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      The Health and Well-Being of Transgender Australians: A National Community Survey

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          Abstract

          Purpose: Transgender, including gender diverse and nonbinary (trans), people experience significant health disparities. We aimed to better understand the health status and needs of Australian trans people to guide resources and health and well-being programs.

          Methods: This anonymous, cross-sectional online survey utilized nonprobability snowball sampling of Australian adults (18 years and over) who self-identified as trans between September 2017 and January 2018. This descriptive study assessed demographic data, community views on access to health care, health burden, access to health resources, and priorities for government funding in transgender health.

          Results: Of 928 participants, 37% reported female, 36% reported male, and 27% reported nonbinary gender identities. Despite 47% having tertiary qualifications, the unemployment rate was 19%, with 33% reporting discrimination in employment due to being trans. Discrimination in accessing health care was reported by 26% and verbal abuse and physical assault were reported by 63% and 22%, respectively. Lifetime diagnosis of depression was reported by 73% and anxiety by 67%. Sixty-three percent reported previous self-harm and 43% had attempted suicide. Autism spectrum disorder and attention-deficit/hyperactivity disorder were reported by 15% and 11%, respectively. The most preferred method of receiving health information was through online resources, with the most popular source being Reddit, an online peer discussion board. Better training for doctors in trans health issues was the top priority for government funding.

          Conclusions: Barriers, including widespread discrimination and unemployment, contribute to health inequity and prevalent mental health conditions. Better training for health professionals in the provision of safe, gender-affirming and general health care for trans people is urgently required.

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          Most cited references20

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          Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

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            Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study.

            We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
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              Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City.

              We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals.
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                Author and article information

                Journal
                LGBT Health
                LGBT Health
                lgbt
                LGBT Health
                Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                2325-8292
                2325-8306
                January 2021
                12 January 2021
                12 January 2021
                : 8
                : 1
                : 42-49
                Affiliations
                [ 1 ]Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia.
                [ 2 ]Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
                Author notes
                [*]Address correspondence to: Ada S. Cheung, PhD, Department of Endocrinology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia adac@ 123456unimelb.edu.au
                Article
                10.1089/lgbt.2020.0178
                10.1089/lgbt.2020.0178
                7826417
                33297824
                87776196-5e53-4a6f-ae20-e086782b5296
                © Ingrid Bretherton et al. 2021; Published by Mary Ann Liebert, Inc.

                This Open Access article is distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 4, References: 29, Pages: 8
                Categories
                Original Articles

                barriers to care,gender-affirming endocrine care,gender-affirming surgical care,gender dysphoria,transgender

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