# paper.pdf ## Metadata - PDFFormatVersion=1.6 - IsLinearized=true - IsAcroFormPresent=false - IsXFAPresent=false - IsCollectionPresent=false - IsSignaturesPresent=false - CreationDate=D:20171219133809-08'00' - Creator=Adobe InDesign CS6 (Macintosh) - ModDate=D:20171220105432-05'00' - Producer=Adobe PDF Library 10.0.1 - Trapped=False - xmp:createdate=2017-12-19T13:38:09-08:00 - xmp:metadatadate=2017-12-20T10:54:32-05:00 - xmp:modifydate=2017-12-20T10:54:32-05:00 - xmp:creatortool=Adobe InDesign CS6 (Macintosh) - xmpmm:instanceid=uuid:a1e9024d-0f5a-4813-bb84-5c83e2cd5152 - xmpmm:originaldocumentid=xmp.did:8007978018206811822A81A519FA8DC9 - xmpmm:documentid=xmp.id:414246BB12246811822AF1DE7356D356 - xmpmm:renditionclass=proof:pdf - xmpmm:derivedfrom=xmp.iid:CC8C4F3F40206811822AB22A4E6BE5EFxmp.did:03D073795B2068118083CEA998D4D260xmp.did:8007978018206811822A81A519FA8DC9default - xmpmm:history=convertedfrom application/x-indesign to application/pdfAdobe InDesign CS6 (Macintosh)/2017-12-19T13:38:09-08:00 - dc:format=application/pdf - pdf:producer=Adobe PDF Library 10.0.1 - pdf:trapped=False ## Contents ### Page 1 THE REPORT OF THE ### Page 2 About the National Center for Transgender Equality The National Center for Transgender Equality (NCTE) is the nation’s leading social justice policy advocacyorganization devoted to ending discrimination and violence against transgender people. NCTE was foundedin 2003 by transgender activists who recognized the urgent need for policy change to advance transgenderequality. NCTE now has an extensive record winning life-saving changes for transgender people. NCTE worksby educating the public and by influencing local, state, and federal policymakers to change policies and lawsto improve the lives of transgender people. By empowering transgender people and our allies, NCTE creates astrong and clear voice for transgender equality in our nation’s capital and around the country. © 2016 The National Center for Transgender Equality. We encourage and grant permission for the reproductionand distribution of this publication in whole or in part, provided that it is done with attribution to the NationalCenter for Transgender Equality. Further written permission is not required. RECOMMENDED CITATION James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S.Transgender Survey. Washington, DC: National Center for Transgender Equality. ### Page 3 The Report of the 2015 U.S. Transgender Survey by: Sandy E. James Jody L. Herman Susan Rankin Mara Keisling Lisa Mottet Ma’ayan Anafi December 2016 ### Page 4 Table of Contents Acknowledgements ...............................................................................................................1 Executive Summary ............................................................................................................... 3 Chapter 1: Introduction ....................................................................................................... 18 Chapter 2: Methodology ..................................................................................................... 21 Chapter 3: Guide to Report and Terminology ...................................................................39 Chapter 4: Portrait of USTS Respondents ......................................................................... 43 Chapter 5: Family Life and Faith Communities .................................................................64 Chapter 6: Identity Documents .......................................................................................... 81 Chapter 7: Health ...............................................................................................................92 Chapter 8: Experiences at School .................................................................................... 130 Chapter 9: Income and Employment Status .................................................................... 139 Chapter 10: Employment and the Workplace .................................................................. 147 Chapter 11: Sex Work and Other Underground Economy Work ..................................... 157 Chapter 12: Military Service ............................................................................................. 166 Chapter 13: Housing, Homelessness, and Shelter Access ............................................. 175 Chapter 14: Police, Prisons, and Immigration Detention ................................................ 184 Chapter 15: Harassment and Violence ........................................................................... 197 Chapter 16: Places of Public Accommodation and Airport Security .............................. 212 Chapter 17: Experiences in Restrooms ............................................................................224 Chapter 18: Civic Participation and Policy Priorities ...................................................... 231 About the Authors ............................................................................................................. 241 Appendix A: Characteristics of the Sample .....................................................................243 Appendix B: Survey Instrument (Questionnaire) ........................................................... 250 Appendix C: Detailed Methodology ................................................................................ 291 ### Page 5 1 Acknowledgements The report authors extend our gratitude to all the members of the transgender community who participatedin the 2015 U.S. Transgender Survey and the hundreds of individuals and organizations that made thissurvey report possible. The following individuals in particular are recognized for their contributions during one or more stages of theprocess, including survey development, implementation, distribution, data preparation and analysis, and reporting: Osman Ahmed M. V. Lee Badgett Kellan Baker Genny Beemyn Aaron Belkin Walter Bockting Kyler Broadus David Chae Cecilia Chung Loree Cook Daniels Kerith Conron Ruby Corado Andrew Cray Kate D’Adamo Laura Durso Jake Eleazer Gary J. Gates Jaime Grant Emily Greytak Ann Haas Jack Harrison-Quintana Mark Hatzenbuehler Darby Hickey Lourdes Ashley Hunter Chai Jindasurat JoAnne Keatley Elliot Kennedy Paul Lillig Emilia Lombardi Jenifer McGuire Ilan Meyer Shannon Price Minter Aaron Morris Asaf Orr Dylan Orr Sari Reisner Gabriel Rodenborn Shelby Rowe Brad Sears Jama Shelton Jillian Shipherd Sharon Stapel Michael Steinberger Catalina Velasquez Bianca Wilson The authors extend special gratitude to the following individuals for their contributionsto the project: Ignacio Rivera, Survey Outreach Coordinator, for leading the survey outreach efforts and building a network ofindividuals and organizations that led to the unprecedented levels of participation in this survey. Andrew Flores for assistance with questionnaire development and the weighting procedures to prepare the datafor analysis. Daniel Merson for continued work in cleaning the data set, re-coding the data, and providing population numbersfor comparative purposes in the final report. Michael Rauch for programming and implementation of the complex survey. Appreciation is also extended toNCTE interns, law fellows, staff, and volunteerswho assistedwith the project, including outreach across the country, development of outreach materials, andtranslation: Bre Kidman Cyres Gibson Mati Gonzalez Gil Romeo Jackson Kory Masen Imari Moon Cullen O’Keefe Nowmee Shehab ### Page 6 2 A special thanks is also extended toUSTS Interns, Fellows, and Assistantsfor theirwork at various stages of the project: Rodrigo Aguayo-Romero Willem Miller Shabab Mirza Davida Schiffer Jeymee Semiti Danielle Stevens Venus Selenite The authors also thank theUSTS Advisory Committee(UAC) members, whodevoted their time to the project by giving valuable recommendations around projectdevelopment and community outreach: Danni Askini Cherno Biko Thomas Coughlin Brooke Cerda Guzman Trudie Jackson Andrea Jenkins Angelica Ross Nowmee Shehab Stephanie Skora Brynn Tannehill Additional acknowledgement goes to the more than 300 transgender, LGBT, and allied organizationsthat promoted and distributed the survey to its members throughout the country for completion. The authors also acknowledge current and former NCTE staff for their workon the project, particularly: Theo George and Vincent Villano for their pivotal work in survey project development and distributionthrough their respective roles in digital media and communication strategy. Arli Christian, Joanna Cifredo, K’ai Smith, and Harper Jean Tobin for their contributions as report co-writers,including lending their subject-matter expertise and analysis to the findings included in this report. Various individuals and firms assisted in spreading the word about the survey, both priorto and during the data collection phase, and they also assisted with survey translation,design, and reporting. Thanks goes to: Sean Carlson Leah Furumo Molly Haigh Anna Zuccaro Design Action Collective Dewey Square Group ThoughtWorks TransTech Social Enterprises ZERN Additionally, NCTE would like to express special appreciation to an anonymous donor for providing thelargest share of the funds needed to conduct and report on the U.S. Transgender Survey. Other importantfunders were the Arcus Foundation, the Gill Foundation, the Human Rights Campaign Foundation, andthe David Bohnett Foundation. NCTE is also grateful to its other funders, many of which supported thisproject through general operating support, including the Ford Foundation, the Evelyn & Walter Haas, Jr.Fund, and the Tides Foundation. Finally, NCTE would like to give special thanks to the National LGBTQ Task Force, for its previouspartnership in conducting the National Transgender Discrimination Survey as a joint project from 2008 to2011, as well as for its support of NCTE’s re-development of it as the U.S. Transgender Survey. ### Page 7 3 ### Page 8 4 USTS Executive Summary The 2015 U.S. Transgender Survey (USTS) is the largest survey examining theexperiences of transgender people in the United States, with 27,715 respondentsfrom all fifty states, the District of Columbia, American Samoa, Guam, Puerto Rico,and U.S. military bases overseas. Conducted in the summer of 2015 by the National Centerfor Transgender Equality, the USTS was an anonymous, online survey for transgenderadults (18 and older) in the United States, available in English and Spanish. The USTSserves as a follow-up to the groundbreaking 2008–09 National Transgender DiscriminationSurvey (NTDS), which helped to shift how the public and policymakers view the lives oftransgender people and the challenges they face. The report of the 2015 USTS provides adetailed look at the experiences of transgender people across a wide range of categories,such as education, employment, family life, health, housing, and interactions with thecriminal justice system. The findings reveal disturbing patterns of mistreatment and discrimination and startlingdisparities between transgender people in the survey and the U.S. population when itcomes to the most basic elements of life, such as finding a job, having a place to live,accessing medical care, and enjoying the support of family and community. Surveyrespondents also experienced harassment and violence at alarmingly high rates. Severalthemes emerge from the thousands of data points presented in the full survey report. Pervasive Mistreatment and Violence Respondents reported high levels of mistreatment, harassment, and violence in everyaspect of life. One in ten (10%) of those who were out to their immediate family reportedthat a family member was violent towards them because they were transgender, and 8%were kicked out of the house because they were transgender. The majority of respondents who were out or perceived as transgender while in school(K–12) experienced some form of mistreatment, including being verbally harassed (54%),physically attacked (24%), and sexually assaulted (13%) because they were transgender.Further, 17% experienced such severe mistreatment that they left a school as a result. In the year prior to completing the survey, 30% of respondents who had a job reportedbeing fired, denied a promotion, or experiencing some other form of mistreatment in theworkplace due to their gender identity or expression, such as being verbally harassed orphysically or sexually assaulted at work. ### Page 9 In the year prior to completing the survey, 46% of respondents were verbally harassed and9% were physically attacked because of being transgender. During that same time period,10% of respondents were sexually assaulted, and nearly half (47%) were sexually assaultedat some point in their lifetime. Severe Economic Hardshipand Instability The findings show large economic disparities between transgender people in the surveyand the U.S. population. Nearly one-third (29%) of respondents were living in poverty,compared to 12% in the U.S. population. A major contributor to the high rate of poverty islikely respondents’ 15% unemployment rate—three times higher than the unemploymentrate in the U.S. population at the time of the survey (5%). Respondents were also far less likely to own a home, with only 16% of respondentsreporting homeownership, compared to 63% of the U.S. population. Even more concerning,nearly one-third (30%) of respondents have experienced homelessness at some point intheir lifetime, and 12% reported experiencing homelessness in the year prior to completingthe survey because they were transgender. Harmful Effects on Physicaland Mental Health The findings paint a troubling picture of the impact of stigma and discrimination on thehealth of many transgender people. A staggering 39% of respondents experienced seriouspsychological distress in the month prior to completing the survey, compared with only5% of the U.S. population. Among the starkest findings is that 40% of respondents haveattempted suicide in their lifetime—nearly nine times the attempted suicide rate in the U.S.population (4.6%). Respondents also encountered high levels of mistreatment when seeking health care. Inthe year prior to completing the survey, one-third (33%) of those who saw a health careprovider had at least one negative experience related to being transgender, such as beingverbally harassed or refused treatment because of their gender identity. Additionally,nearly one-quarter (23%) of respondents reported that they did not seek the health carethey needed in the year prior to completing the survey due to fear of being mistreated as atransgender person, and 33% did not go to a health care provider when needed becausethey could not afford it. ### Page 10 The Compounding Impact of Other Forms of DiscriminationWhen respondents’ experiences are examined by race and ethnicity, a clear and disturbing pattern is revealed: transgender people of color experience deeper and broader patterns of discrimination than white respondents and the U.S. population. While respondents in the USTS sample overall were more than twice as likely as the U.S. population to be living in poverty, people of color, including Latino/a (43%), American Indian (41%), multiracial (40%), and Black (38%) respondents, were more than three times as likely as the U.S. population (12%) to be living in poverty. The unemployment rate among transgender people of color (20%) was four times higher than the U.S. unemployment rate (5%). People of color also experienced greater health disparities. While 1.4% of all respondents were living with HIV— nearly five times the rate in the U.S. population (0.3%)—the rate among Black respondents (6.7%) was substantially higher, and the rate for Black transgender women was a staggering 19%. Undocumented respondents were also more likely to face severe economic hardship and violence than other respondents. In the year prior to completing the survey, nearly one- quarter (24%) of undocumented respondents were physically attacked. Additionally, one- half (50%) of undocumented respondents have experienced homelessness in their lifetime, and 68% have faced intimate partner violence. Respondents with disabilities also faced higher rates of economic instability and mistreatment. Nearly one-quarter (24%) were unemployed, and 45% were living in poverty. Transgender people with disabilities were more likely to be currently experiencing serious psychological distress (59%) and more likely to have attempted suicide in their lifetime (54%). They also reported higher rates of mistreatment by health care providers (42%).Increased Visibility and Growing AcceptanceDespite the undeniable hardships faced by transgender people, respondents’ experiences also show some of the positive impacts of growing visibility and acceptance of transgender people in the United States. One such indication is that an unprecedented number of transgender people—nearly 28,000—completed the survey, more than four times the number of respondents in the 2008–09 NTDS. This number of transgender people who elevated their voices reflects the historic growth in visibility that the transgender community has seen in recent years. Additionally, this growing visibility has lifted up not only the voices of transgender men and women, but also people who are non-binary, which is a term that is often used to describe ### Page 11 people whose gender identity is not exclusively male or female, including those whoidentify as having no gender, a gender other than male or female, or more than one gender.With non-binary people making up over one-third of the sample, the need for advocacy thatis inclusive of all identities in the transgender community is clearer than ever. Respondents’ experiences also suggest growing acceptance by family members,colleagues, classmates, and other people in their lives. More than half (60%) of respondentswho were out to their immediate family reported that their family was supportive of themas a transgender person. More than two-thirds (68%) of those who were out to theircoworkers reported that their coworkers were supportive. Of students who were out totheir classmates, more than half (56%) reported that their classmates supported them as atransgender person. Overall, the report provides evidence of hardships and barriers faced bytransgender people on a day-to-day basis. It portrays the challenges thattransgender people must overcome and the complex systems that they areoften forced to navigate in multiple areas of their lives in order to survive and thrive. Giventhis evidence, governmental and private institutions throughout the United States shouldaddress these disparities and ensure that transgender people are able to live fulfillinglives in an inclusive society. This includes eliminating barriers to quality, affordable healthcare, putting an end to discrimination in schools, the workplace, and other areas of publiclife, and creating systems of support at the municipal, state, and federal levels that meetthe needs of transgender people and reduce the hardships they face. As the nationalconversation about transgender people continues to evolve, public education efforts toimprove understanding and acceptance of transgender people are crucial. The rates ofsuicide attempts, poverty, unemployment, and violence must serve as an immediate callto action, and their reduction must be a priority. Despite policy improvements over thelast several years, it is clear that there is still much work ahead to ensure that transgenderpeople can live without fear of discrimination and violence. ### Page 12 Overview of Key Findings Family Life and Faith Communities • A majority of respondents (60%) who were out to the immediate family they grewup with said that their family was generally supportive of their transgender identity,while 18% said that their family was unsupportive, and 22% said that their family wasneither supportive nor unsupportive.• Those who said that their immediate families were supportive were less likely toreport a variety of negative experiences related to economic stability and health,such as experiencing homelessness, attempting suicide, or experiencing seriouspsychological distress. • One in ten (10%) respondents who were out to their immediate family reported that afamily member was violent towards them because they were transgender. • One in twelve (8%) respondents who were out to their immediate family were kickedout of the house, and one in ten (10%) ran away from home. • Nineteen percent (19%) of respondents who had ever been part of a spiritual orreligious community left due to rejection. Forty-two percent (42%) of those who leftlater found a welcoming spiritual or religious community. Negative experiences among those withsupportive and unsupportive families 0% 10% 20% 30% 40% 50% 60% 27% Experienced homelessness Attempted suicide Currently experiencing seriouspsychological distress 45% 37% 54% 31% 50% % of respondents whose families were supportive % of respondents whose families were unsupportive ### Page 13 Identity Documents • Only 11% of respondents reported that all of their IDs had the name and gender theypreferred, while more than two-thirds (68%) reported that none of their IDs had thename and gender they preferred. • The cost of changing ID documents was one of the main barriers respondents faced,with 35% of those who have not changed their legal name and 32% of those who have notupdated the gender on their IDs reporting that it was because they could not afford it. • Nearly one-third (32%) of respondents who have shown an ID with a name or genderthat did not match their gender presentation were verbally harassed, denied benefitsor service, asked to leave, or assaulted. Updated name or gender on IDOUT OF THOSE WHO HAD ID AND WANTED TO UPDATE IT (%) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 44% Driver’s license/state-issued ID Social Security records Student records (currentor last school attended) Passport Birth certificate 29% 43% 23% 31% 18% 28% 18% 18% 9% Updated name Updated gender ### Page 14 Health Insurance and Health Care • One in four (25%) respondents experienced a problem in the past year with theirinsurance related to being transgender, such as being denied coverage for care related to gender transition or being denied coverage for routine care because they were transgender.• More than half (55%) of those who sought coverage for transition-related surgery in thepast year were denied, and 25% of those who sought coverage for hormones in the past year were denied.• One-third (33%) of those who saw a health care provider in the past year reported havingat least one negative experience related to being transgender, with higher rates for people of color and people with disabilities. This included being refused treatment, verbally harassed, or physically or sexually assaulted, or having to teach the provider about transgender people in order to get appropriate care.• In the past year, 23% of respondents did not see a doctor when they needed to becauseof fear of being mistreated as a transgender person, and 33% did not see a doctor when needed because they could not afford it. Psychological Distress andAttempted Suicide • Thirty-nine percent (39%) of respondents experienced serious psychological distress in themonth before completing the survey(based on the Kessler 6 Psychological Distress Scale),compared with only 5% of the U.S. population. • Forty percent (40%) have attempted suicide in their lifetime, nearly nine times the rate inthe U.S. population (4.6%). • Seven percent (7%) attempted suicide in the past year—nearly twelve times the rate in theU.S. population (0.6%). HIV • Respondents were living with HIV (1.4%) at nearly five times the rate in the U.S.population (0.3%). • HIV rates were higher among transgender women (3.4%), especially transgender womenof color. Nearly one in five (19%) Black transgender women were living with HIV, andAmerican Indian (4.6%) and Latina (4.4%) women also reported higher rates. 10 ### Page 15 Experiences in Schools • More than three-quarters (77%) of those who were out or perceived as transgenderat some point between Kindergarten and Grade 12 (K–12) experienced some form ofmistreatment, such as being verbally harassed, prohibited from dressing accordingto their gender identity, disciplined more harshly, or physically or sexually assaultedbecause people thought they were transgender. • Fifty-four percent (54%) of those who were out or perceived as transgender in K–12were verbally harassed, nearly one-quarter (24%) were physically attacked, and 13%were sexually assaulted in K–12 because of being transgender. • Seventeen percent (17%) faced such severe mistreatment as a transgender personthat they left a K–12 school. • Nearly one-quarter (24%) of people who were out or perceived as transgender incollege or vocational school were verbally, physically, or sexually harassed. Experiences of people who were out as transgender in K–12 or believedclassmates, teachers, or school staff thought they were transgender | EXPERIENCES | % OF THOSE WHO WERE OUT ORPERCEIVED AS TRANSGENDER | | - | - | | Verbally harassed because people thought they were transgender | 54% | | Not allowed to dress in a way that fit their gender identity or expression | 52% | | Disciplined for fighting back against bullies | 36% | | Physically attacked because people thought they were transgender | 24% | | Believe they were disciplined more harshly because teachers or staff thoughtthey were transgender | 20% | | Left a school because the mistreatment was so bad | 17% | | Sexually assaulted because people thought they were transgender | 13% | | Expelled from school | 6% | | One or more experiences listed | 77% | ### Page 16 Income and Employment Status • The unemployment rate among respondents (15%) was three times higher than theunemployment rate in the U.S. population (5%), with Middle Eastern, American Indian,multiracial, Latino/a, and Black respondents experiencing higher rates of unemployment. • Nearly one-third (29%) were living in poverty, more than twice the rate in the U.S.population (12%). Employment and the Workplace • One in six (16%) respondents who have ever been employed—or 13% of all respondentsin the sample—reported losing a job because of their gender identity or expression intheir lifetime. • In the past year, 27% of those who held or applied for a job during that year—19% of allrespondents—reported being fired, denied a promotion, or not being hired for a jobthey applied for because of their gender identity or expression. • Fifteen percent (15%) of respondents who had a job in the past year were verballyharassed, physically attacked, and/or sexually assaulted at work because of theirgender identity or expression. • Nearly one-quarter (23%) of those who had a job in the past year reported otherforms of mistreatment based on their gender identity or expression during that year, Unemployment rateRACE/ETHNICITY (%) 0% 35% 30% 25% 20% 15% 10% 5% 15% Overall American Indian Asian Black Latino/a Middle Eastern* Multiracial White 5% 23% 12% 10% 4% 20% 10% 21% 7% 35% 22% 9% 12% 4% % in USTS (supplemental survey weight applied) % in U.S. population (CPS) * U.S. population data for Middle Eastern people alone is unavailable in the CPS. ### Page 17 such as being forced to use a restroom that did not match their gender identity, being told to present in the wrong gender in order to keep their job, or having a boss or coworker share private information about their transgender status without their permission. • Overall, 30% of respondents who had a job in the past year reported being fired,denied a promotion, or experiencing some other form of mistreatment related to theirgender identity or expression. • More than three-quarters (77%) of respondents who had a job in the past year tooksteps to avoid mistreatment in the workplace, such as hiding or delaying their gendertransition or quitting their job. • Nearly one-quarter (23%) of respondents experienced some form of housingdiscrimination in the past year, such as being evicted from their home or denied ahome or apartment because of being transgender. • Nearly one-third (30%) of respondents have experienced homelessness at some pointin their lives. • In the past year, one in eight (12%) respondents experienced homelessness becauseof being transgender. • More than one-quarter (26%) of those who experienced homelessness in thepast year avoided staying in a shelter because they feared being mistreatedas a transgender person. Those who did stay in a shelter reported high levels ofmistreatment: seven out of ten (70%) respondents who stayed in a shelter in thepast year reported some form of mistreatment, including being harassed, sexually orphysically assaulted, or kicked out because of being transgender. • Respondents were nearly four times less likely to own a home (16%) compared to theU.S. population (63%). Housing, Homelessness,and Shelter Access ### Page 18 Sex Work and Other UndergroundEconomy Work • Respondents reported high rates of experience in the underground economy, includingsex work, drug sales, and other work that is currently criminalized. One in five (20%)have participated in the underground economy for income at some point in their lives—including 12% who have done sex work in exchange for income—and 9% did so in the pastyear, with higher rates among women of color. • Respondents who interacted with the police either while doing sex work or while thepolice mistakenly thought they were doing sex work reported high rates of policeharassment, abuse, or mistreatment, with nearly nine out of ten (86%) reporting beingharassed, attacked, sexually assaulted, or mistreated in some other way by police. • Those who have done income-based sex work were also more likely to haveexperienced violence. More than three-quarters (77%) have experienced intimate partnerviolence and 72% have been sexually assaulted, a substantially higher rate than theoverall sample. Out of those who were working in the underground economy at the timethey took the survey, nearly half (41%) were physically attacked in the past year and overone-third (36%) were sexually assaulted during that year. Police Interactions and Prisons • Respondents experienced high levels of mistreatment and harassment by police. Inthe past year, of respondents who interacted with police or law enforcement officers whothought or knew they were transgender, more than half (58%) experienced some form ofmistreatment. This included being verbally harassed, repeatedly referred to as the wronggender, physically assaulted, or sexually assaulted, including being forced by officers toengage in sexual activity to avoid arrest. • Police frequently assumed that respondents—particularly transgender women of color—were sex workers. In the past year, of those who interacted with law enforcement officerswho thought or knew they were transgender, one-third (33%) of Black transgender womenand 30% of multiracial women said that an officer assumed they were sex workers. • More than half (57%) of respondents said they would feel uncomfortable asking thepolice for help if they needed it. • Of those who were arrested in the past year (2%), nearly one-quarter (22%) believed theywere arrested because they were transgender. ### Page 19 • Respondents who were held in jail, prison, or juvenile detention in the past year faced highrates of physical and sexual assault by facility staff and other inmates. In the past year,nearly one-quarter (23%) were physically assaulted by staff or other inmates, and one in five(20%) were sexually assaulted. Respondents were over five times more likely to be sexuallyassaulted by facility staff than the U.S. population in jails and prisons, and over nine timesmore likely to be sexually assaulted by other inmates. Harassment and Violence • Nearly half (46%) of respondents were verbally harassed in the past year because of beingtransgender. • Nearly one in ten (9%) respondents were physically attacked in the past year because ofbeing transgender. • Nearly half (47%) of respondents were sexually assaulted at some point in their lifetime andone in ten (10%) were sexually assaulted in the past year. Respondents who have done sexwork (72%), those who have experienced homelessness (65%), and people with disabilities(61%) were more likely to have been sexually assaulted in their lifetime. • More than half (54%) experienced some form of intimate partner violence, including actsinvolving coercive control and physical harm. • Nearly one-quarter (24%) have experienced severe physical violence by an intimatepartner, compared to 18% in the U.S. population. Transgender women reporting that police assumed they were sex workers in the past year(out of those who interacted with officers who thought they were transgender)RACE/ETHNICITY (%) 0% 35% 30% 25% 20% 15% 10% 5% 11% Overall* 23% American Indian women 20% Asian women 33% Black women 25% Latina women Middle Easternwomen** 30% Multiracial women 11% White women *Represents respondents of all genders who interacted with officers who thought they were transgender **Sample size too low to report ### Page 20 Places of Public Accommodation • Respondents reported being denied equal treatment or service, verbally harassed,or physically attacked at many places of public accommodation—places that provideservices to the public, like retail stores, hotels, and government offices. Out ofrespondents who visited a place of public accommodation where staff or employeesthought or knew they were transgender, nearly one-third (31%) experienced at leastone type of mistreatment in the past year in a place of public accommodation. Thisincluded 14% who were denied equal treatment or service, 24% who were verballyharassed, and 2% who were physically attacked because of being transgender. • One in five (20%) respondents did not use at least one type of public accommodationin the past year because they feared they would be mistreated as a transgender person. Experiences in Restrooms The survey data was collected before transgender people’s restroom use became thesubject of increasingly intense and often harmful public scrutiny in the national mediaand legislatures around the country in 2016. Yet respondents reported facing frequentharassment and barriers when using restrooms at school, work, or in public places. • Nearly one in ten (9%) respondents reported that someone denied them access to arestroom in the past year. • In the past year, respondents reported being verbally harassed (12%), physicallyattacked (1%), or sexually assaulted (1%) when accessing a restroom. Denied equal treatment or service, verbally harassed, or physically attacked in publicaccommodations in the past year because of being transgender | LOCATION VISITED | % OF THOSE WHO SAIDSTAFF KNEW OR THOUGHTTHEY WERE TRANSGENDER | | - | - | | Public transportation | 34% | | Retail store, restaurant, hotel, or theater | 31% | | Drug or alcohol treatment program | 22% | | Domestic violence shelter or program or rape crisis center | 22% | | Gym or health club | 18% | | Public assistance or government benefit office | 17% | | Department of Motor Vehicles (DMV) | 14% | | Nursing home or extended care facility | 14% | | Court or courthouse | 13% | | Social Security office | 11% | | Legal services from an attorney, clinic, or legal professional | 6% | ### Page 21 • More than half (59%) of respondents avoided usinga public restroom in the past year because they wereafraid of confrontations or other problems they mightexperience. • Nearly one-third (32%) of respondents limited theamount that they ate and drank to avoid using therestroom in the past year. • Eight percent (8%) reported having a urinary tractinfection, kidney infection, or another kidney-relatedproblem in the past year as a result of avoidingrestrooms. Civic Participation and Party Affiliation • More than three-quarters (76%) of U.S. citizens of voting age in the sample reportedthat they were registered to vote in the November 2014 midterm election, comparedto 65% in the U.S. population. • More than half (54%) of U.S. citizens of voting age reported that they had voted in themidterm election, compared to 42% in the U.S. population. • Half (50%) of respondents identified as Democrats, 48% identified as Independents,and 2% identified as Republicans, compared to 27%, 43%, and 27% in the U.S.population, respectively. More than half (59%)ofrespondentsavoided using apublic restroomin the past yearbecause they were afraidof confrontationsor other problemsthey mightexperience. Political party affiliation | POLITICAL PARTY | % IN USTS | % IN U.S.POPULATION (GALLUP) | | - | - | - | | Democrat | 50% | 27% | | Independent | 48% | 43% | | Republican | 2% | 27% | ### Page 22 18 CHAPTER 1 Introduction This report presents the findings of the 2015 U.S. Transgender Survey (USTS), a study conductedby the National Center for Transgender Equality (NCTE). With 27,715 respondents, it is the largest-ever survey examining the lives of transgender people in the United States. The USTS provides adetailed portrait of the experiences of transgender people across many areas, including health, family life,employment, and interactions with the criminal justice system. The USTS serves as a follow-up to the National Transgender Discrimination Survey (NTDS), which wasdeveloped by NCTE and the National LGBTQ Task Force and conducted in 2008–09. The NTDS was thefirst comprehensive survey examining the lives and experiences of transgender and gender nonconformingpeople in the United States. With 6,456 respondents reporting on a range of experiences throughout theirlives, the NTDS was a groundbreaking study. The results were published in the 2011 report, Injustice atEvery Turn, and showed that discrimination against transgender people was pervasive in many areas oflife, including education, employment, health care, and housing. The report also highlighted the resilienceof transgender people in the face of such discrimination and found that family and peer support couldhave a substantially positive impact on a transgender person’s quality of life. The report quickly became avital source of information about transgender people and continues to serve as an important resource foradvocates, policymakers, educators, service providers, media, and the general public. ### Page 23 19 Much has changed since the NTDS was conductedin 2008–09 and results were published in 2011,including increased visibility of transgender peoplein the media and in society in general. Despitemaking significant strides in the five years sincethe report was published, there is still a substantialamount of work to be done to address critical needsin transgender communities throughout the UnitedStates. Transgender people continue to experiencediscrimination and anti-transgender bias in virtuallyall areas of life. The 2015 U.S. Transgender Survey was developedby the National Center for Transgender Equality toprovide updated and more detailed data to informa wide range of audiences about the experiencesof transgender people, how things are changing,and what can be done to improve the lives oftransgender individuals in the United States.It is the largest survey of transgender peopleconducted to date, far surpassing the previoussurvey, with 27,715 respondents. This studyexplores a wider range of topics than the previoussurvey and more deeply examines specific issueareas where transgender people are disparatelyimpacted, such as health care, HIV/AIDS, housing,workplace discrimination, immigration, sex work,and police interactions. Additionally, by closelymirroring questions from federal and other existingsurveys, this study seeks to fill in the gaps leftby the lack of data collected about transgenderpeople in national surveys. Since federal surveydata is often used by government agencies tomake key determinations about policies andprograms that affect individuals in many areas oflife, such as employment and health, it is importantto provide specific data on the potential impactof such policies on transgender people. Thisreport on the U.S. Transgender Survey data drawscomparisons between transgender people and theU.S. population and examines disparities acrossmultiple issue areas. This report demonstrates that transgender peoplecontinue to face discrimination in numerous areasthat significantly impact quality of life, financialstability, and emotional wellbeing, includingemployment, education, housing, and health care.Furthermore, many respondents experienceddiscrimination in multiple areas of their lives,the cumulative effect of which leads to severeeconomic and emotional hardship and can in turnhave devastating effects on other outcome areas,such as health and safety. Although issues impacting transgender peoplehave become more visible in the years since theNTDS was published, the data overwhelminglydemonstrates that there is still a long way togo towards eliminating harmful discriminationand providing sustainable systems of supportfor transgender people throughout their lives.These findings are presented with the recognitionthat advocates, researchers, and transgendercommunities will greatly benefit from additionalresearch conducted using this extensive datasource. The authors encourage subsequentanalyses to delve into areas of the data that thisreport is unable to address, and as before, willstrive to make the dataset available for suchanalyses. ### Page 24 Report Roadmap The next chapter of the report will give anoverview of the study’s methodology, which willbe followed by a guide to this report, includinginformation about terminology used throughout.These will be followed by chapters discussingrespondents’ experiences across a range of areasthat impact transgender people’s lives: • Portrait of USTS Respondents • Family Life and Faith Communities • Identity Documents • Health • Experiences at School • Income and Employment Status • Employment and the Workplace • Sex Work and Other Underground EconomyWork • Military Service • Housing, Homelessness, and Shelter Access • Police, Prisons, and Immigration Detention • Harassment and Violence • Places of Public Accommodation and AirportSecurity • Experiences in Restrooms • Civic Participation and Policy Priorities The report also contains three appendices,which offer more detailed information related tothe study: Appendix A: Characteristics of the Sample Appendix B: Survey Instrument (Questionnaire) Appendix C: Detailed Methodology ### Page 25 21 CHAPTER 2 Methodology The U.S. Transgender Survey is the largest survey ever conducted to examine the experiencesof transgender people in the United States. The survey instrument was comprised of thirty-twosections reflecting 1,140 distinct variables that covered a broad array of topics, such as health andhealth care access, and experiences around employment, education, housing, law enforcement, and publicaccommodation.1 The survey was developed by a team of researchers and advocates and administeredonline to transgender adults residing in the United States.2 The survey was accessible via any web-enableddevice (e.g., computer, tablet, netbook, smart phone), accessible for respondents with disabilities (e.g.,through screen readers), and made available in English and Spanish. Rankin & Associates Consultinghosted the survey on several secure servers. The survey was accessed exclusively through a websitecreated specifically for the promotion and distribution of the survey.3 Data was collected over a 34-dayperiod in the summer of 2015,4 and the final sample included 27,715 respondents from all fifty states, theDistrict of Columbia, American Samoa, Guam, Puerto Rico, and U.S. military bases overseas. The surveycontained mainly closed-ended questions, but respondents were also offered the opportunity to providewrite-in responses in fifty-three of the survey questions. Over 80,000 write-in responses were provided byrespondents. ### Page 26 22 I. About the U.S.Transgender Survey The U.S. Transgender Survey (USTS) wasdeveloped as the follow-up to the groundbreakingNational Transgender DiscriminationSurvey (NTDS), which was the first study tocomprehensively measure experiences and lifeoutcomes of transgender people in the UnitedStates. Fielded in late 2008 to early 2009 by theNational Center for Transgender Equality (NCTE)and the National LGBTQ Task Force (“the TaskForce”), the NTDS provided data that has informedpolicymakers, advocates, and educators sinceits publication in 2011. However, the NTDS reportacknowledged that the study had “just scratchedthe surface of this extensive data source” andencouraged advocates and researchers toconduct additional research to continue collectingdata aimed at identifying and addressing theneeds of transgender people.5 The NTDSauthors also examined the survey instrumentand concluded that there were “imperfections”in the manner in which several questions hadbeen posed.6 The authors addressed areasfor potential improvement with respect to bothsurvey question design and substantive contentin an “issues and analysis” section of the report.7These recommendations were considered in thedevelopment of the U.S. Transgender Survey. In subsequent years, researchers haveperformed additional analyses using the NTDSpublic use dataset provided by NCTE and theTask Force. These analyses provided furtherinsight into the experiences of transgenderpeople, but also increased awareness of thequestions that remained unanswered after theNTDS report was published. In some instances,there was insufficient information to drawnuanced comparisons between life outcomesof transgender people collected in the NTDSand the U.S. general population. In other cases,the ability to form additional conclusions waslimited due to a lack of follow-up questions. Forexample, the NTDS asked a single question aboutsuicide attempts, which did not allow for a clearexamination of suicidal thoughts and behaviors.8Additionally, given the deficiency of longitudinaldata on outcomes specific to transgender people,there remained a need to collect data that couldspeak to the experiences of transgender peopleover time and how outcomes may have changedin the years since the NTDS was published. Inthese respects, the NTDS provided an importantplatform upon which to build the USTS to addressidentified areas for improvement and collect datathat would enable new insights to be drawn abouttransgender people in the United States. The study was renamed the U.S. TransgenderSurvey for several reasons. One was to clarifythe geographical location of the intended studysample both during the data collection periodand following report publication. The use of “U.S.”signaled that this study was developed with theunique needs of transgender people in the UnitedStates and U.S. territories in mind, consideringrelevant policies, procedures, and practicesapplicable to residents of the United States at thetime of the study in areas such as health care andinsurance, income, employment, housing, andeducation. Recognizing the contextual differencesbetween the experiences of transgender peoplein the U.S. and in other parts of the world, theresearch team sought to dispel any confusionarising from the use of “national” in the title. Thenew name was also intended to reflect the depthand breadth of the experiences of transgenderpeople in the U.S. and elevate a variety ofnarratives beyond discrimination, including theresilience and resourcefulness of the transgendercommunity in the face of hardship, as well asexperiences of acceptance and affirmation.“Discrimination” was removed from the title toclarify that the survey was designed to capture allsuch experiences. Additionally, removing the word ### Page 27 reduced potential bias in respondents’ answers orresulting from primarily attracting respondents whofelt they had experienced discrimination. II. USTS Respondents The study population included individuals whoidentified as transgender, trans, genderqueer,non-binary, and other identities on the transgenderidentity spectrum, in order to encompass a widerange of transgender identities, regardless ofterminology used by the respondent. Although“transgender” was defined broadly for thepurposes of this study as being inclusive of awide range of identities—such as genderqueer,non-binary, and crossdresser—the researchteam recognized that many individuals forwhom the study was intended may have useddifferent terminology or definitions and mighthave assumed that the term “transgender” didnot include them. To address this, promotionalmaterials affirmed that the survey was inclusiveof all transgender, trans, genderqueer, and non-binary people. Additionally, materials specified thatthe survey was for adults at any stage of their lives,journey, or transition to encourage participationamong individuals with diverse experiencesregarding their transgender identity. An in-depthdescription of survey respondents is available inthe Portrait of USTS Respondents chapter. The study included individuals aged 18 and olderat the time of survey completion, as did the NTDS.The study was not offered to individuals underthe age of 18 due to limitations created by specificrisk factors and recommendations associated withresearch involving minors. These considerations,including requirements for parental/guardianconsent, would have impacted the survey’s scopeand content and also reduced the literacy level atwhich the survey could be offered.9 Furthermore,the current experiences and needs of transgenderyouth often differ from those of adults in a numberof key areas, including experiences related toeducation, employment, accessing health care,and updating identity documents, and manyof these experiences or needs could not beadequately captured in a survey that was notspecifically tailored to transgender people underthe age of 18. The sample was limited to individuals currentlyresiding in a U.S. state or territory, or on a U.S.military base overseas, since the study focused onthe experiences of people who were subject toU.S. laws and policies at the time they completedthe survey. Individuals residing outside of the U.S.may have vastly different experiences across anumber of outcome measures based on eachrespective country’s laws, policies, and culture,particularly in the areas of education, employment,housing, and health care. Additionally, manysurvey questions were taken from U.S. federalgovernment surveys that also limit their samplepopulation to individuals in the U.S., and theresearch team sought to examine a similarpopulation with regard to geographical locationto allow for comparisons to the U.S. generalpopulation. III. Developing theSurvey Instrument The USTS survey instrument was developed overthe course of a year by a core team of researchersand advocates in collaboration with dozens ofindividuals with lived experience, advocacy andresearch experience, and subject-matter expertise.When developing the survey instrument, theresearch team focused on creating a questionnairethat could provide data to address both currentand emerging needs of transgender peoplewhile gathering information about disparities ### Page 28 that often exist between transgender peopleand non-transgender people throughout the U.S.To achieve this, questions were included thatwould allow comparisons between the USTSsample and known benchmarks for the U.S.population as a whole or populations within theU.S. Consequently, questions were selected tobest match those previously asked in federalgovernment or other national surveys on a numberof measures, such as measures related to incomeand health.10 Changes were made to the languageof comparable questions whenever it was requiredto more appropriately reflect issues pertaining totransgender people and language in common usein the transgender community while maintainingcomparability to the best extent possible. However,in many cases, language was preserved to ensurethat responses to a USTS question would maintainmaximum comparability with surveys such as theU.S. Census Bureau’s American Community Surveyand Current Population Survey. Several questions were also included in anattempt to provide comparability between theNTDS, where possible, to determine how certainoutcomes may have changed since the NTDSdata was collected in 2008–09. While the USTSprovides crucial updated data, it is important tonote that many of the questions asked in the NTDSwere either not included in the USTS, or they wereasked in a manner that reduced comparability withthe NTDS. For example, many USTS questionsasked about whether certain experiencesoccurred within the past year instead of askingwhether those experiences occurred at any pointduring an individual’s lifetime. These questionswere included for both comparability with federalgovernment or other national surveys and alsoto yield improved data regarding changingexperiences in future iterations of the USTS. Insuch instances, the NTDS continues to providethe best available data regarding experiencesthat occurred over respondents’ lifetime. Theauthors suggest referring to both the USTS andthe NTDS to gain a full picture of issues impactingtransgender people. The survey instrument was reviewed byresearchers, members of the transgendercommunity, and transgender advocates at multipleintervals throughout the development process.This included thorough reviews of sections thataddressed specific subject matter and the entirequestionnaire. The questionnaire was revisedbased on feedback from dozens of reviewers. a. Pilot Study Prior to finalizing the survey instrument andlaunching the survey in field, a pilot studywas conducted to evaluate the questionnaire.The pilot study was conducted among a smallgroup of individuals with characteristics thatwere representative of the sample the studywas intended to survey. The pilot study wasadministered through an online test site usingthe same platform and format in which the finalsurvey later appeared. The purpose of the pilotstudy was to provide both a substantive andtechnical evaluation of the survey. Approximately100 individuals were invited to complete andevaluate the survey online during a specifiedperiod of time. In order to receive access to thepilot study test site, invitees were required toconfirm their participation by indicating that theymet the following pilot study criteria: they were(1) 18 years or older, (2) transgender, (3) willing toprovide feedback that would be used to makeimprovements to the survey, (4) available to takethe survey online during specified dates, and(5) agreeing to not share the questions in thepilot study with anyone so as to not compromisethe study. Forty (40) individuals confirmed theirparticipation and received access to the pilotstudy test site. Thirty-two (32) people completedthe study and submitted feedback on thequestionnaire, including participants in fifteenstates ranging in age from 19 to 78. Participants ### Page 29 reported identifying with a range of genderidentities11 and racial and ethnic identities,including 34% who identified as people of color.12 In addition to providing general feedback onindividual questions and the entire questionnaire,pilot study participants were asked to addressspecific questions as part of their evaluation,including: (1) how long it took to complete thesurvey, (2) what they thought about the lengthof the survey, (3) whether any existing questionswere confusing or difficult to answer, (4) whetherthey found any questions offensive or thoughtthey should be removed or fixed, (5) whether theyexperienced technical or computer issues whiletaking the survey, and (6) what they thought aboutthe statement explaining why the term “trans”was used throughout the survey.13 All participantfeedback was compiled, discussed, and used tofurther develop the questionnaire, such as throughthe revision of language and the addition ofquestions to more thoroughly examine an issue. b. Length The final survey questionnaire contained a totalof 324 possible questions in thirty-two discretesections addressing a variety of subjects, suchas experiences related to health and healthcare access, employment, education, housing,interactions with law enforcement, and placesof public accommodation. The online surveyplatform allowed respondents to move seamlesslythrough the questionnaire and ensured they onlyreceived questions that were appropriate basedon previous answers. This was accomplishedusing skip logic, which created unique pathwaysthrough the questionnaire, with each next stepin a pathway being dependent on an individualrespondent’s answer choices. For example,respondents who reported that they had servedin the U.S. Armed Forces, Reserves, or NationalGuard received a series of questions about theirmilitary service, but those who had not serveddid not receive those questions. Due to thecustomized nature of the survey, the length variedgreatly between respondents, and no respondentreceived all possible questions. Prior to the pilotstudy, estimates indicated a survey-completiontime of 30–45 minutes. The completion-timeestimate was extended to 60 minutes based onfeedback from pilot study participants, and it wasconsistent with many reports during the fieldingperiod.14 Despite observations about survey lengthdiscussed in the NTDS,15 evolving data needsrelating to issues affecting transgender peoplerequired an in-depth treatment of multiple issueareas. This often required multiple questions tothoroughly assess an issue—including in areaswhere the NTDS asked only one question—andresulted in a lengthier survey. Survey instrumentlength was assessed throughout its developmentto ensure it would be manageable for as manyparticipants as possible. Furthermore, throughmultiple reviews and evaluations of the surveyinstrument—including the pilot study—surveytakers reported that the length was appropriate fora survey addressing such a wide range of issuesand the need for data outweighed concerns aboutthe overall length of the survey. IV. SurveyDistribution andSample Limitations The survey was produced and distributed in anonline-only format after a determination that itwould not be feasible to offer it in paper formatdue to the length and the complexity of the skiplogic required to move through the questionnaire.With so many unique possibilities for a customizedsurvey experience for each respondent, theintricate level of navigation through the survey ### Page 30 would have created an undue burden andconfusion for many respondents. This could haveled to questions being answered unnecessarilyor being skipped completely, which could haveincreased the potential for missing data in the finaldataset.16 This made online programming the bestoption for ensuring that respondents received allof the questions that were appropriate based ontheir prior answers, decreasing the probability ofmissing data. However, the potential impact ofinternet survey bias on obtaining a diverse samplehas been well documented in survey research,17with findings that online and paper surveys mayreach transgender respondents with “vastlydifferent health and life experiences.”18 With thoseconsiderations in mind, outreach efforts werefocused on addressing potential demographicdisparities in our final sample that could result fromonline bias and other issues relating to limitedaccess. Although the intention was to recruit asample that was as representative as possibleof transgender people in the U.S., it is importantto note that respondents in this study were notrandomly sampled and the actual populationcharacteristics of transgender people in the U.S.are not known. Therefore, it is not appropriateto generalize the findings in this study to alltransgender people. V. Outreach The main outreach objective was to provideopportunities to access the survey for as manytransgender individuals as possible in differentcommunities across the U.S. and its territories.Additionally, outreach efforts focused on reachingpeople who may have had limited access to theonline platform and who were at increased risk ofbeing underrepresented in such survey research.This included, but was not limited to, people ofcolor, seniors, people residing in rural areas, andlow-income individuals. The outreach strategy wasa multi-pronged approach to reach transgenderpeople through various connections and points-of-access, including transgender- or LGBTQ-specificorganizations, support groups, health centers, andonline communities. Outreach efforts began approximately sixmonths prior to the launch of the data-collectionperiod with a variety of tactics designed to raiseawareness of the survey, inform people when itwould be available, and generate opportunitiesfor community engagement, participation,and support. A full-time Outreach Coordinatorworked for a period of six months to develop andimplement the outreach strategy along with a teamof paid and volunteer interns and fellows.19 An initial phase of outreach involved developinglists of active transgender, LGBTQ, and alliedorganizations who served transgender people andwould eventually support the survey by spreadingthe word through multiple communication platformsand in some cases providing direct access to thesurvey at their offices or facilities. Establishingthis network of “supporting organizations” was anessential component of reaching a wide, diversesample of transgender people. Over 800 organizations were contacted by email,phone, and social media, and they were askedif they would support the survey by sharinginformation about it with their members andcontacts. Specifically, supporting organizationswere asked to share information through emailblasts and social media channels, and theresearch team provided language and graphicsfor organizations to use in an effort to recruitappropriate respondents into the study. Of theorganizations contacted, approximately halfresponded to requests for support, resulting indirect recruitment correspondence with nearly400 organizations at regular intervals duringthe pre-data-collection period and while thesurvey was in the field.20,21 These organizations ### Page 31 performed outreach that contributed to thefar reach of the survey and unprecedentednumber of respondents.22 The organizationswere also featured on the survey website sopotential respondents could determine whetherorganizations they knew and trusted had pledgedsupport for the survey. Nearly 400 organizations responded to outreachand confirmed their support for the survey. Theremaining organizations did not respond directlyto invitations to learn more about the surveyand become supporters. Consequently, theseorganizations did not receive correspondenceaimed at directly recruiting respondents prior tothe survey launch or during the data-collectionperiod. It is possible, however, that surveyrespondents were still made aware of the surveythrough those organizations. Since there is noinformation regarding whether these organizationsshared information about the survey through theirchannels, it is difficult to assess the full scope ofthe outreach efforts. a. Advisory Committee A significant element of outreach involvedconvening a USTS Advisory Committee (UAC).The UAC was created to increase communityengagement in the survey project and raiseawareness by connecting with transgender peoplein communities across the country through avariety of networks. The UAC was comprisedof eleven individuals with advocacy, research,and lived experience from a wide range ofgeographical locations.23 Members were invitedto join the committee as advisors on surveyoutreach to facilitate the collection of survey datathat would best reflect the range of narratives andexperiences of transgender people in the U.S.Each member brought unique skills and expertiseto contribute to the committee’s objectives. UACmembers participated in five monthly calls withmembers of the USTS outreach team from Mayto September 2015. UAC monthly calls focusedon providing project updates and identifyingpathways by which outreach could be conductedto increase the survey’s reach and promoteparticipation from a diverse sample. Memberssuggested organizations, individuals, and otheravenues through which to conduct outreach,shared ideas and strategies for improving outreachto specific populations of transgender people, andspread the word about the survey through theirprofessional and personal networks. b. Survey-Taking Events In an effort to increase accessibility of the survey,the outreach team worked with organizationsacross the country to organize events or venueswhere people could complete the survey. Survey-Taking Events,24 or “survey events,” were spaces inwhich organizations offered resources to provideaccess to the survey, such as computers orother web-enabled devices. These organizationsprovided a location in which to take the survey atone particular time or over an extended periodof time, such as during specified hours overthe course of several days.25 The events werecreated with the intention of providing access toindividuals with limited or no computer or internetaccess, those who may have needed assistancewhen completing the survey, or those who neededa safe place to take the survey. Additionally, thepopulation that had previously been identified asbeing more likely to take a paper survey than anonline survey were considered,26 and the eventswere developed to target those individuals. Given the potential variety of these surveyevents—including the types of available resourcesand times at which they were conducted—guidelines were needed to maintain consistencyacross the events and preserve the integrity of thedata-collection process. A protocol was developedoutlining the rules for hosting a survey eventto advise hosts on best practices for ensuring ### Page 32 a successful data-collection process, includingguidelines to prevent the introduction of bias intosurvey responses. The protocols described thesteps for becoming a survey-event host and tipsfor how to conduct outreach about the event. Theprotocol also specified that hosts should informNCTE of their event prior to hosting and report onhow many people attended the event and howmany people completed and submitted the survey.This was helpful information for evaluating therelative success and benefits of these events. Allconfirmed supporting organizations were invitedto become survey event hosts, and those whoaccepted the invitation were sent the protocol.Seventy-one (71) organizations accepted theinvitation and confirmed the date(s) and time(s) oftheir events.27 Survey events were promoted on the surveywebsite and given a specific designation on thesupporting organization map (described furtherin the “Survey Website” section), includinginformation about where and when people couldattend. Hosts were encouraged to promote theirevent through multiple channels and consideroutreach methods beyond online avenues,such as direct mail or flyers, to better reachtransgender people with limited or no internetaccess. Additionally, hosts were provided withflyer templates so they could promote the eventsin their facilities or through communicationswith their members or constituents. Of theorganizations who confirmed their survey events,46 reported information about attendance atthe event. The hosts reported that 341 peopleattended their events, including transgender andnon-transgender friends, family, and volunteers.Approximately 199 respondents completedthe survey at these events.28 However, surveyresponses indicate that additional unreportedsurvey events or similar gatherings may have beenheld where participants had an opportunity tocomplete the survey.29 Event-related informationsubmitted by organizations following the fieldingperiod was not comprehensive enough to make athorough determination as to whether the eventshad achieved their previously stated objectives.30 c. Incentives As an incentive for completing the survey,participants were offered a cash-prize drawing.Incentives, such as cash prizes are widelyaccepted as a means by which to encourage andincrease participation in survey research.31 Studieshave shown that such incentives may have apositive effect on survey response rate, which isthe proportion of individuals in the population ofinterest that participates in the survey.32 Researchhas also found that lottery-style cash drawingsmay be beneficial in online surveys,33 since theyoffer a practical method for providing incentivesin surveys with a large number of respondents byeliminating the potential high cost of both the cashincentive and prize distribution.34 USTS respondents were offered the opportunityto enter into a drawing for one of three cashprizes upon completion of the survey, includingone $500 cash prize and two $250 cash prizes.35After completing and submitting their anonymoussurvey responses, USTS respondents were re-directed away from the survey hosting site36 to aweb page on the NCTE-hosted USTS website. Inaddition to being thanked for their participationon this page, respondents received a messageconfirming that their survey had been submittedand any further information they gave would notbe connected to their survey responses. Onlyindividuals who completed and submitted thesurvey were eligible for one of the cash prizes.To enter into the prize drawing, respondentswere required to check a box giving their consentto be entered.37 Respondents were also askedto provide their contact information in order tobe notified if selected in the drawing. The finaldrawing contained 17,683 entrants. Each entrantwas assigned a number, and six numbers wererandomly chosen by a non-NCTE party: three ### Page 33 numbers for the prize winners and three foralternates if necessary. The three prize winnerswere contacted and awarded their prizes uponacceptance. VI. Communications Communications for the survey required amultifaceted approach and a coordinated effortwith the outreach strategy to most effectivelyreach a wide range of transgender people andensure a robust sample size. The goals of surveycommunications were to: (1) inform people thatNCTE would be conducting a survey to further theunderstanding of the experiences of transgenderpeople in the U.S initially gleaned through theNTDS, (2) communicate when the survey wouldbe available to complete and how it could beaccessed, and (3) find creative ways of reachingdiverse populations of potential respondents. Thisinvolved raising awareness of the survey throughseveral communication methods, including email,social media, and print media, as well as throughadditional unique campaigns. Many surveypromotional materials were produced in Englishand Spanish to increase the accessibility of thesurvey.38 a. Survey Website A website was created and designed specificallyfor the promotion and distribution of the survey.39This website served as a platform for providinginformation about the survey starting severalmonths prior to its release in the field, such as adescription of the survey, information about theteam working on the survey, frequently askedquestions, and sample language and graphics forindividuals and organizations to use for email andsocial media communications, including sampleFacebook and Twitter postings. The websitealso featured an interactive map, which includedinformation about organizations that had pledgedto support the survey. Additionally, the mapdistinctly indicated information about organizationsthat were hosting survey-taking events, includingthe date, time, and location of such events. Thewebsite later served as the only platform throughwhich the survey could be accessed and providedEnglish and Spanish links to enter the survey, sincethere was no direct link available to the off-sitehosting platform. b. Survey Pledge The survey pledge campaign was developed toraise awareness about the survey and generateinvestment in the project. The campaign engagedpotential participants and allies by inviting themto pledge to take the survey and/or spread theword about the survey. The survey pledge wasa critical method of both informing people thatthe survey would be launching and sustainingengagement with potential respondents in themonths leading up to the fielding period. Pledgesreceived reminders about the survey launch dateand availability through email communications.Beginning in January 2015, pledge palm cardswere distributed at a variety of events acrossthe country, including conferences and speakingengagements. The cards contained informationabout the upcoming survey and asked people tosign up to help by committing to: (1) spread theword about the survey; and/or (2) take the survey.Transgender and non-transgender individuals wereasked to complete the pledge information, eitherthrough a palm card or directly online through thesurvey website. Individuals who completed pledgeinformation received email communicationsthroughout the pre-data-collection phase. Pledgeinformation was collected continuously for severalmonths, and by the time of the survey launch, over14,000 people had pledged to take the survey.Additionally, more than 500 people pledged topromote the survey among their transgenderfriends and family.40 The pledge proved to be ### Page 34 an effective method of assessing how manypeople had learned about the survey and wereinterested in completing it, where potential surveyrespondents were distributed geographically,and how more potential respondents could beeffectively engaged. c. Photo Booth Campaign In January 2015, a photo booth campaign waslaunched as another method for engagingpeople and raising awareness about the survey.Individuals and groups were asked to takephotos holding one of two signs with messagesexpressing support for the survey.41 USTS photobooths were conducted at several conferencesand events across the country. More than 300photos were collected and shared directly throughNCTE’s Facebook page. Photos were also sent tomost participants so they could conduct their ownpromotion using their photos. d. Social Media With the increased use of social media in theyears since the previous survey (the NTDS), itwas important to engage via these outlets tofurther the reach of the survey. Facebook andTwitter42 became the primary social media outletsused throughout the survey project, and theiruse significantly amplified awareness, increasingthe number of people who were exposed to thesurvey. A series of postings provided the abilityto rapidly and succinctly communicate withindividuals and groups who had an interest incontributing to the survey’s success by completingthe survey and spreading the word about it.Although social media reach fluctuated duringthe months leading up to the survey launch, over96,000 Facebook users were estimated to havereceived NCTE’s post announcing that the surveywas live and available for completion on August 19,2015. e. USTS Awareness Week Prior to launching the survey in the field,communication was maintained with thousands ofindividuals and organizations who fell into threecategories: (1) people who had signed up to takeor spread the word about the survey (“pledge list”),(2) organizations that had committed to supportthe survey through outreach efforts (“supportingorganization list”), and (3) people who had signedup to be in communication with NCTE about theorganization’s work and projects (“NCTE list”). Communication with the individuals and groups onthese lists through targeted messages occurredat various intervals; however, one of the mostimportant methods for promoting the survey wasthrough USTS Awareness Week. This campaignwas designed to share a significant amount ofinformation about the survey over a concentratedperiod of time in close proximity to the launch ofthe survey. Awareness Week occurred during theweek of July 27, 2015 and highlighted differentaspects of the survey focusing on a differentmedium each day, including social media, email,and blogs. Awareness Week was introduced tothe communication lists on July 15, and recipientswere invited to access and download a planningkit for the campaign, which was available onthe survey website. The planning kit includedlanguage and graphics for email and social mediacommunications. Communications were senton each of the days devoted to social media,43email,44 and blogs45 with appeals for organizationsto share the information with their membershipand individuals to share the information throughtheir personal networks. Awareness Week provedto be one of the most effective methods forincreasing the number of individuals who pledgedto take the survey and likely increased the numberof eventual respondents.46 ### Page 35 f. Additional CommunicationsMethods The overall approach to survey communicationswas diverse and captured many media forms. Inaddition to the previously stated campaigns andprojects, communications involved working witha variety of individuals such as bloggers, artists,advocates, and others to create print blogs andvideos promoting the survey. Op-eds were anothermedium that contributed to survey promotion,and media consultants and traditional mediasources aided in expanding the survey’s reacheven further. Approximately 50 articles, blogs,and op-eds focused on the survey were producedand distributed by organizations, including NCTE,and individuals prior to the launch of the surveyand during the data-collection period. The widevariety of approaches contributed to the numberof individuals who were reached through allcommunications and likely impacted the finalnumber of respondents in the sample. VII. Language andTranslation Throughout the survey questionnaire, the use ofaccessible language was balanced with preservingthe meaning of each question to the greatestextent possible. This was of particular importancein maintaining comparability with questions fromexisting surveys that allowed conclusions to bedrawn about how the experiences of the USTSsample compares to the U.S. population. Inorder to make assessments about USTS surveyrespondents in relation to the U.S. population, itwas important that USTS respondents had similarinterpretations of questions taken from othersurveys as non-transgender survey takers hadto those questions in federal surveys. In manyplaces, language was revised to use terminologythat would most appropriately speak to individualsin the many communities for which the surveywas intended. However, several areas requireddifficult choices about keeping language that mayhave caused discomfort for some respondents.Throughout the questionnaire, language wasavoided that could be interpreted as stigmatizingor characterized as a value judgment whereverpossible while maintaining objectivity in craftingsound research questions. For example, at timessurvey questions referred to work or activitiesthat were “currently considered illegal.” Suchdeliberate language was used in an attempt toseparate the issue of criminalization from theactivity in question while maintaining comparabilitywith other surveys. This was a difficult balanceto achieve throughout the survey. Eliminatingtechnical language was also necessary, unlessit was widely used and accepted in transgendercommunities, such as some medical terminology.Short descriptions or parenthetical explanationswere provided whenever technical language wasrequired for those who may not have been familiarwith the language. Additionally, hyperlinkedexplanations of specific terms were included whenthose terms could be interpreted in several waysor if similar explanations were provided in thefederal surveys from which the questions weretaken. For example, explanations were providedfor the terms “active duty” when asking aboutmilitary service and “household” when askingabout income. The research team remained conscious ofindividual and collective identities throughoutthe survey instrument drafting process, andattempted to use language that acknowledged thebreadth and significance of individual identitieswhile also making the questions accessibleto the widest range of transgender peoplepossible across the U.S. and in the territories.The questionnaire was reviewed and revisedfor consistent readability at an eighth-gradeliteracy level where possible,47 although several ### Page 36 terms used in the survey were at a considerablyhigher literacy level. This included places wherelanguage was preserved for comparability withother surveys and when language describingtransgender-specific experiences or procedureswas used. Additionally, community members andresearchers reviewed the survey and suggestedrevised language throughout the developmentprocess. This collaborative process was beneficialin providing collective insight on the best languageto use in each particular instance based on livedexperience and research expertise. The researchteam acknowledges, however, a continuing needto work towards identifying suitably inclusiveterminology within an evolving language andcommunity for future iterations of the survey. The questionnaire was translated into Spanish bya translation service, and several native-Spanish-speaking community members and NCTE staff andinterns reviewed and revised the language to useterminology that was most prevalent in Spanish-speaking transgender communities in the U.S. Inmany instances, it was difficult to find languagethat accurately captured the meaning of a questionor specific terms, but in each case language wasselected to convey interpretations as close tothe English-language question interpretations aspossible. VIII. InstitutionalReview The study was vetted through an InstitutionalReview Board (IRB) process, which is meant toensure confidentiality and protect the rights andwelfare of individuals participating in a researchstudy. The USTS underwent a full board reviewby the University of California Los Angeles(UCLA) IRB. As a requirement of approval, thequestionnaire began with a study informationsheet describing aspects of the study and rightsof individuals as participants in the study.48To be included in the study, participants wererequired to indicate their consent at the end ofthe information sheet. This process establishedthat participants were fully informed about therisks and benefits of participating in the study andthat their participation was voluntary. IRB reviewalso required the submission of all recruitmentmaterials leading up to the launch of the surveyand throughout the time the survey was in thefield.49 This required the production of a largevolume of messaging for the many differenttypes of media through which people wereinvited to participate in the survey in both Englishand Spanish. It also required anticipating howmessaging might need to change while the surveywas in the field and submitting this language forpre-approval for later use as needed. IX. Survey Hosting The survey was hosted online by Rankin &Associates Consulting, under the supervision ofUSTS research team member, Dr. Susan Rankin.Access to the survey was provided exclusivelythrough the USTS website. All programming ofthe questionnaire and online administration of thesurvey was handled through Rankin & AssociatesConsulting, which managed the process ofcollecting the survey data throughout the 34-dayfielding period. The survey was anonymous, and maintainingprivacy and confidentiality in the collection andmaintenance of survey data was an importantcomponent of preserving participants’ anonymity.Furthermore, as a condition of IRB approval,the research team was required to ensure thatconfidentiality protections were in place forthe study and demonstrate sufficiency of datasecurity protocols. Accordingly, data from online ### Page 37 participants was submitted through seven securefirewalled servers with forced 256-bit SSL (SecureSockets Layer) security and Security-EnhancedLinux (SELinux) security extensions to encryptand protect the survey data. Given the volumeof traffic on the seven servers during the initiallaunch of the survey, an eighth server was added.The survey was stored in an SQL database thatcould only be accessed locally. The serversthemselves were only accessible using encryptedSSH (Secure Shell) connections originating fromthe local network. The servers were also in RAID(Redundant Array of Inexpensive Disks), whichis a data storage virtualization technology thatcombines multiple physical disk drive componentsinto a single logical unit for the purposes of dataredundancy, performance improvement, or both,to reduce the chance of any data loss due tohardware failure. The servers performed nightlysecurity audits from data acquired via the systemlogs and notified the system administrators. Despite a successful data-collection periodevidenced by the large final sample size, it isimportant to note issues that occurred in the initialdays of the survey data-collection period, giventhe potential impact on the data collection andthe final sample. Prior to the survey launch, theonline platform had been assessed and capacitywas predicted for the seven dedicated serversbased on reasonable estimated response rates.However, in the first days of the data-collectionperiod, exceptionally high levels of traffic to thesurvey far exceeded the predicted response ratesand overwhelmed the capacity of the servers,causing significant delays in accessing andcompleting the survey. The resulting server delaysoccurred within hours of the survey launch onAugust 19, 2015, producing unusually long page-loading times and may have served as a barrier tocompleting the survey.50 The survey team notifiedpotential respondents of the delays through emailand social media communication and updated thefirst page of the online survey questionnaire witha note about the issues and information about thecontinued availability of the survey.51 The hostingteam added a server to process the high level oftraffic and returned the survey to normal loadingspeeds within a couple days of the initial reports.Although high numbers of survey submissionswere received throughout these days, it is likelythat the server delays affected the completionand submission of some surveys or may havediscouraged individuals from attempting to takethe survey. X. Cleaning the Data The dataset was cleaned following collection toremove survey responses that did not belong inthe final sample.52 Data cleaning is the process ofdetecting and removing some survey responses(e.g., duplicate responses, incomplete responses,illogical responses) in order to improve the qualityof the sample. This dataset was “cleaned” usingcommonly accepted procedures.53 The first stepwas to remove survey responses from individualswho did not consent to take the survey and thosewho did not meet the eligibility criteria, such asnot being at least 18 years of age and not residingin the U.S. These survey respondents had beenautomatically sent to a disqualification page,54but their responses were included in the initialdataset. Incomplete responses were then removedfrom the sample based on a requirement thatrespondents minimally complete specific questionsin Section 2 of the questionnaire to be includedin the final dataset.55 Duplicate survey responseswere removed next, as were those with illogicalresponses, such as those with contradictoryresponses to related questions. Missing-dataanalyses were then conducted to determine thepercentage of missing data.56 The next step of the process was recoding data,including re-categorization of answer choices ### Page 38 in several questions for improved analysis orto match existing categories for comparison toother surveys. Answers were evaluated for thosequestions that allowed a write-in response whenthe selected option was “not listed above.” Insome cases, these answers were recoded intoexisting answer choices where appropriate, andin other cases, new answer categories werecreated for write-in responses that were frequentlyrepeated. The recoding process included twocoding teams. The first coding team conductedinitial data recoding, and the second teamreviewed the recoding and flagged areas ofdisagreement. A simple percent agreement scorewas calculated to determine inter-rater reliability.57 Several survey weights were developed forpresentation of results in the report.58 A raceand ethnicity weight was developed basedon the Census Bureau’s 2014 AmericanCommunity Survey (ACS).59 Additionally, given thedisproportionally large number of respondentswho reported an age of 18 years old, a weightwas created to balance the representation in thesample of those respondents in relation to therest of the sample.60 The race and ethnicity weightand the 18-year-old weight were both includedin a “standard weight” applied to the dataset.All results presented in this report are weightedbased on the standard weight unless otherwisenoted. Additional survey weights were createdfor the purposes of comparability with federalgovernment and national data sources, includingweights for age and educational attainment.61These weights were applied in addition to thestandard weight when comparing the USTSsample to the U.S. population for items that aresensitive to age and educational attainment, suchas individual and household income, and arenoted accordingly as the “supplemental weight.” XI. Data Analysisand Presentation ofFindings The data was first analyzed to tabulate individualresponses to each of the questions in the survey.The respondents included in each tabulationdiffered throughout the survey due to certainquestions only being asked of a particular set ofrespondents and/or due to some respondentschoosing not to answer a question. Analyseswere performed to explore how survey responsesdiffered based on demographic characteristics—such as race, gender, and income—and non-demographic factors—such as experience withsex work, HIV status, and experiences of familysupport or rejection. All findings in the report are presented asweighted percentages of the entire sampleor of the subgroups being examined. Forexample, educational attainment is presentedas a percentage of the whole sample, whilemuch of the data related to HIV care representpercentages of those respondents who areliving with HIV. In limited instances, unweightedfrequencies are included where the additionalinformation could be informative and to providecontext for the weighted percentages reported. Percentages are rounded to whole numbers,except in cases where a more exact comparisonto national data sources was desired or wheremore precision was needed due to the reportedpercentages being small. When rounding to wholenumbers, the following convention was generallyfollowed: findings containing decimals of 0.50and above were rounded up, and findings with0.49 and below were rounded down (e.g., 1.50%was rounded to 2% and 1.49% was rounded to1%). Additionally, a finding of 0.49% and belowwas generally labeled “less than 1%” or “<1%.”Throughout the report, results are presented in ### Page 39 various figures and tables. The percentages inthese figures and tables do not always add upto 100% due to respondents being able to selectmore than one answer to a question (“mark all thatapply”) or due to rounding. Throughout the report, U.S. population findingsare provided for comparison to USTS findingsor to provide context for USTS findings, whereavailable and/or applicable. Where USTS datais compared to data from existing research, thedata source is specified. When providing U.S.population comparisons, the research team madeefforts to limit the comparisons to adults (18 yearsand older) to most appropriately match the USTSsample. Whenever that was not possible, notesas to age ranges or other limitations are provided.Additionally, calculations made by the researchteam when necessary to present U.S. populationfindings are noted. Data in this report is generallypresented without information regarding statisticaltesting.62 1 The survey included questions related to the followingtopics (in alphabetical order): accessing restrooms;airport security; civic participation; counseling; education;employment; faith; family and peer support; health andhealth insurance; HIV; housing and homelessness;identity documents; immigration; income; intimate partnerviolence; military service; police and incarceration; policypriorities; public accommodations; sex work; sexualassault; substance use; suicidal thoughts and behaviors;unequal treatment, harassment, and physical attack; andvoting. 2 Detailed information about survey methodology isavailable in Appendix C (Detailed Methodology). 3 www.USTransSurvey.org 4 The survey was in the field between August 19 andSeptember 21, 2015. 5 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2011). Injustice at Every Turn: A Reportof the National Transgender Discrimination Survey. (p. 11).DC: National Center for Transgender Equality and NationalGay and Lesbian Task Force. 6 Grant et al., p. 182. 7 Grant et al. 8 See Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014).Suicide Attempts Among Transgender and Gender Non-Conforming Adults. New York, NY & Los Angeles, CA:American Foundation for Suicide Prevention & WilliamsInstitute. 9 See e.g., The GenIUSS Group. (2014). In J. L. Herman(Ed.), Best Practices for Asking Questions to IdentifyTransgender and Other Gender Minority Respondentson Population-Based Surveys (p. vii). Los Angeles, CA:Williams Institute. (“Adolescents may have particulardifficulties with complex vocabulary and sentences.Therefore, questions designed for adolescents shouldtake extra care to use plain language and simplesentences. Terms used in measures of sex and gendershould be defined since adolescents, and cisgender(non-transgender) adolescents in particular, conflate theterms sex and gender, and have varying understanding ofthe term transgender, masculine, and feminine.”). Giventhe need to collect data about the unique experiences oftransgender youth, it is important to design and conductfuture studies focusing on the issue areas and needs mostapplicable to transgender youth. 10 Information about the source of survey questions usedfor comparison to the U.S. population can be found inAppendix C (Detailed Methodology). 11 Forty-four (44%) of pilot participants identified as a womanor trans woman (MTF), 41% as a man or trans man (FTM),and 16% as non-binary or genderqueer. 12 These pilot participants identified as American Indian,Asian, multiracial, Black, Latino/a, and a racial/ethnicidentity not listed above, in addition to 66% who identifiedas white. 13 The following statement was provided to explain whythe word “trans” was used throughout the survey: Weknow that not everyone is comfortable with the word“transgender,” but for this survey, we must use one wordto refer to all trans and non-binary identities. Because ofthis we will use the word “trans” in this survey to refer toall trans and non-binary identities.” ENDNOTES | CHAPTER 2: METHODOLOGY ### Page 40 14 A notable exception to the 30–60 minute estimate forcompleting the survey occurred during the first days of thesurvey’s availability, when a high volume of survey takersoverwhelmed multiple servers, causing lengthy delayswhen completing the survey. This is discussed further inthe “Survey Hosting” section. 15 Grant et al., p. 13. 16 Post-NTDS analysis of respondents who had completedthat survey online or in paper format found that surveyscompleted online were less likely to have missing data,providing further support for the decision to only offer thesurvey online. See Reisner, et al. (2014). Comparing in-person and online survey respondents in the U.S. NationalTransgender Discrimination Survey: Implications fortransgender health research. LGBT Health, 1(2), 98–106. 17 See Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014).Internet, Phone, Mail, and Mixed-Mode Surveys: TheTailored Design Method (4th ed.). Hoboken, NJ: JohnWiley & Sons. 18 Reisner et al., p. 98. See note 16. This analysis also foundthat “[a] higher proportion of in-person respondents wereyoung, male-to-female, people of color, publicly insured,with lower incomes and lower educational attainment thanonline respondents (all p<0.05). In-person respondentsalso were more likely than online respondents to becurrent daily smokers, to endorse substance use to copewith mistreatment, and to self-report as HIV-positive(all p<0.05).” 19 Although outreach efforts were instrumental in obtainingthe largest sample of transgender respondents evercollected, a longer outreach period may have resulted inreaching more individuals in communities that are oftenunderrepresented in online surveys. 20 A total of 827 organizations received at least one outreachemail, and organizations received additional outreachemails and/or phone calls if no response was received.Out of those organizations, 392 confirmed their support,and 435 did not respond to any communications. 21 Correspondence included almost one dozen emails withasks to spread the word about the survey and with variousinformation about the availability of the survey. 22 The research team attempted to ascertain the levelof outreach engagement of supporting organizations;however, the limited amount of information received aboutthe outreach did not allow a calculation of a responserate. Of the 392 organizations that pledged their support,58 (15%) reported information on their outreach activitiesand estimated reaching over 20,000 transgender peoplethrough their channels. In the future, researchers areencouraged to collect consistent outreach activity datafrom supporting organizations that will help to betterassess the effectiveness of outreach and response rateestimates. 23 Information about UAC members can be found in theAcknowledgements section of the report. 24 These events were promoted as “Survey-Taking Events”on recruitment materials and described accordingly(see note 25). However, it is possible that the name didnot appropriately capture the nature of these vastlydiffering events. A lack of clarity may have decreased thenumber of people who attempted to access the surveythrough organizations who offered space or computers tocomplete the survey online. 25 Survey-Taking Events were described as “a functionin which an organization or group opens its doors andprovides access to its facilities (such as community centersand office buildings) to allow trans survey participantsuse of its resources (including computers, tablets, andinternet access) to complete the USTS. This will occurduring specified periods of time or throughout the timethe survey is available on a drop-in basis. For example,a community center might participate by setting asideone Saturday from 9am–6pm where some or all of itscomputers are available for survey takers to use, or itmight host people on Monday–Friday from 5pm–9pmeach evening for a week, or longer.” 26 A total of 435 NTDS respondents completed the surveyin paper format (7% of the sample) and were found todiffer from online survey takers in sociodemographiccharacteristics, health outcomes, and life experiences.Reisner et al., p. 98, 103. See note 16. 27 Although only 71 organizations confirmed their events,based on information reported at various intervalsthroughout the data-collection period, it appeared thatmore organizations hosted survey events or similargatherings to complete the survey without reportingthem to the survey outreach team. Additionally, it is alsopossible that individuals and organizations held informalparties where groups of friends could gather to completethe survey at the same time. Data regarding this sort ofactivity was not collected or received. 28 This completion rate is a conservative estimate based onreports that some individuals started the survey at theevent and then left to complete it on their own at a latertime. 29 Four hundred and seventeen (417) respondents answered“yes” in response to the following survey question: “Areyou taking this survey at a survey event or meeting, suchas one hosted by an LGBTQ or Trans organization ormeeting?” 30 In future iterations of the USTS and other research studies,the research team suggests a more robust approachtowards organizing, conducting, and monitoring surveyevents to increase the reach and availability of suchevents in providing access to the survey. Researchersare also encouraged to conduct follow-up analyses to ### Page 41 determine the demographic characteristics of individualswho completed the survey at events and whetherthese events were successful in capturing a similardemographic to those who had completed paper surveysin the previous survey. See Reisner, et al. (discussing thedemographics of online and paper respondents in theNTDS). 31 See e.g., Göritz, A. S. (2006). Incentives in web studies:Methodological issues and a review. International Journalof Internet Science, 1(1), 58–70. (finding that “materialincentives increase the odds of a person responding by19% over the odds without incentives”). 32 Pedersen, M. J. & Nielsen, C. V. (2016). Improving surveyresponse rates in online panels: Effects of low-costincentives and cost-free text appeal interventions. SocialScience Computer Review, 34(2), 229–243. 33 Pedersen et al., pp. 237–238. 34 Singer, E. & Ye, C. (2013). The use and effects of incentivesin surveys. The ANNALS of the American Academy ofPolitical and Social Science, 645(1), 123–124. 35 Participants were informed of the cash prize incentivesin several ways. The study information sheet placedat the beginning of the survey prior to obtaining eachrespondent’s consent to enter the survey containedthe following information in response to the question ofwhether respondents would be paid for their participation:“You will receive no payment for your participation. Youwill have the option to voluntarily enter a drawing to winone of three cash prizes: one prize of $500 and two prizesof $250.” The frequently asked questions section of thesurvey website also offered the following statement:“When you complete the survey, you will have the optionto enter a drawing to win one of three cash prizes: oneprize of $500 and two prizes of $250. Because thousandsof trans people across the country will complete thesurvey, we cannot offer payment to each participant.”Additionally, some recruitment materials mentioned thecash-prize drawing, including email blasts. 36 The survey was hosted by Rankin & AssociatesConsulting. Further details are described in the “SurveyHosting” section. 37 The check box stated: “Enter me in the drawing for oneof three cash prizes: one prize of $500 and two prizes of$250!” 38 Due to limited funding, it was not possible to translateall survey materials, such as email communications.Translation of all promotional materials may positivelyimpact the response rate amongst respondents withlimited English proficiency in future iterations of the study. 39 www.USTransSurvey.org 40 Final pledge numbers were 14,005 and 561 for surveytakers and promoters, respectively. 41 Photo booth participants could choose from one of twosigns indicating that the survey was coming in the summerof 2015 and stating the following: (1) “My Voice Counts: I’mTaking the #USTransSurvey” or (2) “Every Voice Counts:Spread the Word About the #USTransSurvey.” 42 The Twitter hashtag used to promote the survey was#USTransSurvey. 43 For social media day, recipients received one of thefollowing requests, based on whether they wereorganizations or individuals: (1) “Use the hashtag#USTransSurvey on social media asking your socialnetworks to join us” or (2) “Please join Social Mediaday. We have sample copy and a variety of photos andgraphics.” 44 For email day, recipients received one of the followingrequests, based on whether they were organizations orindividuals: (1) “Email a friend explaining why this is soimportant to you” or (2) “Download the sample email andsend it to your membership list today.” 45 For blog day, recipients were invited to share a blogwritten by Outreach Coordinator, Ignacio Rivera, crosspost the blog on an organization’s blog site, or draft a blogabout the importance of the survey. 46 The number of individuals who pledged to take the surveyon the pledge list increased from approximately 7,700when the initial Awareness Week email was sent on July15 to over 14,000 at the time the survey launched in thefield. The 82% increase in the numbers of survey pledgesis likely due to the increased exposure generated byAwareness Week communications. 47 The initial literacy level review and revision was conductedby a certified copy editor proficient in reading levels, andthe questionnaire was determined to be at an eighthgrade reading level. 48 Due to IRB requirements, the language in the studyinformation sheet was generally at a higher literacy levelthan the rest of the questionnaire. 49 This included all materials aimed at “recruiting” or gettingpeople to participate in a research study, such as websitepages, flyers, emails, and social media messages. 50 The research team received reports that it took someindividuals up to several hours to complete the surveyon the first day, and others reported that they were notable to complete or submit their survey at all due to thetechnical issues. ### Page 42 51 The following note was added to the first page of thesurvey (in English and Spanish) to notify respondentsof the delay: “Our servers have been overwhelmedby the number of enthusiastic participants and someare experiencing unusual delays. We apologize for theinconvenience as we work to address this issue. You cancomplete the survey now but may experience delays.However, the survey will be available to complete throughat least September 21st. If you experience delays, weencourage you to return to this site in the coming days.If the survey is slow to respond, you can leave the pageopen and return later. If the survey times out, you can hitthe ‘back’ button. However, if you close your browser, youmay have to restart the survey.” 52 A detailed description of the cleaning process is includedin Appendix C (Detailed Methodology). 53 Rahm, E. & Do, H. H. (2000). Data cleaning: Problems andcurrent approaches. IEEE Data Engineering Bulletin, 23(4),3–13. 54 Ineligible respondents were sent to one of twodisqualification pages notifying them of their ineligibilityand providing either an opportunity to visit the surveywebsite for more information or giving information abouttheir gender identity or expression and experiencesrelated to gender identity or expression. 55 See Appendix C (Detailed Methodology) for moreinformation on the Section 2 questions that were requiredto remain in the sample. 56 Missing-data analyses determined that there was lessthan 5% missing data on all but two questions. Therefore,the research team did not impute the missing data. SeeAppendix C (Detailed Methodology) for more information. 57 A modified version of an inter-rater reliability metric wasused by the two teams that conducted the review. Eachteam included a principal researcher and an outsideresearcher. One researcher on each team conductedthe initial coding and the other researcher reviewedthe coding for approval or revisions. See Appendix C(Detailed Methodology) for more information. 58 “Weighting” is a common statistical technique used toadjust data with disproportionate sample sizes to be morerepresentative of the population from which the samplewas drawn. For example, the proportion of respondentsaged 18–24 and 25–44 in a survey sample taken in theU.S. may differ from the proportion of those age groups inthe total U.S. population. Therefore, weights are appliedto survey data in order to make comparisons betweenthe collected survey data and the total population. SeeAppendix C (Detailed Methodology) for more detailedinformation about weights applied to the survey data. 59 Studies using representative samples of transgenderadults have found that transgender adults differ from thegeneral population in regard to race and ethnicity, withtransgender people more likely to be people of color. Seee.g., Flores, A. R., Brown, T. N. T., & Herman, J. L. (2016).Race and Ethnicity of Adults who Identify as Transgenderin the United States. Los Angeles, CA: Williams Institute;Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J.(2012). Transgender health in Massachusetts: Resultsfrom a household probability sample of adults. AmericanJournal of Public Health, 102(1), 118–122. However,the USTS sample has a higher percentage of whiterespondents than the U.S. general population. To helpcorrect for this sampling bias, the research team appliedU.S. population weights for race and ethnicity. While thismay still over-represent white respondents, this weightingprocedure brings the sample closer to what is estimatedto be the true population distribution for race and ethnicityfor transgender people. 60 The weight for 18-year-old respondents was createdwith propensity scores developed using a regressiondiscontinuity model. For more information on this processand other weighting procedures, see Appendix C(Detailed Methodology). 61 The age, race, and educational attainment weights werecreated based on the Census Bureau’s 2014 AmericanCommunity Survey (ACS). 62 Due to the large sample size, bivariate statistical testslargely result in statistically significant differences amongthe groups being compared. Small group differences oftenwill be found to be statistically significant, even whenthe differences are small and, therefore, not particularlymeaningful. In writing the findings to this report, theresearch team considered other measures when pointingout meaningful differences among groups, such as aparticular cell’s contribution to an overall chi-square teststatistic and effect sizes. These tests are on file with theresearch team. Future researchers are encouraged to useadditional bivariate and multivariate modeling to providemore nuanced understanding of group differences. ### Page 43 39 CHAPTER 3 Guide to Reportand Terminology Throughout the report, the authors use a variety of terminology to refer to respondents in thesample or experiences that respondents reported. The authors also applied several conventionsin the reporting of results. While explanations are often included in chapters to provide contextand clarity, several terms and conventions that are used widely throughout the report are outlined in thischapter to make the report more accessible to a broad range of audiences. ### Page 44 40 I. Use of the Term“Transgender” in thisReport The term “transgender” is often used to describepeople whose gender identity or expressiondiffers from what is associated with the genderthey were thought to be at birth. Although thisterm has often been described as an “umbrellaterm” that encompasses the spectrum of identitiesand captures the diversity of transgender people,the authors recognize that one term cannot reflecteach individual’s unique identity and some peopleprefer to use other terms to describe their genderidentity. However, in order to make the report’sfindings clear and accessible, it was important toselect a single term for consistent use throughoutthis report that could best represent the range ofidentities expressed in the USTS survey sample. In promotional materials, the survey was describedas being inclusive of all “transgender, trans,genderqueer, and non-binary” people, so thatthose who might have assumed that “transgender”did not include them would know their voicewas welcomed. The survey also acknowledgedthe limitation of current language and used“trans”—a shorthand term that is widely acceptedamongst transgender people—consistentlythroughout the questions. While respondents inthis study identified with a wide range of terms—including more than 500 unique terms that werereported in response to survey questions—88%of respondents thought of themselves astransgender, and 86% expressed that they were“very comfortable,” “somewhat comfortable,”or “neutral” when asked how comfortable theywere with the word “transgender” being usedto describe them. This included 82% percent ofnon-binary respondents. This provides evidenceof the term’s continued broad usage and generalacceptance. Based on this information, theterm transgender is used for the purposes ofthis report to represent the diverse identities ofthe individuals who made their voices heard bycompleting the survey. II. Other Transgender-Specific Terminology Non-binary: This term is used by some to describe peoplewhose gender is not exclusively male or female,including those who identify as having no gender,a gender other than male or female, or morethan one gender. In this report, “non-binaryrespondents” refers to respondents who said thatthe term “non-binary/genderqueer” best describestheir current gender identity in response to Q. 2.3. Crossdresser: While definitions of “crossdresser” vary, manyuse this term to describe a person who dressesin a way that is typically associated with a genderdifferent from the one they were thought to be atbirth, but who may not identify with that gender orintend to live full time as that gender. In this report,the term “crossdressers” refers to respondentswho said that the term “cross-dresser” bestdescribed their current gender identity in responseto Q. 2.3. Gender transition: This is a process in which a person begins tolive according to their gender identity, ratherthan the gender they were thought to be at birth.Not all transgender people have transitioned orintend to do so, but many do. Gender transitionlooks different for every person. Possible stepsin a gender transition may or may not includechanging one’s clothing, appearance, name ### Page 45 and identity documents (for example, a driver’slicense), or undergoing medical procedures suchas hormone therapy to change one’s physicalcharacteristics. This report refers to gendertransition in several places when discussing stepsthat may be included in one’s gender transition,such as updating the name and gender on identitydocuments. Additionally, the report includes avariety of terms to refer to therapy/counseling,hormone therapy, surgical treatments, and otherhealth services transgender people may undergoas part of their transition, including “health carerelated to gender transition” or “transition-relatedcare.” In this report, the term “respondents whohave transitioned” refers to respondents whoreported that they are living full time in responseto Q. 1.12 (see below). Living full time: Respondents in the sample who were describedin the report as “living full time” are those whoreported that they lived full time in a genderdifferent than the gender they were thought to beat birth in response to Q. 1.12. For many people,living full time may include changing one’s name,clothing, and/or appearance, or taking otheractions related to their gender transition. Gender identity or expression: Several questions throughout the report askedwhether respondents thought that an experiencehad occurred due to their “transgender status/gender identity” and/or “gender expression/appearance.” Both answer choices were includedso that respondents could select what they feltbest represented their experience. Since therewas a substantial overlap of respondents whoselected both reasons, and because these termsare commonly used interchangeably or withvery similar meanings, responses of those whoselected one or both of these reasons werecollapsed for reporting in one “gender identity/expression” category. Additionally, several phrasesare used interchangeably to describe experiencesthat respondents had as a result of biases dueto being known or perceived to be transgender.These include, for example: “because they weretransgender,” “because of their transgenderstatus,” or “because of their gender identity orexpression.” III. Additional Termsand ConventionsUsed in the Report Sexual assault: In this report, the term “sexual assault” refersto a variety of experiences of unwanted sexualcontact. These may include, but are not limited to,oral, genital, or anal contact or penetration, forcedfondling, and rape. Respondents were askedabout their experiences with unwanted sexualcontact or sexual assault in a number of differentcontexts. Definitions of these terms varied in somequestions based on the context or, in some cases,on the national survey from which a question wasadapted. Where applicable, the definition providedfor “sexual assault” or “unwanted sexual contact”in each question is included in the report. Underground economy: This terminology refers to fields of work that, ingeneral, are currently criminalized in the UnitedStates. In this report, this term includes income-based sex work (including forms of work inthe sex trade that are not criminalized, such aspornography), drug sales, and other income-basedwork that is currently criminalized. See Sex Workand Other Underground Economy Income chapter. ### Page 46 Time period of reportedexperiences: In the survey, respondents answered questionsabout experiences that occurred within a periodof time prior to having taken the survey, such as inthe past year or the past 30 days. The report refersto the time when these experiences occurredin comparison to the time when the respondentcompleted the survey. For example, respondentswho had certain experiences within the 12 monthsprior to completing the survey were reported ashaving those experiences “in the past 12 months”or “in the past year.” If a respondent had anexperience that occurred within the 30 days priorto completing the survey, the experience wasreferred to as occurring “in the past month,” “in thepast 30 days,” or “currently.” Write-in responses: At several places in the survey, respondentswere given an opportunity to write in a responseto a question. These write-in responses werereviewed for recoding to categorize the responsesinto existing answer choice categories or newcategories when feasible. When it was possible torecode write-in answers into a new category, thoseanswers were often listed in the report and labeledas a “write-in response.” In many cases, it wasnot possible to recode the answers into existingor new categories, and these write-in-responseswere included in categories such as “a reason notlisted above.” For more information about howwrite-in answers were recoded, refer to AppendixC: Detailed Methodology. U.S. population comparisons andother resources: References to experiences of the U.S. populationare included in the report for comparison andto provide context for findings where feasible.References to other research are also provided asresources in several places throughout the report.However, the list of references is not exhaustive,and should be not be treated as a comprehensivelist of sources on any particular subject presentedin this report. Stories included in the report: Throughout the report, excerpts of storiesare included in sections titled “In Our OwnVoices.” These stories, which were submitted byrespondents after they completed the survey, areprovided to support the findings of the report andoffer important anecdotal evidence and context forrespondents’ reported experiences. These storieshave been edited for length and clarity. ### Page 47 43 CHAPTER 4 Portrait of USTS Respondents With 27,715 respondents, the U.S. Transgender Survey (USTS) is the largest survey ever conductedof transgender people in the United States, providing a rich understanding of numerous aspectsof their lives and experiences. In this chapter, an overview of respondents’ diverse genderidentities and experiences with transitioning is presented. Additional characteristics of USTS respondents,such as race and ethnicity, age, educational attainment, and geographic location, are also presented. Thisinformation is discussed in the following sections: I. Gender Identity and Expression II. Experiences with Transitioning III. Being Perceived as a Transgender Person by Others IV. Outness V. Race and Ethnicity VI. Age VII. Location VIII. Primary Language Spoken in Home IX. Religious or Spiritual Identity X. Income and Employment Status XI. Educational Attainment XII. Disability XIII. Citizenship and Immigration Status XIV. Sexual Orientation XV. Relationship Status ### Page 48 44 I. Gender Identity andExpression a. Identity The word transgender is often used as an “umbrellaterm” intended to encompass the spectrum ofidentities and capture the diversity of people whosegender differs from the one they were thought to be atbirth. However, language describing identity continuesto evolve, and it is difficult to describe all of thoseidentities using just one term. Acknowledging thiswide range of identities, the survey asked respondentsif they thought of themselves as “transgender.”Eighty-eight percent (88%) of respondents reportedthat they thought of themselves as transgender, whilethe remaining 12% used other terms to describe theirgender and related experiences.1 Respondents were also asked how comfortablethey were with the word “transgender” beingused to describe them on a five-point scale from“very comfortable” to “very uncomfortable.”Eighty-six percent (86%) expressed that they werecomfortable or neutral using this term, including82% percent of non-binary respondents. Forty-threepercent (43%) were “very comfortable,” and only14% expressed discomfort with being described astransgender2 (Figure 4.1). Respondents were also offered a list of identityterms from which they could check all terms thatdescribed their gender identity, and they werealso given an opportunity write in a gender thatwas not listed (Table 4.1). In addition to the listedterms, respondents wrote in more than 500 uniquegender terms with which they identified. Table 4.1: Gender identity terms | Gender identity terms | % ofrespondents | | - | - | | Transgender | 65% | | Trans | 56% | | Trans woman (MTF, male to female) | 32% | | Trans man (FTM, female to male) | 31% | | Non-binary | 31% | | Genderqueer | 29% | | Gender non-conforming or gendervariant | 27% | | Gender fluid/fluid | 20% | | Androgynous | 18% | | Transsexual | 18% | | Agender | 14% | | Two-spirit | 7% | | Bi-gender | 6% | | Butch | 5% | | Crossdresser | 5% | | Multi-gender | 4% | | Third gender | 4% | | Intersex | 3% | | Drag performer (king/queen) | 2% | | A.G. or aggressive | 1% | | Stud | 1% | | Travesti | 1% | | Bulldagger | <1% | | Fa’afafine | <1% | | Mahu | <1% | | A gender not listed above | 12% | b. Gender Identity CategoriesUsed for Analysis Respondents were also asked to choose only oneterm that best described their current gender identityout of six possible terms (woman, man, trans woman(MTF), trans man (FTM), non-binary/genderqueer,or crossdresser) to determine the gender identitycategories used for primary analysis.3 Respondents ### Page 49 were grouped into four gender identity categoriesbased on their responses. These four categoriesare used throughout this report to discuss theexperiences of those who completed the survey:transgender women, transgender men, non-binarypeople, and crossdressers.4 Those who said thatwoman or transgender woman best described theirgender identity were included in the transgenderwomen analytical category (33%), and those who saidthat man or transgender man best described theirgender identity were included in the transgendermen analytical category (29%). Overall, 62% ofrespondents were included in the transgender menand women categories. Three percent (3%) said thatcrossdresser best described their gender identity.More than one-third (35%) of respondents indicatedthat their gender identity was best described as non-binary or genderqueer, a term often used to describepeople whose gender is not exclusively male orfemale, including those who identify with a genderother than male or female, as more than one gender,or as no gender5 (Figure 4.2). Throughout the report,these respondents are referred to as “non-binary.” c. Gender Assignment at Birth Respondents were asked about the sex theywere “assigned at birth, on [their] original birthcertificate.”6 In this report, the term “respondentswith male on their original birth certificate” is usedto describe respondents who were thought to bemale when they were born (such as transgenderwomen), and “respondents with female on theiroriginal birth certificate” is used to describerespondents who were thought to be femalewhen they were born (such as transgender men).More than half (57%) of respondents had femaleon their original birth certificate, and 43% hadmale on their original birth certificate. Of thosewho were non-binary, 80% had female on theiroriginal birth certificate, and 20% had male ontheir original birth certificate. d. Development of TransgenderIdentity and Interactions withOther Transgender People Respondents received questions related tothe development of their transgender identitythroughout their lives. A majority of respondents(60%) reported that they began to feel “different”from the sex on their original birth certificate atage 10 or younger, including 32% who began tofeel different at age 5 or younger, and 28% whobegan to feel different between the ages of 6 and10. Six percent (6%) reported that they began tofeel different at age 21 or older (Figure 4.3). ### Page 50 Respondents were also asked how old theywere when they started to think of themselves astransgender, even if they did not know that word.One in ten (10%) reported that they began thinkingof themselves as transgender at age 5 or younger.Sixteen percent (16%) began to think of themselvesas transgender between the ages of 6 and 10, and28% between the ages of 11 and 15. Eight percent(8%) reported beginning to think of themselves astransgender at age 26 or older (Figure 4.4). Respondents were also asked at what age theybegan to tell others that they were transgender.One in ten (10%) respondents reported that theybegan to tell others that they were transgenderbetween the ages of 11 and 15, and more thanone-third (37%) did so between the ages of 16 and20. Another 30% began telling people that theywere transgender between the ages of 21 and30, and 14% began telling people that they weretransgender at age 31 or older. Additionally, 5%reported that they had not told anyone else thatthey were transgender (Figure 4.5). e. Gender Identity andCurrent Age The age profile of respondents7 differed widely bygender identity categories, with nearly half (47%) oftransgender men and women being aged 25–44,compared to 35% of non-binary respondents, and29% of crossdressers. Non-binary respondents weremore likely to be younger, with nearly two-thirds (61%)being aged 18–24, in contrast to transgender men(43%), transgender women (24%), and crossdressers(8%). One in five (20%) crossdressers were aged65 or older, compared to only 5% of transgenderwomen, 1% of non-binary respondents, and less than1% of transgender men (Figure 4.6). Figure 4.6: Gender identity by current age 70% 60% 50% 40%30% 20% 10% 0% 61% 47% 46% 43% 43% 35% 29% 26% 24% 20% 8% 9% 5% 4% 1% <1% Trans women Trans men Non-binary Crossdressers 45 to 64 65 and over 18 to 24 25 to 44 ### Page 51 II. Experiences withTransitioning Transitioning is a process by which a person beginsto live in a gender that is different than the one ontheir original birth certificate. Not all transgenderpeople have transitioned or intend to do so, butmany do. Gender transition can involve manydifferent aspects, including changing one’s clothing,appearance, name, and identity documents (suchas driver’s licenses or passports) and asking peopleto use different pronouns (such as he, she, or they)than the ones associated with the gender on one’soriginal birth certificate. Transitioning may alsoinclude undergoing medical procedures, such ashormone therapy or surgeries, to change one’sphysical characteristics. Some people make manyof these changes while others do not, dependingon their needs and resources. Additionally, sometransgender people may desire and make some ofthese changes even if they do not intend to live fulltime in a gender that is different than the one ontheir original birth certificate. However, many peoplewho want to take these steps are not able to do sobecause of financial constraints, safety concerns, fearof discrimination and rejection, and other barriers. a. Full-Time Status and Transition Nearly two-thirds (62%) of respondents werecurrently living full time in a gender that was differentfrom the one on their original birth certificate.Throughout the report, the process of living fulltime in a gender that is different than that on one’soriginal birth certificate is described as “transitioning.”Twenty-two percent (22%) of respondents reportedthat they wanted to transition someday, 13% wereunsure, and 3% did not want to transition (Figure4.7). Three-quarters (75%) of transgender men andwomen had transitioned, and 43% of non-binaryrespondents had transitioned (Figure 4.8).8 Respondents were also asked what gender theywere living in on a day-to-day basis. Thirty-fivepercent (35%) of respondents reported that theycurrently lived as a man on a daily basis, 30% livedas a woman, 21% lived as neither a man nor awoman, and 15% lived part time in one gender andpart time in another. Figure 4.7: Transition status of respondents 3%They do not wantto transition 13%They are not sureif they want totransition 62%Theyhavetransi-tioned 22%Theywant totransitionsomeday % ofrespondents Figure 4.8: Transition status of respondentsGENDER IDENTITY (%) 90% 80% 70% 60% 50% 40%30% 20% 10% 0% 82% 68% 43% 43% 31% 29% 28% 23% 21% 16% 6% 5% 3% 2% <1% <1% Trans men Trans women Non-binary Crossdressers They have transitioned They want to transition someday They are not sure if they want to transition They do not want to transition ### Page 52 b. Age of Transition Those who have transitioned reported the age atwhich they began transitioning, or living full-timein a gender other than that on their original birthcertificate. Nearly half (43%) reported that theybegan transitioning between the ages of 18 and 24,and nearly one-quarter (24%) transitioned betweenages 25 and 34. Fifteen percent (15%) transitionedunder the age of 18, and 18% transitioned at age 35or older. Non-binary respondents and transgendermen were more likely to have transitioned at ayounger age, with 24% of non-binary respondentsand 17% of transgender men transitioning under theage of 18, compared to 7% of transgender women(Figure 4.9).9 c. Number of Years SinceTransitioning The number of years since a respondent hadtransitioned was determined in order to providevaluable information and context for some ofthe respondents’ experiences.10 Nearly one-third(31%) of those who had transitioned had doneso within one year of taking the survey, 38% hadtransitioned 2 to 5 years prior, 13% transitioned6 to 9 years prior, and 18% had transitioned 10 ormore years prior (Figure 4.10). d. Additional Questions forNon-Binary Respondents Non-binary respondents received questions aboutwhat they tell other people about their gender identity.They were asked about what gender they wereperceived to be by people who did not know theywere non-binary. A majority reported that peopleusually assumed they were non-transgender women(58%), including 72% of non-binary respondents withfemale on their original birth certificate, and 2% of non-binary respondents with male on their birth certificate.Seventeen percent (17%) reported that other peopleassumed they were non-transgender men, including77% of non-binary respondents with male on theiroriginal birth certificate, and 3% of non-binaryrespondents with female on their birth certificate.Nearly one in five (19%) reported that assumptionsabout their gender varied (Figure 4.11). Figure 4.9: Age began transitioning GENDER IDENTITY (%) 60% 50% 40%30% 20% 10% 0% 56% 47% 43% 34% 30% 28% 24% 24% 24% 18% 17% 16% 15% 12% 7% 4% Overall Non-binary Trans men Trans women Under 18 18 to 24 25 to 34 35 and over ### Page 53 Non-binary respondents were asked how theyresponded when people in their life assumed theirgender was something other than non-binary.Almost half (44%) reported that they usually letothers assume they were a man or woman, and53% sometimes corrected others and told themabout their non-binary identity. Only 3% alwaystold others that they were non-binary (Figure 4.12). Non-binary respondents who reported that theyusually let others assume they are a man orwoman or only sometimes tell people they arenon-binary were asked for the main reasons theydo not tell others about their non-binary identity.Respondents could select multiple reasons forchoosing not to tell people about their non-binaryidentity. A majority of non-binary respondentsreported that people do not understand so theydo not try to explain it (86%) or that it is easier notto say anything (82%). Approximately two-thirdsreported that their non-binary identity is oftendismissed as not being a real identity or just aphase (63%), and others feared they might faceviolence (43%) (Table 4.2). Table 4.2: Main reasons for not telling people they arenon-binary | Main reasons for not telling othersabout non-binary identity | % of non-binaryrespondents | | - | - | | Most people do not understand so theydo not try to explain it | 86% | | It is easier not to say anything | 82% | | Most people dismiss it as not being a realidentity or a “phase” | 63% | | They might face violence | 43% | | They are not ready to tell people theyidentify as non-binary | 35% | | They might lose their job or not be ableto get a job | 35% | | They might not get the medical carethey need | 24% | | They might be hurt financially | 23% | | They might face mistreatment at school | 18% | | Their friends might reject them | 18% | | They might become homeless | 12% | | Their church or faith community mightreject them | 6% | | A reason not listed above | 18% | e. Pronouns Eighty-four percent (84%) of respondents reportedthat the pronouns they used were different fromthose associated with the sex on their original birthcertificate. Respondents reported a wide rangeof pronouns that they asked people to use whenreferring to them and could select more than onepronoun. The most widely used pronouns were“he/his” (37%), “she/her” (37%), and “they/their”(29%). One in five (20%) reported that they didnot ask people to use specific pronouns whenreferring to them, and another 4% indicated thatthey used pronouns other than those providedin the answer choices. This included more than adozen additional pronouns provided through write-in responses (Figure 4.13). ### Page 54 III. Being Perceived asa Transgender Personby Others Some transgender people find that others canroutinely tell that they are transgender withoutbeing told, while others are generally perceivedas the gender they identify with, and still othersare perceived as the gender they were thought tobe at birth. Many interactions and experiences oftransgender people may be influenced by others’perceptions of them as being a transgenderperson. Transgender people who are visually orotherwise perceived by others as transgender orgender non-conforming may be more vulnerableto negative interactions in public or other settings. To assess whether respondents were perceivedas transgender, they were asked whether otherscould tell that they were transgender even withoutbeing told on a five-point scale from “always” to“never.” Nearly one in ten (9%) reported that otherscould tell they were transgender without beingtold “most of the time,” 32% said others could“sometimes” tell, and 24% said that others couldnever tell (Figure 4.14).11 Respondents’ experienceswith others’ perception of their transgender statusvaried by gender identity (Figure 4.15). Figure 4.15: How often people could tell they weretransgender without being told GENDER IDENTITY (%) 70% 60% 50% 40%30% 20% 10% 0% 62% 61% 57% 47% 35% 32% 32% 30% 19% 11% 9% 6% Trans women Trans men Non-binary Overall Always or most of the time Sometimes Rarely or never ### Page 55 IV. Outness Respondents were asked whether they thoughtdifferent groups of people in their lives knew thatthey were transgender to determine if they were“out”12 about their transgender identity to familymembers, friends, supervisors and colleaguesat work, classmates, and health care providers.Respondents were asked whether all, most, some,or none of the people in their lives knew they weretransgender in each of the groups of people intheir lives. Results reflect only those respondentswho had people from each group in their lives.Overall, 8% reported that they were out to allof the people in their lives, across all groups ofpeople, 48% were out to most, 43% were out tosome, and only 2% were out to none of the peoplein their lives. Nearly two-thirds (62%) were out to all or mostof the immediate family that they grew up with,and 38% were out to all or most of their extendedfamily.13 Regarding workplace environments,nearly one-half reported that none of their currentsupervisors (49%) or coworkers (42%) knew thatthey were transgender.14 In terms of health careproviders, although 40% reported that all oftheir health care providers knew that they weretransgender, almost one-third (31%) indicated thatnone of their health care providers knew that theywere transgender (Figure 4.16). Of all groups of people the survey asked about,respondents were most likely to be out to all oftheir LGBT friends (62%). Respondents were alsoasked about the methods by which they socializewith other transgender people. Sixty-four percent(64%) reported that they socialized with othertransgender people in person, and 79% socializedonline. Nearly one-third (32%) said they interactedwith transgender people in political activism, and10% reported that they did not socialize with othertransgender people. ### Page 56 V. Race and Ethnicity Respondents received a question on race andethnicity and were asked to select only one ofthe following categories that most accuratelydescribed their racial or ethnic identity: • Alaska Native (received a write-in option)15 • American Indian (received a write-in option)16 • Asian or Asian American • Biracial or multiracial (received a follow-upquestion)17 • Black or African American • Latino/a or Hispanic • Middle Eastern or North African • Native Hawaiian or Pacific Islander • White or European American • A racial or ethnic identity not listed above(received a follow-up question)18 Throughout the report, respondents who identifiedas biracial, multiracial, or more than one racialor ethnic category are included in the multiracialgroup. Additionally, due to small sample sizes andfor purposes of analysis, certain racial and ethnicgroups were combined into single categories.American Indian and Alaska Native respondentsare combined in one category and reportedas “American Indian.” Similarly, the Asian/AsianAmerican and Native Hawaiian/Pacific Islandergroups are also combined in one category andreported as “Asian.”19 The USTS sample had a percentage of whiterespondents that is notably higher than the U.S.general population, which is common amonginternet-based surveys.20 Therefore, a race andethnicity weight was developed to more closelyrepresent what is estimated to be the actualracial and ethnic distribution for the transgenderpopulation in the U.S., based on the CensusBureau’s 2014 American Community Survey(ACS).21 Racial and ethnic categories wereweighted to reflect the ACS distribution for raceand ethnicity as part of the standard survey weightthat was applied to all results presented in thereport (Figure 4.17).22 VI. Age The age of respondents in the sample rangedfrom 18 to 87. The overall age of respondentsin the sample was generally younger than thatin the U.S population. In addition to having ayounger age distribution, a disproportionallylarge number of respondents reported an ageof 18 years old. Therefore a weight was createdto balance the representation in the sample ofthose 18-year-old respondents in relation to therest of the sample. This weight was part of thestandard survey weight that was applied to allresults presented in this report (Figure 4.18).Additionally, for certain findings in this report, a“supplemental weight” was applied to adjust theUSTS sample to reflect the age distribution forthe U.S. population based on the ACS.23 ### Page 57 VII. Location The sample included respondents from all 50 states,the District of Columbia, American Samoa, Guam,Puerto Rico, and several U.S. military bases overseas.The geographic distribution of the sample generallymirrors that of the U.S. general population (Figure 4.19). The sample was divided into regions based onthe Census Bureau regions, which included theNortheast, Midwest, South, and West (Figure 4.20).These regional categories did not include U.S.territories or U.S. military bases overseas. Figure 4.18: Age of respondents 2%65 and over 13%18 to 24 14%46 to 64 19%65 and over 42%18 to 24 % in USTS % in U.S.population(ACS) 34%25 to 44 42%25 to 44 34%46 to 64 Figure 4.19 Distribution of 2015 USTS Respondents Distribution of the population of the United States Guam Guam AmericanSamoa AmericanSamoa Alaska Alaska Puerto Rico Puerto Rico Hawaii Hawaii Each dot on the maps represents the number of people in a zip code. Every dot corresponds to at least one person, and the size of each dot increases in accordancewith the number of people in each zip code. ### Page 58 VIII. PrimaryLanguage Spokenin Home Respondents were asked about the primarylanguage spoken in their home. Eighty-fourpercent (84%) reported that English was the onlylanguage spoken in their home, compared to 79%in the U.S. general population, as reported in theAmerican Community Survey (ACS).25 Fourteenpercent (14%) reported that English and anotherlanguage were mainly spoken in their home,and 2% reported that a language other thanEnglish was the primary language spoken in theirhome. In addition to spoken languages, 0.4% ofrespondents also reported that American SignLanguage was either the main language or one ofthe main languages used in their home. Spanish (including Spanish Creole) was reportedas the most common language spoken in theirhome other than English, with 10% of respondentsreporting Spanish was the main language spokenin their home, exclusively or along with English.This was slightly lower than the percentage ofthose who spoke Spanish in the home in theU.S. general population (13%).26 Each of the otheridentified languages were spoken by less than 1%of respondents. IX. Religious orSpiritual Identity Respondents were asked about their currentreligious or spiritual identity and could selectone or more identities from a provided list, orthey could select a religious affiliation or spiritualidentity not listed.27,28 Sixty-three percent (63%) ofrespondents reported that they had a spiritual orreligious identity, and 37% of respondents reportedthat they did not have a spiritual or religiousidentity.29 Respondents were most likely to identifyas agnostic (23%), atheist (22%), or Christian (21%),followed by a smaller percentage who identified asPagan (9%), Buddhist (6%), or Jewish (4%). One-quarter (25%) of respondents identified as spiritual,but with no religious affiliation. Thirteen percent(13%) had no religious or spiritual affiliation, and7% identified with a religious affiliation or spiritualidentity that was not listed (Table 4.3). Figure 4.20: Respondents’ location by region 20%Northeast 31%West % in USTS 19%Midwest 29%South 18%Northeast 24%West % in U.S.population(Census)24 21%Midwest 38%South Northeast(CT, ME, MA, NH, NJ, NY, PA, RI, VT) Midwest(IA, IN, IL, KS, MI, MN, MS, NE, ND, OH, SD, WI) South(AL, AR, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK,SC, TN, TX, VA, WV) West(AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY) ### Page 59 Table 4.3: Current religious or spiritual identity | Current religious or spiritual identity | % ofrespondents | | - | - | | Spiritual, but no religious affiliation | 25% | | Agnostic | 23% | | Atheist | 22% | | Christian | 21% | | Pagan | 9% | | Buddhist | 6% | | Jewish | 4% | | Secular Humanist | 4% | | Wiccan | 4% | | Druid | 1% | | Hindu | 1% | | Muslim | 1% | | Native American Traditional Practitioner orCeremonial | 1% | | Polytheist (write-in response) | 1% | | Taoist | 1% | | Baha’i | <1% | | Confucian | <1% | | Jain | <1% | | Jehovah’s Witness | <1% | | Rastafarian | <1% | | Scientologist | <1% | | Shinto | <1% | | Sikh | <1% | | Tenrikyo | <1% | | A religious affiliation or spiritual identitynot listed above | 7% | | No affiliation | 13% | X. Income andEmployment Status Respondents were asked about various aspectsof their income using a series of questions basedon the Current Population Survey (CPS).30 Resultsfor income and employment status are presentedbriefly in this section and discussed in greaterdetail in the Income and Employment Statuschapter. In order to compare USTS respondents’income and employment data with data from theCPS and other national data sources, incomeand employment results are presented with the“supplement weight” applied.31 a. Sources of Income Nearly half (45%) of respondents received incomefrom multiple sources, such as employment, SocialSecurity income, or a pension. Thirty-six percent(36%) received income solely from their ownemployment or a partner or spouse’s employment(not including underground economy work, suchas sex work, drug sales, or other work that iscurrently criminalized). Nearly one in ten (9%)received income from Social Security, includingdisability, and 3% received income solely froma pension. Three percent (3%) reported thatthey were currently working in the undergroundeconomy, including 1% whose income came solelyfrom underground economy work (Table 4.4). Table 4.4: Current sources of income by single andmultiple sources | Sources of income | % of respondents(supplementalweight) | | - | - | | Employment only (from their ownemployer, partner/spouse’s employer,or self-employment) | 36% | | Social Security income/disability only | 9% | | Pension/retirement only | 3% | | Other sources of income only | 3% | | No income | 2% | | Sex work and other undergroundeconomy work only | 1% | | Unemployment benefits/cashassistance only | 1% | | Multiple sources | 45% | ### Page 60 b. Individual and HouseholdIncome Individual and household incomes for the USTSsample and the U.S. population were reportedfrom 2014, the last full year prior to the surveyfor which annual income figures were available.Respondents reported lower incomes than the U.S.population (Figure 4.21 & Figure 4.22).32 c. Poverty Nearly one-third (29%) of respondents were livingin poverty,33 more than twice the poverty rateamong the general U.S. adult population (12%).34 d. Employment Status When asked about their current employmentstatus, 35% of respondents reported that theycurrently had at least one full-time job, 15% had atleast one part-time job, 15% were self-employed,and 11% were students. The unemployment ratefor USTS respondents was 15%, three times the U.S.unemployment rate at the time of the survey (5%).35 XI. EducationalAttainment Respondents were asked about the highest levelof education or degree that they had completed.Thirteen percent (13%) of respondents had a highschool diploma or GED, or did not complete highschool. Forty percent (40%) had completed somecollege but had not obtained a degree, 9% hadan associate’s degree, and 38% had received abachelor’s degree or higher (Figure 4.23). Throughout the report, educational attainment isreported according to the categories reflected inFigure 4.23. However, alternative categories are Figure 4.21: Individual income in 2014 30% 25% 20% 15% 10% 5% 0% 25% 25% 24% 22% 21% 18% 15% 15% 10% 9% 8% 8% $50,000 to$99,999 $25,000 to$49,999 $100,000or more $10,000 to$24,999 $1 to $9,999 No income % in USTS (supplemental weight) % in U.S. adult population (CPS) Figure 4.22: Household income in 2014 35% 30% 25% 20% 15% 10% 5% 0% 31% 31% 24% 23% 22% 21% 15% 12% 12% 4% 4% 1% $50,000 to$99,999 $25,000 to$49,999 No income $1 to $9,999 $100,000or more $10,000 to$24,999 % in USTS (supplemental weight) % in U.S. adult population (CPS) ### Page 61 also presented here for comparison to the U.S.population.36 The USTS sample overall reflectedhigher educational attainment than the U.S.population, which is common among internet-based surveys.37 To account for differences ineducational attainment by age, USTS respondentsare compared to the U.S. population for two ageranges: (1) ages 18 to 24 (Figure 4.24) and (2) ages25 and older (Figure 4.25).38 XII. Disability Respondents received questions about their disabilitystatus based on questions from the AmericanCommunity Survey (ACS) in order to compare thosein the USTS sample to those with disabilities in theU.S. general population. Overall, 39% of respondentsindicated that they had one or more disability asdescribed in the ACS, compared to 15% of the generalpopulation.39 Four percent (4%) of the sample reportedthat they were deaf or had serious difficulty hearing,similarly to the U.S. general population (4%).40 Threepercent (3%) reported that they were blind or hadserious difficulty seeing even when wearing glasses,similarly to those in the U.S. population (3%).41 USTSrespondents were six times as likely to report havingserious difficulty concentrating, remembering, or makingdecisions because of a physical, mental, or emotionalcondition (30%), in contrast to those in the U.S.population (5%).42 Respondents were also almost fourtimes as likely to report difficulty doing errands alone,such as visiting a doctor’s office or shopping becauseof a physical, mental, or emotional condition (22%),compared to the U.S. population (6%) (Figure 4.26).43 Figure 4.24: Educational attainment (ACScategories), ages 18 to 24 70% 60% 50% 40%30% 20% 10% 0% 65% 46% 30% 17% 15% 14% 10% 3% Did notcompletehigh school High schooldiploma orGED Some college(no degree)/Associate’sdegree Bachelor’sdegree orhigher % in USTS % in U.S. population (ACS) Figure 4.26: Disability status 40% 35% 30% 25% 20% 0% 5% 10% 15% Figure 4.25: Educational attainment (ACScategories), age 25 and older 4% Deaf or have seriousdifficulty hearing 35% 30% 25% 20% 15% 10% 5% 0% 4% 32% 28% 26% Blind or have seriousdifficulty seeing evenwhen wearing glasses 3% 3% 21% 21% 19% Difficulty concentrating,remembering, or makingdecisions because ofa physical, mental, oremotional condition 30% 13% 12% 12% 5% 8% 8% 2% 6% Serious difficulty walkingor climbing stairs 8% Some college (no degree)/Associate’s degree Associates degree Graduate or professionaldegree Bachelor’s degree or higher Did not completehigh school High school diplomaor GED Difficulty dressingor bathing 3% 3% Difficulty doing errands alone,such as visiting a doctor’soffice or shopping, becauseof a physical, mental, oremotional condition 22% 6% % in USTS % in U.S. population (ACS) 39% Any disability coveredin the ACS 15% % in USTS % in U.S. population (ACS) ### Page 62 Respondents were also asked if they identified as aperson with a disability to better capture disabilitiesthat were not outlined in the ACS. Twenty-eightpercent (28%) of the sample identified as a personwith a disability.44 Throughout the report, theexperiences of “people with disabilities” reflect theexperiences of these individuals. XIII. Citizenship andImmigration Status Respondents were asked about their citizenship orimmigration status. In addition to those who werecitizens in the sample (97%), respondents reporteda range of immigration statuses, including beingpermanent residents (1%), visa holders (1%), refugees(<1%), or undocumented residents (<1%) (Table 4.5). Table 4.5: Citizenship or immigration status | Citizenship or immigration status | % ofrespondents | | - | - | | U.S. citizen (by birth) | 94% | | U.S. citizen (naturalized) | 3% | | Permanent resident | 1% | | A visa holder (such as F-1, J-1, H1-B, or U) | 1% | | Undocumented resident | <1% | | DACA (Deferred Action for ChildhoodArrival) | <1% | | Refugee status | <1% | | Currently under a withholding of removalstatus | <1% | | DAPA (Deferred Action for ParentalAccountability) | <1% | | Other documented status not listed | <1% | Six percent (6%) of respondents were not citizensby birth, compared to 16% in the U.S. population.45This included approximately 3% who werenaturalized citizens, 2% who were documentedresidents (such as permanent residents andvisa holders), and <1% who were undocumentedresidents46 (Table 4.6). Table 4.6: Citizenship or immigration status (collapsed) | Citizenship orimmigration status | % in USTS | % in U.S.population(Census) | | - | - | - | | U.S. citizen (by birth) | 94% | 84% | | U.S. citizen (naturalized) | 3% | 8% | | Documented resident | 2% | 8% | | Undocumented resident | <1% | Respondents who were not U.S. citizens by birthwere asked if they had ever applied for asylum in theUnited States. Seven percent (7%) applied for asylum,including 3% who applied on the basis of their genderidentity or sexual orientation. Of those who did notapply for asylum, 51% reported that they did not needasylum in order to stay in the United States becausethey had access to other avenues for becomingcitizens, permanent residents, or visa holders.47 Otherrespondents indicated that they did not know how toapply (17%) or did not apply for other reasons (Table 4.7). Table 4.7: Reasons for not applying for asylum | Reasons for not applyingfor asylum | % of those whodid not applyfor asylum | | - | - | | They had access to other legalstatuses | 51% | | They did not know how to apply | 17% | | They did not want to apply | 16% | | They did not need to or were noteligible | 12% | | They were afraid to apply | 3% | | They believed they were past theone-year deadline | 2% | | A reason not listed above | 30% | Nearly half (48%) of respondents who applied forasylum received it. Another 32% did not receiveasylum but instead received a “withholding ofremoval” status, an alternative form of relief that allowssomeone to stay in the United States under certainconditions. One in five (20%) of these respondentswere denied asylum (Figure 4.27). Of the respondentswho were denied asylum (n=11, unweighted),48 31%reported that they were denied asylum because theywere past the one-year deadline, 44% indicated that itwas because the immigration official decided that theydid not face danger in their country of origin, and 25%reported that it was because of a reason not listed. ### Page 63 XIV. Sexual Orientation Respondents were asked which terms bestdescribed their sexual orientation. Respondentswere most likely to identify as queer (21%), and theyalso identified as pansexual (18%), gay, lesbian, orsame-gender-loving (16%), straight (15%), bisexual(14%), and asexual (10%) (Figure 4.28). XV. Relationship Status Respondents were asked about their relationshipstatus. Thirty-one percent (31%) were partneredand living together, 17% were partnered andnot living together, 49% were single, 2%were in a polyamorous relationship, and 1%had a relationship status that was not listed.Respondents were also asked about their currentlegal marital status for the purpose of comparisonto the U.S. adult population through the ACS.Eighteen percent (18%) of USTS respondents werecurrently married, in contrast to 52% in the U.S.adult population (Figure 4.29).49 Almost three-quarters (72%) of respondents have never beenmarried, which is more than twice as many as theU.S. adult population (30%). Figure 4.27: Outcome of asylum application 20%Deniedasylum % of thosewho appliedfor asylum 48%Receivedasylum 32%Deniedasylum,butreceiveda “with-holding ofremoval” status Figure 4.28: Sexual orientation 40% 45% 35% 30% 25% 20% 15% 10% 5% 0% 10% 4% Asexual 17% 6% 7% 14% 29% Bisexual 10% 20% 12% 16% Gay, lesbian, orsame-gender-loving 13% 8% 27% 12% 18% 6% Pansexual 21% 16% 17% 21% 3% Queer 34% 6% 24% 15% 41% Straight orheterosexual 2% 19% 23% 6% Sexualorientationnot listed 4% 8% 6% 5% Non-binary Overall Crossdressers Trans women Trans men ### Page 64 1 Respondents who were among the 12% who did not “thinkof [themselves] as transgender” in Q. 1.10 were eligible forthe survey based on answers they provided to questionsQ. 1.11–1.18. See Appendix C (Detailed Methodology)for a discussion of eligibility. Many of those individualsidentified other terms that better described their genderand experiences. 2 Although only 12% of respondents reported that they didnot think of themselves as transgender in response to Q.1.10, a slightly larger number (14%) expressed discomfortwith the word “transgender” being used to describethem in Q. 2.4. This may have been due to respondents’differentiation between identity and the terminology usedto describe their identity. For example, while a respondentmay have identified with the word transgender, they maynot have been comfortable using the term “transgender”and would have instead preferred another term to describetheir identity. 3 See Q. 2.3. 4 While most respondents were categorized for analysis bygender identity based on their selection of the term thatbest described them in Q. 2.3 and their selection in Q.2.1 (sex assigned at birth on their original birth certificate)alone, a small number of respondents (n=439) requiredfurther analysis of their survey responses to determineif they met the eligibility criteria for the survey and, if so,what the most appropriate gender identity categories werefor analysis. This included, for example, respondents whoindicated in Q. 2.1 that the gender on their original birthcertificate was female and that they identified as a womanin Q. 2.3, or who indicated that the gender on their originalbirth certificate was male and that they identified as aman. This recoding process is described in further detail inAppendix C (Detailed Methodology). 5 Respondents were also asked in an earlier question (Q.1.11) if they identified “as more than one gender or as nogender (such as genderqueer or non-binary),” withoutasking them if that is the best term to describe theirgender identity. Nearly half (47%) of respondents said thatthey identify as such. This means that some respondentswho said that another term (such as transgender man,transgender woman, or crossdresser) best described theirgender identity also identified as having more than onegender or as no gender. 6 Although the vast majority of people have either maleor female on their original birth certificate, there are rareinstances where the sex on a birth certificate is left blankor where a gender marker other than “male” or “female”is listed at the time of birth. It is possible that somerespondents had an original birth certificate that did notlist them as “male” or “female” at the time of their birth.These respondents may not have been able to accuratelyanswer this question. Respondents were required toselect one response to the question about the sex listedon their original birth certificate in Q. 2.1—either “female”or “male”—in order to proceed, since this answer wasused to determine subsequent questions that they wouldreceive later in the survey. 7 The age of respondents in the sample is discussed infurther detail in section VI of this chapter. 8 Note that Q. 1.12 asked whether respondents werecurrently living full time in a gender different from the oneassigned to them at birth. Some non-binary respondentsmay have been living as a non-binary person full time(including people for whom living part time in one genderand part time in another gender is most consistent withtheir non-binary identity), but did not select “yes” becausethey assumed the survey was asking only about peoplewho were living exclusively in a binary gender (male orfemale) that is different than the gender on their originalbirth certificate. 9 Although 6% of crossdressers reported that theyhad transitioned based on Q. 1.12, the sample size ofcrossdressers who had transitioned was too low to reporton their experiences by age. 10 The number of years since transitioning was calculatedbased on respondents’ current age as reported in Q. 2.13,and the age at which they began to transition, as reportedin Q. 1.13. 11 Throughout this report, respondents’ experiences withbeing perceived as transgender by others are reportedaccording to three categories: those who said that peoplecould tell they were transgender “always” or “most oftime” (11%), those who said that others could “sometimes”tell (32%), and those who said that others could “rarely” or“never” tell (57%). 12 The term “out” is used here to describe a person whoopenly self-identifies as transgender in their private,public, and/or professional lives. 13 See the Family Life and Faith Communities chapter fora more detailed discussion of respondents’ experienceswith being out to the immediate family they grew up withand their extended family, as well as their experienceswith being out to partners or spouses and children. 14 Respondents’ experiences with being out in the workplaceare further discussed in the Employment and theWorkplace chapter. ENDNOTES | CHAPTER 4: PORTRAIT OF USTS RESPONDENTS ### Page 65 15 Respondents who reported that “Alaska Native” mostaccurately described their racial or ethnic identity wereasked to enter their enrolled or principal corporation. 16 Respondents who reported that “American Indian” mostaccurately described their racial or ethnic identity wereasked to enter their enrolled or principal tribe. 17 Those who reported that “biracial/multiracial” bestdescribed their racial or ethnic identity received a follow-up question in which they could select one or more of theracial or ethnic identities listed above that best describedthem. 18 Those who selected “a racial/ethnic identity not listedabove” were asked to specify their identity and thenreceived a follow-up question asking them to select theracial/ethnic identity or identities that best described themfrom the list above, with the exception of the “identity notlisted above” category. 19 Racial and ethnic categories are combined in a mannersimilar to that in the U.S. Census, which is important forthe purposes of making racial and ethnic comparisonsto the U.S. population. A notable exception to U.S.Census categorization is that Middle Eastern and whiterespondents are reported separately throughout thereport. The U.S. Census also offers Asians and NativeHawaiians/Other Pacific Islanders as two separate racialcategories. Additionally, this report includes a Latino/acategory, and other racial and ethnic categories should beconsidered to be of “non-Hispanic” origin, based on U.S.Census categories. 20 The difference in racial and ethnic population distributionin the USTS sample and the U.S. general population maybe due to sampling bias that is common in internet-basedsurveys and convenience samples. See e.g., Dillman, D.A., Smyth, J. D., & Christian, L. M. (2014). Internet, Phone,Mail, and Mixed-Mode Surveys: The Tailored DesignMethod (4th ed.). Hoboken, NJ: John Wiley & Sons. Seealso the Methodology chapter and Appendix C (DetailedMethodology) for more information about potentialinternet-based survey sampling bias. See Appendix A(Characteristics of the Sample) for unweighted frequenciesand percentages for race and ethnicity in the USTS sample. 21 Prior research using representative samples oftransgender adults have found that transgender adultsdiffer from the general population in regard to race andethnicity, with transgender people being more likely tobe people of color. See e.g., Flores, A. R., Brown, T. N.T., & Herman, J. L. (2016). Race and Ethnicity of Adultswho Identify as Transgender in the United States. LosAngeles, CA: Williams Institute; Conron, K. J., Scott, G.,Stowell, G. S., & Landers, S. J. (2012). Transgender healthin Massachusetts: Results from a household probabilitysample of adults. American Journal of Public Health,102(1), 118–122. The USTS sample has a higher percentageof white respondents than the U.S. general population.To help correct for this sampling bias, weights for raceand ethnicity were applied based on the racial and ethnicmakeup of the U.S. population. While this may still over-represent white respondents relative to the makeup of thetransgender adult population, this weighting procedurebrings the sample closer to what is estimated to be thetrue population distribution for race and ethnicity fortransgender people. See the Methodology chapter andAppendix C (Detailed Methodology) for more informationon weighting procedures applied to the sample. Seealso Appendix A (Characteristics of the Sample) forunweighted frequencies and percentages for race andethnicity in the USTS sample. 22 Although the ACS groups Middle Eastern and whitepeople in one category, the experiences of MiddleEastern respondents are presented separately from whiterespondents throughout this report. Despite a low number ofMiddle Eastern respondents in the sample overall (<1%), it isimportant to report in a manner that best reflects the uniquecircumstances of transgender people who identify as MiddleEastern. 23 The weight for 18-year-old respondents was createdwith propensity scores developed using a regressiondiscontinuity model. For more information on this processand other weighting procedures, such as the developmentand application of the “supplemental weight,” seeAppendix C (Detailed Methodology). See Appendix A(Characteristics of the Sample) for unweighted frequenciesand percentages for age in the USTS sample. 24 U.S. Census Bureau. (2015). Annual Estimates of theResident Population: April 1, 2010 to July 1, 2015. Availableat: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2015_PEPANNRES&src=pt. 25 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year estimates: Language spoken at homeby ability to speak English for the population 5 yearsand over. Available at: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_B16001&prodType=table.The percentages of people who reported on theprimary language spoken in their home in the AmericanCommunity Survey (ACS) were calculated by the researchteam. ACS findings include those in the U.S. populationwho are 5 years of age and older, in contrast to the USTSsample, which includes respondents who are 18 and older.Therefore, the comparison to the USTS sample should beinterpreted with caution. 26 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year estimates: Language spoken at home byability to speak English for the population 5 years andover. See note 25. 27 Q. 2.12 asked about religious or spiritual identity only,rather than current involvement in a faith community.More information about respondents’ experiencesin faith communities (including religious and spiritualcommunities) can be found in the Family and FaithCommunities chapter. ### Page 66 28 In addition to the main drop-down list of affiliations, thosewho identified as Christian, Jewish, or Muslim were ableto provide additional specificity for their identity froma drop-down list of more specific religious affiliationsin Q. 2.12. Although respondents were provided withnumerous categories to specify for Christian, Jewish,and Muslim faiths, these lists were not exhaustive andlikely did not capture all religious or spiritual identitiesrepresented in the sample. Furthermore, while those whoidentified as Christian were given an option to write in aChristian affiliation that was not listed, Jewish and Muslimrespondents did not receive that option, which may havelimited the manner in which they were able to identify theirreligious or spiritual identity. 29 Respondents who reported that they did not have areligious or spiritual identity included those who selectedagnostic, atheist, or no affiliation without selecting anotherreligious or spiritual identity. 30 The Current Population Survey is used by the Bureau ofLabor Statistics to make determinations about the state ofemployment in the United States. 31 The “supplemental weight” includes the standard surveyweight for 18-year-olds and race and ethnicity, as well asadditional weights for age and educational attainmentthat were created based on the Census Bureau’s 2014American Community Survey (ACS). This weight wasapplied when comparing the USTS sample to the U.S.population for items that were sensitive to age andeducational attainment, such as employment status andindividual and household income. 32 USTS respondents seem to have similar household sizesto the U.S. population. For instance, according to theCPS, 2015 Annual Social and Economic Supplement,28% of U.S. households have a household size of one,whereas 29% of USTS respondents have a householdsize of one (supplemental weight applied). However,USTS respondents are less likely to be living with familymembers, rather than with unrelated members of thehousehold. Sixty-four percent (64%, supplemental weightapplied) of USTS respondents reported a family size ofone compared to 24% in U.S. population as reported inthe CPS. Available at: https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar15.pdf. Calculations werecompleted by the research team. 33 “Living in poverty” means living at or near the povertyline. The research team calculated the USTS povertymeasure using the official poverty measure, as defined bythe U.S. Census Bureau, which can be found at: https://www.census.gov/hhes/www/poverty/about/overview/measure.html. The income ranges in the USTS allowedfor designation of respondents as living in or near povertyif their total family income fell under 125% of the officialpoverty line. 34 Proctor, B. D., Semega, J. L., & Kollar, M. A. (2016). Incomeand Poverty in the United States: 2015. (p. 13). DC: U.S.Census Bureau. Available at: https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf. Calculations were completed by the researchteam. 35 Bureau of Labor Statistics. (2015). The EmploymentSituation—August 2015. Available at: http://www.bls.gov/news.release/archives/empsit_09042015.pdf; Bureauof Labor Statistics. (2015). The Employment Situation—September 2015. Available at: http://www.bls.gov/news.release/archives/empsit_10022015.pdf. 36 The educational attainment results reported for USTSrespondents likely overestimates the number oftransgender people with a level of education beyondhigh school and/or some college. This may be dueto the method by which the survey was administered(online only) and the sampling technique (conveniencesampling). Population-based surveys in several stateshave found lower educational attainment or no differencein educational attainment among transgender peoplewhen compared to non-transgender people. Conron, etal. See note 21; Meyer, I .H., Brown, T. N. T., Herman, J. L.,Reisner, S. L., & Bockting, W. O. (in press). Demographiccharacteristics and health outcomes among transgenderadults in select U.S. regions in the Behavioral Risk FactorSurveillance System. American Journal of Public Health. 37 See the Methodology chapter and the detailedmethodology explanation in Appendix C (DetailedMethodology) for more information about potential internet-based survey sampling bias. See also note 20. 38 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year estimates: Educational Attainment. Availableat: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S1501&prodType=table. 39 U.S. Census Bureau. (2015). 2015 American Survey1-Year estimates: Disability characteristics. Availableat: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S1810&prodType=table. Calculations were completed bythe research team. 40 U.S. Census Bureau. (2015). See note 39. 41 U.S. Census Bureau. (2015). See note 39. 42 U.S. Census Bureau. (2015). See note 39. 43 U.S. Census Bureau. (2015). See note 39. 44 The difference in the reported rate of those who hadone or more listed ACS disabilities (39%) and those whoidentified as a person with a disability (28%) may be dueto some individuals not being comfortable referring tothemselves as a person with a disability. However, thosewho identified as people with a disability likely reflect amuch wider range of disabilities. ### Page 67 45 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year estimates: Sex by age by nativity andcitizenship status. Available at; https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_B05003&prodType=table.Calculations were completed by the research team. 46 Documented and undocumented residents are oftenunderrepresented in surveys for many reasons,including concerns about jeopardizing their residencyby revealing information about their immigrationstatus on a survey. When asking questions relating tocitizenship and immigration status, the survey includedstatements reminding respondents that their answerswere confidential and could not be used against them.However, it is likely that the number of documented andundocumented residents is underrepresented in thissample. 47 This percentage includes those who reported thatthey had access to other legal statuses and those whoindicated that they were already citizens or permanentresidents in Q. 9.8. 48 Due to the small sample size, the unweighted frequencyis being presented alongside weighted percentages hereto be clear that the percentages reflect the experiencesof a small sample of respondents. While it is importantto present these experiences in this report, the findingspresented in this sentence should be interpreted withcaution due to the small sample size. 49 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year Estimates: Sex by marital status byage for the population 15 years and over. Availableat: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_B12002&prodType=table. These findings, as presentedin the ACS, include adults who are currently married withboth spouses who are present and not present based onthe ACS definitions. Calculations were completed by theresearch team. ### Page 68 64 CHAPTER 5 Family Life and FaithCommunities Family life and the state of relationships with family members, including immediate and extendedfamily, spouses and partners, and children, have been shown to impact life outcomes in many areas,such as physical and mental health, economic status, and housing stability.1 Experiences of supportand rejection within the family environment can have a profound effect on these outcomes for transgenderpeople. The survey explored aspects of family relationships for transgender people, particularly the impactof family acceptance and rejection. Since spiritual and religious communities (such as within a church, synagogue, mosque, or other faithcommunity) can play a significant role within families and throughout an individual’s life, the survey alsoexamined respondents’ experiences with faith communities. Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. ### Page 69 65 KEY FINDINGS Sixty percent (60%) of respondents who were out to the immediate family they grew upwith reported that they had supportive families, and 40% had families that were neutralor not supportive. • One in ten (10%) reported that an immediate family member had been violent towardsthem because they were transgender. • Fifteen percent (15%) ran away from home and/or were kicked out of the housebecause they were transgender. More than one-quarter (27%) of respondents who have been out to any of their past orcurrent spouses or partners reported that a spouse or partner ended their relationshipsolely or partly because they were transgender, including 10% who had a relationshipend solely because they were transgender. Eighteen percent (18%) of respondents were parents. Twenty-one percent (21%) of respondents who were out to their children had a childwho stopped speaking to them or spending time with them after coming out astransgender. One-half (50%) of respondents who were out to their family experienced at least oneform of rejection from the immediate family they grew up with, their spouse or partner,and/or their children because they were transgender. Family support was associated with positive outcomes while family rejection wasassociated with negative outcomes. Respondents who were rejected were: • Nearly twice as likely to have experienced homelessness (40%) as those who werenot rejected (22%). • Almost twice as likely to have engaged in sex work (16%) as those who were notrejected (9%). • More likely to have attempted suicide (49%) than those who were not rejected (33%). Nearly one in five (19%) respondents who had ever been part of a spiritual or religiouscommunity left due to rejection. Forty-two percent (42%) of those who left found awelcoming spiritual or religious community. ### Page 70 I. Outness to Familyand Friends Respondents received a series of questions todetermine whether they were “out”2 about theirtransgender identity to various family membersand friends. Specifically, respondents were askedwhether people in different groups knew theywere transgender, including spouses and partners,children, immediate family they grew up with,extended family, LGBT3 friends, and straight andnon-transgender (non-LGBT) friends. Respondentsthen received questions regarding the impact thatanti-transgender bias had on the relationships withmost of the people in those groups. Eighty-six percent (86%) of respondents reportedhaving a current or former spouse or partner.Fifty-eight percent (58%) of those were out to theircurrent spouse or partner and 53% had been outto at least one of their former spouses or partners.Overall, 88% of these respondents were or havebeen out to a current or former spouse or partner. Of the 18% of respondents who had children,69% reported being out to at least one child. Thisvaried by race and ethnicity, with American Indianrespondents (78%) reporting the highest levelof outness, and Black (62%), Latino/a (62%), andAsian (55%) individuals being out to their childrenless often (Figure 5.1). Respondents were asked whether they werecurrently out to all, most, some, or none of thepeople in several groups, including the immediatefamily they grew up with, extended family,4 LGBTfriends, and straight and non-transgender (non-LGBT) friends. Results for each group reflect onlyrespondents who reported having people fromthat group in their lives. More than half (53%) of respondents reported thatthey were out to all immediate family they grewup with. This number decreased to 49% whenconsidering spouses or partners and children as partof the immediate family. Respondents were less likelyto be out to extended family members, with 23%reporting that they were out to all extended family.Overall, less than one-quarter (22%) of respondentswere out to all immediate family members—includingspouses, partners and children—and extended familymembers. Respondents were also asked whether theirLGBT and non-LGBT friends knew that they weretransgender. LGBT friends were the largest groupof people among whom survey respondents wereout, with 62% reporting that they were out to all oftheir LGBT friends. In contrast, less than one-third(32%) of respondents were out to all of their non-LGBT friends (Table 5.1). Table 5.1: Outness to family and friend groups | Family and friend groups | % of respondents who hadpeople from the family orfriend group in their lives | | - | - | | All | Most orsome | None | | Lesbian, gay, bisexual, ortransgender (LGBT) friends | 62% | 34% | 4% | | Immediate family they grew upwith (such as parents or siblings) | 53% | 25% | 22% | | Immediate family they grew upwith, spouses/partners, children | 49% | 43% | 8% | | Straight, non-transgender(non-LGBT) friends | 32% | 56% | 12% | | Extended family (such as aunts,uncles, and cousins) | 23% | 38% | 39% | | Immediate family they grew upwith, extended family, spouses/partners, and children | 22% | 70% | 8% | ### Page 71 II. Relationships withSpouses or Partners Those who were out to a spouse or partner wereasked whether a spouse or partner had endedtheir relationship because they were transgender.More than a quarter (27%) reported that a spouseor partner ended their relationship solely or partlybecause they were transgender, including 10% whohad a relationship end solely because they weretransgender. Whether a relationship ended solely due to beingtransgender differed based on a respondents’current age, with those aged 45 and older beingtwice as likely to have this experience (Figure 5.2). The age at which a respondent transitioned alsoaffected the likelihood of a relationship ending.Respondents who transitioned at age 35 or olderwere more than twice as likely to have theirrelationship end solely due to being transgender(24%) (Figure 5.3). The likelihood of a relationship ending alsodiffered by gender identity, with transgenderwomen (18%) being more likely to have arelationship with a spouse or partner end solelybecause of being transgender than transgendermen (9%), crossdressers (6%), and non-binarypeople (3%) (Figure 5.4). ### Page 72 Respondents were also asked whether a current orformer romantic or sexual partner had ever beenviolent toward them. More than half (54%) reportedthat they had experienced some form of intimatepartner violence. Experiences with intimate partnerviolence are discussed further in the Harassmentand Violence chapter. III. Parental Statusand Related Childrenin the Household Eighteen percent (18%) of people in the samplewere parents,5 and of those individuals, more thantwo-thirds (69%) reported that they were out astransgender to at least one of their children. In comparison to the U.S. adult population, USTSrespondents were substantially less likely to haverelated children living in their home. Accordingto the Current Population Survey, 34% of adultsin the U.S. population had at least one relatedchild under the age of 18 living in their householdin 2015,6 which was more than twice as many More than one-quarter (27%) ofrespondents who were out totheir spouse or partner reportedthat a spouse or partnerended their relationship solelyor partly because they weretransgender, including 10% whohad a relationship end solelybecause they were transgender. In Our OwnVoices “When I finally had the courageto come out, my parents, who Iknew would freak out, did theunthinkable. They assured me I hadtheir complete support to be who Iam. I was never prouder than in thatmoment.” “My father physically assaulted meand kicked me out of the house. Hescreamed at me, calling me pathetic,a waste, worthless, and so on. I sat insilence.” “When I was 20, I slipped up andaccidentally outed myself to myparents. It was the worst mistake ofmy life. They spoke with a pastorwho convinced them that I waspossessed by demon. A couple ofdays later, they told me to leave andnot come back. I spent the next sixmonths homeless.” “Within an hour of coming out to myparents, I was kicked out into thecold with very few items and my cartaken away. I was soon informedby my college that my parentshad withdrawn my tuition for theupcoming spring semester. I wasdevastated.” “It took my family a while to comearound. At first they didn’t acceptme, but they eventually saw howmuch happier I am and are now mybiggest supporters.” ### Page 73 as USTS respondents (14%).7 These differencespersisted across all age groups, with USTSrespondents aged 25 to 44 being more than fourtimes less likely to have a related child under theage of 18 living in their household (12%) than thecorresponding age group in the U.S. population(54%) (Figure 5.5). IV. Relationships withChildren Respondents who reported that they were outto at least one of their children were asked aquestion to determine whether being transgenderhad ever negatively impacted a relationship withtheir child. Specifically, they were asked whetherany of their children had ever stopped speakingto or spending time with them because they weretransgender. More than one in five (21%) reportedthat at least one of their children stopped speakingor spending time with them, at least for a period oftime. The likelihood of this experience differed bygender identity, with transgender women (28%)being more than four times as likely to report thattheir child stopped speaking or spending time withthem as transgender men (6%) and non-binaryrespondents (6%) (Figure 5.6). Overall, of respondents who have had a spouse orpartner and/or who have children, 28% have hada relationship with their spouse or partner or childend, at least temporarily. More than one in five (21%) ofthose who were out to theirchildren reported that at leastone of their children stoppedspeaking or spending timewith them, temporarily orpermanently. ### Page 74 V. Family Acceptanceand Support Respondents who reported that they were out toall, most, or some of the immediate family theygrew up with were asked to assess how supportivetheir family was of them as a transgender personusing a five-point scale from “very supportive”to “very unsupportive.” The categories werecollapsed to create a new variable reflecting asupportive, neutral, or unsupportive family.8 More than half (60%) reported that their family wassupportive, 18% had unsupportive families, and22% had families that were neither supportive norunsupportive (“neutral”). Experiences varied widely between those withfamily support and those with unsupportivefamilies, with family support being associated witha reduced likelihood of negative experiences.Respondents with family support were: • More likely to be employed (65%) than thosewith unsupportive families (52%). • Less likely to have ever done sex work (11%)than those with unsupportive families (16%). • Less likely to have experienced homelessness(27%) than those with unsupportive families(45%). • Less likely to report currently experiencingserious psychological distress9 (31%) in contrastto those with unsupportive families (50%). • Less likely to have attempted suicide (37%)than those with unsupportive families (54%). VI. Relationships withImmediate Family/Family of Origin10 Nearly half (44%) of respondents who were outto all, most, or some of the immediate familythey grew up with (such as parents and siblings)reported that they had experienced at least oneform of family rejection outlined in the survey. Thisrejection included relationships ending, familyviolence, being kicked out of the house, not beingallowed to wear clothes matching their genderidentity, and being sent to a professional to stopthem from being transgender. A. Ended Relationships Among those who were out to their immediatefamily, more than one-quarter (26%) reported thatan immediate family member stopped speakingto them for a long time or ended their relationshipaltogether because they were transgender. Thiswas higher among American Indian (38%), MiddleEastern (37%), and Black (30%) respondents, andlower for Asian (22%) respondents (Figure 5.7).Undocumented residents (39%) were also morelikely to face this form of family rejection thandocumented non-citizens (22%) and citizens (26%). More than half (60%) ofthose who were out totheir immediate familyreported that their familywas supportive, while 18%said that their family wasunsupportive. ### Page 75 Whether a family member stopped speaking to orended a relationship with a respondent differedby age, with 18 to 24 year olds experiencing theleast amount of family rejection of this nature (18%)compared to those in other age groups, such as45 to 64 year olds (37%) (Figure 5.8). Those who transitioned in the last year (24%) wereless likely to have a family member stop speakingto them or end a relationship than those whotransitioned 2 to 5 years ago (29%), 6 to 9 yearsago (37%), and 10 or more years ago (43%)(Figure 5.9). B. Family Violence Among those who were out to their immediatefamily, one out of every ten (10%) respondentsreported that a family member was violent towardsthem because they were transgender. Prevalenceof family violence differed greatly dependingon the time period during which a respondenttransitioned, with those transitioning 10 or moreyears ago (15%) experiencing almost twice asmuch violence as those who transitioned in thepast year (8%) (Figure 5.10). More than one-quarter (26%)of respondents reported thatan immediate family memberstopped speaking to themfor a long time or ended theirrelationship altogether becausethey were transgender. ### Page 76 American Indian respondents (20%) were twiceas likely to experience family violence, and otherpeople of color, such as Asian (15%) and MiddleEastern (14%) respondents, also experiencedhigher rates of violence (Figure 5.11). Undocumented residents were more than twice aslikely to have experienced family violence (25%) astheir documented non-citizen (13%) and citizen (9%)counterparts. Family violence was associated with increasedlikelihood of negative experiences. Those whoexperienced family violence were: • More than twice as likely to have experiencedhomelessness (59%) than those who did notexperience family violence (29%). • More likely to be currently experiencing seriouspsychological distress (53%) than those whodid not experience family violence (35%). • More likely to have attempted suicide intheir lifetime (65%) than those who did notexperience family violence (39%). C. Kicked out of the House Eight percent (8%) of respondents who were outto the immediate family they grew up with werekicked out of the house, which represents 6%of the whole sample. Those who transitioned 10or more years ago were twice as likely to havebeen kicked out of the house (16%) as those whotransitioned within the last year (7%) (Figure 5.12). People of color were kicked out of the house athigher rates, with Middle Eastern respondents (17%)being twice as likely, and American Indian (14%),Black (12%), Latino/a (11%), multiracial (11%), and Asian(9%) respondents experiencing this form of rejectionmore than white respondents (6%) (Figure 5.13). ### Page 77 Being kicked out of the house was associated withan increased likelihood of a range of negativeexperiences related to economic stability, mentalhealth, and physical health. Respondents whowere kicked out of the house were: • More likely to be living in poverty (43%) thanthose who were not kicked out of the house(28%), and had lower incomes overall. • Three times more likely to have ever done sexwork (33%) than those who were not kicked outof the house (11%). • Almost three times as likely to haveexperienced homelessness (74%) as those whowere not kicked out of the house (28%). • More than twice as likely to be living with HIV(3.5%) than those who were not kicked out ofthe house (1.5%). • Substantially more likely to have attemptedsuicide (66%) than those who were not kickedout of the house (39%). • More likely to be currently experiencing seriouspsychological distress (50%) than those whowere not kicked out of the house (36%). D. Not Allowed To Wear ClothesMatching One’s Gender Identity More than one-quarter (27%) of respondentswho were out to the immediate family they grewup with were not allowed to wear clothes thatmatched their gender. E. Sent to a Professional to StopThem from Being Transgender Fourteen percent (14%) of respondents who wereout reported that their immediate family hadsent them to a professional—such as a therapist,counselor, or religious advisor—to stop them frombeing transgender. This represents 11% of thewhole sample. Those who transitioned 6 or moreyears ago (20%) were twice as likely to be sent toa professional as those who transitioned within thelast year (11%) (Figure 5.14). Fourteen percent (14%) ofrespondents who were out totheir immediate family reportedthat their family sent them to aprofessional—such as a therapist,counselor, or religious advisor—tostop them from being transgender. ### Page 78 Rates differed by race and ethnicity, with nearlyone-third of Middle Eastern respondents (31%) andnearly one-quarter of American Indian respondents(24%) being sent to a professional (Figure 5.15). Additional details on respondents’ experienceswith professionals who attempted to changetheir gender identity are discussed further in the“Conversion Therapy and Other Pressures toDe-Transition” section of the Health chapter. VII. Ran Away FromHome One out of every ten (10%) respondents who wereout to their immediate family ran away from homebecause they were transgender. Almost one-third(32%) of those individuals ran away at age 15 oryounger. Respondents were more than twice as likely tohave run away from home if they transitioned 10 ormore years ago (19%) as compared to those whohad transitioned within the past year (8%)(Figure 5.16). People of color were more likely to have run awayfrom home, with Middle Eastern (25%), AmericanIndian (18%), Black (15%), multiracial (14%), Asian(12%), and Latino/a (12%) respondents all reportingthat they had run away at higher rates than whiterespondents (8%) (Figure 5.17). Rates also differed according to citizenship status,with undocumented residents (36%) running awayfrom home more than three times as often ascitizens (10%) and more than documented non-citizen residents (14%). 12% ### Page 79 Overall, 15% of those who were out to theirimmediate family, or 11% of the whole sample, ranaway from home and/or were kicked out of thehouse. VIII. SupportiveFamily Behaviors Those who were out to their immediate family wereasked whether any of the immediate family theygrew up with demonstrated support of them as atransgender person through any specific acts listedin the question, such as using preferred names,using correct pronouns, and providing financialsupport for their transition. Eighty-two percent (82%)of respondents reported that at least one immediatefamily member supported them through at least oneof these acts, while 18% did not experience any ofthe supportive acts (Table 5.2). Table 5.2: Family support | Supportive family behaviors | % of respondents | | - | - | | Told respondent they respect and/orsupport them | 65% | | Used their preferred name | 58% | | Used the correct pronouns | 55% | | Stood up for them with family, friends,or others | 36% | | Did research to learn how to bestsupport them | 33% | | Gave money to help with gendertransition | 18% | | Supported them in another way | 11% | | Provided help with changing nameand/or gender on an ID document | 10% | | One or more experiences listed | 82% | IX. Family RejectionOverall A variable was created to combine all forms offamily rejection examined in the survey. Thisincluded whether the respondent had a spouse,partner, or child end a relationship, reportedthat their family was unsupportive, or had any ofthe five specific rejecting experiences outlinedin section VI of this chapter. One half (50%) ofrespondents who were out to family membersreported that they experienced some form offamily rejection, which represents 46% of theoverall sample.11 Experience with family rejection differed by theage at which a respondent transitioned, with68% of those who transitioned at age 35 or olderexperiencing rejection, compared to 56% of thosewho transitioned under the age of 18 (Figure5.18). Among respondents who transitioned tenor more years ago, 68% reported family rejectioncompared to 48% of those who transitioned in thepast year (Figure 5.19). ### Page 80 Family rejection also differed by gender identity,with transgender women (63%) experiencingrejection more than transgender men (55%), andtransgender men and women (59%) experiencingnearly twice as much rejection as non-binaryrespondents (32%) (Figure 5.20). Family rejection among respondents of differentracial or ethnic identities varied little, althoughAmerican Indian (66%) respondents experiencedhigher levels of rejection (Figure 5.21). Respondents who experienced family rejectionwere: • Almost twice as likely to have experiencedhomelessness (40%) as those who were notrejected (22%). • Nearly twice as likely to have done in sex work(16%) as those who were not rejected (9%). • More likely to have attempted suicide (49%)than those who were not rejected (33%). X. Experiences with aFaith Community The survey explored respondents’ experienceswith a spiritual or religious community (“faithcommunity”), such as a church, synagogue,mosque, or other faith community. Two-thirds(66%) of the survey sample had been part of a faithcommunity at some point in their life. Black (77%)and Middle Eastern (71%) respondents were morelikely to have been part of a faith community thanrespondents of other races and ethnicities(Figure 5.22). ### Page 81 A. Leaving a Faith CommunityDue to Fear of Rejection More than one-third (39%) of respondents whohave been part of a faith community left dueto fear of being rejected because they weretransgender. People of color, including MiddleEastern (54%), American Indian (51%), Black (49%),Latino/a (46%), Asian (43%), and multiracial (40%)respondents, were more likely to leave becausethey were afraid of rejection (Figure 5.23). B. Leaving a Faith CommunityDue to Rejection Nearly one in five (19%) respondents who hadbeen part of a faith community left becausethey were actually rejected (in contrast to fearedrejection as reported in the last subsection), whichrepresents 12% of all respondents. Experiencesvaried based on the amount of time sincetransition, with nearly one-third (32%) of those whotransitioned 10 or more years ago leaving a faithcommunity due to rejection (Figure 5.24). People of color were rejected by their faithcommunities at higher rates, with one-third ofAmerican Indian respondents (33%) and almostone-quarter of Black (24%) and Middle Eastern(24%) individuals leaving for this reason(Figure 5.25). More than one-third (39%) ofrespondents who have beenpart of a faith community leftbecause they feared rejection asa transgender person. ### Page 82 C. Welcoming Communities andExperiences Within the Past Year Of the people who had been rejected by a faithcommunity, 42% found a new community thatwelcomed them as a transgender person. Thisdiffered by respondents’ race or ethnicity, withAmerican Indian respondents (54%) being morelikely to find a welcoming community, and Latino/a(37%) and Asian (34%) respondents being leastlikely (Figure 5.26). Nearly one-third (30%) of those who had ever beenpart of a faith community reported that they hadbeen part of such a community in the past year,which is 19% of the overall sample. Additionally,sixty percent (60%) of them were in a communitywhere leaders or other members thought or knewthey were transgender. D. Acceptance Within FaithCommunities in the Past Year Respondents whose faith community leaders ormembers thought or knew they were transgenderwere asked about a series of behaviors thatsignaled acceptance within the community in thepast year. Ninety-four percent (94%) reported thatcommunity leaders and/or members acceptedthem for who they are as a transgender person,and more than three-quarters (80%) were toldtheir religion or faith accepts them. Ninety-sixpercent (96%) of respondents who were in a faithcommunity in the past year experienced at leastone of the accepting behaviors (Table 5.3). Table 5.3: Acceptance within a faith community in thepast year | Acceptance within faith community in past year | | - | | Manytimes | A fewtimes | Once ortwice | | Community leaders andmembers accepted themfor who they are as atransgender person | 75% | 11% | 8% | | A leader or member oftheir faith community madethem feel welcome as atransgender person | 72% | 12% | 9% | | They were told that theirreligion or faith accepts themas a transgender person | 59% | 12% | 9% | | One or more experienceslisted12 | 96% | ### Page 83 E. Rejection Within FaithCommunities in the Past Year Those with faith community leaders or memberswho thought or knew they were transgender werealso asked about behaviors that signaled rejectionin the past year. Among them, 6% were asked tomeet with faith leaders to stop them from beingtransgender, and 5% were asked to stop coming toservices or faith community functions (Table 5.4). Table 5.4: Rejection within a faith community in thepast year | Rejection within faith community in past year | | - | | Manytimes | A fewtimes | Once ortwice | | They were told that beingtransgender is a sin orthat their religion does notapprove of them | 5% | 5% | 7% | | They were asked to meetwith faith leaders to stopthem from being transgender | 1% | 2% | 3% | | Community leaders or mem-bers asked them to seekmedical or psychologicalhelp to stop them from beingtransgender | 1% | 2% | 3% | | They were asked to stopcoming to services or faithcommunity functions | 1% | 1% | 3% | | One or more experienceslisted13 | 18% | Nearly one in five (18%) respondents who were ina faith community in the past year reported thatthey experienced at least one of the rejectingbehaviors. Rejection was more likely among Asian(40%) and Black (25%) respondents (Figure 5.27). Conclusion Results showed significant challenges in many areasof family life, including the retention of relationshipswith immediate and extended family, spousesand partners, and children. However, results alsodemonstrate that survey respondents were ableto maintain relationships and successfully buildfamily units despite those challenges. They furthershow the importance of family support in promotingpositive experiences in many aspects of life.Results demonstrate that family rejection is stronglycorrelated with increased negative effects on a widerange of major life experiences, including income,homelessness, HIV infection, serious psychologicaldistress, and suicidal behavior. Additionally, althoughmany respondents experienced negative interactionswithin their faith communities, many others wereable to find welcoming and supportive communities.While respondents’ experiences varied overall, thesefindings reveal the substantial challenges facingmany transgender people within their families andfaith communities. Nearly one in five (19%)respondents who had beenpart of a faith community leftbecause they were rejected. ### Page 84 1 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2011). Injustice at Every Turn: A Reportof the National Transgender Discrimination Survey. (pp.88–105). DC: National Center for Transgender Equality& National Gay and Lesbian Task Force; Huebner, D.,Diaz, R. M., & Sanchez, J. (2010). Family acceptance inadolescence and the health of LGBT young adults. Journalof Child and Adolescent Psychiatric Nursing, 23(4),205–213. 2 The term “out” is used here to describe a person whoopenly self-identifies as transgender in their private,public, and/or professional lives. 3 Lesbian, gay, bisexual, and transgender (LGBT). 4 See Q. 4.5 for descriptions of groups of family members. 5 A respondent’s status as a parent was determined basedon Q. 4.3, which asked if a respondent was out to anyof their children. Eighty-two percent (82%) reported thatthey “do not have any children,” and the remaining 18%answered “yes” or “no” to whether they were out to theirchildren. This question established whether a respondenthad at least one child, but did not determine the numberof children, ages of children, or whether the children livedin the respondent’s household. 6 U.S. Census Bureau. (2015). Current Population Survey,Annual Social and Economic Supplement. 7 The percentage of USTS respondents with relatedchildren under the age of 18 in the household is based onQ. 7.6. 8 “Very supportive” and “supportive” categories werecollapsed into a single “supportive” category. “Veryunsupportive” and “unsupportive” categories werecollapsed into a single “unsupportive” category. See Q.4.6. 9 The “serious psychological distress” measure wasdeveloped from the Kessler 6 scale. See Q. 12.2. See alsoHealth chapter. 10 Section 4 asked about experiences with “immediatefamily [respondent] grew up with,” and indicated that thedefinition included parents and siblings. 11 The figure of 50% of respondents experiencing familyrejection is based on a variable created to reflect anyfamily rejection among several questions, including: (1) Q.4.2 (spouse/partner ended relationship), (2) Q. 4.4 (childstopped speaking or spending time with respondent),(3) Q. 4.6 (reported level of supportiveness of immediatefamily), and (4) acts listed in Q. 4.7. 12 The “any accepting behavior” variable was created basedon respondents who had experienced an acceptingbehavior listed in Q. 5.7 once or twice, a few times, ormany times. 13 The “any rejecting behavior” variable was created basedon respondents who had experienced a rejecting behaviorlisted in Q. 5.7 once or twice, a few times, or many times. ENDNOTES | CHAPTER 5: FAMILY LIFE AND FAITH COMMUNITIES ### Page 85 81 CHAPTER 6 Identity Documents Most non-transgender people take their identity documents (IDs) for granted, but for transgenderpeople, updating and using IDs may present substantial challenges. Transgender people oftenneed to update their IDs to reflect their gender and name. Changing the name listed on moststate or federal IDs and records typically involves obtaining a legal name change from a court.1 Changingthe gender marker listed on most IDs and records generally requires documentation of gender transitionfrom a health provider, though the requirements of this documentation may vary greatly for each typeof ID and from jurisdiction to jurisdiction.2 Previous researchers have documented barriers preventingtransgender people from updating the name and gender on their IDs.3 This chapter explores respondents’ experiences with their IDs and records, including updating their nameand/or gender, and interactions with others related to updating and presenting their IDs and records.Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. ### Page 86 82 Eleven percent (11%) of respondents had their preferred name and gender on all IDsand records, while 68% reported that none of their IDs had the name and gender theypreferred. Forty-nine percent (49%) did not have an ID or record with the name they preferred, and67% did not have an ID or record with the gender they preferred. Thirty percent (30%) of respondents completed a legal name change. Thirty-four percent (34%) of people who were granted a legal name change reportedthat they had spent over $250, and 11% spent over $500. Thirty-five percent (35%) of those who did not try to change their legal name did not trybecause they could not afford it. Of those who wanted to update their driver’s license or state ID, an estimated 44% wereable to change their name on the license and an estimated 29% were able to changetheir gender. Of those who wanted to change the gender on their birth certificate, only an estimated9% were able to do so. As a result of showing an ID with a name or gender that did not match their genderpresentation, 25% of people were verbally harassed, 16% were denied services orbenefits, 9% were asked to leave a location or establishment, and 2% were assaulted orattacked. I. Access to LegalName Changes Changing a name is a step in the transition processfor some, but not all, transgender people. A legalname change order is almost always requiredto update the name listed on many forms ofofficial IDs and records, such as driver’s licenses,passports, and Social Security cards.4 Legal namechanges typically happen through a court order,and the process for obtaining a court order variesin each state and territory. Respondents wereasked a series of questions about factors in theirdecision to legally change their name and theiraccess to a legal name change. Approximately one-third (36%) of respondentshave tried to obtain a legal name change, and30% were able to do so. This rate varied greatlyaccording to gender identity, where transgendermen and women (51%) were almost five timesas likely to have tried or completed the namechange process as non-binary people (11%). A vastmajority (96%) of respondents who underwent theprocess did so through a court order, less than 1% KEY FINDINGS ### Page 87 did so through the immigration or naturalizationprocess, and 4% did so by other methods, includingmarriage, an informal or assumed name, or aprocess in another country. Eighty-eight percent(88%) of those who attempted to legally changetheir name were granted a name change. Thosewho attempted but did not complete the processreported a variety of reasons, such as being denied,running out of money, or giving up (Table 6.1). Table 6.1: Outcome of legal name change attempt | Outcome of legal name changeattempt | % of those whoattempted a legalname change | | - | - | | Court granted name change | 88% | | Court denied name change | 1% | | They are still in process of changingname | 6% | | They stopped trying because they ranout of money | 2% | | They gave up | 2% | | Court initially denied, then later grantedname change | <1% | | Not listed above | <1% | Forty-one percent (41%) of those who attempted alegal name change through a court did so at age24 or younger, 45% between the ages of 25 and44, 13% between the ages of 45 and 64, and lessthan 1% at age 65 or older. Nearly two-thirds (64%) of respondents havenever tried to change their legal name. Theseparticipants reported a variety of reasons for notengaging in the process, including 28% who feltthat their name did not conflict with their genderidentity (Table 6.2). This reason was more commonamong non-binary people (45%) and crossdressers(36%) than transgender men and women (10%). Table 6.2: Reasons for not attempting tochange legal name| Reasons for not attempting tochange legal name | % of those who hadnot attempted namechange | | - | - | | They are not ready | 40% | | They cannot afford it | 35% | | Their name does not conflict withgender identity or expression | 28% | | They do not know how | 24% | | They were worried that changing theirname would out them | 24% | | They do not believe they are allowed | 3% | | A reason not listed | 20% | a. Assistance with a Legal NameChange The legal name change process can becomplicated to navigate, and while many peopleundergo the process without help, some seekthe assistance of others. Of people who tried orcompleted the name change process, 60% did sowithout help and 40% received help, including freehelp from a clinic or non-profit organization (17%),assistance from a from a friend (11%), or help from apaid attorney (9%) (Table 6.3). b. Interactions with Judges andCourt Staff Those who interacted with judges and court staffduring the name change process reported widelyvarying experiences. Of the 84% who believed Thirty percent (30%) ofrespondents completed thelegal name change process. ### Page 88 that the judges and/or court staff thought or knewthey were transgender during their interaction,three-quarters (75%) felt they were always treatedwith respect, almost one-quarter (22%) felt theywere only sometimes treated with respect, and 2%felt they were never treated with respect. Reportsof only sometimes or never being treated withrespect were higher for certain groups of people,including people who were currently working inthe underground economy, such as sex work, drugsales, or other work that is currently criminalized(41%), and people who had not had any hormonalor surgical treatment (35%). Respondents who interacted with judges or courtstaff who thought or knew they were transgenderwere asked about specific experiences duringtheir interactions. Twenty-three percent (23%)were referred to by the wrong gender pronouns(such as he, she, or they) or title (such as Mr. orMs.) during their interactions. Almost one in five(19%) people who interacted with judges or courtstaff were asked questions about their gendertransition, such as whether they take hormonesor have had any surgery. Nearly one in ten (9%)reported that they received unequal treatment orservice, and 3% were verbally harassed. Overall,more than one-third (36%) of those who interactedwith judges or court staff during the name changeprocess reported having at least one of theseexperiences. c. Cost Associated with a LegalName Change The process of obtaining a legal name changemay include many different fees, such as thecost of legal help, court fees, and newspaperpublication. The survey asked respondents torecall how much they spent on the name changeprocess. Approximately one-quarter (27%) of thosewho were granted a legal name change reportedthat the process cost less than $100, more thanhalf (55%) reported it costing $100–$499, and10% reported the process costing $500–$2,000(Figure 6.1). The cost of obtaining a legal name change maymake the process inaccessible for some people.Thirty-five percent (35%) of people who had nottried to legally change their name reported thatthey did not try because they could not afford it.Additionally, of people who had attempted thelegal name change process, 2% did not completethe process because they ran out of money. More than one-third (35%)of respondents who didnot try to legally changetheir name said that itwas because they couldnot afford it. ### Page 89 II. Experiences withUpdating Name andGender on IDs Transgender individuals may seek to update thename on their IDs and records, the gender marker(such as M or F), or both. Only 11% of respondentsreported that all of their IDs and records listedboth the name and gender they preferred, andrates were lower for certain populations, suchas undocumented individuals (4%), people aged18–24 (5%), and people with no income (6%). Morethan two-thirds (68%) reported that none of theirIDs or records had both the name and gender theypreferred. The following sections will first discussrespondents’ experiences with updating the nameon their IDs or records, and then their experienceswith updating the gender marker. a. Updating Name on IDs andRecords In order to change the name on IDs and records,one often needs to first obtain a legal namechange. Generally, a court order granting a namechange must then be presented to update eachID or record separately. Respondents were askedwhether all, some, or none of their IDs and recordsreflected the name they preferred. Thirty percent(30%) of respondents had the name they preferredon all IDs and records, and 22% had the namethey preferred on some IDs and records. Nearlyhalf (49%) of respondents did not have any ID orrecord with the name they preferred. Non-citizens,including undocumented residents (68%), weremore likely to say that none of their IDs or recordsreflected the name they preferred. Respondentswith lower incomes were also more likely to saythat none of their IDs or records had the namethey preferred. In Our OwnVoices “I was intentionally misgenderedand continually verbally harassedby DMV employees. Even afterpaying for proper identification tobe issued, they refused to send theidentification because my femalephoto didn’t match my ‘M’ gendermarker.” “As a non-binary person, not beingable to change my gender on any ofmy identification documents is reallydisheartening, dysphoria inducing,and kind of dehumanizing. I’m notallowed to be me.” “My legal name and gender are notyet changed on any documentsdue to the price. The process forthat should be easier or cheaperbecause that is the main thing thatstops me from doing things thatrequire ID.” “Because my state won’t updatethe gender markers on its birthcertificates, the only way to updatemy driver’s license is by changing myinformation on a federal level withmy passport. The problem is thatnow my documents don’t match.” ### Page 90 Respondents were also asked about theirexperiences with updating the name on specifickinds of IDs or records, like driver’s licenses andbirth certificates. Among those respondents whohad a driver’s license or state ID and wanted toupdate their name on it, less than half (44%) wereestimated5 to have done so. An estimated 44%have changed their name on a work ID, and 43%have changed their name with the Social SecurityAdministration. In contrast, less than one-third (31%)have changed their name on student records, 28%on their passport, and 18% on their birth certificate. Respondents who transitioned were more likely tohave changed the name on their IDs.6 For example,while 44% of the whole sample had updated theirname on their driver’s license, 56% of those whohad transitioned had updated their name on theirdriver’s license. Transgender men and women whohad transitioned were more likely to have updatedtheir name on various types of IDs than non-binaryrespondents who had transitioned. For example,(61%) of transgender men and women who hadtransitioned changed their name their driver’slicense, in contrast to non-binary respondents whohad transitioned (39%) (Figure 6.2). Those who indicated that some or all of their IDslisted the name they prefer were asked specificquestions about their experiences updating thename on different kinds of IDs and records. Foreach type of ID or record, those respondents wereasked if (1) they had been able to change the nameon that ID, (2) they were in process of doing so,(3) they tried to change the name on the ID butwere denied, or (4) they had not tried to changethe name on that ID but wanted to do it someday.7Respondents were most likely to have successfullychanged the name on their driver’s license (87%),work ID (88%), and Social Security records (84%),and they were most likely to be denied a namechange on their birth certificate (6%) (Figure 6.3). More than two-thirds (68%)of respondents did nothave any ID or record thatreflected both the nameand gender they preferred. Figure 6.2: Updated NAME on ID or record, by gender identity and transition status (estimated) 70% 60% 50% 40% 30% 20% 10% 0% All respondentswho had ID/recordand wanted tochange it Respondents whohave transitioned Non-binaryrespondents whohave transitioned Transgender menand women whohave transitioned 61% 61% 59% 56% 56% 55% 44% 44% 43% 42% 40% 39% 39% 39% 38% 36% 31% 29% 28% 26% 24% 21% 18% 14% Birth certificate Driver’s licenseand/or state-issuednon-driver ID Social Securityrecords Passport Student records(current or last schoolattended) Work ID ### Page 91 b. Updating Gender on IDs andRecords Updating the gender marker on any ID or recordis typically a distinct process from updating thename, and may require documentation regardinggender transition from a healthcare provider, acourt order of gender change, an updated birthcertificate, or other documentation. Respondentswere asked whether all, some, or none of theirIDs and records listed the gender they preferred.More than two-thirds (67%) of respondents did nothave any ID or record that listed the gender theypreferred. Twelve percent (12%) of respondentshad the gender they preferred on all IDs andrecords, and 21% of respondents had the genderthey preferred on some IDs and records. Respondents were also asked about theirexperiences with updating the gender on specifickinds of IDs or records, like driver’s licenses andbirth certificates. Among those respondents whohad a driver’s license or state ID and wantedto update their gender on it, an estimated8 lessthan one-third (29%) had done so, and only 9%were able to change their gender on their birthcertificate. Twenty-three percent (23%) of thosewith a Social Security card who wanted to updatetheir gender on it were estimated to have done so,and only 18% had updated their gender on theirpassport. Respondents who had transitioned were morelikely to have changed their gender on their IDs.For example, 29% of the overall sample haveupdated the gender on their driver’s license,while 42% of those who have transitionedupdated the gender marker on their driver’slicense. Transgender men and women who hadtransitioned (52%) were much more likely to haveupdated the gender on their driver’s license, incontrast to non-binary respondents who hadtransitioned (9%) (Figure 6.4). ### Page 92 Those who indicated that some or all of theirIDs listed the gender they preferred were askedspecific questions about their experiencesupdating the gender on different kinds of IDsand records. For each type of ID or record, thoserespondents were asked if (1) they had been ableto change the gender on that ID, (2) they werein process of doing so, (3) they tried to changethe gender on the ID but were denied, or (4) theyhad not tried to change the gender on that IDbut wanted to do it someday.9 Respondents weremost likely to change the gender on their driver’slicense (90%) and Social Security records (70%),and they were most likely to be denied a gendermarker change on their birth certificate (15%)(Figure 6.5). Figure 6.5: Experiences updating GENDER on specific IDs (among those who updated some or all oftheir IDs/Records) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Changedgender Denied genderchange In processof changinggender Have not tried tochange genderbut want to 90% 70% 55% 55% 49% 35% 33% 27% 20% 15% 9% 8% 7% 5% 5% 5% 5% 2% 2% 2% Student records(current or last schoolattended) Passport Social Securityrecords Driver’s licenseand/or state-issuednon-driver ID Birth certificate The above chart reflects respondents who have been able to update some or all of their IDs only (omitting those who have not been able to update anyIDs). It also does not include those who do not have the ID/record or do not want to update it. These numbers should not be reported without clearlystating that they represent only a subset of the respondents. For overall ability to change records, see Figure 6.4. ### Page 93 Those who said that none of the IDs reflectedthe preferred gender were asked why that wasthe case. Twenty-five percent (25%) of theserespondents believed they were not allowed tochange the gender on their IDs or records, forreasons such as not having undergone medicaltreatment needed to change their gender on anID or not having a doctor’s letter. Nearly one-third(32%) of respondents indicated that none of theirIDs or records had the gender they preferredbecause they could not afford it. Eighty-eightpercent (88%) of non-binary individuals whoindicated that none of their IDs or records hadthe gender they preferred reported that it wasbecause the available gender options (male orfemale) did not fit their gender identity, in contrastto 4% of transgender men and women (Table 6.4). III. ExperiencesWhen PresentingIncongruent IdentityDocuments Respondents were asked about their experienceswhen they have shown an ID with a name orgender that did not match the gender in whichthey present. Overall, nearly one-third (32%) ofindividuals who have shown IDs with a nameor gender that did not match their presentationreported negative experiences, such as beingharassed, denied services, and/or attacked. One-quarter (25%) of these respondents reportedbeing verbally harassed. Middle Eastern (44%)and American Indian (39%) respondents reportedexperiencing this more often than other racial orethnic groups (Figure 6.6). Sixteen percent (16%) of people who showed IDswith a name or gender that did not match thegender they present in were denied services orbenefits. Transgender men and women were morelikely to have been denied services or benefits(20%) compared to non-binary respondents (10%). Nearly one-third (32%) ofrespondents who did nothave their preferred genderon any of their IDs or recordsreported that they could notafford to change them. Table 6.4: Reasons for not changing gender on IDs orrecords | Reasons for not changinggender | % of those who reportedhaving no IDs/records withthe gender they preferred | | - | - | | They have not tried yet | 44% | | The available gender options(male or female) do not fit theirgender identity | 41% | | They could not afford it | 32% | | They were not ready | 30% | | They did not know how | 26% | | They believed they were notallowed | 25% | | They worried that they might losebenefits or services | 25% | | They worried that changinggender would out them | 25% | | Their request was denied | 1% | | A reason not listed | 10% | ### Page 94 Nine percent (9%) of people who showed anincongruent ID were asked to leave. Transgenderwomen were more likely to have been askedto leave after presenting incongruent IDs (13%),compared to transgender men (9%) and non-binarypeople (6%). Two percent (2%) of people who showed IDs witha name and gender that did not match the genderthey present in were assaulted or attacked. Theseexperiences differed by race and ethnicity. MiddleEastern respondents were almost five times aslikely (9%) to report experiencing this, AmericanIndians were three times as likely (6%), and Blackrespondents were twice as likely (4%) (Figure 6.7).Undocumented residents were also substantiallymore likely to report being assaulted or attacked(15%), in contrast to documented residents (3%)and citizens (2%). Conclusion Findings indicate that respondents encounteredsubstantial issues related to obtaining IDs andrecords that reflect their gender identity, includingfinancial, procedural, and eligibility barriers.The data suggests that the cost of a legal namechange presents a considerable challenge togetting a preferred name on identity documents.Results also indicate that the cost of updatinggender markers and procedural requirements(such as providing documentation of certainmedical procedures) are among the main barrierspreventing respondents from updating the genderon their IDs and records. Further, results suggestthat respondents who presented IDs that didnot correspond with the gender they presentedin were put at risk of harassment, assault, andother forms of negative treatment. Overall, thesefindings illustrate a variety of difficulties that ariseduring the name and gender change process andemphasize the importance of access to accurateidentity documentation for the safety and well-being of transgender people. Nearly one-third (32%) ofindividuals who have shownIDs that did not matchtheir presentation reportednegative experiences, suchas being harassed, deniedservices, and/or attacked. ### Page 95 1 Forty-nine states and all five U.S. territories have acourt order process for changing a legal name. Hawai‘iis currently the only state with an administrative namechange process. Additionally, a legal name change maybe obtained through other processes, such as throughnaturalization or a common law name change. See NCTE’sIdentity Document Center for more information, availableat:. 2 For more information on gender marker changerequirements for state and federal IDs, see NCTE’s IdentityDocument Center, available at. 3 Brown, T. N. T. & Herman, J. L. (2016). Voter ID Laws andTheir Added Costs for Transgender Voters. Los Angeles,CA: Williams Institute. Available at: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Voter-ID-Laws-and-Their-Added-Costs-for-Transgender-Voters-March-2016.pdf; Hussey, H. (2015). Expanding ID Card Access forLGBT Homeless Youth. DC: Center for American Progress.Available at: https://cdn.americanprogress.org/wp-content/uploads/2015/10/01071118/IDhomelessLGBT.pdf; Grant,J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L.,& Keisling, M. (2011). Injustice at Every Turn: A Report ofthe National Transgender Discrimination Survey. (pp.138–156). DC: National Center for Transgender Equality &National Gay and Lesbian Task Force. 4 See NCTE’s Identity Document Center, available at:. 5 Due to an error in skip logic in this section of the survey,a portion of the respondents who should have seenquestions about updating identity documents—specifically,respondents who said that none of their documents hadthe name or gender they preferred—did not receive them.To create a denominator that included those individuals,the research team used question answers from therespondents who did see the questions to estimate thenumber of respondents from the full sample who did havethe ID in question and wanted to update it. This estimateddenominator was used to calculate the percentages ofthose who updated these IDs out of respondents in thefull sample who had the ID and wanted to update it. 6 For the purposes of this report, “transitioned” is definedas living full-time in a gender different than the one ona person’s original birth certificate, as indicated by theanswer to Q. 1.12. 7 Respondents could also select from the followingadditional answer choices about changing their name:(1) “I do not have this ID/record” and (2) “I do not want tochange this ID/record.” If a respondent selected one ofthose answers, they were removed from the calculation.Therefore, results only reflect the answers of those whohad a particular ID/record and wanted to change therecord. See Q. 10.14. 8 See note 5 regarding the estimated calculations in thissection. 9 Respondents could also select from the followingadditional answer choices about changing their gender:(1) “I do not have this ID/record” and (2) “I do not want tochange this ID/record.” If a respondent selected one ofthose answers, they were removed from the calculation.Therefore, results only reflect the answers of those whohad a particular ID/record and wanted to change therecord. See Q. 10.16. ENDNOTES | CHAPTER 6: IDENTITY DOCUMENTS ### Page 96 2015 U.S. TRANSGENDER SURVEY CHAPTER 7 Health Disparities in health and health care among transgender people have been documented in prior research.1The survey explored several areas related to health care, including respondents’ overall physical andmental health, and their experiences accessing health care services, both related to gender transition androutine health care. Results related to health and health care are presented in six sections: - A. Routine and Transition-Related Health Care and Coverage - B. Overall Health and Psychological Distress - C. Conversion Therapy and Other Pressures to De-Transition - D. Suicidal Thoughts and Behaviors - E. Substance Use - F. HIV Testing and Care Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. 92 ### Page 97 A. ROUTINE AND TRANSITION-RELATED HEALTHCARE AND COVERAGE Previous studies indicate that transgender people face barriers to accessing quality, affordable health care.These barriers include lack of adequate insurance coverage, mistreatment by health providers, and healthproviders’ discomfort or inexperience with treating transgender people.2 Such barriers make it harder fortransgender people to seek both routine health care that is unrelated to their transgender status, andhealth care related to gender transition (“transition-related care”). Transition-related care can include avariety of treatments, such as counseling, hormone therapy, and surgical procedures. While not everytransgender person may need or want medical care related to gender transition, many do, and the specifictreatments that they may undergo vary based on their individualized needs. Respondents were asked about their experiences with health insurance coverage, including coverage fortransition-related care. They were also asked about their experiences receiving general health care fromdoctors and other health providers, including how providers treated them as transgender people. Finally,respondents were asked about transition-related care they have had or wanted to have. One in four (25%) respondents experienced a problem with their insurance in the pastyear related to being transgender, such as being denied coverage for care related togender transition. - • One-quarter (25%) of those who sought coverage for hormones in the past yearwere denied, and 55% of those who sought coverage for transition-relatedsurgery in the past year were denied. One-third (33%) of respondents who had seen a health care provider in the pastyear reported having at least one negative experience related to being transgender,such as verbal harassment, refusal of treatment, or having to teach the health careprovider about transgender people to receive appropriate care. In the past year, 23% of respondents did not see a doctor when they needed tobecause of fear of being mistreated as a transgender person, and 33% did not seea doctor because of cost. While more than three-quarters (78%) of respondents wanted hormone therapyrelated to gender transition, only 49% had ever received it. One-quarter (25%) of respondents have undergone some form of transition-related surgery. HEALTH KEY FINDINGS 93 ### Page 98 94 I. Health Insurance a. Insurance Coverage andSource of Coverage Respondents were asked a series of questionsabout health insurance coverage. Eighty-sixpercent (86%) reported that they were coveredby a health insurance or health coverage plan,and 14% reported that they were uninsured. Thiscompares to 89% of adults in the U.S. generalpopulation who were covered by a healthinsurance or health coverage plan in 2015, asreported in the American Community Survey(ACS).3 Insurance coverage differed by region,with those in the South (20%) being more likelyto be uninsured than those in the overall sample,compared to those in the Midwest (13%), West(11%), and Northeast (9%). Among people ofcolor, Black (20%), American Indian (18%), andLatino/a (17%) respondents were more likelyto be uninsured (Figure 7.1). Respondents whowere not U.S. citizens were more likely to beuninsured, including nearly one-quarter (24%) ofdocumented non-citizens and a majority (58%) ofundocumented residents. The most common source of health insurancereported by respondents was an employer-sponsored insurance plan (either through therespondent’s employer or someone else’semployer) (53%). Fourteen percent (14%) ofrespondents had individual insurance plans thatthey or someone else purchased directly froman insurance company, through healthcare.gov,or from a health insurance marketplace, and 13%were insured through Medicaid (Table 7.1). Table 7.1: Type of health insurance or health coverage plan | Health insurance source | % in USTS | % in U.S.generalpopulation(ACS)4 | | - | - | - | | Insurance through current or formeremployer or union (belonging torespondent or a family member) | 53% | 56% | | Insurance they or someone elsepurchased directly from an insurancecompany or through a health insurancemarketplace (such as healthcare.gov) | 14% | 16% | | Medicaid | 13% | 15% | | Medicare | 5% | 22% | | TRICARE or other military health care | 2% | 3% | | VA | 2% | 3% | | Indian Health Service | <1% | 1%5 | | Another type of insurance | 6% | N/A | More than one-quarter (26%) of respondentssought options for health insurance from a stateor federal health insurance marketplace, such asthrough healthcare.gov, in the past year.6 Of thosewho sought insurance through a marketplace, 42%purchased a plan. When acquiring health insurancethrough healthcare.gov or state marketplaces, mostenrolled in a Medicaid plan (58%), 27% received asubsidy to buy a private plan, and 12% purchased aprivate plan without a subsidy. Fourteen percent (14%) ofrespondents were uninsured,compared to 11% of adults inthe U.S. population. Figure 7.1: Uninsured RACE/ETHNICITY (%) 25% 20% 15% 10% 5% 0% 20% 18% 17% 16% 14% 12% 11% 11% Overall American Indian Asian Middle Eastern Multiracial White Latino/a Black ### Page 99 95 b. Negative Experiences withInsurance Coverage One in four (25%) respondents reported havingproblems with their insurance in the past yearrelated to being transgender, such as being deniedcoverage for care related to gender transition.Among those who were insured and madethe relevant requests of their insurer,7 severalproblems were reported. Seventeen percent (17%)of respondents had an insurer refuse to changetheir name and/or gender in their insurance recordwhen requested. Thirteen percent (13%) reportedthat they were denied coverage for services oftenconsidered to be gender-specific, including routinesexual or reproductive health screenings (such asPap smears, prostate exams, and mammograms).Seven percent (7%) reported that they were deniedcoverage for other routine health care. More thanhalf (55%) of respondents who sought transition-related surgery coverage were denied, and one-quarter (25%) of those who sought coverage forhormones were denied (Table 7.2). Table 7.2: Negative action or policy by health insurer | Negative action or policy | % of respondents whomade such a request oftheir insurer | | - | - | | Denied coverage for transition-relatedsurgery | 55% | | Covered only some of the surgicalcare needed for transition (respondentcould not get coverage for treatmentthey needed) | 42% | | Denied coverage for transition-relatedhormone therapy | 25% | | Covered surgery for transition, but hadno surgery providers in their network | 21% | | Refused to change records to listcurrent name or gender | 17% | | Denied coverage for care oftenconsidered gender-specific becauseof transgender status | 13% | | Denied other routine health carebecause of transgender status | 7% | Denials for hormone coverage differed by gender,with transgender men (32%) and non-binary peoplewho had female on their original birth certificate(36%) more likely to report being denied hormonecoverage than transgender women (18%) and non-binary people who had male on their original birthcertificate (16%). Respondents who were insuredsolely through Medicare were least likely to bedenied coverage for hormones (14%) (Figure 7.2).8 Transgender men (57%) were more likely to bedenied surgery coverage than transgender women(54%) and non-binary people, including non-binarypeople with female on their original birth certificate(49%) and non-binary people with male on theiroriginal birth certificate (35%). With the exception ofthose who were solely covered by Medicare (48%),the rate of denials for surgery was similar among thedifferent types of insurance providers (Figure 7.3). Figure 7.2: Denied coverage for hormone therapyin the past year INSURANCE TYPE (%) 35% 30% 25% 20% 15% 10% 5% 0% 29% 26% 25% 21% 20% 14% Other insuranceonly Private insuranceonly Multiple insurancetypes Medicare only Medicaid only Overall Figure 7.3: Denied coverage for surgery in the past year INSURANCE TYPE (%) 56% 54% 52% 50% 48% 46% 44% 55% 55% 55% 55% 54% 48% Other insuranceonly Private insuranceonly Multiple insurancetypes Medicare only Medicaid only Overall ### Page 100 II. Experiences withHealth Care Providers a. Outness to Health CareProviders Respondents were asked whether their currenthealth care providers knew they were transgender.Of respondents who currently had health careproviders, 40% reported that all of their currenthealth care providers knew they were transgender,13% reported that most knew, and 17% reportedthat some knew that they were transgender.Nearly one-third (31%) of respondents reportedthat none of their health care providers knew theywere transgender. b. Treatment by Health CareProviders as a TransgenderPerson Eighty-seven percent (87%) of respondents hadseen a health care provider in the year prior totaking the survey. Those respondents receivedquestions about how their health care providerinteracted with them as a transgender person.Of those who had seen a provider in the pastyear, 62% said that at least one provider theysaw knew they were transgender and treatedthem with respect. However, one-third (33%) ofrespondents who had seen a provider in thepast year reported having at least one negativeexperience with a doctor or other healthcare provider related to being transgender.This included having to teach the providerabout transgender people in order to receiveappropriate care (24%), being asked invasive orunnecessary questions about being transgendernot related to the reason for the visit (15%), orbeing refused transition-related health care (8%)(Table 7.3). In Our OwnVoices “My state Medicaid does not coverhormones or surgeries. With myvery limited income, it is difficultto afford the treatment I need andI will most likely never be able tohave surgeries.” “I was consistently misnamedand misgendered throughout myhospital stay. I passed a kidneystone during that visit. On thestandard 1–10 pain scale, that’ssomewhere around a 9. But nothaving my identity respected, thathurt far more.” “Multiple medical professionalshave misgendered me, deniedto me that I was transgender ortried to persuade me that my transidentity was just a misdiagnosis ofsomething else, have made jokesat my expense in front of me andbehind my back, and have mademe feel physically unsafe. I oftendo not seek medical attentionwhen it is needed, because I’mafraid of what harassment ordiscrimination I may experience ina hospital or clinic.” “When I was in college, I had myhealth insurance list me as male,and then they denied coveragefor my routine pap smear and agynecological prescription due tomy gender.” ### Page 101 Table 7.3: Negative experiences when seeing a health careprovider in the past year | Negative experience | % of thosewho had seena provider inthe past year | | - | - | | They had to teach their health care provider abouttransgender people to get appropriate care | 24% | | A health care provider asked them unnecessary orinvasive questions about their transgender statusthat were not related to the reason for their visit | 15% | | A health care provider refused to give themtransition-related care | 8% | | They were verbally harassed in a health caresetting (such as a hospital, office, or clinic) | 6% | | A health care provider used harsh or abusivelanguage when treating them | 5% | | A health care provider refused to give them carenot related to gender transition (such as physicalsor care for the flu or diabetes) | 3% | | A health care provider was physically rough orabusive when treating them | 2% | | They were physically attacked by someoneduring their visit in a health care setting (such as ahospital, office, or clinic) | 1% | | They were sexually assaulted9in a health caresetting (such as a hospital, office, or clinic) | 1% | | One or more experiences listed | 33% | Negative experiences with doctors and otherhealth care providers varied by race and ethnicity.American Indian respondents (50%) reported thehighest level of negative experiences, and ratesamong Middle Eastern (40%) and multiracial (38%)respondents were also higher (Figure 7.4). Negative experiences with health care providersalso varied by gender identity. Transgendermen (42%) were more likely to report negativeexperiences than transgender women (36%)and non-binary respondents (24%). People withdisabilities10 (42%) were also more likely to haveat least one negative experience in the past year,compared with respondents who did not identifyas having a disability (30%). c. Providers’ Knowledge AboutTransgender People Respondents were asked about the healthproviders they saw for transgender-relatedcare and for routine health care needs and theproviders’ level of knowledge about transgenderhealth care. More than half (56%) of respondentscurrently had a provider specifically for transition-related care, such as hormone therapy. Of those,65% reported that this provider knew “almosteverything” or “most things” about providinghealth care for transgender people. Seventeenpercent (17%) of respondents reported that theirprovider for transition-related care knew only“some” things about the subject, 8% said thisprovider knew “almost nothing,” and 10% saidthey were not sure. Fifty-one percent (51%) of respondents reported thatthey saw the same provider for transition-relatedcare and other routine health care. One-third (33%)indicated that they have a separate provider forroutine care who is different from the providerthey see for transition-related care. Fifteen percent(15%) of respondents reported that they have notransition-related or routine health care provider. Respondents with a separate provider for routinecare were asked about that provider’s level ofknowledge about caring for transgender people.More than of half (54%) of these respondentswere unsure how much their provider knew abouthealth care for transgender people, while others Figure 7.4: One or more negative experiences withhealth provider in the past year RACE/ETHNICITY (%) 60% 50% 40% 30% 20% 10% 0% 50% 40% 38% 34% 34% 33% 32% 26% Overall American Indian Asian Middle Eastern Multiracial Black White Latino/a ### Page 102 indicated that their routine health care providerknew “some things” (16%) or “almost nothing”(24%). Only 6% of respondents reported that theirroutine care provider knew “almost everything” or“most things” about caring for transgender people. d. Barriers to Accessing Care Respondents were asked about barriers toaccessing health care, including cost of care, fearof being mistreated as a transgender person, anddistance required to travel to see health providersfor transition-related care. Cost was a major factor in accessing health care,with one-third (33%) of respondents reporting thatthere was at least one time in the past year whenthey needed to see a doctor or other health careprovider but did not because of cost. People ofcolor, including multiracial (42%), American Indian(41%), Black (40%), and Latino/a (37%) respondents,were more likely to not have seen a doctor orother health care provider due to cost in the pastyear (Figure 7.5). People with disabilities (42%)were also more likely to not have seen a healthprovider when they needed to because of cost. Additionally, nearly one-quarter (23%) ofrespondents reported that at some point in thepast year they needed health care but did not seekit due to fear of being disrespected or mistreatedas a transgender person. American Indian (37%)and Middle Eastern (34%) respondents were morelikely to not have gone to a doctor or other healthcare provider due to fear of being disrespected ormistreated as a transgender person (Figure 7.6). Fear of being disrespected or mistreated by a healthcare provider also differed by gender identity, withtransgender men (31%) being more likely to avoidcare out of fear of discrimination than transgenderwomen (22%) and non-binary respondents (20%). To examine the accessibility of respondents’ healthcare providers, respondents were asked how farthey had to travel to receive routine care and care Nearly one-quarter (23%) ofrespondents reported that theyavoided seeking health carethey needed in the past yeardue to fear of being mistreatedas a transgender person. Figure 7.6: Did not see health provider due to fearof mistreatment in the past year RACE/ETHNICITY (%) 40% 35% 30% 25% 20% 15% 10% 5% 0% 37% 34% 28% 26% 26% 24% Figure 7.5: Did not see health provider due to costin the past year RACE/ETHNICITY (%) 23% 22% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 42% 41% 40% 37% 36% 33% 31% 27% Overall American Indian Asian Middle Eastern Multiracial Black Latino/a White Overall American Indian Asian Middle Eastern Multiracial Black Latino/a White ### Page 103 related to gender transition (transition-related care).Respondents reported having to travel further fortransition-related care than routine care. While63% indicated that they received routine care fromproviders within 10 miles of their home, less thanhalf (45%) reported that they received transition-related health care within 10 miles of their home.Respondents were three times more likely to haveto travel more than 50 miles for transgender-relatedcare than for routine care (Figure 7.7). III. Transition-RelatedHealth Care Respondents received questions about whether theyhad ever had, or wanted to have, a range of potentialhealth care services related to gender transition. a. Counseling More than three-quarters (77%) of respondentssaid they wanted counseling or therapy for theirgender identity or gender transition at somepoint in their life, but only 58% of respondentshave ever received counseling or therapy. Whiletransgender men and women (81%) were onlyslightly more likely to have ever wanted gender-related counseling than non-binary respondents(70%), transgender men and women weremore than twice as likely to have actually hadcounseling (73%) as compared to non-binaryrespondents (31%). Access to counseling variedgreatly by income, with those who reportedhaving no individual income (39%) and thosewho earned an income of $1 to $9,999 (48%)being much less likely to have receivedcounseling than those who earned $50,000 ormore (76%) (Figure 7.8). b. Hormone Therapy Seventy-eight percent (78%) of respondentswanted to receive hormone therapy at somepoint in their life, but only 49% of respondentshave ever received it. Ninety-two percent (92%)of those who have ever received hormonetherapy were currently still receiving it,representing 44% of all respondents. A largemajority of transgender men and women (95%)have wanted hormone therapy, compared to49% of non-binary respondents. Transgendermen and women were about five times morelikely to have ever had hormone therapy (71%)than non-binary respondents (13%). Figure 7.7: Distance to health care provider 70% 60% 50% 40% 30% 20% 10% 0% 63% Figure 7.8: Counseling/therapy for gender identityor transition INDIVIDUAL INCOME (%) 45% 80% 70% 60% 50% 40% 30% 20% 10% 0% 76% 76% 70% 27% 26% 59% 58% 14% 48% 39% 6% 6% 6% 3% 2% 2% 1% More than 100 miles 75–100 miles 25–50 miles 50–75 miles 10–25 miles Less than 10 miles Transition-related health care Routine health care No income Overall $1 to $9,999 $50,000 to$99,999 $25,000 to$49,999 $100,000or more $10,000 to$24,999 ### Page 104 There were also substantial differences in accessto hormone therapy by income. Respondents whoreported having no individual income (31%) orearning an income of $1 to $9,999 (37%) were abouthalf as likely to have received hormone therapy asthose who earned $25,000 or more (Figure 7.9). Of respondents who have ever had hormonetherapy, 4% started hormone therapy before theage of 18, 41% began between the ages of 18 and24, 43% began between the ages of 25 and 44,and 13% began after age 45. While the majority (91%) of respondents receivedtheir hormone medications only from licensedprofessionals, 6% received them from bothlicensed professionals and friends, and 2%reported receiving them only from friends, onlinesources, or other non-licensed sources.11 Thosewho were uninsured were five times more likelyto receive their hormones only from unlicensedsources (10%). Respondents who were currentlyworking in the underground economy (suchas sex work, drug sales, or other work that iscurrently criminalized) (8%), who have ever donesex work in their lifetime (5%), or who were livingin poverty (4%), were more likely to receive theirhormones only from unlicensed sources, as weretransgender women (4%). c. Puberty-Blocking Hormones Fifteen percent (15%) of respondents reportedthat at some point in their lives, they wantedpuberty-blocking medications, which arehormone suppressors that are used to delayphysical changes associated with puberty andwere described as those usually being used byyouth between the ages of 9 and 16. However,less than 1% of respondents reported everhaving them.12 d. Surgeries and Other Procedures One in four (25%) reported having had some formof transition-related surgery.13 Transgender men(42%) were more likely to have had any kind ofsurgery than transgender women (28%) or non-binary respondents (9%). Respondents who wereliving in poverty14 (17%) were less likely to have hadany surgery, as were those who had low incomes(Figure 7.10). Respondents who were uninsured(18%) were also less likely to have any surgery,while those who were insured through Medicareonly were most likely (44%) (Figure 7.11).15 Seventy-eight percent (78%)of respondents wanted toreceive hormone therapy atsome point in their life, butonly 49% of respondentshave ever received it. Figure 7.9: Hormone therapy for gender transition INDIVIDUAL INCOME (%) 70% 60% 50% 40% 30% 20% 10% 0% 66% 64% 64% 55% 49% 37% 31% $50,000 to$99,999 $25,000 to$49,999 $100,000or more $10,000 to$24,999 $1 to $9,999 Overall No income One in four (25%) respondentsreported having had some formof transition-related surgery. ### Page 105 Respondents were asked a series of questionsabout whether they had received or wanted tohave specific surgical and other procedures.Respondents received different questions basedon the sex that they reported was listed on theiroriginal birth certificate.16 i. Experiences of Respondents WithFemale on Their Original Birth Certificate Of respondents who had female on their originalbirth certificates, 21% had a chest reduction orreconstruction17 and 8% had a hysterectomy.18 Only2% reported having any genital surgery, such asmetoidioplasty19 (1%) or phalloplasty20 (1%) (Table7.4). These experiences differed greatly by genderidentity, with transgender men (Figure 7.12) beingmore likely to have had any of the procedures thannon-binary respondents who had female on theiroriginal birth certificate (Figure 7.13). Table 7.4: Procedures among respondents with femaleon their original birth certificate | Type ofprocedure | Havehad it | Want itsomeday | Not sureif theywant this | Do notwantthis | | - | - | - | - | - | | Chest surgeryreduction orreconstruction | 21% | 52% | 17% | 10% | | Hysterectomy | 8% | 44% | 28% | 19% | | Metoidioplasty | 1% | 15% | 37% | 47% | | Phalloplasty | 1% | 11% | 31% | 56% | | Other procedurenot listed | 3% | 7% | 13% | 77% | Figure 7.10: Any surgery for gender transition INDIVIDUAL INCOME (%) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 43% 43% 36% 25% 24% 15% 12% No income Overall $1 to $9,999 $10,000 to$24,999 $100,000or more $25,000 to$49,999 $50,000 to$99,999 Figure 7.11: Any surgery for gender transition INSURANCE TYPE (%) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Figure 7.12: Procedures among transgender men 44% Chest surgeryreduction orreconstruction 36% 3% 61% 32% Hysterectomy 25% 25% 14% 6% 23% 57% 22% 22% 18% Metoidioplasty 49% 24% 25% 2% Phalloplasty 43% 35% 19% 3% Otherprocedurenot listed Medicaid only No insurance Overall Multiple insurancetypes Private insuranceonly Other insuranceonly Medicare only 62% 19% 13% 6% 100% 80% 0% 20% 40% 60% Have had it Want it some day Not sure if they want this Do not want this Figure 7.13: Procedures among non-binary respondentswith female on their original birth certificate Chest surgeryreduction orreconstruction 42% 21% 31% 6% Hysterectomy 35% 2% 33% 30% Metoidioplasty 24% 72% 4% Phalloplasty 79% 19% 2% Otherprocedurenot listed 87% 8% 3% 2% 100% 80% 60% 40% 20% 0% Have had it Want it some day Not sure if they want this Do not want this ### Page 106 Among those who had female on their originalbirth certificate respondents and who hadundergone any of these surgical procedures,3% had their first procedure before the ageof 18. More than one-third (35%) had their firstprocedure between the ages of 18 and 24, 40%between the ages of 25 and 34, and 22% afterthe age of 34. In addition to transition-related care, respondentswho had female on their original birth certificatewere also asked whether they had received a Papsmear in the past year. Only 27% reported thatthey had a Pap smear in the past year, comparedto 43% in the U.S. adult population.21,22 ii. Experiences of Respondents With Maleon Their Original Birth Certificate Among respondents who had male on theiroriginal birth certificate, hair removal orelectrolysis was both the most commonlyreported and the most commonly desiredprocedure. Forty-one percent (41%) havehad hair removal or electrolysis, and 11% hadreceived voice therapy, the second mostcommonly reported procedure. Regardingsurgical procedures, 10% of respondents hadundergone vaginoplasty and/or labiaplasty,23 9%had an orchiectomy,24 6% had undergone facialfeminization surgery,25 8% had augmentationmammoplasty (top surgery),26 4% had a trachealshave,27 and 1% had undergone voice surgery(Table 7.5). These experiences varied by genderidentity, with transgender women (Figure 7.14)being more likely to have had the proceduresthan non-binary respondents who had male ontheir original birth certificate (Figure 7.15). Table 7.5: Procedures among respondents with maleon their original birth certificate | Type ofprocedure | Havehad it | Want itsomeday | Not sureif theywant this | Do notwantthis | | - | - | - | - | - | | Hair removal orelectrolysis | 41% | 49% | 5% | 5% | | Voice therapy(non-surgical) | 11% | 46% | 19% | 24% | | Vaginoplasty orlabiaplasty | 10% | 45% | 23% | 22% | | Augmentationmammoplasty | 8% | 36% | 31% | 24% | | Orchiectomy | 9% | 40% | 24% | 27% | | Facialfeminizationsurgery | 6% | 39% | 30% | 25% | | Tracheal shave | 4% | 29% | 29% | 38% | | Siliconeinjections28 | 2% | 9% | 27% | 61% | | Voice surgery | 1% | 16% | 32% | 51% | | Other procedurenot listed | 5% | 13% | 15% | 67% | Figure 7.14: Procedures among transgender women Hair removalor electrolysis 3% 2% 47% 48% Voice therapy(non-surgical) 21% 17% 48% 14% Vaginoplastyor labiaplasty 54% 22% 12% 12% Augmentationmammoplasty 19% 11% 30% 40% Orchiectomy 22% 11% 47% 20% Facialfeminizationsurgery 29% 43% 7% 21% Trachealshave 5% 32% 28% 35% Siliconeinjections 27% 10% 60% 3% Voice surgery 49% 32% 18% 1% Otherprocedurenot listed 64% 15% 15% 6% 100% 80% 60% 40% 20% 0% Have had it Want it some day Not sure if they want this Do not want this ### Page 107 Two percent (2%) of respondents with maleon their original birth certificate had their firsttransition-related procedure (not includinghormone therapy) before the age of 18. Nearlyone-quarter (23%) had their first procedurebetween the ages of 18 and 24, 32% had their firstprocedure between the ages 25 and 34, and 43%after the age of 34. e. Summary of Transition-RelatedHealth Care When examining the responses of all respondents,91% reported that they had wanted counseling,hormones, and/or puberty blockers for their genderidentity or gender transition at some point, but only65% reported ever having any of them. Overall,58% of respondents had received counseling.Approximately half (54%) had received hormonetherapy and/or some form of surgery, including49% who had hormone therapy and 25% who hadundergone some form of transition-related surgery. B. OVERALL HEALTH AND PSYCHOLOGICALDISTRESS There is a well-documented link between experiences of discrimination and marginalization and poorphysical and mental health outcomes. Populations that face widespread stigma and discrimination aremore likely to report poor overall health and are more vulnerable to a variety of physical and mental healthconditions.29 Previous research has described substantial health disparities affecting transgender peopleand the impact that experiences of discrimination, rejection, and violence have on these disparities.30 Twenty-two percent (22%) of respondents rated their health as “fair” or “poor,”compared with 18% of the U.S. population. Thirty-nine percent (39%) of respondents were currently experiencing seriouspsychological distress, nearly eight times the rate in the U.S. population (5%). Figure 7.15: Procedures among non-binary respondentswith male on their original birth certificate HEALTH Hair removalor electrolysis 18% 15% 54% 13% Voice therapy(non-surgical) 35% 29% 34% 2% Vaginoplastyor labiaplasty 59% 1% 29% 11% Augmentationmammoplasty 1% 47% 16% 36% Orchiectomy 1% 53% 14% 32% Facialfeminizationsurgery 21% 36% 1% 42% Trachealshave 33% 51% 1% 15% Siliconeinjections 70% 4% 26% Voice surgery 31% 63% 6% Otherprocedurenot listed 75% 16% 4% 5% 0% 20% 40% 60% 80% 100% Have had it Want it some day Not sure if they want this Do not want this KEY FINDINGS 103 ### Page 108 I. Current Health Respondents were asked to rate their currentoverall health on a scale from “excellent” to “poor.”Nearly half (45%) of respondents said their healthwas “excellent” or “very good” and one-third (33%)said it was “good.” Twenty-two percent (22%) saidit was “fair” or “poor” (Figure 7.16), compared with18% of the U.S. general population (Figure 7.17).31 Respondents’ self-reported health varied bygender identity, with non-binary respondentswith female on their original birth certificate (35%)being less likely to report excellent or very goodhealth compared to transgender men (47%),non-binary people with male on their originalbirth certificate (48%), transgender women (50%),and crossdressers (57%). Reporting also differedby age, with older respondents more likely toreport excellent or very good health than youngerrespondents, such as those aged 65 and older(60%) and 45–64 (53%), compared with thoseaged 25–44 (48%) and 18–24 (39%) (Figure 7.18). Family support was associated with an increasedlikelihood of reporting excellent or very good health.Respondents who were out to their immediatefamily and described their family as supportive weremore likely to report excellent or very good health(52%) than those whose families were neutral (42%)or unsupportive (38%) (Figure 7.19). Figure 7:18: Reported overall health CURRENT AGE (%) 40% 35% 30% 25% 20% 15% 10% 5% 0% 38% 35% 35% 35% 33% 33% Figure 7:16: General health rating 32% 31% 30% 27% 22% 12%Excellent 20% 33%Verygood 18% 17% 15% 5%Poor 13% 13% 12% 11% 9% 6% % in USTS 5% 5% 3% 2% 17%Fair Overall 18 to 24 25 to 44 45 to 64 65 and over Excellent Very Good Good Fair Poor 33%Good Figure 7:17: General health rating 19%Excellent 32%Verygood 5%Poor % in U.S.population(BRFSS) 13%Fair Figure 7:19: Reported overall health LEVEL OF FAMILY SUPPORT (%) 40% 35% 30% 25% 20% 15% 10% 5% 0% 37% 35% 32%Good 33% 33% 32% 32% 32% 29% 21% 18% 17% 15% 13% 12% 10% 10% 8% 5% 5% 3% Unsupportive Neutral Supportive Overall Excellent Very Good Good Fair Poor ### Page 109 II. SeriousPsychological Distress Respondents were asked questions to assesstheir level of psychological distress in the past30 days, based on the Kessler PsychologicalDistress Scale (K6), a scale that is widely usedwhen assessing mental health outcomes and isincluded in the National Health Interview Survey(NHIS).32 The K6 includes mental health screeningquestions and is designed to identify people whoare experiencing serious psychological distress.The K6 questions asked respondents to rate howoften they experienced several feelings related topsychological distress—such as hopelessness orworthlessness—during the past month on a scalethat included “none of the time,” “a little of thetime,” “some of the time,” “most of the time,” and“all of the time.”33 Respondents who reported experiencing feelingsrelated to psychological distress at least “a littleof the time” for one or more of the K6 questionswere asked how much the feelings interfered withtheir life or activities. Among them, 27% reportedthat the psychological distress interfered withtheir life or activities a lot during the past 30days, and 58% said it interfered some or a little.Only 10% of respondents reported that it did notinterfere with their life or activities during thepast 30 days (Figure 7.20), in contrast to the 35%in the U.S. general population who reported nointerference with their lives (Figure 7.21).34 A variable was developed from the K6questions to reflect respondents’ current seriouspsychological distress (serious psychologicaldistress experienced in the 30 days priorto participating in the survey).35 Thirty-ninepercent (39%) of respondents reported currentlyexperiencing serious psychological distress, whichis nearly eight times the rate reported in the U.S.population (5%).36 Current serious psychologicaldistress varied by gender identity. Non-binaryrespondents (49%) were more likely to reportserious psychological distress than transgendermen and women (35%) and crossdressers (18%). Figure 7:20: Interference of psychological distress withlife or activities among those who reported feelings ofdistress in the past 30 days Thirty-nine percent (39%)of respondents reportedcurrently experiencing seriouspsychological distress, a ratenearly eight times higher thanin the U.S. population (5%). 29%A lot 35%Some % in USTS 10%Not atall 26%A little Figure 7:21: Interference of psychological distress withlife or activities among those who reported feelings ofdistress in the past 30 days 12%A lot 22%Some % in U.S.population(NHIS) 35%Not atall 31%A little ### Page 110 While all age groups of USTS respondentsreported substantially more distress than theircounterparts in the U.S. population, youngersurvey respondents were more likely to reportcurrent serious psychological distress. Fifty-three percent (53%) of USTS respondents aged18 to 25 reported experiencing current seriouspsychological distress, which was more than sixtimes as high as the rate among respondents whowere 65 and older (8%) (Figure 7.22).37 A similarpattern emerged in reporting of current seriouspsychological distress in the U.S. population, withthose aged 18 to 25 (10%) being five times aslikely to report experiencing serious psychologicaldistress as those aged 65 and older (2%).38 Experiences with current psychological distressdiffered according to educational attainment.Respondents who had not completed high school(58%), those who had completed high school ora GED only (54%), and those with some collegeeducation (48%) were more likely to reportcurrently experiencing serious psychologicaldistress than respondents who had completed anassociate’s degree (32%) or higher (Figure 7.23). 2015 U.S. TRANSGENDER SURVEY In Our OwnVoices “I spent decades torturing myselfinto depression because I wascertain that coming out woulddestroy my life. I did everything Icould to get my transness to goaway but it left me physically andpsychologically weak, and on theverge of suicide.” “I had suffered from anxiety anddepression as a direct result ofgender dysphoria. This caused meto become more and more unableto function in society as time wenton. Only when my state expandedMedicaid was I finally able to startdealing with all of these issuesso I could become a productivemember of society.” “I have struggled with depressionand anxiety ever since puberty.I’ve failed classes, isolated myself,and considered suicide because ofthis. A year ago, I felt hopeless andhad daily suicidal thoughts, andtoday I’ve got a plan for the futureand haven’t had a serious suicidalthought in months. I firmly believethis is because of my transition.I feel so much more comfortableand happy than I’ve ever been.” Figure 7:22: Currently experiencing seriouspsychological distress CURRENT AGE (%) 60% 50% 40% 30% 20% 10% 0% 53% 39% 39% 31% 26% 23% 22% 16% 14% 10% 10% 8% 7% 5% 5% 5% 5% 5% 5% 4% 4% 2% Overall 65 and over 35 to 39 50 to 54 18 to 25 60 to 64 30 to 34 45 to 49 40 to 44 55 to 59 26 to 29 % in USTS % in U.S. population (NSDUH) 106 ### Page 111 Respondents who had transitioned ten or moreyears prior to participating in the survey (24%)were substantially less likely to be currentlyexperiencing serious psychological distress, incontrast to those who had transitioned within thepast year (41%) (Figure 7.24). While psychologicaldistress was higher among those early in theirtransition, it was higher yet among those who havenot transitioned but wanted to. Nearly half (49%)of those who have not transitioned but wanted towere currently experiencing serious psychologicaldistress, compared with 36% of those who hadtransitioned at any time prior to taking the survey. Respondents who were living in poverty weremore likely to currently be experiencing seriouspsychological distress (52%). People withdisabilities (59%) were nearly twice as likelyto currently experience psychological distresscompared to those who did not identify as havinga disability (31%). Psychological distress was associated with avariety of experiences of rejection, discrimination,and violence: - • Respondents who were out to their immediatefamilies and described them as supportive (31%)were less likely to report serious psychologicaldistress than those whose families were neutral(42%) or unsupportive (50%). - • Respondents who were fired or forced toresign, denied a promotion, or not hired inthe past year because they were transgender(51%) were more likely to report current seriouspsychological distress than those who did nothave those experiences in the past year (36%). - • Respondents who were physically attackedin the past year (59%) were more likely to becurrently experiencing serious psychologicaldistress than those who were not physicallyattacked in the past year (36%). - • Respondents who were sexually assaulted inthe past year39 (60%) were more likely to becurrently experiencing serious psychologicaldistress than those who were not sexuallyassaulted in the past year (37%). Figure 7.23: Currently experiencing seriouspsychological distress EDUCATIONAL ATTAINMENT (%) 70% 60% 50% 40% 30% 20% 10% 0% 58% 54% 48% 39% 32% 30% 18% Bachelor’sdegree Associate’sdegree Graduate orprofessionaldegree Some college Completed highschool/GED Did not completehigh school Overall Figure 7.24: Currently experiencing seriouspsychological distress YEARS SINCE BEGAN TRANSITIONING (%) 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 41% 39% 38% 31% 24% 2 to 5 years 6 to 10 years 10 years or more 0 to 1 year Overall ### Page 112 C. CONVERSION THERAPY AND OTHERPRESSURES TO DE-TRANSITION Many transgender people discuss their gender identity with professionals, such as health care providersor religious advisors. However, despite the medical consensus that efforts to change someone’s genderidentity or stop them from being transgender (“conversion therapy”) are ineffective, harmful, and evenabusive,40 some professionals still attempt to do so. Additionally, some transgender people feel pressure tohide their gender identity or to go back to living according to the gender they were thought to be at birth(“de-transition”) for a variety of other reasons. For example, some transgender people are pressured toavoid or put off their transition, or to de-transition after they have started their transition, by family membersor employers, as well as religious advisors or health professionals. Others face significant discriminationwhen they begin transitioning, like losing their jobs or home or being rejected by their family or friends, andmay decide to temporarily delay or even reverse their transition as a result. The survey explored respondents’ experiences discussing their gender identity with professionals, suchas psychologists, counselors, and religious advisors, including pressure from those professionals to de-transition or stop being transgender. Experiences with de-transitioning were also examined. Respondentsoverall demonstrated high levels of resistance to such pressure and other forms of discrimination. Fewrespondents de-transitioned, and many of those who did de-transition did so only temporarily and wereliving according to their gender identity at the time of the survey. Thirteen percent (13%) of respondents reported that one or more professionals,such as a psychologist, counselor, or religious advisor, tried to stop them frombeing transgender. Eight percent (8%) of respondents had de-transitioned temporarily or permanently atsome point, meaning that they went back to living as the gender they were thought tobe at birth for a period of time. The majority of respondents who de-transitioned did so only temporarily, and 62%were currently living full time in a gender different than the one they were thought tobe at birth. Respondents who de-transitioned cited a number of reasons for doing so, includingfacing too much harassment or discrimination after they began transitioning (31%),having trouble getting a job (29%), or pressure from a parent (36%), spouse (18%), orother family members (26%). 2015 U.S. TRANSGENDER SURVEY KEY FINDINGS 108 ### Page 113 I. DiscussingGender Identity withProfessionals andConversion Therapy The survey examined a variety of experienceswith professionals—such as psychologists,counselors, and religious advisors—with whomrespondents had discussed their gender identity.Almost three-quarters of respondents (72%)reported that they had discussed their genderidentity with such a professional. Whether an individual discussed their genderidentity with a professional differed by gender, withtransgender men and women (84%) being morelikely to do so than non-binary respondents (52%)and crossdressers (46%) (Figure 7.25). Of all respondents who discussed their genderidentity with a professional, nearly one in five(18%) reported that the professional tried to stopthem from being transgender, representing 13%of all respondents in the sample.41 Four percent(4%) of all respondents saw a religious/spiritualcounselor or advisor who tried to stop themfrom being transgender, and nearly one in ten(9%) respondents saw a non-religious/spiritualprofessional (such as a therapist or a counselor)who tried to stop them from being transgender. The likelihood that a professional tried to stop arespondent from being transgender differed byrace and ethnicity. While Middle Eastern (32%) andAmerican Indian (27%) respondents were most likelyto have this experience, rates were lower for Black(16%) and Asian (14%) respondents (Figure 7.26). More than three-quarters (78%) of respondentswere under the age of 25 when they had thisexperience, 51% were 18 or younger, and 28%were 15 or younger. Nearly one in five (18%)of those who discussedtheir gender identity with aprofessional—or 13% of allrespondents—reported thatthe professional tried to stopthem from being transgender. HEALTH Figure 7.25: Ever discussed gender identitywith a professional GENDER IDENTITY (%) 85% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 84% 83% Figure 7.26: Professional tried to stop them frombeing transgender RACE/ETHNICITY (%) 72% 52% 35% 30% 25% 20% 15% 10% 5% 0% 46% 32% 27% 21% 19% 18% 17% 16% 14% Trans men Trans women Trans womenand men Non-binary Crossdressers Overall Overall American Indian White Latino/a Black Multiracial Middle Eastern Asian 109 ### Page 114 Of the 4% who reported that a religious or spiritualcounselor or advisor tried to stop them from beingtransgender, American Indian (9%) and MiddleEastern (7%) respondents were more likely to havesuch an experience with a religious or spiritualcounselor or advisor (Figure 7.27). Participants who had a professional try to stopthem from being transgender were: - • Far more likely to currently be experiencingserious psychological distress (47%) thanthose who did not have the experience (34%). - • More likely to have attempted suicide(58%) than those who did not have theexperience (39%). - • Nearly three times as likely to have runaway from home (22%) than those who didnot have the experience (8%). - • More likely to have ever experiencedhomelessness (46%) than those who did nothave the experience (29%). - • More likely to have ever done sex work(18%) than those who did not have theexperience (11%). 2015 U.S. TRANSGENDER SURVEY In Our OwnVoices “The doctor figured out I was transand practiced conversion therapywithout telling anyone, includingmy parents. I tried to tell my familythat the doctor was not working,but nobody listened. I was sentthere for over three years. I becameso badly suicidal that I didn’t go aminute without thinking of death.” “When I was 18, I had to leavewhere I grew up after threats ofphysical violence and conversiontherapy from my family. My parentswere abusive before they knew Iwas trans, but when they found out,they used that to hurt and controlme more.” “[An] OB/GYN forced me onto birthcontrol pills to ‘fix’ me into thinkingI was a woman again. I ended upin the psychiatric ward of my localhospital on suicide watch afterthree days on birth control.” “I was kicked out of my parents’home. I ran out of what little moneyI had, and I had nowhere to go. Myfamily offered to let me return totheir home on the condition that Ide-transition and live as a man. Iaccepted because I had no choice.” Figure 7.27: Religious counselor tried to stop themfrom being transgender RACE/ETHNICITY (%) 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 9% 7% 5% 5% 4% 4% 4% 3% White Latino/a Black Multiracial Middle Eastern Asian American Indian Overall 110 ### Page 115 Sixty-nine percent (69%) of respondents discussedtheir sexual orientation with a professional. Ofthose, 14% reported that a professional tried tochange their sexual orientation, representing 10%of the overall sample. II. De-Transitioning Respondents were asked whether they had ever“de-transitioned,” which was defined as having“gone back to living as [their] sex assigned atbirth, at least for a while.” Eight percent (8%) ofrespondents reported having de-transitioned atsome point. Most of those who de-transitioneddid so only temporarily: 62% of those who hadde-transitioned reported that they were currentlyliving full time in a gender different than thegender they were thought to be at birth. Transgender women were more likely to reporthaving de-transitioned (11%), in contrast totransgender men (4%). Rates of de-transitioningalso differed by race and ethnicity, with AmericanIndian (14%), Asian (10%), and multiracial (10%)respondents reporting the highest levels of de-transitioning (Figure 7.28). Respondents who had de-transitioned cited arange of reasons, though only 5% of those whohad de-transitioned reported that they had doneso because they realized that gender transitionwas not for them, representing 0.4% of the overallsample.42 The most common reason cited forde-transitioning was pressure from a parent(36%). Twenty-six percent (26%) reported thatthey de-transitioned due to pressure from otherfamily members, and 18% reported that they de-transitioned because of pressure from their spouseor partner. Other common reasons included facingtoo much harassment or discrimination after theybegan transitioning (31%), and having troublegetting a job (29%) (Table 7.6). Table 7.6: Reasons why respondents de-transitioned,at least for a little while| Reasons for de-transitioning | % of thosewho had everde-transitioned | | - | - | | Pressure from a parent | 36% | | Transitioning was too hard for them | 33% | | They faced too much harassment ordiscrimination as a transgender person | 31% | | They had trouble getting a job | 29% | | Pressure from other family members | 26% | | Pressure from a spouse or partner | 18% | | Pressure from an employer | 17% | | Pressure from friends | 13% | | Pressure from a mental health professional | 5% | | Pressure from a religious counselor | 5% | | They realized that gender transition was notfor them | 5% | | Initial transition did not reflect the complexityof their gender identity (write-in response) | 4% | | Financial reasons (write-in response) | 3% | | Medical reasons (write-in response) | 2% | | A reason not listed above | 35% | HEALTH Figure 7.28: Ever de-transitioned RACE/ETHNICITY (%) 16% 14% 12% 10% 8% 6% 4% 2% 0% 14% 10% 10% 9% 8% 8% 8% 5% Middle Eastern Multiracial Black Latino/a White Asian American Indian Overall 111 ### Page 116 D. SUICIDAL THOUGHTS AND BEHAVIORS The prevalence of suicide attempts among transgender people is reported in the literature as beingsubstantially higher than that in the U.S. general population. Previous studies identify a variety of risk andprotective factors that affect the rates of suicidal thoughts and behaviors among transgender people,including family support, experiences of anti-transgender discrimination and violence, and access to healthcare, employment, and housing.43 The survey explored suicidal thoughts and behaviors among respondents both over the course of their lifetimeand in the year prior to completing the survey. Respondents were asked whether they had seriously thoughtabout, made a plan, or tried to kill themselves at any time in their lives or in the past twelve months to assess arange of suicidal thoughts and behaviors. Questions were patterned on the National Survey on Drug Use andHealth44 and National Comorbidity Survey Replication45 to allow for comparison to the U.S. population. Forty percent (40%) of respondents have attempted suicide at some point in their life,compared to 4.6% in the U.S. population. Forty-eight percent (48%) of respondents have seriously thought about killingthemselves in the past year, compared to 4% of the U.S. population, and 82% havehad serious thoughts about killing themselves at some point in their life. Nearly one-quarter (24%) of respondents made plans to kill themselves in the pastyear, compared to 1.1% of the U.S. population. Seven percent (7%) of respondents attempted suicide in the past year, compared to0.6% in the U.S. population. More than two-thirds (71%) of respondents who have attempted suicide have doneso more than once in their lifetime, with 46% of those who have attempted suicidereporting three or more attempts. I. Suicidal Thoughtsand Behaviors in thePast Year Nearly half (48%) of all respondents reportedthat they had seriously thought about killingthemselves in the past twelve months, comparedto 4% of the U.S. general population.46 Nearlyone-quarter (24%) of respondents reported makingplans to kill themselves in the past year, comparedto 1.1% in the U.S. population.47 Seven percent (7%) of all respondents attemptedsuicide in the past year, nearly twelve times therate of attempted suicide in the U.S. populationin the past year (0.6%).48 The rate of attemptedsuicide in the past year was higher amongpeople of color, including American Indian (10%),multiracial (10%), Black (9%), and Latino/a (9%)respondents (Figure 7.29). The rate of attemptedsuicide in the past year was also higher amongpeople with disabilities (12%). 2015 U.S. TRANSGENDER SURVEY KEY FINDINGS 112 ### Page 117 Respondents who did not complete high school(17%) were more than twice as likely as the overallsample to have attempted suicide in the past year,and those who completed high school or a GEDonly (13%) were almost twice as likely to haveattempted suicide in that time period (Figure 7.30). Respondents whose current income came onlyfrom work in the underground economy, suchas sex work, drug sales, or other criminalizedwork, had a higher rate of suicide attempts in thepast year (27%). Additionally, respondents whodescribed their families as unsupportive (13%)were more than twice as likely to have attemptedsuicide in the past year as those who describedtheir families as supportive (6%). The rate of suicide attempt in the past year variedby age, with younger respondents being morelikely to have attempted suicide in the past year,a similar pattern to that found in the general U.S.population.49 One in ten (10%) USTS respondentsaged 18–25 have attempted suicide in the pastyear, ten times the rate among those aged 65 andolder (1%) (Figure 7.31). Similarly, those aged 18–25in the U.S. population (1.6%) were eight times morelikely to report having attempted suicide in thepast year than those aged 65 and older (0.2%).50 Figure 7.29: Attempted suicide in the past year RACE/ETHNICITY (%) Seven percent (7%) of allrespondents attempted suicide inthe past year, nearly twelve timesthe rate of attempted suicide inthe U.S. population (0.6%). 12% 10% 8% 6% 4% 2% 0% HEALTH 10% 10% 9% 9% 8% 8% 7% 6% Asian Middle Eastern Multiracial Black Latino/a White American Indian Overall Figure 7.30: Attempted suicide in the past year EDUCATIONAL ATTAINMENT (%) 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 17% 13% 9% 7% 6% 4% 3% Bachelor’sdegree Associate’sdegree Graduate orprofessionaldegree Some college Completed highschool/GED Did not completehigh school Overall Figure 7.31: Attempted suicide in the past year CURRENT AGE (%) 12% 10% 8% 6% 4% 2% 0% 10% 7% 7% 5% 5% 4% 3% 3% 2% 2% 1.6% 1% 0.7% 0.6% 0.6% 0.6% 0.5% 0.4% 0.4% 0.3% 0.2% 0.3% Overall 45 to 49 30 to 34 60 to 64 18 to 25 50 to 54 35 to 39 65 and over 26 to 29 55 to 59 40 to 44 % in USTS % in U.S. population (NSDUH) 113 ### Page 118 Of those who attempted suicide in the past year,45% received medical attention51 as a result,compared to 60% who attempted suicide andreceived medical attention in the U.S. population.52Thirty percent (30%) of respondents who attemptedsuicide stayed in a hospital for at least one night,compared to 41% of those who attempted suicide inthe U.S. population.53 II. Lifetime SuicidalThoughts and Behaviors Eighty-two percent (82%) of all respondents hadseriously thought about killing themselves at somepoint in their lives, and 40% of respondents in thesample reported having attempted suicide at somepoint in their life. This lifetime suicide attempt rateis nearly nine times as high as the prevalence in theU.S. population (4.6%).54 Lifetime suicide attempt rates were higher fortransgender men (45%) than for transgenderwomen (40%) and non-binary respondents (39%),and crossdressers had a substantially lowerrate of attempted suicide in their lifetime (15%).Lifetime suicide attempts were also higher amongpeople of color, with American Indian (57%)respondents reporting the highest rates, followedby multiracial (50%), Black (47%), Latino/a (45%),and Middle Eastern (44%) respondents, incontrast to white (37%) respondents (Figure 7.32). People with disabilities (54%) in the sample weremore likely to report attempting suicide. Lifetimesuicide attempts also varied by level of education,with the highest rates among those who did notcomplete high school (52%), and the lowest ratesamong those with a bachelor’s degree (34%) orhigher (30%) (Figure 7.33). Among respondents who were out to theimmediate family they grew up with, lifetimesuicide attempts varied significantly by familysupport. A majority (54%) of those who describedtheir families as unsupportive had attemptedsuicide in their lifetime, in contrast to 37% ofthose with supportive families.55 Lifetime suicide attempts were also higher forrespondents who were physically attacked inthe past year (65%), or have ever experiencedhomelessness (59%), done sex work (57%), losttheir job for being transgender (55%), or beensexually assaulted56 (54%). 2015 U.S. TRANSGENDER SURVEY Forty percent (40%) ofrespondents have attemptedsuicide in their lifetime, nearlynine times the rate reported inthe U.S. population (4.6%). Figure 7.33: Ever attempted suicide EDUCATIONAL ATTAINMENT (%) 60% 50% 40% 30% 20% 10% 0% 52% 49% 45% 42% 40% 34% 30% Associate’sdegree Graduate or professionaldegree Some college Completed highschool/GED Did not completehigh school Overall Bachelor’sdegree Figure 7.32: Ever attempted suicide RACE/ETHNICITY (%) 60% 50% 40% 30% 20% 10% 0% 57% 50% 47% 45% 44% 40% 40% 37% White Latino/a Black Multiracial Middle Eastern Asian American Indian Overall 114 ### Page 119 More than two-thirds (71%) of all respondents whohad ever attempted suicide did so more than once,including 46% who reported three or more attempts,and 21% who reported five or more attempts. III. Age of SuicideAttempts a. Age of First Attempt Respondents who have attempted suicide (once ormultiple times) were asked about the age of theirfirst suicide attempt. More than one-third (34%)reported that their first attempt was at age 13 oryounger. Thirty-nine percent (39%) reported thattheir first attempt occurred between the ages of 14and 17, 20% reported that it occurred between age18 and 24, and 8% reported that their first attemptwas at age 25 or older. b. Age of Most Recent Attempt Among respondents who reported a suicideattempt,57 6% reported that their most recentattempt happened at age 13 or younger. Morethan one-quarter (26%) reported the most recentattempt occurred between the ages of 14 and 17,41% reported that it happened between the agesof 18 and 24, and 27% reported that their mostrecent attempt was at age 25 or older. E. SUBSTANCE USE Substance use is an important indicator of mental health as well as physical wellbeing, and it may reflectan individual’s level of exposure to a variety of risk and protective factors, such as family acceptance,homelessness, violence, and economic opportunity.58 The survey explored patterns in respondents’substance use with questions informed by the National Survey on Drug Use and Health59 to allow forcomparison to substance use trends in the U.S. population. Respondents were asked whether they hadever consumed certain substances, including alcohol, tobacco, marijuana, and other drugs, such ascocaine, heroin, and methamphetamine. Respondents who reported using such substances received aseries of follow-up questions about the frequency and quantity of their substance use. One-quarter (25%) of respondents used marijuana within the past month, compared to8% of the U.S. population. Seven percent (7%) of respondents used prescription drugs that were not prescribedto them or used them not as prescribed (“nonmedical prescription drug use”) in thepast month, compared to 2% of the U.S. population. Four percent (4%) of respondents used illicit drugs (not including marijuana andnonmedical use of prescription drugs) in the past month, and 29% have used them intheir lifetime. Overall, 29% of respondents reported illicit drug use, marijuana consumption, and/ornonmedical prescription drug use in the past month, nearly three times the rate in theU.S. population (10%). KEY FINDINGS ### Page 120 I. Alcohol Consumption Ninety percent (90%) of respondents reportedhaving a drink of alcohol, such as beer, wine, orhard liquor, at any point in their lives, comparedto 86% in the U.S. adult population.60 Sixty-threepercent (63%) of respondents were currentlyusing alcohol, meaning that they had consumedat least one alcoholic beverage within the 30days prior to taking the survey, compared with56% of the U.S. adult population.61 a. Frequency of CurrentAlcohol Use Respondents who were currently using alcohol wereasked how many days they had used alcohol in thepast month. Twenty-nine percent (29%) used alcoholon 1 or 2 days, and 28% had used alcohol on 3–5days during the prior month. Nineteen percent (19%)used alcohol on 6–10 of the past 30 days, and 23%consumed alcohol on 11 or more days. b. Binge and Heavy Drinking Current alcohol users were also asked for thenumber of days in the month when they consumed5 or more drinks on the same occasion, meaningat the same time or within a couple of hours ofeach other (“binge drinking”).62 Twenty-sevenpercent (27%) of the sample reported bingedrinking in the past month, slightly higher than therate in the U.S. adult population in 2014 (25%).63 Respondents who were currently working in theunderground economy, such as sex work, drugsales, or other criminalized work, were nearly twiceas likely to engage in binge drinking as those in theoverall sample, with nearly half (49%) reporting bingedrinking at least one time in the past month. Latino/a (32%), Middle Eastern (30%), and Black(30%) respondents were more likely to reportbinge drinking, while white (25%) and Asian (19%)respondents reported lower levels (Figure 7.34). Nine percent (9%) of respondents reported bingedrinking on one day during the month and 10%on 2–4 days. Seven percent (7%) of respondentsreported binge drinking on 5 more days thatmonth (“heavy drinking”), the same rate as the U.S.population (7%).64 Respondents who were currentlyworking in the underground economy (19%) weremore than twice as likely to report heavy drinking inthe past month as those in the overall sample. II. Tobacco Use a. Lifetime and CurrentTobacco Use Fifty-seven percent (57%) of respondents reportedthat they had smoked all or part of a cigarette atany point in their lives, lower than the rate in theU.S. population (63%).65 Twenty-two percent (22%)were current smokers, meaning that they smokedat least one cigarette or part of a cigarette withinthirty days of taking the survey, which compares to21% of the U.S. population.66 Respondents who were currently working in theunderground economy were more than twiceas likely as the overall sample to have smokedtobacco within the past month, with 51% reportingcurrent tobacco use. Figure 7.34: Reported binge drinking in the past month RACE/ETHNICITY (%) 35% 30% 25% 20% 15% 10% 5% 0% 32% 30% 30% 27% 26% 25% 25% 19% Middle Eastern Multiracial Black Latino/a White Asian American Indian Overall ### Page 121 b. Frequency of Tobacco UseAmong Current Users Current smokers were also asked the number ofdays on which they had smoked tobacco in thepast month. Twenty-nine percent (29%) of currentusers smoked tobacco on 4 days or fewer inthe past month, and one-quarter (24%) smokedtobacco on 5–20 days. More than one-third (38%)of current smokers smoked tobacco daily duringthe past month, compared to 59% of currentsmokers in the U.S. population.67 Among daily smokers, nearly one-third (32%)smoked one or more packs each day. Smoking morethan one pack a day was more likely to be reportedby daily smokers aged 45–64 (54%) and 65 andover (50%) (Figure 7.35), as well as American Indian(44%) and white (40%) respondents (Figure 7.36). III. E-Cigarettes orVaping Products More than one-third (36%) of respondents had usede-cigarettes or vaping products at some point in theirlives. Lifetime use of these products was elevatedamong respondents who have worked in theunderground economy, with 57% reporting past use.Thirty percent (30%) of respondents who had everused e-cigarettes or vaping products used them within30 days of taking the survey. An additional 40% usedthem more than 30 days prior but less than a yearbefore taking the survey, and 29% had used themmore than 12 months before taking the survey. IV. Marijuana Use Nearly two-thirds (64%) of respondents reportedhaving ever used marijuana,68 compared with 47%of the general population.69 a. Current Marijuana Use One-quarter (25%) of the sample reported currentuse, meaning that they used marijuana within 30days of taking the survey, compared to 8% of theU.S. general population.70 Current marijuana usewas elevated among those who were currentlyworking in the underground economy (60%) andthose who were living with HIV (48%). b. Frequency of Marijuana Use Respondents who had used marijuana in the monthbefore taking the survey were asked for the numberof days in which they smoked marijuana duringthat period. More than one in five (22%) smokedmarijuana on 1–2 days that month. Thirty percent(30%) smoked marijuana on 3–12 days, 26% on13–28 days, and nearly one-quarter (23%) smokedmarijuana on 29 or on all 30 of the past 30 days. Among those who were currently working in theunderground economy, approximately one-third(34%) reported using marijuana on 29–30 days in HEALTH Figure 7.35: Daily smokers consuming one or morepacks a day in the past month CURRENT AGE (%) 60% 50% 40% 30% 20% 10% 0% 54% 50% 32% 29% 19% Overall 18 to 24 25 to 44 45 to 64 65 and over Figure 7.36: Daily smokers consuming one or morepack a day in the past month RACE/ETHNICITY (%) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 44% 40% 32% 27% 22% 18% 14% Middle Eastern* Multiracial Black Latino/a White Asian American Indian Overall *Sample size too low to report 117 ### Page 122 the past month. Respondents who were living withHIV (34%) were also more likely to use marijuanaon 29–30 days within that month. V. Illicit Drugs Nearly one-third (29%) of respondents reported everusing illegal or illicit drugs, such as cocaine, crack,heroin, LSD, methamphetamine, or inhalants likepoppers or whippits (but not including marijuana).71Prior use of illicit drugs was particularly high amongrespondents who have done sex work (56%) andthose who have done underground economy workother than sex work (such as drug sales) (75%). Pastillicit drug use was also higher among those whohave lost a job because of being transgender (43%)or who have ever experienced homelessness (42%). a. Current Illicit Drug Use Four percent (4%) of respondents in the samplereported current use of illicit drugs (not includingmarijuana), meaning they had consumed themwithin 30 days of taking the survey. Respondents who were currently working in theunderground economy (26%) were nearly ninetimes as likely as those who were not currentlyworking in the underground economy (3%) to haveused illicit drugs within the past month. VI. NonmedicalPrescription Drug Use Approximately one-third (34%) of respondents havetaken prescription drugs, such as Oxycontin, Xanax,Adderall, or Ambien, for “nonmedical use,” meaningthat the drugs were not prescribed to them or thatthey were not being taken as prescribed. Among respondents who have worked in theunderground economy, almost two-thirds (63%)reported nonmedical prescription drug use,compared with 26% of those who had no experiencein the underground economy. Rates of nonmedicalprescription drug use were particularly high amongthose who had done underground economy workother than sex work, such as drug sales, with 75%reporting nonmedical prescription drug use. Younger respondents were more likely to reportnonmedical prescription drug use, with those aged25–44 (39%) being most likely, and those aged 65and older (18%) being the least likely to report suchprescription drug use (Figure 7.37). a. Current NonmedicalPrescription Drug Use Of respondents who reported nonmedical useof prescription drugs, over half (51%) had lastengaged in such use more than a year beforetaking the survey, and 28% had done so withinthat year but more than a month earlier. More thanone in five (21%) reported nonmedical prescriptiondrug use within 30 days of taking the survey. Thisrepresents 7% of the overall sample, compared to2% of the U.S. population.72 Almost one-third (29%) ofrespondents reported illicit druguse, marijuana consumption, and/or nonmedical prescription druguse in the past month, comparedwith 10% of the U.S. population. Figure 7.37: Nonmedical use of prescription drugs CURRENT AGE (%) 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 39% 34% 31% 27% 18% 65 and over 45 to 64 25 to 44 18 to 24 Overall ### Page 123 VI. Overall CurrentDrug Use Almost one-third (29%) of respondents inthe overall sample were currently using illicitdrugs, marijuana, and/or prescription drugs notprescribed to them or not as prescribed, meaningthey consumed them within 30 days of taking thesurvey. This was nearly three times higher thanusage in the U.S. general population (10%).73 More than two-thirds (68%) of those currentlyworking in the underground economy reported illicitdrug use (including marijuana and prescription druguse) in the past month (Figure 7.38). Figure 7:38: Substance use in the past month among respondents currently working in the underground economy 80%60% 40% 20% 0% 68% 60% 49% 28% 26% 27% 26% 26% 24% 10% 8% 6% 3% 2% N/A Current illicit drug use, marijuanause, and/or nonmedicalprescription drug use Current illicit drug use (notincluding marijuana ornonmedical prescriptiondrug use) Current nonmedicalprescription drug use Current marijuana use Binge drinkingin past month % in USTS currently working in underground economy % in USTS not currently working in underground % in U.S. population (NSDUH) ### Page 124 F. HIV TESTING AND CARE The prevalence of HIV and AIDS has been found in prior research to be higher among transgender peoplethan in the U.S. general population.74 The Centers for Disease Prevention and Control found that a number offactors increase transgender people’s vulnerability to HIV, including social rejection and stigma, inadequateaccess to transgender-competent care, barriers to accessing education, employment, and housing, and highrates of intimate partner violence.75 Respondents received a series of questions to examine experiencesrelated to HIV testing, HIV care, and living with HIV. Several of the questions in this section of the survey werepatterned on national surveys, including the National Health Interview Survey (NHIS)76 and Behavioral RiskFactor Surveillance System (BRFSS),77 so that answers could be compared to the U.S. population. More than half (55%) of the sample has been tested for HIV, compared to 34% of theU.S. adult population. Respondents reported that they were diagnosed with HIV at a rate of 1.4%, asubstantially higher rate than in the U.S. population (0.3%). Transgender women were more than twice as likely to be living with HIV (3.4%) as theoverall sample. Nearly one in five (19.0%) Black transgender women were living with HIV, andAmerican Indian (4.6%) and Latina (4.4%) transgender women were more than threetimes as likely to be living with HIV as the overall sample. I. HIV Testing Respondents were asked whether they had everbeen tested for HIV, aside from testing obtainedthrough the blood donation process. More thanhalf (55%) of respondents had been tested forHIV, in comparison to 34% of the U.S. adultpopulation.78 This varied by gender identity, withtransgender women (62%) and transgender men(58%) being more likely to be tested, compared tonon-binary people (45%). Black respondents (70%)and American Indian (65%) respondents weremore likely to have been tested than other peopleof color and white respondents (Figure 7.39). KEY FINDINGS Figure 7.39: Ever been tested for HIV RACE/ETHNICITY (%) 80% 70% 60% 50% 40% 30% 20% 10% 0% 70% 65% 59% 55% 54% 53% 52% 49% Latino/a White Black Multiracial Middle Eastern Asian American Indian Overall ### Page 125 People who were currently working in theunderground economy, including sex work anddrug sales, were also more likely to have beentested (78%). a. Test Location Those who were tested for HIV received tests ina wide range of locations, with nearly one-half(45%) being tested at their private doctor’s or HMOoffice, more than one-quarter (26%) at a clinic,and 11% in a counseling or testing site. Testinglocations followed a similar pattern in the U.S.general population, with a few exceptions. USTSrespondents were almost three times as likely tohave been tested at a counseling or testing site(11%) than those in the U.S. general population(4%),79 and three times less likely to be tested as ahospital inpatient (Table 7.7). b. Year of Last Test Thirty-eight percent (38%) of respondents whohave ever been tested for HIV had most recentlybeen tested in 2015 (the year the survey wasconducted), and more than two-thirds (71%) hadlast been tested in 2013 or later (Figure 7.40). c. Reason For Not Being Tested Forty-five (45%) percent of respondents reportedthat they had not been tested for HIV. Of thosewho had not been tested, 86% reported thatthe main reason for not being tested was thatexposure to HIV was unlikely, similarly to therate in the U.S. general population (86%).80Respondents also reported a variety of additionalreasons for not being tested (Table 7.8). Table 7.8: Main reason for not being tested for HIV | Reason | % of thosewho havenot beentested inUSTS | % of thosewho havenot beentested in U.S.population(NHIS) | | - | - | - | | Unlikely they have beenexposed to HIV | 86% | 86% | | Their doctor/health careprovider never mentionedgetting an HIV test | 3% | --- | | They did not know where toget tested | 1% | 0% | | They did not want to think aboutHIV or being HIV-positive | 1% | 0% | | They did not like needles | 1% | 0% | | They were afraid to find out ifthey were HIV-positive | 1% | 0% | | They were worried their namewould be sent to the governmentif they tested positive | <1% | <1% | | They were afraid of losing theirjob, insurance, home, friends,or family if people knew theywere tested | <1% | <1% | | Some other reason | 2% | 1% | | No particular reason | 6% | 12% | Figure 7:40: Year of last HIV test 38%2015 % of thosewho have beentested for HIV 22%2014 20%2010 orearlier 11%2013 6%2012 3%2011 Table 7.7: Locations where last tested for HIV | Location | % in USTS | % in U.S.population(BRFSS) | | - | - | - | | Private doctor or HMO office | 45% | 47% | | Clinic | 26% | 23% | | Counseling or testing site | 11% | 4% | | Hospital inpatient | 3% | 9% | | Emergency room | 1% | 2% | | Home | 1% | 2% | | Jail, prison, or other correctionalfacility | <1% | 1% | | Drug treatment facility | <1% | <1% | | Somewhere else | 9% | 11% | | Military (write-in response) | 2% | --- | | Mobile clinic or testing site (write-in response) | 2% | --- | | Do not know or not sure | --- | 1% | ### Page 126 II. HIV Status The rate of respondents who were living with HIV(1.4%)81,82 was more than four times as high as thatin the U.S. general population (0.3%).83 More thanhalf (53%) were HIV negative,84 and 46% had notbeen tested or did not know the results of theirHIV test. This included 1% of those who weretested but did not know their status because theynever received the results and less than 1% whoreceived results that were unclear, which meantthe test did not determine if they had HIV. HIV status varied by gender identity, withtransgender women being most likely to reportthey were living with HIV (3.4%), in contrast totransgender men (0.3%) and non-binary people(0.4%) (Figure 7.41). The rate of HIV differed by race and ethnicity, withBlack respondents being almost five times as likelyto be HIV positive or reactive (6.7%). AmericanIndian (2.0%) and Latino/a (1.6%) participants alsohad higher rates of HIV compared to the sampleand in contrast to Asian (0.5%) and white (0.4%)respondents (Figure 7.42). In Our OwnVoices “I have consulted with surgeons[for gender transition] only tobe told they would charge me50–100% more for the surgerybecause I am HIV positive. Everyday is a double coming outprocess as transgender and beingundetectably HIV positive.” “The nurse refused to give me HIVtesting because she said thosefunds were reserved for men whohave sex with men and I’m ‘not a realman.’ She told me I was born femaleand just needed to accept reality.” “I am a trans man who has beenliving with HIV for 25 years. I havegood health insurance and getexcellent trans-related and HIV-related health care. I have access toa great therapist who is an expertin gender issues and transitioning.All these factors contribute to mysurvival and my success.” “My first time in jail, and possiblythe time I became infected withHIV, was the scariest of all. Therewere so many times I was in jail andparticipated in unprotected sex outof fear and necessity. This is justone of the harsh realities for youngvulnerable trans women like myself.It is truly bewildering that this realitywas so commonly accepted amongtrans women of color.” Figure 7.41: Living with HIV GENDER IDENTITY (%) 4% 3.5% 3% 2.5% 2% 1.5% 1% 0.5% 0% 3.4% 2.1% 2% 1.4% 1% 0.4% 0.3% 0.2% Non-binary (all) Trans women Trans men Non-binary people with femaleon their birth certificate Trans womenand men Non-binary people with maleon their birth certificate Crossdressers Overall ### Page 127 Nearly one in five (19.0%) Black transgenderwomen reported living with HIV, a rate that is morethan thirteen times higher than that in the overallsample. American Indian (4.6%) and Latina (4.4%)transgender women also reported substantiallyhigher rates of HIV (Figure 7.43). The rate of HIV also differed by current age, withit being highest among those aged 45–64 (3.3%)and also higher for the 25–44 age group (2.0%)(Figure 7.44). Undocumented residents (15.0%) were more thanten times as likely to report that they were livingwith HIV as the overall sample, and documentednon-citizens (3.6%) were also more likely. Therewere also substantial differences when examiningrates of HIV by educational attainment. Those whodid not complete high school (7.2%) were more thanfive times as likely to be living with HIV as those inthe overall sample, in contrast to the lower rates forthose with a bachelor’s degree (0.7%) or a graduateor professional degree (0.8%) (Figure 7.45). The rate of respondents livingwith HIV (1.4%) was nearly fivetimes higher than in the U.S.population (0.3%). Figure 7.44: Living with HIV AGE (%) 3.5% 3% 2.5% 2% 1.5% 1% 0.5% 0% 3.3% Figure 7.42: Living with HIV RACE/ETHNICITY (%) 8% 7% 6% 5% 4% 3% 2% 1% 0% 2.0% 6.7% 1.6% 1.4% 0.2% Overall 25 to 44 45 to 64 18 to 24 65 and over 2.0% 1.6% 1.4% 0.8% 0.5% 0.4% 0% Overall American Indian Asian Middle Eastern Multiracial Black Latino/a White Figure 7.43: Living with HIV among transgender women RACE/ETHNICITY (%) 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 19.0% Figure 7.45: Living with HIV EDUCATIONAL ATTAINMENT (%) 8% 7% 6% 5% 4% 3% 2% 1% 0% 7.2% 4.6% 4.4% 2.5% 1.8% 1.4% 1.8% 1.7% 0.7% 1.6% 0% 1.4% Overall (allrespondents) American Indian Asian Middle Eastern Multiracial White Latina Black 0.8% 0.7% Bachelor’sdegree Associate’sdegree Graduate or pro-fessional degree Some college Completed highschool/GED Did not completehigh school Overall ### Page 128 The rate of HIV was more than ten times higherfor respondents whose current sole source ofincome was from underground economy work(15.0%), five times higher among those who haveparticipated in sex work at any point in their lifetime(7.9%), and almost twice as high for those who haveexperienced homelessness (2.7%). III. HIV Health Care Medical providers and HIV health careadvocates often describe effective treatmentand management of HIV in terms of the HIV carecontinuum or the HIV treatment cascade. The HIVcare continuum describes stages of HIV medicalcare, including “diagnosis of HIV infection, linkageto care, retention in care, receipt of antiretroviraltherapy, and achievement of viral suppression.”85Respondents were asked whether they hadreceived HIV-related health care in the year priorto the survey, and were also asked about otheraspects of the HIV care continuum. Most of the respondents who were living with HIVhad received HIV-specific health care within thepast year, not including care received during anemergency room visit or during a hospital stay.Eighty-nine percent (89%) of respondents livingwith HIV had seen a doctor or health care providerfor HIV care in the past 12 months, and 87%received HIV care in the past 6 months. Respondents who had not seen a doctor for HIVcare in the past 6 months offered a range ofreasons, including not being ready to find healthcare for HIV, not being able to afford HIV care, notfeeling sick enough to look for HIV care, and theirHIV is well controlled enough to only see a doctoronce per year.86 Similarly, those who had not seena doctor for HIV care in the past 12 months offereda variety of reasons, including not having healthinsurance, not being able to afford HIV care, notknowing where to go for HIV care, not feeling sickenough to look for health care, relying on a higherpower or God to help with their HIV, only recentlyfinding out about their HIV status, and otherunspecified reasons.87 Of respondents who were living with HIV, 82%reported that they had their blood tested todetermine their viral load and CD4 counts in thepast 6 months. Five percent (5%) had most recentlyreceived such testing between 6 and 12 monthsago, 6% were last tested more than a year ago,and 7% had never had a blood test for their viralload and CD4 counts. Eighty-seven percent (87%) of respondents livingwith HIV have been prescribed anti-retroviraltherapy (ART), which are medications that canreduce the amount of HIV in the body.88 This iscompared to 94% of those living with HIV in thegeneral population.89 Eighty-one percent (81%)of people living with HIV reported that they werecurrently taking their ART medications. Of thosewho had been prescribed ART, almost two-thirds (64%) reported taking it regularly and asprescribed all of the time, one-third (33%) took itmost of the time, 2% rarely took it, and 1% nevertook it regularly and as prescribed. Approximatelyhalf (45%) of respondents who were not takingtheir ART medication all of the time—includingthose who took it most of the time, rarely, ornever—reported that the main reason for nottaking it as they were supposed to was that theyforgot to take it. The remaining respondents (n=23,unweighted) reported several reasons why thatthey did not take their medication as prescribed,including not being able to afford the medication,not having health insurance, concerns aboutconflicts with other medications, concerns aboutweight gain, not wanting to take ART, and otherreasons not listed in the question. ### Page 129 Conclusion Findings throughout the chapter indicated thatrespondents were impacted by substantial health-related disparities, including access to qualitycare and health outcomes. Respondents reportedsubstantial barriers to receiving the care that theyneed, such as financial constraints, lack of healthinsurance or insurance that does not adequatelyaddress their health needs, and lack of access tohealth care providers who can administer healthcare respectfully and with a sufficient knowledge oftransgender patients’ needs. Furthermore, althoughsome respondents were able to access health carerelated to gender transition, such as counseling,hormone therapy, or a variety of surgicalprocedures, a large number have not received suchhealth care despite wanting to do so, often due toincome and economic instability and lack of accessto adequate health insurance insurance. Results also suggest that insufficient accessto quality care and coverage contributed topoor health outcomes among respondents.Respondents were substantially more likely tobe living with HIV than the general population,with much higher rates among transgenderwomen of color. Respondents were also morelikely to report poor mental health outcomes,including higher rates of substance use, seriouspsychological distress, and suicide attempts.Findings demonstrated an association betweenpoor health outcomes and a number of riskfactors, such as economic instability, housinginstability, lower educational attainment, andlack of family support. 1 Bockting, W. O., Miner, M. H., Swinburne Romine, R. E.,Hamilton, A., & Coleman, E. (2013). Stigma, mental health,and resilience in an online sample of the US transgenderpopulation. American Journal of Public Health, 103(5), 943–951; Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman,J. L., & Keisling, M. (2011). Injustice at Every Turn: A Report ofthe National Transgender Discrimination Survey. (pp. 72–87).DC: National Center for Transgender Equality & National Gayand Lesbian Task Force; Institute of Medicine. (2011). TheHealth of Lesbian, Gay, Bisexual, and Transgender People:Building a Foundation for Better Understanding. DC: NationalAcademy of Sciences. 2 Kosenko, K., Rintamaki, L., Raney, S., Maness, K. (2013).Transgender patient perceptions of stigma in health carecontexts. Medical Care, 51(9), 819–822; Poteat, T., German,D., & Kerrigan, D. (2013). Managing uncertainty: A groundedtheory of stigma in transgender health encounters. SocialScience & Medicine, 84(1), 22–29; Grant, et al. (2011). pp.72–87; Lambda Legal. (2010). When Health Care Isn’t Caring:Lambda Legal’s Survey of Discrimination Against LGBTPeople and People with HIV. New York, NY: Lambda Legal. 3 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year Estimates. Available at: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S2701&prodType=table. 4 U.S. Census Bureau. (2015). 2015 American CommunitySurvey 1-Year Estimates: Private Health Insurance CoverageBy Type. Available at: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S2703&prodType=table; U.S. Census Bureau. (2015). 2015American Community Survey 1-Year Estimates: Public HealthInsurance Coverage by Type. Available at: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S2704&prodType=table. 5 The estimate for the percentage of people who receivecoverage through the Indian Health Service was calculatedbased on a 2015 statement that approximately 2.2 millionAmerican Indian and Alaska Native people were served bythe Indian Health Service. https://www.ihs.gov/newsroom/factsheets/quicklook/. 6 Q. 11.9 specified that “[h]ealth insurance marketplacesare part of the new health care law, sometimes called‘Obamacare’ or the ‘Affordable Care Act,’ where people canget insurance online, such as through healthcare.gov, overthe phone, or in person.” 7 “Insurer” here refers to insurers providing coverage underboth private insurance plans (such as those purchasedthrough an employer) and public plans (such as throughMedicaid or Medicare). HEALTH ENDNOTES | CHAPTER 7: HEALTH 125 ### Page 130 8 The “other insurance” category includes TRICARE or othermilitary coverage, VA, Indian Health Service, and other typesof insurance not listed. See Table 7.1. 9 Respondents were asked if they had “experienced unwantedsexual contact (such as fondling, sexual assault, or rape) in ahealth care setting (such as a hospital, office, clinic)” in Q.12.7. 10 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 11 Respondents on active duty in military service were askedseparately about where they received transition-relatedhealth care. These results are reported in the MilitaryService chapter. 12 Although 1.5% of respondents in the sample reported havingtaken puberty-blocking medication, the percentage reportedhere reflects a reduction in the reported value basedon respondents’ reported ages at the time of taking thismedication. While puberty-blocking medications are usuallyused to delay physical changes associated with puberty inyouth ages 9–16 prior to beginning hormone replacementtherapy, a large majority (73%) of respondents who reportedhaving taken puberty blockers in Q.12.9 reported doingso after age 18 in Q.12.11. This indicates that the questionmay have been misinterpreted by some respondents whoconfused puberty blockers with the hormone therapy givento adults and older adolescents. Therefore, the percentagereported here (0.3% or “less than 1%”) represents only the27% of respondents who reported taking puberty-blockingmedication before the age of 18. 13 “Transition-related surgery” here includes all procedureslisted in Table 7.4 and 7.5, with the exception of electrolysisand non-surgical voice therapy. 14 Respondents who are “living in poverty” represent thosewho are living at or near the poverty line. See the Incomeand Employment Status chapter for more information aboutthe poverty line calculation. 15 The “other insurance” category in Figure 7.11 includesTRICARE or other military coverage, VA, Indian HealthService, and other types of insurance not listed. See Table 7.1. 16 Since the available surgical procedures related to transitiongenerally vary based on individuals’ sex assigned at birth(the gender they were thought to be when they were born),respondents received different questions about surgicalprocedures based on their response to Q. 2.1, which askedabout the sex listed on respondents’ original birth certificate.Respondents who said that they had female on their originalbirth certificate received Q. 12.15, and respondents who saidthey had male on their original birth certificate received Q.12.18. Although the vast majority of respondents receivedonly questions about medical procedures available to them,2.7% of respondents indicated that they were intersex, anda portion of them may not have received questions about allthe surgical procedures that best fit their health care needs. 17 Respondents were asked about having “top/chest surgeryreduction or reconstruction” in Q. 12.15. 18 Respondents were asked about having a“hysterectomy/‘hysto’ (removal of the uterus, ovaries,fallopian tubes, and/or cervix)” in Q. 12.15. 19 Respondents were asked about having a “clitoral release/metoidioplasty/centurion procedure” in Q. 12.15. These aregenital procedures that separate the clitoris from the labia. 20 Respondents were asked about having a “phalloplasty(creation of a penis)” in Q. 12.15. This is a genital procedureinvolving the construction of a larger phallus. 21 The U.S. Preventive Services Task Force currentlyrecommends Pap smears every three years for adultswho have a cervix and are between the ages 21and 65. U.S. Preventive Services Task Force. (2012).Cervical Cancer: Screening. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening. 22 Centers for Disease Prevention and Control. (2016). 2015National Health Interview Survey: Sample Adult File.Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/samadult_freq.pdf 23 Respondents were asked about having a “vaginoplasty/labiaplasty/SRS/GRS/GCS” in Q. 12.18. A vaginoplasty isa surgical creation of a vagina. A labiaplasty is a surgicalmodification or construction of the labia. 24 Respondents were asked about having an“orchidectomy/‘orchy’/removal of the testes” in Q. 12.18. 25 Respondents were asked about having “facial feminizationsurgery (such as nose, brow, chin, cheek)” in Q.12.18. 26 Respondents were asked about having “breastaugmentation/top surgery” in Q. 12.18. This refers to anaugmentation mammoplasty, which reshapes or increasesthe size of the breast. 27 Respondents were asked about having a “tracheal shave(Adam’s apple or thyroid cartilage reduction)” in Q. 12.18. 28 Although silicone injections are sometimes used to modifyone’s appearance, they are often risky and can lead todisfigurement, injury, and even death. Such injections areillegal in the United States. However, due to barriers toaffordable care, some transgender people turn to siliconeinjections as a less expensive or more easily accessiblesubstitute for safer treatments. 29 See e.g., Pascoe, E. A. & Richman, L. S. (2009). Perceiveddiscrimination and health: A meta-analytic review.Psychological Bulletin, 135(4), 531–554. 30 See e.g., Bariola, E. Lyons, A., Leonard, W., Pitts, M., Badcock,P., Couch, M. (2015). Demographic and psychosocial factorsassociated with psychological distress and resilience amongtransgender individuals. American Journal of Public Health,105(10), 2108–2116; Nuttbrock, L., Brockting, W., Rosenblum,A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2014).Gender abuse and major depression among transgenderwomen: A prospective study of vulnerability and resilience. 2015 U.S. TRANSGENDER SURVEY 126 ### Page 131 American Journal of Public Health, 104(11), 2191, 2198;Bockting, W. O., Miner, M. H., Swinburne Romine, R. E.,Hamilton, A., & Coleman, E. (2013). Stigma, mental health,and resilience in an online sample of the US transgenderpopulation. American Journal of Public Health, 103(5), 943–951; Institute of Medicine. (2011). The Health of Lesbian, Gay,Bisexual, and Transgender People: Building a Foundation forBetter Understanding. DC: National Academy of Sciences. 31 The general health rating among adults in the U.S. populationwas calculated by the research team using data fromthe Behavioral Risk Factor Surveillance System (BRFSS).Centers for Disease Control and Prevention. (2015). BRFSSPrevalence & Trends Data. Available at: http://www.cdc.gov/brfss/brfssprevalence. 32 The Kessler Psychological Distress Scale, or K6, assessespsychological distress based on how often in the past 30days respondents felt: so sad that nothing could cheer themup, nervous, restless or fidgety, hopeless, that everythingwas an effort, or worthless. See Q. 12.2. See the NationalHealth Interview Survey for additional information aboutthe K6 mental health screening instrument and measure ofserious psychological distress in adults (available at: http://www.healthindicators.gov/Indicators/Serious-psychological-distress-adults-percent_50055/Profile). 33 The K6 scale rates how often feelings are experienced onthe following scale: (0) none of the time, (1) a little of the time,(2) some of the time, (3) most of the time, and (4) all of thetime. See Q. 12.2. A total score of 13 or above across all sixmeasures indicates serious psychological distress. 34 Centers for Disease Prevention and Control. (2016). 2015National Health Interview Survey: Sample Adult File.Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/samadult_freq.pdf. 35 See note 33 for an explanation of how “serious psychologicaldistress” is calculated based on the K6 scale. 36 Center for Behavioral Health Statistics and Quality.(2016). Results from the 2015 National Survey on Drug Useand Health: Detailed Tables. Table 8.86B. Rockville, MD:Substance Abuse and Mental Health Services Administration.Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf. 37 Serious psychological distress is related to age andeducational attainment in the U.S. general population.(see note 33; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a13.htm). Those who are youngerand have lower educational attainment have a higherprevalence of serious psychological distress. When the“supplemental weight” is applied to the USTS sample’sprevalence of serious psychological distress to adjust thesample to reflect the age and educational attainment of theU.S. adult population, the prevalence is reduced to 30%,six times the national prevalence for U.S. adults. Based onstudies using population-based samples of transgenderadults, it is estimated that the transgender population isyounger and has lower educational attainment than the U.S.adult population. Flores, A. R., Brown, T. N. T., & Herman,J. L. (2016). Race and Ethnicity of Adults who Identify asTransgender in the United States. Los Angeles, CA: WilliamsInstitute; Conron, K. J., Scott, G., Stowell, G. S., & Landers, S.J. (2012). Transgender health in Massachusetts: Results froma household probability sample of adults. American Journalof Public Health, 102(1), 118–122. Therefore, the finding of39% for prevalence of serious psychological distress isreported here using the standard weight only. 38 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.86B. See note 36. 39 Results for respondents who were sexually assaulted herereflect those who reported that they had “experiencedunwanted sexual contact (such as oral, genital, or analcontact or penetration, forced fondling, rape)” in the pastyear (see Q. 18.3). 40 Substance Abuse and Mental Health Services Administration.(2015). Ending Conversion Therapy: Supporting andAffirming LGBTQ Youth. Available at: http://store.samhsa.gov/shin/content//SMA15-4928/SMA15-4928.pdf. 41 Additionally, eleven percent (11%) of respondents in thesample said they were sent to a therapist, counselor, orreligious advisor by immediate family members to stop themfrom being transgender. See the “Sent to a Professional forBeing Transgender” section of the Family Life and FaithCommunities chapter for a discussion about respondentswho were sent to a professional by their family. 42 Although 0.4% of the overall sample reported that gendertransition was not for them, these respondents did identifyas transgender, meeting all criteria for inclusion in the survey(see Q. 1.10–1.18). 43 Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). SuicideAttempts Among Transgender and Gender Non-ConformingAdults. New York, NY & Los Angeles, CA; AmericanFoundation for Suicide Prevention & Williams Institute;Moody, C. & Smith, N. G. (2013). Suicide protective factorsamong trans adults. Archives of Sexual Behavior 42(5),739–752; Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J.,Herman, J. L., & Keisling, M. (2011). Injustice at Every Turn: AReport of the National Transgender Discrimination Survey. (p.82). DC: National Center for Transgender Equality & NationalGay and Lesbian Task Force. 44 Lipari, R., Piscopo, K., Kroutil, L. A., & Miller, G. K. (2015).Suicidal Thoughts and Behaviors Among Adults: Resultsfrom the 2014 National Survey on Drug Use and Health.Rockville, MD: Substance Abuse and Mental Health ServicesAdministration. 45 Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa,S., Hiripi, E., . . . Zheng, H. (2004). The US NationalComorbidity Survey Replication (NCS-R): design and fieldprocedures. International Journal of Methods in PsychiatricResearch, 13(2), 69–92. HEALTH 127 ### Page 132 46 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.70B. See note 36. 47 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.69B. See note 36. 48 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.70B. See note 36. 49 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.70B. See note 36. 50 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.70B. See note 36. 51 Whether or not a person receives medical attention followinga suicide attempt is often used as a measure of the severityof the attempt. However, because many transgender peoplereport avoiding medical professionals because of fear ofmistreatment (see, for example, the previous section on“Experiences with Health Care Providers”), it may be difficultto use this measure to gauge the severity of the attemptamong USTS respondents. 52 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.77B. See note 36. 53 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 8.77B. See note 36. 54 Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalenceof and risk factors for lifetime suicide attempts in the NationalComorbidity Survey. Archives of General Psychiatry, 56(7),617–626. See also Nock, M. K., Hwang, I., Sampson, N. A.,& Kessler, R. C. (2010). Mental disorders, comorbidity andsuicidal behavior: Results from the National ComorbiditySurvey Replication. Molecular Psychiatry, 15(8), 868–876;Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C.,& Lee, S. (2008). Suicide and suicidal behavior. EpidemiologicReviews, 30(1), 133–154 (finding a lifetime prevalence ofsuicide ideation of 5.6–14.3%, a lifetime prevalence forsuicide plans of 3.9%, a lifetime prevalence for suicideattempts of 1.9–8.7%). 55 Respondents who reported that they were out to all, most, orsome of the immediate family they grew up with were askedto assess how supportive their family was using a five-pointscale from “very supportive” to “very unsupportive”. Thecategories were collapsed to create a new variable reflectinga supportive, neutral, or unsupportive family. 56 Results for respondents who were sexually assaulted herereflect those who reported that they had “experiencedunwanted sexual contact (such as oral, genital, or analcontact or penetration, forced fondling, rape)” in theirlifetime (see Q.18.1). 57 The age of the most recent suicide attempt reported hereincludes responses from both respondents who reported asingle attempt and those who reported multiple attempts. Forrespondents who reported a single suicide attempt, the ageof the most recent suicide attempt is also the age of their firstsuicide attempt as reported in the previous section. 58 See e.g., Cleveland, M. J., Feinberg, M. E., Bontempo, D. E.,& Greenberg, M. T. (2008). The role of risk and protectivefactors in substance use across adolescence. Journal ofAdolescent Health, 43(2), 157–164; Kilpatrick, D. G., Ruggiero,K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C.L. (2003). Violence and risk of PTSD, major depression,substance abuse/dependence, and comorbidity: Results fromthe National Survey of Adolescents. Journal of Consultingand Clinical Psychology, 71(4), 692–700. 59 Center for Behavioral Health Statistics and Quality.(2015). 2015 National Survey on Drug Use and HealthQuestionnaire. Available at: http://www.samhsa.gov/data/population-data-nsduh/reports?tab=39. 60 Center for Behavioral Health Statistics and Quality. (2015).Results from the 2014 National Survey on Drug Use andHealth: Detailed Tables. Table 2.6B. Rockville, MD: SubstanceAbuse and Mental Health Services Administration. Availableat: http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf. 61 Results from the 2014 National Survey on Drug Use andHealth: Detailed Tables. Table 2.6B. See note 60. 62 This report follows the 2014 National Survey on Drug Useand Health (NSDUH) definition for binge drinking, whichis defined as “drinking five or more drinks on the sameoccasion on at least 1 day in the past 30 days.” As thisdefinition differs from the 2015 NSDUH definition, generalpopulation comparisons for binge and heavy drinking in thisreport will be drawn from the 2014 NSDUH data. Hedden,S. L., Kennet, J., Lipari, R., Medley, G., Tice, P., Copello, E. A.P., & Kroutil, L. A. (2015). Behavioral Health Trends in theUnited States: Results from the 2014 National Survey onDrug Use and Health. Rockville, MD: Substance Abuse andMental Health Services Administration. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. 63 Results from the 2014 National Survey on Drug Use andHealth: Detailed Tables. Table 2.46B. See note 60. 64 Results from the 2014 National Survey on Drug Use andHealth: Detailed Tables. Table 2.46B. See note 60. 65 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 2.28B. See note 36. 66 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 2.16B. See note 36. 67 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 6.7B. See note 36. 68 Respondents were instructed to include products such as“weed, joints, hashish, hash, or hash oil” when reportingon marijuana use. See Q. 15.1. 69 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 1.35B. See note 36. 70 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 1.35B. See note 36. 2015 U.S. TRANSGENDER SURVEY 128 ### Page 133 71 For the purposes of this report, “illicit drugs” include thosesuch as cocaine, crack, heroin, LSD, methamphetamine, andinhalants, but does not include marijuana or nonmedicaluse of prescription drugs. See Q. 15.1. This differs from illicitdrugs as reported in the NSDUH, which includes “the misuseof prescription psychotherapeutics or the use of marijuana,cocaine (including crack), heroin, hallucinogens, inhalants, ormethamphetamine.” Results from the 2015 National Surveyon Drug Use and Health: Detailed Tables. Table 1.30B. Seenote 36. Due to the difference between the two definitions, acomparison to the U.S. general population for the overall useof illicit drugs (not including marijuana or nonmedical use ofprescription drugs) is not possible. 72 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 1.22B. See note 36. 73 Results from the 2015 National Survey on Drug Use andHealth: Detailed Tables. Table 1.30B. See note 36. 74 Centers for Disease Control and Prevention. (2016). HIV andTransgender Communities. Available at: http://www.cdc.gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf; Baral, S.D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., &Beyrer, C. (2013). Worldwide burden of HIV in transgenderwomen: a systematic review and meta-anaylsis. The LancetInfectious Diseases, 13(3), 214–222; Grant, J. M., Mottet, L.A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011).Injustice at Every Turn: A Report of the National TransgenderDiscrimination Survey. (p. 80). DC: National Center forTransgender Equality & National Gay and Lesbian Task Force;Reisner, S. L., Poteat, T., Keatley, J., Cabral, M. Mothopeng, T.,Dunham, E., Holland, C. E., Max, R., Baral, S. D. (2016). Globalhealth burden and needs of transgender populations: areview. The Lancet Infectious Diseases, 388(10042), 412–436. 75 Centers for Disease Control and Prevention. (2016). HIVand Transgender Communities. Available at: http://www.cdc.gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf. 76 Centers for Disease Control and Prevention (2015).National Health Interview Survey: Survey Description.Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdf . 77 Centers for Disease Control and Prevention (2014). 2015Behavioral Risk Factor Surveillance System Questionnaire.Available at: http://www.cdc.gov/brfss/questionnaires/pdf-ques/2015-brfss-questionnaire-12-29-14.pdf. 78 Centers for Disease Control and Prevention. (2015). BRFSSPrevalence & Trends Data. Available at: http://www.cdc.gov/brfss/brfssprevalence. 79 Centers for Disease Control and Prevention. (2016).Behavioral Risk Factor Surveillance System: 2015Codebook Report. Available at: http://www.cdc.gov/brfss/annual_data/2015/pdf/codebook15_llcp.pdf. 80 Centers for Disease Prevention and Control. (2016). 2015National Health Interview Survey: Sample Adult File.Available at: https://www.cdc.gov/nchs/nhis/nhis_2015_data_release.htm. 81 Percentages related to HIV status are presented with onedecimal place throughout the section for more accuratecomparison with general population figures. 82 The rate of respondents living with HIV includes thosewho were HIV-positive or reactive. Among respondentswho had been tested, the rate of those who testedpositive for HIV was 2.6%. 83 Centers for Disease Control and Prevention. (2015). HIVSurveillance Report, 2014; vol. 26. Table 18a. Available at:http://www.cdc.gov/hiv/library/reports/surveillance/. The HIVSurveillance Report provides data for those who were livingwith diagnosed HIV infection in the U.S. population in 2013.The U.S. population data includes those who are 15 yearsof age and older and does not include rate for those whoare under 18, so it was not possible to exactly match theUSTS sample with the U.S. population data. However, whenestimating the impact of including 15–17 year olds in theU.S. population rate of those living with HIV, research teamcalculations estimated a difference of approximately 0.002%in the rate, which would not impact the rate of those livingwith HIV in the U.S. population as reported here. 84 Ninety-seven percent (97%) of those who were tested forHIV were HIV negative. 85 AIDS.Gov. (2015). HIV Care Continuum. Available at:https://www.aids.gov/federal-resources/policies/care-continuum. 86 Due to a low sample size, response figures could not bereported for those who had not seen a doctor for HIV carein the past 6 months. 87 Due to a low sample size, response figures could not bereported for those who had not seen a doctor for HIV carein the past 12 months. 88 See AIDS.Gov. (2015). Overview of HIV Treatments.Available at: https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/overview-of-hiv-treatments. 89 Centers for Disease Control and Prevention. (2016).Behavioral and Clinical Characteristics of PersonsReceiving Medical Care for HIV Infection–MedicalMonitoring Project, United States, 2013 Cycle (June 2013-May 2014). HIV Surveillance Special Report 16. Availableat: http://www.cdc.gov/hiv/pdf/statistics/systems/mmp/cdc-hiv-hssr-mmp-2013.pdf. HEALTH 129 ### Page 134 130 CHAPTER 8 Experiences at School Many schools provide supportive environments that promote learning and growth, whilesome schools can be unwelcoming and unsupportive for transgender students, whether inKindergarten through 12th grade (K–12), or in technical or higher education institutions (such asa college or university). Other studies have shown that many students feel unsafe and have been verballyharassed or physically attacked because of their transgender identity.1,2 Survey respondents were asked whether they were out or perceived as transgender in K–12 and in highereducation institutions. Those who said that they were out as transgender or that others thought they weretransgender were asked additional questions about negative experiences based on their transgenderstatus, including verbal harassment, physical and sexual assault, leaving school because of mistreatment,and expulsion. Throughout the chapter, notable differences in respondents’ experiences based ondemographic and other characteristics are reported. ### Page 135 131 Twelve percent (12%) of respondents were out as transgender at some point fromKindergarten through the 12th grade. More than three-quarters (77%) of respondents who were out or perceived astransgender in K–12 had one or more negative experiences, such as being verballyharassed, prohibited from dressing according to their gender identity, or physically orsexually assaulted. Fifty-four percent (54%) of people who were out or perceived as transgender in K–12were verbally harassed, and 24% were physically attacked. Seventeen percent (17%) of people who were out or perceived as transgender left aK–12 school because the mistreatment was so bad, and 6% were expelled. Twenty-four percent (24%) of people who were out or perceived as transgender incollege or vocational school were verbally, physically, or sexually harassed. I. Outness in K–12 Twelve percent (12%) of respondents reportedthat they were out as transgender at some pointbetween Kindergarten and the 12th grade (K–12). Ofthose who were not out as transgender, 28% saidthat they believed classmates, teachers, or schoolstaff thought they were transgender. All respondents, including those who were outor perceived as transgender in K–12, were alsoasked whether classmates, teachers, or schoolstaff thought or knew that they were lesbian, gay,bisexual, or queer (LGBQ) in K–12. Three-quarters(75%) believed that classmates, teachers, or schoolstaff thought or knew they were LGBQ. Youngerrespondents were much more likely to report thatclassmates, teachers, or staff in K–12 thought orknew they were LGBQ than older respondents,such as 18- to 24-year-olds (85%) in contrast to 45-to 64-year-olds (51%) (Figure 8.1). KEY FINDINGS ### Page 136 II. Treatment in K–12 Respondents who were out as transgender inK–12 or who said that others thought that theywere transgender received additional questionsabout negative experiences in K–12, such as beingverbally harassed, physically attacked, or expelled.Overall, 77% of those who were out or perceivedas transgender had one or more of these negativeexperiences, while only 23% did not have any ofthese experiences (Table 8.1). American Indian(92%), Middle Eastern (84%), and multiracial(81%) respondents (Figure 8.2) and people withdisabilities3 (82%) were more likely to have one ormore negative experiences. Poor treatment in school was associated with avariety of negative experiences. Respondents whowere out or perceived as transgender in K–12 andhad one or more negative experiences outlined inthis chapter were: • More likely to have attempted suicide (52%) thanthose who were out or perceived as transgenderand did not have any of these negativeexperiences (37%). • More likely to have experienced homelessness(40%) than those who were out or perceived astransgender and did not have any of the negativeexperiences (22%). • More likely to currently be experiencing seriouspsychological distress (47%) than those who wereout or perceived as transgender and did not haveany of the negative experiences (37%). • More likely to have ever worked in theunderground economy, such as in sex work ordrug sales (28%), compared with those who wereout or perceived as transgender and did not haveany of the negative experiences (18%). Table 8.1: Experiences of people who were out astransgender in K–12 or believed classmates, teachers, orschool staff thought they were transgender | Experiences | % of those who wereout or perceived astransgender | | - | - | | Verbally harassed because peoplethought they were transgender | 54% | | Not allowed to dress in a way that fittheir gender identity or expression | 52% | | Disciplined for fighting back againstbullies | 36% | | Physically attacked because peoplethought they were transgender | 24% | | Believe they were disciplined moreharshly because teachers or staffthought they were transgender | 20% | | Left a school because the mistreatmentwas so bad | 17% | | Sexually assaulted because peoplethought they were transgender | 13% | | Expelled from school | 6% | | One or more experiences listed | 77% | More than three-quarters (77%) ofthose who were out or perceivedas transgender had one or morenegative experiences at schoolbecause they were transgender,such as being verbally harassedor physically attacked. ### Page 137 a. Verbal Harassment More than half (54%) of people who were out orperceived as transgender in K–12 were verballyharassed because they were transgender. Verbalharassment differed among people of color,with American Indian (69%) and Middle Eastern(61%) respondents being more likely to have thisexperience, and Latino/a (52%) and Black (51%)respondents being less likely (Figure 8.3). b. Physical Attack Nearly one-quarter (24%) were physically attackedbecause of being transgender. Transgenderwomen (38%) were more likely to have beenphysically attacked than transgender men (20%)and non-binary people (16%) (Figure 8.4). AmericanIndian respondents (49%) were more than twice aslikely to have been physically attacked, and MiddleEastern (36%), multiracial (31%), and Black (28%)respondents were also more likely to have hadthis experience, in contrast to Latino/a (24%), white(23%), and Asian (17%) respondents (Figure 8.5). Nearly one-quarter (24%) ofthose who were out or perceivedas transgender in school werephysically attacked because ofbeing transgender. ### Page 138 c. Sexual Assault Thirteen percent (13%) of people who wereout or perceived as transgender in K–12 weresexually assaulted in school because they weretransgender.4 Transgender women (21%) andcrossdressers (18%) were more likely to have beensexually assaulted than transgender men (9%) andnon-binary people (10%) (Figure 8.6). Whether a respondent was sexually assaultedin K–12 varied by age, with older respondentssuch as 45- to 64-year-olds being more likely tohave been sexually assaulted (22%) than youngerrespondents such as 25- to 44-year-olds (16%)(Figure 8.7). In Our OwnVoices “I was constantly bullied andphysically assaulted by myclassmates. Teachers would oftensee it happen and make no moveto intervene. The harassmentcontinued, and I eventually had tochange high schools three times,each time just as bad as the last,until I finally gave up on publicschools.” “I’d get hit by soda cans, spit balls,and paper airplanes of hate mail.Teachers weren’t there or didn’t care.I had to avoid social interactionslike buses and school bathroomsbecause I didn’t feel safe.” “Every single day at college, Iwas harassed for being a visiblytrans woman. People slowed theircars down to stare at me, theyshouted slurs at me from their dormwindows, insulted me in class, anda lot more I’d rather not think about.It got so bad that I tried to kill myselftwice over the course of threemonths. Getting out of that schoolhas been the best thing to havehappened to me.” “In high school, the staff told me Icould not use the men’s bathroombecause I’d make other studentsuncomfortable, even though I wasout to everyone and none of thestudents were bothered by mygender.” ### Page 139 d. Left School Due to Harassment Seventeen percent (17%) of those who were out orperceived as transgender left a school becausethe mistreatment was so bad. Transgenderwomen (22%) were more likely to have left aschool because of mistreatment, in contrast totransgender men (15%) and non-binary people(15%) (Figure 8.8). American Indian (39%) and Middle Eastern (36%)respondents were more than twice as likely tohave left a school because the mistreatment wasso bad, and Black (22%) and multiracial (21%)respondents were also more likely to have left aschool for this reason (Figure 8.9). e. Expelled from School Six percent (6%) of people who were out orperceived as transgender were expelled fromschool. Transgender women were nearly twice aslikely to have been expelled, with one in ten (10%)reporting that experience (Figure 8.10). Further,respondents who were currently working in theunderground economy (18%) were three times aslikely to have been expelled from school. Seventeen percent (17%)of people who were out orperceived as transgender inK–12 left a school because themistreatment was so bad. 18% ### Page 140 III. Outness andTreatment in Collegeor Vocational School Of respondents who had attended college orvocational school, 46% said their classmates,professors, or staff at college or vocational schoolthought or knew they were transgender. Nearlyone-quarter (24%) of respondents who indicatedthat classmates, professors, or staff at collegeor vocational school thought or knew they weretransgender were verbally, physically, or sexuallyharassed. American Indian (37%), Black (28%),and Middle Eastern (27%) respondents were morelikely to have had these experiences, while white(23%), Latino/a (23%), and Asian (22%) respondentswere less likely (Figure 8.11). Of respondents who were out or perceived astransgender and who experienced some formof harassment, 16% left college or vocationalschool because the harassment was so bad.This represents 2% of all respondents whoattended a higher education institution. Of thosewho experienced some form of harassment,transgender women (21%) were more likely tohave left college or vocational school for thisreason than transgender men (16%) and non-binarypeople (12%) (Figure 8.12). Respondents currentlyworking in the underground economy were almosttwice as likely (31%) to have left college becauseof harassment than other respondents. AmericanIndian (23%), Latino/a (23%), Black (21%), andmultiracial (20%) respondents were more likely toreport leaving school for that reason (Figure 8.13). In addition to the 2% who left because theharassment was so bad, 1% of respondents whoattended college or vocational school wereexpelled or forced out, and 5% left because ofother reasons related to being transgender. 18% ### Page 141 IV. Current Outnessand Support ofClassmates In addition to questions about being out toclassmates at any time while they were in school,respondents were asked whether they currentlyhad classmates, and whether those classmatesknew that they were transgender. Of respondentswho currently had classmates, only 15% saidthat all of their classmates knew that they weretransgender, 10% said that most of them knew,28% said that some of them knew, and nearly half(47%) said that none of their classmates knew thatthey were transgender. Respondents who currently had classmates andreported that all, most, or some of their classmatesknew that they were transgender were askedhow supportive their classmates generally were ofthem as a transgender person. Responses weregiven on a five-point scale from “very supportive”to “very unsupportive.” The categories werecollapsed to create a new variable reflectingsupportive, neutral, or unsupportive classmates.5More than half (56%) reported that their classmateswere supportive, 39% had classmates that wereneither supportive nor unsupportive, and only 5%reported that their classmates were unsupportive(Table 8.2). Conclusion Results indicated that the majority of those whowere out or perceived as transgender in K–12had one or more negative experiences, and thatsuch experiences were correlated with a variety ofpoor outcomes, such as higher rates of attemptedsuicide, homelessness, and serious psychologicaldistress. Although negative experiences werereported at all age groups, results found that olderindividuals were less likely to have been out astransgender in K–12 than younger respondents,but when out, they were more likely to haveexperienced negative treatment in schools. Thisindicates that school environments have improvedfor transgender people over the years, thoughhigh rates of mistreatment were reported evenamong younger respondents. Additionally, results indicated that those whoattended college or another higher educationinstitution were out or perceived as transgenderat high rates. However, they also suggest thattransgender students in such institutions aresubject to harmful experiences that lead tonegative outcomes, such as having to leaveschool to avoid being harassed because of beingtransgender. More than half (56%) ofthose who had at least someclassmates who knew theywere transgender reportedthat their classmates weresupportive. ### Page 142 1 Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen,M. J. (2014). The 2013 National School Climate Survey:The Experiences of Lesbian, Gay, Bisexual andTransgender Youth in Our Nation’s Schools. New York,NY: Gay, Lesbian & Straight Education Network; Kosciw,J. G., Palmer, N. A., Kull, R. M., & Greytak, E. A. (2013).The effect of negative school climate on academicoutcomes for LGBT youth and the role of in-schoolsupports. Journal of School Violence, 12(1), 45–63. 2 Rankin, S. & Beemyn, G. (2012). Beyond a binary: Thelives of gender-nonconforming youth. About Campus,17(4), 2–10; Rankin, S., Weber, G., Blumenfeld, W., &Frazer, S. (2010). 2010 State of Higher Education forLGBT People. Charlotte, NC: Campus Pride. 3 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 4 This data is derived from responses to Q. 26.4, whererespondents were asked if they had “experiencedunwanted sexual contact because people thought [theywere] trans.” 5 “Very supportive” and “supportive” categories werecollapsed into a single “supportive” category. “Veryunsupportive” and “unsupportive” categories werecollapsed into a single “unsupportive” category. See Q.4.12. ENDNOTES | CHAPTER 8: EXPERIENCES AT SCHOOL ### Page 143 139 CHAPTER 9 Income andEmployment Status High rates of poverty, unemployment, and economic vulnerability among transgender people havebeen documented in prior research.1 These disparities can lead to numerous negative outcomesin housing, health, and many other aspects of life. The survey explored respondents’ employmentstatus and income sources with questions that were patterned on the Current Population Survey (CPS), asurvey used by the Bureau of Labor Statistics to assess economic indicators and the state of the labor forcein the United States.2,3 The questions were used to compare the income and employment experiencesof the USTS sample with those in the U.S. population.4 Notable differences in respondents’ experiencesbased on demographic and other characteristics are reported throughout the chapter. ### Page 144 140 The unemployment rate among respondents was 15%, three times higher than the U.S.unemployment rate at the time of the survey (5%). Nearly one-third (29%) of respondents were living in poverty, more than twice the rate inthe U.S. adult population (12%). One in eight (12%) respondents reported an annual household income between $1 and$9,999, three times higher than the U.S. adult population in this income bracket (4%). I. Employment Status Respondents were asked a series of questionsabout their current employment status. More thanone-third (35%) currently had a full-time job, 15%had at least one part-time job, 15% were self-employed, and 11% were students (Table 9.1). Ninepercent (9%) of those who were employed wereworking more than one full-time or part-time job,which represents 4% of the whole sample. Two percent (2%) of respondents were currentlyemployed doing sex work, selling drugs, or doingother work in the underground economy forincome. Of these, 60% indicated that they werecurrently looking for work that is not criminalized.5 Of those who were working either full time orpart time for an employer, 13% were members ofa labor union or an employee association similarto a union (representing 6% of the full sample),while another 2% of those who were working foran employer were not union members but werecovered by a union or employee associationcontract. This compares to 12% of wage and salaryworkers in the U.S. population who were membersof a union or were not union members but werecovered by a union or employee associationcontract.6 Table9.1: Current employment status | Employment status | % of respondents(supplementalweight) | | - | - | | Work full time for an employer | 35% | | Work part time for an employer | 15% | | Self-employed in own business,profession or trade, or operate a farm(not including underground economy) | 15% | | Retired | 14% | | Not employed due to disability | 13% | | Student | 11% | | Unemployed but looking for work | 11% | | Unemployed and have stoppedlooking for work | 5% | | Homemaker or full-time parent | 3% | | Work for pay from sex work, sellingdrugs, or other work currentlycriminalized | 2% | | Not listed above | 4% | The national unemployment rate, as reported bythe Bureau of Labor Statistics, is calculated out ofonly those who are currently “in the labor force.”This includes people who are employed andthose who are unemployed but looking for work.It does not include those who are unemployed butnot looking for work, since they are consideredto be out of the labor force. For the purposes ofcomparison, the unemployment rate for USTSrespondents reported here was calculated inthe same manner. The unemployment rate for KEY FINDINGS ### Page 145 USTS respondents was 15%, three times the U.S.unemployment rate at the time of the survey (5%).7Nearly one-half (49%) of undocumented residentswere unemployed. The unemployment rate wasalso higher among people with disabilities8 (24%)and people of color, with Middle Eastern (35%),American Indian (23%), multiracial (22%), Latino/a(21%), and Black (20%) respondents being morelikely to be unemployed. Unemployment ratesamong Asian, multiracial, Latino/a, and Black USTSrespondents were between two and three timeshigher than Asian, Latino/a, multiracial, and Blackpeople in the U.S. population (Figure 9.1).9 II. Sources of Incomeand Assistance Respondents were asked about their incomesources, and they reported a wide range of sources.In order to compare the USTS sample to the U.S.population in the CPS, the USTS data presentedin Table 9.2 is limited to respondents ages 25 andolder only. Compared to findings from the CPS,respondents’ sources of income differed from theU.S. population in several categories. For instance,57% of USTS respondents aged 25 and olderhad income from their own and/or their spouse’semployment, compared to 67% of adults aged 25and older in the U.S. population (Table 9.2). Table9.2: Current sources of income(ages 25 and older only) | Income source | % in USTS(supplementalweight) | % in U.S.adultpopulation(CPS) | | - | - | - | | Pay from respondent’s and/or partner’sfull-time or part-time job | 57% | 67% | | Self-employment income from ownbusiness, profession or trade, or farm(not including underground economy) | 18% | 7% | | Social Security retirement, railroadretirement income, or Social Securitydisability benefits (SSDI) | 25% | 25% | | Private pension, government employeepension, or other retirement income | 13% | 13% | | Income from dividends, estates ortrusts, royalties, rental income, savings,or bonds | 12% | 61% | | Supplemental Security Income (SSI) | 7% | 3% | | Regular contributions from people notliving in household | 4% | 1% | | Veterans disability benefits and otherveterans benefits | 4% | 2% | | Pay from sex work, selling drugs, orother work currently criminalized | 3% | -- | | Cash assistance from welfare (such asTANF) or other public cash assistanceprogram (not including SNAP or WIC) | 2% | 1% | | Unemployment benefits | 2% | 2% | | Child support or alimony | 1% | 2% | | Workers’ compensation or otherdisability | 1% | 1% | | Income not listed above | 9% | -- | The unemployment rate forUSTS respondents was 15%,three times the unemploymentrate in the U.S. population. *U.S. population data for Middle Eastern people alone is not available. See note 10. ### Page 146 Responses were examined to determine whetherrespondents had one source of income or multiplesources. Nearly one-half (45%) of all respondentsreported having multiple sources of income.Thirty-seven percent (37%) reported that their solesource of income was from their own employmentor their partner’s employment. Nearly one in ten(9%) reported that their sole source of income wasSupplemental Security Income (SSI) or disability,1% received their only income from unemploymentbenefits or cash assistance programs, and 1%reported that their sole source of income wasfrom underground economy work, including sexwork, drug sales, or other work that is currentlycriminalized (Table 9.3). Table9.3: Current sources of income by single and multiple sources | Income source | % of respondents(supplementalweight) | | - | - | | Employment only (from their ownemployment, partner/spouse’semployment, or self-employment) | 37% | | SSI/disability only | 9% | | Pension/retirement only | 3% | | Other sources only | 3% | | Pay from sex work, selling drugs,or other work that is currentlycriminalized only | 1% | | Unemployment benefits/cashassistance only | 1% | | Multiple sources | 45% | Fifteen percent (15%) of respondents reportedreceiving assistance through food stamps(SNAP)11 and/or WIC.12 Forty-one percent (41%) ofrespondents living with HIV received SNAP and/orWIC assistance. People with disabilities (29%), andBlack (23%), American Indian (19%), and Latino/a(18%) respondents were also more likely to receiveSNAP and/or WIC assistance (Figure 9.2). III. Individual andHousehold Incomeand Poverty Respondents also received questions about theirindividual13 and household14 incomes from theyear 2014, which was the last full year prior to thesurvey for which they could provide annual incomefigures. They reported lower incomes overall thanthe U.S. population as a whole, as well as higherpoverty rates. Most of the analysis and reporting inthis chapter focuses on household income. a. Individual Income When asked about their individual income,8% of respondents reported that they had noindividual income, compared to 10% in the U.S.adult population.15,16 Nearly one-quarter (22%) ofrespondents reported that they had an incomebetween $1 and $9,999 per year, compared to 15%in the U.S. adult population (Figure 9.3).17 One in eight (12%) respondents reported that they had ahousehold income between $1 and $9,999 per year, three timesthe rate in the U.S. population (4%). ### Page 147 b. Household Income Turning to household income, 4% of respondentsreported that they had no household income,which was four times higher than the rate ofthose with no income in the U.S. adult population(12%).18 Additionally, one in eight (12%) respondentsreported earning an annual household incomebetween $1 and $9,999, which was three times asmany when compared to the U.S. adult population(4%) (Figure 9.4).19 Respondents were nearly twiceas likely to have a household income of only$10,000 to $24,999 (22%) as those in the U.S.adult population (12%). Furthermore, respondentswere less likely to have household incomes of$50,000 to $100,000 (23%) than those in the U.S.adult population (31%). In Our OwnVoices “The day I came out as transgenderat work, I was let go. Sincetransitioning, employment has beendifficult, with a 95% reduction inearnings.” “I quit after seven months ofunbearable working conditions. Ihave been struggling to keep afloatfinancially. I’m afraid of going toapply for unemployment or SNAPbenefits because I know that I willbe discriminated against. I’m on thebrink of being homeless and myown family hasn’t even reached outto help me.” “I have had to live my life withno safety net or resources, andit’s hard. I’m constantly battlinghomelessness, I rarely get hiredbecause I’m mixed and visiblyqueer, and I end up having to relyon government assistance andfriends with available couches.” “In the nearly seven yearssince I transitioned, I have beenunemployed, surviving off thecharity of friends and family, andgovernment assistance when Icould get it. I have over 20 yearsof experience in my field, yet Icannot even land a part-time retailposition.” Nearly one-third (29%) ofrespondents were living inpoverty, more than twice therate in the U.S. population (12%). Figure 9.3: Individual income in 2014 30% 25% 20% 15% 10% 5% 0% 25% 25% 24% 22% 21% 18% 15% 15% 10% 9% 8% 8% $100,000 or more $50,000 to $99,999 $25,000 to $49,999 $10,000 to $24,999 $1 to $9,999 No income % in USTS (supplemental weight) % in U.S. adult population (CPS) ### Page 148 More than half (53%) of respondents whose solesource of income was from the undergroundeconomy had a household income between$1 and $9,999 per year, more than four timesthe rate in the overall sample. Nearly one-third(31%) of those who were currently working in theunderground economy and also had additionalsources of income reported this low householdincome, nearly three times the rate of the overallsample. People with disabilities (21%) were nearlytwice as likely as the overall sample, and thoseliving with HIV (19%) and people of color, includingBlack (19%), Latino/a (18%), and American Indian(16%) respondents, were also more likely to have ahousehold income between $1 and $9,999(Figure 9.5). c. Poverty Nearly one-third (29%) of respondents were livingin poverty,20 more than twice the rate of peopleliving in poverty in the U.S. adult population at thetime of the survey (12%).21 More than two-thirds (69%) of undocumentedresidents and nearly two-thirds (62%) of thosecurrently working in the underground economywere living in poverty. Respondents living with HIV(51%) and people with disabilities (45%) were alsomore likely to be living in poverty. Among peopleof color, Latino/a (43%), American Indian (41%),multiracial (40%), and Black (38%) respondentswere most likely to be living in poverty (Figure 9.6). Figure 9.4: Household income in 2014 35% 30% 25% 20% 15% 10% 5% 0% 31% 31% 24% 23% 22% 21% 15% 12% 12% 4% 4% 1% $100,000 or more $50,000 to $99,999 $25,000 to $49,999 $10,000 to $24,999 $1 to $9,999 No income % in USTS (supplemental weight) % in U.S. adult population (CPS) ### Page 149 Conclusion The results indicate that respondents faced higherlevels of unemployment and poverty compared tothe U.S. adult population. They were three timesmore likely than the U.S. adult population to beunemployed, more than twice as likely to be livingin poverty, and more than three times as likely tohave an annual household income below $10,000.People of color, undocumented residents, peoplewith disabilities, and respondents living with HIVwere more likely to report being unemployed,living in poverty, and having low incomes, whichindicate that these respondents have experiencedsubstantial economic instability. 1 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2011). Injustice at Every Turn: A Reportof the National Transgender Discrimination Survey. (p.22). DC: National Center for Transgender Equality &National Gay and Lesbian Task Force; Center for AmericanProgress & Movement Advancement Project. (2015).Paying an Unfair Price: The Financial Penalty for BeingTransgender in America. Available at: http://www.lgbtmap.org/file/paying-an-unfair-price-transgender.pdf. 2 U.S Census Bureau & Bureau of Labor Statistics. (2015).Current Population Survey (CPS). 3 This chapter provides an overview of respondents’income and employment status. Experiences in specificfields of work are discussed further in the Sex Work andOther Underground Economy Work and Military Servicechapters. Experiences in employment settings, such beingfired or harassed in the workplace, are discussed in moredetail in the Employment and the Workplace chapter. 4 Throughout this chapter, findings regarding respondents’income and employment have been weighted witha supplemental survey weight to reflect the age andeducational attainment of the U.S. population in additionto the standard survey weight. The USTS sample differssubstantially from the U.S. population in regard to age andeducational attainment. Therefore, this additional weightis applied to all percentages reported in this chapter inorder to provide a more accurate comparison to the U.S.general population. See the Methodology and Portrait ofUSTS Respondents chapters for more information aboutthe supplemental survey weight. 5 Experiences of respondents with sex work and otherunderground economy work are discussed further in theSex Work and Other Underground Economy Work chapter. 6 Bureau of Labor Statistics. (2016). Union Affiliationof Employed Wage and Salary Workers by SelectedCharacteristics, 2014–2015 Annual Averages. Available at:http://www.bls.gov/news.release/union2.t01.htm#union_a01.f.1. The percentage of people in the U.S. who aremembers of a union or covered by a union or employeeassociation contract includes those in the U.S. populationwho are 16 years of age and older, in contrast to the USTSsample, which includes respondents who are 18 and older.Therefore, the comparison to the USTS sample should beinterpreted with caution. 7 Bureau of Labor Statistics. (2015). The EmploymentSituation—August 2015. Available at: http://www.bls.gov/news.release/archives/empsit_09042015.pdf; Bureauof Labor Statistics. (2015). The Employment Situation—September 2015. Available at: http://www.bls.gov/news.release/archives/empsit_10022015.pdf. The nationalunemployment rate for August and September 2015, aspublished by the Bureau of Labor Statistics, includes those ENDNOTES | CHAPTER 9: INCOME AND EMPLOYMENT STATUS ### Page 150 in the U.S. population who are 16 years of age and older.The USTS sample includes respondents who are 18 andolder. Therefore, the comparison between the nationalunemployment rate and the USTS unemployment ratesample should be interpreted with caution. 8 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 9 The unemployment rate by race and ethnicity amongadults in the U.S. population was calculated by the researchteam using CPS data available via the CPS Table Creator(http://www.census.gov/cps/data/cpstablecreator.html).CPS Table Creator data utilizes data from the March 2015Current Population Survey Annual Social and EconomicSupplement, in which the overall U.S. unemploymentrate was 5.5%. This March 2015 national unemploymentrate was higher than the national rate at the time of thesurvey (5.1% in August and September 2015), as outlinedin this report (see the unemployment rate time series tableavailable through the Bureau of Labor Statistics, availableat http://data.bls.gov/timeseries/LNS14000000). Giventhe higher national unemployment rate in March 2015, thecomparison of the national unemployment rate by race andethnicity to the unemployment rate for USTS respondentsby race and ethnicity as reported here likely reflectssmaller differences in the unemployment rate than wouldhave existed at the time of the survey. Therefore, thesecomparisons should be interpreted accordingly. 10 CPS data combines people of Middle Eastern descentand white people in a single “white/Caucasian” category,therefore Middle Eastern respondents in the U.S. populationare included in the CPS percentage for this category. 11 See Q. 7.10. Respondents received the following definitionfor SNAP: “The Supplemental Nutrition AssistanceProgram (SNAP) is sometimes called the Food Stampprogram. It helps people who have low or no income tobuy food, usually with an EBT card.” SNAP benefits are notconsidered income. 12 See Q. 7.10. Respondents received the following definitionfor WIC: “‘WIC’ stands for ‘Women, Infants, and Children.’It’s the short name for the Special Supplemental NutritionProgram for Women, Infants, and Children. WIC is a federalprogram to help women who are pregnant or breastfeedingand children less than five years old get health care andhealthy food.” WIC benefits are not considered income. 13 See Q. 7.12. Respondents received the following notedescribing individual income: “‘Individual income’includes money from jobs, employment, net income frombusiness, income from farms or rentals, income from self-employment, pensions, dividends, interest, social securitypayments, and other money income that you personallyreceived in 2014. Do not include assistance from foodstamps (SNAP) or WIC as income.” 14 See Q. 7.14. Respondents received the following notedescribing household income: “‘Household income’includes you and all members of your household whohave lived with you during the past 12 months andincludes money from jobs, employment, net income frombusiness, income from farms or rentals, income from self-employment, pensions, dividends, interest, social securitypayments, and any other money income received by youand members of your household who are 15 years of age orolder in 2014. Do not include assistance from food stamps(SNAP) or WIC as income.” 15 Current Population Survey (CPS). See note 2. 16 Those who report having “no income” in the USTS andCPS are a group with characteristics that are distinct fromlow-income earners, such as those who earn an incomebetween $1 and $9,999. For example, they are more likelyto be out of the labor force. Therefore, when differences inexperiences by income level are highlighted in this report,the experiences of those who report no household incomeare generally presented separately from those of low-income earners. 17 Current Population Survey (CPS). See note 2. 18 Current Population Survey (CPS). See note 2. 19 Current Population Survey (CPS). See note 2. 20 The research team calculated the USTS poverty measureusing the official poverty measure, as defined by the U.S.Census Bureau, which can be found at: https://www.census.gov/hhes/www/poverty/about/overview/measure.html.The income ranges in the USTS allowed for designation ofrespondents as in or near poverty if their total family incomefell below 125% of the official poverty measure for purposesof comparison to the U.S. adult population. Respondentswho are “living in poverty” represent those who are living ator near the poverty line. 21 Proctor, B. D., Semega, J. L., & Kollar, M. A. (2016). Incomeand Poverty in the United States: 2015. (p. 13). DC: U.S.Census Bureau. Available at: https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-256.pdf. Calculations were completed by the researchteam. ### Page 151 147 CHAPTER 10 Employment andthe Workplace Access to employment is critical to people’s ability to support themselves and their families. Priorresearch has shown that transgender people face pervasive mistreatment, harassment, anddiscrimination in the workplace and during the hiring process.1 In addition to being fired, forcedout of their jobs, or not hired for jobs because of their gender identity or expression, transgender peopleare also often subject to additional forms of mistreatment at work, such as being verbally harassed, beingforced to present as the wrong gender in order to keep their jobs, or being physically attacked at work.2 Respondents were asked about being out in the workplace and the level of support they received fromcoworkers. They were also asked how they were treated in the workplace as a transgender person,including whether they had been fired, denied a promotion, or not hired because of being transgender,whether they had been harassed or faced other forms of mistreatment, and whether they had to takeactions to avoid mistreatment, such as quitting their job or delaying their transition. Throughout the chapter,notable differences in respondents’ experiences based on demographic and other characteristics arereported. ### Page 152 148 Sixteen percent (16%) of respondents who have ever been employed reported losing atleast one job because of their gender identity or expression. Thirty percent (30%) of respondents who had a job in the past year reported being fired,denied a promotion, or experiencing some other form of mistreatment in the workplacerelated to their gender identity or expression, such as being harassed or attacked. In the past year, 27% of those who held or applied for a job reported being fired, denieda promotion, or not hired for a job they applied for because of their gender identity orexpression. Fifteen percent (15%) of respondents who had a job in the past year were verballyharassed, physically attacked, and/or sexually assaulted at work because of theirgender identity or expression. Nearly one-quarter (23%) of those who had a job in the past year reported other formsof mistreatment based on their gender identity or expression during that year, such asbeing told by their employer to present as the wrong gender in order to keep their jobor having employers or coworkers share private information about their transgenderstatus with others without permission. More than three-quarters (77%) of respondents who had a job in the past year tooksteps to avoid mistreatment in the workplace, such as hiding or delaying their gendertransition or quitting their job. I. Outness andSupport in theWorkplace Respondents were asked whether their currentbosses or supervisors and their current coworkersknew they were transgender. Of respondents whocurrently had bosses or supervisors, 35% said thatall of their current bosses or supervisors knewthey were transgender, 6% reported that mostknew, and 10% indicated that some knew that theywere transgender. Nearly half (49%) reported thatnone of their bosses or supervisors knew that theywere transgender. Of respondents who currentlyhad coworkers, less than one-quarter (23%)reported that all of their coworkers knew theywere transgender, 11% reported that most of theircoworkers knew, and 24% said that some of theircoworkers knew they were transgender. Forty-two percent (42%) indicated that none of theircoworkers knew that they were transgender. Respondents who currently had coworkers andreported that all, most, or some of their coworkersknew that they were transgender were askedhow supportive their coworkers generally wereof them as a transgender person.3 Responseswere provided on a five-point scale from “very KEY FINDINGS ### Page 153 supportive” to “very unsupportive.” More thantwo-thirds (68%) of these respondents reportedthat their coworkers were supportive, 29% hadcoworkers who were neither supportive norunsupportive, and only 3% had unsupportivecoworkers (Figure 10.1). II. Loss ofEmployment DuringLifetime Eighty-one percent (81%) of respondents hadworked at a job or business at some point in theirlifetime.4 Those respondents were asked whetherthey had ever experienced a loss of employment,including losing a job, being laid off, being fired,or being forced to resign, and the reasons theybelieved this happened. Overall, more than half (53%) of respondentswho had ever held a job experienced a loss ofemployment for any reason. Respondents whowere living with HIV (78%) and those who havedone sex work (73%) were more likely to havelost a job at some point in their lifetime. AmericanIndian (66%) and Black (60%) respondents (Figure10.2), transgender women (66%), and people withdisabilities5 (59%) were also more likely to haveever lost a job. Respondents who had lost a job at some point intheir lifetime were asked what they believed thereasons were for that treatment, and they selectedone or more reasons from a list, such as age, raceor ethnicity, and gender identity or expression(Table 10.1). Table 10.1: Reported reasons for losing a job | Reason for losing job | % of thosewho have everlost job | % of thosewho havebeenemployed | | - | - | - | | Age | 7% | 4% | | Disability | 13% | 7% | | Income level or education | 5% | 2% | | Gender identity orexpression | 30% | 16% | | Race or ethnicity | 5% | 3% | | Religion or spirituality | 2% | 1% | | Sexual orientation | 13% | 7% | | None of the above | 61% | 32% | One in six (16%) respondents who have beenemployed reported that they had lost a jobbecause of their gender identity or expression.6This represents 13% of the overall sample. ### Page 154 American Indian (21%), multiracial (18%), andBlack (17%) respondents were more likely thanthe overall sample to have lost a job because oftheir gender identity or expression (Figure 10.3).More than one-quarter of respondents who havedone sex work (27%) and respondents livingwith HIV (26%) have lost a job because of beingtransgender. Transgender women (18%) were morelikely than transgender men (14%) and non-binarypeople (7%) to have lost a job because of theirgender identity or expression (Figure 10.4). III. Firing, Hiring, andPromotions in thePast Year Seventy percent (70%) of respondents hadheld and/or applied for a job in the past year.Those respondents were asked if they hadnegative experiences related to firing, hiring, andpromotions in the past year. Overall, approximately two-thirds (67%) ofrespondents who held or applied for a job in thepast year reported that they were fired or forcedto resign from a job, not hired for a job that theyapplied for, and/or denied a promotion (Table 10.2).Respondents currently working in the undergroundeconomy, such as sex work, drug sales, or otherwork that is currently criminalized (78%), andpeople with disabilities (75%) were more likely tohave had one or more of these experiences in thepast year. Black (75%) and Middle Eastern (74%)respondents were also more likely to have hadone or more of these experiences in the past year,in contrast to white (63%) and American Indian(64%) respondents (Figure 10.5). Table 10.2: Fired, not hired, or denied a promotion forany reason in the past year | Occurrence in the past year | % of those who held orapplied for job | | - | - | | Not hired for a job theyapplied for | 61% | | Denied a promotion | 13% | | Fired or forced to resign | 12% | | One or more experienceslisted | 67% | More than one-quarter (27%) of those who held or applied for a jobin the past year reported not being hired, being denied a promotion,or being fired during that year because of their gender identity orexpression. ### Page 155 Respondents who reported these experiences wereasked what they believed the reasons were for thattreatment. Forty-one percent (41%) of respondents whowere fired or forced to resign from a job, not hired fora job that they applied for, or were denied a promotionbelieved that it was due to their gender identity orexpression (Table 10.3). This means that 27% of all ofthose who held or applied for a job in the past year (or19% of the overall sample) reported not being hired fora job they applied for, being denied a promotion, orbeing fired from a job in the past year because of theirgender identity or expression. Table 10.3: Reported reasons for not being hired, beingdenied a promotion, or being fired in the past year | Reported reasonsfor negativeexperience in thepast year | Reasonsfor notbeinghired (% ofthose nothired) | Reasonsfor beingdeniedpromotion(% of thosedeniedpromotion) | Reasons forbeing fired(% of thosefired) | | - | - | - | - | | Age | 21% | 16% | 6% | | Disability | 7% | 9% | 15% | | Income level oreducation | 21% | 13% | 6% | | Gender identity orexpression | 39% | 49% | 43% | | Race or ethnicity | 11% | 14% | 10% | | Religion orspirituality | 1% | 3% | 2% | | Sexual orientation | 10% | 16% | 14% | | None of the above | 41% | 33% | 40% | In Our OwnVoices “Coworkers would gossip aboutme as news about my trans statusspread through the workplace. I wastreated significantly differently oncepeople heard about me being trans.Coworkers felt they had the right todisrespect me because the ownersset the tone. I became a spectacle inmy own workplace.” “The day before I started work, HRsent a mass email to everyone in theoffice ‘warning’ them about my transstatus. I used the women’s bathroomsince starting, but a month in to thejob, I was called to my manager’soffice and told that I could not usethe women’s bathroom. I did notfeel safe in the men’s bathroom, so Itold the HR manager that due to citylaw, I could not be denied access tothe bathroom matching my genderidentity. I was fired the next day forno given reason.” “I changed jobs from a high-payingone where I was not comfortablebeing out as a trans person to amuch lower-paying one where I feltthat my identity would be respected.Having a job where my genderidentity is respected consistently,where I don’t have to constantlyfight for myself or hide myself, hasimproved my quality of life more thanany other aspect of my transition.” ### Page 156 IV. Responsesto Firing Due toTransgender Status Respondents who reported that they had beenfired in the past year because of their genderidentity or expression were asked how theyresponded. While more than two-thirds (69%)of these respondents did not take any formalaction in response, 14% filed an official complaint(Table 10.4). Respondents who filed a complaintwere asked where they filed it. More than half(53%) reported that they filed a complaint withtheir employer’s human resources or personneldepartment. One-third (33%) of respondents whofiled complaints did so with the federal EqualEmployment Opportunity Commission (EEOC),the agency that enforces federal employmentnondiscrimination laws (Table 10.5). Table 10.4: Response to being fired in the past yearbecause of their gender identity or expression | Response to being fired | % of those fired becauseof their gender identity orexpression | | - | - | | They did nothing | 69% | | They contacted a lawyer (seeTable 10.6) | 15% | | They made an officialcomplaint (see Table 10.5) | 14% | | They contacted atransgender, LGBT, or othergroup | 10% | | They contacted their unionrepresentative | 2% | | Not listed above | 7% | Table 10.5: Location where respondent made anofficial complaint | Place complaint was filed | % of those who filed anofficial complaint | | - | - | | Employer’s human resources orpersonnel department | 53% | | Equal Employment OpportunityCommission (EEOC) | 33% | | Employer’s Equal EmploymentOpportunity (EEO) office | 18% | | Local or state human rightscommission | 17% | | Supervisor or manager | 9% | | Not listed above | 26% | Fifteen percent (15%) of those who were fired inthe past year because of their gender identity orexpression responded by contacting a lawyer.These respondents were asked what happenedafter they contacted the lawyer. Nearly one-third(29%) reported that they were not able to hirethe lawyer. Other respondents reported that thelawyer filed a lawsuit (21%), helped them file anofficial complaint (14%), called or wrote a letter totheir employer (10%), or advised them not to takeany action (10%) (Table 10.6). Table 10.6: Assistance provided to those whocontacted a lawyer | Outcome of contacting lawyer | % of those whocontacted a lawyer | | - | - | | They were not able to hire thelawyer | 29% | | Lawyer filed a lawsuit | 21% | | Lawyer helped them to file anofficial complaint | 14% | | Lawyer called or wrote a letter toemployer | 10% | | Lawyer advised them to take noaction (write-in response) | 10% | | Lawyer did nothing or did not followup (write-in response) | 7% | | Not listed above | 9% | ### Page 157 V. Other Formsof Mistreatmentin the Past Year Respondents who held a job in the past year wereasked a series of questions about other formsof mistreatment in the workplace that happenedbecause they were transgender. a. Verbal Harassment, PhysicalAttack, and Sexual Assault In the past year, 15% of respondents who had helda job during that year were verbally harassed,physically attacked, and/or sexually assaultedat work because of their transgender status.7Respondents currently working in the undergroundeconomy (34%), American Indian respondents(28%), and Middle Eastern respondents (26%)were more likely to report one or more of thoseexperiences in the past year (Figure 10.6). Fourteen percent (14%) of those who held a jobin the past year were verbally harassed at workbecause they were transgender. Respondentswho said that others can always or usually tellthat they are transgender (23%) were more likelyto be verbally harassed at work in the past year,compared with those who said that others cansometimes (19%) and rarely or never (10%) tell theyare transgender. One percent (1%) of respondents were physicallyattacked at work in the past year because theywere transgender, with higher numbers amongrespondents who were currently working in theunderground economy (4%). One percent (1%) reported that they were sexuallyassaulted at work in the past year because theywere transgender. Asian (4%) and American Indian(2%) respondents and transgender women (2%)were more likely report this experience. b. Other Mistreatmentin the Past Year Respondents were asked if their employer, boss,or coworkers took other negative actions in thepast year because of their transgender status,such as telling them to present as the wronggender in order to keep their jobs, removing themfrom direct contact with clients, or sharing privateinformation. Nearly one-quarter (23%) of respondents whoheld a job in the past year reported that theyexperienced one or more of those actions in thepast year because of their transgender status.One in six (16%) said that, because they weretransgender, a boss or coworker shared personalinformation about them that should not havebeen shared. Six percent (6%) said that their bossgave them a negative review because they weretransgender, 4% were told to present in the wronggender in order to keep their job, and 4% saidthat they were not allowed to use the restroomconsistent with their gender identity (Table 10.7). ### Page 158 Table 10.7: Mistreatment at work due to beingtransgender in the past year | Mistreatment at work due to beingtransgender in the past year | % of those whohad a job | | - | - | | Employer/boss or coworkers sharedinformation about them they shouldnot have | 16% | | Employer/boss gave them a negativejob review | 6% | | Employer/boss forced them to resign | 4% | | Employer/boss did not allow them touse the restroom they should be usingbased on their gender identity | 4% | | Employer/boss told them to present inthe wrong gender to keep their job | 4% | | Employer/boss removed them fromdirect contact with clients, customers,or patients | 3% | | Employer/boss could not work out anacceptable restroom situation withthem | 3% | | Employer/boss forced them to transferto a different position or departmentat their job | 2% | | One or more experiences listed | 23% | c. Efforts to Avoid Discrimination Respondents who held a job in the past year werealso asked a series of questions about actions theytook in order to avoid discrimination at work in thepast year, including hiding their gender identity,delaying their transition, and quitting their job.More than three-quarters (77%) took one or moreactions to avoid discrimination (Table 10.8). Table 10.8: Actions taken to avoid anti-transgenderdiscrimination at work in the past year | Actions taken to avoid anti-transgenderdiscrimination at work in the past year | % of those whohad a job | | - | - | | They had to hide their gender identity | 53% | | They did not ask employer to use pronounsthey prefer (such as he, she, or they) | 47% | | They delayed their gender transition | 26% | | They stayed in a job they would have preferredto leave | 26% | | They hid the fact that they had alreadytransitioned gender | 25% | | They kept a job for which they wereoverqualified | 24% | | They quit their job | 15% | | They did not seek promotion or raise | 13% | | They requested transfer to a different positionor department | 6% | | One or more experiences listed | 77% | Respondents who were living in poverty8 (82%),non-binary respondents (81%), and people withdisabilities (81%) were more likely to take one ormore of these steps to avoid discrimination. More than half (53%) reported having to hide theirgender identity at work.9 Nearly half (47%) saidthey did not ask their employer to refer to themwith correct pronouns (such as he, she, or they) outof fear of discrimination. Non-binary respondents(66%) were nearly twice as likely to avoid asking tobe referred to by their correct pronouns comparedto transgender men and women (34%). More than one-quarter (26%) said that theystayed at a job that they would have preferredto leave for fear of encountering discriminationelsewhere. American Indian (40%), Black (31%), andLatino/a (28%) respondents and respondents withdisabilities (30%) were more likely to stay at a jobthat they would have preferred to leave in order toavoid discrimination. More than three-quarters(77%) of respondents who hada job in the past year hid theirgender identity at work, quittheir job, or took other actionsto avoid discrimination. ### Page 159 One-quarter (25%) of respondents reported thatthey hid the fact that they had already transitioned.In the past year, more than one-third (36%) oftransgender men hid their past gender transitionin the workplace in order to avoid discrimination(Figure 10.7). Fifteen percent (15%) of respondents who held ajob in the past year reported that they quit their jobin order to avoid workplace discrimination. Thosecurrently working in the underground economy(28%), American Indian respondents (23%), Blackrespondents (19%), and people with disabilities(21%) were more likely to quit their job to avoiddiscrimination (Figure 10.8). VI. Overall NegativeExperiences in theWorkplace Overall, 30% of all respondents who held a job inthe past year experienced some form of workplacediscrimination during that year, including beingfired or being denied a promotion because of theirgender identity or expression, being harassed orassaulted at work, or experiencing one or moreof the other forms of mistreatment discussed insection V of this chapter.12 This represents 16% of allrespondents. Further, 80% of respondents who helda job in the past year reported either experiencingsome form of discrimination and/or taking steps toavoid discrimination at work, representing 41% of allrespondents. Conclusion Respondents reported high levels of workplacediscrimination based on their gender identity orexpression, including losing employment opportunities,being harassed, being assaulted, and facing otherforms of mistreatment because of being transgender.Many reported losing their job due to anti-transgenderbias, with the experience being more likely to occuramong people of color, people with undergroundeconomy experience, and people with disabilities.Many respondents who applied for or held a job inthe past year reported that they were fired, denieda promotion, or not hired for a job they applied forbecause of their gender identity or expression.Respondents also faced substantial levels ofharassment and mistreatment on the job because oftheir gender identity or expression, including verbalharassment, physical and sexual assault, and breachesof confidentiality. A large number of respondents feltthey had to take actions to avoid discrimination, suchas quitting a job or hiding their transition, despite thepotential impact on their wellbeing or financial stability. ### Page 160 1 Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2011). Injustice at Every Turn: A Reportof the National Transgender Discrimination Survey. (pp.50–71). DC: National Center for Transgender Equality& National Gay and Lesbian Task Force; Sears, B. &Mallory, C. (2011). Documented Evidence of EmploymentDiscrimination & Its Effect on LGBT People. Los Angeles,CA: Williams Institute. Available at: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Sears-Mallory-Discrimination-July-20111.pdf; Rainey, T. & Imse, E. E.(2015). Qualified and Transgender: A Report on Resultsof Resume Testing for Employment Discrimination Basedon Gender Identity. DC: DC Office of Human Rights.Available at: http://ohr.dc.gov/sites/default/files/dc/sites/ohr/publication/attachments/QualifiedAndTransgender_FullReport_1.pdf. 2 Grant, et al.; Sears, et al. 3 Respondents were not asked about the level of supportfrom their current boss or supervisor. 4 Q. 21.1 and other questions in this chapter asked onlyabout jobs doing legal work and excluded undergroundeconomy work, such as sex work, drug sales, and otherwork that is currently illegal. 5 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 6 The survey included both “transgender status/genderidentity” and “gender expression/appearance” as answerchoices so that respondents could select what they feltbest represented their experience. Because there wasa substantial overlap of respondents who selected bothreasons, and because these terms are commonly usedinterchangeably or with very similar meanings, responsesof those who selected one or both of these reasons arecollapsed for reporting as “gender identity or expression.” 7 Respondents were asked whether they had “experiencedunwanted sexual contact (such as fondling, sexual assault,or rape)” at work because they were transgender in Q.22.3. 8 Respondents who are “living in poverty” represent thosewho are living at or near the poverty line. See the Incomeand Employment chapter for more information about thepoverty line calculation. 9 Respondents were asked if they “had to be in the closetabout [their] gender identity in the past year” in order toavoid discrimination. 10 This figure does not include the experience of not beinghired for a job in the past year, since this figure representsadverse actions in the workplace experienced by thosewho had a job only. It also does not include experiencesof those who applied for a job but did not work a job in thepast year. ENDNOTES | CHAPTER 10: EMPLOYMENT AND THE WORKPLACE ### Page 161 157 CHAPTER 11 Sex Work andOther UndergroundEconomy Work Many people participate in sex work, drug sales, and other activities that are currently criminalized(“underground economy”) to earn an income, or in exchange for food, a place to sleep, or othergoods or services. The commercial sex trade exists in a variety of forms, including street-basedsex work, pornography, and escort services.1 Participation in the sex trade is often higher among those whohave faced family rejection, poverty, or unequal opportunities in employment, housing, and education.2Previous studies have documented higher levels of participation in sex work among transgender people,and in particular people of color and those facing homelessness or poverty.3 They have also found highrates of negative mental and physical health outcomes, police abuse, and experiences of violence amongtransgender people who have done sex work.4 Respondents were asked a series of questions about their participation in sex work and other undergroundeconomy work, and their interactions with law enforcement officers when they were doing sex work orwhen police thought that they were doing sex work. Notable differences in respondents’ experiencesbased on demographic and other characteristics are reported throughout the chapter. ### Page 162 158 One in five (20%) respondents have participated in the underground economy forincome at some point in their lives, including in sex work, drug sales, and othercurrently criminalized work, and 9% did so in the past year. One in eight (12%) respondents have participated in sex work for income. Six percent(6%) have engaged in sexual activity for food, and 8% have done so for a place tosleep. Overall, nearly one in five (19%) respondents reported doing some type of sexwork, such as for money, food, or a place to sleep. Three percent (3%) of all respondents have interacted with the police either while theywere doing sex work or while police thought that they were doing sex work. - • Of those who interacted with the police while doing or thought to be doing sex work,86% reported some form of police harassment, abuse, or mistreatment, includingbeing verbally harassed, physically attacked, or sexually assaulted by police. - • Of those who interacted with the police while doing or thought to be doing sex work,32% said that at least one of those interactions led to an arrest. Nearly half (44%) ofrespondents who were arrested said that police used condoms in their possession asevidence of sex work. One in eight (12%) respondents have earned income by selling drugs (11%) or by doingother work that is currently criminalized (2%), other than sex work. I. Overall UndergroundEconomy Participation Respondents were asked about theirparticipation in sex work, drug sales, andother forms of work in areas that are currentlycriminalized, referred to throughout this reportas underground economy work. Overall, one in five (20%) respondents hadparticipated in the underground economy forincome at some point in their lives. Undocumentedresidents (38%) and respondents who have lost ajob because of their gender identity or expression(37%) were more likely to have participated in theunderground economy. Transgender women ofcolor were also more likely to participate in theunderground economy for income, including Black(44%), American Indian (41%), multiracial (38%), andLatina (30%) respondents (Figure 11.1). KEY FINDINGS Figure 11.1: Underground economy experience amongtransgender women RACE/ETHNICITY (%) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 44% 41% 38% 30% 26% 20% 20% 19% Overall (allrespondents) White Latina Black Multiracial Middle Eastern Asian American Indian ### Page 163 Nearly one in ten (9%) respondents haveparticipated in the underground economy forincome in the past year (Table 11.1). Undocumentedresidents (29%) were more than three times aslikely to have worked in the underground economyin the past year. Further, respondents who havebeen homeless in the past year (23%) werenearly three times as likely to have worked in theunderground economy during that year. II. Sex Work a. Income-Based Sex Work One in eight (12%) respondents have done sex workfor income at some point in their lifetime, meaningthat they have exchanged sex or sexual activity formoney or worked in the sex industry, such as inerotic dancing, webcam work, or pornography. Of respondents who have done sex work for moneyin their lifetime, transgender women representone-half (50%), non-binary people with female ontheir original birth certificates represent nearly one-quarter (23%), and transgender men represent 19%(Figure 11.2). While this chapter primarily highlightsthe experiences of transgender women of colordue to their disproportionately high representationamong those who have done sex work, it is alsoimportant to recognize that non-binary peoplewith female on their original birth certificates andtransgender men account for a large proportion ofthose in the sample who have done sex work. Transgender women of color, including Black (42%),American Indian (28%), multiracial (27%), Latina(23%), and Asian (22%) women (Figure 11.3), weremore likely to have participated in sex work thanthe overall sample. Undocumented residents (36%),those who have lost a job because of their genderidentity or expression (25%), and those who have everexperienced homelessness (23%) were also morelikely to have participated in sex work. One in five (20%) respondentshave participated in theunderground economy at somepoint in their lives and 9%participated in the past year. Figure 11.2: Income-based sex work in lifetime GENDER IDENTITY (%) 23%Non-binary respondentswith female on theiroriginal birth certificate 1%Crossdressers % of thosewho haveever donesex work 50%Transwomen 19%Transmen Table 11.1: Income-based underground economyexperiences | Type of work | % ofrespondents(past year) | % ofrespondents(in lifetime) | | - | - | - | | Income-based sex work | 5% | 12% | | Drug sales | 4% | 11% | | Other criminalized work | 1% | 2% | | Any underground economy work | 9% | 20% | 7%Non-binary respondents with maleon their original birth certificate Figure 11.3: Income-based sex work amongtransgender women RACE/ETHNICITY (%) 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 42% 28% 27% 23% 22% 12% 11% 9% Overall (allrespondents) White Latina Black Multiracial Middle Eastern Asian American Indian ### Page 164 Respondents who have done income-based sexwork during their lifetime were more likely to haveexperienced a number of challenges: - • Nearly half (45%) of respondents who havedone income-based sex work were currentlyliving in poverty, in contrast to 26% of thosewho have not done sex work. - • Nearly three-quarters (72%) of respondents whohave done income-based sex work have beensexually assaulted in their lifetime, in contrast tothose who have not done sex work (44%). - • More than three-quarters (77%) of respondentswho have done income-based sex work haveexperienced some form of intimate partnerviolence, compared with 51% of those whohave not done sex work. - • Respondents with sex work experience werenearly sixteen times as likely to be living withHIV (7.9%) as those who have never done sexwork (0.5%), and nearly six times more likelythan those in the overall sample (1.4%). Five percent (5%) of all respondents did sex workfor income in the past year. More than half (55%) ofthose who did income-based sex work in the pastyear were transgender women, 22% were non-binarypeople with female on their original birth certificate,and 14% were transgender men (Figure 11.4). Figure 11.4: Income-based sex work in past year GENDER IDENTITY (%) One in eight (12%) respondentshave done sex work for income,and 5% of respondents did soin the past year. 22%Non-binary respondentswith female on theiroriginal birth certificate 1%Crossdressers % of thosewho did sexwork in thepast year 55%Transwomen 14%Transmen 8%Non-binary respondents with maleon their original birth certificate Respondents who experienced homelessness inthe past year (17%) were more than three times aslikely to have participated in sex work during thatyear compared to the overall sample. Respondentswho were living with HIV (32%) and undocumentedresidents (29%) were substantially more likely to haveparticipated in sex work in the past year. Additionally,transgender women of color reported higher ratesof sex work participation in the past year, particularlyBlack transgender women (24%), who were almostfive times as likely to have done sex work for incomein the past year (Figure 11.5). Figure 11.5: Income-based sex work in past yearamong transgender women RACE/ETHNICITY (%) 30% 25% 20% 15% 10% 5% 0% 24% 13% 13% 13% 12% 9% 5% 5% Latina White Black Multiracial Middle Eastern Asian American Indian Overall (allrespondents) ### Page 165 Respondents who have done sex work for incomereported working in a wide range of settings,including sex work advertised online (36%),webcam work (35%), and street-based sex work(21%) (Table 11.2). Among those who have donesome type of sex work, transgender women(30%) were more likely than others with sex workexperience to have done street-based sex work,with women of color, including American Indian(50%), Black (48%), and Latina (31%) women, beingsubstantially more likely to participate in street-based sex work (Figure 11.6). In Our OwnVoices “At 17, I ran away with no way ofsupporting myself. I turned toInternet prostitution, which allowedme to do things for myself thatI couldn’t [before], like buy girlclothes, pay out of pocket for mydoctor to prescribe HRT, and put aroof over my head.’’ “Sometimes I slept in my truckwhen friends couldn’t put me up attheir house, and sometimes I wouldmeet people at a bar and have sexwith them to really just sleep overand shower.” “I couldn’t find work. I watched oneguy throw away my applicationliterally 30 seconds after turning itin. I resorted to escorting. It’s theonly way to keep food in my bellyand a roof over my head.” “I became a sex worker to supportmyself and pay for my transition. Idid not want to do sex work, but Ihave had worse jobs that paid less.” “An officer attempted to arrest meon prostitution charges becauseI was at a street corner. It wasroughly noon, I was holding abag of food in my hand, and I wasclearly waiting for the street light tochange so I could cross the street.” Table 11.2: Type of income-based sex work | Type of sex work | % of those who haveever done sex work | | - | - | | Informal sex work through word of mouth,occasional hook ups with dates in mynetworks, or things like that | 38% | | Sex work advertised online | 36% | | Webcam work | 35% | | Pornography (picture or video) | 28% | | Fetish work | 24% | | Street-based sex work | 21% | | Phone sex | 14% | | Escort, call girl, or rent boy with an agency | 12% | | Erotic dancer or stripper | 11% | | Sex work advertised in magazinesor newspapers | 7% | | Not listed above | 9% | Figure 11.6: Participation in street-based sex workamong transgender women who have done sex work RACE/ETHNICITY (%) 60% 50% 40% 30% 20% 10% 0% 50% 48% 31% 29% 25% 21% 18% White Latina Black Multiracial Middle Eastern* Asian American Indian Overall (allrespondents) * Sample size too low to report ### Page 166 b. Sex Work for Goods orServices All survey respondents, including those who didnot report doing sex work for income, were askedwhether they had sex or engaged in sexual activityfor food, for a place to sleep, for drugs, or inexchange for something else (Table 11.3). Six percent (6%) of respondents have everengaged in sexual activity for food. Respondentsliving with HIV (32%) were more than five timesas likely to have engaged in sexual activityfor food. Undocumented residents (17%) andAmerican Indian (15%), Black (12%), and multiracial(10%) respondents were also more likely to haveengaged in sexual activity for food. One in twelve (8%) respondents engaged in sexualactivity for a place to sleep. Respondents who wereliving with HIV (28%), who have ever experiencedhomelessness (20%), or who were undocumentedresidents (17%) were more likely to have engaged insexual activity for a place to sleep. Overall, 19% participated in sex work, suchas for money, food, a place to sleep, or othergoods or services. c. Police Interactions All survey respondents were asked if they hadever interacted with police either while doing sexwork, or when police thought they were doing sexwork. One percent (1%) of respondents said thatthey interacted with police while participating in sexwork, and an additional 2% said they did so whenpolice thought they were doing sex work. Overall,3% of respondents have interacted with police whiledoing sex work or when police thought they weredoing sex work. Transgender women of color, including Black(15%), Middle Eastern (13%), American Indian (12%),multiracial (8%), and Latina (7%) women, weremore likely than the overall sample to interact withpolice who thought they were doing sex work(Figure 11.7). Nearly one in five (19%)respondents participated insex work, such as for money,food, a place to sleep, or othergoods or services. Table 11.3: Engaged in sexual activity in exchange forgoods or services | Type of activity | % ofrespondents(past year) | % ofrespondents(in lifetime) | | - | - | - | | Engaged in sexual activityfor food | 2% | 6% | | Engaged in sexual activity fora place to sleep (in someone'sbed, at their home, or in theirhotel room) | 2% | 8% | | Engaged in sexual activityfor drugs | 1% | 5% | | Engaged in sexual activity inexchange for something notlisted above | 3% | 7% | Figure 11.7: Interacted with police who thought theywere doing sex work among transgender women RACE/ETHNICITY (%) 16% 14% 12% 10% 8% 6% 4% 2% 0% 15% 13% 12% 8% 7% 4% 3% 2% Overall (allrespondents) American Indian Asian White Latina Black Multiracial Middle Eastern ### Page 167 Respondents who interacted with the policewhile doing sex work or when police thoughtthey were doing sex work were asked aboutspecific experiences they had with police. Eighty-six percent (86%) reported at least one negativeexperience during the interaction (Table 11.4). More than two-thirds (69%) said that officersrepeatedly referred to them as the wronggender. This experience was more likely amongtransgender women (74%). Nearly two-thirds (65%)were verbally harassed by police. More than one-quarter (27%) of respondents whohad interacted with police in this context weresexually assaulted by an officer, including beingfondled, raped, or experiencing another formof sexual assault.6 Respondents who have everexperienced homelessness (34%) were more likelyto be sexually assaulted by an officer. Fourteenpercent (14%) also reported that they were forcedto have sex or engage in sexual activity to avoidarrest. d. Arrest Respondents who interacted with police whileengaging in sex work or when police thought theywere engaging in sex work were also asked if theywere arrested during any of those interactions.Almost one-third (32%) reported being arrestedduring at least one interaction. Black respondents(50%) and transgender women (40%) were morelikely to report that their interaction with the policeled to an arrest. Respondents who reported being arrested wereasked how many times they were arrested whilethey were doing sex work or when police thoughtthey were doing sex work. Approximately one-third (34%) were arrested once, 32% were arrestedtwo or three times, and 35% were arrested four ormore times (Figure 11.8). Respondents who were arrested while doing orwhile police thought they were doing sex workwere also asked whether police considered items intheir possession, such as condoms, as “evidence ofprostitution.” Forty-four percent (44%) said that thepolice considered condoms in their possession tobe evidence of prostitution (Figure 11.9). Table 11.4: Interactions with police while doing orwhen police thought they were doing sex work | Type of interaction | % of those who interactedwith police who thoughtthey were doing sex work,or while doing sex work | | - | - | | Officers kept using the wronggender pronouns (such as he,she, or they) or the wrong title(such as Mr. or Ms.) | 69% | | Officers verbally harassed them | 65% | | Officers asked questions abouttheir gender transition (such ashormones and surgical status) | 41% | | Officers sexually assaulted them | 27% | | Officers physically attacked them | 18% | | Officers forced them to have sexor engage in sexual activity toavoid arrest | 14% | | Arrested for drugs in theirpossession when police stoppedthem for doing sex work | 11% | | One or more experiences listed | 86% | Figure 11.8: Number of times arrested while doing orwhen police thought they were doing sex work 34%1 time 19%2 times Number oftimes arrested 13%3 times 19%11 or moretimes 16%4–10 times ### Page 168 Respondents were asked about the outcomesof their arrests. More than half (55%) of therespondents who were arrested pleaded guilty inconnection to one or more of their arrests, whilenearly half (48%) reported that the charges weredropped on at least one occasion (Figure 11.10). III. Drug Sales andOther UndergroundEconomy Work One in eight (12%) respondents have done workin the underground economy other than sex workat some point in their lifetime. This included thosewho had participated in drug sales (11%) and/or other work that is currently criminalized (2%).7Respondents who were living with HIV (27%), whohave lost a job because of their gender identityor expression (22%), or have ever experiencedhomelessness (21%) were more likely to have beenpaid for underground economy work apart fromsex work during their lifetime. In the past year, 4% of all respondents haveparticipated in drug sales, and 1% have participated inother underground economy work (other than drugsales or sex work) (see Table 11.1). Conclusion Respondents reported substantial levels ofinvolvement in sex work and other undergroundeconomy work, particularly people of color, thoseliving with HIV, undocumented residents, andthose who have experienced homelessness. Manyrespondents, especially transgender women ofcolor, also reported that police often assumed theywere doing sex work, even when they were not.The vast majority of those who interacted with thepolice while doing sex work or while suspectedof doing sex work reported being mistreatedby police, including being verbally harassed,physically attacked, or sexually assaulted by lawenforcement officers. Figure 11.9: Items in possession considered asevidence when arrested (% of those arrested whiledoing or suspected of doing sex work) 60% 50% 40% 30% 20% 10% 0% 48% 44% 12% 9% 4% Another item They did notknow Condoms, sextoys, and/oranother item Sex toys Condoms Figure 11.10: Outcome of arrest (% of those arrestedwhile doing or suspected of doing sex work) 60% 50% 40% 30% 20% 10% 0% 55% 48% 27% 15% 11% Went to trial andfound guilty Not listedabove Went to trial andfound not guilty The chargeswere dropped Pleaded guilty ### Page 169 1 See Ditmore, M. & Thukral, J. (2011). Behind Closed Doors:An Analysis of Indoor Sex Work in New York City. NewYork, NY: Sex Workers Project at the Urban Justice Center).Available at: http://sexworkersproject.org/downloads/BehindClosedDoors.pdf; Ditmore, M. & Thukral, J. (2003).Revolving Door: An Analysis of Street-Based Prostitution inNew York. NY, New York: Sex Workers Project at the UrbanJustice Center. Available at: http://sexworkersproject.org/downloads/RevolvingDoor.pdf. 2 Amnesty International. (2016). Amnesty International Policyon State Obligations to Respect, Protect and Fulfill theHuman Rights of Sex Workers. Available at: https://www.amnesty.org/en/documents/pol30/4062/2016/en. 3 Fitzgerald, E., Elspeth, S., & Hicky, D. Meaningful Work:Transgender Experiences in the Sex Trade. DC & NY,New York: Best Practices Policy, National Center forTransgender Equality, & Red Umbrella Project. Availableat: http://www.transequality.org/sites/default/files/Meaningful%20Work-Full%20Report_FINAL_3.pdf;Amnesty International. (2016). Amnesty International Policyon State Obligations to Respect, Protect and Fulfill theHuman Rights of Sex Workers. Available at: https://www.amnesty.org/en/documents/pol30/4062/2016/en. 4 Fitzgerald, et al. See note 3. 5 Respondents were asked whether they had “everengaged in sex or sexual activity for money (sex work)or worked in the sex industry (such as erotic dancing,webcam work, or porn films)” in Q. 6.1 and whether theyhad done such work in the past year in Q. 6.2. This reportuses the term “sex work” to refer to all work in the sexindustry or involving the exchange of sexual activity forincome, food, a place to sleep, or other goods or services.While many of forms of sex work are currently criminalizedin the United States, some of them are not. 6 Respondents were asked whether they had “experiencedunwanted sexual contact from an officer (such as fondling,sexual assault, or rape)” in Q. 6.6. 7 Respondents were asked in Q. 6.11 if they had “everbeen paid for selling drugs or other work that is currentlyconsidered illegal.” ENDNOTES | CHAPTER 11: SEX WORK AND OTHER UNDERGROUND ECONOMY WORK ### Page 170 166 CHAPTER 12 Military Service Prior research suggests that transgender people serve in the military at a higher rate than the U.S.general population.1 USTS respondents with military experience were asked a series of questionsabout their service, their treatment as transgender service members, and their separation fromthe military. They were also asked about health care that they received through military providers and theVeterans Health Administration. At the time that survey data was collected in 2015, the military still barred transgender people from servingopenly in the military, and service members could be discharged simply for being transgender.2 TheDepartment of Defense announced that it was lifting the ban on June 30, 2016, with full implementationof specific policies related to transgender service members expected to be completed in 2017.3 Despitethe long-standing ban, thousands of transgender people have served and continue to serve in the military,many of them openly and with the support of their colleagues and commanders. This chapter examines the experiences of current and former service members, including their interactionswith leadership and health care providers as transgender people. It also explores veterans’ uniqueexperiences of separating from the military and accessing health care. Notable differences in respondents’experiences based on demographic and other characteristics are reported throughout the chapter. ### Page 171 167 I. Current and PastMilitary Service Nearly one in five (18%) respondents in the samplehave served in the military, including respondentswho were currently serving in the military on activeduty (0.5%), and those who were currently onactive duty for training in the Reserves or NationalGuard (2%).4 Fifteen percent (15%) of respondentswere veterans, compared with 8% in the U.S.population.5 Respondents in every age group were more likelyto be veterans than their counterparts in the U.S.population. More than half (52%) of respondentsover the age of 75 and 40% of respondentsbetween the ages of 65 and 74 were veterans,compared with 22% and 18% of those age groupsin the U.S. population, respectively.6 One-quarter(25%) of respondents between the ages of 55 and64 were veterans, more than three times higherthan that age group in the U.S. population (8%).7Fifteen percent (15%) of respondents between theages of 35 and 54 were veterans, which was threetimes higher than the same age group in the U.S.population (5%)8 (Figure 12.1). KEY FINDINGS Nearly one in five (18%) respondents have served in the military, including veterans andthose currently on active duty. Of current service members whose leadership or commanding officers knew or thoughtthey were transgender, nearly one-quarter (23%) said that actions were taken todischarge them. Sixty percent (60%) of service members who separated from the military within the pastten years said that they might or would return to the military if the ban on transgenderservice members were lifted. Nearly one in five (19%) respondents who separated from the military more than tenyears ago said they were discharged partly or completely because of their transgenderstatus, and 19% left the military to avoid being mistreated or harassed as a transgenderperson. ### Page 172 Among those with past or current military service,crossdressers (33%), transgender women (23%),and non-binary people with male on their originalbirth certificate (22%) were more likely to haveserved, compared with transgender men (8%) andnon-binary people with female on their originalbirth certificate (2%) (Figure 12.2). White (21%),American Indian (20%), and Middle Eastern (20%)respondents were more likely to have servedin the military, while Asian (7%) and Latino/a(7%) respondents were less likely (Figure 12.3).Multiracial respondents were ten times as likely asthe overall sample to currently be on active duty,with 5% on active duty at the time they took thesurvey. Of those who reported military service, 2% werestill serving. Nearly one-third (31%) of those whowere no longer serving separated from militaryservice within the past ten years, and 69%separated from military service more than tenyears ago. II. Branch of Service Current and former service members were askedto identify their current or most recent branchof service. Twenty-eight percent (28%) of theserespondents currently or most recently served inthe Army, 22% in the Navy, 18% in the Air Force, 7%in the Marine Corps, and 1% served in the CoastGuard. Nearly one-quarter (24%) served in theReserves or the National Guard (Table 12.1). Table.1: Current or most recent branch of service | Branch of service | % of current or formerservice members | | - | - | | Air Force | 18% | | Air Force Reserve | 2% | | Air National Guard | 2% | | Army | 28% | | Army Reserve | 8% | | Army National Guard | 8% | | Coast Guard | 1% | | Coast Guard Reserve | <1% | | Marine Corps | 7% | | Marine Corps Reserve | 1% | | Navy | 22% | | Navy Reserve | 3% | Fifteen percent (15%) ofrespondents were veterans,compared with 8% in the U.S.population. ### Page 173 III. Outness orBeing Perceived asTransgender Current service members9 were asked how manypeople in the military (with the exception of othertransgender people) thought or knew that theywere transgender.10 More than half (52%) of current service memberssaid that, as far as they knew, no one elsethought or knew that they were transgender.Approximately one-third (34%) of current servicemembers indicated that a few or some peoplein the military thought or knew that they weretransgender, and 13% indicated that most or allpeople in the military thought or knew that theywere transgender (Figure 12.4).11 Figure.4: Number of people in the military whothought or knew that respondent was transgender IV. LeadershipResponse toTransgender Status Among current service members who said thata few, some, most, or all others in the militarythought or knew they were transgender, 48%indicated that their leadership or commandingofficer thought or knew that they weretransgender. These respondents were asked about theways in which their leadership or commandingofficer responded to them being transgender,and they selected one or more response. Manyreported that their leadership or commandingofficer responded to their transgender status ina variety of positive ways, including supportingtheir name change (47%) and supporting theirtransition-related medical treatment (36%). Thirtypercent (30%) reported that their leadership orcommanding officer ignored their transgenderstatus or looked the other way. Approximatelyone-quarter (23%) reported that their leadershipor commanding officer had taken actions todischarge them (Table 12.2). One-third (33%) of these respondents wrote inresponses describing additional actions theirleadership or commanding officers took becausethey thought or knew the respondent wastransgender. Their write-in responses includedseveral positive actions, such as supportingtheir social transition or their use of pronounsand uniforms that were consistent with theirgender identity. These respondents also offeredseveral additional negative actions, such asforcing respondents to present in a way that wasinconsistent with their gender identity, forbiddingthem from discussing their transgender statuswith anyone else, passing them over for awardsand duties, and subjecting them to administrativediscipline. More than half (52%) of currentservice members said that, asfar as they knew, no one elsethought or knew that they weretransgender. ### Page 174 Table.2: Response of leadership and/or commandingofficer to being transgender | Leadership or commandingofficers’ response | % of current servicemembers whosecommanding officerthought/knew they weretransgender | | - | - | | Supported name change | 47% | | Supported medical treatment | 36% | | Ignored or looked the other way | 30% | | Took actions to discharge them | 23% | | Not listed above | 33% | V. Separation fromMilitary Service Veterans were divided into two groups for thepurposes of analysis: those who separated within thepast ten years and those who separated more than tenyears prior to taking the survey. The two groups weregiven distinct questions based on a consideration ofthe types of experiences a service member may haveencountered during their service and the changingnature of the military.12 a. Type of Discharge Respondents who separated from military servicemore than ten years ago13 were asked about thereasons for their separation from service, includingthe type of discharge they received. More than three-quarters (79%) of these respondents reported beinghonorably discharged, and the remaining 21% reporteda variety of other types of discharges (Table 12.3). Table.3: Type of discharge | Discharge | % of veterans who separated morethan 10 years ago | | - | - | | Honorable | 79% | | General | 7% | | Medical | 6% | | Other-than-honorable | 3% | | Entry level separation | 2% | | Bad conduct | 1% | | Retired | 1% | | Dishonorable | <1% | | Not listed above | 2% | b. Discharged Because ofTransgender Status While 81% of respondents who had separated fromservice more than ten years prior reported that theydid not believe their discharge was related to beingtransgender, 19% believed their discharge waseither partially related (14%) or completely related(5%) to being transgender. Respondents who indicated that their dischargewas related to being transgender were less likelyto have been honorably discharged. Eighty-sixpercent (86%) of those who said their dischargewas not related to their transgender status werehonorably discharged, while only 45% of those who In Our OwnVoices “I began to accept myself as awoman. I was happier than I everhad been before. But the armydidn’t share my enthusiasm. A yearafter returning from deployment, Iwas kept in under penal conditions.I was demoted from a sergeant to aprivate, the lowest rank in the army.” “I am repeatedly harassed in myworkplace, and am continuallyrequired to conceal my transgenderstatus. When I sought assistancefrom the Equal Opportunity Office,I was told that they were unableto help because transgenderindividuals are not protectedagainst harassment in the military.” ### Page 175 said their discharge was partially related to beingtransgender and 51% of those who indicated that itwas completely related were honorably discharged. Respondents with female on their original birthcertificate (24%) were more likely to say that theirdischarge was partially or completely related tobeing transgender than those with male on theiroriginal birth certificate (17%). Latino/a (28%) andBlack (24%) respondents were also more likely toreport that their transgender status was a factorin their discharge, compared with white (16%)respondents. Even though these discharges took place morethan ten years ago, the experience of beingdischarged partly or completely because of one’stransgender status was associated with a varietyof negative outcomes affecting respondentsat the time they took the survey. Respondentswho were currently living in poverty (29%) orcurrently working in the underground economy(34%) were more likely to say that their dischargewas completely or partially connected to theirtransgender status, as were respondents whowere currently experiencing serious psychologicaldistress (28%). c. Separated to Transition orAvoid Harassment Nearly one in ten (9%) respondents who separatedfrom military service more than ten years ago leftthe service in order to transition, and an additional19% said they left the service to avoid beingmistreated or harassed as a transgender person. Differences emerged by race, where Latino/a (28%)and Black respondents (26%) were more likely tohave left to avoid mistreatment or harassment. Approximately one-third (32%) of those who werecurrently living in poverty and more than one-thirdof those who have done sex work (38%) also left themilitary to avoid mistreatment or harassment. VI. Name Change onDischarge Papers Respondents who separated from military servicemore than ten years earlier were also asked if theyhad changed their name on their military dischargepapers, known as the DD 214. Two percent (2%)applied for and received an updated DD 214with a new name, or they received a DD 215 (analternative form used to correct errors in a DD 214)with their new name. Six percent (6%) applied fora name change on their military discharge papers,but their request was denied. The remaining 92%had not tried to change their name on their militarydischarge papers. VII. Health CareTreatment fromMilitary Providers Current service members and veterans whoseparated from military service within the ten yearsprior to taking the survey were asked whetherthey had received health care related to gendertransition from a military provider, not including theVeterans Health Administration. Twelve percent(12%) had received mental health treatment relatedto gender transition from a military provider,and 4% had received medical treatment relatedto gender transition other than mental healthtreatment, such as hormone therapy or surgicalcare, from a military provider. Even though this survey was conducted priorto the Department of Defense’s announcementof plans to allow transgender people to serveopenly, more than one-quarter (28%) of all currentservice members reported taking hormones fortheir gender identity or gender transition at thetime they participated in the survey. Among these ### Page 176 current service members, 28% reported gettingtheir hormones from an on-post medical doctorand/or pharmacy. Nearly three-quarters (74%)received their hormones through an off-postmedical doctor, and 57% received them through anoff-post pharmacy (Table 12.4). Table.4: Source of hormones | Source of hormones | % of current servicemembers who takehormones | | - | - | | Off-post medical doctor | 74% | | Off-post pharmacy | 57% | | On-post pharmacy | 15% | | Friends, online, or othernon-licensed sources | 15% | | On-post medical doctor | 13% | Current services members were asked whethera military medical provider, including anymental health provider, had reported to theircommanding officer that they were transgenderor recommended them for discharge. Of currentservice members whose providers knew they weretransgender,14 86% reported no action being takenby military medical or mental health providers.However, 8% said that their provider reported theirtransgender status to their commander, and 12%said that their provider recommended them fordischarge. VIII. VeteransHealth Care Veterans who separated from the military morethan ten years ago were asked about theirexperiences receiving health care through theVeterans Health Administration (VA).15 Forty percent (40%) of former service membershave received health care through the VA, 75% ofwhom were currently receiving care through theVA. Of those who received health care through theVA at any point, more than half (56%) received carerelated to gender transition. Nearly three-quarters (72%) indicated that theywere out to their VA providers as transgender.Of those who were out to their VA providers astransgender, almost half (47%) reported that theywere always treated respectfully as a transgenderperson, and 40% said that they received mostlyrespectful care. Eleven percent (11%) reported thatthey were sometimes treated respectfully, and3% said that they were never treated respectfully(Figure 12.5). IX. Impact ofRepealing Ban onTransgender Service At the time the survey was taken, the militaryhad not yet announced it would let transgenderpeople serve openly. Current military servicemembers were asked what they would do if themilitary allowed transgender people to serveopenly. Nearly one-quarter (24%) said that theywould start to transition while still serving, and 18%said that they would finish the transition that they Figure.5: Frequency of respectful treatment at the VA ### Page 177 had already started while continuing to serve.Additionally, 21% reported that they had alreadytransitioned (Table 12.5). Table 12.5: What respondent would do if open servicein the military was allowed for transgender people | What they would do if allowed to serveopenly | % of currentservicemembers | | - | - | | They would start to transition while still serving | 24% | | They have already transitioned | 21% | | They would finish the transition they alreadystarted and continue to serve | 18% | | They would leave the military to transition andnot return | 6% | | They do not want to transition | 6% | | They would leave the military to transition andthen return to service | 3% | | They would not finish the transition theyalready started and continue to serve | 1% | | Not listed above | 21% | Veterans who separated from the military withinthe past ten years were asked whether they wouldreturn to military service if transgender peoplewere allowed to serve. Nearly one-third (30%)of these respondents indicated that they wouldreturn, 30% said that they might return, and theremaining 39% reported that they would not returnto military service. Transgender men (42%) weremore likely than transgender women (25%) andnon-binary people (18%) to say that they wouldreturn to service. Conclusion Despite a ban on transgender service membersat the time the survey was administered, nearlyone in five respondents reported having servedin the military, and respondents were nearlytwice as likely to be veterans as the general U.S.population. The findings indicated that a majorityof current service members were interested inserving openly as transgender people, includingthose who would transition during their militaryservice. Responses also indicated diverseexperiences of acceptance and rejection oftransgender people in military and veteransettings by military officials, direct superiors, andhealth care providers. The results suggest thatlifting the ban on transgender service membersand implementing new policies could lead to asubstantial number of current and former servicemembers continuing or resuming their militaryservice. ### Page 178 1 Gates, G. J. & Herman, J. L. (2014). Transgender MilitaryService in the United States. Los Angeles, CA: WilliamsInstitute. Available at: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Transgender-Military-Service-May-2014.pdf; Blosnich, J. R., Brown, G. R., Shipherd, J. C., Kauth, M.,Piegari, R. I., & Bossarte, R. M. (2013). Prevalence of genderidentity disorder and suicide risk among transgenderveterans utilizing Veterans Health Administration care.American Journal of Public Health, 103(10), e27–e32;Shipherd, J. C., Mizock, L., Maguen, S., & Green, K. E. (2012).Male-to-female transgender veterans and VA health careutilization. International Journal of Sexual Health, 24(1),78–87. 2 Although the ban is described in this chapter as being onethat prevented “transgender people from serving openlyin the military,” in actuality, the ban categorically barredtransgender people from serving, regardless of whether ornot they were open about being transgender. However, it isclear that tens of thousands of transgender people chose toserve in the military despite the ban, and many had to hidetheir identity to do so. Therefore, the ban is being describedhere as relating to open service as a transgender person. 3 See e.g., Rosenberg, M. (2016, June 30). Transgenderpeople will be allowed to serve openly in military. TheNew York Times. Available at: http://www.nytimes.com/2016/07/01/us/transgender-military.html. 4 In this section of this chapter, the percentages ofrespondents who have served or are currently serving in theU.S. Armed Forces have been weighted to reflect the ageand educational attainment of the U.S. population in additionto the standard survey weight. The USTS sample differssubstantially from the U.S. population in regard to age andeducational attainment, and therefore, this additional weightis applied in order to provide a more accurate comparison tothe percentage of U.S. adults who have served in the armedforces, as reported in the American Community Survey.See the Methodology and Portrait of USTS Respondentschapters for more information about the application of thesupplemental survey weight. 5 U.S. Census Bureau. (2015). American CommunitySurvey 1-Year Estimates: Veteran status. Availableat: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_15_1YR_S2101&prodType=table. 6 U.S. Census Bureau. See note 5. 7 U.S. Census Bureau. See note 5. 8 U.S. Census Bureau. See note 5. 9 “Current service members” includes individuals who were(1) currently serving on active duty, (2) only on active dutyfor training in the Reserves or National Guard, or (3) nolonger on active duty but had been in the past and were stillserving in the military. See Q. 2.17. 10 Q. 8.9 asked, “How many people in the military (who aren’ttrans) believe you are trans?” In the context of the questionsin this section, this question was intended to assess howmany people were out as transgender in the military bydetermining if other non-transgender people thought orknew that they were transgender. 11 This question (Q. 8.9) did not distinguish between servicemembers who were not out or perceived as transgenderbecause they were not living according to their genderidentity, and those who were already living full timeaccording to their gender identity but did not disclose thefact that they had previously transitioned. However, 47%of service members who said that no one in the militarythought or knew they were transgender also reportedthat they were living full-time in Q. 1.12, suggesting that asubstantial number of respondents who were not out toothers in the military were living according to their genderidentity without disclosing their past transition. 12 During the development of the survey questionnaire,the research team consulted with individuals and groupswith subject-matter expertise in LGBT military service ingeneral, and transgender military service in particular. Afterconsultation, the research team chose to divide those whohad separated from service into two groups to evaluatethe experiences that each group might have had basedon their time of service and separation. It was determinedthat those who had separated from service within the pastten years were serving in a time of changing societal andmilitary culture and policies—including the repeal of “Don’tAsk, Don’t Tell,” permitting lesbian, gay, and bisexual (butnot transgender) service members to serve openly—andmay have had different experiences as a result. This groupmay have also had different experiences with transitioning,receiving medical care for transition- and non-transition-related health care, and eligibility to return to service. Thetwo groups were directed to specific questions accordingly. 13 Those who separated within the past ten years shouldhave received questions 8.12–8.21 (which covered thereasons for separation and the nature of their discharge, VAhealth care, and military discharge papers) to evaluate thedifferences in experiences between them and those whoseparated more than ten years prior to participating in thesurvey. However, due to a programming error, respondentswho separated within the past ten years did not receivethese questions. Therefore, results of questions thataddressed veterans’ issues only reflected the experiencesof those who separated more than ten years prior and likelyunderestimated certain experiences reported in this section. 14 Thirty-seven percent (37%) of current service members saidthat the question did not apply to them, as none of theirmilitary health providers knew that they were transgender,while 63% indicated that at least one military health providerknew they were transgender. 15 Veterans who separated from the military within the past tenyears did not receive this question due to a programmingerror. See note 13. ENDNOTES | CHAPTER 12: MILITARY SERVICE ### Page 179 175 CHAPTER 13 Housing,Homelessness, andShelter Access Housing is one of the most vital needs all people share. However, many transgender peoplehave faced discrimination when seeking housing, and are vulnerable to actions such as evictionbecause of their transgender status. Such discrimination, in addition to family rejection and otherrisk factors, can lead to housing instability and higher rates of homelessness.1 For transgender peoplewho experience homelessness, shelters present additional problems and often are unsafe environments.Previous studies have found that shelters frequently turn transgender people away because of theirgender identity, or require them to stay in facilities that are inappropriate for their gender, often puttingthem at further risk of violence and harassment.2 This chapter explores respondents’ current living arrangements and their experiences with homelessness,as well as with specific forms of housing discrimination and instability occurring in the past year becauseof their transgender status. It also examines respondents’ experiences with homelessness in the past year,including access to shelters and the treatment they received in those shelters as transgender people.Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. ### Page 180 176 Only 16% of respondents owned their homes, in contrast to 63% in the U.S. population. Nearly one-third (30%) of respondents have experienced homelessness at some pointin their lives. One in eight (12%) experienced homelessness in the past year because ofbeing transgender. Nearly one-quarter (23%) of respondents experienced some form of housingdiscrimination in the past year, such as being evicted from their home or denied a homeor apartment because of being transgender. More than one-quarter (26%) of respondents who were homeless in the past yearavoided staying in homeless shelters because they feared they would be mistreatedas a transgender person. Additionally, six percent (6%) were denied access to a shelter,including 4% who were denied access due to being transgender. Seventy percent (70%) of those who stayed in a shelter in the past year reported someform of mistreatment because of being transgender. • More than half (52%) of those who stayed at a shelter in the past year wereverbally harassed, physically attacked, and/or sexually assaulted because of beingtransgender. • Nearly one in ten (9%) respondents were thrown out once the shelter staff found outthat they were transgender, and 44% decided to leave the shelter because of poortreatment or unsafe conditions. • One-quarter (25%) decided to dress or present as the wrong gender in order to feelsafe in a shelter, and 14% said that the shelter staff forced them to dress or present asthe wrong gender in order to stay at the shelter. KEY FINDINGS ### Page 181 I. Current LivingArrangements Respondents were asked what their current livingarrangements were at the time they participated inthe survey. Nearly half (44%) of respondents wereliving in a house, apartment, or condo they rented,either alone or with others, which was the mostcommonly reported living arrangement. Seventeenpercent (17%) had not yet left home and were livingwith their parents or the family they grew up with(Table 13.1). Table 13.1: Current living arrangements | Current living arrangements | % ofrespondents | | - | - | | Living in house, apartment, or condo theyrent (alone or with others) | 44% | | Living with parents or family they grew upwith because they have not yet left home | 17% | | Living in house, apartment, or condo theyown (alone or with others) | 16% | | Living temporarily with friends or familybecause they cannot afford their ownhousing | 9% | | Living in campus or university housing | 7% | | Living with a partner, spouse, or other personwho pays for the housing | 5% | | Living on the street, in a car, in an abandonedbuilding, in a park, or a place that is NOT ahouse, apartment, shelter, or other housing | <1% | | Living in a shelter (including homeless,domestic violence, or other type ofemergency shelter) or in a hotel or motelwith an emergency shelter voucher | <1% | | Living in transitional housing or a halfwayhouse | <1% | | Living in a hotel or motel that they pay for | <1% | | Living in military barracks | <1% | | Living in a nursing home or other adult carefacility | <1% | | Living in a foster group home or other fostercare | <1% | | Living in a hospital | <1% | | Not listed above | 2% | In contrast to the 63% homeownership rate in theU.S. at the time of the survey,3 USTS respondentswere nearly four times less likely to own a home,with only 16% reporting that they were living in ahouse, apartment, or condo that they owned. Alarge difference in the rate of homeownership wasconsistent across age groups (Figure 13.1).4 Respondents also reported substantial housinginstability. Nearly one in ten (9%) respondentswere living temporarily with friends or familybecause they could not afford their own housing.Approximately half of one percent (0.53%) ofrespondents were homeless at the time theyparticipated in the survey, including those whowere living in a shelter (other than a domesticviolence shelter), or on the street. This was threetimes the rate of current homelessness amongadults in the U.S. population (0.18%), as reportedby the Department of Housing and UrbanDevelopment.5 ### Page 182 II. HomelessnessDuring One’s Lifetime Nearly one-third (30%) of respondents haveexperienced homelessness during their lifetime,including those who have stayed in a shelter,lived on the street, lived out of a car, or stayedtemporarily with family or friends because theycould not afford housing. The homelessness ratewas substantially higher among respondentswhose immediate family had kicked them out ofthe house, with nearly three-quarters (74%) ofthese respondents experiencing homelessness.The homelessness rate was also nearly twice ashigh among respondents who have done sexwork (59%) and those living with HIV (59%), as wellas respondents who have lost their job becauseof their gender identity or expression (55%).Transgender women of color, including AmericanIndian (59%), Black (51%), multiracial (51%), andMiddle Eastern (49%) women, also experiencedespecially high rates of homelessness (Figure13.2). III. HousingDiscrimination andHomelessness in thePast Year Respondents were asked about specificexperiences with housing discrimination andinstability in the past year, such as being evicted orbeing homeless, because they were transgender(Table 13.2).6 Table 13.2: Housing situations that occurred in thepast year because of being transgender | Housing situation | % of people to whomsituation applied | | - | - | | They had to move back in withfamily members or friends | 20% | | They slept in different places forshort periods of time (such as ona friend’s couch) | 15% | | They had to move into a lessexpensive home or apartment | 13% | | They experienced homelessness | 12% | | They were denied a home orapartment | 6% | | They were evicted from a homeor apartment | 5% | | One or more experiences listed | 30% | One in eight (12%) respondents reportedexperiencing homelessness in the past year asa result of anti-transgender bias. Those currentlyworking in the underground economy (such as sexwork, drug sales, and other work that is currentlycriminalized) (37%), undocumented residents(32%), and those living with HIV (27%) were morelikely to report experiencing homelessness inthe past year because they were transgender.Transgender women of color, including Black (31%),American Indian (27%), multiracial (18%), and Latina(18%) women, were substantially more likely toreport being homeless in the past year because ofbeing transgender (Figure 13.3). ### Page 183 Six percent (6%) of respondents were denied ahome or apartment in the past year because theywere transgender, with transgender women ofcolor, including Black (17%), multiracial (15%), andLatina (11%) women, being more likely to have thisexperience (Figure 13.4). In Our OwnVoices “I was ejected from my apartmentwhile I was out of town after mylandlord discovered I was trans.The apartment was empty when Ireturned home.’’ “I lost my job after I came out astransgender. I became homelessfor about year. I never stayedin a shelter because I fearedharassment.” “When I was 18, I ran away frommy abusive parents who had beenviolent toward me because of mysexuality and gender expression.I became homeless for severalyears, traveling all over the country,stealing food and sleeping inabandoned buildings.” “When I go to shelters, I amadmonished and told that I shouldreturn to ‘being a woman’ in orderto use the shelter system.” “I’ve tried shelters. The men’s onesaren’t safe for trans men: if thosemen find out who you are, you’reopening yourself up to physical andsexual violence. And when I turnedto the women’s shelters, I was toomasculine to make the womencomfortable.” ### Page 184 Five percent (5%) of respondents were evictedfrom their home or apartment in the past yearbecause of anti-transgender bias. Differencesemerged by demographic characteristics, whereundocumented residents (18%), people withdisabilities7 (8%), and people of color, includingAmerican Indian (9%) and Black (9%) respondents,were more likely to report this experience. Overall, nearly one-third (30%) of respondents towhom these housing situations applied—23% ofall respondents—experienced one or more formsof housing discrimination or instability in the pastyear because they were transgender. Respondentswho were currently working in the undergroundeconomy (59%) and those who had been kickedout of the house by their family at some point intheir lives because they were transgender (59%)were nearly twice as likely to report one or moreof these experiences. Undocumented residents(50%) and transgender women of color werealso more likely have had one or more of theseexperiences, including Black (49%), multiracial(39%), American Indian (39%), and Latina (37%)women (Figure 13.5). IV. Shelters a. Access to Shelters Respondents who experienced homelessness inthe past year because of their transgender statuswere asked whether they had gone to a homelessshelter during that year (Table 13.3). Table 13.3: Experiences with homeless shelters in thepast year | Experiences with homelessshelters | % of people who werehomeless | | - | - | | They sought shelter and stayedat one or more shelters | 10% | | They sought shelter and weredenied access to one or moreshelters | 6% | | They did not seek shelter,because they fearedmistreatment as a transgenderperson | 26% | | They did not seek shelter forother reasons | 59% | One in ten (10%) respondents sought shelterand stayed at one or more shelters in the pastyear. Higher percentages were noted amongrespondents living with HIV (22%) and AmericanIndian (23%) and Black (15%) respondents. More than one-quarter (26%) did not seek shelterbecause they feared being mistreated as atransgender person in the past year. Asian (43%)and American Indian (37%) respondents weremore likely to report avoiding a shelter for thisreason, in contrast to other people of color, suchas Black (25%) and Latino/a (22%) respondents(Figure 13.6). Respondents currently working in theunderground economy (36%), and respondentswhose families had kicked them out of the housefor being transgender (35%) were more likely toavoid seeking shelter for fear of being mistreated. Five percent (5%) of respondentswere evicted from their home inthe past year because of anti-transgender bias. ### Page 185 Six percent (6%) of respondents were deniedaccess to a shelter in the past year. Transgenderwomen of color were more likely to be deniedaccess to a shelter, with multiracial women (30%)being five times as likely, and Black women (13%)being more than twice as likely. Those who werecurrently working in the underground economy(13%) were also more likely to be denied access toa shelter. Respondents who were denied access to one ormore shelters in the past year were asked whatthey believed the reasons were for that treatment,and they selected one or more reasons from a list,such as age, race or ethnicity, and gender identity.Nearly three-quarters (74%) believed that theywere denied access to a shelter because of theirgender identity or expression.8 This represents4% of those who were homeless in the past year(Table 13.4). Table 13.4: Reported reasons for being denied accessto one or more shelters | Reason for denial | % of those deniedaccess to shelter | | - | - | | Age | 7% | | Disability | 8% | | Income level or education | 5% | | Gender identity or expression | 74% | | Race or ethnicity | 4% | | Religion or spirituality | 4% | | Sexual orientation | 17% | | None of the above | 19% | b. Treatment in Shelters Respondents who stayed at one or more sheltersin the past year received questions about howthey were treated at the shelter(s) as a transgenderperson. Seventy percent (70%) encountered atleast one negative experience based on theirtransgender status in the past year, such as beingforced out, harassed, or attacked because theywere transgender. Nearly one in ten (9%) respondents who stayed ata shelter in the past year were thrown out after theshelter staff found out that they were transgender.Forty-four percent (44%) decided to leave theshelter because of poor treatment or unsafeconditions, even though they had no other place togo. One-quarter (25%) of respondents decided todress or present as the wrong gender in order tofeel safe in a shelter, and 14% said that the shelterstaff forced them to dress or present as the wronggender in order to stay at the shelter (Table 13.5). Seven out of ten (70%) respondentswho stayed at a shelter in thepast year faced some form ofmistreatment, such as being forcedout, harassed, or attacked becauseof being transgender. ### Page 186 Table 13.5: Experiences while staying in homelessshelters in the past year | Experiences while staying inhomeless shelters | % of people whostayed in a shelter | | - | - | | They left because of poor treatment orunsafe conditions, even though theyhad nowhere else to go | 44% | | They decided to dress or present as thewrong gender to feel safe in shelter | 25% | | The shelter required them to dress orpresent as the wrong gender | 14% | | They were thrown out after shelter stafflearned they were transgender | 9% | | One or more experiences listed | 58% | Respondents who stayed at a homeless shelterin the past year were also asked whether theywere verbally harassed, physically attacked, orsexually assaulted9 at the shelter because theywere transgender. Nearly half (49%) reported thatthey were verbally harassed because they weretransgender. Nearly one-fifth (19%) were physicallyattacked, and 17% were sexually assaulted at theshelter because they were transgender (Table 13.6). Table.6: Verbal harassment, physical attack, andsexual assault in homeless shelters in the past yearbecause they were transgender | Experiences while staying inhomeless shelters | % of people whostayed in a shelter | | - | - | | Verbally harassed | 49% | | Physically attacked | 19% | | Sexually assaulted | 17% | | One or more experiences listed | 52% | Conclusion Respondents reported high rates of homelessnessboth in their lifetime and the past year. Theresults also indicated that a substantial number ofrespondents experienced housing discriminationand housing instability in the past year basedon their transgender status, with higher ratesamong transgender women of color, people livingwith HIV, people who have been kicked out oftheir homes by their families, and respondentscurrently working in the underground economy.Many of those who experienced homelessnessin the past year reported that they avoided usinga shelter because they feared being mistreatedas a transgender person, and those who diduse a shelter in the past year faced high rates ofmistreatment based on their transgender status,such as being kicked out of the shelter, beingverbally harassed, physically attacked, or sexuallyassaulted. ### Page 187 1 See e.g., Davidson, C. (2014). Gender minority andhomelessness. In Focus: A Quarterly Research Reviewof the National Health Care for the Homeless Council,3(1). Available at: http://www.nhchc.org/wp-content/uploads/2014/10/in-focus_transgender_sep2014_final.pdf; Durso, L. E. & Gates, G. J. (2012). Serving Our Youth:Findings from a National Survey of Service ProvidersWorking with Lesbian, Gay, Bisexual, and TransgenderYouth who are Homeless or at Risk of BecomingHomeless. Los Angeles, CA: Williams Institute. Availableat: http://williamsinstitute.law.ucla.edu/wp-content/uploads/Durso-Gates-LGBT-Homeless-Youth-Survey-July-2012.pdf;Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J.L., & Keisling, M. (2011). Injustice at Every Turn: A Report ofthe National Transgender Discrimination Survey. (p. 112).DC: National Center for Transgender Equality & NationalGay and Lesbian Task Force. 2 Grant, et al.; Rooney, C., Durso, L. E., & Gruberg, S. (2016).Discrimination Against Transgender Women SeekingAccess to Homeless Shelters. DC: Center for AmericanProgress. Available at: https://www.americanprogress.org/issues/lgbt/report/2016/01/07/128323/discrimination-against-transgender-women-seeking-access-to-homeless-shelters/. 3 U.S. Census Bureau. (2015). American CommunitySurvey 1-Year Estimates: Homeownership Rate by Ageof Householder. The ACS homeownership rate includeages 15 and older, in contrast to the USTS rate, whichincludes respondents who are 18 and older. Becausethe ACS includes people under 18 years of age, an exactcomparison to the USTS sample could not be made.Therefore, this comparison should be interpreted withcaution. 4 U.S. Census Bureau. (2015). American CommunitySurvey 1-Year Estimates: Homeownership Rate by Age ofHouseholder. The ACS homeownership rate for the “under25” age group includes those who are 15–24 years of age,in contrast to the USTS rate, which includes respondentswho are 18–24 years of age. See note 3. 5 The homelessness point-in-time estimate is based onJanuary 2015 data. Department of Housing and UrbanDevelopment. (2015). 2015 Annual HomelessnessAssessment Report (AHAR) to Congress. Availableat: https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf. Calculation is based onthe 436,921 people over the age of 18 who were homelesson a given night in 2015 and the January 2015 estimatedadult population (247,492,492). 6 Respondents were given the choice of answering “yes,”“no,” or “does not apply to me” for each housing scenariolisted in Q. 23.2. They were instructed to select “doesnot apply to me” if the housing situation could not havehappened to them in the past year. For example, thosewho did not rent a home in the past year could not havebeen evicted, and were instructed to select “does notapply to me” for that question. The results reported in thissection do not include those who answered “does notapply to me” for each of the housing situations. 7 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 8 The survey included both “transgender status/genderidentity” and “gender expression/appearance” as answerchoices so that respondents could select what they feltbest represented their experience. Because there wasa substantial overlap of respondents who selected bothreasons, and because these terms are commonly usedinterchangeably or with very similar meanings, responsesof those who selected one or both of these reasons arecollapsed for reporting as “gender identity or expression.” 9 Respondents were asked if they had experienced“unwanted sexual contact (such as fondling, sexualassault, or rape)” in Q. 24.4. ENDNOTES | CHAPTER 13: HOUSING, HOMELESSNESS, AND SHELTER ACCESS ### Page 188 184 CHAPTER 14 Police, Prisons, andImmigration Detention Transgender people, particularly transgender people of color, face elevated levels of negativeinteractions with law enforcement officers and the criminal justice system. This includes higherrates of police mistreatment,1 incarceration,2 and physical and sexual assault in jails and prisons.3Furthermore, when navigating the United States immigration system, many transgender people, includingthose who are seeking asylum based on their gender identity, face the prospect of being placed into unsafeimmigration detention centers. While in immigration detention, transgender people are often placed infacilities that do not match their gender identity or face extended periods of solitary confinement, leavingthem vulnerable to physical and sexual abuse, denial of medical treatment, and other dangerous conditions.4 This chapter explores respondents’ experiences with police and other law enforcement officers, in jail,prison, or juvenile detention centers, and in immigration detention, including experiences of physical andsexual assault during interactions with law enforcement and while incarcerated. Many of the questions in thissection were modeled on the Bureau of Justice Statistics’ National Inmate Survey. Results in this chapter arepresented in three sections: (A) Interactions with Law Enforcement Officers, (B) Incarceration in Jail, Prison,or Juvenile Detention, and (C) Experiences in Immigration Detention. Notable differences in respondents’experiences based on demographic and other characteristics are reported throughout the chapter. ### Page 189 185 A. INTERACTIONS WITH LAWENFORCEMENT OFFICERS Of respondents who interacted with police or law enforcement officers who thoughtor knew they were transgender in the past year, 57% said they were never or onlysometimes treated respectfully. Further, 58% reported some form of mistreatment, suchas being repeatedly referred to as the wrong gender, verbally harassed, or physical orsexually assaulted. More than half (57%) of respondents said they were either somewhat or veryuncomfortable asking the police for help. Two percent (2%) of respondents were arrested in the past year, and of those arrested,22% believed they were arrested because they were transgender. I. Law EnforcementInteractions in thePast Year Forty percent (40%) of respondents said thatthey interacted with the police or other lawenforcement officers in the past year. Of those,65% said that they believed none of the officersthought or knew they were transgender, and 35%said that some or all of the officers thought orknew they were transgender (Figure 14.1). Respondents who said that some or all of the lawenforcement officers thought or knew they weretransgender were then asked whether they weretreated with respect during the interactions. Morethan half of these respondents (57%) said thatthey were never or only sometimes treated withrespect, and 43% reported that they were alwaystreated with respect (Figure 14.2). Respondents who were currently working in theunderground economy (80%) were more likely to KEY FINDINGS ### Page 190 report never or only sometimes being treated withrespect, as were those who were currently living inpoverty5 (69%). Non-binary respondents (70%) andtransgender men (62%) were more likely to reporthaving never or only sometimes been treated withrespect than transgender women (51%) (Figure14.3). People of color were also more likely toreport never or only sometimes being treated withrespect, particularly American Indian (72%) andBlack (70%) respondents (Figure 14.4). Respondents who said that some or all of theofficers they interacted with thought or knew theywere transgender were also asked whether theyexperienced specific forms of mistreatment intheir interactions with law enforcement officers inthe past year, such as being repeatedly referredto as the wrong gender, verbally harassed, orphysically attacked. More than half (58%) of theserespondents reported having experienced one ormore forms of mistreatment (Table 14.1). Table 14.1: Mistreatment by police or other lawenforcement officers in the past year | Experiences ofmistreatment in thepast year | % of those who interactedwith officers who thought orknew they were transgenderin the past year | | - | - | | Officers kept using the wronggender pronouns (such as he/him or she/her) or wrong title(such as Mr. or Ms.) | 49% | | Verbally harassed by officers | 20% | | Officers asked questionsabout gender transition(such as about hormones orsurgical status) | 19% | | Officers assumed they weresex workers | 11% | | Physically attacked by officers | 4% | | Sexually assaulted by officers | 3% | | Forced by officers to engagein sexual activity to avoidarrest | 1% | | One or more experienceslisted | 58% | People of color, including American Indian(74%), multiracial (71%), Latino/a (66%), and Black(61%) respondents, were more likely to haveexperienced one or more forms of mistreatment(Figure 14.5). Respondents who were homelessin the past year (78%), those who were currentlyunemployed (75%), and people with disabilities6(68%) were also more likely to report one or moreof these experiences. ### Page 191 Verbal harassment was frequently reported byrespondents who interacted with police or otherlaw enforcement officers who thought or knewthey were transgender. In the past year, one infive (20%) of these respondents reported verbalharassment by an officer. Those who had beenhomeless in the past year were twice as likely tobe verbally harassed by an officer (40%), and thosewho were currently working in the undergroundeconomy were more than twice as likely to beverbally harassed (51%). In the past year, more than one in ten (11%)respondents who interacted with law enforcementofficers who thought or knew they weretransgender reported that an officer assumedthat they were sex workers. Transgender womenof color were more likely to report that an officerassumed they were sex workers, including Black(33%), multiracial (30%), Latina (25%), AmericanIndian (23%), and Asian (20%) women (Figure 14.6). Respondents who interacted with law enforcementofficers who thought or knew they weretransgender in the past year also reported beingphysically or sexually assaulted. Six percent (6%)of these respondents were physically attacked,sexually assaulted,7 and/or forced to engagein sexual activity to avoid arrest by an officer.Respondents who were currently working in theunderground economy (27%) and those whowere homeless in the past year (17%) were more More than half (58%) ofrespondents who interactedwith a law enforcementofficer who thought or knewthat they were transgenderwere verbally harassed,physically or sexuallyassaulted, or mistreated inanother way in the past year. ### Page 192 likely to report one or more of these experiences.Transgender women of color, including AmericanIndian (20%), Black (17%), and multiracial (16%)women, were also more likely to report one or moreof these experiences (Figure 14.7). II. Comfort Interactingwith Law EnforcementOfficers All respondents were asked how comfortable theywould feel asking for help from the police if theyneeded it. Twenty-nine percent (29%) reportedthat they would either be very comfortable orsomewhat comfortable asking for help from thepolice, and 15% said they were neutral. A majority(57%) of the sample said that they were somewhatuncomfortable or very uncomfortable asking forhelp from the police (Figure 14.8). In Our OwnVoices “When I began to live in my correctgender, I was stopped by policeand forced to strip in public in frontof them as well as being verballyharassed, threatened with arrest,and accused of being a sex worker.” “While I was in solitary, a copasked me about my gender. Itold him I was male, and he toldme I sounded female. Next thingI knew, I was being taken to thejail doctor to spread my legs andhave him confirm my gender. It washumiliating.” “I was in [ jail] for 12 days housedwith male detainees. Upon beingbooked, I was escorted to theshower area where I was forced tostrip down and shower with maleinmates who made sexual advancestowards me while mocking me forbeing different. I feared for my lifeand the guards were of no helpbecause they mocked me for beingtransgender.” “When I was booked, the officersasked very intrusive questionsabout my genitalia in a verynonprofessional manner andlaughed about it. They ended upbooking me into an all-femalesolitary confinement cell, keptcalling me ‘miss,’ and gave mefemale colors even though I passfull time as male.” ### Page 193 Middle Eastern (70%), Black (67%), and multiracial(67%) respondents were more likely to say thatthey were either somewhat or very uncomfortableasking for help from the police (Figure 14.9).Respondents with disabilities (70%) and those whowere living in poverty (67%) were also more likelyto be somewhat or very uncomfortable asking forhelp from the police. III. Arrest Two percent (2%) of all respondents reportedhaving been arrested in the past year. Almostone-quarter (22%) of those who were arrestedbelieved that they were arrested because theywere transgender. Respondents who were homeless in the past year(6%) were more likely to be arrested during thatyear. Transgender women of color, including Black(6%), American Indian (6%), and multiracial (3%)women, were also more likely to be arrested in thepast year (Figure 14.10). A majority (57%) of respondentssaid they would be somewhator very uncomfortable askingfor help from the police if theyneeded it. ### Page 194 B. INCARCERATION IN JAIL, PRISON,OR JUVENILE DETENTION Two percent (2%) of respondents were held in jail, prison, or juvenile detention in thepast year. Nearly one-third (30%) of respondents who were incarcerated were physically and/orsexually assaulted by facility staff and/or another inmate in the past year. During the past year, more than one-third (37%) of respondents who were takinghormones before their incarceration were prevented from taking their hormoneswhile incarcerated. I. OverallIncarceration Rates Two percent (2%) of respondents wereincarcerated (held in jail, prison, or juveniledetention) in the past year. Twelve percent (12%)of undocumented respondents were incarceratedin the past year. Transgender women of color,including Black (9%) and American Indian(6%) women, were more likely to have beenincarcerated in the past year (Figure 14.11), as wererespondents who had been homeless in the pastyear (7%). Respondents who were incarcerated in the pastyear were asked what type of jail, prison, orjuvenile detention facility they were in, and theymade one or more selections. Most of theserespondents were incarcerated in a local jail (64%)and/or held in a holding cell (58%) (Figure 14.12). KEY FINDINGS Figure 14.12: Types of incarceration facilities 70% 60% 50% 40% 30% 20% 10% 0% 64% 58% 6% 5% 2% 1% 1% Other correctional facility Locally or privately operatedjuvenile facilities Federal prison State juvenile system State prison Holding cell Local jail 0% ### Page 195 II. Physical andSexual Assault DuringIncarceration Respondents who were incarcerated in jail,prison, or juvenile detention in the past yearwere asked whether they had been physicallyor sexually assaulted8 by facility staff or otherinmates during that time period. One in five (20%)respondents reported being sexually assaultedby facility staff or other inmates. This rate wasfive to six times higher than the rates of sexualassault by facility staff or other inmates reportedby the U.S. incarcerated population in prisons(4%) and in jails (3.2%).9 Nearly one-quarter (23%)were physically assaulted.10 Overall, 30% werephysically and/or sexually assaulted in the pastyear while incarcerated (Figure 14.13). Physical andsexual assault by staff or other inmates is exploredseparately in the following sections. a. Physical and Sexual Assaultby Facility Staff One in five (20%) respondents who were incarcer-ated in jail, prison, or juvenile detention in the pastyear were physically and/or sexually assaulted byfacility staff during that time (Figure 14.14). Almost one in five (18%) respondents who wereincarcerated in the past year were physicallyassaulted by facility staff during their time injail, prison, or juvenile detention. Respondentswho were physically assaulted by facility staffin the past year were asked how many times ithappened. More than half (53%) reported that theyhad been physically assaulted once, 12% reportedthat it happened twice, 16% said that it happenedbetween three and seven times, and nearly one infive (19%) reported that it happened eight or moretimes (Figure 14.15). 30% 23% 20% ### Page 196 Eleven percent (11%) were sexually assaulted byfacility staff in the past year during their time injail, prison, or juvenile detention. The rate amongUSTS respondents was five to six times higherthan the rates of sexual assault by facility staffreported by the U.S. incarcerated population inprisons (2.4%) and in jails (1.8%).11 Respondentswho were sexually assaulted by facility staff inthe past year were asked how many times ithappened. Nearly half (49%) said that it happenedonce, 9% reported that it happened twice, 19% saidit happened between three and seven times, andalmost one-quarter (23%) said that it happenedeight or more times (Figure 14.16). b. Physical and Sexual Assault byOther Inmates Twenty-two percent (22%) of respondents whowere incarcerated in jail, prison, or juveniledetention in the past year reported that they werephysically and/or sexually assaulted by otherinmates during that time (Figure 14.17). One in six (16%) respondents who wereincarcerated in the past year were physicallyassaulted by another inmate during their time injail, prison, or juvenile detention. Respondentswho were physically assaulted by another inmatein the past year were asked how many timesit happened. Fewer than half (43%) of thoserespondents were physically assaulted once, 13%were physically assaulted twice, 34% said that ithappened between three and seven times, andone in ten (10%) said that it happened eight ormore times (Figure 14.18). Respondents who wereincarcerated were five to sixtimes more likely than thegeneral incarcerated populationto be sexually assaulted byfacility staff, and nine to tentimes more likely to be sexuallyassaulted by another inmate. ### Page 197 Seventeen percent (17%) of respondents who wereincarcerated in the past year reported that theywere sexually assaulted by another inmate duringtheir time in jail, prison, or juvenile detention. Therate among USTS respondents was nine to tentimes higher than the rates of sexual assault byother inmates reported by the U.S. incarceratedpopulation in prisons (2%) and in jails (1.6%).12 Respondents who were sexually assaulted byanother inmate in the past year were asked howmany times it happened. Forty-three percent (43%)of those respondents were sexually assaultedonce, and 16% were sexually assaulted twice.Nearly one in five (18%) said it happened betweenthree and seven times, and nearly one-quarter(23%) said that it happened eight or more times(Figure 14.19). III. Hormone TherapyDuring Incarceration Over half (58%) of respondents who wereincarcerated in the past year had been takinghormones before their time in jail, prison,or juvenile detention. Of those, 82% had aprescription for those hormones. More thanone-third (37%) of respondents who had beentaking hormones before their incarceration wereprohibited from taking their hormones in the pastyear while in jail, prison, or juvenile detention. In the past year, more thanone-third (37%) of respondentswho had been taking hormonesbefore being incarcerated wereprohibited from taking thosehormones while in jail, prison, orjuvenile detention. ### Page 198 C. EXPERIENCES IN IMMIGRATIONDETENTION Four percent (4%) of respondents who were not U.S. citizens by birth had been heldin immigration detention at some point in their lives. More than half (52%) of respondents who were held in immigration detention weresegregated from other people in detention, including 42% who were held in solitaryconfinement. Forty-five percent (45%) of respondents who were in immigration detentionexperienced some form of mistreatment, such as being physically or sexuallyassaulted or being denied access to hormones. I. Placementin ImmigrationDetention Respondents who were not U.S. citizens bybirth were asked if they had ever been heldin immigration detention, such as being heldin an Immigration and Customs Enforcement(ICE) detention center or a local jail just forimmigration court proceedings.13 Four percent(4%) (n=30, unweighted)14 had been held inimmigration detention. More than two-thirds(69%) of those who were held in immigrationdetention said that staff, guards, or othersthought or knew that they were transgender orlesbian, gay, or bisexual (LGB). II. Isolation andSolitary Confinement Respondents who were detained were askedwhether they had been segregated fromothers who were also in detention. Of the thirtyrespondents who answered this question, morethan half (52%) reported being isolated in one ormore ways. Seventeen percent (17%) were heldin a separate area for transgender and/or LGBpeople, such as a pod, unit, tank, or other housingarea. Forty-two percent (42%) were held in solitaryconfinement. Those who were held in solitary confinement wereasked how long they were held in confinement.Of the nine respondents who had been in solitaryconfinement, forty percent (40%) were held for 14days or less (up to two weeks). More than one-quarter (28%) were held for 1–3 months, while14% were held in solitary confinement for over sixmonths (Figure 14.20). KEY FINDINGS ### Page 199 * Due to the small sample size, these findings should be interpreted withcaution. III. Mistreatment andAssault in ImmigrationDetention Those who were placed in immigration detentionwere asked about any mistreatment they facedwhile they were there, such as being physicallyor sexually assaulted, threatened with sexualassault, or denied access to hormones orgender-appropriate clothing. Of the twenty-ninerespondents who answered these questions, 45%reported one or more of these experiences fromtheir time in immigration detention. Approximately one-quarter (23%) were physicallyassaulted and 15% were sexually assaulted bystaff or detention officers or by other detainees orinmates, while 19% were threatened with sexualassault. Nearly one-third (29%) were denied accessto hormone treatment (Table 14.2). Table 14.2: Mistreatment and assault in immigrationdetention | Form of mistreatment or assault(n=29, unweighted) | % of thosedetained | | - | - | | Denied access to hormones | 29% | | Physically assaulted | 23% | | Denied gender-appropriate clothing | 22% | | Threatened with sexual assault | 19% | | Sexually assaulted | 15% | | One or more experiences listed | 45% | * Due to the small sample size, these findings should be interpreted withcaution. Conclusion Respondents reported frequent contact withthe law enforcement and criminal justicesystems, as well as high rates of mistreatmentby police, physical and sexual abuse in jails andprisons, and denial of medical treatment whileincarcerated. Experiences with law enforcementvaried by demographic groups, with transgenderpeople of color, those who have experiencedhomelessness, people with disabilities, and low-income transgender people reporting higherrates of discomfort with and mistreatment bypolice and other law enforcement officers. Resultsalso indicated substantial levels of mistreatmentand abuse in jail, prisons, and juvenile detentioncenters. Additionally, the experiences ofrespondents who were placed in immigrationdetention included harmful conditions andmistreatment, such as lengthy periods of solitaryconfinement and physical and sexual assault bydetention staff and other detainees. ### Page 200 1 Center for American Progress & Movement AdvancementProject. (2016). Unjust: How the Broken Criminal JusticeSystem Fails LGBT People. Available at: http://www.lgbtmap.org/file/lgbt-criminal-justice.pdf. 2 Center for American Progress & Movement AdvancementProject. (2016). Unjust: How the Broken Criminal JusticeSystem Fails LGBT People. Available at: http://www.lgbtmap.org/file/lgbt-criminal-justice.pdf; Lydon, J. (2015).Coming out of Concrete Closets: A Report on Black &Pink’s National LGBTQ Survey. Available at: http://www.blackandpink.org/wp-content/upLoads/Coming-Out-of-Concrete-Closets.-Black-and-Pink.-October-21-2015..pdf. 3 Beck, A. J. (2014). Sexual Victimization in Prisons andJails Reported by Inmates, 2011–12: Supplemental Tables:Prevalence of Sexual Victimization Among TransgenderAdult Inmates. DC: Bureau of Justice Statistics. Availableat: https://www.bjs.gov/content/pub/pdf/svpjri1112_st.pdf. 4 Human Rights Watch. (2016). “Do You See How Much I’mSuffering Here?”: Abuse Against Transgender Women inUS Immigration Detention. NY, New York: Human RightsWatch. Available at: https://www.hrw.org/sites/default/files/report_pdf/us0316_web.pdf; Jeanty, J. & Tobin,H. J. (2013). Our Moment for Reform: Immigration andTransgender People. DC: National Center for TransgenderEquality. Available at: http://www.transequality.org/sites/default/files/docs/resources/OurMoment_CIR_en.pdf. 5 Respondents who are “living in poverty” represent thosewho are living at or near the poverty line. See the Incomeand Employment Status chapter for more informationabout the poverty line calculation. 6 “Respondents with disabilities” here refers to respondentswho identified as a person with a disability in Q. 2.20. 7 Respondents received the following answer choice in Q.28.5: “I experienced unwanted sexual contact from anofficer (such as fondling, sexual assault, or rape).” 8 Respondents were asked in Q. 28.10 and Q. 28.12 whetherthey were “physically forced, pressured, or made to feelthat [they] had to have sex or sexual contact” with facilitystaff or with another inmate. This question was based onthe language used by the Bureau of Justice’s NationalInmate Survey to allow for comparison with the generalincarcerated population. Beck, A. J., Berzofsky, M., Caspar,R., & Krebs, C. (2013). Sexual Victimization in Prisons andJails Reported by Inmates 2011–12. DC: Bureau of JusticeStatistics. Available at: https://www.bjs.gov/content/pub/pdf/svpjri1112.pdf. 9 Beck et al. See note 8. The Bureau of Justice Statistics(BJS) presents data separately for people incarcerated instate and federal prisons and people incarcerated in jails,but they do not present data for those held in juveniledetention facilities. USTS data includes the experiencesof those who were incarcerated in jail, prison, and juveniledetention. Therefore, data from the U.S. incarceratedpopulation in this section is provided as a benchmark forexperiences among USTS respondents and should beinterpreted with caution. 10 The National Inmate Survey does not ask about physicalassault that does not involve sexual violence. 11 Beck et al. See note 8. 12 Beck et al. See note 8. 13 This section discusses the specific experiences of thoseheld in immigration detention. General information aboutcitizenship and immigration status, including experienceswith applications for asylum, is provided in the Portrait ofUSTS Respondents chapter. 14 Although a small number of respondents in the sample(n=30, unweighted) had been held in an immigrationdetention facility, it was important to highlight theirexperiences in this report. Due to the small samplesize, unweighted frequencies are presented alongsideweighted percentages in this section to be clear that thepercentages reflect the experiences of a small numberof respondents. While it is important to present theseexperiences in this report, the findings presented in thissection should be interpreted with caution due to thesmall sample size. ENDNOTES | CHAPTER 14: POLICE, PRISONS, AND IMMIGRATION DETENTION ### Page 201 197 CHAPTER 15 Harassmentand Violence The freedom to participate in public life without fear of discrimination, harassment, and violence hasbeen shown to have wide-ranging impacts on health, economic stability, and other key aspects oflife.1 Transgender people, however, are often vulnerable to mistreatment in public spaces, resultingin barriers to civic and economic participation.2 Transgender people also face high rates of violence,including physical attacks, sexual assault, and intimate partner violence.3 Respondents were asked about their experiences in the past year with unequal treatment or service4in businesses, government agencies, and other public places (more broadly than just in publicaccommodations, which are covered in the Places of Public Accommodation and Airport Security chapter),as well their experiences with verbal harassment.5 They also received questions about experiences withbeing physically attacked or sexually assaulted in a variety of settings. Finally, they were asked aboutexperiences with intimate partner violence. Questions were informed by several national surveys, includingthe National Crime Victimization Survey and the National Intimate Partner and Sexual Violence Survey.6Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. ### Page 202 198 Nearly half (48%) of all respondents in the sample reported being denied equaltreatment, verbally harassed, and/or physically attacked in the past year because ofbeing transgender. • One in seven (14%) respondents reported that they were denied equal treatment orservice in a public place in the past year because of being transgender. • Nearly half (46%) of respondents reported that they were verbally harassed in thepast year because of being transgender. • Nearly one in ten (9%) respondents reported that they were physically attacked in thepast year because of being transgender. Nearly half (47%) of respondents have been sexually assaulted at some point in theirlifetime. One in ten (10%) respondents in the survey were sexually assaulted in the past year. More than half (54%) of respondents experienced some form of intimate partnerviolence. • More than one-third (35%) experienced physical violence by an intimate partner,compared to 30% of the U.S. adult population. Nearly one-quarter (24%) experiencedsevere physical violence by a current or former partner, compared with 18% of theU.S. population. I. Overall Experiencesof Unequal Treatment,Harassment, andPhysical Attack Respondents were asked if they had been deniedequal treatment or service, verbally harassed, orphysically attacked in the past year for any reason,regardless of whether it happened because theywere transgender. This section of the chapter willexamine respondents’ overall experiences in thepast year, and is followed by separate sectionsexamining denial of equal treatment, verbalharassment, and physical attacks in greater detail. Fifty-eight percent (58%) of respondents said thatthey were denied equal treatment or service,verbally harassed, and/or physically attacked in thepast year for any reason. Respondents who werecurrently working in the underground economy,such as sex work, drug sales, or other work thatis currently criminalized (82%), and people withdisabilities7 (69%) were more likely to report oneor more of these experiences. Middle Eastern(70%), multiracial (70%), and American Indian (69%)respondents were also more likely to report one ormore of these experiences (Figure 15.1). KEY FINDINGS ### Page 203 Respondents who had one or more of theseexperiences were then asked what they believedthe reasons were for that treatment. Eighty-fourpercent (84%) believed that it happened becauseof their gender identity or expression. This meansthat 48% of all respondents in the survey reportedthat they were denied equal treatment or service,verbally harassed, and/or physically attackedbecause of being transgender in the past year(Table 15.1). Table 15.1: Denial of equal treatment, verbalharassment, and physical attack in the past year | Experience | Had experiencefor any reason (%of respondents) | Had experiencebecause of beingtransgender (% ofrespondents) | | - | - | - | | Denied equaltreatment | 16% | 14% | | Verballyharassed | 54% | 46% | | Physicallyattacked | 13% | 9% | | One or moreexperienceslisted | 58% | 48% | Those who said that others could usually or alwaystell that they were transgender (66%) were more likelyto report having one or more of these experiencesbecause of being transgender, in contrast to thosewho said that others could rarely or never tell thatthey were transgender (39%) (Figure 15.2). Almost three-quarters (73%) of respondents whowere currently working in the underground economyreported being denied equal treatment, verballyharassed, and/or physically attacked in the past yearbecause of being transgender (Figure 15.3). Nearly half (48%) of respondentsreported that they were deniedequal treatment or service,verbally harassed, and/orphysically attacked because ofbeing transgender in the past year. ### Page 204 II. Unequal Treatmentor Service Sixteen percent (16%) of respondents were deniedequal treatment or service in the year beforetaking the survey, such as at a place of business,government agency, or other public place, for anyreason, regardless of whether it was related tobeing transgender. People of color were more likely to haveexperienced unequal treatment or service. Almostone-third (30%) of American Indian respondentsreported being denied equal treatment orservice at a public place in the past year. MiddleEastern (23%), multiracial (22%), and Black (20%)respondents also reported higher rates (Figure15.4). Undocumented residents (39%) were morethan twice as likely to have been denied equaltreatment or service as those in the overall sample,in contrast to documented non-citizens (20%) andcitizens (16%). Respondents who were denied equal treatment orservice were asked what they believed thereasons were for that treatment, and they selectedone or more reasons from a list, such as age, raceor ethnicity, and gender identity or expression(Table 15.2). Table.2: Reported reasons for denial of equaltreatment or service | Reason for experience8 | % of thosedeniedequaltreatment | % ofwholesample | | - | - | - | | Age | 14% | 2% | | Disability | 14% | 2% | | Income level or education | 13% | 2% | | Gender identity or expression | 88% | 14% | | Race or ethnicity | 24% | 4% | | Religion or spirituality | 5% | 1% | | Sexual orientation | 36% | 6% | | None of the above | 2% | <1% | Fourteen percent (14%) of all respondents saidthey had been denied equal treatment or servicein the past year because of their gender identity orexpression.9 Respondents also reported that they had beendenied equal treatment or service because of theirrace or ethnicity. Among people of color, Black (15%),Asian (9%), and multiracial (8%) respondents were ### Page 205 most likely to report being denied equal treatment orservice because of their race or ethnicity (Figure 15.5). III. Verbal Harassment Respondents were asked if anyone had verballyharassed them in the past year for any reason,regardless of whether it was related to beingtransgender. More than half (54%) reported thatthey had experienced verbal harassment. Thosewho were currently working in the undergroundeconomy (77%) were more likely to experience verbalharassment. Among people of color, Middle Eastern(67%), multiracial (66%), and American Indian (65%)respondents were more likely to have been verballyharassed in the past year (Figure 15.6). In Our OwnVoices “When people have tried to grope mein the street or have verbally harassedme, it’s usually either because theysee me as a sexual target or becausethey can’t figure out whether I am a‘man’ or a ‘woman’ and they thinkthey have the right to demand anexplanation.” “I was sexually assaulted at myuniversity. I was also attacked andstalked. The university didn’t doanything to help me. Instead, itthreatened to punish me. I lived interror the entire time I was on campus.I was denied a rape kit because Iwas transgender and the police werecompletely uninterested.” “I was found in a ditch after beingbrutally raped for three days. I wastaken to an ER. There I met anofficer who told me I deserved it forattempting to be a woman and shouldhave died. He also refused to take areport.” “I was a victim of spousal abuse forover ten years. This grew worse when Itransitioned, as [my transition] becamean easy justification for verbally,emotionally and physically abusing me.” “My trans status was used as a tool to[make me] stay with my former partner.She would say things such as ‘no oneelse would ever love you.’” ### Page 206 Respondents who were verbally harassed wereasked what they believed the reasons were forthat treatment (Table 15.3). Table.3: Reported reasons for verbal harassment | Reason for experience | % of thoseverballyharassed | % of wholesample | | - | - | - | | Age | 10% | 5% | | Disability | 10% | 5% | | Income level or education | 7% | 4% | | Gender identity or expression | 84% | 46% | | Race or ethnicity | 16% | 9% | | Religion or spirituality | 5% | 3% | | Sexual orientation | 42% | 23% | | None of the above | 8% | 4% | Nearly half (46%) of respondents in the overallsample reported they were verbally harassed inthe past year because of being transgender. Among people of color, Black (29%), Asian (27%),Middle Eastern (25%), and multiracial (18%)respondents were most likely to report beingverbally harassed because of their race or ethnicity(Figure 15.7). Respondents were asked if they had been verballyharassed in public by strangers because of beingtransgender in the past year.10 One-third (33%) ofall respondents reported having this experience inthe past year. Transgender women of color weremore likely to be harassed by strangers becauseof their gender identity or expression, particularlymultiracial (51%) and American Indian (47%) women(Figure 15.8). Those who said that others couldalways or usually tell that they were transgender,even without being told (55%), were substantiallymore likely to have been verbally harassed bystrangers, in contrast to those who said thatpeople could rarely or never tell that they weretransgender (22%). IV. Physical Attack Thirteen percent (13%) of respondents said thatsomeone had physically attacked them in thepast year, such as by grabbing them, throwingsomething at them, punching them, or using aweapon against them for any reason. Those who were currently working in theunderground economy (41%) were more than threetimes as likely to report being physically attackedin the past year. Undocumented residents (24%)were almost twice as likely to report beingphysically attacked. Experiences of physical attackalso varied by race and ethnicity, with AmericanIndian (25%), Middle Eastern (25%), and multiracial ### Page 207 (19%) respondents being more likely to report aphysically attack in the past year (Figure 15.9). Those who had been physically attacked in thepast year were asked what they believed thereasons were for that attack (Table 15.4). Table 15.4: Reported reasons for physical attack | Reason for experience | % of thosephysicallyattacked | % ofwholesample | | - | - | - | | Age | 7% | 1% | | Disability | 8% | 1% | | Income level or education | 5% | 1% | | Gender identity or expression | 66% | 9% | | Race or ethnicity | 11% | 1% | | Religion or spirituality | 3% | <1% | | Sexual orientation | 32% | 4% | | None of the above | 25% | 3% | Nearly one in ten (9%) respondents in the overallsample reported being physically attacked in thepast year because of being transgender. AmericanIndian (19%), Middle Eastern (14%), multiracialrespondents (12%), and Asian respondents (11%)were more likely to report being attacked becauseof being transgender (Figure 15.10), as wereundocumented residents (23%). Respondents also reported that they had beenphysically attacked because of their race orethnicity. Among people of color, Middle Eastern(6%), American Indian (4%), Black (4%), and Asian(4%) respondents were most likely to report beingphysically attacked because of their race orethnicity (Figure 15.11). Five percent (5%) of respondents in the overallsample were physically attacked in public bystrangers because of being transgender.11Undocumented residents (20%) and respondentscurrently working in the underground economy(20%) were four times more likely to report thisexperience than the overall sample. Transgenderwomen of color were also more likely to reportthis experience, particularly American Indian (19%),Middle Eastern (12%), and multiracial (11%) women ### Page 208 Respondents who were physically attacked forany reason in the past year were asked how manytimes they had been attacked. Forty-five percent(45%) were attacked once that year, and 25%were attacked twice. Thirteen percent (13%) wereattacked three times, and 16% were attacked fouror more times that year (Figure 15.13). These respondents were also asked to specifyhow they were attacked. Nearly three-quarters(73%) of those who were physically attacked in thepast year reported that someone had grabbed,punched, or choked them. Twenty-nine percent(29%) reported that someone threw an object atthem, like a rock or a bottle. Nearly one-third (29%)of those who reported being physically attackedwere sexually assaulted.12 (Table 15.5). Table 15.5: Means of physical attack in the past year | Type of physical attack | % of thosephysicallyattacked | | - | - | | By being grabbed, punched, or choked | 73% | | By having something thrown at them (suchas a rock or bottle) | 29% | | By being sexually assaulted | 29% | | With another weapon (like a baseball bat,frying pan, scissors, or stick) | 7% | | With a knife | 5% | | With a gun | 3% | | Not listed above | 9% | Three percent (3%) of respondents who werephysically attacked reported being attacked with agun in the past year. Transgender women of color,particularly Black (11%) and Latina (11%) women, werenearly four times as likely to report that they wereattacked with a gun (Figure 15.14). Respondentscurrently working in the underground economy(10%) were more than three times as likely to havebeen attacked with a gun, and those whose onlysource of income was from underground economywork (16%) were more than five times as likely tohave been attacked with a gun. ### Page 209 V. Sexual Assault In addition to questions about being physicallyattacked in the past year, respondents were askedquestions about their experiences with sexualassault during their lifetime and in the past year,13informed by questions from the National IntimatePartner and Sexual Violence Survey (NISVS).14 Nearly half (47%) of respondents have beensexually assaulted at some point in their lifetime.This included any experiences with “unwantedsexual contact, such as oral, genital, or analcontact, penetration, forced fondling, or rape.”15,16 Respondents who have participated in sex work(72%), those who have experienced homelessness(65%), and people with disabilities (61%) were morelikely to have been sexually assaulted in theirlifetime. Among people of color, American Indian(65%), multiracial (59%), Middle Eastern (58%), andBlack (53%) respondents were most likely to havebeen sexually assaulted in their lifetime (Figure15.15). Experiences also varied across gender, withtransgender men (51%) and non-binary people withfemale on their original birth certificate (58%) beingmore likely to have been sexually assaulted, incontrast to transgender women (37%) and non-binary people with male on their original birthcertificate (41%) (Figure 15.16). Among transgendermen and non-binary people with female on theiroriginal birth certificates, rates of sexual assaultwere higher among people of color, particularlyAmerican Indian, Middle Eastern, and multiracialpeople (Figure 15.17 & Figure 15.18). Nearly half (47%) ofrespondents have beensexually assaulted at somepoint in their lifetime. ### Page 210 Respondents who reported this experience werethen asked who had committed the sexual assault.Approximately one-third (34%) of those who weresexually assaulted said that a current or formerpartner had sexually assaulted them. One-quarter(25%) of sexual assault survivors reported that arelative was the perpetrator. Nearly one-third (30%)of sexual assault survivors reported that a strangercommitted the assault (Table 15.6). Table.6: Person who committed sexual assault | Person who committed sexualassault | % of respondentswho have beensexually assaulted | | - | - | | A friend or acquaintance | 47% | | A partner or ex-partner | 34% | | A stranger | 30% | | A relative | 25% | | A coworker | 5% | | A health care provider or doctor | 4% | | A teacher or school staff member | 3% | | A law enforcement officer | 2% | | A boss or supervisor | 2% | | A person not listed above | 12% | One in ten (10%) respondents in the survey weresexually assaulted in the past year.17,18 Respondentswho were currently working in the undergroundeconomy (36%) were more than three times as likelyto have been sexually assaulted in the past year. VI. Intimate PartnerViolence a. Overall Intimate PartnerViolence Respondents who reported ever having had aromantic or sexual partner received questionsabout their experiences with harm involvinga current or former intimate partner, includingphysical, emotional, or financial harm, many ofwhich were based on questions in the NationalIntimate Partner and Sexual Violence Survey(NISVS).19 Such acts of harm as described in thesurvey are defined as “intimate partner violence.”20 Overall, more than half (54%) of all respondentsexperienced some form of intimate partnerviolence in their lifetime. Over three-quarters(77%) of respondents who have done sex workand nearly three-quarters (72%) of those whohave been homeless experienced intimatepartner violence. Undocumented residents (68%),people with disabilities (61%), and people of color,including American Indian (73%), multiracial (62%),and Middle Eastern (62%) respondents, were alsomore likely to report this experience (Figure 15.19). One in ten (10%)respondents in the surveywere sexually assaulted inthe past year. ### Page 211 b. Intimidation, Emotional, andFinancial Harm Respondents received two sets of questionscovering a range of experiences with intimatepartner violence. The first set of questions involvedexperiences with coercive control, includingintimidation, emotional and financial harm, andphysical harm to others who were important torespondents. Sixteen percent (16%) of respondentsreported that they had been stalked, comparedto 6% in the U.S. population.21 One in four (25%)respondents were told that they were not a “real”woman or man by a partner, 23% were kept fromseeing or talking to family or friends, and 15% werekept from leaving the house when they wanted togo (Table 15.7). Table.7: Intimate partner violence involving coercivecontrol, including intimidation, emotional and financialharm, and physical harm to others | Type of intimate partner violenceinvolving coercive control | % ofrespondents | | - | - | | Told them that they were not a “real” womanor man | 25% | | Tried to keep them from seeing or talking tofamily or friends | 23% | | Stalked | 16% | | Kept them from leaving the house when theywanted to go | 15% | | Threatened to call the police on them | 11% | | Threatened to “out” them | 11% | | Kept them from having money for their ownuse | 9% | | Hurt someone they love | 9% | | Threatened to hurt a pet or threatened totake a pet away | 6% | | Would not let them have their hormones | 3% | | Would not let them have other medications | 3% | | Threatened to use their immigration statusagainst them | 1% | | One or more experiences listed | 44% | | One or more experiences related to beingtransgender listed | 27% | Overall, nearly half (44%) of respondents in thesample experienced some form of intimatepartner violence involving coercive control,including intimidation, emotional, and financialharm. Experience with this type of intimate partnerviolence differed by race, with American Indian(66%), Middle Eastern (56%), and multiracial (51%)respondents reporting higher rates of theseexperiences (Figure 15.20). Respondents whohave done sex work (66%), have experiencedhomelessness (62%), or were undocumented(60%) were also more likely to have experiencedintimate partner violence of this form. More than half (54%) of allrespondents experiencedsome form of intimatepartner violence in theirlifetime. ### Page 212 Furthermore, more than a quarter (27%) of surveyrespondents reported acts of coercive controlrelated to their transgender status, including beingtold that they were not a “real” woman or man,threatened with being “outed” by revealing theirtransgender status, or prevented from taking theirhormones. Transgender women of color, includingAmerican Indian (57%) and multiracial (39%)women, were more likely to report acts of harmrelated to their transgender status (Figure 15.21). c. Intimate Partner ViolenceInvolving Physical Harm Respondents received additional questions aboutexperiences of intimate partner violence involvingphysical harm inflicted on them (Table 15.8). Table | Type of intimate partnerviolence | % of USTSrespondents | % in U.S.population(NISVS) | | - | - | - | | Pushed or shoved | 30% | 23% | | Slapped | 24% | 19% | | Made threats to physically harmthem | 20% | -- | | Forced them to engage insexual activity | 19% | -- | | Hit them with a fist orsomething hard | 16% | 12% | | Slammed them againstsomething | 14% | 9% | | Hurt them by pulling their hair | 11% | 6% | | Kicked | 10% | 6% | | Tried to hurt them by choking orsuffocating them | 7% | 9% | | Beat them | 6% | 6% | | Used a knife or gun againstthem | 3% | 3% | | Burned them on purpose | 2% | 1% | | Any physical violence | 35% | 30% | | Any severe physical violence | 24% | 18% | | One or more experienceslisted | 42% | --- | Overall, 42% of all survey respondents reportedexperiencing some form of intimate partnerviolence involving physical harm, including thethreat of physical violence, over their lifetime.Respondents who have done sex work (67%) orwho have experienced homelessness (61%) weremore likely to report intimate partner violenceinvolving physical harm, as were undocumented(59%), American Indian (61%), multiracial (54%), andMiddle Eastern (49%) respondents (Figure 15.22). ### Page 213 More than one-third (35%) experienced someform of physical violence by an intimate partner,as defined by the National Intimate Partner andSexual Violence Survey,22 compared to 30% ofthe U.S. adult population.23 Moreover, nearly one-quarter (24%) of respondents reported havingexperienced severe physical violence from apartner, compared to 18% in the U.S. population.24 Conclusion The findings indicated that respondents facedhigh levels of unequal treatment, harassment, andphysical attacks in the past year, with higher ratesof these experiences reported among peopleof color, respondents currently working in theunderground economy, and those who reportedthat others can tell that they are transgender.Respondents also experienced high rates ofsexual assault in their lifetime and in the past year,and were more likely than the U.S. population toexperience physical intimate partner violence.People of color and undocumented residentswere more likely to report experiences of sexualassault and intimate partner violence, as wererespondents who have worked in the undergroundeconomy or who have experienced homelessness. 1 Langton, L. & Truman, J. (2014). Socio-Emotional Impact ofViolent Crime. DC: Bureau of Justice Statistics. Availableat: http://www.bjs.gov/content/pub/pdf/sivc.pdf; Lick, D.J., Durso, L. E., & Johnson, K. L. (2013). Minority stress andphysical health among sexual minorities. Perspectiveson Psychological Science, (8)521. Available at: http://pps.sagepub.com/content/8/5/521.full.pdf+html. 2 See e.g., Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J.,Herman, J. L., & Keisling, M. (2011). Injustice at Every Turn:A Report of the National Transgender DiscriminationSurvey. (pp. 124–135). DC: National Center for TransgenderEquality & National Gay and Lesbian Task Force. 3 See e.g., Grant et al., 100, 127; Beemyn, G. & Rankin, S.(2011). The Lives of Transgender People. New York, NY:Columbia University Press. 4 This chapter discusses general experiences withunequal treatment in public places in the past year, whichincludes both public accommodations as well as otherpublic spaces. For findings related to unequal treatmentin specific public places, such as stores, restaurants,and government agencies, see the Places of PublicAccommodation and Airport Security chapter. 5 This chapter discusses overall experiences with verbalharassment in the past year. Findings related to verbalharassment in specific settings are discussed in otherchapters, such as the Experiences at School, Employmentand the Workplace, and Health chapters. ENDNOTES | CHAPTER 15: HARASSMENT AND VIOLENCE ### Page 214 6 Truman, J. L. & Morgan, R. E. (2016). Criminal Victimization,2015. DC: Bureau of Justice Statistics; Breiding, M. J.,Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., &Merrick, M. T. (2014). Prevalence and characteristics ofsexual violence, stalking, and intimate partner violencevictimization—National Intimate Partner and SexualViolence Survey, United States, 2011. MMWR, 63(8).Available at: http://www.cdc.gov/mmwr/pdf/ss/ss6308.pdf. 7 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. 8 Respondents were asked to select all the reasons thatapplied to their experience. 9 The survey included both “transgender status/genderidentity” and “gender expression/appearance” as answerchoices so that respondents could select what they feltbest represented their experience. Because there wasa substantial overlap of respondents who selected bothreasons, and because these terms are commonly usedinterchangeably or with very similar meanings, responsesof those who selected one or both of these reasons arecollapsed for reporting as “gender identity or expression.” 10 Only respondents who reported that they were verballyharassed because of their transgender status, genderidentity, gender expression, or appearance receivedthis question (Q. 17.6), which asked: “In the past year, didstrangers verbally harass you in public because of yourtrans status, gender identity, or gender expression?”Results are reported out of the full sample. 11 Only respondents who reported that they were physicallyattacked because of their transgender status, genderidentity, gender expression, or appearance receivedthis question (Q. 17.10), which asked: “In the past year,did strangers physically attack you in public because ofyour trans status, gender identity, or gender expression?”Results are reported out of the full sample. 12 In Q. 17.8, respondents were asked if they were physicallyattacked with “unwanted sexual contact (such as rape,attempted rape, being forced to penetrate).” 13 Q.18.1 asked if respondents had ever “experiencedunwanted sexual contact, such as oral, genital, or analcontact, penetration, forced fondling, or rape.” 14 Breiding et al. See note 6. 15 Respondents were asked if they had ever “experiencedunwanted sexual contact, such as oral, genital, or analcontact, penetration, forced fondling, or rape” in Q. 18.1.This definition of sexual assault encompassed severalcategories of sexual violence as outlined in the NationalIntimate Partner and Sexual Violence Survey (NISVS). Seenote 16. 16 Due to differences between Q. 18.1 and the NISVSquestions about sexual violence, a direct comparisonto the U.S. population was not feasible for this report.However, as context for USTS respondents’ experiencewith sexual assault, NISVS findings indicate that anestimated 11% of adults in the U.S. population have beenraped in their lifetime, 19% have experienced unwantedsexual contact, 10% have experienced sexual coercion,and 4% were forced to penetrate someone. Breiding etal. See note 6. The figures for the prevalence of sexualviolence during one’s lifetime in the U.S. population werecalculated by the research team to present a combinedpercentage for the experiences of men and women using2011 data from the NISVS, as reported by the Centers forDisease Control. Since NISVS respondents could reportexperiences with multiple forms of sexual violence, anNISVS respondent’s experiences could be reflectedin several categories of sexual violence. The researchteam was unable to avoid double counting respondentswho reported more than one experience in the NISVS,and therefore, were unable to combine the percentagesof NISVS respondents who experienced any form ofsexual violence to match the broader USTS category of“unwanted sexual contact,” and make a direct comparison.Therefore, findings for the U.S. population in regard torape, unwanted sexual contact, sexual coercion, andbeing forced to penetrate are presented separately, andcomparisons between the NISVS and USTS findingsshould be interpreted with caution. 17 The 10% rate of sexual assault in the past year reportedin this section was based on Q. 18.3. This differs fromthe rate of sexual assault in the past year reported inthe “Physical Attack” section of this chapter (4%), whichwas based on Q. 17.8. This difference is likely due tothe number of respondents in the sample who receivedeach question based on skip-logic patterns. While allrespondents in the sample received Q. 18.3, a limitednumber of respondents received Q. 17.8 based on theiranswer to Q. 17.3. Respondents who indicated that theyhad been physically attacked in Q. 17.3, received a follow-up question asking how they were physically attacked(Q. 17.8), which included an answer choice of “unwantedsexual contact.” Those respondents who did not identifytheir experience of unwanted sexual contact as a formof physical attack would not have received the follow-upquestion regarding the method of the attack, if they hadnot reported another form of physical attack. Additionally,the difference in reporting may partly result from themore inclusive examples of unwanted sexual contactprovided in Q. 18.3 (“such as oral, genital, or anal contact,penetration, forced fondling, or rape”), in contrast to thedefinition of unwanted sexual contact in Q. 17.8 (“such asrape, attempted rape, being forced to penetrate”). ### Page 215 18 Due to differences between Q. 18.3 (sexual assault inthe past year) and the NISVS questions about sexualviolence, a direct comparison to the U.S. population wasnot feasible for this report. However, as context for USTSrespondents’ experience with sexual assault, NISVSfindings indicate that an estimated 1.9% of adults in theU.S. population experienced unwanted sexual contact inthe past year and an estimated 1.7% experienced sexualcoercion in the past year. These figures were calculatedby the research team to present a combined percentagefor the experiences of men and women using 2011 datafrom the NISVS. Additionally, an estimated 1.6% of womenwere raped in the past year. Due to the small number ofmen who reported being raped in the past year, a reliableestimate was not available for men. An estimated 1.7%of men were forced to penetrate a perpetrator in thepast year, while the number of women who were forcedto penetrate a perpetrator was too low to produce areliable estimate. Breiding et al. See note 6. Since NISVSrespondents could report experiences with multiple formsof sexual violence, an NISVS respondent’s experiencescould be reflected in several categories of sexual violence.The research team was unable to avoid double countingrespondents who reported more than one experience inthe NISVS, and therefore, were unable to combine thepercentages of NISVS respondents who experiencedany form of sexual violence to match the broader USTScategory of “unwanted sexual contact,” and make a directcomparison. Therefore, findings for the U.S. population inregard to rape, unwanted sexual contact, sexual coercion,and being forced to penetrate are presented separately,and comparisons between the NISVS and USTS findingsshould be interpreted with caution. 19 Breiding et al. See note 6. 20 See Q. 19.2 and Q. 19.3 for a list of acts described as formsof intimate partner violence. 21 Breiding et al. See note 6. 22 The NISVS measure for “any physical violence” includesall of the actions listed in Table 15.8, except for forcedsexual activity and threats of physical violence. 23 The figures for the prevalence of intimate partner violenceinvolving physical violence and/or severe physicalviolence in the U.S. population was calculated by theresearch team to present a combined percentage for theexperiences of men and women using 2011 data from theNISVS, as reported by the Centers for Disease Control andPrevention. See Breiding et al. See note 6. 24 According to the NISVS, “severe physical violence”includes being hurt by having one’s hair pulled, being hitwith a fist or something hard, kicked, slammed againstsomething, choked or suffocated, beaten, burned, orattacked with a knife or gun. ### Page 216 212 CHAPTER 16 Places of PublicAccommodationand Airport Security Public accommodations are places of business or other locations generally open to the public,which provide essential services that allow people to meet basic needs and participate in civic life,including government agencies, retail stores, and restaurants.1 For transgender people, places ofpublic accommodation are potentially unwelcoming or unsafe. Prior research has found that transgenderpeople may face unequal treatment or harassment in public settings such as retail stores.2 The surveyexplored respondents’ experiences in specific types of public accommodations in the past year and foundthat respondents were denied equal treatment, verbally harassed, and physically attacked in several ofthese locations. Respondents were also asked questions about their experiences in airports related to their gender identityor expression in the past year, given numerous reports of transgender people being subjected to excessivescrutiny and searches by Transportation Security Administration (TSA) officers when going through airportsecurity screening.3 Widely used body scanners often flag transgender people’s bodies and gender-related clothing or items for additional screening, which can lead to unnecessary searches and make themvulnerable to harassment and discriminatory treatment by TSA officers and bystanders.4 Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter. ### Page 217 213 I. Overall Experiencesin Places of PublicAccommodation Respondents received questions about theirexperiences in places of public accommodation,such as hotels, restaurants, or governmentagencies in the past year. They were first askedwhether they had visited or used services inspecific kinds of public accommodations, andthey then received follow-up questions based ontheir responses. For each type of location thatthey had visited in the past year, respondentswere asked whether they thought that staff oremployees at the location knew or thought theywere transgender. They were also asked whetherthey had been denied equal treatment, verballyharassed, or physically attacked at the selectedtype of location because they were transgender. Nearly all respondents in the sample (96%) hadvisited or used services in at least one of theplaces of public accommodation outlined in thischapter in the past year. Of those who had visitedor used services, 50% reported that they thoughtthe staff or employees knew or thought theywere transgender at one or more of the locations.Nearly one-third (31%) of those who said thatstaff or employees knew or thought they weretransgender experienced negative treatment in atleast one of the locations, including being deniedequal treatment or service, verbally harassed, orphysically attacked (Table 16.1). KEY FINDINGS Of respondents who said that staff or employees at a place of public accommodationthey visited thought or knew that they were transgender, nearly one-third (31%)experienced at least one type of negative experience, including being denied equaltreatment or service (14%), verbally harassed (24%), and/or physically attacked (2%) inthe past year. • Among those who visited a retail store, restaurant, hotel, or theater and said that staffor employees thought or knew that they were transgender, 31% were denied equaltreatment, verbally harassed, and/or physically attacked there. • Approximately one-third (34%) of respondents had one or more of these negativeexperiences in the past year when using public transportation where employeesthought or knew they were transgender. • Nearly one-quarter (22%) of respondents had one or more of these experiences inthe past year when visiting a domestic violence shelter or program or a rape crisiscenter where employees thought or knew they were transgender. One in five (20%) respondents did not use one or more places of public accommodationin the past year because they thought they would be mistreated as a transgenderperson. Additionally, 43% of respondents who went through airport security in the past yearexperienced a problem related to being transgender, such as being patted down orsearched because of a gender-related item, having the name or gender on their IDquestioned, or being detained. ### Page 218 Respondents’ experiences in each type ofpublic accommodation visited or used in thepast year are described in detail throughout thechapter (Table 16.2). Those who had not visiteda specific type of public accommodation wereasked whether they did not visit or use servicesat that place because they were afraid of beingmistreated as a transgender person. Overall, onein five (20%) reported that they did not visit oruse services at one or more of these locationsbecause they thought they would be mistreated asa transgender person. II. PublicTransportation Two-thirds (66%) of the sample used publictransportation services in the past year, such asa bus, train, subway, or taxi. Two percent (2%) ofrespondents did not use public transportationin the past year for fear of mistreatment as atransgender person. Twenty-four percent (24%)of those who used public transportation believedthat the employees knew or thought they weretransgender. Of those, 34% reported being deniedequal treatment or service, verbally harassed, orphysically attacked because of being transgenderwhile using public transportation (Table 16.3). Non-binary people (39%) were more likely to haveexperienced negative treatment than transgendermen and women (32%) when using publictransportation (Figure 16.1). These experiencesalso varied by race and ethnicity, with AmericanIndian (48%), multiracial (45%), and Asian (39%)respondents being more likely to have a negativeexperience (Figure 16.2). Those who werecurrently working in the underground economy(such as sex work, drug sales, or other work that iscurrently criminalized) (49%) and those who wereliving in poverty (39%) were also more likely toreport such an experience. ### Page 219 III. Retail Store,Restaurant, Hotel, orTheater Ninety-one percent (91%) of respondents visitedor used services in a retail store, restaurant,hotel, or theater in the past year. One percent(1%) of respondents reported not visiting a retailstore, restaurant, hotel, or theater in the past yearbecause they were afraid of mistreatment as atransgender person. Approximately one-third (34%)of those who visited or used services at theselocations believed that the staff or employeesknew or thought they were transgender. Of those,31% reported being denied equal treatment orservice, verbally harassed, or physically attackedbecause of being transgender (Table 16.4). American Indian (49%), multiracial (41%), Black(36%), and Asian (36%) respondents were morelikely to have a negative experience (Figure16.3). Those who were currently working in theunderground economy (52%), those who wereliving in poverty level (37%), and people withdisabilities5 (39%) were also more likely to havesuch experiences in these locations. Nearly one-third (31%) ofrespondents who visited a store,restaurant, hotel, or theaterwhere the staff knew or thoughtthey were transgender weremistreated because of theirgender identity or expression. ### Page 220 IV. Drug or AlcoholTreatment Program Two percent (2%) of the sample visited or usedservices at a drug or alcohol treatment programin the past year. One percent (1%) of respondentsdid not go to a treatment center in the past yearbecause of fear of mistreatment as a transgenderperson. Of those who visited or used servicesat a treatment program, 58% believed that thestaff or employees knew or thought they weretransgender. Of those, 22% reported being deniedequal treatment or service, verbally harassed, orphysically attacked because of being transgender(Table 16.5). In Our OwnVoices “When I attempted to change mygender marker on my state ID, I wasdenied three times. All three timesI was harassed. In one incident, themanager of the DMV location madefun of me and started laughing andtalked so loud that other patrons atthe DMV also began to laugh.” “A year ago I had my Social Securityupdated to reflect my new name andgender. I was treated with respectat all times. The woman workingin the Social Security office wrote‘congratulations’ and drew a hearton my copy of the documentation.” “A TSA officer referred to me as‘it’ when I couldn’t walk throughtheir security screen following topsurgery. I had to argue with TSA thata male employee needed to do thepat down and I was informed that awoman would be more appropriate.I stood my ground after repeatedlybeing told that I was not a man.” “I was subjected to a longer TSAscreening while they searched mybag, pulled out my intimate items,and called over friends to look andlaugh. I had to remove my wig toprove I was the same person. I washumiliated.” ### Page 221 Those who were currently working in theunderground economy (34%) and those who wereliving in poverty (27%) were more likely to reporthaving a negative experience in a drug or alcoholtreatment program. V. Domestic ViolenceShelter, DomesticViolence Program, orRape Crisis Center One percent (1%) of the sample visited or usedservices at a domestic violence (DV) shelter, DVprogram, or rape crisis center in the past year.Two percent (2%) of respondents did not go to aDV shelter or program or rape crisis center in thepast year because they were afraid they wouldbe mistreated as a transgender person. Of thosewho went to one of these locations, more thanhalf (59%) believed that the staff or employeesknew or thought they were transgender. Of those,nearly one-quarter (22%) reported being deniedequal treatment or service, verbally harassed, orphysically attacked because of being transgender(Table 16.6). Transgender women (28%) were more likely toreport having a negative experience at a DV shelter,DV program, or rape crisis center (Figure 16.4). VI. Gym orHealth Club More than one-third (35%) of the sample had visitedor used services at a gym or health club in the pastyear. Fourteen percent (14%) of respondents did notgo to a gym or health club in the past year becausethey were afraid of mistreatment as a transgenderperson. Of those respondents who had visited agym or health club, 28% believed that the staff oremployees knew or thought they were transgender.Of those, 18% reported being denied equal treatmentor service, verbally harassed, or physically attackedbecause of being transgender (Table 16.7). Nearly one in four (22%)respondents who went to adomestic violence shelter orprogram or rape crisis centerwhere staff knew or thought theywere transgender experiencedmistreatment of some kind. ### Page 222 Respondents who were currently working in theunderground economy were nearly twice as likelyto report having a negative experience in a gym orhealth club (35%). VII. Public Assistanceor GovernmentBenefits Office Twelve percent (12%) of the sample had visitedor used services at a public assistance orgovernment benefits office in the past year, suchas for receiving Supplemental Nutrition AssistanceProgram (SNAP or food stamps) or Women, Infants,and Children (WIC) benefits. Two percent (2%) ofrespondents did not go to such an agency in thepast year because they feared mistreatment as atransgender person. Over one-third (36%) of thosewho visited or used services at these locationsbelieved that the staff or employees knew orthought they were transgender. Of those, 17%reported being denied equal treatment or serviceor being verbally harassed because of beingtransgender (Table 16.8). American Indian (25%), multiracial (22%), Black(20%), and Latino/a (20%) respondents reportedhigher rates of mistreatment, in contrast to 15%of white respondents (Figure 16.5). People withdisabilities (21%) and those who were currentlyworking in the underground economy (24%)were also more likely to report having a negativeexperience in a public assistance or governmentbenefits office. ### Page 223 VIII. DMV Nearly half (44%) of the sample visited or usedservices at a DMV (Department of Motor Vehicles)in the past year. Three percent (3%) of respondentsdid not go to a DMV in the past year because offear of mistreatment as a transgender person.More than one-third (36%) of those who visited thislocation believed that the staff or employees knewor thought they were transgender. Of those, 14%reported being denied equal treatment or serviceor being verbally harassed because of beingtransgender (Table 16.9). IX. Nursing Homeor Extended CareFacility Four percent (4%) of the sample visited or usedservices at a nursing home or extended carefacility in the past year. One percent (1%) ofrespondents did not go to a nursing home orextended care facility in the past year becausethey were afraid of mistreatment as a transgenderperson. Twenty-two percent (22%) of those whovisited or used services in this location believedthat the staff or employees knew or thoughtthey were transgender. Of those, 14% reportedbeing denied equal treatment or service, verballyharassed, or physically attacked because of beingtransgender (Table 16.10). X. Court orCourthouse Approximately one in four (22%) respondents inthe sample visited or used services at a court orcourthouse in the past year. Two percent (2%) ofrespondents did not go to a court or courthousein the past year because they were afraid ofmistreatment as a transgender person. One-half(50%) of those who visited or used services therebelieved that court staff or employees knew orthought they were transgender. Of those, 13%reported being denied equal treatment or service,verbally harassed, or physically attacked becauseof being transgender (Table 16.11). Nearly one in five (18%)respondents who went to agym or health club wherestaff knew or thought theywere transgender experiencedmistreatment of some kind. ### Page 224 Those who were currently working in theunderground economy (37%) were substantiallymore likely to report having a negative experiencein court or a courthouse, and the rate was alsohigher among people with disabilities (19%). XI. Social SecurityOffice Nearly one in four respondents (19%) visited orused services at a Social Security office in thepast year, such as for updating the name orgender on their records, receiving or changing aSocial Security card, or accessing public benefits.Four percent (4%) of respondents did not go toa Social Security office in the past year for fearof mistreatment as a transgender person. Fifty-seven percent (57%) of those who went to a SocialSecurity office believed that the staff or employeesknew or thought they were transgender. Of those,11% reported being denied equal treatment orservice, verbally harassed, or physically attackedbecause of being transgender (Table 16.12). Asian (15%), Black (15%), and Latino/a (14%)respondents were more likely to report havinga negative experience in a Social Security office(Figure 16.6). Respondents who were currentlyworking in the underground economy (36%) andpeople with disabilities (16%) were also more likelyto have such an experience. ### Page 225 XII. Legal Servicesfrom an Attorney,Clinic, or LegalProfessional Twelve percent (12%) of the sample visited or usedlegal services from an attorney, clinic, or legalprofessional in the past year. Two percent (2%)of respondents did not visit or use such servicesin the past year due to fear of mistreatment as atransgender person. Fifty-seven percent (57%)of those who sought services from an attorney,legal clinic, or legal professional believed that thestaff or employees knew or thought they weretransgender. Of those respondents, 6% reportedbeing denied equal treatment or service, verballyharassed, or physically attacked because of beingtransgender (Table 16.13). Non-binary respondents (12%) were more thantwice as likely to report having a negativeexperience when seeking legal services, in contrastto transgender men and women (5%) (Figure16.7). Those who were currently working in theunderground economy (23%) were almost fourtimes as likely to report a negative experience asthe overall sample. XIV. Experiences withAirport Security In addition to the questions regardingmistreatment in and avoidance of publicaccommodations, respondents were asked abouttheir experiences traveling through airport securityin the United States in the past year. More thanhalf (53%) of respondents reported having gonethrough airport security during that time period.These respondents were asked about specificexperiences and interactions with TransportationSecurity Administration (TSA) officers during thesecurity screening process. Forty-three percent (43%)of those who went throughairport security in the pastyear experienced at leastone problem related to theirgender identity or expression. ### Page 226 Forty-three percent (43%) of those who wentthrough airport security in the past yearexperienced at least one issue related to theirgender identity or expression, such as TSA officersusing the wrong pronoun or title to refer to them,searching their bodies or belongings because of agender-related item, or detaining them (Table 16.14). More than half (56%) of Middle Eastern and 50% ofmultiracial respondents who went through airportsecurity in the past year reported one or more ofthese experiences (Figure 16.8). Respondents whosaid that others can always or usually (61%) orsometimes (53%) tell that they are transgenderwere more likely to report one or more of theseexperiences, in comparison to those who said thatothers can rarely or never tell that they aretransgender without being told (35%). Experiencesalso differed by gender, with transgender men(52%) being more likely to report one or more ofthese experiences than transgender women (31%).Respondents who said that none of their IDsreflect the name and/or gender they prefer (51%)were also more likely to report negativeexperiences in airport security related to theirgender identity. Conclusion Responses indicated that many respondents facedmistreatment in places of public accommodation,including being denied equal treatment or service,verbally harassed, and/or physically attacked inone or more of the locations. People of color andrespondents currently working in the undergroundeconomy were more likely to report mistreatment.A substantial number of respondents also did ### Page 227 not visit or use services in places of publicaccommodation altogether because of fearof being mistreated as a transgender person.Additionally, findings demonstrated that manytransgender people experienced mistreatmentrelated to their gender identity when passingthrough airport security and, as a result, wereat risk of potential harm while traveling throughairports. 1 The legal definitions of public accommodations varyaccording to local, state, and federal laws, but frequentlyinclude places open to the public, such as restaurants,stores, hotels, places of public transportation, andgovernment agencies. 2 See e.g., Equal Rights Center. (2016). Room forChange. DC: Equal Rights Center. Available at: http://www.equalrightscenter.org/site/DocServer/Contents.pdf?docID=2681. 3 See e.g., Charles, C. (2015, October 1). Dear TSA, my bodyis not an anomaly. The Advocate. Available at: http://www.advocate.com/commentary/2015/10/01/dear-tsa-my-body-not-anomaly; Ennis, D. (2015, October 21). Traveling whiletrans: Women share their stories. The Advocate. Availableat: http://www.advocate.com/transgender/2015/10/21/traveling-while-trans-women-share-their-stories; Rogers,K. (2015, September 22). T.S.A. defends treatment oftransgender air traveler. New York Times. Available at:http://www.nytimes.com/2015/09/23/us/shadi-petosky-tsa-transgender.html. 4 TSA body scanners examine each passenger’s bodybased on the gender the officer perceives the passengerto be. As a result, transgender people’s body parts, oritems such as chest binders (compression garments) andprosthetics (such as packers and breast forms), may getflagged. This often causes transgender passengers tobe outed or to face additional searches and scrutiny. Seenote 3. 5 “People with disabilities” here refers to respondents whoidentified as a person with a disability in Q. 2.20. ENDNOTES | CHAPTER 16: PLACES OF PUBLIC ACCOMMODATION AND AIRPORT SECURITY ### Page 228 2015 U.S. TRANSGENDER SURVEY CHAPTER 17 Experiences inRestrooms Safe access to public restrooms is a basic necessity and essential for most people’s participationin civic life, the workplace, and school.1 Many transgender people, however, face harassment andviolence when seeking to use public restrooms, or they are excluded from restrooms by policiesor staff.2 Lack of safe restroom access has been linked to medical problems such as kidney infections,urinary tract infections, and stress-related conditions.3 Transgender people who are denied equal accessto restrooms consistent with their gender identity are vulnerable to harassment, violence, and poor mentalhealth, including higher levels of suicidal thoughts and behaviors.4 This chapter explores respondents’ experiences in restrooms in public places, at work, and at school,including experiences with denial of access, harassment, and violence, as well as avoidance ofpublic restrooms. Notable differences in respondents’ experiences based on demographic and othercharacteristics are reported throughout the chapter. It is important to note that the survey was conducted between August and September 2015, morethan six months before the state of North Carolina passed a law in March 2016 restricting transgenderpeople’s restroom access, and before similar legislation was introduced in at least 23 other states in2016.5 This legislation prompted substantial media coverage and public scrutiny of transgender people’srestroom access. Widespread anecdotal evidence suggests that this climate had an adverse effect on theexperiences of transgender people in restrooms and their perceptions of safety when accessing and usingpublic restrooms. As a result, data collected after March 2016 would likely differ from USTS survey results,with potentially higher numbers of respondents reporting negative experiences in public restrooms. 224 ### Page 229 Nearly one-quarter (24%) of respondents said that someone had questioned orchallenged their presence in a restroom in the past year. Nearly one in ten (9%) respondents reported that someone denied them access to arestroom in the past year. One in eight (12%) respondents were verbally harassed, physically attacked, orsexually assaulted when accessing or using a restroom in the past year. More than half (59%) avoided using a public restroom in the past year because theywere afraid of having problems. Nearly one-third (32%) limited the amount they ate or drank to avoid using therestroom in the past year. Eight percent (8%) reported having a urinary tract infection, kidney infection, oranother kidney-related problem in the past year as a result of avoiding restrooms. I. Access to Restrooms Nearly one-quarter (24%) of respondents said thatsomeone told them or asked them if they wereusing the wrong restroom in the past year, andnearly one in ten (9%) said that someone stoppedthem from entering or denied them access to arestroom in the past year. American Indian (18%),Asian (13%), and Middle Eastern (12%) respondentswere more likely to report that someone stoppedthem from entering or denied them accessto a restroom in the past year (Figure 17.1).Undocumented residents (23%) and respondentscurrently working in the underground economy,such as sex work, drug sales, and other work thatis currently criminalized (20%), were more thantwice as likely to be denied access to restroomsthan those in the overall sample. KEY FINDINGS EXPERIENCES IN RESTROOMS Figure 17.1: Denied access to a restroom in thepast year RACE/ETHNICITY (%) 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 18% 13% 12% 11% 10% 9% 9% 8% White Latino/a Black Multiracial Middle Eastern Asian American Indian Overall 225 ### Page 230 II. Verbal Harassment,Physical Attack, andSexual Assault Twelve percent (12%) of respondents reportedbeing verbally harassed, physically attacked,and/or sexual assaulted6 when accessing orwhile using a restroom in the past year. Theseexperiences were more frequently reported byundocumented residents (34%), respondentscurrently working in the underground economy(25%), and American Indian (24%) and multiracial(16%) respondents (Figure 17.2). a. Verbal Harassment One out of eight (12%) respondents were verballyharassed in a restroom in the past year. Respondents who were verbally harassed inrestrooms were asked for the places where theharassment had occurred. Eighty-nine percent(89%) were verbally harassed in a restroom at apublic place, such as a restaurant, shopping mall,or movie theater, and 20% were verbally harassedin a school restroom (Table 17.1). b. Physical Attack One percent (1%) of the sample (228 respondents,unweighted) was physically attacked in a restroomin the past year. Undocumented residents (4%)and American Indian respondents (3%) were morelikely to be physically attacked in a restroom. Respondents who were physically attacked wereasked where they had experienced the physicalattack. Eighty-six percent (86%) were physicallyattacked in a restroom at a public place, such asa restaurant, shopping mall, or movie theater, andover one-quarter (27%) said they were physicallyattacked in a restroom at school (Table 17.2). 2015 U.S. TRANSGENDER SURVEY Nearly one in ten (9%)respondents said that someonestopped them from enteringor denied them access to arestroom in the past year. Table 17.1: Location of verbal harassment in restroomin past year | Restroom location | % of respondents who wereverbally harassed | | - | - | | Public place (such as arestaurant, shopping mall, ormovie theater) | 89% | | School | 20% | | Workplace | 14% | | Another location | 5% | Figure 17.2: Verbal harassment, physical attack, and/orsexual assault in a restroom in the past year RACE/ETHNICITY (%) 30% 25% 20% 15% 10% 5% 0% 24% 16% 13% 12% 12% 12% 12% 10% Table 17.2: Location of physical attack in restroom inpast year | Restroom location | % of respondents who werephysically attacked | | - | - | | Public place (such as arestaurant, shopping mall, ormovie theater) | 86% | | School | 27% | | Workplace | 14% | | Another location | 9% | Overall American Indian Asian Middle Eastern Multiracial Black Latino/a White 226 ### Page 231 c. Sexual Assault Approximately one percent (0.6%) of the sample(139 respondents, unweighted) reported beingsexually assaulted in a restroom in the past year.Those currently working in the undergroundeconomy were more likely to have had thisexperience (4%). Additionally, transgender womenof color, including Asian (3.2%), Middle Eastern(3.2%), American Indian (2.8%), and multiracial (2.4%)women were more likely to have been sexuallyassaulted in a restroom in the past year (Figure 17.3). More than three-quarters (78%) of respondentswho were sexually assaulted reported that thesexual assault occurred in a restroom at a publicplace, and 19% were sexually assaulted at a schoolrestroom (Table 17.3). III. Overall Accessto and Treatment inRestrooms Overall, in the year prior to taking the survey,26% of all respondents were denied access torestrooms, had their presence in a restroomquestioned, and/or were verbally harassed,physically attacked, or sexually assaulted ina restroom. This was nearly twice as high forundocumented residents (50%) and was alsohigher for respondents currently working in theunderground economy (39%). It was also higheramong American Indian (36%) and multiracial (32%)respondents (Figure 17.4). Respondents who saidthat others could always or usually tell they weretransgender without being told (45%) or sometimestell they were transgender (38%) were more likelyto report one or more of these experiences, incontrast to those who said that others could rarelyor never tell that they were transgender (16%). EXPERIENCES IN RESTROOMS Figure 17.3: Sexual assault in a restroom in the pastyear among transgender women RACE/ETHNICITY (%) 3.5% 3% 2.5% 2% 1.5% 1% 0.5% 0% 3.2% 3.2% 2.8% 2.4% 0.9% 0.8% 0.6% 0.5% Figure 17.4: Any reported problem in a restroomin the past year RACE/ETHNICITY (%) White Latino/a Black Multiracial Middle Eastern Asian American Indian Overall 40% 35% 30% 25% 20% 15% 10% 5% 0% 36% 32% 29% 29% 28% 27% 26% 25% Table 17.3: Location of sexual assault in restroom inpast year | Restroom location | % of respondents who weresexually assaulted | | - | - | | Public place (such as arestaurant, shopping mall, ormovie theater) | 78% | | School | 19% | | Workplace | 14% | | Another location | 18% | White Latino/a Black Multiracial Middle Eastern Asian American Indian Overall 227 ### Page 232 IV. Avoidance ofPublic Restrooms Even prior to the increased public scrutiny andconversations in North Carolina and across thecountry about anti-transgender bathroom legislationin 2016, 59% of respondents reported that in thepast year they had either sometimes (48%) or always(11%) avoided using a restroom, such as in public,at work, or at school, because they were afraid ofconfrontations or other problems. Transgender men (75%) were far more likely toreport sometimes or always avoiding using apublic restroom, in contrast to transgender women(53%) and non-binary respondents (53%) (Figure17.5). Undocumented residents were also morelikely to report sometimes or always avoidingusing a public restroom in the past year (72%).Eighty percent (80%) of respondents who said thatothers could always or usually tell that they weretransgender and 72% of those who said that otherscan sometimes tell they are transgender reportedavoiding using public restroom, in contrast to 48%of those who said that others can rarely or nevertell that they are transgender. 2015 U.S. TRANSGENDER SURVEY In Our OwnVoices “I either have to ‘hold it’ or breakdown and use a male restroom in apublic place. I’m not allowed to usethe female restroom and have beenconfronted multiple times whenattempting to.” “I went into the men’s bathroom, beinga man and all. I was using a stall, and Icame out only to find one person whoapparently thought it was okay to goafter me. I was just washing my handswhen he first punched me in the backand then went for my vagina. I nearlypassed out due to the blow.” “I walked into a stall to do my businesslike I had done so many times before.This time, though, someone recognizedme. He and his buddies circled aroundme as I tried to exit the restroom andpushed me around between them. Apolice officer walked into the restroomand tried to protest their harassment.The men responded by ripping mypants down. The officer shot me adisgusted look and left the room.” “I spent high school having to usethe nurse’s bathroom, because if Iused the boys’ bathroom, I wouldget reprimanded, and the samewould happen if I went into the girls’bathroom since I was living as a boy.Going to the nurse’s office always feltlike a walk of shame, like there was nodignified place for me simply becauseI’m transgender.” Figure 17.5: Sometimes or always avoided bathroomsin the past year GENDER IDENTITY (%) 80% 70% 60% 50% 40% 30% 20% 10% 0% 75% 64% 59% 53% 53% 36% Trans women Non-binary Trans womenand men Trans men Crossdressers Overall 228 ### Page 233 Respondents were also asked if they hadexperienced any physical problems as a result ofavoiding restrooms in public places, at work, orat school. Nearly one-third (32%) of the sampleavoided drinking or eating so that they would notneed to use the restroom, and 8% reported havinga urinary tract infection or kidney-related medicalproblem as a result of avoiding restrooms in thepast year (Table 17.4). Conclusion Responses suggest that using restrooms inpublic places, at work, or at school presentsserious challenges for transgender people.Respondents faced numerous barriers andproblems when attempting to use a publicrestroom, including being verbally harassed,physically attacked, sexually assaulted, ordenied access to the restroom altogether.In many instances, these experiences weremore frequently reported by people of color.A majority of people had avoided usingpublic restrooms in the past year due to fearof encountering confrontations and otherproblems, which led to a range of health issues,including urinary tract infections and kidney-related problems. Nearly one-third (32%) of thesample avoided drinking oreating so that they would notneed to use the restroom, and8% reported having a urinarytract infection or kidney-related medical problem as aresult of avoiding restroomsin the past year. EXPERIENCES IN RESTROOMS Table 17.4: Physical problems due to avoiding publicrestrooms in the past year | Physical problem | % of respondentswho avoidedusing restrooms | % of allrespondents | | - | - | - | | Did not use therestroom whenneeded to (“held it”) | 89% | 55% | | Avoided drinkingor eating | 52% | 32% | | Urinary tractinfection | 12% | 8% | | Kidney infection | 2% | 1% | | Other kidney-related problems | 2% | 1% | | Kidney-relatedproblem and/or a urinary tractinfection | 13% | 8% | | A problem notlisted | 2% | 1% | 229 ### Page 234 1 Department of Labor & Occupational Safety and HealthAdministration. (2015). Best Practices: A Guide toRestroom Access for Transgender Workers. Available at:https://www.osha.gov/Publications/OSHA3795.pdf. 2 Herman, J. L. (2013). Gendered restrooms and minoritystress: The public regulation of gender and its impact ontransgender people’s lives. Journal of Public Management& Social Policy, 19(1), 65–85. 3 Herman, J. L. See note 2. 4 Seelman, K. L. (2016). Transgender adults’ access tocollege bathrooms and housing and the relationship tosuicidality. Journal of Homosexuality, 63(10), 1378–1399. 5 Movement Advancement Project, Equality FederationInstitute, Freedom for All Americans, & National Centerfor Transgender Equality. (2016). The Facts: BathroomSafety, Nondiscrimination Laws, and BathroomBan Laws. Available at: http://www.lgbtmap.org/file/bathroom-ban-laws.pdf. 6 Respondents were asked if they had experienced“unwanted sexual contact” when accessing or while usinga bathroom in Q. 20.3 and Q. 20.6. 7 Movement Advancement Project et al. See note 5. 2015 U.S. TRANSGENDER SURVEY ENDNOTES | CHAPTER 17: EXPERIENCES IN RESTROOMS 230 ### Page 235 231 CHAPTER 18 Civic Participationand Policy Priorities Voting and other forms of participation in the political process are important methods by whichpeople involve themselves in their communities and can have a voice in governance at the local,state, and federal levels. They are also significant avenues by which individuals and groups canaffect change and influence the policies and procedures that impact their lives. Respondents received questions about voting in the previous national election (November 2014)1 to assesslevels of voting and determine reasons for not participating, including potential barriers to voting such asvoter identification laws. Relevant questions were patterned on the November 2014 Voting and RegistrationSupplement of the Current Population Survey (CPS). Additionally, respondents were asked questionsabout their political engagement, political party affiliation, and policy priorities as they relate to issues thatimpact transgender people, some of which were patterned on the Gallup U.S. Daily Tracking Poll. Notabledifferences in respondents’ experiences based on demographic and other characteristics are reportedthroughout the chapter. ### Page 236 232 More than three-quarters (76%) of U.S. citizens of voting age in the sample reported thatthey were registered to vote in the November 2014 midterm election, compared to 65%of individuals in the U.S. population who reported that they were registered. More than half (54%) of U.S. citizens of voting age in the sample reported that they hadvoted in the election, compared to 42% of those who reported they had voted in theU.S. population. Over one-quarter (27%) of those who said they had not been registered to vote saidthat the main reason was that they were not interested in the election or not involved inpolitics. Three percent (3%) of those who said they werenot registered to votereported that themain reason was that they wanted to avoid harassment by election officials becausethey were transgender. Nineteen percent (19%) of those who reported they were registered but did notvote said that they thought their vote would not make a difference or they were notinterested in the election, compared to 16% of those in the U.S. population. Three percent (3%) of those who reportedbeing registered to votebut not votingsaidthat the main reason was that they wanted to avoid harassment by election officialsbecause they were transgender. When asked about what they believed the most important policy priorities were fortransgender people, respondents most often identified addressing violence againsttransgender people (25%), health insurance coverage (15%), and racism (11%) as theirtop priorities. I. Voter Registrationand Voting a. Voter Registration Survey respondents were asked about voting inrelation to the November 4, 2014 midterm election,which was the national election held in closestproximity to the survey. More than three-quarters(76%) of U.S. citizens in the survey sample whowere of voting age at the time of the election2reported that they were registered to vote,compared to 65% of those individuals in the U.S.population.3 The number of reported registeredvoters differed by race or ethnicity, with MiddleEastern (71%), Latino/a (70%), and Asian (65%)respondents being less likely to be registeredthan American Indian (77%), white (78%), and Black(79%) respondents (Figure 18.1). KEY FINDINGS ### Page 237 Naturalized citizens (69%) were less likely to reportbeing registered than citizens who were born in theUnited States (76%). There were also differencesin voting registration based on respondents’sources of income, with only 48% of those whosesole source of income was from the undergroundeconomy—including sex work, drug sales, and otherwork that is currently criminalized—reporting beingregistered. Respondents whose only source ofincome was from unemployment benefits or othercash assistance programs such as TANF4 (65%)were also less likely to be registered (Figure 18.2). b. Reasons for Not Registeringto Vote Respondents who said they were not registeredto vote in the November 4, 2014 election wereasked to identify the main reason why they werenot registered based on categories outlined in theCurrent Population Survey (CPS) and additionalexperiences they might have had as a transgenderperson. More than one-quarter (27%) of those in thesample who reported that they were not registeredto vote said that they were not interested in theelection or not involved in politics, which was themost frequently selected reason for not beingregistered. Sixteen percent (16%) did not knowwhere or how to register, and 15% indicated thatthey did not meet registration deadlines. One ineight (12%) felt that their vote would not make adifference and therefore did not register (Table18.1).5 Additionally, respondents reported not beingregistered to vote because they wanted to avoidanti-transgender harassment by election officials(3%), because they did not have their currentname updated on their Social Security card (2%),and because they thought their state’s voteridentification law would stop them from voting(1%). Avoiding anti-transgender harassment byelection officials was a more common reasonfor transgender men and women (5%) than forcrossdressers (2%) and non-binary respondents Three percent (3%) ofrespondents who were citizensand of voting age at the timeof the 2014 midterm electionwere not registered to votebecause they wanted to avoidanti-transgender harassment byelection officials. ### Page 238 (1%) (Figure 18.3). Those who reported that peoplecould always or usually tell they were transgendereven without being told were more than twice aslikely to report this reason (8%), in contrast to thosewho said people could rarely or never tell theywere transgender without being told (3%). Blackrespondents (7%) were also more likely to reportthat they did not register to vote in order to avoidharassment by election officials (Figure 18.4). Table 18.1: Main reason for not being registered tovote on November 4, 2014 | Reasons for not beingregistered to vote | % of USTS citizensnot registered to vote | | - | - | | They were not interested in theelection or not involved in politics | 27% | | They did not know where or how toregister | 16% | | They did not meet registrationdeadlines | 15% | | They felt their vote would not make adifference | 12% | | They did not live in place longenough or meet residencyrequirements | 5% | | They were not eligible to vote (dueto criminal/felony conviction or otherreason) | 3% | | Permanent illness or disability | 2% | | Difficulty with English | <1% | | Other reasons (including): | 19% | | They wanted to avoid harassment byelection officials because they weretransgender | 3% | | They did not have an identitydocument (ID) and thought theyneeded one to register | 2% | | Their current name did not match thename on their Social Security card | 2% | | They thought their state’s voter ID lawwould stop them from voting | 1% | | Protest or philosophical reasons(write-in response) | 1% | c. Voting in the 2014 Election More than half (54%) of U.S. citizens in the samplewho were of voting age at the time of the electionreported that they voted in the election, comparedto 42% of those in the U.S. population.6 Amongpeople of color, Asian respondents (44%) wereleast likely to report having voted, and Latino/a(48%) and Black (50%) respondents were also lesslikely to report voting (Figure 18.5). More than half (54%) ofrespondents who were citizensand of voting age at the timeof the 2014 midterm electionreported that they voted in theelection, compared to 42% inthe U.S. population. ### Page 239 Respondents who were living in poverty7 (41%)were also less likely to say they had voted, aswere those who were currently working in theunderground economy (40%), unemployed (42%),or out of the labor force (50%). d. Reasons for Not Voting Respondents who reported being registered butdid not vote in the November 4, 2014 electionwere asked to identify the main reason why theydid not vote, based on categories outlined inthe CPS and additional experiences they mighthave had as a transgender person. Nearly one infive (19%) respondents who reported they wereregistered but did not vote reported that theywere not interested or felt their vote would notmake a difference, compared to 16% of such votersin the U.S. population.8 Respondents were alsomore than twice as likely to report not voting dueto registration problems, such as not receivingan absentee ballot or not being registered in thecurrent location (5%), than registered voters in theU.S. general population (2%) (Table 18.2). Among those who provided additional reasons fornot voting that were not included in the CPS, 3%of respondents reported that they wanted to avoidharassment by election officials because theywere transgender. Transgender men and women In Our OwnVoices “Lawmakers pushed throughvoter ID reforms in my state,requiring every voter to presenta photo ID with a gendermarker. Since I was unableto do so, I was a victim of ‘defacto’ disenfranchisement andvoter intimidation tactics thatare now, unfortunately, all toocommon.” “When changing my nameon my voter registration, theDMV put in the wrong name.I don’t know how to fix it andI’m scared that if I try to vote(something I really want to do!)I won’t be able to becausethe voter registration has thewrong name.” “I had to try twice to get mycounty to change my name inthe voter registration, whichis extremely embarrassing aspeople are essentially shoutingthat you’re trans in a publicplace. Some accused me ofattempting voter fraud when allI wanted to do was try to makesure I had the best candidateswho would protect my rights.” ### Page 240 (4%) were more likely to report that they did notvote because they wanted to avoid harassment byan election official than non-binary respondents(<1%) (Figure 18.6). Two percent (2%) of those whodid not vote said that the main reason was thattheir ID did not match their current name or genderor that their photo did not match their appearance,and 1% said that the main reason was that theircurrent name or gender that did not match theirvoter registration. Table.2: Main reason for not voting on November 4, 2014 | Reasons included in the CurrentPopulation Survey (CPS): | % of USTS respondentswho were registered butdid not vote | % in U.S. populationwho were registeredbut did not vote (CPS) | | - | - | - | | They were not interested or felt their vote would notmake a difference | 19% | 16% | | They forgot to vote or send in an absentee ballot | 19% | 8% | | They were too busy or had a conflicting work or schoolschedule | 16% | 28% | | They were out of town or away from home | 12% | 10% | | They did not like the candidates or campaign issues | 8% | 8% | | Registration problems (e.g., they did not receive anabsentee ballot or they were not registered in theircurrent location) | 5% | 2% | | Illness or disability (own or family’s) | 5% | 11% | | Inconvenient hours, polling place, or hours or lines toolong | 3% | 2% | | Transportation problems | 3% | 2% | | Bad weather conditions | <1% | <1% | | Other reasons | 10% | 9% | | Additional reasons not included in the CPS: | | They wanted to avoid harassment by election officialsbecause they were transgender | 3% | --- | | Their ID did not match their current name or gender, orthey had an old photo | 2% | --- | | Name or gender on ID did not match voter registration | 1% | --- | | They did not have the ID they needed to vote | 1% | --- | | They did not know the process for voting or did notknow about the candidates (write-in response) | 1% | --- | | Protest or philosophical reasons (write-in response) | 1% | --- | | They were not allowed by a poll worker or electionofficial because they were transgender | <1% | --- | ### Page 241 II. PoliticalEngagement andParty Affiliation Respondents received a question about politicalaffairs to examine how much of an influencethey believed they could have on governmentdecisions. Specifically, they were asked to rateon five-point scale from “strongly agree” to“strong disagree” what they thought about thefollowing statement: “Someone like me can’treally influence government decisions.” Nearlyhalf (44%) of respondents disagreed or stronglydisagreed with the statement, and approximatelyone-third (32%) agreed or strongly agreed with thestatement (Figure 18.7). This means that there weremore respondents who thought that they couldhave some influence on government decisionsthan those who believed they could not influencegovernment decisions. Respondents were also asked about theirpolitical party affiliation with questions that werepatterned on the Gallup U.S. Daily Tracking Poll,including whether they consider themselves aRepublican, Democrat, or Independent. Half (50%)of respondents identified as Democrats, 48%identified as Independents, and 2% identifiedas Republicans, compared to 27%, 43%, and27% in the U.S general population, respectively(Figure 18.8).9 Respondents who did not identifyas Democrats or Republicans wrote in severalpolitical parties and political movements, includingsocialist or democratic socialist (4%), Green Party(2%), Libertarian (1%), and anarchist (1%). Forcomparison with the Gallup Daily Tracking Poll,these respondents are included as Independentsin Figure 18.8. Those who identified as Independents were alsoasked whether they lean more to the DemocraticParty or the Republican Party. Overall, 79% inthe sample reported that they were Democratsor lean towards the Democratic Party, 4% wereRepublicans or lean towards the Republican Party, Half (50%) of respondentsidentified as Democrats, 48%identified as Independents,and 2% identified asRepublicans, compared to27%, 43%, and 27% in theU.S. general population,respectively. ### Page 242 and 17% were Independents who do not leantowards the Democratic or Republican parties. Thiscompares to 44% in the U.S. population who areDemocrats or lean towards the Democratic Party,45% who are Republicans or lean towards theRepublican Party, and 11% who are Independentsand do not lean towards either party (Figure 18.9).10 When asked about their political views, more thanhalf (55%) of the sample described themselves as“very liberal,” 27% selected “liberal,” 15% selected“moderate,” 2% selected “conservative,” and only1% described themselves as “very conservative.” III. Policy Priorities The survey explored respondents’ opinions on themost important policy priorities for transgenderpeople in the U.S. and asked for those issuesto be ranked from “very important” to “notvery important.” Violence against transgenderpeople was most widely selected as being avery important issue (94%). Insurance coveragefor transgender-related health care (90%), policemistreatment of transgender people (88%), and ### Page 243 employment (87%) were also commonly selectedas very important priorities (Table 18.3). Table.3: Respondents’ policy priorities | Issue | Veryimportant | Important | Not veryimportant | | - | - | - | - | | Violence againsttransgender people | 94% | 5% | 1% | | Insurance coveragefor transgender-related health care | 90% | 9% | 1% | | Police mistreatmentof transgenderpeople | 88% | 11% | 1% | | Employment | 87% | 13% | 1% | | Training health careproviders abouttransgender health | 86% | 13% | 1% | | Housing andhomelessness | 85% | 14% | 1% | | Poverty | 84% | 15% | 1% | | Bullying anddiscrimination inschools | 84% | 15% | 1% | | Racism | 83% | 15% | 3% | | Mistreatment inprisons or jails | 82% | 16% | 2% | | Identity documents | 79% | 20% | 1% | | HIV/AIDS | 68% | 29% | 3% | | Parenting andadoption rights | 68% | 28% | 4% | | Conversion therapy | 68% | 22% | 10% | | Immigration reform | 60% | 30% | 10% | | Marriagerecognition | 55% | 32% | 13% | | Military (openservice fortransgenderpeople) | 49% | 33% | 18% | Respondents were also asked for their top threepolicy priorities. One-quarter (25%) reported thatviolence against transgender people was the toppolicy priority for them, and more than half (54%)reported that it was one of their top three priorities.Fifteen percent (15%) reported that health insurancecoverage was the most important priority forthem, and 11% reported that racism was the mostimportant policy priority for them (Table 18.4). Table 18.4: Top policy priorities | Respondents’ mostimportant priority | % of respondents | | - | - | | Violence against transgenderpeople | 25% | | Insurance coverage fortransgender-related health care | 15% | | Racism | 11% | | Employment | 7% | | Identity documents | 7% | | Poverty | 6% | | Bullying and discrimination inschools | 5% | | Training health care providersabout transgender health | 5% | | Police mistreatment oftransgender people | 5% | | Housing and homelessness | 4% | | Mistreatment in prisons or jails | 2% | | HIV/AIDS | 1% | | Conversion therapy | 1% | | Military (open service fortransgender people) | 1% | | Immigration reform | 1% | | Parenting and adoption rights | 1% | | Marriage recognition | 1% | Conclusion Participation in the political process throughactivities such as voting is a vital componentof influencing policies that impact lives andcommunities at the local, state, and national levelsthroughout the U.S. However, the process may beinaccessible at times or may otherwise presenta difficult avenue through which policy prioritiesand day-to-day needs can be expressed. Theresults indicate that while a majority of eligiblerespondents had registered to vote in the mostrecent national election, only half had engaged inthe process by voting, providing reasons such asnot believing their vote would make a difference or ### Page 244 wanting to avoid potential harassment by electionofficials as a transgender person. Respondentswere substantially more likely to identify with theDemocratic Party or lean towards the DemocraticParty than other political parties. Policy prioritiesthat respondents identified as most important arethose directly related to the safety and wellbeingof transgender people, including violence againsttransgender people, health insurance and healthcare, police treatment of transgender people,racism, employment, and housing. 1 Questions referred to the midterm elections held onTuesday, November 4, 2014, and respondents receivedthe explanation that “[t]his was the election in November2014 to elect members of the U.S. Congress and state-level offices.” See Q. 29.1 and 29.2. 2 Voter registration and voting results reported in thischapter are based on the responses of U.S. citizens inthe sample who were aged 18 or older at the time of theelection to provide the most appropriate comparison toCurrent Population Survey data on registration and votingin the U.S. population. 3 Reported voter registration in the U.S. is among U.S.citizens aged 18 and over. U.S. Census Bureau, (2014,November). Current Population Survey: Reported Votingand Registration, by Sex and Single Years of Age:November 2014. Available at: https://www.census.gov/data/tables/time-series/demo/voting-and-registration/p20-577.html. 4 TANF (the Temporary Assistance for Needy Familiesprogram) is a federal cash assistance program. 5 Although the Current Population Survey asked aboutthe main reason for not registering to vote on November4, 2014, U.S. population data for that question was notavailable at the time of this report. 6 The number of USTS respondents who voted represents70% of those in the sample who were registered to votein the election. According to the CPS, 42% of citizenvoters aged 18 and older voted in the 2014 election, whichrepresents 65% of registered voters. U.S. Census Bureau.(2014, November). Current Population Survey. ReportedVoting and Registration, by Sex and Single Years of Age:November 2014. Available at: https://www.census.gov/data/tables/time-series/demo/voting-and-registration/p20-577.html. See also File, T. (2015). Who Votes?Congressional Elections and the American Electorate:1978-2014. (p. 2). DC: U.S. Census Bureau. Available at:https://www.census.gov/content/dam/Census/library/publications/2015/demo/p20-577.pdf. 7 Respondents who are “living in poverty” represent thosewho are living at or near the poverty line. See the Incomeand Employment Status chapter for more informationabout the poverty line calculation. 8 U.S. Census Bureau. (2014, November). Current PopulationSurvey. Voting and Registration in the Election ofNovember 2014. Available at: https://www.census.gov/data/tables/time-series/demo/voting-and-registration/p20-577.html. 9 This data is based on Gallup Poll results from September9–13, 2015, the poll in closest proximity to when thesurvey was in the field. Gallup Poll. (2015, September9–13). Party Affiliation. Available at: http://www.gallup.com/poll/15370/party-affiliation.aspx. 10 Gallup Poll. (2015, September 9–13). Party Affiliation.Available at: http://www.gallup.com/poll/15370/party-affiliation.aspx. ENDNOTES | CHAPTER 18: CIVIC PARTICIPATION AND POLICY PRIORITIES ### Page 245 241 About the Authors Sandy E. James As Survey Project Manager at the National Center for Transgender Equality, Sandy led the researchteam in developing, fielding, analyzing, and presenting the 2015 U.S. Transgender Survey. After adecade-long career as a forensic toxicologist, Sandy launched a new career as a civil rights advocatefocused on law, research, and policy to advance transgender rights. He has worked on numerousprojects involving trans-related legislation, policy, and research, including extensive work with datafrom the 2008–09 National Transgender Discrimination Survey. Sandy has been published in TheGeorgetown Journal of Gender and the Law and the LGBTQ Policy Journal at the Harvard KennedySchool. Sandy received a J.D and M.A in American Government from Georgetown University, where heis also currently pursuing his Ph.D. Jody L. Herman Jody L. Herman is a Scholar of Public Policy at the Williams Institute at the UCLA School of Law. Sheholds a Ph.D. in Public Policy and Public Administration in the field of Gender and Social Policy from theGeorge Washington University, where she also earned her M.A. in Public Policy with a concentrationin Women’s Studies. Her doctoral dissertation focused on the problems transgender and gendernon-conforming people face when using public restrooms and the development of anti-discriminationprotections in public accommodations based on gender identity and expression. She has workedon issues of poverty, women’s rights, voting rights, and anti-discrimination policy development withnon-profit research, advocacy, and direct-service organizations in the United States and Mexico. Sheserved as a co-author on the groundbreaking report Injustice at Every Turn, based on the NationalTransgender Discrimination Survey conducted by the National Gay and Lesbian Task Force andthe National Center for Transgender Equality. Her research at the Williams Institute focuses on theprevalence and impact of interpersonal and structural discrimination based on gender identity orexpression. Sue Rankin Sue Rankin is the principal of Rankin & Associates Consulting. She retired from the PennsylvaniaState University in 2013 after 36 years, where she most recently served as an Associate Professorof Education, and Associate in the Center for the Study of Higher Education. Sue earned her B.S.from Montclair State University in 1978, and an M.S. and Ph.D. from the Pennsylvania State University.She has presented and published widely on the impact of sexism, racism, and heterosexism inthe academy and in intercollegiate athletics. Her current research focuses on the assessment ofinstitutional climate and providing program planners and policymakers with recommended strategiesto improve the campus climate for under-served communities. Her recent publications include TheState of Higher Education for LGBT People and The Lives of Transgender People in 2010 and anNCAA Student-Athlete Climate Study in 2011. In addition to serving as a consultant for the NationalTransgender Discrimination Survey in 2011, she has collaborated with over 170 institutions inimplementing assessments and developing strategic plans regarding social justice issues. ### Page 246 242 Mara Keisling Mara Keisling is the founding Executive Director of the National Center for Transgender Equality, one ofthe nation’s leading social justice organizations winning life-saving change for transgender people. Aftera 25-year career in survey research, Mara helped found NCTE and quickly became one of the nation’sforemost authorities on transgender issues. Mara has led organizational and coalition efforts that havewon significant advances in transgender equality throughout the country, especially in federal law andpolicy. Under her leadership, NCTE has won well over 100 federal policy changes that have improved thelives of transgender people. Mara was a co-author of Injustice at Every Turn: The Report of the NationalTransgender Discrimination Survey. A native of Pennsylvania and a transgender woman, Mara holds a B.A.from Pennsylvania State University and conducted her graduate studies in American Government at HarvardUniversity. Lisa Mottet Lisa Mottet joined the National Center for Transgender Equality as the Deputy Executive Director in 2013,helping to grow NCTE from 5 staff to now 15 staff. She helps guide the organization’s local, state, andfederal policy advocacy, while also helping to oversee communications and development. In her previousposition as Director of the Transgender Civil Rights Project at the National LGBTQ Task Force (formerly theNational Gay and Lesbian Task Force), where she served for 12 years, she was a member of the researchteam for the National Transgender Discrimination Survey, and co-authored the report of its findings, Injusticeat Every Turn (2011). As a long-time ally to the transgender community, Lisa was a major figure in promotingtrans-inclusion in the LGBT movement and, while at the Task Force, she helped engineer the addition of“gender identity” to the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, which becamelaw in 2009, and to the Employment Non-Discrimination Act. Her thoughts and guidance on trans-inclusionwere recorded in the 2008 publication, Opening the Door to Transgender Inclusion: The Nine Keys toMaking LGBT Organizations Fully Transgender-Inclusive. Also while at the Task Force, Lisa co-authoredTransitioning Our Shelters: A Guide to Making Homeless Shelters Safe for Transgender People. Lisagraduated from the University of Washington in 1998 and received her J.D. from the Georgetown UniversityLaw Center in 2001. Ma’ayan Anafi Ma’ayan Anafi is a Policy Counsel at the National Center for Transgender Equality. As part of the NCTEteam, Ma’ayan has worked to strengthen and preserve nondiscrimination protections for transgendercommunities, with a focus on efforts to defeat anti-transgender state legislation and the implementation offederal nondiscrimination laws in health care, employment, education, and housing. Ma’ayan obtained a J.D.from Harvard Law School and a B.A. from the University of Toronto. An Autistic and non-binary transgenderperson, Ma’ayan is the co-leader of the DC chapter of the Autistic Self-Advocacy Network. ### Page 247 243 Appendix A Demographic Description andOther Characteristics of the Sample Throughout the report, findings were presented with the standard or supplemental surveyweight applied. These weights adjusted the sample to reflect the U.S. population in regard toage, race, and educational attainment and also adjusted for disproportionate representationof 18-year-olds in the sample. In this appendix, unweighted tabulations of selected demographic andother variables are presented to provide a description of the sample before weights were applied.This includes recoded variables, which are indicated as such. See the Methodology chapter andAppendix C: Detailed Methodology for a description of the weights used in this report. ### Page 248 244 | Q1.4. What U.S. state orterritory do you currentlylive in? | Unweightedfrequency | Unweighted% | | - | - | - | | U.S. military base outsideof the U.S. | 32 | 0.1% | | Alabama | 228 | 0.8% | | Alaska | 84 | 0.3% | | American Samoa | 2 | 0.0% | | Arizona | 537 | 1.9% | | Arkansas | 222 | 0.8% | | California | 3453 | 12.5% | | Colorado | 669 | 2.4% | | Connecticut | 319 | 1.2% | | Delaware | 84 | 0.3% | | District of Columbia | 214 | 0.8% | | Florida | 1099 | 4.0% | | Georgia | 614 | 2.2% | | Guam | 2 | 0.0% | | Hawai‘i | 69 | 0.3% | | Idaho | 155 | 0.6% | | Illinois | 1082 | 3.9% | | Indiana | 452 | 1.6% | | Iowa | 219 | 0.8% | | Kansas | 197 | 0.7% | | Kentucky | 274 | 1.0% | | Louisiana | 274 | 1.0% | | Maine | 182 | 0.7% | | Maryland | 662 | 2.4% | | Massachusetts | 1195 | 4.3% | | Michigan | 894 | 3.2% | | Minnesota | 670 | 2.4% | | Mississippi | 82 | 0.3% | | Missouri | 509 | 1.8% | | Montana | 72 | 0.3% | | Nebraska | 165 | 0.6% | | Nevada | 206 | 0.7% | | New Hampshire | 225 | 0.8% | | New Jersey | 550 | 2.0% | | New Mexico | 213 | 0.8% | | New York | 1779 | 6.4% | | North Carolina | 686 | 2.5% | | North Dakota | 46 | 0.2% | | Ohio | 941 | 3.4% | | Oklahoma | 215 | 0.8% | | Q1.4. What U.S. state orterritory do you currently livein? (continued) | Unweightedfrequency | Unweighted% | | Oregon | 1152 | 4.2% | | Pennsylvania | 1171 | 4.2% | | Puerto Rico | 27 | 0.1% | | Rhode Island | 119 | 0.4% | | South Carolina | 233 | 0.8% | | South Dakota | 43 | 0.2% | | Tennessee | 416 | 1.5% | | Texas | 1490 | 5.4% | | Utah | 270 | 1.0% | | Vermont | 163 | 0.6% | | Virginia | 723 | 2.6% | | Washington | 1667 | 6.0% | | West Virginia | 83 | 0.3% | | Wisconsin | 541 | 2.0% | | Wyoming | 44 | 0.2% | | Total | 27715 | 100% | | Q1.4. U.S. region of currentresidence (recode based onCensus regions) | Unweightedfrequency | Unweighted% | | - | - | - | | Northeast | 5703 | 21% | | Midwest | 5759 | 21% | | South | 7599 | 27% | | West | 8591 | 31% | | Total | 27652 | 100% | | Q1.10. Do you think ofyourself as transgender? | Unweightedfrequency | Unweighted% | | No | 3270 | 12% | | Yes | 24445 | 88% | | Total | 27715 | 100% | | Q1.11. Do you identify asmore than one gender or asno gender? | Unweightedfrequency | Unweighted% | | - | - | - | | No | 14362 | 52% | | Yes | 13353 | 48% | | Total | 27715 | 100% | | Q1.12. Do you currently livefull-time in a gender thatis different from the oneassigned to you at birth? | Unweightedfrequency | Unweighted% | | No | 11135 | 40% | | Yes | 16580 | 60% | | Total | 27715 | 100% | ### Page 249 | Q1.14. Someday do you wantto live full time in a genderthat is different from the oneassigned to you at birth?* | Unweightedfrequency | Unweighted% | | - | - | - | | No | 770 | 7% | | Yes | 6497 | 58% | | Not sure | 3862 | 35% | | Total | 11129 | 100% | | *Asked of those who responded “No” to Q1.12. | | Q1.16. Have you seriouslythought about living in agender that is different fromthe one assigned to you atbirth (transitioning gender)?* | Unweightedfrequency | Unweighted% | | No | 251 | 33% | | Yes | 519 | 67% | | Total | 770 | 100% | | *Asked of those who responded “No” to Q1.12 and Q1.14. | | Q1.17. Do you consideryourself to be a cross-dresser? | Unweightedfrequency | Unweighted% | | No | 25225 | 91% | | Yes | 2490 | 9% | | Total | 27715 | 100% | | Q1.18. Do you live part ofthe time in one gender andpart of the time in anothergender? | Unweightedfrequency | Unweighted% | | No | 19063 | 69% | | Yes | 8652 | 31% | | Total | 27715 | 100% | | Q2.1. What sex were youassigned at birth, on youroriginal birth certificate? | Unweightedfrequency | Unweighted% | | Female | 15858 | 57% | | Male | 11857 | 43% | | Total | 27715 | 100% | | Q2.1 & Q2.3. Gendercategories used for analysis(recode) | Unweightedfrequency | Unweighted% | | Crossdressers | 758 | 3% | | Transgender women | 9238 | 33% | | Transgender men | 7950 | 29% | | Non-binary people, assignedfemale at birth | 7844 | 28% | | Non-binary people, assignedmale at birth | 1925 | 7% | | Total | 27715 | 100% | | Q2.1 & Q2.3. Gendercategories (collapsedrecode) | Unweightedfrequency | Unweighted% | | Transgender men and women | 17188 | 64% | | Non-binary people | 9769 | 36% | | Total | 26957 | 100% | | Q2.4. How comfortableare you with the word“transgender” being used todescribe you? | Unweightedfrequency | Unweighted% | | Very comfortable | 12189 | 44% | | Somewhat comfortable | 7413 | 27% | | Neutral | 4129 | 15% | | Somewhat uncomfortable | 3116 | 11% | | Very uncomfortable | 830 | 3% | | Total | 27677 | 100% | | Q2.5. What genderpronouns do you ask peopleto use to refer to you? | Unweightedfrequency | Unweighted%* | | He, his | 9981 | 36% | | She, hers | 10138 | 37% | | They, their | 8026 | 29% | | Ze, hir | 466 | 2% | | No pronouns. I ask peopleonly to use my name. | 1095 | 4% | | I don’t ask people to usespecific pronouns. | 5619 | 20% | | Pronouns not listed above | 1162 | 4% | | *Multiple choices were allowed, so percentages do not add to 100%. | | Q2.6. What gender do youcurrently live in on aday-to-day basis? | Unweightedfrequency | Unweighted% | | Man | 9418 | 34% | | Woman | 8271 | 30% | | Neither man nor woman/Genderqueer/Non-binary | 5721 | 21% | | Part time one gender/parttime another gender | 4305 | 16% | | Total | 27715 | 100% | | Q2.7. People can tell I amtrans even if I don’t tellthem. | Unweightedfrequency | Unweighted% | | Always | 549 | 2% | | Most of the time | 2629 | 10% | | Sometimes | 9139 | 33% | | Rarely | 8986 | 33% | | Never | 6346 | 23% | | Total | 27649 | 100% | ### Page 250 | Q2.8. What best describesyour current sexualorientation? | Unweightedfrequency | Unweighted% | | - | - | - | | Asexual | 2984 | 11% | | Bisexual | 4129 | 15% | | Gay | 1316 | 5% | | Heterosexual/Straight | 3363 | 12% | | Lesbian | 3037 | 11% | | Same-gender loving | 264 | 1% | | Pansexual | 5056 | 18% | | Queer | 5706 | 21% | | Demisexual* | 287 | 1% | | A sexual orientation not listedabove | 1573 | 6% | | Total | 27715 | 100% | | *Added to the response list from write-in responses. | | Q2.9-Q2.11. Race/ethnicity(recode) | Unweightedfrequency | Unweighted% | | Alaska Native alone | 17 | 0.1% | | American Indian alone | 302 | 1.1% | | Asian/Asian American alone | 721 | 2.6% | | Biracial/Multiracial | 1513 | 5.5% | | Black/African American alone | 796 | 2.9% | | Latino/a/Hispanic alone | 1473 | 5.3% | | Middle Eastern/North Africanalone | 132 | 0.5% | | Native Hawaiian/PacificIslander alone | 62 | 0.2% | | White/European Americanalone | 22658 | 81.8% | | A racial/ethnic identity notlisted above | 41 | 0.2% | | Total | 27715 | 100% | | Q2.12. Religious/spiritualidentity (recode) | Unweightedfrequency | Unweighted% | | Not religious/spiritual | 10460 | 38% | | Religious/spiritual | 17195 | 62% | | Total | 27655 | 100% | | Q2.13. Age ranges (recode) | Unweightedfrequency | Unweighted% | | 18 to 24 | 11840 | 43% | | 25 to 44 | 10987 | 40% | | 45 to 64 | 4085 | 15% | | 65 and over | 803 | 3% | | Total | 27715 | 100% | | Q2.15. What is your currentrelationship status? | Unweightedfrequency | Unweighted% | | Partnered, living together | 8762 | 31.6% | | Partnered, not living together | 4630 | 16.7% | | Single | 13219 | 47.7% | | Not listed above | 404 | 1.5% | | Aromantic/not active/platonic* | 67 | 0.2% | | Open relationship* | 53 | 0.2% | | Poly* | 535 | 1.9% | | Single, divorced* | 11 | 0.0% | | Single, widowed* | 28 | 0.1% | | Total | 27709 | 100% | | *Added to the response list from write-in responses. | | Q2.16. What is your currentlegal marital status? | Unweightedfrequency | Unweighted% | | Married | 4671 | 16.9% | | Legally recognized civil union | 67 | 0.2% | | Registered domesticpartnership | 238 | 0.9% | | Widowed | 216 | 0.8% | | Divorced | 2538 | 9.2% | | Separated | 456 | 1.7% | | Single, never married | 19463 | 70.4% | | Total | 27649 | 100% | | Q2.17. Have you ever servedon active duty in the U.S.Armed Forces, Reserves, orNational Guard? | Unweightedfrequency | Unweighted% | | Never served in the military | 25263 | 91.3% | | Only active duty for trainingin the Reserves or NationalGuard | 298 | 1.1% | | Now on active duty | 129 | 0.5% | | On active duty in the past, butnot now | 1976 | 7.1% | | Total | 27666 | 100% | | Q2.18. What is yourcitizenship or immigrationstatus in the U.S.? | Unweightedfrequency | Unweighted% | | U.S. citizen, birth | 26684 | 96.3% | | U.S. citizen, naturalized | 555 | 2.0% | | Permanent Resident | 249 | 0.9% | | A visa holder (such as F-1, J-1,H1-B, and U) | 115 | 0.4% | | DACA (Deferred Action forChildhood Arrival) | 16 | 0.1% | | DAPA (Deferred Action forParental Accountability) | 1 | 0.0% | | Refugee status | 6 | 0.0% | | Other documented status notmentioned above | 40 | 0.1% | | Currently under a withholdingof removal status | 3 | 0.0% | | Undocumented resident | 46 | 0.2% | | Total | 27715 | 100% | ### Page 251 | Q2.20. Disability (questionsbased on AmericanCommunity Survey, withthe exception of the lastquestion) | Unweightedfrequency | Unweighted%* | | - | - | - | | Are you deaf or have seriousdifficulty hearing? | 1072 | 4% | | Are you blind or have seriousdifficulty seeing even whenwearing glasses? | 679 | 2% | | Because of a physical mentalor emotional condition, doyou have serious difficultyconcentrating, remembering,or making decisions? | 8471 | 31% | | Do you have serious difficultywalking or climbing stairs? | 1729 | 6% | | Do you have difficultydressing or bathing? | 924 | 3% | | Because of a physical, mental,or emotional condition, doyou have difficulty doingerrands alone, such as visitinga doctor’s office or shopping? | 6200 | 23% | | Do YOU identify as a personwith a disability? | 7764 | 28% | | *Multiple choices were allowed, so percentages do not add to 100%. | | Q2.20. Any disability(recode) (based onAmerican CommunitySurvey questions only, notincluding self-identification) | Unweightedfrequency | Unweighted% | | No | 16305 | 60% | | Yes | 10913 | 40% | | Total | 27218 | 100 | | Q2.21. What is the mainlanguage that people speakin your home? | Unweightedfrequency | Unweighted% | | English only | 24958 | 90.1% | | Language(s) other thanEnglish | 285 | 1.0% | | English and other language(s) | 2461 | 8.9% | | Total | 27704 | 100% | | Q2.22. What is the highestlevel of school or degreeyou have completed? | Unweightedfrequency | Unweighted% | | Less than 8th grade | 48 | 0.2% | | 8th grade | 54 | 0.2% | | Some high school, no diplomaor GED | 804 | 2.9% | | GED | 661 | 2.4% | | High school graduate | 2806 | 10.1% | | Some college, no degree(including currently in college) | 10486 | 37.8% | | Associate degree in college—Occupational/vocationalprogram | 858 | 3.1% | | Associate degree in college—Academic program | 1475 | 5.3% | | Bachelor’s degree | 5291 | 19.1% | | Some graduate work, nograduate degree | 1652 | 6.0% | | Master’s degree (M.A, M.S.,MBA) | 2562 | 9.2% | | Doctoral degree (e.g., Ph.D.,Ed.D.) | 504 | 1.8% | | Professional degree (e.g.,MD, JD) | 514 | 1.9% | | Total | 27715 | 100% | | Q2.23. What are yourcurrent living arrangements? | Unweightedfrequency | Unweighted% | | Living in house/apartment/condo I OWN alone or withothers (with a mortgage orthat you own free and clear) | 4697 | 17.0% | | Living in house/apartment/condo I RENT alone or withothers | 11507 | 41.5% | | Living with a partner, spouse,or other person who pays forthe housing | 1443 | 5.2% | | Living temporarily with friendsor family because I can’tafford my own housing | 2229 | 8.0% | | Living with parents or family Igrew up with because I havenot yet left home | 5149 | 18.6% | | Living in a foster group homeor other foster care | 10 | 0.0% | | Living in campus/universityhousing | 1821 | 6.65% | | Living in a nursing home orother adult care facility | 9 | 0.0% | | Living in a hospital | 2 | 0.0% | | Living in military barracks | 31 | 0.1% | | Living in a hotel or motel that Ipay for myself | 37 | 0.1% | | Living in a hotel or motelwith an emergency sheltervoucher | 6 | 0.0% | ### Page 252 | Q2.23. What are yourcurrent living arrangements?(continued) | Unweightedfrequency | Unweighted% | | - | - | - | | Living in transitional housing/halfway house | 48 | 0.2% | | Living on the street, in a car, inan abandoned building, in apark, or a place that is NOT ahouse, apartment, shelter, orother housing | 91 | 0.3% | | Living in a homeless shelter | 36 | 0.1% | | Living in a domestic violenceshelter | 6 | 0.0% | | Living in a shelter that is not ahomeless shelter or domesticviolence shelter | 3 | 0.0% | | A living arrangement notlisted above | 126 | 0.5% | | Mobile housing (RV, camper,etc.)* | 40 | 0.1% | | A place owned/rented bysomeone else* | 176 | 0.6% | | A group home or treatmentfacility* | 13 | 0.1% | | At home/with family for otherreasons* | 186 | 0.7% | | Nomadic* | 16 | 0.1% | | Commune/co-op/collective* | 28 | 0.1% | | Total | 27710 | 100% | | *Added to the response list from write-in responses. | | Q2.24. Is there at leastone telephone INSIDEyour home that is currentlyworking and is not a cellphone? | Unweightedfrequency | Unweighted% | | No | 18255 | 66% | | Yes | 9313 | 34% | | Total | 27568 | 100% | | Q2.24. Do you have a cellphone? | Unweightedfrequency | Unweighted% | | No | 882 | 3% | | Yes | 26744 | 97% | | Total | 27626 | 100% | | Q14.1 & Q14.2 HIV status(recode) | Unweightedfrequency | Unweighted% | | HIV positive | 179 | 0.7% | | HIV negative | 13869 | 50.2% | | Don’t know/not tested | 13606 | 49.2% | | Total | 27654 | 100% | | Q7.7 Employment status | Unweightedfrequency | Unweighted%* | | Work for pay from sex work,selling drugs, or other work thatis currently considered illegal | 516 | 1.9% | | Work full-time for an employer | 9560 | 34.5% | | Work part-time for anemployer | 6735 | 24.3% | | Self-employed in your ownbusiness, profession ortrade, or operate a farm (notincluding sex work, sellingdrugs, or other work that iscurrently considered illegal) | 3868 | 14.0% | | Unemployed but looking forwork | 3991 | 14.4% | | Unemployed and havestopped looking for work | 1247 | 4.5% | | Not employed due todisability | 2255 | 8.1% | | Student | 8639 | 31.2% | | Retired | 1107 | 4.0% | | Homemaker or full-timeparent | 549 | 2.0% | | Not listed above | 1240 | 4.5% | | Seasonal work/odd jobs/otherpart-time work* | 136 | 0.5% | | Volunteer* | 76 | 0.3% | | Internship* | 66 | 0.2% | | *Multiple choices were allowed, so percentages do not add to 100%. | | Q7.8. Respondent ismember of a union (recode) | Unweightedfrequency | Unweighted% | | No | 25997 | 94% | | Yes | 1691 | 6% | | Total | 27688 | 100% | | Q7.8 & Q7.9. Respondent isa union member or under aunion contract (recode) | Unweightedfrequency | Unweighted% | | No | 25623 | 92% | | Yes | 2082 | 8% | | Total | 27705 | 100% | | Q7.10. Do you currentlyreceive assistance fromfood stamps (SNAP) or WIC? | Unweightedfrequency | Unweighted% | | No | 25060 | 91% | | Yes | 2606 | 9% | | Total | 27666 | 100% | ### Page 253 | Q7.11. Current sources ofincome (recode) | Unweightedfrequency | Unweighted% | | - | - | - | | Pay from sex work, sellingdrugs, or other work that iscurrently considered illegalonly | 143 | 0.6% | | Pay from employment only | 10519 | 40.4% | | Pay from pension orretirement only | 227 | 0.9% | | SSI or disability income only | 903 | 3.5% | | Unemployment benefits orcash assistance only | 207 | 0.8% | | Other income source only | 1165 | 4.5% | | Multiple income sources | 12183 | 46.8% | | No income | 664 | 2.6% | | Total | 26011 | 100% | | Q7.12. Individual income in2014 (includes all incomesources except food stamps(SNAP) or WIC) | Unweightedfrequency | Unweighted% | | No income | 3913 | 14.4% | | $1 to $5,000 | 4647 | 17.1% | | $5,000 to $7,499 | 1665 | 6.1% | | $7,500 to $9,999 | 1444 | 5.3% | | $10,000 to $12,499 | 1743 | 6.4% | | $12,500 to $14,999 | 1184 | 4.4% | | $15,000 to $17,499 | 843 | 3.1% | | $17,500 to $19,999 | 772 | 2.9% | | $20,000 to $24,999 | 1568 | 5.8% | | $25,000 to $29,999 | 1071 | 4.0% | | $30,000 to $34,999 | 1163 | 4.3% | | $35,000 to $39,999 | 888 | 3.3% | | $40,000 to $49,999 | 1355 | 5.0% | | $50,000 to $59,999 | 1049 | 3.9% | | $60,000 to $74,999 | 1070 | 3.9% | | $75,000 to $99,999 | 1118 | 4.1% | | $100,000 to $149,999 | 998 | 3.7% | | $150,000 or more | 636 | 2.3% | | Total | 27127 | 100% | | Q7.12 - Q7.14 Householdincome in 2014 (recode) | Unweightedfrequency | Unweighted% | | No income | 996 | 3.9% | | $1 to $5,000 | 1433 | 5.7% | | $5,000 to $7,499 | 811 | 3.2% | | $7,500 to $9,999 | 869 | 3.4% | | $10,000 to $12,499 | 1109 | 4.4% | | $12,500 to $14,999 | 897 | 3.6% | | $15,000 to $17,499 | 725 | 2.9% | | $17,500 to $19,999 | 725 | 2.9% | | $20,000 to $24,999 | 1571 | 6.2% | | $25,000 to $29,999 | 1220 | 4.8% | | $30,000 to $34,999 | 1367 | 5.4% | | $35,000 to $39,999 | 1224 | 4.8% | | $40,000 to $49,999 | 1872 | 7.4% | | $50,000 to $59,999 | 1806 | 7.1% | | $60,000 to $74,999 | 2096 | 8.3% | | $75,000 to $99,999 | 2360 | 9.3% | | $100,000 to $149,999 | 2418 | 9.6% | | $150,000 or more | 1797 | 7.1% | | Total | 25296 | 100% | | Q29.1 & Q29.2 Registered tovote on November 4, 2014(recode) | Unweightedfrequency | Unweighted% | | No | 8468 | 31% | | Yes | 19215 | 69% | | Total | 27683 | 100% | | Q29.1. Did you vote in theelection held on Tuesday,November 4, 2014? | Unweightedfrequency | Unweighted% | | No | 13846 | 50% | | Yes | 13805 | 50% | | Total | 27651 | 100% | ### Page 254 250 Appendix B Survey Instrument (Questionnaire) ### Page 255 251 The survey was offered online only. The questionnaire hasbeen reproduced here to best reflect what respondents sawwhen completing the survey. Programming notes are indicatedin italics. QUESTIONNAIRE: The National Center for Transgender Equality welcomes youto the 2015 U.S. Trans Survey, the follow up to the NationalTransgender Discrimination Survey: Injustice At Every Turn.We thank you for participating in this survey. Every voicecounts in documenting and better understanding the livesand experiences of trans people in the United States, and weappreciate yours. Sincerely,The National Center for Transgender Equality Survey Team UNIVERSITY OF CALIFORNIALOS ANGELES Study information sheet 2015 U.S. Trans Survey This study has been commissioned by the National Center forTransgender Equality (NCTE). A research team made up of JodyL. Herman, Ph.D. and Susan Rankin, Ph.D. are conducting thisstudy. Your participation in this study is voluntary. WHY IS THIS STUDY BEING DONE? This study is being conducted to better understand thedemographics, health, and experiences of trans people in theUnited States. The findings of this study will be used for thebenefit of the trans community and the research community. WHAT WILL HAPPEN IF I TAKE PART IN THIS RESEARCHSTUDY? If you volunteer to participate in this study, the researchers askthat you participate in an online survey. The purpose of thesurvey is to gather information about you and your experiencesas a trans person in the United States. You will be one of over700,000 possible participants who may take part in this survey,which is the current best estimate of the total number of trans-identified adults in the United States. HOW LONG WILL I BE IN THE RESEARCH STUDY? Participation in the study will take between 30 and 60 minutes. ARE THERE ANY RISKS OR DISCOMFORTS THAT I CANEXPECT FROM THIS STUDY? Participating in this study poses no risks that are not ordinarilyencountered in daily life. Any information you provide in thesurvey will be confidential. Some of the questions asked of youas part of this survey may make you feel uncomfortable. Youmay refuse to answer questions posed to you by skipping thequestion. You may stop your participation in this study at anytime by exiting the survey. Should you need them, there will bea list of resources, including hotlines, provided at the end of thesurvey. ARE THERE ANY BENEFITS IF I PARTICIPATE? The results of the research will be used for the benefit ofthe trans community in the United States and the researchcommunity. You will not directly benefit from your participationin the research. WILL I BE PAID FOR MY PARTICIPATION? You will receive no payment for your participation. You will havethe option to voluntarily enter a drawing to win one of threecash prizes: one prize of $500 and two prizes of $250. HOW WILL INFORMATION ABOUT ME AND MYPARTICIPATION BE KEPT CONFIDENTIAL? Your survey response will be anonymous, so no informationthat can be used to identify you will be collected unless youvoluntarily provide it. Any information that is obtained inconnection with this study and that can identify you will remainconfidential. If you do voluntarily provide any information thatcould be used to identify you, the research team will maintainyour confidentiality by taking precautions to minimize any riskto your privacy from participating in this survey. You will be given the option at the end of the survey to bedirected to a separate page on a secure website if you wishto provide your contact information to receive survey resultsfrom NCTE, be entered into the drawing for one of three cashprizes, or share your personal story with NCTE. NCTE will NOTbe provided with any responses from your survey in connectionwith your contact information. NCTE will only know that youhave participated in the survey. NCTE will not provide to theresearch team any information that could be used to identifyyou, such as your name. Therefore, you will remain anonymousto the research team. ### Page 256 Results of this research study that are reported in publishedform will not name you or identify you as a participant. If youchoose to self-identify anywhere on the survey and provide awritten response, a different name will be created and usedinstead of your name if quoting you directly in any publicationand any content of quotes that could be used to identify youwill be removed. CAN THE RESEARCHERS REMOVE ME FROM THIS STUDY? The researchers will not remove you from the study. You mayremove yourself from the study by exiting the survey. If you exitthe survey, your responses will not be recorded or used in thestudy. WHAT ARE MY RIGHTS IF I TAKE PART IN THIS STUDY? Taking part in this study is your choice. You can choose whetheror not you want to participate. Whatever decision you make,there will be no penalty to you. • You have a right to have all of your questions answeredbefore deciding whether to take part in the study. • If you decide to take part in the study, you have the right toexit the study at anytime by exiting the survey. • If you decide at any point to stop participating in this study,you have the right to exit the study at any time by exitingthe survey. WHO CAN I CONTACT IF I HAVE QUESTIONS ABOUT THISSTUDY? The Research Team: You may contact Jody L. Herman at (310) 267-4382 or SusanRankin at (814) 625-2780 with any questions or concerns aboutthe research or your participation in this study. UCLA Office of the Human Research Protection Program(OHRPP): If you have questions about your rights while taking part in thisstudy, or you have concerns or suggestions and you want totalk to someone other than the researchers about the study,you may contact the UCLA OHRPP by phone: (310) 825-7122or U.S. mail: UCLA OHRPP, 11000 Kinross Ave., Suite 102, Box951694, Los Angeles, CA 90095-1694. If you agree to take part in this study, as described in detailabove, please click on the “I AGREE” button below. By clickingon the “I AGREE” button, you will indicate your consent toparticipate in this study. If you do not agree to take part in this study, as describedabove, please click on the “I DO NOT AGREE” button below. ☐ I AGREEI agree and give my consent to participate in this study. ☐ I DO NOT AGREEI do not agree to participate in this study. Respondents who selected “do not agree” were sent adisqualification page #2.1 Survey Instructions Please read and answer each question carefully. For eachanswer, click on the appropriate oval and/or fill in theappropriate blank. If you want to change an answer, click on theoval of your new answer and/or edit the appropriate blank, andyour previous response will be erased. You may decline to answer specific questions. The survey willtake between 30-60 minutes to complete. There will be several places in the survey where you willsee a word or phrase that is underlined and bolded. You canclick on those words or phrases and a definition or additionalinformation will be offered. In order to clear a response choice, please use the back buttonon your browser. WARNING: If you use the back button on your browserto return to a previous question, the responses you haveentered for each page you clicked back on will be erased.For instance, if you click back three pages in the survey, youranswers on those three pages will be erased. Responsesbefore those three pages would stay the same.In the survey, please do not provide any information thatcould be used to identify you, such as your name or contactinformation. All of your answers are confidential and cannot beused against you. You must hit the “submit” button on the last page of thesurvey for your responses to be included in the final analyses. Section 1 1.1 Please make an ID in question 1.1. The research team will usethe ID for their analysis. It will not be used to identify you. Enter the first and last letter of your preferred first name. Forexample, if your first name is “Robert”, enter “RT”. [Text box] Enter the first letter of your preferred last name. For example, ifyour last name is “Smith”, enter “S”. [Text box] 1.2 It is important that people only complete this survey onetime so that we can gather accurate information. You will onlybe entered into the prize drawing once, even if you completethis survey more than once. Have you already completed thissurvey before? [Must answer to continue.] No Yes [Sent to disqualification page #1]2 1.3 Are you 18 years of age or older? [Must answer to continue.] No [Sent to disqualification page #2]3 Yes ### Page 257 1.4 What U.S. state or territory do you currently live in? [Mustanswer to continue.] [Drop-down list of all U.S. states and territories.] I do not live in a U.S. state or territory. [Sent todisqualification page #1]4 1.5 How did you hear about this survey? (Mark all that apply.) Email from an organization (listserv, e-newsletter) Social networking site (such as Facebook) Organization website (such as NCTE) I was told about it in person (at an organization, event, orsupport group) Flier or print advertisement Word of mouth (e-mail from a friend, a friend told youabout it) Not listed above (please specify) ________________ 1.6 Are you taking this survey at a survey event or meeting,such as one hosted by an LGBTQ or Trans organization ormeeting? No Yes 1.7 How are you taking this survey? On my home computer/laptop On my work computer On a public computer (such as in a computer lab or library) On my mobile phone or tablet On a friend’s or family member’s mobile phone, tablet, orcomputer Not listed above (please specify) ___________________ 1.8 Not including for this survey, do you use the internet oremail, at least occasionally? (Mark all that apply.) No [Respondents could not select “No” in combinationwith any other option.] Yes, the internet Yes, email 1.9 If a national survey company, like Gallup, asked you thefollowing question: “We are asking only for statistical purposes:Do you, personally, identify as lesbian, gay, bisexual, ortransgender?” How would you answer? I would answer No I would answer Yes I would not answer the question PLEASE READ AND RESPOND CAREFULLY TO THEFOLLOWING QUESTIONS. This is a survey for people who are transgender, trans, or non-binary. It doesn’t matter if you have transitioned gender or ifyou plan to. To see if this survey is for you, please answer thefollowing questions. 1.10 Do you think of yourself as transgender? [Must answer tocontinue.] No Yes 1.11 Do you identify as more than one gender or as no gender(such as genderqueer or non-binary)? [Must answer tocontinue.] No Yes 1.12 Do you currently live full-time in a gender that is differentfrom the one assigned to you at birth? [Must answer tocontinue.] No [Skip to 1.14] Yes 1.13 How old were you when you started to live full-time in agender that is different from the one assigned to you at birth?[Only respondents who selected “Yes” in response to 1.12received this question.] [Drop-down list of all ages from “1” through “99,” and “100and above” as final response choice] 1.14 Someday do you want to live full-time in a gender that isdifferent from the one assigned to you at birth? [Respondentswho selected “No” in response to 1.12 must answer to continue.] No [Skip to 1.16] Yes Not sure 1.15 What are the main reasons that you don’t live full-time in agender that is different from the one assigned to you at birth?(Mark all that apply.) [Only respondents who selected “Yes” or“Not sure” in response to 1.14 received this question.] My spouse and/or kids might reject me. My parents might reject me. I might lose my job or not be able to get a job. I might face mistreatment at school. My friends might reject me. I might not get the medical care I need. I might be hurt financially. I might become homeless. My church or faith community might reject me. ### Page 258 I might face violence. I am not ready to transition. A reason not listed above(please specify) _______________ 1.16 Have you seriously thought about living in a gender thatis different from the one assigned to you at birth (transitioninggender)? [Respondents who selected “No” in response to 1.13must answer to continue.] No Yes 1.17 Do you consider yourself to be a cross-dresser? [Mustanswer to continue.] No Yes 1.18 Do you live part of the time in one gender and part of thetime in another gender? [Must answer to continue.] No Yes [Respondents who answered “No” to 1.10, 1.11, 1.12, 1.14, 1.16, 1.17,and 1.18 were sent to disqualification page #1.]5 Section 2 2.1 What sex were you assigned at birth, on your original birthcertificate? [Must answer to continue.] Female Male 2.2 Which of these terms do you identify with? (Mark all thatapply.) A.G. or aggressive Agender Androgynous Bi-gender Butch Bulldagger Cross dresser Drag performer (king/queen) Fa’afafine Gender non-conforming or gender variant Genderqueer Gender fluid/fluid Intersex Mahu Multi-gender Non-binary Third gender Stud Transgender Trans Trans man (FTM, female to male) Transsexual Trans woman (MTF, male to female) Travesti Two-spirit A gender not listed above(please specify)_______________ 2.3 If you had to choose only one of the following terms, whichbest describes your current gender identity? (Please chooseonly one answer.) Cross-dresser Woman Man Trans woman (MTF) Trans man (FTM) Non-binary/Genderqueer [Respondents who selected thisanswer received questions 2.3_1, 2.3_2, and 2.3_3.] 2.3_1 For people in your life who don’t know that you’re non-binary/genderqueer, what gender do they usually think you are?[Only respondents who selected “Non-binary/Genderqueer” inresponse to 2.3 received this question.] Man Woman Trans Man Trans Woman Non-Binary/Genderqueer They can’t tell It varies 2.3_2 When people in your life assume you are somethingother than non-binary/genderqueer (such as a man or awoman), how do you respond? [Only respondents who selected“Non-binary/Genderqueer” in response to 2.3 received thisquestion.] I usually let them assume I am a man or a woman I sometimes tell them I identify as non-binary/genderqueer(or whatever words I use) I always tell them I identify as non-binary/genderqueer (orwhatever words I use) [Skip to 2.4.] ### Page 259 2.3_3 What are the main reasons that you don’t tell peopleyou identify as non-binary/genderqueer? (Mark all that apply).[Only respondents who selected “Non-binary/Genderqueer” inresponse to 2.3 and either selected “I usually let them assumeI am a man or a woman” or “I sometimes tell them I identify asnon/binary genderqueer” in response to 2.3_2 received thisquestion.] Most people don’t understand so I don’t try to explain it. Most people dismiss it as not being a real identity or a“phase.” It is just easier not to say anything. I am not ready to tell people I identify as non-binary/genderqueer. I might lose my job or not be able to get a job. I might face mistreatment at school. My friends might reject me. I might not get the medical care I need. I might be hurt financially. I might become homeless. My church or faith community might reject me. I might face violence. A reason not listed above(please specify) _______________ 2.4 How comfortable are you with the word “transgender”being used to describe you? Very comfortable Somewhat comfortable Neutral Somewhat uncomfortable Very uncomfortable [All respondents received the following message.] Weknow that not everyone is comfortable with the word“transgender,” but for this survey, we must use one word torefer to all trans and non-binary identities. Because of thiswe will use the word “trans” in this survey to refer to all transand non-binary identities. 2.5 What gender pronouns do you ask people to use to refer toyou? [Respondents could mark all answers that applied.] He, his She, hers They, their Ze, hir No pronouns. I ask people only to use my name. I don’t ask people to use specific pronouns. Pronouns not listed above (please specify) ____________ 2.6 What gender do you currently live in on a day-to-day basis? Man Woman Neither man nor woman/Genderqueer/Non-binary Part time one gender/part time another gender 2.7 People can tell I am trans even if I don’t tell them. Always Most of the time Sometimes Rarely Never 2.8 What best describes your current sexual orientation? Asexual Bisexual Gay Heterosexual/Straight Lesbian Same-gender loving Pansexual Queer A sexual orientation not listed above (pleasespecify)_______ 2.9 Although the choices listed below may not represent yourfull identity or use the language you prefer, for this surveyplease select the choice that most accurately describes yourracial/ethnic identity. (Please choose only one answer.) Alaska Native Enter your enrolledor principal corporation:_________________ [required] American Indian Enter your enrolled or principal tribe:______________ [required] Asian/Asian American Biracial/Multiracial [respondents received follow-upquestion 2.10] Black/African American Latino/a/Hispanic Middle Eastern/North African Native Hawaiian/Pacific Islander White/European American A racial/ethnic identity not listed above (please specify)_____________ [respondents received follow-up question2.11] ### Page 260 2.10 You said that you are biracial or multiracial. Please choosethe racial/ethnic identities that best describe you. (Mark all thatapply.) [Only respondents who selected “Biracial/Multiracial” in 2.9received this question.] Alaska Native Enter your enrolled or principal corporation:_________________ [required] American Indian Enter your enrolled or principal tribe:______________ [required] Asian/Asian American Black/African American Latino/a/Hispanic Middle Eastern/North African Native Hawaiian/ Pacific Islander White/European American A racial/ethnic identity not listed above(please specify) ___________________ 2.11 You said that you had a racial/ethnic identity that was notlisted above. Please choose the racial/ethnic identities that bestdescribe you. (Mark all that apply.) [Only respondents who selected “A racial/ethnic identity notlisted above” in 2.9 received this question.] Alaska Native Enter your enrolled or principal corporation:_________________ [required] American Indian Enter your enrolled or principal tribe:______________ [required] Asian/Asian American Black/African American Latino/a/Hispanic Middle Eastern/North African Native Hawaiian/ Pacific Islander White/European American 2.12 What is your current religious or spiritual identity? (Mark allthat apply.) Agnostic Atheist Baha’i Buddhist Christian (Please click here to specify) [Respondentsreceived the following drop-down list.] African Methodist Episcopal African Methodist Episcopal Zion Assembly of God Baptist Catholic/Roman Catholic Church of Christ Church of God in Christ Christian Orthodox Christian Methodist Episcopal Christian Reformed Church (CRC) Episcopalian Evangelical Greek Orthodox Lutheran Mennonite Moravian Nondenominational Christian Pentecostal Presbyterian Protestant Protestant Reformed Church (PR) Quaker Reformed Church of America (RCA) Russian Orthodox Seventh Day Adventist The Church of Jesus Christ of Latter-day Saints United Methodist Unitarian Universalist United Church of Christ A Christian affiliation not listed above(please specify) _______________ Confucianist Druid Hindu Jain Jehovah’s Witness Jewish (Please click here to specify) [Respondentsreceived the following drop-down list.] Conservative Orthodox Reform Muslim (Please click here to specify) [Respondentsreceived the following drop-down list.] Ahmadi Shi’ite Sufi Sunni Native American Traditional Practitioner or Ceremonial Pagan ### Page 261 Rastafarian Scientologist Secular Humanist Shinto Sikh Taoist Tenrikyo Wiccan Spiritual, but no religious affiliation No affiliation A religious affiliation or spiritual identity not listed above(please specify) ________________ 2.13 What is your current age? [Drop-down list of all ages from “18” through “99,” and“100 and above” as final response choice] 2.14 What month and year were you born? Month [Drop-down list of all months] Year [Drop-down list with years 1997–1915, and earlier asfinal response choice] 2.15 What is your current relationship status? Partnered, living together Partnered, not living together Single Not listed above (please specify) _________ 2.16 What is your current legal marital status? Married Legally recognized civil union Registered domestic partnership Widowed Divorced Separated Single, never married 2.17 Have you ever served on active duty in the U.S. ArmedForces, Reserves, or National Guard? As a reminder, youranswers are confidential and cannot be used against you. Never served in the military Only on active duty for training in the Reserves or NationalGuard Now onactive duty6 On active duty in the past, but not now 2.18 What is your citizenship or immigration status in the U.S.?As a reminder, your answers are confidential and cannot beused against you. U.S. citizen, birth [Respondents directed to 2.19] U.S. citizen, naturalized Permanent Resident A visa holder (such as F-1, J-1, H1-B, and U) DACA (Deferred Action for Childhood Arrival) DAPA (Deferred Action for Parental Accountability) Refugee status Other documented status not mentioned above Currently under a withholding of removal status Undocumented resident 2.19 In what U.S. state or territory were you born? [Onlyrespondents who selected “U.S. citizen, birth” in 2.18 receivedthis question.] I was not born in a U.S. state or territory. [Drop-down list for all U.S. states and territories for otherresponse choices. Respondents who selected “New York”received an additional drop-down choice for “New YorkCity.”] 2.20 Please answer each question below. (Please provide ananswer in each row.) | No | Yes | | - | - | | Are you deaf or have serious difficulty hearing? | O | O | | Are you blind or have serious difficulty seeingeven when wearing glasses? | O | O | | Because of a physical mental or emotionalcondition, do you have serious difficulty concen-trating, remembering, or making decisions? | O | O | | Do you have serious difficulty walking orclimbing stairs? | O | O | | Do you have difficulty dressing or bathing? | O | O | | Because of a physical, mental, or emotionalcondition, do you have difficulty doing errandsalone, such as visiting a doctor’s office orshopping? | O | O | | DoYOUidentify as a person with a disability? | O | O | 2.21 What is the main language that people speak in yourhome? English only Language(s) other than English Armenian Chinese French German Greek ### Page 262 Italian Japanese Korean Persian Polish Portuguese or Portuguese Creole Russian Serbo-Croatian Spanish or Spanish Creole Tagalog Vietnamese Yiddish A language not listed above(_____________________) English and other language(s) Armenian Chinese French German Greek Italian Japanese Korean Persian Polish Portuguese or Portuguese Creole Russian Serbo-Croatian Spanish or Spanish Creole Tagalog Vietnamese Yiddish A language not listed above(_____________________) 2.22 What is the highest level of school or degree you havecompleted? Less than 8th grade 8th grade Some high school, no diploma or GED GED High school graduate Some college, no degree (including currently in college) Associate degree in college – Occupational/vocationalprogram Associate degree in college – Academic program Bachelor’s degree Some graduate work, no graduate degree Master’s degree (M.A, M.S., MBA) Doctoral degree (e.g., Ph.D., Ed.D.) Professional degree (e.g., MD, JD) 2.23 What are your current living arrangements? Living in house/apartment/condo I OWN alone or withothers (with a mortgage or that you own free and clear) Living in house/apartment/condo I RENT alone or withothers Living with a partner, spouse, or other person who pays forthe housing Living temporarily with friends or family because I can’tafford my own housing Living with parents or family I grew up with because I havenot yet left home Living in a foster group home or other foster care Living in campus/university housing Living in a nursing home or other adult care facility Living in a hospital Living in military barracks Living in a hotel or motel that I pay for myself Living in a hotel or motel with an emergency sheltervoucher Living in transitional housing/halfway house Living on the street, in a car, in an abandoned building, in apark, or a place that is NOT a house, apartment, shelter, orother housing [Skip to 2.25] Living in a homeless shelter [Skip to 2.25] Living in a domestic violence shelter [Skip to 2.25] Living in a shelter that is not a homeless shelter ordomestic violence shelter [Skip to 2.25] A living arrangement not listed above(please specify) _______________________ 2.24 Is there at least one telephone INSIDE your home that iscurrently working and is not a cell phone? No Yes 2.25 Do you have a cell phone? No Yes 2.26 What is the zip code where you currentlylive? _____________ ### Page 263 Section 3 3.1 At about what age did you begin to feel that your genderwas “different” from your assigned birth sex? [Drop-down list of ages] 3.2 At about what age did you start to think you were trans(even if you did not know the word for it)? [Drop-down list of ages] 3.3 At about what age did you first start to tell others that youwere trans (even if you did not use that word)? I have not told others that I am trans. [Drop-down list of ages for other responses] 3.4 How do you socialize with other trans people? (Mark allthat apply.) In political activism Socializing in person Socializing on-line (such as Facebook or Twitter) In support groups I don’t socialize with other trans people [Respondentscould not select this answer in combination with any otheroption.] Not listed above (please specify) _____________ Section 4 These are questions about the people in your life andwhether they know you are trans. 4.1 Have any of your spouses/partners known that you are transduring your relationship with them? (Mark all that apply). I have never had a spouse/partner [Respondents could notselect this answer in combination with any other option.Skip to 4.3 if selected.] No [Respondents could not select this answer incombination with any other option. Skip to 4.3 if selected.] Yes, my current spouse/partner knows I am trans Yes, at least one of my former spouses or partners knew Iwas trans 4.2 Have any of your spouses/partners ended your relationshipbecause you are trans? [Only respondents who indicated thatat least one of their past or current spouses knew they weretrans in 4.1 received this question.] No Yes, only because I was trans. Yes, because I was trans and other reasons. 4.3 Do any of your children know you are trans? I do not have any children [Skip to 4.5] No [Skip to 4.5] Yes 4.4 Have any of your children ever stopped speaking to you orspending time with you because you are trans? No Yes 4.5 How many people in each group below currently know youare trans? (Please provide an answer in each row.) | I currentlyhave nopeople likethis in mylife | AllknowthatI amtrans | MostknowthatI amtrans | SomeknowthatI amtrans | NoneknowthatI amtrans | | - | - | - | - | - | | Immediate familyyou grew up with(mother, father, sis-ters, brothers, etc.) | O | O | O | O | O | | Extended family(aunts, uncles,cousins, etc.) | O | O | O | O | O | | Lesbian, gay, bisex-ual, or trans (LGBT)friends | O | O | O | O | O | | Straight, non-trans(non-LGBT) friends | O | O | O | O | O | | Current boss/manager/supervisor | O | O | O | O | O | | Current coworkers | O | O | O | O | O | | Current classmates | O | O | O | O | O | | Current health careproviders | O | O | O | O | O | 4.6 You said some or all of your immediate family you grew upwith (mother, father, sisters, brothers, etc.) know that you aretrans. On average, how supportive are they of you being trans?[Only respondents who said in response to 4.5 that some, most,or all of their immediate family members knew they were transreceived this question.] Very supportive Supportive Neither supportive nor unsupportive Unsupportive Very unsupportive 4.7 Did any of your immediate family members you grew upwith (mother, father, sisters, brothers, etc.) do any of thesethings to you because you are trans? (Mark all that apply.)[Only respondents who said in response to 4.5 that some, most,or all of their immediate family members knew they were transreceived this question.] Stopped speaking to you for a long time or ended yourrelationship Were violent towards you Kicked you out of the house ### Page 264 Did not allow you to wear the clothes that matched yourgender Sent you to a therapist, counselor, or religious advisor tostop you from being trans None of the above [Respondents could not select thisanswer in combination with any other option.] 4.8 Did any of your immediate family members you grew upwith (mother, father, sisters, brothers, etc.) do any of thesethings to support you? (Mark all that apply.) [Only respondentswho said in response to 4.5 that some, most, or all of theirimmediate family members knew they were trans received thisquestion.] Told you that they respect and/or support you Used your preferred name Used your correct pronouns (such as he/she/they) Gave you money to help with any part of your gendertransition Helped you change your name and/or gender on youridentity documents (ID), like your driver’s license (such asdoing things like filling out papers or going with you tocourt) Did research to learn how to best support you (such asreading books, using online information, or attending aconference) Stood up for me with family, friends, or others Supported you in another way not listed above (pleasespecify)____________ None of the above [Respondents could not select thisanswer in combination with any other option.] 4.9 Did you ever run away from home because you are trans?[Only respondents who said in response to 4.5 that some, most,or all of their immediate family members knew they were transreceived this question.] No [Skip to 4.11] Yes 4.10 At what age did you run away from home because you aretrans? [Only respondents who selected “Yes” in 4.9 receivedthis question.] [Drop-down list of ages] 4.11 On average, how supportive are your co-workers with youbeing trans? [Only respondents who said in response to 4.5that some, most, or all of their coworkers knew they were transreceived this question.] Very supportive Supportive Neither supportive nor unsupportive Unsupportive Very unsupportive 4.12 On average, how supportive are your classmates withyou being trans? [Only respondents who said in response to4.5 that some, most, or all of their classmates knew they weretrans received this question.] Very supportive Supportive Neither supportive nor unsupportive Unsupportive Very unsupportive Section 5 These questions are about your experiences with yourchurch, synagogue, mosque, or other faith community. 5.1 Have you ever been part of a spiritual/religious community(such as a church, synagogue, mosque, or other faithcommunity)? No [Skip to 6.1] Yes 5.2 Have you ever left your spiritual/religious communitybecause you were afraid they might reject you because youare a trans person? No Yes 5.3 Have you ever left your spiritual/religious communitybecause they did reject you because you are a trans person? No [Skip to 5.5] Yes 5.4 After you stopped attending, did you find a spiritual/religious community that welcomed you as a trans person?[Only respondents who selected “Yes” in 5.4 received thisquestion.] No Yes 5.5 Now just thinking about the past year, have you been partof a spiritual/religious community? No [Skip to 6.1] Yes 5.6 In the past year, did any leaders or other members of yourspiritual/religious community think or know you were trans? No [Skip to 6.1] Yes ### Page 265 5.7 In the past year, how often did leaders or other members ofyour spiritual/religious community… (Please provide an answerin each row.) | In the past year… | Never | Once ortwice | A fewtimes | Manytimes | | - | - | - | - | - | | Make you feel welcome as atrans person attending services/faith community functions? | O | O | O | O | | Accept you for who you are as atrans person? | O | O | O | O | | Tell you that your religion/faithaccepts you as a trans person? | O | O | O | O | | Tell you that your being trans is asin or that your religion does notapprove of your being trans? | O | O | O | O | | Ask you to meet with spiritual/religious leaders to stop you frombeing trans? | O | O | O | O | | Ask you to seek medical/psy-chological help to stop you frombeing trans? | O | O | O | O | | Ask you to stop coming toservices or faith communityfunctions? | O | O | O | O | Section 6 These are questions about work for pay in the sex industryand sex work. As a reminder, your answers are confidentialand cannot be used against you. 6.1 Have you ever engaged in sex or sexual activity for money(sex work) or worked in the sex industry (such as erotic dancing,webcam work, or porn films)? No [Skip to 6.4] Yes 6.2 Now just thinking about the past year, have you engagedin sex or sexual activity for money (sex work) or worked in thesex industry (such as erotic dancing, webcam work, or pornfilms) in the past year? [Only respondents who selected “Yes” in6.1 received this question.] No Yes 6.3 What type of sex work or work in the sex industry haveyou ever done? (Mark all that apply). [Only respondents whoselected “Yes” in 6.1 received this question.] Street-based sex work Sex work advertised online Sex work advertised in magazines or newspapers Informal sex work through word of mouth, occasional hookups with dates in my networks, or things like that Escort/call girl/rent boy with an agency Pornography/picture or video Phone sex Webcam work Erotic dancer/stripper Fetish work (Domme, sub, switch) Not listed above (please specify) _________________ 6.4 Have you engaged in sex or sexual activity for any ofthe following? (Please mark all that apply in each row.)[Respondents could not select “No” in combination with anyother option.] | No | Yes, withinthe past year | Yes, but morethan a year ago | | - | - | - | | I engaged in sex or sexualactivity for food | O | O | O | | I engaged in sex or sexualactivity for a place to sleepin someone’s bed, at theirhome, or in their hotel room | O | O | O | | I engaged in sex or sexualactivity for drugs | O | O | O | | For something not listedabove (please specify)_______________[Response recorded as “No”if text left blank.] | O | O | O | 6.5 Did you ever interact with the police while doing sexwork or when police thought you were doing sex work?[Respondents could select multiple answer choices, but couldnot select “No” in combination with any other option.] No [Skip to 6.11] Yes, while I was doing sex work. Yes, when police thought I was doing sex work. 6.6 When you interacted with police while doing sex workor when police thought you were doing sex work, did youexperience any of the following? (Please provide an answer ineach row.) | No | Yes | | - | - | | Officers kept calling me by the wronggender pronouns (such as he/him or she/her) or the wrong title (such as Mr. or Ms.). | O | O | | Officers asked me questions about mygender transition (such as hormones andsurgical status). | O | O | | Officers verbally harassed me. | O | O | | Officers physically attacked me. | O | O | | Officers forced me to have sex or sexualactivity to avoid arrest. | O | O | | I experienced unwanted sexual contactfrom an officer (such as fondling, sexualassault, or rape). | O | O | | I was arrested for drugs in my possessionwhen police stopped me for doing sexwork. | O | O | 6.7 Have you ever been arrested for doing sex work or whenpolice thought you were doing sex work? [Only respondentswho selected “Yes, while I was doing sex work” and/or “Yes,when police thought I was doing sex work” in 6.5 received this ### Page 266 question. Respondents could select multiple answer choicesbut could not select “No” in combination with any other option.] No [Skip to 6.11] Yes, while I was doing sex work Yes, when the police thought I was doing sex work 6.8 How many times have you been arrested for doing sexwork or when police thought you were doing sex work? [Drop-down list of 1–10 and “11 or more”] 6.9 When police arrested you, did they consider things inyour possession such as condoms or sex toys as “evidenceof prostitution”? [Respondents could select multiple answerchoices.] No Yes, condoms Yes, sex toys Yes, items not listed above (please specify)_______________ I don’t know 6.10 Did any of these things happen when you were arrested?(Mark all that apply.) The charges were dropped. I pled guilty. I went to trial and was found not guilty. I went to trial and was found guilty. Something not listed above (please specify) __________ 6.11 Have you ever been paid for selling drugs or other workthat is currently considered illegal? (Mark all that apply.)[Respondents could not select “No” in combination with anyother option.] No [Skip to 7.1] Yes, selling drugs Yes, other work (please specify) ________________ 6.12 Now just thinking about the past year, were you paid forselling drugs or other work that is currently considered illegalin the past year? (Mark all that apply.) [Only respondentswho selected an answer choice other than “No” received thisquestion. Respondents could not select “No” in combinationwith any other option.] No Yes, selling drugs Yes, other work (please specify) __________________ Section 7 These questions are about your household, your income, andyour current job. As a reminder, your answers are confidential andcannot be used against you. These questions are based on nationalsurveys that we will use to compare with the U.S. population. 7.1 How many adults (age 18 or older) live in yourhousehold,7including yourself? (Do not include neighbors or others who do notlive with you in your house, apartment, or single housing unit.) Formore information, click on household above. 1 [Skip to 7.5] 2 3 4 5 6 7 8 9 or more 7.2 How are the other adults (age 18 or older) who live in yourhousehold related to you? (Mark all that apply). Spouse (legally married) Partner (not legally married) Child or children Grandchild or grandchildren Parent(s) (Mother/Father/Step-Parent(s)) Brother(s)/Sister(s)/Step-Brother(s)/Step-Sister(s) Other relative(s) (Aunt, Cousin, Nephew, Mother-in-law, etc.) Foster child or foster children Housemate(s)/Roommate(s) Roomer(s)/Boarder(s) Other non-relative(s) Not listed above (please specify) ________________ 7.3 How many adults in your household arerelated to you8 by birth(blood relatives), adoption, or legal marriage? Don’t include partnerswho aren’t legally married to you or adults who aren’t related to you.We will ask about them later. 0 [Skip to 7.5] 1 2 3 4 5 6 7 8 9 or more ### Page 267 7.4 Is any person aged 65 or oldernamed on the lease,mortgage, or deed9 for your household? No Yes 7.5 How many babies and other children under age 18 live inyour household? 0 [Skip to 7.7] 1 2 3 4 5 6 7 8 9 or more 7.6 How many of the children under age 18 who live in yourhousehold arerelated to you10 by birth (blood relatives) oradoption? Don’t include children who aren’t related to you bybirth or legal adoption. We will ask about them later. 0 1 2 3 4 5 6 7 8 9 or more 7.7 What is your current employment status? (Mark all thatapply.) Work for pay from sex work, selling drugs, or other workthat is currently considered illegal [Respondents who selected this answer choicereceived the following question.] Are you activelylooking for legal work outside sex work, selling drugs ,or other work that is currently considered illegal No Yes Work full-time for an employer [Respondents who selected this answer choicereceived the following question.] Do you have morethan one full-time job? No Yes Work part-time for an employer [Respondents who selected this answer choicereceived the following question.] Do you have morethan one part-time job? No Yes Self-employed in your own business, profession or trade,or operate a farm (not including sex work, selling drugs, orother work that is currently considered illegal) Unemployed but looking for work Unemployed and have stopped looking for work Not employed due to disability Student Retired Homemaker or full-time parent Not listed above (please specify) ________________ 7.8 On any of your full-time or part-time jobs, are you a memberof a labor union or of an employee association similar to aunion? [Only respondents who selected “Work full-time foran employer” and/or “Work part-time for an employer” in 7.7received this question. Respondents could select multipleanswer choices but could not select “No” in combination withany other option.] No Yes in a part-time job [Skip to 7.10] Yes in a full-time job [Skip to 7.10] 7.9 On any of your full-time or part-time jobs, are youcovered by a union or employee association contract? [Onlyrespondents who selected “Work full-time for an employer”and/or “Work part-time for an employer” in 7.7 AND selected“No” in 7.8 received this question. Respondents couldselect multiple answer choices but could not select “No” incombination with any other option.] No Yes in a part-time job Yes in a full-time job 7.10 Do you currently receive assistance from FOOD STAMPS(SNAP)11 orWIC12? (Mark all that apply.) [Respondents could notselect “No” in combination with any other option.] No Yes, assistance from food stamps (SNAP)13 Yes, assistance from WIC14,15 7.11 What are your current sources of income? (Mark all thatapply.) Pay from sex work, selling drugs, or other work that iscurrently considered illegal Pay from your full-time or part-time job Pay from your partner’s/spouse’s full-time or part-time job ### Page 268 Self-employment income from your own business,profession or trade, or farm (not including undergroundeconomy) Income from dividends, estates or trusts, royalties, orrental income Interest income (on savings or bonds) Cash assistance from welfare (such as TANF) or otherpublic cash assistance program (DO NOT include foodstamps (SNAP) or WIC) Unemployment benefits Child support or alimony Social security retirement or railroad retirement income Private pension or government employee pension Other retirement income Social security disability benefits (SSDI) Supplemental security income (SSI) Workers’ comp or other disability Veteran’s disability benefits and other Veteran’s benefits Regular contributions from people who don’t live in thehousehold Income not listed above,(please specify) ___________________________ 7.12 What was your total combinedIndividual Income16 (beforetaxes) in 2014? This includes all income sources except foodstamps (SNAP) or WIC. No income 1 to 5,000 5,000 to 7,499 7,500 to 9,999 10,000 to 12,499 12,500 to 14,999 15,000 to 17,499 17,500 to 19,999 20,000 to 24,999 25,000 to 29,999 30,000 to 34,999 35,000 to 39,999 40,000 to 49,999 50,000 to 59,999 60,000 to 74,999 75,000 to 99,999 100,000 to 149,999 150,000 or more 7.13 What was your total combinedFamily Income17 (beforetaxes) in 2014? This includes all income from all familymembers who are related to you by legal marriage, birth,or adoption and who have lived with you during the last 12months. Don’t include food stamps (SNAP) or WIC. [Onlyrespondents who selected an answer choice other than “0”in 7.3 (related adults in household) and/or selected an answerchoice other than “0” in 7.6 (related children in household)received this question.] No income 1 to 5,000 5,000 to 7,499 7,500 to 9,999 10,000 to 12,499 12,500 to 14,999 15,000 to 17,499 17,500 to 19,999 20,000 to 24,999 25,000 to 29,999 30,000 to 34,999 35,000 to 39,999 40,000 to 49,999 50,000 to 59,999 60,000 to 74,999 75,000 to 99,999 100,000 to 149,999 150,000 or more 7.14 How much was your total combined HOUSEHOLDINCOME18 (before taxes) in 2014? This includes income fromall members of your household from all sources except foodstamps (SNAP) or WIC. [Only respondents with non-relatedadults and/or non-related children in their household receivedthis question. Respondents received this question if theyindicated that they had non-related adults in their household(they selected “2” or more in 7.1 and selected a higher numberin response to 7.3 than in response to 7.1) and/or they indicatedthat they had non-related children in the household (theyselected “1” or more in 7.5 and selected a higher number inresponse to 7.6 than in response to 7.5).] No income 1 to 5,000 5,000 to 7,499 7,500 to 9,999 10,000 to 12,499 12,500 to 14,999 15,000 to 17,499 17,500 to 19,999 20,000 to 24,999 25,000 to 29,999 30,000 to 34,999 35,000 to 39,999 40,000 to 49,999 50,000 to 59,999 ### Page 269 60,000 to 74,999 75,000 to 99,999 100,000 to 149,999 150,000 or more Section 8 [Only respondents who selected an answer choice other than“never served in the military” in 2.17 received question in thissection.] You said earlier that you currently serve or have served onactive duty in U.S. Armed Forces, Reserves, or NationalGuard. These are questions about your military service. As areminder, your answers are confidential and cannot be usedagainst you. 8.1 What is your current or most recent branch of service? Air Force Air Force Reserve Air National Guard Army Army Reserve Army National Guard Coast Guard Coast Guard Reserve Marine Corps Marine Corps Reserve Navy Navy Reserve 8.2 Are you still serving in the military? [Only respondentswho selected “on active duty in the past, but not now” in 2.17received this question.] No Yes [Skip to 8.4] 8.3 Did you separate from military service within the last 10years? [Only respondents who selected “on active duty in thepast, but not now” in 2.17 received this question.] Yes No [Skip to 8.12] 8.4 While serving in the military, have you ever received mentalhealth treatment related to a gender transition from a militaryprovider (do not include VA)? [Only respondents who selected“Yes” in 8.2 or selected “Yes” in 8.3 received this question.] No Yes 8.5 While serving in the military, have you ever received medicaltreatment related to a gender transition from a military provider(do not include VA)? [Only respondents who selected “Yes” in 8.2or selected “Yes” in 8.3 received this question.] No Yes 8.6 Has any military medical or mental health provider reportedto your commanding officer that you are trans or recommendedyou for discharge? (Mark all that apply.) [Only respondents whoselected “Yes” in 8.2 received this question. Respondents couldnot select “No” in combination with any other option.] No Yes, reported that I was trans Yes, recommended me for discharge Does not apply to me, none of these providers knew that Iwas trans 8.7 If trans people were allowed to serve openly, which of thesewould apply to you? [Only respondents who selected “Yes” in 8.2received this question.] I would start to transition while still serving I would finish the transition that I have already started whilestill serving I would not finish the transition that I have already startedwhile still serving I would leave military service so that I could transition, andnot return. I would leave military service so that I could transition, thenreturn to service after transition I do not want to transition I have already transitioned None of the options listed above 8.8 If trans people were allowed to serve openly, I would return toservice: [Only respondents who selected “Yes” in 8.3 received thisquestion.] Yes No Maybe 8.9 How many people in the military (who aren’t trans) believe youare trans? [Only respondents would selected “Yes” in 8.2 receivedthis question.] None [Skip to 9.1] A few Some Most All ### Page 270 8.10 Does your leadership or commanding officer (or both) thinkor know you are trans? [Only respondents who selected “Yes”in 8.2 and an answer choice other than “None” in 8.9 receivedthis question.] No [Skip to 9.1] Yes 8.11 How has your leadership or commanding officer (orboth) reacted to you being trans? (Mark all that apply.) [Onlyrespondents who selected “Yes” in 8.10 received this question.] Supported my name change Supported my medical treatment Ignored it or looked the other way Took actions to discharge me Not listed above (please specify) ______________ [Only respondents who selected “No” in 8.2 and “No” in8.3 received questions 8.12–8.21] 8.12 What was your character of discharge? Entry Level Separation Honorable General Medical Other-than-honorable Bad Conduct Dishonorable None of the options listed above(please specify) ______________ 8.13 Do you believe your discharge was related to being trans? No Yes, partially Yes, completely 8.14 Did you leave the service in order to transition? No Yes 8.15 Did you leave the service to avoid mistreatment/harassment? No Yes 8.16 Did any military medical or mental health provider tellyour commander that you are trans or recommend you fordischarge? (Mark all that apply.) [Respondents could not select“No” in combination with any other option.] No Yes, reported that I was trans. Yes, recommended me for discharge. Does not apply to me, none of these providers knew thatI was trans. 8.17 Did you ever get any type of health care through the VA? No [Skip to 8.21] Yes 8.18 Did you ever get health care related to a gender transitionthrough the VA? No Yes 8.19 Do you currently get any type of health care through theVA? No Yes 8.20 As a trans person, have you received respectful care atthe VA? Never Sometimes Mostly Always Does not apply to me, the VA staff do not know I’m trans 8.21 Have you changed your name on your DD214 militarydischarge papers? Yes, I received an updated DD214 with new name. Yes, I received a DD215 (amended) with new name. No, I was denied. No, I never tried. Section 9 [Only respondents who selected any answer choice other than“U.S. citizen, birth” in 2.18 received questions in this section.] You said earlier that you are not a U.S. citizen by birth. Theseare questions about immigration experiences you may havehad. As a reminder, your answers are confidential and cannotbe used against you. 9.1 Have you ever been held in immigration detention (suchas being held in an Immigration and Customs Enforcement(ICE) detention center or local jail just for immigration courtproceedings)? No [Skip to 9.6] Yes ### Page 271 9.2 While you were in immigration detention, do you believestaff, guards, or others thought or knew you were trans orlesbian, gay, or bisexual (LGB)? No Yes 9.3 When you were in immigration detention, separated fromothers who were also in detention? (Mark all that apply.)[Respondents could not choose “No” in combination with anyother option.] No [Skip to 9.5] Yes, in solitary confinement Yes, in a separate area for trans or LGB people (such as apod, unit, tank, or other housing area) [Skip to 9.5] Not listed above (please specify) _____________ [Skip to9.5] 9.4 In total, how long were you held in solitary confinement?[Only respondents who selected “Yes, in solitary confinement”received this question.] Up to 14 days (up to two weeks) 15 days to 30 days (three or four weeks) 31 days to 90 days (1-3 months) 91 days to 180 days (3-6 months) 181 days to one year (more than 6 months up to a year) More than 1 year 9.5 When you were in immigration detention, did any of thesethings happen to you? (Mark all that apply.) [Respondentscould not select “None of these things happened to me” incombination with any other option.] I was physically assaulted. [Respondents who selected this answer choicereceived the following question.] Were you physicallyassaulted by: Staff or detention officers Other detainees or inmates I was sexually assaulted. [Respondents who selected this answer choicereceived the following question.] Were you sexuallyassaulted by: Staff or detention officers Other detainees or inmates I was threatened with sexual assault [Respondents who selected this answer choicereceived the following question.] Were you threatenedwith sexual assault by: Staff or detention officers Other detainees or inmates I was denied access to hormones that I use. I was denied gender-appropriate clothing. None of these things happened to me. 9.6 Have you ever applied for asylum in the United States?[Respondents could select multiple answer choices but couldnot select “No” in combination with any other answer choice.] No [Skip to 9.8] Yes, because I am trans or LGB Yes, for another reason 9.7 Did you receive asylum in the United States? [Onlyrespondents who selected “Yes, because I am trans or LGB” or“Yes, for another reason” received this question.] Yes [Skip to 10.1] No [Skip to 9.9] No, but I received a “withholding of removal” status. [Skipto 10.1] 9.8 Why didn’t you apply for asylum? [Only respondents whoselected “No” in 9.6 received this question.] I didn’t know how to apply. I have access to other legal statuses. I didn’t want to apply. I was afraid to apply. I believed I was past the 1 year deadline. A reason not listed above(please specify) _______________ 9.9 Why didn’t you receive asylum? [Only respondents whoselected “No” in 9.7 received this question.] I was past the 1 year deadline. The immigration official decided that I didn’t face danger inmy country. A reason not listed above(please specify) _______________ Section 10 These are questions about legal name change and yourcurrent identification documents, such as your birthcertificate or driver’s license. 10.1 Did you ever try OR complete the process to get a legalname change to match your gender identity? No [Skip to 10.12] Yes 10.2 How did you try to change your name? With a court order During the immigration/naturalization process [Skip to10.13] By another method (Please tell us what method)__________________ [Skip to 10.13] ### Page 272 10.3 For your legal name change, did you interact with judgesor court staff? [Only respondents who selected “With a courtorder” in 10.2 received this question.] No [Skip to 10.7] Yes 10.4 Do you believe the judges or court staff you interactedwith thought or knew you were trans? [Only respondents whoselected “Yes” in 10.3 received this question.] No [Skip to 10.7] Yes 10.5 When you interacted with judges or court staff, were youtreated with respect? [Only respondents who selected “Yes” in10.4 received this question.] I was never treated with respect I was sometimes treated with respect I was always treated with respect 10.6 When you interacted with judges or court staff, did youexperience any of the following? (Please provide an answerin each row.) [Only respondents who selected “Yes” in 10.4received this question.] | No | Yes | | - | - | | I was verbally harassed. | O | O | | I received unequal treatment/service. | O | O | | They kept calling me by the wrong genderpronouns (such as he/him or she/her) or a wrongtitle (Mr. or Ms.). | O | O | | I was asked questions about my gender transition(such as hormones and surgical status). | O | O | 10.7 Did the court grant your name change? [Only respondentswho selected “With a court order” in 10.2 received thisquestion.] Yes, the court granted my name change. [Skip to 10.9] No, the court denied my name change. No, I ran out of money to complete the process. [Skip to10.9] No, I gave up. [Skip to 10.9] Not sure yet. I am still in the process of getting my courtordered name change.[Skip to 10.9] Not listed above (please specify) _______________ [Skipto 10.9] 10.8 Why did the court deny your name change? [Onlyrespondents who selected “No, the court denied my namechange” in 10.7 received this question.] [Text box] 10.9 How old were you when you went to court to get yourlegal name change? [Only respondents who selected “With acourt order” in 10.2 received this question.] [Drop-down list of ages] 10.10 Did you get legal help to change your name? [Onlyrespondents who selected “With a court order” in 10.2 receivedthis question.] No Yes, I got legal help from a paid attorney. Yes, I got help for free from a legal clinic or non-profitorganization. Yes, I got help from a friend. Yes, I got help from some other source. 10.11 How much did your legal name change cost? Pleaseinclude the cost of legal help, court fees, newspaperpublication, etc. [Only respondents who selected “Yes, the courtgranted my name change” in 10.7 received this question.] $0 $1 - $99 $100 - $249 $250 - $499 $500 - $749 $750 - $999 $1,000 - $2,000 More than $2,000 I do not remember the cost of my legal name change. 10.12 Why you have not tried to legally change your name?(Mark all that apply.) [Only those who selected “No” in 10.1received this question.] I feel like my name doesn’t conflict with my gender identityor expression. I am not ready. I cannot afford it. I don’t know how. I believe I am not allowed (for example, because of mycriminal record, immigration status, or residency). I am worried that changing my name would out me. A reason not listed above (please specify) ___________ 10.13 Thinking about how your NAME is listed on all of your IDsand records that list your name, such as your birth certificate,driver’s license, passport, etc. Which of the statements below ismost true? [All respondents received this question.] All of my IDs and records list the name I prefer. Some of my IDs and records list the name I prefer. None of my IDs and records list the name I prefer. [Skip to10.15] 10.14 Which of these IDs/records have you changed to list yourpreferred NAME? (Please provide an answer in each row.)[Only respondents who selected “All of my IDs and recordslist the name I prefer” or “Some of my IDs and records list thename I prefer” in 10.13 received this question.] ### Page 273 | Ido nothavethis ID/record | Ichangedmy NAMEon thisID/record | I wasdenieda NAMEchangeon thisID/record | I amin theprocessof chang-ingmy NAMEon thisID/record | IhavenottriedtochangemyNAME onthis ID/recordbut Iwant to | Ido notwanttochangemyNAMEon thisID/record | | - | - | - | - | - | - | | Birthcertificate | O | O | O | O | O | O | | Driver’slicenseand/or stateissuednon-driverID | O | O | O | O | O | O | | SocialSecurityrecords | O | O | O | O | O | O | | Passport | O | O | O | O | O | O | | Studentrecords(current orlast schoolattended) | O | O | O | O | O | O | | Work ID | O | O | O | O | O | O | 10.15 Thinking about how your GENDER is listed on all ofyour IDs and records that list your gender, such as yourbirth certificate, driver’s license, passport, etc. Which of thestatements below is most true? [All respondents received thisquestion.] All of my IDs and records list the gender I prefer. Some of my IDs and records list the gender I prefer. None of my IDs and records list the gender I prefer. [Skipto 10.17] 10.16 Which of these IDs/records have you changed to list yourpreferred GENDER? (Please provide an answer in each row.)[Only respondents who selected “All of my IDs and records listthe gender I prefer” or “Some of my IDs and records list thegender I prefer” in 10.15 received this question.] | IdonothavethisID/record | IchangedmyGENDERon this ID/record | I wasdeniedaGENDERchangeon thisID/re-cord | I aminthe pro-cessofchang-ing myGENDERon thisID/re-cord | Ihave nottriedtochangemyGENDERon this ID/record butI want to | Ido notwanttochangemyGENDERon this ID/record | | - | - | - | - | - | - | | Birthcertificate | O | O | O | O | O | O | | Driver’slicenseand/orstate issuednon-driv-er ID | O | O | O | O | O | O | | SocialSecurityrecords | O | O | O | O | O | O | | Passport | O | O | O | O | O | O | | Studentrecords(current orlast schoolattended) | O | O | O | O | O | O | 10.17 You said that none of your IDs or records list the genderyou prefer. Why haven’t you changed your gender on yourIDs or records? (Mark all that apply.) [Only respondents whoselected “None of my IDs and records list the gender I prefer”in 10.15 received this question.] The gender options that are available (male or female) donot fit my gender identity. I have not tried yet. My request was denied. I am not ready. I cannot afford it. I do not know how. I believe I am not allowed. (For example, I have not had themedical treatment needed to change my gender on ID. OrI can’t get a doctor’s letter or other letter that is needed toupdate the gender.) I am worried that if I change my gender, I might not beable to get some benefits or services. These might includemedical, insurance, employment, etc. I am worried that changing my gender would out me. A reason not listed above (pleasespecify)______________________________ 10.18 When I have shown IDs with my name or gender thatdo not match the gender I present as… (Mark all that apply).[All respondents received this question. Respondents couldnot select “I have had none of the above problems” or “Thisdoes not apply to me. I have only shown IDs that match” incombination with any other option.] I have been verbally harassed. I have been assaulted/attacked. I have been asked to leave. I have been denied services or benefits. I have had none of the above problems. This does not apply to me. I have only shown IDs thatmatch. Section 11 These are questions about your current health insurancecoverage, your health care providers, and the healthinsurance marketplace (such as healthcare.gov). 11.1 Are you currently covered by any health insurance or healthcoverage plan? No [Skip to 11.4] Yes 11.2 What type of health insurance or health coverage plan doyou have? (Mark all that apply.) Insurance through my current or former employer or union Insurance through someone else’s current or formeremployer or union Insurance I or someone else purchased through ### Page 274 HealthCare.Gov or a Health Insurance Marketplace(sometimes called “Obamacare”) Insurance I or someone else purchased directly from aninsurance company Medicare (for people 65 and older, or people with certaindisabilities) Medicaid (government-assistance plan for those with lowincomes or a disability) TRICARE or other military health care VA (including those who have ever used or enrolled for VAhealth care) Indian Health Service Any other type of health insurance or health coverage plan(please specify) _______ 11.3 In the past year, did any of these things happen with yourhealth insurance company? (Please provide an answer in eachrow. If you didn’t try to get the kind of care listed or if you nevertried to change your records, choose “I have not asked forthis.”) | In the past year… | Yes | No | I have notasked forthis | | - | - | - | - | | My health insurance companywouldn’t change my records tolist my current name or gender. | O | O | O | | My health insurance companydenied me hormone therapyfor transition. | O | O | O | | My health insurance com-pany denied me surgery fortransition. | O | O | O | | My health insurance companycovers only some of thesurgical care I need for mytransition. | O | O | O | | My health insurance companycovers surgery for transition,but has no surgery providers intheir network. | O | O | O | | My health insurance companydenied me gender-specifichealth care (such as Papsmears, prostate exams,mammogram, etc.) because Iam trans. | O | O | O | | My health insurance companydenied me other routine healthcare because I am trans. | O | O | O | 11.4 Thinking about the doctor or provider you go to for yourtrans-related health care (such as hormone treatment), howmuch do they know about providing health care for transpeople? I don’t have a trans-related doctor or health care providerright now [Skip to 11.7] They know almost everything about trans healthcare They know most things about trans healthcare They know some things about trans healthcare They know almost nothing about trans healthcare I am not sure 11.5 How far do you travel to see your trans-related health careprovider? Less than 10 miles 10-25 miles 25-50 miles 50-75 miles 75-100 miles Over 100 miles 11.6 Do you also go to your trans-related health care providerfor your routine health care, like physicals, flu, diabetes, etc.? Yes, I see my trans health care provider for my routinehealth care [Skip to 11.9] No, I see a different doctor or health care provider for myroutine healthcare No, I do not get any routine health care [Skip to 11.9] 11.7 How much does your routine health care provider (whoyou see for physicals, flu, diabetes, etc.) know about healthcare for trans people? [Only respondents who selected “No, Isee a different doctor or health care provider for my routinehealthcare” received this question.] I don’t have a routine health care provider [Skip to 11.9] They know almost everything about trans health care They know most things They know some things They know almost nothing I am not sure 11.8 How far do you travel to see your routine health careprovider? [Only respondents who selected “No, I see a differentdoctor or health care provider for my routine healthcare”received this question.] Less than 10 miles 10-25 miles 25-50 miles 50-75 miles 75-100 miles Over 100 miles 11.9 In the past year, did you look for health insurance froma state or federal health insurance marketplace? (Healthinsurance marketplaces are part of the new health care law,sometimes called “Obamacare” or the “Affordable Care Act,”where people can get insurance online, such as throughhealthcare.gov, over the phone, or in person.) No [Skip to 12.1] Yes 11.10 Did you buy insurance or enroll in a state Medicaidprogram through a health insurance marketplace? [Onlyrespondents who selected “Yes” in 11.9 received this question.] No [Skip to 12.1] Yes ### Page 275 11.11 What type of insurance coverage did you buy? [Onlyrespondents who selected “Yes” in 11.10 received this question.] Coverage through a state Medicaid program Coverage through a private plan with a subsidy, so I pay alower price because of my income Coverage through a private plan without a subsidy Not listed above (please specify) _______________ Section 12 These are questions about your health, experiences withdoctors or health care providers, and health care. 12.1 Would you say that in general your health is… Excellent Very good Good Fair Poor 12.2 The following questions ask about how you have beenfeeling during the past 30 days. For each row, please selectthe column that best describes how often you had this feeling.(Please provide an answer in each row.) | During the past 30 days,how often did you feel… | All ofthetime | Mostof thetime | Someof thetime | A littleof thetime | Noneof thetime | | - | - | - | - | - | - | | …so sad that nothing couldcheer you up? | O | O | O | O | O | | …nervous? | O | O | O | O | O | | …restless or fidgety? | O | O | O | O | O | | …hopeless? | O | O | O | O | O | | …that everything was aneffort? | O | O | O | O | O | | …worthless? | O | O | O | O | O | 12.3 We just asked about a number of feelings you had duringthe past 30 days. Altogether, how MUCH did these feelingsinterfere with your life or activities? [Only respondents whoselected an answer choice other than “None of the time” in12.2 received this question.] A lot Some A little Not at all 12.4 Was there a time in the past 12 months when you neededto see a doctor but could not because of cost? No Yes 12.5 Was there a time in the past 12 months when you neededto see a doctor but did not because you thought you would bedisrespected or mistreated as a trans person? No Yes 12.6 In the past year, have you seen a doctor or health careprovider? No [Skip to 12.8] Yes 12.7 In the past year, did you have any of these things happen toyou, as a trans person, when you went to see a doctor or healthcare provider? (Please provide an answer in each row.) [Onlyrespondents who selected “Yes” in 12.6 received this question.] | In the past year… | No | Yes | | - | - | - | | My doctor knew I was trans and treated me with respect. | O | O | | I had to teach my doctor or other health care provider abouttrans people so that I could get appropriate care. | O | O | | A doctor or other health care provider refused to give metrans-related care. | O | O | | A doctor or other health care provider refused to give me otherhealth care (such as for like physicals, flu, diabetes). | O | O | | My doctor asked me unnecessary/invasive questions about mytrans status that were not related to the reason for my visit. | | A doctor or other health care provider used harsh or abusivelanguage when treating me. | O | O | | A doctor or other health care provider was physically rough orabusive when treating me. | O | O | | I was verbally harassed in a health care setting (such as ahospital, office, clinic). | O | O | | I was physically attacked by someone during my visit in a healthcare setting (such as a hospital, office, clinic). | O | O | | I experienced unwanted sexual contact (such as fondling, sexualassault, or rape) in a health care setting (such as a hospital,office, clinic). | O | O | 12.8 Have you ever wanted any of the health care listed below foryour gender identity or gender transition? (Mark all that apply.)[Respondents could not select “None of the above” in combinationwith any other option.] Counseling/Therapy Hormone Treatment/HRT Puberty Blocking Hormones (usually used by youth ages 9-16) None of the above 12.9 Have you ever had any of the health care listed below foryour gender identity or gender transition? (Mark all that apply.)[Respondents could not select “None of the above” in combinationwith any other option.] Counseling/Therapy Hormone Treatment/HRT Puberty Blocking Hormones (usually used by youth ages 9-16) None of the above ### Page 276 12.10 At what age did you begin hormone treatment/HRTtreatment? [Only respondents who selected “HormoneTherapy/HRT” in 12.9 received this question.] [Drop-down list of ages] 12.11 At what age did you begin taking Puberty BlockingHormones? [Only respondents who selected “Puberty BlockingHormones” in 12.9 received this question.] [Drop-down list of ages] 12.12 Are you currently taking hormones for your genderidentity or gender transition? No [Skip to 12.15] Yes 12.13 Where do you currently get your hormones? [Onlyrespondents who selected “Yes” in 12.12 and did not select“Now on active duty” in 2.17 received this question.] I only go to licensed professionals (like a doctor) forhormones In addition to licensed professionals, I also get hormonesfrom friends, online, or other non-licensed sources I ONLY get hormones from friends, online, or other non-licensed sources 12.14 Where do you currently get your hormones? (Mark allthat apply.) [Only respondents who selected “Yes” in 12.12 andselected “Now on active duty” in 2.17 received this question.] On-post medical doctor Off-post medical doctor On-post pharmacy Off-post pharmacy Through friends, online, or other non-licensed sources (notthrough a doctor or medical provider) Another source not listed above(please specify) __________ 12.15 Have you had or do you want any of the health care listedbelow for gender transition? (Please give an answer in eachrow.) [Only respondents who selected “Female” in 2.1 receivedthis question.] | Havehad it | Want itsomeday | Notsure ifI wantthis | Do notwantthis | | - | - | - | - | | Top/chest surgery reduction orreconstruction | O | O | O | O | | Hysterectomy/“hysto” (removalof the uterus, ovaries, fallopiantubes, and/or cervix) | O | O | O | O | | Clitoral release/metoidioplasty/centurion procedure | O | O | O | O | | Phalloplasty (creation of a penis) | O | O | O | O | | Other procedure not listed:_________________ | O | O | O | O | 12.16 You said that you had at least one procedure foryour gender transition. At what age did you have your firstprocedure (other than hormones)? [Only respondents whoselected “Have had it” at least once in 12.15 received thisquestion.] [Drop-down list of ages] 12.17 Have you had a Pap smear or Pap test in the past year?[Only respondents who selected “Female” in 2.1 received thisquestion.] No Yes 12.18 Have you had or do you want any of the health carelisted below for gender transition? (Please provide an answerin each row.) [Only respondents who selected “Male” in 2.1received this question.] | Havehad it | Want itsome day | Not sureif I wantthis | Do notwantthis | | - | - | - | - | | Hair removal/electrolysis | O | O | O | O | | Breast augmentation / top surgery | O | O | O | O | | Silicone injections | O | O | O | O | | Orchidectomy / “orchy” / removal oftestes | O | O | O | O | | Vaginoplasty/labiaplasty/SRS/GRS/GCS | O | O | O | O | | Trachea shave (Adam’s apple or thyroidcartilage reduction) | O | O | O | O | | Facial feminization surgery (such asnose, brow, chin, cheek) | O | O | O | O | | Voice therapy (non-surgical) | O | O | O | O | | Voice surgery | O | O | O | O | | Other procedure not listed:__________________ | O | O | O | O | 12.19 You said that you had at least one procedure foryour gender transition. At what age did you have your firstprocedure (other than hormones)? [Only respondents whoselected “Have had it” at least once for a procedure other than“voice therapy (non-surgical)” in 12.15 received this question.] [Drop-down list of ages] 12.20 Have you ever de-transitioned? In other words, have youever gone back to living as your sex assigned at birth, at leastfor a while? I have never transitioned. [Skip to 13.1] No [Skip to 13.1] Yes 12.21 Why did you de-transition? In other words, why did yougo back to living as your sex assigned at birth? (Mark all thatapply.) Pressure from spouse or partner Pressure from a parent ### Page 277 Pressure from other family members Pressure from friends Pressure from my employer Pressure from a religious counselor Pressure from a mental health professional I had trouble getting a job. I realized that gender transition was not for me. I faced too much harassment/discrimination. It was just too hard for me. Not listed above (please specify)___________________ Section 13 These are questions about experiences you may have hadwith some professionals, such as psychologists, counselors,religious advisors. 13.1 Did you ever discuss your gender identity or trans identitywith a professional (such as a psychologist, counselor, religiousadvisor)? No [Skip to 13.5] Yes 13.2 Did any professional (such as a psychologist, counselor,religious advisor) try to make you identify only with your sexassigned at birth (in other words, try to stop you being trans)? No [Skip to 13.5] Yes 13.3 How old were you the first time a professional tried tomake you identify only with your sex assigned at birth (in otherwords, try to stop you being trans)? [Only respondents whoselected “Yes” in 13.2 received this question.] [Drop-down list of ages] 13.4 Was this person a religious or spiritual counselor/advisor?[Only respondents who selected “Yes” in 13.2 received thisquestion.] No Yes 13.5 Did you ever discuss your sexual orientation with anyprofessional (such as a psychologist, counselor, religiousadvisor)? No [Skip to 14.1] Yes 13.6 Did any professional (such as a psychologist, counselor,religious advisor) ever try to change your sexual orientationor who you are attracted to (such as try to make you straight/heterosexual)? [Only respondents who selected “Yes” in 13.5received this question.] No Yes Section 14 These are questions about HIV testing and care. 14.1 This question is about the test for HIV, the virus that causesAIDS. Except for tests you may have had as part of blooddonations, have you ever been tested for HIV? No [Skip to 14.3] Yes 14.2 What was the result of your most recent HIV test? [Onlythose who selected “Yes” in 14.1 received this question.] HIV positive or reactive, meaning I have HIV. [Skip to 14.4] HIV negative, meaning I do not have HIV. [Skip to 14.4] HIV test results were unclear, meaning the test could notdetermine if I have HIV. [Skip to 14.4] I don’t know. I never received the results. [Skip to 14.4] 14.3 Here is a list of reasons why some people have not beentested for HIV (the virus that causes AIDS). Which one of thesewould you say is the MAIN reason why you have not beentested? [Only respondents who selected “No” in 14.1 receivedthis question.] It’s unlikely I’ve been exposed to HIV. I was afraid to find out if I was HIV positive (that you hadHIV). I didn’t want to think about HIV or about being HIVpositive. I was worried my name would be sent to the government ifI tested positive. I didn’t know where to get tested. I don’t like needles. I was afraid of losing my job, insurance, home, friends, orfamily if people knew I was tested for AIDS infection. My doctor/health care provider never mentioned gettingan HIV test. Some other reason No particular reason 14.4_1 Where were you last tested? [Only respondents whoselected “Yes” in 14.1 received this question.] Private doctor or HMO office Counseling and testing site Emergency room Hospital inpatient ### Page 278 Clinic Jail or prison (or other correctional facility) Drug treatment facility At home Somewhere else A place not listed above(please specify) _______________________ 14.4_2 Not including blood donations, in what month and yearwas your last HIV test? [Only respondents who selected “Yes”in 14.1 received this question.] Month [Drop-down list of all months] Year [Drop-down list with years 2015–1984 and “before1984” as a final option] [Only respondents who selected “HIV positive or reactive,meaning I have HIV” in 14.2 received questions 14.5–14.13.] 14.5 In the past 12 MONTHS, have you seen a doctor or healthcare provider for HIV care? Don’t include care you receivedduring emergency room visits or while staying in the hospital. No Yes [Skip to 14.7] 14.6 What is the main reason you haven’t seen a doctor orhealth care provider for HIV care in the past 12 months? [Onlyrespondents who selected “No” in 14.5 received this question.] I couldn’t afford it. I have no health insurance. I only recently found out I have HIV. I have needed other types of medical or mental healthcare. I didn’t know where to go for HIV care. I wasn’t ready to look for health care for HIV. I didn’t feel sick enough to look for health care. My family or partner would find out I have HIV. I believed that I would be mistreated because I am trans. I rely on a higher power/God to help my HIV. A reason not listed above(please specify) _______________________ 14.7 In the past 6 MONTHS, have you seen a doctor or healthcare provider for HIV care? Don’t include care you receivedduring emergency room visits or while staying in the hospital.[Only respondents who selected “Yes” in 14.5 received thisquestion.] No Yes [Skip to 14.9] 14.8 What is the main reason that you haven’t seen a doctor orhealth care provider for HIV care in the past 6 months? [Onlyrespondents who selected “No” in 14.7 received this question.] I couldn’t afford it. I have no health insurance. I have needed other types of medical or mental healthcare. I didn’t know where to go for HIV care. I wasn’t ready to look for health care for HIV. I didn’t feel sick enough to look for health care. My family or partner would find out I have HIV. I believed that I would be mistreated because I am trans. I rely on a higher power/God to help my HIV. A reason not listed above(please specify) _______________________ 14.9 When was your last blood test to determine your viral loadand CD4 counts? Within the past 6 months Within the past year More than a year ago I have never had a blood test for my viral load and CD4count. 14.10 Have you ever been prescribed anti-retroviral therapy,which are the pills that reduce the amount of HIV in your body(often called ART)? No Yes 14.11 Are you currently taking anti-retroviral therapy (ART)? No [Skip to 14.13] Yes 14.12 Do you take your anti-retroviral therapy (ART) like you’resupposed to (regularly and as prescribed)? Never Rarely Most of the time All of the time [Skip to 15.1] 14.13 What is the main reason that are you not taking or notregularly taking anti-retroviral therapy (ART) all of the time?[Only respondents who selected “No” in 14.11 or “Never,”“Rarely,” or “Most of the time” in 14.12 received this question.] I can’t afford it. I have no health insurance. I only recently found out I have HIV. My doctor or health care provider said I didn’t need it. I am afraid it would conflict with my hormones. I am afraid it would conflict with my other medications. I would gain weight. ### Page 279 I don’t know where to get it. I don’t want to take anti-retroviral therapy (ART). I don’t feel sick enough to take anti-retroviral therapy(ART). My family, partner, or friends would find out I have HIV. I rely on a higher power/God to help my HIV. A reason not listed above(please specify) _______________________ Section 15 These are questions about your use of alcohol, tobacco,marijuana, or other drugs. 15.1 Have you everhad a drink19 of any type of alcoholic beverage,smoked part or all of a cigarette, or used any of the other followingsubstances? (Please provide an answer in each row.) | No | Yes | | - | - | | Alcohol20(such as beer, wine, or hard liquor) | O | O | | Cigarettes21(tobacco only) | O | O | | E-Cigarettes or vaping products22 | O | O | | Marijuana or hashish23(such as weed, joints,hash, hash oil) | O | O | | Illegal or illicit drugs24(such as cocaine, crack,heroin, LSD, meth, inhalants like poppers orwhippits) | O | O | | Prescription drugs25(such as Oxycontin, Xanax,Adderall, Ambien)thatweren’t prescribed toyou, or that you didn’t take as prescribed. | O | O | [Only respondents who selected “Yes” under “Alcohol (such asbeer, wine, or hard liquor)” in 15.1 received questions 15.2–15.4] 15.2 How long has it been since you lastdrank an alcoholicbeverage26? Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago 15.3 During the past 30 days, on how many days did youdrink one or more drinks27 of an alcoholic beverage? [Onlyrespondents who selected “Within the past 30 days” in 15.2received this question.] [Drop-down list of numbers 1–30] 15.4 During the past 30 days, on how many days did you have5 or moredrinks28 on the same occasion? By ‘occasion,’ wemean at the same time or within a couple of hours of eachother. [Only respondents who selected “Within the past 30days” in 15.2 received this question.] [Drop-down list of numbers 1–30] [Only respondents who selected “Yes” under “Cigarettes(tobacco only)” in 15.1 received questions 15.5–15.7] 15.5 How long has it been since you last smoked part or all ofa cigarette? Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago 15.6 During the past 30 days, on how many days did yousmoke part or all of a cigarette? [Only respondents whoselected “Within the past 30 days” in 15.5 received thisquestion.] [Drop-down list of numbers 1–30] 15.7 On the days you smoked cigarettes during the past 30days, how many cigarettes did you smoke per day, on average?[Only respondents who selected “Within the past 30 days” in15.5 received this question.] Less than one cigarette per day 1 cigarette per day 2 to 5 cigarettes per day 6 to 15 cigarettes per day (about ½ pack) 16 to 25 cigarettes per day (about 1 pack) 26 to 35 cigarettes per day (about 1 ½ packs) More than 35 cigarettes per day (about 2 packs or more) 15.8 How long has it been since you last used E-Cigarettes orvaping products? [Only respondents who selected “Yes” under“E-cigarettes or vaping products” in 15.1 received this question.] Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago 15.9 How long has it been since you last used marijuanaor hashish? [Only respondents who selected “Yes” under“Marijuana or hashish (such as weed, joints, hash, hash oil)” in15.1 received this question.] Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago 15.10 During the past 30 days, on how many days did you usemarijuana or hashish? [Only respondents who selected “Withinthe past 30 days” in 15.9 received this question.] [Drop-down list of numbers 1–30] 15.11 How long has it been since you last used any illegal/illicitdrug (such as cocaine, crack, heroin, LSD, meth, inhalants likepoppers or whippits)? [Only respondents who selected “Yes”under “Illegal or illicit drugs (such as cocaine, crack, heroin,LSD, meth, inhalants like poppers or whippits)” in 15.1 receivedthis question.] Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago ### Page 280 15.12 How long has it been since you last used any prescriptiondrugs not as prescribed or not prescribed to you? [Onlyrespondents who selected “Yes” under “Prescription drugs(such as Oxycontin, Xanax, Adderall, Ambien) that weren’tprescribed to you, or that you didn’t take as prescribed” in 15.1received this question.] Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago Section 16 These are questions about suicidal thoughts and behaviors.Talking about suicidal thoughts or behaviors sometimesbrings up difficult emotions. If you experience any difficultemotions because of these questions we encourage youto get help from someone you trust or call one of theanonymous helplines listed at the end of the section. 16.1 The next few questions are about thoughts of suicide. Atany time in the past 12 months did you seriously think abouttrying to kill yourself? No [Skip to 16.6] Yes 16.2 During the past 12 months, did you make any plans to killyourself? [Only respondents who selected “Yes” in 16.1 receivedthis question.] No Yes 16.3 During the past 12 months, did you try to kill yourself?[Only respondents who selected “Yes” in 16.1 received thisquestion.] No [Skip to 16.8] Yes 16.4 During the past 12 months, did you get medical attentionfrom a doctor or other health professional as a result of anattempt to kill yourself? [Only respondents who selected “Yes”in 16.3 received this question.] No [Skip to 16.9] Yes 16.5 Did you stay in a hospital overnight or longer because youtried to kill yourself? [Only respondents who selected “Yes” in16.4 received this question.] No [Skip to 16.9] Yes [Skip to 16.9] 16.6 At any time in your life, have you seriously thought abouttrying to kill yourself? [Only respondents who selected “No” in16.1 received this question.] No [Skip to 17.1] Yes 16.7 At any time in your life, did you make any plans to killyourself? [Only respondents who selected “Yes” in 16.6received this question.] No Yes 16.8 At any time in your life, did you try to kill yourself? [Onlyrespondents who said “Yes” in 16.6 received this question.] No [Skip to 17.1] Yes 16.9 How many times have you tried to kill yourself in yourlifetime? [Only respondents who selected “Yes” in 16.3 “or “Yes”to 16.8 received this question.] [Drop-down list of numbers 1–25 and “more than 25” aslast option] 16.10 How old were you when you tried to kill yourself? [Onlyrespondents who selected “1” in 16.9 received this question.] [Drop-down list of ages] 16.11 How old were you the first time you tried to kill yourself?[Only respondents who selected a value other than “1” in 16.9received this question.] [Drop-down list of ages] 16.12 How old were you the last time you tried to kill yourself? [Drop-down list of ages] If you are experiencing any difficult emotions after answeringthese questions and would like to talk to someone, pleasecontact one of the anonymous resources below: National Suicide Prevention Helpline1-800-273-8255http://www.suicidepreventionlifeline.org/ Veterans Crisis Line (for veterans, military personnel, and theirfamilies)1-800-273-8255 and Press 1http://veteranscrisisline.net/ The Trevor ProjectThe Trevor Project is a phone and internet chat hotline forLGBTQ people. For those participating in this survey, The TrevorProject will speak or chat with people of all ages.1-866-488-7386http://www.thetrevorproject.org/section/get-help ### Page 281 Section 17 These are questions about being treated unequally, harassed,or physically attacked. 17.1 In the past year, have you been denied equal treatment orservice, such as at a place of business, government agency, orpublic place for any reason? No Yes 17.2 In the past year, did anyone verbally harass you for anyreason? No Yes 17.3 In the past year, did anyone physically attack you (such asgrab you, throw something at you, punch you, use a weapon)for any reason? No Yes 17.4 You said that you were denied equal treatment or servicein the past year. Do you believe any of those experiences werebecause of your… (Mark all that apply.) [Only respondents whoselected “Yes” in 17.1 received this question. Respondents couldnot select “None of the above” in combination with any otheroption.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 17.5 You said that you have been verbally harassed in the pastyear. Do you believe any of those experiences were becauseof your… (Mark all that apply.) [Only respondents who selected“Yes” in 17.2 received this question. Respondents could notselect “None of the above” in combination with any otheroption.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 17.6 In the past year, did strangers verbally harass you inpublic because of your trans status, gender identity, or genderexpression? [Only respondents who selected “Trans status/gender identity” or “Gender expression/appearance” in 17.5received this question.] No Yes [Only respondents who selected “Yes” in 17.3 receivedquestions 17.7–17.10.] 17.7 In the past year, how many times were you physicallyattacked? __________ [Drop-down list of numbers] 17.8 How were you physically attacked? (Mark all that apply.) With a gun With a knife With another weapon (like a baseball bat, frying pan,scissors, or stick) By something thrown (such as a rock or bottle) By someone grabbing, punching, or choking you Unwanted sexual contact (such as rape, attempted rape,being forced to penetrate) Not listed above 17.9 When you were physically attacked in the past year, doyou believe any of those experiences were because of your…(Mark all that apply). [Respondents could not select “None ofthe above” in combination with any other option.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 17.10 In the past year, did strangers physically attack you inpublic because of your trans status, gender identity, or genderexpression? [Only respondents who selected “Trans status/gender identity” or “Gender expression/appearance” in 17.9received this question.] No Yes ### Page 282 Section 18 These are questions about unwanted sexual contact. Somepeople get sexual attention that they don’t want and don’task for. It could come from someone they know well - aromantic or sexual partner, a friend, a teacher, a coworker, asupervisor, or a family member. These questions are basedon national surveys that we will use to compare with the U.S.population. If you experience any difficult emotions becauseof these questions we encourage you to get help fromsomeone you trust or call one of the anonymous helplineslisted at the end of the section. 18.1 Have you ever experienced unwanted sexual contact (suchas oral, genital, or anal contact or penetration, forced fondling,rape)? No [Skip to 19.1] Yes 18.2 Who did this to you? (Mark all that apply.) A partner/ex-partner A relative A friend/acquaintance A law enforcement officer A health care provider/doctor A stranger A boss or supervisor A co-worker A teacher or school staff member A person not listed above 18.3 Now just thinking about the past year, have youexperienced unwanted sexual contact (such as oral, genital, oranal contact or penetration, forced fondling, rape)? No Yes If you are experiencing any difficult emotions after answeringthese questions and would like to talk to someone, pleasecontact one of the anonymous resources below: Veterans Crisis Line (for veterans, military personnel, and theirfamilies)1-800-273-8255 and Press 1http://veteranscrisisline.net/ FORGE Transgender Sexual Violence Project414-559-2123http://forge-forward.org/anti-violence/for-survivors/ to list ofresources National Sexual Assault Hotline800-656-HOPE (4673)https://ohl.rainn.org/online/ Section 19 These are questions about any harm caused by a currentor former romantic or sexual partner. This could includephysical, emotional, or financial harm. 19.1 Have you ever had a romantic or sexual partner? No [Skip to 20.1] Yes 19.2 Have any of your romantic or sexual partners ever...?(Please provide an answer in each row.) | No | Yes | | - | - | | Tried to keep you from seeing or talking to your familyor friends | O | O | | Kept you from having money for your own use | O | O | | Kept you from leaving the house when you wantedto go | O | O | | Hurt someone you love | O | O | | Threatened to hurt a pet or threatened to take a petaway from you | O | O | | Wouldn’t let you have your hormones | O | O | | Wouldn’t let you have other medications | O | O | | Threatened to call the police on you | O | O | | Threatened to “out” you | O | O | | Told you that you weren’t a “real” woman or man | O | O | | Stalked you | O | O | | Threatened to use your immigration status against you | O | O | 19.3 Have any of your romantic or sexual partners ever...?(Please provide an answer in each row.) | No | Yes | | - | - | | Made threats to physically harm you | O | O | | Slapped you | O | O | | Pushed or shoved you | O | O | | Hit you with a fist or something hard | O | O | | Kicked you | O | O | | Hurt you by pulling your hair | O | O | | Slammed you against something | O | O | | Forced you to engage in sexual activity | O | O | | Tried to hurt you by choking or suffocating you | O | O | | Beaten you | O | O | | Burned you on purpose | O | O | | Used a knife or gun on you | O | O | ### Page 283 Section 20 These are questions about your experiences with bathroomswhile in public places, at work, or at school. 20.1 In the past year, did anyone tell or ask you if you wereusing the wrong bathroom? No Yes 20.2 In the past year, did anyone stop you from entering ordeny you access to a bathroom? No Yes 20.3 In the past year, were you verbally harassed, physicallyattacked, or experience unwanted sexual contact whenaccessing or while using a bathroom? (Mark all that apply.)[Respondents could not select “No” in combination with anyother option.] No [Skip to 20.7] Yes, verbally harassed Yes, physically attacked Yes, experienced unwanted sexual contact 20.4 You said that you were verbally harassed in a bathroomin the past year. Where did this happen? (Mark all that apply.)[Only respondents who selected “Yes, verbally harassed” in20.3 received this question.] A bathroom in a public place (such as a restaurant,shopping mall, movie theater, etc.) A bathroom at my workplace A bathroom at my school A bathroom at another location(please specify) _____________ 20.5 You said that you were physically attacked in a bathroomin the past year. Where did this happen? (Mark all that apply.)[Only respondents who selected “Yes, physically attacked” in20.3 received this question.] A bathroom in a public place (such as a restaurant,shopping mall, movie theater, etc.) A bathroom at my workplace A bathroom at my school A bathroom at another location(please specify) _____________ 20.6 You said that you experienced unwanted sexual contactin a bathroom in the past year. Where did this happen?(Mark all that apply.) [Only respondents who selected “Yes,experienced unwanted sexual contact” in 20.3 received thisquestion.] A bathroom in a public place (such as a restaurant,shopping mall, movie theater, etc.) A bathroom at my workplace A bathroom at my school A bathroom at another location(please specify) _____________ 20.7 In the past year, did you avoid going to the bathroombecause you were afraid of having problems using them? Thiswould include bathrooms in public, at work, or at school. I have never avoided them [Skip to 21.1] I have sometimes avoided them I have always avoided them Not listed above (please specify) _____________ 20.8 Did you experience any of the following because youavoided using bathrooms in public places, at work, or atschool? (Mark all that apply.) [Only respondents who selectedan answer choice other than “I have never avoided them” in20.8 received this question.] Not going when needed (“holding it”) I avoided drinking or eating Urinary tract infection Kidney infection Other kidney-related problems I have never had physical problems from avoidingbathrooms Not listed above (please specify) ______________ Section 21 These are questions about things that might have happenedto you at your job or business, or while you were looking forwork. 21.1 Have you ever worked at a job or business? Do notinclude sex work, selling drugs, or other work that is currentlyconsidered illegal. No [Skip to 21.6] Yes 21.2 Have you ever lost a job or been laid off? No [Skip to 21.4] Yes 21.3 Do you believe that you were ever laid off or lost a jobbecause of your… (Mark all that apply.) [Only respondents whoselected “Yes” in 21.2 received this question. Respondentscould not select “None of the above” in combination with anyother option.] ### Page 284 Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 21.4 Have you ever been fired or forced to resign from a job? No [Skip to 21.6] Yes 21.5 Do you believe that you were ever fired or forced to resignbecause of your… (Mark all that apply.) [Only respondents whoselected “Yes” in 21.4 received this question. Respondentscould not select “None of the above” in combination with anyother option.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 21.6 Now just thinking about the past year, did you apply for ajob and/or work at a job or business? Do not include sex work,selling drugs, or other work that is currently considered illegal.(Mark all that apply.) [Respondents could not select “No” incombination with any other option.] No [Skip to 22.1] Yes, I applied for a job Yes, I worked at job or business 21.7 In the past year, how many times have you been… (Pleaseprovide an answer in each row.) | In the past year… | 0times | 1time | 2times | 3times | 4times | 5 ormoretimes | | - | - | - | - | - | - | - | | Denied a promotionat a job | O | O | O | O | O | O | | Not hired for a jobyouapplied for | O | O | O | O | O | O | | Fired or forced toresign from a job | O | O | O | O | O | O | 21.8_1 Do you believe that any of the times that you weredenied a promotion at a job in the past year were because ofyour… (Mark all that apply.) [Only respondents who selecteda value other than “0” under “Denied a promotion at a job”in 21.7 received this question. Respondents could not select“None of the above” in combination with any other option.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 21.8_2 Do you believe that any of the times that you were nothired for a job you applied for in the past year were becauseof your… (Mark all that apply.) [Only respondents who selecteda value other than “0” under “Not hired for a job you appliedfor” in 21.7 received this question. Respondents could not select“None of the above” in combination with any other option.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 21.8_3 Do you believe that any of the times that you were firedor forced to resign from a job in the past year were becauseof your… (Mark all that apply.) [Only respondents who selecteda value other than “0” under “Fired or forced to resign froma job” in 21.7 received this question. Respondents could notselect “None of the above” in combination with any otheroption.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above ### Page 285 [Only respondents who selected “Trans status/gender identity”or “gender expression/appearance” in 21.8_3 receivedquestions 21.9–21.11.] 21.9 Now just thinking about when you were fired or forced toresign from a job because of your gender identity, trans status,and/or gender expression in the past year, please describeyour response. (Mark all that apply.) I did nothing [Skip to 22.1] I contacted a lawyer. I contacted a trans, LGBT, or other non-profit group. [Skipto 22.1] I contacted my union representative. [Skip to 22.1] I made an official complaint. Not listed above (please specify) _________________[Skip to 22.1] 21.10 You said that you contacted a lawyer in response to beingfired or forced to resign from a job in the past year. What didthe lawyer do to help you? [Only respondents who selected “Icontacted a lawyer” in 21.9 received this question.] I was not able to hire the lawyer. The lawyer called or wrote a letter to my employer. The lawyer helped me file an official complaint. The lawyer filed a lawsuit for me. Not listed above (please specify) _________________ 21.11 You said that you made an official complaint in responseto being fired or forced to resign from a job in the past year.Where did you make the official complaint? (Mark all thatapply.) [Only respondents who selected “I made an officialcomplaint” in 21.9 received this question.] EEOC (Equal Employment Opportunity Commission Local/State Human Rights Commission The Human Resources or Personnel department of theemployer Equal Employment Opportunity (EEO) office of theemployer Not listed above (please specify) _________________ Section 22 [Only respondents who selected “Yes, I worked at a job orbusiness” in 21.6 received questions 22.1–22.3.] 22.1 In the past year, toavoid trans discrimination at work…(Please provide an answer in each row.) | No | Yes | | - | - | | I asked for a transfer to a different position/department atmy job in the past year | O | O | | I stayed in a job I’d prefer to leave in the past year | O | O | | I didn’t seek a promotion or a raise in the past year | O | O | | I quit my job in the past year | O | O | | I had/have a job for which I am over-qualified (in the pastyear) | O | O | | I had to be in the closet about my gender identity in thepast year | O | O | | I delayed my gender transition in the past year | O | O | | I did not ask my employer to use the pronouns I prefer inthe past year (such as he, she, or they) | O | O | | I hid the fact that I have transitioned gender already in thepast year | O | O | 22.2 In the past year, did any of these things happen to youbecause of trans discrimination at work? (Please provide ananswer in each row.) | No | Yes | | - | - | | My employer/boss forced me to resign in the past year. | O | O | | My employer/boss forced me to transfer to a differentposition/department at my job in the past year. | O | O | | My employer/boss removed me from direct contact withclients, customers, or patients in the past year. | O | O | | My employer/boss told me to present in the wrong genderin order to keep my job in the past year. | O | O | | My employer/boss gave me a negative job review in thepast year. | O | O | | My employer/boss and I could not work out an acceptablebathroom situation in the past year. | O | O | | My employer/boss did not let me use the bathroom Ishould be using based on my gender identity in the pastyear. | O | O | | My employer/boss or coworkers shared information aboutme that they should not have in the past year. | O | O | 22.3 In the past year, did any of these things happen toyou at work because you are trans? (Mark all that apply.)[Respondents could not select “None of the above” incombination with any other option.] I was verbally harassed I was physically attacked I experienced unwanted sexual contact (such as fondling,sexual assault, or rape) None of the above ### Page 286 Section 23 These are questions about experiences you may have hadwith housing. 23.1 Have you ever experienced homelessness? Experiencinghomelessness includes such things as staying in a shelter, livingon the street, living out of a car, or staying temporarily withfamily or friends because you can’t afford housing. No Yes 23.2 Now just thinking about the past year, have you had anyof these housing situations because you are trans? (Pleaseprovide an answer in each row.) Please choose “Does not apply to me” if you could not havehad that housing situation in the past year. For example, if youdidn’t rent a home in the past year, you would answer “Doesnot apply to me” to the first question because you could nothave been evicted. | In the past year... | Yes | No | Does notapply tome | | - | - | - | - | | I was evicted from my home/apartment. | O | O | O | | I was denied a home/apartment. | O | O | O | | I experiencedhomelessness.29 | O | O | O | | I had to move back in with family members orfriends. | O | O | O | | I had to move into a less expensive home/apartment. | O | O | O | | I slept in different places for short periods oftime, such as on a friend’s couch. | O | O | O | Section 24 [Only respondents who selected “I experienced homelessness”in 23.2 received questions 24.1–24.4.] 24.1 When you experienced homelessness this past year, didyou seek shelter in a homeless shelter? (Mark all that apply.)[Respondents could not select a “No” answer in combinationwith a “Yes” answer.] Yes, and I stayed at one or more shelters. [Skip to 24.3] Yes, but I was denied access to one or more shelters. No, because I feared I would be mistreated as a transperson [Skip to 25.1] No, for other reasons [Skip to 25.2] 24.2 Do you believe that you were denied access to ahomeless shelter in the past year because of your … (Mark allthat apply.) [Only respondents who selected “Yes, but I wasdenied access to one or more shelters” in 24.1 received thisquestion. Respondents could not select “None of the above” incombination with any other option.] Age Disability Income level or education Trans status/gender identity Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above 24.3 In the past year, did any of these things happen to you inthe homeless shelter? (Please provide an answer in each row.)[Only respondents who selected “Yes, and I stayed at one ormore shelters” in 24.1 received this question.] | No | Yes | | - | - | | I was thrown out after they learned I was trans. | O | O | | I decided to dress/present as the wrong gender to feel safein a shelter. | O | O | | They required me to dress/present as the wrong gender inthe shelter. | O | O | | I decided to leave a shelter because of poor treatment orunsafe conditions, even though I had no place to go. | O | O | 24.4 In the past year, did any of these things happen to youin a homeless shelter because you are trans? (Mark all thatapply.) [Only respondents who selected “Yes, and I stayedat one or more shelters” in 24.1 received this question.Respondents could not select “None of the above” incombination with any other option.] I was verbally harassed I was physically attacked I experienced unwanted sexual contact (such as fondling,sexual assault, or rape) None of the above Section 25 These are questions about your experiences in places ofpublic accommodations, such as hotels, restaurants, orgovernment agencies. 25.1 In the past year, have you visited or used services in anyof these places? (Mark all that apply.) [Respondents couldnot select “I have not visited or used services in any of theseplaces” in combination with any other option.] Domestic violence shelter/DV program/Rape crisis center Drug/alcohol treatment program DMV or RMV (Department or Registry of Motor Vehicles) Social Security office (such as for name or gender change,Social Security card, public benefits) ### Page 287 Public assistance/government benefits office (such asSNAP, WIC) Gym/health club Legal services from an attorney, clinic, or legal professional Court/court house Nursing home/extended care facility Public transportation (such as bus, train, subway, taxi) Retail store, restaurant, hotel, theater I have not visited or used services in any of these places. 25.2 In the past year, did you NOT visit or use services atthese places because you thought you would be mistreatedas a trans person? (Please give an answer for each place.)[Respondents received this question foreach of the locationsthat they did not select in 25.1.] | No | Yes (I did NOT visit because Ithought I would be mistreated) | | - | - | | [Location not selected in 25.1] | O | O | 25.3 In the past year, when you visited or used services atthese places, do you think the staff or employees knew orthought you were trans? (Please give an answer for eachplace.) [Respondents received this question foreach of thelocations that they selected in 25.1.] | No | Yes | | - | - | | [Location selected in 25.1] | O | O | 25.4 In the past year, when you visited or used services atthese places, did any of these things happen to you becauseyou are trans? (Please provide an answer for each location.)[Respondents received this question foreach of the locationsthat they selected in 25.1.] | Denied equaltreatment orservice | Verballyharassed | Physicallyattacked | None of thesethings happenedto me at this place | | - | - | - | - | | [Locationselected in25.1] | O | O | O | O | Section 26 These are questions about experiences you may have had inschool. 26.1 Were you out as trans in school at any time betweenKindergarten and 12th grade? No Yes [Skip to 26.3] 26.2 Do you believe that any of your classmates, teachers, orschool staff in Kindergarten through 12th grade (K-12) thoughtyou were trans? [Only respondents who selected “No” in 26.1received this question.] No Yes 26.3 Do you believe that any of your classmates, teachers orschool staff in K-12 thought or knew you were lesbian, gay,bisexual, or queer (LGBQ)? No Yes 26.4 Did any of these happen to you while in K-12? (If any ofthese things were done to you in K-12 by classmates, teachers,or school staff, please answer “yes.”) (Please provide ananswer in each row.) [Only respondents who selected “Yes” in26.1 or “Yes” in 26.2 received this question.] | NO | YES | | - | - | | I was verbally harassed because people thought I wastrans. | O | O | | I was physically attacked because people thought I wastrans. | O | O | | I experienced unwanted sexual contact because peoplethought I was trans | O | O | | I wasn’t allowed to dress in the way that fit my genderidentity/expression. | O | O | | I was disciplined for fighting back against bullies. | O | O | | I believe I was disciplined more harshly because teach-ers/staff thought I was trans. | O | O | | I left a school because the mistreatment was so bad. | O | O | | I was expelled from school. | O | O | 26.5 Did any of these happen to you while in K-12? (If any ofthese things were done to you in K-12 by classmates, teachers,or school staff, please answer “yes.”) (Please provide ananswer in each row.) [Only respondents who selected “No”in 26.1, AND “No” in 26.2, AND “Yes” in 26.3 received thisquestion.] | YES | NO | | - | - | | I was verbally harassed because peoplethought I was LGBQ. | O | O | | I was physically attacked because peoplethought I was LGBQ. | O | O | | I experienced unwanted sexual contactbecause people thought I was LGBQ. | O | O | | I wasn’t allowed to dress in a way that fit mygender identity/expression. | O | O | | I was disciplined for fighting back againstbullies. | O | O | | I left a school because the mistreatment wasso bad. | O | O | | I was expelled from school. | O | O | [Only respondents who selected a level of educationalattainment higher than “high school graduate” in 2.22 receivedquestions 26.6–26.9.] ### Page 288 26.6 Now just thinking about classmates, professors, or staff atyour college or vocational school, did they think or know youwere trans? No [Skip to 26.9] Yes 26.7 Were you harassed (verbally, physically, or sexually) atcollege or vocational school because people thought or knewyou were trans? [Only respondents who selected “Yes” in 26.6received this question.] No [Skip to 26.9] Yes 26.8 Did you have to leave your college or vocational schoolbecause the harassment was so bad? [Only respondents whoselected “Yes” in 26.7 received this question.] No Yes 26.9 Did you leave or were you forced to leave a college orvocational school because you are trans? (Mark all that apply.)[Respondents could not select “No” in combination with anyother option.] No Yes, I left school because the mistreatment was so bad. Yes, I was expelled or forced out. Yes, I left for other trans-related reasons. Section 27 These are questions about things that may have happened toyou when going through airport security. 27.1 In the past year, have you gone through airport security inthe United States? No [Skip to 28.1] Yes 27.2 When you went through airport security in the pastyear, did a TSA officer do any of these things to you? (Markall that apply.) [List was randomized for each respondent.Respondents could not select “None of the above” incombination with any other option.] They questioned the name or gender on my ID. They used the wrong pronouns with me (he/him or she/her) or wrong title (Mr. or Ms.) They patted me down due to gender-related clothing oritems (such as a binder, packer). I was patted down by a TSA officer of the wrong gender. They searched my bag due to a gender-related item (suchas binder, packer). They asked me to remove or lift clothing to show a binder,undergarment, or other sensitive area. They took me to a separate room for questioning/examination. They announced or questioned loudly my gender, bodyparts, or sensitive items (such as a binder, packer). They called the police about me. I missed my flight due to screening. I was not allowed to fly. They detained me for over an hour. They verbally harassed me. They physically attacked me. I experienced unwanted sexual contact (beyond a typicalpat down by a TSA officer) None of the above Section 28 These are questions about things that happened to you withpolice, in jail, in prison, or in a juvenile detention center. 28.1 If you needed help from the police, how comfortable wouldyou feel asking them for help? Very comfortable Somewhat comfortable Neutral Somewhat uncomfortable Very uncomfortable 28.2 In the past year, did you interact with the police or otherlaw enforcement officers? No [Skip to 28.8] Yes 28.3 In the past year, do you believe the police or other lawenforcement officers you interacted with thought or knew youwere trans? None of the officers thought or knew I was trans. [Skip to28.6] Some officers thought or knew I was trans, some did not. All officers thought or knew I was trans. 28.4 In the past year, when you interacted with police or otherlaw enforcement officers, were you treated with respect? I was never treated with respect. I was sometimes treated with respect. I was always treated with respect. ### Page 289 28.5 In the past year, when you interacted with police or otherlaw enforcement officers, did any of these things happen toyou? (Please give an answer in each row.) | In the past year… | No | Yes | | - | - | - | | Officers kept called me by the wrong genderpronouns (such as he/him or she/her) or wrong title(Mr. or Ms.) | O | O | | Officers asked me questions about my gendertransition (such as hormones and surgical status). | O | O | | Officers assumed I was a sex worker. | O | O | | Officers verbally harassed me. | O | O | | Officers physically attacked me. | O | O | | Officers forced me to engage in sexual activity toavoid arrest | O | O | | I experienced unwanted sexual contact from anofficer (such as fondling, sexual assault, or rape) | O | O | 28.6 In the past year, were you arrested for any reason? No [Skip to 28.8] Yes 28.7 In the past year, do you believe that you were arrestedbecause you were trans? No Yes 28.8 In the past year, at any time were you held in jail, prison,or juvenile detention? No [Skip to 29.1] Yes [Only respondents who selected “Yes” in 28.8 receivedquestions 28.9–28.20.] 28.9 In the past year, what types of jail, prison or juveniledetention facility were you in? (Mark all that apply.) Federal prison State prison Local jail Holding cell State juvenile system Locally or privately-operated juvenile facilities Other correctional facility(please specify) _____________________ 28.10 In the past year, during your time in jail, prison or juveniledetention facility were you physically forced, pressured, ormade to feel that you had to have sex or sexual contact withany facility staff? No [Skip to 28.12] Yes 28.11 In the past year, how many times did this happen to you?[Only respondents who selected “Yes” in 28.10 received thisquestion.] [Drop-down list of numbers 1–10 and “11 or more”] 28.12 In the past year, during your time in jail, prison or juveniledetention facility, were you physically forced, pressured, ormade to feel that you had to have sex or sexual contact withanother inmate? No [Skip to 28.14] Yes 28.13 In the past year, how many times did this happen to you?[Only respondents who selected “Yes” in 28.12 received thisquestion.] [Drop-down list of numbers 1–10 and “11 or more”] 28.14 In the past year, during your time in jail, prison or juveniledetention facility were you physically assaulted or attacked byfacility staff? No [Skip to 28.16] Yes 28.15 In the past year, how many times did this happen to you?[Only respondents who selected “Yes” in 28.14 received thisquestion.] [Drop-down list of numbers 1–10 and “11 or more”] 28.16 In the past year, during your time in jail, prison or juveniledetention facility were you physically assaulted or attacked byanother inmate? No [Skip to 28.18] Yes 28.17 In the past year, how many times did this happen to you?[Only respondents who selected “Yes” in 28.16 received thisquestion.] [Drop-down list of numbers 1–10 and “11 or more”] 28.18 Before your time in jail, prison, or juvenile detention, wereyou taking hormones? No [Skip to 29.1] Yes 28.19 Did you have a prescription for the hormones you weretaking? No Yes ### Page 290 28.20 In the past year, during your time in jail, prison,or juvenile detention, were you not allowed to take yourhormones? No Yes Section 29 Now we have some questions about voting and registration. 29.1 In any election, some people are not able to vote becausethey are sick or busy or have some other reason, and others donot want to vote. Did you vote in the election held onTuesday,November 4, 201430? No Yes [Skip to 30.1] 29.2 Were you registered to vote in theNovember 4, 2014election31? [Only respondents who selected “No” in 29.1received this question.] No Yes [Skip to 29.4] 29.3 Which of the following was the MAIN reason you were notregistered to vote? (Please choose only one response.) [Onlyrespondents who selected “No” in 29.2 received this question.] Not eligible to vote because I am not a U.S. citizen. I wanted to avoid being harassed by election officialsbecause I am trans. My current name does not match social security card. I thought my state’s voter ID law could stop me fromvoting. I don’t have ID and thought I would need one to register. Did not meet registration deadlines. Did not know where or how to register Did not live here long enough/did not meet residencyrequirements. Permanent illness or disability Difficulty with English Not interested in the election or not involved in politics. My vote would not make a difference. Not eligible to vote because of a criminal/felonyconviction. Not eligible to vote for a reason other than a criminal/felony conviction. A reason not listed above(please specify) _____________________ 29.4 What was the MAIN reason you did not vote? (Pleasechoose only one response.) [Only respondents who selected“Yes” in 29.2 received this question.] I wanted to avoid being harassed by election officialsbecause I am trans. Illness or disability (own or family’s) Out of town or away from home Forgot to vote (or send in absentee ballot) Not interested, felt my vote wouldn’t make a difference Too busy, conflicting work or school schedule Transportation problems Didn’t like candidates or campaign issues. Registration problems (for example, I didn’t receive anabsentee ballot or wasn’t registered in current location) Bad weather conditions Inconvenient hours, polling place, or hours or lines toolong I didn’t have the identification documents (ID) I needed tovote. My identification documents (ID) do not match my currentname, gender, or have an old photo. My gender/name on my identification document (ID) doesnot match my voter registration. I was not allowed to vote by a poll worker or electionofficial because I am trans. A reason not listed above(please specify) _________________________ Section 30 These are questions about civic and political activities. 30.1 Do you agree or disagree with the following statementabout political affairs in this country? Someone like me can’t really influence government decisions. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree 30.2 People may be involved in civic and political activities. Inthe lastPresidential election in 201232 did you… (Please providean answer in each row.) [Response choices were randomized,keeping the first two and last two grouped together in thefollowing order.] | In the last Presidential election in 2012 did you … | No | Yes | | - | - | - | | Volunteer or work for a Presidential campaign | | Volunteer or work for another political candidate,issue, or cause | | Give money to a Presidential campaign | | Give money to another political candidate, issue, orcause | ### Page 291 30.3 In the past 12 months have you… (Please provide ananswer in each row.) [Response choices were randomized.] | In the past 12 months, have you… | No | Yes | | - | - | - | | Attended a political protest or rally | | Contacted a government official | | Worked with others in your community to solve aproblem | | Served on a community board | | Written a “letter to the editor” | | Commented about politics on a message board orInternet site | | Held a publicly elected office | 30.4 In politics, as of today, do you consider yourself aRepublican, a Democrat, or an Independent? Republican [Skip to 30.6] Democrat [Skip to 30.6] Independent Other party (please specify) ________________________ 30.5 As of today, do you lean more to the Democratic Partyor the Republican Party? [Only respondents who selected“Independent” or “Other party” in 30.4 received this question.] Democratic Republican Neither/Other 30.6 How would you describe your political views? Very conservative Conservative Moderate Liberal Very liberal Section 31 This question asks for your opinion on the most important policypriorities for trans people in the United States. This is a two-part question: 31.1 For each issue below that affects trans people in the U.S., pleasemark how important it is. (Please provide an answer in each row.)[Response choices were randomized. Respondents could select up to3 response choices in the last column.] | Veryimportant | Important | Not veryimportant | | - | - | - | | HIV/AIDS | O | O | O | | Identity documents (ID) (updating name and gender) | O | O | O | | Bullying/discrimination in schools | O | O | O | | Police mistreatment of trans people | O | O | O | | Mistreatment in prisons/jails | O | O | O | | Immigration reform | O | O | O | | Military (ability to be openly trans) | O | O | O | | Training health care providers about trans health | O | O | O | | Insurance coverage for trans-related health care | O | O | O | | Employment | O | O | O | | Housing and homelessness | O | O | O | | Violence against trans people | O | O | O | | Parenting and adoption rights | O | O | O | | Marriage recognition | O | O | O | | Conversion Therapy | O | O | O | | Racism | O | O | O | | Poverty | O | O | O | 31.2 Of these issues, please select your top 3 most important issues. Issue#1 [Drop-down list of issues listed in 31.1] Issue#2 [Drop-down list of issues listed in 31.1] Issue#3 [Drop-down list of issues listed in 31.1] Section 32 32.1 Is there anything else that you would like to tell us about yourexperiences of acceptance or discrimination so we can betterunderstand your experiences? No [Responses were submitted and respondents were directedto the Thank You Page hosted by NCTE.] Yes 32.2 Please tell us anything else that you would like to tell us aboutyour experiences of acceptance or discrimination so we can betterunderstand your experiences. Please do not provide any informationthat could be used to identify you, such as your name or contactinformation. Your response will be anonymous. [Only respondentswho selected “Yes” in 32.1 received this question.] [Text box] Please enter your survey responses by clicking on the submit buttonbelow: SUBMIT ### Page 292 [Once completed, responses were submitted and respondentswere directed to the Thank You Page hosted by NCTE.] Thank You Page THANK YOU FOR MAKING YOUR VOICE HEARD YOUR SURVEY HAS BEEN SUBMITTED Want to be one of the first to get the survey results? Want to win one of the cash prizes? Give us your info here. This information will not be connected to your surveyresponses. Preferred name Email address Zip Code (required) Phone (optional) [ ] Send me the results of the survey when you releasethem! [ ] Enter me in the drawing for one of three cash prizes:one prize of $500 and two prizes of $250! SUBMIT RESOURCES We recognize that answering some of the questions on thissurvey may have been hard. If you are experiencing any difficultemotions after answering the questions and would like to talkto someone, please contact one of the anonymous resourcesbelow: National Suicide Prevention Helpline1-800-273-8255 FORGE Transgender Sexual Violence Project414-559-2123http://forge-forward.org/anti-violence/for-survivors/ to list ofresources Veterans Crisis Line (for veterans, military personnel, and theirfamilies)1-800-273-8255 and Press 1 The Trevor ProjectThe Trevor Project is a phone and internet chat hotline forLGBTQ people. For those participating in this survey, The TrevorProject will speak or chat with people of all ages.1-866-488-7386 National Sexual Assault Hotline800-656-HOPE (4673) 1 Respondents who were sent to disqualification page #2received the following message: “Based on your answers,you are not eligible to complete this survey. Thank youfor your interest in participating in this study. For moreinformation about this project please visit the NCTEwebsite: http://www.ustranssruvey.org.” 2 Respondents who were sent to disqualification page #1received the following message: “Thank you for yoursurvey responses. We’re interested to learn more aboutyour identity and experiences. If you would like to tell usmore, please respond to the following questions. Pleasedo not provide any information that could be used toidentify you, such as your name or contact information. Tell us about your gender identity or expression. [Textbox.] Tell us about your experiences related to your genderidentity or expression. [Text box.]” 3 See note 1. 4 See note 2. 5 See note 2. 6 Respondents received the following hyperlinked definitionfor “active duty”: “Active duty means full-time service,other than active duty for training as a member of theArmy, Navy, Air Force, Marine Corps, Coast Guard, or asa commissioned officer of the Public Health Service orthe National Oceanic and Atmospheric Administration,or its predecessors, the Coast and Geodetic Survey orEnvironmental Science Service Administration. Active dutyalso applies to a person who is a cadet attending one ofthe five United States Military Service Academies. For aperson with service in the military Reserves or NationalGuard, mark the “Only on active duty for training in theReserves or National Guard” box if the person has neverbeen called up for active duty, mobilized, or deployed. For ENDNOTES | APPENDIX B ### Page 293 a person whose only service was as a civilian employeeor civilian volunteer for the Red Cross, USO, Public HealthService, or War or Defense Department, mark the ‘Neverserved in the military’ box. For Merchant Marine service,count only the service during World War II as active dutyand no other period of service.” 7 Respondents received the following hyperlinked definitionfor “household”: “A household includes all the adultswho live with you in the same house, apartment, groupof rooms, or room that is used as one home. If you live ingroup housing, such as a dormitory, only include yourselfand your adult family members who live with you. 8 Respondents received the following hyperlinked noteregarding the term “related to you”: “Include only adultsyou’re related to by blood, legal adoption, or legalmarriage that is recognized by the U.S. government. Donot include your unmarried partner or unrelated adults.Later we will ask about the people not included here.” 9 Respondents received the following hyperlinked noteregarding the term “named on the lease, mortgage, ordeed”: “This includes people who are listed on the lease,mortgage, or deed for your home. If your home is notowned or rented by anyone who lives with you, includeany adult in the home except roomers, boarders, or paidemployees.” 10 Respondents received the following hyperlinked noteregarding the term “related to you”: “Do not includechildren that are not related to you by birth or by legaladoption. For instance, your unmarried partner’s childrenwould not be included here unless you have legallyadopted them. We ask about these members of yourhousehold elsewhere in the survey.” 11 Respondents received the following hyperlinked definitionfor “SNAP”: “The Supplemental Nutrition AssistanceProgram (SNAP) is sometimes called the Food Stampprogram. It helps people who have low or no income tobuy food, usually with an EBT card.” 12 Respondents received the following hyperlinked definitionfor “WIC”: “‘WIC’ stands for ‘Women, Infants, and Children.’It’s the short name for the Special Supplemental NutritionProgram for Women, Infants, and Children. WIC is afederal program to help women who are pregnant orbreastfeeding and children less than five years old gethealth care and healthy food.” 13 Respondents who selected this answer choice receivedthe message and clicked “OK” to proceed: “Please notethat for upcoming questions about income, don’t includefood stamps (SNAP) as income.” 14 Respondents who selected this answer choice receivedthe message and clicked “OK” to proceed: “For upcomingquestions about income, don’t include assistance fromWIC as income.” 15 Respondents who selected multiple answer choices in thisquestion received the following message and clicked “OK”to proceed: “Please note that for upcoming questionsabout income, don’t include assistance from food stamps(SNAP) or WIC as income.” 16 Respondents received the following hyperlinkeddefinition for “Individual Income”: “Individual income”includes money from jobs, employment, net income frombusiness, income from farms or rentals, income from self-employment, pensions, dividends, interest, social securitypayments, and other money income that you personallyreceived in 2014. Do not include assistance from foodstamps (SNAP) or WIC as income.” 17 Respondents received the following hyperlinked definitionfor “Family Income”: “‘Family income’ includes you andmembers of your family related by legally-recognizedmarriage, by birth, or by adoption who have lived withyou during the last 12 months and includes money fromjobs, employment, net income from business, income fromfarms or rentals, income from self-employment, pensions,dividends, interest, social security payments, and anyother money income received by you and family membersin your household who are 15 years of age or older in2014. Do not include assistance from food stamps (SNAP)or WIC as income.” 18 Respondents received the following hyperlinked definitionfor “Household Income”: “‘Household income’ includesyou and all members of your household who have livedwith you during the past 12 months and includes moneyfrom jobs, employment, net income from business, incomefrom farms or rentals, income from self-employment,pensions, dividends, interest, social security payments,and any other money income received by you andmembers of your household who are 15 years of age orolder in 2014. Do not include assistance from food stamps(SNAP) or WIC as income.” 19 Respondents received the following hyperlinked noteregarding the term “had a drink”: “Please do not includeany time when you only had a sip or two from a drink.” 20 Respondents received the following hyperlinked definitionfor “alcohol”: “Alcoholic beverages, such as beer, wine,brandy, and mixed drinks.” 21 Respondents received the following hyperlinked definitionfor “cigarettes”: “Cigarettes made of tobacco. Do notinclude electronic cigarettes (E-cigs).” 22 Respondents received the following hyperlinked definitionfor “e-cigarettes or vaping products”: “This includeselectronic cigarettes (e-cigs or e-cigarettes), personalvaporizer (PV), or electronic nicotine delivery system(ENDS), all of which are battery-powered vaporizers thatfeel similar to tobacco smoking.” 23 Respondents received the following hyperlinked definitionfor “marijuana or hashish”: “Marijuana is also called pot orgrass. Marijuana is usually smoked, either in cigarettes,called joints, or in a pipe. It is sometimes cooked in food.Hashish is a form of marijuana that is also called ‘hash.’It is usually smoked in a pipe. Another form of hashish ishash oil.” ### Page 294 24 Respondents received the following hyperlinked definitionfor “illegal or illicit drugs”: “Drugs like cocaine, crack,heroin, LSD, and meth that are considered to be illegal.Inhalants are liquids, sprays, and gases that people sniff orinhale to get high or to make them feel good, like poppersor whippits. We are not interested in times when youinhaled a substance accidentally— such as when painting,cleaning an oven, or filling a car with gasoline.” 25 Respondents received the following hyperlinked definitionfor “prescription drugs”: “Use of prescription drugs in anyway a doctor did not direct you to use them. When youanswer this question, please think only about your use ofthe prescription drug in any way a doctor did not directyou to use it, including: • Using it without a prescription of your own • Using it in greater amounts, more often, or longer thanyou were told to take it • Using it in any other way a doctor did not direct you touse it” 29 Respondents received the following hyperlinked definitionfor “homelessness”: “Experiencing homelessness includessuch things as staying in a shelter, living on the street,living out of a car, or staying temporarily with family orfriends because you can’t afford housing.” 26 Respondents received the following note regarding theterm “drank an alcoholic beverage”: “A can or bottle ofbeer, a glass of wine or a wine cooler, a shot of liquor, or amixed drink with liquor in it. We are not asking about timeswhen you only had a sip or two from a drink.” 27 Respondents received the following note regarding theterm “drink one or more drinks”: “A can or bottle of beer, aglass of wine or a wine cooler, a shot of liquor, or a mixeddrink with liquor in it. We are not asking about times whenyou only had a sip or two from a drink.” 28 Respondents received the following note regarding theterm “drinks”: “A can or bottle of beer, a glass of wine or awine cooler, a shot of liquor, or a mixed drink with liquor init. We are not asking about times when you only had a sipor two from a drink.” 30 Respondents received the following hyperlinked note:“This was the election in November 2014 to electmembers of the U.S. Congress and state-level offices.” 31 Respondents received the following hyperlinked note:“This was the election in November 2014 to electmembers of the U.S. Congress and state-level offices.” 32 Respondents received the following hyperlinked noteregarding this term: “This was the presidential election in2012 between Mitt Romney and Barack Obama.” ### Page 295 291 Appendix C Detailed Methodology Survey Sources When developing the survey instrument, the research team focused on creating a questionnairethat could provide data to address both current and emerging needs of transgender peoplewhile gathering information about disparities that often exist between transgender people andnon-transgender people throughout the United States. To achieve this, questions were included that wouldallow comparisons between the U.S. Transgender Survey (USTS) sample and known benchmarks for theU.S. population as a whole or populations within the U.S. Consequently, questions were selected to bestmatch those previously asked in federal government or other national surveys on a number of measures,such as measures related to income and health. Questions in the USTS survey instrument were drawn fromfederally administered national population-based surveys, either exactly as they appeared in the sourcesurvey or with modifications, as follows: ### Page 296 292 | USTS Questions | Source Survey | | - | - | | 2.16–2.22; 11.1 & 11.2 | American Community Survey(ACS) | | 2.24 & 2.25; 15.1–15.12;16.1–16.5 | National Survey on Drug Useand Health (NSDUH) | | 7.1–7.14 | Current Population Survey(CPS) | | 12.1; 12.4; 12.6; 12.17; 14.4 | CDC’s Behavioral Risk FactorSurveillance System (BRFSS) | | 12.2 & 12.3; 14.1; 14.3 | National Health InterviewSurvey (NHIS) | | 16.6–16.12 | National Comorbidity SurveyReplication (NCS-R) | | 17.7 & 17.8 | National Crime VictimizationSurvey (NCVS) | | 18.1–18.3; 19.2 & 19.3 | National Intimate Partnerand Sexual Violence Survey(NISVS) | | 28.10–28.17 | National Inmate Survey (NIS) | | 29.1–29.4 | Current Population Survey(CPS) 2014 NovemberSupplement | | 30.4–30.6 | Gallup Daily Tracking Poll(U.S. Political and EconomicDaily Tracking) | Data Cleaning Data cleaning is the process of detecting andremoving some survey responses (e.g., duplicateresponses, incomplete responses, illogicalresponses) in order to improve the quality of thesample. Cleaning of the USTS data proceededin the following steps: (1) flagging and removal ofrespondents not eligible to take the survey, (2)flagging and removal of incomplete responses, (3)flagging and removal of duplicate responses, and(4) flagging and removal of illogical responses. The first step was to remove survey responsesfrom individuals who did not meet basic eligibilitycriteria for the survey. Respondents had to consentto take the survey, be at least 18 years of age,and reside in the U.S., a U.S. territory, or on a U.S.military base. Additionally, respondents neededto identify as transgender—including non-binaryidentities—or meet other criteria related to theirgender identity or expression. Additionally,respondents were asked if they had alreadycompleted this survey before. Respondentswho indicated that they had completed thesurvey before were also ineligible to take thesurvey. Skip logic was added to the survey tosend respondents who did not meet these basiceligibility criteria to a disqualification page, buttheir responses were included in the initial datasetand had to be removed. Additional analyses ofthe dataset were completed to remove ineligiblerespondents. Respondents who provided amonth and year of birth that indicated they wereunder 18 at the time they took the survey wereflagged and removed from the dataset. Additionalanalyses of responses related to gender identityand transition status in Sections 1 and 2 of thesurvey were completed to flag additional ineligiblerespondents, which included those who did notidentify as transgender or with a range of othergender-related experiences associated withtransgender communities. Please see the “VariableRecoding Process” section below for a moredetailed description of this process. In all, 10,304responses were removed from the initial datasetdue to being ineligible to take the survey. Incomplete responses were then removedfrom the sample based on a requirement thatrespondents minimally complete Section 1 andspecific demographic questions in Section 2 ofthe questionnaire. Missing data was otherwiseallowed provided respondents completed thesequestions. The required Section 2 questionswere as follows: 2.1, 2.3, 2.6, 2.8, 2.9, either 2.13or 2.14, 2.15, 2.18, 2.19, 2.22, 2.23, and 2.26. It wasdetermined that these questions would providekey information about respondents, includingquestions used to determine eligibility, and thesequestions were used to set a minimal level ofsurvey “completeness” the research team waswilling to accept for a respondent to remain in thedataset. In all 515 respondents were removed forincomplete survey responses. ### Page 297 Duplicate survey responses were then flagged andremoved. Duplicates were determined based onall quantitative responses in the survey. Qualitative(“write-in”) responses were not considered whendetermining whether a response was a duplicate.In all, 329 responses were considered duplicatesand were removed from the final dataset. Finally, respondents who provided more than oneillogical response were flagged and removedfrom the final dataset. An illogical response isone that provides information that contradictsother information provided by a respondent. Forinstance, the USTS survey included 16 questionsrelated to respondents’ age, including currentage, age they first disclosed to others they aretransgender, age of suicide attempts, and ages ofother milestones or experiences. An example ofan illogical response would be a respondent whoreported they attempted suicide at an age olderthan their current age. An illogical response couldbe due to an accidental miscode on the part of therespondent, meaning they accidentally filled out aquestion incorrectly, or could be evidence that arespondent is not taking the survey in earnest. Theresearch team considered a respondent havingmore than one illogical response as evidence thatthe respondent may not have been taking thesurvey in earnest. In all, 53 respondents had morethan one illogical response and were removedfrom the final dataset.1 | Total initial sample: | 38,916 | | - | - | | Total cases removed: | 11,201 | | Did not consent to take survey | 223 | | Not eligible: under 18 years of age | 6,168 | | Not eligible: had already taken survey | 1,072 | | Not eligible: did not live in U.S., territory, ormilitary base | 1,052 | | Not eligible: gender identity or expressiondid not meet minimum criteria | 1, 789 | | Duplicate responses | 329 | | Incomplete responses | 515 | | Illogical responses | 53 | | Final sample: | 27,715 | Missing Data andImputation When a dataset has substantial amounts of missingdata, such as over 5% missing data, researchersshould consider techniques to impute the missingdata.2 The research team conducted an analysisto determine whether missing data should beimputed in the USTS dataset. The percentageof missing data due to item non-response (notincluding intentionally missing data due to skiplogic) on any original quantitative variable (notincluding recoded variables or “write-in” variables)was less than 5%, with the exception of twovariables. Question 14.4 regarding the month ofrespondents’ last HIV test had 5.9% missing data(Q. 14.4: “Not including blood donations, in whatmonth was your last HIV test?”). This item mayhave had relatively higher item non-responsebecause respondents may have been more likelyto recall the year of their last HIV test, which wasalso requested in Q. 14.4, than the month. Question7.11 regarding respondents’ sources of income had6.2% missing data (Q. 7.11: “What are your currentsources of income?”). This may reflect a generalreluctance to provide financial information that isroutinely found in item non-response to income-related questions in population-based surveys.The research team determined that due to thelow amount of missing data, including minimalmissing data on questions that routinely have highitem non-response in population-based surveys(e.g., individual and household income), missingdata imputation was not necessary for this report.Future researchers are encouraged to investigatethe impact of data imputation when using thisdataset. ### Page 298 Variable RecodingProcess The initial final dataset contained 1,140 uniquevariables based on 324 items respondentscould have received in the survey. Most of thesevariables required quantitative or qualitativerecoding for use in the study. Quantitative recodes,such as for creating variables to reflect how “out”a respondent was about their transgender identity,were completed by one primary researcherand the syntax for that recode was reviewed byanother researcher. Any errors in the syntax thatwere found in the review were submitted to theprimary researcher in order to make corrections.The primary researcher completed any correctionsand the variable was then considered a finalrecode. In all, the research team produced over2,000 recodes used to generate the findingspresented in this report. Respondents to the survey had many opportunitiesto write in responses to questions by selecting ananswer such as “none of the above” and writingin a unique response or responding to an open-ended question. The research team reviewedapproximately 80,000 write-in responses forrecoding. The recoding process included twocoding teams that conducted initial coding, whichwas reviewed by another coding team and areasof disagreement were flagged. A simple percentagreement score was calculated to assess inter-rater reliability. For nearly all variables that wererecoded, the coding team and the review teamhad 90% or higher agreement, two variables hadagreement between 80% and 90%, and three fellbelow 80% agreement (Q. 1.7 (79%), Q. 9.3 (67%),and Q. 21.11 (70%)). In the case of a question with write-in responseswhere only one answer option was allowed,write-in responses were reviewed to see if theycould be recoded into existing answer options. Ifsubstantial numbers of respondents wrote in thesame response, a new answer option could beadded to the question to reflect those responses.If it was not feasible for a response to be recodedinto an existing answer option or to be combinedwith others to create a new answer option, theresponse remained in the “none of the above”category as a unique response. In the case of aquestion that allowed multiple choices, a similarprocess took place. However, if a substantialnumber of responses could be grouped into a newanswer option and a new variable was createdto describe those responses, those respondentsalso remained in the “none of the above” category.Therefore, new answer options based on write-inquestions that allowed multiple answer choicesshould be viewed as a subset of the “none of theabove” category. A different recoding process was established inorder to recode respondents into four genderidentity categories: transgender women,transgender men, non-binary people, andcrossdressers. To categorize respondents basedon gender identity, the research team relied onrespondents’ self-selected gender category inQ. 2.3, which was cross-tabulated with Q. 2.1 toidentify transgender men and transgender women.For instance, the researchers would categorizesomeone assigned female at birth in Q. 2.1 whoidentifies as a man in Q. 2.3 as a transgenderman and would categorize someone assignedmale at birth in Q. 2.1 who identifies as a womanin Q. 2.3 as a transgender woman. In a few cases(n=439), a respondent selected female in Q. 2.1and woman in Q. 2.3 or selected male in Q. 2.1and man in Q. 2.3. These respondents requiredadditional analysis of their survey responsesin order to determine if they met the eligibilitycriteria for the survey, and if so, to categorizethem as transgender men, transgender women,non-binary people, or crossdressers. The researchteam relied on questions in Sections 1, 2, and 12to help make these determinations. Members ### Page 299 of the research team completed initial recodingof these respondents to indicate whether theywere eligible for the survey, and if so, in which ofthese categories they should be included. Theseinitial recodes were reviewed by other membersof the research team. When initial recoders andreviewers were not in agreement on a recode, theteam met to discuss the disagreements and madea final decision on the recode as a group. In all,250 respondents were determined to be ineligiblefor the survey based on this recoding and reviewprocess and were removed from the final dataset. Weights The USTS sample was a purposive sample thatwas created using direct outreach, modifiedvenue-based sampling, and “snowball” sampling.As a non-probability sample, generalizability islimited, meaning it is unclear whether the findingspresented in this report would hold true for thetransgender population of the U.S. as a whole.In addition, prior research has found that onlinesurveys have a known bias, particularly in regardto demographic representation. Online samplestend to over-represent those who are white,young, more highly educated, and with higherincomes.3 In order to address these biases, at leastin part, the research team created and utilizedweights to adjust the USTS sample in certainways in order to better represent what is believedto be the actual population characteristics oftransgender people in the U.S. and in order tomake more accurate comparisons with population-based samples of the U.S. population. Prior research using probability samples oftransgender adults have found that transgenderadults differ from the general population in regardto race and ethnicity and age, with those thatidentify as transgender being more likely to bepeople of color and younger than the generalpopulation.4 Studies have found no differencein educational attainment or lower educationalattainment and have found lower incomesamong transgender people as compared tonon-transgender people.5 The USTS sample hasa higher percentage of white, young, and morehighly educated respondents than the U.S. generalpopulation, which may be due, at least in part, tointernet survey bias. However, the younger age isalso likely due to the transgender population beingyounger overall. The USTS sample also has higherincidence of low incomes as compared to the U.S.population, which goes against the typical internetsurvey bias. Based on the existing research aboutthe transgender population, there is not adequateinformation available to attempt to correct forbias in the sample based on age, educationalattainment, or income. However, there is sufficientevidence to indicate that the race and ethnicity ofthe USTS sample does not reflect the racial andethnic makeup of the U.S. transgender populationas a whole. “Weighting” is a common statistical techniqueused to adjust data drawn from a sample of apopulation to be more representative of thepopulation from which the sample was drawn.For example, in a survey sample of the U.S.population, the proportion of respondents aged18–24 may differ from the proportion of thatage group in the U.S. population as a whole, inwhich case weights are commonly applied toadjust the sample to be more representative ofthe U.S. population. To help correct for samplingbias in the USTS sample in regard to race andethnicity, U.S. population weights based onthe American Community Survey for race andethnicity were created as part of the standardweight applied to all findings in this report. Whilethis may still over-represent white respondentsrelative to the makeup of the transgender adultpopulation, this weighting procedure brings thesample closer to what is believed to be the truepopulation distribution for race and ethnicity for ### Page 300 transgender people in the U.S. The standardweight also includes an adjustment to the 18-year-old category, described in more detail below.Additional survey weights were created for thepurposes of comparability with federal governmentand national data sources, including weights forage and educational attainment.6 These weightswere applied in addition to the standard weightwhen comparing the USTS sample to the U.S.population for items that are sensitive to age andeducational attainment, such as individual andhousehold income, and are noted accordingly asthe “supplemental weight.” Weighted percentagesfor these and other variables can be foundin the Portrait of USTS Respondents chapter.Unweighted frequencies and percentagesfor these and other variables can be found inAppendix A (Characteristics of the Sample). In addition to the potential biases describedabove, the USTS had a high volume ofrespondents who indicated that their age was 18years old, and respondents who, based on theirbirth date, were 17 years old.7 It was suspectedthat the increased binning of 18-year-olds may beattributable to multiple factors, including a higherprevalence of respondents who were youngerthan 18 at the time of the survey. This resultedin 18-year-olds comprising 9% of the sample,compared to 19-year-olds comprising 6% of thesample. It is impossible to determine the sourceof this binning entirely, but in order to correct forit, the research team created a weight to adjustthe 18-year-olds in the sample so that respondentsreporting that age appeared more like the19-year-old respondents in both sample size andother demographics. The rationale behind thisadjustment is that a person’s year of birth is likelyrandomly distributed around the date in whichthey took the survey. This would imply that thecomposition of 18-year-olds should strongly matchthe composition of 19-year-olds. A sample matching and weighting procedure wasused to balance the composition of 18-year-oldrespondents to 19-year-old respondents. Thisprocess is done by using the Covariate BalancePropensity Score (CBPS), which treats the 18-year-olds as a “treatment group” and 19-year-oldsas a baseline “control group.”8 The estimationprocedure then tries to achieve balance oncovariates used in the model while simultaneouslyaccounting for the conditional probability of beingin one group over the other. The former processreduces observable differences among 18-year-olds to make their demographic compositionreflect 19-year-olds.9 The latter process weightsthe data such that the two groups are of equivalentsize. After weighting, the size of the 18-year-oldsample comprises 6%, which is the same as the19-year-old sample. Any observed demographicdifferences between 18- and 19-year-olds wereminimized, and many failed to reach statisticalsignificance. The goal of this weighting process is to up-weight respondents who are most likely 18 yearsold by making them observationally equivalentto the age cohort closest to them (i.e., 19-year-olds) and to down-weight respondents who areless likely to actually be 18 years old. This way, ifrespondents who were binned at 18 years of ageare really younger than 18 years of age, it wouldbe expected that their responses would divergefrom 19-year-olds as that age gap increases.10The weighting process down-weights 18-year-oldrespondents as they diverge from 19-year-olds,minimizing the influence of that group on findings.This adjustment for 18-year-olds was included inthe standard survey weight applied to all findingsin this report. ### Page 301 1 Respondents sometimes provided responses thatseemed unlikely, for instance running away from homeat a very young age, such as two years old. Thesetypes of responses were only considered to be illogicalresponses if they contradicted other responses. In thecase of responses that were considered unlikely, theywere allowed to remain in the dataset. These outliers werenegligible in the overall findings in that only a handful ofoutliers are found in any given variable and, therefore,they do not skew the findings. Findings based on age andother variables are often presented in ranges, which alsohelps to mitigate any influence of outliers. 2 Dong, Y. & Pang, C. Y. J. (2013). Principled missing datamethods for researchers. SpringerPlus, 2, 222. 3 Online survey bias is related to demographic differencesin internet access. See e.g., Dillman, D. A., Smyth, J. D., &Christian, L. M. (2014). Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method (4th ed.).Hoboken, NJ: John Wiley & Sons; Smith, A. (2014). AfricanAmericans and Technology Use: A Demographic Portrait.DC: The Pew Research Center; Herman, J. L. & Hess, D.R. (2009). Internet Access and Voter Registration. DC:Project Vote. 4 See e.g., Flores, A. R., Brown, T. N. T., & Herman, J. L.(2016). Race and Ethnicity of Adults who Identify asTransgender in the United States. Los Angeles, CA:Williams Institute; Conron, K. J., Scott, G., Stowell, G. S., &Landers, S. J. (2012). Transgender health in Massachusetts:Results from a household probability sample of adults.American Journal of Public Health, 102(1), 118–122;Meyer, I. H., Brown, T. N. T., Herman, J. L., Reisner, S. L.,& Bockting, W. O. (in press). Demographic characteristicsand health outcomes among transgender adults in selectregions in the Behavioral Risk Factor Surveillance System.American Journal of Public Health. (accepted); Harris,B.C. (2015). Likely Transgender Individuals in U.S. FederalAdministrative Records and the 2010 Census, WorkingPaper #2015-03. DC: Center for Administrative RecordsResearch and Applications Working Papers. Availableat: https://www.census.gov/srd/carra/15_03_Likely_Transgender_Individuals_in_ARs_and_2010Census.pdf. 5 See note 4. 6 The weights for race, age, and educational attainmentwere created based on the Census Bureau’s 2014American Community Survey (ACS). 7 Respondents who are younger than 18 were removedfrom the final dataset and, therefore, are excluded from allreporting because they were not eligible to participate inthe study. 8 Imai, K. & Ratkovic, M. (2014). Covariate balancingpropensity score. Journal of the Royal Statistical Society,Series B, 76(1), 243–263. 9 Variables used for covariate balance were based on thefollowing questions: Q. 1.4; Q. 1.10; Q. 1.11; Q. 1.12; Q. 1.14; Q.1.16; Q. 1.17; Q. 1.18; Q. 2.1; Q. 2.3; Q. 2.4; Q. 2.5; Q. 2.6; Q.2.7; Q. 2.9; Q. 2.16; Q. 2.17; Q. 2.18; Q. 2.19; Q. 2.22; Q. 2.23;Q. 3.1; Q. 3.2; Q. 3.3; Q. 4.1; Q. 4.3; Q. 4.5; Q. 6.1; Q. 7.7; Q.7.12; Q. 7.13; Q. 7.14; Q. 10.1; Q. 11.1; Q. 11.2; Q. 12.1; Q. 12.8; Q.12.12; Q. 12.20; Q. 13.1; Q. 14.1; Q. 15.2; Q. 15.9; Q. 16.3; Q.16.8; Q. 17.1; Q. 17.2; Q. 17.4; Q. 17.5; Q. 17.6; Q. 17.3; Q. 17.9;Q. 18.1; Q. 18.3; Q. 19.1; Q. 20.1; Q. 20.2; Q. 20.7; Q. 21.1; Q.21.2; Q. 21.7; Q. 23.1; Q. 23.2; Q. 26.1; Q. 26.6; Q. 27.1; Q.28.1; Q. 28.2; Q. 29.1; Q. 29.2; Q. 30.4; and Q. 30.6. 10 Prior to weighing, the demographic characteristics of18-year-olds were more similar to respondents who wereidentified as being 17 years of age and had less similarityto 19-year-olds. After weighting, there are many moresimilarities between 18- and 19-year-olds and far lesscommonality with 17-year-olds. ENDNOTES | APPENDIX C ### Page 302 Updated December 2017 ustranssurvey.org | transequality.org