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Abstract:

Transgender people are “compromised survivors” who both experience and challenge gender-based oppression. The term “transgender” describes a diverse population of people whose identity does not conform to normative gender expectations. Transgender people experience adverse health outcomes unlikely to be biological in nature, and are best understood in terms of social determinants of health. The social determinants framework contextualizes transgender health outcomes, situating them within a larger social context of discriminatory gender oppression. Life history interviews with 13 transgender people, focus groups with 16 transgender people and 9 in-depth interviews with “key informants” suggest that stress, (lack of) social support, and social exclusion are the primary social determinants of transgender health. Violence-related stress is most pronounced. Violence against transgender people is associated with level of gender variance; transgender people who regularly “pass” as either gender reported lower frequency of violence. Almost all participants reported frequent fear of violence. Hair-trigger violence, or sudden unprovoked aggression, was an important phenomenon among male-to-female (MTF) vector transgender people. Violence is often experienced within sexual relationships or within the context of sex work. Internal gender oppression creates another layer of stress, often manifesting itself through addictions. For some participants, addiction problems were resolved on “transition” from birth to true gender. Social support is weak or absent for many transgender people. Participants experience alienation from families-of-origin, friend networks, and potential romantic partners. Social exclusion of transgender people further compromises their health status. Exclusion from healthcare, education, housing, and employment means that transgender people often lack access to basic resources. Some female-to-male (FTM) participants experience an improvement in social standing if they “pass” as male, but this is tempered with concomitant exposure to gender bias. The demographic factors of SES, race, gender vector (MTF or FTM), and ability to pass as gender normative have an interactive effect with social determinants. A diverse participant pool allows for the observation of gender-related trends across race and class. The approach used to recruit a diverse group of participants from a hard-to-reach population was successful and can serve to inform work with other populations.