Table 1.
Sample Distributions of Participants Wanting Medical Gender Affirmation Services
| Variables | Wanted Therapy/Counseling (N = 18,195) | Wanted Hormone Treatment (N = 18,421) |
|---|---|---|
| State‐level policies | ||
| Nondiscrimination protections, % (n) | ||
| State policy includes gender identity/expression | 47.81 (8,699) | 47.71 (8,788) |
| State policy does not include gender identity/expression | 52.19 (9,496) | 52.29 (9,633) |
| Religious exemption laws, % (n) | ||
| Broad law exists in state | 35.61 (6,480) | 36.04 (6,639) |
| Only specific law exists in state | 6.97 (1,269) | 7.06 (1,300) |
| No law exists in state | 57.41 (10,446) | 56.90 (10,482) |
| Private health insurance, % (n) | ||
| State policy has TGGD‐specific protections | 39.13 (7,119) | 39.14 (7,210) |
| State policy does not have TGGD‐specific protections | 60.87 (11,076) | 60.86 (11,211) |
| Medicaid policies, % (n) | ||
| State has TGGD‐specific Medicaid policies | 71.31 (12,975) | 71.43 (13,158) |
| State excludes TGGD‐specific care | 5.57 (1,014) | 5.53 (1,018) |
| State includes TGGD‐specific care | 23.12 (4,206) | 23.04 (4,245) |
| Gender marker change requirements on state ID, % (n) | ||
| No policies exist in state | 1.45 (264) | 1.49 (274) |
| State requires proof of surgery, court order, or amended birth certificate | 19.07 (3,469) | 19.18 (3,534) |
| State accepts documentation from a limited list of providers | 37.93 (6,902) | 37.71 (6,946) |
| State accepts documentation from a broad range of providers | 41.55 (7,560) | 41.62 (7,667) |
| Legal name change requirements, % (n) | ||
| State has unclear rules or requirements are decided by an individual court | 48.97 (8,911) | 49.09 (9,043) |
| State requires a public announcement | 8.44 (1,536) | 8.21 (1,512) |
| State does not require a public announcement | 42.58 (7,748) | 42.70 (7,866) |
| Composite score, mean (SD) | 1.61 (2.15) | 1.61 (2.15) |
| State‐level characteristics | ||
| State proportion of non‐Hispanic white people, mean (SD) | 77.81 (8.59) | 77.83 (8.63) |
| State population density, mean (SD) | 318.36 (872.72) | 315.44 (864.55) |
| State proportion living in an urban area, mean (SD) | 0.56 (0.22) | 0.56 (0.22) |
| Individual‐level sociodemographic characteristics | ||
| Age (y), mean (SD) | 31.03 (12.84) | 31.45 (12.97) |
| Gender identity, % (n) | ||
| Transfeminine | 37.47 (6,817) | 41.25 (7,599) |
| Transmasculine | 30.70 (5,586) | 36.11 (6,651) |
| Other gender diverse (AFAB) | 25.45 (4,631) | 17.46 (3,217) |
| Other gender diverse (AMAB) | 6.38 (1,161) | 5.18 (954) |
| Sexual identity, % (n) | ||
| Heterosexual/straight | 11.01 (2,004) | 12.75 (2,349) |
| LGB+ | 73.17 (13,313) | 71.85 (13,236) |
| Asexual | 9.40 (1,711) | 9.11 (1,679) |
| Other | 6.41 (1,167) | 6.28 (1,157) |
| Race/ethnicity, % (n) | ||
| Non‐Hispanic White | 81.62 (14,851) | 81.48 (15,010) |
| American Indian/Alaska Native | 1.13 (205) | 1.19 (220) |
| Asian, Native Hawaiian, Pacific Islander | 2.59 (472) | 2.68 (493) |
| Black | 2.53 (461) | 2.71 (500) |
| Latinx/Hispanic | 5.03 (916) | 4.90 (902) |
| Multiracial | 4.48 (816) | 4.46 (822) |
| Other | 2.61 (474) | 2.57 (474) |
| Has U.S. citizenship, % (n) | 98.40 (17,903) | 98.41 (18,128) |
| Highest education level, % (n) | ||
| Less than high school | 2.73 (496) | 2.92 (537) |
| High school graduate (including GED) | 11.12 (2,023) | 11.76 (2,166) |
| Some college (no degree) | 37.71 (6,862) | 37.50 (6,908) |
| Undergraduate degree | 34.93 (6,355) | 34.53 (6,361) |
| Graduate or professional degree | 13.51 (2,459) | 13.29 (2,449) |
| Employment status, % (n) | ||
| Employed | 67.45 (12,272) | 67.42 (12,420) |
| Unemployed | 12.72 (2,314) | 12.69 (2,338) |
| Out of the labor force | 19.84 (3,609) | 19.88 (3,663) |
| Experiences of transgender‐related stigma in past year | ||
| Experienced discrimination, % (n) | 14.75 (2,683) | 15.26 (2,811) |
| Experienced verbal harassment, % (n) | 49.13 (8,940) | 47.81 (8,807) |
| Experienced physical violence, % (n) | 9.19 (1,672) | 9.00 (1,658) |
| Experiences of racism in past year | ||
| Experienced discrimination, % (n) | 1.79 (326) | 1.70 (313) |
| Experienced verbal harassment, % (n) | 4.83 (878) | 4.40 (810) |
| Experienced physical violence, % (n) | 0.89 (162) | 0.76 (140) |
| Gender expression, outness, and social support | ||
| Living full time in gender different from sex assigned at birth, % (n) | 62.80 (11,426) | 68.20 (12,564) |
| Outness scale, mean (SD) | 3.61 (2.34) | 3.90 (2.27) |
| Has social support, % (n) | 63.49 (11,552) | 66.67 (12,281) |
| Systemic vulnerability | ||
| Living at/near poverty, % (n) | 32.67 (5,945) | 32.34 (5,958) |
| Ever experienced homelessness, % (n) | 29.83 (5,427) | 30.88 (5,689) |
| Incarcerated in the past year, % (n) | 1.27 (231) | 1.38 (254) |
| Ever engaged in sex work/industry, % (n) | 10.16 (1,849) | 10.94 (2,016) |
| Health status and health insurance | ||
| Experienced psychological distress in the past month, % (n) | 40.44 (7,358) | 38.29 (7,054) |
| Ever experienced suicidal ideation, % (n) | 84.46 (15,368) | 83.81 (15,439) |
| HIV status, % (n) | ||
| Not living with HIV | 52.67 (9,583) | 53.50 (9,855) |
| Living with HIV | 0.55 (100) | 0.69 (128) |
| Never tested/does not know | 46.78 (8,512) | 45.81 (8,438) |
| Experienced binge drinking in the past 30 days, % (n) | 25.71 (4,678) | 25.39 (4,678) |
| Used drugs in the past 30 days, % (n) | 28.63 (5,209) | 28.66 (5,280) |
| Has health insurance coverage, % (n) | 87.99 (16,009) | 87.56 (16,130) |
Abbreviations: AFAB, assigned female at birth; AMAB, assigned male at birth; GED, general educational development certificate; HRT, hormone replacement treatment; LGB+, lesbian, gay, bisexual, etc.; SD, standard deviation; TGGD, transgender and other gender‐diverse.