Transgender Americans experience significant economic, health challenges, study confirms

Transgender adults experience considerably greater economic hardship and worse health than cisgender adults, according to the first study to document the socioeconomic struggles of this population in the United States.

The study was coauthored by Kitt Carpenter, E. Bronson Ingram Professor of Economics and director of the Program in Public Policy Studies, Gilbert Gonzales, assistant professor of medicine, health and society, and Vanderbilt alumnus Samuel Eppink, now an economist with the Centers for Disease Control.

"Transgender Status, Gender Identity, and Socioeconomic Outcomes in the United States" appears in the Industrial and Labor Relations Review.

"Historically, it's been very difficult to study the transgender population because there hasn't been a lot of data to work with," Carpenter said. "Partly that's because the transgender population is so small—less than one percent of Americans—and partly because very few surveys even ask people if they're transgender in the first place."

However, in 2014, the CDC began including routine questions about gender identity and transgender status in its massive annual Behavioral Risk Factor Surveillance System survey project. The survey is designed to track how Americans manage their health, but it also contains demographic questions about employment, income, education and more. The size of the study—there were around 400,000 respondents—allowed Carpenter and his coauthors a glimpse into the socioeconomic lives of more than 2,100 transgender people from 35 states across the United States.

These representative data provide the first large-scale evidence that transgender Americans are doing worse than cisgender Americans along a number of important indicators of wellbeing.

"We found that transgender Americans are about 14 percentage points less likely to have completed college and 14 percentage points more likely to live in poverty," said Carpenter. Notably, even after controlling for the lack of a college degree and other observable differences, transgender Americans are still 11 percentage points less likely to have jobs than comparably situated cisgender men (i.e., men who are not transgender).

"Economists call this an unexplained gap, but it's likely that discrimination plays a role," Carpenter said. He noted that in about half the country, there are no laws prohibiting employment discrimination for transgender workers.

In states where those laws do exist, however, the researchers said they didn't see much of a difference. Though the sample size for any given state in this survey was too small for the researchers to draw broad conclusions, Gonzales said that future research should examine such policies more closely.

"It may be because these laws are still too recent to have made much of a difference, or it may be that prohibiting discrimination in the workplace isn't enough to address the many reasons transgender people may be unable to work," said Gonzales. "From previous research, we know that transgender people have higher rates of stress-associated physical and mental illness and disability, some of which may begin in childhood. We also know that transgender people have a harder time accessing medical care. It may be that solving these disparities will require broader policies that prohibit discrimination in schools, health care, housing and other settings as well."