THE REPORT OF THE

About the National Center for Transgender Equality
The National Center for Transgender Equality (NCTE) is the nation’s leading social justice policy advocacy
organization 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 works
by educating the public and by influencing local, state, and federal policymakers to change policies and laws
to 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 reproduction
and distribution of this publication in whole or in part, provided that it is done with attribution to the National
Center for Transgender Equality. Further written permission is not required.

RECOMMENDED CITATIONJames, 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.

The Report of the2015 U.S. Transgender Survey
by:Sandy E. James
Jody L. Herman
Susan Rankin
Mara Keisling
Lisa Mottet
Ma’ayan Anafi

December 2016

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

AcknowledgementsT

he 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

Andrew Cray

Chai Jindasurat

Gabriel Rodenborn

M. V. Lee Badgett

Kate D’Adamo

JoAnne Keatley

Shelby Rowe

Kellan Baker

Laura Durso

Elliot Kennedy

Brad Sears

Genny Beemyn

Jake Eleazer

Paul Lillig

Jama Shelton

Aaron BelkinGary J. Gates

Emilia Lombardi

Jillian Shipherd

Walter Bockting

Jaime Grant

Jenifer McGuire

Sharon Stapel

Kyler Broadus

Emily Greytak

Ilan Meyer

Michael Steinberger

David Chae

Ann Haas

Shannon Price MinterCatalina Velasquez

Cecilia ChungJack Harrison-Quintana

Aaron Morris

Bianca Wilson

Loree Cook Daniels

Mark Hatzenbuehler

Asaf Orr

Kerith Conron

Darby Hickey

Dylan Orr

Ruby Corado

Lourdes Ashley Hunter

Sari Reisner

The authors extend special gratitude to the following individuals for their contributions
to 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 data
for analysis.
Daniel Merson for continued work in cleaning the data set, re-coding the data, and providing population numbers
for comparative purposes in the final report.
Michael Rauch for programming and implementation of the complex survey.

Bre Kidman

Mati Gonzalez Gil

Kory Masen

Cullen O’Keefe

Cyres Gibson

Romeo Jackson

Imari Moon

Nowmee Shehab

ACKNOWLEDGEMENTS

Appreciation is also extended to NCTE interns, law fellows, staff, and volunteers who assistedwith the project, including outreach across the country, development of outreach materials, andtranslation:1

A special thanks is also extended to USTS Interns, Fellows, and Assistants for theirwork at various stages of the project:Rodrigo Aguayo-Romero

Shabab Mirza

Jeymee Semiti

Willem Miller

Davida Schiffer

Danielle Stevens

Venus Selenite

The authors also thank the USTS Advisory Committee (UAC) members, whodevoted their time to the project by giving valuable recommendations around project
development and community outreach:
Danni Askini

Brooke Cerda Guzman

Angelica Ross

Cherno Biko

Trudie Jackson

Nowmee Shehab

Thomas Coughlin

Andrea Jenkins

Stephanie Skora

Brynn Tannehill

Additional acknowledgement goes to the more than 300 transgender, LGBT, and allied organizations
that 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 distribution
through 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.

2015 U.S. TRANSGENDER SURVEY

Various individuals and firms assisted in spreading the word about the survey, both prior
to and during the data collection phase, and they also assisted with survey translation,
design, and reporting. Thanks goes to:2

Sean Carlson

Anna Zuccaro

ThoughtWorks

Leah Furumo

Design Action Collective

TransTech Social Enterprises

Molly Haigh

Dewey Square Group

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 previous
partnership in conducting the National Transgender Discrimination Survey as a joint project from 2008 to
2011, as well as for its support of NCTE’s re-development of it as the U.S. Transgender Survey.

EXECUTIVE SUMMARY

3

USTS Executive SummaryT

he 2015 U.S. Transgender Survey (USTS) is the largest survey examining theexperiences of transgender people in the United States, with 27,715 respondents
from 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 Center
for Transgender Equality, the USTS was an anonymous, online survey for transgenderadults (18 and older) in the United States, available in English and Spanish. The USTS
serves as a follow-up to the groundbreaking 2008–09 National Transgender Discrimination
Survey (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 startling
disparities between transgender people in the survey and the U.S. population when it
comes 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. Survey
respondents also experienced harassment and violence at alarmingly high rates. Several
themes emerge from the thousands of data points presented in the full survey report.

Pervasive Mistreatment and Violence2015 U.S. TRANSGENDER SURVEY

Respondents reported high levels of mistreatment, harassment, and violence in every
aspect of life. One in ten (10%) of those who were out to their immediate family reported
that a family member was violent towards them because they were transgender, and 8%
were kicked out of the house because they were transgender.

4

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 reported
being 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 or
physically or sexually assaulted at work.

In the year prior to completing the survey, 46% of respondents were verbally harassed and
9% were physically attacked because of being transgender. During that same time period,
10% of respondents were sexually assaulted, and nearly half (47%) were sexually assaulted
at some point in their lifetime.

Severe Economic Hardshipand Instability
The findings show large economic disparities between transgender people in the survey
and 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 unemployment
rate 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 respondents
reporting 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 serious
psychological distress in the month prior to completing the survey, compared with only
5% 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%).

EXECUTIVE SUMMARY

Respondents also encountered high levels of mistreatment when seeking health care. In
the 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 being
verbally 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 because
they could not afford it.

5

The Compounding Impact of Other
Forms of Discrimination
When respondents’ experiences are examined by race and ethnicity, a clear and disturbing
pattern is revealed: transgender people of color experience deeper and broader patternsof 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 inpoverty, 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 andviolence than other respondents. In the year prior to completing the survey, nearly onequarter (24%) of undocumented respondents were physically attacked. Additionally, onehalf (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 andmistreatment. 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%).

2015 U.S. TRANSGENDER SURVEY

Increased Visibility and Growing
Acceptance6

Despite the undeniable hardships faced by transgender people, respondents’ experiences
also show some of the positive impacts of growing visibility and acceptance of transgenderpeople 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 thehistoric 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 andwomen, but also people who are non-binary, which is a term that is often used to describepeople whose gender identity is not exclusively male or female, including those who
identify 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 respondents
who 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. Given
this evidence, governmental and private institutions throughout the United States should
address these disparities and ensure that transgender people are able to live fulfilling
lives 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 public
life, 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 national
conversation 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.

EXECUTIVE SUMMARY
7

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 serious
psychological distress.

Negative experiences among those withsupportive and unsupportive families
0%

10%

20%

Experienced homelessness

30%

40%

60%

27%
45%

37%

Attempted suicide

Currently experiencing serious
psychological distress

50%

54%

31%
50%

% of respondents whose families were supportive

2015 U.S. TRANSGENDER SURVEY% of respondents whose families were unsupportive

8• 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 or
religious community left due to rejection. Forty-two percent (42%) of those who leftlater found a welcoming spiritual or religious community.

Identity Documents• Only 11% of respondents reported that all of their IDs had the name and gender they
preferred, while more than two-thirds (68%) reported that none of their IDs had thename and gender they preferred.

Updated name or gender on ID
OUT OF THOSE WHO HAD ID AND WANTED TO UPDATE IT (%)
0%

5%

10%

15%

20%

25%

40%

45%

50%

29%
43%

Social Security records

23%
31%

Student records (current
or last school attended)

18%
28%

Passport

Updated name

35%

44%

Driver’s license/
state-issued ID

Birth certificate

30%

18%
18%
9%
Updated gender• 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 not
updated 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 benefits
or service, asked to leave, or assaulted.
EXECUTIVE SUMMARY
9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 togender 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 having
at least one negative experience related to being transgender, with higher rates forpeople of color and people with disabilities. This included being refused treatment, verballyharassed, or physically or sexually assaulted, or having to teach the provider abouttransgender 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 whenneeded 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 in
the U.S. population (4.6%).
• Seven percent (7%) attempted suicide in the past year—nearly twelve times the rate in the
U.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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 of
mistreatment, such as being verbally harassed, prohibited from dressing according
to their gender identity, disciplined more harshly, or physically or sexually assaulted
because people thought they were transgender.
• Fifty-four percent (54%) of those who were out or perceived as transgender in K–12
were 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 believed
classmates, teachers, or school staff thought they were transgender
EXPERIENCES% OF THOSE WHO WERE OUT ORPERCEIVED AS TRANSGENDER

Verbally harassed because people thought they were transgender54%

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 transgender24%

Believe they were disciplined more harshly because teachers or staff thought
they 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%

EXECUTIVE SUMMARY
11

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.

Unemployment rate
RACE/ETHNICITY (%)
0%5%

Overall

10%

15%

5%

American Indian
Asian

20%

25%

10%

4%

Black

20%

10%

21%

7%

35%

Middle Eastern*
Multiracial
White

35%

23%

12%

Latino/a

30%

15%

22%

9%
4%

% in USTS (supplemental survey weight applied)12%% in U.S. population (CPS)* U.S. population data for Middle Eastern people alone is unavailable in the CPS.

• Nearly one-third (29%) were living in poverty, more than twice the rate in the U.S.
population (12%).

Employment and the Workplace

2015 U.S. TRANSGENDER SURVEY• One in six (16%) respondents who have ever been employed—or 13% of all respondents
in the sample—reported losing a job because of their gender identity or expression in
their lifetime.

12• In the past year, 27% of those who held or applied for a job during that year—19% of all
respondents—reported being fired, denied a promotion, or not being hired for a job
they 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,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 orcoworker share private information about their transgender status without theirpermission.
• 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 took
steps to avoid mistreatment in the workplace, such as hiding or delaying their gendertransition or quitting their job.

Housing, Homelessness,and Shelter Access• Nearly one-quarter (23%) of respondents experienced some form of housing
discrimination 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 of
mistreatment: seven out of ten (70%) respondents who stayed in a shelter in thepast year reported some form of mistreatment, including being harassed, sexually or
physically assaulted, or kicked out because of being transgender.

Seven out of ten respondents whostayed in a shelter in the past year
reported being mistreated becauseof being transgender.
EXECUTIVE SUMMARY• Respondents were nearly four times less likely to own a home (16%) compared to the
U.S. population (63%).

13

Sex Work and Other Underground
Economy Work• Respondents reported high rates of experience in the underground economy, including
sex 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 past
year, 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 police
harassment, 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 partner
violence 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 over
one-third (36%) were sexually assaulted during that year.

Police Interactions and Prisons• Respondents experienced high levels of mistreatment and harassment by police. In
the past year, of respondents who interacted with police or law enforcement officers who
thought or knew they were transgender, more than half (58%) experienced some form of
mistreatment. This included being verbally harassed, repeatedly referred to as the wrong
gender, physically assaulted, or sexually assaulted, including being forced by officers toengage in sexual activity to avoid arrest.

2015 U.S. TRANSGENDER SURVEY• Police frequently assumed that respondents—particularly transgender women of color—
were sex workers. In the past year, of those who interacted with law enforcement officers
who 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.

14• 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 they
were arrested because they were transgender.

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%
Overall*

5%

10%

15%

20%

25%

30%

35%

11%

American Indian
women

23%

Asian women

20%
33%

Black women

25%

Latina women
Middle Eastern
women**

30%

Multiracial womenWhite women

11%*Represents respondents of all genders who interacted with officers who thought they were transgender**Sample size too low to report• 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 times
more 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 sex
work (72%), those who have experienced homelessness (65%), and people with disabilities(61%) were more likely to have been sexually assaulted in their lifetime.

• Nearly one-quarter (24%) have experienced severe physical violence by an intimate
partner, compared to 18% in the U.S. population.

EXECUTIVE SUMMARY• More than half (54%) experienced some form of intimate partner violence, including acts
involving coercive control and physical harm.

15

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 provide
services to the public, like retail stores, hotels, and government offices. Out of
respondents who visited a place of public accommodation where staff or employees
thought or knew they were transgender, nearly one-third (31%) experienced at least
one type of mistreatment in the past year in a place of public accommodation. This
included 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.
Denied equal treatment or service, verbally harassed, or physically attacked in public
accommodations in the past year because of being transgender
LOCATION VISITED% OF THOSE WHO SAID
STAFF KNEW OR THOUGHT
THEY 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 club18%

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 office11%

Legal services from an attorney, clinic, or legal professional

6%2015 U.S. TRANSGENDER SURVEY

Experiences in Restrooms

16

The survey data was collected before transgender people’s restroom use became thesubject of increasingly intense and often harmful public scrutiny in the national media
and 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 a
restroom in the past year.
• In the past year, respondents reported being verbally harassed (12%), physicallyattacked (1%), or sexually assaulted (1%) when accessing a restroom.

• More than half (59%) of respondents avoided using
a 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 the
restroom in the past year.
• Eight percent (8%) reported having a urinary tract
infection, kidney infection, or another kidney-related
problem in the past year as a result of avoiding
restrooms.

More than half (59%) of
respondents avoided using apublic restroom in the past year
because they were afraidof confrontations
or other problems
they mightexperience.

Civic Participation and Party Affiliation• More than three-quarters (76%) of U.S. citizens of voting age in the sample reported
that they were registered to vote in the November 2014 midterm election, compared
to 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.
Political party affiliation% IN USTS% IN U.S.
POPULATION (GALLUP)

Democrat

50%

27%

Independent

48%

43%

Republican

2%

27%

POLITICAL PARTYEXECUTIVE SUMMARY
17

CHAPTER 1

IntroductionT2015 U.S. TRANSGENDER SURVEY

his 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 largestever 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.

18

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 nonconforming
people 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 could
have 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.

This report demonstrates that transgender people
continue to face discrimination in numerous areasthat significantly impact quality of life, financial
stability, and emotional wellbeing, including
employment, education, housing, and health care.
Furthermore, many respondents experienced
discrimination in multiple areas of their lives,the cumulative effect of which leads to severe
economic and emotional hardship and can in turnhave devastating effects on other outcome areas,such as health and safety.

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 people
conducted to date, far surpassing the previous
survey, with 27,715 respondents. This study
explores a wider range of topics than the previous
survey and more deeply examines specific issue
areas where transgender people are disparately
impacted, such as health care, HIV/AIDS, housing,workplace discrimination, immigration, sex work,and police interactions. Additionally, by closely
mirroring questions from federal and other existing
surveys, this study seeks to fill in the gaps leftby the lack of data collected about transgenderpeople in national surveys. Since federal survey
data 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 impact
of such policies on transgender people. This
report on the U.S. Transgender Survey data draws
comparisons between transgender people and the
U.S. population and examines disparities acrossmultiple issue areas.

Although issues impacting transgender people
have become more visible in the years since the
NTDS was published, the data overwhelmingly
demonstrates that there is still a long way to
go towards eliminating harmful discriminationand providing sustainable systems of support
for transgender people throughout their lives.
These findings are presented with the recognition
that advocates, researchers, and transgendercommunities will greatly benefit from additional
research conducted using this extensive data
source. The authors encourage subsequent
analyses to delve into areas of the data that thisreport is unable to address, and as before, will
strive to make the dataset available for suchanalyses.

INTRODUCTION

Much has changed since the NTDS was conducted
in 2008–09 and results were published in 2011,
including increased visibility of transgender people
in the media and in society in general. Despite
making significant strides in the five years since
the report was published, there is still a substantial
amount of work to be done to address critical needsin transgender communities throughout the UnitedStates. Transgender people continue to experience
discrimination and anti-transgender bias in virtually
all areas of life.

19

Report Roadmap
The next chapter of the report will give an
overview of the study’s methodology, which will
be followed by a guide to this report, including
information about terminology used throughout.
These will be followed by chapters discussing
respondents’ 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 Economy
Work• Military Service• Housing, Homelessness, and Shelter Access• Police, Prisons, and Immigration Detention• Harassment and Violence• Places of Public Accommodation and Airport
Security• Experiences in Restrooms• Civic Participation and Policy Priorities

2015 U.S. TRANSGENDER SURVEY

The report also contains three appendices,which offer more detailed information related tothe study:

20

Appendix A: Characteristics of the Sample
Appendix B: Survey Instrument (Questionnaire)
Appendix C: Detailed Methodology

CHAPTER 2

Methodology

T

METHODOLOGY

he 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-two
sections 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 public
accommodation.1 The survey was developed by a team of researchers and advocates and administered
online to transgender adults residing in the United States.2 The survey was accessible via any web-enabled
device (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 Consulting
hosted the survey on several secure servers. The survey was accessed exclusively through a website
created specifically for the promotion and distribution of the survey.3 Data was collected over a 34-day
period 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 survey
contained mainly closed-ended questions, but respondents were also offered the opportunity to provide
write-in responses in fifty-three of the survey questions. Over 80,000 write-in responses were provided byrespondents.

21

I. About the U.S.
Transgender Survey

2015 U.S. TRANSGENDER SURVEY

The U.S. Transgender Survey (USTS) was
developed as the follow-up to the groundbreaking
National Transgender Discrimination
Survey (NTDS), which was the first study tocomprehensively measure experiences and life
outcomes of transgender people in the UnitedStates. Fielded in late 2008 to early 2009 by the
National Center for Transgender Equality (NCTE)
and the National LGBTQ Task Force (“the Task
Force”), the NTDS provided data that has informed
policymakers, advocates, and educators since
its publication in 2011. However, the NTDS reportacknowledged that the study had “just scratched
the surface of this extensive data source” andencouraged advocates and researchers to
conduct additional research to continue collecting
data aimed at identifying and addressing theneeds of transgender people.5 The NTDS
authors also examined the survey instrument
and concluded that there were “imperfections”
in the manner in which several questions had
been posed.6 The authors addressed areasfor potential improvement with respect to bothsurvey question design and substantive content
in an “issues and analysis” section of the report.7
These recommendations were considered in thedevelopment of the U.S. Transgender Survey.

22

In subsequent years, researchers have
performed additional analyses using the NTDS
public use dataset provided by NCTE and theTask Force. These analyses provided further
insight into the experiences of transgenderpeople, but also increased awareness of thequestions that remained unanswered after the
NTDS report was published. In some instances,
there was insufficient information to draw
nuanced comparisons between life outcomesof transgender people collected in the NTDS
and the U.S. general population. In other cases,

the ability to form additional conclusions waslimited due to a lack of follow-up questions. For
example, the NTDS asked a single question aboutsuicide attempts, which did not allow for a clear
examination of suicidal thoughts and behaviors.8
Additionally, given the deficiency of longitudinal
data on outcomes specific to transgender people,
there remained a need to collect data that could
speak to the experiences of transgender people
over time and how outcomes may have changedin the years since the NTDS was published. In
these respects, the NTDS provided an important
platform upon which to build the USTS to address
identified 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. Transgender
Survey for several reasons. One was to clarify
the geographical location of the intended study
sample both during the data collection period
and 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, considering
relevant policies, procedures, and practices
applicable 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 differences
between the experiences of transgender people
in the U.S. and in other parts of the world, theresearch team sought to dispel any confusion
arising from the use of “national” in the title. The
new name was also intended to reflect the depth
and 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 as
experiences of acceptance and affirmation.
“Discrimination” was removed from the title toclarify that the survey was designed to capture allsuch experiences. Additionally, removing the word

reduced potential bias in respondents’ answers or
resulting from primarily attracting respondents who
felt they had experienced discrimination.

II. USTS Respondents
The study population included individuals who
identified as transgender, trans, genderqueer,
non-binary, and other identities on the transgender
identity spectrum, in order to encompass a wide
range of transgender identities, regardless ofterminology used by the respondent. Although“transgender” was defined broadly for the
purposes 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 might
have assumed that the term “transgender” did
not include them. To address this, promotional
materials affirmed that the survey was inclusiveof all transgender, trans, genderqueer, and nonbinary people. Additionally, materials specified thatthe survey was for adults at any stage of their lives,
journey, or transition to encourage participation
among individuals with diverse experiences
regarding their transgender identity. An in-depth
description of survey respondents is available in
the Portrait of USTS Respondents chapter.

The sample was limited to individuals currently
residing in a U.S. state or territory, or on a U.S.
military base overseas, since the study focused on
the experiences of people who were subject to
U.S. laws and policies at the time they completed
the survey. Individuals residing outside of the U.S.
may have vastly different experiences across anumber of outcome measures based on each
respective country’s laws, policies, and culture,
particularly in the areas of education, employment,
housing, and health care. Additionally, many
survey questions were taken from U.S. federal
government surveys that also limit their sample
population to individuals in the U.S., and theresearch team sought to examine a similar
population with regard to geographical location
to allow for comparisons to the U.S. general
population.

III. Developing theSurvey Instrument
The USTS survey instrument was developed overthe course of a year by a core team of researchers
and 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 current
and emerging needs of transgender people
while gathering information about disparities

METHODOLOGY

The study included individuals aged 18 and older
at the time of survey completion, as did the NTDS.
The study was not offered to individuals under
the 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 not
specifically tailored to transgender people under
the age of 18.

23

2015 U.S. TRANSGENDER SURVEY

that often exist between transgender people
and non-transgender people throughout the U.S.
To achieve this, questions were included thatwould allow comparisons between the USTS
sample and known benchmarks for the U.S.
population as a whole or populations within the
U.S. Consequently, questions were selected tobest match those previously asked in federal
government or other national surveys on a numberof measures, such as measures related to income
and health.10 Changes were made to the languageof comparable questions whenever it was required
to more appropriately reflect issues pertaining totransgender people and language in common use
in the transgender community while maintaining
comparability 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 the
U.S. Census Bureau’s American Community Survey
and Current Population Survey.

24

Several questions were also included in an
attempt to provide comparability between the
NTDS, where possible, to determine how certain
outcomes may have changed since the NTDS
data was collected in 2008–09. While the USTS
provides crucial updated data, it is important tonote that many of the questions asked in the NTDS
were either not included in the USTS, or they wereasked in a manner that reduced comparability with
the NTDS. For example, many USTS questions
asked about whether certain experiences
occurred within the past year instead of asking
whether those experiences occurred at any point
during an individual’s lifetime. These questions
were included for both comparability with federal
government or other national surveys and also
to yield improved data regarding changing
experiences in future iterations of the USTS. In
such instances, the NTDS continues to provide
the best available data regarding experiencesthat occurred over respondents’ lifetime. The
authors suggest referring to both the USTS andthe NTDS to gain a full picture of issues impacting
transgender people.
The survey instrument was reviewed byresearchers, members of the transgendercommunity, and transgender advocates at multiple
intervals throughout the development process.
This included thorough reviews of sections that
addressed specific subject matter and the entire
questionnaire. The questionnaire was revised
based on feedback from dozens of reviewers.

a. Pilot Study
Prior to finalizing the survey instrument andlaunching the survey in field, a pilot study
was conducted to evaluate the questionnaire.
The pilot study was conducted among a small
group of individuals with characteristics thatwere representative of the sample the study
was intended to survey. The pilot study wasadministered through an online test site using
the same platform and format in which the final
survey later appeared. The purpose of the pilot
study was to provide both a substantive andtechnical evaluation of the survey. Approximately
100 individuals were invited to complete andevaluate the survey online during a specified
period of time. In order to receive access to thepilot study test site, invitees were required toconfirm their participation by indicating that they
met the following pilot study criteria: they were
(1) 18 years or older, (2) transgender, (3) willing toprovide feedback that would be used to make
improvements 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 compromise
the study. Forty (40) individuals confirmed their
participation and received access to the pilot
study test site. Thirty-two (32) people completed
the study and submitted feedback on thequestionnaire, including participants in fifteenstates ranging in age from 19 to 78. Participantsreported identifying with a range of gender
identities11 and racial and ethnic identities,
including 34% who identified as people of color.12
In addition to providing general feedback on
individual questions and the entire questionnaire,pilot study participants were asked to address
specific 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 questions
were confusing or difficult to answer, (4) whether
they found any questions offensive or thought
they should be removed or fixed, (5) whether theyexperienced technical or computer issues while
taking the survey, and (6) what they thought about
the statement explaining why the term “trans”
was used throughout the survey.13 All participant
feedback 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

Despite observations about survey length
discussed in the NTDS,15 evolving data needs
relating to issues affecting transgender people
required an in-depth treatment of multiple issue
areas. This often required multiple questions tothoroughly assess an issue—including in areas
where the NTDS asked only one question—andresulted in a lengthier survey. Survey instrument
length was assessed throughout its development
to ensure it would be manageable for as many
participants as possible. Furthermore, throughmultiple reviews and evaluations of the survey
instrument—including the pilot study—survey
takers reported that the length was appropriate fora survey addressing such a wide range of issues
and the need for data outweighed concerns about
the overall length of the survey.

IV. Survey
Distribution andSample Limitations
The survey was produced and distributed in an
online-only format after a determination that it
would not be feasible to offer it in paper format
due to the length and the complexity of the skip
logic required to move through the questionnaire.
With so many unique possibilities for a customized
survey experience for each respondent, theintricate level of navigation through the survey

METHODOLOGY

The final survey questionnaire contained a totalof 324 possible questions in thirty-two discrete
sections 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 survey
platform allowed respondents to move seamlessly
through the questionnaire and ensured they only
received questions that were appropriate basedon previous answers. This was accomplishedusing skip logic, which created unique pathways
through the questionnaire, with each next stepin a pathway being dependent on an individual
respondent’s answer choices. For example,
respondents who reported that they had servedin the U.S. Armed Forces, Reserves, or National
Guard received a series of questions about theirmilitary service, but those who had not served

did not receive those questions. Due to thecustomized nature of the survey, the length varied
greatly between respondents, and no respondent
received all possible questions. Prior to the pilot
study, estimates indicated a survey-completiontime of 30–45 minutes. The completion-time
estimate was extended to 60 minutes based on
feedback from pilot study participants, and it wasconsistent with many reports during the fielding
period.14

25

would have created an undue burden andconfusion for many respondents. This could have
led to questions being answered unnecessarilyor being skipped completely, which could haveincreased the potential for missing data in the final
dataset.16 This made online programming the best
option for ensuring that respondents received allof the questions that were appropriate based on
their prior answers, decreasing the probability of
missing data. However, the potential impact ofinternet survey bias on obtaining a diverse sample
has been well documented in survey research,17
with findings that online and paper surveys may
reach transgender respondents with “vastlydifferent health and life experiences.”18 With thoseconsiderations in mind, outreach efforts werefocused on addressing potential demographic
disparities 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 important
to note that respondents in this study were notrandomly sampled and the actual population
characteristics of transgender people in the U.S.
are not known. Therefore, it is not appropriate
to generalize the findings in this study to alltransgender people.

2015 U.S. TRANSGENDER SURVEY

V. Outreach26

The main outreach objective was to provide
opportunities to access the survey for as manytransgender individuals as possible in different
communities 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-ofaccess, including transgender- or LGBTQ-specificorganizations, support groups, health centers, andonline communities.
Outreach efforts began approximately six
months prior to the launch of the data-collection
period with a variety of tactics designed to raiseawareness of the survey, inform people when it
would be available, and generate opportunities
for community engagement, participation,and support. A full-time Outreach Coordinator
worked 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 developing
lists of active transgender, LGBTQ, and alliedorganizations who served transgender people andwould eventually support the survey by spreading
the word through multiple communication platforms
and in some cases providing direct access to thesurvey at their offices or facilities. Establishing
this network of “supporting organizations” was an
essential component of reaching a wide, diverse
sample of transgender people.
Over 800 organizations were contacted by email,phone, and social media, and they were asked
if they would support the survey by sharing
information about it with their members andcontacts. Specifically, supporting organizations
were asked to share information through email
blasts and social media channels, and theresearch team provided language and graphics
for organizations to use in an effort to recruit
appropriate respondents into the study. Of theorganizations contacted, approximately half
responded to requests for support, resulting in
direct recruitment correspondence with nearly
400 organizations at regular intervals during
the pre-data-collection period and while thesurvey was in the field.20,21 These organizations

performed outreach that contributed to thefar reach of the survey and unprecedented
number of respondents.22 The organizations
were also featured on the survey website sopotential respondents could determine whetherorganizations they knew and trusted had pledged
support for the survey.
Nearly 400 organizations responded to outreachand confirmed their support for the survey. The
remaining organizations did not respond directly
to invitations to learn more about the survey
and become supporters. Consequently, theseorganizations did not receive correspondence
aimed at directly recruiting respondents prior to
the survey launch or during the data-collection
period. It is possible, however, that survey
respondents were still made aware of the survey
through those organizations. Since there is no
information regarding whether these organizations
shared information about the survey through theirchannels, it is difficult to assess the full scope ofthe outreach efforts.

a. Advisory Committeeb. Survey-Taking Events
In an effort to increase accessibility of the survey,
the outreach team worked with organizations
across the country to organize events or venues
where people could complete the survey. SurveyTaking Events,24 or “survey events,” were spaces inwhich organizations offered resources to provide
access to the survey, such as computers orother web-enabled devices. These organizations
provided a location in which to take the survey at
one 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 internet
access, 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 as
being more likely to take a paper survey than an
online survey were considered,26 and the eventswere developed to target those individuals.
Given the potential variety of these survey
events—including the types of available resources
and times at which they were conducted—
guidelines were needed to maintain consistency
across the events and preserve the integrity of thedata-collection process. A protocol was developed
outlining the rules for hosting a survey eventto advise hosts on best practices for ensuring

METHODOLOGY

A significant element of outreach involved
convening a USTS Advisory Committee (UAC).
The UAC was created to increase community
engagement in the survey project and raiseawareness by connecting with transgender people
in communities across the country through avariety of networks. The UAC was comprisedof eleven individuals with advocacy, research,and lived experience from a wide range of
geographical locations.23 Members were invited
to join the committee as advisors on survey
outreach 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. UAC
members participated in five monthly calls withmembers of the USTS outreach team from May

to September 2015. UAC monthly calls focusedon providing project updates and identifying
pathways by which outreach could be conducted
to 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.

27

2015 U.S. TRANSGENDER SURVEY

a successful data-collection process, including
guidelines to prevent the introduction of bias into
survey responses. The protocols described thesteps for becoming a survey-event host and tips
for how to conduct outreach about the event. The
protocol also specified that hosts should inform
NCTE of their event prior to hosting and report on
how many people attended the event and how
many people completed and submitted the survey.
This was helpful information for evaluating therelative success and benefits of these events. All
confirmed supporting organizations were invited
to become survey event hosts, and those who
accepted the invitation were sent the protocol.
Seventy-one (71) organizations accepted theinvitation and confirmed the date(s) and time(s) of
their events.27

28

Survey events were promoted on the survey
website and given a specific designation on the
supporting organization map (described further
in the “Survey Website” section), including
information about where and when people could
attend. Hosts were encouraged to promote theirevent through multiple channels and consider
outreach methods beyond online avenues,
such as direct mail or flyers, to better reachtransgender people with limited or no internet
access. Additionally, hosts were provided withflyer templates so they could promote the eventsin their facilities or through communications
with their members or constituents. Of theorganizations who confirmed their survey events,
46 reported information about attendance atthe event. The hosts reported that 341 people
attended their events, including transgender andnon-transgender friends, family, and volunteers.
Approximately 199 respondents completed
the survey at these events.28 However, survey
responses indicate that additional unreported
survey events or similar gatherings may have been
held where participants had an opportunity tocomplete the survey.29 Event-related information
submitted by organizations following the fielding

period was not comprehensive enough to make athorough determination as to whether the events
had 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 widely
accepted as a means by which to encourage andincrease participation in survey research.31 Studies
have 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 Research
has also found that lottery-style cash drawings
may be beneficial in online surveys,33 since they
offer a practical method for providing incentives
in surveys with a large number of respondents byeliminating the potential high cost of both the cash
incentive and prize distribution.34
USTS respondents were offered the opportunity
to enter into a drawing for one of three cash
prizes upon completion of the survey, including
one $500 cash prize and two $250 cash prizes.35
After completing and submitting their anonymous
survey responses, USTS respondents were redirected away from the survey hosting site36 to a
web page on the NCTE-hosted USTS website. In
addition to being thanked for their participationon this page, respondents received a message
confirming that their survey had been submitted
and any further information they gave would not
be connected to their survey responses. Only
individuals who completed and submitted thesurvey were eligible for one of the cash prizes.
To enter into the prize drawing, respondents
were required to check a box giving their consent
to be entered.37 Respondents were also asked
to provide their contact information in order tobe notified if selected in the drawing. The final
drawing contained 17,683 entrants. Each entrant
was assigned a number, and six numbers wererandomly chosen by a non-NCTE party: threenumbers for the prize winners and three foralternates if necessary. The three prize winners
were contacted and awarded their prizes upon
acceptance.

VI. Communications
Communications for the survey required amultifaceted approach and a coordinated effort
with the outreach strategy to most effectively
reach a wide range of transgender people andensure a robust sample size. The goals of survey
communications were to: (1) inform people that
NCTE would be conducting a survey to further theunderstanding of the experiences of transgenderpeople in the U.S initially gleaned through the
NTDS, (2) communicate when the survey would
be available to complete and how it could beaccessed, and (3) find creative ways of reaching
diverse populations of potential respondents. This
involved raising awareness of the survey throughseveral communication methods, including email,social media, and print media, as well as throughadditional unique campaigns. Many survey
promotional materials were produced in English
and Spanish to increase the accessibility of thesurvey.38

a. Survey Website

b. Survey Pledge
The survey pledge campaign was developed toraise awareness about the survey and generate
investment in the project. The campaign engaged
potential 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 sustaining
engagement with potential respondents in themonths leading up to the fielding period. Pledges
received reminders about the survey launch date
and availability through email communications.
Beginning in January 2015, pledge palm cards
were distributed at a variety of events acrossthe country, including conferences and speaking
engagements. The cards contained information
about 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, either
through a palm card or directly online through thesurvey website. Individuals who completed pledge
information received email communications
throughout the pre-data-collection phase. Pledge
information was collected continuously for several
months, and by the time of the survey launch, over
14,000 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

METHODOLOGY

A website was created and designed specificallyfor the promotion and distribution of the survey.39
This website served as a platform for providing
information about the survey starting several
months prior to its release in the field, such as a
description of the survey, information about theteam working on the survey, frequently asked
questions, and sample language and graphics forindividuals and organizations to use for email andsocial media communications, including sample
Facebook and Twitter postings. The website
also featured an interactive map, which included

information about organizations that had pledged
to support the survey. Additionally, the map
distinctly indicated information about organizations
that were hosting survey-taking events, including
the date, time, and location of such events. The
website later served as the only platform throughwhich the survey could be accessed and provided
English and Spanish links to enter the survey, since
there was no direct link available to the off-sitehosting platform.

29

an effective method of assessing how many
people had learned about the survey and wereinterested in completing it, where potential survey
respondents were distributed geographically,and how more potential respondents could be
effectively engaged.

c. Photo Booth Campaign
In January 2015, a photo booth campaign was
launched as another method for engaging
people and raising awareness about the survey.
Individuals and groups were asked to takephotos holding one of two signs with messages
expressing support for the survey.41 USTS photobooths were conducted at several conferencesand events across the country. More than 300
photos were collected and shared directly through
NCTE’s Facebook page. Photos were also sent tomost participants so they could conduct their own
promotion using their photos.

2015 U.S. TRANSGENDER SURVEY

d. Social Media

30

With the increased use of social media in theyears since the previous survey (the NTDS), it
was important to engage via these outlets tofurther the reach of the survey. Facebook andTwitter42 became the primary social media outlets
used throughout the survey project, and theiruse significantly amplified awareness, increasing
the number of people who were exposed to thesurvey. A series of postings provided the ability
to 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 during
the months leading up to the survey launch, over
96,000 Facebook users were estimated to havereceived NCTE’s post announcing that the survey
was 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 three
categories: (1) people who had signed up to takeor spread the word about the survey (“pledge list”),(2) organizations that had committed to support
the survey through outreach efforts (“supportingorganization list”), and (3) people who had signed
up 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 campaign
was designed to share a significant amount of
information about the survey over a concentrated
period of time in close proximity to the launch of
the survey. Awareness Week occurred during theweek of July 27, 2015 and highlighted different
aspects of the survey focusing on a different
medium 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 planning
kit for the campaign, which was available on
the survey website. The planning kit included
language and graphics for email and social media
communications. Communications were sent
on each of the days devoted to social media,43
email,44 and blogs45 with appeals for organizations
to share the information with their membershipand individuals to share the information throughtheir personal networks. Awareness Week proved
to be one of the most effective methods forincreasing the number of individuals who pledged
to take the survey and likely increased the numberof eventual respondents.46

f. Additional Communications
Methods
The overall approach to survey communications
was diverse and captured many media forms. In
addition 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 media
sources aided in expanding the survey’s reacheven further. Approximately 50 articles, blogs,
and op-eds focused on the survey were produced
and distributed by organizations, including NCTE,
and individuals prior to the launch of the survey
and during the data-collection period. The wide
variety of approaches contributed to the numberof individuals who were reached through allcommunications and likely impacted the final
number of respondents in the sample.

VII. Language andTranslation
Throughout the survey questionnaire, the use ofaccessible language was balanced with preserving
the meaning of each question to the greatest
extent possible. This was of particular importancein maintaining comparability with questions fromexisting surveys that allowed conclusions to be
drawn about how the experiences of the USTS
sample compares to the U.S. population. In
order to make assessments about USTS survey
respondents in relation to the U.S. population, it
was important that USTS respondents had similar

The research team remained conscious ofindividual and collective identities throughout
the survey instrument drafting process, andattempted to use language that acknowledged thebreadth and significance of individual identities
while also making the questions accessible
to the widest range of transgender people
possible across the U.S. and in the territories.
The questionnaire was reviewed and revisedfor consistent readability at an eighth-grade
literacy level where possible,47 although several

METHODOLOGY

interpretations of questions taken from othersurveys as non-transgender survey takers hadto those questions in federal surveys. In many
places, language was revised to use terminologythat would most appropriately speak to individuals
in the many communities for which the survey
was intended. However, several areas required
difficult choices about keeping language that may
have caused discomfort for some respondents.
Throughout the questionnaire, language wasavoided that could be interpreted as stigmatizingor characterized as a value judgment wherever
possible while maintaining objectivity in craftingsound research questions. For example, at times
survey questions referred to work or activities
that were “currently considered illegal.” Such
deliberate language was used in an attempt toseparate the issue of criminalization from theactivity in question while maintaining comparability
with other surveys. This was a difficult balance
to achieve throughout the survey. Eliminating
technical language was also necessary, unless
it was widely used and accepted in transgendercommunities, such as some medical terminology.
Short descriptions or parenthetical explanations
were provided whenever technical language was
required for those who may not have been familiar
with the language. Additionally, hyperlinked
explanations of specific terms were included whenthose terms could be interpreted in several ways
or if similar explanations were provided in thefederal surveys from which the questions weretaken. For example, explanations were provided
for the terms “active duty” when asking about
military service and “household” when asking
about income.

31

terms used in the survey were at a considerably
higher literacy level. This included places wherelanguage was preserved for comparability withother surveys and when language describing
transgender-specific experiences or procedures
was used. Additionally, community members andresearchers reviewed the survey and suggested
revised language throughout the development
process. This collaborative process was beneficial
in providing collective insight on the best language
to use in each particular instance based on lived
experience and research expertise. The researchteam acknowledges, however, a continuing need
to work towards identifying suitably inclusive
terminology within an evolving language andcommunity for future iterations of the survey.
The questionnaire was translated into Spanish bya translation service, and several native-Spanishspeaking community members and NCTE staff andinterns reviewed and revised the language to use
terminology that was most prevalent in Spanishspeaking transgender communities in the U.S. In
many 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 to
the English-language question interpretations as
possible.

2015 U.S. TRANSGENDER SURVEY

VIII. Institutional
Review

32

The study was vetted through an Institutional
Review 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 review
by the University of California Los Angeles(UCLA) IRB. As a requirement of approval, thequestionnaire began with a study information

sheet describing aspects of the study and rights
of individuals as participants in the study.48
To be included in the study, participants wererequired to indicate their consent at the end of
the information sheet. This process establishedthat participants were fully informed about therisks and benefits of participating in the study andthat their participation was voluntary. IRB review
also required the submission of all recruitment
materials leading up to the launch of the survey
and throughout the time the survey was in thefield.49 This required the production of a large
volume of messaging for the many different
types of media through which people wereinvited to participate in the survey in both English
and Spanish. It also required anticipating how
messaging might need to change while the survey
was 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 of
USTS research team member, Dr. Susan Rankin.
Access to the survey was provided exclusively
through the USTS website. All programming of
the questionnaire and online administration of thesurvey was handled through Rankin & Associates
Consulting, which managed the process ofcollecting the survey data throughout the 34-day
fielding period.
The survey was anonymous, and maintaining
privacy 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 that
confidentiality protections were in place forthe study and demonstrate sufficiency of data
security protocols. Accordingly, data from online

participants was submitted through seven secure
firewalled servers with forced 256-bit SSL (Secure
Sockets Layer) security and Security-Enhanced
Linux (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 that
could only be accessed locally. The servers
themselves were only accessible using encrypted
SSH (Secure Shell) connections originating fromthe local network. The servers were also in RAID
(Redundant Array of Inexpensive Disks), which
is a data storage virtualization technology thatcombines multiple physical disk drive components
into a single logical unit for the purposes of data
redundancy, performance improvement, or both,to reduce the chance of any data loss due tohardware failure. The servers performed nightly
security audits from data acquired via the systemlogs and notified the system administrators.

X. Cleaning the Data
The dataset was cleaned following collection toremove survey responses that did not belong in
the 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” using
commonly accepted procedures.53 The first step
was to remove survey responses from individuals
who did not consent to take the survey and those
who did not meet the eligibility criteria, such as
not being at least 18 years of age and not residingin the U.S. These survey respondents had been
automatically sent to a disqualification page,54
but their responses were included in the initial
dataset. Incomplete responses were then removed
from the sample based on a requirement that
respondents minimally complete specific questionsin Section 2 of the questionnaire to be includedin the final dataset.55 Duplicate survey responses
were removed next, as were those with illogicalresponses, such as those with contradictory
responses to related questions. Missing-data
analyses 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

METHODOLOGY

Despite a successful data-collection period
evidenced by the large final sample size, it isimportant to note issues that occurred in the initialdays of the survey data-collection period, given
the potential impact on the data collection andthe final sample. Prior to the survey launch, theonline platform had been assessed and capacity
was predicted for the seven dedicated servers
based on reasonable estimated response rates.
However, in the first days of the data-collection
period, exceptionally high levels of traffic to thesurvey far exceeded the predicted response rates
and overwhelmed the capacity of the servers,
causing significant delays in accessing andcompleting the survey. The resulting server delays
occurred within hours of the survey launch on
August 19, 2015, producing unusually long pageloading times and may have served as a barrier tocompleting the survey.50 The survey team notified
potential respondents of the delays through email
and 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 loading
speeds within a couple days of the initial reports.
Although high numbers of survey submissions
were 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.

33

2015 U.S. TRANSGENDER SURVEY

in several questions for improved analysis or
to match existing categories for comparison toother surveys. Answers were evaluated for thosequestions that allowed a write-in response when
the selected option was “not listed above.” Insome cases, these answers were recoded into
existing answer choices where appropriate, andin other cases, new answer categories werecreated for write-in responses that were frequently
repeated. The recoding process included twocoding teams. The first coding team conducted
initial data recoding, and the second teamreviewed the recoding and flagged areas ofdisagreement. A simple percent agreement score
was calculated to determine inter-rater reliability.57

34

Several survey weights were developed forpresentation of results in the report.58 A raceand ethnicity weight was developed basedon the Census Bureau’s 2014 American
Community Survey (ACS).59 Additionally, given thedisproportionally large number of respondents
who 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 weight
and the 18-year-old weight were both included
in a “standard weight” applied to the dataset.
All results presented in this report are weighted
based on the standard weight unless otherwise
noted. Additional survey weights were created
for the purposes of comparability with federal
government and national data sources, including
weights for age and educational attainment.61
These weights were applied in addition to thestandard weight when comparing the USTS
sample to the U.S. population for items that are
sensitive to age and educational attainment, suchas individual and household income, and arenoted accordingly as the “supplemental weight.”

XI. Data Analysis
and Presentation of
Findings
The data was first analyzed to tabulate individual
responses to each of the questions in the survey.
The respondents included in each tabulationdiffered throughout the survey due to certain
questions only being asked of a particular set of
respondents and/or due to some respondents
choosing not to answer a question. Analyses
were performed to explore how survey responses
differed based on demographic characteristics—
such as race, gender, and income—and nondemographic factors—such as experience with
sex work, HIV status, and experiences of family
support or rejection.
All findings in the report are presented asweighted percentages of the entire sample
or of the subgroups being examined. For
example, educational attainment is presented
as a percentage of the whole sample, whilemuch of the data related to HIV care represent
percentages of those respondents who areliving with HIV. In limited instances, unweighted
frequencies are included where the additional
information could be informative and to provide
context for the weighted percentages reported.
Percentages are rounded to whole numbers,
except in cases where a more exact comparison
to national data sources was desired or wheremore precision was needed due to the reported
percentages being small. When rounding to whole
numbers, the following convention was generally
followed: findings containing decimals of 0.50
and above were rounded up, and findings with
0.49 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 below
was generally labeled “less than 1%” or “<1%.”
Throughout the report, results are presented invarious figures and tables. The percentages inthese figures and tables do not always add up
to 100% due to respondents being able to selectmore than one answer to a question (“mark all that
apply”) or due to rounding.
Throughout the report, U.S. population findings
are provided for comparison to USTS findings
or 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 years
and older) to most appropriately match the USTS
sample. Whenever that was not possible, notes
as to age ranges or other limitations are provided.
Additionally, calculations made by the researchteam when necessary to present U.S. population
findings are noted. Data in this report is generally
presented without information regarding statistical
testing.62

ENDNOTES | CHAPTER 2: METHODOLOGY

1

The survey included questions related to the following
topics (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 partner
violence; military service; police and incarceration; policy
priorities; public accommodations; sex work; sexualassault; substance use; suicidal thoughts and behaviors;
unequal treatment, harassment, and physical attack; andvoting.

See e.g., The GenIUSS Group. (2014). In J. L. Herman(Ed.), Best Practices for Asking Questions to Identify
Transgender and Other Gender Minority Respondents
on 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 simple
sentences. 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 of
the term transgender, masculine, and feminine.”). Given
the need to collect data about the unique experiences oftransgender youth, it is important to design and conduct
future studies focusing on the issue areas and needs mostapplicable to transgender youth.

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 and
September 21, 2015.

10

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 National
Gay and Lesbian Task Force.

Information about the source of survey questions used
for comparison to the U.S. population can be found in
Appendix C (Detailed Methodology).

11

Forty-four (44%) of pilot participants identified as a woman
or trans woman (MTF), 41% as a man or trans man (FTM),
and 16% as non-binary or genderqueer.

6

Grant et al., p. 182.

12

7

Grant et al.

8

See Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014).
Suicide Attempts Among Transgender and Gender NonConforming Adults. New York, NY & Los Angeles, CA:
American Foundation for Suicide Prevention & Williams
Institute.

These pilot participants identified as American Indian,
Asian, multiracial, Black, Latino/a, and a racial/ethnic
identity not listed above, in addition to 66% who identified
as white.

13

The following statement was provided to explain why
the word “trans” was used throughout the survey: We
know that not everyone is comfortable with the word
“transgender,” but for this survey, we must use one word
to 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.”

5

METHODOLOGY

935

2015 U.S. TRANSGENDER SURVEY

1436

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 takers
overwhelmed multiple servers, causing lengthy delays
when 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 completed
that survey online or in paper format found that surveys
completed 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 inperson and online survey respondents in the U.S. National
Transgender 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: The
Tailored Design Method (4th ed.). Hoboken, NJ: John
Wiley & 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 than
online respondents (all p<0.05). In-person respondents
also were more likely than online respondents to be
current 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 obtaining
the largest sample of transgender respondents evercollected, a longer outreach period may have resulted inreaching more individuals in communities that are often
underrepresented 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 various
information 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 about
the outreach did not allow a calculation of a response
rate. Of the 392 organizations that pledged their support,
58 (15%) reported information on their outreach activities
and estimated reaching over 20,000 transgender people
through their channels. In the future, researchers areencouraged to collect consistent outreach activity datafrom supporting organizations that will help to better
assess the effectiveness of outreach and response rateestimates.

23

Information about UAC members can be found in the
Acknowledgements 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 did
not appropriately capture the nature of these vastlydiffering events. A lack of clarity may have decreased thenumber of people who attempted to access the survey
through 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 participants
use of its resources (including computers, tablets, andinternet access) to complete the USTS. This will occur
during specified periods of time or throughout the time
the survey is available on a drop-in basis. For example,
a community center might participate by setting aside
one Saturday from 9am–6pm where some or all of its
computers are available for survey takers to use, or it
might host people on Monday–Friday from 5pm–9pm
each evening for a week, or longer.”26

A total of 435 NTDS respondents completed the survey
in paper format (7% of the sample) and were found todiffer from online survey takers in sociodemographic
characteristics, 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 intervals
throughout the data-collection period, it appeared that
more organizations hosted survey events or similar
gatherings to complete the survey without reportingthem to the survey outreach team. Additionally, it is also
possible that individuals and organizations held informal
parties where groups of friends could gather to complete
the 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 later
time.

29

Four hundred and seventeen (417) respondents answered“yes” in response to the following survey question: “Are
you taking this survey at a survey event or meeting, suchas one hosted by an LGBTQ or Trans organization or
meeting?”

30

In future iterations of the USTS and other research studies,
the research team suggests a more robust approach
towards organizing, conducting, and monitoring survey
events to increase the reach and availability of such
events in providing access to the survey. Researchers
are also encouraged to conduct follow-up analyses todetermine the demographic characteristics of individuals
who completed the survey at events and whether
these events were successful in capturing a similar
demographic to those who had completed paper surveys
in the previous survey. See Reisner, et al. (discussing thedemographics of online and paper respondents in the
NTDS).
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 “material
incentives increase the odds of a person responding by
19% over the odds without incentives”).

32

Pedersen, M. J. & Nielsen, C. V. (2016). Improving survey
response rates in online panels: Effects of low-cost
incentives and cost-free text appeal interventions. Social
Science Computer Review, 34(2), 229–243.

33

Pedersen et al., pp. 237–238.

34

Singer, E. & Ye, C. (2013). The use and effects of incentives
in surveys. The ANNALS of the American Academy of
Political and Social Science, 645(1), 123–124.

35

Participants were informed of the cash prize incentives
in several ways. The study information sheet placedat the beginning of the survey prior to obtaining each
respondent’s consent to enter the survey contained
the following information in response to the question ofwhether respondents would be paid for their participation:“You will receive no payment for your participation. You
will have the option to voluntarily enter a drawing to win
one 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 option
to enter a drawing to win one of three cash prizes: one
prize 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 the
cash-prize drawing, including email blasts.

40

Final pledge numbers were 14,005 and 561 for survey
takers and promoters, respectively.

41

Photo booth participants could choose from one of two
signs indicating that the survey was coming in the summerof 2015 and stating the following: (1) “My Voice Counts: I’m
Taking 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 social
networks to join us” or (2) “Please join Social Media
day. We have sample copy and a variety of photos andgraphics.”

44

For email day, recipients received one of the following
requests, based on whether they were organizations or
individuals: (1) “Email a friend explaining why this is so
important 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 blog
written by Outreach Coordinator, Ignacio Rivera, cross
post the blog on an organization’s blog site, or draft a blog
about the importance of the survey.

46

The number of individuals who pledged to take the survey
on the pledge list increased from approximately 7,700
when the initial Awareness Week email was sent on July
15 to over 14,000 at the time the survey launched in thefield. The 82% increase in the numbers of survey pledges
is 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 eighth
grade reading level.

The survey was hosted by Rankin & Associates
Consulting. Further details are described in the “Survey
Hosting” section.

48

Due to IRB requirements, the language in the study
information sheet was generally at a higher literacy level
than the rest of the questionnaire.

37

The check box stated: “Enter me in the drawing for oneof three cash prizes: one prize of $500 and two prizes of$250!”

49

This included all materials aimed at “recruiting” or getting
people to participate in a research study, such as website
pages, flyers, emails, and social media messages.

38

Due to limited funding, it was not possible to translate
all survey materials, such as email communications.
Translation of all promotional materials may positively
impact the response rate amongst respondents withlimited English proficiency in future iterations of the study.

50

The research team received reports that it took someindividuals up to several hours to complete the survey
on the first day, and others reported that they were notable to complete or submit their survey at all due to thetechnical issues.

39

www.USTransSurvey.org

METHODOLOGY

36

37

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, we
encourage 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 hit
the ‘back’ button. However, if you close your browser, you
may 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

2015 U.S. TRANSGENDER SURVEY

55

38

Ineligible respondents were sent to one of two
disqualification pages notifying them of their ineligibility
and providing either an opportunity to visit the survey
website for more information or giving information about
their gender identity or expression and experiences
related to gender identity or expression.
See Appendix C (Detailed Methodology) for more
information on the Section 2 questions that were required
to 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. See
Appendix 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 outside
researcher. One researcher on each team conducted
the initial coding and the other researcher reviewed
the 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 more
representative of the population from which the sample
was drawn. For example, the proportion of respondents
aged 18–24 and 25–44 in a survey sample taken in the
U.S. may differ from the proportion of those age groups in
the total U.S. population. Therefore, weights are applied
to survey data in order to make comparisons between
the collected survey data and the total population. See
Appendix C (Detailed Methodology) for more detailed
information 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. American
Journal of Public Health, 102(1), 118–122. However,the USTS sample has a higher percentage of white
respondents than the U.S. general population. To help
correct for this sampling bias, the research team applied
U.S. population weights for race and ethnicity. While thismay still over-represent white respondents, this weighting
procedure brings the sample closer to what is estimatedto be the true population distribution for race and ethnicity
for transgender people.

60

The weight for 18-year-old respondents was createdwith propensity scores developed using a regression
discontinuity model. For more information on this process
and other weighting procedures, see Appendix C(Detailed Methodology).

61

The age, race, and educational attainment weights werecreated based on the Census Bureau’s 2014 American
Community Survey (ACS).

62

Due to the large sample size, bivariate statistical tests
largely result in statistically significant differences among
the groups being compared. Small group differences often
will be found to be statistically significant, even when
the differences are small and, therefore, not particularly
meaningful. 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 test
statistic and effect sizes. These tests are on file with theresearch team. Future researchers are encouraged to use
additional bivariate and multivariate modeling to provide
more nuanced understanding of group differences.

CHAPTER 3

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 context
and 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.

GUIDE TO REPORT AND TERMINOLOGY

Guide to Report
and Terminology

39

I. Use of the Term
“Transgender” in thisReport2015 U.S. TRANSGENDER SURVEY

The term “transgender” is often used to describe
people whose gender identity or expression
differs 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 identities
and captures the diversity of transgender people,
the authors recognize that one term cannot reflect
each individual’s unique identity and some people
prefer to use other terms to describe their gender
identity. However, in order to make the report’s
findings clear and accessible, it was important toselect a single term for consistent use throughout
this report that could best represent the range ofidentities expressed in the USTS survey sample.

40

In promotional materials, the survey was described
as 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 voice
was welcomed. The survey also acknowledged
the limitation of current language and used“trans”—a shorthand term that is widely acceptedamongst transgender people—consistently
throughout 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 they
were with the word “transgender” being used
to describe them. This included 82% percent of
non-binary respondents. This provides evidenceof the term’s continued broad usage and general
acceptance. Based on this information, theterm transgender is used for the purposes ofthis report to represent the diverse identities of
the individuals who made their voices heard bycompleting the survey.

II. Other TransgenderSpecific Terminology
Non-binary:This term is used by some to describe people
whose 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-binary
respondents” refers to respondents who said thatthe term “non-binary/genderqueer” best describes
their current gender identity in response to Q. 2.3.

Crossdresser:
While definitions of “crossdresser” vary, many
use this term to describe a person who dresses
in 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 or
intend to live full time as that gender. In this report,
the term “crossdressers” refers to respondents
who said that the term “cross-dresser” best
described their current gender identity in response
to Q. 2.3.

Gender transition:
This is a process in which a person begins tolive according to their gender identity, rather
than the gender they were thought to be at birth.
Not all transgender people have transitioned orintend to do so, but many do. Gender transition
looks different for every person. Possible steps
in a gender transition may or may not include
changing one’s clothing, appearance, nameand identity documents (for example, a driver’s
license), or undergoing medical procedures suchas hormone therapy to change one’s physicalcharacteristics. This report refers to gendertransition in several places when discussing steps
that may be included in one’s gender transition,such as updating the name and gender on identity
documents. Additionally, the report includes avariety of terms to refer to therapy/counseling,hormone therapy, surgical treatments, and other
health services transgender people may undergo
as part of their transition, including “health carerelated to gender transition” or “transition-relatedcare.” In this report, the term “respondents who
have transitioned” refers to respondents whoreported that they are living full time in response
to Q. 1.12 (see below).

expression” category. Additionally, several phrases
are used interchangeably to describe experiencesthat respondents had as a result of biases due
to being known or perceived to be transgender.
These include, for example: “because they weretransgender,” “because of their transgenderstatus,” or “because of their gender identity or
expression.”

Living full time:

In this report, the term “sexual assault” refers
to a variety of experiences of unwanted sexual
contact. These may include, but are not limited to,oral, genital, or anal contact or penetration, forced
fondling, and rape. Respondents were asked
about their experiences with unwanted sexual
contact or sexual assault in a number of different
contexts. Definitions of these terms varied in somequestions based on the context or, in some cases,on the national survey from which a question was
adapted. Where applicable, the definition provided
for “sexual assault” or “unwanted sexual contact”
in each question is included in the report.

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:

Sexual assault:

Underground economy:
This terminology refers to fields of work that, ingeneral, are currently criminalized in the UnitedStates. In this report, this term includes incomebased sex work (including forms of work inthe sex trade that are not criminalized, such as
pornography), drug sales, and other income-based
work that is currently criminalized. See Sex Workand Other Underground Economy Income chapter.

GUIDE TO REPORT AND TERMINOLOGY

Several questions throughout the report asked
whether respondents thought that an experience
had occurred due to their “transgender status/
gender identity” and/or “gender expression/
appearance.” Both answer choices were included
so that respondents could select what they felt
best represented their experience. Since there
was a substantial overlap of respondents who
selected both reasons, and because these terms
are commonly used interchangeably or withvery similar meanings, responses of those who
selected one or both of these reasons werecollapsed for reporting in one “gender identity/

III. Additional Terms
and Conventions
Used in the Report41Time period of reported
experiences:

U.S. population comparisons andother resources:

In the survey, respondents answered questions
about experiences that occurred within a periodof time prior to having taken the survey, such as in
the past year or the past 30 days. The report refers
to the time when these experiences occurredin comparison to the time when the respondent
completed the survey. For example, respondents
who had certain experiences within the 12 months
prior 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 prior
to completing the survey, the experience wasreferred to as occurring “in the past month,” “in thepast 30 days,” or “currently.”

References to experiences of the U.S. population
are 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 comprehensive
list of sources on any particular subject presented
in this report.

Write-in responses:

2015 U.S. TRANSGENDER SURVEY

At several places in the survey, respondents
were given an opportunity to write in a response
to a question. These write-in responses werereviewed for recoding to categorize the responses
into existing answer choice categories or new
categories when feasible. When it was possible torecode write-in answers into a new category, thoseanswers were often listed in the report and labeled
as a “write-in response.” In many cases, it was
not possible to recode the answers into existingor new categories, and these write-in-responses
were included in categories such as “a reason notlisted above.” For more information about how
write-in answers were recoded, refer to Appendix
C: Detailed Methodology.

42

Stories included in the report:
Throughout the report, excerpts of stories
are included in sections titled “In Our Own
Voices.” 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 for
respondents’ reported experiences. These stories
have been edited for length and clarity.

CHAPTER 4

Portrait of USTS
RespondentsW

ith 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 gender
identities 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. This
information is discussed in the following sections:

PORTRAIT OF USTS RESPONDENTS

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. AgeVII. 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 Status43

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 whose
gender differs from the one they were thought to be atbirth. However, language describing identity continues
to evolve, and it is difficult to describe all of those
identities using just one term. Acknowledging thiswide range of identities, the survey asked respondents
if they thought of themselves as “transgender.”Eighty-eight percent (88%) of respondents reported
that they thought of themselves as transgender, while
the remaining 12% used other terms to describe theirgender and related experiences.1

2015 U.S. TRANSGENDER SURVEY

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-binary31%

Genderqueer

29%

Gender non-conforming or gendervariant

27%

Gender fluid/fluid

20%

Androgynous

18%

Respondents were also asked how comfortable
they were with the word “transgender” being
used 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, including
82% percent of non-binary respondents. Forty-three
percent (43%) were “very comfortable,” and only
14% expressed discomfort with being described astransgender2 (Figure 4.1).

Transsexual

18%

Agender

14%

Figure 4.1: Respondent’s level of comfort with theword “transgender” being used to describe them3%
Very uncomfortable

44

Respondents were also offered a list of identity
terms from which they could check all terms that
described their gender identity, and they werealso given an opportunity write in a gender thatwas not listed (Table 4.1). In addition to the listed
terms, respondents wrote in more than 500 uniquegender terms with which they identified.

11%
Somewhat
uncomfortable
16%
Neutral% ofrespondents

27%
Somewhatcomfortable

43%
Very
comfortableTwo-spirit

7%Bi-gender

6%

Butch

5%

Crossdresser

5%

Multi-gender4%

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 Categories
Used for Analysis
Respondents were also asked to choose only one
term that best described their current gender identity
out of six possible terms (woman, man, trans woman(MTF), trans man (FTM), non-binary/genderqueer,
or crossdresser) to determine the gender identity
categories used for primary analysis.3 Respondents

were grouped into four gender identity categories
based on their responses. These four categories
are used throughout this report to discuss theexperiences of those who completed the survey:
transgender women, transgender men, non-binary
people, 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 said
that man or transgender man best described theirgender identity were included in the transgender
men analytical category (29%). Overall, 62% of
respondents were included in the transgender men
and 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 nonbinary or genderqueer, a term often used to describe
people 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.”
Figure 4.2: Gender identity

   3%
Crossdressers

29%
Transgender
men

% of
respondents

35%
Nonbinarypeoplec. Gender Assignment at Birth
Respondents were asked about the sex they
were “assigned at birth, on [their] original birthcertificate.”6 In this report, the term “respondents
with male on their original birth certificate” is used

d. Development of Transgender
Identity and Interactions with
Other Transgender People
Respondents received questions related tothe development of their transgender identity
throughout 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).
Figure 4.3: Age they began to feel gender wasdifferent from the one on their original birth certificate
4%
21 to 252%
26 and over13%
16 to 20

21%
11 to 15

32%
5 and
under

% of
respondents

28%
6 to 10

PORTRAIT OF USTS RESPONDENTS

33%
Transgenderwomen

to describe respondents who were thought to bemale when they were born (such as transgenderwomen), and “respondents with female on their
original birth certificate” is used to describe
respondents who were thought to be female
when they were born (such as transgender men).
More than half (57%) of respondents had female
on their original birth certificate, and 43% had
male on their original birth certificate. Of those
who were non-binary, 80% had female on their
original birth certificate, and 20% had male on
their original birth certificate.

45

Respondents were also asked how old they
were 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 themselves
as transgender between the ages of 6 and 10, and
28% 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).

Figure 4.5: Age they started to tell others that they
were transgender
5%
They have not told others

5%
10 and under

14%
31 andover

10%
11 to 159%26 to 30

Figure 4.4: Age they started to think they weretransgender

Figure 4.6: Gender identity by current age
70%
61%

60%
50%

47%
43%

43%

40%

46%

35%
29%

30%

9%

8%

5%

18 to 2445 to 64

25 to 44

65 and over

en
ns

w

ns

m

om

en

ry

<1%

na
bi
nNo

ss
e

rs

0%

1%

Tr
a

4%

Tr
a

10%

26%

24%

20%

20%

re

Respondents were also asked at what age they
began to tell others that they were transgender.
One in ten (10%) respondents reported that they
began to tell others that they were transgender
between the ages of 11 and 15, and more than
one-third (37%) did so between the ages of 16 and
20. Another 30% began telling people that they
were 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).

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, and
29% 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 aged
65 or older, compared to only 5% of transgenderwomen, 1% of non-binary respondents, and less than
1% of transgender men (Figure 4.6).

sd

28%
11 to 15e. Gender Identity andCurrent Ageos16%
6 to 1029%
16 to 202015 U.S. TRANSGENDER SURVEY

21%
21 to 25

10%
5 and
under

% of
respondents

46

37%
16 to 20Cr

10%
21 to 258%
26 andover% ofrespondents

62%
They
have
transitioned% of
respondents

Figure 4.8: Transition status of respondents
GENDER IDENTITY (%)
90%

82%

80%
68%

70%
60%
50%

43%

43%

40%
31%

28%

30%

23%

29%

21%

20%

16%

10%

6%

5%

3%

2% <1%

<1%

en
om

en

w
ns
Tr
a

Tr
an

s

m

na
bi
No

n-

ss

er

ry

s

0%

They have transitioned
They want to transition someday
They are not sure if they want to transition
They do not want to transition

Respondents were also asked what gender they
were living in on a day-to-day basis. Thirty-five
percent (35%) of respondents reported that they
currently lived as a man on a daily basis, 30% lived
as a woman, 21% lived as neither a man nor awoman, and 15% lived part time in one gender andpart time in another.

PORTRAIT OF USTS RESPONDENTS

Nearly two-thirds (62%) of respondents werecurrently living full time in a gender that was different
from 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’s
original birth certificate is described as “transitioning.”
Twenty-two percent (22%) of respondents reported
that they wanted to transition someday, 13% were
unsure, and 3% did not want to transition (Figure4.7). Three-quarters (75%) of transgender men andwomen had transitioned, and 43% of non-binary
respondents had transitioned (Figure 4.8).8

22%
They
want totransition
somedayrea. Full-Time Status and Transition

3%
They do not want
to transition

13%
They are not sureif they want totransitionossdTransitioning is a process by which a person begins
to live in a gender that is different than the one on
their 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 people
to use different pronouns (such as he, she, or they)
than the ones associated with the gender on one’s
original birth certificate. Transitioning may also
include undergoing medical procedures, such as
hormone therapy or surgeries, to change one’s
physical 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 on
their original birth certificate. However, many people
who want to take these steps are not able to do so
because of financial constraints, safety concerns, fearof discrimination and rejection, and other barriers.

Figure 4.7: Transition status of respondents

Cr

II. Experiences withTransitioning47

Figure 4.10: Number of years since transitioningb. Age of Transition
Those who have transitioned reported the age at
which they began transitioning, or living full-timein a gender other than that on their original birthcertificate. Nearly half (43%) reported that they
began transitioning between the ages of 18 and 24,
and nearly one-quarter (24%) transitioned between
ages 25 and 34. Fifteen percent (15%) transitioned
under the age of 18, and 18% transitioned at age 35
or older. Non-binary respondents and transgender
men were more likely to have transitioned at a
younger age, with 24% of non-binary respondents
and 17% of transgender men transitioning under theage of 18, compared to 7% of transgender women(Figure 4.9).9
Figure 4.9: Age began transitioning
GENDER IDENTITY (%)
60%

56%

50%

47%
43%

40%

34%
30%
28%

30%
20%

24%

24%

24%

18%

15%

17%

16%

12%

10%

7%

4%

en
om

en

Under 18

w
ns
Tr
a

Tr
a

ns

m

na
bi
nNo

O

ve

ra

ry

ll

0%

18 to 2425 to 34
35 and over2015 U.S. TRANSGENDER SURVEY

c. Number of Years Since
Transitioning48

The number of years since a respondent had
transitioned was determined in order to provide
valuable information and context for some of
the respondents’ experiences.10 Nearly one-third(31%) of those who had transitioned had done
so within one year of taking the survey, 38% had
transitioned 2 to 5 years prior, 13% transitioned
6 to 9 years prior, and 18% had transitioned 10 ormore years prior (Figure 4.10).

18%
10 or more

13%
6 to 931%
0 to 1% ofrespondents

38%
2 to 5d. Additional Questions for
Non-Binary Respondents
Non-binary respondents received questions about
what they tell other people about their gender identity.
They were asked about what gender they wereperceived to be by people who did not know they
were non-binary. A majority reported that people
usually assumed they were non-transgender women(58%), including 72% of non-binary respondents withfemale on their original birth certificate, and 2% of nonbinary respondents with male on their birth certificate.
Seventeen percent (17%) reported that other people
assumed they were non-transgender men, including
77% of non-binary respondents with male on their
original birth certificate, and 3% of non-binary
respondents with female on their birth certificate.
Nearly one in five (19%) reported that assumptions
about their gender varied (Figure 4.11).
Figure 4.11: Gender that people who do not know
they are non-binary usually assume they are
2%
Others cannot
tell their gender1%
Non-binary
1%
Trans
woman
2%
Trans
man

         19%Assumptions
about theirgendervary

17%
Non-transman% ofnon-binary
respondents
58%
Non-trans
womanNon-binary respondents were asked how they
responded 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, and
53% sometimes corrected others and told them
about their non-binary identity. Only 3% always
told others that they were non-binary (Figure 4.12).
Figure 4.12: Response when people assume that
their gender is something other than non-binary
3%
They always tell others
they are non-binary

53%
44%
They
They
usually
some% oftimes
letnon-binary
otherstellrespondents assume
othersthey arethey area man ornonbinary
a womanMain reasons for not telling others
about non-binary identity% of non-binary
respondents

Most people do not understand so they
do not try to explain it

86%

It is easier not to say anything82%

Most people dismiss it as not being a real
identity or a “phase”

63%

They might face violence

43%

They are not ready to tell people they
identify as non-binary

35%

They might lose their job or not be able
to 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 might
reject them

6%

A reason not listed above

18%

e. Pronouns
Eighty-four percent (84%) of respondents reported
that 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 one
pronoun. The most widely used pronouns were
“he/his” (37%), “she/her” (37%), and “they/their”(29%). One in five (20%) reported that they did
not ask people to use specific pronouns whenreferring to them, and another 4% indicated thatthey used pronouns other than those provided
in the answer choices. This included more than adozen additional pronouns provided through writein responses (Figure 4.13).

PORTRAIT OF USTS RESPONDENTS

Non-binary respondents who reported that theyusually let others assume they are a man or
woman or only sometimes tell people they are
non-binary were asked for the main reasons they
do not tell others about their non-binary identity.
Respondents could select multiple reasons forchoosing not to tell people about their non-binary
identity. A majority of non-binary respondents
reported that people do not understand so they
do not try to explain it (86%) or that it is easier not
to say anything (82%). Approximately two-thirds
reported that their non-binary identity is often
dismissed 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 are
non-binary49

Figure 4.13: Pronouns respondents ask people to use
40%

37%

37%

35%
29%

30%
25%

20%

20%
15%
10%
4%

5%

4%

2%

could tell they were transgender without being
told “most of the time,” 32% said others could“sometimes” tell, and 24% said that others could
never tell (Figure 4.14).11 Respondents’ experienceswith others’ perception of their transgender statusvaried by gender identity (Figure 4.15).
Figure 4.14: How often people could tell they weretransgender without being told
2%
Always

Th

on

ou

ns

(th

24%
Never

No

pr

9%
Most ofthe time

Ze

,h
ey
ir
to as
ey
us k p
e e
do
th op
ei le
no
rn o
ta
am nly
sp sk
e)
p
ec e
Pr
ific op
on
l
e
ou
pr t
on o
ns
ou use
no
ns
tl
ist
ed
ab
ov
e

r
Th
ey
,t
he
i

Sh
e,
he
r

He
,h
is

0%

33%
RarelyIII. Being Perceived asa Transgender Person
by Others
Some transgender people find that others canroutinely tell that they are transgender without
being told, while others are generally perceived
as the gender they identify with, and still others
are perceived as the gender they were thought to
be 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 vulnerable
to negative interactions in public or other settings.

32%
Sometimes% of
respondents

Figure 4.15: How often people could tell they weretransgender without being told
GENDER IDENTITY (%)
70%
62%

60%

61%

57%

50%

47%

40%
30%

32%

35%

32%

30%

20%
10%

19%
11%

9%

6%

50

Always or most of the time
Sometimes
Rarely or never

en
om

m

Tr
a

ns

w

ns
Tr
a

No

n-

bi
n

ar

en

y

ll
ra
O
ve

2015 U.S. TRANSGENDER SURVEY

0%

To assess whether respondents were perceived
as transgender, they were asked whether others
could tell that they were transgender even without
being told on a five-point scale from “always” to“never.” Nearly one in ten (9%) reported that others

IV. Outness
Respondents were asked whether they thought
different groups of people in their lives knew thatthey were transgender to determine if they were“out”12 about their transgender identity to family
members, friends, supervisors and colleagues
at 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 respondents
who 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 people
in 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 extended
family.13 Regarding workplace environments,
nearly one-half reported that none of their current
supervisors (49%) or coworkers (42%) knew thatthey were transgender.14 In terms of health careproviders, although 40% reported that all of
their health care providers knew that they weretransgender, almost one-third (31%) indicated thatnone of their health care providers knew that they
were transgender (Figure 4.16).

0%

10%

20% 30% 40% 50% 60% 70%
53%

Immediate family they
grew up with (such as
parents and siblings)

9%
16%
22%
23%

Extended family (suchas aunts, uncles, andcousins)

15%
23%
39%
62%

Lesbian, gay, bisexual,or transgender (LGBT)
friends

20%
14%
4%
32%

Straight, nontransgender(non-LGBT) friends

23%
34%
12%
35%

Current bosses,
managers, or
supervisors

6%
10%
49%
23%
11%

Current coworkers

24%
42%
15%
10%

Current classmates

28%
47%
40%
12%
17%

Current health careproviders

31%
0%

10%

20%

30%

40%

50%

60%

70%

All know that they are transgender
Most know that they are transgender
Some know that they are transgender
None know that they are transgender

PORTRAIT OF USTS RESPONDENTS

Of all groups of people the survey asked about,
respondents were most likely to be out to all of
their LGBT friends (62%). Respondents were also
asked about the methods by which they socialize
with other transgender people. Sixty-four percent(64%) reported that they socialized with othertransgender people in person, and 79% socialized
online. Nearly one-third (32%) said they interactedwith transgender people in political activism, and
10% reported that they did not socialize with othertransgender people.

Figure 4.16: Outness to people in respondents’ lives

51

V. Race and Ethnicity
Respondents received a question on race andethnicity and were asked to select only one of
the following categories that most accurately
described their racial or ethnic identity:• Alaska Native (received a write-in option)15

Bureau’s 2014 American Community Survey(ACS).21 Racial and ethnic categories were
weighted 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
Figure 4.17: Race and ethnicity of respondents• American Indian (received a write-in option)

16

0.7%
American Indian• Asian or Asian American

5.1%
Asian

• Biracial or multiracial (received a follow-up
question)17

12.6%
Black

• Black or African American• Latino/a or Hispanic• Middle Eastern or North African• Native Hawaiian or Pacific Islander

62.2%
White

• White or European American2015 U.S. TRANSGENDER SURVEY
52

The USTS sample had a percentage of white
respondents 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 closely
represent what is estimated to be the actual
racial and ethnic distribution for the transgender
population in the U.S., based on the Census

16.6%
Latino/a

0.4%
Middle Eastern• A racial or ethnic identity not listed above(received a follow-up question)18
Throughout the report, respondents who identified
as biracial, multiracial, or more than one racialor ethnic category are included in the multiracial
group. Additionally, due to small sample sizes andfor purposes of analysis, certain racial and ethnic
groups were combined into single categories.
American Indian and Alaska Native respondents
are combined in one category and reported
as “American Indian.” Similarly, the Asian/Asian
American and Native Hawaiian/Pacific Islandergroups are also combined in one category andreported as “Asian.”19% of
respondents

2.5%
Multiracial

VI. Age
The age of respondents in the sample ranged
from 18 to 87. The overall age of respondents
in 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 all
results presented in this report (Figure 4.18).
Additionally, for certain findings in this report, a“supplemental weight” was applied to adjust the
USTS sample to reflect the age distribution for
the U.S. population based on the ACS.23

Figure 4.18: Age of respondents
2%
65 and over14%
46 to 6419%
65 and over42%
18 to 24% in U.S.
population(ACS)% in USTS

42%
25 to 4413%
18 to 2434%
25 to 4434%
46 to 64

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 generally
mirrors that of the U.S. general population (Figure 4.19).

The sample was divided into regions based on
the 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 4.19
Distribution of 2015 USTS Respondents

Distribution of the population of the United States

Guam

Guam

American
Samoa

AmericanSamoa

Puerto Rico

AlaskaHawaii

Puerto Rico

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.

PORTRAIT OF USTS RESPONDENTS

AlaskaHawaii53

Figure 4.20: Respondents’ location by region

20%
Northeast

  31%
West

% in USTS
    19%Midwest   29%
South

24%
West

18%
Northeast% in U.S.
population(Census)24

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)2015 U.S. TRANSGENDER SURVEY

Spanish (including Spanish Creole) was reported
as the most common language spoken in theirhome other than English, with 10% of respondents
reporting Spanish was the main language spoken
in their home, exclusively or along with English.
This was slightly lower than the percentage of
those who spoke Spanish in the home in the
U.S. general population (13%).26 Each of the otheridentified languages were spoken by less than 1%of respondents.

   21%
Midwest

38%
South

54

American Community Survey (ACS).25 Fourteen
percent (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% of
respondents also reported that American Sign
Language was either the main language or one of
the main languages used in their home.

VIII. Primary
Language Spoken
in HomeRespondents were asked about the primarylanguage spoken in their home. Eighty-fourpercent (84%) reported that English was the only
language spoken in their home, compared to 79%
in the U.S. general population, as reported in the

IX. Religious or
Spiritual Identity
Respondents were asked about their current
religious or spiritual identity and could selectone or more identities from a provided list, orthey could select a religious affiliation or spiritual
identity not listed.27,28 Sixty-three percent (63%) of
respondents reported that they had a spiritual or
religious identity, and 37% of respondents reported
that they did not have a spiritual or religious
identity.29 Respondents were most likely to identify
as agnostic (23%), atheist (22%), or Christian (21%),
followed by a smaller percentage who identified as
Pagan (9%), Buddhist (6%), or Jewish (4%). Onequarter (25%) of respondents identified as spiritual,
but with no religious affiliation. Thirteen percent(13%) had no religious or spiritual affiliation, and
7% identified with a religious affiliation or spiritual
identity that was not listed (Table 4.3).

Table 4.3: Current religious or spiritual identity
Current religious or spiritual identity% ofrespondents

Spiritual, but no religious affiliation

25%

Agnostic

23%

Atheist22%

Christian

21%

Pagan

9%

Buddhist

6%

Jewish4%

Secular Humanist

4%

Wiccan

4%

Druid

1%

Hindu

1%

Muslim1%

Native American Traditional Practitioner orCeremonial

1%

Polytheist (write-in response)

1%

Taoist1%

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 identity
not listed above

7%

No affiliation13%

briefly in this section and discussed in greater
detail in the Income and Employment Status
chapter. In order to compare USTS respondents’income and employment data with data from the
CPS and other national data sources, income
and employment results are presented with the“supplement weight” applied.31

a. Sources of Income
Nearly half (45%) of respondents received income
from multiple sources, such as employment, Social
Security income, or a pension. Thirty-six percent(36%) received income solely from their own
employment 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, including
disability, and 3% received income solely froma pension. Three percent (3%) reported thatthey were currently working in the undergroundeconomy, including 1% whose income came solely
from underground economy work (Table 4.4).
Table 4.4: Current sources of income by single andmultiple sources

Sources of income

X. Income and
Employment Status

Employment only (from their own
employer, partner/spouse’s employer,
or self-employment)

36%

Social Security income/disability only

9%

Pension/retirement only

3%

Other sources of income only3%

No income2%

Sex work and other undergroundeconomy work only1%

Unemployment benefits/cash
assistance only1%

Multiple sources

45%

PORTRAIT OF USTS RESPONDENTS

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 presented% of respondents(supplemental
weight)55

b. Individual and Household
Incomed. Employment Status

Individual and household incomes for the USTS
sample and the U.S. population were reported
from 2014, the last full year prior to the survey
for which annual income figures were available.
Respondents reported lower incomes than the U.S.
population (Figure 4.21 & Figure 4.22).32

When asked about their current employment
status, 35% of respondents reported that they
currently 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

Figure 4.21: Individual income in 2014
30%
25%
24%

25%
22%

XI. Educational
Attainment

25%
21%

20%

18%
15%

15%

15%

10%

10%

9%

8%

8%

5%

$1
0
or 0,0
m 00
or
e

$1
0
$2 ,004, 0 t
99 o
9
$2
5,
$4 00
9, 0 t
99 o
9
$5
0,
$9 00
9, 0 t
99 o
9

$1

No

to

in

co

$9
,9

m

99

e

0%

% in USTS (supplemental weight)

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% had
an associate’s degree, and 38% had received abachelor’s degree or higher (Figure 4.23).

% in U.S. adult population (CPS)

Figure 4.23: Educational attainment(categories used in report)

Figure 4.22: Household income in 20142%
Did not completehigh school

35%
31%

31%

30%
24%

25%

22%

21%

23%

13%
Graduate or
professional
degree

20%
15%

15%

12%

12%

11%
High school
diploma or
GED

10%
5%

4%

4%

25%

1%

2015 U.S. TRANSGENDER SURVEY
56$10
or 0,0
m 00
or
e

$1
0
$2 ,004, 0 t
99 o
9
$2
5,
$4 00
9, 0 t
99 o
9
$5
0,
$9 00
9, 0 t
99 o
9

to
$1

No

in

co

$9
,9
9

m

9

e

0%

% in USTS (supplemental weight)% in U.S. adult population (CPS)

Bachelor’s
degree% ofrespondents

40%
Some
college(no degree)  9%
Associate’s
degreec. Poverty
Nearly one-third (29%) of respondents were living
in poverty,33 more than twice the poverty rate
among the general U.S. adult population (12%).34

Throughout the report, educational attainment isreported according to the categories reflected in
Figure 4.23. However, alternative categories arealso presented here for comparison to the U.S.
population.36 The USTS sample overall reflected
higher educational attainment than the U.S.
population, which is common among internetbased surveys.37 To account for differences in
educational attainment by age, USTS respondents
are compared to the U.S. population for two age
ranges: (1) ages 18 to 24 (Figure 4.24) and (2) ages
25 and older (Figure 4.25).38
Figure 4.24: Educational attainment (ACS
categories), ages 18 to 24
70%

65%

60%
50%

46%

40%
30%

30%
20%

17%

15%

14%

10%

10%
3%

Ba
de ch
gr elohi ee r’s
gh or
er

Hi
g
di h s
pl c
om ho
a o
G or l
ED
So
(n me
o
As de collso gr ege ede ciat e)/
gr e’see

hi co Did
gh m nsc ple ot
ho te
ol

0%

% in USTS

XII. Disability
Respondents received questions about their disability
status based on questions from the American
Community Survey (ACS) in order to compare thosein the USTS sample to those with disabilities in the
U.S. general population. Overall, 39% of respondents
indicated that they had one or more disability as
described in the ACS, compared to 15% of the general
population.39 Four percent (4%) of the sample reported
that they were deaf or had serious difficulty hearing,similarly to the U.S. general population (4%).40 Three
percent (3%) reported that they were blind or hadserious difficulty seeing even when wearing glasses,
similarly to those in the U.S. population (3%).41 USTS
respondents were six times as likely to report having
serious difficulty concentrating, remembering, or making
decisions because of a physical, mental, or emotional
condition (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% in U.S. population (ACS)

Figure 4.26: Disability status
0%

Figure 4.25: Educational attainment (ACS
categories), age 25 and older
35%

32%

30%

10%

15% 20% 25% 30% 35% 40%

4%
4%

28%
26%

25%

21%

20%
15%

13%

10%
5%

Deaf or have serious
difficulty hearing

5%

19%
12%

8%

Blind or have serious
difficulty seeing evenwhen wearing glasses

21%

12%
8%

2%

Difficulty concentrating,remembering, or making
decisions because ofa physical, mental, or
emotional condition

30%
5%

6%

Serious difficulty walking
or climbing stairs

Difficulty dressing
or bathing

8%

3%
3%

Di

d

no
t
hi co
gh m
Hi
sc ple
gh
ho te
sc
ol
ho
So
ol
di
m
e
or plom
co
G a
l
l
As eg
ED
so e
ci (no
at d
e’ e
s g
de re
As
gr e)/
so
ee
ci
Ba
a
te
ch
s
el
de
or
gr
’s
ee
de
gr
ee
or
G
ra
hi
du
gh
at
er
e
or
pr
of
es
de siogr nalee

3%% in USTS% in U.S. population (ACS)

Difficulty doing errands alone,such as visiting a doctor’s
office or shopping, becauseof a physical, mental, or
emotional condition

22%
6%

39%

Any disability coveredin the ACS

15%% in USTS

PORTRAIT OF USTS RESPONDENTS

0%3%% in U.S. population (ACS)57

Respondents were also asked if they identified as aperson with a disability to better capture disabilities
that 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.

% in USTS% in U.S.
population(Census)

U.S. citizen (by birth)

94%

84%

U.S. citizen (naturalized)

3%

8%Documented resident

2%

Undocumented resident

<1%

8%

Respondents were asked about their citizenship or
immigration status. In addition to those who were
citizens in the sample (97%), respondents reported
a range of immigration statuses, including being
permanent residents (1%), visa holders (1%), refugees(<1%), or undocumented residents (<1%) (Table 4.5).
Table 4.5: Citizenship or immigration status

Table 4.7: Reasons for not applying for asylum

Citizenship or immigration status2015 U.S. TRANSGENDER SURVEY

Citizenship or
immigration status

Respondents who were not U.S. citizens by birthwere asked if they had ever applied for asylum in the
United States. Seven percent (7%) applied for asylum,
including 3% who applied on the basis of their gender
identity or sexual orientation. Of those who did not
apply for asylum, 51% reported that they did not needasylum in order to stay in the United States because
they had access to other avenues for becoming
citizens, permanent residents, or visa holders.47 Other
respondents indicated that they did not know how toapply (17%) or did not apply for other reasons (Table 4.7).

XIII. Citizenship andImmigration Status

58

Table 4.6: Citizenship or immigration status (collapsed)% ofrespondents

Reasons for not applying
for asylum% of those who
did not apply
for asylum

U.S. citizen (by birth)

94%

U.S. citizen (naturalized)

3%

They had access to other legal
statuses51%

Permanent resident

1%

They did not know how to apply

17%

A visa holder (such as F-1, J-1, H1-B, or U)

1%

They did not want to apply

16%

Undocumented resident<1%

DACA (Deferred Action for Childhood
Arrival)12%<1%They did not need to or were noteligible
They were afraid to apply

3%

Refugee status<1%

Currently under a withholding of removal
status2%<1%

They believed they were past the
one-year deadline
A reason not listed above

30%

DAPA (Deferred Action for Parental
Accountability)<1%

Other documented status not listed<1%

Six percent (6%) of respondents were not citizens
by birth, compared to 16% in the U.S. population.45
This included approximately 3% who were
naturalized citizens, 2% who were documented
residents (such as permanent residents andvisa holders), and <1% who were undocumented
residents46 (Table 4.6).

Nearly half (48%) of respondents who applied for
asylum received it. Another 32% did not receive
asylum but instead received a “withholding ofremoval” status, an alternative form of relief that allows
someone to stay in the United States under certain
conditions. One in five (20%) of these respondents
were denied asylum (Figure 4.27). Of the respondents
who were denied asylum (n=11, unweighted),48 31%
reported that they were denied asylum because they
were past the one-year deadline, 44% indicated that it
was because the immigration official decided that they
did not face danger in their country of origin, and 25%
reported that it was because of a reason not listed.

XV. Relationship Status

Figure 4.27: Outcome of asylum application

20%
Deniedasylum% of those
who applied
for asylum

48%
Received
asylumDeniedasylum,but
receiveda “withholding ofremoval” status

XIV. Sexual Orientation
Respondents were asked which terms best
described their sexual orientation. Respondents
were most likely to identify as queer (21%), and theyalso identified as pansexual (18%), gay, lesbian, or
same-gender-loving (16%), straight (15%), bisexual(14%), and asexual (10%) (Figure 4.28).

Figure 4.29: Currently married
CURRENT AGE (%)
70%

66%

60%

56%

53%

50%

Figure 4.28: Sexual orientation
10% 15% 20% 25% 30% 35% 40% 45%

30%

4%

20%
10%

to

24

29%
10%

18

20%

12%
16%

Gay, lesbian, or
same-genderloving

64

0%

14%

Bisexual

8%
3%
to

6%
7%

45

17%

25

Asexual

45%

23%

10%

44

5%

to

0%

42%

40%

65
ov ander

32%

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 current
legal marital status for the purpose of comparison
to 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 threequarters (72%) of respondents have never beenmarried, which is more than twice as many as the
U.S. adult population (30%).

% in USTS

13%
8%% U.S. population (ACS)

27%
12%
18%
6%

Pansexual

21%
16%

17%
21%

3%

34%
6%

24%
15%

Straight or
heterosexual

41%
2%

19%
23%

Sexualorientation
not listed

6%
4%
8%
6%
5%

Overall

Crossdressers

Trans womenNon-binary

PORTRAIT OF USTS RESPONDENTS

Queer

Trans men

59

ENDNOTES | CHAPTER 4: PORTRAIT OF USTS RESPONDENTS

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 questions
Q. 1.11–1.18. See Appendix C (Detailed Methodology)
for a discussion of eligibility. Many of those individuals
identified other terms that better described their genderand experiences.

2

Although only 12% of respondents reported that they did
not think of themselves as transgender in response to Q.
1.10, a slightly larger number (14%) expressed discomfort
with the word “transgender” being used to describe
them in Q. 2.4. This may have been due to respondents’
differentiation between identity and the terminology used
to describe their identity. For example, while a respondent
may have identified with the word transgender, they may
not have been comfortable using the term “transgender”
and would have instead preferred another term to describe
their 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) required
further analysis of their survey responses to determine
if they met the eligibility criteria for the survey and, if so,
what the most appropriate gender identity categories were
for analysis. This included, for example, respondents who
indicated in Q. 2.1 that the gender on their original birthcertificate was female and that they identified as a woman
in Q. 2.3, or who indicated that the gender on their original
birth certificate was male and that they identified as aman. This recoding process is described in further detail in
Appendix C (Detailed Methodology).

2015 U.S. TRANSGENDER SURVEY

5

60

6

Respondents were also asked in an earlier question (Q.
1.11) if they identified “as more than one gender or as no
gender (such as genderqueer or non-binary),” without
asking 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 respondents
who said that another term (such as transgender man,transgender woman, or crossdresser) best described theirgender identity also identified as having more than one
gender or as no gender.

is listed at the time of birth. It is possible that some
respondents 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 accurately
answer this question. Respondents were required to
select 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 would
receive 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 one
assigned to them at birth. Some non-binary respondents
may 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 with
their non-binary identity), but did not select “yes” because
they assumed the survey was asking only about people
who were living exclusively in a binary gender (male orfemale) that is different than the gender on their original
birth certificate.

9

Although 6% of crossdressers reported that they
had 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 calculated
based on respondents’ current age as reported in Q. 2.13,
and the age at which they began to transition, as reported
in Q. 1.13.

11

Throughout this report, respondents’ experiences withbeing perceived as transgender by others are reported
according to three categories: those who said that people
could 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 who
openly 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 workplace
are further discussed in the Employment and the
Workplace chapter.

Although the vast majority of people have either maleor female on their original birth certificate, there are rare
instances where the sex on a birth certificate is left blankor where a gender marker other than “male” or “female”

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” best
described their racial or ethnic identity received a followup question in which they could select one or more of the
racial or ethnic identities listed above that best described
them.

18

Those who selected “a racial/ethnic identity not listed
above” were asked to specify their identity and thenreceived a follow-up question asking them to select the
racial/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 manner
similar to that in the U.S. Census, which is important forthe purposes of making racial and ethnic comparisons
to the U.S. population. A notable exception to U.S.
Census categorization is that Middle Eastern and white
respondents are reported separately throughout thereport. The U.S. Census also offers Asians and Native
Hawaiians/Other Pacific Islanders as two separate racial
categories. 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

21

The difference in racial and ethnic population distribution
in the USTS sample and the U.S. general population may
be due to sampling bias that is common in internet-based
surveys 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 Design
Method (4th ed.). Hoboken, NJ: John Wiley & Sons. See
also the Methodology chapter and Appendix C (Detailed
Methodology) for more information about potential
internet-based survey sampling bias. See Appendix A(Characteristics of the Sample) for unweighted frequencies
and percentages for race and ethnicity in the USTS sample.

22

Although the ACS groups Middle Eastern and white
people in one category, the experiences of Middle
Eastern respondents are presented separately from white
respondents 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 unique
circumstances of transgender people who identify as Middle
Eastern.

23

The weight for 18-year-old respondents was createdwith propensity scores developed using a regression
discontinuity model. For more information on this process
and other weighting procedures, such as the development
and application of the “supplemental weight,” seeAppendix C (Detailed Methodology). See Appendix A(Characteristics of the Sample) for unweighted frequencies
and percentages for age in the USTS sample.

24

U.S. Census Bureau. (2015). Annual Estimates of the
Resident Population: April 1, 2010 to July 1, 2015. Available
at: https://factfinder.census.gov/faces/tableservices/
jsf/pages/productview.xhtml?pid=PEP_2015_
PEPANNRES&src=pt.

25

U.S. Census Bureau. (2015). 2015 American Community
Survey 1-Year estimates: Language spoken at homeby ability to speak English for the population 5 years
and 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 the
primary language spoken in their home in the American
Community Survey (ACS) were calculated by the researchteam. ACS findings include those in the U.S. population
who are 5 years of age and older, in contrast to the USTS
sample, 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 Community
Survey 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 Faith
Communities chapter.

PORTRAIT OF USTS RESPONDENTS

Prior research using representative samples oftransgender adults have found that transgender adults
differ 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 Adults
who Identify as Transgender in the United States. Los
Angeles, CA: Williams Institute; Conron, K. J., Scott, G.,
Stowell, G. S., & Landers, S. J. (2012). Transgender healthin Massachusetts: Results from a household probability
sample 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 ethnic
makeup 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 information
on weighting procedures applied to the sample. See
also Appendix A (Characteristics of the Sample) for
unweighted frequencies and percentages for race andethnicity in the USTS sample.

61

28

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 of
employment in the United States.

31

The “supplemental weight” includes the standard survey
weight for 18-year-olds and race and ethnicity, as well as
additional weights for age and educational attainmentthat were created based on the Census Bureau’s 2014
American 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

2015 U.S. TRANSGENDER SURVEY

33

62

In addition to the main drop-down list of affiliations, those
who identified as Christian, Jewish, or Muslim were able
to provide additional specificity for their identity froma drop-down list of more specific religious affiliations
in 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 identities
represented in the sample. Furthermore, while those who
identified as Christian were given an option to write in a
Christian affiliation that was not listed, Jewish and Muslim
respondents did not receive that option, which may have
limited the manner in which they were able to identify theirreligious or spiritual identity.

USTS respondents seem to have similar household sizes
to the U.S. population. For instance, according to the
CPS, 2015 Annual Social and Economic Supplement,
28% of U.S. households have a household size of one,
whereas 29% of USTS respondents have a household
size of one (supplemental weight applied). However,
USTS respondents are less likely to be living with family
members, rather than with unrelated members of thehousehold. Sixty-four percent (64%, supplemental weight
applied) of USTS respondents reported a family size of
one compared to 24% in U.S. population as reported in
the CPS. Available at: https://www2.census.gov/programssurveys/cps/techdocs/cpsmar15.pdf. Calculations werecompleted by the research team.
“Living in poverty” means living at or near the poverty
line. The research team calculated the USTS poverty
measure using 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 of respondents as living in or near poverty
if their total family income fell under 125% of the official
poverty line.

34

Proctor, B. D., Semega, J. L., & Kollar, M. A. (2016). Income
and 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/p60256.pdf. Calculations were completed by the research
team.

35

Bureau of Labor Statistics. (2015). The Employment
Situation—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 USTS
respondents likely overestimates the number oftransgender people with a level of education beyond
high 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 states
have found lower educational attainment or no differencein educational attainment among transgender people
when 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). Demographic
characteristics and health outcomes among transgenderadults in select U.S. regions in the Behavioral Risk Factor
Surveillance System. American Journal of Public Health.

37

See the Methodology chapter and the detailed
methodology explanation in Appendix C (Detailed
Methodology) for more information about potential internetbased survey sampling bias. See also note 20.

38

U.S. Census Bureau. (2015). 2015 American Community
Survey 1-Year estimates: Educational Attainment. Available
at: 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 Survey
1-Year estimates: Disability characteristics. Available
at: http://factfinder.census.gov/faces/tableservices/
jsf/pages/productview.xhtml?pid=ACS_15_1YR_
S1810&prodType=table. Calculations were completed by
the 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 had
one or more listed ACS disabilities (39%) and those who
identified as a person with a disability (28%) may be due
to some individuals not being comfortable referring tothemselves as a person with a disability. However, those
who identified as people with a disability likely reflect amuch wider range of disabilities.

45

U.S. Census Bureau. (2015). 2015 American Community
Survey 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 often
underrepresented in surveys for many reasons,
including concerns about jeopardizing their residency
by revealing information about their immigration
status on a survey. When asking questions relating tocitizenship and immigration status, the survey included
statements reminding respondents that their answers
were 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 who
indicated that they were already citizens or permanent
residents in Q. 9.8.

48

Due to the small sample size, the unweighted frequency
is being presented alongside weighted percentages here
to 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 Community
Survey 1-Year Estimates: Sex by marital status byage for the population 15 years and over. Available
at: https://factfinder.census.gov/faces/tableservices/
jsf/pages/productview.xhtml?pid=ACS_15_1YR_
B12002&prodType=table. These findings, as presented
in the ACS, include adults who are currently married withboth spouses who are present and not present based on
the ACS definitions. Calculations were completed by the
research team.

PORTRAIT OF USTS RESPONDENTS
63

CHAPTER 5

Family Life and Faith
Communities
2015 U.S. TRANSGENDER SURVEY

F

64

amily life and the state of relationships with family members, including immediate and extended
family, 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 also
examined respondents’ experiences with faith communities.
Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter.

KE Y FI N D I N GS

Sixty percent (60%) of respondents who were out to the immediate family they grew up
with reported that they had supportive families, and 40% had families that were neutral
or not supportive.
• One in ten (10%) reported that an immediate family member had been violent towards
them because they were transgender.
• Fifteen percent (15%) ran away from home and/or were kicked out of the house
because they were transgender.
More than one-quarter (27%) of respondents who have been out to any of their past or
current 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 one
form 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 was
associated with negative outcomes. Respondents who were rejected were:• Nearly twice as likely to have experienced homelessness (40%) as those who were
not 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%).
FAMILY LIFE AND FAITH COMMUNITIESNearly one in five (19%) respondents who had ever been part of a spiritual or religious
community left due to rejection. Forty-two percent (42%) of those who left found awelcoming spiritual or religious community.

65

I. Outness to Family
and Friends
Respondents received a series of questions todetermine whether they were “out”2 about theirtransgender identity to various family members
and friends. Specifically, respondents were asked
whether people in different groups knew they
were transgender, including spouses and partners,
children, immediate family they grew up with,extended family, LGBT3 friends, and straight andnon-transgender (non-LGBT) friends. Respondents
then 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 reported
having a current or former spouse or partner.
Fifty-eight percent (58%) of those were out to theircurrent spouse or partner and 53% had been out
to 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 Indian
respondents (78%) reporting the highest levelof outness, and Black (62%), Latino/a (62%), andAsian (55%) individuals being out to their children
less 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 LGBT
friends, and straight and non-transgender (nonLGBT) friends. Results for each group reflect only
respondents 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% when
considering spouses or partners and children as partof the immediate family. Respondents were less likely
to be out to extended family members, with 23%
reporting that they were out to all extended family.
Overall, less than one-quarter (22%) of respondents
were out to all immediate family members—including
spouses, partners and children—and extended family
members.
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 of
their LGBT friends. In contrast, less than one-third(32%) of respondents were out to all of their nonLGBT friends (Table 5.1).
Table 5.1: Outness to family and friend groups
Family and friend groups

Figure 5.1: Out to children
RACE/ETHNICITY (%)

All

Most orsome

None

Lesbian, gay, bisexual, ortransgender (LGBT) friends

62%

34%

4%

Immediate family they grew up
with (such as parents or siblings)

53%

25%

22%

Immediate family they grew up
with, spouses/partners, children

49%

43%

8%

40%

Straight, non-transgender(non-LGBT) friends

32%

56%

12%

40%

Extended family (such as aunts,
uncles, and cousins)

23%

38%

39%

Immediate family they grew up
with, extended family, spouses/
partners, and children

22%

70%

8%

90%
78%

80%

72%

71%

69%
62%

60%

62%

55%

50%

30%
20%

*Sample size too low to report

hi

te

l
W

ac

ia

n*
ul
M

Ea
e
dl
id

M

tir

st

in

er

o/

a

k
La
t

ac
Bl

n
As
ia

an

Am

er

ic

an

In

di

ra

ll

0%
O
ve

2015 U.S. TRANSGENDER SURVEY

70%

66

% of respondents who had
people from the family or
friend group in their lives

Figure 5.2: Spouse/partner ended relationshipsolely because of transgender status
CURRENT AGE (%)
25%

20%

20%

19%

25%

24%

20%

15%
12%

12%

10%

10%

9%

5%

35
a
ov nd
er

34
25

Un

18

de

to

r1

to

24

8

ll

0%
ra

Whether a relationship ended solely due to beingtransgender differed based on a respondents’current age, with those aged 45 and older being
twice as likely to have this experience (Figure 5.2).

AGE OF TRANSITION (%)

ve

Those who were out to a spouse or partner wereasked whether a spouse or partner had ended
their relationship because they were transgender.
More than a quarter (27%) reported that a spouseor partner ended their relationship solely or partly
because they were transgender, including 10% who
had a relationship end solely because they weretransgender.

Figure 5.3: Spouse/partner ended relationship solely
because of transgender status

O

II. Relationships with
Spouses or Partners

The likelihood of a relationship ending also
differed by gender identity, with transgenderwomen (18%) being more likely to have arelationship with a spouse or partner end solely
because of being transgender than transgendermen (9%), crossdressers (6%), and non-binary
people (3%) (Figure 5.4).
Figure 5.4: Spouse/partner ended relationshipsolely because of transgender status

15%

GENDER IDENTITY (%)

11%

10%

10%

20%
5%

18%

18%

6%

16%
14%

14%
65
a
ov nd
er

64
45

to

44
to
25

to
18

O

ve
r

al

24

l

0%

12%
10%

10%
9%

8%

4%

3%

2%
en
m
d

m

an

ns
ns

w

om

en

Tr
a
Tr
a

om
w
ns
Tr
a

en

en

ry
na
bi
nNo

es
se
r
sd
r
os

Cr

O
ve

ra

s

ll

0%

FAMILY LIFE AND FAITH COMMUNITIESThe age at which a respondent transitioned also
affected the likelihood of a relationship ending.
Respondents who transitioned at age 35 or older
were more than twice as likely to have theirrelationship end solely due to being transgender(24%) (Figure 5.3).

6%

6%

67

More than one-quarter (27%) of
respondents who were out totheir spouse or partner reported
that a spouse or partner
ended their relationship solely
or partly because they weretransgender, including 10% who
had a relationship end solely
because they were transgender.
Respondents were also asked whether a current orformer romantic or sexual partner had ever been
violent toward them. More than half (54%) reported
that they had experienced some form of intimate
partner violence. Experiences with intimate partner
violence are discussed further in the Harassment
and Violence chapter.

III. Parental Status
and Related Children
in the Household2015 U.S. TRANSGENDER SURVEY

Eighteen percent (18%) of people in the sample
were parents,5 and of those individuals, more than
two-thirds (69%) reported that they were out astransgender to at least one of their children.

68

In comparison to the U.S. adult population, USTS
respondents were substantially less likely to haverelated children living in their home. According
to the Current Population Survey, 34% of adults
in 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

In Our Own
Voices“When I finally had the courage
to come out, my parents, who I
knew would freak out, did theunthinkable. They assured me I had
their complete support to be who I
am. I was never prouder than in thatmoment.”“My father physically assaulted me
and kicked me out of the house. He
screamed 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 of
my life. They spoke with a pastor
who convinced them that I was
possessed by demon. A couple ofdays later, they told me to leave andnot come back. I spent the next six
months homeless.”“Within an hour of coming out to myparents, I was kicked out into thecold with very few items and my car
taken away. I was soon informedby my college that my parents
had withdrawn my tuition for theupcoming spring semester. I wasdevastated.”“It took my family a while to comearound. At first they didn’t accept
me, but they eventually saw how
much happier I am and are now mybiggest supporters.”

as USTS respondents (14%).7 These differences
persisted across all age groups, with USTS
respondents 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).
Figure 5.5: Respondents with related children
under 18 living in household
AGE (%)

More than one in five (21%) of
those who were out to theirchildren reported that at least
one of their children stopped
speaking or spending timewith them, temporarily or
permanently.

60%
54%

or spending time with them, at least for a period of
time.

50%
40%

38%
34%

30%

27%

20%

19%
14%

12%

10%

11%
6%
3%
er
ov

64

d
an
65

45

to

44
25

to

24
to
18

O

ve

ra

ll

0%

USTS respondents with a related child under
18 in household
Adults in the U.S. population with a related childunder 18 in household (CPS)The likelihood of this experience differed bygender identity, with transgender women (28%)
being more than four times as likely to report that
their child stopped speaking or spending time withthem as transgender men (6%) and non-binary
respondents (6%) (Figure 5.6).
Figure 5.6: Children stopped speaking or spendingtime with respondent because of transgender status
GENDER IDENTITY (%)
30%

28%

25%

23%
21%

20%
17%

15%

6%

en
m
d

m

an

ns
Tr
a

ns

w

om

en

Tr
a

om
w
ns

en

en

ry
na
bi
Tr
a

nNo

es
se
r
sd
r
os

O
ve
ra

ll

s

0%

Overall, of respondents who have had a spouse orpartner and/or who have children, 28% have hada relationship with their spouse or partner or child
end, at least temporarily.

FAMILY LIFE AND FAITH COMMUNITIESRespondents who reported that they were out
to at least one of their children were asked aquestion to determine whether being transgender
had ever negatively impacted a relationship with
their child. Specifically, they were asked whether
any of their children had ever stopped speaking
to or spending time with them because they weretransgender. More than one in five (21%) reported
that at least one of their children stopped speaking

6%

5%

Cr

IV. Relationships withChildren

10%69

V. Family Acceptanceand Support
Respondents who reported that they were out toall, most, or some of the immediate family they
grew up with were asked to assess how supportive
their 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 a
supportive, neutral, or unsupportive family.8
More than half (60%) reported that their family was
supportive, 18% had unsupportive families, and
22% had families that were neither supportive nor
unsupportive (“neutral”).
Experiences varied widely between those withfamily support and those with unsupportive
families, 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 experiencing
serious psychological distress9 (31%) in contrast
to those with unsupportive families (50%).

2015 U.S. TRANSGENDER SURVEY• Less likely to have attempted suicide (37%)
than those with unsupportive families (54%).

70

More than half (60%) of
those who were out totheir immediate family
reported that their family
was supportive, while 18%
said that their family was
unsupportive.

VI. Relationships with
Immediate Family/
Family of Origin10
Nearly half (44%) of respondents who were out
to all, most, or some of the immediate family
they grew up with (such as parents and siblings)
reported that they had experienced at least one
form of family rejection outlined in the survey. This
rejection included relationships ending, family
violence, being kicked out of the house, not being
allowed to wear clothes matching their gender
identity, 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 speaking
to them for a long time or ended their relationshipaltogether because they were transgender. Thiswas higher among American Indian (38%), Middle
Eastern (37%), and Black (30%) respondents, andlower for Asian (22%) respondents (Figure 5.7).
Undocumented residents (39%) were also more
likely to face this form of family rejection thandocumented non-citizens (22%) and citizens (26%).

Figure 5.7: Immediate family member stopped
speaking or ended relationship
RACE/ETHNICITY (%)
40%

38%

37%
30%

30%

28%

26%

27%

25%

22%

20%

10%

More than one-quarter (26%)
of respondents reported thatan immediate family member
stopped speaking to themfor a long time or ended theirrelationship altogether because
they were transgender.

W

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La
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a
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As

Bl

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an
In
di

id

dl

ago (37%), and 10 or more years ago (43%)(Figure 5.9).

M

Am

O

er
ic
an

ve

ra
l

l

0%

Whether a family member stopped speaking to or
ended 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 as
45 to 64 year olds (37%) (Figure 5.8).

Figure 5.9: Immediate family member stopped
speaking or ended relationship
YEARS SINCE TRANSITIONING (%)
45%

43%

40%

37%

35%
29%

30%

26%

24%

25%
20%

Figure 5.8: Immediate family member stopped
speaking or ended relationship

15%

CURRENT AGE (%)

10%
37%

40%

5%

35%

20%

e
or
m

B. Family Violence

18%

15%
10%
5%
er
ov

64

d
an
65

45

to

44
25

to
18

to

24

ll
ra

Those who transitioned in the last year (24%) wereless likely to have a family member stop speaking
to them or end a relationship than those whotransitioned 2 to 5 years ago (29%), 6 to 9 years

Among those who were out to their immediatefamily, one out of every ten (10%) respondents
reported that a family member was violent towards
them because they were transgender. Prevalenceof family violence differed greatly dependingon the time period during which a respondenttransitioned, with those transitioning 10 or more
years ago (15%) experiencing almost twice asmuch violence as those who transitioned in thepast year (8%) (Figure 5.10).

FAMILY LIFE AND FAITH COMMUNITIES

0%
ve

or
10

25%

O

9
to
6

5
to

1
to

2

O

0

29%

26%

ve

29%

30%

ra

ll

0%

71

Figure 5.10: Experienced violence by family member
YEARS SINCE TRANSITIONING (%)
18%
16%

15%
14%

14%
12%
10%

10%

10%

6%
4%
2%

• More likely to have attempted suicide in
their lifetime (65%) than those who did notexperience family violence (39%).

m
10

or

to
6

or
e

9

5
to
2

0

ve

to

ra
l

1

l

0%
O

• More than twice as likely to have experienced
homelessness (59%) than those who did notexperience family violence (29%).
• More likely to be currently experiencing serious
psychological distress (53%) than those who
did not experience family violence (35%).

8%

8%

Family violence was associated with increased
likelihood of negative experiences. Those who
experienced family violence were:

American Indian respondents (20%) were twice
as likely to experience family violence, and otherpeople of color, such as Asian (15%) and Middle
Eastern (14%) respondents, also experienced
higher rates of violence (Figure 5.11).
Figure 5.11: Experienced violence by family member
RACE/ETHNICITY (%)

C. Kicked out of the House
Eight percent (8%) of respondents who were out
to the immediate family they grew up with were
kicked out of the house, which represents 6%of the whole sample. Those who transitioned 10
or 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).

25%

Figure 5.12: Kicked out of the house by family

20%

20%

YEARS SINCE TRANSITIONING (%)
18%

15%

15%

14%
12%

13%

12%

14%

10%

10%

16%

16%

8%

12%

12%
10%

5%

8%

8%
0%

8%
7%

4%
2%

72

e
or

m

or

9
to
6

5
to
2

to

10

Undocumented residents were more than twice as
likely to have experienced family violence (25%) as
their documented non-citizen (13%) and citizen (9%)
counterparts.

0

ve
O

2015 U.S. TRANSGENDER SURVEY

ra

ll

0%
1

hi
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ac
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ic

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O

ve

ra

di
an

ll

6%

People of color were kicked out of the house at
higher 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 rejection
more than white respondents (6%) (Figure 5.13).

Fourteen percent (14%) of

Figure 5.13: Kicked out of the house by family
RACE/ETHNICITY (%)
18%

respondents who were out to

17%

16%

their immediate family reported

14%

14%

12%

12%
10%

that their family sent them to a11%

professional—such as a therapist,

9%

8%

8%

11%

6%

6%
4%

counselor, or religious advisor—tostop them from being transgender.

2%

25%
20%

20%
15%

20%

15%

14%
11%

10%
5%

or
m
or
10

to
6

9

to
2

5

e

0%
1

• More likely to be currently experiencing serious
psychological distress (50%) than those who
were not kicked out of the house (36%).

YEARS SINCE TRANSITIONING (%)

to• Substantially more likely to have attemptedsuicide (66%) than those who were not kickedout of the house (39%).

Figure 5.14: Sent to a professional to stop themfrom being transgender

FAMILY LIFE AND FAITH COMMUNITIES• More than twice as likely to be living with HIV(3.5%) than those who were not kicked out of
the house (1.5%).

0• Almost three times as likely to haveexperienced homelessness (74%) as those who
were not kicked out of the house (28%).

Fourteen percent (14%) of respondents who wereout reported that their immediate family had
sent 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 more
years ago (20%) were twice as likely to be sent toa professional as those who transitioned within thelast year (11%) (Figure 5.14).

ll• Three times more likely to have ever done sex
work (33%) than those who were not kicked outof the house (11%).

E. Sent to a Professional to Stop
Them from Being Transgenderra• More likely to be living in poverty (43%) thanthose who were not kicked out of the house(28%), and had lower incomes overall.

More than one-quarter (27%) of respondents
who were out to the immediate family they grewup with were not allowed to wear clothes thatmatched their gender.

ve

Being kicked out of the house was associated withan increased likelihood of a range of negative
experiences related to economic stability, mental
health, and physical health. Respondents who
were kicked out of the house were:

D. Not Allowed To Wear Clothes
Matching One’s Gender Identity

O

hi
te
W

La
tin
o/
a
dl
e
Ea
st
er
n
M
ul
tir
ac
ia
l
id
M

ac
k
Bl

n
ia
As

an
In
di

O

Am

er
ic
an

ve

ra
l

l

0%

73

Rates differed by race and ethnicity, with nearly
one-third of Middle Eastern respondents (31%) andnearly one-quarter of American Indian respondents(24%) being sent to a professional (Figure 5.15).

Figure 5.16: Ran away from home
YEARS SINCE TRANSITIONING (%)
20%

19%

16%
14%

Figure 5.15: Sent to a professional to stop themfrom being transgender

12%
10%

RACE/ETHNICITY (%)

10%
8%

8%

35%
31%

30%

4%

25%

24%

or
e
m
or

to
6

10

to

0

14%

2

to

16%

5

1

l
ra
l

16%

14%

ve

15%

14%

O

15%

9

0%

20%

10%
5%

te

l
W

ac

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ia

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ul
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Ea
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tir

st

in

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o/

a

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Bl

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In

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ic

an

O

ve

di

ra

ll

an

0%

Additional details on respondents’ experienceswith professionals who attempted to change
their gender identity are discussed further in the“Conversion Therapy and Other Pressures to
De-Transition” section of the Health chapter.

People of color were more likely to have run awayfrom home, with Middle Eastern (25%), American
Indian (18%), Black (15%), multiracial (14%), Asian(12%), and Latino/a (12%) respondents all reportingthat they had run away at higher rates than white
respondents (8%) (Figure 5.17).
Figure 5.17: Ran away from home
RACE/ETHNICITY (%)
30%
25%

25%
20%
18%
15%

15%

2015 U.S. TRANSGENDER SURVEY
74

Respondents were more than twice as likely tohave run away from home if they transitioned 10 ormore years ago (19%) as compared to those who
had transitioned within the past year (8%)(Figure 5.16).

10%
8%

5%

W

hi

te

l
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ac

ia

rn
Ea

e
dl
M

id

M

in

st
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o/

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ac
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In
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an
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O
ve

ra

ll

0%

er

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.

10%Am

VII. Ran Away From
Home

14%
12%

12%

Rates also differed according to citizenship status,with undocumented residents (36%) running awayfrom home more than three times as often as
citizens (10%) and more than documented noncitizen residents (14%).

65%

Used their preferred name58%

Used the correct pronouns

55%

80%

Stood up for them with family, friends,
or others

36%

70%

Did research to learn how to best
support them33%

Gave money to help with gendertransition

18%

40%

Supported them in another way

11%

30%

Provided help with changing name
and/or gender on an ID document

10%

20%

One or more experiences listed

82%

Figure 5.18: Any family rejection
AGE OF TRANSITION (%)

68%

60%
50%

59%

56%

54%

50%

er
ov

34

d
an
35

Un

de

r1
8

ll

0%

FAMILY LIFE AND FAITH COMMUNITIES

10%

to

% of respondents

Told respondent they respect and/or
support them

O
ve
ra

Supportive family behaviors

25

Table 5.2: Family support

Experience with family rejection differed by theage at which a respondent transitioned, with
68% of those who transitioned at age 35 or older
experiencing rejection, compared to 56% of those
who transitioned under the age of 18 (Figure5.18). Among respondents who transitioned ten
or more years ago, 68% reported family rejection
compared to 48% of those who transitioned in thepast year (Figure 5.19).

24

Those who were out to their immediate family wereasked whether any of the immediate family they
grew up with demonstrated support of them as atransgender person through any specific acts listed
in the question, such as using preferred names,
using correct pronouns, and providing financial
support 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 of
the supportive acts (Table 5.2).

A variable was created to combine all forms offamily rejection examined in the survey. This
included whether the respondent had a spouse,
partner, or child end a relationship, reported
that their family was unsupportive, or had any of
the five specific rejecting experiences outlined
in section VI of this chapter. One half (50%) of
respondents who were out to family members
reported that they experienced some form offamily rejection, which represents 46% of theoverall sample.11

toVIII. Supportive
Family Behaviors

IX. Family Rejection
Overall18

Overall, 15% of those who were out to their
immediate family, or 11% of the whole sample, ran
away from home and/or were kicked out of thehouse.

75

Figure 5.19: Any family rejection

Figure 5.21: Any family rejection

YEARS SINCE TRANSITIONING (%)

RACE/ETHNICITY (%)

80%

70%
68%

70%

60%

58%

60%
50%

50%

66%

68%

50%

50%

48%

49%

49%

hi
te

an

l

In
di

ra
l
ve
O

Am

10

er
ic
an

to
6

or

to
2

0

m

5

1
to

ra
l
ve
O

or
e

Respondents who experienced family rejection
were:• Almost twice as likely to have experienced
homelessness (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%).

GENDER IDENTITY (%)
70%

W

0%
ac
k
La
tin
M
o/
id
a
dl
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Ea
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er
n
M
ul
tir
ac
ia
l

0%

Figure 5.20: Any family rejection

63%

60%

59%

55%

• More likely to have attempted suicide (49%)
than those who were not rejected (33%).

50%
38%

40%

X. Experiences with aFaith Community

32%

30%
20%
10%

en

Tr
a

ns

w

om

en

Tr
a

an

ns

d

m

m

en

en
ns

w

bi

om

na

ry

s
nNo

Tr
a

Cr

os
sd

re

O
ve

ss
er

ra

ll

0%

2015 U.S. TRANSGENDER SURVEY

52%
48%

Bl

10%

n

10%

ia

20%

As

20%

9

30%

l

30%

Family rejection also differed by gender identity,
with transgender women (63%) experiencing
rejection more than transgender men (55%), andtransgender men and women (59%) experiencing
nearly twice as much rejection as non-binary
respondents (32%) (Figure 5.20).

76

52%

40%

40%

50%

50%

Family rejection among respondents of different
racial or ethnic identities varied little, although
American Indian (66%) respondents experienced
higher levels of rejection (Figure 5.21).

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 more
likely to have been part of a faith community thanrespondents of other races and ethnicities(Figure 5.22).

B. Leaving a Faith Community
Due to Rejection

Figure 5.22: Ever been part of a faith community
RACE/ETHNICITY (%)
90%
80%

77%
71%

70%

66%

65%

60%

66%

65%

62%

59%

50%
40%
30%
20%

Nearly one in five (19%) respondents who had
been part of a faith community left because
they were actually rejected (in contrast to feared
rejection as reported in the last subsection), which
represents 12% of all respondents. Experiences
varied 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).

10%
hi
te

l

W

tir

YEARS SINCE TRANSITIONING (%)

M

id

35%

M

Am

Figure 5.24: Ever left faith community due to rejection

ul

Ea
e
dl

ic
er

ac
ia

st
er
n

o/
a
in
La
t

Bl
ac
k

n
ia
As

di

an

32%

30%

29%

25%
20%

19%

19%

15%
10%
5%

e
or
m
or
10

to
6

5
to
2

1
to
0

ra

ll

0%
ve

More than one-third (39%) of respondents who
have been part of a faith community left due
to fear of being rejected because they weretransgender. People of color, including Middle
Eastern (54%), American Indian (51%), Black (49%),
Latino/a (46%), Asian (43%), and multiracial (40%)
respondents, were more likely to leave because
they were afraid of rejection (Figure 5.23).

23%

9

A. Leaving a Faith Community
Due to Fear of Rejection

O

O

In

ve

ra
l

l

an

0%

Figure 5.23: Ever left faith community due tofear of rejection
RACE/ETHNICITY (%)
60%
54%

51%

50%

49%
46%

43%

40%

40%

39%

30%
20%
10%

hi
W

ac

M

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tir

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Ea
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/a
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In

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M

Am

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O
ve

ra

ll

0%

More than one-third (39%) of
respondents who have beenpart of a faith community left
because they feared rejection asa transgender person.

FAMILY LIFE AND FAITH COMMUNITIES

35%

People of color were rejected by their faithcommunities at higher rates, with one-third ofAmerican Indian respondents (33%) and almost
one-quarter of Black (24%) and Middle Eastern(24%) individuals leaving for this reason(Figure 5.25).

77

Figure 5.25: Ever left faith community due to rejection
RACE/ETHNICITY (%)
35%

33%

30%
24%

25%

24%

22%
19%

20%

21%

21%

17%

15%
10%

Nearly one-third (30%) of those who had ever beenpart of a faith community reported that they had
been 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 community
where leaders or other members thought or knew
they were transgender.

D. Acceptance Within Faith
Communities in the Past Year

5%

hi
te
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tin
o/
a
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Ea
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n
M
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O

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ve

In
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ra
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an

l

0%

C. Welcoming Communities andExperiences Within the Past YearOf 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, with
American Indian respondents (54%) being more
likely to find a welcoming community, and Latino/a(37%) and Asian (34%) respondents being least
likely (Figure 5.26).

Respondents whose faith community leaders or
members 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 that
community leaders and/or members accepted
them for who they are as a transgender person,
and more than three-quarters (80%) were told
their religion or faith accepts them. Ninety-six
percent (96%) of respondents who were in a faithcommunity in the past year experienced at least
one 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

Figure 5.26: Found new welcoming faithcommunity after rejection

Many
times

A few
times

Once ortwice

Community leaders andmembers accepted themfor who they are as atransgender person

75%

11%

8%

A leader or member of
their 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%

RACE/ETHNICITY (%)
60%

54%

50%
42%

42%

40%

43%

41%
37%

34%

30%

78

10%

M

id

hi

te

l
tir

ul
M

W

ac

ia

n*

dl

e

Ea

La
t

st

in

er

o/

a

k
ac

n

*Sample size too low to report

Bl

As
ia

di
In
an

er
ic

O
ve

ra

ll

an

0%

Am

2015 U.S. TRANSGENDER SURVEY

20%

One or more experiences
listed1296%

E. Rejection Within Faith
Communities in the Past Year

Figure 5.27: Any rejecting behavior by faith community
in past year
RACE/ETHNICITY (%)
40%

40%
35%
30%

25%

25%
20%

20%

18%

10%
5%

They were told that beingtransgender is a sin orthat their religion does not
approve of them

5%

5%

7%

They were asked to meetwith faith leaders to stopthem from being transgender

1%

2%

3%

Community leaders or members asked them to seek
medical 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 experiences
listed13

hi
te
W

La
tin
o/
a
e
Ea
st
er
n*
M
ul
tir
ac
ia
l
dl
id
M

ia

an

ac
k
Bl

O

Once or
twice

In
di

ve

ra
l

A few
times

n

0%

Am

Many
times

15%

15%

er
ic
an

Rejection within faith community in past year

21%

17%

l

Table 5.4: Rejection within a faith community in thepast year

45%

As

Those with faith community leaders or members
who 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).

*Sample size too low to report

18%

Nearly one in five (18%) respondents who were ina faith community in the past year reported thatthey experienced at least one of the rejecting
behaviors. Rejection was more likely among Asian(40%) and Black (25%) respondents (Figure 5.27).

Results showed significant challenges in many areasof family life, including the retention of relationships
with immediate and extended family, spouses
and partners, and children. However, results also
demonstrate that survey respondents were able
to maintain relationships and successfully build
family units despite those challenges. They further
show the importance of family support in promoting
positive experiences in many aspects of life.
Results demonstrate that family rejection is strongly
correlated with increased negative effects on a wide
range of major life experiences, including income,homelessness, HIV infection, serious psychologicaldistress, and suicidal behavior. Additionally, althoughmany respondents experienced negative interactions
within their faith communities, many others wereable to find welcoming and supportive communities.
While respondents’ experiences varied overall, thesefindings reveal the substantial challenges facing
many transgender people within their families andfaith communities.

FAMILY LIFE AND FAITH COMMUNITIESNearly one in five (19%)
respondents who had beenpart of a faith community left
because they were rejected.

Conclusion

79

ENDNOTES | CHAPTER 5: FAMILY LIFE AND FAITH COMMUNITIES2015 U.S. TRANSGENDER SURVEY

180

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.

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.

9The “serious psychological distress” measure wasdeveloped from the Kessler 6 scale. See Q. 12.2. See also
Health chapter.

2

The term “out” is used here to describe a person who
openly self-identifies as transgender in their private,public, and/or professional lives.

10

Section 4 asked about experiences with “immediatefamily [respondent] grew up with,” and indicated that thedefinition included parents and siblings.

3

Lesbian, gay, bisexual, and transgender (LGBT).

11

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 respondent
had at least one child, but did not determine the numberof children, ages of children, or whether the children lived
in the respondent’s household.

The figure of 50% of respondents experiencing family
rejection is based on a variable created to reflect any
family 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 accepting
behavior 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 behavior
listed in Q. 5.7 once or twice, a few times, or many times.

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 on
Q. 7.6.

CHAPTER 6

Identity Documents

M

This chapter explores respondents’ experiences with their IDs and records, including updating their name
and/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.

IDENTITY DOCUMENTS

ost non-transgender people take their identity documents (IDs) for granted, but for transgenderpeople, updating and using IDs may present substantial challenges. Transgender people often
need 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 Changing
the gender marker listed on most IDs and records generally requires documentation of gender transition
from 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 preventing
transgender people from updating the name and gender on their IDs.3

81

KE Y FI N D I N GS

Eleven percent (11%) of respondents had their preferred name and gender on all IDs
and records, while 68% reported that none of their IDs had the name and gender they
preferred.
Forty-nine percent (49%) did not have an ID or record with the name they preferred, and
67% 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 reported
that 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 try
because 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 change
their gender.
Of those who wanted to change the gender on their birth certificate, only an estimated
9% were able to do so.

2015 U.S. TRANSGENDER SURVEY

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 or
attacked.

82

I. Access to Legal
Name Changes

asked a series of questions about factors in theirdecision to legally change their name and theiraccess to a legal name change.

Changing a name is a step in the transition process
for some, but not all, transgender people. A legalname change order is almost always required
to 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 varies
in each state and territory. Respondents wereApproximately one-third (36%) of respondents
have tried to obtain a legal name change, and
30% were able to do so. This rate varied greatly
according to gender identity, where transgender
men and women (51%) were almost five times
as likely to have tried or completed the namechange process as non-binary people (11%). A vast
majority (96%) of respondents who underwent theprocess did so through a court order, less than 1%

Thirty percent (30%) of
respondents completed thelegal name change process.
did so through the immigration or naturalization
process, and 4% did so by other methods, including
marriage, an informal or assumed name, or aprocess in another country. Eighty-eight percent(88%) of those who attempted to legally change
their name were granted a name change. Those
who 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 change
attempt% of those who
attempted a legalname change

Court granted name change

88%

Court denied name change

1%They are still in process of changing
name

6%

They stopped trying because they ran
out 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 age
24 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.

Reasons for not attempting tochange legal name% of those who had
not attempted namechangeThey 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 allowed3%

A reason not listed

20%

a. Assistance with a Legal Name
ChangeThe legal name change process can becomplicated to navigate, and while many people
undergo the process without help, some seek
the assistance of others. Of people who tried orcompleted the name change process, 60% did so
without help and 40% received help, including free
help from a clinic or non-profit organization (17%),
assistance from a from a friend (11%), or help from a
paid attorney (9%) (Table 6.3).
Table 6.3: Assistance for people who tried orcompleted the legal name change process

Type of assistance% of those who
attempted namechangeNone

60%

Free help from a legal clinic or
non-profit organization17%

Help from a friend

11%

Legal help from a paid attorney9%

Help from another source

7%b. Interactions with Judges andCourt Staff
Those who interacted with judges and court staff
during the name change process reported widely
varying experiences. Of the 84% who believed

IDENTITY DOCUMENTS

Nearly two-thirds (64%) of respondents havenever tried to change their legal name. These
participants reported a variety of reasons for not
engaging in the process, including 28% who feltthat their name did not conflict with their gender
identity (Table 6.2). This reason was more common
among non-binary people (45%) and crossdressers(36%) than transgender men and women (10%).

Table 6.2: Reasons for not attempting tochange legal name83

2015 U.S. TRANSGENDER SURVEY84

with judges or court staff during the name change
process reported having at least one of theseexperiences.

35%
32%

30%
25%

23%
20%

20%
15%
10%
7%

8%

7%

5%
2%

e
or

r
be

0

em

,0
0

em

$2
no

th

an

0–
,0
0

$1
M

Do

–9

2,
00

0

99

49
50
$7

00
$5

–4

–7

99

49
50

1%

tr

1%

0%

$2

Respondents who interacted with judges or court
staff who thought or knew they were transgenderwere asked about specific experiences during
their 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 court
staff 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 interacted

Figure 6.1: Reported cost of a legal name change

9that the judges and/or court staff thought or knew
they were transgender during their interaction,
three-quarters (75%) felt they were always treatedwith respect, almost one-quarter (22%) felt they
were 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 in
the underground economy, such as sex work, drug
sales, or other work that is currently criminalized(41%), and people who had not had any hormonalor surgical treatment (35%).

–2

not afford it.

00

was because they could–9

their name said that it$1

not try to legally change

The process of obtaining a legal name change
may include many different fees, such as thecost of legal help, court fees, and newspaper
publication. The survey asked respondents torecall how much they spent on the name change
process. Approximately one-quarter (27%) of those
who were granted a legal name change reported
that the process cost less than $100, more thanhalf (55%) reported it costing $100–$499, and
10% reported the process costing $500–$2,000(Figure 6.1).

$0of respondents who didc. Cost Associated with a Legal
Name Change$1More than one-third (35%)

The cost of obtaining a legal name change may
make 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 complete
the process because they ran out of money.

II. Experiences with
Updating Name andGender on IDs

In Our Own
VoicesTransgender individuals may seek to update thename on their IDs and records, the gender marker(such as M or F), or both. Only 11% of respondents
reported that all of their IDs and records listed
both the name and gender they preferred, andrates were lower for certain populations, suchas undocumented individuals (4%), people aged
18–24 (5%), and people with no income (6%). Morethan two-thirds (68%) reported that none of theirIDs or records had both the name and gender they
preferred. The following sections will first discuss
respondents’ experiences with updating the nameon their IDs or records, and then their experienceswith updating the gender marker.

“I was intentionally misgendered
and continually verbally harassed
by DMV employees. Even after
paying for proper identification to
be issued, they refused to send theidentification because my female
photo didn’t match my ‘M’ gendermarker.”a. Updating Name on IDs andRecords“My legal name and gender are notyet changed on any documents
due to the price. The process forthat should be easier or cheaper
because that is the main thing thatstops me from doing things that
require ID.”
“Because my state won’t update
the gender markers on its birthcertificates, the only way to update
my driver’s license is by changing myinformation on a federal level withmy passport. The problem is thatnow my documents don’t match.”
IDENTITY DOCUMENTS

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 asked
whether all, some, or none of their IDs and records
reflected 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. Nearly
half (49%) of respondents did not have any ID or
record with the name they preferred. Non-citizens,
including undocumented residents (68%), weremore likely to say that none of their IDs or records
reflected the name they preferred. Respondents
with lower incomes were also more likely to saythat none of their IDs or records had the namethey preferred.

“As a non-binary person, not being
able to change my gender on any of
my identification documents is reallydisheartening, dysphoria inducing,and kind of dehumanizing. I’m notallowed to be me.”85

More than two-thirds (68%)
of respondents did nothave any ID or record thatreflected both the nameand gender they preferred.

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 who
had a driver’s license or state ID and wanted to
update their name on it, less than half (44%) were
estimated5 to have done so. An estimated 44%
have changed their name on a work ID, and 43%
have changed their name with the Social Security
Administration. In contrast, less than one-third (31%)
have changed their name on student records, 28%
on their passport, and 18% on their birth certificate.

Those who indicated that some or all of their IDs
listed the name they prefer were asked specificquestions about their experiences updating thename on different kinds of IDs and records. For

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 who
had transitioned had updated their name on theirdriver’s license. Transgender men and women who
had transitioned were more likely to have updated
their name on various types of IDs than non-binary
respondents who had transitioned. For example,(61%) of transgender men and women who hadtransitioned changed their name their driver’s
license, in contrast to non-binary respondents who
had transitioned (39%) (Figure 6.2).

each 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 but
were denied, or (4) they had not tried to change
the name on that ID but wanted to do it someday.7
Respondents 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).

Figure 6.2: Updated NAME on ID or record, by gender identity and transition status (estimated)
70%
61%

60%

61%

59%

56%

56%

55%

Respondents who
have transitioned

50%
42%

40%

38%

39%

36%
28%

26%

24%

44%

39%
31%

30%

29%

18%
14%

10%

ID
k
W
or

re Stunt dor en
la t res
at t sc cor
te h ds
nd oo
ed l
)
ur
(c

rt
sp
o
Pa
s

Se
re cu
co rit
rd y
s

al
ci
So

d/ Drior ves r
no tat ’s lic
n- e-i en
dr ss sive ue e
rI d
D

ce

rti

fic

at

e

0%

rth

Non-binary
respondents who
have transitioned
Transgender men
and women who
have transitioned

21%

20%

an

86

43%
39%

Bi

2015 U.S. TRANSGENDER SURVEY

44%

40%

All respondents
who had ID/record
and wanted tochange itFigure 6.3: Experiences updating NAME on specific IDs (among those who updated some or all of their IDs/records)
100%

Changed name

90%

88%

87%

Denied namechange84%

80%

In process ofchanging name

70%
61%

60%

55%

50%

Have not tried tochange name but
want to

47%

40%

36%

36%
30%

30%
20%
9%

9%

ID

1%

k

re Stunt dor en
la t res
at t sc cor
te h ds
nd oo
ed l
)

3%

(c

ur

or
t
sp

6%

W
or

3%

1%

Pa
s

Se
re cu
co rit
rd y
s

1%

3%

an

d/ Drior ves r
no tat ’s lic
n- e-i en
dr ss sive ue e
rI d
D

at
e
fic
rti
ce
rth

3%

al

<1%

0%

Bi

10%

10%

8%

ci

6%

So

10%

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 any
IDs). 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 6.2.

b. Updating Gender on IDs andRecords
Updating the gender marker on any ID or record
is typically a distinct process from updating thename, and may require documentation regarding
gender transition from a healthcare provider, a
court order of gender change, an updated birthcertificate, or other documentation. Respondents
were 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 they
preferred. Twelve percent (12%) of respondents
had the gender they preferred on all IDs andrecords, and 21% of respondents had the genderthey preferred on some IDs and records.

Respondents who had transitioned were more
likely 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 transitioned
updated the gender marker on their driver’s
license. 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).

IDENTITY DOCUMENTS

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 who
had a driver’s license or state ID and wanted

to 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 update
their gender on it were estimated to have done so,and only 18% had updated their gender on their
passport.

87

Figure 6.4: Updated GENDER on ID or record, by gender identity and transition status (estimated)
60%

All respondents who
had ID/record andwanted to change it

52%

50%
42%

Respondents who
have transitioned

41%

40%
33%

33%

32%

29%

30%

26%

23%

20%

18%

16%

Non-binary
respondents who
have transitioned

25%
18%

13%
9%

10%

9%

6%

4%

2%

Transgender men
and women who
have transitioned

6%

ur S
re tu
nt d
or en
la t res
at t sc cor
te h ds
nd oo
ed l
)

Pa
s

sp

or
t

lS
e
re cu
co rit
rd y
s

(c

So
ci
a

Bi

rth

an D
d/ ri
or ve
s r
no tat ’s lic
n- e-i en
dr ss sive ue e
rI d
D

ce
rti
fic
at
e

0%

the gender on the ID but were denied, or (4) they
had not tried to change the gender on that ID
but wanted to do it someday.9 Respondents weremost likely to change the gender on their driver’s
license (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).

Those who indicated that some or all of theirIDs listed the gender they preferred were asked
specific questions about their experiences
updating the gender on different kinds of IDs
and records. For each type of ID or record, those
respondents were asked if (1) they had been able
to change the gender on that ID, (2) they werein process of doing so, (3) they tried to change

Figure 6.5: Experiences updating GENDER on specific IDs (among those who updated some or all of
their IDs/Records)
Changedgender

100%
90%

90%

Denied genderchange

80%
70%

70%
60%

55%

In processof changing
gender

55%

49%

50%
40%

35%

88

27%
20%

20%

15%

10%

8%

9%

7%

5% 5%

2% 2%

5%

2%

5%

re Stunt dor en
la t res
at t sc cor
te h ds
nd oo
ed l
)
ur

t
or
Pa
ss
p

Se
re cu
co rit
rd y
s

al
ci
So

(c

an

d/ Drior ves r
no tat ’s lic
n- e-i en
dr ss sive ue e
rI d
D

rth

ce

rti

fic

at

e

0%

Bi

2015 U.S. TRANSGENDER SURVEY

33%

30%

Have not tried tochange gender
but want to

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 any
IDs). 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.

III. Experiences
When Presenting
Incongruent Identity
Documents

One-quarter (25%) of these respondents reported
being verbally harassed. Middle Eastern (44%)
and American Indian (39%) respondents reported
experiencing this more often than other racial or
ethnic groups (Figure 6.6).
Figure 6.6: Verbally harassed when using an ID with aname or gender that did not match their presentation
RACE/ETHNICITY (%)
50%
44%

45%
39%

40%
35%

33%

30%

Table 6.4: Reasons for not changing gender on IDs orrecords

20%

Reasons for not changing
gender10%

They did not know how

26%

They believed they were notallowed

25%

They worried that they might lose
benefits or services

25%

They worried that changing
gender would out them

25%

Their request was denied

1%

A reason not listed

10%

te
hi

l
ac

M

ul

tir

st
Ea
e

W

ia

n
er

/a
in
o
dl

n

k

id

di

As
ia

La
t
M

30%

Am

32%

They were not readySixteen percent (16%) of people who showed IDs
with a name or gender that did not match thegender they present in were denied services orbenefits. Transgender men and women were more
likely to have been denied services or benefits(20%) compared to non-binary respondents (10%).

IDENTITY DOCUMENTS

They could not afford it

an

ll

In

41%

24%

5%
ra

The available gender options(male or female) do not fit theirgender identity

27%

26%

0%
an

44%

24%

15%

er
ic

They have not tried yet

25%

O
ve

% of those who reported
having no IDs/records withthe gender they preferred

25%

ac

Those who said that none of the IDs reflected
the preferred gender were asked why that was
the case. Twenty-five percent (25%) of these
respondents believed they were not allowed tochange the gender on their IDs or records, forreasons such as not having undergone medical
treatment needed to change their gender on an
ID 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 who
indicated that none of their IDs or records had
the gender they preferred reported that it was
because the available gender options (male orfemale) did not fit their gender identity, in contrast
to 4% of transgender men and women (Table 6.4).

Respondents were asked about their experiences
when they have shown an ID with a name orgender that did not match the gender in which
they present. Overall, nearly one-third (32%) ofindividuals who have shown IDs with a nameor gender that did not match their presentation
reported negative experiences, such as beingharassed, denied services, and/or attacked.

Bl

Nearly one-third (32%) of
respondents who did nothave their preferred genderon any of their IDs or records
reported that they could notafford to change them.

89

Nearly one-third (32%) ofindividuals who have shown
IDs that did not match
their presentation reported
negative experiences, suchas being harassed, denied
services, and/or attacked.
Nine percent (9%) of people who showed anincongruent ID were asked to leave. Transgenderwomen were more likely to have been asked
to leave after presenting incongruent IDs (13%),compared to transgender men (9%) and non-binary
people (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. Middle
Eastern respondents were almost five times as
likely (9%) to report experiencing this, American
Indians were three times as likely (6%), and Black
respondents 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%).
Figure 6.7: Assaulted or attacked when using an
ID with a name or gender that did not match theirpresentation
RACE/ETHNICITY (%)
10%
9%

8%
7%
6%

6%
5%

4%

4%
3%

3%
2%

3%

2%

2%

te
W

hi

l
ac
ul

M

Ea
e
dl
id

tir

st

in

er

ia

n

a
o/

k
ac
Bl

n
As
ia

La
t
M

er

ic

an

In

di

ra

an

ll

0%

Am

90

2%

1%

O
ve

2015 U.S. TRANSGENDER SURVEY

9%

Conclusion
Findings indicate that respondents encounteredsubstantial issues related to obtaining IDs andrecords that reflect their gender identity, including
financial, 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 updating
gender markers and procedural requirements(such as providing documentation of certain
medical procedures) are among the main barriers
preventing respondents from updating the genderon their IDs and records. Further, results suggestthat respondents who presented IDs that did
not correspond with the gender they presented
in were put at risk of harassment, assault, andother forms of negative treatment. Overall, thesefindings illustrate a variety of difficulties that arise
during the name and gender change process andemphasize the importance of access to accurate
identity documentation for the safety and wellbeing of transgender people.

ENDNOTES | CHAPTER 6: IDENTITY DOCUMENTS
1

Forty-nine states and all five U.S. territories have acourt order process for changing a legal name. Hawai‘i
is currently the only state with an administrative namechange process. Additionally, a legal name change may
be obtained through other processes, such as throughnaturalization or a common law name change. See NCTE’s
Identity Document Center for more information, available
at: www.transequality.org/documents.

2

For more information on gender marker change
requirements for state and federal IDs, see NCTE’s Identity
Document Center, available at www.transequality.org/
documents.

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-andTheir-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 of
the 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: www.
transequality.org/documents.

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 had
the 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 of
those 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 defined
as 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 following
additional 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 who
had 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 following
additional 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 who
had a particular ID/record and wanted to change therecord. See Q. 10.16.

IDENTITY DOCUMENTS
91

CHAPTER 7

HealthDisparities in health and health care among transgender people have been documented in prior research.1
The 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

2015 U.S. TRANSGENDER SURVEY

B. Overall Health and Psychological Distress92

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.

A. ROUTINE AND TRANSITION-RELATED HEALTH
CARE 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 for

K EY F INDIN GS

transition-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 past
year 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 year
were denied, and 55% of those who sought coverage for transition-related
surgery in the past year were denied.
One-third (33%) of respondents who had seen a health care provider in the past
year 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 see
a doctor because of cost.
While more than three-quarters (78%) of respondents wanted hormone therapy
related to gender transition, only 49% had ever received it.
One-quarter (25%) of respondents have undergone some form of transitionrelated surgery.

HEALTH93

I. Health Insurance
a. Insurance Coverage andSource of Coverage
Respondents were asked a series of questions
about health insurance coverage. Eighty-six
percent (86%) reported that they were coveredby a health insurance or health coverage plan,and 14% reported that they were uninsured. This
compares to 89% of adults in the U.S. general
population 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 likely
to 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 likely
to be uninsured (Figure 7.1). Respondents who
were not U.S. citizens were more likely to beuninsured, including nearly one-quarter (24%) of
documented non-citizens and a majority (58%) of
undocumented residents.
Figure 7.1: Uninsured
RACE/ETHNICITY (%)
25%
20%

20%

18%

15%

17%

16%

Fourteen percent (14%) of
respondents were uninsured,compared to 11% of adults in
the U.S. population.
The most common source of health insurance
reported by respondents was an employersponsored insurance plan (either through the
respondent’s employer or someone else’s
employer) (53%). Fourteen percent (14%) of
respondents 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 former
employer or union (belonging to
respondent or a family member)

53%

56%

Insurance they or someone elsepurchased directly from an insurancecompany or through a health insurance
marketplace (such as healthcare.gov)

14%

16%

Medicaid

13%

15%

Medicare5%

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

14%
11%

12%

11%

10%

94

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0%

Am

2015 U.S. TRANSGENDER SURVEY

5%

More than one-quarter (26%) of respondents
sought options for health insurance from a stateor federal health insurance marketplace, such as
through healthcare.gov, in the past year.6 Of those
who sought insurance through a marketplace, 42%purchased a plan. When acquiring health insurance
through healthcare.gov or state marketplaces, mostenrolled in a Medicaid plan (58%), 27% received a
subsidy to buy a private plan, and 12% purchased a
private plan without a subsidy.

Figure 7.2: Denied coverage for hormone therapy
in the past year
INSURANCE TYPE (%)
35%
29%

30%

26%

25%

25%

21%

20%

20%
14%

15%
10%
5%

su
ra
ty nce
pe
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ul

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su

su

ra
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on ce
ly

ra
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ly

ly
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0%
ve

One in four (25%) respondents reported having
problems with their insurance in the past year
related to being transgender, such as being denied
coverage for care related to gender transition.
Among those who were insured and madethe relevant requests of their insurer,7 several
problems were reported. Seventeen percent (17%)
of respondents had an insurer refuse to change
their name and/or gender in their insurance record
when requested. Thirteen percent (13%) reported
that they were denied coverage for services often
considered to be gender-specific, including routine
sexual or reproductive health screenings (such as
Pap smears, prostate exams, and mammograms).
Seven percent (7%) reported that they were denied
coverage for other routine health care. More thanhalf (55%) of respondents who sought transitionrelated surgery coverage were denied, and onequarter (25%) of those who sought coverage forhormones were denied (Table 7.2).

coverage than transgender women (18%) and nonbinary people who had male on their original birthcertificate (16%). Respondents who were insured
solely through Medicare were least likely to bedenied coverage for hormones (14%) (Figure 7.2).8O

b. Negative Experiences with
Insurance Coverage

Denied coverage for transition-related
surgery

55%

Covered only some of the surgicalcare needed for transition (respondent
could not get coverage for treatment
they needed)

42%

Transgender men (57%) were more likely to bedenied surgery coverage than transgender women(54%) and non-binary people, including non-binary
people with female on their original birth certificate(49%) and non-binary people with male on their
original birth certificate (35%). With the exception of
those who were solely covered by Medicare (48%),
the rate of denials for surgery was similar among thedifferent types of insurance providers (Figure 7.3).

Denied coverage for transition-related
hormone therapy

25%

Figure 7.3: Denied coverage for surgery in the past year

Covered surgery for transition, but had
no surgery providers in their network

21%

Refused to change records to list
current name or gender

17%

54%

Denied coverage for care often
considered gender-specific becauseof transgender status

13%

52%

Denied other routine health carebecause of transgender status

7%

Table 7.2: Negative action or policy by health insurer

INSURANCE TYPE (%)
56%

55%

55%

55%

50%
48%

48%
46%

ul
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pe
s

in
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tip

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O

su

an
on ce
ly

su
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in
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on ce
ly

ly
on
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ar
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ed

M

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ra

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ll

44%
HEALTH

Denials for hormone coverage differed by gender,
with transgender men (32%) and non-binary people
who had female on their original birth certificate(36%) more likely to report being denied hormone

55%
54%

Pr

Negative action or policy% of respondents who
made such a request of
their insurer

95II. Experiences with
Health Care Providers
a. Outness to Health Care
Providers
Respondents were asked whether their current
health care providers knew they were transgender.
Of respondents who currently had health careproviders, 40% reported that all of their current
health care providers knew they were transgender,
13% reported that most knew, and 17% reported
that some knew that they were transgender.
Nearly one-third (31%) of respondents reported
that none of their health care providers knew they
were transgender.

2015 U.S. TRANSGENDER SURVEY

b. Treatment by Health Care
Providers as a Transgender
Person96

Eighty-seven percent (87%) of respondents had
seen a health care provider in the year prior to
taking the survey. Those respondents received
questions about how their health care provider
interacted with them as a transgender person.
Of those who had seen a provider in the past
year, 62% said that at least one provider theysaw knew they were transgender and treatedthem with respect. However, one-third (33%) of
respondents who had seen a provider in thepast year reported having at least one negative
experience with a doctor or other healthcare provider related to being transgender.
This included having to teach the provider
about transgender people in order to receive
appropriate care (24%), being asked invasive or
unnecessary questions about being transgender
not related to the reason for the visit (15%), or
being refused transition-related health care (8%)(Table 7.3).

In Our Own
Voices“My state Medicaid does not cover
hormones or surgeries. With myvery limited income, it is difficult
to afford the treatment I need andI will most likely never be able tohave surgeries.”“I was consistently misnamed
and misgendered throughout myhospital stay. I passed a kidneystone during that visit. On thestandard 1–10 pain scale, that’s
somewhere around a 9. But nothaving my identity respected, thathurt far more.”“Multiple medical professionals
have misgendered me, denied
to me that I was transgender ortried to persuade me that my transidentity was just a misdiagnosis ofsomething else, have made jokes
at my expense in front of me andbehind my back, and have mademe feel physically unsafe. I often
do not seek medical attention
when it is needed, because I’mafraid of what harassment or
discrimination 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.”Table 7.3: Negative experiences when seeing a health careprovider in the past year
% of those
who had seen
a provider inthe past year

Negative experience
They had to teach their health care provider abouttransgender people to get appropriate care24%

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 abusive
language when treating them5%

A health care provider refused to give them care
not related to gender transition (such as physicals
or care for the flu or diabetes)3%

A health care provider was physically rough or
abusive when treating them

2%

They were physically attacked by someone
during their visit in a health care setting (such as a
hospital, office, or clinic)

1%

They were sexually assaulted9 in a health caresetting (such as a hospital, office, or clinic)

1%

One or more experiences listed

33%

Negative experiences with doctors and other
health care providers varied by race and ethnicity.
American Indian respondents (50%) reported thehighest level of negative experiences, and rates
among Middle Eastern (40%) and multiracial (38%)
respondents were also higher (Figure 7.4).
Figure 7.4: One or more negative experiences withhealth provider in the past year
RACE/ETHNICITY (%)
60%
50%

50%

40%

40%
34%

33%

30%

38%
34%

32%

26%

Negative experiences with health care providers
also varied by gender identity. Transgendermen (42%) were more likely to report negative
experiences 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 identify
as having a disability (30%).

c. Providers’ Knowledge About
Transgender People
Respondents were asked about the healthproviders they saw for transgender-related
care and for routine health care needs and theproviders’ level of knowledge about transgender
health care. More than half (56%) of respondents
currently had a provider specifically for transitionrelated care, such as hormone therapy. Of those,
65% reported that this provider knew “almost
everything” or “most things” about providing
health care for transgender people. Seventeen
percent (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% said
they were not sure.
Fifty-one percent (51%) of respondents reported thatthey saw the same provider for transition-related
care and other routine health care. One-third (33%)
indicated that they have a separate provider forroutine care who is different from the provider
they see for transition-related care. Fifteen percent(15%) of respondents reported that they have notransition-related or routine health care provider.

20%
10%

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HEALTH

Respondents with a separate provider for routine
care were asked about that provider’s level ofknowledge about caring for transgender people.
More than of half (54%) of these respondents
were unsure how much their provider knew about
health care for transgender people, while others97indicated that their routine health care provider
knew “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 providers
for transition-related care.
Cost was a major factor in accessing health care,with one-third (33%) of respondents reporting that
there was at least one time in the past year when
they 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 past
year (Figure 7.5). People with disabilities (42%)
were also more likely to not have seen a healthprovider when they needed to because of cost.

RACE/ETHNICITY (%)
40%

37%
34%

35%

28%

30%

42%
36%

5%

5%

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Bl

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n

33%

As
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37%

10%

20%

2015 U.S. TRANSGENDER SURVEY

22%

an

40%

25%

98

24%

26%

26%

15%

41%

30%

Figure 7.6: Did not see health provider due to fearof mistreatment in the past year

an

35%

it due to fear of being disrespected or mistreatedas a transgender person. American Indian (37%)
and Middle Eastern (34%) respondents were more
likely to not have gone to a doctor or other healthcare provider due to fear of being disrespected or
mistreated as a transgender person (Figure 7.6).

20%

RACE/ETHNICITY (%)
40%

Additionally, nearly one-quarter (23%) of
respondents reported that at some point in thepast year they needed health care but did not seek

25% 23%Figure 7.5: Did not see health provider due to costin the past year
45%

Nearly one-quarter (23%) of
respondents reported that they
avoided seeking health carethey needed in the past year
due to fear of being mistreatedas a transgender person.

Fear of being disrespected or mistreated by a healthcare provider also differed by gender identity, withtransgender men (31%) being more likely to avoid
care 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 far
they had to travel to receive routine care and carerelated to gender transition (transition-related care).
Respondents reported having to travel further fortransition-related care than routine care. While
63% indicated that they received routine care fromproviders within 10 miles of their home, less thanhalf (45%) reported that they received transitionrelated health care within 10 miles of their home.
Respondents were three times more likely to haveto travel more than 50 miles for transgender-related
care than for routine care (Figure 7.7).
Figure 7.7: Distance to health care provider
70%
63%transgender men and women (81%) were only
slightly more likely to have ever wanted genderrelated counseling than non-binary respondents(70%), transgender men and women weremore than twice as likely to have actually hadcounseling (73%) as compared to non-binary
respondents (31%). Access to counseling varied
greatly by income, with those who reported
having no individual income (39%) and those
who earned an income of $1 to $9,999 (48%)
being much less likely to have received
counseling than those who earned $50,000 or
more (76%) (Figure 7.8).

60%

Figure 7.8: Counseling/therapy for gender identity
or transition

50%
45%

INDIVIDUAL INCOME (%)

40%

80%

30%

76%

27% 26%

50%

14%

10%
6%

30%
ile

s

m

ile
00

0

m

ile

20%
10%

Respondents received questions about whether they
had ever had, or wanted to have, a range of potential
health care services related to gender transition.

a. Counselingto$1b. Hormone Therapy
Seventy-eight percent (78%) of respondents
wanted to receive hormone therapy at somepoint in their life, but only 49% of respondents
have ever received it. Ninety-two percent (92%)
of those who have ever received hormone
therapy were currently still receiving it,
representing 44% of all respondents. A large
majority of transgender men and women (95%)
have wanted hormone therapy, compared to
49% of non-binary respondents. Transgender
men and women were about five times more
likely to have ever had hormone therapy (71%)
than non-binary respondents (13%).

HEALTHMore than three-quarters (77%) of respondents
said they wanted counseling or therapy for theirgender identity or gender transition at somepoint in their life, but only 58% of respondents
have ever received counseling or therapy. While

$9
,9

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III. Transition-Related
Health Care99
$10
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99 o
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0%OTransition-related health care

M

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75

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–5
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48%
39%

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10

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59%

58%

60%

20%

76%

70%

70%

99

Seventy-eight percent (78%)
of respondents wanted toreceive hormone therapy atsome point in their life, but
only 49% of respondents
have ever received it.
There were also substantial differences in accessto hormone therapy by income. Respondents whoreported having no individual income (31%) or
earning an income of $1 to $9,999 (37%) were about
half as likely to have received hormone therapy as
those who earned $25,000 or more (Figure 7.9).
Figure 7.9: Hormone therapy for gender transition
INDIVIDUAL INCOME (%)
70%

64%

60%

66%

64%

55%
49%

50%
40%

Fifteen percent (15%) of respondents reported
that at some point in their lives, they wanted
puberty-blocking medications, which are
hormone suppressors that are used to delay
physical 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

20%

Of respondents who have ever had hormone
therapy, 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.

One in four (25%) reported having had some formof transition-related surgery.13 Transgender men(42%) were more likely to have had any kind of
surgery than transgender women (28%) or nonbinary respondents (9%). Respondents who were
living in poverty14 (17%) were less likely to have had
any 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 Medicare
only were most likely (44%) (Figure 7.11).15

While the majority (91%) of respondents received
their hormone medications only from licensed
professionals, 6% received them from bothlicensed professionals and friends, and 2%
reported receiving them only from friends, online

One in four (25%) respondents
reported having had some formof transition-related surgery.

10%

99
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2015 U.S. TRANSGENDER SURVEY

c. Puberty-Blocking Hormones

37%
31%

30%

100

sources, or other non-licensed sources.11 Those
who were uninsured were five times more likely
to receive their hormones only from unlicensed
sources (10%). Respondents who were currently
working in the underground economy (suchas sex work, drug sales, or other work that iscurrently criminalized) (8%), who have ever done
sex work in their lifetime (5%), or who were living
in poverty (4%), were more likely to receive theirhormones only from unlicensed sources, as weretransgender women (4%).

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%

more likely to have had any of the procedures thannon-binary respondents who had female on their
original birth certificate (Figure 7.13).
Table 7.4: Procedures among respondents with female
on their original birth certificate

24%Type ofprocedure

15%

$1
0
$2 ,004, 0 t99 o$2 9
5$4 ,009, 0 t
9 o
$5 99
0,
$9 00
9, 0 t
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12%

Want it
some
day

Have
had itNot sure
if theywant thisDo notwant
this

Chest surgery
reduction orreconstruction

21%

52%

17%

Hysterectomy

8%

44%

28%

19%

Metoidioplasty

1%

15%

37%

47%

Phalloplasty

1%

11%

31%

56%

Other procedure
not listed

3%

7%

13%

77%

10%

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%

32%

Hysterectomy

25%

25%

22%

22%

61%

14%

57%

23%

25%

Phalloplasty 3%

19%

Other
procedure 6%
not listed

13%

3%

49%

6%

24%

43%

35%

19%

62%

su

e

20%

40%

60%

80%

100%

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36%

Metoidioplasty 2%

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18%

O

Chest surgery
reduction orreconstruction

Have had it
Want it some day

Respondents were asked a series of questions
about 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 their
original birth certificate.16

i. Experiences of Respondents With
Female on Their Original Birth Certificate

Do not want thisFigure 7.13: Procedures among non-binary respondents
with female on their original birth certificate
Chest surgery
reduction or 6%
reconstruction

42%

Hysterectomy 2%

30%

Metoidioplasty 4%

24%

Phalloplasty 2%

31%

35%

33%

72%

19%

79%

Other
procedure 2%3% 8%
not listed

0%

21%

87%

20%

40%

60%

80%

100%

Have had it
Want it some day
Not sure if they want thisDo not want thisHEALTHOf respondents who had female on their original
birth certificates, 21% had a chest reduction orreconstruction17 and 8% had a hysterectomy.18 Only
2% reported having any genital surgery, such as
metoidioplasty19 (1%) or phalloplasty20 (1%) (Table
7.4). These experiences differed greatly by gender
identity, with transgender men (Figure 7.12) being

Not sure if they want this101

Among those who had female on their original
birth certificate respondents and who had
undergone 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% after
the age of 34.
In addition to transition-related care, respondents
who had female on their original birth certificate
were also asked whether they had received a Pap
smear in the past year. Only 27% reported thatthey had a Pap smear in the past year, compared
to 43% in the U.S. adult population.21,22

2015 U.S. TRANSGENDER SURVEY

ii. Experiences of Respondents With Maleon Their Original Birth Certificate

102

Among respondents who had male on their
original birth certificate, hair removal orelectrolysis was both the most commonly
reported and the most commonly desired
procedure. Forty-one percent (41%) have
had hair removal or electrolysis, and 11% hadreceived voice therapy, the second mostcommonly reported procedure. Regarding
surgical procedures, 10% of respondents had
undergone vaginoplasty and/or labiaplasty,23 9%
had an orchiectomy,24 6% had undergone facial
feminization surgery,25 8% had augmentation
mammoplasty (top surgery),26 4% had a tracheal
shave,27 and 1% had undergone voice surgery(Table 7.5). These experiences varied by gender
identity, with transgender women (Figure 7.14)
being more likely to have had the procedures
than non-binary respondents who had male on
their original birth certificate (Figure 7.15).

Table 7.5: Procedures among respondents with maleon their original birth certificate
Type ofprocedure

Want it
some
day

Have
had itNot sure
if theywant thisDo notwant
thisHair removal orelectrolysis

41%

49%

5%

5%

Voice therapy(non-surgical)

11%

46%

19%

24%

Vaginoplasty orlabiaplasty

10%

45%

23%

22%

Augmentation
mammoplasty

8%

36%

31%

24%

Orchiectomy

9%

40%

24%

27%

Facialfeminization
surgery

6%

39%

30%

25%

Tracheal shave

4%

29%

29%

38%

Silicone
injections28

2%

9%

27%

61%

Voice surgery

1%

16%

32%

51%

Other procedure
not listed

5%

13%

15%

67%

Figure 7.14: Procedures among transgender women
Hair removal
or electrolysis

48%

Voice therapy(non-surgical)

14%

Vaginoplasty
or labiaplasty

12%

Augmentation
mammoplasty

11%

Orchiectomy

11%

Tracheal
shave

5%

Silicone
injections

3% 10%

6%

0%

54%

21%

22%

32%

19%

22%

20%

29%

21%

28%

35%

27%

60%

32%

15%

49%

15%

20%

12%

30%

43%

18%

3% 2%

17%

47%

7%

Other
procedure
not listed

48%

40%

Facialfeminization
surgery

Voice surgery 1%

47%

64%

40%

60%

Have had it
Want it some day
Not sure if they want thisDo not want this

80%

100%

Figure 7.15: Procedures among non-binary respondents
with male on their original birth certificate
Hair removal
or electrolysis

13%

Voice therapy 2%(non-surgical)

54%

34%

Vaginoplasty 1% 11%
or labiaplasty
Augmentation 1%
mammoplasty

Tracheal 1%
shave

Other
procedure 5% 4%
not listed
0%

47%

32%

53%

21%

6%

35%

36%

36%

e. Summary of Transition-Related
Health Care

42%

33%

15%

18%

59%

16%

Silicone 4%
injections
Voice surgery

29%

29%

Orchiectomy 1% 14%
Facialfeminization 1%
surgery

15%

51%

26%

70%

31%

63%

16%

20%

75%

40%

60%

Have had it
Want it some day
Not sure if they want this80%

Two percent (2%) of respondents with maleon their original birth certificate had their firsttransition-related procedure (not including
hormone therapy) before the age of 18. Nearly
one-quarter (23%) had their first procedure
between the ages of 18 and 24, 32% had their firstprocedure between the ages 25 and 34, and 43%
after the age of 34.

100%

When examining the responses of all respondents,
91% reported that they had wanted counseling,hormones, and/or puberty blockers for their gender
identity or gender transition at some point, but only
65% reported ever having any of them. Overall,
58% of respondents had received counseling.
Approximately half (54%) had received hormone
therapy and/or some form of surgery, including
49% who had hormone therapy and 25% who had
undergone some form of transition-related surgery.

Do not want thisB. OVERALL HEALTH AND PSYCHOLOGICAL
DISTRESSK E Y F I N DI N G S

There is a well-documented link between experiences of discrimination and marginalization and poor
physical and mental health outcomes. Populations that face widespread stigma and discrimination are
more 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 people
and 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 serious
psychological distress, nearly eight times the rate in the U.S. population (5%).
HEALTH103

I. Current HealthRespondents were asked to rate their current
overall 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%) said
it was “fair” or “poor” (Figure 7.16), compared with
18% of the U.S. general population (Figure 7.17).31

and crossdressers (57%). Reporting also differedby age, with older respondents more likely toreport excellent or very good health than younger
respondents, such as those aged 65 and older(60%) and 45–64 (53%), compared with those
aged 25–44 (48%) and 18–24 (39%) (Figure 7.18).
Figure 7:18: Reported overall health
CURRENT AGE (%)
40%
35%

Figure 7:16: General health rating

38%
35%

35%

33% 33%

35%

32%
31%

30%

30%

27%

25%
22%

33%
Very
good

13%

12%

13%
11%

10%

9%
6%

5%

5%
3%

2%

er
ov
65

an

45

d

to

to
18

O

64

44

ra

24

ll

0%
ve

17%
Fair

15%

15%

5%

% in USTS

18%

17%

to

5%
Poor

20%

20%

25

12%
Excellent

Excellent

33%
Good

Figure 7:17: General health rating
19%
Excellent
5%
Poor
13%
Fair

% in U.S.
population(BRFSS)

32%
Very
good

Very Good

Fair

Poor

Family support was associated with an increased
likelihood 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 7:19: Reported overall health
LEVEL OF FAMILY SUPPORT (%)
40%

32%
Good

Good

35%

37%
35%
33% 33%

32%

32%

32%

30%

29%

25%
21%

104

15%

15%

13%

12%

10%

10%

10%
8%

5%

5%

5%
3%

Excellent

Very Good

e

l

tiv
or

ut

pp

Ne

Un

su

Su

pp

or

tiv

ra

ll

e

0%
ra

Respondents’ self-reported health varied bygender identity, with non-binary respondents
with female on their original birth certificate (35%)
being less likely to report excellent or very good
health compared to transgender men (47%),
non-binary people with male on their original
birth certificate (48%), transgender women (50%),

18%

17%

O
ve

2015 U.S. TRANSGENDER SURVEY

20%

Good

Fair

Poor

Thirty-nine percent (39%)
of respondents reported
currently experiencing serious
psychological distress, a ratenearly eight times higher thanin the U.S. population (5%).

II. Serious
Psychological DistressRespondents were asked questions to assess
their level of psychological distress in the past
30 days, based on the Kessler PsychologicalDistress Scale (K6), a scale that is widely used
when assessing mental health outcomes and isincluded in the National Health Interview Survey(NHIS).32 The K6 includes mental health screening
questions and is designed to identify people whoare experiencing serious psychological distress.
The K6 questions asked respondents to rate howoften they experienced several feelings related to
psychological distress—such as hopelessness or
worthlessness—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

29%
A lot

10%
Not at
all

35%
Some

% in USTS

26%
A little

Figure 7:21: Interference of psychological distress withlife or activities among those who reported feelings of
distress in the past 30 days

12%
A lot

35%
Not at
all

22%
Some

% in U.S.
population(NHIS)
31%
A little

A variable was developed from the K6questions to reflect respondents’ current serious
psychological distress (serious psychologicaldistress experienced in the 30 days prior
to participating in the survey).35 Thirty-nine
percent (39%) of respondents reported currently
experiencing serious psychological distress, which
is nearly eight times the rate reported in the U.S.
population (5%).36 Current serious psychologicaldistress varied by gender identity. Non-binary
respondents (49%) were more likely to report
serious psychological distress than transgender
men and women (35%) and crossdressers (18%).

HEALTH

Respondents who reported experiencing feelings
related to psychological distress at least “a littleof the time” for one or more of the K6 questions
were asked how much the feelings interfered with
their life or activities. Among them, 27% reported
that the psychological distress interfered with
their life or activities a lot during the past 30
days, 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

Figure 7:20: Interference of psychological distress withlife or activities among those who reported feelings of
distress in the past 30 days

105

While all age groups of USTS respondents
reported substantially more distress than theircounterparts in the U.S. population, younger
survey respondents were more likely to reportcurrent serious psychological distress. Fiftythree percent (53%) of USTS respondents aged
18 to 25 reported experiencing current serious
psychological distress, which was more than six
times as high as the rate among respondents who
were 65 and older (8%) (Figure 7.22).37 A similar
pattern emerged in reporting of current serious
psychological distress in the U.S. population, withthose aged 18 to 25 (10%) being five times as
likely to report experiencing serious psychologicaldistress as those aged 65 and older (2%).38

60%
53%

50%
39%

39%
31%

30%

26%

23%

22%

20%

16%

14%
10%

10%

10%

7%

5%

5%

5%

5%

5%

5%

4%

8%

4%

2%

er

64

ov

d
an

65

60

to

59

54

to
55

49
to

to
50

45

40

to

44

39

34

to
35

29

to

to

30

26

to
18

O

ve

ra

25

ll

0%

% in USTS

2015 U.S. TRANSGENDER SURVEY% in U.S. population (NSDUH)

106“I spent decades torturing myself
into depression because I was
certain that coming out would
destroy my life. I did everything I
could to get my transness to go
away 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 me
to become more and more unable
to function in society as time went
on. Only when my state expanded
Medicaid was I finally able to startdealing with all of these issues
so I could become a productive
member of society.”

Figure 7:22: Currently experiencing serious
psychological distress
CURRENT AGE (%)

40%

In Our Own
VoicesExperiences 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 college
education (48%) were more likely to reportcurrently experiencing serious psychologicaldistress than respondents who had completed an
associate’s degree (32%) or higher (Figure 7.23).

“I have struggled with depression
and 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 suicidal
thought in months. I firmly believe
this is because of my transition.
I feel so much more comfortable
and happy than I’ve ever been.”Respondents who were living in poverty weremore likely to currently be experiencing serious
psychological distress (52%). People withdisabilities (59%) were nearly twice as likely
to currently experience psychological distresscompared to those who did not identify as having
a disability (31%).

Figure 7.23: Currently experiencing serious
psychological distress
EDUCATIONAL ATTAINMENT (%)
70%
58%

60%

54%

50%
40%

48%
39%
32%

30%

30%

20%

18%

10%

•

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 in
the past year because they were transgender(51%) were more likely to report current serious
psychological distress than those who did nothave those experiences in the past year (36%).

•

Respondents who were physically attacked
in the past year (59%) were more likely to be
currently experiencing serious psychologicaldistress than those who were not physicallyattacked in the past year (36%).

•

Respondents who were sexually assaulted in
the past year39 (60%) were more likely to be
currently experiencing serious psychologicaldistress than those who were not sexuallyassaulted in the past year (37%).

Di

d

O
ve
ra
no
ll
tc
hi o
gh m
sc ple
Co
ho te
m
ol
pl
sc eteho dol hi
So /GE gh
D
m
e
co
lle
ge
As
so
de ciat
gr e’seBa echde elogr r’seeG
pr radof u
es atede sio or
gr nalee

0%Psychological distress was associated with avariety of experiences of rejection, discrimination,and violence:

Respondents who had transitioned ten or more
years prior to participating in the survey (24%)
were substantially less likely to be currently
experiencing 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.
Figure 7.24: Currently experiencing serious
psychological distress
YEARS SINCE BEGAN TRANSITIONING (%)
45%
40%

41%

39%

38%

35%

31%

30%
25%

24%

20%
15%
10%
5%
e

s
s

10

or

m

ye

or

ar

ar
ye

ar
ye

6

2

to

5

1y
to
0

to

10

r
ea

ll
ra
O
ve

s

0%

HEALTH107

C. CONVERSION THERAPY AND OTHERPRESSURES TO DE-TRANSITION
Many transgender people discuss their gender identity with professionals, such as health care providers
or religious advisors. However, despite the medical consensus that efforts to change someone’s gender
identity 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 to
avoid or put off their transition, or to de-transition after they have started their transition, by family members
or employers, as well as religious advisors or health professionals. Others face significant discrimination
when 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.

K EY F INDIN GS

The survey explored respondents’ experiences discussing their gender identity with professionals, suchas psychologists, counselors, and religious advisors, including pressure from those professionals to detransition or stop being transgender. Experiences with de-transitioning were also examined. Respondents
overall demonstrated high levels of resistance to such pressure and other forms of discrimination. Few
respondents de-transitioned, and many of those who did de-transition did so only temporarily and were
living 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 to
be at birth for a period of time.

2015 U.S. TRANSGENDER SURVEY

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 to
be at birth.

108

Respondents who de-transitioned cited a number of reasons for doing so, including
facing too much harassment or discrimination after they began transitioning (31%),
having trouble getting a job (29%), or pressure from a parent (36%), spouse (18%), or
other family members (26%).

I. Discussing
Gender Identity withProfessionals andConversion Therapy
The survey examined a variety of experienceswith professionals—such as psychologists,
counselors, and religious advisors—with whom
respondents had discussed their gender identity.
Almost three-quarters of respondents (72%)
reported that they had discussed their gender
identity with such a professional.
Whether an individual discussed their gender
identity with a professional differed by gender, withtransgender men and women (84%) being more
likely to do so than non-binary respondents (52%)
and crossdressers (46%) (Figure 7.25).
Figure 7.25: Ever discussed gender identitywith a professional
GENDER IDENTITY (%)
90%
80%

85%

83%

Nearly one in five (18%)
of those who discussed
their gender identity with aprofessional—or 13% of all
respondents—reported thatthe professional tried to stopthem from being transgender.
from 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 a
respondent from being transgender differed byrace and ethnicity. While Middle Eastern (32%) andAmerican Indian (27%) respondents were most likely
to have this experience, rates were lower for Black(16%) and Asian (14%) respondents (Figure 7.26).

84%

Figure 7.26: Professional tried to stop them frombeing transgender

72%

70%
60%

RACE/ETHNICITY (%)

52%

50%

35%

46%

40%

32%

30%

30%

27%

25%

20%

Tr
a

ns

w
ns
Tr
a

m

en
om

na
bi
n-

Tr
a

s
No

sd
r

es

se
r

ra
Cr

os

O
ve

ns
an wo
d me
m n
en

15%
en

0%
ry

20%

ll

10%

21%
19%

18%
14%

17%

16%

10%
5%

te
hi

ac
tir
ul
M

Ea
e

M

id

dl

W

ia

l

n
st

in

er

o/

a

k
La
t

Bl
ac

n
As
ia

di

ic

an

In

ve
O

er
Am

Of all respondents who discussed their gender
identity 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/spiritual
counselor or advisor who tried to stop them

ra

ll

an

0%

More than three-quarters (78%) of respondents
were under the age of 25 when they had thisexperience, 51% were 18 or younger, and 28%
were 15 or younger.
HEALTH109

Of the 4% who reported that a religious or spiritual
counselor or advisor tried to stop them from beingtransgender, American Indian (9%) and Middle
Eastern (7%) respondents were more likely to havesuch an experience with a religious or spiritual
counselor or advisor (Figure 7.27).
Figure 7.27: Religious counselor tried to stop themfrom being transgender
RACE/ETHNICITY (%)
10%
9%
8%
7%
6%
5%

9%

7%
5%

5%
4%

4%
3%
2%
1%
0%

4%

4%

hi
W

ac
tir
ul
M

Ea
e

M

id

dl

te

l
ia

n
st

in

er

o/

a

k
La
t

ac
Bl

n
ia

di
In
an

ic

As

an

ll
ra
ve
O

er
Am

2015 U.S. TRANSGENDER SURVEY
110“The doctor figured out I was transand practiced conversion therapy
without telling anyone, including
my parents. I tried to tell my family
that the doctor was not working,but nobody listened. I was sent
there for over three years. I became
so badly suicidal that I didn’t go aminute without thinking of death.”

3%

Participants who had a professional try to stopthem from being transgender were:•

In Our Own
VoicesFar more likely to currently be experiencing
serious 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 did
not have the experience (8%).

•

More likely to have ever experienced
homelessness (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%).

“When I was 18, I had to leave
where I grew up after threats ofphysical violence and conversion
therapy from my family. My parents
were abusive before they knew I
was trans, but when they found out,
they used that to hurt and control
me more.”“[An] OB/GYN forced me onto birthcontrol pills to ‘fix’ me into thinking
I was a woman again. I ended up
in the psychiatric ward of my local
hospital on suicide watch after
three days on birth control.”“I was kicked out of my parents’
home. I ran out of what little money
I had, and I had nowhere to go. My
family offered to let me return totheir home on the condition that I
de-transition and live as a man. I
accepted because I had no choice.”Sixty-nine percent (69%) of respondents discussed
their sexual orientation with a professional. Of
those, 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%) of
respondents reported having de-transitioned atsome point. Most of those who de-transitioned
did so only temporarily: 62% of those who had
de-transitioned reported that they were currently
living 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-transitioning
also differed by race and ethnicity, with American
Indian (14%), Asian (10%), and multiracial (10%)
respondents reporting the highest levels of detransitioning (Figure 7.28).

Respondents who had de-transitioned cited arange of reasons, though only 5% of those who
had de-transitioned reported that they had done
so because they realized that gender transition
was not for them, representing 0.4% of the overall
sample.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 detransitioned because of pressure from their spouseor partner. Other common reasons included facing
too much harassment or discrimination after they
began transitioning (31%), and having trouble
getting 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 those
who had everde-transitioned

Pressure from a parent

36%

Transitioning was too hard for them

33%

They faced too much harassment or
discrimination 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 not
for them

5%4%

Initial transition did not reflect the complexityof their gender identity (write-in response)

4%

2%

Financial reasons (write-in response)

3%0%

Medical reasons (write-in response)2%

A reason not listed above

35%

Figure 7.28: Ever de-transitioned
RACE/ETHNICITY (%)
16%
14%

14%
12%

10%

10%

9%

8%

8%

10%
8%

8%

6%

hi

te

l
ac

W

ia

n

ul
tir

Ea
e
dl
id

M

st

in

er

o/

a

k
ac
Bl

n
As
ia

In

La
t
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HEALTH111

D. SUICIDAL THOUGHTS AND BEHAVIORS
The prevalence of suicide attempts among transgender people is reported in the literature as being
substantially 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

K EY FINDIN GS

The survey explored suicidal thoughts and behaviors among respondents both over the course of their lifetime
and in the year prior to completing the survey. Respondents were asked whether they had seriously thought
about, 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 and
Health44 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% have
had serious thoughts about killing themselves at some point in their life.
Nearly one-quarter (24%) of respondents made plans to kill themselves in the past
year, compared to 1.1% of the U.S. population.
Seven percent (7%) of respondents attempted suicide in the past year, compared to
0.6% in the U.S. population.

2015 U.S. TRANSGENDER SURVEY

More than two-thirds (71%) of respondents who have attempted suicide have done
so more than once in their lifetime, with 46% of those who have attempted suicide
reporting three or more attempts.

112

I. Suicidal Thoughts
and Behaviors in the
Past Year
Nearly half (48%) of all respondents reported
that they had seriously thought about killingthemselves in the past twelve months, compared
to 4% of the U.S. general population.46 Nearly
one-quarter (24%) of respondents reported making
plans 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%).

Seven percent (7%) of all
respondents attempted suicide in
the past year, nearly twelve times
the rate of attempted suicide in
the U.S. population (0.6%).

Figure 7.29: Attempted suicide in the past year
RACE/ETHNICITY (%)
12%
10%

10%

10%
9%

9%
8%

8%

8%

7%
6%

6%
4%
2%

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n

Respondents whose current income came only
from work in the underground economy, suchas sex work, drug sales, or other criminalized
work, had a higher rate of suicide attempts in thepast year (27%). Additionally, respondents who
described their families as unsupportive (13%)
were more than twice as likely to have attemptedsuicide in the past year as those who described
their families as supportive (6%).

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Respondents who did not complete high school(17%) were more than twice as likely as the overall
sample to have attempted suicide in the past year,
and those who completed high school or a GED
only (13%) were almost twice as likely to haveattempted suicide in that time period (Figure 7.30).

The rate of suicide attempt in the past year varied
by age, with younger respondents being more
likely 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 respondents
aged 18–25 have attempted suicide in the past
year, ten times the rate among those aged 65 andolder (1%) (Figure 7.31). Similarly, those aged 18–25
in the U.S. population (1.6%) were eight times more
likely to report having attempted suicide in thepast year than those aged 65 and older (0.2%).50

Figure 7.30: Attempted suicide in the past year
EDUCATIONAL ATTAINMENT (%)
18%
17%
16%
14%
13%
12%
10%
9%
8%
7%
6%
4%
2%
0%

6%
4%

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gh m
p
Co sch lete
oo
m
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l
sc ete
ho d
ol hi
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e
co
lle
ge
As
so
de ciat
gr e’seBa echde elogr r’s
ee
G
r
pr ad
of u
es atede sio or
gr nalee

3%

Figure 7.31: Attempted suicide in the past year
CURRENT AGE (%)
12%
10%

10%
8%
7%

6%

7%
5%

4%

5%
4%

64

59
to

65

55

1%

0.3%

0.3%

54
50

to

49
to
45

2%

% in USTS

0.2%

ov
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0.6%

0.4%

44
to
40

35

to

39

34
to
30

to
26

to
18

29

25

ll
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0.5%

0.4%

HEALTH

ve

0.6%

an
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2%
0.7%

0.6%

O

3%

to

3%
1.6%

0%

60

2%

% in U.S. population (NSDUH)

113

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.52
Thirty percent (30%) of respondents who attemptedsuicide stayed in a hospital for at least one night,
compared to 41% of those who attempted suicide in
the U.S. population.53

Forty percent (40%) of
respondents have attemptedsuicide in their lifetime, nearlynine times the rate reported in
the U.S. population (4.6%).

II. Lifetime Suicidal
Thoughts and Behaviors

People with disabilities (54%) in the sample weremore likely to report attempting suicide. Lifetime
suicide attempts also varied by level of education,with the highest rates among those who did notcomplete high school (52%), and the lowest rates
among those with a bachelor’s degree (34%) or
higher (30%) (Figure 7.33).

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 the
U.S. population (4.6%).54

Figure 7.33: Ever attempted suicide
EDUCATIONAL ATTAINMENT (%)
60%
52%

50%

Figure 7.32: Ever attempted suicide
RACE/ETHNICITY (%)
60%
57%

114

50%

47%
40%

40%

45%

44%

40%

37%

30%
20%
10%

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0%

Am

2015 U.S. TRANSGENDER SURVEY

50%

40%

40%

45%
42%
34%
30%

30%
20%
10%

O

ve
ra
ll
no
t
hi co
gh m
sc ple
ho te
Co
ol
m
p
sc let
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As
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de ciagr te’s
ee
Ba
ch
de el
gr or’s
ee
G
pr ra
of du
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dessio te ogr na r
ee l

0%

Di
d

Lifetime suicide attempt rates were higher fortransgender men (45%) than for transgenderwomen (40%) and non-binary respondents (39%),and crossdressers had a substantially lower
rate 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).

49%

Among respondents who were out to theimmediate family they grew up with, lifetime
suicide attempts varied significantly by family
support. A majority (54%) of those who described
their families as unsupportive had attemptedsuicide in their lifetime, in contrast to 37% of
those with supportive families.55
Lifetime suicide attempts were also higher for
respondents who were physically attacked in
the past year (65%), or have ever experienced
homelessness (59%), done sex work (57%), losttheir job for being transgender (55%), or beensexually assaulted56 (54%).

More than two-thirds (71%) of all respondents who
had 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 Suicide
Attempts
a. Age of First Attempt
Respondents who have attempted suicide (once or
multiple 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 that
their first attempt occurred between the ages of 14
and 17, 20% reported that it occurred between age
18 and 24, and 8% reported that their first attempt
was at age 25 or older.

b. Age of Most Recent Attempt
Among respondents who reported a suicide
attempt,57 6% reported that their most recent
attempt happened at age 13 or younger. Morethan one-quarter (26%) reported the most recent
attempt 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

K E Y F I N DI N G S

Substance use is an important indicator of mental health as well as physical wellbeing, and it may reflect
an 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 had
ever consumed certain substances, including alcohol, tobacco, marijuana, and other drugs, such as
cocaine, 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 to
8% 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.

HEALTHOverall, 29% of respondents reported illicit drug use, marijuana consumption, and/or
nonmedical prescription drug use in the past month, nearly three times the rate in the
U.S. population (10%).

115

RACE/ETHNICITY (%)
35%
30%

30%

27%

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 3–5
days 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

2015 U.S. TRANSGENDER SURVEY

Current alcohol users were also asked for thenumber of days in the month when they consumed
5 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 binge
drinking in the past month, slightly higher than therate in the U.S. adult population in 2014 (25%).63

116

Respondents who were currently working in theunderground economy, such as sex work, drug
sales, or other criminalized work, were nearly twice
as likely to engage in binge drinking as those in theoverall sample, with nearly half (49%) reporting binge
drinking 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).

30%

26%

25%

25%

19%

20%
15%
10%
5%

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Am

a. Frequency of Current
Alcohol Use

32%

25%

O

Ninety percent (90%) of respondents reported
having a drink of alcohol, such as beer, wine, or
hard liquor, at any point in their lives, comparedto 86% in the U.S. adult population.60 Sixty-three
percent (63%) of respondents were currently
using alcohol, meaning that they had consumed
at least one alcoholic beverage within the 30days prior to taking the survey, compared with
56% of the U.S. adult population.61

Figure 7.34: Reported binge drinking in the past month

er
ic
an

I. Alcohol Consumption

Nine percent (9%) of respondents reported binge
drinking on one day during the month and 10%
on 2–4 days. Seven percent (7%) of respondents
reported binge drinking on 5 more days thatmonth (“heavy drinking”), the same rate as the U.S.
population (7%).64 Respondents who were currently
working in the underground economy (19%) weremore than twice as likely to report heavy drinking in
the past month as those in the overall sample.

II. Tobacco Usea. Lifetime and Current
Tobacco Use
Fifty-seven percent (57%) of respondents reported
that they had smoked all or part of a cigarette at
any point in their lives, lower than the rate in the
U.S. population (63%).65 Twenty-two percent (22%)
were current smokers, meaning that they smokedat least one cigarette or part of a cigarette within
thirty days of taking the survey, which compares to
21% of the U.S. population.66
Respondents who were currently working in theunderground economy were more than twice
as likely as the overall sample to have smokedtobacco within the past month, with 51% reporting
current tobacco use.

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 current
users 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 during
the past month, compared to 59% of current
smokers 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 reported
by 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).
Figure 7.35: Daily smokers consuming one or more
packs a day in the past month
CURRENT AGE (%)
60%

50%

40%
32%

29%

30%
19%

20%
10%

ov
er

64

44

d

to

IV. Marijuana Use
Nearly two-thirds (64%) of respondents reported
having ever used marijuana,68 compared with 47%of the general population.69

a. Current Marijuana Use
One-quarter (25%) of the sample reported current
use, meaning that they used marijuana within 30
days of taking the survey, compared to 8% of the
U.S. general population.70 Current marijuana use
was elevated among those who were currently
working in the underground economy (60%) andthose who were living with HIV (48%).

65

an

45

18

25

to

to

al

24

l

0%
ve
r

More than one-third (36%) of respondents had used
e-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 within
30 days of taking the survey. An additional 40% usedthem more than 30 days prior but less than a year
before taking the survey, and 29% had used themmore than 12 months before taking the survey.

54%

50%

O

III. E-Cigarettes or
Vaping Products

Figure 7.36: Daily smokers consuming one or more
pack a day in the past month

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27%

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40%

Respondents who had used marijuana in the month
before 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% on
13–28 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

HEALTHan

RACE/ETHNICITY (%)
50%
44%
45%
40%
35%
32%
30%
25%
22%
20%
15%
10%
5%
0%

b. Frequency of Marijuana Use*Sample size too low to report117the past month. Respondents who were living withHIV (34%) were also more likely to use marijuana
on 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).71
Prior use of illicit drugs was particularly high among
respondents who have done sex work (56%) andthose who have done underground economy work
other than sex work (such as drug sales) (75%). Past
illicit 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 sample
reported current use of illicit drugs (not including
marijuana), 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 currently
working in the underground economy (3%) to haveused illicit drugs within the past month.

Almost one-third (29%) of
respondents reported illicit druguse, marijuana consumption, and/or nonmedical prescription drug
use in the past month, comparedwith 10% of the U.S. population.
prescription drug use were particularly high among
those who had done underground economy work
other than sex work, such as drug sales, with 75%
reporting nonmedical prescription drug use.
Younger respondents were more likely to report
nonmedical prescription drug use, with those aged
25–44 (39%) being most likely, and those aged 65
and older (18%) being the least likely to report suchprescription drug use (Figure 7.37).
Figure 7.37: Nonmedical use of prescription drugs
CURRENT AGE (%)
45%
39%

40%
35%

34%
31%

30%

27%

25%
20%

18%

15%
10%
5%

2015 U.S. TRANSGENDER SURVEY
118

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 nonmedical

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VI. Nonmedical
Prescription Drug Use

0%

a. Current Nonmedical
Prescription Drug Use
Of respondents who reported nonmedical useof prescription drugs, over half (51%) had lastengaged in such use more than a year before
taking the survey, and 28% had done so withinthat year but more than a month earlier. More than
one in five (21%) reported nonmedical prescription
drug use within 30 days of taking the survey. This
represents 7% of the overall sample, compared to
2% of the U.S. population.72

VI. Overall Current
Drug Usethey consumed them within 30 days of taking thesurvey. This was nearly three times higher thanusage in the U.S. general population (10%).73

Almost one-third (29%) of respondents inthe overall sample were currently using illicit
drugs, marijuana, and/or prescription drugs notprescribed to them or not as prescribed, meaning

More than two-thirds (68%) of those currently
working in the underground economy reported illicit
drug 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%
68%
60%

60%
49%

40%
26%

27%

26%

24%

28%

26%

20%

pr Cu
es rrecr nt
ip n
tio on
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e

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nt

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ar

iju

an

a

us

Bi
n
in ge
pa d
st rin
m kin
on g
th

e

0%

% in USTS currently working in underground economy

10%
3%

2%

N/A

rre
no inc nt i
nm lu lliced din it d
ic g m rug
al a upr rij see u
dr scri ana (noug pt o t
us ion r
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ip n mtio o an nm riju
dr e aug dic na
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e

6%

Cu

8%

% in USTS not currently working in underground% in U.S. population (NSDUH)

HEALTH119

F. HIV TESTING AND CAREK EY F INDIN GS

The prevalence of HIV and AIDS has been found in prior research to be higher among transgender people
than 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, inadequate
access 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 experiences
related to HIV testing, HIV care, and living with HIV. Several of the questions in this section of the survey were
patterned on national surveys, including the National Health Interview Survey (NHIS)76 and Behavioral Risk
Factor 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 the
U.S. adult population.
Respondents reported that they were diagnosed with HIV at a rate of 1.4%, a
substantially 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.

120

RACE/ETHNICITY (%)
80%
70%

70%

65%

60%

59%

55%

54%

49%

50%

53%

52%

40%
30%
20%
10%
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Respondents were asked whether they had everbeen tested for HIV, aside from testing obtained
through the blood donation process. More thanhalf (55%) of respondents had been tested forHIV, in comparison to 34% of the U.S. adult
population.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).

Figure 7.39: Ever been tested for HIVAm2015 U.S. TRANSGENDER SURVEY

I. HIV TestingPeople who were currently working in theunderground economy, including sex work anddrug sales, were also more likely to have beentested (78%).

Figure 7:40: Year of last HIV test

38%
2015

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 HMO
office, more than one-quarter (26%) at a clinic,
and 11% in a counseling or testing site. Testing
locations followed a similar pattern in the U.S.
general population, with a few exceptions. USTS
respondents 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 a
hospital inpatient (Table 7.7).
Table 7.7: Locations where last tested for HIV

Location% in U.S.
population(BRFSS)% in USTS

Private doctor or HMO office

45%

47%

Clinic26%

23%% of those
who have beentested for HIV
20%2010 orearlier
6%
2012

22%
2014

11%
2013

3%
2011

c. Reason For Not Being Tested
Forty-five (45%) percent of respondents reported
that they had not been tested for HIV. Of those
who had not been tested, 86% reported thatthe main reason for not being tested was that
exposure to HIV was unlikely, similarly to therate in the U.S. general population (86%).80
Respondents also reported a variety of additional
reasons for not being tested (Table 7.8).

Counseling or testing site

11%

4%

Hospital inpatient

3%

9%Emergency room

1%

2%

Home

1%

2%

Jail, prison, or other correctional
facility<1%1%Drug treatment facility

<1%

<1%

Somewhere else

9%

11%

ReasonMilitary (write-in response)

2%

---

Unlikely they have been
exposed to HIV

86%

86%

Mobile clinic or testing site (writein response)

2%

---

3%

---

Do not know or not sure

---

1%

Their doctor/health careprovider never mentioned
getting an HIV test
They did not know where to
get tested

1%0%b. Year of Last Test

They did not want to think about
HIV or being HIV-positive

1%

0%

Thirty-eight percent (38%) of respondents who
have ever been tested for HIV had most recently
been tested in 2015 (the year the survey was
conducted), and more than two-thirds (71%) hadlast been tested in 2013 or later (Figure 7.40).

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 government
if they tested positive

<1%

<1%

They were afraid of losing theirjob, insurance, home, friends,
or family if people knew they
were tested

<1%

<1%

Table 7.8: Main reason for not being tested for HIV% of those
who havenot beentested in U.S.
population(NHIS)% of those
who havenot beentested in
USTS

2%

1%

No particular reason

6%

12%

HEALTH

Some other reason

121

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 their
HIV test. This included 1% of those who were
tested but did not know their status because they
never received the results and less than 1% who
received results that were unclear, which meant
the 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).

GENDER IDENTITY (%)
4%
3.4%

3.5%
3%
2.5%

2.1%

2%

2%
1.4%
1%

1%
0.5%

0.2%

0.4%

0.3%

2015 U.S. TRANSGENDER SURVEY

No

O
ve
ra
nC
ll
bi
ro
ss
on nar
d
y
re
No
th pe
ss
ei o
ner
r p
bi
s
na birt lewhon ry pce ithrti mth eo
fic alei p
r b leat e
e
irt wi
h th
ce fe
rti m
No fic ale
n- ate
bi
na
ry
(a
Tr
ll)
an
s
w
om
en
Tr
an
s
m
en
Tr
an
s
an wo
d me
m n
en

0%

122

“I have consulted with surgeons[for gender transition] only to
be told they would charge me
50–100% more for the surgery
because I am HIV positive. Everyday is a double coming out
process as transgender and being
undetectably HIV positive.”“The nurse refused to give me HIV
testing because she said those
funds were reserved for men who
have sex with men and I’m ‘not a realman.’ She told me I was born female
and just needed to accept reality.”

Figure 7.41: Living with HIV

1.5%

In Our Own
Voices

The rate of HIV differed by race and ethnicity, withBlack respondents being almost five times as likely
to be HIV positive or reactive (6.7%). American
Indian (2.0%) and Latino/a (1.6%) participants also
had higher rates of HIV compared to the sample
and in contrast to Asian (0.5%) and white (0.4%)
respondents (Figure 7.42).

“I am a trans man who has been
living with HIV for 25 years. I havegood health insurance and get
excellent trans-related and HIVrelated health care. I have access toa great therapist who is an expert
in gender issues and transitioning.
All these factors contribute to mysurvival and my success.”“My first time in jail, and possibly
the time I became infected with
HIV, was the scariest of all. There
were so many times I was in jail andparticipated in unprotected sex outof fear and necessity. This is justone of the harsh realities for young
vulnerable trans women like myself.
It is truly bewildering that this reality
was so commonly accepted amongtrans women of color.”

The rate of respondents livingwith HIV (1.4%) was nearly fivetimes higher than in the U.S.
population (0.3%).
Figure 7.42: Living with HIV

The rate of HIV also differed by current age, with
it being highest among those aged 45–64 (3.3%)
and also higher for the 25–44 age group (2.0%)(Figure 7.44).
Figure 7.44: Living with HIV
AGE (%)
3.5%

3.3%

3%

RACE/ETHNICITY (%)

2.5%

8%
7%

2.0%

2%

6.7%

6%

1.5%

5%

1%

4%

0.5%

3%

0%

1.6%

1.4%

te
hi

M

e
dl
id
M

Am

Nearly one in five (19.0%) Black transgenderwomen reported living with HIV, a rate that is morethan thirteen times higher than that in the overall
sample. American Indian (4.6%) and Latina (4.4%)transgender women also reported substantiallyhigher rates of HIV (Figure 7.43).
Figure 7.43: Living with HIV among transgender women

er
ov

64

d
an
65

45

to

to

Undocumented residents (15.0%) were more thanten times as likely to report that they were livingwith HIV as the overall sample, and documented
non-citizens (3.6%) were also more likely. There
were also substantial differences when examining
rates of HIV by educational attainment. Those who
did not complete high school (7.2%) were more than
five times as likely to be living with HIV as those in
the overall sample, in contrast to the lower rates for
those with a bachelor’s degree (0.7%) or a graduate
or professional degree (0.8%) (Figure 7.45).
Figure 7.45: Living with HIV

19.0%

EDUCATIONAL ATTAINMENT (%)
8%
7.2%

7%
6%
5%
4%
4.4%

3%
0.7%

2%
1%

1.4%

1.8%

1.6%

1.7%
0.7%

hi

0.8%

d

O
ve
ra
no
ll
tc
hi o
gh m
sc ple
Co
ho te
m
ol
pl
sc eteho dol hi
So /GE gh
D
m
e
co
lle
ge
As
so
de ciat
gr e’seBa echde eloG
gr r’see
fe radss u
io atena old r
eg prore e

0%

HEALTH

Di

W

tir
ul
M

Ea
le

ac

st
e

ia

l

rn

a
in
La
t
id
d
M

ac

k

0%

te

2.5%

Bl

n
As
ia

re O
sp ve
o ra
Am nde ll (an ller
ic ts)anIn
dian

RACE/ETHNICITY (%)
20%
18%
16%
14%
12%
10%
8%
6%
4.6%
4%
1.8%
2%
1.4%
0%

25

0.4%

ul

Ea

tir

st

ac

er

o/
in
La
t

ic
er

ia

n

a

k
ac
Bl

n
ia
As

In
an

O

ve

di

ra

ll

an

0%

l

0%

18

0.8%

0.5%

W

1%

to

ra
O

ve

1.6%

1.4%

24

ll

2.0%

2%

44

0.2%

123

The rate of HIV was more than ten times higher
for 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 treatment
and management of HIV in terms of the HIV care
continuum or the HIV treatment cascade. The HIV
care continuum describes stages of HIV medicalcare, including “diagnosis of HIV infection, linkage
to care, retention in care, receipt of antiretroviraltherapy, and achievement of viral suppression.”85
Respondents were asked whether they hadreceived HIV-related health care in the year prior
to the survey, and were also asked about otheraspects of the HIV care continuum.

2015 U.S. TRANSGENDER SURVEY

Most of the respondents who were living with HIV
had received HIV-specific health care within thepast year, not including care received during an
emergency room visit or during a hospital stay.
Eighty-nine percent (89%) of respondents livingwith HIV had seen a doctor or health care provider
for HIV care in the past 12 months, and 87%
received HIV care in the past 6 months.

124

Respondents who had not seen a doctor for HIV
care 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 their
HIV is well controlled enough to only see a doctor
once 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 higher
power or God to help with their HIV, only recently
finding 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 recently
received such testing between 6 and 12 months
ago, 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 can
reduce 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 those
who had been prescribed ART, almost twothirds (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% never
took it regularly and as prescribed. Approximately
half (45%) of respondents who were not taking
their ART medication all of the time—including
those who took it most of the time, rarely, or
never—reported that the main reason for nottaking it as they were supposed to was that they
forgot 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 about
conflicts with other medications, concerns about
weight gain, not wanting to take ART, and otherreasons not listed in the question.

Conclusion

income and economic instability and lack of accessto adequate health insurance insurance.

Findings throughout the chapter indicated that
respondents were impacted by substantial healthrelated disparities, including access to quality
care and health outcomes. Respondents reported
substantial barriers to receiving the care that theyneed, such as financial constraints, lack of healthinsurance or insurance that does not adequately
address 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 such
health care despite wanting to do so, often due to

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 more
likely to report poor mental health outcomes,
including higher rates of substance use, serious
psychological distress, and suicide attempts.
Findings demonstrated an association between
poor health outcomes and a number of risk
factors, such as economic instability, housing
instability, lower educational attainment, andlack of family support.

ENDNOTES | CHAPTER 7: HEALTH

1

2

Kosenko, K., Rintamaki, L., Raney, S., Maness, K. (2013).
Transgender patient perceptions of stigma in health care
contexts. Medical Care, 51(9), 819–822; Poteat, T., German,
D., & Kerrigan, D. (2013). Managing uncertainty: A groundedtheory of stigma in transgender health encounters. Social
Science & 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 LGBT
People and People with HIV. New York, NY: Lambda Legal.
U.S. Census Bureau. (2015). 2015 American Community
Survey 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 Community
Survey 1-Year Estimates: Private Health Insurance Coverage
By 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). 2015
American Community Survey 1-Year Estimates: Public Health
Insurance 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 receive
coverage through the Indian Health Service was calculated
based on a 2015 statement that approximately 2.2 million
American Indian and Alaska Native people were served by
the Indian Health Service. https://www.ihs.gov/newsroom/
factsheets/quicklook/.

6

Q. 11.9 specified that “[h]ealth insurance marketplaces
are 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 purchased
through an employer) and public plans (such as throughMedicaid or Medicare).

HEALTH

3

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 transgender
population. 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 of
the National Transgender Discrimination Survey. (pp. 72–87).
DC: National Center for Transgender Equality & National Gay
and Lesbian Task Force; Institute of Medicine. (2011). The
Health of Lesbian, Gay, Bisexual, and Transgender People:
Building a Foundation for Better Understanding. DC: National
Academy of Sciences.

125

8

The “other insurance” category includes TRICARE or othermilitary coverage, VA, Indian Health Service, and other typesof insurance not listed. See Table 7.1.

18

Respondents were asked about having a“hysterectomy/‘hysto’ (removal of the uterus, ovaries,
fallopian tubes, and/or cervix)” in Q. 12.15.

9

Respondents were asked if they had “experienced unwanted
sexual contact (such as fondling, sexual assault, or rape) in ahealth care setting (such as a hospital, office, clinic)” in Q.12.7.

19

Respondents were asked about having a “clitoral release/metoidioplasty/centurion procedure” in Q. 12.15. These are
genital procedures that separate the clitoris from the labia.

10“People with disabilities” here refers to respondents who
identified as a person with a disability in Q. 2.20.

20

11

Respondents on active duty in military service were asked
separately about where they received transition-related
health care. These results are reported in the MilitaryService chapter.

Respondents were asked about having a “phalloplasty(creation of a penis)” in Q. 12.15. This is a genital procedure
involving the construction of a larger phallus.

21

The U.S. Preventive Services Task Force currently
recommends Pap smears every three years for adults
who have a cervix and are between the ages 21
and 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). 2015
National 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 feminization
surgery (such as nose, brow, chin, cheek)” in Q.12.18.

26

Respondents were asked about having “breast
augmentation/top surgery” in Q. 12.18. This refers to anaugmentation mammoplasty, which reshapes or increases
the 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 modify
one’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 silicone
injections as a less expensive or more easily accessible
substitute for safer treatments.

29

See e.g., Pascoe, E. A. & Richman, L. S. (2009). Perceived
discrimination 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 factors
associated 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.

12

13

14

15

2015 U.S. TRANSGENDER SURVEY

16

126

17

Although 1.5% of respondents in the sample reported having
taken puberty-blocking medication, the percentage reported
here 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 replacement
therapy, a large majority (73%) of respondents who reported
having taken puberty blockers in Q.12.9 reported doing
so after age 18 in Q.12.11. This indicates that the question
may have been misinterpreted by some respondents who
confused puberty blockers with the hormone therapy given
to adults and older adolescents. Therefore, the percentage
reported here (0.3% or “less than 1%”) represents only the
27% of respondents who reported taking puberty-blocking
medication before the age of 18.
“Transition-related surgery” here includes all procedures
listed in Table 7.4 and 7.5, with the exception of electrolysis
and non-surgical voice therapy.
Respondents who are “living in poverty” represent those
who are living at or near the poverty line. See the Income
and Employment Status chapter for more information about
the poverty line calculation.
The “other insurance” category in Figure 7.11 includes
TRICARE or other military coverage, VA, Indian HealthService, and other types of insurance not listed. See Table 7.1.
Since the available surgical procedures related to transition
generally 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 asked
about the sex listed on respondents’ original birth certificate.
Respondents who said that they had female on their original
birth certificate received Q. 12.15, and respondents who said
they had male on their original birth certificate received Q.
12.18. Although the vast majority of respondents received
only 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 all
the surgical procedures that best fit their health care needs.
Respondents were asked about having “top/chest surgery
reduction or reconstruction” in Q. 12.15.

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 transgender
population. 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 for
Better Understanding. DC: National Academy of Sciences.
31

The general health rating among adults in the U.S. population
was calculated by the research team using data fromthe Behavioral Risk Factor Surveillance System (BRFSS).
Centers for Disease Control and Prevention. (2015). BRFSS
Prevalence & Trends Data. Available at: http://www.cdc.gov/
brfss/brfssprevalence.

studies using population-based samples of transgenderadults, it is estimated that the transgender population is
younger 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: Williams
Institute; 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 of
39% for prevalence of serious psychological distress isreported here using the standard weight only.
Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.86B. See note 36.

The Kessler Psychological Distress Scale, or K6, assesses
psychological distress based on how often in the past 30
days respondents felt: so sad that nothing could cheer themup, nervous, restless or fidgety, hopeless, that everything
was an effort, or worthless. See Q. 12.2. See the National
Health Interview Survey for additional information about
the K6 mental health screening instrument and measure ofserious psychological distress in adults (available at: http://
www.healthindicators.gov/Indicators/Serious-psychologicaldistress-adults-percent_50055/Profile).

39

Results for respondents who were sexually assaulted herereflect those who reported that they had “experienced
unwanted sexual contact (such as oral, genital, or anal
contact or penetration, forced fondling, rape)” in the past
year (see Q. 18.3).

40

Substance Abuse and Mental Health Services Administration.
(2015). Ending Conversion Therapy: Supporting and
Affirming LGBTQ Youth. Available at: http://store.samhsa.gov/
shin/content//SMA15-4928/SMA15-4928.pdf.

33

The K6 scale rates how often feelings are experienced on
the 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 six
measures indicates serious psychological distress.

41

34

Centers for Disease Prevention and Control. (2016). 2015
National Health Interview Survey: Sample Adult File.
Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/
Dataset_Documentation/NHIS/2015/samadult_freq.pdf.

Additionally, eleven percent (11%) of respondents in thesample said they were sent to a therapist, counselor, or
religious advisor by immediate family members to stop themfrom being transgender. See the “Sent to a Professional for
Being Transgender” section of the Family Life and Faith
Communities chapter for a discussion about respondents
who 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 identify
as 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). Suicide
Attempts Among Transgender and Gender Non-Conforming
Adults. New York, NY & Los Angeles, CA; American
Foundation for Suicide Prevention & Williams Institute;
Moody, C. & Smith, N. G. (2013). Suicide protective factors
among 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: A
Report of the National Transgender Discrimination Survey. (p.
82). DC: National Center for Transgender Equality & National
Gay 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 Services
Administration.

45

Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa,
S., Hiripi, E., . . . Zheng, H. (2004). The US National
Comorbidity Survey Replication (NCS-R): design and fieldprocedures. International Journal of Methods in PsychiatricResearch, 13(2), 69–92.

32

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/NSDUHDetTabs-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 younger
and have lower educational attainment have a higher
prevalence of serious psychological distress. When the“supplemental weight” is applied to the USTS sample’s
prevalence of serious psychological distress to adjust the
sample to reflect the age and educational attainment of the
U.S. adult population, the prevalence is reduced to 30%,
six times the national prevalence for U.S. adults. Based on

HEALTH

38

127

46

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.70B. See note 36.

47

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.69B. See note 36.

48

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.70B. See note 36.

49

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.70B. See note 36.

50

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.70B. See note 36.

51

Whether or not a person receives medical attention following
a suicide attempt is often used as a measure of the severityof the attempt. However, because many transgender people
report avoiding medical professionals because of fear of
mistreatment (see, for example, the previous section on“Experiences with Health Care Providers”), it may be difficult
to use this measure to gauge the severity of the attemptamong USTS respondents.

52

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 8.77B. See note 36.

53

Results from the 2015 National Survey on Drug Use and
Health: 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 National
Comorbidity 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 Comorbidity
Survey 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. Epidemiologic
Reviews, 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 suicide
attempts of 1.9–8.7%).

2015 U.S. TRANSGENDER SURVEY

55

128

56

57

Respondents who reported that they were out to all, most, orsome of the immediate family they grew up with were asked
to assess how supportive their family was using a five-point
scale from “very supportive” to “very unsupportive”. The
categories were collapsed to create a new variable reflecting
a supportive, neutral, or unsupportive family.
Results for respondents who were sexually assaulted herereflect those who reported that they had “experienced
unwanted sexual contact (such as oral, genital, or anal
contact or penetration, forced fondling, rape)” in their
lifetime (see Q.18.1).
The age of the most recent suicide attempt reported here
includes responses from both respondents who reported asingle attempt and those who reported multiple attempts. For
respondents 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 protective
factors in substance use across adolescence. Journal of
Adolescent 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 Consulting
and Clinical Psychology, 71(4), 692–700.

59

Center for Behavioral Health Statistics and Quality.
(2015). 2015 National Survey on Drug Use and Health
Questionnaire. 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 and
Health: Detailed Tables. Table 2.6B. Rockville, MD: Substance
Abuse and Mental Health Services Administration. Available
at: http://www.samhsa.gov/data/sites/default/files/NSDUHDetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.
pdf.

61

Results from the 2014 National Survey on Drug Use and
Health: Detailed Tables. Table 2.6B. See note 60.

62This report follows the 2014 National Survey on Drug Useand Health (NSDUH) definition for binge drinking, which
is 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, general
population 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 the
United States: Results from the 2014 National Survey on
Drug 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 and
Health: Detailed Tables. Table 2.46B. See note 60.

64

Results from the 2014 National Survey on Drug Use and
Health: Detailed Tables. Table 2.46B. See note 60.

65

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 2.28B. See note 36.

66

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 2.16B. See note 36.

67

Results from the 2015 National Survey on Drug Use and
Health: 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 and
Health: Detailed Tables. Table 1.35B. See note 36.

70

Results from the 2015 National Survey on Drug Use and
Health: Detailed Tables. Table 1.35B. See note 36.

71

For the purposes of this report, “illicit drugs” include thosesuch as cocaine, crack, heroin, LSD, methamphetamine, andinhalants, but does not include marijuana or nonmedical
use of prescription drugs. See Q. 15.1. This differs from illicit
drugs as reported in the NSDUH, which includes “the misuseof prescription psychotherapeutics or the use of marijuana,
cocaine (including crack), heroin, hallucinogens, inhalants, or
methamphetamine.” Results from the 2015 National Survey
on 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 and
Health: Detailed Tables. Table 1.22B. See note 36.

73

Results from the 2015 National Survey on Drug Use and
Health: 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 Lancet
Infectious 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 Transgender
Discrimination 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). Global
health burden and needs of transgender populations: areview. The Lancet Infectious Diseases, 388(10042), 412–436.

80

Centers for Disease Prevention and Control. (2016). 2015
National 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 one
decimal place throughout the section for more accuratecomparison with general population figures.

82

The rate of respondents living with HIV includes those
who were HIV-positive or reactive. Among respondents
who had been tested, the rate of those who tested
positive for HIV was 2.6%.

83

Centers for Disease Control and Prevention. (2015). HIV
Surveillance Report, 2014; vol. 26. Table 18a. Available at:
http://www.cdc.gov/hiv/library/reports/surveillance/. The HIV
Surveillance 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 who
are under 18, so it was not possible to exactly match the
USTS sample with the U.S. population data. However, whenestimating the impact of including 15–17 year olds in the
U.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 for
HIV were HIV negative.

85

AIDS.Gov. (2015). HIV Care Continuum. Available at:https://www.aids.gov/federal-resources/policies/carecontinuum.

75

Centers for Disease Control and Prevention. (2016). HIV
and Transgender Communities. Available at: http://www.
cdc.gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf.

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.

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 .

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/justdiagnosed-with-hiv-aids/treatment-options/overview-ofhiv-treatments.

89

Centers for Disease Control and Prevention. (2016).
Behavioral and Clinical Characteristics of Persons
Receiving Medical Care for HIV Infection–Medical
Monitoring Project, United States, 2013 Cycle (June 2013May 2014). HIV Surveillance Special Report 16. Available
at: http://www.cdc.gov/hiv/pdf/statistics/systems/mmp/cdchiv-hssr-mmp-2013.pdf.

77

Centers for Disease Control and Prevention (2014). 2015
Behavioral Risk Factor Surveillance System Questionnaire.
Available at: http://www.cdc.gov/brfss/questionnaires/pdfques/2015-brfss-questionnaire-12-29-14.pdf.

78

Centers for Disease Control and Prevention. (2015). BRFSS
Prevalence & Trends Data. Available at: http://www.cdc.
gov/brfss/brfssprevalence.

79

Centers for Disease Control and Prevention. (2016).
Behavioral Risk Factor Surveillance System: 2015
Codebook Report. Available at: http://www.cdc.gov/brfss/
annual_data/2015/pdf/codebook15_llcp.pdf.

HEALTH129

CHAPTER 8

Experiences at School2015 U.S. TRANSGENDER SURVEY

M

130

any 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 higher
education 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 on
demographic and other characteristics are reported.

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–12
were verbally harassed, and 24% were physically attacked.
Seventeen percent (17%) of people who were out or perceived as transgender left a
K–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.

CURRENT AGE (%)
90%
80%

85%
76%

75%

70%
60%
51%

50%
40%
30%

24%

20%
10%

65
a
ov nd
er

45

to

44
25

to

24
to
18

64

0%
EXPERIENCES AT SCHOOL

All respondents, including those who were outor perceived as transgender in K–12, were also
asked 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. Younger
respondents were much more likely to report thatclassmates, teachers, or staff in K–12 thought or
knew they were LGBQ than older respondents,

Figure 8.1: Perceived as LGBQ in K–12

ll

Twelve percent (12%) of respondents reported
that they were out as transgender at some point
between Kindergarten and the 12th grade (K–12). Of
those who were not out as transgender, 28% said
that they believed classmates, teachers, or schoolstaff thought they were transgender.

such as 18- to 24-year-olds (85%) in contrast to 45to 64-year-olds (51%) (Figure 8.1).

ra

I. Outness in K–12

O
ve

KE Y FI N D I N GS

Twelve percent (12%) of respondents were out as transgender at some point from
Kindergarten through the 12th grade.

131

More than three-quarters (77%) of
those who were out or perceived
as transgender had one or morenegative experiences at school
because they were transgender,such as being verbally harassedor physically attacked.

II. Treatment in K–12
Respondents who were out as transgender in
K–12 or who said that others thought that they
were transgender received additional questions
about negative experiences in K–12, such as being
verbally harassed, physically attacked, or expelled.
Overall, 77% of those who were out or perceived
as transgender had one or more of these negative
experiences, 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.
Figure 8.2: Had one or more negative experiencesin K–12 (of those who were out or perceived astransgender)• More likely to have experienced homelessness(40%) than those who were out or perceived astransgender and did not have any of the negative
experiences (22%).
• More likely to currently be experiencing serious
psychological 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 or
drug 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, or
school staff thought they were transgender

Experiences% of those who wereout or perceived astransgender

Verbally harassed because people
thought they were transgender

54%

100%

Not allowed to dress in a way that fit
their gender identity or expression

52%

Disciplined for fighting back againstbullies36%

Physically attacked because people
thought they were transgender24%

Believe they were disciplined moreharshly because teachers or staff
thought they were transgender

20%

Left a school because the mistreatment
was so bad

17%

10%

Sexually assaulted because people
thought they were transgender

13%

0%

Expelled from school

6%

One or more experiences listed

77%

80%

92%
84%
77%

73%

74%

81%

79%

74%

70%
60%
50%
40%
30%

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20%

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2015 U.S. TRANSGENDER SURVEY• More likely to have attempted suicide (52%) thanthose who were out or perceived as transgenderand did not have any of these negative
experiences (37%).

RACE/ETHNICITY (%)

90%

132

Poor treatment in school was associated with avariety of negative experiences. Respondents who
were out or perceived as transgender in K–12 andhad one or more negative experiences outlined inthis chapter were:a. Verbal Harassment
More than half (54%) of people who were out orperceived as transgender in K–12 were verballyharassed because they were transgender. Verbal
harassment 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).
Figure 8.3: Verbally harassed in K–12 because people
thought they were transgender

Nearly one-quarter (24%) of
those who were out or perceived
as transgender in school were
physically attacked because ofbeing transgender.
Figure 8.4: Physically attacked in K–12 because people
thought they were transgender
GENDER IDENTITY (%)

RACE/ETHNICITY (%)

40%

80%

35%
69%

70%

30%

54%

53%

58%

55%

52%

51%

28%
26%

61%

60%

38%

24%

25%

50%

20%

40%

15%

30%

10%

20%

5%

10%

0%

20%

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Figure 8.5: Physically attacked in K–12 because people
thought they were transgender
60%
49%

50%
40%

36%

30%

31%

28%
24%

24%

20%

23%

17%

10%

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EXPERIENCES AT SCHOOL

Nearly one-quarter (24%) were physically attacked
because of being transgender. Transgenderwomen (38%) were more likely to have been
physically attacked than transgender men (20%)
and non-binary people (16%) (Figure 8.4). American
Indian respondents (49%) were more than twice as
likely to have been physically attacked, and Middle
Eastern (36%), multiracial (31%), and Black (28%)
respondents were also more likely to have had
this experience, in contrast to Latino/a (24%), white(23%), and Asian (17%) respondents (Figure 8.5).

Am

b. Physical Attack

RACE/ETHNICITY (%)

133

c. Sexual Assault
Thirteen percent (13%) of people who wereout or perceived as transgender in K–12 were
sexually 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).
Figure 8.6: Sexually assaulted in K–12 because people
thought they were transgender
GENDER IDENTITY (%)
25%
21%

20%

18%

15%

10%

9%

5%

en

en

m

m

d
an

“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 interactions
like buses and school bathrooms
because I didn’t feel safe.”

Tr
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0%

Whether a respondent was sexually assaulted
in K–12 varied by age, with older respondents
such as 45- to 64-year-olds being more likely tohave been sexually assaulted (22%) than younger
respondents such as 25- to 44-year-olds (16%)(Figure 8.7).
Figure 8.7: Sexually assaulted in K–12 because people
thought they were transgender
CURRENT AGE (%)
25%
22%

23%

“Every single day at college, I
was harassed for being a visiblytrans woman. People slowed theircars down to stare at me, they
shouted slurs at me from their dorm
windows, insulted me in class, anda lot more I’d rather not think about.
It got so bad that I tried to kill myself
twice over the course of threemonths. Getting out of that school
has been the best thing to have
happened to me.”

20%
16%

15%

13%
9%

10%
5%

a
ov nd
er

65

64
45

to

44
25

to

24
18

to

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0%
O
ve

2015 U.S. TRANSGENDER SURVEY“I was constantly bullied andphysically assaulted by myclassmates. Teachers would often
see it happen and make no moveto intervene. The harassment
continued, and I eventually had tochange high schools three times,
each time just as bad as the last,
until I finally gave up on publicschools.”

14%

13%

10%

134

In Our Own
Voices“In high school, the staff told me I
could not use the men’s bathroom
because I’d make other students
uncomfortable, even though I wasout to everyone and none of thestudents were bothered by mygender.”d. Left School Due to Harassment
Seventeen percent (17%) of those who were out orperceived as transgender left a school because
the 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).
Figure 8.8: Left school due to mistreatment in K–12
GENDER IDENTITY (%)
25%
22%

20%

18%

17%
15%

15%

15%

12%

10%
5%

Seventeen percent (17%)
of people who were out orperceived as transgender in
K–12 left a school because themistreatment was so bad.
e. Expelled from School
Six percent (6%) of people who were out orperceived as transgender were expelled fromschool. Transgender women were nearly twice as
likely 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 as
likely to have been expelled from school.

enmdFigure 8.10: Expelled from school in K–12

an

GENDER IDENTITY (%)

en
om

10%

10%
8%

7%
6%

6%

4%

4%

3%

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os

RACE/ETHNICITY (%)

se
r

al

s

0%
O

Figure 8.9: Left school due to mistreatment in K–12

3%

2%

l

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).

ns

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39%

40%

36%

35%
30%
25%

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17%

16%

16%

15%
11%

10%
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EXPERIENCES AT SCHOOL

22%

20%

135

III. Outness andTreatment in College
or Vocational School
Of respondents who had attended college or
vocational school, 46% said their classmates,
professors, or staff at college or vocational school
thought or knew they were transgender. Nearly
one-quarter (24%) of respondents who indicatedthat classmates, professors, or staff at college
or vocational school thought or knew they weretransgender were verbally, physically, or sexuallyharassed. American Indian (37%), Black (28%),
and Middle Eastern (27%) respondents were more
likely to have had these experiences, while white(23%), Latino/a (23%), and Asian (22%) respondents
were less likely (Figure 8.11).

have left college or vocational school for thisreason than transgender men (16%) and non-binary
people (12%) (Figure 8.12). Respondents currently
working in the underground economy were almost
twice as likely (31%) to have left college becauseof harassment than other respondents. American
Indian (23%), Latino/a (23%), Black (21%), andmultiracial (20%) respondents were more likely toreport leaving school for that reason (Figure 8.13).
Figure 8.12: Left college or vocational school because
harassment was so bad (of those who were harassed)
GENDER IDENTITY (%)
25%
21%

20%

18%
16%

16%

15%

12%

10%

8%

5%

en
m
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an

Tr
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RACE/ETHNICITY (%)

Tr
a

ll
ra

s

0%

Figure 8.11: Verbally, physically, or sexually harassed incollege or vocational school

40%

37%

35%
30%

28%
24%

25%

27%

25%

23%

22%

Figure 8.13: Left college or vocational school because
harassment was so bad (of those who were harassed)
23%

20%

25%

23%
20%

20%
16%

10%

15%

5%

13%

10%

0%

9%

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Of respondents who were out or perceived astransgender and who experienced some formof harassment, 16% left college or vocational
school because the harassment was so bad.
This represents 2% of all respondents who
attended a higher education institution. Of those
who experienced some form of harassment,
transgender women (21%) were more likely to

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2015 U.S. TRANSGENDER SURVEY

23%
21%

15%

136

RACE/ETHNICITY (%)*Sample size too low to report

In addition to the 2% who left because theharassment was so bad, 1% of respondents who
attended college or vocational school were
expelled or forced out, and 5% left because ofother reasons related to being transgender.

IV. Current Outness
and Support ofClassmates
In addition to questions about being out toclassmates at any time while they were in school,
respondents were asked whether they currently
had classmates, and whether those classmates
knew that they were transgender. Of respondents
who currently had classmates, only 15% said
that 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 classmates
knew that they were transgender were asked
how supportive their classmates generally were ofthem as a transgender person. Responses were
given on a five-point scale from “very supportive”
to “very unsupportive.” The categories werecollapsed to create a new variable reflecting
supportive, neutral, or unsupportive classmates.5
More than half (56%) reported that their classmates
were supportive, 39% had classmates that wereneither supportive nor unsupportive, and only 5%
reported that their classmates were unsupportive(Table 8.2).
Table 8.2: Classmates’ level of support of them as atransgender person
Level of support% of those who reported
that all, most, or some of
their classmates knew they
were transgender21%

Supportive

35%

Neither supportive nor
unsupportive

39%

Unsupportive

4%

Very unsupportive

1%

Conclusion
Results indicated that the majority of those who
were out or perceived as transgender in K–12
had 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 older
individuals 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. This
indicates that school environments have improved
for transgender people over the years, thoughhigh rates of mistreatment were reported evenamong younger respondents.
Additionally, results indicated that those who
attended college or another higher education
institution were out or perceived as transgenderat high rates. However, they also suggest thattransgender students in such institutions are
subject to harmful experiences that lead tonegative outcomes, such as having to leaveschool to avoid being harassed because of beingtransgender.

EXPERIENCES AT SCHOOL

Very supportive

More than half (56%) of
those who had at least someclassmates who knew they
were transgender reported
that their classmates were
supportive.

137

ENDNOTES | CHAPTER 8: EXPERIENCES AT SCHOOL
1

2015 U.S. TRANSGENDER SURVEY

2

138

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 academic
outcomes for LGBT youth and the role of in-schoolsupports. Journal of School Violence, 12(1), 45–63.
Rankin, S. & Beemyn, G. (2012). Beyond a binary: The
lives 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 who
identified as a person with a disability in Q. 2.20.

4This data is derived from responses to Q. 26.4, where
respondents were asked if they had “experienced
unwanted 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.

CHAPTER 9

Income and
Employment Status
INCOME AND EMPLOYMENT STATUS

H

igh 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’ employment
status and income sources with questions that were patterned on the Current Population Survey (CPS), a
survey used by the Bureau of Labor Statistics to assess economic indicators and the state of the labor force
in 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’ experiences
based on demographic and other characteristics are reported throughout the chapter.

139

KE Y FI N D I N GS

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 in
the 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 Status2015 U.S. TRANSGENDER SURVEY

Respondents were asked a series of questions
about their current employment status. More than
one-third (35%) currently had a full-time job, 15%
had at least one part-time job, 15% were selfemployed, and 11% were students (Table 9.1). Nine
percent (9%) of those who were employed were
working more than one full-time or part-time job,which represents 4% of the whole sample.

140

Table 9.1: Current employment status

Employment status% of respondents(supplemental
weight)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%

Two percent (2%) of respondents were currently
employed 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

Unemployed but looking for work

11%

Unemployed and have stopped
looking for work5%

Homemaker or full-time parent

3%

Work for pay from sex work, selling
drugs, or other work currently
criminalized2%

Of those who were working either full time orpart time for an employer, 13% were members ofa labor union or an employee association similar
to 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 association
contract. This compares to 12% of wage and salary
workers in the U.S. population who were membersof a union or were not union members but werecovered by a union or employee association
contract.6

Not listed above

4%

The national unemployment rate, as reported by
the Bureau of Labor Statistics, is calculated out of
only 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 but
not looking for work, since they are considered
to be out of the labor force. For the purposes ofcomparison, the unemployment rate for USTS
respondents reported here was calculated in
the same manner. The unemployment rate for

The unemployment rate for
USTS respondents was 15%,three times the unemployment
rate in the U.S. population.
USTS respondents was 15%, three times the U.S.
unemployment rate at the time of the survey (5%).7
Nearly one-half (49%) of undocumented residents
were 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 more
likely to be unemployed. Unemployment rates
among Asian, multiracial, Latino/a, and Black USTS
respondents were between two and three times
higher than Asian, Latino/a, multiracial, and Black
people in the U.S. population (Figure 9.1).9

57%

67%

Self-employment income from own
business, profession or trade, or farm
(not including underground economy)

18%

7%

Social Security retirement, railroad
retirement income, or Social Security
disability benefits (SSDI)

25%

25%

Private pension, government employee
pension, 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%

--

2%

1%

% in USTS (supplemental survey weight applied)

Cash assistance from welfare (such as
TANF) or other public cash assistanceprogram (not including SNAP or WIC)% in U.S. population (ACS)

Unemployment benefits

2%2%Child support or alimony

1%

2%

Workers’ compensation or otherdisability

1%1%Income not listed above

9%

--

35%

35%
30%
25%

23%
20%

20%

22%

21%

15%
12%

12%
10%

10%

10%

9%
7%

5%

4%

4%

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*U.S. population data for Middle Eastern people alone is not available. See note 10.

Income source

INCOME AND EMPLOYMENT STATUS

Pay from respondent’s and/or partner’s
full-time or part-time job

40%

O
ve
ra

Table 9.2: Current sources of income(ages 25 and older only)% in U.S.
adult
population(CPS)

RACE/ETHNICITY (%)

5%

Respondents were asked about their income
sources, 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 presented
in Table 9.2 is limited to respondents ages 25 andolder only. Compared to findings from the CPS,
respondents’ sources of income differed from the
U.S. population in several categories. For instance,
57% of USTS respondents aged 25 and older
had income from their own and/or their spouse’s
employment, compared to 67% of adults aged 25
and older in the U.S. population (Table 9.2).

% in USTS(supplemental
weight)Figure 9.1: Unemployment rate

15%

II. Sources of Income
and Assistance141criminalized (Table 9.3).
Table 9.3: Current sources of income by single andmultiple sources

Income source
Employment only (from their own
employment, partner/spouse’s
employment, or self-employment)

37%

SSI/disability only

9%

Pension/retirement only

3%

Other sources only3%

Pay from sex work, selling drugs,
or other work that is currently
criminalized only1%

Unemployment benefits/cash
assistance only

1%2015 U.S. TRANSGENDER SURVEY

Multiple sources142% of respondents(supplemental
weight)45%

Fifteen percent (15%) of respondents reported
receiving assistance through food stamps(SNAP)11 and/or WIC.12 Forty-one percent (41%) of
respondents living with HIV received SNAP and/or
WIC assistance. People with disabilities (29%), andBlack (23%), American Indian (19%), and Latino/a(18%) respondents were also more likely to receive
SNAP and/or WIC assistance (Figure 9.2).

Figure 9.2: Currently receive SNAP or WIC assistance
RACE/ETHNICITY (%)
25%

23%

20%

19%

18%

17%

15%

15%

13%

10%

8%
5%

5%

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Responses were examined to determine whether
respondents had one source of income or multiple
sources. Nearly one-half (45%) of all respondents
reported having multiple sources of income.
Thirty-seven percent (37%) reported that their solesource of income was from their own employment
or their partner’s employment. Nearly one in ten(9%) reported that their sole source of income was
Supplemental Security Income (SSI) or disability,
1% received their only income from unemployment
benefits or cash assistance programs, and 1%
reported that their sole source of income wasfrom underground economy work, including sex
work, drug sales, or other work that is currently

III. Individual andHousehold Income
and 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 income
figures. They reported lower incomes overall thanthe U.S. population as a whole, as well as higher
poverty 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 no
individual income, compared to 10% in the U.S.
adult population.15,16 Nearly one-quarter (22%) of
respondents reported that they had an income
between $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 times
the rate in the U.S. population (4%).

Nearly one-third (29%) of
respondents were living inpoverty, more than twice therate in the U.S. population (12%).
Figure 9.3: Individual income in 2014
30%
25%

25%

25%

24%

22%

18%
15%

10%

8%

15%

10%

9%

8%

5%

e
or
m
or
0

00
,0
0
$1

$5

0,
00

5,
00

0

0

to

to

$9

$4

9,
9

9,
9

99

99

9
99
4,
$2
$2

$1

0,
00

0

$1

to

to

in

co

$9
,9

m

99

e

0%

No

“The day I came out as transgenderat work, I was let go. Sincetransitioning, employment has beendifficult, with a 95% reduction inearnings.”

21%

20%
15%

In Our Own
Voices% in USTS (supplemental weight)“I quit after seven months of
unbearable working conditions. I
have been struggling to keep afloat
financially. I’m afraid of going toapply for unemployment or SNAP
benefits because I know that I will
be discriminated against. I’m on thebrink of being homeless and myown family hasn’t even reached out
to help me.”% in U.S. adult population (CPS)b. Household Income“In the nearly seven years
since I transitioned, I have been
unemployed, surviving off thecharity of friends and family, andgovernment assistance when I
could get it. I have over 20 yearsof experience in my field, yet I
cannot even land a part-time retail
position.”

INCOME AND EMPLOYMENT STATUS

Turning to household income, 4% of respondents
reported 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%) respondents
reported earning an annual household income
between $1 and $9,999, which was three times as
many when compared to the U.S. adult population(4%) (Figure 9.4).19 Respondents were nearly twice
as likely to have a household income of only
$10,000 to $24,999 (22%) as those in the U.S.
adult population (12%). Furthermore, respondents
were less likely to have household incomes of$50,000 to $100,000 (23%) than those in the U.S.
adult population (31%).

“I have had to live my life withno safety net or resources, andit’s hard. I’m constantly battlinghomelessness, I rarely get hired
because I’m mixed and visibly
queer, and I end up having to rely
on government assistance andfriends with available couches.”143

Figure 9.5: Household income from $1 to $9,999

Figure 9.4: Household income in 2014

RACE/ETHNICITY (%)

35%
31%

31%

30%

20%

19%
18%

18%
24%

25%

22%

23%

16%

16%

21%

20%

15%

14%
15%

15%

12%

12%

12%

12%

10%

10%

10%
4%

5%

4%

9%

8%

8%
6%

1%

0%
or
e
m
or

2%

0

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% in USTS (supplemental weight)

an

0%
ve

0,
00

0
$5
0,
00

$1
0

to

to
5,
00

0

to
$2

0
0,
00
$1

$9
9,
99
9

$4
9,
99
9

$2
4,
99
9

$9
,9
99
$1
to

No

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e

4%

% in U.S. adult population (CPS)2015 U.S. TRANSGENDER SURVEY

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 times
the 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 overall
sample. People with disabilities (21%) were nearly
twice 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).

144

c. Poverty
Nearly one-third (29%) of respondents were living
in poverty,20 more than twice the rate of people
living in poverty in the U.S. adult population at thetime of the survey (12%).21
More than two-thirds (69%) of undocumented
residents and nearly two-thirds (62%) of thosecurrently working in the underground economy
were living in poverty. Respondents living with HIV(51%) and people with disabilities (45%) were also
more likely to be living in poverty. Among peopleof color, Latino/a (43%), American Indian (41%),
multiracial (40%), and Black (38%) respondents
were most likely to be living in poverty (Figure 9.6).

Conclusion

Figure 9.6: Living in poverty
RACE/ETHNICITY (%)
50%
45%

43%
41%

40%

40%

38%

35%

34%
32%
29%

30%
25%

24%

20%
15%
10%
5%

The results indicate that respondents faced higher
levels of unemployment and poverty compared to
the U.S. adult population. They were three times
more likely than the U.S. adult population to be
unemployed, more than twice as likely to be living
in poverty, and more than three times as likely tohave an annual household income below $10,000.
People of color, undocumented residents, people
with disabilities, and respondents living with HIV
were more likely to report being unemployed,
living in poverty, and having low incomes, whichindicate that these respondents have experienced
substantial economic instability.

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ENDNOTES | CHAPTER 9: INCOME AND EMPLOYMENT STATUS
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 American
Progress & Movement Advancement Project. (2015).
Paying an Unfair Price: The Financial Penalty for Being
Transgender in America. Available at: http://www.lgbtmap.
org/file/paying-an-unfair-price-transgender.pdf.
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 Service
chapters. Experiences in employment settings, such being
fired 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 addition
to the standard survey weight. The USTS sample differs
substantially from the U.S. population in regard to age andeducational attainment. Therefore, this additional weightis applied to all percentages reported in this chapter in5

Experiences of respondents with sex work and other
underground economy work are discussed further in the
Sex Work and Other Underground Economy Work chapter.

6

Bureau of Labor Statistics. (2016). Union Affiliationof Employed Wage and Salary Workers by Selected
Characteristics, 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 employee
association contract includes those in the U.S. population
who are 16 years of age and older, in contrast to the USTS
sample, 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 Employment
Situation—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 national
unemployment rate for August and September 2015, as
published by the Bureau of Labor Statistics, includes those

INCOME AND EMPLOYMENT STATUS

2order to provide a more accurate comparison to the U.S.
general population. See the Methodology and Portrait of
USTS Respondents chapters for more information about
the supplemental survey weight.

145

2015 U.S. TRANSGENDER SURVEY

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 national
unemployment rate and the USTS unemployment rate
sample should be interpreted with caution.

146

8“People with disabilities” here refers to respondents who
identified as a person with a disability in Q. 2.20.

9The unemployment rate by race and ethnicity among
adults 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 2015
Current Population Survey Annual Social and Economic
Supplement, in which the overall U.S. unemployment
rate was 5.5%. This March 2015 national unemployment
rate 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, available
at http://data.bls.gov/timeseries/LNS14000000). Given
the higher national unemployment rate in March 2015, thecomparison of the national unemployment rate by race andethnicity to the unemployment rate for USTS respondents
by race and ethnicity as reported here likely reflects
smaller differences in the unemployment rate than would
have existed at the time of the survey. Therefore, thesecomparisons should be interpreted accordingly.

10

CPS data combines people of Middle Eastern descent
and white people in a single “white/Caucasian” category,therefore Middle Eastern respondents in the U.S. population
are included in the CPS percentage for this category.

11

See Q. 7.10. Respondents received the following definition
for SNAP: “The Supplemental Nutrition Assistance
Program (SNAP) is sometimes called the Food Stamp
program. 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 definition
for WIC: “‘WIC’ stands for ‘Women, Infants, and Children.’It’s the short name for the Special Supplemental Nutrition
Program for Women, Infants, and Children. WIC is a federal
program to help women who are pregnant or breastfeeding
and 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 note
describing individual income: “‘Individual income’includes money from jobs, employment, net income frombusiness, income from farms or rentals, income from selfemployment, pensions, dividends, interest, social security
payments, 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 note
describing household income: “‘Household income’includes you and all members of your household who
have lived with you during the past 12 months andincludes money from jobs, employment, net income frombusiness, income from farms or rentals, income from selfemployment, pensions, dividends, interest, social security
payments, and any other money income received by you
and 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 from
low-income earners, such as those who earn an income
between $1 and $9,999. For example, they are more likely
to 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 income
are generally presented separately from those of lowincome 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 of
respondents as in or near poverty if their total family income
fell below 125% of the official poverty measure for purposesof comparison to the U.S. adult population. Respondents
who 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). Income
and 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/p60256.pdf. Calculations were completed by the researchteam.

CHAPTER 10

Employment andthe Workplace

A

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.

EMPLOYMENT AND THE WORKPLACE

ccess to employment is critical to people’s ability to support themselves and their families. Prior
research 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 people
are also often subject to additional forms of mistreatment at work, such as being verbally harassed, being
forced to present as the wrong gender in order to keep their jobs, or being physically attacked at work.2

147

KE Y FI N D I N GS

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 workplace
related 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, denied
a promotion, or not hired for a job they 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 other formsof mistreatment based on their gender identity or expression during that year, such as
being 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 took
steps to avoid mistreatment in the workplace, such as hiding or delaying their gendertransition or quitting their job.

2015 U.S. TRANSGENDER SURVEY

I. Outness andSupport in the
Workplace148

Respondents were asked whether their current
bosses or supervisors and their current coworkers
knew they were transgender. Of respondents whocurrently had bosses or supervisors, 35% said that
all of their current bosses or supervisors knew
they were transgender, 6% reported that mostknew, and 10% indicated that some knew that they
were transgender. Nearly half (49%) reported thatnone of their bosses or supervisors knew that they

were transgender. Of respondents who currently
had coworkers, less than one-quarter (23%)
reported that all of their coworkers knew they
were transgender, 11% reported that most of theircoworkers knew, and 24% said that some of theircoworkers knew they were transgender. Fortytwo 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 coworkers
knew that they were transgender were asked
how supportive their coworkers generally wereof them as a transgender person.3 Responses
were provided on a five-point scale from “verysupportive” to “very unsupportive.” More than
two-thirds (68%) of these respondents reported
that their coworkers were supportive, 29% had
coworkers who were neither supportive nor
unsupportive, and only 3% had unsupportive
coworkers (Figure 10.1).

Indian (66%) and Black (60%) respondents (Figure10.2), transgender women (66%), and people withdisabilities5 (59%) were also more likely to haveever lost a job.

Figure 10.1: Level of support

70%

2%
Unsupportive

1%
Very unsupportive

Figure 10.2: Ever lost job for any reason
RACE/ETHNICITY (%)
66%
60%

60%

56%

53%

50%

50%

53%

44%
38%

40%
30%
20%

36%
Supportive

II. Loss of
Employment During
Lifetime

Overall, more than half (53%) of respondents
who had ever held a job experienced a loss of
employment for any reason. Respondents who
were living with HIV (78%) and those who havedone sex work (73%) were more likely to havelost a job at some point in their lifetime. American

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Respondents who had lost a job at some point intheir lifetime were asked what they believed thereasons were for that treatment, and they selected
one 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% of those
who have everlost job% of those
who havebeen
employed

Age

7%

4%

Disability

13%

7%

Income level or education

5%

2%

Gender identity or
expression

30%

16%

Race or ethnicity

5%

3%

Religion or spirituality

2%

1%

Reason for losing job

Sexual orientation

13%

7%

None of the above

61%

32%

One in six (16%) respondents who have been
employed reported that they had lost a job
because of their gender identity or expression.6
This represents 13% of the overall sample.

EMPLOYMENT AND THE WORKPLACE

Eighty-one percent (81%) of respondents had
worked at a job or business at some point in their
lifetime.4 Those respondents were asked whether
they had ever experienced a loss of employment,
including losing a job, being laid off, being fired,or being forced to resign, and the reasons they
believed this happened.

10%

O

32%
Very
supportiveer% of those who
said that all,most, or some of
their coworkers
knew they weretransgenderAm

29%
Neither
supportivenor
unsupportive149

American Indian (21%), multiracial (18%), andBlack (17%) respondents were more likely thanthe overall sample to have lost a job because of
their 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 more
likely than transgender men (14%) and non-binary
people (7%) to have lost a job because of theirgender identity or expression (Figure 10.4).
Figure 10.3: Ever lost job because of being transgender
RACE/ETHNICITY (%)
25%
21%

20%

18%

17%

15%

14%

13%

12%

11%

10%

8%

5%

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Figure 10.4: Ever lost job because of being transgender
GENDER IDENTITY (%)
20%

18%
16%

16%

14%

13%

III. Firing, Hiring, andPromotions in the
Past Year
Seventy percent (70%) of respondents had
held and/or applied for a job in the past year.
Those respondents were asked if they had
negative experiences related to firing, hiring, andpromotions in the past year.
Overall, approximately two-thirds (67%) of
respondents who held or applied for a job in thepast year reported that they were fired or forced
to resign from a job, not hired for a job that they
applied 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 had
one 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 for
any reason in the past year
Occurrence in the past year

12%
8%

7%

4%

3%

150

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Not hired for a job they
applied for

61%

Denied a promotion

13%

Fired or forced to resign

12%

One or more experiences
listed

67%

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2015 U.S. TRANSGENDER SURVEY

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% of those who held or
applied for job

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 or
expression.

Figure 10.5: Fired, not hired, or denied a promotion for
any reason in the past year
RACE/ETHNICITY (%)
80%

75%
67%

70%

64%

72%

68%

74%

71%

In Our Own
Voices63%

60%“Coworkers would gossip about
me as news about my trans statusspread through the workplace. I was
treated significantly differently once
people heard about me being trans.
Coworkers felt they had the right todisrespect me because the owners
set the tone. I became a spectacle inmy own workplace.”

50%
40%
30%
20%
10%
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Respondents who reported these experiences wereasked what they believed the reasons were for thattreatment. Forty-one percent (41%) of respondents who
were fired or forced to resign from a job, not hired fora job that they applied for, or were denied a promotion
believed that it was due to their gender identity or
expression (Table 10.3). This means that 27% of all of
those 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, or
being fired from a job in the past year because of theirgender identity or expression.
Table 10.3: Reported reasons for not being hired, being
denied a promotion, or being fired in the past year
Reasons
for beingdeniedpromotion(% of thosedeniedpromotion)

Age

21%

16%

6%

Disability

7%

9%

15%

Income level oreducation

21%

13%

6%

Gender identity or
expression

39%

49%

43%

Race or ethnicity

11%

14%

10%

Religion or
spirituality

1%

3%

2%

Sexual orientation

10%

16%

14%

None of the above

41%

33%

40%

Reported reasonsfor negative
experience in thepast year

Reasons forbeing fired(% of those
fired)“I changed jobs from a high-paying
one 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 gender
identity is respected consistently,
where I don’t have to constantly
fight for myself or hide myself, has
improved my quality of life more thanany other aspect of my transition.”

EMPLOYMENT AND THE WORKPLACE

Reasons
for not
being
hired (% ofthose nothired)“The day before I started work, HR
sent a mass email to everyone in theoffice ‘warning’ them about my transstatus. I used the women’s bathroom
since starting, but a month in to thejob, I was called to my manager’s
office and told that I could not use
the women’s bathroom. I did not
feel safe in the men’s bathroom, so I
told the HR manager that due to city
law, I could not be denied access tothe bathroom matching my gender
identity. I was fired the next day forno given reason.”151

IV. Responses
to Firing Due toTransgender Status

Table 10.5: Location where respondent made an
official complaint

Employer’s human resources or
personnel department

53%

Respondents who reported that they had been
fired in the past year because of their gender
identity or expression were asked how they
responded. While more than two-thirds (69%)
of these respondents did not take any formal
action in response, 14% filed an official complaint(Table 10.4). Respondents who filed a complaint
were asked where they filed it. More than half(53%) reported that they filed a complaint with
their employer’s human resources or personnel
department. One-third (33%) of respondents who
filed complaints did so with the federal Equal
Employment Opportunity Commission (EEOC),
the agency that enforces federal employment
nondiscrimination laws (Table 10.5).

Equal Employment Opportunity
Commission (EEOC)

33%

Employer’s Equal Employment
Opportunity (EEO) office18%

Local or state human rights
commission

17%

Place complaint was filed

Table 10.4: Response to being fired in the past year
because of their gender identity or expression

2015 U.S. TRANSGENDER SURVEY

Response to being fired

152% of those fired becauseof their gender identity or
expression

They did nothing

69%

They contacted a lawyer (seeTable 10.6)

15%

They made an official
complaint (see Table 10.5)

14%

They contacted atransgender, LGBT, or other
group

10%

They contacted their union
representative2%

Not listed above

7%% of those who filed an
official complaint

Supervisor or manager

9%

Not listed above

26%

Fifteen percent (15%) of those who were fired in
the past year because of their gender identity or
expression responded by contacting a lawyer.
These respondents were asked what happened
after they contacted the lawyer. Nearly one-third(29%) reported that they were not able to hire
the 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 who
contacted a lawyer

Outcome of contacting lawyer% of those who
contacted a lawyer

They were not able to hire thelawyer29%

Lawyer filed a lawsuit

21%

Lawyer helped them to file anofficial complaint

14%

Lawyer called or wrote a letter to
employer

10%

Lawyer advised them to take noaction (write-in response)10%

Lawyer did nothing or did not follow
up (write-in response)

7%

Not listed above

9%V. Other Formsof Mistreatmentin the Past Yearto be verbally harassed at work in the past year,
compared with those who said that others cansometimes (19%) and rarely or never (10%) tell they
are transgender.

Respondents who held a job in the past year wereasked a series of questions about other formsof mistreatment in the workplace that happened
because 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 assaulted
at work because of their transgender status.7
Respondents 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).
Figure 10.6: Verbally harassed, physically attacked,
or sexually assaulted at work in the past year
RACE/ETHNICITY (%)
30%

28%

20%

18%
15%

15%

15%

15%

13%

10%
5%

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Am

One percent (1%) reported that they were sexuallyassaulted at work in the past year because they
were 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 wrong
gender in order to keep their jobs, removing themfrom direct contact with clients, or sharing private
information.

26%

25%

15%

One percent (1%) of respondents were physicallyattacked at work in the past year because they
were transgender, with higher numbers among
respondents who were currently working in theunderground economy (4%).

EMPLOYMENT AND THE WORKPLACE

Fourteen percent (14%) of those who held a jobin the past year were verbally harassed at work
because they were transgender. Respondents
who said that others can always or usually tellthat they are transgender (23%) were more likely

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 personal
information about them that should not havebeen shared. Six percent (6%) said that their boss
gave them a negative review because they weretransgender, 4% were told to present in the wrong
gender in order to keep their job, and 4% said
that they were not allowed to use the restroom
consistent with their gender identity (Table 10.7).

153

Table 10.7: Mistreatment at work due to beingtransgender in the past year

Table 10.8: Actions taken to avoid anti-transgender
discrimination at work in the past year

Mistreatment at work due to beingtransgender in the past year

% of those who
had a job

Actions taken to avoid anti-transgender
discrimination at work in the past year

Employer/boss or coworkers shared
information about them they should
not have

16%

Employer/boss gave them a negative
job review

They had to hide their gender identity

53%

They did not ask employer to use pronouns
they prefer (such as he, she, or they)

47%

6%

They delayed their gender transition

26%

Employer/boss forced them to resign

4%

They stayed in a job they would have preferred
to leave

26%

Employer/boss did not allow them to
use the restroom they should be using
based on their gender identity

4%

They hid the fact that they had alreadytransitioned gender

25%

Employer/boss told them to present in
the wrong gender to keep their job

4%

They kept a job for which they were
overqualified

24%

Employer/boss removed them fromdirect contact with clients, customers,
or patients

They quit their job

15%

3%

They did not seek promotion or raise

13%

They requested transfer to a different position
or department

6%

One or more experiences listed

77%

Employer/boss could not work out an
acceptable restroom situation with
them

3%

Employer/boss forced them to transfer
to a different position or department
at their job

2%

One or more experiences listed

23%c. Efforts to Avoid Discrimination

2015 U.S. TRANSGENDER SURVEY

Respondents who held a job in the past year werealso asked a series of questions about actions they
took 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).

154% of those who
had a jobMore than three-quarters(77%) of respondents who hada job in the past year hid theirgender identity at work, quit
their job, or took other actions
to avoid discrimination.

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%) said
they did not ask their employer to refer to themwith correct pronouns (such as he, she, or they) out
of fear of discrimination. Non-binary respondents(66%) were nearly twice as likely to avoid asking to
be referred to by their correct pronouns compared
to transgender men and women (34%).
More than one-quarter (26%) said that they
stayed at a job that they would have preferred
to 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.

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).
Figure 10.7: Hid past transition to avoid discriminationin the past year
GENDER IDENTITY (%)
40%
36%

35%

33%

30%

29%
25%

25%
20%

14%

15%
10%
5%

VI. Overall Negative
Experiences in the
Workplace
Overall, 30% of all respondents who held a job in
the past year experienced some form of workplace
discrimination during that year, including being
fired or being denied a promotion because of theirgender identity or expression, being harassed or
assaulted at work, or experiencing one or moreof the other forms of mistreatment discussed in
section V of this chapter.12 This represents 16% of all
respondents. Further, 80% of respondents who helda job in the past year reported either experiencing
some form of discrimination and/or taking steps to
avoid discrimination at work, representing 41% of all
respondents.

4%

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Fifteen percent (15%) of respondents who held a
job in the past year reported that they quit their job
in order to avoid workplace discrimination. Those
currently working in the underground economy(28%), American Indian respondents (23%), Black
respondents (19%), and people with disabilities(21%) were more likely to quit their job to avoid
discrimination (Figure 10.8).
Figure 10.8: Quit job to avoid discrimination in
the past year
RACE/ETHNICITY (%)
25%
20%
15%

19%
17%

15%

17%

17%
14%

11%

10%
5%

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EMPLOYMENT AND THE WORKPLACE

23%

Respondents reported high levels of workplace
discrimination based on their gender identity or
expression, 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 occur
among people of color, people with undergroundeconomy experience, and people with disabilities.
Many respondents who applied for or held a job in
the past year reported that they were fired, denied
a promotion, or not hired for a job they applied for
because of their gender identity or expression.
Respondents also faced substantial levels of
harassment and mistreatment on the job because of
their gender identity or expression, including verbal
harassment, physical and sexual assault, and breachesof confidentiality. A large number of respondents felt
they had to take actions to avoid discrimination, suchas quitting a job or hiding their transition, despite thepotential impact on their wellbeing or financial stability.

155

ENDNOTES | CHAPTER 10: EMPLOYMENT AND THE WORKPLACE2015 U.S. TRANSGENDER SURVEY

1

156

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 Employment
Discrimination & Its Effect on LGBT People. Los Angeles,
CA: Williams Institute. Available at: http://williamsinstitute.
law.ucla.edu/wp-content/uploads/Sears-MalloryDiscrimination-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.

2Grant, et al.; Sears, et al.

3

Respondents were not asked about the level of support
from their current boss or supervisor.

4

Q. 21.1 and other questions in this chapter asked only
about 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 who
identified as a person with a disability in Q. 2.20.

6

The survey included both “transgender status/gender
identity” and “gender expression/appearance” as answer
choices so that respondents could select what they felt
best 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 “experienced
unwanted 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 those
who are living at or near the poverty line. See the Income
and Employment chapter for more information about thepoverty line calculation.

9

Respondents were asked if they “had to be in the closet
about [their] gender identity in the past year” in order toavoid discrimination.

10

This figure does not include the experience of not being
hired for a job in the past year, since this figure represents
adverse actions in the workplace experienced by those
who 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.

CHAPTER 11

Sex Work andOther Underground
Economy Work

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 or
when police thought that they were doing sex work. Notable differences in respondents’ experiences
based on demographic and other characteristics are reported throughout the chapter.

SEX WORK AND OTHER UNDERGROUND ECONOMY WORKM

any 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-based
sex 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.2
Previous 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

157

KE Y FI N D I N GS

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 sex
work, such as for money, food, or a place to sleep.
Three percent (3%) of all respondents have interacted with the police either while they
were 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, including
being 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%) of
respondents who were arrested said that police used condoms in their possession as
evidence of sex work.

158

I. Overall Underground
Economy Participation

Figure 11.1: Underground economy experience amongtransgender women

Respondents were asked about their
participation in sex work, drug sales, andother forms of work in areas that are currently
criminalized, referred to throughout this reportas underground economy work.

45%

50%
44%
41%

40%

38%

35%
30%

30%
26%

25%
20%

20%

20%

19%

15%
10%
5%
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Overall, one in five (20%) respondents had
participated in the underground economy forincome at some point in their lives. Undocumented
residents (38%) and respondents who have lost a
job 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).

RACE/ETHNICITY (%)

re O
sp ve
on ra
de ll (a
Am
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s)
ic
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In
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2015 U.S. TRANSGENDER SURVEY

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.

One in five (20%) respondents
have participated in theunderground economy at somepoint in their lives and 9%
participated in the past year.

important to recognize that non-binary people
with female on their original birth certificates andtransgender men account for a large proportion of
those in the sample who have done sex work.
Figure 11.2: Income-based sex work in lifetime
GENDER IDENTITY (%)

23%
Non-binary respondents
with female on their
original birth certificate

1%
Crossdressers

Nearly one in ten (9%) respondents haveparticipated in the underground economy forincome in the past year (Table 11.1). Undocumented
residents (29%) were more than three times as
likely to have worked in the underground economy
in the past year. Further, respondents who havebeen homeless in the past year (23%) were
nearly three times as likely to have worked in theunderground economy during that year.

% of those
who haveever done
sex work

50%
Trans
women

19%
Trans
men

Table 11.1: Income-based underground economy
experiences

RACE/ETHNICITY (%)
42%

28%

27%
23%

22%
12%

11%

te
hi

ac
tir

W

ia

l

n

9%

er

45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

ul

Of respondents who have done sex work for moneyin their lifetime, transgender women represent
one-half (50%), non-binary people with female on
their original birth certificates represent nearly onequarter (23%), and transgender men represent 19%(Figure 11.2). While this chapter primarily highlights
the experiences of transgender women of color
due to their disproportionately high representation
among those who have done sex work, it is also

Figure 11.3: Income-based sex work amongtransgender womenst

One in eight (12%) respondents have done sex work
for 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.

SEX WORK AND OTHER UNDERGROUND ECONOMY WORK

a. Income-Based Sex WorkM

II. Sex Work

a

20%

Ea

9%

in

Any underground economy 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 gender
identity or expression (25%), and those who have everexperienced homelessness (23%) were also more
likely to have participated in sex work.

e

2%

La
t

1%

dl

Other criminalized work

id

11%

M

4%

k

Drug sales

ac

12%

Bl

5%

n

Income-based sex work

Type of work

7%
Non-binary respondents with maleon their original birth certificate

As
ia

% of
respondents(in lifetime)

re O
sp ve
on ra
Am den ll (a
ts ll
er
)
ic
an
In
di
an

% of
respondents(past year)

159

Figure 11.4: Income-based sex work in past year
GENDER IDENTITY (%)

Respondents who have done income-based sex
work during their lifetime were more likely to haveexperienced a number of challenges:

55%
Trans
women

• Nearly half (45%) of respondents who havedone income-based sex work were currently
living in poverty, in contrast to 26% of those
who have not done sex work.

160

Figure 11.5: Income-based sex work in past year
among transgender women
RACE/ETHNICITY (%)
30%
25%

24%

20%
15%

13%

13%

13%

12%
9%

10%
5%

5%

5%

hi

te

l
W

tir
ul
M

Ea
e
dl

ac

st
e

ia

rn

a
in
La
t
id
M

k

0%
ac

Five percent (5%) of all respondents did sex work
for income in the past year. More than half (55%) of
those who did income-based sex work in the past
year were transgender women, 22% were non-binary
people with female on their original birth certificate,and 14% were transgender men (Figure 11.4).

Bl2015 U.S. TRANSGENDER SURVEY• Respondents with sex work experience were
nearly sixteen times as likely to be living withHIV (7.9%) as those who have never done sex
work (0.5%), and nearly six times more likely
than those in the overall sample (1.4%).

14%
Trans
men

Respondents who experienced homelessness inthe past year (17%) were more than three times as
likely to have participated in sex work during thatyear compared to the overall sample. Respondents
who were living with HIV (32%) and undocumented
residents (29%) were substantially more likely to haveparticipated in sex work in the past year. Additionally,transgender women of color reported higher rates
of sex work participation in the past year, particularlyBlack transgender women (24%), who were almost
five times as likely to have done sex work for incomein the past year (Figure 11.5).

n• More than three-quarters (77%) of respondents
who have done income-based sex work haveexperienced some form of intimate partner
violence, compared with 51% of those whohave not done sex work.

% of those
who did sex
work in thepast year

8%
Non-binary respondents with maleon their original birth certificate

re O
sp ve
o r
Am nd all (
en al
er
l
ic ts)anIndian• Nearly three-quarters (72%) of respondents who
have done income-based sex work have beensexually assaulted in their lifetime, in contrast to
those who have not done sex work (44%).

22%
Non-binary respondents
with female on their
original birth certificate

1%
Crossdressers

Asia

One in eight (12%) respondents
have done sex work for income,and 5% of respondents did soin the past year.

Respondents who have done sex work for income
reported 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 work
experience to have done street-based sex work,with women of color, including American Indian(50%), Black (48%), and Latina (31%) women, being
substantially more likely to participate in streetbased sex work (Figure 11.6).
Table 11.2: Type of income-based sex work
% of those who haveever done sex work

Type of sex work
Informal sex work through word of mouth,
occasional hook ups with dates in my
networks, or things like that38%

Sex work advertised online

36%

Webcam work

35%

Pornography (picture or video)

28%

Fetish work

24%

Street-based sex work21%

Phone sex

14%

Escort, call girl, or rent boy with an agency

12%

Erotic dancer or stripper

11%

Sex work advertised in magazines
or newspapers

7%

Not listed above

9%

Figure 11.6: Participation in street-based sex work
among transgender women who have done sex work

In Our Own
Voices“At 17, I ran away with no way of
supporting myself. I turned toInternet prostitution, which allowed
me to do things for myself that
I 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 truck
when friends couldn’t put me up attheir house, and sometimes I would
meet people at a bar and have sex
with them to really just sleep overand shower.”“I couldn’t find work. I watched one
guy throw away my application
literally 30 seconds after turning it
in. I resorted to escorting. It’s the
only way to keep food in my belly
and a roof over my head.”

RACE/ETHNICITY (%)

50%

50%

“I became a sex worker to support
myself and pay for my transition. I
did not want to do sex work, but I
have had worse jobs that paid less.”

48%

40%

20%

31%

29%

30%

25%
21%

18%

10%

* Sample size too low to report

W

hi

te

l
tir
ul

M

e

Ea

st

ac

er

ia

n*

a
in
La
t

dl
id
M

k
ac
Bl

n
As
ia

re O
sp ve
on ra
Am de ll (a
nt ll
er
s)
ic
an
In
di
an

0%

“An officer attempted to arrest me
on prostitution charges because
I was at a street corner. It was
roughly noon, I was holding a
bag of food in my hand, and I wasclearly waiting for the street light tochange so I could cross the street.”

SEX WORK AND OTHER UNDERGROUND ECONOMY WORK

60%

161

Nearly one in five (19%)
respondents participated in
sex work, such as for money,
food, a place to sleep, or othergoods or services.
b. Sex Work for Goods orServices

RACE/ETHNICITY (%)
16%

15%

14%

13%
12%

12%
10%

8%

8%

7%

6%
4%

4%
2%

3%

2%

ac
tir

te
W
hi

rn

ia
l

0%
ul

Six percent (6%) of respondents have everengaged in sexual activity for food. Respondents
living with HIV (32%) were more than five times
as likely to have engaged in sexual activity
for food. Undocumented residents (17%) andAmerican Indian (15%), Black (12%), and multiracial(10%) respondents were also more likely to haveengaged in sexual activity for food.

Figure 11.7: Interacted with police who thought they
were doing sex work among transgender women

M

7%

st
e

3%

a

Engaged in sexual activity inexchange for something notlisted above

Ea

5%

in

1%

le

Engaged in sexual activity
for drugs

id
d

8%

M

2%

k

Engaged in sexual activity fora place to sleep (in someone's
bed, at their home, or in theirhotel room)

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 with
police who thought they were doing sex work
(Figure 11.7).

La
t

6%

Bl
ac

2%

n

Engaged in sexual activity
for foodia% ofrespondents(in lifetime)As

2015 U.S. TRANSGENDER SURVEY% ofrespondents(past year)

All survey respondents were asked if they had
ever interacted with police either while doing sex
work, or when police thought they were doing sex
work. One percent (1%) of respondents said thatthey interacted with police while participating in sex
work, and an additional 2% said they did so whenpolice thought they were doing sex work. Overall,
3% of respondents have interacted with police while
doing sex work or when police thought they were
doing sex work.

re O
sp ve
o ra
Am nde ll (an ller
ic ts)anIn
dian

Table 11.3: Engaged in sexual activity in exchange forgoods or services

162

Overall, 19% participated in sex work, suchas for money, food, a place to sleep, or othergoods or services.

c. Police Interactions

All survey respondents, including those who did
not report doing sex work for income, were asked
whether they had sex or engaged in sexual activity
for food, for a place to sleep, for drugs, or in
exchange for something else (Table 11.3).

Type of activity

One in twelve (8%) respondents engaged in sexual
activity for a place to sleep. Respondents who were
living with HIV (28%), who have ever experienced
homelessness (20%), or who were undocumented
residents (17%) were more likely to have engaged insexual activity for a place to sleep.

Respondents who interacted with the police
while doing sex work or when police thought
they were doing sex work were asked about
specific experiences they had with police. Eightysix percent (86%) reported at least one negative
experience during the interaction (Table 11.4).
Table 11.4: Interactions with police while doing or
when police thought they were doing sex work

Type of interaction% of those who interactedwith police who thought
they were doing sex work,or while doing sex work

Officers kept using the wrong
gender 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 about
their gender transition (such as
hormones and surgical status)

41%

Officers sexually assaulted them

27%

Officers physically attacked them

18%

Officers forced them to have sex
or engage in sexual activity to
avoid arrest

14%

Arrested for drugs in theirpossession when police stopped
them for doing sex work11%

One or more experiences listed

86%

More than one-quarter (27%) of respondents who
had interacted with police in this context were
sexually assaulted by an officer, including being
fondled, raped, or experiencing another formof sexual assault.6 Respondents who have everexperienced homelessness (34%) were more likely
to be sexually assaulted by an officer. Fourteen
percent (14%) also reported that they were forced
to have sex or engage in sexual activity to avoid
arrest.

Respondents who interacted with police while
engaging in sex work or when police thought they
were engaging in sex work were also asked if they
were arrested during any of those interactions.
Almost one-third (32%) reported being arrested
during at least one interaction. Black respondents(50%) and transgender women (40%) were more
likely to report that their interaction with the police
led to an arrest.
Respondents who reported being arrested wereasked how many times they were arrested while
they were doing sex work or when police thought
they were doing sex work. Approximately onethird (34%) were arrested once, 32% were arrested
two or three times, and 35% were arrested four ormore times (Figure 11.8).
Figure 11.8: Number of times arrested while doing or
when police thought they were doing sex work

34%
1 time19%
2 timesNumber oftimes arrested
19%
11 or more
times

13%
3 times
16%
4–10 times

Respondents who were arrested while doing or
while police thought they were doing sex work
were also asked whether police considered items intheir possession, such as condoms, as “evidence of
prostitution.” Forty-four percent (44%) said that thepolice considered condoms in their possession to
be evidence of prostitution (Figure 11.9).

SEX WORK AND OTHER UNDERGROUND ECONOMY WORK

More than two-thirds (69%) said that officers
repeatedly referred to them as the wrong
gender. This experience was more likely amongtransgender women (74%). Nearly two-thirds (65%)
were verbally harassed by police.

d. Arrest163

Figure 11.9: Items in possession considered as
evidence when arrested (% of those arrested while
doing or suspected of doing sex work)
60%
50%

48%
44%

40%
30%
20%
10%

12%

9%
4%
m

Co
n
to doman ys
ot , a s, she nd er i /o x
te r
m
Th
ey
di
d
kn no
ow t

An
ot
he
r

ite

s
to
y
Se
x

Co
nd
o

m

s

0%

Respondents were asked about the outcomesof their arrests. More than half (55%) of the
respondents who were arrested pleaded guilty inconnection to one or more of their arrests, while
nearly half (48%) reported that the charges were
dropped on at least one occasion (Figure 11.10).
Figure 11.10: Outcome of arrest (% of those arrested
while doing or suspected of doing sex work)
60%

55%
48%

50%
40%
30%

27%

20%

15%
11%

10%

2015 U.S. TRANSGENDER SURVEY
164

tl
ab iste
ov d
e

No

w Th
er e
e ch
dr ar
op ge
pe s
d
W
en
tt
fo o tun ria
d la
gu nd
ilty
W
fo entun tod tr
no ialt g an
ui d
lty

Pl
ea

de
d

gu

ilty

0%

III. Drug Sales andOther Underground
Economy WorkOne in eight (12%) respondents have done workin the underground economy other than sex work
at some point in their lifetime. This included those
who had participated in drug sales (11%) and/or other work that is currently criminalized (2%).7
Respondents who were living with HIV (27%), whohave lost a job because of their gender identity
or expression (22%), or have ever experienced
homelessness (21%) were more likely to have been
paid 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 drug
sales or sex work) (see Table 11.1).

Conclusion
Respondents reported substantial levels of
involvement in sex work and other undergroundeconomy work, particularly people of color, thoseliving with HIV, undocumented residents, andthose who have experienced homelessness. Many
respondents, especially transgender women ofcolor, also reported that police often assumed they
were 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 law
enforcement officers.

ENDNOTES | CHAPTER 11: SEX WORK AND OTHER UNDERGROUND ECONOMY WORK
1

2

3

See Ditmore, M. & Thukral, J. (2011). Behind Closed Doors:
An Analysis of Indoor Sex Work in New York City. New
York, 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 in
New York. NY, New York: Sex Workers Project at the Urban
Justice Center. Available at: http://sexworkersproject.org/
downloads/RevolvingDoor.pdf.
Amnesty International. (2016). Amnesty International Policy
on State Obligations to Respect, Protect and Fulfill the
Human Rights of Sex Workers. Available at: https://www.
amnesty.org/en/documents/pol30/4062/2016/en.
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. Available
at: http://www.transequality.org/sites/default/files/
Meaningful%20Work-Full%20Report_FINAL_3.pdf;
Amnesty International. (2016). Amnesty International Policy
on State Obligations to Respect, Protect and Fulfill the
Human 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 they
had done such work in the past year in Q. 6.2. This report
uses the term “sex work” to refer to all work in the sex
industry 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 criminalized
in the United States, some of them are not.

6

Respondents were asked whether they had “experienced
unwanted 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 currently
considered illegal.”

SEX WORK AND OTHER UNDERGROUND ECONOMY WORK165

CHAPTER 12

Military ServiceP2015 U.S. TRANSGENDER SURVEY

rior 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 questions
about 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.

166

At the time that survey data was collected in 2015, the military still barred transgender people from serving
openly in the military, and service members could be discharged simply for being transgender.2 The
Department 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 Despite
the 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 interactions
with 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.

Of current service members whose leadership or commanding officers knew or thought
they 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 ten
years 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.

I. Current and Past
Military Service
Nearly one in five (18%) respondents in the sample
have served in the military, including respondents
who were currently serving in the military on active
duty (0.5%), and those who were currently on
active duty for training in the Reserves or National
Guard (2%).4 Fifteen percent (15%) of respondents
were veterans, compared with 8% in the U.S.
population.5

Fifteen 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).
Figure 12.1: Veteran status
AGE (%)
60%
52%

50%
40%

40%
30%
25%

22%

20%
15%

10%

18%

15%
8%

8%
5%

3% 2%

us
75

pl

74
65

to

64
55

to

54
to
35

to
18

ve
r

al

34

l

0%

% in USTS (supplemental survey weight applied)% in U.S. general population (ACS)MILITARY SERVICE

Respondents in every age group were more likely
to be veterans than their counterparts in the U.S.
population. More than half (52%) of respondents
over the age of 75 and 40% of respondents
between the ages of 65 and 74 were veterans,compared with 22% and 18% of those age groups
in the U.S. population, respectively.6 One-quarter(25%) of respondents between the ages of 55 and
64 were veterans, more than three times higher
than that age group in the U.S. population (8%).7

O

KE Y FI N D I N GS

Nearly one in five (18%) respondents have served in the military, including veterans andthose currently on active duty.

167

Among those with past or current military service,crossdressers (33%), transgender women (23%),and non-binary people with male on their original
birth certificate (22%) were more likely to have
served, compared with transgender men (8%) andnon-binary people with female on their original
birth 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 as
the overall sample to currently be on active duty,with 5% on active duty at the time they took thesurvey.
Figure 12.2: Past or current military service
GENDER IDENTITY (%)
35%

33%

30%
25%

23%

22%

20%

19%

18%

15%
10%

9%

5%

8%

Fifteen percent (15%) of
respondents were veterans,compared with 8% in the U.S.
population.
Of those who reported military service, 2% werestill serving. Nearly one-third (31%) of those who
were no longer serving separated from military
service within the past ten years, and 69%
separated from military service more than ten
years ago.

II. Branch of Service
Current and former service members were asked
to identify their current or most recent branchof service. Twenty-eight percent (28%) of these
respondents currently or most recently served in
the Army, 22% in the Navy, 18% in the Air Force, 7%in the Marine Corps, and 1% served in the Coast
Guard. Nearly one-quarter (24%) served in the
Reserves or the National Guard (Table 12.1).

2%

Table 12.1: Current or most recent branch of service
ss
y
w
er
s
bi ithrth fe
al
ce ma
e
on
rt le
bi ifica on
rth
te
ce
rti
fic
at
No
e
nbi
na
ry
(a
ll)
Tr
an
s
w
om
en
Tr
Tr
an
an
s
s
w
m
om
en
en
an
d
m
en

Branch of service% of current or former
service members

Air Force

18%

Air Force Reserve

2%

ry

w

ith

No

m

nb

in
ar

Cr

os

sd

O

re

ve

ra

ll

0%

2%

Army

28%

Army Reserve

8%

Figure 12.3: Past or current military service

Army National Guard

8%

RACE/ETHNICITY (%)

Coast Guard

1%

Coast Guard Reserve<1%

Marine Corps

7%

Marine Corps Reserve

1%

168

25%
20%

21%

20%

20%
18%

18%
15%

15%
10%

7%

7%

5%

l

hi
te
W

ul
tir

ac

te
M

dl
e
id
M

ia

rn

a

Ea
s

in

o/

k
La
t

ac
Bl

n
ia
As

an
In

er

ic

an

O

ve

di

ra

ll

0%

Am

2015 U.S. TRANSGENDER SURVEY

No

nbi

na

Air National Guard

Navy

22%

Navy Reserve3%III. Outness or
Being Perceived asTransgender

IV. LeadershipResponse toTransgender Status

Current service members9 were asked how many
people in the military (with the exception of othertransgender people) thought or knew that they
were transgender.10

Among current service members who said thata few, some, most, or all others in the military
thought or knew they were transgender, 48%
indicated that their leadership or commanding
officer thought or knew that they weretransgender.

More than half (52%) of current service members
said that, as far as they knew, no one elsethought or knew that they were transgender.
Approximately one-third (34%) of current service
members indicated that a few or some people
in the military thought or knew that they weretransgender, and 13% indicated that most or all
people in the military thought or knew that they
were transgender (Figure 12.4).11
Figure 12.4: Number of people in the military who
thought or knew that respondent was transgender

8%
Most
22%
Some

5%
All

% of current
servicemembers

52%
None

23%
A few

One-third (33%) of these respondents wrote in
responses describing additional actions theirleadership or commanding officers took because
they thought or knew the respondent wastransgender. Their write-in responses included
several positive actions, such as supporting
their social transition or their use of pronouns
and uniforms that were consistent with theirgender identity. These respondents also offered
several additional negative actions, such as
forcing respondents to present in a way that wasinconsistent with their gender identity, forbidding
them from discussing their transgender status
with anyone else, passing them over for awards
and duties, and subjecting them to administrative
discipline.

MILITARY SERVICE

More than half (52%) of current
service members said that, as
far as they knew, no one elsethought or knew that they weretransgender.

These respondents were asked about theways in which their leadership or commanding
officer responded to them being transgender,
and they selected one or more response. Many
reported that their leadership or commanding
officer responded to their transgender status ina variety of positive ways, including supporting
their name change (47%) and supporting theirtransition-related medical treatment (36%). Thirty
percent (30%) reported that their leadership orcommanding officer ignored their transgenderstatus or looked the other way. Approximately
one-quarter (23%) reported that their leadershipor commanding officer had taken actions todischarge them (Table 12.2).

169

Table 12.2: Response of leadership and/or commanding
officer to being transgender

Leadership or commanding
officers’ response% of current service
members whose
commanding officer
thought/knew they weretransgender

Supported name change

47%

Supported medical treatment

36%

Ignored or looked the other way

30%

Took actions to discharge them23%

Not listed above

33%

V. Separation fromMilitary Service
Veterans were divided into two groups for the
purposes of analysis: those who separated within thepast ten years and those who separated more than ten
years prior to taking the survey. The two groups were
given distinct questions based on a consideration of
the types of experiences a service member may haveencountered during their service and the changing
nature of the military.12

In Our Own
Voices“I began to accept myself as awoman. I was happier than I everhad been before. But the army
didn’t share my enthusiasm. A year
after returning from deployment, I
was kept in under penal conditions.
I was demoted from a sergeant to a
private, 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 unable
to help because transgenderindividuals are not protectedagainst harassment in the military.”

a. Type of Discharge
Respondents who separated from military service
more than ten years ago13 were asked about thereasons for their separation from service, including
the type of discharge they received. More than threequarters (79%) of these respondents reported being
honorably discharged, and the remaining 21% reported
a variety of other types of discharges (Table 12.3).

2015 U.S. TRANSGENDER SURVEY

Table 12.3: Type of discharge

170

Discharge
Honorable% of veterans who separated morethan 10 years ago

b. Discharged Because of
Transgender Status
While 81% of respondents who had separated fromservice more than ten years prior reported that they
did not believe their discharge was related to beingtransgender, 19% believed their discharge waseither partially related (14%) or completely related(5%) to being transgender.

79%

General7%

Medical

6%

Other-than-honorable

3%

Entry level separation

2%

Bad conduct

1%

Retired
Dishonorable

1%<1%

Not listed above2%

Respondents who indicated that their discharge
was related to being transgender were less likely
to have been honorably discharged. Eighty-six
percent (86%) of those who said their discharge
was not related to their transgender status were
honorably discharged, while only 45% of those whosaid their discharge was partially related to beingtransgender and 51% of those who indicated that itwas completely related were honorably discharged.

VI. Name Change on
Discharge Papers

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 their
original birth certificate (17%). Latino/a (28%) andBlack (24%) respondents were also more likely toreport that their transgender status was a factor
in their discharge, compared with white (16%)
respondents.

Respondents who separated from military service
more than ten years earlier were also asked if they
had changed their name on their military discharge
papers, known as the DD 214. Two percent (2%)
applied for and received an updated DD 214
with 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.

Even though these discharges took place morethan ten years ago, the experience of being
discharged partly or completely because of one’s
transgender status was associated with a varietyof negative outcomes affecting respondents
at the time they took the survey. Respondents
who were currently living in poverty (29%) or
currently working in the underground economy(34%) were more likely to say that their discharge
was completely or partially connected to theirtransgender status, as were respondents who
were currently experiencing serious psychologicaldistress (28%).

c. Separated to Transition or
Avoid Harassment
Nearly one in ten (9%) respondents who separated
from military service more than ten years ago left
the service in order to transition, and an additional
19% said they left the service to avoid being
mistreated 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.

Current service members and veterans who
separated from military service within the ten years
prior to taking the survey were asked whether
they had received health care related to gendertransition from a military provider, not including theVeterans Health Administration. Twelve percent(12%) had received mental health treatment related
to gender transition from a military provider,and 4% had received medical treatment related
to gender transition other than mental healthtreatment, such as hormone therapy or surgicalcare, from a military provider.
Even though this survey was conducted prior
to the Department of Defense’s announcementof plans to allow transgender people to serve
openly, more than one-quarter (28%) of all current
service members reported taking hormones fortheir gender identity or gender transition at thetime they participated in the survey. Among these

MILITARY SERVICE

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 the
military to avoid mistreatment or harassment.

VII. Health Care
Treatment fromMilitary Providers

171

current service members, 28% reported getting
their hormones from an on-post medical doctor
and/or pharmacy. Nearly three-quarters (74%)
received their hormones through an off-post
medical doctor, and 57% received them through an
off-post pharmacy (Table 12.4).
Table 12.4: Source of hormones

Source of hormones% of current service
members 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 whether
a military medical provider, including any
mental health provider, had reported to theircommanding officer that they were transgenderor recommended them for discharge. Of current
service members whose providers knew they weretransgender,14 86% reported no action being taken
by 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.

2015 U.S. TRANSGENDER SURVEY

VIII. Veterans
Health Care

172

Veterans who separated from the military morethan ten years ago were asked about theirexperiences receiving health care through the
Veterans Health Administration (VA).15
Forty percent (40%) of former service members
have received health care through the VA, 75% ofwhom were currently receiving care through the
VA. Of those who received health care through the

VA at any point, more than half (56%) received carerelated to gender transition.
Nearly three-quarters (72%) indicated that they
were out to their VA providers as transgender.
Of those who were out to their VA providers astransgender, almost half (47%) reported that they
were always treated respectfully as a transgenderperson, and 40% said that they received mostly
respectful care. Eleven percent (11%) reported thatthey were sometimes treated respectfully, and
3% said that they were never treated respectfully(Figure 12.5).
Figure 12.5: Frequency of respectful treatment at the VA
3%
Never
11%
Sometimes

47%
Always% of veterans
who were out astransgender totheir VA provider

40%
MostlyIX. Impact of
Repealing Ban on
Transgender Service
At the time the survey was taken, the military
had not yet announced it would let transgenderpeople serve openly. Current military service
members were asked what they would do if themilitary allowed transgender people to serve
openly. Nearly one-quarter (24%) said that theywould start to transition while still serving, and 18%
said that they would finish the transition that they

Conclusion

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 service
in the military was allowed for transgender people
What they would do if allowed to serve
openly% of current
servicemembers

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 they
already started and continue to serve1%

Not listed above

21%

Veterans who separated from the military within
the past ten years were asked whether they would
return to military service if transgender people
were allowed to serve. Nearly one-third (30%)
of these respondents indicated that they would
return, 30% said that they might return, and theremaining 39% reported that they would not return
to military service. Transgender men (42%) weremore likely than transgender women (25%) andnon-binary people (18%) to say that they would
return to service.

Despite a ban on transgender service members
at the time the survey was administered, nearly
one in five respondents reported having servedin the military, and respondents were nearly
twice 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, including
those who would transition during their military
service. Responses also indicated diverse
experiences 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 members
and implementing new policies could lead to a
substantial number of current and former service
members continuing or resuming their military
service.

MILITARY SERVICE173

ENDNOTES | CHAPTER 12: MILITARY SERVICE
12015 U.S. TRANSGENDER SURVEY

2

174

Gates, G. J. & Herman, J. L. (2014). Transgender MilitaryService in the United States. Los Angeles, CA: Williams
Institute. 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 gender
identity 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.
Although the ban is described in this chapter as being one
that prevented “transgender people from serving openly
in the military,” in actuality, the ban categorically barredtransgender people from serving, regardless of whether or
not 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 hide
their 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. The
New York Times. Available at: http://www.nytimes.
com/2016/07/01/us/transgender-military.html.

4

In this section of this chapter, the percentages of
respondents who have served or are currently serving in the
U.S. Armed Forces have been weighted to reflect the age
and educational attainment of the U.S. population in addition
to the standard survey weight. The USTS sample differs
substantially 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 to
the percentage of U.S. adults who have served in the armed
forces, as reported in the American Community Survey.
See the Methodology and Portrait of USTS Respondents
chapters for more information about the application of the
supplemental survey weight.

5

U.S. Census Bureau. (2015). American Community
Survey 1-Year Estimates: Veteran status. Available
at: 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 duty
for training in the Reserves or National Guard, or (3) nolonger on active duty but had been in the past and were still
serving 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 how
many people were out as transgender in the military bydetermining if other non-transgender people thought or
knew that they were transgender.

11

This question (Q. 8.9) did not distinguish between service
members who were not out or perceived as transgenderbecause they were not living according to their gender
identity, and those who were already living full time
according 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 military
thought or knew they were transgender also reported
that 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 gender
identity without disclosing their past transition.

12

During the development of the survey questionnaire,the research team consulted with individuals and groups
with subject-matter expertise in LGBT military service ingeneral, and transgender military service in particular. Afterconsultation, the research team chose to divide those who
had separated from service into two groups to evaluate
the 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’t
Ask, Don’t Tell,” permitting lesbian, gay, and bisexual (butnot transgender) service members to serve openly—andmay have had different experiences as a result. This group
may have also had different experiences with transitioning,receiving medical care for transition- and non-transitionrelated health care, and eligibility to return to service. The
two 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, VA
health care, and military discharge papers) to evaluate thedifferences in experiences between them and those who
separated more than ten years prior to participating in thesurvey. However, due to a programming error, respondents
who separated within the past ten years did not receive
these questions. Therefore, results of questions that
addressed veterans’ issues only reflected the experiencesof those who separated more than ten years prior and likely
underestimated certain experiences reported in this section.

14

Thirty-seven percent (37%) of current service members said
that 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 provider
knew they were transgender.

15

Veterans who separated from the military within the past ten
years did not receive this question due to a programming
error. See note 13.

CHAPTER 13

Housing,
Homelessness, and
Shelter AccessThis 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.

HOUSING, HOMELESSNESS, AND SHELTER ACCESS

H

ousing is one of the most vital needs all people share. However, many transgender people
have faced discrimination when seeking housing, and are vulnerable to actions such as eviction
because 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 people
who 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 putting
them at further risk of violence and harassment.2

175

KE Y FI N D I N GS

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 housing
discrimination 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 year
avoided 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 poor
treatment or unsafe conditions.

2015 U.S. TRANSGENDER SURVEY• 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 as
the wrong gender in order to stay at the shelter.

176

I. Current Living
Arrangements
Respondents were asked what their current living
arrangements were at the time they participated in
the survey. Nearly half (44%) of respondents were
living in a house, apartment, or condo they rented,
either alone or with others, which was the mostcommonly reported living arrangement. Seventeen
percent (17%) had not yet left home and were livingwith their parents or the family they grew up with
(Table 13.1).

CURRENT AGE (%)
80%

78%
75%

70%

69%

68%
63%

60%

58%

56%

43%

40%

Living in transitional housing or a halfway
house

<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 foster
care

<1%

Living in a hospital<1%

Not listed above

2%

5

ll
de

r2

ra
Un

ve

er

<1%

ov

Living in a shelter (including homeless,domestic violence, or other type of
emergency shelter) or in a hotel or motelwith an emergency shelter voucher

d

<1%

an

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

64

5%

to

Living with a partner, spouse, or other person
who pays for the housing

65

7%

55

Living in campus or university housing

54

9%

to

Living temporarily with friends or family
because they cannot afford their own
housing

34

16%

1%

0%

to

Living in house, apartment, or condo theyown (alone or with others)

11%

25

17%

13%

10%

% in USTS% in U.S. population (ACS)Respondents also reported substantial housing
instability. Nearly one in ten (9%) respondents
were living temporarily with friends or family
because they could not afford their own housing.
Approximately half of one percent (0.53%) of
respondents were homeless at the time they
participated in the survey, including those who
were living in a shelter (other than a domestic
violence shelter), or on the street. This was threetimes the rate of current homelessness among
adults in the U.S. population (0.18%), as reportedby the Department of Housing and Urban
Development.5

HOUSING, HOMELESSNESS, AND SHELTER ACCESS

Living with parents or family they grew up
with because they have not yet left home

16%

45

20%

44

44%

28%

to

30%

35

% of
respondents

37%

O

Living in house, apartment, or condo they
rent (alone or with others)

Figure 13.1: Homeownership rate

50%

Table 13.1: Current living arrangements

Current living arrangements

In contrast to the 63% homeownership rate in the
U.S. at the time of the survey,3 USTS respondents
were 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

177

II. Homelessness
During 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 stayed
temporarily with family or friends because they
could not afford housing. The homelessness rate
was substantially higher among respondents
whose immediate family had kicked them out of
the house, with nearly three-quarters (74%) of
these respondents experiencing homelessness.
The homelessness rate was also nearly twice ashigh among respondents who have done sex
work (59%) and those living with HIV (59%), as well
as respondents who have lost their job becauseof their gender identity or expression (55%).
Transgender women of color, including American
Indian (59%), Black (51%), multiracial (51%), andMiddle Eastern (49%) women, also experienced
especially high rates of homelessness (Figure13.2).
Figure 13.2: Lifetime homelessness rate amongtransgender women
RACE/ETHNICITY (%)
70%

51%

50%
40%

35%
31%

30%
25%

10%

hi
te
W

l
tir
ul

M

e

Ea

st

ac

er

ia

n

a
in
La
t

dl
id
M

k
ac
Bl

As
ia

n

0%
re O
sp ve
Am ond raller en (allic ts)anIn
dian

2015 U.S. TRANSGENDER SURVEY

Table 13.2: Housing situations that occurred in thepast year because of being transgender

Housing situation% of people to whom
situation applied

They had to move back in withfamily members or friends

20%

They slept in different places for
short 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 listed30%

One in eight (12%) respondents reported
experiencing homelessness in the past year as

51%

49%

20%

178

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

59%

60%

30%

III. Housing
Discrimination andHomelessness in the
Past Yeara result of anti-transgender bias. Those currently
working in the underground economy (such as sex
work, drug sales, and other work that is currently
criminalized) (37%), undocumented residents(32%), and those living with HIV (27%) were more
likely 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).

Figure 13.3: Homelessness in the past year because ofbeing transgender among transgender women
RACE/ETHNICITY (%)
35%

In Our Own
Voices

31%

30%
27%

25%
20%

18%

15%

18%

13%

12%

12%

10%

“I was ejected from my apartment
while I was out of town after mylandlord discovered I was trans.
The apartment was empty when I
returned home.’’			

5%

hi
te
W

l
ul
tir
ac
ia

M

id

dl

e

M

Ea

st
er
n*

La
tin
a

ac
k
Bl

n
ia
As

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

0%

*Sample size too low to report

Six percent (6%) of respondents were denied ahome or apartment in the past year because they
were transgender, with transgender women ofcolor, including Black (17%), multiracial (15%), andLatina (11%) women, being more likely to have thisexperience (Figure 13.4).
Figure 13.4: Denial of home/apartment in the past year
due to being transgender among transgender women
RACE/ETHNICITY (%)
18%“I lost my job after I came out astransgender. I became homelessfor about year. I never stayed
in a shelter because I feared
harassment.”“When I was 18, I ran away frommy abusive parents who had been
violent toward me because of mysexuality and gender expression.
I became homeless for several
years, traveling all over the country,
stealing food and sleeping inabandoned buildings.”

17%

16%
14%
12%

11%
10%

10%

10%

8%
6%

6%

6%

4%
2%

*Sample size too low to report

te
hi

l
W

ac
ul
tir
M

Ea
e

ia

*
st
er
n

a
in
La
t

dl
id
M

k
ac
Bl

n
As
ia

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

0%

“I’ve tried shelters. The men’s ones
aren’t safe for trans men: if thosemen find out who you are, you’re
opening yourself up to physical andsexual violence. And when I turnedto the women’s shelters, I was too
masculine to make the women
comfortable.”

HOUSING, HOMELESSNESS, AND SHELTER ACCESS“When I go to shelters, I am
admonished and told that I should
return to ‘being a woman’ in order
to use the shelter system.”

15%

179

Five percent (5%) of respondents
were evicted from their home in
the past year because of antitransgender bias.
Five percent (5%) of respondents were evictedfrom their home or apartment in the past year
because of anti-transgender bias. Differences
emerged by demographic characteristics, where
undocumented residents (18%), people withdisabilities7 (8%), and people of color, including
American 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% of
all respondents—experienced one or more formsof housing discrimination or instability in the past
year because they were transgender. Respondents
who 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).
Figure 13.5: Any housing discrimination and/or
instability in past year due to being transgenderamong transgender women
RACE/ETHNICITY (%)
60%
2015 U.S. TRANSGENDER SURVEY

49%

50%

180

*Sample size too low to report

39%

40%
30%

30%

39%

37%
33%

27%

20%
10%

te
hi

l
ac

M

ul

tir

st
e
Ea
e

W

ia

*
rn

a
in
La
t

dl
id
M

k
ac
Bl

n
ia
As

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

0%

IV. Sheltersa. Access to Shelters
Respondents who experienced homelessness inthe past year because of their transgender status
were 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 were
homeless

They sought shelter and stayedat one or more shelters

10%

They sought shelter and weredenied access to one or more
shelters

6%

They did not seek shelter,because they feared
mistreatment as a transgenderperson26%

They did not seek shelter forother reasons59%

One in ten (10%) respondents sought shelterand stayed at one or more shelters in the past
year. Higher percentages were noted among
respondents living with HIV (22%) and American
Indian (23%) and Black (15%) respondents.
More than one-quarter (26%) did not seek shelter
because 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 respondents
whose families had kicked them out of the housefor being transgender (35%) were more likely to
avoid seeking shelter for fear of being mistreated.

Figure 13.6: Did not seek shelter for fear of
mistreatment as a transgender person in the past year
RACE/ETHNICITY (%)
50%
45%

43%

40%

37%

35%
30%
26%

26%

25%

25%

22%

22%

20%
15%

Seven out of ten (70%) respondents
who stayed at a shelter in thepast year faced some form of
mistreatment, such as being forced
out, harassed, or attacked becauseof being transgender.
Table 13.4: Reported reasons for being denied accessto one or more shelters
Reason for denial% of those denied
access to shelter0%

Income level or education

5%

Gender identity or expression

74%

te
hi
W

ul

Race or ethnicity

4%

Religion or spirituality

4%

Sexual orientation

17%

None of the above

19%

M

id

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M

Ea

tir

st

ac

er

ia

n*

a
o/
e

ac

in
La
t

Bl

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di
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ic

an

As

ll
ra
ve
O

er
Am

l

8%

k

7%

Disability
n

Age

5%

an

10%

*Sample size too low to report

Six percent (6%) of respondents were denied
access to a shelter in the past year. Transgenderwomen of color were more likely to be denied
access 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 stayed at one or more sheltersin the past year received questions about how
they 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 being
forced out, harassed, or attacked because they
were transgender.
Nearly one in ten (9%) respondents who stayed ata shelter in the past year were thrown out after the
shelter staff found out that they were transgender.
Forty-four percent (44%) decided to leave theshelter because of poor treatment or unsafe
conditions, 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 shelter
staff forced them to dress or present as the wrong
gender in order to stay at the shelter (Table 13.5).

HOUSING, HOMELESSNESS, AND SHELTER ACCESS

Respondents who were denied access to one ormore shelters in the past year were asked what
they 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 they
were denied access to a shelter because of theirgender identity or expression.8 This represents
4% of those who were homeless in the past year
(Table 13.4).

b. Treatment in Shelters

181

Table 13.5: Experiences while staying in homelessshelters in the past year

Conclusion

Experiences while staying inhomeless shelters

Respondents reported high rates of homelessness
both in their lifetime and the past year. The
results also indicated that a substantial number of
respondents experienced housing discriminationand housing instability in the past year basedon their transgender status, with higher rates
among transgender women of color, people livingwith HIV, people who have been kicked out of
their homes by their families, and respondents
currently working in the underground economy.
Many of those who experienced homelessness
in the past year reported that they avoided using
a shelter because they feared being mistreatedas a transgender person, and those who did
use a shelter in the past year faced high rates of
mistreatment based on their transgender status,
such as being kicked out of the shelter, being
verbally harassed, physically attacked, or sexuallyassaulted.

% of people whostayed in a shelter

They left because of poor treatment or
unsafe conditions, even though they
had 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 staff
learned they were transgender9%

One or more experiences listed

58%

Respondents who stayed at a homeless shelterin the past year were also asked whether they
were verbally harassed, physically attacked, or
sexually assaulted9 at the shelter because they
were transgender. Nearly half (49%) reported thatthey were verbally harassed because they weretransgender. Nearly one-fifth (19%) were physicallyattacked, and 17% were sexually assaulted at the
shelter because they were transgender (Table 13.6).
Table 13.6: Verbal harassment, physical attack, andsexual assault in homeless shelters in the past year
because they were transgender2015 U.S. TRANSGENDER SURVEY

Experiences while staying inhomeless shelters

182% of people whostayed in a shelter

Verbally harassed

49%

Physically attacked

19%

Sexually assaulted

17%

One or more experiences listed

52%

ENDNOTES | CHAPTER 13: HOUSING, HOMELESSNESS, AND SHELTER ACCESS
1

2

3

4

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 Providers
Working with Lesbian, Gay, Bisexual, and Transgender
Youth who are Homeless or at Risk of Becoming
Homeless. Los Angeles, CA: Williams Institute. Available
at: 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 of
the National Transgender Discrimination Survey. (p. 112).
DC: National Center for Transgender Equality & National
Gay and Lesbian Task Force.
Grant, et al.; Rooney, C., Durso, L. E., & Gruberg, S. (2016).
Discrimination Against Transgender Women Seeking
Access to Homeless Shelters. DC: Center for American
Progress. Available at: https://www.americanprogress.
org/issues/lgbt/report/2016/01/07/128323/discriminationagainst-transgender-women-seeking-access-to-homelessshelters/.
U.S. Census Bureau. (2015). American Community
Survey 1-Year Estimates: Homeownership Rate by Ageof Householder. The ACS homeownership rate include
ages 15 and older, in contrast to the USTS rate, which
includes respondents who are 18 and older. Because
the ACS includes people under 18 years of age, an exact
comparison to the USTS sample could not be made.
Therefore, this comparison should be interpreted withcaution.

The homelessness point-in-time estimate is based on
January 2015 data. Department of Housing and Urban
Development. (2015). 2015 Annual Homelessness
Assessment Report (AHAR) to Congress. Available
at: https://www.hudexchange.info/resources/
documents/2015-AHAR-Part-1.pdf. Calculation is based on
the 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 scenario
listed in Q. 23.2. They were instructed to select “doesnot apply to me” if the housing situation could not have
happened to them in the past year. For example, those
who did not rent a home in the past year could not havebeen evicted, and were instructed to select “does not
apply to me” for that question. The results reported in thissection do not include those who answered “does not
apply to me” for each of the housing situations.

7“People with disabilities” here refers to respondents who
identified as a person with a disability in Q. 2.20.

8The survey included both “transgender status/gender
identity” and “gender expression/appearance” as answer
choices so that respondents could select what they felt
best 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.

HOUSING, HOMELESSNESS, AND SHELTER ACCESS

U.S. Census Bureau. (2015). American Community
Survey 1-Year Estimates: Homeownership Rate by Age ofHouseholder. The ACS homeownership rate for the “under
25” age group includes those who are 15–24 years of age,in contrast to the USTS rate, which includes respondents
who are 18–24 years of age. See note 3.

5183

CHAPTER 14

Police, Prisons, andImmigration DetentionT2015 U.S. TRANSGENDER SURVEY

ransgender people, particularly transgender people of color, face elevated levels of negativeinteractions with law enforcement officers and the criminal justice system. This includes higher
rates of police mistreatment,1 incarceration,2 and physical and sexual assault in jails and prisons.3
Furthermore, when navigating the United States immigration system, many transgender people, including
those who are seeking asylum based on their gender identity, face the prospect of being placed into unsafe
immigration detention centers. While in immigration detention, transgender people are often placed in
facilities that do not match their gender identity or face extended periods of solitary confinement, leaving
them vulnerable to physical and sexual abuse, denial of medical treatment, and other dangerous conditions.4

184

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.

KE Y FI N D I N GS

A. INTERACTIONS WITH LAW
ENFORCEMENT OFFICERS
Of respondents who interacted with police or law enforcement officers who thought
or knew they were transgender in the past year, 57% said they were never or only
sometimes 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 very
uncomfortable 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 Enforcement
Interactions in the
Past Year
Forty percent (40%) of respondents said thatthey interacted with the police or other law
enforcement officers in the past year. Of those,
65% said that they believed none of the officers
thought or knew they were transgender, and 35%
said that some or all of the officers thought or
knew they were transgender (Figure 14.1).

12%
All

65%
None

% of respondents
who interactedwith police in thepast year

23%
Some

Figure 14.2: Frequency of respectful treatment by policeor other law enforcement officers in the past year
14%
Never treatedwith respect% of those who
43%     interacted with
Alwaysofficers who thought
treatedor knew they werewithtransgender in therespect
past year  43%
Sometimes
treatedwith respect

Respondents who were currently working in theunderground economy (80%) were more likely to

POLICE, PRISONS, AND IMMIGRATION DETENTION

Figure 14.1: Interaction with officers
who thought or knew respondents weretransgender

Respondents who said that some or all of the law
enforcement 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 always
treated with respect (Figure 14.2).

185

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 they
were transgender were also asked whether theyexperienced specific forms of mistreatment intheir interactions with law enforcement officers in
the past year, such as being repeatedly referred
to as the wrong gender, verbally harassed, or
physically attacked. More than half (58%) of these
respondents reported having experienced one ormore forms of mistreatment (Table 14.1).

Figure14.3: Never or only sometimes treated with						
respect by law enforcement officers in the past year

Table 14.1: Mistreatment by police or other law
enforcement officers in the past year

GENDER IDENTITY (%)
80%

Experiences of
mistreatment in thepast year

70%

70%

62%
57%

60%

55%

Officers kept using the wrong
gender pronouns (such as he/him or she/her) or wrong title(such as Mr. or Ms.)

49%

20%

Verbally harassed by officers

20%

Officers asked questions
about gender transition(such as about hormones orsurgical status)

19%

s

51%

Officers assumed they were
sex workers

11%

Physically attacked by officers

4%

Sexually assaulted by officers

3%

Forced by officers to engage
in sexual activity to avoid
arrest1%

One or more experiences
listed

58%

50%
40%
30%
20%
10%

m

Tr
a

ns

w

om

Tr
a

en

ns

Tr
a

an

d

en

en
m

om
w

ns

en

ry
na

Cr

os

No

sd

n-

re

bi

ss

ve

er

ra

ll

0%
O

% of those who interactedwith officers who thought or
knew they were transgenderin the past year

Figure 14.4: Never or only sometimes treated withrespect by law enforcement officers in the past year
RACE/ETHNICITY (%)
80%
72%

70%

70%

66%
62%

60%

57%

57%
52%

50%

186

30%
20%
10%

*Sample size too low to report

te
W

ac
tir
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hi

l
ia

n*

dl
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M

M

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Ea

La
t

st

in

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a

k
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Bl

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As
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an
di
In

an

er

ic

O
ve

ra

ll

0%

Am

2015 U.S. TRANSGENDER SURVEY

40%

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 currently
unemployed (75%), and people with disabilities6(68%) were also more likely to report one or moreof these experiences.

More than half (58%) of
respondents who interactedwith a law enforcement
officer who thought or knewthat they were transgenderwere verbally harassed,
physically or sexuallyassaulted, or mistreated inanother way in the past year.

be verbally harassed by an officer (40%), and those
who 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 enforcement
officers who thought or knew they weretransgender reported that an officer assumed
that they were sex workers. Transgender womenof color were more likely to report that an officer
assumed they were sex workers, including Black(33%), multiracial (30%), Latina (25%), American
Indian (23%), and Asian (20%) women (Figure 14.6).
Figure 14.6: Law enforcement officer assumed
they were a sex worker in the past year amongtransgender women

Figure 14.5: Experienced one or more forms of
mistreatment by law enforcement officers in thepast year

RACE/ETHNICITY (%)
35%

33%

RACE/ETHNICITY (%)

30%

30%
80%

74%

70%
60%

66%
60%

58%

25%

25%

71%

23%
20%

20%

61%
55%

15%

50%

11%

11%

10%
40%
5%
30%

te

W

hi

te

l
tir
ul

M

Ea

st

ac

er

ia

n*

a
in
e

La
t

id
dl
M

k
ac
Bl

ia

W

hi

l
ac
ul

M

Ea

M

id

dl

e

tir

st

in

er

ia

n*

a
o/

k
La
t

ac
Bl

n
As
ia

an
di
In
n

ic
a
er
Am

*Sample size too low to report*Sample size too low to report

Verbal harassment was frequently reported byrespondents who interacted with police or otherlaw enforcement officers who thought or knew
they were transgender. In the past year, one infive (20%) of these respondents reported verbal
harassment by an officer. Those who had been
homeless in the past year were twice as likely to

Respondents who interacted with law enforcement
officers who thought or knew they weretransgender in the past year also reported being
physically or sexually assaulted. Six percent (6%)
of these respondents were physically attacked,
sexually assaulted,7 and/or forced to engage
in sexual activity to avoid arrest by an officer.
Respondents who were currently working in theunderground economy (27%) and those who
were homeless in the past year (17%) were more

POLICE, PRISONS, AND IMMIGRATION DETENTION

O
ve

ra

ll

0%

As

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

10%

n

0%
20%

187

likely to report one or more of these experiences.
Transgender women of color, including American
Indian (20%), Black (17%), and multiracial (16%)
women, were also more likely to report one or moreof these experiences (Figure 14.7).
Figure 14.7: Physically attacked, sexually assaulted,
and/or forced to engage in sexual activity to avoid
arrest in the past year among transgender women
RACE/ETHNICITY (%)
25%
20%

20%

17%

5%

10%
8%
6%
3%

W

hi

te

l
tir
ul

M

e

Ea

st

ac

er

ia

n*

a
in
La
t

dl
id
M

k
ac
Bl

n
ia
As

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

0%

*Sample size too low to report2015 U.S. TRANSGENDER SURVEY

II. Comfort Interactingwith Law Enforcement
Officers

188“When I began to live in my correct
gender, 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.”

16%

15%
10%

In Our Own
VoicesAll respondents were asked how comfortable theywould feel asking for help from the police if theyneeded it. Twenty-nine percent (29%) reported
that 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 somewhat
uncomfortable or very uncomfortable asking forhelp from the police (Figure 14.8).

“While I was in solitary, a cop
asked me about my gender. I
told him I was male, and he toldme I sounded female. Next thing
I knew, I was being taken to thejail doctor to spread my legs andhave him confirm my gender. It was
humiliating.”“I was in [ jail] for 12 days housedwith male detainees. Upon being
booked, I was escorted to theshower area where I was forced tostrip down and shower with male
inmates who made sexual advances
towards me while mocking me forbeing different. I feared for my life
and the guards were of no help
because they mocked me for beingtransgender.”“When I was booked, the officers
asked very intrusive questions
about my genitalia in a very
nonprofessional manner andlaughed about it. They ended up
booking me into an all-female
solitary confinement cell, kept
calling me ‘miss,’ and gave me
female colors even though I passfull time as male.”Figure 14.8: Comfort asking the police for help

A majority (57%) of respondents
said they would be somewhat
or very uncomfortable asking
for help from the police if theyneeded it.

12%
Very
comfortable
17%

31%
Very
uncomfortable

Somewhatcomfortable% ofrespondents

III. Arrest

15%
Neutral26%
Somewhat
uncomfortable

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 who
were living in poverty (67%) were also more likely
to be somewhat or very uncomfortable asking forhelp from the police.
Figure 14.9: Somewhat or very uncomfortableasking the police for help

Two percent (2%) of all respondents reported
having been arrested in the past year. Almost
one-quarter (22%) of those who were arrested
believed that they were arrested because they
were 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).
Figure 14.10: Arrested in the past year for any reason
among transgender women

RACE/ETHNICITY (%)

RACE/ETHNICITY (%)

80%
70%

70%

67%

60%

59%

57%

67%

6%

6%

6%

59%

58%

53%

50%

4%
3%

40%

2%

2%

2%

30%

hi
W

ac
tir

te

l
ia

rn
ul

Ea
e
dl
id

M

in

st
e

o/

a

k
Bl
ac

n
ia
As

an
In

La
t
M

Am

er

ic

an

O

ve

di

ra

ll

te
hi
W

tir
ul

Ea

st

ac

er

ia

n

a
in
e

k

n

ac
Bl

La
t

dl
id
M

0%

As
ia

re O
sp ve
Am ond raller en (allic ts)
an
In
di
an

10%

l

0%

0%

M

20%

POLICE, PRISONS, AND IMMIGRATION DETENTION

2%

2%

189

KE Y FI N D I N GS

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/or
sexually 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 taking
hormones before their incarceration were prevented from taking their hormones
while incarcerated.

I. Overall
Incarceration Rates
Two percent (2%) of respondents wereincarcerated (held in jail, prison, or juvenile
detention) in the past year. Twelve percent (12%)
of undocumented respondents were incarcerated
in the past year. Transgender women of color,
including Black (9%) and American Indian(6%) women, were more likely to have been
incarcerated in the past year (Figure 14.11), as were
respondents who had been homeless in the past
year (7%).

Respondents who were incarcerated in the past
year were asked what type of jail, prison, or
juvenile detention facility they were in, and they
made one or more selections. Most of these
respondents were incarcerated in a local jail (64%)
and/or held in a holding cell (58%) (Figure 14.12).
Figure 14.12: Types of incarceration facilities
70%

64%
58%

60%
50%
40%
30%
20%

190

ra
de

pr

or

al
ly
Lo
c

4%

3%
2%

2%

2%

1%
te
hi

ac
tir
ul

W

ia

rn
st
e
Ea
e

dl
id
M

k

a
in
La
t

Bl
ac

n
As
ia

l

0%

0%

M

2%

1%

lp
ris
on
iva
ju te
ve ly
O
th
er nile ope
cofa rrre cili ate
ti d
ct
io es
na
lf
ac
ilit
y

te
sy
s
Fe

le
ni

St
a

6%

6%

re O
sp ve
Am ond raller en (allic ts)anIn
dian

2015 U.S. TRANSGENDER SURVEY

te

ju

8%

1%

m

n
iso
pr

g
in
ld
Ho

9%

ve

ja
Lo
c

al

10%

5%

2%

te

0%

6%

ce
ll

RACE/ETHNICITY (%)

St
a

10%

il

Figure 14.11: Incarcerated in the past year amongtransgender womenFigure 14.13: Physical and sexual assault by staff orinmates in the past year during incarceration
35%
30%

30%
25%

23%
20%

20%
15%
10%
5%

se Ph
x y
st ual sica
aff a lor ssa andin ult /o
m b r
at y
es

xu
a
by l ass s
in taff aul
m o t
at r
es

Se

ic
a
by l asst sa
in aff ult
m or
at
e

ys
Ph

Figure 14.14: Physical and sexual assault by facility
staff during the past year
25%
20%

20%

18%

15%
11%

10%
5%
se Ph
xu ysial ca
a lfa ss andci au /
lity lt or
st by
aff

0%

Almost one in five (18%) respondents who wereincarcerated in the past year were physicallyassaulted by facility staff during their time in
jail, prison, or juvenile detention. Respondents
who were physically assaulted by facility staff
in the past year were asked how many times it
happened. More than half (53%) reported that they
had been physically assaulted once, 12% reported
that it happened twice, 16% said that it happened
between three and seven times, and nearly one infive (19%) reported that it happened eight or moretimes (Figure 14.15).
Figure 14.15: Number of physical assaults
by facility staff

19%
8 or more
times

16%
3–7
times

% of those who
were physicallyassaulted by
staff
12%
Twice

53%
Once

POLICE, PRISONS, AND IMMIGRATION DETENTION0%

One in five (20%) respondents who were incarcerated in jail, prison, or juvenile detention in the past
year were physically and/or sexually assaulted byfacility staff during that time (Figure 14.14).

S
by exufa al aci slity sa
st ultaff

Respondents who were incarcerated in jail,prison, or juvenile detention in the past year
were 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 assaulted
by 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% were
physically and/or sexually assaulted in the past
year while incarcerated (Figure 14.13). Physical andsexual assault by staff or other inmates is explored
separately in the following sections.

a. Physical and Sexual Assault
by Facility StaffPhyby sicfa al aci slity sa
st ultaff

II. Physical andSexual Assault During
Incarceration

191

Figure 14.16: Number of sexual assaults byfacility staff

23%
8 or more
times

19%
3–7 times% of those
who weresexuallyassaulted by
staff

49%
Once

9%
Twice

Figure 14.17: Physical and sexual assault by otherinmates during the past year
25%

22%
16%

17%

by Se
ot xu
he al
r i asnm sa
at ultes

20%

by Phyot siche al
r i asnm sa
at ult
es

15%
10%
5%
0%
se Ph
xu ysiot al a cal
he ss anr i au d/
nm lt orat byes

Eleven percent (11%) were sexually assaulted byfacility staff in the past year during their time in
jail, prison, or juvenile detention. The rate among
USTS respondents was five to six times higher
than the rates of sexual assault by facility staff
reported by the U.S. incarcerated population inprisons (2.4%) and in jails (1.8%).11 Respondents
who were sexually assaulted by facility staff in
the past year were asked how many times it
happened. Nearly half (49%) said that it happened
once, 9% reported that it happened twice, 19% said
it happened between three and seven times, andalmost one-quarter (23%) said that it happened
eight or more times (Figure 14.16).

One in six (16%) respondents who wereincarcerated in the past year were physicallyassaulted by another inmate during their time in
jail, prison, or juvenile detention. Respondents
who were physically assaulted by another inmatein the past year were asked how many times
it happened. Fewer than half (43%) of those
respondents were physically assaulted once, 13%
were physically assaulted twice, 34% said that it
happened 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 six

2015 U.S. TRANSGENDER SURVEY

b. Physical and Sexual Assault by
Other Inmates

192

Twenty-two percent (22%) of respondents who
were incarcerated in jail, prison, or juvenile
detention in the past year reported that they were
physically and/or sexually assaulted by otherinmates during that time (Figure 14.17).

times more likely than thegeneral incarcerated population
to be sexually assaulted byfacility staff, and nine to tentimes more likely to be sexuallyassaulted by another inmate.

Figure 14.18: Number of physical assaults byanother inmate
10%
8 or more
times

34%
3-7
times

% of those who
were physicallyassaulted byanother inmate

Figure 14.19: Number of sexual assaults byanother inmate

23%
8 or more
times
43%
Once

13%
Twice

Seventeen percent (17%) of respondents who wereincarcerated in the past year reported that they
were sexually assaulted by another inmate during
their time in jail, prison, or juvenile detention. The
rate among USTS respondents was nine to tentimes higher than the rates of sexual assault byother inmates reported by the U.S. incarcerated
population in prisons (2%) and in jails (1.6%).12

43%
Once

16%
Twice

III. Hormone Therapy
During Incarceration
Over half (58%) of respondents who wereincarcerated in the past year had been taking
hormones before their time in jail, prison,or juvenile detention. Of those, 82% had aprescription for those hormones. More than
one-third (37%) of respondents who had been
taking hormones before their incarceration wereprohibited from taking their hormones in the past
year while in jail, prison, or juvenile detention.

In the past year, more than
one-third (37%) of respondents
who had been taking hormones
before being incarcerated wereprohibited from taking thosehormones while in jail, prison, or
juvenile detention.

POLICE, PRISONS, AND IMMIGRATION DETENTION

Respondents who were sexually assaulted byanother inmate in the past year were asked how
many times it happened. Forty-three percent (43%)
of those respondents were sexually assaulted
once, and 16% were sexually assaulted twice.
Nearly one in five (18%) said it happened between
three and seven times, and nearly one-quarter(23%) said that it happened eight or more times(Figure 14.19).

18%
3–7
times

% of those who
were sexuallyassaulted byanother inmate

193

KE Y FI N D I N GS

C. EXPERIENCES IN IMMIGRATIONDETENTION
Four percent (4%) of respondents who were not U.S. citizens by birth had been held
in 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 detention
experienced some form of mistreatment, such as being physically or sexuallyassaulted or being denied access to hormones.

I. Placementin Immigration
Detention2015 U.S. TRANSGENDER SURVEY

Respondents who were not U.S. citizens bybirth were asked if they had ever been held
in immigration detention, such as being held
in an Immigration and Customs Enforcement(ICE) detention center or a local jail just for
immigration court proceedings.13 Four percent(4%) (n=30, unweighted)14 had been held in
immigration detention. More than two-thirds(69%) of those who were held in immigration
detention said that staff, guards, or others
thought or knew that they were transgender or
lesbian, gay, or bisexual (LGB).

194

II. Isolation and
Solitary Confinement
Respondents who were detained were asked
whether they had been segregated fromothers who were also in detention. Of the thirty
respondents who answered this question, morethan half (52%) reported being isolated in one ormore ways. Seventeen percent (17%) were held
in a separate area for transgender and/or LGB
people, 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 14
days or less (up to two weeks). More than onequarter (28%) were held for 1–3 months, while
14% were held in solitary confinement for over six
months (Figure 14.20).

Figure 14.20: Duration of solitary confinement(n=9, unweighted)

Form of mistreatment or assault(n=29, unweighted)

14%
Six months
to a year14%
3–6
months% of those
held in solitaryconfinement

Table 14.2: Mistreatment and assault in immigration
detention40%
14 daysor less% 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.

28%
1–3 months
3%
15–30 days
* Due to the small sample size, these findings should be interpreted withcaution.

III. Mistreatment andAssault 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).

Respondents reported frequent contact withthe law enforcement and criminal justicesystems, as well as high rates of mistreatment
by police, physical and sexual abuse in jails andprisons, and denial of medical treatment while
incarcerated. Experiences with law enforcement
varied by demographic groups, with transgenderpeople of color, those who have experienced
homelessness, people with disabilities, and lowincome transgender people reporting higher
rates of discomfort with and mistreatment by
police and other law enforcement officers. Results
also indicated substantial levels of mistreatment
and abuse in jail, prisons, and juvenile detention
centers. Additionally, the experiences of
respondents who were placed in immigration
detention included harmful conditions andmistreatment, such as lengthy periods of solitaryconfinement and physical and sexual assault bydetention staff and other detainees.

POLICE, PRISONS, AND IMMIGRATION DETENTION

Those who were placed in immigration detention
were asked about any mistreatment they faced
while they were there, such as being physicallyor sexually assaulted, threatened with sexualassault, or denied access to hormones orgender-appropriate clothing. Of the twenty-nine
respondents who answered these questions, 45%
reported one or more of these experiences fromtheir time in immigration detention.

Conclusion

195

2015 U.S. TRANSGENDER SURVEY

ENDNOTES | CHAPTER 14: POLICE, PRISONS, AND IMMIGRATION DETENTION

196

1

Center for American Progress & Movement Advancement
Project. (2016). Unjust: How the Broken Criminal Justice
System Fails LGBT People. Available at: http://www.
lgbtmap.org/file/lgbt-criminal-justice.pdf.

2

Center for American Progress & Movement Advancement
Project. (2016). Unjust: How the Broken Criminal Justice
System 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-ofConcrete-Closets.-Black-and-Pink.-October-21-2015..pdf.

3Beck, A. J. (2014). Sexual Victimization in Prisons andJails Reported by Inmates, 2011–12: Supplemental Tables:
Prevalence of Sexual Victimization Among Transgender
Adult Inmates. DC: Bureau of Justice Statistics. Available
at: https://www.bjs.gov/content/pub/pdf/svpjri1112_st.pdf.

4

Human Rights Watch. (2016). “Do You See How Much I’m
Suffering Here?”: Abuse Against Transgender Women in
US Immigration Detention. NY, New York: Human Rights
Watch. 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 Transgender
Equality. Available at: http://www.transequality.org/sites/
default/files/docs/resources/OurMoment_CIR_en.pdf.

5

Respondents who are “living in poverty” represent those
who are living at or near the poverty line. See the Income
and Employment Status chapter for more information
about the poverty line calculation.

6“Respondents with disabilities” here refers to respondents
who 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 an
officer (such as fondling, sexual assault, or rape).”8

Respondents were asked in Q. 28.10 and Q. 28.12 whether
they were “physically forced, pressured, or made to feelthat [they] had to have sex or sexual contact” with facility
staff or with another inmate. This question was based on
the language used by the Bureau of Justice’s National
Inmate 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 Justice
Statistics. Available at: https://www.bjs.gov/content/pub/
pdf/svpjri1112.pdf.

9Beck 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 juvenile
detention facilities. USTS data includes the experiencesof those who were incarcerated in jail, prison, and juvenile
detention. Therefore, data from the U.S. incarcerated
population 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.

13This section discusses the specific experiences of those
held in immigration detention. General information about
citizenship and immigration status, including experienceswith applications for asylum, is provided in the Portrait of
USTS Respondents chapter.

14

Although a small number of respondents in the sample(n=30, unweighted) had been held in an immigration
detention facility, it was important to highlight theirexperiences in this report. Due to the small sample
size, unweighted frequencies are presented alongside
weighted 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.

CHAPTER 15

Harassment
and ViolenceT

he freedom to participate in public life without fear of discrimination, harassment, and violence has
been 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, resulting
in 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

HARASSMENT AND VIOLENCE

Respondents were asked about their experiences in the past year with unequal treatment or service4
in businesses, government agencies, and other public places (more broadly than just in public
accommodations, 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 about
experiences with intimate partner violence. Questions were informed by several national surveys, including
the National Crime Victimization Survey and the National Intimate Partner and Sexual Violence Survey.6
Notable differences in respondents’ experiences based on demographic and other characteristics arereported throughout the chapter.

197

KE Y FI N D I N GS

Nearly half (48%) of all respondents in the sample reported being denied equal
treatment, 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 their
lifetime.
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 partner
violence.
• 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%) experienced
severe physical violence by a current or former partner, compared with 18% of the
U.S. population.

2015 U.S. TRANSGENDER SURVEY

I. Overall Experiencesof Unequal Treatment,
Harassment, andPhysical Attack

198

Respondents were asked if they had been denied
equal treatment or service, verbally harassed, or
physically attacked in the past year for any reason,
regardless of whether it happened because they
were transgender. This section of the chapter will
examine respondents’ overall experiences in thepast year, and is followed by separate sections

examining denial of equal treatment, verbal
harassment, 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 one
or 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).

Figure 15.1: Unequal treatment, verbal
harassment, and/or physical attack for any
reason in the past year
RACE/ETHNICITY (%)
80%
70%

69%

70%
60%

58%

58%

58%

70%

57%

57%

50%
40%

Nearly half (48%) of respondents
reported that they were denied
equal treatment or service,verbally harassed, and/or
physically attacked because ofbeing transgender in the past year.

30%
20%
10%

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Respondents who had one or more of theseexperiences were then asked what they believed
the 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 reported
that they were denied equal treatment or service,verbally harassed, and/or physically attacked
because of being transgender in the past year
(Table 15.1).

Those who said that others could usually or always
tell that they were transgender (66%) were more likely
to report having one or more of these experiences
because of being transgender, in contrast to those
who said that others could rarely or never tell thatthey were transgender (39%) (Figure 15.2).
Figure 15.2: Denial of equal treatment, verbal
harassment, and physical attack in the past year
OTHERS’ PERCEPTION OF TRANSGENDER STATUS (%)
70%
60%

40%
30%
20%

39%

36%
24%
18%
10%

15%

11%
6%

Denied equal
treatment

16%

14%

Verbally
harassed54%

46%

Physicallyattacked

13%

9%

One or moreexperiences
listed58%

48%% of those who said others could always or usuallytell they were transgender% of those who said others could sometimes
tell they were transgender% of those who said others could rarely or nevertell they were transgender

Almost three-quarters (73%) of respondents who
were currently working in the underground economy
reported being denied equal treatment, verballyharassed, and/or physically attacked in the past year
because of being transgender (Figure 15.3).

HARASSMENT AND VIOLENCE

Had experience
because of beingtransgender (% ofrespondents)

be tre De
in atm nieg
tra en d e
ns t d quge ue al
nd to
er
Ve
rb
al
du ly htra e t ara
ns o b sse
ge ei d
nd ng
er
Ph
ys
ic
a
du lly a
tra e t tta
ns o b cke
ge ei d
nd ng
er
ex
pe O
rie nenc o
es r mlis orte e
d0%

Had experience
for any reason (%of respondents)

Experience

59%

56%

50%

10%

Table 15.1: Denial of equal treatment, verbal
harassment, and physical attack in the past year

66%

63%

199

Figure 15.3: Unequal treatment, harassment, andphysical attack in the past year
CURRENT PARTICIPATION IN THE UNDERGROUNDECONOMY (%)

Figure 15.4: Denial of equal treatment or service
for any reason in the past year

80%

30%

73%

70%

70%

48%

45%

23%

29%

16%

17%
14%

5%

Sixteen percent (16%) of respondents were denied
equal treatment or service in the year before
taking the survey, such as at a place of business,government agency, or other public place, for any
reason, regardless of whether it was related tobeing transgender.
People of color were more likely to haveexperienced unequal treatment or service. Almost
one-third (30%) of American Indian respondents
reported being denied equal treatment orservice at a public place in the past year. Middle
Eastern (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 equal
treatment or service as those in the overall sample,
in contrast to documented non-citizens (20%) andcitizens (16%).

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II. Unequal Treatment
or ServiceAm

be tre De
in atm nieg
tra en d e
ns t d quge ue al
nd to
er
Ve
rb
al
du ly htra e t ara
ns o b sse
ge ei d
nd ng
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Ph
ys
ic
a
du lly a
tra e t tta
ns o b cke
ge ei d
nd ng
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ex
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es r mlis orte ed% of those who are not currently working in
the underground economy

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13%

% of those who are currently working in theunderground economy

2015 U.S. TRANSGENDER SURVEY

18%

15%

0%

200

22%

20%

10%

33%

30%

10%

30%

20%

50%

20%

35%

25%

60%

40%

RACE/ETHNICITY (%)

Respondents who were denied equal treatment orservice were asked what they believed thereasons were for that treatment, and they selected
one or more reasons from a list, such as age, raceor ethnicity, and gender identity or expression(Table 15.2).
Table 15.2: Reported reasons for denial of equal
treatment or service
Reason for experience8% of thosedeniedequal
treatment

% of
whole
sample

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 said
they had been denied equal treatment or service
in the past year because of their gender identity or
expression.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most likely to report being denied equal treatment orservice because of their race or ethnicity (Figure 15.5).
Figure 15.5: Denial of equal treatment or service
in the past year because of race or ethnicity

In Our Own
Voices

RACE/ETHNICITY (%)
16%

15%

14%
12%
10%

9%

9%
8%

8%

7%
6%

6%
4%

4%
2%

<1%
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“When people have tried to grope mein the street or have verbally harassed
me, it’s usually either because theysee me as a sexual target or because
they can’t figure out whether I am a‘man’ or a ‘woman’ and they thinkthey have the right to demand an
explanation.”

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. Those
who were currently working in the undergroundeconomy (77%) were more likely to experience verbal
harassment. 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).
Figure 15.6: Verbal harassment for any reason
in the past year

“I was sexually assaulted at myuniversity. I was also attacked andstalked. The university didn’t doanything to help me. Instead, it
threatened to punish me. I lived in
terror the entire time I was on campus.
I was denied a rape kit because I
was transgender and the police werecompletely uninterested.”“I was found in a ditch after being
brutally raped for three days. I was
taken to an ER. There I met an
officer who told me I deserved it for
attempting to be a woman and shouldhave died. He also refused to take areport.”

RACE/ETHNICITY (%)
80%
70%

67%

65%

60%

56%

53%

54%

53%

50%
40%

“I was a victim of spousal abuse forover ten years. This grew worse when I
transitioned, as [my transition] became
an easy justification for verbally,
emotionally and physically abusing me.”

30%
20%
10%

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“My trans status was used as a tool to[make me] stay with my former partner.
She would say things such as ‘no one
else would ever love you.’”

HARASSMENT AND VIOLENCE

54%

66%

201

Respondents who were verbally harassed wereasked what they believed the reasons were forthat treatment (Table 15.3).
Table 15.3: Reported reasons for verbal harassment% of thoseverbally
harassed% 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%

Figure 15.8: Verbal harassment in public by strangers in
the past year among transgender women
RACE/ETHNICITY (%)
60%
50%

Nearly half (46%) of respondents in the overall
sample reported they were verbally harassed in
the past year because of being transgender.

40%

51%

47%
39%

38%

38%

37%

34%

33%

30%
20%
10%

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Among people of color, Black (29%), Asian (27%),
Middle Eastern (25%), and multiracial (18%)
respondents were most likely to report being
verbally harassed because of their race or ethnicity(Figure 15.7).

re O
sp ve
Am ond raller en (allic ts)anIndian

Reason for experience

the past year. Transgender women of color weremore likely to be harassed by strangers becauseof their gender identity or expression, particularly
multiracial (51%) and American Indian (47%) women(Figure 15.8). Those who said that others could
always 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%).

Figure 15.7: Verbal harassment in the past year
because of race or ethnicity
RACE/ETHNICITY (%)

IV. Physical Attack

35%
30%

27%

29%
25%

25%
20%

Thirteen percent (13%) of respondents said thatsomeone had physically attacked them in thepast year, such as by grabbing them, throwing
something at them, punching them, or using aweapon against them for any reason.

18%
16%

15%

13%
9%

10%
5%

202

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2015 U.S. TRANSGENDER SURVEY

1%0%

Respondents were asked if they had been verballyharassed in public by strangers because of beingtransgender in the past year.10 One-third (33%) of
all respondents reported having this experience inThose who were currently working in theunderground economy (41%) were more than threetimes as likely to report being physically attacked
in the past year. Undocumented residents (24%)
were almost twice as likely to report being
physically attacked. Experiences of physical attack
also varied by race and ethnicity, with American
Indian (25%), Middle Eastern (25%), and multiracial(19%) respondents being more likely to report aphysically attack in the past year (Figure 15.9).

Figure 15.10: Physical attack in the past year
because of being transgender

Figure 15.9: Physical attack for any reason in thepast year

20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%

RACE/ETHNICITY (%)

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o/
a

an

l

In
di

ra
l
O

M

Am

hi
te

l

W

ul
tir
ac
ia

3%

<1%

Sexual orientation

32%

4%

None of the above

25%

3%

ra
ic

an

In

ve
O

er
Am

Five percent (5%) of respondents in the overall
sample were physically attacked in public bystrangers because of being transgender.11
Undocumented residents (20%) and respondents
currently 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 report
this experience, particularly American Indian (19%),
Middle Eastern (12%), and multiracial (11%) women

HARASSMENT AND VIOLENCE

Nearly one in ten (9%) respondents in the overall
sample reported being physically attacked in thepast year because of being transgender. American
Indian (19%), Middle Eastern (14%), multiracial
respondents (12%), and Asian respondents (11%)
were more likely to report being attacked becauseof being transgender (Figure 15.10), as were
undocumented residents (23%).

di
an

ll

<1%
te

Religion or spirituality

1%

hi

1%

W

11%

ia
l

Race or ethnicity

3%
2%

ac

9%

tir

66%

4%
3%

ul

Gender identity or expression

4%

M

1%

rn

5%

st
e

Income level or education

6%

Ea

1%

e

8%

7%
6%
5%
4%
3%
2%
1%
0%

dl

Disability

RACE/ETHNICITY (%)

id

1%

o/
a

7%

in

Age

Figure 15.11: Physical attack in the past year
because of race or ethnicity

La
t

% of
whole
sampleM% of thosephysicallyattackedk

Table 15.4: Reported reasons for physical attack

ac

M

Those who had been physically attacked in thepast year were asked what they believed thereasons were for that attack (Table 15.4).

Reason for experience

8%

Respondents also reported that they had been
physically attacked because of their race or
ethnicity. Among people of color, Middle Eastern(6%), American Indian (4%), Black (4%), and Asian(4%) respondents were most likely to report being
physically attacked because of their race or
ethnicity (Figure 15.11).

id

dl

M

st
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Ea
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Bl

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As

an
In
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Am

er

ic

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O

ve

ra
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l

0%

er
ic
an

ve

5%

ac
k

12%

10%

9%

Bl

14%

ia
n

14%

La
tin
o/
a

14%

13%

ac
k

15%

9%

Bl

19%

20%

9%

As

25%

12%

11%

n

25%

25%

14%

ia

30%

As

RACE/ETHNICITY (%)

19%

203

Figure 15.12: Physical attack in public by strangers in
the past year among transgender women
RACE/ETHNICITY (%)

Table 15.5: Means of physical attack in the past year

19%

12%
9%

9%

8%
6%

l

hi
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M
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st
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M

id

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Ea

La
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Bl

n
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As

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).
Figure 15.13: Number of physical attacks in thepast year
16%
Four or more
times
13%
Three
times

% of thosephysicallyattacked% of thosephysicallyattackedType of physical attack
11%

5%

re O
sp ve
o ra
Am nde ll (aer nts ll
ic
an )
In
di
an

20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%

of those who reported being physically attacked
were sexually assaulted.12 (Table 15.5).

45%
Once

By being grabbed, punched, or choked73%

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 were
physically attacked reported being attacked with a
gun in the past year. Transgender women of color,
particularly Black (11%) and Latina (11%) women, were
nearly four times as likely to report that they wereattacked with a gun (Figure 15.14). Respondents
currently working in the underground economy(10%) were more than three times as likely to havebeen attacked with a gun, and those whose only
source of income was from underground economy
work (16%) were more than five times as likely tohave been attacked with a gun.
Figure 15.14: Attacked with a gun among transgenderwomen who were physically attacked in the past year
RACE/ETHNICITY (%)
12%

25%
Twice

11%

11%

10%
8%

7%

6%

204

3%

2%

*Sample size too low to report

te
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*
rn

a
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La
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Bl

n

0%

M

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%)

3%

As
ia

These respondents were also asked to specify
how they were attacked. Nearly three-quarters(73%) of those who were physically attacked in thepast year reported that someone had grabbed,

4%
3%

re O
sp ve
o
Am nd raller ent (all
s
ic
an )
In
di
an

2015 U.S. TRANSGENDER SURVEY

4%

Nearly half (47%) of
respondents have beensexually assaulted at somepoint in their lifetime.

Figure 15.15: Lifetime sexual assault
RACE/ETHNICITY (%)
70%

65%
59%

58%

60%

53%

50%

48%

47%

45%

41%

40%
30%

hi
te

l

M
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tir
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W

st
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n

id

dl

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Ea

La
tin
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Bl

ac
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As

an
In
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O

ve

ra
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l

0%
er
ic
an

M

Figure 15.16: Lifetime sexual assault
GENDER IDENTITY (%)
70%

Nearly half (47%) of respondents have beensexually assaulted at some point in their lifetime.
This included any experiences with “unwanted
sexual contact, such as oral, genital, or anal
contact, penetration, forced fondling, or rape.”15,1660%

Respondents who have participated in sex work(72%), those who have experienced homelessness(65%), and people with disabilities (61%) were more
likely to have been sexually assaulted in their
lifetime. 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 (Figure
15.15). Experiences also varied across gender, withtransgender men (51%) and non-binary people withfemale on their original birth certificate (58%) being
more likely to have been sexually assaulted, in
contrast to transgender women (37%) and nonbinary people with male on their original birthcertificate (41%) (Figure 15.16). Among transgender
men and non-binary people with female on their
original birth certificates, rates of sexual assault
were higher among people of color, particularly
American Indian, Middle Eastern, and multiracialpeople (Figure 15.17 & Figure 15.18).

10%

58%

50%

55%

51%

47%

44%

41%

40%

37%

30%
19%

20%

0%

No

Cr

os

O

ve

ra

ll

sd
nre
bi
ss
n
on a
er
s
No bi ry w
rin- th thbicfena er mry tifi albi wit cate e
rth h
ce ma
r le
No tific on
n- ate
bi
na
ry
(a
ll)
Tr
an
s
w
om
en
Tr
Tr
an
an
s
s
w
m
om
en
en
an
d
m
en

Figure 15.17: Lifetime sexual assault amongtransgender men
RACE/ETHNICITY (%)
80%
71%

70%

67%
58%

60%
50%

51%

47%

52%

48%

42%

30%
20%
10%

hi

te

l
ac

M

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tir

st
Ea
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dl

id

W

ia

n
er

o
in
La
t
M

k
ac
Bl

n

re O
sp ve
o r
Am nd all(er ent all
s
ic
an )
In
di
an

0%

HARASSMENT AND VIOLENCE

40%

As
ia

In addition to questions about being physicallyattacked in the past year, respondents were asked
questions about their experiences with sexualassault during their lifetime and in the past year,13
informed by questions from the National Intimate
Partner and Sexual Violence Survey (NISVS).14

10%

Am

V. Sexual Assault

20%

205

Figure 15.18: Lifetime sexual assault among non-binary
people with female on their original birth certificate
RACE/ETHNICITY (%)
80%

74%

70%
60%
50%

67%

65%

62%

59%

55%
47%

One in ten (10%)
respondents in the survey
were sexually assaulted in
the past year.

47%

40%
30%
20%
10%
hi
te
W

La
tin
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a
dl
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Ea
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M
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Bl

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re O
sp ve
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Am nd all (er ents all
ic
an )
In
di
an

0%

Respondents who reported this experience werethen asked who had committed the sexual assault.
Approximately one-third (34%) of those who were
sexually assaulted said that a current or former
partner had sexually assaulted them. One-quarter(25%) of sexual assault survivors reported that a
relative was the perpetrator. Nearly one-third (30%)
of sexual assault survivors reported that a stranger
committed the assault (Table 15.6).
Table 15.6: Person who committed sexual assault2015 U.S. TRANSGENDER SURVEY

Person who committed sexualassault

206

One in ten (10%) respondents in the survey were
sexually assaulted in the past year.17,18 Respondents
who were currently working in the undergroundeconomy (36%) were more than three times as likely
to have been sexually assaulted in the past year.

% of respondents
who have beensexually assaulted

A friend or acquaintance47%

A partner or ex-partner

34%

A stranger

30%

A relative25%

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%

VI. Intimate Partner
Violencea. Overall Intimate Partner
Violence
Respondents who reported ever having had aromantic or sexual partner received questions
about their experiences with harm involving
a current or former intimate partner, including
physical, emotional, or financial harm, many ofwhich were based on questions in the National
Intimate 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 respondents
experienced some form of intimate partner
violence in their lifetime. Over three-quarters(77%) of respondents who have done sex workand nearly three-quarters (72%) of those whohave been homeless experienced intimate
partner violence. Undocumented residents (68%),
people with disabilities (61%), and people of color,
including American Indian (73%), multiracial (62%),
and Middle Eastern (62%) respondents, were also
more likely to report this experience (Figure 15.19).

Table 15.7: Intimate partner violence involving coercive
control, including intimidation, emotional and financial
harm, and physical harm to others

Figure 15.19: Intimate partner violence
RACE/ETHNICITY (%)
80%
73%

70%
60%

62%
56%

54%

Type of intimate partner violence
involving coercive control

62%

54%

54%

% of
respondents

Told them that they were not a “real” woman
or man25%

Tried to keep them from seeing or talking tofamily or friends

23%

Stalked16%

10%

Kept them from leaving the house when theywanted to go

15%

0%

Threatened to call the police on them

11%

Threatened to “out” them

11%

Kept them from having money for their own
use

9%

Hurt someone they love9%

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%

50%
43%

40%
30%

hi
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Bl

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As

re O
sp ve
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Am nd all (er ents all
ic
an )
In
di
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20%

b. Intimidation, Emotional, andFinancial Harm
Respondents received two sets of questions
covering a range of experiences with intimate
partner violence. The first set of questions involved
experiences with coercive control, including
intimidation, emotional and financial harm, andphysical harm to others who were important to
respondents. Sixteen percent (16%) of respondents
reported that they had been stalked, compared
to 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% were
kept from leaving the house when they wanted togo (Table 15.7).

44%

One or more experiences related to beingtransgender listed

27%

Overall, nearly half (44%) of respondents in thesample experienced some form of intimate
partner violence involving coercive control,
including intimidation, emotional, and financial
harm. Experience with this type of intimate partner
violence differed by race, with American Indian(66%), Middle Eastern (56%), and multiracial (51%)
respondents reporting higher rates of theseexperiences (Figure 15.20). Respondents who
have done sex work (66%), have experienced
homelessness (62%), or were undocumented(60%) were also more likely to have experienced
intimate partner violence of this form.

HARASSMENT AND VIOLENCE

More than half (54%) of all
respondents experienced
some form of intimate
partner violence in their
lifetime.

One or more experiences listed

207

c. Intimate Partner Violence
Involving Physical Harm

Figure 15.20: Intimate partner violence involving
intimidation, emotional, and financial harm
RACE/ETHNICITY (%)
70%

Respondents received additional questions about
experiences of intimate partner violence involving
physical harm inflicted on them (Table 15.8).

66%

60%

56%
51%

50%

44%

44%

40%

44%

44%

Table 15.8: Intimate partner violence involving
physical harm

35%

30%
20%

% of USTS
respondents% in U.S.
population(NISVS)

Pushed or shoved

30%

23%

Slapped24%

19%

Made threats to physically harm
them

20%

--

Forced them to engage insexual activity

19%

--

Hit them with a fist or
something hard

16%

12%

Slammed them against
something

14%

9%

Hurt them by pulling their hair

11%

6%

Kicked10%

6%

Tried to hurt them by choking or
suffocating them

7%9%Beat them

6%

6%

Used a knife or gun against
them

3%

3%

Burned them on purpose2%

1%

Any physical violence

35%

30%

Any severe physical violence

24%

18%

One or more experiences
listed42%---

Type of intimate partner
violence

10%

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0%

Furthermore, more than a quarter (27%) of survey
respondents reported acts of coercive control
related to their transgender status, including being
told 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, including
American Indian (57%) and multiracial (39%)
women, were more likely to report acts of harm
related to their transgender status (Figure 15.21).
Figure 15.21: Intimate partner violence related totransgender status among transgender women
RACE/ETHNICITY (%)
57%

60%
50%
40%

36%

30%

39%

37%

36%

34%

28%

27%

20%

208

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0%

Am

2015 U.S. TRANSGENDER SURVEY

10%

Overall, 42% of all survey respondents reported
experiencing some form of intimate partner
violence involving physical harm, including thethreat of physical violence, over their lifetime.
Respondents who have done sex work (67%) or
who have experienced homelessness (61%) weremore likely to report intimate partner violence
involving physical harm, as were undocumented(59%), American Indian (61%), multiracial (54%), andMiddle Eastern (49%) respondents (Figure 15.22).

Conclusion

Figure 15.22: Intimate partner violence involving
physical harm
RACE/ETHNICITY (%)
70%
61%

60%

54%
49%

50%

44%

42%

43%

42%

40%
30%

30%
20%
10%

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Bl

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re O
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Am nd all (er ent all
ic s)
an
In
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0%

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% of
the U.S. adult population.23 Moreover, nearly onequarter (24%) of respondents reported having
experienced severe physical violence from apartner, compared to 18% in the U.S. population.24

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 reported
that 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 residents
were more likely to report experiences of sexualassault and intimate partner violence, as were
respondents who have worked in the undergroundeconomy or who have experienced homelessness.

ENDNOTES | CHAPTER 15: HARASSMENT AND VIOLENCE
Langton, L. & Truman, J. (2014). Socio-Emotional Impact ofViolent Crime. DC: Bureau of Justice Statistics. Available
at: 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. Perspectives
on Psychological Science, (8)521. Available at: http://pps.
sagepub.com/content/8/5/521.full.pdf+html.

4This chapter discusses general experiences withunequal treatment in public places in the past year, which
includes 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 Public
Accommodation and Airport Security chapter.

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 Discrimination
Survey. (pp. 124–135). DC: National Center for Transgender
Equality & National Gay and Lesbian Task Force.

5

This chapter discusses overall experiences with verbal
harassment in the past year. Findings related to verbal
harassment in specific settings are discussed in otherchapters, such as the Experiences at School, Employment
and the Workplace, and Health chapters.

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.

HARASSMENT AND VIOLENCE

1

209

2015 U.S. TRANSGENDER SURVEY
210

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 violence
victimization—National Intimate Partner and Sexual
Violence 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 who
identified 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/gender
identity” and “gender expression/appearance” as answer
choices so that respondents could select what they felt
best 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, gender
identity, gender expression, or appearance received
this 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, gender
identity, gender expression, or appearance received
this 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 “experienced
unwanted sexual contact, such as oral, genital, or anal
contact, penetration, forced fondling, or rape.”

14

Breiding et al. See note 6.

15

Respondents were asked if they had ever “experienced
unwanted sexual contact, such as oral, genital, or anal
contact, penetration, forced fondling, or rape” in Q. 18.1.
This definition of sexual assault encompassed several
categories of sexual violence as outlined in the National
Intimate Partner and Sexual Violence Survey (NISVS). Seenote 16.

16

Due to differences between Q. 18.1 and the NISVS
questions about sexual violence, a direct comparison
to the U.S. population was not feasible for this report.
However, as context for USTS respondents’ experience
with sexual assault, NISVS findings indicate that an
estimated 11% of adults in the U.S. population have been
raped in their lifetime, 19% have experienced unwanted
sexual contact, 10% have experienced sexual coercion,and 4% were forced to penetrate someone. Breiding etal. See note 6. The figures for the prevalence of sexual
violence during one’s lifetime in the U.S. population were
calculated by the research team to present a combined
percentage for the experiences of men and women using
2011 data from the NISVS, as reported by the Centers for
Disease Control. Since NISVS respondents could reportexperiences with multiple forms of sexual violence, an
NISVS respondent’s experiences could be reflected
in several categories of sexual violence. The researchteam was unable to avoid double counting respondents
who reported more than one experience in the NISVS,
and therefore, were unable to combine the percentages
of NISVS respondents who experienced any form of
sexual 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 findings
should be interpreted with caution.

17

The 10% rate of sexual assault in the past year reported
in this section was based on Q. 18.3. This differs fromthe rate of sexual assault in the past year reported in
the “Physical Attack” section of this chapter (4%), which
was based on Q. 17.8. This difference is likely due tothe number of respondents in the sample who received
each question based on skip-logic patterns. While all
respondents in the sample received Q. 18.3, a limited
number of respondents received Q. 17.8 based on theiranswer to Q. 17.3. Respondents who indicated that they
had been physically attacked in Q. 17.3, received a followup question asking how they were physically attacked(Q. 17.8), which included an answer choice of “unwanted
sexual contact.” Those respondents who did not identify
their experience of unwanted sexual contact as a formof physical attack would not have received the follow-up
question regarding the method of the attack, if they had
not reported another form of physical attack. Additionally,
the difference in reporting may partly result from themore inclusive examples of unwanted sexual contact
provided 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 as
rape, attempted rape, being forced to penetrate”).

Due to differences between Q. 18.3 (sexual assault in
the past year) and the NISVS questions about sexual
violence, a direct comparison to the U.S. population was
not feasible for this report. However, as context for USTS
respondents’ experience with sexual assault, NISVS
findings indicate that an estimated 1.9% of adults in the
U.S. population experienced unwanted sexual contact in
the past year and an estimated 1.7% experienced sexual
coercion in the past year. These figures were calculatedby the research team to present a combined percentage
for the experiences of men and women using 2011 datafrom the NISVS. Additionally, an estimated 1.6% of women
were raped in the past year. Due to the small number ofmen who reported being raped in the past year, a reliable
estimate 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 forced
to penetrate a perpetrator was too low to produce a
reliable estimate. Breiding et al. See note 6. Since NISVS
respondents could report experiences with multiple forms
of sexual violence, an NISVS respondent’s experiences
could be reflected in several categories of sexual violence.
The research team was unable to avoid double counting
respondents who reported more than one experience in
the NISVS, and therefore, were unable to combine thepercentages of NISVS respondents who experienced
any form of sexual violence to match the broader USTS
category 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 findings
should 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 forms
of intimate partner violence.

21

Breiding et al. See note 6.

22

The NISVS measure for “any physical violence” includes
all of the actions listed in Table 15.8, except for forced
sexual activity and threats of physical violence.

23

The figures for the prevalence of intimate partner violence
involving physical violence and/or severe physicalviolence in the U.S. population was calculated by the
research team to present a combined percentage for theexperiences of men and women using 2011 data from the
NISVS, 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 hit
with a fist or something hard, kicked, slammed against
something, choked or suffocated, beaten, burned, or
attacked with a knife or gun.

HARASSMENT AND VIOLENCE

18

211

CHAPTER 16

Places of Public
Accommodation
and Airport SecurityP2015 U.S. TRANSGENDER SURVEY

ublic 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 survey
explored 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.

212

Respondents were also asked questions about their experiences in airports related to their gender identity
or expression in the past year, given numerous reports of transgender people being subjected to excessive
scrutiny and searches by Transportation Security Administration (TSA) officers when going through airport
security screening.3 Widely used body scanners often flag transgender people’s bodies and genderrelated 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.

KE Y FI N D I N GS

Of respondents who said that staff or employees at a place of public accommodation
they visited thought or knew that they were transgender, nearly one-third (31%)
experienced at least one type of negative experience, including being denied equal
treatment or service (14%), verbally harassed (24%), and/or physically attacked (2%) in
the past year.
• Among those who visited a retail store, restaurant, hotel, or theater and said that staff
or employees thought or knew that they were transgender, 31% were denied equal
treatment, verbally harassed, and/or physically attacked there.
• Approximately one-third (34%) of respondents had one or more of these negative
experiences in the past year when using public transportation where employees
thought or knew they were transgender.
• Nearly one-quarter (22%) of respondents had one or more of these experiences in
the past year when visiting a domestic violence shelter or program or a rape crisis
center 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 year
experienced 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 ID
questioned, or being detained.

I. Overall Experiencesin Places of Public
Accommodation

Nearly all respondents in the sample (96%) had
visited 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 thought
the staff or employees knew or thought they
were transgender at one or more of the locations.
Nearly one-third (31%) of those who said that
staff or employees knew or thought they weretransgender experienced negative treatment in atleast one of the locations, including being denied
equal treatment or service, verbally harassed, or
physically attacked (Table 16.1).

PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

Respondents received questions about theirexperiences in places of public accommodation,such as hotels, restaurants, or government
agencies in the past year. They were first asked
whether they had visited or used services in
specific kinds of public accommodations, andthey then received follow-up questions based on
their responses. For each type of location thatthey had visited in the past year, respondents
were asked whether they thought that staff or
employees at the location knew or thought they
were transgender. They were also asked whether

they had been denied equal treatment, verballyharassed, or physically attacked at the selected
type of location because they were transgender.

213

Table 16.1: Overall experiences in any place of
public accommodation in the past year because ofbeing transgender
Experience at a place of
public accommodation% of those who believe staff
knew or thought they weretransgenderDenied equal treatment orservice

14%

Verbally harassed

24%

Physically attacked

2%

One or more experiences
listed31%

2015 U.S. TRANSGENDER SURVEY

Respondents’ experiences in each type of
public 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 services
at that place because they were afraid of being
mistreated as a transgender person. Overall, one
in five (20%) reported that they did not visit oruse services at one or more of these locations
because they thought they would be mistreated asa transgender person.

214

II. Public
Transportation
Two-thirds (66%) of the sample used public
transportation services in the past year, such asa bus, train, subway, or taxi. Two percent (2%) of
respondents 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 denied
equal treatment or service, verbally harassed, or
physically attacked because of being transgenderwhile using public transportation (Table 16.3).
Table 16.3: Experiences on public transportation in
the past year because of being transgender
Experience in location% of those who believe
staff knew or thought
they were transgenderDenied equal treatment or service

4%

Verbally harassed

32%

Physically attacked

3%

Table 16.2: Negative experiences in places ofpublic accommodation in the past year because ofbeing transgender

One or more experiences listed

34%

Location visited

Non-binary people (39%) were more likely to haveexperienced negative treatment than transgender
men and women (32%) when using public
transportation (Figure 16.1). These experiences
also varied by race and ethnicity, with American
Indian (48%), multiracial (45%), and Asian (39%)
respondents being more likely to have a negative
experience (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 were
living in poverty (39%) were also more likely toreport such an experience.

% of those who believe
staff knew or thought
they were transgenderPublic 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 club18%

Public assistance or government
benefit office17%

DMV (Department of Motor
Vehicles)14%

Nursing home or extended carefacility

14%

Court or courthouse

13%

Social Security office11%

Legal services from an attorney,clinic, or legal professional

6%

III. Retail Store,
Restaurant, Hotel, or
Theater

Figure 16.1: Negative experiences on public
transportation in the past year
GENDER IDENTITY (%)
45%
39%

40%

35%

34%

35%

32%

30%

27%

25%
20%
15%

12%

10%
5%
en

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n-

Cr

os

No

sd

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bi

ss

ve

ra
l

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er
s

0%

Figure 16.2: Negative experience on public
transportation in the past year

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 year
because 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 employees
knew or thought they were transgender. Of those,
31% reported being denied equal treatment orservice, verbally harassed, or physically attacked
because of being transgender (Table 16.4).

RACE/ETHNICITY (%)

Table 16.4: Experiences in a retail store, restaurant,
hotel, or theater in the past year because of beingtransgender

60%
48%

50%

45%
39%

40%

34%

35%

31%

30%

33%

20%

Experience in location% of those who believe staff
knew or thought they weretransgender

Physically attacked

1%

One or more experiences
listed

31%

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er

l

24%

k

Verbally harassed
n

0%
an

Denied equal treatment orservice

11%

10%*Sample size too low to report

Nearly one-third (31%) ofrestaurant, hotel, or theater
where the staff knew or thought
they were transgender were
mistreated because of theirgender identity or expression.

PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

respondents who visited a store,

American Indian (49%), multiracial (41%), Black(36%), and Asian (36%) respondents were more
likely to have a negative experience (Figure16.3). Those who were currently working in theunderground economy (52%), those who were
living in poverty level (37%), and people withdisabilities5 (39%) were also more likely to havesuch experiences in these locations.

215

In Our Own
VoicesFigure 16.3: Experiences in a retail store,
restaurant, hotel, or theater in the past year
because of being transgender
RACE/ETHNICITY (%)
60%
49%

50%
40%

41%

36%

36%

31%

30%

34%
29%

29%

20%
10%
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an

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0%

IV. Drug or Alcohol
Treatment Program
Two percent (2%) of the sample visited or used
services at a drug or alcohol treatment programin the past year. One percent (1%) of respondents
did not go to a treatment center in the past year
because of fear of mistreatment as a transgenderperson. Of those who visited or used services
at a treatment program, 58% believed that thestaff or employees knew or thought they weretransgender. Of those, 22% reported being denied
equal treatment or service, verbally harassed, or
physically attacked because of being transgender(Table 16.5).

2015 U.S. TRANSGENDER SURVEY

Table 16.5: Experiences in a drug or alcohol
treatment program in the past year because ofbeing transgender

216

Experience in location% of those who believe staff
knew or thought they weretransgenderDenied equal treatment orservice

11%

Verbally harassed

13%

Physically attacked

1%

One or more experiences
listed22%“When I attempted to change mygender marker on my state ID, I wasdenied three times. All three times
I was harassed. In one incident, themanager of the DMV location madefun of me and started laughing andtalked so loud that other patrons at
the DMV also began to laugh.”“A year ago I had my Social Security
updated to reflect my new name andgender. I was treated with respect
at all times. The woman working
in the Social Security office wrote‘congratulations’ and drew a heart
on my copy of the documentation.”“A TSA officer referred to me as‘it’ when I couldn’t walk throughtheir security screen following top
surgery. 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 repeatedly
being told that I was not a man.”“I was subjected to a longer TSA
screening 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 was
humiliated.”

30%

28%
24%

25%

22%

21%
19%

20%
15%
10%
5%

en

en

m

m

an

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ns

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om

Tr
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Tr
a

Tr
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om

na
bi
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ss
re
sd
os

en

ry

s*
er

ra

ll

0%

*Sample size too low to report

VI. Gym or
Health Club

Table 16.6: Experiences in a DV shelter, DV
program, or rape crisis center in the past year
because of being transgender
Experience in location

GENDER IDENTITY (%)

ve

One percent (1%) of the sample visited or used
services at a domestic violence (DV) shelter, DV
program, or rape crisis center in the past year.
Two percent (2%) of respondents did not go to a
DV shelter or program or rape crisis center in thepast year because they were afraid they would
be mistreated as a transgender person. Of those
who went to one of these locations, more thanhalf (59%) believed that the staff or employees
knew or thought they were transgender. Of those,nearly one-quarter (22%) reported being denied
equal treatment or service, verbally harassed, or
physically attacked because of being transgender(Table 16.6).

Figure 16.4: Negative experiences in domestic
violence shelter in the past year

Cr

V. Domestic Violence
Shelter, Domestic
Violence Program, orRape Crisis Center

Nearly one in four (22%)
respondents who went to adomestic violence shelter or
program or rape crisis center
where staff knew or thought they
were transgender experienced
mistreatment of some kind.

O

Those who were currently working in theunderground economy (34%) and those who were
living in poverty (27%) were more likely to reporthaving a negative experience in a drug or alcohol
treatment program.

% of those who believe staff
knew or thought they weretransgender16%

Verbally harassed

11%

Physically attacked

2%

One or more experiences
listed22%

Transgender women (28%) were more likely toreport having a negative experience at a DV shelter,
DV program, or rape crisis center (Figure 16.4).

PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

Denied equal treatment orservice

More than one-third (35%) of the sample had visitedor used services at a gym or health club in the past
year. Fourteen percent (14%) of respondents did not
go to a gym or health club in the past year because
they were afraid of mistreatment as a transgenderperson. Of those respondents who had visited a
gym or health club, 28% believed that the staff or
employees knew or thought they were transgender.
Of those, 18% reported being denied equal treatment
or service, verbally harassed, or physically attacked
because of being transgender (Table 16.7).

2172015 U.S. TRANSGENDER SURVEY
218

Figure 16.5: Negative experiences in a public assistanceor government benefits office in the past year
RACE/ETHNICITY (%)
30%
25%

25%
20%

20%

22%

20%

17%

15%

15%
10%
5%

*Sample size too low to report

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k

0%
ac

Twelve percent (12%) of the sample had visitedor used services at a public assistance or
government benefits office in the past year, suchas for receiving Supplemental Nutrition Assistance
Program (SNAP or food stamps) or Women, Infants,
and Children (WIC) benefits. Two percent (2%) of
respondents did not go to such an agency in thepast year because they feared mistreatment as atransgender person. Over one-third (36%) of those
who visited or used services at these locations
believed that the staff or employees knew or
thought they were transgender. Of those, 17%reported being denied equal treatment or service
or being verbally harassed because of beingtransgender (Table 16.8).

American Indian (25%), multiracial (22%), Black(20%), and Latino/a (20%) respondents reported
higher rates of mistreatment, in contrast to 15%
of white respondents (Figure 16.5). People withdisabilities (21%) and those who were currently
working in the underground economy (24%)
were also more likely to report having a negative
experience in a public assistance or government
benefits office.

Bl

VII. Public Assistanceor Government
Benefits Office

17%

n*

Respondents who were currently working in theunderground economy were nearly twice as likely
to report having a negative experience in a gym or
health club (35%).

One or more experiences
listed

As
ia

18%

9%

an

One or more experiences
listedVerbally harassed

di

1%

11%

ll

Physically attacked

Denied equal treatment orservice

In

13%

ra

Verbally harassedn7%% of those who believe staff
knew or thought they weretransgendericaDenied equal treatment orservice

Experience in locationOve% of those who believe staff
knew or thought they weretransgendererExperience in location

Table 16.8: Experiences in a public assistanceor government benefits office in the past year
because or being transgenderAm

Table 16.7: Experiences in a gym or health club in
the past year because of being transgender

VIII. DMVNearly half (44%) of the sample visited or used
services at a DMV (Department of Motor Vehicles)in the past year. Three percent (3%) of respondents
did 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 knew
or thought they were transgender. Of those, 14%reported being denied equal treatment or service
or being verbally harassed because of beingtransgender (Table 16.9).

Nearly one in five (18%)
respondents who went to a
gym or health club where
staff knew or thought they
were transgender experienced
mistreatment of some kind.
Table 16.10: Experiences in a nursing home orextended care facility in the past year because ofbeing transgender
Experience in location

Table 16.9: Experiences in a DMV in the past year
because of being transgender
Experience in location% of those who believe staff
knew or thought they weretransgenderDenied equal treatment orservice

9%

Verbally harassed

7%

One or more experiences
listed14%

IX. Nursing Homeor Extended Care
Facility

Denied equal treatment orservice6%

Verbally harassed

11%

Physically attacked

1%

One or more experiences
listed

14%

X. Court or
Courthouse
Approximately one in four (22%) respondents inthe sample visited or used services at a court or
courthouse in the past year. Two percent (2%) of
respondents did not go to a court or courthousein the past year because they were afraid of
mistreatment as a transgender person. One-half(50%) of those who visited or used services there
believed that court staff or employees knew or
thought they were transgender. Of those, 13%
reported being denied equal treatment or service,verbally harassed, or physically attacked becauseof being transgender (Table 16.11).

PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

Four percent (4%) of the sample visited or used
services at a nursing home or extended carefacility in the past year. One percent (1%) of
respondents did not go to a nursing home orextended care facility in the past year because
they were afraid of mistreatment as a transgenderperson. Twenty-two percent (22%) of those who
visited or used services in this location believedthat the staff or employees knew or thought
they were transgender. Of those, 14% reported
being denied equal treatment or service, verballyharassed, or physically attacked because of beingtransgender (Table 16.10).

% of those who believe staff
knew or thought they weretransgender219

Table 16.11: Experiences in court or a courthouse in
the past year because of being transgender

Table 16.12: Experiences in a Social Security officein the past year because of being transgender

Experience in location

Experience in location% of those who believe staff
knew or thought they weretransgenderDenied equal treatment orservice8%

Denied equal treatment orservice

Verbally harassed

8%

Verbally harassed

5%

Physically attacked<1%

Physically attacked<1%

One or more experiences
listed13%

One or more experiences
listed11%

2015 U.S. TRANSGENDER SURVEY

16%

15%

15%

14%

14%
12%

13%
11%

10%

9%

8%
6%
4%
2%

*Sample size too low to report

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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 a
Social 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. Fiftyseven percent (57%) of those who went to a Social
Security office believed that the staff or employees
knew or thought they were transgender. Of those,
11% reported being denied equal treatment orservice, verbally harassed, or physically attacked
because of being transgender (Table 16.12).

RACE/ETHNICITY (%)

O
ve
ra

XI. Social Security
OfficeFigure 16.6: Negative experience in a Social
Security office in the past year

ermore likely to report having a negative experiencein court or a courthouse, and the rate was also
higher among people with disabilities (19%).

8%

Asian (15%), Black (15%), and Latino/a (14%)
respondents were more likely to report having
a negative experience in a Social Security office(Figure 16.6). Respondents who were currently
working in the underground economy (36%) andpeople with disabilities (16%) were also more likely
to have such an experience.

Am

Those who were currently working in theunderground economy (37%) were substantially220% of those who believe staff
knew or thought they weretransgender

XII. Legal Services
from an Attorney,
Clinic, or Legal
Professional

Figure 16.7: Negative experiences with legal
services from an attorney, clinic, or legal
professional in the past year
GENDER IDENTITY (%)
14%

10%

Table 16.13: Experiences with legal services froman attorney, clinic, or legal professional in the past
year because of being transgender% of those who believe staff
knew or thought they weretransgenderDenied equal treatment orservice4%

Verbally harassed3%

One or more experiences
listed

6%

6%

6%
5%
4%

4%
2%

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sd
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No

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ve

se

ra
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l

rs
*

0%

XIV. Experiences with
Airport Security
In addition to the questions regarding
mistreatment in and avoidance of public
accommodations, respondents were asked about
their experiences traveling through airport security
in the United States in the past year. More thanhalf (53%) of respondents reported having gone
through airport security during that time period.
These respondents were asked about specificexperiences and interactions with Transportation
Security Administration (TSA) officers during thesecurity screening process.

Forty-three percent (43%)
of those who went throughairport security in the past
year experienced at least
one problem related to theirgender identity or expression.

PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

Non-binary respondents (12%) were more than
twice as likely to report having a negative
experience when seeking legal services, in contrast
to 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 as
the overall sample.

8%
6%

O

Twelve percent (12%) of the sample visited or usedlegal services from an attorney, clinic, or legal
professional in the past year. Two percent (2%)
of respondents did not visit or use such services
in 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% reported
being denied equal treatment or service, verballyharassed, or physically attacked because of beingtransgender (Table 16.13).

Experience in location

12%

12%

221

Forty-three percent (43%) of those who went
through airport security in the past year
experienced at least one issue related to theirgender identity or expression, such as TSA officers
using 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).
Table 16.14: Issues when going through airport
security in the past year

2015 U.S. TRANSGENDER SURVEY
222% of those who
had gone throughairport security

TSA officers used the wrong pronouns(such as he, she, or they) or title (suchas Mr. or Ms.)

29%

They were patted down due to genderrelated clothing/items (such as a binderor packer)

17%

They were patted down by TSA
officers of the wrong gender

14%

TSA officers questioned the name orgender on ID

11%

TSA officers loudly announced orquestioned their gender, body parts, orsensitive items (e.g., binder, packer)

6%

Figure 16.8: Negative experience in airport security
in the past year
RACE/ETHNICITY (%)
60%
50%

50%
45%

43%

Their bag was searched due to agender-related item (such as a binderor packer)

5%

They were asked to remove or lift
clothing to show binder, undergarment,or other sensitive area

4%

They were taken to a separate room
for questioning or examination

4%

They were verbally harassed by TSA
officers

2%

They experienced unwanted sexual
contact (beyond typical pat down by
TSA officers)

1%

They were detained for over an hour

1%

They missed their flight due toscreening

1%

TSA officers called the police about
them

<1%

They were physically attacked
attacked by TSA officers<1%

They were not allowed to fly<1%

One or more experiences listed

43%

56%

49%
44%

43%

43%

40%
30%
20%
10%

More than half (56%) of Middle Eastern and 50% of
multiracial respondents who went through airport
security in the past year reported one or more of

W

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Airportsecurity issue

these experiences (Figure 16.8). Respondents who
said that others can always or usually (61%) or
sometimes (53%) tell that they are transgenderwere more likely to report one or more of theseexperiences, in comparison to those who said that
others can rarely or never tell that they aretransgender without being told (35%). Experiences
also 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 IDs
reflect the name and/or gender they prefer (51%)
were also more likely to report negative
experiences in airport security related to theirgender identity.

Conclusion
Responses indicated that many respondents faced
mistreatment in places of public accommodation,
including being denied equal treatment or service,verbally harassed, and/or physically attacked in
one 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not visit or use services in places of public
accommodation altogether because of fearof being mistreated as a transgender person.
Additionally, findings demonstrated that manytransgender people experienced mistreatment

related to their gender identity when passing
through airport security and, as a result, wereat risk of potential harm while traveling throughairports.

ENDNOTES | CHAPTER 16: PLACES OF PUBLIC ACCOMMODATION AND AIRPORT SECURITY
1

The legal definitions of public accommodations vary
according to local, state, and federal laws, but frequently
include 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 for
Change. DC: Equal Rights Center. Available at: http://
www.equalrightscenter.org/site/DocServer/Contents.
pdf?docID=2681.
See e.g., Charles, C. (2015, October 1). Dear TSA, my body
is not an anomaly. The Advocate. Available at: http://www.
advocate.com/commentary/2015/10/01/dear-tsa-my-bodynot-anomaly; Ennis, D. (2015, October 21). Traveling whiletrans: Women share their stories. The Advocate. Available
at: 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-tsatransgender.html.

TSA body scanners examine each passenger’s body
based on the gender the officer perceives the passenger
to be. As a result, transgender people’s body parts, oritems such as chest binders (compression garments) andprosthetics (such as packers and breast forms), may get
flagged. This often causes transgender passengers to
be outed or to face additional searches and scrutiny. Seenote 3.

5“People with disabilities” here refers to respondents who
identified as a person with a disability in Q. 2.20.
PLACES OF PUBLIC ACCOMMODATION
AND AIRPORT SECURITY

3

4

223

CHAPTER 17

Experiences in
Restrooms

S

afe 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 policies
2or staff. 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 mental
health, including higher levels of suicidal thoughts and behaviors.4

2015 U.S. TRANSGENDER SURVEY

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 of
public restrooms. Notable differences in respondents’ experiences based on demographic and othercharacteristics are reported throughout the chapter.

224

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’s
restroom 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 using
public 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.

Nearly one in ten (9%) respondents reported that someone denied them access to a
restroom in the past year.
One in eight (12%) respondents were verbally harassed, physically attacked, or
sexually 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 they
were afraid of having problems.
Nearly one-third (32%) limited the amount they ate or drank to avoid using the
restroom in the past year.
Eight percent (8%) reported having a urinary tract infection, kidney infection, or
another kidney-related problem in the past year as a result of avoiding restrooms.

I. Access to Restrooms

Figure 17.1: Denied access to a restroom in thepast year

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 stopped
them from entering or denied them access to a
restroom in the past year. American Indian (18%),
Asian (13%), and Middle Eastern (12%) respondents
were more likely to report that someone stopped
them from entering or denied them accessto a restroom in the past year (Figure 17.1).
Undocumented residents (23%) and respondents
currently working in the underground economy,such as sex work, drug sales, and other work thatis currently criminalized (20%), were more than
twice as likely to be denied access to restrooms
than those in the overall sample.

20%

RACE/ETHNICITY (%)
18%

18%
16%
14%

13%

12%

12%
10%

9%

9%

11%

10%
8%

8%
6%
4%
2%

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Am

KE Y FI N D I N GS

Nearly one-quarter (24%) of respondents said that someone had questioned orchallenged their presence in a restroom in the past year.

EXPERIENCES IN RESTROOMS
225

Nearly one in ten (9%)
respondents said that someone
stopped them from entering
or denied them access to a
restroom in the past year.

II. Verbal Harassment,
Physical Attack, andSexual Assault
Twelve percent (12%) of respondents reported
being verbally harassed, physically attacked,
and/or sexual assaulted6 when accessing or
while using a restroom in the past year. Theseexperiences were more frequently reported by
undocumented residents (34%), respondents
currently working in the underground economy(25%), and American Indian (24%) and multiracial(16%) respondents (Figure 17.2).
Figure 17.2: Verbal harassment, physical attack, and/or
sexual assault in a restroom in the past year
RACE/ETHNICITY (%)
30%
25%

24%

20%
16%

15%
12%

12%

13%

12%

12%

10%

10%

226

One out of eight (12%) respondents were verballyharassed in a restroom in the past year.
Respondents who were verbally harassed in
restrooms were asked for the places where theharassment had occurred. Eighty-nine percent(89%) were verbally harassed in a restroom at a
public place, such as a restaurant, shopping mall,or movie theater, and 20% were verbally harassed
in a school restroom (Table 17.1).
Table 17.1: Location of verbal harassment in restroom
in past year
Restroom location% of respondents who wereverbally harassed

Public place (such as a
restaurant, shopping mall, ormovie theater)

89%

School20%

Workplace

14%

Another location

5%b. Physical Attack
One percent (1%) of the sample (228 respondents,
unweighted) was physically attacked in a restroom
in the past year. Undocumented residents (4%)
and American Indian respondents (3%) were more
likely 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).

hi
te

ac
tir
ul

Table 17.2: Location of physical attack in restroom inpast year

M

Ea
e
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id

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in
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/a

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In

O
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0%

Am

2015 U.S. TRANSGENDER SURVEY

5%

a. Verbal Harassment

Restroom location% of respondents who were
physically attacked

Public place (such as a
restaurant, shopping mall, ormovie theater)

86%

School27%

Workplace

14%

Another location

9%

c. Sexual Assault
Approximately one percent (0.6%) of the sample(139 respondents, unweighted) reported being
sexually 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).
Figure 17.3: Sexual assault in a restroom in the past
year among transgender women
RACE/ETHNICITY (%)
3.5%

3.2%

3%

3.2%

2.8%
2.4%

2.5%
2%
1.5%
1%

0.9%

0.8%
0.6%

0.5%

0.5%

hi
W

ac
tir
ul

Figure 17.4: Any reported problem in a restroom
in the past year
RACE/ETHNICITY (%)

M

Ea
e

Overall, in the year prior to taking the survey,
26% of all respondents were denied access torestrooms, had their presence in a restroom
questioned, and/or were verbally harassed,
physically attacked, or sexually assaulted ina restroom. This was nearly twice as high for
undocumented residents (50%) and was also
higher for respondents currently working in theunderground economy (39%). It was also higher
among American Indian (36%) and multiracial (32%)
respondents (Figure 17.4). Respondents who said
that others could always or usually tell they weretransgender without being told (45%) or sometimes
tell they were transgender (38%) were more likely
to report one or more of these experiences, incontrast to those who said that others could rarelyor never tell that they were transgender (16%).

40%

M

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an

0%

III. Overall Accessto and Treatment in
Restrooms

36%

35%

More than three-quarters (78%) of respondents
who were sexually assaulted reported that thesexual assault occurred in a restroom at a public
place, and 19% were sexually assaulted at a school
restroom (Table 17.3).

32%
29%

30%
26%

29%

28%

27%

25%

25%
20%
15%
10%

Workplace

14%

Another location

18%

hi
W

ac

te

l
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tir

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As
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an

La
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id

19%

M

Schoolic

78%

EXPERIENCES IN RESTROOMS

Public place (such as a
restaurant, shopping mall, ormovie theater)

0%
O
ve

% of respondents who were
sexually assaulteder

Restroom location

5%

Am

Table 17.3: Location of sexual assault in restroom inpast year227

IV. Avoidance of
Public Restrooms

In Our Own
VoicesEven 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 more
likely to report sometimes or always avoiding
using a public restroom in the past year (72%).
Eighty percent (80%) of respondents who said that
others could always or usually tell that they weretransgender and 72% of those who said that others
can sometimes tell they are transgender reported
avoiding using public restroom, in contrast to 48%
of those who said that others can rarely or nevertell that they are transgender.
Figure 17.5: Sometimes or always avoided bathroomsin the past year
GENDER IDENTITY (%)
80%

75%

70%

64%
59%

60%

53%

53%

“I either have to ‘hold it’ or break
down and use a male restroom in a
public place. I’m not allowed to use
the female restroom and have been
confronted multiple times whenattempting to.”“I went into the men’s bathroom, beinga man and all. I was using a stall, and I
came out only to find one person who
apparently thought it was okay to go
after me. I was just washing my hands
when 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 recognized
me. He and his buddies circled aroundme as I tried to exit the restroom andpushed me around between them. A
police officer walked into the restroom
and tried to protest their harassment.
The men responded by ripping mypants down. The officer shot me a
disgusted look and left the room.”

50%
40%

36%

228

20%
10%

ns
an wo
d me
m n
en

en
m
ns
Tr
a

om
w
ns
Tr
a

Tr
a

en

ry
na
bi
n-

os
sd
Cr

No

re

ve

ss
er

ra

s

ll

0%
O

2015 U.S. TRANSGENDER SURVEY

30%“I spent high school having to use
the nurse’s bathroom, because if I
used the boys’ bathroom, I would
get reprimanded, and the same
would happen if I went into the girls’
bathroom since I was living as a boy.
Going to the nurse’s office always felt
like a walk of shame, like there was no
dignified place for me simply because
I’m transgender.”Nearly one-third (32%) of thesample avoided drinking or
eating so that they would notneed to use the restroom, and
8% reported having a urinary
tract infection or kidneyrelated medical problem as aresult of avoiding restroomsin the past year.
Respondents were also asked if they had
experienced any physical problems as a result of
avoiding restrooms in public places, at work, orat school. Nearly one-third (32%) of the sample
avoided drinking or eating so that they would notneed to use the restroom, and 8% reported having
a urinary tract infection or kidney-related medical
problem 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 presents
serious challenges for transgender people.
Respondents faced numerous barriers andproblems when attempting to use a public
restroom, 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 using
public 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 kidneyrelated problems.

Table 17.4: Physical problems due to avoiding public
restrooms in the past year
% of respondents
who avoidedusing restrooms% of allrespondents

Did not use therestroom whenneeded to (“held it”)

89%

55%

Avoided drinking
or eating

52%

32%

Urinary tract
infection

12%8%

Kidney infection

2%

1%

Other kidneyrelated problems

2%

1%

Kidney-related
problem and/or a urinary tract
infection

13%

8%

A problem notlisted2%

1%

EXPERIENCES IN RESTROOMS

Physical problem

229

2015 U.S. TRANSGENDER SURVEY

ENDNOTES | CHAPTER 17: EXPERIENCES IN RESTROOMS

230

1

Department of Labor & Occupational Safety and HealthAdministration. (2015). Best Practices: A Guide to
Restroom Access for Transgender Workers. Available at:https://www.osha.gov/Publications/OSHA3795.pdf.

2

Herman, J. L. (2013). Gendered restrooms and minority
stress: 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 Federation
Institute, Freedom for All Americans, & National Center
for Transgender Equality. (2016). The Facts: Bathroom
Safety, Nondiscrimination Laws, and Bathroom
Ban 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 using
a bathroom in Q. 20.3 and Q. 20.6.

7

Movement Advancement Project et al. See note 5.

CHAPTER 18

Civic Participation
and Policy Priorities
Respondents received questions about voting in the previous national election (November 2014)1 to assess
levels of voting and determine reasons for not participating, including potential barriers to voting such as
voter identification laws. Relevant questions were patterned on the November 2014 Voting and Registration
Supplement of the Current Population Survey (CPS). Additionally, respondents were asked questions
about their political engagement, political party affiliation, and policy priorities as they relate to issues that
impact 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 reported
throughout the chapter.

CIVIC PARTICIPATION AND POLICY PRIORITIES

V

oting 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.

231

KE Y FI N D I N GS

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 had
voted in the election, compared to 42% of those who reported they had voted in the
U.S. population.
Over one-quarter (27%) of those who said they had not been registered to vote said
that the main reason was that they were not interested in the election or not involved inpolitics.
Three percent (3%) of those who said they were not registered to vote reported that themain reason was that they wanted to avoid harassment by election officials because
they were transgender.
Nineteen percent (19%) of those who reported they were registered but did not
vote 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 reported being registered to vote but not voting said
that the main reason was that they wanted to avoid harassment by election officials
because they were transgender.
When asked about what they believed the most important policy priorities were fortransgender people, respondents most often identified addressing violence against
transgender people (25%), health insurance coverage (15%), and racism (11%) as their
top priorities.

2015 U.S. TRANSGENDER SURVEY

I. Voter Registration
and Voting

232

a. Voter Registration
Survey respondents were asked about voting in
relation to the November 4, 2014 midterm election,
which was the national election held in closest
proximity to the survey. More than three-quarters(76%) of U.S. citizens in the survey sample who

were of voting age at the time of the election2
reported 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 Middle
Eastern (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).

Figure 18.1: Registered to vote
RACE/ETHNICITY (%)
80%

79%

77%

76%

70%

78%

75%
71%

70%
65%

60%
50%
40%
30%
20%
10%

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0%

Naturalized citizens (69%) were less likely to reportbeing registered than citizens who were born in the
United States (76%). There were also differences
in 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 being
registered. 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).
Figure 18.2: Registered to vote
SOURCES OF INCOME (%)
90%
76%

76%

70%

79%
75%
65%

60%

66%
61%

48%

50%
40%
30%
20%
10%

oy on y
m ly
en
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to
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nl
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en
to
nl
Un
SS
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em
I/d
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oy
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so ce
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ce
M
on
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tip
ly
le
so
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ce
s
No
in
co
m
e

Additionally, respondents reported not being
registered to vote because they wanted to avoid
anti-transgender harassment by election officials(3%), because they did not have their current
name updated on their Social Security card (2%),
and because they thought their state’s voter
identification law would stop them from voting(1%). Avoiding anti-transgender harassment byelection officials was a more common reason
for transgender men and women (5%) than forcrossdressers (2%) and non-binary respondents

Three percent (3%) of
respondents who were citizens
and of voting age at the timeof the 2014 midterm election
were not registered to votebecause they wanted to avoid
anti-transgender harassment byelection officials.

sio

om
on

ec

Em
pl

Pe
n

Un

de

rg

ro
un

d

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ve

ra

ll

0%

Respondents who said they were not registered
to vote in the November 4, 2014 election wereasked to identify the main reason why they were
not registered based on categories outlined in the
Current Population Survey (CPS) and additional
experiences they might have had as a transgenderperson. More than one-quarter (27%) of those in thesample who reported that they were not registered
to vote said that they were not interested in theelection or not involved in politics, which was themost frequently selected reason for not being
registered. Sixteen percent (16%) did not know
where 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 (Table
18.1).5

CIVIC PARTICIPATION AND POLICY PRIORITIES

81%

80%

b. Reasons for Not Registering
to Vote233

Figure 18.3: Not registered due to avoiding
anti-transgender harassment
GENDER IDENTITY (%)
6%

6%

5%
4%

4%

3%
2%

2%

1%

6%
4%

4%

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ve

0%
k

12%

0%

0%

ac

They felt their vote would not make adifference

2%

n

15%

3%

2%

Bl

They did not meet registration
deadlines

3%

ia

16%

3%

As

27%

7%

O

2015 U.S. TRANSGENDER SURVEY
234m

RACE/ETHNICITY (%)

ra

They did not know where or how toregister

en
w
om

Tr
an
s

Figure 18.4: Not registered due to avoiding
anti-transgender harassment

Lat% of USTS citizens
not registered to vote

8%
They were not interested in theelection or not involved in politics

an
d

Tr
an
s

Tr
an
s

Table 18.1: Main reason for not being registered tovote on November 4, 2014
Reasons for not being
registered to vote

en

en
m

en
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om

in
ar
y

Cr
os

No

sd

nb

re
s

ve

se

ra
l

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rs

0%
O

(1%) (Figure 18.3). Those who reported that people
could always or usually tell they were transgendereven without being told were more than twice as
likely to report this reason (8%), in contrast to those
who said people could rarely or never tell they
were transgender without being told (3%). Black
respondents (7%) were also more likely to reportthat they did not register to vote in order to avoid
harassment by election officials (Figure 18.4).

c. Voting in the 2014 Election

They did not live in place longenough or meet residency
requirements

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 identity
document (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 law
would stop them from voting

1%

Protest or philosophical reasons(write-in response)

1%

More than half (54%) of U.S. citizens in the sample
who were of voting age at the time of the election
reported that they voted in the election, compared
to 42% of those in the U.S. population.6 Among
people 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%) of
respondents who were citizens
and of voting age at the timeof the 2014 midterm election
reported that they voted in theelection, compared to 42% in
the U.S. population.

Figure 18.5: Voted in election
RACE/ETHNICITY (%)
60%

56%

54%

50%

50%

53%

56%

53%

48%

44%

In Our Own
Voices

40%
30%
20%
10%

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0%

Respondents who were living in poverty7 (41%)
were also less likely to say they had voted, as
were those who were currently working in theunderground economy (40%), unemployed (42%),or out of the labor force (50%).

d. Reasons for Not Voting

Among those who provided additional reasons for
not voting that were not included in the CPS, 3%
of respondents reported that they wanted to avoid
harassment by election officials because they
were transgender. Transgender men and women“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 because
the voter registration has thewrong name.”“I had to try twice to get mycounty to change my name in
the voter registration, whichis extremely embarrassing as
people are essentially shoutingthat you’re trans in a public
place. Some accused me ofattempting voter fraud when all
I wanted to do was try to makesure I had the best candidates
who would protect my rights.”

CIVIC PARTICIPATION AND POLICY PRIORITIESRespondents who reported being registered but
did not vote in the November 4, 2014 election
were asked to identify the main reason why they
did not vote, based on categories outlined in
the CPS and additional experiences they might
have had as a transgender person. Nearly one infive (19%) respondents who reported they wereregistered but did not vote reported that they
were not interested or felt their vote would not
make a difference, compared to 16% of such votersin the U.S. population.8 Respondents were also
more than twice as likely to report not voting due
to registration problems, such as not receiving
an absentee ballot or not being registered in thecurrent location (5%), than registered voters in the
U.S. general population (2%) (Table 18.2).

“Lawmakers pushed throughvoter ID reforms in my state,requiring every voter to present
a photo ID with a gendermarker. Since I was unable
to do so, I was a victim of ‘defacto’ disenfranchisement andvoter intimidation tactics thatare now, unfortunately, all too
common.”235

their 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.

(4%) were more likely to report that they did not
vote because they wanted to avoid harassment by
an election official than non-binary respondents(<1%) (Figure 18.6). Two percent (2%) of those who
did not vote said that the main reason was that
Table 18.2: Main reason for not voting on November 4, 2014

Reasons included in the Current
Population Survey (CPS):% of USTS respondents
who were registered but
did not vote% in U.S. population
who were registered
but did not vote (CPS)

They were not interested or felt their vote would not
make 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 an
absentee 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 too
long

3%

2%

Transportation problems

3%2%

Bad weather conditions

<1%

<1%

Other reasons

10%

9%

They wanted to avoid harassment by election officials
because they were transgender

3%

---

Their ID did not match their current name or gender, or
they 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 election
official because they were transgender

<1%

---

2015 U.S. TRANSGENDER SURVEY

Additional reasons not included in the CPS:

236

have some influence on government decisions
than those who believed they could not influence
government decisions.

Figure 18.6: Did not vote due to avoiding
anti-transgender harassment
GENDER IDENTITY (%)
6%

5%
4%

4%

3%

3%

2%

13%
Strongly
agree

m
an
d

en

en
Tr
an
s

w
om

en

m
Tr
an
s

en
w
om
Tr
an
s

No

re
s
sd
Cr
os

nb

se

in
ar
y

rs

l
ra
l
ve
O

16%
Strongly
disagree

<1%

0%

0%

Figure 18.7: Perception of ability to
influence government decisions

II. Political
Engagement andParty Affiliation
Respondents received a question about politicalaffairs to examine how much of an influence
they believed they could have on government
decisions. Specifically, they were asked to rate
on five-point scale from “strongly agree” to“strong disagree” what they thought about thefollowing statement: “Someone like me can’t
really influence government decisions.” Nearly
half (44%) of respondents disagreed or strongly
disagreed with the statement, and approximately
one-third (32%) agreed or strongly agreed with thestatement (Figure 18.7). This means that there weremore respondents who thought that they could

19%
Agree

24%
Neither agree
nor disagree

Respondents were also asked about theirpolitical party affiliation with questions that were
patterned on the Gallup U.S. Daily Tracking Poll,
including whether they consider themselves a
Republican, Democrat, or Independent. 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 general population, respectively(Figure 18.8).9 Respondents who did not identify
as Democrats or Republicans wrote in several
political parties and political movements, including
socialist or democratic socialist (4%), Green Party(2%), Libertarian (1%), and anarchist (1%). For
comparison with the Gallup Daily Tracking Poll,these respondents are included as Independents
in Figure 18.8.
Those who identified as Independents were also
asked whether they lean more to the Democratic
Party or the Republican Party. Overall, 79% in
the sample reported that they were Democrats
or lean towards the Democratic Party, 4% were
Republicans or lean towards the Republican Party,

CIVIC PARTICIPATION AND POLICY PRIORITIESHalf (50%) of respondents
identified as Democrats, 48%
identified as Independents,
and 2% identified as
Republicans, compared to27%, 43%, and 27% in the
U.S. general population,
respectively.

“Someonelike me can’t
really influence
28%
government
Disagreedecisions.”237

and 17% were Independents who do not lean
towards the Democratic or Republican parties. This
compares to 44% in the U.S. population who are
Democrats or lean towards the Democratic Party,
45% who are Republicans or lean towards theRepublican Party, and 11% who are Independents
and 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 only
1% described themselves as “very conservative.”

Figure 18.9: Democratic or Republican party
affiliation and leaning
4%
Republican orlean Republican
17%
Independent(no lean)

Political party
and leaning% USTS79%
Democrator lean
Democrat

Figure 18.8: Consider themselves a Republican,
Democrat, or Independent2%
Republican
11%
Independent(no lean)48%
Independent

Political party% USTS

50%
Democrat

Political party
and leaning% in U.S.
population(Gallup)44%
Democrator lean
Democrat

45%
Republican or leanRepublican2015 U.S. TRANSGENDER SURVEY

27%
Republican

238

27%
Democrat

Political party% in U.S.
population(Gallup)43%
Independent

III. Policy Priorities
The survey explored respondents’ opinions on themost important policy priorities for transgenderpeople in the U.S. and asked for those issues
to 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%), police
mistreatment of transgender people (88%), andemployment (87%) were also commonly selected
as very important priorities (Table 18.3).
Table 18.3: Respondents’ policy priorities

Table 18.4: Top policy priorities
Respondents’ mostimportant priority% of respondents

Violence against transgenderpeople25%

Insurance coverage fortransgender-related health care

15%

Racism

11%

Employment

7%

Identity documents

7%

Poverty6%

Bullying and discrimination inschools5%

Training health care providers
about transgender health5%

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%1%

Parenting and adoption rights

1%

29%

3%

Marriage recognition

1%

68%

28%

4%

Conversion therapy

68%

22%

10%

Immigration reform

60%

30%

10%

Marriagerecognition

55%

32%

13%

Military (openservice fortransgenderpeople)49%

Veryimportant

ImportantViolence against
transgender people

94%

5%

Insurance coveragefor transgenderrelated health care

90%

Police mistreatmentof transgenderpeople88%

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%

HIV/AIDS

68%

Parenting andadoption rights

Issue

9%

11%

33%

Not very
important
1%

1%

1%

18%

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 levels
throughout the U.S. However, the process may beinaccessible at times or may otherwise present
a difficult avenue through which policy priorities
and day-to-day needs can be expressed. The
results indicate that while a majority of eligible
respondents had registered to vote in the mostrecent national election, only half had engaged in
the process by voting, providing reasons such as
not believing their vote would make a difference or

CIVIC PARTICIPATION AND POLICY PRIORITIESRespondents were also asked for their top threepolicy priorities. One-quarter (25%) reported that
violence against transgender people was the top
policy priority for them, and more than half (54%)
reported that it was one of their top three priorities.
Fifteen percent (15%) reported that health insurance
coverage was the most important priority forthem, and 11% reported that racism was the mostimportant policy priority for them (Table 18.4).

Conclusion239

wanting to avoid potential harassment by election
officials as a transgender person. Respondents
were substantially more likely to identify with the
Democratic Party or lean towards the Democratic
Party than other political parties. Policy priorities
that respondents identified as most important arethose directly related to the safety and wellbeingof transgender people, including violence against
transgender people, health insurance and healthcare, police treatment of transgender people,
racism, employment, and housing.

ENDNOTES | CHAPTER 18: CIVIC PARTICIPATION AND POLICY PRIORITIES
1Questions referred to the midterm elections held on
Tuesday, November 4, 2014, and respondents received
the explanation that “[t]his was the election in November
2014 to elect members of the U.S. Congress and statelevel 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 to
Current Population Survey data on registration and votingin the U.S. population.

2015 U.S. TRANSGENDER SURVEY

3240

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 Voting
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/p20577.html.

4

TANF (the Temporary Assistance for Needy Families
program) is a federal cash assistance program.

5

Although the Current Population Survey asked about
the main reason for not registering to vote on November
4, 2014, U.S. population data for that question was notavailable at the time of this report.

6

The number of USTS respondents who voted represents
70% of those in the sample who were registered to votein the election. According to the CPS, 42% of citizen
voters aged 18 and older voted in the 2014 election, which
represents 65% of registered voters. U.S. Census Bureau.
(2014, November). Current Population Survey. Reported

Voting 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 those
who are living at or near the poverty line. See the Income
and Employment Status chapter for more information
about the poverty line calculation.

8

U.S. Census Bureau. (2014, November). Current Population
Survey. Voting and Registration in the Election ofNovember 2014. Available at: https://www.census.gov/
data/tables/time-series/demo/voting-and-registration/p20577.html.

9This data is based on Gallup Poll results from September
9–13, 2015, the poll in closest proximity to when thesurvey was in the field. Gallup Poll. (2015, September
9–13). 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/partyaffiliation.aspx.

About the Authors
Sandy E. JamesAs 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 advocate
focused on law, research, and policy to advance transgender rights. He has worked on numerous
projects involving trans-related legislation, policy, and research, including extensive work with datafrom the 2008–09 National Transgender Discrimination Survey. Sandy has been published in The
Georgetown Journal of Gender and the Law and the LGBTQ Policy Journal at the Harvard Kennedy
School. 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. She
holds 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 gender
non-conforming people face when using public restrooms and the development of anti-discrimination
protections in public accommodations based on gender identity and expression. She has worked
on issues of poverty, women’s rights, voting rights, and anti-discrimination policy development with
non-profit research, advocacy, and direct-service organizations in the United States and Mexico. She
served as a co-author on the groundbreaking report Injustice at Every Turn, based on the National
Transgender 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 or
expression.

Sue Rankin

ABOUT THE AUTHORS

Sue Rankin is the principal of Rankin & Associates Consulting. She retired from the Pennsylvania
State 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 in
the academy and in intercollegiate athletics. Her current research focuses on the assessment ofinstitutional climate and providing program planners and policymakers with recommended strategies
to improve the campus climate for under-served communities. Her recent publications include The
State of Higher Education for LGBT People and The Lives of Transgender People in 2010 and an
NCAA Student-Athlete Climate Study in 2011. In addition to serving as a consultant for the National
Transgender Discrimination Survey in 2011, she has collaborated with over 170 institutions in
implementing assessments and developing strategic plans regarding social justice issues.

241Mara Keisling
Mara Keisling is the founding Executive Director of the National Center for Transgender Equality, one of
the 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’s
foremost 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 National
Transgender 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 Harvard
University.

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 previous
position as Director of the Transgender Civil Rights Project at the National LGBTQ Task Force (formerly the
National 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 promoting
trans-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 became
law in 2009, and to the Employment Non-Discrimination Act. Her thoughts and guidance on trans-inclusion
were recorded in the 2008 publication, Opening the Door to Transgender Inclusion: The Nine Keys to
Making 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. Lisa
graduated from the University of Washington in 1998 and received her J.D. from the Georgetown University
Law Center in 2001.

2015 U.S. TRANSGENDER SURVEY

Ma’ayan Anafi

242

Ma’ayan Anafi is a Policy Counsel at the National Center for Transgender Equality. As part of the NCTE
team, 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.

Appendix A
Demographic Description andOther Characteristics of the Sample

T

APPENDIX A

hroughout the report, findings were presented with the standard or supplemental survey
weight 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.

243

Q1.4. What U.S. state or
territory do you currently
live in?

Unweighted%

U.S. military base outsideof the U.S.

32

0.1%

Alabama228

0.8%

Alaska84

0.3%

Puerto Rico

27

0.1%

2

0.0%

Rhode Island

119

0.4%

Arizona537

1.9%South Carolina

233

0.8%

Arkansas

222

0.8%

South Dakota

43

0.2%

California

3453

12.5%

Tennessee

416

1.5%

1490

5.4%

2015 U.S. TRANSGENDER SURVEY

American Samoa244

Q1.4. What U.S. state or
territory do you currently livein? (continued)

Unweighted
frequency

Unweighted
frequency

Unweighted%

Oregon1152

4.2%

Pennsylvania

1171

4.2%

Colorado

669

2.4%

Texas

Connecticut

319

1.2%

Utah

270

1.0%

Delaware84

0.3%

Vermont

163

0.6%

District of Columbia

214

0.8%

Virginia

723

2.6%

1667

6.0%

Florida

1099

4.0%

Washington

Georgia614

2.2%West Virginia

83

0.3%

Guam

2

0.0%

Wisconsin

541

2.0%

Hawai‘i

69

0.3%

Wyoming
Total

44

0.2%

27715

100%

Unweighted
frequency

Unweighted
%

5703

21%

Idaho

155

0.6%

Illinois

1082

3.9%

Indiana

452

1.6%

Iowa

219

0.8%

Q1.4. U.S. region of current
residence (recode based on
Census regions)Kansas197

0.7%

Northeast

Kentucky

274

1.0%

Midwest

5759

21%

7599

27%

Louisiana

274

1.0%

South

Maine

182

0.7%

West

8591

31%

Maryland

662

2.4%

Total

27652

100%

Massachusetts

1195

4.3%

Michigan

894

3.2%

Minnesota

670

2.4%

Unweighted
frequency

Unweighted%

Mississippi

82

0.3%

No

3270

12%

Missouri

509

1.8%

Yes

24445

88%

Montana

72

0.3%

Total

27715

100%

Nebraska

165

0.6%

Nevada206

0.7%

New Hampshire

225

0.8%

Unweighted
frequency

Unweighted%

New Jersey

550

2.0%

No

14362

52%

New Mexico

213

0.8%

Yes

13353

48%

New York

1779

6.4%

Total

27715

100%

North Carolina

686

2.5%

North Dakota

46

0.2%

Ohio

941

3.4%

Oklahoma

215

0.8%

Unweighted
frequency

Unweighted
%

No

11135

40%

Yes

16580

60%

Total

27715

100%

Q1.10. Do you think ofyourself as transgender?

Q1.11. Do you identify as
more than one gender or as
no gender?

Q1.12. Do you currently live
full-time in a gender thatis different from the one
assigned to you at birth?

Q1.14. Someday do you wantto live full time in a genderthat is different from the one
assigned to you at birth?*

Unweighted
frequency

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 seriously
thought about living in agender that is different fromthe one assigned to you atbirth (transitioning gender)?*

Q2.1 & Q2.3. Gendercategories (collapsed
recode)Unweighted
frequency

Unweighted%

Transgender men and women

17188

64%

Non-binary people

9769

36%

Total

26957

100%

Unweighted
frequency

Unweighted%

Very comfortable

12189

44%

Somewhat comfortable

7413

27%

Neutral4129

15%

Q2.4. How comfortable
are you with the word
“transgender” being used todescribe you?

Unweighted
frequency

Unweighted
%

251

33%

Somewhat uncomfortable

3116

11%

830

3%

27677

100%

Unweighted
frequency

Unweighted%*

He, his

9981

36%

No
Yes

519

67%

Very uncomfortable

Total

770

100%

Total

*Asked of those who responded “No” to Q1.12 and Q1.14.

Q1.17. Do you consider
yourself to be a crossdresser?

Q2.5. What genderpronouns do you ask people
to use to refer to you?

Unweighted
frequency

Unweighted
%

No

25225

91%

She, hers

10138

37%

Yes

2490

9%

They, their

8026

29%

Ze, hir466

2%

No pronouns. I ask people
only to use my name.

1095

4%

I don’t ask people to use
specific pronouns.

5619

20%

Pronouns not listed above

1162

4%

Total
Q1.18. Do you live part of
the time in one gender andpart of the time in anothergender?

27715

100%

Unweighted
frequency

Unweighted
%

No

19063

69%

Yes

8652

31%

Total

27715

100%

Q2.1. What sex were you
assigned at birth, on youroriginal birth certificate?

Unweighted
frequency

Unweighted%

Female

15858

57%

Male

11857

43%

Total

27715

100%

Q2.1 & Q2.3. Gendercategories used for analysis(recode)*Multiple choices were allowed, so percentages do not add to 100%.

Q2.6. What gender do you
currently live in on a
day-to-day basis?

Unweighted
frequency

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%

Unweighted
frequency

Unweighted%

Unweighted
frequency

Unweighted%

Crossdressers

758

3%

Q2.7. People can tell I amtrans even if I don’t tell
them.

9238

33%

Always

549

2%

7950

29%

Most of the time

2629

10%

Non-binary people, assigned
female at birth

7844

28%

Sometimes

9139

33%

Non-binary people, assigned
male at birth

Rarely

8986

33%

1925

7%

Never

6346

23%

100%

Total

27649

100%

Total

27715

APPENDIX A

Transgender womenTransgender men

245

Q2.8. What best describes
your current sexual
orientation?

Unweighted
frequency

Unweighted%

Asexual2984

11%Bisexual

4129

15%

Gay

1316

5%

Heterosexual/Straight

3363

12%

Lesbian3037

11%

Same-gender loving

264

1%

Pansexual

5056

18%

Queer

5706

21%

Demisexual*

287

1%

A sexual orientation not listed
above

1573

6%

Total

27715

100%

*Added to the response list from write-in responses.

Q2.15. What is your current
relationship status?

Unweighted
frequency

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%

27709

100%

Unweighted
frequency

Unweighted
%

4671

16.9%

Legally recognized civil union

67

0.2%

Registered domestic
partnership

238

0.9%

Widowed216

0.8%

Divorced

2538

9.2%

Separated

456

1.7%

Single, never married

19463

70.4%

Total

27649

100%

Unweighted
frequency

Unweighted%

Never served in the military

25263

91.3%

Only active duty for training
in the Reserves or National
Guard

298

1.1%

Now on active duty

129

0.5%

On active duty in the past, but
not now

1976

7.1%

27666

100%

Unweighted
frequency

Unweighted
%

26684

96.3%

Total
*Added to the response list from write-in responses.

Q2.16. What is your current
legal marital status?
Married

Q2.9-Q2.11. Race/ethnicity(recode)Unweighted
frequency

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 African
alone

132

0.5%

Native Hawaiian/PacificIslander alone

62

0.2%

White/European American
alone

22658

81.8%

A racial/ethnic identity notlisted above

41

0.2%

27715

100%

Total

2015 U.S. TRANSGENDER SURVEY

Q2.12. Religious/spiritual
identity (recode)

Unweighted
frequency

Unweighted%

Not religious/spiritual

10460

38%

Religious/spiritual

17195

62%

Total

27655

100%

Unweighted
frequency

Unweighted%

18 to 24

11840

43%

25 to 44

10987

40%

45 to 64

4085

15%

65 and over

803

3%

27715

100%

Q2.13. Age ranges (recode)

Total

Q2.17. Have you ever servedon active duty in the U.S.
Armed Forces, Reserves, or
National Guard?

Total
Q2.18. What is yourcitizenship or immigration
status in the U.S.?
U.S. citizen, birth
U.S. citizen, naturalized

555

2.0%

Permanent Resident

249

0.9%

115

0.4%

16

0.1%

1

0.0%

6

0.0%

40

0.1%

3

0.0%

46

0.2%

27715

100%

A visa holder (such as F-1, J-1,
H1-B, and U)DACA (Deferred Action forChildhood Arrival)
DAPA (Deferred Action for
Parental Accountability)
Refugee status
Other documented status not
mentioned above
Currently under a withholdingof removal status
Undocumented resident

246

Total

Q2.20. Disability (questions
based on American
Community Survey, withthe exception of the last
question)Q2.22. What is the highest
level of school or degree
you have completed?
Unweighted
frequency

Unweighted%*

Are you deaf or have serious
difficulty hearing?

1072

4%

Are you blind or have serious
difficulty seeing even when
wearing glasses?

679

2%

Because of a physical mental
or emotional condition, do
you have serious difficulty
concentrating, remembering,or making decisions?

8471

Do you have serious difficulty
walking or climbing stairs?

1729

6%

Do you have difficulty
dressing or bathing?

924

3%

Because of a physical, mental,
or emotional condition, do
you have difficulty doing
errands alone, such as visitinga doctor’s office or shopping?

6200

Do YOU identify as a personwith a disability?

7764

31%

23%

28%

*Multiple choices were allowed, so percentages do not add to 100%.

Q2.20. Any disability(recode) (based on
American Community
Survey questions only, notincluding self-identification)

Unweighted
%

No

16305

60%

Yes

10913

40%

Total

27218

100

Unweighted
frequency

Unweighted
%

24958

90.1%

Language(s) other thanEnglish285

1.0%

English and other language(s)

2461

8.9%

27704

100%

English only

Total

Less than 8th grade

48

0.2%

8th grade

54

0.2%

Some high school, no diploma
or 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/vocational
program858

3.1%

Associate degree in college—
Academic program

1475

5.3%

Bachelor’s degree

5291

19.1%

Some graduate work, no
graduate 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%

27715

100%

Unweighted
frequency

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 friends
or family because I can’t
afford my own housing

2229

8.0%

Living with parents or family I
grew up with because I have
not yet left home

5149

18.6%

Living in a foster group homeor other foster care

10

0.0%

Living in campus/university
housing

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 I
pay for myself

37

0.1%

Living in a hotel or motelwith an emergency sheltervoucher6

0.0%

Q2.23. What are yourcurrent living arrangements?

APPENDIX A

Unweighted
%

Total

Unweighted
frequency

Q2.21. What is the main
language that people speakin your home?

Unweighted
frequency

247

Q2.23. What are yourcurrent living arrangements?
(continued)

Unweighted
frequency

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 violence
shelter60.0%

Living in a shelter that is not ahomeless shelter or domestic
violence shelter

3

0.0%

Unweighted
frequency

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 an
employer

6735

24.3%

Self-employed in your own
business, profession ortrade, or operate a farm (notincluding sex work, selling
drugs, or other work that iscurrently considered illegal)

3868

14.0%

Unemployed but looking for
work

3991

14.4%

Q7.7 Employment status

A living arrangement notlisted above

126

0.5%

1247

4.5%

Mobile housing (RV, camper,etc.)*

Unemployed and havestopped looking for work

40

0.1%

2255

8.1%

A place owned/rented bysomeone else*

Not employed due todisability

176

0.6%

Student

8639

31.2%

A group home or treatment
facility*

13

0.1%

Retired

1107

4.0%

At home/with family for otherreasons*

549

2.0%

186

0.7%

Homemaker or full-timeparentNot listed above

1240

4.5%

Nomadic*

16

0.1%

Commune/co-op/collective*

28

0.1%

Seasonal work/odd jobs/otherpart-time work*

136

0.5%

27710

100%

Volunteer*

76

0.3%

Internship*

66

0.2%

Total
*Added to the response list from write-in responses.

*Multiple choices were allowed, so percentages do not add to 100%.

Q2.24. Is there at least
one telephone INSIDE
your home that is currently
working and is not a cell
phone?

Unweighted
frequency

Unweighted
%

No

18255

66%

Yes

9313

34%

Total

27568

100%

Unweighted
frequency

Unweighted%

2015 U.S. TRANSGENDER SURVEY

Q2.24. Do you have a cell
phone?

248

Q7.8. Respondent ismember of a union (recode)

Unweighted
frequency

Unweighted
%

No

25997

94%

Yes

1691

6%

Total

27688

100%

Unweighted
frequency

Unweighted%

Q7.8 & Q7.9. Respondent isa union member or under aunion contract (recode)

No

882

3%

No

25623

92%

Yes

26744

97%

Yes

2082

8%

Total

27626

100%

Total

27705

100%

Unweighted
frequency

Unweighted%

Unweighted
frequency

Unweighted%

Q14.1 & Q14.2 HIV status(recode)Q7.10. Do you currently
receive assistance fromfood stamps (SNAP) or WIC?

HIV positive

179

0.7%

HIV negative

13869

50.2%

No

25060

91%

Don’t know/not tested

13606

49.2%

Yes

2606

9%

Total

27654

100%

Total

27666

100%

Q7.11. Current sources ofincome (recode)

Unweighted
frequency

Unweighted%

Pay from sex work, selling
drugs, or other work that iscurrently considered illegal
only

143

0.6%

Pay from employment only

10519

Pay from pension orretirement only

Q7.12 - Q7.14 Householdincome in 2014 (recode)

Unweighted
frequency

Unweighted%

No income

996

3.9%

$1 to $5,000

1433

5.7%

$5,000 to $7,499

811

3.2%

40.4%

$7,500 to $9,999

869

3.4%

227

0.9%

$10,000 to $12,499

1109

4.4%

SSI or disability income only

903

3.5%

$12,500 to $14,999

897

3.6%

Unemployment benefits or
cash assistance only

207

0.8%

$15,000 to $17,499

725

2.9%

$17,500 to $19,999

725

2.9%

Other income source only

1165

4.5%

$20,000 to $24,999

1571

6.2%

Multiple income sources

12183

46.8%

$25,000 to $29,999

1220

4.8%

No income

664

2.6%

$30,000 to $34,999

1367

5.4%

26011

100%

$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%

25296

100%

Unweighted
frequency

Unweighted
%

No

8468

31%

Yes

19215

69%

Total

27683

100%

Unweighted
frequency

Unweighted
%

Total

Q7.12. Individual income in2014 (includes all income
sources except food stamps(SNAP) or WIC)

Unweighted
frequency

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%

Q29.1. Did you vote in theelection held on Tuesday,
November 4, 2014?

$50,000 to $59,999

1049

3.9%

No

13846

50%

$60,000 to $74,999

1070

3.9%

Yes

13805

50%

$75,000 to $99,999

1118

4.1%

Total

27651

100%

$100,000 to $149,999

998

3.7%

$150,000 or more

636

2.3%

27127

100%

Total

Total

Q29.1 & Q29.2 Registered tovote on November 4, 2014
(recode)APPENDIX A
249

Appendix B2015 U.S. TRANSGENDER SURVEY

Survey Instrument (Questionnaire)

250

The survey was offered online only. The questionnaire has
been reproduced here to best reflect what respondents saw
when completing the survey. Programming notes are indicatedin italics.

QUESTIONNAIRE:
The National Center for Transgender Equality welcomes you
to the 2015 U.S. Trans Survey, the follow up to the National
Transgender Discrimination Survey: Injustice At Every Turn.
We thank you for participating in this survey. Every voice
counts in documenting and better understanding the lives
and experiences of trans people in the United States, and weappreciate yours.
Sincerely,
The National Center for Transgender Equality Survey Team

WHAT WILL HAPPEN IF I TAKE PART IN THIS RESEARCHSTUDY?
If you volunteer to participate in this study, the researchers ask
that you participate in an online survey. The purpose of thesurvey is to gather information about you and your experiences
as a trans person in the United States. You will be one of over
700,000 possible participants who may take part in this survey,
which is the current best estimate of the total number of transidentified 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 ordinarily
encountered in daily life. Any information you provide in thesurvey will be confidential. Some of the questions asked of you
as part of this survey may make you feel uncomfortable. You
may refuse to answer questions posed to you by skipping thequestion. You may stop your participation in this study at any
time 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 of
the 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 three
cash prizes: one prize of $500 and two prizes of $250.
HOW WILL INFORMATION ABOUT ME AND MY
PARTICIPATION BE KEPT CONFIDENTIAL?

UNIVERSITY OF CALIFORNIALOS ANGELES
Study information sheet2015 U.S. Trans Survey
This study has been commissioned by the National Center forTransgender Equality (NCTE). A research team made up of Jody
L. Herman, Ph.D. and Susan Rankin, Ph.D. are conducting thisstudy. Your participation in this study is voluntary.
WHY IS THIS STUDY BEING DONE?

You will be given the option at the end of the survey to be
directed to a separate page on a secure website if you wish
to provide your contact information to receive survey resultsfrom NCTE, be entered into the drawing for one of three cash
prizes, or share your personal story with NCTE. NCTE will NOT
be provided with any responses from your survey in connection
with your contact information. NCTE will only know that you
have participated in the survey. NCTE will not provide to theresearch team any information that could be used to identify
you, such as your name. Therefore, you will remain anonymous
to the research team.

APPENDIX B

This study is being conducted to better understand thedemographics, health, and experiences of trans people in the
United States. The findings of this study will be used for the
benefit of the trans community and the research community.

Your survey response will be anonymous, so no informationthat can be used to identify you will be collected unless you
voluntarily provide it. Any information that is obtained inconnection with this study and that can identify you will remain
confidential. If you do voluntarily provide any information that
could be used to identify you, the research team will maintainyour confidentiality by taking precautions to minimize any risk
to your privacy from participating in this survey.

251Results of this research study that are reported in publishedform will not name you or identify you as a participant. If you
choose 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 publication
and any content of quotes that could be used to identify you
will be removed.
CAN THE RESEARCHERS REMOVE ME FROM THIS STUDY?
The researchers will not remove you from the study. You may
remove yourself from the study by exiting the survey. If you exit
the survey, your responses will not be recorded or used in the
study.
WHAT ARE MY RIGHTS IF I TAKE PART IN THIS STUDY?
Taking part in this study is your choice. You can choose whether
or 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 answered
before 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 exiting
the survey.

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 will
see a word or phrase that is underlined and bolded. You canclick on those words or phrases and a definition or additional
information will be offered.
In order to clear a response choice, please use the back button
on your browser.
WARNING: If you use the back button on your browser
to 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. Responses
before those three pages would stay the same.
In the survey, please do not provide any information that
could be used to identify you, such as your name or contact
information. All of your answers are confidential and cannot be
used against you.
You must hit the “submit” button on the last page of thesurvey for your responses to be included in the final analyses.

WHO CAN I CONTACT IF I HAVE QUESTIONS ABOUT THISSTUDY?
The Research Team:

Section 1

You may contact Jody L. Herman at (310) 267-4382 or Susan
Rankin at (814) 625-2780 with any questions or concerns about
the research or your participation in this study.

1.1 Please make an ID in question 1.1. The research team will use
the ID for their analysis. It will not be used to identify you.

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) 825-7122
or U.S. mail: UCLA OHRPP, 11000 Kinross Ave., Suite 102, Box
951694, 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 clicking
on the “I AGREE” button, you will indicate your consent toparticipate in this study.

2015 U.S. TRANSGENDER SURVEY

If you do not agree to take part in this study, as describedabove, please click on the “I DO NOT AGREE” button below.

252☐ I AGREE
I agree and give my consent to participate in this study.
☐ I DO NOT AGREE
I do not agree to participate in this study.
Respondents who selected “do not agree” were sent adisqualification page #2.1

Enter the first and last letter of your preferred first name. For
example, if your first name is “Robert”, enter “RT”.
[Text box]
Enter the first letter of your preferred last name. For example, if
your last name is “Smith”, enter “S”.
[Text box]
1.2 It is important that people only complete this survey one
time so that we can gather accurate information. You will only
be entered into the prize drawing once, even if you complete
this 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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)

PLEASE READ AND RESPOND CAREFULLY TO THE
FOLLOWING QUESTIONS.
This is a survey for people who are transgender, trans, or nonbinary. It doesn’t matter if you have transitioned gender or if
you 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.]Social networking site (such as Facebook)No

Organization website (such as NCTE)

Yes

I was told about it in person (at an organization, event, or
support group)
Flier or print advertisement
Word of mouth (e-mail from a friend, a friend told you
about 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 or
meeting?

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 different
from the one assigned to you at birth? [Must answer tocontinue.]

No

No [Skip to 1.14]

Yes

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 or
email, at least occasionally? (Mark all that apply.)
No [Respondents could not select “No” in combination
with 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?

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 1.12
received 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? [Respondents
who 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 would answer No

I might face mistreatment at school.

I would answer Yes

My friends might reject me.

I would not answer the question

I might not get the medical care I need.
I might be hurt financially.
My church or faith community might reject me.

APPENDIX B

I might become homeless.

253

I might face violence.

Third gender

I am not ready to transition.

Stud

A reason not listed above(please specify) _______________

Transgender

1.16 Have you seriously thought about living in a gender thatis different from the one assigned to you at birth (transitioning
gender)? [Respondents who selected “No” in response to 1.13
must answer to continue.]

Trans
Trans man (FTM, female to male)Transsexual
Trans woman (MTF, male to female)
TravestiNo

Two-spiritYes

A gender not listed above(please specify)_______________

1.17 Do you consider yourself to be a cross-dresser? [Mustanswer to continue.]NoYes

2.3 If you had to choose only one of the following terms, which
best describes your current gender identity? (Please choose
only one answer.)
Cross-dresser

1.18 Do you live part of the time in one gender and part of thetime in another gender? [Must answer to continue.]

Woman
Man

No

Trans woman (MTF)

Yes

Trans man (FTM)[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.]

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 nonbinary/genderqueer, what gender do they usually think you are?
[Only respondents who selected “Non-binary/Genderqueer” in
response to 2.3 received this question.]Man

Female

Woman

Male

Trans Man
Trans Woman

2.2 Which of these terms do you identify with? (Mark all that
apply.)
A.G. or aggressive
AgenderAndrogynous
Bi-gender
Butch
Bulldagger

2015 U.S. TRANSGENDER SURVEY

Cross dresser

254

Drag performer (king/queen)
Fa’afafine
Gender non-conforming or gender variant
Genderqueer
Gender fluid/fluid
Intersex
Mahu
Multi-genderNon-binary

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.]

2.3_3 What are the main reasons that you don’t tell people
you identify as non-binary/genderqueer? (Mark all that apply).
[Only respondents who selected “Non-binary/Genderqueer” in
response to 2.3 and either selected “I usually let them assume
I am a man or a woman” or “I sometimes tell them I identify as
non/binary genderqueer” in response to 2.3_2 received thisquestion.]

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

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.”2.7 People can tell I am trans even if I don’t tell them.
Always

It is just easier not to say anything.

Most of the time

I am not ready to tell people I identify as non-binary/genderqueer.

Sometimes

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) _______________

RarelyNever
2.8 What best describes your current sexual orientation?
AsexualBisexual
Gay
Heterosexual/StraightLesbianSame-gender loving
Pansexual

2.4 How comfortable are you with the word “transgender”
being used to describe you?
Very comfortableQueer
A sexual orientation not listed above (please
specify)_______

Somewhat comfortable
NeutralSomewhat uncomfortable
Very uncomfortable

2.9 Although the choices listed below may not represent yourfull identity or use the language you prefer, for this survey
please select the choice that most accurately describes yourracial/ethnic identity. (Please choose only one answer.)
Alaska Native[All respondents received the following message.] We
know 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.

Enter your enrolled or principal corporation:_________________ [required]
American IndianEnter your enrolled or principal tribe:______________ [required]
Asian/Asian American

2.5 What gender pronouns do you ask people to use to refer toyou? [Respondents could mark all answers that applied.]

Biracial/Multiracial [respondents received follow-up
question 2.10]

He, hisBlack/African American

She, hers

Latino/a/Hispanic

They, theirMiddle Eastern/North African

Ze, hir

Native Hawaiian/Pacific Islander

No pronouns. I ask people only to use my name.

White/European American

I don’t ask people to use specific pronouns.

A racial/ethnic identity not listed above (please specify)_____________ [respondents received follow-up question
2.11]

Pronouns not listed above (please specify) ____________

APPENDIX B
255

2.10 You said that you are biracial or multiracial. Please choose
the racial/ethnic identities that best describe you. (Mark all that
apply.)[Only respondents who selected “Biracial/Multiracial” in 2.9
received this question.]
Alaska Native
Enter your enrolled or principal corporation:_________________ [required]
American IndianEnter your enrolled or principal tribe:______________ [required]
Asian/Asian AmericanBlack/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) ___________________

BaptistCatholic/Roman Catholic
Church of Christ
Church of God in Christ
Christian Orthodox
Christian Methodist Episcopal
Christian Reformed Church (CRC)
EpiscopalianEvangelical
Greek Orthodox
LutheranMennonite
Moravian
Nondenominational ChristianPentecostal
Presbyterian
ProtestantProtestant Reformed Church (PR)2.11 You said that you had a racial/ethnic identity that was notlisted above. Please choose the racial/ethnic identities that best
describe 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 IndianEnter your enrolled or principal tribe:______________ [required]

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

Black/African American

Druid

Latino/a/Hispanic

Hindu

Middle Eastern/North African

Jain

Native Hawaiian/ Pacific Islander

Jehovah’s Witness

White/European American

Jewish (Please click here to specify) [Respondents
received the following drop-down list.]

Agnostic
2015 U.S. TRANSGENDER SURVEY

Reformed Church of America (RCA)

Asian/Asian American

2.12 What is your current religious or spiritual identity? (Mark allthat apply.)256

QuakerAtheistBaha’i
Buddhist
Christian (Please click here to specify) [Respondents
received the following drop-down list.]
African Methodist Episcopal

Conservative
Orthodox
ReformMuslim (Please click here to specify) [Respondents
received the following drop-down list.]
Ahmadi
Shi’ite
Sufi
Sunni

African Methodist Episcopal Zion

Native American Traditional Practitioner or Ceremonial

Assembly of God

Pagan

Rastafarian
Scientologist
Secular Humanist
ShintoSikh
TaoistTenrikyo
WiccanSpiritual, but no religious affiliation
No affiliation
A religious affiliation or spiritual identity not listed above(please specify) ________________

2.18 What is your citizenship or immigration status in the U.S.?
As a reminder, your answers are confidential and cannot be
used 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

2.13 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 as
final response choice]2.15 What is your current relationship status?
Partnered, living together

2.19 In what U.S. state or territory were you born? [Onlyrespondents who selected “U.S. citizen, birth” in 2.18 received
this question.]
I was not born in a U.S. state or territory.
[Drop-down list for all U.S. states and territories for other
response choices. Respondents who selected “New York”
received an additional drop-down choice for “New York
City.”]
2.20 Please answer each question below. (Please provide ananswer in each row.)No

Yes

Are you deaf or have serious difficulty hearing?

OO

Are you blind or have serious difficulty seeing
even when wearing glasses?

O

O

Because of a physical mental or emotional
condition, do you have serious difficulty concentrating, remembering, or making decisions?

OO

Do you have serious difficulty walking or
climbing stairs?

OO

Do you have difficulty dressing or bathing?

OO

Because of a physical, mental, or emotional
condition, do you have difficulty doing errands
alone, such as visiting a doctor’s office or
shopping?

OO

Do YOU identify as a person with a disability?

O

O

Partnered, not living together
SingleNot listed above (please specify) _________
2.16 What is your current legal marital status?
MarriedLegally recognized civil union
Registered domestic partnership
WidowedDivorced
Separated
Single, never married
2.17 Have you ever served on active duty in the U.S. Armed
Forces, Reserves, or National Guard? As a reminder, youranswers are confidential and cannot be used against you.

2.21 What is the main language that people speak in yourhome?

Never served in the military

English only

Only on active duty for training in the Reserves or National
Guard

Language(s) other than English

Now on active duty6
On active duty in the past, but not now

Armenian
ChineseFrenchGreek

APPENDIX B

German257

ItalianSome graduate work, no graduate degree

Japanese

Master’s degree (M.A, M.S., MBA)

KoreanDoctoral degree (e.g., Ph.D., Ed.D.)

PersianProfessional degree (e.g., MD, JD)

PolishPortuguese or Portuguese Creole
Russian
Serbo-Croatian
Spanish or Spanish Creole
TagalogVietnamese
YiddishA language not listed above(_____________________)English and other language(s)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 withothersLiving with a partner, spouse, or other person who pays forthe housing
Living temporarily with friends or family because I can’t
afford my own housing
Living with parents or family I grew up with because I have
not yet left homeArmenian

Living in a foster group home or other foster care

ChineseLiving in campus/university housing

FrenchLiving in a nursing home or other adult care facility

GermanLiving in a hospital

Greek

Living in military barracks

Italian

Living in a hotel or motel that I pay for myself

Japanese

Living in a hotel or motel with an emergency sheltervoucher

KoreanPersian

Living in transitional housing/halfway house

Portuguese or Portuguese Creole

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]

Russian

Living in a homeless shelter [Skip to 2.25]

Serbo-Croatian

Living in a domestic violence shelter [Skip to 2.25]

Spanish or Spanish Creole

Living in a shelter that is not a homeless shelter ordomestic violence shelter [Skip to 2.25]

PolishTagalogVietnamese

A living arrangement not listed above(please specify) _______________________

YiddishA language not listed above(_____________________)

2.24 Is there at least one telephone INSIDE your home that iscurrently working and is not a cell phone?
No

2.22 What is the highest level of school or degree you havecompleted?

2015 U.S. TRANSGENDER SURVEY

Less than 8th grade258

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/vocational
program
Associate degree in college – Academic program
Bachelor’s degreeYes
2.25 Do you have a cell phone?
No
Yes
2.26 What is the zip code where you currently
live? _____________

Section 3

No [Skip to 4.5]

3.1 At about what age did you begin to feel that your gender
was “different” from your assigned birth sex?

Yes

[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)?

4.4 Have any of your children ever stopped speaking to you orspending time with you because you are trans?
No
Yes[Drop-down list of ages]
3.3 At about what age did you first start to tell others that you
were trans (even if you did not use that word)?

4.5 How many people in each group below currently know you
are trans? (Please provide an answer in each row.)
I currently
have nopeople likethis in my
life

All
know
that
I am
trans

Most
know
that
I am
trans

Some
know
that
I am
trans

None
know
that
I am
trans

Immediate family
you grew up with(mother, father, sisters, brothers, etc.)

O

O

O

O

O

Extended family(aunts, uncles,
cousins, etc.)

O

O

O

O

O

Lesbian, gay, bisexual, 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

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 [Respondents
could 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 in
combination with any other option. Skip to 4.3 if selected.]

4.6 You said some or all of your immediate family you grew up
with (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

Yes, my current spouse/partner knows I am transNeither supportive nor unsupportive

Yes, at least one of my former spouses or partners knew I
was trans

Unsupportive

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.

Very unsupportive
4.7 Did any of your immediate family members you grew up
with (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 yourrelationshipI do not have any children [Skip to 4.5]

Kicked you out of the house

APPENDIX B

Were violent towards you
4.3 Do any of your children know you are trans?

259

Did not allow you to wear the clothes that matched yourgenderSent 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.]

4.12 On average, how supportive are your classmates withyou being trans? [Only respondents who said in response to
4.5 that some, most, or all of their classmates knew they weretrans received this question.]
Very supportive
Supportive
Neither supportive nor unsupportive

4.8 Did any of your immediate family members you grew up
with (mother, father, sisters, brothers, etc.) do any of thesethings to support you? (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 trans received thisquestion.]
Told you that they respect and/or support you
Used your preferred name

Unsupportive
Very unsupportive

Section 5
These questions are about your experiences with yourchurch, synagogue, mosque, or other faith community.

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 as
doing things like filling out papers or going with you tocourt)
Did research to learn how to best support you (such as
reading books, using online information, or attending a
conference)
Stood up for me with family, friends, or others
Supported you in another way not listed above (please
specify)____________
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 received
this question.]2015 U.S. TRANSGENDER SURVEY[Drop-down list of ages]

260

4.11 On average, how supportive are your co-workers with you
being trans? [Only respondents who said in response to 4.5
that some, most, or all of their coworkers knew they were transreceived this question.]
Very supportive
Supportive
Neither supportive nor unsupportive
Unsupportive
Very unsupportive

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 community
because you were afraid they might reject you because you
are a trans person?
NoYes
5.3 Have you ever left your spiritual/religious community
because 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

5.7 In the past year, how often did leaders or other members ofyour spiritual/religious community… (Please provide an answer
in each row.)

Erotic dancer/stripper
Fetish work (Domme, sub, switch)
Not listed above (please specify) _________________

Never

Once or
twice

A few
times

Many
times

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

6.4 Have you engaged in sex or sexual activity for any of
the following? (Please mark all that apply in each row.)[Respondents could not select “No” in combination with anyother option.]

Tell you that your religion/faith
accepts you as a trans person?

O

O

O

O

No

Yes, within
the past year

Yes, but morethan a year ago

Tell you that your being trans is asin or that your religion does not
approve of your being trans?

O

O

O

O

O

O

O

Ask you to meet with spiritual/religious leaders to stop you frombeing trans?

O

O

O

O

O

O

O

Ask you to seek medical/psychological help to stop you frombeing trans?

O

O

O

O

I engaged in sex or sexual
activity for drugs

O

O

O

Ask you to stop coming toservices or faith community
functions?

O

For something not listed
above (please specify)_______________[Response recorded as “No”
if text left blank.]

O

O

O

In the past year…

O

O

O

Section 6
These are questions about work for pay in the sex industry
and sex work. As a reminder, your answers are confidential
and 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 engaged
in 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” in
6.1 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 who
selected “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
Phone sex
Webcam work

I engaged in sex or sexual
activity for a place to sleep
in someone’s bed, at theirhome, or in their hotel room

6.5 Did you ever interact with the police while doing sex
work or when police thought you were doing sex work?
[Respondents could select multiple answer choices, but could
not 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 you
experience any of the following? (Please provide an answer ineach row.)
No

Yes

Officers kept calling me by the wrong
gender 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.

OO

Officers physically attacked me.

OO

Officers forced me to have sex or sexual
activity to avoid arrest.

OO

I experienced unwanted sexual contactfrom an officer (such as fondling, sexualassault, or rape).

O

O

I was arrested for drugs in my possession
when police stopped me for doing sex
work.

O

O

6.7 Have you ever been arrested for doing sex work or whenpolice thought you were doing sex work? [Only respondents
who selected “Yes, while I was doing sex work” and/or “Yes,when police thought I was doing sex work” in 6.5 received thisAPPENDIX B

Pornography/picture or video

I engaged in sex or sexual
activity for food261

question. Respondents could select multiple answer choices
but 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 sex
work or when police thought you were doing sex work?
[Drop-down list of 1–10 and “11 or more”]

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 national
surveys that we will use to compare with the U.S. population.
7.1 How many adults (age 18 or older) live in your household,7
including yourself? (Do not include neighbors or others who do notlive with you in your house, apartment, or single housing unit.) For
more information, click on household above.
1 [Skip to 7.5]

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 answer
choices.]

2
3
4

No

5

Yes, condoms

6

Yes, sex toys

7

Yes, items not listed above (please specify)_______________

8
9 or more

I don’t know
6.10 Did any of these things happen when you were arrested?
(Mark all that apply.)

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)

The charges were dropped.

Partner (not legally married)

I pled guilty.

Child or children

I went to trial and was found not guilty.

Grandchild or grandchildren

I went to trial and was found guilty.

Parent(s) (Mother/Father/Step-Parent(s))

Something not listed above (please specify) __________

Brother(s)/Sister(s)/Step-Brother(s)/Step-Sister(s)Other relative(s) (Aunt, Cousin, Nephew, Mother-in-law, etc.)

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.]

Foster child or foster children
Housemate(s)/Roommate(s)Roomer(s)/Boarder(s)No [Skip to 7.1]

Other non-relative(s)Yes, selling drugs

Not listed above (please specify) ________________

2015 U.S. TRANSGENDER SURVEY

Yes, other work (please specify) ________________

262

6.12 Now just thinking about the past year, were you paid for
selling drugs or other work that is currently considered illegal
in the past year? (Mark all that apply.) [Only respondents
who selected an answer choice other than “No” received thisquestion. Respondents could not select “No” in combination
with any other option.]No
Yes, selling drugs
Yes, other work (please specify) __________________

7.3 How many adults in your household are related to you8 by birth(blood relatives), adoption, or legal marriage? Don’t include partners
who 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7.4 Is any person aged 65 or older named on the lease,mortgage, or deed9 for your household?
No
YesWork part-time for an employer[Respondents who selected this answer choicereceived the following question.] Do you have morethan one part-time job?
No

7.5 How many babies and other children under age 18 live inyour household?
0 [Skip to 7.7]
1

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

2

Unemployed and have stopped looking for work3

Not employed due to disability

4Student

5

Retired6

Homemaker or full-time parent

7

Not listed above (please specify) ________________

8
9 or more
7.6 How many of the children under age 18 who live in yourhousehold are related to you10 by birth (blood relatives) or
adoption? Don’t include children who aren’t related to you bybirth or legal adoption. We will ask about them later.
0

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 7.7
received this question. Respondents could select multiple
answer choices but could not select “No” in combination withany other option.]No

1

Yes in a part-time job [Skip to 7.10]

2

Yes in a full-time job [Skip to 7.10]

3
4
5
6
7
8
9 or more

7.9 On any of your full-time or part-time jobs, are you
covered 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 could
select multiple answer choices but could not select “No” in
combination with any other option.]No

7.7 What is your current employment status? (Mark all that
apply.)
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 actively
looking for legal work outside sex work, selling drugs ,or other work that is currently considered illegal
No
YesWork full-time for an employer[Respondents who selected this answer choicereceived the following question.] Do you have morethan one full-time job?
Yes

Yes in a full-time job
7.10 Do you currently receive assistance from FOOD STAMPS(SNAP)11 or WIC12? (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 that
apply.)
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

APPENDIX BNo

Yes in a part-time job

263

Self-employment income from your own business,
profession or trade, or farm (not including undergroundeconomy)Income from dividends, estates or trusts, royalties, or
rental income

months. 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 answer
choice other than “0” in 7.6 (related children in household)received this question.]
No incomeInterest 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

1 to 5,000
5,000 to 7,499
7,500 to 9,999
10,000 to 12,499

Child support or alimony

12,500 to 14,999

Social security retirement or railroad retirement income
Private pension or government employee pension
Other retirement income

15,000 to 17,499
17,500 to 19,999
20,000 to 24,999

Social security disability benefits (SSDI)

25,000 to 29,999

Supplemental security income (SSI)

30,000 to 34,999

Workers’ comp or other disability

35,000 to 39,999

Veteran’s disability benefits and other Veteran’s benefits

40,000 to 49,999

Regular contributions from people who don’t live in thehousehold50,000 to 59,999

Income not listed above,(please specify) ___________________________

75,000 to 99,999

60,000 to 74,999
100,000 to 149,999

7.12 What was your total combined Individual Income (before
taxes) in 2014? This includes all income sources except foodstamps (SNAP) or WIC.
16

No income1 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

2015 U.S. TRANSGENDER SURVEY

17,500 to 19,999

264

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-related
adults and/or non-related children in their household received
this question. Respondents received this question if they
indicated that they had non-related adults in their household(they selected “2” or more in 7.1 and selected a higher number
in 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 in
response to 7.6 than in response to 7.5).]

20,000 to 24,999

No income

25,000 to 29,999

1 to 5,000

30,000 to 34,999

5,000 to 7,499

35,000 to 39,999

7,500 to 9,999

40,000 to 49,999

10,000 to 12,499

50,000 to 59,999

12,500 to 14,999

60,000 to 74,999

15,000 to 17,499

75,000 to 99,999

17,500 to 19,999

100,000 to 149,999

20,000 to 24,999

150,000 or more

25,000 to 29,999
30,000 to 34,999

7.13 What was your total combined Family Income17 (before
taxes) in 2014? This includes all income from all family
members who are related to you by legal marriage, birth,or adoption and who have lived with you during the last 12

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

8.5 While serving in the military, have you ever received medical
treatment related to a gender transition from a military provider(do not include VA)? [Only respondents who selected “Yes” in 8.2
or selected “Yes” in 8.3 received this question.]No
Yes

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 on
active duty in U.S. Armed Forces, Reserves, or National
Guard. These are questions about your military service. As areminder, your answers are confidential and cannot be usedagainst you.

8.6 Has any military medical or mental health provider reported
to your commanding officer that you are trans or recommended
you for discharge? (Mark all that apply.) [Only respondents who
selected “Yes” in 8.2 received this question. Respondents could
not select “No” in combination with any other option.]No
Yes, reported that I was transYes, recommended me for discharge
Does not apply to me, none of these providers knew that I
was trans

8.1 What is your current or most recent branch of service?
Air Force
Air Force Reserve

8.7 If trans people were allowed to serve openly, which of thesewould apply to you? [Only respondents who selected “Yes” in 8.2
received this question.]

Air National Guard

I would start to transition while still serving

Army

I would finish the transition that I have already started whilestill serving

Army Reserve
Army National Guard
Coast Guard
Coast Guard Reserve
Marine Corps

I would not finish the transition that I have already started
while still serving
I would leave military service so that I could transition, andnot return.

Marine Corps Reserve

I would leave military service so that I could transition, thenreturn to service after transition

Navy

I do not want to transition

Navy Reserve

I have already transitioned
None of the options listed above

8.2 Are you still serving in the military? [Only respondents
who selected “on active duty in the past, but not now” in 2.17
received this question.]No
Yes [Skip to 8.4]

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

8.3 Did you separate from military service within the last 10
years? [Only respondents who selected “on active duty in thepast, but not now” in 2.17 received this question.]
Yes
No [Skip to 8.12]Maybe
8.9 How many people in the military (who aren’t trans) believe you
are trans? [Only respondents would selected “Yes” in 8.2 received
this question.]
None [Skip to 9.1]

8.4 While serving in the military, have you ever received mental
health 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

Some
Most
All
APPENDIX B

Yes

A few

265

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 received
this question.]

Yes, recommended me for discharge.
Does not apply to me, none of these providers knew that
I was trans.

No [Skip to 9.1]
Yes

8.17 Did you ever get any type of health care through the VA?
No [Skip to 8.21]

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 changeYes
8.18 Did you ever get health care related to a gender transition
through the VA?

Supported my medical treatment

No

Ignored it or looked the other way

Yes

Took actions to discharge me
Not listed above (please specify) ______________[Only respondents who selected “No” in 8.2 and “No” in
8.3 received questions 8.12–8.21]

8.19 Do you currently get any type of health care through the
VA?
No
Yes

8.12 What was your character of discharge?
Entry Level Separation
Honorable
General
MedicalOther-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

8.20 As a trans person, have you received respectful care at
the VA?
Never
Sometimes
MostlyAlways
Does not apply to me, the VA staff do not know I’m trans8.21 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.

8.14 Did you leave the service in order to transition?
No
Yes

2015 U.S. TRANSGENDER SURVEY

8.15 Did you leave the service to avoid mistreatment/harassment?

266

No

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 have
had. As a reminder, your answers are confidential and cannot
be used against you.

Yes
8.16 Did any military medical or mental health provider tell
your 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.

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 court
proceedings)?
No [Skip to 9.6]
Yes

9.2 While you were in immigration detention, do you believe
staff, guards, or others thought or knew you were trans or
lesbian, gay, or bisexual (LGB)?

9.6 Have you ever applied for asylum in the United States?
[Respondents could select multiple answer choices but could
not select “No” in combination with any other answer choice.]

No

No [Skip to 9.8]

Yes

Yes, because I am trans or LGB
Yes, for another reason

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 to
9.5]
9.4 In total, how long were you held in solitary confinement?
[Only respondents who selected “Yes, in solitary confinement”
received this question.]

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 who
selected “No” in 9.6 received this question.]
I didn’t know how to apply.
I have access to other legal statuses.

Up to 14 days (up to two weeks)

I didn’t want to apply.

15 days to 30 days (three or four weeks)

I was afraid to apply.

31 days to 90 days (1-3 months)

I believed I was past the 1 year deadline.

91 days to 180 days (3-6 months)

A reason not listed above(please specify) _______________

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.) [Respondents
could 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:

9.9 Why didn’t you receive asylum? [Only respondents who
selected “No” in 9.7 received this question.]
I was past the 1 year deadline.
The immigration official decided that I didn’t face danger in
my country.
A reason not listed above(please specify) _______________

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:

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

Other detainees or inmates

During the immigration/naturalization process [Skip to10.13]I was denied access to hormones that I use.
I was denied gender-appropriate clothing.
None of these things happened to me.

By another method (Please tell us what method)__________________ [Skip to 10.13]

APPENDIX B

Staff or detention officers

267

10.3 For your legal name change, did you interact with judges
or court staff? [Only respondents who selected “With a court
order” in 10.2 received this question.]

10.10 Did you get legal help to change your name? [Onlyrespondents who selected “With a court order” in 10.2 received
this question.]

No [Skip to 10.7]

No

Yes

Yes, I got legal help from a paid attorney.

10.4 Do you believe the judges or court staff you interactedwith thought or knew you were trans? [Only respondents who
selected “Yes” in 10.3 received this question.]

Yes, I got help for free from a legal clinic or non-profit
organization.
Yes, I got help from a friend.
Yes, I got help from some other source.

No [Skip to 10.7]
Yes
10.5 When you interacted with judges or court staff, were you
treated with respect? [Only respondents who selected “Yes” in
10.4 received this question.]10.11 How much did your legal name change cost? Please
include the cost of legal help, court fees, newspaper
publication, etc. [Only respondents who selected “Yes, the court
granted my name change” in 10.7 received this question.]$0

I was never treated with respect$1 - $99

I was sometimes treated with respect$100 - $249

I was always treated with respect$250 - $499
$500 - $749

10.6 When you interacted with judges or court staff, did you
experience any of the following? (Please provide an answer
in each row.) [Only respondents who selected “Yes” in 10.4
received this question.]No

Yes

I was verbally harassed.

OO

I received unequal treatment/service.

O

O

They kept calling me by the wrong genderpronouns (such as he/him or she/her) or a wrong
title (Mr. or Ms.).

O

O

I was asked questions about my gender transition(such as hormones and surgical status).

OO

10.7 Did the court grant your name change? [Only respondents
who selected “With a court order” in 10.2 received thisquestion.]

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 10.1
received this question.]
I feel like my name doesn’t conflict with my gender identity
or 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).

No, the court denied my name change.

I am worried that changing my name would out me.

No, I ran out of money to complete the process. [Skip to
10.9]

A reason not listed above (please specify) ___________

Not sure yet. I am still in the process of getting my court
ordered name change.[Skip to 10.9]

2015 U.S. TRANSGENDER SURVEY$1,000 - $2,000

Yes, the court granted my name change. [Skip to 10.9]

No, I gave up. [Skip to 10.9]268$750 - $999

Not listed above (please specify) _______________ [Skipto 10.9]

10.13 Thinking about how your NAME is listed on all of your IDs
and 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.

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]

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 records
list the name I prefer” or “Some of my IDs and records list thename I prefer” in 10.13 received this question.]Birthcertificate

I do nothave
this ID/
recordI changed
my NAMEon thisID/record

I wasdenieda NAMEchangeon thisID/
record

O

O

O

I am
in theprocessof changing
my NAMEon thisID/record

I havenottried tochangemy
NAME onthis ID/
recordbut Iwant toOO

I do notwant tochangemyNAME
on thisID/
record
O

10.17 You said that none of your IDs or records list the gender
you prefer. Why haven’t you changed your gender on yourIDs or records? (Mark all that apply.) [Only respondents who
selected “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) do
not fit my gender identity.
I have not tried yet.
My request was denied.
I am not ready.

Driver’s
licenseand/or stateissuednon-driverID

O

SocialSecurity
records

O

O

O

O

O

O

Passport

O

O

O

O

O

O

Student
records(current orlast school
attended)

O

O

O

O

O

O

I am worried that changing my gender would out me.

Work ID

O

O

O

O

O

O

A reason not listed above (please
specify)______________________________

I cannot afford it.
O

O

O

O

O

I do not know how.
I believe I am not allowed. (For example, I have not had the
medical treatment needed to change my gender on ID. Or
I can’t get a doctor’s letter or other letter that is needed to
update the gender.)I am worried that if I change my gender, I might not beable to get some benefits or services. These might include
medical, insurance, employment, etc.

10.18 When I have shown IDs with my name or gender that
do not match the gender I present as… (Mark all that apply).
[All respondents received this question. Respondents could
not 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.]

10.15 Thinking about how your GENDER is listed on all of
your 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.

I have been verbally harassed.

Some of my IDs and records list the gender I prefer.

I have been assaulted/attacked.

None of my IDs and records list the gender I prefer. [Skipto 10.17]

I have been asked to leave.
I have been denied services or benefits.
I have had none of the above problems.

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 list
the gender I prefer” or “Some of my IDs and records list thegender I prefer” in 10.15 received this question.]

This does not apply to me. I have only shown IDs thatmatch.

I am inthe process ofchanging my
GENDERon thisID/record

I have nottried tochangemy
GENDERon this ID/
record but
I want to

I do notwant tochangemy
GENDERon this ID/
record

I do
not
have
this
ID/
recordI changed
my
GENDERon this ID/
recordI wasdenied a
GENDERchangeon thisID/record

Birthcertificate

O

O

O

O

O

O

Driver’s
licenseand/orstate issued
non-driver ID

O

O

O

O

O

O

SocialSecurity
records

O

O

O

O

O

O

Passport

O

O

O

O

O

O

Student
records(current orlast school
attended)

O

O

O

O

O

O

Section 11
These are questions about your current health insurance
coverage, 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

Insurance through my current or former employer or union
Insurance through someone else’s current or former
employer or union

APPENDIX B

11.2 What type of health insurance or health coverage plan doyou have? (Mark all that apply.)

Insurance I or someone else purchased through269

11.5 How far do you travel to see your trans-related health careprovider?

HealthCare.Gov or a Health Insurance Marketplace(sometimes called “Obamacare”)
Insurance I or someone else purchased directly from aninsurance company

Less than 10 miles

Medicare (for people 65 and older, or people with certain
disabilities)

25-50 miles

Medicaid (government-assistance plan for those with low
incomes or a disability)

75-100 miles

VA (including those who have ever used or enrolled for VA
health 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.”)

2015 U.S. TRANSGENDER SURVEY

50-75 miles
Over 100 miles

TRICARE or other military health care270

10-25 miles

In the past year…

Yes

No

I have notasked forthis

My health insurance company
wouldn’t change my records tolist my current name or gender.

O

O

O

My health insurance company
denied me hormone therapy
for transition.

O

My health insurance company denied me surgery fortransition.

O

My health insurance company
covers only some of thesurgical care I need for mytransition.

O

O

O

My health insurance company
covers surgery for transition,
but has no surgery providers intheir network.

O

O

O

11.6 Do you also go to your trans-related health care provider
for your routine health care, like physicals, flu, diabetes, etc.?
Yes, I see my trans health care provider for my routine
health 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, I
see a different doctor or health care provider for my routine
healthcare” received this question.]
I don’t have a routine health care provider [Skip to 11.9]
They know almost everything about trans health careO

O

They know most things
They know some things

O

O

They know almost nothing
I am not sure11.8 How far do you travel to see your routine health careprovider? [Only respondents who selected “No, I see a different
doctor or health care provider for my routine healthcare”
received this question.]
Less than 10 miles

My health insurance company
denied me gender-specifichealth care (such as Pap
smears, prostate exams,
mammogram, etc.) because I
am trans.

O

My health insurance company
denied me other routine healthcare because I am trans.

O

10-25 miles
OO

25-50 miles
50-75 miles
75-100 miles

OO

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 provider
right now [Skip to 11.7]
They know almost everything about trans healthcare

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

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

11.10 Did you buy insurance or enroll in a state Medicaid
program through a health insurance marketplace? [Onlyrespondents who selected “Yes” in 11.9 received this question.]
No [Skip to 12.1]
Yes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

12.5 Was there a time in the past 12 months when you needed
to see a doctor but did not because you thought you would bedisrespected or mistreated as a trans person?
No
Yes

Coverage through a private plan without a subsidy
12.6 In the past year, have you seen a doctor or health careprovider?

Not listed above (please specify) _______________No [Skip to 12.8]
Yes

Section 12
These are questions about your health, experiences with
doctors or health care providers, and health care.
12.1 Would you say that in general your health is…

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

Good

I had to teach my doctor or other health care provider abouttrans people so that I could get appropriate care.

O

O

Fair

A doctor or other health care provider refused to give metrans-related care.

OO

A doctor or other health care provider refused to give me other
health care (such as for like physicals, flu, diabetes).

OO

A doctor or other health care provider used harsh or abusive
language when treating me.

OO

A doctor or other health care provider was physically rough or
abusive when treating me.

OO

I was verbally harassed in a health care setting (such as a
hospital, office, clinic).

O

O

I was physically attacked by someone during my visit in a healthcare setting (such as a hospital, office, clinic).

OO

I experienced unwanted sexual contact (such as fondling, sexualassault, or rape) in a health care setting (such as a hospital,
office, clinic).

O

O

Excellent
Very goodPoor
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 of
the
time

Most
of thetime

Someof thetime

A littleof thetime

Noneof thetime…so sad that nothing could
cheer 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 during
the past 30 days. Altogether, how MUCH did these feelings
interfere with your life or activities? [Only respondents who
selected an answer choice other than “None of the time” in
12.2 received this question.]

My doctor asked me unnecessary/invasive questions about mytrans status that were not related to the reason for my visit.

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 combination
with any other option.]Counseling/Therapy
Hormone Treatment/HRT
Puberty Blocking Hormones (usually used by youth ages 9-16)
None of the above

A lot
Some
A little
Not at all

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 combination
with any other option.]Counseling/Therapy

12.4 Was there a time in the past 12 months when you needed
to see a doctor but could not because of cost?
Yes

Puberty Blocking Hormones (usually used by youth ages 9-16)
None of the above

APPENDIX B

No

Hormone Treatment/HRT

271

12.10 At what age did you begin hormone treatment/HRT
treatment? [Only respondents who selected “Hormone
Therapy/HRT” in 12.9 received this question.]

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 who
selected “Have had it” at least once in 12.15 received thisquestion.][Drop-down list of ages]
12.11 At what age did you begin taking Puberty Blocking
Hormones? [Only respondents who selected “Puberty Blocking
Hormones” in 12.9 received this question.][Drop-down list of ages][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

12.12 Are you currently taking hormones for your gender
identity or gender transition?

Yes

No [Skip to 12.15]
12.18 Have you had or do you want any of the health care
listed below for gender transition? (Please provide an answer
in each row.) [Only respondents who selected “Male” in 2.1
received this question.]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) for
hormones
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 nonlicensed 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

Have
had itWant itsome dayNot sure
if I wantthis

Do notwant
thisHair removal/electrolysis

O

O

O

O

Breast augmentation / top surgery

O

O

O

O

Silicone injections

O

O

O

O

Orchidectomy / “orchy” / removal oftestesOOOO

Vaginoplasty/labiaplasty/SRS/GRS/GCS

O

O

O

O

Trachea shave (Adam’s apple or thyroid
cartilage reduction)

O

O

O

O

Facial feminization surgery (such as
nose, 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

Off-post pharmacy
Through friends, online, or other non-licensed sources (notthrough a doctor or medical provider)
Another source not listed above(please specify) __________

12.19 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 who
selected “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]

2015 U.S. TRANSGENDER SURVEY

12.15 Have you had or do you want any of the health care listed
below for gender transition? (Please give an answer in eachrow.) [Only respondents who selected “Female” in 2.1 received
this question.]272

12.20 Have you ever de-transitioned? In other words, have you
ever gone back to living as your sex assigned at birth, at least
for a while?

Have
had itWant it
some
day

Not
sure if
I wantthis

Do notwant
this

Top/chest surgery reduction orreconstruction

O

O

O

O

Hysterectomy/“hysto” (removalof the uterus, ovaries, fallopian
tubes, 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

Pressure from spouse or partner

Other procedure not listed:_________________

O

O

O

O

Pressure from a parent

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 you
go back to living as your sex assigned at birth? (Mark all that
apply.)

Pressure from other family members
Pressure from friends
Pressure from my employer
Pressure from a religious counselor
Pressure from a mental health professional

or who you are attracted to (such as try to make you straight/
heterosexual)? [Only respondents who selected “Yes” in 13.5
received this question.]No
Yes

I had trouble getting a job.
I realized that gender transition was not for me.
I faced too much harassment/discrimination.

Section 14

It was just too hard for me.

These are questions about HIV testing and care.

Not listed above (please specify)___________________
14.1 This question is about the test for HIV, the virus that causes
AIDS. Except for tests you may have had as part of blood
donations, have you ever been tested for HIV?

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, religious
advisor)?

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]

No [Skip to 13.5]

HIV test results were unclear, meaning the test could not
determine if I have HIV. [Skip to 14.4]

Yes

I don’t know. I never received the results. [Skip to 14.4]

13.2 Did any professional (such as a psychologist, counselor,religious advisor) try to make you identify only with your sex
assigned 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 who
selected “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 any
professional (such as a psychologist, counselor, religious
advisor)?
No [Skip to 14.1]
Yes

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 received
this question.]
It’s unlikely I’ve been exposed to HIV.
I was afraid to find out if I was HIV positive (that you had
HIV).
I didn’t want to think about HIV or about being HIV
positive.
I was worried my name would be sent to the government if
I 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 getting
an HIV test.
Some other reason
No particular reason
14.4_1 Where were you last tested? [Only respondents who
selected “Yes” in 14.1 received this question.]13.6 Did any professional (such as a psychologist, counselor,religious advisor) ever try to change your sexual orientationCounseling and testing site
Emergency room
Hospital inpatient

APPENDIX B

Private doctor or HMO office273

Clinic

respondents who selected “No” in 14.7 received this question.]

Jail or prison (or other correctional facility)

I couldn’t afford it.

Drug treatment facility

I have no health insurance.

At homeI have needed other types of medical or mental healthcare.

Somewhere else
A place not listed above(please specify) _______________________

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.

14.4_2 Not including blood donations, in what month and year
was 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 “before
1984” 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 received
during emergency room visits or while staying in the hospital.
No

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 CD4
count.

Yes [Skip to 14.7]
14.6 What is the main reason you haven’t seen a doctor or
health 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.

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

I have no health insurance.
I only recently found out I have HIV.
I have needed other types of medical or mental healthcare.

14.11 Are you currently taking anti-retroviral therapy (ART)?
No [Skip to 14.13]
Yes

I didn’t know where to go for HIV care.
I wasn’t ready to look for health care for HIV.

2015 U.S. TRANSGENDER SURVEY

I didn’t feel sick enough to look for health care.

274

14.12 Do you take your anti-retroviral therapy (ART) like you’re
supposed to (regularly and as prescribed)?

My family or partner would find out I have HIV.

Never

I believed that I would be mistreated because I am trans.

RarelyI rely on a higher power/God to help my HIV.

Most of the time

A reason not listed above(please specify) _______________________All of the time [Skip to 15.1]

14.7 In the past 6 MONTHS, have you seen a doctor or healthcare provider for HIV care? Don’t include care you received
during 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 or
health care provider for HIV care in the past 6 months? [Only14.13 What is the main reason that are you not taking or not
regularly 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.

15.5 How long has it been since you last smoked part or all ofa cigarette?

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.

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago

I rely on a higher power/God to help my HIV.
15.6 During the past 30 days, on how many days did you
smoke part or all of a cigarette? [Only respondents who
selected “Within the past 30 days” in 15.5 received thisquestion.]A reason not listed above(please specify) _______________________[Drop-down list of numbers 1–30]

Section 15
These are questions about your use of alcohol, tobacco,
marijuana, or other drugs.
15.1 Have you ever had a drink19 of any type of alcoholic beverage,
smoked part or all of a cigarette, or used any of the other following
substances? (Please provide an answer in each row.)
No

Yes

Alcohol20 (such as beer, wine, or hard liquor)OO

Cigarettes21 (tobacco only)OO

E-Cigarettes or vaping products22

O

O

Marijuana or hashish (such as weed, joints,
hash, hash oil)OO

15.7 On the days you smoked cigarettes during the past 30
days, how many cigarettes did you smoke per day, on average?
[Only respondents who selected “Within the past 30 days” in
15.5 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)

23

Illegal or illicit drugs24 (such as cocaine, crack,heroin, LSD, meth, inhalants like poppers or
whippits)

O

O

Prescription drugs25 (such as Oxycontin, Xanax,
Adderall, Ambien) that weren’t prescribed toyou, or that you didn’t take as prescribed.

OO

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

[Only respondents who selected “Yes” under “Alcohol (such as
beer, wine, or hard liquor)” in 15.1 received questions 15.2–15.4]
15.2 How long has it been since you last drank an alcoholic
beverage26?
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 you
drink one or more drinks27 of an alcoholic beverage? [Onlyrespondents who selected “Within the past 30 days” in 15.2
received this question.][Drop-down list of numbers 1–30][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]

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)” 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
15.10 During the past 30 days, on how many days did you use
marijuana or hashish? [Only respondents who selected “Within
the 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/illicit
drug (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 received
this question.]
Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago

APPENDIX B

15.4 During the past 30 days, on how many days did you have
5 or more drinks28 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 30
days” in 15.2 received this question.]

More than 30 days ago but within the past 12 months

275

15.12 How long has it been since you last used any prescription
drugs not as prescribed or not prescribed to you? [Onlyrespondents who selected “Yes” under “Prescription drugs(such as Oxycontin, Xanax, Adderall, Ambien) that weren’t
prescribed to you, or that you didn’t take as prescribed” in 15.1
received this question.]

16.6 At any time in your life, have you seriously thought about
trying to kill yourself? [Only respondents who selected “No” in
16.1 received this question.]
No [Skip to 17.1]
Yes

Within the past 30 days
More than 30 days ago but within the past 12 months
More than 12 months ago

16.7 At any time in your life, did you make any plans to killyourself? [Only respondents who selected “Yes” in 16.6
received this question.]No
Yes

Section 16
These are questions about suicidal thoughts and behaviors.
Talking about suicidal thoughts or behaviors sometimes
brings up difficult emotions. If you experience any difficult
emotions because of these questions we encourage you
to 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. At
any time in the past 12 months did you seriously think about
trying 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 received
this 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]

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 16.9
received 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]

Yes
16.4 During the past 12 months, did you get medical attention
from a doctor or other health professional as a result of an
attempt to kill yourself? [Only respondents who selected “Yes”
in 16.3 received this question.]
No [Skip to 16.9]
2015 U.S. TRANSGENDER SURVEY

Yes

276

16.5 Did you stay in a hospital overnight or longer because you
tried to kill yourself? [Only respondents who selected “Yes” in
16.4 received this question.]
No [Skip to 16.9]
Yes [Skip to 16.9]

If you are experiencing any difficult emotions after answering
these questions and would like to talk to someone, pleasecontact one of the anonymous resources below:
National Suicide Prevention Helpline
1-800-273-8255
http://www.suicidepreventionlifeline.org/
Veterans Crisis Line (for veterans, military personnel, and theirfamilies)
1-800-273-8255 and Press 1
http://veteranscrisisline.net/
The Trevor Project
The Trevor Project is a phone and internet chat hotline for
LGBTQ people. For those participating in this survey, The Trevor
Project will speak or chat with people of all ages.
1-866-488-7386
http://www.thetrevorproject.org/section/get-helpSection 17

Sexual orientation

These are questions about being treated unequally, harassed,or physically attacked.

None of the above

17.1 In the past year, have you been denied equal treatment orservice, such as at a place of business, government agency, or
public place for any reason?
No
Yes
17.2 In the past year, did anyone verbally harass you for any
reason?
No
Yes
17.3 In the past year, did anyone physically attack you (such as
grab you, throw something at you, punch you, use a weapon)
for any reason?
No
Yes

17.6 In the past year, did strangers verbally harass you in
public because of your trans status, gender identity, or gender
expression? [Only respondents who selected “Trans status/
gender identity” or “Gender expression/appearance” in 17.5
received this question.]No
Yes[Only respondents who selected “Yes” in 17.3 received
questions 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 gunWith a knife

17.4 You said that you were denied equal treatment or service
in the past year. Do you believe any of those experiences were
because of your… (Mark all that apply.) [Only respondents who
selected “Yes” in 17.1 received this question. Respondents could
not select “None of the above” in combination with any otheroption.]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

Age

Unwanted sexual contact (such as rape, attempted rape,
being forced to penetrate)

Disability

Not listed above

Income level or education
Trans status/gender identity
Gender expression/appearance
Race/ethnicity

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 of
the above” in combination with any other option.]

Religion/spirituality

Age

Sexual orientation

Disability

None of the above

Income level or education
Trans status/gender identity

17.5 You said that you have been verbally harassed in the past
year. 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.]Gender expression/appearance
Race/ethnicity
Religion/spirituality
Sexual orientation
None of the above

Age
Disability
Income level or education
Trans status/gender identity
Gender expression/appearance

17.10 In the past year, did strangers physically attack you in
public because of your trans status, gender identity, or gender
expression? [Only respondents who selected “Trans status/
gender identity” or “Gender expression/appearance” in 17.9
received this question.]No

Religion/spirituality

Yes

APPENDIX B

Race/ethnicity

277

Section 18

Section 19

These are questions about unwanted sexual contact. Somepeople get sexual attention that they don’t want and don’t
ask 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 helplines
listed at the end of the section.

These are questions about any harm caused by a current
or former romantic or sexual partner. This could include
physical, emotional, or financial harm.

18.1 Have you ever experienced unwanted sexual contact (suchas oral, genital, or anal contact or penetration, forced fondling,rape)?

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

No [Skip to 19.1]

Tried to keep you from seeing or talking to your family
or friends

O

O

Yes

Kept you from having money for your own use

OO

Kept you from leaving the house when you wanted
to go

O

O

Hurt someone you loveOO

A relative

Threatened to hurt a pet or threatened to take a pet
away from youOO

A friend/acquaintance

Wouldn’t let you have your hormonesOO

A law enforcement officer

Wouldn’t let you have other medications

OO

A health care provider/doctor

Threatened to call the police on you

OO

Threatened to “out” youOO

Told you that you weren’t a “real” woman or manOO

Stalked you

OO

Threatened to use your immigration status against youOO

18.2 Who did this to you? (Mark all that apply.)
A partner/ex-partner

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 you
experienced unwanted sexual contact (such as oral, genital, or
anal contact or penetration, forced fondling, rape)?
No
Yes
If you are experiencing any difficult emotions after answering
these questions and would like to talk to someone, pleasecontact one of the anonymous resources below:

2015 U.S. TRANSGENDER SURVEY

Veterans Crisis Line (for veterans, military personnel, and theirfamilies)
1-800-273-8255 and Press 1
http://veteranscrisisline.net/

278

FORGE Transgender Sexual Violence Project414-559-2123
http://forge-forward.org/anti-violence/for-survivors/ to list ofresources
National Sexual Assault Hotline
800-656-HOPE (4673)
https://ohl.rainn.org/online/

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

OO

Slapped you

OO

Pushed or shoved you

OO

Hit you with a fist or something hard

O

O

Kicked you

OO

Hurt you by pulling your hair

O

O

Slammed you against something

O

O

Forced you to engage in sexual activity

OO

Tried to hurt you by choking or suffocating you

OO

Beaten you

OO

Burned you on purpose

O

O

Used a knife or gun on you

OOSection 20
These are questions about your experiences with bathrooms
while in public places, at work, or at school.

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

20.1 In the past year, did anyone tell or ask you if you wereusing the wrong bathroom?

A bathroom at another location(please specify) _____________

No
Yes
20.2 In the past year, did anyone stop you from entering or
deny 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 bathroom
in the past year. Where did this happen? (Mark all that apply.)[Only respondents who selected “Yes, verbally harassed” in
20.3 received this question.]20.7 In the past year, did you avoid going to the bathroom
because you were afraid of having problems using them? This
would 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 themNot listed above (please specify) _____________
20.8 Did you experience any of the following because you
avoided using bathrooms in public places, at work, or at
school? (Mark all that apply.) [Only respondents who selected
an answer choice other than “I have never avoided them” in
20.8 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 avoiding
bathrooms
Not listed above (please specify) ______________

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 bathroom
in the past year. Where did this happen? (Mark all that apply.)[Only respondents who selected “Yes, physically attacked” in
20.3 received this question.]
A bathroom in a public place (such as a restaurant,
shopping mall, movie theater, etc.)

Section 21
These are questions about things that might have happened
to 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 currently
considered illegal.
No [Skip to 21.6]
Yes

A bathroom at my workplace
A bathroom at my school
A bathroom at another location(please specify) _____________No [Skip to 21.4]
Yes
21.3 Do you believe that you were ever laid off or lost a job
because of your… (Mark all that apply.) [Only respondents who
selected “Yes” in 21.2 received this question. Respondents
could not select “None of the above” in combination with anyother option.]

APPENDIX B

20.6 You said that you experienced unwanted sexual contact
in 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.]21.2 Have you ever lost a job or been laid off?

279

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 of
your… (Mark all that apply.) [Only respondents who selected
a 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

Age

Race/ethnicity

Disability

Religion/spirituality

Income level or education

Sexual orientation

Trans status/gender identity

None of the above

Gender expression/appearance

21.4 Have you ever been fired or forced to resign from a job?
No [Skip to 21.6]

Race/ethnicity
Religion/spirituality
Sexual orientation

Yes

None of the above

21.5 Do you believe that you were ever fired or forced to resign
because of your… (Mark all that apply.) [Only respondents who
selected “Yes” in 21.4 received this question. Respondents
could not select “None of the above” in combination with anyother option.]Age21.8_2 Do you believe that any of the times that you were not
hired for a job you applied for in the past year were becauseof your… (Mark all that apply.) [Only respondents who selected
a 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.]

Disability

Age

Income level or education

Disability

Trans status/gender identity

Income level or education

Gender expression/appearance

Trans status/gender identity

Race/ethnicity

Gender expression/appearance

Religion/spirituality

Race/ethnicity

Sexual orientation

Religion/spirituality

None of the above

Sexual orientation
None of the above

21.6 Now just thinking about the past year, did you apply for a
job 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” in
combination with any other option.]
No [Skip to 22.1]
Yes, I applied for a job
Yes, I worked at job or businessAge2015 U.S. TRANSGENDER SURVEY

21.7 In the past year, how many times have you been… (Pleaseprovide an answer in each row.)

280

0
times

1
time

2
times

3
times

4
times

5 or
more
times

Denied a promotion
at a job

O

O

O

O

O

O

Not hired for a job
youapplied for

O

O

O

O

O

O

Fired or forced toresign from a job

O

O

O

O

O

O

In the past year…

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 selected
a 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.]Disability
Income level or education
Trans status/gender identity
Gender expression/appearance
Race/ethnicity
Religion/spirituality
Sexual orientation
None of the above

[Only respondents who selected “Trans status/gender identity”
or “gender expression/appearance” in 21.8_3 received
questions 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 describe
your response. (Mark all that apply.)

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, to avoid trans discrimination at work…
(Please provide an answer in each row.)No

Yes

I asked for a transfer to a different position/department at
my job in the past year

OO

I stayed in a job I’d prefer to leave in the past year

OO

I didn’t seek a promotion or a raise in the past year

OO

I quit my job in the past year

OO

I made an official complaint.

I had/have a job for which I am over-qualified (in the past
year)

O

O

Not listed above (please specify) _________________[Skip to 22.1]

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

OO

I did not ask my employer to use the pronouns I prefer inthe past year (such as he, she, or they)OO

I hid the fact that I have transitioned gender already in thepast year

OO

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]

21.10 You said that you contacted a lawyer in response to being
fired or forced to resign from a job in the past year. What did
the 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.

22.2 In the past year, did any of these things happen to you
because of trans discrimination at work? (Please provide ananswer in each row.)

The lawyer filed a lawsuit for me.
Not listed above (please specify) _________________
21.11 You said that you made an official complaint in response
to being fired or forced to resign from a job in the past year.
Where did you make the official complaint? (Mark all that
apply.) [Only respondents who selected “I made an official
complaint” 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) _________________

No

Yes

My employer/boss forced me to resign in the past year.

OO

My employer/boss forced me to transfer to a different
position/department at my job in the past year.

OO

My employer/boss removed me from direct contact withclients, customers, or patients in the past year.

OO

My employer/boss told me to present in the wrong genderin order to keep my job in the past year.

OO

My employer/boss gave me a negative job review in thepast year.

OO

My employer/boss and I could not work out an acceptablebathroom situation in the past year.

OO

My employer/boss did not let me use the bathroom I
should be using based on my gender identity in the past
year.

O

O

My employer/boss or coworkers shared information aboutme that they should not have in the past year.

OO

22.3 In the past year, did any of these things happen to
you 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
APPENDIX B
281

Age

Section 23
These are questions about experiences you may have hadwith housing.

Disability
Income level or education
Trans status/gender identity

23.1 Have you ever experienced homelessness? Experiencing
homelessness 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.

Gender expression/appearance
Race/ethnicity
Religion/spirituality
Sexual orientation

No

None of the aboveYes
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 have
had that housing situation in the past year. For example, if you
didn’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 experienced homelessness.29

O

O

O

I had to move back in with family members orfriends.

OOO

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

24.3 In the past year, did any of these things happen to you in
the 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.

OO

I decided to dress/present as the wrong gender to feel safe
in a shelter.

O

O

They required me to dress/present as the wrong gender inthe shelter.

OO

I decided to leave a shelter because of poor treatment or
unsafe conditions, even though I had no place to go.

OO

24.4 In the past year, did any of these things happen to you
in a homeless shelter because you are trans? (Mark all that
apply.) [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

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, did
you seek shelter in a homeless shelter? (Mark all that apply.)[Respondents could not select a “No” answer in combination
with a “Yes” answer.]
Yes, and I stayed at one or more shelters. [Skip to 24.3]

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.

2015 U.S. TRANSGENDER SURVEY

Yes, but I was denied access to one or more shelters.

282

No, because I feared I would be mistreated as a transperson [Skip to 25.1]
No, for other reasons [Skip to 25.2]

25.1 In the past year, have you visited or used services in anyof these places? (Mark all that apply.) [Respondents could
not 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

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.]

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)Public assistance/government benefits office (such as
SNAP, WIC)No
Yes

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)

26.3 Do you believe that any of your classmates, teachers or
school staff in K-12 thought or knew you were lesbian, gay,bisexual, or queer (LGBQ)?
No
Yes

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 for each of the locations
that they did not select in 25.1.]
No[Location not selected in 25.1]

YES

trans.

OO

I was physically attacked because people thought I wastrans.

OO

I experienced unwanted sexual contact because people
thought I was transOO

I wasn’t allowed to dress in the way that fit my gender
identity/expression.

OO

I was disciplined for fighting back against bullies.

OO

I was verbally harassed because people thought I wasO

25.3 In the past year, when you visited or used services atthese places, do you think the staff or employees knew or
thought you were trans? (Please give an answer for eachplace.) [Respondents received this question for each of thelocations that they selected in 25.1.]
NoYes

I believe I was disciplined more harshly because teachers/staff thought I was trans.

O

O

O

O

I left a school because the mistreatment was so bad.

O

O

I was expelled from school.

OO

25.4 In the past year, when you visited or used services atthese places, did any of these things happen to you because
you are trans? (Please provide an answer for each location.)[Respondents received this question for each of the locations
that they selected in 25.1.]
Denied equal
treatment orservice

Verbally
harassed

Physicallyattacked

None of thesethings happened
to me at this place

O

O

O

O

[Location
selected in
25.1]

NO

Yes (I did NOT visit because I
thought I would be mistreated)O[Location selected in 25.1]

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” in
26.1 or “Yes” in 26.2 received this question.]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 people
thought I was LGBQ.

OOI was physically attacked because people
thought I was LGBQ.

OOI experienced unwanted sexual contact
because people thought I was LGBQ.

OOI wasn’t allowed to dress in a way that fit mygender identity/expression.

OO

I was disciplined for fighting back againstbullies.

O

ONo

I left a school because the mistreatment wasso bad.

OO

Yes [Skip to 26.3]

I was expelled from school.

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 between
Kindergarten and 12th grade?

[Only respondents who selected a level of educational
attainment higher than “high school graduate” in 2.22 received
questions 26.6–26.9.]

APPENDIX B

26.2 Do you believe that any of your classmates, teachers, or
school staff in Kindergarten through 12th grade (K-12) thought
you were trans? [Only respondents who selected “No” in 26.1
received this question.]283

26.6 Now just thinking about classmates, professors, or staff atyour college or vocational school, did they think or know you
were trans?
No [Skip to 26.9]
Yes
26.7 Were you harassed (verbally, physically, or sexually) atcollege or vocational school because people thought or knew
you were trans? [Only respondents who selected “Yes” in 26.6
received this question.]
No [Skip to 26.9]
Yes
26.8 Did you have to leave your college or vocational school
because the harassment was so bad? [Only respondents who
selected “Yes” in 26.7 received this question.]

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

No
Yes

Section 28
26.9 Did you leave or were you forced to leave a college or
vocational 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.

These are questions about things that happened to you with
police, in jail, in prison, or in a juvenile detention center.
28.1 If you needed help from the police, how comfortable would
you feel asking them for help?
Very comfortable
Somewhat comfortable
NeutralSomewhat uncomfortable
Very uncomfortable

Section 27
These are questions about things that may have happened to
you when going through airport security.
27.1 In the past year, have you gone through airport security in
the United States?
No [Skip to 28.1]

2015 U.S. TRANSGENDER SURVEY

Yes

284

27.2 When you went through airport security in the past
year, 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 or
items (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).

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 law
enforcement officers you interacted with thought or knew you
were trans?
None of the officers thought or knew I was trans. [Skip to
28.6]
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.

28.5 In the past year, when you interacted with police or otherlaw enforcement officers, did any of these things happen to
you? (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.

OO

Officers physically attacked me.

OO

Officers forced me to engage in sexual activity to
avoid arrest

OO

I experienced unwanted sexual contact from an
officer (such as fondling, sexual assault, or rape)OO

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 juvenile
detention 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”]

28.6 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 arrested
because you were trans?

28.14 In the past year, during your time in jail, prison or juvenile
detention facility were you physically assaulted or attacked byfacility staff?
No [Skip to 28.16]
Yes

No
Yes
28.8 In the past year, at any time were you held in jail, prison,or juvenile detention?

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”]

No [Skip to 29.1]
Yes[Only respondents who selected “Yes” in 28.8 received
questions 28.9–28.20.]
28.9 In the past year, what types of jail, prison or juvenile
detention facility were you in? (Mark all that apply.)

28.16 In the past year, during your time in jail, prison or juvenile
detention facility were you physically assaulted or attacked byanother inmate?
No [Skip to 28.18]
Yes

Federal prison

28.17 In the past year, how many times did this happen to you?
[Only respondents who selected “Yes” in 28.16 received thisquestion.]

State prison[Drop-down list of numbers 1–10 and “11 or more”]

Local jailHolding cellState juvenile system

28.18 Before your time in jail, prison, or juvenile detention, were
you taking hormones?

Locally or privately-operated juvenile facilities

No [Skip to 29.1]

Other correctional facility(please specify) _____________________

Yes

28.10 In the past year, during your time in jail, prison or juvenile
detention facility were you physically forced, pressured, ormade to feel that you had to have sex or sexual contact withany facility staff?
Yes

No
Yes
APPENDIX B

No [Skip to 28.12]

28.19 Did you have a prescription for the hormones you weretaking?

285

28.20 In the past year, during your time in jail, prison,or juvenile detention, were you not allowed to take yourhormones?
No
Yes

I wanted to avoid being harassed by election officials
because 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

Section 29
Now we have some questions about voting and registration.
29.1 In any election, some people are not able to vote because
they are sick or busy or have some other reason, and others do
not want to vote. Did you vote in the election held on Tuesday,
November 4, 201430?
No
Yes [Skip to 30.1]
29.2 Were you registered to vote in the November 4, 2014
election31? [Only respondents who selected “No” in 29.1
received this question.]No
Yes [Skip to 29.4]

Transportation problems
Didn’t like candidates or campaign issues.
Registration problems (for example, I didn’t receive an
absentee ballot or wasn’t registered in current location)
Bad weather conditions
Inconvenient hours, polling place, or hours or lines too
long
I didn’t have the identification documents (ID) I needed tovote.
My identification documents (ID) do not match my current
name, gender, or have an old photo.
My gender/name on my identification document (ID) does
not match my voter registration.
I was not allowed to vote by a poll worker or election
official because I am trans.
A reason not listed above(please specify) _________________________

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 officials
because 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 residency
requirements.
Permanent illness or disability

Section 30
These are questions about civic and political activities.
30.1 Do you agree or disagree with the following statement
about political affairs in this country?
Someone like me can’t really influence government decisions.
Strongly agree
Agree
Neither agree nor disagree
DisagreeStrongly disagree

Difficulty with English
Not interested in the election or not involved in politics.
2015 U.S. TRANSGENDER SURVEY

My vote would not make a difference.

286

Not eligible to vote because of a criminal/felony
conviction.
Not eligible to vote for a reason other than a criminal/
felony conviction.
A reason not listed above(please specify) _____________________

30.2 People may be involved in civic and political activities. In
the last Presidential election in 201232 did you… (Please provide
an 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 …
Volunteer or work for a Presidential campaign
Volunteer or work for another political candidate,issue, or cause
Give money to a Presidential campaign

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.]

Give money to another political candidate, issue, or
cause

No

Yes

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

Section 31
This question asks for your opinion on the most important policy
priorities for trans people in the United States.
This is a two-part question:

Contacted a government official
Worked with others in your community to solve a
problemServed on a community board
Written a “letter to the editor”

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 to
3 response choices in the last column.]

Commented about politics on a message board orInternet site

Veryimportant

ImportantNot very
important

HIV/AIDSO

OO

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

Republican [Skip to 30.6]

Mistreatment in prisons/jails

O

O

O

Democrat [Skip to 30.6]

Immigration reform

O

O

O

Independent

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

RacismOOO

PovertyO

OO

Held a publicly elected office30.4 In politics, as of today, do you consider yourself a
Republican, a Democrat, or an 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

31.2 Of these issues, please select your top 3 most important issues.

Conservative

Issue#1 [Drop-down list of issues listed in 31.1]

Moderate

Issue#2 [Drop-down list of issues listed in 31.1]

LiberalIssue#3 [Drop-down list of issues listed in 31.1]

Very liberal

Section 32
32.1 Is there anything else that you would like to tell us about yourexperiences of acceptance or discrimination so we can better
understand 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 about
your experiences of acceptance or discrimination so we can better
understand your experiences. Please do not provide any informationthat could be used to identify you, such as your name or contact
information. Your response will be anonymous. [Only respondents
who selected “Yes” in 32.1 received this question.]

SUBMIT

APPENDIX B[Text box]
Please enter your survey responses by clicking on the submit button
below:

287

[Once completed, responses were submitted and respondents
were directed to the Thank You Page hosted by NCTE.]

Thank You Page
THANK YOU FOR MAKING YOUR VOICE HEARD
YOUR SURVEY HAS BEEN SUBMITTED
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Want to win one of the cash prizes?
Give us your info here.
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Phone (optional)[ ] Send me the results of the survey when you release
them!
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one prize of $500 and two prizes of $250!

RESOURCES
We recognize that answering some of the questions on thissurvey may have been hard. If you are experiencing any difficult
emotions after answering the questions and would like to talkto someone, please contact one of the anonymous resources
below:
National Suicide Prevention Helpline
1-800-273-8255
http://www.suicidepreventionlifeline.org/
FORGE Transgender Sexual Violence Project414-559-2123
http://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
http://veteranscrisisline.net/
The Trevor Project
The Trevor Project is a phone and internet chat hotline for
LGBTQ people. For those participating in this survey, The Trevor
Project will speak or chat with people of all ages.
1-866-488-7386
http://www.thetrevorproject.org/section/get-help
National Sexual Assault Hotline
800-656-HOPE (4673)
https://ohl.rainn.org/online/

SUBMIT

ENDNOTES | APPENDIX B
12015 U.S. TRANSGENDER SURVEY

2288

Respondents who were sent to disqualification page #2
received the following message: “Based on your answers,
you are not eligible to complete this survey. Thank you
for your interest in participating in this study. For more
information about this project please visit the NCTE
website: http://www.ustranssruvey.org.”
Respondents who were sent to disqualification page #1
received the following message: “Thank you for yoursurvey responses. We’re interested to learn more about
your identity and experiences. If you would like to tell us
more, please respond to the following questions. Please
do not provide any information that could be used to
identify 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 gender
identity or expression. [Text box.]”3

See note 1.

4

See note 2.

5

See note 2.

6

Respondents received the following hyperlinked definition
for “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 as
a commissioned officer of the Public Health Service or
the National Oceanic and Atmospheric Administration,or its predecessors, the Coast and Geodetic Survey orEnvironmental Science Service Administration. Active duty
also applies to a person who is a cadet attending one of
the five United States Military Service Academies. For a
person with service in the military Reserves or National
Guard, mark the “Only on active duty for training in the
Reserves or National Guard” box if the person has neverbeen called up for active duty, mobilized, or deployed. Fora person whose only service was as a civilian employee
or 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 duty
and no other period of service.”
7

Respondents received the following hyperlinked definition
for “household”: “A household includes all the adults
who 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 yourself
and your adult family members who live with you.

8

Respondents received the following hyperlinked noteregarding the term “related to you”: “Include only adults
you’re related to by blood, legal adoption, or legal
marriage that is recognized by the U.S. government. Do
not 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 not
owned or rented by anyone who lives with you, include
any adult in the home except roomers, boarders, or paid
employees.”

10

Respondents received the following hyperlinked noteregarding the term “related to you”: “Do not include
children that are not related to you by birth or by legal
adoption. For instance, your unmarried partner’s children
would not be included here unless you have legally
adopted them. We ask about these members of yourhousehold elsewhere in the survey.”

11

Respondents received the following hyperlinked definition
for “SNAP”: “The Supplemental Nutrition Assistance
Program (SNAP) is sometimes called the Food Stamp
program. It helps people who have low or no income tobuy food, usually with an EBT card.”

12

Respondents received the following hyperlinked definition
for “WIC”: “‘WIC’ stands for ‘Women, Infants, and Children.’It’s the short name for the Special Supplemental Nutrition
Program 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.”
Respondents who selected this answer choice received
the message and clicked “OK” to proceed: “Please notethat for upcoming questions about income, don’t include
food stamps (SNAP) as income.”

14

Respondents who selected this answer choice received
the message and clicked “OK” to proceed: “For upcoming
questions about income, don’t include assistance from
WIC 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 questions

16

Respondents received the following hyperlinked
definition for “Individual Income”: “Individual income”
includes money from jobs, employment, net income frombusiness, income from farms or rentals, income from selfemployment, pensions, dividends, interest, social security
payments, 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 definition
for “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 members
in your household who are 15 years of age or older in
2014. Do not include assistance from food stamps (SNAP)
or WIC as income.”

18

Respondents received the following hyperlinked definition
for “Household Income”: “‘Household income’ includes
you and all members of your household who have lived
with you during the past 12 months and includes moneyfrom jobs, employment, net income from business, income
from 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 include
any time when you only had a sip or two from a drink.”

20

Respondents received the following hyperlinked definition
for “alcohol”: “Alcoholic beverages, such as beer, wine,brandy, and mixed drinks.”

21

Respondents received the following hyperlinked definition
for “cigarettes”: “Cigarettes made of tobacco. Do notinclude electronic cigarettes (E-cigs).”

22

Respondents received the following hyperlinked definition
for “e-cigarettes or vaping products”: “This includes
electronic cigarettes (e-cigs or e-cigarettes), personal
vaporizer (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 definition
for “marijuana or hashish”: “Marijuana is also called pot or
grass. 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.”

APPENDIX B

13

about income, don’t include assistance from food stamps(SNAP) or WIC as income.”

289

24

Respondents received the following hyperlinked definition
for “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 poppers
or whippits. We are not interested in times when you
inhaled a substance accidentally— such as when painting,cleaning an oven, or filling a car with gasoline.”

25

Respondents received the following hyperlinked definition
for “prescription drugs”: “Use of prescription drugs in any
way a doctor did not direct you to use them. When you
answer this question, please think only about your use of
the prescription drug in any way a doctor did not direct
you to use it, including:• Using it without a prescription of your own• Using it in greater amounts, more often, or longer than
you were told to take it2015 U.S. TRANSGENDER SURVEY• Using it in any other way a doctor did not direct you to
use it”

290

29

Respondents received the following hyperlinked definition
for “homelessness”: “Experiencing homelessness includes
such things as staying in a shelter, living on the street,living out of a car, or staying temporarily with family or
friends 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 times
when 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 mixed
drink with liquor in it. We are not asking about times when
you 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 in
it. 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.”

Appendix C
Detailed Methodology
Survey Sources

W

APPENDIX C

hen developing the survey instrument, the research team focused on creating a questionnairethat could provide data to address both current and emerging needs of transgender people
while gathering information about disparities that often exist between transgender people andnon-transgender people throughout the United States. To achieve this, questions were included that would
allow comparisons between the U.S. Transgender Survey (USTS) sample and known benchmarks for the
U.S. population as a whole or populations within the U.S. Consequently, questions were selected to best
match 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 source
survey or with modifications, as follows:

291

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 Factor
Surveillance System (BRFSS)

12.2 & 12.3; 14.1; 14.3

National Health Interview
Survey (NHIS)

16.6–16.12

National Comorbidity Survey
Replication (NCS-R)

17.7 & 17.8

National Crime Victimization
Survey (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 November
Supplement

30.4–30.6

Gallup Daily Tracking Poll
(U.S. Political and Economic
Daily Tracking)

Data Cleaning2015 U.S. TRANSGENDER SURVEY

Data cleaning is the process of detecting andremoving some survey responses (e.g., duplicate
responses, incomplete responses, illogicalresponses) in order to improve the quality of thesample. Cleaning of the USTS data proceededin the following steps: (1) flagging and removal of
respondents 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.

292

The first step was to remove survey responses
from individuals who did not meet basic eligibility
criteria for the survey. Respondents had to consent
to 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 needed
to identify as transgender—including non-binary
identities—or meet other criteria related to theirgender identity or expression. Additionally,
respondents were asked if they had alreadycompleted this survey before. Respondents
who 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 basic
eligibility criteria to a disqualification page, but
their responses were included in the initial dataset
and had to be removed. Additional analyses ofthe dataset were completed to remove ineligible
respondents. Respondents who provided amonth and year of birth that indicated they were
under 18 at the time they took the survey were
flagged and removed from the dataset. Additional
analyses of responses related to gender identity
and transition status in Sections 1 and 2 of thesurvey were completed to flag additional ineligible
respondents, which included those who did not
identify as transgender or with a range of othergender-related experiences associated withtransgender communities. Please see the “Variable
Recoding Process” section below for a moredetailed description of this process. In all, 10,304
responses were removed from the initial dataset
due to being ineligible to take the survey.
Incomplete responses were then removed
from the sample based on a requirement that
respondents minimally complete Section 1 andspecific demographic questions in Section 2 ofthe questionnaire. Missing data was otherwise
allowed provided respondents completed thesequestions. The required Section 2 questions
were as follows: 2.1, 2.3, 2.6, 2.8, 2.9, either 2.13
or 2.14, 2.15, 2.18, 2.19, 2.22, 2.23, and 2.26. It wasdetermined that these questions would provide
key information about respondents, including
questions used to determine eligibility, and thesequestions were used to set a minimal level ofsurvey “completeness” the research team was
willing to accept for a respondent to remain in thedataset. In all 515 respondents were removed forincomplete survey responses.

Duplicate survey responses were then flagged andremoved. Duplicates were determined based on
all quantitative responses in the survey. Qualitative(“write-in”) responses were not considered when
determining 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 one
illogical response were flagged and removed
from the final dataset. An illogical response is
one that provides information that contradicts
other information provided by a respondent. For
instance, the USTS survey included 16 questions
related to respondents’ age, including current
age, 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 who
reported they attempted suicide at an age older
than their current age. An illogical response could
be due to an accidental miscode on the part of the
respondent, meaning they accidentally filled out aquestion incorrectly, or could be evidence that a
respondent is not taking the survey in earnest. The
research team considered a respondent having
more 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 removed
from 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, or
military base

1,052

Not eligible: gender identity or expression
did not meet minimum criteria

1, 789Duplicate responses

329

Incomplete responses

515

Illogical responses

53

27,715

When a dataset has substantial amounts of missing
data, such as over 5% missing data, researchers
should consider techniques to impute the missing
data.2 The research team conducted an analysis
to determine whether missing data should be
imputed in the USTS dataset. The percentageof missing data due to item non-response (notincluding intentionally missing data due to skip
logic) on any original quantitative variable (notincluding recoded variables or “write-in” variables)
was less than 5%, with the exception of two
variables. Question 14.4 regarding the month of
respondents’ last HIV test had 5.9% missing data
(Q. 14.4: “Not including blood donations, in whatmonth was your last HIV test?”). This item may
have had relatively higher item non-response
because respondents may have been more likely
to recall the year of their last HIV test, which was
also requested in Q. 14.4, than the month. Question
7.11 regarding respondents’ sources of income had
6.2% missing data (Q. 7.11: “What are your current
sources of income?”). This may reflect a general
reluctance to provide financial information that isroutinely found in item non-response to incomerelated questions in population-based surveys.
The research team determined that due to the
low amount of missing data, including minimal
missing data on questions that routinely have highitem non-response in population-based surveys(e.g., individual and household income), missing
data imputation was not necessary for this report.
Future researchers are encouraged to investigate
the impact of data imputation when using thisdataset.

APPENDIX C

Final sample:

Missing Data and
Imputation

293

Variable Recoding
Process

2015 U.S. TRANSGENDER SURVEY

The initial final dataset contained 1,140 uniquevariables based on 324 items respondents
could have received in the survey. Most of thesevariables required quantitative or qualitative
recoding 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 researcher
and 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 corrections
and the variable was then considered a final
recode. In all, the research team produced over
2,000 recodes used to generate the findingspresented in this report.

294

Respondents to the survey had many opportunities
to write in responses to questions by selecting ananswer such as “none of the above” and writing
in a unique response or responding to an openended question. The research team reviewed
approximately 80,000 write-in responses forrecoding. The recoding process included twocoding teams that conducted initial coding, which
was reviewed by another coding team and areasof disagreement were flagged. A simple percent
agreement score was calculated to assess interrater reliability. For nearly all variables that wererecoded, the coding team and the review teamhad 90% or higher agreement, two variables had
agreement between 80% and 90%, and three fell
below 80% agreement (Q. 1.7 (79%), Q. 9.3 (67%),
and Q. 21.11 (70%)).
In the case of a question with write-in responses
where only one answer option was allowed,
write-in responses were reviewed to see if they
could be recoded into existing answer options. If

substantial numbers of respondents wrote in thesame response, a new answer option could be
added to the question to reflect those responses.
If it was not feasible for a response to be recoded
into 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 similar
process took place. However, if a substantial
number of responses could be grouped into a new
answer option and a new variable was created
to describe those responses, those respondents
also remained in the “none of the above” category.
Therefore, new answer options based on write-inquestions that allowed multiple answer choices
should be viewed as a subset of the “none of theabove” category.
A different recoding process was established inorder to recode respondents into four gender
identity categories: transgender women,transgender men, non-binary people, andcrossdressers. To categorize respondents basedon gender identity, the research team relied on
respondents’ self-selected gender category in
Q. 2.3, which was cross-tabulated with Q. 2.1 toidentify transgender men and transgender women.
For instance, the researchers would categorize
someone assigned female at birth in Q. 2.1 who
identifies as a man in Q. 2.3 as a transgender
man and would categorize someone assigned
male at birth in Q. 2.1 who identifies as a woman
in Q. 2.3 as a transgender woman. In a few cases(n=439), a respondent selected female in Q. 2.1
and woman in Q. 2.3 or selected male in Q. 2.1
and man in Q. 2.3. These respondents required
additional analysis of their survey responses
in order to determine if they met the eligibility
criteria for the survey, and if so, to categorize
them as transgender men, transgender women,
non-binary people, or crossdressers. The researchteam relied on questions in Sections 1, 2, and 12
to help make these determinations. Members

of the research team completed initial recodingof these respondents to indicate whether they
were eligible for the survey, and if so, in which ofthese categories they should be included. These
initial 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 ineligible
for the survey based on this recoding and review
process and were removed from the final dataset.

population.4 Studies have found no differencein educational attainment or lower educational
attainment and have found lower incomesamong transgender people as compared to
non-transgender people.5 The USTS sample hasa higher percentage of white, young, and more
highly educated respondents than the U.S. general
population, which may be due, at least in part, tointernet survey bias. However, the younger age isalso likely due to the transgender population being
younger overall. The USTS sample also has higher
incidence of low incomes as compared to the U.S.
population, which goes against the typical internet
survey bias. Based on the existing research about

Weights

the transgender population, there is not adequate
information available to attempt to correct forbias in the sample based on age, educational
attainment, or income. However, there is sufficientevidence to indicate that the race and ethnicity of
the USTS sample does not reflect the racial andethnic makeup of the U.S. transgender population
as a whole.

The USTS sample was a purposive sample thatwas created using direct outreach, modified
venue-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 online
surveys have a known bias, particularly in regard
to demographic representation. Online samples
tend to over-represent those who are white,
young, more highly educated, and with higher
incomes.3 In order to address these biases, at leastin part, the research team created and utilized
weights to adjust the USTS sample in certain
ways in order to better represent what is believed
to be the actual population characteristics oftransgender people in the U.S. and in order tomake more accurate comparisons with populationbased samples of the U.S. population.

APPENDIX C

Prior research using probability samples oftransgender adults have found that transgenderadults differ from the general population in regard
to race and ethnicity and age, with those that
identify as transgender being more likely to bepeople of color and younger than the general“Weighting” is a common statistical techniqueused to adjust data drawn from a sample of a
population to be more representative of the
population from which the sample was drawn.
For example, in a survey sample of the U.S.
population, the proportion of respondents aged
18–24 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 of
the U.S. population. To help correct for samplingbias in the USTS sample in regard to race andethnicity, U.S. population weights based on
the American Community Survey for race andethnicity were created as part of the standard
weight applied to all findings in this report. While
this may still over-represent white respondents
relative to the makeup of the transgender adult
population, this weighting procedure brings the
sample closer to what is believed to be the true
population distribution for race and ethnicity for295

2015 U.S. TRANSGENDER SURVEY
296

transgender people in the U.S. The standard
weight also includes an adjustment to the 18-yearold category, described in more detail below.
Additional survey weights were created for the
purposes of comparability with federal government
and national data sources, including weights forage and educational attainment.6 These weights
were applied in addition to the standard weight
when 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 as
the “supplemental weight.” Weighted percentages
for these and other variables can be foundA sample matching and weighting procedure wasused to balance the composition of 18-year-old
respondents to 19-year-old respondents. This
process is done by using the Covariate Balance
Propensity Score (CBPS), which treats the 18-yearolds as a “treatment group” and 19-year-olds
as a baseline “control group.”8 The estimation
procedure then tries to achieve balance on
covariates used in the model while simultaneously
accounting for the conditional probability of being
in one group over the other. The former process
reduces observable differences among 18-yearolds to make their demographic compositionreflect 19-year-olds.9 The latter process weights

in the Portrait of USTS Respondents chapter.
Unweighted frequencies and percentages
for these and other variables can be found in
Appendix A (Characteristics of the Sample).

the data such that the two groups are of equivalentsize. After weighting, the size of the 18-year-old
sample comprises 6%, which is the same as the
19-year-old sample. Any observed demographic
differences between 18- and 19-year-olds wereminimized, and many failed to reach statisticalsignificance.

In addition to the potential biases describedabove, the USTS had a high volume of
respondents who indicated that their age was 18
years old, and respondents who, based on theirbirth date, were 17 years old.7 It was suspectedthat the increased binning of 18-year-olds may be
attributable to multiple factors, including a higher
prevalence of respondents who were younger
than 18 at the time of the survey. This resulted
in 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 adjust
the 18-year-olds in the sample so that respondents
reporting 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 likely
randomly distributed around the date in which
they took the survey. This would imply that thecomposition of 18-year-olds should strongly matchthe composition of 19-year-olds.

The goal of this weighting process is to upweight respondents who are most likely 18 years
old by making them observationally equivalent
to the age cohort closest to them (i.e., 19-yearolds) and to down-weight respondents who areless likely to actually be 18 years old. This way, if
respondents who were binned at 18 years of age
are really younger than 18 years of age, it would
be expected that their responses would diverge
from 19-year-olds as that age gap increases.10
The weighting process down-weights 18-year-old
respondents as they diverge from 19-year-olds,
minimizing the influence of that group on findings.
This adjustment for 18-year-olds was included in
the standard survey weight applied to all findingsin this report.

ENDNOTES | APPENDIX C
1Respondents sometimes provided responses that
seemed unlikely, for instance running away from home
at 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, they
were allowed to remain in the dataset. These outliers were
negligible 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 also
helps to mitigate any influence of outliers.

2

Dong, Y. & Pang, C. Y. J. (2013). Principled missing data
methods for researchers. SpringerPlus, 2, 222.

3

Online survey bias is related to demographic differences
in internet access. See e.g., Dillman, D. A., Smyth, J. D., &Christian, L. M. (2014). Internet, Phone, Mail, and MixedMode Surveys: The Tailored Design Method (4th ed.).
Hoboken, NJ: John Wiley & Sons; Smith, A. (2014). African
Americans 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 characteristics
and 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. Federal
Administrative Records and the 2010 Census, Working
Paper #2015-03. DC: Center for Administrative Records
Research and Applications Working Papers. Available
at: 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 attainment
were created based on the Census Bureau’s 2014
American Community Survey (ACS).

7

Respondents who are younger than 18 were removed
from the final dataset and, therefore, are excluded from allreporting because they were not eligible to participate in
the study.

8Imai, K. & Ratkovic, M. (2014). Covariate balancing
propensity 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 of
18-year-olds were more similar to respondents who wereidentified as being 17 years of age and had less similarity
to 19-year-olds. After weighting, there are many moresimilarities between 18- and 19-year-olds and far lesscommonality with 17-year-olds.

APPENDIX C
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