Trans People in the U.S.: Identities, Demographics, and Wellbeing
The recently released KFF/Washington Post Trans Survey, the most in-depth, representative survey of transgender adults living in the U.S., was aimed at providing a deeper understanding of trans people’s experiences in the U.S. over the life span including during childhood, through gender transition, and present wellbeing. Building on that report, and using the survey data, this analysis provides the most comprehensive representative profile of trans Americans ever complied, while also offering insights on their experiences in the health care system. While some federal surveys include a representative share of trans people, demographic questions tend to be fairly general and do not allow for more in depth analysis of the experiences and identities of trans people, particularly related to health access. At a time when issues around LGBTQ rights, including in health care, are at the forefront of national conversations, understanding trans people’s experiences and wellbeing is especially timely.
The survey included interviews with 515 trans and gender non-conforming individuals and a comparison sample of 823 cisgender adults. Trans adults include those who identify as transgender or as a trans adult; cisgender (non-trans) adults include those do not identify as trans and their gender is the same as their sex assigned at birth. For more information about sampling and method of recruitment, see the methodology section in the full report.
Gender Identity. Gender identity is based on one’s intrinsic sense of who they are, be that male, female, transgender, non-binary, or some other identity. When one’s gender identity aligns with their sex assigned at birth they are considered cisgender. When one’s gender identity does not align with sex assigned at birth, they are often described as being transgender, though many people use other terms to describe themselves, including being gender nonconforming or nonbinary, among others.
When asked how they think of themselves, a plurality of trans adults identify as non-binary (40%), with about one in five identifying as trans women (22%) or gender non-conforming (22%), and a smaller share identifying as trans men (12%). Others say they identify in some other way (2%). Some use one term and others use multiple terms. Those who described themselves in “some other way” commonly described themselves as agender or genderfluid when asked to specify. Those aged 18 to 34 are more likely to identify as non-binary than those aged 35 or older (47% v 32%).
Sex assigned at birth. Sex assigned at birth differs from gender identity because it is based on phenotypic sex characteristics and is the sex stated on an individual’s birth certificate. It may or may not align with gender identity. Trans and non-trans adults are equally likely to have been assigned either male or female at birth.
Sexual orientation. Sexual orientation is separate from sex assigned at birth (being biologically male, female, or intersex) and gender identity (which is based on an internal sense of being such as being cisgender or transgender, among other identities). Sexual orientation refers to the gender or genders someone experiences sexual, emotional, or romantic attraction or attachment to. Heterosexual/straight, lesbian, gay, bisexual, and queer are examples of sexual orientations. Most (70%) trans adults considered themselves to be lesbian, gay, bisexual or queer while just 8% of non-trans adults did so. However, three in ten (29%) trans adults do not identify as lesbian, gay, bisexual, or queer.
Pronoun use. Pronouns are a shorthand way of referring to an individual without using their name. Often, pronouns connote gender as is the case with he/him or she/her. Some adults, especially LGBTQ adults, and trans or nonbinary adults in particular, use a pronoun that would not traditionally be associated with their sex assigned at birth or does not reflect the historic gender binary (male/female), such as they/them. In addition, some adults use multiple pronouns or are comfortable with any pronouns.
Nearly half (48%) of trans adults use they/them pronouns, with those ages 18-34 being more than twice as likely to use these terms than those 35+ (64% vs. 28%). About half of trans adults use she/her (49%) pronouns and almost four in ten (37%) use he/him pronouns. About one-third of trans adults say they use a combination of they/them and she/her or he/him pronouns. (Note: Percentages do not sum to 100% as respondents could select multiple genders).
Age. Trans adults are a younger population than non-trans adults. Over half (53%) of trans adults are under 35 years old compared to just over a quarter of non-trans adults (28%). Just a small share (8%) of trans adults are seniors, those over the age of 65, compared to 22% of non-trans adults (not shown in chart).
Race/Ethnicity. Similar shares of trans and non-trans adults are White, Hispanic, Black, and other races/ethnicities.
Income. A larger share of trans adults have incomes below $50,000 per year than non-trans adults (57% v. 45%), potentially reflecting younger age, lower levels of education, and higher unemployment (see below).
Education. Trans adults have lower levels of education when compared to non-trans adults. More than 8 in 10 (84%) have less than a college degree compared to 65% of non-trans adults. Non-trans adults are more than twice as likely to have graduated college than trans adults (35% vs. 15%). This finding held true even when controlling for age, and despite having similar incomes at most levels.
Employment. A larger share of trans adults report being unemployed (14% vs. 8%) or being students (8% vs. 4%) than non-trans adults and smaller shares report being retired, likely due the fact that the trans adult population is younger in age than the non-trans adult population. Similar shares report being employed, being on disability, or being a stay at home parent/home maker.
Partisan identification. Four in ten trans adults (42%) identify as a Democrat, a larger share than non-trans adults (29%) and few, just one in ten (10%), identify as a Republican compared to almost one-third (31%) of non-trans adults. Trans adults are also more likely to say their political identity is something other than Republican, Democrat, or independent (20% vs. 14%).
Marital Status. Trans adults are about half as likely to be currently married than non-trans adults (26% vs. 49%) and also less likely to have ever been married (25% vs. 38% ) which likely reflects, at least in part, their younger age. However, they are twice as likely to be living with an unmarried partner (20% vs. 10%). The share of trans adults who are widowed or divorced is similar to that of non-trans adults.
Parenthood. Overall, similar shares of trans adults are a parent or guardian to a child under the age of 18 living in their household (27% vs 26%). However, looking at younger adults, there are significantly fewer trans parents under the age of 40 than non-trans parents under 40 (23% vs. 40%).
Insurance Coverage. Larger shares of trans adults report being uninsured than non-trans adults (15% vs. 10%). The share of trans adults who report not having health insurance is similar across age groups and racial and ethnic identities, but larger among those with lower household incomes compared to those with higher incomes.
About half of both trans adults and non-trans adults report having private insurance (55% vs. 51%), although trans adults are three times as likely to report having such coverage through a parent (10% vs. 3%), likely reflecting their younger age. Smaller shares of trans adults have Medicare (6% vs. 25%), likely reflecting the younger age of the population, and about one in four have Medicaid (21%), a larger share than non trans-adults (14%).
Care location. Trans adults use different types of health care settings to access care than non-trans adults. They are more likely to get their usual care at clinics including health centers, pharmacies, and urgent care (36% vs. 21%) and less likely to get this care at a doctor’s office (48% vs. 64%). Trans adults of color, those under age 35, and those earning less than $40,000 per year were more likely to say their usual source of care is the ER than White, older, or higher income trans adults. Among trans adults, those ages 35 and older and those earning more than $40,000 per year are more likely to receive care at a doctor’s office than trans adults who are younger or who have lower incomes. Like non-trans adults, about one in ten have no place they get care.
Health and Well-being
Physical Health. Despite being a younger population, trans adults report poor physical health more so than non-trans adults. Looking back across the past 30 days, on average, trans adults had more days when their physical health, including physical illness and injury, was “not good”. Smaller shares of trans adults than non-trans adults had zero days when their physical health was not good in the preceding 30 days (27% vs. 41%) and nearly double the share of trans adults said their health had not been good for 21-30 days (17% vs. 9%). Among trans adults, there were minimal differences when looking across demographic factors including, race/ethnicity, age, and income.
Mental Health. Similarly, while four in ten (39%) non-trans adults say there were zero days in the past month when their mental health, including stress, depression, and problems with emotions, was not good, just about one-in-ten trans adults (13%) said so. Conversely, nearly one quarter of trans adults (23%) say their mental health had been not good 21-30 days in the preceding 30. Notably, trans adults who reported having had a happy childhood reported fewer not good mental health days. Among trans adults, there were minimal differences when looking across demographic factors including, race/ethnicity, age, and income. In our main report on this survey, we find specifically that trans adults report higher rates of anxiety, depression, and loneliness than non-trans adults.