Social support may reduce heart, stroke effects of discrimination in transgender and gender conforming

Higher levels of social support may help offset increased heart disease and stroke risk factors triggered by discrimination and gender expectations among transgender and gender non-conforming adults, according to preliminary research to be presented at the American Heart Association's Scientific Sessions 2019—November 16-18 in Philadelphia.

Researchers examined the link to discrimination in day-to-day life, such as job discrimination, difficulty finding housing and being threatened or harassed—and internalized transphobia (internalizing societal gender expectations and/or feeling shame towards one's own gender identity) and behaviors known to influence heart disease risk, such as tobacco use, drinking, low levels of physical activity, sleeping too little and being overweight or obese.

Participants included 288 adults (half assigned as female at birth, average age 34) taking part in Project AFFIRM, a three-city, long-term study of health in people who identify as transgender and gender non-conforming (those with gender identities outside the conventional notion of male or female).

Researchers found:

• Higher levels of discrimination and internalized transphobia were linked with higher rates of risky drinking and lower sleep duration.
• However, greater levels of social support raised the odds of getting enough sleep by half, increased odds of getting adequate exercise by almost a third and weakened the link between discrimination and sleep duration.

Hormone use did not influence heart disease and stroke risk factors in this study. While previous studies have found hormone use to be associated with higher rates of clot-caused strokes in transgender women than in non-transgender women, this study analyzed risk factors rather than the occurrence of heart attacks or strokes.

"Our findings are important because they suggest that social support might protect against the negative heart disease and stroke effects of discrimination among transgender and gender-nonconforming persons," said Billy A. Caceres, Ph.D., R.N., lead author of the study and assistant professor in the Program for the Study of LGBT Health at the Columbia University School of Nursing in New York. "It's important for healthcare professionals to ask these patients about their exposure to these types of stressors, hormone use and whether they have adequate social support."

Because participants in Project AFFIRM lived in New York, San Francisco and Atlanta, these findings may not be generalizable to people in rural or suburban areas of the United States or to transgender and gender non-conforming people living in other countries.