KFF/The Washington Post Trans Survey

Executive Summary

This survey of trans adults, including transgender adults, gender non-conforming people, and nonbinary adults, as well as the comparison survey of cisgender adults is aimed at better understanding the trans experience in the U.S. Six in ten trans adults do not identify as either a “trans man” or a “trans woman,” but rather say “trans, gender non-conforming” or “trans, nonbinary” are better ways of describing themselves. Consistent with these findings, about half of trans adults (48%) use they/them pronouns, and about one-third say they use a combination of they/them, she/her or he/him pronouns. Seven in ten trans adults identify as lesbian, gay, or bisexual. The trans adult population is also younger than the larger cisgender adult population, with the majority of trans adults are younger than 35 years old. One in seven trans adults say they are a Republican or a Republican-leaning independent, with most trans adults identifying as Democrats or Democratic-leaning independents. In addition, six in ten identify as political liberals, while three in ten say they are political moderates, and one in seven are conservatives. The survey identifies major themes in better understanding the trans experience in the U.S. (developing identity, coming out and transitioning, facing discrimination and barriers). Below is a brief overview of key findings by theme, followed by deep dives into each arena.

Developing identity: Many transgender adults report understanding their gender identity at a young age and face many difficulties during childhood.

Most trans adults say they knew their gender differed from their sex assigned at birth when they were a child or teenager, but few told others before the age of 18. Trans adults are more likely than cisgender adults to say they felt isolated as a child or teenager and many report serious difficulties growing up, including unsafe learning environments and mental health struggles. Trans people who report having a trusted adult to confide in while growing up were less likely to report adverse childhood experiences.

• While most trans adults began to understand their own gender identity before they were an adult, only about four in ten of those who recognized their identity this early say they shared this information with others.
• Trans adults are much less likely than cisgender adults to report they felt safe in their homes or at school as a child or teenager, and a minority of trans adults said they felt safe participating in youth sports (44%), youth activities (41%), or in religious gatherings (35%).
• Three in ten trans adults say they experienced homelessness or got kicked out of their home while they were growing up, including nearly four in ten (38%) trans people of color. One in four trans adults say they attended religious services as a child or teenager that tried to change their sexual orientation or gender identity, and one in ten (11%) say they attended conversion or reparative therapy.
• Trans people who report having a trusted adult to talk to about personal issues while growing up were less likely to report feeling unsafe growing up. Yet, a minority of trans adults say they had a trusted adult to talk to about personal issues including, about one-third (34%) of trans people of color.

Coming out and transitioning: Transgender adults report a diverse set of experiences in being open with others about their gender identity, as well as the ways they present their gender to others.

Nearly 8 in 10 trans adults (78%) say living as a gender that is different from their gender assigned at birth has made them “more satisfied” with their life. Yet, some trans people are not out to family or friends and a small but significant share (16%) say they “never” physically present as a gender different from their sex assigned at birth. Being “out” is less common among older trans adults (ages 35 and older) as well as trans people of color.

• While most trans adults have told at least some members of their immediate family (68%) or people in their friend group (78%) that they are trans, one in seven (14%) have not come out to any of their family members or friends. This increases to one in five (21%) among trans adults who are 35 or older.
• Trans adults who present as a gender different from the one they were assigned at birth either “all” or “most of the time” are three times more likely to say they are “a lot more satisfied” living as a gender different than their sex assigned at birth compared to those who present as a different gender “some of the time” (62% v. 19%). White trans adults are more likely than trans people of color to present as a different gender than their gender assigned at birth at least most of the time (55% compared to 42%) as are younger trans adults compared to those 35 and older (56% compared to 43%).
• What it means to “transition” differs widely among trans adults, and not all trans adults feel the need to transition in any one way. The majority (88%) of trans adults say they have taken at least one action in transitioning, with most reporting they have made changes to their physical appearance to better fit their gender identity or go by pronouns associated with their gender that are different from their sex assigned at birth.
• Much smaller shares of trans adults report having attended counseling or therapy as a part of their gender transition (38%), using hormone treatments (31%), legally changing their names (24%), or undergoing gender-affirming surgery to change their physical appearance (16%). Notably these experiences are more common among trans men and trans women than those who identify as trans, gender non-conforming or trans, non-binary.

Facing discrimination and barriers: Trans adults report high levels of discrimination, including facing prejudice from health care providers, as well as barriers accessing mental health care.

More than six in ten trans adults have been discriminated against because of their gender identity and/or expression, with verbal attacks being the most commonly experienced form of discrimination reported. Trans adults also face discrimination in accessing health care with nearly half of trans adults saying the health care providers they have come into contact with know “not too much” or “nothing at all” about providing health care to trans people, and many reporting facing bias when getting care. Trans adults are more likely than cisgender adults to report recent mental health struggles as well as more likely to report difficulty accessing mental health coverage

• A majority of trans adults (64%) have been verbally attacked because of their gender identity, gender expression or sexual identity and one in four report having been physically attacked. The share of trans adults who have been physically attacked because of their gender identity increases to 31% among trans people of color.
• Trans adults face other types of discrimination beyond verbal and physical attacks, including being asked unnecessary or invasive questions at their place of work (49%) or being harassed or feeling unsafe in a restroom or locker room (41%). One in five trans adults report having been fired, denied a job or promotion (21%) or been refused health care from a health care provider (17%) due to their gender identity. One in eight trans adults (13%) say they have been evicted or denied housing because of their gender identity or expression, increasing to one in five (21%) among trans people of color.
• Nearly half of trans adults (47%) say there was a time in the past year where they needed but didn’t get mental health services or medication (compared to a quarter of cisgender adults). Among those who did not get mental health services or medication, cost is the biggest deterrent from getting care.
• Trans adults are more likely than cisgender adults to struggle with adverse mental health experiences including having suicidal thoughts in the past month (43% compared to 16%). In addition, 17% of trans adults say they harmed themselves over that period, compared to 3% of cisgender adults. The shares of trans adults who report having suicidal thoughts increases to half of those without supportive family members, and one in four of whom say they have engaged in self-harm in the past 12 months.

Understanding Identity and Coming Out to Others

Most trans adults (66%) say they began to understand that their gender was different from the sex they were assigned at birth before the age of 18, including a third (32%) who say they began to understand when they were ten years old or younger and another third (34%) who say it began between the ages of 11 and 17. A small share say this awareness happened between the ages of 18 and 25 (18%), 26 and 40 (10%), and 4% say it happened at age 41 or older.

There is a generational divide, with three-fourths of trans adults (73%) between the ages of 18 and 34 saying they were under the age of 18 when they began to understand their gender identity differed from their sex assigned at birth compared to 58% of trans adults who are 35 years old or older.

While most trans adults understood their own gender identity before they reached 18, only about four in ten of those who understood this also told others that they were trans or gender non-conforming before they turned 18. Overall, about one in ten trans adults say they began telling others before the age of 11, and an additional one in five (21%) say they came out to others when they were between 11 and 17 years old. One third of all trans adults say they began telling others when they were between the ages of 18 and 25, and a quarter say they began telling others when they were 26 years old or older. One in ten (12%) trans adults say they have not told anyone they are trans or gender non-conforming. The share of trans adults who haven’t told anyone about their trans identity increases to 18% among those who are 35 or older.

While most trans adults have told all, most, or some of either members of their immediate family (68%) or people in their friend group (78%) that they are trans, one in seven (14%) have not come out to any of their family members or friends. This increases to one in five (21%) who are 35 and older, who are less likely to be out to their immediate family members or to people in their friend group.

Among trans people who have told at least one immediate family member, most (69%) say their family members are at least “somewhat supportive” of their trans identity, including one-fourth who say their family members are “very supportive.” On the flip side, three in ten (31%) say their families are unsupportive, including one in ten (13%) who say their family members are “very unsupportive.” Majorities of white trans adults (68%) and trans adults of color (72%) who have told their immediate family members say their families are at least somewhat supportive, as well as majorities of trans adults who identify as non-binary or gender non-conforming (68%).

Most trans adults (83%) say they physically present as a gender different from the one assigned to them at birth at least some of the time, including three in ten who say they physically present this way “all of the time.” About one in seven trans adults (16%) say they “never” physically present as a gender different from their sex assigned at birth. This is largely driven by trans adults who identify as non-binary or gender non-conforming, with about one in five of this group “never” physically presenting as a gender different from their sex assigned at birth compared to 9% of trans men or women. White trans adults are more likely than trans people of color to present as a different gender than their gender assigned at birth “all” or “most” of the time (56% compared to 42%) as are younger trans adults as compared to trans adults ages 35 and older (56% compared to 43%).

Nearly 8 in 10 trans adults (78%) say that living as a gender different from the one assigned to them at birth has made them “more satisfied” with their life, including just under half (45%) who say they are “a lot more satisfied.” Trans adults who say they present as a different gender “all” or “most of the time” are three times more likely to say they are “a lot more satisfied” living as a gender different from the sex they were assigned at birth, compared to those who present as a different gender “some of the time” (62% v. 19%).

Growing Up Trans

With most trans adults reporting that they began to understand that their gender identity differed from their sex assigned at birth when they were a child or teenager, the KFF/Washington Post survey asked trans adults to report on what it was like growing up. Overall, trans adults report more difficulties in childhood, less safe growing and learning environments, and more mental health struggles than their cisgender counterparts. Some of these differences are mitigated among trans adults who report having a trusted adult while they were growing up. Yet only four in ten trans adults say they had a trusted adult to talk to about personal issues, including about one-third (34%) of trans people of color and less than half (45%) of white trans adults.

About half (53%) of trans adults report having at least a “somewhat happy” childhood but cisgender adults are more than twice as likely as trans adults to say their childhood was “very happy” (36% compared to 15%)Half (46%) of trans adults describe their childhood as unhappy, including 17% who would describe it as “very unhappy.” While trans adults are less likely than cisgender adults to say they would describe their childhood as happy, two-thirds of trans adults (67%) who reported having a trusted adult to talk to say they had a happy childhood, compared to less than half (44%) of trans adults who didn’t have a trusted adult growing up.

While many trans adults report growing up in safe environments, a smaller share of trans adults compared to cisgender adults report they felt generally safe in their homes (69% v. 86%) or at school (55% v. 90%). In addition, they are also much less likely to report they felt safe participating in youth sports (44% v. 70%), youth activities (41% v. 64%), or in religious gatherings (35% v. 76%).

Once again, having a trusted adult did seem to matter for trans kids and teenagers. Trans adults who say they had a trusted adult growing up are more likely to report they felt safe as a child or teenager both at home (85%) and at school (65%), compared to trans people without a trusted adult growing up (60% and 48%, respectively).

Isolation and mental health struggles growing up

Large shares of trans adults report adverse mental health experiences during their childhood. Eight in ten trans adults (78%) say growing up they experienced serious mental health problems such as depression or anxiety, and three in ten (29%) say they had alcohol or drug use problems as a child or teenager. Three in ten trans adults say they experienced homelessness or got kicked out of their home while they were growing up, including nearly four in ten (38%) trans people of color. One in four trans adults say they attended religious services as a child or teenager that tried to change their sexual orientation or gender identity, and one in ten (11%) say they attended conversion or reparative therapy. Trans adults facing adverse mental health challenges as children or teenagers was equally common, regardless of whether they had a trusted adult to talk to about personal issues.

The Diversity of Trans Experiences and Identity

Six in ten adults whose gender identity differs from their sex assigned at birth do not identify as either a “trans man” or a “trans woman,” but rather say “trans, gender non-conforming” (22%) or “trans, nonbinary” (40%) are the best ways of describing themselves. Nearly half of trans adults 18-34 say “trans, nonbinary” is the best way to describe themselves, compared to one-third of trans adults 35 or older. Given the majority of trans adults are younger than 35, non-binary or gender non-conforming identities may become even more prevalent among trans adults as the population ages.

Consistent with these findings, about half of trans adults (48%) use they/them pronouns, and about one-third say they use a combination of they/them, she/her or he/him pronouns. Seven in ten trans adults identify as lesbian, gay, queer, or bisexual. This survey finds trans adults and cisgender adults report similar household incomes, even when controlling for age, with four in ten trans adults reporting annual incomes of less than $40,000 (compared to 37% of cisgender adults). However, trans adults are much less likely than cisgender adults to have a college degree, even when accounting for the younger age of this population. About 15% of trans adults report having at least a college degree compared to 35% of cisgender adults. This includes 12% of trans adults under the age of 35 and one in five (19%) of trans adults over age 35 (compared to 31% of cis adults under 35 and 37% over age 35). Few trans adults say they are Republicans (10%) or Republican-leaning independents (4%), with most trans adults identifying as Democrats (42%) or Democratic-leaning independents (26%). Regarding political ideology, six in ten (58%) identify as political liberals, while three in ten (28%) say they are political moderates, and one in seven are conservatives (13%).

There Isn’t one way to Transition

What it means to “transition” differs widely among trans adults, and not all trans adults may feel the need to transition in any one way or seek the same types of gender affirming care. While the majority (88%) of trans adults say they have taken at least one of several select actions (described below) in the process of transitioning, these actions vary. Most trans adults report they have made changes to their physical appearance, such as changing the types of clothes they wear (77%) or changing their hairstyle or grooming habits (76%) to better fit their gender identity. Many also report going by pronouns associated with their gender that are different from their sex assigned at birth (72%), with slightly fewer, but still a majority, saying they use a different name than the one on their birth certificate (57%) – even if they have not legally changed their name. About four in ten transgender people report having attended counseling or therapy as a part of their gender transition (38%) (which is sometimes a requirement for other gender affirming care), and one-quarter (24%) having legally changed their name on identifying documents, such as a passport or driver’s license. Smaller shares report having used hormone treatments, HRT or puberty blocking hormones (31%) or having undergone gender-affirming surgery to change their physical appearance (16%).

While most trans adults who identify as nonbinary or gender non-conforming have changed their physical appearance in ways that reflect their gender identity, such as changing the types of clothes they wear (77%) or changing their hair style or grooming habits (76%) and most are going by different pronouns (73%), few from this group have used hormone treatments (17%), legally changed their names (15%), or undergone gender-affirming surgery or other surgical treatments to change their physical appearance (9%). In comparison, among those who identify as trans women or trans men, six in ten have used hormone treatments, just over four in ten (43%) have legally changed their name and three in ten (31%) have undergone gender-affirming surgery or other surgical treatments.

Seeking Acceptance

At least one in four (27%) trans adults say they have moved to a different part of town, a new city or a new state because they thought it would be a more accepting place for someone who is trans to live, including 35% of trans adults who now live in urban areas. Moving to a different town, city or state to find a more accepting environment is more common for trans adults who say they had an unhappy childhood or unsupportive immediate family. One-third of trans adults who say they had unhappy childhoods (36%) report moving to a more accepting place later in life, compared to one in five (21%) who had happy childhoods. Similarly, nearly half (48%) of trans adults who report having unsupportive families say they moved to a more accepting place, compared to three in ten trans adults with supportive families and one in ten trans adults who are not out to their families. Similar shares of trans adults across race, ethnicity, age, and income report moving to a more accepting place.

Trans Adults in U.S. Report High Levels of Discrimination

Despite taking steps to lessen experiences of stigma and discrimination, such as moving to places believed to be more accepting, more than six in ten trans adults (63%) say they feel discriminated against because of their gender identity and expression at least sometimes. Trans people of color report experiencing discrimination on multiple intersectional fronts, with most feeling discriminated against because of their gender identity (63%), their race or ethnicity (59%), their income level or education (58%) and their sexual orientation (53%).

Verbal attacks are the most commonly experienced discrimination measured in the poll. A majority of trans adults (64%) say they have been verbally attacked because of their gender identity, gender expression or sexual identity. One in four trans adults say they have been physically attacked because of their gender identity, gender expression, or sexual identity. The share of trans adults who have been physically attacked because of their gender identity increases to 31% among trans people of color.

Trans adults face other types of discrimination beyond verbal and physical attacks, including being asked unnecessary or invasive questions at their place of work (49%) or being harassed or feeling unsafe in a restroom or locker room (41%) because of their gender or sexual identity. One in five trans adults say they have been fired, denied a job or promotion (21%) or been refused health care from a health care provider (17%) due to their gender identity. One in eight trans adults (13%) say they have been evicted or denied housing because of their gender identity or expression, increasing to one in five (21%) among trans people of color.

Experiences with discrimination are far more common among trans adults who physically present as a gender different from their sex assigned at birth at least most of the time. Three-quarters of those who present as a different gender all or most of the time say they have been verbally attacked for their gender identity or sexual orientation, compared with half of those who present as a different gender some of the time or less. In addition, three in ten trans adults who physically present as a different gender report being physically attacked.

Beyond verbal and physical attacks, trans adults who physically present as a different gender at least some of the time are more likely to report being asked unnecessary or invasive questions at work (61%), being harassed or feeling unsafe in a restroom or locker room (50%), being fired or denied a job or promotion (29%), or  being refused health care (24%).

Trans adults living in urban areas are also more likely than their suburban and rural counterparts to report facing certain types of discrimination, including one-third of trans urban residents who say they have been physically attacked, despite being no more likely than those living in suburban and rural areas to say they physically present as a gender different from their sex assigned at birth at least some of the time.

Difficulty Accessing Health Care

Trans adults report significant issues accessing gender-affirming health care, that is health care that supports and affirms an individual’s gender identity when it  differs from the gender they were assigned at birth. This includes counseling, routine health visits, medications, and surgeries, among other services. About three in ten trans adults say they have had to teach a doctor or other health care provider about trans people so they could get appropriate care (31%), had a doctor or other health care provider refuse to acknowledge their preferred gender identity and instead refer to their sex assigned at birth (31%), or been asked unnecessary or invasive questions about their gender identity unrelated to their visit (29%). About one in five (17%) trans adult say they have had a doctor or other health care provider refuse to provide them with gender-affirming treatment, such as hormone treatments (17%).

Nearly half (47%) of trans adults say the health care providers they have come into contact with know “not too much” or “nothing at all” about providing health care to trans people. Just 10% say their health care providers  know “a lot,” which is the same as the share who say their providers know “nothing at all.” Larger shares of young trans adults (54% of those ages 18-34) say doctors and health care providers know “not too much” or “nothing at all” about providing health care for trans people compared to 38% of trans adults ages 35 and older who say the same.

Among trans adults with health insurance, about a quarter (27%) say their insurance covers gender-affirming treatment or health care, while 14% say their health insurance does not cover this and six in ten (58%) are unsure. More generally, one in five trans adults say they have had health insurance that would not cover gender-affirming treatments or health care (22%). About one in seven trans adults have changed jobs or health insurance in order to get gender-affirming treatments or health care.

Most trans adults (72%) say they currently have a doctor or health care provider they feel comfortable seeking health care from, however, trans adults report more difficulty accessing routine health care than cisgender adults. Nearly half of trans adults (46%) say it is difficult to find health care that they can afford, compared to 37% of cisgender adults. Nearly half of trans adults (47%) also report it’s difficult to find a health care provider they can get an appointment with quickly (compared to 37% of cisgender adults). Trans adults also more likely to say they have difficulty finding a health care provider who treats them with dignity and respect (37% trans adults vs. 24% cisgender adults), or health care at a location that is easy for them to get to (35% trans adults vs. 21% cisgender adults).

Difficulty accessing routine health care transcends age and racial identities among trans people. Significant shares of trans adults ages 18-34 and ages 35 and older say it’s difficult to get health care they can afford (46% for both groups), a quick appointment (51% v. 42%), a provider who treats them with a dignity and respect (42% v. 29%), or health care at an easy location to get to (39% v. 31%). In addition, at least one third white trans adults and trans people of color report difficulties finding health care they can afford (49% v. 41%), a quick appointment (48% v. 45%), a provider who treats them with a dignity and respect (39% v. 33%), or health care at an easy location to get to (39% v. 31%).

Mental Health

With most Americans saying the U.S. is facing a mental health crisis, and LGBTQ people having historically faced widespread mental health disparities, the KFF-Post poll also asked about mental health experiences and access to mental health services. More than four in ten trans adults report feeling anxious (56%), depressed (48%), or lonely (44%), either always or often in the past 12 months. The share of trans adults who report these feelings  in the past year is larger than the share of cisgender adults (31%  report feeling anxious, 21% depressed, and 21% lonely). Trans adults are also less likely than their cisgender counterparts to report feeling happy (40% compared to 59%) or hopeful (29% compared to 50%) always or often over the past 12 months.

Similar to overall life satisfaction, about half of trans adults with families that are unsupportive of their trans identities report feelings of depression, loneliness, and anxiety. Feelings of hopefulness are higher among trans adults who say they have supportive immediate families. Younger trans adults are more likely to report feelings of anxiety and depression, though these age gaps mirror those among the general public.

The KFF-Post poll finds large shares of LGBT adults, and specifically transgender adults, report struggling with serious mental health issues. This includes  one-third (34%) of all LGBT adults as well as more than four in ten (43%) trans adults who say they have had suicidal thoughts in the past 12 months. Trans adults are about six times as likely as cisgender adults to say they have engaged in self-harm in the past year, and more than twice as likely to say they have had an eating disorder in the past year or had suicidal thoughts in the past year.

Similar to previous studies finding that younger adults are more likely to report serious mental health struggles, younger trans adults ages 18 to 34 are more likely than older trans adults ages 35 and older to report having had suicidal thoughts in the past year (50% v. 36%) or having self-harmed in the past year (25% v. 9%).

The shares of trans adults who report having suicidal thoughts increases to half of those with unsupportive family members. In addition, about one in four of these individuals say they have engaged in self-harm in the past 12 months.

Accessing mental health care

Nearly half of trans adults (47%) say there was a time in the past year where they needed mental health services or medications but didn’t get them (compared to a quarter of cisgender adults who say the same). Among those who did not get mental health services or medication, three in ten say the main reason was because they could not afford them, 22% say it was because they were too busy, 17% say they were afraid or embarrassed to seek care and one in ten say they couldn’t find an appropriate provider. Relatively few say it was because they didn’t know how to find services (7%), that their insurance wouldn’t cover it (5%), that they had a long wait for an appointment (3%), that they didn’t want medication (2%) or were discriminated against or didn’t feel safe getting treatment (2%).

Trans adults under age 35 are more likely than those ages 35 and older to say they could not access needed mental health services at some point in the past year (55% vs. 39%). Among the younger trans population, cost was the biggest deterrent from getting needed mental health care. One-third of trans adults 18-34 who said they did not get the care they thought they needed, said they didn’t get this care due to the cost (14% of all trans adults). For older trans adults, cost was among a list of reasons for not getting care. One in four trans adults 35 and older said they didn’t mental health care due to cost (9% of total trans adults 35 or older), which is similar to the share who say they were too embarrassed or afraid to seek care (24%, 9%). The difficulty that younger trans adults report getting mental health care is similar to the reasons provided by younger cisgender adults.