwomen and the presentation and analysis
of data along these lines. This is extremely
Rhonda J. Factor and Esther D. Rothblum 29
important, given the overwhelming focus on
MTFs in prior research.
Although the sibling methodology has advan-
tages, it also has limitations. We do not know
how many trans participants chose not to partic-
ipate precisely because they were asked to in-
clude a nontrans sibling in the study. Trans par-
ticipants reported receiving less support from
family of origin, which may include siblings.
Thus, they may have lost touch with siblings
or feel disconnected to them. It may be pre-
cisely those trans people who feel most iso-
lated from their families who would have lower
income, or higher rates of violence, for exam-
ple. Conversely, there may be trans participants
in this study who remain in touch with their
families, but it is their nontrans siblings who
did not respond because they are isolated or
alienated.
Another major weakness of the sibling
methodology is its lack of a significant sample
of participants of color. Collaborating with orga-
nizations of trans people of color might help to
illuminate issues of particular relevance for this
population, adapt methodologies to increase par-
ticipation, and increase outreach effectiveness. It
would be important to explore terminology used
in trans communities of color through qualitative
research.
Finally, this study captures individuals’ expe-
riences at one point in time. Longitudinal studies
that could track changes over time would en-
hance insight into the relationship between edu-
cation and income, for example, or the ways in
which demographics may change over time.
One of the most significant clinical impli-
cations of this study is that the vast majority
of trans people have experienced violence and
harassment. Even if their current environment
is supportive, the history of hostility that they
likely encountered will, typically, leave its scars.
The high rates of rape and sexual assault among
transwomen and transmen will also be important
clinical issues. Insofar as these assaults involved
denigration or hostility based on gender expres-
sion, there could be multiple levels of trauma.
Further, it is also important to recognize the
likelihood of attack among nontrans men and
the likelihood of sexual assault among nontrans
women.
Many trans people do not experience social
support from their families of origin. It is also
clear that relationships with partners often end
when individuals expand their preferred gender
expression. Thus, treatment for family of origin,
as well as current partners, has the potential to
be very useful. In addition, support groups for
family members, as well as partners, may help
individuals understand their own reactions and
not rely solely on their son, sister, or partner to
learn about trans issues.
Nevertheless, this study shows that many
trans people are thriving despite societal igno-
rance, hostility, and discrimination. They are
highly educated and employed. They have de-
veloped a spirituality outside of formal Western
religions. About half are in partnered relation-
ships, and most perceive high levels of social
support from friends. Further research should fo-
cus on what enables members of this oppressed
group to overcome barriers and live satisfying
lives.
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... Studies that treat transgender as a homogenous category by failing to distinguish between trans women, trans men, and nonbinary trans people obfuscate important information, as illustrated by the findings from an innovative national study of almost 300 transgender people and their cisgender siblings. Factor and Rothblum (2008) found that transgender respondents more often reported having been "punched, hit, kicked, or beaten" than cisgender respondents. However, these differences shifted when respondents were further disaggregated by gender. ...
... In the few studies of non-lethal violence against transgender people that disaggregate their data by gender, findings have differed greatly from one study to the next, often because they operationalize "violence" differently. Some found much higher rates of violence against transgender women compared to transgender men (Kenagy, 2005;Stotzer, 2008), whereas others found higher rates for trans men (Factor & Rothblum, 2008). Messinger et al. (2021), utilizing data from the 2015 U.S. Transgender Survey, found wide variation of risk within the category of transgender, depending on the type of violence. ...
... By contrast, there are clearer patterns related to sexual assault. Studies constantly find that transgender men experience higher rates than transgender women (Beckman et al., 2018;Factor & Rothblum, 2008;Murchison et al., 2019). However, there are mixed findings around rates of sexual assault experienced by binary versus nonbinary trans people (Factor & Rothblum, 2008;Murchison et al., 2019). ...
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Violence against transgender people is a prevalent but understudied form of gender‐based violence. In recent years, this body of literature has expanded substantially. However, analysis of violence experienced by transgender people has been hampered by a shortage of good data. This article explores those data dilemmas and details what is and is not currently known about violence against transgender people in the United States. National surveys with sample sizes large enough to facilitate comparisons between transgender and cisgender respondents as well as attend to diversity with the category of transgender tend to not ask questions that count transgender respondents. Moreover, when they do, surveys often do not follow established best practices. Additionally, qualitative research on this topic is underfunded, resulting in small sample sizes with similar constraints. Therefore, although there is increased knowledge around rates of violence for transgender versus cisgender people, differences in risk related to gender and race, and intimate partner and sexual violence, this knowledge is flawed and does not cover the range of violence that transgender people experience. To better address this topic, data collection and analysis must be improved and scholars should attend to ways to prevent violence against transgender people.
... However, SDY were less likely to get sexual orientation-specific support from family members compared to receiving support from friends (Doty et al., 2010). Gender diverse people may also receive less overall support from family members (Factor & Rothblum, 2007). Transgender women report less family support than gay and bisexual cisgender men (authors) and cisgender women (Davey et al., 2014). ...
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To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned female at birth (82.2%). The majority (97.8%) were sexually diverse (e.g., queer, pansexual, lesbian, gay, asexual, bisexual) and half (50%) were gender diverse (e.g. transgender, agender, genderqueer, nonbinary). Participants completed an online survey. This analysis is focused on participants’ responses to open-ended questions regarding responses they perceived to be supportive and unsupportive of their SGD identity/identities. Content analysis of participants’ open-ended survey responses was conducted using a combination of inductive and deductive coding. Six themes emerged for both supportive responses (communication, actions, acceptance, open-mindedness, unconditional love, and advocacy) and unsupportive responses (distancing, hostility, minimizing, controlling, blaming, and bumbling). For some themes, different sub-themes emerged based on identity. Parents/caregivers as well as other adults in the lives of SGD YA can implement specific responses to demonstrate support for sexual orientation and gender identity with the potential to improve the mental health of SGD YA.
... Central to our analysis was the notion that trans youth are capable of generating expert knowledge about their lives and experiences and that this knowledge is integral to the transformation of issues and institutions that impact their everyday lives. Given the implicit power relations in youth-parent-provider triads and data demonstrating that a significant portion of trans individuals experience explicit rejection from family members as a result of their gender identity (Bradford et al., 2013;Factor & Rothblum, 2007;Graham et al., 2014;Koken et al., 2009), more research is needed to understand how the intersecting power relations/structures of domination related to cisnormativity and trans youths' status as legal minors impact their abilities to access a wide variety of health services across a diversity of health systems throughout the U.S. today. Such research should include waivers of parental permission that permit the participation of youth under the age of 18, both with and without parental support, as a necessary and fundamental strategy for recognizing youths' authority of knowledge and for understanding intersectional power dynamics related to age, gender, and other aspects of trans youths' social identities that impact how they navigate research participation and healthcare systems as legal minors. ...
Article
Contemporary transgender youth in the U.S. today face increasing stigmatization as extraordinary legislative attacks intensify discrimination and exclusion of these young people in healthcare, recreation, and school life. These attacks reflect broader political, religious, and cultural ideologies embedded in systems of power that regulate the provision of healthcare for American transgender youth. We apply Foucauldian discourse analysis and a theory-driven conceptual framework for structural analysis of transgender health inequities—Intersectionality Research for Transgender Health Justice—to identify discourses youth encounter within healthcare practice. We analyzed data from interviews conducted in Western Washington State with youth ages 13–17 ( n =11) and asked how transgender subjectivity was constructed in their accounts and in what ways youth made use of the discursive resources available to them when navigating systems of care. Three sets of discourses—discourses of normativity, discourses of temporality, and discourse of access—characterized participants’ narratives. We discuss how participants negotiated discursively situated systems of power in order to ensure their safety and access to care.
... In the U.S., Benjamin (1967) used data from his medical practice to argue that for every one so-called "female to male" (FTM) transgender person, there were eight so-called "male to female" (MTF) transgender persons. Pauly (1968) argued that the ratio of trans women to trans men was 4:1, and that there were 2,000 transgender women and 500 transgender men in the U.S. Transgender scholarship later evolved to analyses using data from small samples, mostly of a qualitative nature (Bender-Baird, 2013;Factor & Rothblum, 2007;Schilt, 2006;Schilt & Wiswall, 2008), in which non-Hispanic whites and highly educated individuals were overrepresented (Harris, 2015). ...
Chapter
In this chapter we undertake a series of empirical analyses of the prevalence and the demographic and socioeconomic characteristics of the transgender and cisgender populations in the United States. We employ a definition of transgender that is based on self-identification and is mostly aligned with the conceptualizations of identities that fall under the “trans umbrella.” We draw mainly on data from two recent U.S. surveys of these populations to ascertain the prevalence of the transgender population and their characteristics. At the end of the chapter, we make some recommendations for future directions for research about the transgender and cisgender populations.
... There is a specific need to determine if providers receive adequate training in transgender medicine. (7)(8)(9)(10)(11)(12) The actual awareness, motivation and equality of rights etc should not be necessarily given to them but the awareness should be given to the genders who even though hold high degree or social status shows such a big stigma and discrimination towards the transgenders. It is also noticed that there is great amount of disrespect shown towards them and the healthcare professionals are not using the pronouns to address them. ...
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Background: The third genders are said to be the vulnerable and most marginalized group in the society and their health care needs should be addressed with priority, since they are under high pressure of social stigmatization. This paper is based on the discussion the researcher had with the transgender community on their access of health care system and how they define health in their own terms and experiences. Aims & Objective: To find the issues they face while navigating through the health care system. Their expectations from the health care system and their opinion on the current scenario is also reflected in the study. Material & Methods: This is a qualitative study using focus group discussion as the method adopted for collecting the data. Three focus group discussions were carried out with 8 respondents each. Hence the total number of respondents for the case study was 24 in number. Their collective opinion is also reviewed. Result and conclusion: The experience of the transgender community is appalling that they are not satisfied with the health care facilities provided. Preference should be given to them because the physical agony along with mental stress and stigma from the society is such a pathetic situation.
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Gender-affirming surgery (GAS) is among the most rapidly growing and expanding subfields in plastic surgery due to increased awareness, decreased stigma, rising demand, and improved access for transgender and gender non-conforming individuals (TGNC). In order to address potential barriers and facilitators in GAS education and training, there is a need to explore the experiences of TGNC individuals. The purpose of this study was to qualitatively explore the factors that influence TGNC patient experiences in surgical consultation for GAS. Targeted recruitment was used to recruit and enroll participants who identified as TGNC and who had undergone consultation with a surgeon to discuss GAS. Semi-structured interviews were used to explore patient experiences with GAS. Recorded audio from these interviews was later transcribed verbatim. Open coding of these transcripts was then performed independently by 3 individual members of the research team using the consensual qualitative coding methods. Fifteen interviews were conducted (transmale, n = 7; transfemale, n = 4; gender non-conforming/non-binary, n = 4). Participants frequently expressed worry and frustration over insurance coverage and exorbitant out-of-pocket expense, whether actual or perceived. Logistical barriers were the most frequently cited category of barriers. The majority of participants made at least 1 reference to relying on others during the process of insurance pre-authorization. The majority of participants described their interactions with surgeons as positive, indicating that they felt comfortable during consultation and that their surgeons ensured their understanding. Our findings provide important insight into this often stressful and challenging process. Ensuring a welcoming, safe, and gender-affirming environment and experience for these individuals is essential. These findings may help to guide future education for medical students, trainees, clinic staff, and surgeons, as well as to direct changes necessary to improve the patient experience in clinics and hospitals for TGNC individuals undergoing consultation for GAS.
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Shame-based social interactions are a minority social stressor commonly experienced by transgender individuals. However, few studies have explored the centrality of shame experiences in transgender identity and mental health. Also, the ability to receive care and soothing support may be influenced by intrapersonal shame- and fear-related factors, which may hinder openness, and support and care seeking, thus contributing to psychological distress. This study aims to examine the relationship between central shame experiences, fear of receiving compassion from others, self-concealment, and psychological distress (depression, anxiety, and stress symptoms) in a sample of Portuguese transgender adults. Following a cross-sectional design, data from a convenience sample of 70 self-identified transgender individuals undergoing gender-affirming medical interventions (GAMIs) were analyzed, using SPSS PROCESS, to determine whether the relationship between central shame experiences and psychological suffering occurred indirectly through fear of receiving compassion from others, and self-concealment. Results suggest that fear of receiving compassion from others, but not self-concealment, was the underlying factor between central shame experiences, and depression and anxiety. Results suggest that the centrality of shame experiences and stress symptomatology associate sequentially through fear of compassion and, in turn, through self-concealment. Clinical implications for mental health interventions with transgender individuals undergoing GAMI are discussed.
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Background: Transgender women are disproportionately affected by gender-based violence (GBV). However, little is known about how they respond to GBV. Aims: This study aims to understand transgender women’s response to GBV and identify barriers and facilitators in accessing healthcare and legal aid after experiencing the violence. Methods: We conducted a qualitative study between February to March 2020 in Phnom Penh, Cambodia. Data were collected through in-depth interviews with 20 transgender women aged between 21 and 49 who had experienced GBV or knew a peer who had experienced GBV. Thematic analysis was conducted for the coding process, and an inductive approach was used to develop a coding frame. Results: All participants had experienced at least one form of GBV in their lifetime, and most participants had experienced multiple forms of GBV. However, most of them did not seek any services from healthcare providers, law enforcement officers, or assistance for healthcare and legal aid from non-governmental organizations (NGOs). Participants reported the following barriers to access to GBV services: anticipated stigma, the internalized stigma, which resulted in shame and low self-esteem, a lack of knowledge on NGOs’ services that can assist with healthcare and legal aid, the perception that mental health services were unavailable, a lack of social support, enacted stigma by the police, and the perceived healthcare cost. The participants reported social support and knowledge of NGOs’ services as facilitators of access to GBV service. Social media and NGO staff were reported to be preferred sources of information. Participants wanted more effective law enforcement services, comprehensive healthcare catered to the unique transgender women’s needs, and non-discriminating service providers. Discussion: Interventions to address GBV and improve the health outcomes of transgender women should involve creating an enabling environment for help-seeking with the partnership between NGOs and different sectors and building social support.
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We conducted a systematic review of research into transgender and gender non-conforming people's experiences of psychological therapy. Ten studies were subjected to a thematic meta-synthesis, resulting in two analytic themes and five subthemes. One theme was concerned with participants' experiences of how gender was approached in therapy, including experiences of it being overemphasized, ignored, or pathologized. The second theme related to participants' views on their therapists' identities, and their approaches to therapeutic work and social action. We argue that therapists should be mindful of issues of power in the co-creation of therapeutic relationships and that therapists should discuss with clients about whether and how gender is discussed within therapy.
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Background Research on the experiences of LGBTQIA+ youth in out-of-home care has mainly focused on these youth's adversities and the resulting negative impact on their wellbeing. Little is known about the ways through which LGBTQIA+ youth in out-of-home care are resilient to these adversities. To date, a review study on resilience in this population is lacking. Objective To map and synthesize the existing research on resilience among LGBTQIA+ children and youth in out-of-home care. Specific goals were to summarize and analyze 1) the general characteristics of the existing studies, and 2) the resilience resources found at the individual, relational, sociocultural, and ecological levels. Methods We carried out a scoping review examining empirical published academic literature. Results The 14 studies included in this scoping review indicated that resilience studies among LGBTQIA+ youth in out-of-home care are mainly qualitative, cross-sectional, US-based, and were centered on gay youth. Studies suggested that resilience resources were mostly focused at the socio/relational level (e.g., foster family acceptance) with fewer studies at the individual (e.g., LGBTQ positive identity), and community levels (e.g., LGBTQ centers). Importantly, no studies explored the interaction of resilience resources across these different domains. Conclusions Resilience among LGBTQIA+ youth in out-of-home care remains understudied and the results of this scoping review point to specific research gaps. Recommendations are provided for research, practice, and policy.
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A United States sample of 166 transgender adults including 50 male-to-females (MTFs), 52 female-to-males (FTMs), and 64 genderqueers (neither completely female nor completely male), were surveyed about identity development, levels of disclosure of transgender status, and relationship to community. There was no difference among transgender groups in age of first experiencing oneself differently from assigned birth sex. MTFs first identified as other than their assigned sex earlier than FTMs. However, they did not present themselves to others in a gender-congruent way until much later than FTMs. MTFs were less likely to disclose their gender identity to their parents than were FTMs. Disclosure of assigned birth sex was more common among younger participants. There was no difference in the extent to which individuals felt connected to the transgender community. Genderqueers felt more connected to the lesbian, gay, and bisexual community than did MTFs or FTMs. Implications for health care professionals and transgender communities are discussed.
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This study provides an innovative methodology to study social issues across sexual orientations. Lesbians, gay men, and bisexualwomen and men (LGB) were recruited via LGB periodicals and organizations, and they in turn recruited their siblings. Results of female participants indicate that lesbians are more highly educated, have occupations with greater status, are less religious, and are more geographically mobile than are heterosexual women. Heterosexual women are more similar to census data in terms of marriage, children, religion, and homemaker status. Gay men have moved to large cities and are more highly educated than are heterosexual men. In general, bisexual women are more comparable demographically to lesbians, whereas bisexual men are more similar to heterosexual men. Limiting the sample to paired comparisons between lesbian-heterosexual sisters and gay-heterosexual brothers generally yielded similar means on demographic variables.
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Three studies are described in which measures of perceived social support from friends (PSS-Fr) and from family (PSS-Fa) were developed and validated. The PSS measures were internally consistent and appeared to measure valid constructs that were separate from each other and from network measures. PSS-Fr and PSS-Fa were both inversely related to symptoms of distress and psychopathology but the relationship was stronger for PSS-Fa. PSS-Fr was more closely related to social competence. PSS-Fa was unaffected by either positive or negative mood states (self-statements), but the reporting of PSS-Fr was lowered by negative mood states. High PSS-Fr subjects were significantly lower in trait anxiety and talked about themselves more to friends and sibs than low PSS-Fr subjects. Low PSS-Fa subjects showed marked verbal inhibition with sibs.
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Research on transgendered individuals has tended to come from medical, psychiatric, or deviance perspectives, with little attention to the social context in which these individuals exist or their efforts to resist normative expectations of sex and gender. Based upon in-depth interviews with 65 masculine-to-feminine transgendered individuals, this research examines gender as a social institution. Focusing on the pressures experienced by individuals to maintain binary enactments of gender, we demonstrate how the institution of gender is taken for granted as a presumably natural aspect of social life. Social pressures to conform, experienced as desires for relationship maintenance and self-preservation, as well as the overwhelming need to actualize an identity that does not fit within the binary system of sex and gender, illuminate the gender resistance and conformity exhibited among the individuals in our sample. Our analysis is rooted in an expanded Foucauldian perspective incorporating the theoretical insights of contemporary feminists who consider social actors as active agents in the development and enactment of everyday resistance. Transgenderism is a discursive act that both challenges and reifies the binary gender system. As such, it provides important lessons about the power dynamics of gender and how such systems may and may not be resisted.
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In Leslie Feinberg's novel, Stone Butch Blues, the main character, Jess, can be read as either stone butch or transgendered, suggesting that stone butch and (female-born) transgender presentations are similar. Yet, with similar behaviors and expectations, it seems unclear what makes these two identifications distinct. In this paper, I suggest that one significant difference between these categories is the audience that is foregrounded in developing presentations of self. I suggest that stone butch identification prioritizes a lesbian, specifically butch and fem, audience in developing self, whereas transgender identification prioritizes a heterosexual audience, specifically people invested in the dominant paradigm of a rigid gender system (as a critique to that paradigm). Using Feinberg's character Jess as a prototype of both stone butch and transgender selves, I discuss the theoretical and political implications of foregrounding audiences.
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Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.
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Coming to recognize oneself as transsexual involves a number of stages of exploration and analysis on both an interpersonal and intrapersonal level over the course of many years. A model encompassing fourteen possible stages is proposed: (1) Abiding Anxiety, (2) Identity Confusion About Originally Assigned Gender and Sex, (3) Identity Comparisons About Originally Assigned Gender and Sex, (4) Discovery of Transsexualism, (5) Identity Confusion About Transsexualism, (6) Identity Comparisons About Transsexualism, (7) Tolerance of Transsexual Identity, (8) Delay Before Acceptance of Transsexual Identity, (9) Acceptance of Transsexualism Identity, (10) Delay Before Transition, (11) Transition, (12) Acceptance of Post-Transition Gender and Sex Identities, (13) Integration, and (14) Pride.
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