How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

Abstract

BackgroundSince the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people.Methods and findingsAs an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis.5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate.ConclusionsTransgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality.

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

“…Half of the individuals in this survey reported reduced access to one or more gender-affirming resource. This was similar to the TransCareCovid-19 online survey of 5,267 transgender and nonbinary individuals in upper and middle income countries, with most participants residing in Germany (23.9%) and the United Kingdom (10.3%) [29]. However, in our study, individuals from the European region reported more reductions in access to hormone therapy (40.5%) and surgical aftercare materials (39.8%) than reported in the TransCareCovid-19 survey (21% and 3% respectively).…”

“…The COVID-19 crisis has also had unique impacts on the transgender community. For example, there have been documented cancellations and delays in gender-affirming surgeries [ 29 ]; such delays and cancellations have previously been connected to negative mental health consequences [ 23 , 30 ]. Furthermore, many transgender and nonbinary individuals who were living according to their gender prior to the emergence of COVID-19 have had to return to living according to their sex assigned at birth upon moving in with relatives [ 31 ].…”

Psychological Well-Being of Trans* People in Italy During the COVID-19 Pandemic: Critical Issues and Personal Experiences

“…Recently, Jarrett et al ( 2020 ) and Koehler et al ( 2020 ) reported the effects of the pandemic on transgender people and confirmed its significant impact on the psychological well-being of subjects who experienced deferrals in gender-affirming care. In Italy, care for transgender people is complex and multifaceted and, as suggested by the latest guidelines, promoted by the Standards of Care for transsexual, transgender, and gender-non-conforming people developed by the World Professional Association for Transgender Health (SOC 7, WPATH, 2011 ), should be focused on psychological and endocrinological support and family involvement, particularly for youths.…”

Sexual and Gender Minorities Facing the Coronavirus Pandemic: A Systematic Review of the Distinctive Psychosocial and Health-related Impact

“…These results are particularly critical considering that many SGM are at increased risk for various diseases, including chronic conditions, respiratory diseases, overweight (Cahill, 2020;Potter et al, 2020;Whittington et al, 2020). Findings from a global study underline the severity of this issue, as over half (52.6%) of the respondents reported at least one acute or chronic condition (Koehler et al, 2020). Again, LGBTQ individuals of color are a particularly vulnerable group to medical conditions and risks (Jen et al, 2020).…”

“…Jarrett et al (2020) conducted a global online survey showing that 55% of the transgender and non-binary respondents reported reduced access to gender-affirming care. Another global survey revealed that among those, who had already undergone transition-related treatment, 49.3% reported restrictions in access to transgender health care services during pandemic (Koehler et al, 2020). Further analysis showed that participants assigned male at birth and individuals with a lower income were at a higher risk of experiencing restrictions to adequate services (Koehler et al, 2020).…”