What The Hell America!

Transgender Americans are experiencing poor physical and mental health more than other LGBTQ+ people, in part due to higher rates of discrimination, while intersex Americans are struggling to find or afford health care at all, according to new data from the Center for American Progress (CAP) and NORC at the University of Chicago. 

These findings, part of a wider biennial survey on the experiences of LGBTQI+ Americans, underscore the health disparities faced by transgender and intersex people at a time when their identities are being targeted and misrepresented by a new presidential administration that has declared war against “gender ideology.” 

And these disparities may only get worse as the Trump administration attempts to restrict gender-affirming care and threatens federal funding for LGBTQ+ programs, researchers say. 

“I worry about this being a baseline that already is telling us a concerning story,” said Cait Smith, LGBTQI+ policy director at the liberal Center for American Progress. 

Restricting gender-affirming care doesn’t just keep trans people from accessing hormone therapy and surgery to alleviate gender dysphoria — it can keep them from seeing a primary care provider at all, Smith said. Providers of gender-affirming medical care are often a trans person’s main health resource.  

“We have hospitals that are really being threatened with loss of funding, with even retaliatory attacks by the administration. We’re not only talking about gender-affirming care, we’re talking about medical care for LGBTQ folks,” they said. 

When hospitals in states like Massachusetts and New York halted gender-affirming care for young trans adults following President Donald Trump’s executive orders, the consequences spilled beyond gender-affirming care. As The 19th previously reported, one trans adult who receives care at NYU Langone Health said that, following Trump’s orders, his deadname has been used almost exclusively by the hospital. Because of that, he faces a paperwork roadblock to treating the potential spread of endometriosis in his body. He spoke on condition of anonymity, out of fear of losing access to his health care for speaking out.

CAP’s new survey found that last year, medical providers used the wrong name to refer to or intentionally misgendered 26 percent of transgender adults; 31 percent of disabled transgender adults experienced the same treatment. 

This can have real consequences: The NYU Langone patient is worried that bringing an MRI with incorrect personal information to his surgeon at Mount Sinai will cause issues with his insurance — since NYU Langone used his deadname for his MRI results. The hospital has not responded to a request for comment.

LGBTQ+ adults are more likely than their peers to postpone or not access medical care, due to high costs, high rates of discrimination and insurance challenges, CAP’s study found. This is especially likely for trans and intersex people. Forty-five percent of trans adults and 60 percent of intersex adults postponed care due to affordability, while 37 percent of trans adults and 45 percent of intersex adults postponed or did not seek medical care when they were sick or injured due to fear of discrimination. 

This data is taken from a survey of over 3,000 adults conducted by NORC at the University of Chicago in July 2024, with a margin of error of 3.06 percentage points. The survey used a nationally representative sample of LGBTQI+ and non-LGBTQI+ adults from NORC’s AmeriSpeak Panel, as well as an LGBTQI+ sample from Dynata’s nonprobability panel. Final data was weighted.

Overall, 21 percent of transgender people rated their physical health in the past year as poor or bad, according to CAP’s study, while 54 percent rated their mental health the same. Although intersex people reported significantly better physical and mental health, they still face unique barriers to accessing health care. 

The study found that intersex Americans traveled out of state to access reproductive or abortion care more than any other LGBTQ+ group. Nearly 1 in 4 intersex adults said they had traveled to a different state to access such care, because laws in their state ban or restrict it. And as LGBTQ+ adults overall struggle to access mental health care, 44 percent of intersex adults do not feel comfortable discussing their identity with their therapist — more often than trans adults. 

Intersex people, who make up roughly 1.7 percent of the world’s population, face significant stigma and medical abuse, as detailed by the intersex rights group interACT and the civil rights group Human Rights Watch. As infants, many are subjected to procedures and invasive surgeries that assign them a sex — which leaves them struggling to find health care later in life. 

Intersex people already have fewer options to find a health care provider who will treat them with basic dignity and have a basic medical understanding of their needs, Smith said — and abortion bans likely only make that scarcity worse. 

“Intersex folks are generally more impacted, across the board, when it comes to challenges in accessing affordable health care that’s free from discrimination,” they said.

These new findings from CAP align with existing research, said Lindsey Dawson, director of LGBTQ Health Policy at KFF. LGBTQ+ people — especially transgender people — have worse health disparities driven in part by stigma, discrimination and isolation, she said. 

“Those experiences can lead to really substantial mental health struggles, and that is evolving in an environment where policy is being made at the state and now federal level that aims to restrict LGBTQ+ people’s access to care,” she said. 

Although this study was conducted prior to the Trump administration’s blitz of executive orders targeting transgender Americans, states have been pushing an unprecedented amount of anti-LGBTQ+ bills for years — leaving LGBTQ+ people afraid of routine tasks, like finding a new doctor. That evolving policy landscape is affecting people’s wellbeing while also making it harder for them to access health care, Dawson said.

“When this survey was fielded, about half of states at that point had had a prohibition on access to gender-affirming care for young people,” she said. “It was fielded in a moment when this policy rhetoric was ramping up. Now that restrictions are being proposed nationwide by the administration, even being surrounded in that discourse can have a negative impact on wellbeing.”