Study links COVID-19 pandemic to reduced access to gender-affirming care

A survey offered to transgender and nonbinary people across six continents and in thirteen languages shows that during the first months of the novel coronavirus (COVID-19) pandemic, many faced reduced access to gender-affirming resources, and this reduction was linked to poorer mental health, according to findings published in the journal PLOS One.

Gender-affirming resources, which can include healthcare such as surgery or hormone therapy as well as gender affirming services and products, are well-known to significantly boost mental health and quality of life for transgender and nonbinary people. However, factors such as transphobia, lack of proper clinician training, and individual economic insecurity can hamper access to such resources.

Meanwhile, mounting evidence suggests that measures to reduce the spread of COVID-19 exacerbated these challenges. For instance, people may have had to cancel gender-affirming surgeries that were perceived to be elective. Or they may have had to move in with unsupportive relatives and spend more time living according to their sex assigned at birth instead of their actual gender.

To better understand the worldwide impact of the COVID-19 crisis on transgender and nonbinary people, researchers surveyed 964 adults residing in 76 countries via the social networking apps Hornet and Her. The survey, conducted between April and August 2020, asked participants questions about how the pandemic had affected their access to gender-affirming resources, mental health, and financial stability.

Statistical analyses of the survey responses showed that about half of the participants faced reduced access to gender-affirming resources during the study period. Nearly 40 percent said that the pandemic reduced their ability to live according to their gender. Many also reported anticipating financial hardships, such as possible reduced income and possible loss of health insurance. Those who reported reduced access to gender-affirming resources also had increased prevalence of depressive symptoms, anxiety, and suicidal ideation.

The researchers say that their findings highlight a need to increase and secure access to gender-affirming resources to improve the health of transgender and nonbinary people, during and beyond the COVID-19 pandemic.

"Transgender communities, who already face a myriad of health inequities, experienced even further health burdens due to restrictions imposed during COVID, like reduced access to gender-affirming treatments and mental health resources,” the authors wrote. “To move forward, we need to support trans communities with policies that make gender-affirming healthcare affordable, accessible, and recognized as essential."

Editor's note: Click here for more information and ongoing COVID-19 updates for integrative healthcare professionals.