Transgender Americans experience stigma and systemic inequality in many aspects of their lives, including education, work and health-care access, a wide-ranging Washington Post-KFF poll finds.
Many have been harassed or verbally abused. They’ve been kicked out of their homes, denied health care and accosted in bathrooms. A quarter have been physically attacked, and about 1 in 5 have been fired or lost out on a promotion because of their gender identity. They are more than twice as likely as the population at large to have experienced serious mental health struggles such as depression.
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Yet most trans adults say transitioning has made them more satisfied with their lives.
“Living doesn’t hurt anymore,” said TC Caldwell, a 37-year-old Black nonbinary person from Montgomery, Ala. “It feels good to just breathe and be myself.”
End of carouselThe Post-KFF poll is the largest nongovernmental survey of U.S. transgender adults to rely on random sampling methods. More than 500 people who identify as trans answered questions about their childhoods, their feelings and their lives post-transition.
The poll builds on a growing but limited body of research. In 2015, the National Center for Transgender Equality polled 27,715 trans people from the United States and its territories, and the nonprofit is in the middle of analyzing data from a much larger pool of respondents who filled out the volunteer survey last year. That project, along with two federal health surveys and a random-sample poll conducted by the Williams Institute, have offered significant insight into the community, but trans people say additional data is needed.
Josie Caballero, the director of the National Center for Transgender Equality’s U.S. Trans Survey and a trans woman herself, said polls like it and the Post-KFF survey “provide critical tools for researchers, policymakers and advocates seeking to better understand the needs of transgender people to find ways to improve their lives.”
Other studies have shown that the trans community has grown to an estimated 1.3 million adults, and surveys by the Centers for Disease Control and Prevention find that the trans adult population is younger than the cisgender adult population at large. Most trans adults are younger than 35 years old.
The Post-KFF survey finds that trans adults hold widely different ideas about what it means to transition. While most trans people have socially transitioned, meaning they’ve changed their clothing, names or pronouns, far fewer have medically transitioned. Less than a third have used hormone treatments or puberty blockers, and about 1 in 6 have undergone gender-affirming surgery or other surgical treatment to change their physical appearance.
A 62 percent majority of trans adults identify as “trans, gender non-conforming” or “trans, non-binary,” while 33 percent identify as a “trans man” or “trans woman.” Nearly half ask people to refer to them with they/them pronouns, although most say they sometimes use she/her or he/him pronouns.
“I think there’s a pushback against this idea that we have to fit in one of those boxes,” said Josie Nixon, a 30-year-old nonbinary person who lives in Denver. “There are certainly binary trans men and women who fit well in those boxes and love being there, but I think there is a trend, especially as more young people find themselves, to say, ‘These boxes don’t do me justice, and they don’t represent me in a way that encompasses all of who I am, so I’d rather exist in between or outside those boxes.’”
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Childhood
Most trans adults say they knew when they were young that their gender identity was different from the sex they were assigned at birth. About a third (32 percent) say they began to understand their own gender identity when they were 10 or younger, and another third (34 percent) realized it between the ages of 11 and 17.
Alyssa Rogers, a White 26-year-old trans woman who lives in Austin, said she first knew when she was around 5 years old. Her mother had been arrested for drug use, and Rogers was sent to live in an orphanage. While she was there, Rogers tried on a pink princess dress for the first time, and she immediately felt “right.”
“It was the first time I got to do something like that,” Rogers said. “It was nice. I wanted to share it, but I was scared to because I knew it wouldn’t be accepted.”
Rogers eventually moved in with her grandparents, and like other trans people in the Post-KFF survey, she struggled with depression and loneliness in her childhood.
Compared with Americans as a whole, trans adults are more than twice as likely to say they experienced serious mental health problems such as depression or anxiety growing up (78 percent versus 32 percent for the U.S. overall).
Just over half of trans adults say they had a happy childhood (53 percent), but that rate is far lower than the 81 percent of Americans overall who say their childhood was happy.
Most trans people (59 percent) say they lacked a trusted adult to talk to while growing up, including 64 percent of trans people of color. Those who did have a trusted adult were much more likely to report feeling safe in their childhood homes and to have a happy childhood.
School marked one of the greatest stressors for trans children. More than 4 in 10 say they felt unsafe at school, and one-quarter felt unsafe participating in sports or in other youth activities.
Rogers said she was an “outcast” at school, so few classmates commented when she began cross-dressing as a teenager. But her family grew upset, she said. Rogers said her grandparents committed her to a mental hospital and later sent her to conversion therapy in Colorado. The state has since banned the practice, but Rogers’s experience was commonplace. One in 4 trans adults say they attended religious services as a child or teenager that tried to change their sexual orientation or gender identity, and about 1 in 10 say they attended conversion or reparative therapy.
“I definitely thought about killing myself,” Rogers said. “I was in a terrible situation.”
For years, Rogers went to bed hungry, sometimes out of necessity, and sometimes because she believed if she didn’t eat, she wouldn’t grow. If she didn’t grow, she thought, she could pass more easily as a girl.
A few years after Rogers went through conversion therapy, she decided to start taking estrogen. She knew many in her family would reject her once she told them she was a woman.
Though 69 percent of trans people who are out to at least some immediate family members say their families are at least “somewhat supportive” of their gender identity, about 3 in 10 say their families are not supportive, including 13 percent who are “very unsupportive.” Similarly, 29 percent of trans adults say they experienced homelessness or got kicked out of their home while they were growing up, rising to 38 percent among trans people of color.
“I knew I was going to lose some of my family,” Rogers said. “It wasn’t a question of if. It was a question of how many.”
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Transition
Poll data shows that there is no one timeline for trans people. Three in 10 say they began telling others they were trans before the age of 18, while about a third (32 percent) came out between the ages of 18 and 25. Others came out later, and 12 percent of trans adults have not told anyone.
For Nixon, the 30-year-old nonbinary person who lives in Denver, the process started six years ago. One night, they cried until they fell asleep, and when they woke up, they brushed their teeth, looked in the mirror and said the word for the first time.
“I just said, ‘You’re trans,’” Nixon recalled. “Then I crumpled on the floor, crying. I probably cried for like a week.”
What a trans person does as part of their transition varies, and increasingly, younger people are opting out of a path from one binary gender to the other. The poll reveals that most adults who identify as trans or transgender prefer the terms “nonbinary” (40 percent) or “gender non-conforming” (22 percent), while 22 percent identify as a “trans woman” and 12 percent identify as a “trans man.”
Nixon lived in Grand Rapids, Mich., when they decided to transition. The town felt conservative, and Nixon didn’t want to live in a place where everyone knew them as a guy, so they decided to relocate. About one in 4 (27 percent) trans adults say they have moved to a different place because they thought it would be a more accepting location, including larger shares of urban (35 percent) trans adults.
“I literally Googled ‘Where do trans people live,’” Nixon said, “And I found Colorado.”
Nixon initially moved to Boulder. There, they changed their name, grew out their hair and started taking estrogen.
Large majorities of trans adults have changed their physical appearance in ways that reflect their gender identity, with 77 percent changing the types of clothes they wear and 76 percent changing their hairstyle or grooming habits. Fewer have used hormone treatments (31 percent), legally changed their names (24 percent), or undergone gender-affirming surgery or other surgical treatments to change their physical appearance (16 percent).
Trans adults who identify as either a “trans man” or a “trans woman” are more than three times as likely as those who identify as nonbinary or gender non-conforming to say they have used hormone treatments (60 percent) or undergone gender-affirming surgery (31 percent).
Though Nixon experienced repeated discrimination, including in Colorado, they soon found themself feeling happy in a way they never had before. They’d always struggled to make friends as a young person, in large part, they think, because they were hiding a huge part of themself, and kids are adept at picking out inauthenticity. As Nixon’s hair grew and their body changed, people sometimes harassed them in bathrooms, and a roommate “came out” as transphobic. Still, Nixon felt newly relieved.
“The worst day I’ve ever had as a trans person is still better than the best days I had pre-transition,” Nixon said. “That’s not to say that I don’t look fondly on the memories of my life, but at the end of the day, not living authentically was terrible, and I would rather live authentically than hide a version of myself to appease people I don’t even know.”
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Among those who present themselves differently from their gender assigned at birth, the Post-KFF poll finds 78 percent say that living as a different gender has made them more satisfied with their lives. More than 4 in 10 say they are “a lot” more satisfied.
Trans people don’t always present as a gender other than the one they were assigned at birth.
Three in 10 trans people physically present as a different gender all of the time, while 20 percent do so “most of the time.” Another 34 percent present as a different gender some of the time, and a small but significant share (16 percent) say they “never” physically present as a gender different from their sex assigned at birth.
In Colorado, Nixon said they are “visibly trans” every day, but strangers perceive them in different ways.
“When I answer the phone, I get ‘Hello, sir’ 100 percent of the time,” Nixon said. “But when I go to the grocery store, I get ‘he,’ ‘she’ and ‘they’ on a daily basis. I have decided that that’s where I want to be. I want to live in this androgynous space.”
Hardship
Though 57 percent of trans adults say they are satisfied with their lives as a whole, that rate is lower than the U.S. adult population at large, of whom 73 percent say they are satisfied.
More than half (56 percent) of trans adults say they have felt anxious at least “often” in the past year, compared with 31 percent of cisgender adults. And they are more than twice as likely as cis people to say they felt depressed (48 percent, compared with 21 percent) or lonely (45 percent, compared with 21 percent) in the past year.
Tim McCoy, a White 72-year-old trans man who lives in Syracuse, N.Y., said he has suffered from chronic depression and anxiety since he was young. Those feelings initially dissipated after he began taking testosterone.
“I was floating on a cloud when I first transitioned,” he said. “I just thought that was the answer to all my problems. I felt wonderful, but after I had transitioned for about five years, the depression came back. Transitioning has definitely made my quality of life better, but it’s not the answer to everything.”
That’s due, he said, in large part to the discrimination trans people face. That has worsened as the political climate has turned increasingly hostile toward trans people, he said.
“You always have that fear of what’s going to happen when you tell somebody you’re transgender, especially these days,” he said. “That definitely affects one’s quality of life. It’s a constant stress.”
One in 4 trans adults say they have been physically attacked because of their gender identity, gender expression or sexual identity, and more than 6 in 10 (64 percent) say they have been verbally attacked.
Tessa Jelani, a 26-year-old Black trans woman from Washington, D.C., said she was harassed often before she learned the best ways to feminize her appearance.
“At the beginning of my transition, I got hit with a bat upside my head,” Jelani said. “I remember him saying, ‘I’m not going to hit a woman, but I’ll hit you.’”
Trans adults experience discrimination in a range of day-to-day activities, according to the Post-KFF poll. About half (49 percent) say they have been asked unnecessary or invasive questions at their place of work, and 21 percent report being fired or denied a job or promotion because of their gender identity or expression or sexual identity.
Beyond the workplace, 17 percent say their identity has led them to be refused service from a health-care provider. Another 13 percent report being evicted or denied housing, including 21 percent of trans people of color.
Caldwell, the nonbinary person from Montgomery, Ala., said they went in for a coronavirus test and chest X-ray last year, and when the providers discovered Caldwell was trans, the quality of care changed.
“To me, it was a regular routine checkup, but they switched my nurse to a male nurse, and nobody would talk to me,” Caldwell said. “It was an all-Black clinic, and it felt defeating to know that even your own people will treat you like ‘other.’ Looking back, a lot of times, I feel like it’s just ignorance. They might have even thought they were helping.”
Still, both Caldwell and Jelani said they have found a growing acceptance in recent years. Alabama has passed a string of anti-trans bills, but Caldwell said their fellow Alabamians often surprise them with their support. The first time Caldwell went to pick up their prescription for testosterone, for instance, they felt nervous until they met the pharmacist.
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“I was shaking,” Caldwell said. “But I had the most affirming pharmacist, a Black lady, who was like, ‘Are you okay?’ When I told her what was going on, she said, ‘Oh, you’re going to be great.’ And she walked me through how to do the syringe, how to measure out my dosage, the difference between the drawing needle and the injection.”
A majority of trans people believe people’s perceptions are changing for the better. Fifty-five percent believe people in the United States are more accepting of them than they were 10 years ago, and Jelani thinks that will only improve as more people get to know their trans community members.
“The younger generation is showing how accepting they are,” Jelani said. “They are willing to love people’s differences, and it’s definitely having an effect on the older generation and showing them to loosen up. Not everything has to be explained in order for you to agree with it. We have always been here. We’re always going to be here, and y’all can’t stop it.”
The Washington Post-KFF Survey Project is a partnership combining survey research and reporting to better inform the public. The Trans Survey is the 36th in the series. It was conducted in English and Spanish from Nov. 10-Dec. 1, 2022, among 515 U.S. adults who identify as trans and 823 cisgender U.S. adults. Sampling, data collection, weighting and tabulation were managed by SSRS. Trans adults were reached via three survey panels recruited using random sampling methods: The Gallup Panel, NORC’s AmeriSpeak Panel and the SSRS Opinion Panel. Additional trans respondents were recontacted from previous randomized telephone interviews. Random sampling methods help ensure results are representative of the trans population overall. The samples of trans adults were combined and weighted to match the demographics of the national U.S. adult trans population. Cisgender adults were recruited through the SSRS Opinion Panel. Results among the sample of trans adults have a margin of sampling error of plus or minus seven percentage points and the margin of sampling error is plus or minus four percentage points among the sample of cisgender adults. In collaboration with The Post, KFF researchers worked to design the survey sample and questionnaire, analyze and report findings. The project team from KFF included Mollyann Brodie, Ashley Kirzinger, Audrey Kearney, Alex Montero and Grace Sparks.
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