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This section is dedicated to the unique health needs of transgender and gender diverse persons. The terms transgender and gender diverse as used in this text are inclusive of those who identify with the terms gender nonbinary, gender nonconforming, genderqueer, and transsexual. The umbrella term “transgender” incorporates a range of identities and experiences of individuals whose gender identities or expression, or both, differ from those associated with the sex assigned to them at birth. In contrast, the gender of cisgender individuals is concordant with the sex assigned to them at birth. The term transfeminine as used in this text refers to persons who identify along a female or feminine spectrum and transmasculine refers to people who identify along a male or masculine spectrum. Despite this simplification, a significant proportion of transgender people do not identify with a binary conception of gender. Transgender people may use any pronoun, including the gender-neutral singular pronoun “they.” It is also important to note that sexual orientation is distinct from gender and transgender people, like cisgender people, have a diversity of sexual attraction and activity.


Few well-designed, long-term, large studies describe the population and well-being of transgender people. Additionally, methodological challenges exist in the description of the transgender population; these limitations include inconsistent or incomplete collection of sexual orientation and gender identity information in the medical record, population databases, and health studies, and variable case definition (self-identification, clinical diagnosis, or receipt of gender affirming treatment). Evidence-based recommendations on the collection and analysis of sexual orientation and gender identity data are available for clinicians and researchers. Based on studies that rely on transgender relevant medical diagnoses in health system data, the prevalence of transgender persons is 0.017–0.033%. Survey-based studies that use self-identification report a prevalence of 0.5–4.5% transgender persons among adults and 2.5–8.4% among children and adolescents.

Deutsch  MB  et al. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inform Assoc. 2013;20:700.
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Tate  CC  et al. A two-question method for assessing gender categories in the social and medical sciences. J Sex Res. 2013;50:767.
[PubMed: 22989000]  
Zhang  Q  et al. Epidemiological considerations in transgender health: a systematic review with focus on higher quality data. Int J Transgend Health. 2020;21:125.
[PubMed: 33015664]  


Transgender people experience multiple structural barriers to health. High levels of societal stigma and discrimination, along with the lack of legal protections in education, the workplace, and housing, result in socioeconomic disadvantage and housing instability. Transgender people also face discrimination when seeking medical care. One in five transgender people reports delay in seeking medical care for fear of being mistreated based on their gender; among those who accessed a health care provider in the last year, 33% ...

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