The 2015 U.S. Transgender Survey, which marks the largest-ever survey of trans adults in the U.S., shows elevated rates of economic instability and mental health issues within the trans community.
The survey was released on Thursday and covered 27,715 people from all 50 states and U.S. territories. It showed trans people “really struggling to get a foothold into some of the most basic parts of society,” said Mara Keisling, executive director of the National Center for Transgender Equality, which conducted the survey.
Respondents — which included people across the gender spectrum, including trans, non-binary, gender fluid, two-spirit and agender — reported sharp differences in mental health from the general population. Fully 40 percent of respondents said they had attempted suicide in their lifetime — nine times the general population’s 4.6 percent rate. And 39 percent of respondents reported “serious psychological distress” in the month before submitting to the survey, about six times that of the general population.
Economic instability represented a major challenge for respondents. Nearly one-third of respondents lived in poverty, and 15 percent were unemployed, as opposed to 5 percent of the U.S. population. Trans people of color and those with disabilities reported compounding forms of discrimination and economic hardship, with poverty rates much higher for trans people who are Latino (43 percent), American Indian (41 percent), multiracial (40 percent) and black (38 percent).
Trans people with disabilities also reported more economic instability, with 24 percent unemployed and 45 percent living in poverty. Four out of 10 respondents said they had been mistreated by health care providers, and 54 percent of trans people with disabilities said they had attempted suicide.
The report also asked about respondents’ experiences in school, with more than half saying they were verbally harassed, 24 percent attacked, and 13 percent sexually assaulted. For 17 percent of respondents, the mistreatment compelled them to leave before graduating high school. For those who continued to college or vocational school and were “out or perceived as transgender,” about one-quarter of these respondents were verbally, physically or sexually harassed.
Problems also persisted for many people accessing health care and insurance. One in four respondents had experienced an insurance problem in the past year, and more than half who sought insurance coverage in the last year for transition-related surgical procedures said they were denied. The laws on insurance coverage for transition-related care widely varies by state — 12 states and the District of Columbia have banned private insurers and Medicaid from excluding transition-related care.
Identification and official documents were also a problematic issue for some survey respondents. More than two-thirds of respondents said none of their IDs matched their preferred name or gender. Some people reported negative consequences from this difference — 32 percent of people whose IDs did not match their appearance were “verbally harassed, denied benefits or service, asked to leave, or assaulted.”
This report marks a substantial addition to data on trans people, which remained scant even as estimations on the number of trans people in the U.S. have grown to as many as 1.4 million. It follows up on the National Transgender Discrimination Survey, which surveyed 6,456 trans people from 2008 to 2009 and was released in 2011.
Some respondents also reported problems with using the restroom that matches their gender, with six out of 10 respondents said they avoided using a restroom out of fear. For some people, this had health consequences, with 8 percent of respondents reporting a urinary tract infection or kidney-related problem that stemmed from avoiding restrooms.
But Keisling said discussion around transgender restroom use sometimes overshadows pervasive challenges that trans people face.
“Every minute we spend talking about [restrooms], we’re not talking about the problems in real people’s lives,” she said. “We’re not talking about the economic marginalization, we’re not talking about the real inability to get a career going for so many people. We’re not talking about people being alienated from their faith communities and from their families.”
Keisling said the National Center for Transgender Equality hopes to continue surveying the trans community every five years, aiming to “educate America about who we are in an accurate way.”