Transgender Equality

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 founded in 2003 by transgender activists who recognized the urgent need for policy change to advance transgender equality. 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 a strong 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 CITATION

James, 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 the 2015 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 ACKNOWLEDGEMENTS 1

who assisted Gabriel Rodenborn Shelby Rowe Brad Sears Jama Shelton Jillian Shipherd Sharon Stapel Michael Steinberger Catalina Velasquez Bianca Wilson Cullen O’Keefe Nowmee Shehab Chai Jindasurat JoAnne Keatley Elliot Kennedy Lillig Paul Emilia Lombardi Jenifer McGuire Ilan Meyer Shannon Price Minter Aaron Morris Asaf Orr Dylan Orr Sari Reisner Kory Masen Kory Imari Moon NCTE interns, law fellows, staff, and volunteers interns, law fellows, staff, NCTE Andrew Cray D’Adamo Kate Durso Laura Eleazer Jake Gates Gary J. Jaime Grant Emily Greytak Ann Haas Jack Harrison-Quintana Mark Hatzenbuehler Darby Hickey Ashley Hunter Lourdes Mati Gonzalez Gil Jackson Romeo for programming and implementation of the complex survey. for assistance with questionnaire development and the weighting procedures to prepare the data for assistance with questionnaire development and the weighting procedures for continued work in cleaning the data set, re-coding the data, and providing population numbers for continued work in cleaning the data set, re-coding the data, and providing , Survey Outreach Coordinator, for leading the survey outreach efforts and building a network of , Survey Outreach Coordinator,

he report authors extend our gratitude to all the members of the transgender community who participated of the transgender community extend our gratitude to all the members he report authors and organizations that made this and the hundreds of individuals Survey Transgender in the 2015 U.S. survey report possible.

translation: Bre Kidman Cyres Gibson Michael Rauch Appreciation is also extended to materials, and development of outreach with the project, including outreach across the country, Andrew Flores for analysis. Daniel Merson for comparative purposes in the final report. to the following individuals for their contributions The authors extend special gratitude to the project: Ignacio Rivera in this survey. individuals and organizations that led to the unprecedented levels of participation The following individuals in particular are recognized for their contributions during one or more stages of the for their contributions during one or in particular are recognized The following individuals analysis, and reporting: distribution, data preparation and survey development, implementation, process, including Osman Ahmed Badgett Lee M. V. Baker Kellan Genny Beemyn Aaron Belkin Bockting Walter Broadus Kyler David Chae Cecilia Chung Cook Daniels Loree Conron Kerith Ruby Corado

Acknowledgements T 2 2015 U.S. TRANSGENDER SURVEY 2011, aswellforitssupport ofNCTE’s re-developmentofitastheU.S. Transgender Survey. partnership inconductingthe NationalTransgender Discrimination Surveyasajointprojectfrom2008to Finally, NCTEwould like togivespecialthanks tothe Fund project throughgeneraloperatingsupport,includingthe the funders werethe largest shareofthefundsneededtoconductandreport ontheU.S. Transgender Survey. Otherimportant Additionally, NCTEwouldlike toexpressspecialappreciation Molly Haigh Leah Furumo Sean Carlson design, andreporting.Thanksgoesto: to andduringthedatacollectionphase, andtheyalsoassistedwithsurveytranslation, Various individualsandfirmsassistedinspreadingthewordaboutsurvey, bothprior including lendingtheirsubject-matterexpertiseandanalysistothefindingsincludedinthisreport. Arli Christian,JoannaCifredo, K’aiSmith through theirrespectiverolesindigitalmediaandcommunicationstrategy. Theo George on theproject,particularly: The authorsalsoacknowledgecurrentandformerNCTE staff fortheirwork that promotedanddistributedthesurveytoitsmembersthroughoutcountryforcompletion. Additional acknowledgementgoestothe Thomas Coughlin Cherno Biko Danni Askini development andcommunityoutreach: devoted theirtimetotheprojectbygivingvaluablerecommendationsaround The authorsalsothankthe Willem Miller Rodrigo Aguayo-Romero work atvariousstagesoftheproject: A specialthanksisalsoextendedto David BohnettFoundation , andthe and Tides Foundation Arcus Foundation Vincent Villano Andrea Jenkins Trudie Jackson Brooke CerdaGuzman Davida Schiffer Shabab Mirza . NCTEisalsogratefultoitsotherfunders,manyofwhich supportedthis . Dewey SquareGroup Design ActionCollective Anna Zuccaro USTS AdvisoryCommittee fortheirpivotalworkinsurveyprojectdevelopmentanddistribution , the Gill Foundation , and more than300transgender, LGBT, andalliedorganizations USTS Interns,Fellows,and Assistants Harper JeanTobin National LGBTQ Task Force Stephanie Skora Nowmee Shehab Angelica Ross Danielle Stevens Jeymee Semiti , the Ford Foundation Human RightsCampaignFoundation an anonymousdonor for their contributions as report co-writers, fortheircontributionsasreportco-writers, ZERN TransTech SocialEnterprises ThoughtWorks (UAC) members,who , the Evelyn&Walter Haas,Jr. , foritsprevious Brynn Tannehill Venus Selenite forprovidingthe fortheir

, and

EXECUTIVE SUMMARY 3 4 2015 U.S. TRANSGENDER SURVEY T physically orsexuallyassaulted atwork. workplace duetotheirgender identityorexpression,suchasbeingverballyharassed or being fired,deniedapromotion,orexperiencingsome otherformofmistreatmentinthe In theyearpriortocompletingsurvey, 30%ofrespondentswhohadajobreported Further, 17% experiencedsuchseveremistreatmentthattheyleftaschoolasresult. physically attacked (24%),andsexuallyassaulted(13%)becausetheyweretransgender. (K–12) experiencedsomeformofmistreatment,including beingverballyharassed(54%), The majorityofrespondentswhowereoutorperceived astransgenderwhileinschool were kicked outofthehousebecausetheyweretransgender. that afamilymemberwasviolenttowardsthembecausetheyweretransgender, and8% aspect oflife. Oneinten(10%)ofthosewhowereouttotheirimmediatefamilyreported Respondents reportedhighlevelsofmistreatment,harassment,andviolenceinevery Pervasive MistreatmentandViolence themes emergefromthethousandsofdatapointspresentedinfullsurveyreport. respondents alsoexperiencedharassmentandviolenceatalarminglyhighrates.Several accessing medicalcare, andenjoyingthesupportoffamilycommunity. Survey comes tothemostbasicelementsoflife, suchasfindingajob, havingaplacetolive, disparities betweentransgenderpeopleinthesurveyandU.S. populationwhenit The findingsrevealdisturbingpatternsofmistreatmentanddiscriminationstartling criminal justicesystem. such aseducation,employment,familylife, health,housing,andinteractionswiththe detailed lookattheexperiencesoftransgenderpeopleacrossawiderangecategories, transgender peopleandthechallengestheyface. Thereportofthe2015USTS providesa Survey (NTDS),whichhelpedtoshifthowthepublicandpolicymakers viewthelivesof serves asafollow-uptothegroundbreaking2008–09NationalTransgender Discrimination adults (18andolder)intheUnitedStates, availableinEnglishandSpanish.TheUSTS for Transgender Equality, theUSTS wasananonymous,onlinesurveyfortransgender and U.S. militarybasesoverseas.Conducted inthesummerof2015byNationalCenter USTS Executive Summary from allfiftystates,theDistrictofColumbia,AmericanSamoa,Guam,PuertoRico, experiences oftransgenderpeopleintheUnitedStates, with27,715 respondents he 2015U.S. Transgender Survey(USTS) isthelargestsurveyexamining the EXECUTIVE SUMMARY 5

transgender person, and 33% did not go to a health care provider when needed because transgender person, and 33% did not go to a health care provider when they could not afford it. the year prior to completing the survey, one-third (33%) of those who saw a health care one-third the year prior to completing the survey, such as being provider had at least one negative experience related to being transgender, Additionally, verbally harassed or refused treatment because of their gender identity. the health care nearly one-quarter (23%) of respondents reported that they did not seek mistreated as a they needed in the year prior to completing the survey due to fear of being 5% of the U.S. population. Among the starkest findings is that 40% of respondents have population. Among the starkest 5% of the U.S. rate in the U.S. attempted suicide in their lifetime—nearly nine times the attempted suicide population (4.6%). In encountered high levels of mistreatment when seeking health care. also Respondents and Mental Health of the impact of stigma and discrimination on the The findings paint a troubling picture serious A staggering 39% of respondents experienced health of many transgender people. compared with only psychological distress in the month prior to completing the survey, their lifetime, and 12% reported experiencing homelessness in the year prior to completing and 12% reported experiencing homelessness in the year their lifetime, the survey because they were transgender. on Physical Harmful Effects rate in the U.S. population at the time of the survey (5%). population rate in the U.S. with only 16% of respondents to own a home, were also far less likely Respondents Even more concerning, population. 63% of the U.S. compared to reporting homeownership, have experienced homelessness at some point in nearly one-third (30%) of respondents and Instability transgender people in the survey large economic disparities between The findings show in poverty, (29%) of respondents were living population. Nearly one-third and the U.S. the high rate of poverty is population. A major contributor to compared to 12% in the U.S. rate—three times higher than the unemployment 15% unemployment respondents’ likely Severe Economic Hardship Hardship Severe Economic In the year prior to completing the survey, 46% of respondents were verbally harassed and harassed and were verbally 46% of respondents the survey, prior to completing In the year that same time period, During being transgender. because of physically attacked 9% were assaulted were sexually and nearly half (47%) assaulted, were sexually 10% of respondents in their lifetime. at some point 6 2015 U.S. TRANSGENDER SURVEY poverty, peopleofcolo USTS sampleoverallweremorethantwiceaslikely astheU.S. populationtobelivingin of discriminationthanwhiterespondentsandtheU.S. population.Whilerespondentsinthe pattern isrevealed:transgenderpeopleofcolorexperiencedeeperandbroaderpatterns When respondents’ experiencesareexaminedbyraceandethnicity, aclearanddisturbing Forms ofDiscrimination The CompoundingImpactofOther women, butalsopeoplewho arenon-binary,whichisatermthatoftenusedto describe Additionally, thisgrowingvisibility hasliftedupnotonlythevoicesoftransgender menand historic growthinvisibilitythat thetransgendercommunityhasseeninrecentyears. 2008–09 NTDS.Thisnumber oftransgenderpeoplewhoelevatedtheirvoicesreflects the 28,000—completed thesurvey,morethanfourtimes the numberofrespondentsin One suchindicationisthatanunprecedentednumber oftransgenderpeople—nearly people intheUnitedStates. also showsomeofthepositiveimpactsgrowingvisibility andacceptanceoftransgender Despite theundeniablehardshipsfacedbytransgender people, respondents’ experiences Acceptance Increased Visibilityand Growing (54%). Theyalsoreportedhigherratesofmistreatmentbyhealthcareproviders(42%). psychological distress(59%)andmorelikely tohaveattemptedsuicideintheirlifetime Transgender peoplewithdisabilitiesweremorelikely tobecurrentlyexperiencingserious mistreatment. Nearlyone-quarter(24%)wereunemployed,and45%livinginpoverty. Respondents withdisabilitiesalsofacedhigherratesofeconomicinstabilityand and 68%havefacedintimatepartnerviolence. half (50%)ofundocumentedrespondentshaveexperiencedhomelessnessintheirlifetime, quarter (24%)ofundocumentedrespondentswerephysicallyattacked. Additionally, one- violence thanotherrespondents.Intheyearpriortocompletingsurvey, nearly one- Undocumented respondentswerealsomorelikely tofacesevereeconomichardshipand 19%. (6.7%) wassubstantiallyhighe nearly fivetimestheratein U.S. population(0.3%)—the rateamong Blackrespondents experienced greaterhealthdisparities.While1.4%ofallrespondentswerelivingwithHIV— (20%) wasfourtimeshigherthantheU.S. unemploymentrate(5%).People ofcoloralso (12%) tobelivinginpoverty. Theunemployment rateamongtransgenderpeopleofcolor and Black(38%)respondents,weremorethanthreetimesaslikely astheU.S. population r , includingLatino/a (43%),AmericanIndian(41%),multiracial(40%), r, andtherateforBlacktransgenderwomenwasastaggering EXECUTIVE SUMMARY 7

verall, the report provides evidence of hardships and barriers faced by verall, the report provides evidence basis. It portrays the challenges that transgender people on a day-to-day and the complex systems that they are transgender people must overcome

last several years, it is clear that there is still much work ahead to ensure that transgender last several years, it is clear that there is still much work ahead to ensure people can live without fear of discrimination and violence. the needs of transgender people and reduce the hardships they face. As the national reduce the hardships they face. the needs of transgender people and public education efforts to continues to evolve, conversation about transgender people of transgender people are crucial. The rates of improve understanding and acceptance and violence must serve as an immediate call unemployment, suicide attempts, poverty, policy improvements over the Despite a priority. to action, and their reduction must be this evidence, governmental and private institutions throughout the United States should should States governmental and private institutions throughout the United this evidence, that transgender people are able to live fulfilling address these disparities and ensure health affordable eliminating barriers to quality, This includes lives in an inclusive society. and other areas of public in schools, the workplace, putting an end to discrimination care, and federal levels that meet support at the municipal, state, and creating systems of life, often forced to navigate in multiple areas of their lives in order to survive and thrive. Given areas of their lives in order to survive and thrive. often forced to navigate in multiple their classmates, more than half (56%) reported that their classmates supported them as a classmates supported them as a than half (56%) reported that their their classmates, more transgender person. Respondents’ experiences also suggest growing acceptance by family members, also suggest growing acceptance experiences Respondents’ More than half (60%) of respondents and other people in their lives. colleagues, classmates, their family was supportive of them immediate family reported that who were out to their those who were out to their More than two-thirds (68%) of as a transgender person. out to Of students who were were supportive. that their coworkers reported coworkers people whose gender identity is not exclusively male or female, including those who including or female, male is not exclusively gender identity people whose gender. or more than one or female, other than male a gender having no gender, identify as that need for advocacy the of the sample, up over one-third people making With non-binary than ever. community is clearer the transgender of all identities in is inclusive O 8 2015 U.S. TRANSGENDER SURVEY Nineteen • One • One • Those who said that their immediate families were supportive were less likely to • A majority of respondents (60%) who were out to the immediate family they grew • Family LifeandFaithCommunities Overview ofKey Findings later foundawelcomingspiritual orreligiouscommunity. out ofthehouse,andoneinten(10%)ranaway fromhome. family memberwasviolenttowardsthembecausetheyweretransgender. religious psychological distress. such asexperiencinghomelessness,attemptingsuicide,orserious report avarietyofnegativeexperiencesrelatedtoeconomicstabilityandhealth neither supportivenorunsupportive. while 18%saidthattheirfamilywasunsupportive,and22% up withsaidthattheirfamilywasgenerallysupportiveoftransgenderidentity Currently experiencingserious Experienced homelessness

in in

psychological distress twelve ten supportive andunsupportivefamilies Negative experiencesamongthosewith

community Attempted suicide percent % ofrespondentswhosefamilieswereunsupportive % ofrespondentswhosefamiliesweresupportive (10%)respondentswhowereouttotheirimmediatefamily reported that

(8%)

(19%)

respondents whowereouttotheirimmediatefamilykicked

left

0% of

due

respondents

10% rejection

who 20% . Forty-twopercent(42%)of thosewholeft

had

ever 30% 27% 31%

been 37% 40%

part

of 45%

a 50%

spiritual 50% 54% 60%

, EXECUTIVE SUMMARY 9 , 50% 44% 45% 43% 40% of their IDs had the of their IDs had the 35% none 31% 29% 30% 28% 25% 23%

of their IDs had the name and gender they of their IDs had the 20% 18% 18% 18% all who have shown an ID with a name or gender 15% 9% 10% Updated gender 5% of respondents 0%

Passport Updated name or gender on ID IT (%) UPDATE TO OUT OF THOSE WHO HAD ID AND WANTED state-issued ID Updated name Birth certificate one-third (32%) Driver’s license/ Driver’s Social Security records or last school attended) Student records (current Student that did not match their gender presentation were verbally harassed, denied benefits that did not match their gender presentation were verbally harassed, or assaulted. to leave, asked or service, with 35% of those who have not changed their legal name and 32% of those who have notwith 35% of those who have not changed their legal name and 32% of those not afford it. updated the gender on their IDs reporting that it was because they could that than two-thirds (68%) reported preferred, while more they preferred. name and gender • Nearly • of the main barriers respondents faced The cost of changing ID documents was one Identity Documents Identity • that Only 11% of respondents reported Health Insurance and Health Care

• One in four (25%) respondents experienced a problem in the past year with their insurance related to being transgender, such as being denied coverage for care related to gender 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 the past 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 for people of color and people with disabilities. This included being refused treatment, verbally harassed, or physically or sexually assaulted, or having to teach the provider about transgender people in order to get appropriate care. • In the past year, 23% of respondents did not see a doctor when they needed to because of fear of being mistreated as a transgender person, and 33% did not see a doctor when needed because they could not afford it.

Psychological Distress and Attempted Suicide

• Thirty-nine percent (39%) of respondents experienced serious psychological distress in the month 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 women of color. Nearly one in five (19%) Black transgender women were living with HIV, and American Indian (4.6%) and Latina (4.4%) women also reported higher rates.

10 EXECUTIVE SUMMARY 11

13%

OR 6%

17% 13% 77% 24% 54% 36% 52% 20% OUT

and person

WERE

WHO

attacked,

THOSE

transgender PERCEIVED AS TRANSGENDER PERCEIVED AS OF

a %

physically

were

mistreatment (24%)

severe

such of those who were out or perceived as transgender of those who were one-quarter

(77%) of people who were out or perceived as transgender in of people who were out or perceived

faced

nearly of those who were out or perceived as transgender in K–12 out or perceived as transgender in of those who were

(17%) (24%)

(54%)

harassed,

percent three-quarters

percent Experiences of people who were out as transgender in K–12 or believed transgender in K–12 Experiences of people who were out as they were transgender classmates, teachers, or school staff thought

one-quarter

than verbally

EXPERIENCES harassed because people thought they were transgender Verbally Not allowed to dress in a way that fit their gender identity or expression Not allowed to dress in a way that fit their gender identity Disciplined for fighting back against bullies because people thought they were transgender Physically attacked teachers or staff thoughtBelieve they were disciplined more harshly because they were transgender a school because the mistreatment was so bad Left Sexually assaulted because people thought they were transgender Expelled from school One or more experiences listed that they left a K–12 school. that they left a K–12 were because of being transgender. in K–12 were sexually assaulted were verbally, physically, or sexually harassed. or physically, college or vocational school were verbally, experienced some form of experienced some Kindergarten and Grade 12 (K–12) at some point between according harassed, prohibited from dressing mistreatment, such as being verbally or sexually assaulted or physically disciplined more harshly, to their gender identity, they were transgender. because people thought • Nearly • Fifty-four • Seventeen • More Experiences in Schools Experiences 12 2015 U.S. TRANSGENDER SURVEY Nearly • Fifteen • In • One • Employment andtheWorkplace Nearly • The • Income andEmploymentStatus RACE/ETHNICITY Unemployment rate multiracial, Latino/a, andBlackrespondentsexperiencinghigherratesofunemployment. respondents— in thesample— forms ofmistreatmentbasedontheirgenderidentity orexpressionduringthatyear, gender identityorexpression. harassed, physicallyattacked, and/orsexuallyassaultedatworkbecauseoftheir they appliedforbecauseoftheirgenderidentityor expression. population unemployment their lifetime.

* U.S. populationdataforMiddleEasternpeoplealoneisunavailableintheCPS. American Indian the Middle Eastern*

unemployment in Multiracial

% inUST past

Latino/a one-third one-quarter six percent Overall White Asian Black S (supplementalsurveyweightapplied)

(16%)

year, (12%).

(%) 0% reported reported

rate respondentswhohaveeverbeenemployed—or13% ofallrespondents (15%)

27% (29%)

(23%)

rate in ofthosewhoheldorappliedforajobduringthatyear—19% ofall 4%

4% 5% of

the

5% were being

losing respondents among

U.S. 7%

those living

10% fired, 9%

a population 10%

10%

respondents job % inU

who in

12% 12% denied .S. population(CPS)

because

poverty, who 15%

had 15%

had (5%), a

promotion,

of (15%) job more

a 20%

their

with MiddleEastern,AmericanIndian, job

20% in 21%

was than

the in 22%

gender 23%

the

25%

past

three

or twice

past not

year identity

times

the being

year 30%

reported

rate

higher

were

or hired

expression 35%

the verbally

other than for 35%

U.S.

the job in EXECUTIVE SUMMARY 13 the point

fired, because

some

the

being

housing

compared

(16%)

homelessness form

reported

homelessness

homelessness home

year some

past

own

experienced

to the

experienced

in experienced

experienced

likely job

have who

respondents who stayed in a shelter in the respondents who stayed in a shelter

less

respondents

had

those of respondents who had a job in the past year took of respondents who

(70%)

times of

who (12%)

respondents

ten

(77%) of respondents four

eight (26%) of

. in out

(23%)

nearly

(30%) one

(63%)

respondents

seven were of

year, one-quarter three-quarters

30%

one-third one-quarter

past than than

population

Seven out of ten respondents who stayed in a shelter in the past year reported being mistreated because of being transgender. the

U.S. past year avoided staying in a shelter because they feared being mistreated past year avoided staying in a shelter high levels of as a transgender person. Those who did stay in a shelter reported mistreatment: in their lives. , such as being evicted from their home or denied a discrimination in the past year, such as being evicted from their home transgender. home or apartment because of being denied a promotion, or experiencing some other form of mistreatment related to their or experiencing some other form denied a promotion, expression. gender identity or such as being forced to use a restroom that did not match their gender identity, being gender identity, not match their a restroom that did forced to use such as being or having a boss or to keep their job, gender in order in the wrong told to present without their transgender status about their share private information coworker permission. , such as hiding or delaying their gender in the workplace, such as hiding or steps to avoid mistreatment their job. transition or quitting past year reported some form of mistreatment, including being harassed, sexually or past year reported some form of mistreatment, including being harassed, out because of being transgender. physically assaulted, or kicked of being transgender. • Respondents • More • Nearly • In • Nearly Housing, Homelessness, Housing, Homelessness, and Shelter Access • Overall, • More 14 2015 U.S. TRANSGENDER SURVEY Economy Work Sex Work andOtherUnderground Ofthosewhowerearrestedinthepast year(2%), • More thanhalf(57%) • Police frequentlyassumedthatrespondents—particularlytransgenderwomenofcolor— • Respondents experiencedhighlevelsofmistreatmentandharassmentbypolice. • Police InteractionsandPrisons Thosewhohavedoneincome-basedsexworkwerealso morelikely tohave • Respondents whointeractedwiththepoliceeitherwhiledoingsexworkor • Respondents reportedhighratesofexperienceintheundergroundeconomy, including • were arrestedbecausethey weretransgender police forhelp and 30%ofmultiracialwomensaidthatanofficerassumed theyweresexworkers. who thoughtorknewtheyweretransgender, one-third(33%)ofBlacktransgenderwomen were sexworkers. engage insexualactivitytoavoidarrest. gender, physicallyassaulted,orsexuallyincludingbeingf mistreatment. thought orknewtheyweretransgender, the pastyear, ofrespondentswhointeractedwithpoliceorlawenforcementofficers one-third (36%)weresexuallyassaultedduringthatyear. they tookthesurvey, nearlyhalf(41%)werephysicallyattacked inthepastyearandover overall sample. Outofthosewhowereworkingintheundergroundeconomyattime violence and72%havebeensexuallyassaulted,asubstantiallyhigherratethanthe experienced violence. harassed, attacked, sexuallyassaulted,ormistreatedinsomeotherwaybypolice harassment, abuse, ormistreatment,with police mistakenly thought theyweredoingsexworkreportedhighratesofpolice year, withhigherratesamongwomenofcolor. including 12%whohavedonesexworkinexchange forincome—and9%didsointhepast have participatedintheundergroundeconomy sex work,drugsales,andotherworkthatiscurrentlycriminalized. This included if theyneededit Inthepastyear, ofthosewhointeractedwithlawenforcementofficers of respondentssaidtheywouldfeel More thanthree-quarters(77%)haveexperiencedintimatepartner

being verballyharassed,repeatedlyreferredtoasthewrong . more thanhalf(58%)experiencedsomeformof nearly .

nine outoften(86%) forincomeatsomepointintheirlives— nearly one-quarter(22%)believedthey uncomfortable askingthe One infive(20%) orced byofficersto

reporting being In . EXECUTIVE SUMMARY 15 high 35% nine times 33% , including acts

30% . In the past year, . In the past year, 30% 25% in the past year because of 25% at some point in their lifetime and Respondents who have done sex Respondents in the past year because of being 23% five times more likely to be sexually five times more likely

. 20% 20% physically attacked

15% verbally harassed

11% 11% 10% than the U.S. population in jails and prisons, and over population than the U.S. 5% (54%) experienced some form of intimate partner violence

(46%) of respondents were

(10%) were sexually assaulted in the past year.

0% women Overall* women** Black women White women Asian women Latina women Latina *Represents respondents of all genders who interacted with officers who thought they were transgender respondents of all genders who interacted *Represents **Sample size too low to report Middle Eastern population. compared to 18% in the U.S. partner, one in ten with disabilities work (72%), those who have experienced homelessness (65%), and people to have been sexually assaulted in their lifetime. (61%) were more likely involving coercive control and physical harm. transgender. being transgender. (20%) were sexually assaulted. Respondents were over (20%) were sexually assaulted. Respondents assaulted by facility staff to be sexually assaulted by other inmates more likely rates of physical and sexual assault by facility staff and other inmates rates of physical and sexual assault assaulted by staff or other inmates, and one in five nearly one-quarter (23%) were physically American Indian Transgender women reporting that police assumed they were sex workers in the past year in the past were sex workers assumed they reporting that police women Transgender transgender) thought they were with officers who who interacted (out of those (%) RACE/ETHNICITY Multiracial women • physical violence by an intimate Nearly one-quarter (24%) have experienced severe • More than half • Nearly one in ten (9%) respondents were • assaulted Nearly half (47%) of respondents were sexually Harassment and Violence Harassment and • Nearly half • year faced who were held in jail, prison, or juvenile detention in the past Respondents 16 2015 U.S. TRANSGENDER SURVEY Places ofPublicAccommodation Inthepastyear, • Nearlyoneinten • harassment andbarrierswhenusingrestroomsatschool, work,orinpublicplaces. and legislaturesaroundthecountryin2016.Yet respondentsreportedfacingfrequent subject ofincreasinglyintenseandoftenharmfulpublic scrutinyinthenationalmedia The surveydatawascollectedbeforetransgenderpeople’s restroom usebecamethe Experiences inRestrooms • Respondents reportedbeingdeniedequaltreatmentorservice, verballyharassed, • accommodations inthepastyearbecauseofbeingtransgender Denied equaltreatmentorservice, verballyharassed,orphysically attacked inpublic attacked (1%),orsexuallyassaulted (1%) restroom inthepastyear. in thepastyearbecausetheyfearedwouldbemistreatedasatransgenderperson. One infive(20%)respondentsdidnotuseatleastonetypeofpublicaccommodation harassed, and2%whowerephysicallyattacked becauseofbeingtransgender. included 14%whoweredeniedequaltreatmentorservice, 24%whowereverbally one typeofmistreatmentinthepastyearaplacepublicaccommodation thought orknewtheyweretransgender, respondents whovisitedaplaceofpublicaccommodationwherestafforemployees services tothepublic,like retailstores,hotels,andgovernmentoffices.Outof or physicallyattacked atmanyplacesofpublicaccommodation—placesthatprovide Legal servicesfromanattorney, clinic,orlegalprofessional Social Securityoffice Court orcourthouse Nursing homeorextendedcarefacility Department ofMotorVehicles (DMV) Public assistanceorgovernmentbenefitoffice Gym orhealthclub Domestic violenceshelterorprogramrapecrisiscenter Drug oralcoholtreatmentprogram Retail store, restaurant,hotel,ortheater Public transportation LOCATION VISITED respondentsreportedbeing verballyharassed(12%),physically

(9%) respondentsreported thatsomeonedeniedthemaccesstoa

nearly one-third(31%)experiencedatleast when accessingarestroom. THEY WERETRANSGENDER STAFF KNEWORTHOUGHT % OFTHOSEWHOSAID 22% 22% 34% 18% 14% 14% 13% 31% 17% 11% 6%

. This

EXECUTIVE SUMMARY 17

in the past year in the past avoided using a avoided compared

half (59%) More than respondents public restroom afraid because they were of confrontations or other problems they might experience.

reported that they had voted in the reported that they had voted in the 27% 27% 43% % IN U.S. limited the urinary tract avoided using avoided (GALLUP) POPULATION , compared to 27%, 43%, and 27% in the U.S. the U.S. , compared to 27%, 43%, and 27% in to avoid using the to avoid using the 2% 48% 50% % IN USTS of respondents of respondents of U.S. citizens of voting age of U.S. reported having a reported having a compared to 42% in the U.S. population. compared to 42% in the U.S. in the past year because they were year because they in the past (8%)

in the past year as a result of avoiding in the past year as Democrat Independent Republican POLITICAL PARTY POLITICAL population, respectively. to 65% in the U.S. population. to 65% in the U.S. midterm election, and 2% identified as Republicans that they were registered to vote in the November 2014 midterm election that they were registered to vote in problem restrooms. amount that they ate and drank amount that they year. restroom in the past infection, or another kidney-related infection, kidney a public restroom might problems they or other afraid of confrontations experience. Political party affiliation party Political • (54%) More than half • identified as Democrats, 48% identified as Independents, Half (50%) of respondents Civic Participation and Party Affiliation and Party Civic Participation • of voting age in the sample reported citizens (76%) of U.S. More than three-quarters • Nearly one-third (32%) • Eight percent • half (59%) More than 18 2015 U.S. TRANSGENDER SURVEY T advocates, policymakers, educators,serviceproviders, media,andthegeneralpublic. vital sourceofinformationabout transgenderpeopleandcontinuestoserveasan importantresourcefor have asubstantiallypositive impactonatransgenderperson’s qualityoflife. Thereportquicklybecamea of transgenderpeopleinthe faceofsuchdiscriminationandfoundthatfamily peersupportcould life, includingeducation,employment, healthcare, andhousing.Thereport alsohighlightedtheresilience Every Turn lives, theNTDSwasagroundbreakingstudy. Theresultswerepublishedinthe2011 report, people intheUnitedStates. With6,456respondents reportingonarangeofexperiencesthroughouttheir first comprehensivesurveyexaminingthelivesandexperiences oftransgenderandgendernonconforming developed byNCTEandtheNationalLGBTQ Task Forceandconducted in2008–09. TheNTDSwasthe The USTS servesasafollow-uptotheNationalTransgender DiscriminationSurvey(NTDS),whichwas employment, andinteractionswiththecriminaljustice system. detailed portraitoftheexperiencestransgenderpeopleacrossmanyareas,includinghealth,familylife, Introduction CHAPTER 1 ever surveyexaminingthelivesoftransgenderpeopleinUnitedStates. TheUSTS providesa by theNationalCenterforTransgender Equality(NCTE).With27,715 respondents,itisthelargest- his reportpresentsthefindingsof2015 U.S. Transgender Survey(USTS), astudyconducted , andshowedthatdiscriminationagainsttransgender people waspervasiveinmanyareasof Injustice at INTRODUCTION 19

and providing sustainable systems of support and providing sustainable systems of lives. for transgender people throughout their recognition These findings are presented with the that advocates, researchers, and transgender additional communities will greatly benefit from data research conducted using this extensive subsequent The authors encourage source. that this analyses to delve into areas of the data will report is unable to address, and as before, the dataset available for such strive to make analyses. This report demonstrates that transgender people transgender people demonstrates that This report in numerous areas to face discrimination continue financial of life, impact quality that significantly including and emotional wellbeing, stability, housing, and health care. employment, education, respondents experienced many Furthermore, areas of their lives, discrimination in multiple of which leads to severe the cumulative effect hardship and can in turn economic and emotional on other outcome areas, have devastating effects safety. such as health and transgender people Although issues impacting since the have become more visible in the years NTDS was published, the data overwhelmingly way to demonstrates that there is still a long go towards eliminating harmful discrimination multiple issue areas. life, such as employment and health, it is important life, to provide specific data on the potential impact This of such policies on transgender people. Survey data draws Transgender report on the U.S. comparisons between transgender people and the and examines disparities across population U.S. by the lack of data collected about transgender people in national surveys. Since federal survey data is often used by government agencies to determinations about policies and key make programs that affect individuals in many areas of impacted, such as health care, HIV/AIDS, housing, HIV/AIDS, impacted, such as health care, sex work, workplace discrimination, immigration, by closely and police interactions. Additionally, other existing mirroring questions from federal and gaps left surveys, this study seeks to fill in the conducted to date, far surpassing the previous conducted to date, respondents. This study with 27,715 survey, the previous explores a wider range of topics than issue survey and more deeply examines specific disparately areas where transgender people are a wide range of audiences about the experiences a wide range of audiences about the how things are changing, of transgender people, lives of and what can be done to improve the States. transgender individuals in the United people It is the largest survey of transgender discrimination and anti-transgender bias in virtuallydiscrimination and all areas of life. was developed Survey Transgender The 2015 U.S. Equality to by the National Center for Transgender data to inform provide updated and more detailed making significant strides in the five years sincemaking significant there is still a substantialthe report was published, be done to address critical needsamount of work to throughout the Unitedin transgender communities to experience people continue Transgender States. Much has changed since the NTDS was conducted NTDS was conducted changed since the Much has in 2008–09 in 2011, were published and results of transgender people increased visibility including in general. Despite and in society in the media 20 2015 U.S. TRANSGENDER SURVEY the study: which offermoredetailedinformationrelatedto The reportalsocontainsthreeappendices, CivicParticipation andPolicy Priorities • ExperiencesinRestrooms • PlacesofPublicAccommodationandAirport • HarassmentandViolence • Police, Prisons,andImmigrationDetention • Housing,Homelessness,andShelterAccess • MilitaryService • SexWork andOtherUndergroundEconomy • EmploymentandtheWorkplace • IncomeandEmploymentStatus • ExperiencesatSchool • Health • IdentityDocuments • FamilyLifeandFaithCommunities • Portrait ofUSTS Respondents • that impacttransgenderpeople’s lives: respondents’ experiencesacrossarangeofareas These willbefollowedbychaptersdiscussing information aboutterminologyusedthroughout. be followedbyaguidetothisreport,including overview ofthestudy’s methodology, whichwill The nextchapterofthereportwillgivean Report Roadmap Appendix C:DetailedMethodology Appendix B:SurveyInstrument(Questionnaire) Appendix A:CharacteristicsoftheSample Security Work

METHODOLOGY 21 Rankin & Associates Consulting Rankin

Data was collected over a 34-day respondents from all fifty states, the 3

The survey was accessible via any web-enabled 2 and the final sample included 27,715 4 The survey was developed by a team of researchers and advocates and administered The survey was developed by a team of researchers and advocates and 1

of transgender people in the United States. The survey instrument was comprised of thirty-two The survey instrument was comprised of transgender people in the United States. distinct variables that covered a broad array of topics, such as health and sections reflecting 1,140 he U.S. Transgender Survey is the largest survey ever conducted to examine the experiences Survey is the largest survey ever conducted to examine the Transgender he U.S.

District of Columbia, American Samoa, Guam, Puerto Rico, and U.S. military bases overseas. The survey military bases overseas. The survey and U.S. District of Columbia, American Samoa, Guam, Puerto Rico, the opportunity to provide contained mainly closed-ended questions, but respondents were also offered write-in responses were provided by write-in responses in fifty-three of the survey questions. Over 80,000 respondents. device (e.g., computer, tablet, netbook, smart phone), accessible for respondents with disabilities (e.g., with disabilities (e.g., tablet, netbook, smart phone), accessible for respondents computer, device (e.g., through screen readers), and made available in English and Spanish. through a website exclusively hosted the survey on several secure servers. The survey was accessed created specifically for the promotion and distribution of the survey. period in the summer of 2015, health care access, and experiences around employment, education, housing, law enforcement, and public health care access, and experiences around employment, education, housing, accommodation. online to transgender adults residing in the United States.

CHAPTER 2 CHAPTER Methodology T 22 2015 U.S. TRANSGENDER SURVEY and theU.S. generalpopulation.In othercases, of transgenderpeoplecollected intheNTDS nuanced comparisonsbetween lifeoutcomes there wasinsufficientinformation todraw NTDS reportwaspublished.Insomeinstances, questions thatremainedunansweredafterthe people, butalsoincreasedawareness ofthe insight intotheexperiencesoftransgender Task Force. Theseanalysesprovidedfurther public usedatasetprovidedbyNCTEandthe performed additionalanalysesusingtheNTDS In subsequentyears,researchershave development oftheU.S. Transgender Survey. These recommendationswereconsideredinthe in an“issuesandanalysis” sectionofthereport. survey questiondesignandsubstantivecontent for potentialimprovementwithrespecttoboth been posed. in themannerwhichseveralquestionshad and concludedthattherewere“imperfections” authors alsoexaminedthesurveyinstrument needs oftransgenderpeople. data aimedatidentifyingandaddressingthe conduct additionalresearchtocontinuecollecting encouraged advocatesandresearchersto the surfaceofthisextensivedatasource” and acknowledged thatthestudyhad“justscratched its publicationin2011.However, theNTDSreport policymakers, advocates,andeducatorssince Force”), theNTDSprovideddatathathasinformed and theNationalLGBTQ Task Force(“theTask National CenterforTransgender Equality(NCTE) States. Fieldedinlate2008toearly2009bythe outcomes oftransgenderpeopleintheUnited comprehensively measureexperiencesandlife Survey (NTDS),whichwasthefirststudyto National Transgender Discrimination developed asthefollow-uptogroundbreaking The U.S. Transgender Survey(USTS) was Transgender Survey I. AbouttheU.S. 6 Theauthorsaddressedareas 5 TheNTDS 7

examination ofsuicidalthoughtsandbehaviors. suicide attempts,whichdidnotallowforaclear example, theNTDSasked asinglequestionabout limited duetoalackoffollow-upquestions.For the abilitytoformadditionalconclusionswas transgender peopleintheUnitedStates. that wouldenablenewinsightstobedrawnabout identified areasforimprovementandcollectdata platform uponwhichtobuildtheUSTS toaddress these respects,theNTDSprovidedanimportant in theyearssinceNTDSwaspublished. over timeandhowoutcomesmayhavechanged speak to there remainedaneedtocollectdatathatcould data onoutcomesspecifictotransgenderpeople, Additionally, giventhedeficiencyoflongitudinal such experiences.Additionally, removing theword clarify thatthesurveywasdesigned tocaptureall “Discrimination” wasremovedfromthetitleto experiences ofacceptance andaffirmation. community inthefaceofhardship, aswell resilience andresourcefulnessofthetransgender narratives beyonddiscrimination,includingthe people intheU.S. andelevateavarietyof and breadthoftheexperiencestransgender new namewasalsointendedtoreflectthedepth arising fromtheuseof“national”intitle. The research teamsoughttodispelanyconfusion in theU.S. andinotherpartsoftheworld, between theexperiencesoftransgenderpeople education. Recognizing thecontextualdifferences insurance, income, employment,housing,and time ofthestudyinareassuchashealthcareand applicable toresidentsoftheUnitedStates atthe relevant policies,procedures,andpractices States andU.S. territoriesinmind,considering unique needsoftransgenderpeopleintheUnited signaled thatthisstudywasdevelopedwiththe and followingreportpublication.Theuseof“U.S.” sample bothduringthedatacollectionperiod the geographicallocationofintendedstudy Survey forseveralreasons.Onewastoclarify The studywasrenamedtheU.S. Transgender the experiencesoftransgenderpeople In 8

METHODOLOGY 23 research experience, and subject-matter expertise. and subject-matter expertise. research experience, When developing the survey instrument, the research team focused on creating a questionnaire that could provide data to address both current and emerging needs of transgender people while gathering information about disparities respective country’s laws, policies, and culture, laws, policies, and culture, respective country’s employment, particularly in the areas of education, many Additionally, housing, and health care. federal from U.S. survey questions were taken sample government surveys that also limit their and the population to individuals in the U.S., similar research team sought to examine a location population with regard to geographical general to allow for comparisons to the U.S. population. III. Developing the Survey Instrument survey instrument was developed over The USTS the course of a year by a core team of researchers and advocates in collaboration with dozens of advocacy and individuals with lived experience, youth often differ from those of adults in a number of adults in a number differ from those youth often related to including experiences areas, of key health care, employment, accessing education, and many identity documents, and updating or needs could not be of these experiences in a survey that was not adequately captured to transgender people under specifically tailored the age of 18. to individuals currently The sample was limited U.S. or on a state or territory, residing in a U.S. since the study focused on military base overseas, people who were subject to the experiences of laws and policies at the time they completed U.S. Individuals residing outside of the U.S. the survey. across a may have vastly different experiences on each number of outcome measures based Furthermore, Furthermore, 9 chapter. Portrait of USTS Respondents of USTS Portrait and content and also reduced the literacy level at which the survey could be offered. the current experiences and needs of transgender The study was not offered to individuals under the age of 18 due to limitations created by specific risk factors and recommendations associated with research involving minors. These considerations, including requirements for parental/guardian scope consent, would have impacted the survey’s description of survey respondents is available in the The study included individuals aged 18 and older at the time of survey completion, as did the NTDS. binary people. Additionally, materials specified that materials Additionally, binary people. of their lives, the survey was for adults at any stage participation or transition to encourage journey, among individuals with diverse experiences An in-depth regarding their transgender identity. different terminology or definitions and might different terminology or definitions did have assumed that the term “transgender” address this, promotional not include them. To was inclusive materials affirmed that the survey and non- trans, genderqueer, of all transgender, “transgender” was defined broadly for the “transgender” was defined broadly of a purposes of this study as being inclusive wide range of identities—such as genderqueer, and crossdresser—the research non-binary, for team recognized that many individuals used whom the study was intended may have identified as transgender, trans, genderqueer, trans, genderqueer, identified as transgender, other identities on the transgender and non-binary, in order to encompass a wide identity spectrum, of range of transgender identities, regardless Although terminology used by the respondent. II. USTS Respondents II. USTS included individuals who The study population reduced potential bias in respondents’ answers or answers potential bias in respondents’ reduced who respondents from primarily attracting resulting experienced discrimination. felt they had 24 2015 U.S. TRANSGENDER SURVEY authors suggestreferringto boththeUSTS and that occurredoverrespondents’ lifetime. The the bestavailabledataregarding experiences such instances,theNTDScontinues toprovide experiences infutureiterationsoftheUSTS. In to yieldimproveddataregardingchanging government orothernationalsurveysandalso were includedforbothcomparabilitywithfederal during anindividual’s lifetime. Thesequestions whether thoseexperiencesoccurredatanypoint occurred withinthepastyearinsteadofasking asked aboutwhethercertainexperiences the NTDS.Forexample, manyUSTS questions asked inamannerthatreducedcomparabilitywith were eithernotincludedintheUSTS, ortheywere note thatmanyofthequestionsasked in theNTDS provides crucialupdateddata,itisimportantto data wascollectedin2008–09. WhiletheUSTS outcomes mayhavechangedsincetheNTDS NTDS, wherepossible, todeterminehowcertain attempt toprovidecomparabilitybetweenthe Several questionswerealsoincludedinan and CurrentPopulation Survey. U.S. CensusBureau’s AmericanCommunitySurvey maximum comparabilitywithsurveyssuchasthe that responsestoaUSTS questionwouldmaintain in manycases,languagewaspreservedtoensure comparability to the best extentpossible. However, in thetransgendercommunitywhilemaintaining transgender people to moreappropriatelyreflectissuespertaining of comparablequestionswheneveritwasrequired and health. of measures,suchasmeasuresrelatedtoincome government orothernationalsurveysonanumber best matchthosepreviouslyasked infederal U.S. Consequently, questionswereselectedto population asawholeorpopulationswithinthe sample andknownbenchmarksfortheU.S. would allowcomparisonsbetweentheUSTS To achievethis,questionswereincludedthat and non-transgenderpeoplethroughouttheU.S. that oftenexistbetweentransgenderpeople 10 Changesweremadetothelanguage

and languageincommonuse The pilotstudywasconductedamongasmall was conductedtoevaluatethequestionnaire. launching thesurveyinfield,apilotstudy Prior tofinalizingthesurveyinstrumentand a. PilotStudy based onfeedbackfromdozensofreviewers. questionnaire. Thequestionnairewasrevised addressed specificsubjectmatterandtheentire This includedthoroughreviewsofsectionsthat intervals throughoutthedevelopmentprocess. community, andtransgenderadvocatesatmultiple researchers, membersofthetransgender The surveyinstrumentwasreviewedby transgender people. the NTDStogainafullpictureofissuesimpacting states ranginginagefrom 19 to78.Participants questionnaire, including participantsinfifteen the studyandsubmittedfeedback onthe study testsite. Thirty-two (32)peoplecompleted participation andreceivedaccesstothepilot the study. Forty(40)individualsconfirmedtheir pilot studywithanyonesoastonotcompromise (5) agreeingtonotsharethequestionsin the surveyonlineduringspecifieddates,and improvements tothesurvey, (4)availabletotake provide feedbackthatwouldbeusedtomake (1) 18yearsorolder, (2)transgender, (3)willingto met thefollowingpilotstudycriteria:theywere confirm theirparticipationbyindicatingthatthey pilot studytestsite, inviteeswererequiredto period oftime. Inordertoreceiveaccessthe evaluate thesurveyonlineduringaspecified 100 individualswereinvitedtocompleteand technical evaluationofthesurvey. Approximately study wastoprovidebothasubstantiveand survey laterappeared.Thepurposeofthepilot the sameplatformandformatinwhichfinal administered throughanonlinetestsiteusing was intendedtosurvey. Thepilotstudywas were representativeofthesamplestudy group ofindividualswithcharacteristicsthat METHODOLOGY 25 evolving data needs evolving data needs

14 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, the intricate level of navigation through the survey where the NTDS asked only one question—and only one question—and where the NTDS asked Survey instrument resulted in a lengthier survey. development length was assessed throughout its as many to ensure it would be manageable for through Furthermore, participants as possible. the survey multiple reviews and evaluations of instrument—including the pilot study—survey reported that the length was appropriate for takers of issues a survey addressing such a wide range about and the need for data outweighed concerns the overall length of the survey. Survey IV. Distribution and Sample Limitations The survey was produced and distributed in an online-only format after a determination that it did not receive those questions. Due to the those questions. did not receive the length varied nature of the survey, customized and no respondent respondents, greatly between Prior to the pilot all possible questions. received indicated a survey-completion estimates study, The completion-time time of 30–45 minutes. to 60 minutes based on estimate was extended study participants, and it was feedback from pilot reports during the fielding consistent with many period. about survey length Despite observations discussed in the NTDS, people relating to issues affecting transgender issue required an in-depth treatment of multiple to areas. This often required multiple questions in areas thoroughly assess an issue—including 12 All participant 13 and racial and ethnic identities, and ethnic identities, and racial 11 in the U.S. Armed Forces, Reserves, or National or National Armed Forces, Reserves, in the U.S. Guard received a series of questions about their but those who had not served military service, using skip logic, which created unique pathways with each next step through the questionnaire, in a pathway being dependent on an individual answer choices. For example, respondent’s respondents who reported that they had served of public accommodation. The online survey platform allowed respondents to move seamlessly through the questionnaire and ensured they only received questions that were appropriate based on previous answers. This was accomplished of 324 possible questions in thirty-two discrete of 324 possible questions in thirty-two such sections addressing a variety of subjects, health as experiences related to health and housing, care access, employment, education, interactions with law enforcement, and places the revision of language and the addition of the revision of language and the addition an issue. questions to more thoroughly examine Length b. a total The final survey questionnaire contained taking the survey, and (6) what they thought about taking the survey, “trans” the statement explaining why the term was used throughout the survey. and used to feedback was compiled, discussed, such as through further develop the questionnaire, of the survey, (3) whether any existing questions (3) of the survey, (4) whether difficult to answer, were confusing or offensive or thought they found any questions (5) whether they they should be removed or fixed, issues while experienced technical or computer In addition to providing general feedback on In addition to providing and the entire questionnaire, individual questions to address were asked pilot study participants as part of their evaluation, specific questions it took to complete the including: (1) how long what they thought about the length (2) survey, reported identifying with a range of gender identifying with a reported identities as people of color. 34% who identified including 26 2015 U.S. TRANSGENDER SURVEY low-income individuals.The outreachstrategywas color, seniors,people residinginruralareas,and This included,butwasnot limited to, people of being underrepresentedin suchsurveyresearch. online platformandwhowereatincreasedriskof people whomayhavehadlimitedaccesstothe Additionally, outreacheffortsfocusedonreaching communities acrosstheU.S. anditsterritories. transgender individualsaspossibleindifferent opportunities toaccessthesurveyforasmany The mainoutreachobjectivewastoprovide V. Outreach transgender people. to generalizethefindingsinthisstudyall are notknown.Therefore, itisnotappropriate characteristics oftransgenderpeopleintheU.S. randomly sampledandtheactualpopulation to notethatrespondentsinthisstudywerenot of transgenderpeopleintheU.S., sample thatwasasrepresentativepossible access. Althoughtheintentionwastorecruita online biasandotherissuesrelatingtolimited disparities inourfinalsamplethatcouldresultfrom focused onaddressingpotentialdemographic considerations inmind,outreacheffortswere different healthandlifeexperiences.” reach transgenderrespondentswith“vastly with findingsthatonlineandpapersurveysmay has beenwelldocumentedinsurveyresearch, internet surveybiasonobtainingadiversesample missing data.However, thepotentialimpactof their prioranswers,decreasingtheprobabilityof of thequestionsthatwereappropriatebasedon option forensuringthatrespondentsreceivedall dataset. increased thepotentialformissingdatainfinal or beingskippedcompletely, whichcouldhave led toquestionsbeingansweredunnecessarily confusion formanyrespondents.Thiscouldhave would havecreatedanundueburdenand 16 Thismadeonlineprogrammingthebest

it isimportant 18 Withthose 17

An initial phase of outreach involved developing An initialphaseofoutreachinvolveddeveloping of paidandvolunteerinternsfellows. implement theoutreachstrategyalongwithateam worked foraperiodofsixmonthstodevelopand and support.Afull-timeOutreachCoordinator for communityengagement,participation, would beavailable, andgenerateopportunities awareness ofthesurvey, informpeoplewhenit period withavarietyoftacticsdesignedtoraise months priortothelaunchofdata-collection Outreach effortsbeganapproximately six online communities. organizations, supportgroups,healthcenters,and access, includingtransgender-orLGBTQ-specific people throughvariousconnectionsandpoints-of- a multi-prongedapproachtoreachtransgender survey wasinthefield. the pre-data-collectionperiod andwhilethe 400 organizationsatregular intervalsduring direct recruitmentcorrespondencewithnearly responded torequestsforsupport,resultingin organizations contacted,approximately half appropriate respondentsintothestudy. Ofthe for organizationstouseinaneffortrecruit research teamprovidedlanguageandgraphics blasts andsocialmediachannels,the were asked toshareinformationthroughemail contacts. Specifically, supportingorganizations information aboutitwiththeirmembersand if theywouldsupportthesurveybysharing phone, andsocialmedia,theywereasked Over 800organizationswerecontactedbyemail, sample oftransgenderpeople. essential componentofreachingawide, diverse this networkof“supporting organizations” wasan survey attheirofficesorfacilities.Establishing and insomecasesprovidingdirectaccesstothe the wordthroughmultiplecommunicationplatforms would eventuallysupportthesurveybyspreading organizations whoservedtransgenderpeopleand lists ofactivetransgender, LGBTQ, andallied 20,21 Theseorganizations 19

METHODOLOGY 27 Survey- and the events 26 The events were 25 or “survey events,” were spaces in events,” or “survey 24 , and times at which they were conducted— guidelines were needed to maintain consistency across the events and preserve the integrity of the data-collection process. A protocol was developed outlining the rules for hosting a survey event to advise hosts on best practices for ensuring where people could complete the survey. where people could complete the survey. Events Taking to provide which organizations offered resources or such as computers access to the survey, other web-enabled devices. These organizations the survey at provided a location in which to take period one particular time or over an extended hours over such as during specified of time, the course of several days. access to created with the intention of providing or internet individuals with limited or no computer assistance access, those who may have needed needed or those who when completing the survey, the Additionally, the survey. a safe place to take population that had previously been identified as a paper survey than an to take being more likely online survey were considered, were developed to target those individuals. Given the potential variety of these survey events—including the types of available resources to September 2015. UAC monthly calls focused calls focused monthly 2015. UAC to September and identifying project updates on providing could be conducted by which outreach pathways reach and promote the survey’s to increase Members a diverse sample. participation from individuals, and other suggested organizations, to conduct outreach, avenues through which outreach improving for and strategies ideas shared and of transgender people, to specific populations the survey through their spread the word about networks. professional and personal Events Survey-Taking b. of the survey, In an effort to increase accessibility with organizations the outreach team worked or venues across the country to organize events The organizations The organizations Members were invited 22 23 to contribute to the committee’s objectives. UAC objectives. UAC to contribute to the committee’s members participated in five monthly calls with outreach team from May members of the USTS to join the committee as advisors on survey outreach to facilitate the collection of survey data that would best reflect the range of narratives and experiences of transgender people in the U.S. Each member brought unique skills and expertise in communities across the country through a was comprised variety of networks. The UAC research, of eleven individuals with advocacy, and lived experience from a wide range of geographical locations. A significant element of outreach involved A significant element of outreach involved Advisory Committee (UAC). convening a USTS community was created to increase The UAC raise engagement in the survey project and awareness by connecting with transgender people shared information about the survey through their shared information about the survey full scope of channels, it is difficult to assess the the outreach efforts. a. Advisory Committee the survey launch or during the data-collection the survey launch or during the data-collection that survey however, period. It is possible, of the survey respondents were still made aware is no through those organizations. Since there organizations information regarding whether these remaining organizations did not respond directly remaining organizations more about the survey to invitations to learn these Consequently, and become supporters. organizations did not receive correspondence prior to aimed at directly recruiting respondents potential respondents could determine whether potential respondents knew and trusted had pledged organizations they support for the survey. responded to outreach Nearly 400 organizations The support for the survey. and confirmed their performed outreach that contributed to the outreach that contributed performed unprecedented of the survey and far reach respondents. number of website so featured on the survey were also 28 2015 U.S. TRANSGENDER SURVEY submitted byorganizations followingthefielding complete thesurvey. held whereparticipantshad anopportunityto survey eventsorsimilargatherings mayhavebeen responses indicatethatadditionalunreported the surveyattheseevents. Approximately 199respondentscompleted non-transgender friends,family, andvolunteers. attended theirevents,includingtransgenderand the event.Thehostsreportedthat341people 46 reportedinformationaboutattendanceat organizations whoconfirmedtheirsurveyevents, with theirmembersorconstituents.Ofthe in theirfacilitiesorthroughcommunications flyer templatessotheycouldpromotetheevents access. Additionally, hostswereprovidedwith transgender peoplewithlimitedornointernet such asdirectmailorflyers,tobetterreach outreach methodsbeyondonlineavenues, event throughmultiplechannelsandconsider attend. Hostswereencouragedtopromotetheir information aboutwhereandwhenpeoplecould in the“SurveyWebsite” section),including supporting organizationmap(describedfurther website andgivenaspecificdesignationonthe Survey eventswerepromotedonthesurvey their events. invitation andconfirmedthedate(s)time(s)of Seventy-one (71)organizationsacceptedthe accepted theinvitationweresentprotocol. to becomesurveyeventhosts,andthosewho confirmed supportingorganizationswereinvited relative successandbenefitsoftheseevents.All This washelpfulinformationforevaluatingthe many peoplecompletedandsubmittedthesurvey. how manypeopleattendedtheeventand NCTE oftheireventpriortohostingandreporton protocol alsospecifiedthathostsshouldinform for howtoconductoutreachabouttheevent.The steps forbecomingasurvey-eventhostandtips survey responses.Theprotocolsdescribedthe guidelines topreventtheintroductionofbiasinto a successfuldata-collectionprocess,including 27

29 Event-relatedinformation 28 However, survey may bebeneficialinonlinesurveys, has alsofoundthatlottery-stylecashdrawings interest thatparticipatesinthesurvey. the proportionofindividualsinpopulation positive effectonsurveyresponserate, whichis have shownthatsuchincentivesmaya increase participationinsurveyresearch. accepted asameansbywhichtoencourageand Incentives, suchascashprizesarewidely participants wereofferedacash-prizedrawing. As anincentiveforcompletingthesurvey, c. Incentives had achievedtheirpreviouslystatedobjectives. thorough determinationastowhethertheevents period wasnotcomprehensiveenoughtomake a directed awayfromthesurveyhostingsite survey responses,USTS respondentswerere- After completing andsubmittingtheiranonymous one $500cashprizeandtwo$250prizes. prizes uponcompletionofthesurvey, including to enterintoadrawingforoneofthreecash USTS respondents wereofferedtheopportunity incentive andprizedistribution. eliminating thepotentialhighcostofbothcash in surveyswithalargenumberofrespondentsby offer apracticalmethodforprovidingincentives randomly chosenbyanon-NCTE party:three was assignedanumber, andsixnumbers were drawing contained17,683 entrants.Eachentrant be notifiedifselectedinthe drawing.Thefinal to providetheircontactinformation inorderto to beentered. were requiredtocheckabox givingtheirconsent To enterintotheprizedrawing,respondents survey wereeligibleforoneofthecashprizes. individuals whocompletedandsubmittedthe be connectedtotheirsurveyresponses.Only and anyfurtherinformationtheygavewouldnot confirming thattheirsurveyhadbeensubmitted on thispage, respondentsreceivedamessage addition tobeingthanked fortheirparticipation web pageontheNCTE-hostedUSTS website. In 37 Respondents werealsoasked 34

33 sincethey 32 Research 31 Studies 36 toa 30 35

METHODOLOGY 29 The pledge proved to be 40 information was collected continuously for several months, and by the time of the survey launch, over the survey. people had pledged to take 14,000 more than 500 people pledged to Additionally, promote the survey among their transgender friends and family. to pledge to take the survey and/or spread the the survey and/or spread to pledge to take was The survey pledge word about the survey. that a critical method of both informing people sustaining the survey would be launching and in the engagement with potential respondents Pledges months leading up to the fielding period. launch date received reminders about the survey and availability through email communications. cards Beginning in January 2015, pledge palm across were distributed at a variety of events including conferences and speaking the country, information engagements. The cards contained people to about the upcoming survey and asked sign up to help by committing to: (1) spread the the survey. word about the survey; and/or (2) take and non-transgender individuals were Transgender either to complete the pledge information, asked through a palm card or directly online through the Individuals who completed pledge survey website. information received email communications Pledge throughout the pre-data-collection phase. information about organizations that had pledged that had pledged about organizations information the map Additionally, the survey. to support about organizations indicated information distinctly events, including hosting survey-taking that were The and location of such events. time, the date, as the only platform through website later served be accessed and provided which the survey could since links to enter the survey, English and Spanish link available to the off-site there was no direct hosting platform. Pledge Survey b. to The survey pledge campaign was developed generate raise awareness about the survey and engaged investment in the project. The campaign them potential participants and allies by inviting

39 38 social media communications, including sample postings. The website Facebook and Twitter which included also featured an interactive map, months prior to its release in the field, such as a information about the description of the survey, frequently asked team working on the survey, questions, and sample language and graphics for individuals and organizations to use for email and a. Survey Website A website was created and designed specifically for the promotion and distribution of the survey. This website served as a platform for providing information about the survey starting several additional unique campaigns. Many survey additional unique campaigns. Many in English promotional materials were produced of the and Spanish to increase the accessibility survey. accessed, and (3) find creative ways of reaching accessed, and (3) find creative ways This diverse populations of potential respondents. through involved raising awareness of the survey email, several communication methods, including as through social media, and print media, as well NCTE would be conducting a survey to further the NCTE would be conducting a survey transgender understanding of the experiences of gleaned through the initially people in the U.S would NTDS, (2) communicate when the survey could be be available to complete and how it multifaceted approach and a coordinated effort multifaceted approach strategy to most effectively with the outreach of transgender people and reach a wide range of survey The goals ensure a robust sample size. that communications were to: (1) inform people VI. Communications the survey required a Communications for numbers for the prize winners and three for for the prize winners numbers prize winners The three if necessary. alternates their prizes upon and awarded were contacted acceptance. 30 2015 U.S. TRANSGENDER SURVEY 2015. was liveandavailableforcompletion onAugust 19, received NCTE’s postannouncing thatthesurvey 96,000 Facebookuserswereestimatedtohave the monthsleadinguptosurveylaunch,over Although socialmediareachfluctuatedduring the surveyandspreadingwordaboutit. contributing tothesurvey’s successbycompleting individuals andgroupswhohadaninterestin to rapidlyandsuccinctlycommunicatewith survey. Aseriesofpostings provided theability the numberofpeoplewhowereexposedto use significantlyamplifiedawareness,increasing used throughoutthesurveyproject,andtheir Twitter further thereachofsurvey. Facebookand was importanttoengageviatheseoutlets years sincetheprevioussurvey(theNTDS),it With theincreaseduseofsocialmediain d. SocialMedia promotion usingtheirphotos. most participantssotheycouldconducttheirown NCTE’s Facebookpage. Photoswere alsosentto photos werecollectedandshareddirectlythrough and eventsacrossthecountry. Morethan300 booths wereconductedatseveralconferences expressing supportforthesurvey. photos holdingoneoftwosignswithmessages Individuals andgroupswereasked totake people andraisingawarenessaboutthesurvey. launched asanothermethodforengaging In January2015,aphotoboothcampaignwas c. PhotoBoothCampaign effectively engaged. and howmorepotentialrespondentscouldbe respondents weredistributedgeographically, interested incompletingit,wherepotentialsurvey people hadlearnedaboutthesurveyandwere an effectivemethodofassessinghowmany 42 becametheprimarysocialmediaoutlets 41 USTS photo through USTS Awareness Week. Thiscampaign important methodsforpromotingthesurveywas at variousintervals;however, oneofthemost these liststhroughtargetedmessagesoccurred Communication withtheindividualsandgroupson organization’s workandprojects(“NCTElist”). up tobeincommunicationwithNCTEaboutthe organization list”),and(3)peoplewhohadsigned the surveythroughoutreachefforts(“supporting (2) organizationsthathadcommittedtosupport or spreadthewordaboutsurvey(“pledgelist”), categories: (1)peoplewhohadsigneduptotake individuals andorganizationswhofellintothree communication wasmaintainedwiththousandsof Prior tolaunchingthesurveyinfield, e. USTS Awareness Week on eachofthedaysdevotedtosocialmedia, communications. Communicationsweresent language andgraphicsforemailsocialmedia the surveywebsite. Theplanningkitincluded kit forthecampaign,whichwasavailableon were invitedtoaccessanddownloadaplanning the communicationlistsonJuly15,andrecipients and blogs.Awareness Week wasintroducedto medium eachday, includingsocialmedia,email, aspects ofthesurveyfocusingonadifferent week ofJuly27, 2015andhighlighteddifferent the survey. Awareness Week occurredduringthe period oftimeincloseproximity tothelaunchof information aboutthesurveyoveraconcentrated was designedtoshareasignificantamountof of eventualrespondents. to take thesurveyandlikely increasedthenumber increasing thenumberofindividualswhopledged to beoneofthemosteffectivemethodsfor their personalnetworks.Awareness Week proved and individualstosharetheinformationthrough to sharetheinformationwiththeirmembership email, 44 andblogs 45 withappealsfororganizations 46 43

METHODOLOGY 31 although several 47 while also making the questions accessible to the widest range of transgender people and in the territories. possible across the U.S. The questionnaire was reviewed and revised for consistent readability at an eighth-grade literacy level where possible, technical language was also necessary, unless technical language was also necessary, transgender it was widely used and accepted in terminology. communities, such as some medical Short descriptions or parenthetical explanations was were provided whenever technical language been familiar required for those who may not have hyperlinked Additionally, with the language. included when explanations of specific terms were several ways those terms could be interpreted in in the or if similar explanations were provided were federal surveys from which the questions provided explanations were For example, taken. for the terms “active duty” when asking about military service and “household” when asking about income. The research team remained conscious of individual and collective identities throughout the survey instrument drafting process, and attempted to use language that acknowledged the breadth and significance of individual identities that would most appropriately speak to individuals speak to individuals most appropriately that would which the survey communities for in the many areas required several However, was intended. that may keeping language choices about difficult for some respondents. have caused discomfort language was Throughout the questionnaire, be interpreted as stigmatizing avoided that could a value judgment wherever or characterized as objectivity in crafting possible while maintaining at times For example, sound research questions. to work or activities survey questions referred Such considered illegal.” that were “currently attempt to deliberate language was used in an from the separate the issue of criminalization comparability activity in question while maintaining balance with other surveys. This was a difficult Eliminating to achieve throughout the survey. surveys as non-transgender survey takers had surveys as non-transgender survey takers to those questions in federal surveys. In many places, language was revised to use terminology sample compares to the U.S. population. In sample compares to the U.S. survey assessments about USTS order to make population, it respondents in relation to the U.S. respondents had similar was important that USTS from other interpretations of questions taken the meaning of each question to the greatest This was of particular importance extent possible. in maintaining comparability with questions from existing surveys that allowed conclusions to be drawn about how the experiences of the USTS VII. Language and VII. Language Translation the use of Throughout the survey questionnaire, accessible language was balanced with preserving communications and likely impacted the final impacted the final communications and likely number of respondents in the sample. and distributed by organizations, including NCTE, and distributed by organizations, including the survey and individuals prior to the launch of The wide and during the data-collection period. the number variety of approaches contributed to all of individuals who were reached through medium that contributed to survey promotion, medium that contributed and traditional media and media consultants reach the survey’s sources aided in expanding blogs, 50 articles, Approximately even further. produced and op-eds focused on the survey were addition to the previously stated campaigns and addition to the previously involved working with projects, communications such as bloggers, artists, a variety of individuals to create print blogs and advocates, and others Op-eds were another the survey. videos promoting f. Additional Communications Communications Additional f. Methods communications approach to survey The overall many media forms. In was diverse and captured 32 2015 U.S. TRANSGENDER SURVEY questionnaire beganwitha studyinformation (UCLA) IRB.Asarequirement ofapproval,the by theUniversityofCalifornia Los Angeles study. TheUSTS underwentafull boardreview welfare ofindividualsparticipatinginaresearch ensure confidentialityandprotecttherights Review Board(IRB)process,whichismeantto The studywasvettedthroughanInstitutional Review VIII. Institutional possible. the English-languagequestioninterpretationsas selected toconveyinterpretationsasclose or specificterms,butineachcaselanguagewas that accuratelycapturedthemeaningofaquestion many instances,itwasdifficulttofindlanguage speaking transgendercommunitiesintheU.S. terminology thatwasmostprevalentinSpanish- interns reviewedandrevisedthelanguagetouse speaking communitymembersandNCTEstaff a translationservice, andseveralnative-Spanish- The questionnairewastranslatedintoSpanishby community forfutureiterationsofthesurvey. terminology withinanevolvinglanguageand to worktowardsidentifyingsuitablyinclusive team acknowledges,however, acontinuingneed experience andresearchexpertise. Theresearch to useineachparticularinstancebasedonlived in providingcollectiveinsightonthebestlanguage process. Thiscollaborativeprocesswasbeneficial revised languagethroughoutthedevelopment researchers reviewedthesurveyandsuggested was used.Additionally, communitymembersand transgender-specific experiencesorprocedures other surveysandwhenlanguagedescribing language waspreservedforcomparabilitywith higher literacylevel.Thisincludedplaceswhere terms usedinthesurveywereataconsiderably

In messaging mightneedtochangewhilethesurvey and Spanish.Italsorequiredanticipatinghow invited toparticipateinthesurveybothEnglish types ofmediathroughwhichpeoplewere volume ofmessagingforthemanydifferent field. and throughoutthetimesurveywasin materials leadinguptothelaunchofsurvey also requiredthesubmissionofallrecruitment that theirparticipationwasvoluntary. IRBreview risks andbenefitsofparticipatinginthestudy that participantswerefullyinformedaboutthe the informationsheet.Thisprocessestablished required toindicatetheirconsentattheendof To beincludedinthestudy, participantswere of individualsasparticipantsinthestudy. sheet describingaspectsofthestudyandrights security protocols.Accordingly, data from online the studyanddemonstrate sufficiencyofdata confidentiality protections were inplacefor the researchteamwasrequired toensurethat Furthermore, asaconditionofIRBapproval, component ofpreservingparticipants’ anonymity. maintenance ofsurveydatawasanimportant privacy and confidentiality inthecollectionand The surveywasanonymous,andmaintaining fielding period. collecting thesurveydatathroughout34-day Consulting, whichmanagedtheprocessof survey washandledthroughRankin &Associates the questionnaireandonlineadministrationof through theUSTS website. Allprogrammingof Access tothesurveywasprovidedexclusively USTS research teammember, Dr. SusanRankin. Associates Consulting,underthesupervisionof The surveywashostedonlinebyRankin & IX. SurveyHosting pre-approval forlateruseasneeded. was inthefieldandsubmittingthislanguagefor 49 Thisrequiredtheproductionofalarge 48

METHODOLOGY 33

54 The hosting The hosting 51 The first step 53

56 Duplicate survey responses 55 Data cleaning is the process of 52 responses to related questions. Missing-data analyses were then conducted to determine the percentage of missing data. The next step of the process was recoding data, including re-categorization of answer choices remove survey responses that did not belong in remove survey responses that did not the final sample. responses detecting and removing some survey incomplete responses, duplicate responses, (e.g., the quality illogical responses) in order to improve This dataset was “cleaned” using of the sample. commonly accepted procedures. individuals was to remove survey responses from the survey and those who did not consent to take such as who did not meet the eligibility criteria, not residing not being at least 18 years of age and respondents had been These survey in the U.S. automatically sent to a disqualification page, 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 questions in Section 2 of the questionnaire to be included in the final dataset. were removed next, as were those with illogical responses, such as those with contradictory a note about the issues and information about the information about the issues and a note about survey. availability of the continued of the high level a server to process team added to normal loading returned the survey traffic and days of the initial reports. speeds within a couple of survey submissions Although high numbers these days, it is likely were received throughout affected the completion that the server delays some surveys or may have and submission of from attempting to take discouraged individuals the survey. Data X. Cleaning the to The dataset was cleaned following collection The survey team notified 50 potential respondents of the delays through email and social media communication and updated the first page of the online survey questionnaire with completing the survey. The resulting server delays completing the survey. occurred within hours of the survey launch on 2015, producing unusually long page- 19, August loading times and may have served as a barrier to completing the survey. based on reasonable estimated response rates. in the first days of the data-collection However, high levels of traffic to the period, exceptionally the predicted response rates survey far exceeded and overwhelmed the capacity of the servers, causing significant delays in accessing and days of the survey data-collection period, given days of the survey data-collection period, and the potential impact on the data collection Prior to the survey launch, the the final sample. and capacity online platform had been assessed servers was predicted for the seven dedicated logs and notified the system administrators. period Despite a successful data-collection it is size, evidenced by the large final sample in the initial important to note issues that occurred into a single logical unit for the purposes of data into a single logical unit for the purposes performance improvement, or both, redundancy, due to to reduce the chance of any data loss The servers performed nightly hardware failure. the system security audits from data acquired via themselves were only accessible using encrypted themselves were only connections originating from SSH (Secure Shell) The servers were also in RAID the local network. Array of Inexpensive Disks), which (Redundant that is a data storage virtualization technology components combines multiple physical disk drive and protect the survey data. Given the volume and protect the survey seven servers during the initial of traffic on the an eighth server was added. launch of the survey, in an SQL database that The survey was stored The servers locally. could only be accessed participants was submitted through seven secure through seven secure was submitted participants 256-bit SSL (Secure servers with forced firewalled security and Security-Enhanced Layer) Sockets to encrypt security extensions Linux (SELinux) 34 2015 U.S. TRANSGENDER SURVEY noted accordinglyasthe“supplemental weight.” as individualandhouseholdincome, andare sensitive toageandeducationalattainment,such sample totheU.S. populationforitemsthatare standard weightwhencomparingtheUSTS These weightswereappliedinadditiontothe weights forageandeducationalattainment. government andnationaldatasources,including for thepurposesofcomparabilitywithfederal noted. Additionalsurveyweightswerecreated based onthestandardweightunlessotherwise All resultspresentedinthisreportareweighted in a“standard weight”appliedtothedataset. and the18-year-oldweightwerebothincluded rest ofthesample. sample ofthoserespondentsinrelationtothe was createdtobalancetherepresentationin who reportedanageof18yearsold,aweight disproportionally largenumberofrespondents Community Survey(ACS). on theCensusBureau’s 2014American and ethnicityweightwasdevelopedbased presentation ofresultsinthereport. Several surveyweightsweredevelopedfor was calculatedtodetermineinter-raterreliability. disagreement. Asimplepercentagreementscore reviewed therecodingandflaggedareasof initial datarecoding,andthesecondteam coding teams.Thefirstteamconducted repeated. Therecodingprocessincludedtwo created forwrite-inresponsesthatwerefrequently in othercases,newanswercategorieswere existing answerchoiceswhereappropriate, and some cases,theseanswerswererecodedinto the selectedoptionwas“notlistedabove.” In questions thatallowedawrite-inresponsewhen other surveys.Answerswereevaluatedforthose to matchexistingcategoriesforcomparison in severalquestionsforimprovedanalysisor 60 Theraceandethnicityweight 59 Additionally, giventhe 58 Arace 61

57 sex work,HIVstatus,andexperiencesoffamily demographic factors—suchasexperiencewith such asrace, gender, andincome—andnon- differed basedondemographiccharacteristics— were performedtoexplorehowsurveyresponses choosing nottoansweraquestion.Analyses respondents and/orduetosome questions onlybeingasked ofaparticularset differed throughoutthesurveyduetocertain The respondentsincludedineachtabulation responses toeachofthequestionsinsurvey. The datawasfirstanalyzedtotabulateindividual Findings and Presentationof XI. DataAnalysis Throughout thereport,results arepresentedin was generallylabeled“less than1%”or“<1%.” 1%). Additionally, afinding of 0.49% andbelow was roundedto2%and1.49% wasroundedto 0.49 andbelowwereroundeddown(e.g., 1.50% and abovewereroundedup, andfindingswith followed: findingscontainingdecimalsof 0.50 numbers, thefollowingconventionwasgenerally percentages beingsmall.Whenroundingtowhole more precisionwasneededduetothereported to nationaldatasourceswasdesiredorwhere except incaseswhereamoreexactcomparison Percentages areroundedtowholenumbers, context fortheweightedpercentagesreported. information couldbeinformativeandtoprovide frequencies areincludedwheretheadditional living withHIV. Inlimitedinstances,unweighted percentages ofthoserespondentswhoare much ofthedatarelatedtoHIVcarerepresent as apercentageofthewholesample, while example, educationalattainmentispresented or ofthesubgroupsbeingexamined.For weighted percentagesoftheentiresample All findingsinthereportarepresentedas support orrejection. METHODOLOGY 35 .”). Given .”). feminine . , and (p. vii). Los Angeles, CA: Angeles, CA: vii). Los (p. masculine , transgender Best Practices for Asking Questions to Identify Best Practices for Asking Questions to Identify 62 as white. The following statement was provided to explain why was used throughout the survey: We the word “trans” know that not everyone is comfortable with the word we must use one word but for this survey, “transgender,” to refer to all trans and non-binary identities. Because of in this survey to refer to this we will use the word “trans” all trans and non-binary identities.” (Ed.), and Other Gender Minority Respondents Transgender Surveys on Population-Based may have particular (“Adolescents Williams Institute. difficulties with complex vocabulary and sentences. questions designed for adolescents should Therefore, extra care to use plain language and simple take in measures of sex and gender used sentences. Terms should be defined since adolescents, and cisgender conflate the (non-transgender) adolescents in particular, and have varying understanding of terms sex and gender, the term of the need to collect data about the unique experiences conduct transgender youth, it is important to design and needs most future studies focusing on the issue areas and applicable to transgender youth. Information about the source of survey questions used population can be found in for comparison to the U.S. Appendix C (Detailed Methodology) 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. These pilot participants identified as American Indian, and a racial/ethnic Asian, multiracial, Black, Latino/a, in addition to 66% who identified identity not listed above, See e.g., The GenIUSS Group. (2014). In J. L. Herman (2014). In J. The GenIUSS Group. See e.g., 13 10 11 12 data source is specified. When providing U.S. When providing is specified. data source research team made comparisons, the population years to adults (18 limit the comparisons efforts to match the USTS to most appropriately and older) notes that was not possible, Whenever sample. other limitations are provided. as to age ranges or made by the research calculations Additionally, population to present U.S. team when necessary Data in this report is generally findings are noted. information regarding statistical presented without testing. 9 . (p. 11). . (p. . Injustice at Every Turn: A Report A Report Injustice at Every Turn: . New York, NY & Los Angeles, CA: Angeles, CA: NY & Los . New York, Appendix C (Detailed Methodology) | CHAPTER 2: METHODOLOGY Institute. Institute. Grant et al., p. 182. Grant et al., p. Grant et al. L. (2014). J. L., & Herman, P. Rodgers, See Haas, A. P., and Gender Non- Among Transgender Suicide Attempts Conforming Adults American Foundation for Suicide Prevention & Williams Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. Herman, J. Harrison, J., J., M., Mottet, L. A., Tanis, Grant, J. M. (2011). L., & Keisling, Discrimination Survey of the National Transgender Equality and National DC: National Center for Transgender Force. Task Gay and Lesbian Detailed information about survey methodology is Detailed information about survey methodology available in August 19 and The survey was in the field between September 21, 2015. health insurance; HIV; housing and homelessness; health insurance; HIV; housing and homelessness; partner identity documents; immigration; income; intimate policy violence; military service; police and incarceration; sexual priorities; public accommodations; sex work; behaviors; assault; substance use; suicidal thoughts and attack; and unequal treatment, harassment, and physical voting. The survey included questions related to the following The survey included questions related to the topics (in alphabetical order): accessing restrooms; education; airport security; civic participation; counseling; and employment; faith; family and peer support; health 6 7 8 5 2 3 www.USTransSurvey.org 4 1 is compared to data from existing research, the is compared to data ENDNOTES apply”) or due to rounding. apply”) or due to rounding. population findings U.S. Throughout the report, findings to USTS are provided for comparison where findings, for USTS or to provide context data Where USTS available and/or applicable. various figures and tables. The percentages in The percentages and tables. various figures up not always add and tables do these figures being able to select to respondents to 100% due that question (“mark all one answer to a more than 36 2015 U.S. TRANSGENDER SURVEY 22 21 20 19 18 17 16 15 14 estimates. assess theeffectivenessofoutreach andresponserate from supportingorganizationsthat willhelptobetter encouraged tocollectconsistent outreach activitydata through theirchannels.Inthefuture, researchersare and estimatedreachingover20,000 transgenderpeople 58 (15%)reportedinformationontheiroutreachactivities rate. Ofthe392organizationsthatpledgedtheirsupport, the outreachdidnotallowacalculationofresponse however, thelimitedamountofinformationreceivedabout of outreachengagementsupportingorganizations; The researchteamattemptedtoascertainthelevel information abouttheavailabilityofsurvey. asks tospreadthewordaboutsurveyandwithvarious Correspondence includedalmostonedozenemailswith and 435didnotrespondtoanycommunications. Out ofthoseorganizations,392confirmedtheirsupport, emails and/orphonecallsifnoresponsewasreceived. email, andorganizationsreceivedadditionaloutreach A totalof827organizationsreceivedatleastoneoutreach underrepresented inonlinesurveys. reaching moreindividualsincommunitiesthatareoften collected, alongeroutreachperiodmayhaveresultedin the largestsampleoftransgenderrespondentsever Although outreacheffortswereinstrumentalinobtaining (all with mistreatment,andtoself-reportasHIV-positive current dailysmokers, toendorsesubstanceusecope also weremorelikely thanonlinerespondentstobe online respondents(all with lowerincomesandeducationalattainmentthan young, male-to-female, peopleofcolor, publiclyinsured, that “[a]higherproportionofin-personrespondentswere Reisner etal.,p. 98.Seenote16.Thisanalysisalsofound Wiley &Sons. Tailored DesignMethod Internet, Phone, Mail,andMixed-Mode Surveys:The See Dillman,D. A.,Smyth,J. D., &Christian,L.M.(2014). transgender healthresearch. Transgender DiscriminationSurvey: Implicationsfor person andonlinesurveyrespondentsintheU.S. National survey online. SeeReisner, etal.(2014).Comparingin- providing furthersupportforthedecisiontoonlyoffer completed onlinewerelesslikely tohavemissingdata, that surveyonlineorinpaperformatfoundsurveys Post-NTDS analysisofrespondentswhohadcompleted Grant etal.,p. 13. the “SurveyHosting”section. when completingthesurvey. Thisisdiscussedfurtherin overwhelmed multipleservers,causinglengthydelays survey’s availability, whenahighvolumeofsurveytakers completing thesurveyoccurredduringfirstdaysof A notableexception tothe30–60minuteestimatefor p <0.05).” p (4thed.).Hoboken, NJ:John <0.05). In-personrespondents LGBT Health,1 (2), 98–106. 25 24 23 30 29 28 27 26 might hostpeopleonMonday–Fridayfrom5pm–9pm computers areavailableforsurveytakers touse, orit one Saturdayfrom9am–6pmwheresomeorallofits a communitycentermightparticipatebysettingaside the surveyisavailableonadrop-inbasis.Forexample, during specifiedperiodsoftimeorthroughoutthe internet access)tocompletetheUSTS. Thiswilloccur use ofitsresources(includingcomputers,tablets,and and officebuildings)toallowtranssurveyparticipants provides accesstoitsfacilities(suchascommunitycenters in whichanorganizationorgroupopensitsdoorsand Survey-Taking Eventsweredescribedas“afunction complete thesurveyonline. through organizationswhoofferedspaceorcomputersto number ofpeoplewhoattemptedtoaccessthesurvey differing events.Alackofclaritymayhavedecreasedthe not appropriatelycapturethenatureofthesevastly (see note25).However, itispossiblethatthenamedid on recruitmentmaterialsanddescribedaccordingly These eventswerepromotedas“Survey-Taking Events” Acknowledgements Information aboutUAC memberscanbefoundinthe are alsoencouragedtoconductfollow-up analysesto events inprovidingaccesstothe survey. Researchers events toincreasethereachand availability ofsuch towards organizing,conducting,and monitoringsurvey the researchteamsuggestsamore robustapproach In futureiterationsoftheUSTS andotherresearchstudies, meeting?” as onehostedbyanLGBTQ orTrans organizationor you takingthissurveyataeventormeeting,such “yes” inresponsetothefollowingsurveyquestion: “Are Four hundredandseventeen(417)respondentsanswered time. event andthenlefttocompleteitontheirownatalater reports thatsomeindividualsstartedthesurveyat This completionrateisaconservativeestimatebasedon activity wasnotcollectedorreceived. the surveyatsametime. Dataregarding thissortof parties wheregroupsoffriendscouldgathertocomplete possible thatindividualsandorganizationsheldinformal them tothesurveyoutreachteam.Additionally, itisalso gatherings tocompletethesurveywithoutreporting more organizationshostedsurveyeventsorsimilar throughout thedata-collectionperiod,itappearedthat based oninformationreportedatvariousintervals Although only71organizationsconfirmedtheirevents, Reisner etal.,p. 98,103.Seenote16. characteristics, healthoutcomes,andlifeexperiences. differ fromonlinesurveytakers insociodemographic in paperformat(7%ofthesample)andwerefoundto A totalof435NTDSrespondentscompletedthesurvey each eveningforaweek,orlonger.” sectionofthereport. METHODOLOGY 37 individuals up to several hours to complete the survey and others reported that they were not on the first day, able to complete or submit their survey at all due to the technical issues. send it to your membership list today.” were invited to share a blog recipients For blog day, Ignacio Rivera, cross written by Outreach Coordinator, or draft a blog blog site, post the blog on an organization’s about the importance of the survey. the survey The number of individuals who pledged to take 7,700 on the pledge list increased from approximately email was sent on July Week when the initial Awareness at the time the survey launched in the 15 to over 14,000 pledges field. The 82% increase in the numbers of survey by due to the increased exposure generated is likely communications. Week Awareness conducted The initial literacy level review and revision was levels, and by a certified copy editor proficient in reading the questionnaire was determined to be at an eighth grade reading level. Due to IRB requirements, the language in the study information sheet was generally at a higher literacy level than the rest of the questionnaire. This included all materials aimed at “recruiting” or getting such as website people to participate in a research study, pages, flyers, emails, and social media messages. The research team received reports that it took some Final pledge numbers were 14,005 and 561 for survey numbers were 14,005 Final pledge respectively. and promoters, takers from one of two participants could choose Photo booth coming in the summer that the survey was signs indicating Counts: I’m following: (1) “My Voice of 2015 and stating the Counts: or (2) “Every Voice #USTransSurvey” the Taking About the #USTransSurvey.” Spread the Word the survey was hashtag used to promote The Twitter #USTransSurvey. the recipients received one of For social media day, on whether they were following requests, based (1) “Use the hashtag organizations or individuals: your social on social media asking #USTransSurvey or (2) “Please join Social Media networks to join us” have sample copy and a variety of photos and We day. graphics.” received one of the following recipients For email day, or requests, based on whether they were organizations this is so individuals: (1) “Email a friend explaining why email and important to you” or (2) “Download the sample 45 46 47 48 49 50 40 41 42 43 44 Social International Journal (1), 123–124. (finding that “material

(2), 229–243. 645

34 , (1), 58–70. 1

The ANNALS of the American Academy of limited English proficiency in future iterations of the study. of three cash prizes: one prize of $500 and two prizes of $250!” Due to limited funding, it was not possible to translate all survey materials, such as email communications. of all promotional materials may positively Translation impact the response rate amongst respondents with cash-prize drawing, including email blasts. & Associates The survey was hosted by Rankin Consulting. Further details are described in the “Survey Hosting” section. me in the drawing for one stated: “Enter The check box survey website also offered the following statement: survey website also offered the following statement: you will have the option “When you complete the survey, one to enter a drawing to win one of three cash prizes: Because thousands prize of $500 and two prizes of $250. the of trans people across the country will complete we cannot offer payment to each participant.” survey, some recruitment materials mentioned the Additionally, respondent’s consent to enter the survey contained respondent’s of the following information in response to the question participation: whether respondents would be paid for their will receive no payment for your participation. You “You to win will have the option to voluntarily enter a drawing two prizes one of three cash prizes: one prize of $500 and questions section of the The frequently asked of $250.” Singer, E. & Ye, C. (2013). The use and effects of incentives E. & Ye, Singer, in surveys. and Social Science, Political were informed of the cash prize incentives Participants placed in several ways. The study information sheet each at the beginning of the survey prior to obtaining Pedersen, M. J. & Nielsen, C. V. (2016). Improving survey (2016). Improving survey & Nielsen, C. V. M. J. Pedersen, panels: Effects of low-cost response rates in online text appeal interventions. incentives and cost-free Science Computer Review 237–238. et al., pp. Pedersen NTDS). A. S. (2006). Incentives in web studies: Göritz, See e.g., and a review. Methodological issues of Internet Science, odds of a person responding by incentives increase the incentives”). 19% over the odds without determine the demographic characteristics of individuals of individuals demographic characteristics determine the and whether the survey at events who completed a similar were successful in capturing these events paper surveys to those who had completed demographic the et al. (discussing See Reisner, survey. in the previous and paper respondents in the demographics of online www.USTransSurvey.org 39 www.USTransSurvey.org 38 36 37 34 35 32 33 31 38 2015 U.S. TRANSGENDER SURVEY 58 57 56 55 See 54 53 52 51 information aboutweightsapplied tothesurveydata. Appendix C the collectedsurveydataandtotalpopulation.See to surveydatainordermake comparisonsbetween the totalU.S. population.Therefore, weightsareapplied U.S. maydifferfromtheproportionofthoseagegroupsin aged 18–24and25–44inasurveysampletaken inthe was drawn.Forexample, theproportionofrespondents representative ofthepopulationfromwhichsample adjust datawithdisproportionatesamplesizestobemore “Weighting” isacommonstatistical techniqueusedto (Detailed Methodology) the codingforapprovalorrevisions.See the initialcodingandotherresearcherreviewed researcher. Oneresearcheroneachteamconducted team includedaprincipalresearcherandanoutside used bythetwoteamsthatconductedreview. Each A modifiedversionofaninter-raterreliabilitymetricwas Appendix C(DetailedMethodology) the researchteamdidnotimputemissingdata.See than 5%missingdataonallbuttwoquestions.Therefore, Missing-data analysesdeterminedthattherewasless to remaininthesample. information ontheSection2questionsthatwererequired related togenderidentityorexpression. their genderidentityorexpressionandexperiences website formoreinformationorgivingabout and providingeitheranopportunitytovisitthesurvey disqualification pagesnotifyingthemoftheirineligibility Ineligible respondentsweresenttooneoftwo 3–13. current approaches. Rahm, E.&Do, H.(2000).Datacleaning:Problemsand in A detaileddescriptionofthecleaningprocessisincluded may havetorestartthesurvey.” the ‘back’button.However, ifyoucloseyourbrowser, you open andreturnlater. Ifthesurveytimesout,youcanhit If thesurveyisslowtorespond,youcanleavepage encourage youtoreturnthissiteinthecomingdays. at leastSeptember21 However, thesurveywillbeavailabletocompletethrough complete thesurveynowbutmayexperiencedelays. inconvenience asweworktoaddressthisissue. You can are experiencingunusualdelays.We apologizeforthe by thenumberofenthusiasticparticipantsandsome of thedelay:“Our servershavebeenoverwhelmed survey (inEnglishandSpanish)tonotifyrespondents The followingnotewasaddedtothefirstpageof Appendix C(DetailedMethodology) Appendix C(DetailedMethodology) ( Detailed Methodology IEEE DataEngineeringBulletin, st . Ifyouexperiencedelays,we formoreinformation. ) formoredetailed formoreinformation. . formore Appendix C

23 (4), 60 59 62 61 discontinuity model.Formoreinformationonthisprocess with propensityscoresdevelopedusingaregression The weightfor18-year-oldrespondentswascreated for transgenderpeople. to bethetruepopulationdistributionforraceandethnicity procedure bringsthesampleclosertowhatisestimated may stillover-representwhiterespondents,thisweighting U.S. populationweightsforraceandethnicity. Whilethis correct forthissamplingbias,theresearchteamapplied respondents thantheU.S. generalpopulation.To help the USTS samplehasahigherpercentageofwhite Journal ofPublicHealth from ahouseholdprobabilitysampleofadults. (2012). Transgender healthinMassachusetts: Results Conron, K.J., Scott,G.,Stowell, G.S.,&Landers, S.J. in theUnitedStates Race andEthnicityofAdultswhoIdentifyasTransgender e.g., Flores,A.R.,Brown,T. N.T., &Herman,J. L.(2016). transgender peoplemorelikely tobepeopleofcolor. See general populationinregardtoraceandethnicity, with adults havefoundthattransgenderdifferfromthe Studies usingrepresentativesamplesoftransgender more nuancedunderstandingofgroupdifferences. additional bivariateandmultivariatemodelingtoprovide research team.Futureresearchersareencouragedtouse statistic andeffectsizes.Thesetestsareonfilewiththe particular cell’s contributiontoanoverall chi-squaretest out meaningfuldifferencesamonggroups,suchasa research teamconsideredothermeasureswhenpointing meaningful. Inwritingthefindingstothisreport, the differencesaresmalland,therefore, notparticularly will befoundtostatisticallysignificant,evenwhen the groupsbeingcompared.Smallgroupdifferencesoften largely resultinstatisticallysignificantdifferencesamong Due tothelargesamplesize, bivariate statisticaltests Community Survey(ACS). created basedontheCensusBureau’s 2014American The age, race, andeducationalattainmentweightswere (Detailed Methodology) and otherweightingprocedures,see . Los Angeles,CA: WilliamsInstitute; . , 102 (1), 118–122.However, Appendix C American GUIDE TO REPORT AND TERMINOLOGY 39

in the reporting of results. While explanations are often included in chapters to provide context in the reporting of results. While explanations are often included in chapters hroughout the report, the authors use a variety of terminology to refer to respondents in the hroughout the report, the authors use a variety of terminology to refer to several conventions sample or experiences that respondents reported. The authors also applied

and clarity, several terms and conventions that are used widely throughout the report are outlined in this several terms and conventions that are used widely throughout the report are outlined in this and clarity, the report more accessible to a broad range of audiences. chapter to make Guide to Report Guide to Report and Terminology CHAPTER 3 CHAPTER T 40 2015 U.S. TRANSGENDER SURVEY acceptance. Based onthisinformation,the of theterm’s continuedbroadusageandgeneral non-binary respondents.This providesevidence to describethem.Thisincluded 82%percentof were withtheword“transgender”beingused or “neutral”whenasked howcomfortablethey “very comfortable,” “somewhat comfortable,” transgender, and86%expressedthattheywere of respondentsthoughtthemselvesas reported inresponsetosurveyquestions—88% including morethan500uniquetermsthatwere this studyidentifiedwithawiderangeofterms— throughout thequestions.Whilerespondentsin amongst transgenderpeople—consistently “trans”—a shorthandtermthatiswidelyaccepted the limitationofcurrentlanguageandused was welcomed.Thesurveyalsoacknowledged did notincludethemwouldknowtheirvoice those whomighthaveassumedthat“transgender” genderqueer, andnon-binary”people, sothat as beinginclusiveofall“transgender, trans, In promotionalmaterials,thesurveywasdescribed identities expressedintheUSTS surveysample. this reportthatcouldbestrepresenttherangeof select asingletermforconsistentusethroughout findings clearandaccessible, itwasimportantto identity. However, inordertomake thereport’s prefer touseothertermsdescribetheirgender each individual’s uniqueidentityandsomepeople the authorsrecognizethatonetermcannotreflect and capturesthediversityoftransgenderpeople, term” that encompassesthespectrumofidentities term hasoftenbeendescribedasan“umbrella they werethoughttobeatbirth.Althoughthis differs fromwhatisassociatedwiththegender people whosegenderidentityorexpression The term“transgender”isoftenusedtodescribe Report “Transgender” inthis I. UseoftheTerm than onegender. Inthisreport,“non-binary a genderotherthanmaleorfemale, including thosewhoidentifyashavingnogender, whose genderisnotexclusively maleorfemale, This termisusedbysometodescribepeople Non-binary: Specific Terminology II. OtherTransgender- completing thesurvey. the individualswhomadetheirvoicesheardby this reporttorepresentthediverseidentitiesof term changing one’s clothing,appearance, name in agendertransitionmay or maynotinclude looks differentforeveryperson. Possible steps intend todoso, but manydo. Gendertransition Not alltransgenderpeoplehavetransitionedor than thegendertheywerethoughttobeatbirth. live accordingtotheirgenderidentity, rather This Gender transition: to Q. 2.3. described theircurrentgenderidentityinresponse who saidthattheterm“cross-dresser”best the term“crossdressers” referstorespondents intend tolivefulltimeasthatgender. Inthisreport, birth, butwhomaynotidentifywiththatgenderor different fromtheonetheywerethoughttobeat in awaythatistypicallyassociatedwithgender use thistermtodescribeapersonwhodresses While definitionsof“crossdresser”vary, many Crossdresser: their currentgenderidentityinresponsetoQ. 2.3. the term“non-binary/genderqueer”bestdescribes respondents” referstorespondentswhosaidthat

is aprocessinwhichpersonbeginsto transgender isusedforthepurposesof or more GUIDE TO REPORT AND TERMINOLOGY 41 chapter. Sex Work Sex Work refers to fields of work that, in

the sex trade that are not criminalized, such as pornography), drug sales, and other income-based work that is currently criminalized. See and Other Underground Economy Income Sexual assault: assault” refers In this report, the term “sexual sexual to a variety of experiences of unwanted limited to, but are not contact. These may include, forced oral, genital, or anal contact or penetration, were asked Respondents fondling, and rape. sexual about their experiences with unwanted of different contact or sexual assault in a number varied in some contexts. Definitions of these terms in some cases, questions based on the context or, question was on the national survey from which a provided the definition adapted. Where applicable, or “unwanted sexual contact” assault” for “sexual in each question is included in the report. Underground economy: This terminology general, are currently criminalized in the United this term includes income- In this report, States. based sex work (including forms of work in expression” category. Additionally, several phrases several phrases Additionally, category. expression” describe experiences interchangeably to are used result of biases due had as a that respondents to be transgender. known or perceived to being for example: “because they were These include, transgender “because of their transgender,” or or “because of their gender identity status,” expression.” Terms III. Additional and Conventions Used in the Report very similar meanings, responses of those who selected one or both of these reasons were collapsed for reporting in one “gender identity/ so that respondents could select what they felt Since there best represented their experience. was a substantial overlap of respondents who selected both reasons, and because these terms are commonly used interchangeably or with Several questions throughout the report asked 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/ Both answer choices were included appearance.” living full time may include changing one’s name, name, one’s living full time may include changing or taking other clothing, and/or appearance, actions related to their gender transition. Gender identity or expression: Respondents in the sample who were described Respondents are those who in the report as “living full time” gender reported that they lived full time in a thought to be different than the gender they were For many people, 1.12. at birth in response to Q. have transitioned” refers to respondents who have transitioned” refers to respondents in response reported that they are living full time (see below). 1.12 to Q. Living full time: hormone therapy, surgical treatments, and other hormone therapy, people may undergo health services transgender including “health care as part of their transition, or “transition-related related to gender transition” the term “respondents who In this report, care.” transition in several places when discussing steps transition in several gender transition, in one’s that may be included name and gender on identity such as updating the the report includes a documents. Additionally, refer to therapy/counseling, variety of terms to and identity documents (for example, a driver’s a driver’s example, documents (for and identity procedures such undergoing medical license), or physical one’s therapy to change as hormone refers to gender This report characteristics. 42 2015 U.S. TRANSGENDER SURVEY C: DetailedMethodology. write-in answerswererecoded,referto listed above.” Formoreinformationabouthow were includedincategoriessuchas“areasonnot or newcategories,andthesewrite-in-responses not possibletorecodetheanswersintoexisting as a“write-inresponse.” Inmanycases,itwas answers wereoftenlistedinthereportandlabeled recode write-inanswersintoanewcategory, those categories whenfeasible. Whenitwaspossibleto into existinganswerchoicecategoriesornew reviewed forrecodingtocategorizetheresponses to aquestion.Thesewrite-inresponseswere were givenanopportunitytowriteinaresponse At severalplacesinthesurvey, respondents Write-in responses: past 30days,” or“currently.” referred toasoccurring“inthepastmonth,” “inthe to completingthesurvey, theexperiencewas experience thatoccurredwithinthe30daysprior or “inthepastyear.” Ifarespondenthadan having thoseexperiences“inthepast12months” prior tocompletingthesurveywerereportedas who hadcertainexperienceswithinthe12months completed thesurvey. Forexample, respondents in comparisontothetimewhenrespondent to thetimewhentheseexperiencesoccurred the pastyearor30days.Thereportrefers of timepriortohavingtaken thesurvey, suchasin about experiencesthatoccurredwithinaperiod In thesurvey, respondentsansweredquestions experiences: Time periodofreported

Appendix Voices.” are includedinsectionstitled“InOur Own Throughout thereport,excerpts ofstories Stories includedinthereport: in thisreport. list ofsourcesonanyparticularsubjectpresented and shouldbenottreatedasacomprehensive However, thelistofreferencesisnotexhaustive, resources inseveralplacesthroughoutthereport. References tootherresearcharealsoprovided as to providecontextforfindingswherefeasible. are includedinthereportforcomparisonand References toexperiencesoftheU.S. population other resources: U.S. populationcomparisonsand have beeneditedforlengthandclarity. respondents’ offer important anecdotalevidenceandcontextfor provided tosupportthefindingsofreportand respondents aftertheycompletedthesurvey,are These stories,whichweresubmittedby reported experiences.Thesestories PORTRAIT OF USTS RESPONDENTS 43

ith 27,715 respondents, the U.S. Transgender Survey (USTS) is the largest survey ever conducted is the largest survey ever conducted Survey (USTS) Transgender respondents, the U.S. ith 27,715 providing a rich understanding of numerous aspects States, of transgender people in the United diverse gender an overview of respondents’ chapter, of their lives and experiences. In this

XIII. Citizenship and Immigration Status Sexual Orientation XIV. Status Relationship XV. VII. Location in Home Spoken VIII. Primary Language Spiritual Identity or IX. Religious X. Income and Employment Status XI. Educational Attainment XII. Disability II. Experiences with Transitioning by Others Person as a Transgender III. Being Perceived Outness IV. and Ethnicity Race V. VI. Age I. Gender Identity and Expression

identities and experiences with transitioning is presented. Additional characteristics of USTS respondents, is presented. Additional characteristics of USTS identities and experiences with transitioning This educational attainment, and geographic location, are also presented. age, such as race and ethnicity, sections: information is discussed in the following W CHAPTER 4 CHAPTER PortraitUSTS of Respondents 44 2015 U.S. TRANSGENDER SURVEY word “transgender”beingusedtodescribethem Figure 4.1: Respondent’s levelofcomfortwiththe transgender 14% expresseddiscomfortwithbeingdescribedas percent (43%)were“verycomfortable,” andonly 82% percentofnon-binaryrespondents.Forty-three comfortable orneutralusingthisterm,including Eighty-six percent(86%)expressedthattheywere “very comfortable” to“veryuncomfortable.” used todescribethemonafive-pointscalefrom they werewiththeword“transgender”being Respondents werealsoasked howcomfortable gender andrelatedexperiences. the remaining12%usedothertermstodescribetheir that theythoughtofthemselvesastransgender, while Eighty-eight percent(88%)ofrespondentsreported if theythoughtofthemselvesas“transgender.” wide rangeofidentities,thesurveyasked respondents identities usingjustoneterm.Acknowledgingthis to evolve, anditisdifficulttodescribeallofthose birth. However, languagedescribingidentitycontinues gender differsfromtheonetheywerethoughttobeat identities andcapturethediversityofpeoplewhose term” intended toencompassthespectrumof The word a. Identity Expression I. GenderIdentityand Neutral 16% transgender Very uncomfortable 2 (Figure4.1).

uncomfort Somewhat comfortable Somewhat able 11% respondents 27% 3%

is often used as an “umbrella isoftenusedasan“umbrella

- % of

comfort Very 43% able

- Table 4.1: Genderidentityterms gender termswithwhichtheyidentified. terms, respondentswroteinmorethan500unique was notlisted(Table 4.1). Inadditiontothelisted also givenanopportunitywriteinagenderthat described theirgenderidentity, andtheywere terms fromwhichtheycouldcheckallthat Respondents werealsoofferedalistofidentity categories used forprimaryanalysis. or (MTF) out ofsixpossibleterms( term thatbestdescribedtheir currentgenderidentity Respondents were alsoasked tochooseonlyone Used forAnalysis b. Gender IdentityCategories Gender non-conforming or gender Gender non-conformingorgender Genderqueer Non-binary Trans man(FTM,femaletomale) Trans woman(MTF, maletofemale) Trans Transgender Gender identityterms A gender not listed above A gendernotlistedabove Mahu Fa’afafine Bulldagger Travesti Stud A.G. oraggressive Drag performer(king/queen) Intersex Third gender Multi-gender Crossdresser Butch Bi-gender Two-spirit Agender Transsexual Androgynous Gender fluid/fluid variant crossdresser , trans man(FTM) ) to determine the gender identity ) todetermine thegenderidentity , non-binary/genderqueer woman, man, trans woman woman, man,transwoman 3 Respondents respondents % of 20% 56% 65% 29% 32% 27% 12% 18% 18% 14% 31% 31% <1% <1% <1% 6% 5% 5% 2% 4% 4% 3% 7% , 1% 1% 1% PORTRAIT OF USTS RESPONDENTS 45

32% 5 and under

28%

6 to 10 2% 26 and over % of respondents

13% 21 to 25 16 to 20 21% 11 to 15 Respondents received questions related to Respondents identity the development of their transgender respondents throughout their lives. A majority of “different” (60%) reported that they began to feel at from the sex on their original birth certificate including 32% who began to age 10 or younger, and 28% who feel different at age 5 or younger, ages of 6 and began to feel different between the began to Six percent (6%) reported that they 10. 4.3). feel different at age 21 or older (Figure was Figure 4.3: Age they began to feel gender birth certificate different from the one on their original to describe respondents who were thought to be to be were thought respondents who to describe (such as transgender they were born male when with female on their and “respondents women), used to describe is certificate” original birth were thought to be female respondents who (such as transgender men). when they were born of respondents had female More than half (57%) and 43% had certificate, on their original birth Of those birth certificate. male on their original 80% had female on their who were non-binary, on and 20% had male original birth certificate, certificate. their original birth d. Development of Transgender with Identity and Interactions People Other Transgender non-

35%

Non- non-binary binary people , 3% Crossdressers best described their

best described their Those who said that

4 . % of , a term often used to describe

transgender men ,

respondents 33% women (Figure 4.2). Throughout the report, 5 men 29% Transgender Transgender best described their gender identity. best described their gender identity. In this report, the term “respondents In this report, the term “respondents crossdressers transgender man 6 Transgender Transgender transgender woman genderqueer or or , and or man these respondents are referred to as “non-binary.” these respondents are referred to as Figure 4.2: Gender identity were “assigned at birth, on [their] original birth were “assigned at birth, on [their] original birth certificate.” is used with male on their original birth certificate” c. Gender Assignment at Birth about the sex they asked were Respondents other than male or female, as more than one gender, more than one gender, as other than male or female, or as no gender crossdresser indicatedMore than one-third (35%) of respondents as that their gender identity was best described binary or male people whose gender is not exclusively identify with a gender including those who female, that included in the transgendergender identity were (29%). Overall, 62% ofmen analytical category menrespondents were included in the transgender (3%) said thatand women categories. Three percent transgender women people woman included in the transgendergender identity were (33%), and those who saidwomen analytical category were grouped into four gender identity categories into four gender were grouped four categories their responses. These based on to discuss thethroughout this report are used the survey: of those who completed experiences 46 2015 U.S. TRANSGENDER SURVEY they weretransgender(Figure4.5). reported thattheyhadnottoldanyoneelse transgender atage31orolder. Additionally, 5% 30, and14%begantellingpeoplethattheywere were transgenderbetweentheagesof21and 20. Another30%begantellingpeoplethatthey one-third (37%)didsobetweentheagesof16and between theagesof11and15,morethan began totellothersthattheyweretransgender One inten(10%)respondentsreportedthatthey began totellothersthattheyweretransgender. Respondents werealsoasked atwhatagethey transgender Figure 4.4:Agetheystartedtothinkwere transgender atage26orolder(Figure4.4). (8%) reportedbeginningtothinkofthemselvesas 28% betweentheagesof11and15.Eightpercent as transgenderbetweentheagesof6and10, and Sixteen percent(16%)begantothinkofthemselves of themselvesastransgenderatage5oryounger. One inten(10%)reportedthattheybeganthinking transgender, eveniftheydidnotknowthatword. were whentheystartedtothinkofthemselvesas Respondents werealsoasked howoldthey 16 to20 29% 21 to25 10%

respondents 26 and over 8% % of

under 5 and 10%

11 to15 28% 6 to10 16%

e. GenderIdentityand 1% oftransgendermen(Figure4.6). women, 1%ofnon-binaryrespondents,andlessthan 65 orolder, comparedtoonly5%oftransgender (8%). Oneinfive(20%)crossdresserswereaged (43%), transgenderwomen(24%),andcrossdressers being aged18–24,incontrasttotransgendermen more likely tobeyounger, withnearlytwo-thirds(61%) 29% ofcrossdressers.Non-binaryrespondentswere compared to35%ofnon-binaryrespondents,and transgender menandwomenbeingaged25–44, gender identitycategories,withnearlyhalf(47%)of The ageprofileofrespondents Current Age were transgender Figure 4.5:Agetheystartedtotellothersthat Figure 4.6: Genderidentitybycurrent age 60% 20% 50% 30% 40% 70% 10% 0% They havenottoldothers

Crossdressers 26 to30 9% 25 to44 18 to24 8% 29% 21 to25 31 and

5% 21% over 14% 43% 20%

respondents Non-binary 61% 35% % of 4% 1% 65 andover 45 to64

10 andunder 43%

Trans men 7 11 to15 differed widely by differedwidelyby 10% 47% 5% 9%

16 to20

<1% 37%

Trans women 24%

46% 26% 5%

PORTRAIT OF USTS RESPONDENTS 47 <1% 3% 29%

68% Trans women Trans 62% have They tioned transi <1% 2%

16%

82% men Trans 3%

to transition 5% They do not want They do not % of 31%

21% 43% Non-binary respondents

23%

43%

They have transitioned They want to transition someday They are not sure if they want to transition They do not want to transition 22% They want to 28% transition

someday

6% 13% Crossdressers transition

if they want to if they want 0% 10% They are not sure They are not 70% 40% 30% 80% 50% 20% 90% 60% 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 a woman, and 15% lived part time in one gender and part time in another. Respondents were also asked what gender they also asked were Respondents were living in on a day-to-day basis. Thirty-five Figure 4.7: Transition status of respondents status of respondents Transition Figure 4.7: status of respondents Figure 4.8: Transition GENDER IDENTITY (%) 8 respondents had transitioned (Figure 4.8). Twenty-two percent (22%) of respondents reported Twenty-two 13% were that they wanted to transition someday, and 3% did not want to transition (Figureunsure, men and Three-quarters (75%) of transgender 4.7). women had transitioned, and 43% of non-binary currently living full time in a gender that was different from the one on their original birth certificate. Throughout the report, the process of living full time in a gender that is different than that on one’s original birth certificate is described as “transitioning.” because of financial constraints, safety concerns, fearbecause of financial constraints, safety barriers. of discrimination and rejection, and other and Transition a. Full-Time Status Nearly two-thirds (62%) of respondents were transgender people may desire and make some oftransgender people may desire and make to live fullthese changes even if they do not intend the one ontime in a gender that is different than many people However, their original birth certificate. these steps are not able to do sowho want to take include undergoing medical procedures, such asinclude undergoing medical procedures, one’s hormone therapy or surgeries, to change many make physical characteristics. Some people dependingof these changes while others do not, some on their needs and resources. Additionally, different aspects, including changing one’s clothing, changing one’s different aspects, including (such and identity documents name, appearance, asking people licenses or passports) and as driver’s or they) she, to use different pronouns (such as he, on one’s than the ones associated with the gender Transitioning may also original birth certificate. Transitioning is a process by which a person begins Transitioning is different than the one onto live in a gender that Not all transgendertheir original birth certificate. but or intend to do so, people have transitioned Gender transition can involve many many do. II. Experiences with II. Experiences Transitioning 48 2015 U.S. TRANSGENDER SURVEY more yearsprior(Figure4.10). 6 to9yearsprior, and18%hadtransitioned 10or transitioned 2to5yearsprior, 13%transitioned so withinoneyearoftaking thesurvey, 38%had (31%) ofthosewhohadtransitioneddone the respondents’ experiences. valuable informationandcontextforsomeof transitioned wasdeterminedinordertoprovide The numberofyearssincearespondenthad Transitioning c. NumberofYears Since GENDER IDENTITY(%) Figure 4.9:Agebegantransitioning (Figure 4.9). age of18,comparedto7%transgenderwomen and 17%oftransgendermentransitioningunderthe younger age, with24%ofnon-binaryrespondents men weremorelikely tohavetransitionedata or older. Non-binaryrespondentsandtransgender under theageof18,and18%transitionedat35 ages 25and34.Fifteenpercent(15%)transitioned and nearlyone-quarter(24%)transitionedbetween began transitioningbetweentheagesof18and24, certificate. Nearlyhalf(43%)reportedthatthey in agenderotherthanthatontheiroriginalbirth which theybegantransitioning,orlivingfull-time Those whohavetransitionedreportedtheageat b. AgeofTransition 60% 20% 50% 30% 40% 10% 0%

35 andover 25 to34 18 to24 Under 18 15% Overall 43% 24% 9 18%

Non-binary 24% 56% 16% 4%

Trans men 17% 10 Nearlyone-third 47% 24% 12%

Trans women 7% 30% 28% 34% Non-binary respondents received questions about Non-binary respondentsreceivedquestionsabout Non-Binary Respondents d. AdditionalQuestionsfor Figure 4.10: Numberofyearssincetransitioning they arenon-binaryusuallyassume Figure 4.11: Genderthatpeople whodonotknow about theirgendervaried(Figure4.11). Nearly oneinfive(19%)reportedthatassumptions respondents withfemaleontheirbirthcertificate. original birthcertificate, and3%ofnon-binary 77% ofnon-binaryrespondentswithmaleontheir assumed theywerenon-transgendermen,including Seventeen percent(17%)reportedthatotherpeople binary respondentswithmaleontheirbirthcertificate. female ontheiroriginalbirthcertificate, and2%ofnon- (58%), including72%ofnon-binaryrespondentswith usually assumedtheywerenon-transgenderwomen were non-binary. Amajorityreportedthatpeople perceived tobebypeoplewhodidnotknowthey They wereasked aboutwhatgendertheywere what theytellotherpeopleabouttheirgenderidentity. tell theirgender Non-binary Others cannot woman Trans 1% 6 to9 1% Trans 13% man 2% 2%

10 ormore

18% respondents

19% vary gender about their Assumptions 2 to5 38% % of

respondents

non-binary

Non-trans % of woman 58% 0 to1 31%

Non-trans

man 17%

PORTRAIT OF USTS RESPONDENTS 49 6% 18% 18% 18% 12% 43% 23% 24% 35% 35% 63% 82% 86% respondents % of non-binary

Their church or faith community might reject them A reason not listed above Main reasons for not telling others for not telling others Main reasons identity about non-binary so theyMost people do not understand do not try to explain it It is easier not to say anything as not being a realMost people dismiss it identity or a “phase” They might face violence people theyThey are not ready to tell identify as non-binary or not be ableThey might lose their job to get a job They might not get the medical care they need They might be hurt financially They might face mistreatment at school Their friends might reject them They might become homeless e. Pronouns e. reported Eighty-four percent (84%) of respondents from that the pronouns they used were different original birth those associated with the sex on their Respondents reported a wide range certificate. people to use when of pronouns that they asked than one referring to them and could select more were pronoun. The most widely used pronouns (37%), and “they/their” (37%), “she/her” “he/his” (29%). One in five (20%) reported that they did not ask people to use specific pronouns when referring to them, and another 4% indicated that they used pronouns other than those provided in the answer choices. This included more than a dozen additional pronouns provided through write- in responses (Figure 4.13). Table 4.2: Main reasons for not telling people they are not telling people Main reasons for 4.2: Table non-binary

let others assume usually they are They a man or 44% a woman

% of non-binary respondents

- 53% binary non- 3% tell They times some others they are they are non-binary They always tell others They always tell others to say anything (82%). Approximately two-thirds to say anything (82%). Approximately reported that their non-binary identity is often dismissed as not being a real identity or just a phase (63%), and others feared they might face 4.2). violence (43%) (Table Respondents could select multiple reasons for could Respondents choosing not to tell people about their non-binary A majority of non-binary respondents identity. reported that people do not understand so they do not try to explain it (86%) or that it is easier not Non-binary respondents who reported that they Non-binary respondents who reported man or usually let others assume they are a they are woman or only sometimes tell people they for the main reasons non-binary were asked do not tell others about their non-binary identity. Figure 4.12: Response when people assume that when Response Figure 4.12: other than non-binary their gender is something others assume they were a man or woman, and others assume they others and told them 53% sometimes corrected Only 3% always identity. about their non-binary were non-binary (Figure 4.12). told others that they Non-binary respondents were asked how they how asked respondents were Non-binary their their life assumed when people in responded than non-binary. something other gender was that they usually let (44%) reported Almost half 50 2015 U.S. TRANSGENDER SURVEY “never.” Nearlyoneinten(9%)reported thatothers being toldonafive-point scale from“always” to could tellthattheyweretransgenderevenwithout as transgender, theywereasked whether others To assesswhetherrespondentswereperceived to negativeinteractionsinpublicorothersettings. gender non-conformingmaybemorevulnerable otherwise perceivedbyothersastransgenderor person. Transgender peoplewhoarevisuallyor perceptions ofthemasbeingatransgender transgender peoplemaybeinfluencedbyothers’ be atbirth.Manyinteractionsandexperiencesof are perceivedasthegendertheywerethoughtto as thegendertheyidentifywith,andstillothers being told,whileothersaregenerallyperceived routinely tellthattheyaretransgenderwithout Some transgenderpeoplefindthatotherscan by Others a Transgender Person III. BeingPerceived as Figure 4.13: Pronounsrespondentsaskpeopletouse 20% 25% 30% 40% 35% 10% 15% 0% 5%

He, his 37%

She, her 37%

They, their

No pronouns (they ask people only 29%

Ze, hir 2% They do notto askuse peopletheir name) to use 4% specific pronouns Pronouns not listed above 20% 4% GENDER IDENTITY(%) transgender withoutbeingtold Figure 4.15: Howoftenpeoplecouldtelltheywere transgender withoutbeingtold Figure 4.14: Howoftenpeoplecouldtelltheywere varied bygenderidentity(Figure4.15). with others’ perceptionoftheirtransgenderstatus never tell(Figure4.14). “sometimes” tell,and24%saidthatotherscould told “mostofthetime,” 32%saidotherscould could telltheyweretransgenderwithoutbeing 60% 20% 50% 30% 40% 70% 10% 0%

Overall 11% Rarely ornever Sometimes Always ormostofthetime 32% 57% Rarely Never 33% 24%

Non-binary respondents

6% 32% 11 62% Respondents’ experiences % of Always the time Most of

Trans men 2%

9% 9% 30%

61%

Some times 32% Trans women 19% -

35% 47% PORTRAIT OF USTS RESPONDENTS 51 70% 70% 62% 60% 60% 53% 49% 47% 50% 50% 42% 40% 39% 40% 40% 35% 34% 32% 31% 28% 30% 30% 24% 23% 23% 23% 23% 22% 20% 17% 20% 16% 20% 15% 15% 14% 12% 12% 11% 10% 10% 9% 10% 10% 6% 4% 0% 0%

friends cousins) providers supervisors transgender managers, or Straight, non- Straight, Current bosses, (non-LGBT) friends (non-LGBT) Current coworkers Current classmates Current health care All know that they are transgender Most know that they are transgender Some know that they are transgender None know that they are transgender parents and siblings) as aunts, uncles, and grew up with (such as Immediate family they Immediate family Extended family (such or transgender (LGBT) or transgender (LGBT) Lesbian, gay, bisexual, bisexual, gay, Lesbian, Figure 4.16: Outness to people in respondents’ lives to people in respondents’ Outness Figure 4.16: In terms of health care 14 Regarding workplace environments, Regarding about their transgender identity to family about their transgender 13 12 10% reported that they did not socialize with other transgender people. with other transgender people. Sixty-four percent with other transgender people. (64%) reported that they socialized with other transgender people in person, and 79% socialized Nearly one-third (32%) said they interacted online. with transgender people in political activism, and were transgender (Figure 4.16). were transgender (Figure 4.16). about, Of all groups of people the survey asked to be out to all of respondents were most likely were also friends (62%). Respondents their LGBT socialize about the methods by which they asked they were transgender. all of providers, although 40% reported that they were their health care providers knew that almost one-third (31%) indicated that transgender, none of their health care providers knew that they of the immediate family that they grew up with, of the immediate family that they grew extended and 38% were out to all or most of their family. their current nearly one-half reported that none of (42%) knew that supervisors (49%) or coworkers of the people in their lives, across all groups of of the people in their lives, across all 43% were out to 48% were out to most, people, to none of the people and only 2% were out some, in their lives. all or most Nearly two-thirds (62%) were out to or none of the people in their lives knew they were or none of the people of the groups of people in transgender in each reflect only those respondents their lives. Results their lives. who had people from each group in out to all Overall, 8% reported that they were they were transgender to determine if they were they were transgender “out” supervisors and colleagues members, friends, and health care providers. at work, classmates, some, whether all, most, were asked Respondents IV. Outness IV. they thought whether were asked Respondents of people in their lives knew that different groups 52 2015 U.S. TRANSGENDER SURVEY population intheU.S., basedonthe Census racial andethnicdistribution forthetransgender represent whatisestimated tobetheactual ethnicity weightwasdevelopedtomoreclosely internet-based surveys. general population,whichiscommonamong respondents thatisnotablyhigherthantheU.S. The USTS samplehadapercentageofwhite reported as“Asian.” groups arealsocombinedinonecategoryand American andNativeHawaiian/Pacific Islander as “American Indian.” Similarly, theAsian/Asian are combinedinonecategoryandreported American IndianandAlaskaNativerespondents groups werecombinedintosinglecategories. for purposesofanalysis,certainracialandethnic group. Additionally, duetosmallsamplesizesand or ethniccategoryareincludedinthemultiracial as biracial,multiracial,ormorethanoneracial Throughout thereport,respondentswhoidentified Aracialorethnicidentitynotlistedabove • WhiteorEuropeanAmerican • NativeHawaiianorPacific Islander • MiddleEasternorNorthAfrican • Latino/a orHispanic • BlackorAfrican American • Biracialormultiracial(receivedafollow-up • AsianorAmerican • AmericanIndian(receivedawrite-inoption) • AlaskaNative(receivedawrite-inoption) • described theirracialorethnicidentity: the followingcategoriesthatmostaccurately ethnicity andwereasked toselectonlyoneof Respondents receivedaquestiononraceand V. Race andEthnicity (received afollow-upquestion) question) 17

20 Therefore, araceand 18 15 16 Figure 4.17: Race andethnicityofrespondents report (Figure4.17). that wasappliedtoallresultspresentedinthe and ethnicityaspartofthestandardsurveyweight weighted toreflectthe ACS distributionforrace (ACS). Bureau’s 2014AmericanCommunitySurvey the U.S. population basedontheACS. USTS sampletoreflecttheagedistribution for “supplemental weight” wasappliedtoadjustthe Additionally, forcertainfindings inthisreport, a results presentedinthisreport(Figure4.18). standard surveyweightthatwasappliedtoall rest ofthesample. Thisweight waspartofthe those 18-year-oldrespondentsinrelationtothe to balancetherepresentationinsampleof of 18yearsold.Thereforeaweightwascreated large numberofrespondentsreportedanage younger agedistribution,adisproportionally in theU.S population.Inadditiontohavinga in thesamplewasgenerallyyoungerthanthat from 18to87. Theoverallageofrespondents The ageofrespondentsinthesampleranged VI. Age 21 Racial andethniccategorieswere 62.2% White

American Indian respondents 22

0.7% % of

Asian 5.1%

12.6% Black Latino/a

16.6% Multiracial 23 Middle Eastern 2.5%

0.4%

PORTRAIT OF USTS RESPONDENTS 53 Puerto Rico

34% 25 to 44

Alaska 13% 18 to 24

(ACS) % in U.S. population

Hawaii 19% American Samoa Guam 34% 65 and over Distribution of the population of the United States Distribution of the population of the United 46 to 64 The sample was divided into regions based on The sample was divided into regions the the Census Bureau regions, which included (Figure 4.20). Northeast, Midwest, South, and West U.S. These regional categories did not include bases overseas. military territories or U.S.

42% Puerto Rico 18 to 24

2% 65 and over Alaska % in USTS

14% 42% 46 to 64 25 to 44

Hawaii American Samoa Guam Distribution of 2015 USTS Respondents Distribution of 2015 USTS 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 accordanceEach dot on the maps represents the number of people in a zip code. with the number of people in each zip code. Figure 4.19 the District of Columbia, American Samoa, Guam,the District of Columbia, American Samoa, military bases overseas. and several U.S. Puerto Rico, generallyThe geographic distribution of the sample general population (Figure 4.19). mirrors that of the U.S. VII. Location all 50 states,The sample included respondents from Figure 4.18: Age of respondents Age of Figure 4.18: 54 2015 U.S. TRANSGENDER SURVEY in theU.S. generalpopulation,asreported inthe language spoken intheirhome, compared to79% percent (84%)reportedthat Englishwastheonly language spoken intheirhome. Eighty-four Respondents wereasked abouttheprimary in Home Language Spoken VIII. Primary Figure 4.20:Respondents’ locationbyregion West SC, TN,TX,VA, WV) South Midwest Northeast (AK, AZ,CA, CO, HI,ID, MT, NM,NV, OR,UT, WA, WY) (AL,AR,DE,DC,FL,GA, KY, LA,MD, MS,NC,OK, 31% West (IA,IN,IL,KS,MI,MN,MS,NE,ND, OH,SD, WI) (CT, ME,MA,NH,NJ, NY, PA, RI,VT) South 38% West 24%

29% South population (Census) % inUSTS % inU.S.

Northeast 24 Northeast 18% 20%

Midwest 19% Midwest

21%

those whospoke Spanishinthehome This wasslightlylowerthanthepercentageof in theirhome, exclusively oralongwithEnglish. reporting Spanishwasthemainlanguagespoken home otherthanEnglish,with10%ofrespondents as themostcommonlanguagespoken intheir Spanish (includingCreole)wasreported the mainlanguagesusedintheirhome. Language waseitherthemainlanguageoroneof respondents alsoreportedthatAmericanSign home. Inadditiontospoken languages,0.4% of English wastheprimarylanguagespoken intheir and 2%reportedthatalanguageotherthan language weremainlyspoken intheirhome, percent (14%)reportedthatEnglishandanother American CommunitySurvey(ACS). identity thatwasnotlisted (Table 4.3). 7% identifiedwithareligious affiliationorspiritual (13%) hadnoreligiousorspiritual affiliation,and but withnoreligiousaffiliation.Thirteenpercent quarter (25%)ofrespondentsidentifiedasspiritual, Pagan (9%), Buddhist(6%),orJewish(4%).One- followed byasmallerpercentagewhoidentifiedas as agnostic(23%),atheist(22%),orChristian(21%), identity. that theydidnothaveaspiritualorreligious religious identity, and37%of respondentsreported respondents reportedthattheyhadaspiritualor identity notlisted. they couldselectareligiousaffiliationorspiritual one ormoreidentitiesfromaprovidedlist, religious orspiritualidentityandcouldselect Respondents wereasked abouttheircurrent Spiritual Identity IX. Religious or of respondents. identified languageswerespoken byless than1% U.S. generalpopulation(13%). 29 Respondents weremostlikely toidentify 27,28 Sixty-threepercent(63%)of 26 Eachoftheother 25 Fourteen PORTRAIT OF USTS RESPONDENTS 55 1% 1% 3% 3% 2% 9% 36% 45%

weight) (supplemental % of respondents

31 Income and Employment Status Income and 4.4: Current sources of income by single and 4.4: Current sources of income by single Multiple sources Employment only (from their own employer, partner/spouse’s employer, or self-employment) Social Security income/disability only only Pension/retirement Other sources of income only No income Sex work and other underground economy work only Unemployment benefits/cash assistance only Sources of income currently criminalized). Nearly one in ten (9%) currently criminalized). Nearly one in including received income from Social Security, and 3% received income solely from disability, that a pension. Three percent (3%) reported they were currently working in the underground income came solely including 1% whose economy, 4.4). from underground economy work (Table Table multiple sources briefly in this section and discussed in greater discussed in greater this section and briefly in detail in the respondents’ to compare USTS In order chapter. the with data from employment data income and data sources, income CPS and other national are presented with the and employment results weight” applied. “supplement Income a. Sources of respondents received income Nearly half (45%) of such as employment, Social from multiple sources, or a pension. Thirty-six percent Security income, own (36%) received income solely from their employment employment or a partner or spouse’s work, such (not including underground economy that is as sex work, drug sales, or other work 1% 1% 1% 1% 1% 1% 7% 4% 4% 4% 9% 6% <1% <1% <1% <1% <1% <1% <1% <1% <1% 13% 21% 23% 22% 25% % of Results Results 30 respondents 4.3: Current religious or spiritual identity religious or spiritual 4.3: Current Shinto Sikh Tenrikyo A religious affiliation or spiritual identity not listed above No affiliation Confucian Jain Witness Jehovah’s Rastafarian Scientologist Native American Traditional Practitioner or Native American Traditional Ceremonial (write-in response) Polytheist Taoist Baha’i Jewish Secular Humanist Wiccan Druid Hindu Muslim Agnostic Atheist Christian Pagan Buddhist Current religious or spiritual identity Current religious no religious affiliation Spiritual, but Table Table Respondents were asked about various aspects asked were Respondents of their income using a series of questions based Survey (CPS). on the Current Population for income and employment status are presented X. Income and Employment Status 56 2015 U.S. TRANSGENDER SURVEY Figure 4.22:Householdincomein2014 Figure 4.21:Individualincomein2014 population (Figure4.21&Figure4.22). Respondents reportedlowerincomesthan theU.S. for whichannualincomefigureswereavailable. from 2014,thelastfullyearpriortosurvey sample andtheU.S. populationwerereported Individual andhouseholdincomesfortheUSTS Income b. IndividualandHousehold among thegeneralU.S. adultpopulation (12%). in poverty, Nearly one-third(29%)ofrespondents wereliving c. Poverty 20% 20% 25% 25% 30% 30% 35% 10% 10% 15% 15% 0% 0% 5% 5%

No income No income 4% 8% % inU.S. adultpopulation(CPS) % inUSTS (supplementalweight) % inU.S. adultpopulation (CPS) % inUSTS (supplementalweight) 1% 10% 33

morethantwicethepoverty rate $1 to $9,999 $1 to $9,999 12% 22% 4% 15%

$10,000 to $10,000 to 22%

$24,999 $24,999 25% 12% 24%

$25,000 to $25,000 to 21% $49,999 24% $49,999 25% 21%

$50,000 to $50,000 to 23% 15% $99,999 $99,999 32 31% 18%

$100,000 $100,000 15% 9% 34 or more or more 31%

8% of educationordegreethattheyhadcompleted. Respondents wereasked aboutthehighestlevel Attainment XI. Educational unemployment rateatthetimeofsurvey(5%). for USTS respondentswas15%,threetimestheU.S. and 11%werestudents.Theunemploymentrate least onepart-timejob, 15%wereself-employed, currently hadatleastonefull-timejob, 15%hadat status, 35%ofrespondentsreportedthatthey When asked abouttheircurrentemployment d. EmploymentStatus Figure 4.23.However, alternativecategoriesare reported accordingtothecategories reflectedin Throughout thereport,educational attainmentis (categories usedinreport) Figure 4.23:Educationalattainment bachelor’s degreeorhigher(Figure4.23). an associate’s degree, and38%hadreceiveda college buthadnotobtainedadegree, 9%had school. Fortypercent(40%)hadcompletedsome school diplomaorGED, ordidnotcompletehigh Thirteen percent(13%)ofrespondentshadahigh Bachelor’s degree 25%

professional Graduate or Associate’s Associate’s degree degree 9% 13% respondents Did notcomplete

high school % of 2% High school

diploma or GED 11%

(no degree) college college Some Some 40%

35 PORTRAIT OF USTS RESPONDENTS 57 39% 40% 43 ). 35% 30% ecause 4.26 Three USTS b 30% 41 40 25% 22% 20% 15% doing errands alone, 15% 8% 10% 6% 6% 5% 4% 4% 5% 3% 3% 3% 3% % in USTS population (ACS) % in U.S. Respondents were also almost four Respondents 0%

42 Four percent (4%) of the sample reported Four percent (4%) of 39 in the ACS or bathing or climbing stairs difficulty hearing Difficulty dressing emotional condition emotional condition a physical, mental, or decisions because of Deaf or have serious Blind or have serious Any disability covered difficulty seeing even when wearing glasses of a physical, mental, or Difficulty concentrating, Serious difficulty walking remembering, or making such as visiting a doctor’s such as visiting a doctor’s Figure 4.26: Disability status decisions because of a physical, mental, or emotionaldecisions because of a physical, mental, U.S.condition (30%), in contrast to those in the population (5%). to report difficulty times as likely office or shopping such as visiting a doctor’s (22%),of a physical, mental, or emotional condition population (6%) (Figure compared to the U.S. XII. Disability disability about their received questions Respondents from the Americanstatus based on questions in order to compare those (ACS) Community Survey with disabilities in the sample to those in the USTS of respondents general population. Overall, 39% U.S. one or more disability asindicated that they had to 15% of the general compared described in the ACS, population. or had serious difficulty hearing,that they were deaf (4%). general population similarly to the U.S. or hadpercent (3%) reported that they were blind wearing glasses,serious difficulty seeing even when population (3%). similarly to those in the U.S. to report havingrespondents were six times as likely or makingserious difficulty concentrating, remembering, office or shopping, because Difficulty doing errands alone,

12%

degree 10% higher

21%

17% or degree Bachelor’s Bachelor’s 19%

32%

Graduate or professional professional or Graduate degree 46%

8% Associate’s Associate’s

65%

(no degree)/ (no 12%

Some college college Some 38 higher or degree Bachelor’s

21%

Associates degree Associates GED

30%

26%

diploma or or diploma

15%

High school school High Associate’s degree Associate’s

To account for differences in account for differences To 28% or GED or 37

8% The USTS sample overall reflected overall reflected sample The USTS degree)/ (no college Some 36 14%

13%

high school high

complete complete Did not not Did 3% diploma school High % in USTS (ACS) population % in U.S.

2% high school high % in USTS population (ACS) % in U.S.

5% complete not Did 0% 0% 15% 10% 10% 35% 30% 25% 20% 70% 40% 30% 20% 50% 60% Figure 4.25: Educational attainment (ACS Figure 4.25: Educational attainment (ACS categories), age 25 and older Figure 4.24: Educational attainment (ACS attainment (ACS Figure 4.24: Educational to 24 categories), ages 18 based surveys. respondents USTS by age, educational attainment age population for two U.S. are compared to the to 24 (Figure 4.24) and (2) ages ranges: (1) ages 18 4.25). 25 and older (Figure also presented here for comparison to the U.S. to the U.S. here for comparison also presented population. than the U.S. attainment higher educational among internet- which is common population, 58 2015 U.S. TRANSGENDER SURVEY residents visa holders),and<1%whowere undocumented residents (suchaspermanent residentsand naturalized citizens,2%whoweredocumented This includedapproximately 3%whowere by birth,comparedto16%intheU.S. population. Six percent(6%)ofrespondentswerenotcitizens Table 4.5:Citizenshiporimmigrationstatus (<1%), orundocumentedresidents(<1%)(Table 4.5). permanent residents(1%),visaholdersrefugees a rangeofimmigrationstatuses,includingbeing citizens inthesample(97%),respondentsreported immigration status.Inadditiontothosewhowere Respondents wereasked abouttheircitizenshipor Immigration Status XIII. Citizenshipand experiences oftheseindividuals. experiences of“peoplewithdisabilities” reflectthe with adisability. percent (28%)ofthesampleidentifiedasaperson that werenotoutlinedintheACS. Twenty-eight person withadisabilitytobettercapturedisabilities Respondentsa werealsoasked iftheyidentifiedas Other documentedstatusnotlisted Accountability) DAPA (DeferredActionforParental status Currently underawithholdingofremoval Refugee status Arrival) DACA (DeferredActionforChildhood Undocumented resident A visaholder(suchasF-1,J-1,H1-B,orU) Permanent resident U.S. citizen(naturalized) U.S. citizen(bybirth) Citizenship orimmigrationstatus 46 (Table 4.6). 44 Throughout the report, the Throughoutthereport, respondents % of 94% <1% <1% <1% <1% <1% <1% 3% 1% 1% 45

citizens, permanentresidents,orvisaholders. they hadaccesstootheravenuesforbecoming asylum inordertostaytheUnitedStates because apply forasylum,51%reportedthattheydidnotneed identity orsexualorientation.Ofthosewhodidnot including 3%whoappliedonthebasisoftheirgender United States. Sevenpercent(7%)appliedforasylum, were asked iftheyhadeverappliedforasyluminthe Respondents whowerenotU.S. citizensbybirth Table 4.6: Citizenshiporimmigrationstatus(collapsed) reported thatit wasbecauseofareasonnot listed. did notfacedanger intheircountryoforigin, and25% was becausetheimmigration officialdecidedthatthey were pasttheone-yeardeadline, 44%indicatedthatit reported thattheyweredenied asylumbecausethey who weredeniedasylum(n=11, unweighted), were deniedasylum(Figure4.27).Oftherespondents conditions. Oneinfive(20%)oftheserespondents someone tostayintheUnitedStates undercertain removal” status,analternativeformofreliefthatallows asylum butinsteadreceiveda“withholdingof asylum receivedit.Another32%didnotreceive Nearly half(48%)ofrespondentswhoappliedfor Table apply (17%)ordidnotforotherreasons(Table 4.7). respondents indicatedthattheydidnotknowhowto Undocumented resident Documented resident U.S. citizen(naturalized) U.S. citizen(bybirth) immigration status Citizenship or A reasonnotlistedabove one-year deadline They believedtheywerepastthe They wereafraidtoapply eligible They didnotneedtoorwere They didnotwanttoapply They didnotknowhowtoapply statuses They hadaccesstootherlegal for asylum Reasons fornotapplying 4.7: Reasons fornotapplyingasylum

% inUSTS 94% <1% 2% 3% % ofthosewho did notapply for asylum population 48 (Census) % inU.S. 30% 47 16% 51% 12% 31% 31% 17% 2% 3% Other Other 84% 8% 8% PORTRAIT OF USTS RESPONDENTS 59

56%

over 65 and and 65 45% 66%

Almost three- 42% 64 to 45 49

53% 23% 44 to 25 8%

% in USTS population (ACS) % U.S. 3% 24 to 18 0% 10% 70% 40% 30% 50% 20% 60% Figure 4.29: Currently married (%) CURRENT AGE XV. Relationship Status Relationship XV. their relationship about were asked Respondents percent (31%) were partnered status. Thirty-one 17% were partnered and and living together, 2% 49% were single, not living together, and 1% relationship, were in a polyamorous status that was not listed. had a relationship about their current were also asked Respondents for the purpose of comparison legal marital status ACS. adult population through the to the U.S. were respondents (18%) of USTS Eighteen percent in the U.S. currently married, in contrast to 52% adult population (Figure 4.29). never been quarters (72%) of respondents have many as the married, which is more than twice as adult population (30%). U.S. 45% 41%

40% 48% 34% asylum 35% Received Received 29% 30%

27% Non-binary 24% 25% 23% 21% 21% 20% 19% 20% 18% 17% 17% Trans men Trans 16% 16% 15% 14% 15% 13% 12% 12% Crossdressers 10% 10% % of those for asylum who applied 10%

8% 8%

7% 6% 6% 6% 6% 6%

4% 4% removal” status 5% 3% 20% 2% but holding of asylum Denied a “with- Trans women Trans Overall 32% 0% received

Denied asylum, loving Queer Sexual Asexual Bisexual not listed Pansexual Straight or Straight orientation heterosexual same-gender- same-gender-loving (16%), straight (15%), bisexualsame-gender-loving (16%), straight (15%), (14%), and asexual (10%) (Figure 4.28). XIV. Sexual Orientation XIV. which terms best were asked Respondents described their sexual orientation. Respondents to identify as queer (21%), and theywere most likely lesbian, or also identified as pansexual (18%), gay, Figure 4.27: Outcome of asylum application Outcome of asylum Figure 4.27: Figure 4.28: Sexual orientation Gay, lesbian, or Gay, 60 2015 U.S. TRANSGENDER SURVEY 6 5 4 3 2 1 ENDNOTES or whereagendermarker otherthan“male” or“female” instances wherethesexonabirth certificateisleftblank or femaleontheiroriginalbirthcertificate, therearerare Although thevastmajorityofpeoplehaveeithermale gender orasnogender. gender identityalsoidentifiedashavingmorethanone transgender woman,orcrossdresser)bestdescribedtheir who saidthatanotherterm(suchastransgenderman, they identifyassuch.Thismeansthatsomerespondents gender identity. Nearlyhalf(47%)ofrespondentssaidthat asking themifthatisthe gender (suchasgenderqueerornon-binary),” without 1.11) iftheyidentified“asmorethanonegender orasno Respondents werealsoasked inanearlierquestion(Q. Appendix C(DetailedMethodology). man. Thisrecodingprocessisdescribedinfurtherdetail a birth certificatewasmaleandthattheyidentifiedas in Q. 2.3,orwhoindicatedthatthegenderontheiroriginal certificate wasfemaleandthattheyidentifiedasawoman indicated inQ. 2.1 thatthegenderontheiroriginalbirth for analysis.Thisincluded,example, respondentswho what themostappropriategenderidentitycategorieswere if theymettheeligibilitycriteriaforsurveyand,so, further analysisoftheirsurveyresponsestodetermine alone, asmallnumberofrespondents(n=439)required 2.1 (sexassignedatbirthontheiroriginalcertificate) best describedtheminQ. 2.3andtheirselectioninQ. gender identitybasedontheirselectionofthetermthat While mostrespondentswerecategorizedforanalysisby See Q. 2.3. their identity. and wouldhaveinsteadpreferredanothertermtodescribe not havebeencomfortableusingtheterm“transgender” may haveidentifiedwiththewordtransgender, theymay to describetheiridentity. Forexample, whilearespondent differentiation betweenidentityandtheterminologyused them inQ. 2.4.Thismayhavebeenduetorespondents’ with theword“transgender”beingusedtodescribe 1.10, aslightlylargernumber(14%)expresseddiscomfort not thinkofthemselvesastransgenderinresponsetoQ. Although only12%ofrespondentsreportedthattheydid and experiences. identified othertermsthatbetterdescribedtheirgender for adiscussionofeligibility. Manyofthoseindividuals Q. 1.11–1.18. See the surveybasedonanswerstheyprovidedtoquestions of [themselves]astransgender”inQ. 1.10 wereeligiblefor Respondents whowereamongthe12%didnot“think |CHAPTER4:PORTRAIT OFUSTS RESPONDENTS Appendix C best ( Detailed Methodology termtodescribetheir ) 8 7 14 13 12 11 10 9 and parttimeinanothergenderismostconsistentwith (including peopleforwhomlivingparttimeinonegender may havebeenlivingasanon-binarypersonfulltime assigned tothematbirth.Somenon-binaryrespondents currently livingfulltimeinagenderdifferentfromtheone Note thatQ. 1.12 asked whetherrespondentswere further detailinsectionVIofthischapter. The ageofrespondentsinthesampleisdiscussed receive laterinthesurvey. used todeterminesubsequentquestionsthattheywould or “male”—in ordertoproceed,sincethisanswerwas on theiroriginalbirthcertificatein Q. 2.1—either “female” select oneresponsetothequestionaboutsexlisted answer thisquestion.Respondents wererequiredto These respondentsmaynothavebeenabletoaccurately list themas“male” or“female” atthetimeoftheirbirth. respondents hadanoriginalbirthcertificatethatdidnot is listedatthetimeofbirth.Itpossiblethatsome Workplace are furtherdiscussedinthe Respondents’ experienceswithbeingoutintheworkplace with beingouttopartnersorspouses andchildren. and theirextendedfamily, aswell astheirexperiences with beingouttotheimmediatefamilytheygrewup a moredetaileddiscussionofrespondents’ experiences See the public, and/orprofessionallives. openly self-identifiesastransgenderintheirprivate, The term“out”isusedheretodescribeapersonwho “never” tell(57%). tell (32%),andthosewhosaidthatotherscould“rarely”or time” (11%),thosewhosaidthatotherscould“sometimes” could telltheyweretransgender“always” or“mostof according tothreecategories:thosewhosaidthatpeople being perceivedastransgenderbyothersarereported Throughout thisreport,respondents’ experienceswith in Q. 1.13. and theageatwhichtheybegantotransition,asreported based onrespondents’ currentageasreportedinQ. 2.13, The numberofyearssincetransitioningwascalculated on theirexperiencesbyage. crossdressers whohadtransitionedwastoolowtoreport had transitionedbasedonQ. 1.12, thesamplesizeof Although 6%ofcrossdressersreportedthatthey birth certificate. female) thatisdifferentthanthegenderontheiroriginal who werelivingexclusively inabinarygender(maleor they assumedthesurveywasaskingonlyaboutpeople their non-binaryidentity),butdidnotselect“yes” because Family LifeandFaithCommunities chapter. Employment andthe chapter for PORTRAIT OF USTS RESPONDENTS 61

Available Available ) for chapter and chapter and Appendix A for more information . See Family and Faith ) for unweighted frequencies Methodology Methodology Annual Estimates of the 2015 American Community 2015 American Community Characteristics of the Sample ( chapter. Available at: https://factfinder.census. Available See note 25. Appendix A Characteristics of the Sample ability to speak English for the population 5 years and over. about religious or spiritual identity only, asked 2.12 Q. rather than current involvement in a faith community. experiences More information about respondents’ in faith communities (including religious and spiritual communities) can be found in the Communities and application of the “supplemental weight,” see weight,” and application of the “supplemental Appendix C (Detailed Methodology) ( sample. and percentages for age in the USTS Census Bureau. (2015). U.S. April 1, 2010 to July 1, 2015. Population: Resident at: https://factfinder.census.gov/faces/tableservices/ jsf/pages/productview.xhtml?pid=PEP_2015_ PEPANNRES&src=pt. Census Bureau. (2015). U.S. at home spoken estimates: Language Survey 1-Year 5 years by ability to speak English for the population and over. gov/faces/tableservices/jsf/pages/productview. xhtml?pid=ACS_15_1YR_B16001&prodType=table. The percentages of people who reported on the in their home in the American primary language spoken calculated by the research were Community Survey (ACS) U.S. population findings include those in the team. ACS in contrast to the USTS who are 5 years of age and older, which includes respondents who are 18 and older. sample, sample should be to the USTS the comparison Therefore, interpreted with caution. Census Bureau. (2015). U.S. at home by spoken estimates: Language Survey 1-Year represent white respondents relative to the makeup of the to the makeup respondents relative represent white weighting procedure adult population, this transgender estimated to be the closer to what is brings the sample and ethnicity for distribution for race true population See the people. transgender Appendix C (Detailed Methodology) See applied to the sample. on weighting procedures also and percentages for race and unweighted frequencies sample. ethnicity in the USTS groups Middle Eastern and white Although the ACS the experiences of Middle people in one category, presented separately from whiteEastern respondents are this report. Despite a low number ofrespondents throughout in the sample overall (<1%), it isMiddle Eastern respondents manner that best reflects the uniqueimportant to report in a as Middlecircumstances of transgender people who identify Eastern. The weight for 18-year-old respondents was created with propensity scores developed using a regression this processdiscontinuity model. For more information on and other weighting procedures, such as the development 27 24 25 26 22 23

, . Los . Los Appendix A Internet, Phone, Appendix C (Detailed ) for unweighted frequencies Race and Ethnicity of Adults Race chapter and American Journal of Public Health . Hoboken, NJ: John Wiley & Sons. See. Hoboken, for more information about potential Methodology (1), 118–122. The USTS sample has a higher percentage (1), 118–122. The USTS Characteristics of the Sample in Massachusetts: Results from a household probability in Massachusetts: Results sample of adults. 102 general population. of white respondents than the U.S. bias, weights for race help correct for this sampling To and ethnicity were applied based on the racial and ethnic population. While this may still over- of the U.S. makeup differ from the general population in regard to race and to with transgender people being more likely ethnicity, N. Flores, A. R., Brown, T. See e.g., be people of color. L. (2016). & Herman, J. T., in the United States who Identify as Transgender G., Scott, Williams Institute; Conron, K. J., Angeles, CA: health (2012). Transgender J. S. G. S., & Landers, Stowell, Methodology) internet-based survey sampling bias. See ( sample. and percentages for race and ethnicity in the USTS Prior research using representative samples of transgender adults have found that transgender adults in the USTS sample and the U.S. general population may sample and the U.S. in the USTS be due to sampling bias that is common in internet-based Dillman, D. surveys and convenience samples. See e.g., & Christian, L. M. (2014). D., A., Smyth, J. Design Tailored Surveys: The Mail, and Mixed-Mode Method (4th ed.) also the report. The U.S. Census also offers Asians and Native report. The U.S. two separate racial Islanders as Hawaiians/Other Pacific this report includes a Latino/a categories. Additionally, and ethnic categories should be and other racial category, based on U.S. origin, considered to be of “non-Hispanic” Census categories. distributionThe difference in racial and ethnic population Racial and ethnic categories are combined in a manner Racial Census, which is important for similar to that in the U.S. the purposes of making racial and ethnic comparisons to U.S. A notable exception population. to the U.S. and white Census categorization is that Middle Eastern the respondents are reported separately throughout Those who selected “a racial/ethnic identity not listedThose who selected “a specify their identity and then to were asked above” asking them to select thereceived a follow-up question themracial/ethnic identity or identities that best described of the “identity not with the exception from the list above, category. listed above” asked to enter their enrolled or principal tribe. to enter their enrolled asked “biracial/multiracial” best Those who reported that ethnic identity received a follow- described their racial or could select one or more of the up question in which they listed above that best described racial or ethnic identities them. Respondents who reported that “Alaska Native” most most Native” that “Alaska who reported Respondents ethnic identity were their racial or accurately described corporation. their enrolled or principal to enter asked most Indian” that “American who reported Respondents racial or ethnic identity were accurately described their 21 20 19 18 17 15 16 62 2015 U.S. TRANSGENDER SURVEY 33 32 31 30 29 28 poverty line. if theirtotalfamilyincomefellunder 125%oftheofficial for designationofrespondentsas livinginornearpoverty measure.html. TheincomerangesintheUSTS allowed www.census.gov/hhes/www/poverty/about/overview/ the U.S. CensusBureau,whichcanbefoundat:https:// measure usingtheofficialpovertymeasure, asdefinedby line. TheresearchteamcalculatedtheUSTS poverty “Living inpoverty”meanslivingatornearthepoverty completed bytheresearchteam. surveys/cps/techdocs/cpsmar15.pdf. Calculationswere the CPS.Available at:https://www2.census.gov/programs- one comparedto24%inU.S. populationasreportedin applied) ofUSTS respondentsreportedafamilysizeof household. Sixty-fourpercent(64%,supplementalweight members, ratherthanwithunrelatedmembersofthe USTS respondentsarelesslikely tobelivingwithfamily size ofone(supplementalweightapplied).However, whereas 29%ofUSTS respondentshaveahousehold 28% ofU.S. householdshaveahousehold sizeofone, CPS, 2015AnnualSocialandEconomicSupplement, to theU.S. population.Forinstance, accordingtothe USTS respondentsseemtohavesimilarhouseholdsizes individual andhouseholdincome. educational attainment,suchasemploymentstatusand population foritemsthatweresensitivetoageand applied whencomparingtheUSTS sampletotheU.S. American CommunitySurvey(ACS). Thisweightwas that werecreatedbasedontheCensusBureau’s 2014 additional weightsforageandeducationalattainment weight for18-year-oldsandraceethnicity, aswell The “supplemental weight”includesthestandardsurvey employment intheUnitedStates. Labor Statistics tomake determinationsaboutthestateof The CurrentPopulation SurveyisusedbytheBureauof religious orspiritualidentity. agnostic, atheist,ornoaffiliationwithoutselectinganother religious orspiritualidentityincludedthosewhoselected Respondents whoreportedthattheydidnothavea religious orspiritualidentity. limited themannerinwhichtheywereabletoidentifytheir respondents didnotreceivethatoption,whichmayhave Christian affiliationthatwasnotlisted,JewishandMuslim identified asChristianweregivenanoptiontowriteina represented inthesample. Furthermore, whilethosewho likely didnotcaptureallreligiousorspiritualidentities and Muslimfaiths,theselistswerenotexhaustive numerous categoriestospecifyforChristian,Jewish, in Q. 2.12. Althoughrespondentswereprovidedwith a drop-downlistofmorespecificreligiousaffiliations to provideadditionalspecificityfortheiridentityfrom who identifiedasChristian,Jewish,orMuslimwereable In additiontothemaindrop-downlistofaffiliations,those 36 35 34 44 43 42 41 40 39 38 37

when comparedtonon-transgenderpeople. Conron,et in educationalattainmentamongtransgenderpeople have foundlowereducationalattainmentornodifference sampling). Population-based surveysinseveralstates (online only)andthesamplingtechnique(convenience to themethodbywhichsurveywasadministered high schooland/orsomecollege. Thismaybedue transgender peoplewithalevelofeducationbeyond respondents likely overestimatesthenumberof The educationalattainmentresultsreportedforUSTS release/archives/empsit_10022015.pdf. September 2015. of Labor Statistics. (2015). news.release/archives/empsit_09042015.pdf; Bureau Situation—August 2015. Bureau ofLabor Statistics. (2015). team. 256.pdf. Calculationswerecompletedbytheresearch content/dam/Census/library/publications/2016/demo/p60- Census Bureau.Available at:https://www.census.gov/ and Poverty intheUnitedStates: 2015 Proctor, B.D., Semega,J. L.,&Kollar, M.A.(2016). much widerrange ofdisabilities. who identifiedas peoplewithadisabilitylikely reflecta themselves asapersonwithdisability. However, those to someindividualsnotbeingcomfortable referringto identified asapersonwithdisability (28%)maybedue one ormorelistedACS disabilities(39%)andthosewho The differenceinthereportedrate ofthosewhohad U.S. CensusBureau.(2015).Seenote39. U.S. CensusBureau.(2015).Seenote39. U.S. CensusBureau.(2015).Seenote39. U.S. CensusBureau.(2015).Seenote39. the researchteam. S1810&prodType=table. Calculationswerecompletedby jsf/pages/productview.xhtml?pid=ACS_15_1YR_ at: http://factfinder.census.gov/faces/tableservices/ 1-Year estimates:Disability characteristics. U.S. CensusBureau.(2015). S1501&prodType=table. jsf/pages/productview.xhtml?pid=ACS_15_1YR_ at: https://factfinder.census.gov/faces/tableservices/ Survey 1-Year estimates:EducationalAttainment. U.S. CensusBureau.(2015). based surveysamplingbias.Seealsonote20. Methodology methodology explanationin See the Surveillance System. adults inselectU.S. regionsinthe BehavioralRiskFactor characteristics andhealthoutcomesamongtransgender Reisner, S.L.,&Bockting,W. O. (inpress).Demographic al. Seenote21;Meyer, I.H.,Brown,T. N.T., Herman,J. L., Methodology )

for moreinformationaboutpotentialinternet- Available American JournalofPublicHealth. chapter and the detailed chapter andthedetailed Available at:http://www.bls.gov/ The EmploymentSituation—

at: http://www.bls.gov/news. Appendix C 2015 AmericanSurvey 2015 AmericanCommunity The Employment . (p. 13).DC:U.S. ( Detailed Detailed Available Available Income

PORTRAIT OF USTS RESPONDENTS 63 Available Available 2015 American Community 2015 American Community 2015 American Available at; https://factfinder. Available research team. age for the population 15 years and over. at: https://factfinder.census.gov/faces/tableservices/ jsf/pages/productview.xhtml?pid=ACS_15_1YR_ findings, as presented These B12002&prodType=table. currently married with include adults who are in the ACS, based on both spouses who are present and not present were completed by the definitions. Calculations the ACS of a small sample of respondents. While it is important of a small sample of respondents. While it is findings to present these experiences in this report, the with presented in this sentence should be interpreted caution due to the small sample size. Census Bureau. (2015). U.S. Estimates: Sex by marital status by Survey 1-Year they had access to other legal statuses and those who they had access to other legal statuses and those indicated that they were already citizens or permanent 9.8. residents in Q. the unweighted frequency Due to the small sample size, here is being presented alongside weighted percentages experiences to be clear that the percentages reflect the statements reminding respondents that their answers statements reminding could not be used against them. were confidential and and that the number of documented it is likely However, is underrepresented in this undocumented residents sample. that This percentage includes those who reported Documented and undocumented residents are often Documented and undocumented for many reasons, underrepresented in surveys jeopardizing their residency including concerns about about their immigration by revealing information to When asking questions relating status on a survey. status, the survey included citizenship and immigration U.S. Census Bureau. (2015). Census Bureau. (2015). U.S. nativity and Sex by age by estimates: Survey 1-Year status. citizenship census.gov/faces/tableservices/jsf/pages/productview. xhtml?pid=ACS_15_1YR_B05003&prodType=table. by the research team. Calculations were completed 49 48 47 46 45 64 2015 U.S. TRANSGENDER SURVEY F Communities Family LifeandFaith CHAPTER 5 reported throughoutthechapter. Notable differencesinrespondents’ experiences basedondemographicandothercharacteristics are examined respondents’ experienceswithfaithcommunities. community) canplayasignificant rolewithinfamiliesandthroughoutanindividual’s life, thesurvey also Since spiritualandreligiouscommunities(suchaswithin achurch,synagogue, mosque, orotherfaith of familyacceptanceandrejection. people. Thesurveyexplored aspectsoffamilyrelationshipsfortransgenderpeople, particularlytheimpact and rejectionwithinthefamilyenvironmentcanhave a profoundeffectontheseoutcomesfortransgender such asphysicalandmentalhealth,economicstatus, and housingstability. family, spousesandpartners, andchildren,havebeenshowntoimpactlifeoutcomes amily lifeandthestateofrelationshipswithfamilymembers, includingimmediateandextended 1 Experiencesofsupport

in manyareas, FAMILY LIFE AND FAITH COMMUNITIES 65 rejected (9%). not rejected (22%). them because they were transgender. were transgender. them because they transgender. because they were

community left due to rejection. Forty-two percent (42%) of those who left found a community left due to rejection. Forty-two percent (42%) of those welcoming spiritual or religious community. Nearly one in five (19%) respondents who had ever been part of a spiritual or religious Nearly one in five (19%) respondents who had ever been part Family support was associated with positive outcomes while family rejection was Family support was associated with who were rejected were: Respondents associated with negative outcomes. transgender. transgender. were out to their family experienced at least one One-half (50%) of respondents who partner, their spouse or family they grew up with, form of rejection from the immediate were transgender. and/or their children because they Eighteen percent (18%) of respondents were parents. Eighteen percent (18%) of respondents (21%) of respondents who were out to their children had a child percent Twenty-one spending time with them after coming out as who stopped speaking to them or More than one-quarter (27%) of respondents who have been out to any of their past or have been out to any of their past (27%) of respondents who More than one-quarter ended their relationship or partner or partners reported that a spouse current spouses had a relationship including 10% who they were transgender, solely or partly because end solely because they were transgender. Sixty percent (60%) of respondents who were out to the immediate family they grew up family were out to the immediate who (60%) of respondents Sixty percent were neutral families that had and 40% supportive families, that they had with reported or not supportive. • to have engaged in sex work (16%) as those who were not Almost twice as likely • rejected (33%). to have attempted suicide (49%) than those who were not More likely • (40%) as those who were to have experienced homelessness Nearly twice as likely • violent towards family member had been ten (10%) reported that an immediate One in • out of the house home and/or were kicked percent (15%) ran away from Fifteen KEY FINDINGS KEY 66 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) Figure 5.1: Outtochildren less often(Figure5.1). Asian (55%)individualsbeingouttotheirchildren of outness,andBlack(62%),Latino/a (62%),and respondents (78%)reportingthehighestlevel varied byraceandethnicity, withAmericanIndian 69% reportedbeingouttoatleastonechild.This Of the18%ofrespondentswhohadchildren, been outtoacurrentorformerspousepartner. Overall, 88%oftheserespondentswereorhave to atleastoneoftheirformerspousesorpartners. current spouseorpartnerand53%hadbeenout Fifty-eight percent(58%)ofthosewereouttotheir having acurrentorformerspousepartner. Eighty-six percent(86%)ofrespondentsreported most ofthepeopleinthosegroups. anti-transgender biashadontherelationshipswith then receivedquestionsregardingtheimpactthat non-transgender (non-LGBT) friends.Respondents extended family, LGBT children, immediatefamilytheygrewupwith, were transgender, includingspousesandpartners, whether peopleindifferentgroupsknewthey and friends.Specifically, respondentswereasked transgender identitytovariousfamilymembers determine whethertheywere“out” Respondents receivedaseriesofquestions to and Friends I. OutnesstoFamily 90% 60% 20% 50% 80% 30% 40% 40% 70% *Sample size toolowtoreport 0%

Overall

American Indian 69% 78%

Asian 55% 3 friends,andstraight

Black 62%

Latino/a 62% Middle Eastern* 2 abouttheir

Multiracial 71%

White 72% Overall, less than one-quarter (22%) of respondents Overall, lessthanone-quarter(22%)ofrespondents reporting thattheywereouttoallextendedfamily. to beoutextendedfamilymembers,with23% of theimmediatefamily. Respondents werelesslikely considering spousesorpartnersandchildrenaspart up with.Thisnumberdecreasedto49%when they wereouttoallimmediatefamilygrew More thanhalf(53%)ofrespondentsreportedthat that groupintheirlives. respondents whoreportedhavingpeoplefrom LGBT) friends.Results foreachgroupreflectonly friends, andstraightnon-transgender(non- family theygrewupwith,extendedfamily, people inseveralgroups,includingtheimmediate currently outtoall,most,some, ornoneofthe Respondents wereasked whethertheywere Table 5.1: Outnesstofamilyandfriendgroups LGBT friends(Table 5.1). (32%) ofrespondentswereouttoalltheirnon- their LGBT friends.Incontrast,lessthanone-third out, with62%reportingthattheywereouttoallof of peopleamongwhomsurveyrespondentswere transgender. LGBT friendswerethelargestgroup LGBT andnon-LGBT friendsknewthattheywere Respondents werealsoasked whethertheir members. spouses, partnersandchildren—andextendedfamily were outtoallimmediatefamilymembers—including partners, andchildren with, extendedfamily, spouses/ Immediate familytheygrewup uncles, andcousins) Extended family(suchasaunts, (non-LGBT) friends Straight, non-transgender with, spouses/partners,children Immediate familytheygrewup with (suchasparentsorsiblings) Immediate familytheygrewup transgender (LGBT) friends Lesbian, gay, bisexual,or Family andfriendgroups

22% % ofrespondentswhohad people fromthefamilyor friend groupintheirlives 62% 49% 53% 23% 32% All Most or some 38% 56% 25% 70% 43% 34% 4 LGBT None 22% 39% 12% 8% 8% 4% FAMILY LIFE AND FAITH COMMUNITIES 67

14% over

24% 35 and and 35

9% Trans women and men and women Trans

12%

Trans men Trans 25 to 34 to 25 18%

18 to 24 to 18 Trans women Trans 3%

12%

Non-binary Under 18 Under 6%

10%

Overall Crossdressers

10% Overall 5% 0% 15% 10% 4% 25% 8% 2% 20% 6% 0% 14% 18% 12% 16% 10%

20%

The likelihood of a relationship ending also The likelihood with transgender differed by gender identity, to have a women (18%) being more likely end solely relationship with a spouse or partner transgender because of being transgender than men (9%), crossdressers (6%), and non-binary people (3%) (Figure 5.4). Figure 5.4: Spouse/partner ended relationship solely because of transgender status GENDER IDENTITY (%) Figure 5.3: Spouse/partner ended relationship solely relationship solely Spouse/partner ended Figure 5.3: transgender status because of (%) OF TRANSITION AGE over

20% 65 and and 65

19% 45 to 64 to 45

11% 25 to 44 to 25

6% 18 to 24 to 18

10% Overall 5% 0% 15% 10% 25% 20% The age at which a respondent transitioned also ending. of a relationship affected the likelihood transitioned at age 35 or older who Respondents their to have were more than twice as likely relationship end solely due to being transgender (24%) (Figure 5.3). current age, with those aged 45 and older being with those aged current age, to have this experience (Figure 5.2). twice as likely Figure 5.2: Spouse/partner ended relationship solely because of transgender status (%) CURRENT AGE because they were transgender, including 10% who including transgender, because they were end solely because they werehad a relationship transgender. due to beingWhether a relationship ended solely transgender differed based on a respondents’ Those who were out to a spouse or partner wereThose who were out or partner had ended whether a spouse asked they were transgender. their relationship because (27%) reported that a spouseMore than a quarter relationship solely or partlyor partner ended their II. Relationships with with II. Relationships Partners or Spouses 68 2015 U.S. TRANSGENDER SURVEY in 2015, child undertheageof18living intheirhousehold in theU.S. populationhadatleastonerelated to theCurrentPopulation Survey, 34%ofadults related childrenlivingintheirhome. According respondents weresubstantiallylesslikely tohave In comparisontotheU.S. adultpopulation,USTS transgender toatleastoneoftheirchildren. two-thirds (69%)reportedthattheywereoutas were parents, Eighteen percent(18%)ofpeopleinthesample in theHousehold and Related Children III. Parental Status and Violence violence arediscussedfurtherinthe partner violence. Experienceswithintimatepartner that theyhadexperiencedsomeformofintimate violent towardthem.Morethanhalf(54%)reported former romanticorsexualpartnerhadeverbeen Respondents werealsoasked whetheracurrent or because theyweretransgender. had arelationshipendsolely transgender, including10%who or partlybecausetheywere ended theirrelationshipsolely that aspouseorpartner their spouseorpartnerreported respondents whowereoutto More thanone-quarter(27%)of 6 whichwasmorethantwice asmany chapter. 5 andofthoseindividuals,morethan Harassment Harassment screamed atme, callingmepathetic, and kicked meoutofthehouse. He “My fatherphysicallyassaultedme moment.” am. Iwasneverprouderthaninthat their completesupporttobewhoI unthinkable. TheyassuredmeIhad knew wouldfreakout,didthe to comeout,myparents,whoI “When Ifinallyhadthecourage Voices In OurOwn biggest supporters.” much happier Iamandarenowmy me, buttheyeventuallysawhow around. At firsttheydidn’t accept “It tookmyfamilyawhile tocome devastated.” upcoming springsemester. Iwas had withdrawnmytuitionforthe by mycollegethatparents taken away. Iwassooninformed cold withveryfewitemsandmycar parents, Iwaskicked outintothe “Within anhourofcomingouttomy months homeless.” not comeback.Ispentthenextsix days later, theytoldmetoleaveand possessed bydemon.Acoupleof who convincedthemthatIwas my life. Theyspoke withapastor parents. Itwastheworstmistake of accidentally outedmyselftomy “When Iwas20, Islippedupand silence.” a waste, worthless,andsoon.Isatin FAMILY LIFE AND FAITH COMMUNITIES 69 23%

Trans women and men and women Trans Trans men Trans

28% Trans women Trans

6% Non-binary

17% Crossdressers

21% Overall 5% 0% 15% 10% 30% 25% 20% Overall, of respondents who have had a spouse or partner and/or who have children, 28% have had a relationship with their spouse or partner or child end, at least temporarily. their child stopped speaking or spending time with their child stopped speaking or spending non-binary them as transgender men (6%) and respondents (6%) (Figure 5.6). Children stopped speaking or spending Figure 5.6: status time with respondent because of transgender GENDER IDENTITY (%) More than one in five (21%) of five (21%) than one in More out to their who were those that at least children reported children stopped one of their spending time speaking or temporarily or with them, permanently. them, at least for a period of or spending time with time. of this experience differed by The likelihood with transgender women (28%) gender identity, to report that being more than four times as likely 6%

3% 65 and over and 65 27%

11% 45 to 64 to 45 These differences These differences

54%

7 12% 44 to 25

38% 19% 24 to 18 USTS respondents with a related child under respondents with a related USTS 18 in household population with a related child Adults in the U.S. under 18 in household (CPS)

34% Overall 14% 0% 10% 40% 30% 50% 20% 60% to or spending time with them because they were More than one in five (21%) reported transgender. that at least one of their children stopped speaking to at least one of their children were asked a to at least one of their children were asked question to determine whether being transgender had ever negatively impacted a relationship with whether they were asked their child. Specifically, any of their children had ever stopped speaking IV. Relationships with Relationships IV. Children reported that they were out who Respondents (%) AGE age of 18 living in their household (12%) than the age of 18 living in population group in the U.S. corresponding age (54%) (Figure 5.5). children with related Figure 5.5: Respondents under 18 living in household as USTS respondents (14%). respondents as USTS with USTS across all age groups, persisted four being more than aged 25 to 44 respondents under the to have a related child likely times less 70 2015 U.S. TRANSGENDER SURVEY Less likely tohaveattemptedsuicide(37%) • Less likely toreportcurrentlyexperiencing • Less likely tohaveexperienced homelessness • Less likely tohaveever donesexwork(11%) • Morelikely tobeemployed(65%)thanthose • Respondents withfamilysupportwere: a reducedlikelihood ofnegativeexperiences. families, withfamilysupportbeingassociated family supportandthosewithunsupportive Experiences variedwidelybetweenthosewith unsupportive (“neutral”). 22% hadfamiliesthatwereneithersupportivenor supportive, 18%hadunsupportivefamilies,and More thanhalf(60%)reportedthattheirfamilywas supportive, neutral,orunsupportivefamily. collapsed tocreateanewvariablereflecting to “veryunsupportive.” Thecategorieswere using afive-pointscalefrom“verysupportive” their familywasofthemasatransgenderperson grew upwithwereasked toassesshowsupportive all, most,orsomeoftheimmediatefamilythey Respondents whoreportedthattheywere out to and Support V. FamilyAcceptance than thosewithunsupportivefamilies(54%). to thosewithunsupportivefamilies(50%). serious psychologicaldistress (45%). (27%) thanthosewithunsupportivefamilies than thosewithunsupportivefamilies(16%). with unsupportivefamilies(52%). 9 (31%)incontrast 8

unsupportive. said thattheirfamilywas was supportive, while18% reported thattheirfamily their immediatefamily those whowereoutto More thanhalf(60%)of Family ofOrigin Immediate Family/ VI. Relationships with documented non-citizens(22%) andcitizens(26%). likely tofacethisformoffamily rejectionthan Undocumented residents(39%)werealsomore lower forAsian(22%)respondents(Figure5.7). Eastern (37%),andBlack(30%)respondents, was higheramongAmericanIndian(38%),Middle altogether becausetheyweretransgender. This to themforalongtimeorendedtheirrelationship an immediatefamilymemberstoppedspeaking family, morethanone-quarter (26%)reportedthat Among thosewhowereouttotheirimmediate A. EndedRelationships them frombeingtransgender. identity, andbeingsenttoaprofessionalstop allowed towearclothesmatchingtheirgender violence, beingkicked outofthehouse, notbeing rejection includedrelationshipsending,family form offamilyrejectionoutlinedinthesurvey. This reported thattheyhadexperiencedatleastone they grewupwith(suchasparentsandsiblings) to all,most,orsomeoftheimmediatefamily Nearly half(44%)ofrespondentswhowereout 10 FAMILY LIFE AND FAITH COMMUNITIES 71 43%

10 or more or 10

37% 6 to 9 to 6 29% 5 to 2

24% 0 to 1 to 0

26% Overall 5% 0% 15% 10% 45% 35% 40% 30% 25% 20%

transitioned, with those transitioning 10 or more years ago (15%) experiencing almost twice as much violence as those who transitioned in the past year (8%) (Figure 5.10). YEARS SINCE TRANSITIONING (%) B. Family Violence Among those who were out to their immediate one out of every ten (10%) respondents family, reported that a family member was violent towards Prevalence them because they were transgender. of family violence differed greatly depending on the time period during which a respondent More than one-quarter (26%) (26%) than one-quarter More that reported of respondents family member an immediate to them stopped speaking or ended their for a long time altogether because relationship they were transgender. (43%) ago (37%), and 10 or more years ago (Figure 5.9). stopped Figure 5.9: Immediate family member speaking or ended relationship White 25% 29%

27%

65 and over and 65 Multiracial 37%

37%

45 to 64 to 45

28% Eastern Middle Latino/a

29%

Black

30% 44 to 25 22% Asian

18% 18 to 24 to 18 38%

26% 26% Indian American

Overall Overall 0% 5% 0% 10% 15% 10% 40% 30% 20% 35% 40% 30% 25% 20% to them or end a relationship than those who transitioned 2 to 5 years ago (29%), 6 to 9 years Those who transitioned in the last year (24%) were speaking to have a family member stop less likely (%) CURRENT AGE compared to those in other age groups, such as compared to those in other age groups, 45 to 64 year olds (37%) (Figure 5.8). stopped Figure 5.8: Immediate family member speaking or ended relationship Whether a family member stopped speaking to or Whether a family member stopped speaking differed ended a relationship with a respondent experiencing the with 18 to 24 year olds by age, nature (18%) least amount of family rejection of this Figure 5.7: Immediate family member stopped member stopped Immediate family Figure 5.7: or ended relationship speaking (%) RACE/ETHNICITY 72 2015 U.S. TRANSGENDER SURVEY counterparts. their documentednon-citizen(13%)andcitizen(9%) likely tohaveexperiencedfamilyviolence(25%)as Undocumented residentsweremorethantwiceas RACE/ETHNICITY (%) Figure 5.11: Experiencedviolencebyfamilymember higher ratesofviolence(Figure5.11). Eastern (14%)respondents,alsoexperienced people ofcolor, suchasAsian(15%)andMiddle as likely toexperiencefamilyviolence, andother American Indianrespondents(20%)weretwice YEARS SINCETRANSITIONING(%) Figure 5.10: Experiencedviolencebyfamilymember 10% 16% 12% 18% 14% 0% 6% 2% 8% 4% 20% 25% 10% 15% 0% 5%

Overall Overall

American Indian 10% 10% 20%

0 to 1 Asian 8% 15%

Black 12% 2 to 5 10% Latino/a

Middle Eastern 12%

6 to 9 14% 14%

Multiracial

13% 10 or more 15% White 8% C. Kicked outoftheHouse Morelikely tohaveattemptedsuicidein • Morelikely tobecurrentlyexperiencingserious • Morethantwiceaslikely tohaveexperienced • experienced familyviolencewere: likelihood ofnegativeexperiences.Thosewho Family violencewasassociatedwithincreased more thanwhite respondents(6%)(Figure 5.13). (9%) respondentsexperiencing thisformofrejection Black (12%),Latino/a (11%),multiracialandAsian being twiceaslikely, and AmericanIndian(14%), higher rates,withMiddleEastern respondents(17%) People ofcolorwerekicked outofthehouse at YEARS SINCETRANSITIONING(%) Figure 5.12: Kicked outofthehousebyfamily transitioned withinthelastyear(7%)(Figure5.12). been kicked outofthehouse(16%)asthosewho or moreyearsagoweretwiceaslikely tohave of thewholesample. Thosewhotransitioned10 kicked outofthehouse, whichrepresents6% to theimmediatefamilytheygrewupwithwere Eight percent(8%)ofrespondentswhowereout 10% 16% 12% 18% 14% 0% 6% 2% 8% 4% experience familyviolence(39%). their lifetime(65%)thanthosewhodidnot did notexperiencefamilyviolence(35%). psychological distress(53%)thanthosewho experience familyviolence(29%). homelessness (59%)thanthosewhodidnot

Overall 8%

0 to 1 7%

2 to 5 8%

6 to 9 12%

10 or more 16% FAMILY LIFE AND FAITH COMMUNITIES 73

20% 10 or more or 10

20% 6 to 9 to 6

15% 2 to 5 to 2

11% 0 to 1 to 0

14% Overall 5% 0% 15% 10% 25% 20% matched their gender. matched their gender. to Stop E. Sent to a Professional Them from Being Transgender who were Fourteen percent (14%) of respondents had out reported that their immediate family a therapist, sent them to a professional—such as or religious advisor—to stop them from counselor, This represents 11% of the being transgender. Those who transitioned 6 or more whole sample. to be sent to years ago (20%) were twice as likely within the a professional as those who transitioned last year (11%) (Figure 5.14). to stop them Sent to a professional Figure 5.14: from being transgender YEARS SINCE TRANSITIONING (%) Fourteen percent (14%) of percent Fourteen were out to who respondents family reported their immediate sent them to a that their family as a therapist, professional—such religious advisor—to or counselor, being transgender. stop them from Clothes Wear Not Allowed To D. Gender Identity Matching One’s More than one-quarter (27%) of respondents they grew who were out to the immediate family that up with were not allowed to wear clothes

6% White

11% Multiracial

17%

Middle Eastern Middle

11% Latino/a

12% Black

9% Asian 14%

8% American Indian American Overall 4% 8% 2% 6% 0% 14% 18% 12% 16% 10% psychological distress (50%) than those who out of the house (36%). were not kicked suicide (66%) than those who were not kicked out of the house (39%). experienced homelessness (74%) as those who out of the house (28%). were not kicked out of (3.5%) than those who were not kicked the house (1.5%). (28%), and had lower incomes overall. out kicked work (33%) than those who were not of the house (11%). those who were not kicked out of the house those who were not kicked Figure 5.13: Kicked out of the house by family out Kicked Figure 5.13: (%) RACE/ETHNICITY • to have attempted Substantially more likely • to be currently experiencing serious More likely • to be living with HIV More than twice as likely • sex to have ever done Three times more likely • to have Almost three times as likely health, and physical health. Respondents who health, and physical health. Respondents out of the house were: were kicked • to be living in poverty (43%) than More likely Being kicked out of the house was associated with out of the house was associated Being kicked of a range of negative an increased likelihood mental experiences related to economic stability, 74 2015 U.S. TRANSGENDER SURVEY (Figure 5.16). had transitionedwithinthe past year(8%) more yearsago(19%)ascompared tothosewho have runawayfromhome if theytransitioned10or Respondents weremorethantwiceaslikely to younger. (32%) ofthoseindividualsranawayatage15or because theyweretransgender. Almostone-third out totheirimmediatefamilyranawayfromhome One outofeveryten(10%)respondentswhowere Home VII. Ran Away From De-Transition” sectionofthe “Conversion TherapyandOtherPressuresto their genderidentityarediscussedfurtherinthe with professionalswhoattemptedtochange Additional detailsonrespondents’ experiences RACE/ETHNICITY (%) from beingtransgender Figure 5.15: Senttoaprofessionalstopthem (24%) beingsenttoaprofessional(Figure5.15). nearly one-quarterofAmericanIndianrespondents one-third ofMiddleEasternrespondents(31%)and Rates differedbyraceandethnicity, withnearly 20% 25% 30% 35% 10% 15% 0% 5%

Overall American Indian 14% 24%

Asian 15%

Black 14%

Health Latino/a

Middle Eastern 16% chapter. 31%

Multiracial 16%

White 14% Indian (18%),Black(15%),multiracial(14%),Asian from home, withMiddleEastern(25%),American People ofcolorweremorelikely tohaverunaway YEARS SINCETRANSITIONING(%) Figure 5.16: Ran awayfromhome citizen residents(14%). citizens (10%)andmorethan documentednon- from homemorethanthree timesasoften with undocumentedresidents(36%)runningaway Rates also differed accordingtocitizenshipstatus, RACE/ETHNICITY (%) Figure 5.17: Ran awayfromhome respondents (8%)(Figure5.17). that theyhadrunawayathigherratesthanwhite (12%), andLatino/a (12%)respondentsallreporting 20% 20% 25% 30% 16% 12% 10% 15% 0% 8% 4% 0% 5%

Overall American Indian Overall 10% 10% 18%

0 to 1 8%

Asian 12%

Black 15% 2 to 5 10% Latino/a

Middle Eastern 12%

25% 6 to 9 14%

Multiracial

14% 10 or more 19% White 8% FAMILY LIFE AND FAITH COMMUNITIES 75

68% 35 and over and 35

59% 25 to 34 to 25

54% 18 to 24 to 18

56% Under 18 Under 11

50% Overall 0% 10% 70% 40% 30% 80% 20% 50% 60% Any family rejection Figure 5.18: OF TRANSITION (%) AGE 68% of those who transitioned at age 35 or older 68% of those who transitioned at age 56% of those experiencing rejection, compared to (Figure who transitioned under the age of 18 Among respondents who transitioned ten 5.18). 68% reported family rejection or more years ago, in the compared to 48% of those who transitioned past year (Figure 5.19). Rejection IX. Family Overall to combine all forms of A variable was created This in the survey. family rejection examined the respondent had a spouse, included whether reported or child end a relationship, partner, or had any of unsupportive, that their family was rejecting experiences outlined the five specific One half (50%) of chapter. in section VI of this were out to family members respondents who form of reported that they experienced some of the family rejection, which represents 46% overall sample. by the Experience with family rejection differed with age at which a respondent transitioned, 11% 18% 10% 33% 36% 58% 55% 65% 82% % of respondents and/or gender on an ID document One or more experiences listed Did research to learn how to best support them Gave money to help with gender transition Supported them in another way Provided help with changing name support them Used their preferred name Used the correct pronouns friends, up for them with family, Stood or others Supportive family behaviors respondent they respect and/or Told the supportive acts (Table 5.2). the supportive acts (Table 5.2: Family support Table in the question, such as using preferred names,in the question, such as using preferred financialusing correct pronouns, and providing percent (82%)support for their transition. Eighty-two one immediateof respondents reported that at least at least onefamily member supported them through any ofof these acts, while 18% did not experience Those who were out to their immediate family wereThose who were out of the immediate family they whether any asked of them as agrew up with demonstrated support acts listedtransgender person through any specific VIII. Supportive VIII. Supportive Family Behaviors Overall, 15% of those who were out to their of those who were Overall, 15% ran of the whole sample, or 11% family, immediate of the out kicked home and/or were away from house. 76 2015 U.S. TRANSGENDER SURVEY higher levelsofrejection(Figure 5.21). American Indian(66%)respondents experienced racial orethnicidentitiesvariedlittle, although Family rejectionamongrespondentsofdifferent GENDER IDENTITY(%) Figure 5.20:Anyfamilyrejection respondents (32%)(Figure5.20). nearly twiceasmuchrejectionnon-binary transgender menandwomen(59%)experiencing rejection morethantransgendermen(55%),and with transgenderwomen(63%)experiencing Family rejectionalsodifferedbygenderidentity, YEARS SINCETRANSITIONING(%) Figure 5.19: Anyfamilyrejection 60% 20% 50% 80% 30% 40% 70% 60% 20% 50% 30% 40% 70% 10% 10% 0% 0%

Overall Overall 50% 50% Crossdressers 38%

0 to 1 48% Non-binary 32%

Trans women 2 to 5 58% 63%

Trans womenTrans and men

6 to 9 68% 55%

10 or more 59% 68% Respondents whoexperiencedfamilyrejection RACE/ETHNICITY (%) Figure 5.21:Anyfamilyrejection (Figure 5.22). respondents ofotherraces and ethnicities likely tohavebeenpartofafaithcommunitythan and MiddleEastern(71%)respondentsweremore community atsomepointintheirlife. Black(77%) (66%) ofthesurveysamplehadbeenpartafaith mosque, orotherfaithcommunity. Two-thirds community”), suchasachurch,synagogue, with aspiritualorreligiouscommunity(“faith The surveyexploredrespondents’ experiences Faith Community X. Experienceswitha Morelikely tohaveattemptedsuicide(49%) • Nearlytwiceaslikely tohavedoneinsexwork • Almosttwiceaslikely tohaveexperienced • were: than thosewhowerenotrejected(33%) (16%) asthosewhowerenotrejected(9%). rejected (22%). homelessness (40%)asthosewhowerenot 60% 20% 50% 30% 40% 70% 10% 0%

Overall American Indian 50% 66%

Asian 50%

Black 52%

Latino/a

Middle Eastern 52% 48%

Multiracial 49%

White 49% FAMILY LIFE AND FAITH COMMUNITIES 77

32% 10 or more or 10

29% 6 to 9 to 6

23% 2 to 5 to 2

19% 0 to 1 to 0

19% Overall 5% 0% 15% 10% 35% 30% 25% 20% respondents who have been part of a faith community left because they feared rejection as a transgender person. of color were rejected by their faith People communities at higher rates, with one-third of American Indian respondents (33%) and almost one-quarter of Black (24%) and Middle Eastern (24%) individuals leaving for this reason (Figure 5.25). More than one-third (39%) of B. Leaving a Faith Community Community a Faith B. Leaving Rejection Due to who had in five (19%) respondents Nearly one community left because been part of a faith rejected (in contrast to feared they were actually in the last subsection), which rejection as reported all respondents. Experiences represents 12% of amount of time since varied based on the one-third (32%) of those who transition, with nearly more years ago leaving a faith transitioned 10 or rejection (Figure 5.24). community due to due to rejection Figure 5.24: Ever left faith community YEARS SINCE TRANSITIONING (%)

66% White 35% White

65% 40%

Multiracial Multiracial

71%

54%

Middle Eastern Middle Middle Eastern Middle

62% 46%

Latino/a Latino/a

77% Black 49% Black

59% Asian Asian 43% 65% 51%

66%

American Indian American

American Indian American 39%

Overall Overall 0% 0% 10% 10% 70% 40% 30% 80% 50% 20% 60% 90% 40% 30% 50% 20% 60% Latino/a (46%), Asian (43%), and multiracial (40%) (46%), Asian Latino/a to leave because respondents, were more likely 5.23). they were afraid of rejection (Figure due to Figure 5.23: Ever left faith community fear of rejection (%) RACE/ETHNICITY More than one-third (39%) of respondents who More than one-third (39%) of respondents left due have been part of a faith community were to fear of being rejected because they including Middle of color, People transgender. Black (49%), Eastern (54%), American Indian (51%), A. Leaving a Faith Community a Faith Community A. Leaving Due to Fear of Rejection Figure 5.22: Ever been part of a faith community Ever been part of Figure 5.22: (%) RACE/ETHNICITY 78 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) community afterrejection Figure 5.26:Foundnewwelcomingfaith likely (Figure5.26). (37%) andAsian(34%)respondentsbeingleast likely tofindawelcomingcommunity, and Latino/a American Indianrespondents(54%)beingmore differed byrespondents’ raceorethnicity, with welcomed themasatransgenderperson.This community, 42%foundanewcommunitythat Of thepeoplewhohadbeenrejectedbyafaith Experiences WithinthePast Year C. Welcoming Communitiesand RACE/ETHNICITY (%) Figure 5.25:Everleftfaithcommunityduetorejection 60% 20% 50% 30% 40% 10% 0% *Sample sizetoolowtoreport 20% 25% 30% 35% 10% 15% 0% 5% Overall American Indian 42% Overall American Indian 19% 54% 33%

Asian 34%

Asian 22%

Black 42% Black 24% Latino/a

Middle Eastern* 37% Latino/a

Middle Eastern 21%

Multiracial 24%

Multiracial 41% 21%

White 43% White 17% community leadersand/ormembersaccepted past year. Ninety-fourpercent(94%)reportedthat signaled acceptancewithinthecommunityin were asked aboutaseries ofbehaviorsthat members thoughtorknewtheyweretransgender Respondents whosefaithcommunityleaders or Communities inthePast Year D. AcceptanceWithinFaith they weretransgender. where leadersorothermembersthoughtknew sixty percent(60%)ofthemwereinacommunity which is19%oftheoverallsample. Additionally, been partofsuchacommunityinthepastyear, part ofafaithcommunityreportedthattheyhad Nearly one-third(30%)ofthosewhohadeverbeen past year Table 5.3:Acceptancewithinafaithcommunityinthe one oftheacceptingbehaviors(Table 5.3). community inthepastyearexperiencedatleast percent (96%)ofrespondentswhowereinafaith their religionorfaithacceptsthem.Ninety-six and morethanthree-quarters(80%)weretold them forwhotheyareasatransgenderperson, listed One ormoreexperiences as atransgenderperson religion orfaithacceptsthem They weretoldthattheir transgender person them feelwelcomeasa their faithcommunitymade A leaderormemberof transgender person for whotheyareasa members acceptedthem Community leadersand Acceptance withinfaithcommunityinpastyear 12 Many times 59% 75% 72% 96% A few times 12% 12% 11% Once or twice 9% 9% 8% FAMILY LIFE AND FAITH COMMUNITIES 79

15% White

21%

Multiracial

20% Eastern* Middle Latino/a

25% Black 40% Asian 17%

18%

American Indian American Overall 5% 0% 15% 10% 45% 35% 40% 30% 25% 20% *Sample size too low to report many transgender people within their families and faith communities. Conclusion showed significant challenges in many areas Results including the retention of relationships of family life, spouses with immediate and extended family, results also and partners, and children. However, were able demonstrate that survey respondents build to maintain relationships and successfully They further family units despite those challenges. in promoting show the importance of family support of life. positive experiences in many aspects demonstrate that family rejection is strongly Results correlated with increased negative effects on a wide range of major life experiences, including income, homelessness, HIV infection, serious psychological although Additionally, distress, and suicidal behavior. many respondents experienced negative interactions within their faith communities, many others were able to find welcoming and supportive communities. experiences varied overall, these While respondents’ findings reveal the substantial challenges facing by faith community Any rejecting behavior Figure 5.27: in past year (%) RACE/ETHNICITY 7% 3% 3% 3% twice Once or 1% 2% 2% 5% times A few 18% 1% 1% 1% 5% times Many - 13 community functions One or more experiences listed Community leaders or mem them to seek bers asked medical or psychological help to stop them from being transgender to stop They were asked coming to services or faith They were told that being transgender is a sin or that their religion does not approve of them to meet They were asked with faith leaders to stop them from being transgender within faith community in past year Rejection because they were rejected. Nearly one in five (19%) respondents who had been part of a faith community left a faith community in the past year reported that they experienced at least one of the rejecting among Asian was more likely behaviors. Rejection (40%) and Black (25%) respondents (Figure 5.27). Nearly one in five (18%) respondents who were in community in the within a faith 5.4: Rejection Table past year also asked about behaviors that signaled rejection about behaviors also asked to asked Among them, 6% were in the past year. to stop them from being meet with faith leaders to to stop coming and 5% were asked transgender, 5.4). functions (Table services or faith community E. Rejection Within Faith Within Faith E. Rejection Year Past in the Communities leaders or members faith community Those with they were transgender were who thought or knew 80 2015 U.S. TRANSGENDER SURVEY 7 6 5 4 3 2 1 ENDNOTES Q. 7.6. children undertheageof18inhouseholdisbasedon The percentageofUSTS respondentswithrelated Annual SocialandEconomicSupplement U.S. CensusBureau.(2015). in therespondent’s household. of children,agesorwhetherthechildrenlived had atleastonechild,butdidnotdeterminethenumber children. Thisquestionestablishedwhetherarespondent answered “yes” or“no” towhether theywereouttotheir they “donothaveanychildren,” andtheremaining18% of theirchildren.Eighty-twopercent(82%)reportedthat on Q. 4.3,whichasked ifarespondent wasouttoany A respondent’s statusasaparent was determinedbased See Q. 4.5fordescriptionsofgroupsfamilymembers. Lesbian, gay, bisexual,andtransgender(LGBT). public, and/orprofessionallives. openly self-identifiesastransgenderintheirprivate, The term“out”isusedheretodescribeapersonwho 205–213. of ChildandAdolescentPsychiatricNursing, adolescence andthehealthofLGBT youngadults. Diaz, R.M.,&Sanchez,J. (2010). Familyacceptancein & NationalGayandLesbian Task Force;Huebner, D., 88–105). DC:NationalCenterforTransgender Equality of theNationalTransgender DiscriminationSurvey L., &Keisling, M.(2011). Grant, J. M.,Mottet,L.A.,Tanis, J., Harrison,J., Herman,J. |CHAPTER5:FAMILY LIFEANDFAITH COMMUNITIES Injustice atEveryTurn: AReport Current Population Survey, .

23 (4), . (pp. Journal 11 10 9 8 13 12 family), and(4)actslistedinQ. 4.7. (3) Q. 4.6 (reportedlevelofsupportivenessimmediate stopped speakingorspendingtimewithrespondent), 4.2 (spouse/partnerendedrelationship),(2)Q. 4.4(child family rejectionamongseveralquestions,including:(1)Q. rejection isbasedonavariablecreatedtoreflectany The figureof50%respondentsexperiencingfamily definition includedparentsandsiblings. family [respondent]grewupwith,” andindicatedthatthe Section 4asked aboutexperienceswith“immediate Health developed fromtheKessler 6scale. SeeQ. 12.2.Seealso The “serious psychologicaldistress” measurewas 4.6. collapsed intoasingle“unsupportive” category. SeeQ. unsupportive” and“unsupportive” categorieswere collapsed intoasingle“supportive” category. “Very “Very supportive” and“supportive” categorieswere listed inQ. 5.7 onceortwice, afewtimes,ormanytimes. on respondentswhohadexperiencedarejectingbehavior The “anyrejectingbehavior”variablewascreatedbased many times. behavior listedinQ. 5.7 onceortwice, afewtimes,or on respondentswhohadexperiencedanaccepting The “anyacceptingbehavior”variablewascreatedbased chapter.

IDENTITY DOCUMENTS 81 Changing 1 3 Previous researchers have documented barriers preventing 2

ost non-transgender people take their identity documents (IDs) for granted, but for transgender ost non-transgender people take people often updating and using IDs may present substantial challenges. Transgender people, Changing the name listed on most need to update their IDs to reflect their gender and name.

and/or gender, and interactions with others related to updating and presenting their IDs and records. and interactions with others related to updating and presenting their IDs and records. and/or gender, based on demographic and other characteristics are experiences Notable differences in respondents’ reported throughout the chapter. the gender marker listed on most IDs and records generally requires documentation of gender transition the gender marker may vary greatly for each type though the requirements of this documentation from a health provider, of ID and from jurisdiction to jurisdiction. transgender people from updating the name and gender on their IDs. with their IDs and records, including updating their name experiences This chapter explores respondents’ state or federal IDs and records typically involves obtaining a legal name change from a court. state or federal IDs and records typically involves obtaining a legal name Identity Documents Identity CHAPTER 6 CHAPTER M 82 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS in eachstateandterritory. Respondents were and theprocessforobtaining acourtordervaries changes typicallyhappenthrough acourtorder, passports, andSocialSecurity cards. official IDsandrecords,suchasdriver’s licenses, to updatethenamelistedonmanyformsof name changeorderisalmostalwaysrequired for some, butnotall,transgender people. Alegal Changing anameisstepinthetransitionprocess Name Changes I. AccesstoLegal Thirty percent(30%)ofrespondentscompletedalegalnamechange. 67% didnothaveanIDorrecordwiththegendertheypreferred. Forty-nine percent(49%)didnothaveanIDorrecordwiththenametheypreferred,and preferred. and records,while68%reportedthatnoneoftheirIDshad thenameandgenderthey Eleven percent(11%)ofrespondentshadtheirpreferred nameandgenderonallIDs attacked. benefits, 9%wereasked toleavealocationorestablishment,and2%wereassaulted presentation, 25%ofpeoplewereverballyharassed,16%deniedservicesor As aresultofshowinganIDwithnameorgenderthatdidnotmatchtheir 9% wereabletodoso. Of thosewhowantedtochangethegenderontheirbirthcertificate, onlyanestimated their gender. able tochangetheirnameonthelicenseandanestimated29%were Of thosewhowantedtoupdatetheirdriver’s licenseorstateID, anestimated44%were because theycouldnotaffordit. Thirty-five percent(35%)ofthosewhodidnottrytochange theirlegalnamedidnottry that theyhadspentover$250, and11%spentover$500. Thirty-four percent(34%)ofpeoplewhoweregranted alegalnamechangereported 4 Legal name process did sothroughacourtorder, process lessthan1% majority (96%)ofrespondents whounderwentthe change processasnon-binary people(11%).Avast as likely tohavetriedorcompleted thename men andwomen(51%)werealmostfivetimes according togenderidentity, wheretransgender 30% wereabletodoso. Thisratevariedgreatly have triedtoobtainalegalnamechange, and Approximately one-third(36%)ofrespondents access toalegalnamechange. decision tolegallychangetheirnameand asked aseriesofquestionsaboutfactorsintheir IDENTITY DOCUMENTS 83

7% 9% 11% 17% 3% 60% 24% 24% 35% 28% 40% 20% change change

% of those who attempted name who had % of those not attempted name not attempted

6.2: Reasons for not attempting to for not attempting 6.2: Reasons Help from a friend help from a paid attorney Legal Help from another source Free help from a legal clinic or non-profit organization None Type of assistance Type Reasons for not attempting to for not attempting Reasons change legal name They are not ready They cannot afford it withTheir name does not conflict gender identity or expression They do not know how changing theirThey were worried that name would out them are allowed They do not believe they A reason not listed b. Interactions with Judges and b. Court Staff Those who interacted with judges and court staff during the name change process reported widely varying experiences. Of the 84% who believed The legal name change process can be The legal name change process can people and while many complicated to navigate, some seek undergo the process without help, who tried or the assistance of others. Of people 60% did so completed the name change process, including free without help and 40% received help, (17%), help from a clinic or non-profit organization or help from a assistance from a from a friend (11%), 6.3). paid attorney (9%) (Table tried or 6.3: Assistance for people who Table completed the legal name change process Table Table name change legal Name a. Assistance with a Legal Change 1% 2% 2% 6% <1% <1% 88% name change % of those who attempted a legal 6.1: Outcome of legal name change attempt 6.1: Court initially denied, then later granted name change Not listed above Court denied name change They are still in process of changing name They stopped trying because they ran out of money They gave up Outcome of legal name change attempt Court granted name change among non-binary people (45%) and crossdressers (36%) than transgender men and women (10%). Nearly two-thirds (64%) of respondents have These never tried to change their legal name. participants reported a variety of reasons for not engaging in the process, including 28% who felt that their name did not conflict with their gender 6.2). This reason was more common identity (Table legal name change through a court did so at age 45% between the ages of 25 and 24 or younger, 44, 13% between the ages of 45 and 64, and less than 1% at age 65 or older. Forty-one percent (41%) of those who attempted a Table Table (88%) of those who attempted to legally change(88%) of those who Those a name change. their name were granted did not complete the processwho attempted but being denied,reported a variety of reasons, such as 6.1). or giving up (Table running out of money, did so through the immigration or naturalizationdid so through the so by other methods, includingprocess, and 4% did or a an informal or assumed name, marriage, Eighty-eight percent country. process in another Thirty percent (30%) of percent (30%) Thirty the completed respondents change process. legal name 84 2015 U.S. TRANSGENDER SURVEY experiences. process reportedhavingat leastoneofthese with judgesorcourtstaff during thenamechange more thanone-third(36%)ofthosewhointeracted service, and3%wereverbally harassed.Overall, reported thattheyreceivedunequaltreatmentor or havehadanysurgery. Nearlyoneinten(9%) transition, suchaswhethertheytake hormones staff wereasked questionsabouttheirgender (19%) peoplewhointeractedwithjudgesorcourt Ms.) duringtheirinteractions.Almostoneinfive (such ashe, she, orthey)title(suchasMr. or were referredtobythewronggenderpronouns their interactions.Twenty-three percent(23%) were asked aboutspecificexperiencesduring staff whothoughtorknewtheyweretransgender Respondents whointeractedwithjudgesorcourt or surgicaltreatment(35%). (41%), andpeoplewhohadnotanyhormonal sales, orotherworkthatiscurrentlycriminalized the undergroundeconomy, suchassexwork,drug including peoplewhowerecurrentlyworkingin respect werehigherforcertaingroupsofpeople, of onlysometimesorneverbeingtreatedwith felt theywerenevertreatedwithrespect.Reports were onlysometimestreatedwithrespect,and2% with respect,almostone-quarter(22%)feltthey three-quarters (75%)felttheywerealwaystreated they weretransgenderduringtheirinteraction, that thejudgesand/orcourtstaffthoughtorknew not affordit. was becausetheycould their namesaidthatit not trytolegallychange of respondentswhodid More thanone-third(35%) (Figure 6.1). 10% reportedtheprocesscosting$500–$2,000 half (55%)reporteditcosting$100–$499, and that theprocesscostlessthan$100, morethan who weregrantedalegalnamechangereported process. Approximately one-quarter(27%)ofthose recall howmuchtheyspentonthenamechange publication. Thesurveyasked respondentsto cost oflegalhelp, courtfees,andnewspaper may includemanydifferentfees,suchasthe The processofobtainingalegalnamechange Name Change c. CostAssociatedwithaLegal the processbecausetheyranoutofmoney. legal namechangeprocess,2%didnotcomplete Additionally, ofpeoplewhohadattemptedthe they didnottrybecausecouldaffordit. tried tolegallychangetheirnamereportedthat Thirty-five percent(35%)ofpeoplewhohadnot make theprocessinaccessibleforsomepeople. The costofobtainingalegalnamechangemay 20% Figure 6.1: Reported costofalegalnamechange 25% 30% 35% 10% 15% 0% 5%

$0 7%

$1–99 20%

$100–249 32%

$250–499 23%

$500–749 7% $750–999

$1,000–2,000 1%

More than $2,000 2%

Do not remember 1% 8% IDENTITY DOCUMENTS 85 my identification documents is really my identification documents is disheartening, dysphoria inducing, not and kind of dehumanizing. I’m allowed to be me.” not “My legal name and gender are yet changed on any documents The process for due to the price. that should be easier or cheaper that because that is the main thing stops me from doing things that require ID.” update “Because my state won’t on its birth the gender markers certificates, the only way to update license is by changing my my driver’s information on a federal level with my passport. The problem is that match.” now my documents don’t In Our Own Own In Our Voices misgendered “I was intentionally verbally harassed and continually Even after by DMV employees. identification to paying for proper refused to send the be issued, they my female identification because match my ‘M’ gender photo didn’t marker.” not being a non-binary person, “As any of able to change my gender on of their none of their IDs and records listed of their IDs and records all they preferred. including undocumented residents (68%), were to say that none of their IDs or records more likely Respondents reflected the name they preferred. to say with lower incomes were also more likely that none of their IDs or records had the name (30%) of respondents had the name they preferred on all IDs and records, and 22% had the name they 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, change. Generally, a court order granting a name Generally, change. each change must then be presented to update were asked Respondents ID or record separately. or none of their IDs and records whether all, some, reflected the name they preferred. Thirty percent a. Updating Name on IDs and a. Updating Name on IDs Records and records, In order to change the name on IDs name one often needs to first obtain a legal IDs or records had both the name and gender they IDs or records had both the name and first discuss preferred. The following sections will experiences with updating the name respondents’ experiences on their IDs or records, and then their with updating the gender marker. both the name and gender they preferred, and both the name and certain populations, such rates were lower for individuals (4%), people aged as undocumented (6%). More 18–24 (5%), and people with no income than two-thirds (68%) reported that Gender on IDs Gender individuals may seek to update the Transgender and records, the gender marker name on their IDs both. Only 11% of respondents (such as M or F), or reported that II. Experiences with II. Experiences and Name Updating 86 2015 U.S. TRANSGENDER SURVEY Figure 6.2:UpdatedNAMEonIDorrecord,bygenderidentityandtransitionstatus(estimated) 60% 20% 50% 30% had transitioned(39%)(Figure6.2). who license, incontrasttonon-binaryrespondents transitioned changedtheirnamedriver’s (61%) oftransgendermenandwomenwhohad respondents whohadtransitioned.Forexample, their nameonvarioustypesofIDsthannon-binary had transitionedweremorelikely tohaveupdated driver’s license. Transgender menandwomenwho had transitionedupdatedtheirnameon name ontheirdriver’s license, 56%ofthosewho while 44%ofthewholesamplehadupdatedtheir have changedthenameontheirIDs. Respondents whotransitionedweremore likely to on theirpassport,and18%birthcertificate. have changedtheirnameonstudentrecords,28% Administration. Incontrast,lessthanone-third(31%) have changedtheirnamewiththeSocialSecurity have changedtheirnameonaworkID, and43% estimated update theirnameonit,lessthanhalf(44%)were had adriver’s licenseorstateIDandwanted to birth certificates.Amongthoserespondentswho kinds ofIDsorrecords,like driver’s licensesand experiences withupdatingthenameonspecific werealsoasked abouttheir Respondents 40% 70% 10% 0%

Birth certificate 18% 24% 5 to have done so. An estimated 44% tohavedoneso. Anestimated44% 14% 26%

and/or state-issued Driver’s license 44%

non-driver ID 56% 39% 61%

Social Security 43% 6 For example, Forexample, 55% records 38% 59% 28%

Passport 36% 21% on thatID, (2)theywereinprocessofdoingso, asked if(1)theyhadbeenabletochangethename each typeofIDorrecord,thoserespondentswere name ondifferentkindsofIDsandrecords.For questions abouttheirexperiencesupdatingthe listed thenametheypreferwereasked specific Those whoindicatedthatsomeoralloftheirIDs change ontheirbirthcertificate(6%)(Figure6.3). and theyweremostlikely tobedenieda name work ID(88%),andSocialSecurityrecords(84%), changed thenameontheirdriver’s license(87%), Respondents weremostlikely tohavesuccessfully the nameonthatIDbutwantedtodoitsomeday. were denied,or(4)theyhadnottriedtochange (3) theytriedtochangethenameonIDbut and gendertheypreferred. reflected boththename have anyIDorrecordthat of respondentsdidnot More thantwo-thirds(68%) 40%

(current or last school Student records 31% 39% attended) 29% 42% 44%

Work ID 56% 39% 61% have transitioned and womenwho Transgender men have transitioned respondents who Non-binary have transitioned Respondents who change it and wantedto who hadID/record All respondents 7

IDENTITY DOCUMENTS 87

less 8 Changed name Denied name change In process of changing name Have not tried to change name but want to 9%

3% 1% ID Work 88% 30%

6% attended) 3%

61%

Student records records Student (current or last school school last or (current 36% updated the gender on their driver’s license, in license, updated the gender on their driver’s contrast to non-binary respondents who had transitioned (9%) (Figure 6.4). to update their gender on it, an estimated and only 9% than one-third (29%) had done so, their birth were able to change their gender on Twenty-three percent (23%) of those certificate. to update with a Social Security card who wanted have done so, their gender on it were estimated to on their and only 18% had updated their gender passport. had transitioned were more who Respondents their IDs. to have changed their gender on likely 29% of the overall sample have For example, license, updated the gender on their driver’s while 42% of those who have transitioned on their driver’s updated the gender marker men and women who had Transgender license. to have transitioned (52%) were much more likely 9%

1% Passport 55%

10%

3% records 1%

84%

Respondents Respondents Social Security Security Social 10% 3%

<1% non-driver ID non-driver

87%

Driver’s license license Driver’s and/or state-issued state-issued and/or 47% 8% 6%

36% Birth certificate Birth 0% 10% 70% 40% 30% 80% 50% 20% 60% 90% 100% kinds of IDs or records, like driver’s licenses and driver’s kinds of IDs or records, like birth certificates. Among those respondents who license or state ID and wanted had a driver’s records, and 21% of respondents had the gender they preferred on some IDs and records. about their also asked were Respondents experiences with updating the gender on specific were asked whether all, some, or none of their or none of whether all, some, were asked IDs and records listed the gender they preferred. More than two-thirds (67%) of respondents did not have any ID or record that listed the gender they percent (12%) of respondents preferred. Twelve had the gender they preferred on all IDs and is typically a distinct process from updating the is typically a distinct process from updating regarding and may require documentation name, a provider, gender transition from a healthcare birth an updated court order of gender change, or other documentation. certificate, b. Updating Gender on IDs and b. Records on any ID or record Updating the gender marker 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 their IDs only able to update some or all of The above chart reflects respondents who have been numbers should not be reported without clearly update it. These the ID/record or do not want to IDs). It also does not include those who do not have records, see Figure 6.2. For overall ability to change stating that they represent only a subset of the respondents. Figure 6.3: Experiences updating NAME on specific IDs (among those who updated some or all of their IDs/records) who updated some IDs (among those NAME on specific Experiences updating Figure 6.3: 88 2015 U.S. TRANSGENDER SURVEY stating thattheyrepresent onlyasubsetoftherespondents. Foroverallabilitytochange records, seeFigure6.4. IDs). Italsodoesnot includethosewhodonothavetheID/record ordonotwantto update it.Thesenumbersshouldnot bereportedwithoutclearly The abovechartreflects respondentswhohavebeenable toupdatesomeorallof theirIDsonly(omittingthosewho have notbeenabletoupdateany their IDs/Records) Figure 6.5:ExperiencesupdatingGENDERonspecificIDs(amongthosewhoupdatedsomeorallof in processofdoingso, (3)theytriedtochange to changethegenderonthatID, (2)theywere respondents wereasked if(1)theyhadbeenable and records.ForeachtypeofIDorrecord,those updating thegenderondifferentkindsofIDs specific questionsabouttheirexperiences IDs listedthegendertheypreferredwereasked Those whoindicatedthatsomeoralloftheir Figure 6.4:UpdatedGENDERonIDorrecord,bygenderidentityandtransitionstatus(estimated) 100% 60% 20% 50% 30% 40% 60% 90% 20% 50% 80% 10% 30% 40% 70% 10% 0% 0%

Birth certificate Birth certificate 27% 9% 13% 15% 8% 2% 49% 16%

and/or state-issued and/or state-issued Driver’s license Driver’s license 29% 90%

non-driver ID non-driver ID 42% 2% 2% 9% 52% 7%

Social Security 70% Social Security 23% 33% 5% records records 5% 6% 20% 41% the genderonIDbutweredenied,or(4)they (Figure 6.5). marker changeontheirbirthcertificate(15%) and theyweremostlikely tobedenieda gender license (90%)andSocialSecurityrecords(70%), most likely tochangethegenderontheirdriver’s but wantedtodoitsomeday. had nottriedtochangethegenderonthatID 55% 18% Passport Passport 26% 2% 9% 4% 33% 33%

(current or last school (current or last school Student records Student records 55% 18% 25% 5% attended) attended) 5% 6% 9 Respondents were 35% 32%

but wantto change gender Have nottriedto gender of changing In process change Denied gender gender Changed have transitioned and womenwho Transgender men have transitioned respondents who Non-binary have transitioned Respondents who wanted tochangeit had ID/recordand All respondentswho IDENTITY DOCUMENTS 89

24% White

33% Multiracial 44%

, such as being Middle Eastern Middle

27% Latino/a

26% Black

24% Asian

39%

American Indian American

25% Overall 5% 0% 15% 10% 45% 35% 40% 30% 25% 20% 50% with a name or gender that did not match the gender they present in were denied services or Transgender men and women were more benefits. benefits to have been denied services or likely (20%) compared to non-binary respondents (10%). being verbally harassed. Middle Eastern (44%) being verbally harassed. Middle Eastern reported and American Indian (39%) respondents racial or experiencing this more often than other ethnic groups (Figure 6.6). harassed when using an ID with a Verbally Figure 6.6: presentation name or gender that did not match their (%) RACE/ETHNICITY Sixteen percent (16%) of people who showed IDs III. Experiences III. Experiences Presenting When Identity Incongruent Documents about their experiences were asked Respondents an ID with a name or when they have shown match the gender in which gender that did not nearly one-third (32%) of they present. Overall, shown IDs with a name individuals who have or gender that did not match their presentation reported negative experiences harassed, denied services, and/or attacked. reported One-quarter (25%) of these respondents 1% 41% 10% 44% 32% 30% 25% 25% 25% 26% % of those who reported having no IDs/records with the gender they preferred benefits or services They worried that changing gender would out them Their request was denied A reason not listed They could not afford it They were not ready They did not know how They believed they were not allowed They worried that they might lose Reasons for not changing Reasons gender They have not tried yet The available gender options (male or female) do not fit their gender identity because the available gender options (male or because the available gender options in contrast female) did not fit their gender identity, 6.4). (Table to 4% of transgender men and women for not changing gender on IDs or 6.4: Reasons Table records IDs or records had the gender they preferred IDs or records had the gender they because they could not afford it. Eighty-eight who percent (88%) of non-binary individuals had indicated that none of their IDs or records that it was the gender they preferred reported change the gender on their IDs or records, for change the gender on their IDs or records, medical reasons such as not having undergone on an treatment needed to change their gender Nearly one-third letter. ID or not having a doctor’s none of their (32%) of respondents indicated that Those who said that none of the IDs reflected Those who said that that was why were asked the preferred gender percent (25%) of these Twenty-five the case. allowed to respondents believed they were not on any of their IDs or records on any of their they could not reported that them. afford to change Nearly one-third (32%) of one-third Nearly did not who respondents gender have their preferred 90 2015 U.S. TRANSGENDER SURVEY and citizens(2%). (15%), incontrasttodocumentedresidents(3%) more likely toreportbeingassaultedorattacked Undocumented residentswerealsosubstantially respondents weretwiceaslikely (4%)(Figure 6.7). Indians werethreetimesaslikely (6%),and Black likely (9%)toreportexperiencingthis,American Eastern respondentswerealmostfivetimesas experiences differedbyraceandethnicity. Middle they presentinwereassaultedorattacked. These a nameandgenderthatdidnotmatchthe Two percent(2%)ofpeoplewhoshowedIDswith people (6%). compared totransgendermen(9%)andnon-binary to leaveafterpresentingincongruentIDs(13%), women weremorelikely tohavebeenasked incongruent IDwereasked toleave. Transgender Nine percent(9%)ofpeoplewhoshowedan services, and/orattacked. as beingharassed,denied negative experiences,such their presentationreported IDs thatdidnotmatch individuals whohaveshown Nearly one-third(32%)of RACE/ETHNICITY (%) presentation ID withanameorgenderthatdidnotmatchtheir Figure 6.7: Assaultedorattacked whenusingan 10% 0% 9% 6% 2% 5% 8% 3% 4% 7% 1%

Overall American Indian 2% 6%

Asian 3%

Black 4%

Latino/a

Middle Eastern 2% 9%

Multiracial 3%

White 2% not correspondwiththegendertheypresented that respondentswhopresentedIDsdid on theirIDsandrecords. preventing respondentsfromupdatingthegender medical procedures)areamongthemainbarriers (such asprovidingdocumentationofcertain gender markers andprocedural requirements Results alsoindicatethatthecostofupdating getting apreferrednameonidentitydocuments. change presentsaconsiderablechallengeto The datasuggeststhatthecostofalegalname financial, procedural,andeligibilitybarriers. records thatreflecttheirgenderidentity, including substantial issuesrelatedtoobtainingIDsand Findings indicatethatrespondentsencountered Conclusion being oftransgenderpeople. identity documentationforthesafetyandwell- emphasize theimportanceofaccesstoaccurate during thenameandgenderchangeprocess findings illustrateavarietyofdifficultiesthatarise other formsofnegativetreatment.Overall,these in wereputatriskofharassment,assault,and Further, resultssuggest IDENTITY DOCUMENTS 91 change this ID/record.” If a respondent selected one of If a respondent selected change this ID/record.” calculation. those answers, they were removed from the results only reflect the answers of those who Therefore, the had a particular ID/record and wanted to change 10.16. record. See Q. For the purposes of this report, “transitioned” is defined is defined of this report, “transitioned” For the purposes than the one on in a gender different as living full-time by the as indicated original birth certificate, a person’s 1.12. answer to Q. following could also select from the Respondents about changing their name: additional answer choices and (2) “I do not want to (1) “I do not have this ID/record” If a respondent selected one of change this ID/record.” removed from the calculation. those answers, they were of those who results only reflect the answers Therefore, and wanted to change the had a particular ID/record 10.14. record. See Q. in this See note 5 regarding the estimated calculations section. could also select from the following Respondents gender: additional answer choices about changing their not want to (1) “I do not have this ID/record” and (2) “I do 6 7 8 9 www. NCTE’s NCTE’s

. (pp. . (pp. . Los Angeles, . Los Voter ID Laws and ID Laws Voter . www.transequality.org/ . Expanding ID Card Access for . DC: Center for American Progress. see the questions to estimate the Injustice at Every Turn: A Report of A Report Injustice at Every Turn: did | CHAPTER 6: IDENTITY DOCUMENTS | CHAPTER . NCTE’s Identity Document Center, available at: Identity Document Center, NCTE’s

www.transequality.org/documents the research team used question answers from the respondents who number of respondents from the full sample who did have the ID in question and wanted to update it. This estimated denominator was used to calculate the percentages of those who updated these IDs out of respondents in the full sample who had the ID and wanted to update it. Due to an error in skip logic in this section of the survey, the survey, Due to an error in skip logic in this section of seen a portion of the respondents who should have questions about updating identity documents—specifically, had respondents who said that none of their documents receive them. the name or gender they preferred—did not that included those individuals, create a denominator To & Keisling, M. (2011). & Keisling, Discrimination Survey the National Transgender Equality & 138–156). DC: National Center for Transgender Force. Task National Gay and Lesbian transequality.org/documents law.ucla.edu/wp-content/uploads/Voter-ID-Laws-and- Their-Added-Costs-for-Transgender-Voters-March-2016. H. (2015). pdf; Hussey, Homeless Youth LGBT at: https://cdn.americanprogress.org/wp-content/ Available Grant, uploads/2015/10/01071118/IDhomelessLGBT.pdf; L., Herman, J. Harrison, J., J., M., Mottet, L. A., Tanis, J. requirements for state and federal IDs, see NCTE’s Identity and federal IDs, see NCTE’s requirements for state available at Document Center, documents L. (2016). & Herman, J. N. T. Brown, T. Voters Their Added Costs for Transgender at: http://williamsinstitute. Available Williams Institute. CA: is currently the only state with an administrative name is currently the only state change may a legal name change process. Additionally, processes, such as through be obtained through other See law name change. naturalization or a common for more information, available Identity Document Center at: change gender marker For more information on Forty-nine states and all five U.S. territories have a U.S. territories and all five Forty-nine states Hawai‘i a legal name. process for changing court order 5 4 See 3 2 ENDNOTES ENDNOTES 1 92 2015 U.S. TRANSGENDER SURVEY reported throughoutthechapter. Notable differencesinrespondents’ experiences basedondemographicandothercharacteristics are Results relatedtohealthandcarearepresentedinsixsections: routine healthcare. mental health,andtheirexperiencesaccessinghealthcareservices,bothrelatedtogendertransition The surveyexploredseveralareasrelatedtohealthcare, including respondents’ overallphysicaland Disparities inhealthandcareamongtransgenderpeoplehavebeendocumentedpriorresearch. Health CHAPTER 7 F. E. D. C. B. A.

HIV Testing andCare Substance Use Suicidal ThoughtsandBehaviors Conversion TherapyandOtherPressurestoDe-Transition Overall HealthandPsychologicalDistress Routine andTransition-Related HealthCareand Coverage 1

HEALTH 93 Such barriers make it harder for Such barriers make 2 surgery in the past year were denied. One-quarter (25%) of those who sought coverage for hormones in the past year sought coverage for hormones in the past year One-quarter (25%) of those who who sought coverage for transition-related were denied, and 55% of those While more than three-quarters (78%) of respondents wanted hormone therapy therapy While more than three-quarters (78%) of respondents wanted hormone related to gender transition, only 49% had ever received it. of transition- One-quarter (25%) of respondents have undergone some form related surgery. In the past year, 23% of respondents did not see a doctor when they needed to to 23% of respondents did not see a doctor when they needed In the past year, and 33% did not see because of fear of being mistreated as a transgender person, a doctor because of cost. One-third (33%) of respondents who had seen a health care provider in the past who had seen a health care provider in the past One-third (33%) of respondents negative experience related to being transgender, year reported having at least one of treatment, or having to teach the health care such as verbal harassment, refusal provider about transgender people to receive appropriate care. One in four (25%) respondents experienced a problem with their insurance in the past One in four (25%) respondents experienced related to such as being denied coverage for care year related to being transgender, gender transition. •

doctors and other health providers, including how providers treated them as transgender people. Finally, Finally, including how providers treated them as transgender people. doctors and other health providers, care they have had or wanted to have. about transition-related respondents were asked variety of treatments, such as counseling, hormone therapy, and surgical procedures. While not every and surgical such as counseling, hormone therapy, variety of treatments, and the specific to gender transition, many do, may need or want medical care related transgender person individualized needs. may undergo vary based on their treatments that they including coverage for insurance coverage, about their experiences with health were asked Respondents their experiences receiving general health care from about asked They were also transition-related care. Previous studies indicate that transgender people face barriers to accessing quality, affordable health care. affordable health care. barriers to accessing quality, that transgender people face Previous studies indicate by health providers, and health mistreatment lack of adequate insurance coverage, These barriers include transgender people. discomfort or inexperience with treating providers’ status, and is unrelated to their transgender to seek both routine health care that transgender people care can include a Transition-related care”). to gender transition (“transition-related health care related A. ROUTINE AND TRANSITION-RELATED HEALTH HEALTH TRANSITION-RELATED AND A. ROUTINE AND COVERAGE CARE KEY FINDINGS KEY 94 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) Figure 7.1: Uninsured undocumented residents. documented non-citizensandamajority(58%)of uninsured, includingnearlyone-quarter(24%)of were notU.S. citizensweremorelikely tobe to beuninsured(Figure7.1). Respondents who Latino/a (17%)respondentsweremorelikely color, Black(20%),AmericanIndian(18%),and (11%), andNortheast(9%).Amongpeopleof compared tothoseintheMidwest(13%),West to beuninsuredthanthoseintheoverallsample, with thoseintheSouth(20%)beingmorelikely (ACS). reported intheAmericanCommunitySurvey insurance orhealthcoverageplanin2015,as population whowerecoveredbyahealth compares to89%ofadultsintheU.S. general and 14%reportedthattheywereuninsured.This by ahealthinsuranceorcoverageplan, percent (86%)reportedthattheywerecovered about healthinsurancecoverage. Eighty-six Respondents wereasked aseriesofquestions Source ofCoverage a. InsuranceCoverageand I. HealthInsurance 20% 25% 10% 15% 0% 5% 3

Overall Insurancecoveragedifferedbyregion,

American Indian 14% 18%

Asian 11%

Black 20%

Latino/a

Middle Eastern 17% 11%

Multiracial 16%

White 12% private planwithout asubsidy. subsidy tobuy aprivateplan,and12%purchased a enrolled inaMedicaidplan (58%), 27%receiveda through healthcare.gov orstate marketplaces, most purchased aplan.Whenacquiring healthinsurance who soughtinsurancethrough amarketplace, 42% through healthcare.gov, inthepastyear. or federalhealthinsurancemarketplace, suchas sought optionsforhealthinsurancefromastate More thanone-quarter(26%)ofrespondents were insuredthrough or fromahealthinsurancemarketplace, and13% an insurancecompany, throughhealthcare.gov, they orsomeoneelsepurchaseddirectlyfrom respondents hadindividual employer) (53%).Fourteenpercent(14%)of respondent’s employerorsomeoneelse’s sponsored insuranceplan(eitherthroughthe reported byrespondentswasanemployer- The mostcommonsourceofhealthinsurance the U.S. population. compared to11%ofadultsin respondents wereuninsured, Fourteen percent(14%)of Table 7.1: Type of healthinsuranceorcoverageplan Another typeofinsurance Indian HealthService VA TRICARE orothermilitaryhealthcare Medicare Medicaid marketplace (suchashealthcare.gov) company orthroughahealthinsurance purchased directlyfromaninsurance Insurance theyorsomeoneelse respondent orafamilymember) employer orunion(belongingto Insurance throughcurrentorformer Health insurancesource Medicaid(Table 7.1). insurance plansthat % inUSTS 53% 14% 13% <1% 6% 5% 2% 2% 6 Of those Ofthose (ACS) population general % inU.S. 4 56% 22% N/A 16% 15% 1% 3% 3% 5 HEALTH 95

types types

21% 54%

only

Multiple insurance insurance Multiple Multiple insurance insurance Multiple only

20% 55%

Other insurance insurance Other

Other insurance insurance Other only only

26% 55%

Private insurance insurance Private Private insurance insurance Private

14% 48%

Medicare only Medicare Medicare only Medicare

29% 55%

Medicaid only Medicaid Medicaid only Medicaid

25%

55%

Overall Overall 5% 0% 15% 10% 35% 30% 25% 44% 20% Transgender men (57%) were more likely to be men (57%) were more likely Transgender womendenied surgery coverage than transgender including non-binary(54%) and non-binary people, certificatepeople with female on their original birth on their(49%) and non-binary people with male of exception original birth certificate (35%). With the (48%),those who were solely covered by Medicare among thethe rate of denials for surgery was similar 7.3). different types of insurance providers (Figure coverage than transgender women (18%) and non- women (18%) and than transgender coverage on their original birth who had male binary people insured who were Respondents (16%). certificate to be least likely Medicare were solely through hormones (14%) (Figure 7.2). denied coverage for for hormone therapy Denied coverage Figure 7.2: in the past year INSURANCE TYPE (%) 48% 54% 46% 52% 56% 50% Figure 7.3: Denied coverage for surgery in the past year Figure 7.3: INSURANCE TYPE (%) 7% 17% 13% 21% 42% 25% 55% several 7 % of respondents who made such a request of their insurer Negative action or policy Denied coverage for care often considered gender-specific because of transgender status Denied other routine health care because of transgender status they needed) Denied coverage for transition-related hormone therapy Covered surgery for transition, but had no surgery providers in their network to change records to list Refused current name or gender Denied coverage for transition-related surgery Covered only some of the surgical care needed for transition (respondent could not get coverage for treatment with transgender men (32%) and non-binary people who had female on their original birth certificate hormone to report being denied (36%) more likely Denials for hormone coverage differed by gender, Denials for hormone coverage differed by gender, related surgery coverage were denied, and one- related surgery coverage were denied, for quarter (25%) of those who sought coverage 7.2). hormones were denied (Table insurer Negative action or policy by health 7.2: Table sexual or reproductive health screenings (such as sexual or reproductive health screenings exams, and mammograms). smears, prostate Pap were denied Seven percent (7%) reported that they More than coverage for other routine health care. transition- half (55%) of respondents who sought of respondents had an insurer refuse to change of respondents had gender in their insurance record their name and/or percent (13%) reported when requested. Thirteen services often that they were denied coverage for routine considered to be gender-specific, including related to being transgender, such as being denied such as being related to being transgender, related to gender transition. coverage for care were insured and made Among those who of their insurer, the relevant requests Seventeen percent (17%) problems were reported. b. Negative Experiences with Experiences Negative b. Coverage Insurance reported having (25%) respondents One in four insurance in the past year problems with their 96 2015 U.S. TRANSGENDER SURVEY (Table 7.3). being refusedtransition-related healthcare(8%) not relatedtothereasonforvisit(15%),or unnecessary questionsaboutbeingtransgender appropriate care(24%),beingasked invasiveor about transgenderpeopleinordertoreceive This includedhavingtoteachtheprovider care providerrelatedtobeingtransgender. experience withadoctororotherhealth past yearreportedhavingatleastonenegative respondents whohadseenaproviderinthe them withrespect.However, one-third(33%)of saw knewtheyweretransgenderandtreated year, 62%saidthatatleastoneproviderthey Of thosewhohadseenaproviderinthepast interacted withthemasatransgenderperson. questions abouthowtheirhealthcareprovider taking thesurvey. Thoserespondentsreceived seen ahealthcareproviderintheyearpriorto Eighty-seven percent(87%)ofrespondentshad Person Providers asaTransgender b. Treatment byHealthCare were transgender. that noneoftheirhealthcareprovidersknewthey Nearly one-third(31%)ofrespondentsreported that someknewtheyweretransgender. 13% reportedthatmostknew, and17%reported health careprovidersknewtheyweretransgender, providers, 40%reportedthatalloftheircurrent Of respondentswhocurrentlyhadhealthcare health careprovidersknewtheyweretransgender. Respondents wereasked whethertheircurrent Providers a. OutnesstoHealthCare Health CareProviders II. Experienceswith stone duringthatvisit.Onthe hospital stay. Ipassedakidney and misgenderedthroughoutmy “I wasconsistentlymisnamed have surgeries.” I willmostlikely neverbeableto to affordthetreatmentIneedand very limitedincome, itisdifficult hormones orsurgeries.Withmy “My stateMedicaiddoesnotcover Voices In OurOwn my gender.” gynecological prescription dueto for myroutinepapsmear anda and thentheydenied coverage health insurancelistme asmale, “When Iwasincollege, Ihadmy a hospitalorclinic.” discrimination Imayexperiencein afraid ofwhatharassmentor when itisneeded,becauseI’m do notseekmedicalattention me feelphysicallyunsafe. Ioften behind myback,andhavemade at myexpenseinfrontofmeand something else, havemadejokes identity wasjustamisdiagnosisof tried topersuademethatmytrans to methatIwastransgenderor have misgenderedme, denied “Multiple medicalprofessionals hurt farmore.” having myidentityrespected,that somewhere arounda9. Butnot standard 1–10painscale, that’s HEALTH 97 (42%) were also more likely to have to have likely (42%) were also more 10 care were asked about that provider’s level of about that provider’s care were asked knowledge about caring for transgender people. More than of half (54%) of these respondents were unsure how much their provider knew about while others health care for transgender people, health care. More than half (56%) of respondents (56%) of respondents More than half health care. for transition- currently had a provider specifically Of those, therapy. such as hormone related care, “almost 65% reported that this provider knew about providing everything” or “most things” Seventeen health care for transgender people. that their percent (17%) of respondents reported knew only provider for transition-related care the subject, 8% said this things about “some” and 10% said provider knew “almost nothing,” they were not sure. reported thatFifty-one percent (51%) of respondents they saw the same provider for transition-related One-third (33%)care and other routine health care. indicated that they have a separate provider for routine care who is different from the provider Fifteen percentthey see for transition-related care. (15%) of respondents reported that they have no transition-related or routine health care provider. a separate provider for routine with Respondents Negative experiences with health care providers health care providers experiences with Negative Transgender by gender identity. also varied to report negative were more likely men (42%) women (36%) than transgender experiences with (24%). People and non-binary respondents disabilities experience in the past year, at least one negative who did not identify compared with respondents (30%). as having a disability About Knowledge c. Providers’ People Transgender about the health were asked Respondents providers they saw for transgender-related and the care and for routine health care needs about transgender level of knowledge providers’ 1% 1% 3% 8% 2% 5% 6%

15%

24% 33% 34% White

38% Multiracial % of those who had seen in a provider the past year

40% Middle Eastern Middle

32% Latino/a

34% Black in a health care 9

26% Asian

50%

33% Indian American Overall Negative experience 0% transition-related care in a health care They were verbally harassed or clinic) office, setting (such as a hospital, harsh or abusive A health care provider used language when treating them A health care provider refused to give them care not related to gender transition (such as physicals or care for the flu or diabetes) They had to teach their health care provider about They had to teach their health appropriate care transgender people to get them unnecessary orA health care provider asked transgender statusinvasive questions about their reason for their visit that were not related to the to give them A health care provider refused One or more experiences listed A health care provider was physically rough or abusive when treating them by someone They were physically attacked during their visit in a health care setting (such as a or clinic) hospital, office, They were sexually assaulted or clinic) setting (such as a hospital, office, 10% 40% 30% 20% 50% 60% (%) RACE/ETHNICITY Figure 7.4: One or more negative experiences with One or more negative experiences Figure 7.4: health provider in the past year Table 7.3: Negative experiences when seeing a health care when seeing a health experiences Negative 7.3: Table the past year provider in highest level of negative experiences, and rates highest level of negative experiences, (38%) among Middle Eastern (40%) and multiracial 7.4). respondents were also higher (Figure Negative experiences with doctors and other Negative experiences with doctors and and ethnicity. health care providers varied by race reported the American Indian respondents (50%) 98 2015 U.S. TRANSGENDER SURVEY provider whentheyneededtobecauseofcost. were alsomorelikely tonothaveseenahealth year (Figure7.5). People withdisabilities(42%) other healthcareproviderduetocostinthepast were morelikely tonothaveseenadoctoror (41%), Black(40%),andLatino/a (37%)respondents, color, includingmultiracial(42%),AmericanIndian provider butdidnotbecauseofcost.People of they neededtoseeadoctororotherhealthcare there wasatleastonetimeinthepastyearwhen with one-third(33%)ofrespondentsreportingthat Cost wasamajorfactorinaccessinghealthcare, for transition-relatedcare. distance requiredtotravelseehealthproviders of beingmistreatedasatransgenderperson,and accessing healthcare, includingcostofcare, fear Respondents wereasked aboutbarriersto d. BarrierstoAccessingCare “most things” aboutcaringfortransgenderpeople. routine careproviderknew“almosteverything”or (24%). Only6%ofrespondentsreportedthattheir knew “some things” (16%)or“almostnothing” indicated thattheirroutinehealthcareprovider RACE/ETHNICITY (%) in thepastyear Figure 7.5: Didnotseehealthproviderduetocost 20% 25% 30% 40% 35% 45% 10% 15% 0% 5%

Overall American Indian 33% 41%

Asian 27%

Black 40%

Latino/a

Middle Eastern 37% 36%

Multiracial 42%

White 31% and MiddleEastern(34%)respondentsweremore as atransgenderperson.AmericanIndian(37%) it duetofearofbeingdisrespectedormistreated past year they needed health care but didnotseek respondents reportedthatatsomepointinthe Additionally, nearlyone-quarter(23%)of as atransgenderperson. due tofearofbeingmistreated they neededinthepastyear avoided seekinghealthcare respondents reportedthatthey Nearly one-quarter(23%)of they had to travel to receive routine care and care they hadtotravelreceive routinecareand care providers,respondents wereasked howfar To examinetheaccessibilityofrespondents’ health women (22%)andnon-binary respondents(20%). care outoffeardiscriminationthantransgender transgender men(31%)beingmorelikely toavoid care provideralsodifferedbygenderidentity, with Fear ofbeingdisrespectedormistreatedbyahealth RACE/ETHNICITY (%) of mistreatmentinthepastyear Figure 7.6: Didnotseehealthproviderduetofear mistreated asatransgenderperson(Figure7.6). care providerduetofearofbeingdisrespectedor likely tonothavegoneadoctororotherhealth 20% 25% 30% 40% 35% 10% 15% 0% 5%

Overall

American Indian 23% 37%

Asian 24%

Black 26%

Latino/a

Middle Eastern 26% 34%

Multiracial 28%

White 22%

HEALTH 99

76% more or $100,000 $100,000

76%

$99,999

$50,000 to to $50,000

70% $49,999 $25,000 to to $25,000

59%

$24,999 $10,000 to to $10,000

48% $1 to $9,999 to $1

39% No income No

58% Overall 0% 10% 70% 40% 30% 80% 50% 20% 60% have wanted hormone therapy, compared to compared to have wanted hormone therapy, 49% of non-binary respondents. Transgender men and women were about five times more (71%) to have ever had hormone therapy likely than non-binary respondents (13%). b. Hormone Therapy b. Seventy-eight percent (78%) of respondents wanted to receive hormone therapy at some but only 49% of respondents point in their life, 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%) transgender men and women (81%) were only (81%) were only men and women transgender ever wanted gender- to have likely slightly more respondents than non-binary related counseling women were men and (70%), transgender to have actually had likely more than twice as as compared to non-binary counseling (73%) Access to counseling varied respondents (31%). with those who reported greatly by income, income (39%) and those having no individual (48%) of $1 to $9,999 who earned an income to have received being much less likely or who earned $50,000 counseling than those more (76%) (Figure 7.8). Counseling/therapy for gender identity Figure 7.8: or transition INCOME (%) INDIVIDUAL 2% 6%

1% More than 100 miles 100 than More

3% 75–100 miles 75–100 2%

6% 50–75 miles miles 50–75 6%

14% 25–50 miles miles 25–50 26%

27% 10–25 miles 10–25 63% Transition-related health care Transition-related care health Routine

45% Less than 10 miles 10 than Less 0% 10% 70% 40% 30% 50% 20% 60% Figure 7.7: Distance to health care provider Figure 7.7: gender identity or gender transition at some gender identity or gender transition at some but only 58% of respondents point in their life, While have ever received counseling or therapy. a. Counseling More than three-quarters (77%) of respondents said they wanted counseling or therapy for their Health Care questions about whether they received Respondents a range of potentialhad ever had, or wanted to have, health care services related to gender transition. III. Transition-Related III. Transition-Related care than for routine care (Figure 7.7). care than for routine providers within 10 miles of their home, less than miles of their home, providers within 10 that they received transition- half (45%) reported within 10 miles of their home.related health care to have likely were three times more Respondents 50 miles for transgender-relatedto travel more than related to gender transition (transition-related care). (transition-related gender transition related to forhaving to travel further reported Respondents Whileroutine care. care than transition-related from routine care that they received 63% indicated 100 2015 U.S. TRANSGENDER SURVEY reported receivingthemonly fromfriends,online licensed professionalsand friends,and2% professionals, 6%receivedthemfromboth their hormonemedicationsonlyfromlicensed While themajority(91%)ofrespondentsreceived and 13%beganafterage45. 24, 43%beganbetweentheagesof25and44, age of18,41%beganbetweentheages18and therapy, 4%startedhormonetherapybeforethe Of respondentswhohaveeverhadhormone INDIVIDUAL INCOME(%) Hormone therapy forgendertransition 7.9: Figure those whoearned$25,000 ormore(Figure7.9). half aslikely tohavereceivedhormonetherapyas earning anincomeof$1to$9,999 (37%)wereabout reported havingnoindividualincome(31%)or to hormonetherapybyincome. Respondents who There werealsosubstantialdifferencesinaccess have everreceivedit. only 49%ofrespondents some pointintheirlife, but receive hormonetherapyat of respondentswantedto Seventy-eight percent(78%) 60% 20% 50% 30% 40% 70% 10% 0%

Overall 49%

No income 31%

$1 to $9,999 37%

$10,000 to

$24,999 55%

$25,000 to

$49,999 64%

$50,000 to

$99,999 66%

$100,000

or more 64% hormone suppressorsthatareusedtodelay puberty-blocking medications,whichare that atsomepointintheirlives,theywanted Fifteen percent(15%)ofrespondentsreported c. Puberty-BlockingHormones transgender women(4%). hormones onlyfromunlicensedsources,aswere in poverty(4%),weremorelikely toreceivetheir sex workintheirlifetime(5%),orwhowereliving currently criminalized)(8%),whohaveeverdone as sexwork,drugsales,orotherworkthatis working intheundergroundeconomy(such sources (10%).Respondents whowerecurrently to receivetheirhormonesonlyfromunlicensed who wereuninsuredfivetimesmorelikely sources, orothernon-licensedsources. of transition-related surgery. reported havinghad someform One infour(25%)respondents only weremostlikely (44%)(Figure7.11). while thosewhowereinsuredthroughMedicare (18%) werealsolesslikely tohaveanysurgery, (Figure 7.10). Respondents whowereuninsured any surgery, aswerethosewhohadlowincomes living inpoverty binary respondents(9%).Respondents whowere surgery thantransgenderwomen(28%)ornon- (42%) weremorelikely tohavehadanykindof of transition-relatedsurgery. One infour(25%)reportedhavinghadsomeform d. SurgeriesandOtherProcedures having them. less than1%ofrespondentsreportedever youth betweentheagesof9and16.However, were describedasthoseusuallybeingusedby physical changesassociatedwithpubertyand 12

14 (17%)werelesslikely tohavehad 13 Transgender men 15 11 Those HEALTH 101 3% 100% 100% 6% 19% 77% 47% 56% 10% 21% 24% 35% 33% 23% Do not want this 80% 80% 31% 13% 37% 17% 28% 62% 61% 31% Not sure if they want this 60% 72% 60% 79% 49% 87% 7% 11% 35% 15% 44% 52% 43% 57% 40% 40% Want it Want some day 1% 1% 19% 3% 8% 21% 42% Have had it it some day Want Not sure if they want this Do not want this Have had it it some day Want Not sure if they want this Do not want this 20% 20% 36% 30% 24% Have had it 25% 13% 19% 19%

8% 14% 3% 6% 6% 3% 2% 2% 2% 4% 2%

0% 0% Other Other not listed not listed procedure procedure Phalloplasty Phalloplasty reduction or reduction or Type of of Type procedure

Chest surgery reduction or reconstruction Hysterectomy Metoidioplasty Phalloplasty Other procedure not listed Chest surgery

Hysterectomy Chest surgery reconstruction Hysterectomy Figure 7.13: Procedures among non-binary respondents Procedures among Figure 7.13: with female on their original birth certificate Figure 7.12: Procedures among transgender men Figure 7.12: Metoidioplasty Metoidioplasty reconstruction more likely to have had any of the procedures than had any of the to have more likely had female on their respondents who non-binary 7.13). certificate (Figure original birth among respondents with female Procedures 7.4: Table certificate on their original birth

types or more or 32% 43%

Only

$100,000 $100,000 18

only

Multiple insurance insurance Multiple

43% 22% $99,999

(1%) (Table (1%) (Table $50,000 to to $50,000

20 only Other insurance insurance Other

36% 25% $49,999

$25,000 to to $25,000

Private insurance insurance Private

44% 24% $24,999

$10,000 to to $10,000 16 Medicare only Medicare

15% 22%

$1 to $9,999 to $1 Medicaid only Medicaid (1%) or phalloplasty and 8% had a hysterectomy.

19 17

12% 18%

No income No No insurance No

25%

25% Overall Overall 5% 5% 0% 0% 15% 15% 10% 10% 45% 45% 35% 35% 40% 40% 30% 30% 25% 25% 20% 50% 20% 50% 2% reported having any genital surgery, such as such 2% reported having any genital surgery, metoidioplasty These experiences differed greatly by gender 7.4). being with transgender men (Figure 7.12) identity, i. Experiences of Respondents With i. Experiences of Respondents Female on Their Original Birth Certificate Of respondents who had female on their original birth certificates, 21% had a chest reduction or reconstruction have specific surgical and other procedures. different questions based received Respondents on the sex that they reported was listed on their original birth certificate. Respondents were asked a series of questions were asked Respondents about whether they had received or wanted to INSURANCE TYPE (%) Figure 7.11: Any surgery for gender transition Figure 7.11: Figure 7.10: Any surgery for gender transition for gender transition Any surgery Figure 7.10: INCOME (%) INDIVIDUAL 102 2015 U.S. TRANSGENDER SURVEY their originalbirthcertificate(Figure 7.15). than non-binaryrespondentswhohadmaleon being morelikely tohavehadtheprocedures identity, withtransgenderwomen (Figure7.14) (Table 7.5). Theseexperiencesvariedbygender shave, mammoplasty (topsurgery), feminization surgery, had anorchiectomy, undergone vaginoplastyand/orlabiaplasty, surgical procedures,10%ofrespondentshad commonly reportedprocedure. Regarding received voicetherapy, thesecondmost had hairremovalorelectrolysis,and11% procedure. Forty-onepercent(41%)have reported andthemostcommonlydesired electrolysis wasboththemostcommonly original birthcertificate, hairremovalor Among respondentswhohadmaleontheir on TheirOriginalBirthCertificate ii. ExperiencesofRespondents WithMale to 43%intheU.S. adultpopulation. they hadaPap smearinthepastyear, compared smear inthepastyear. Only27%reportedthat were alsoasked whether theyhadreceivedaPap who hadfemaleontheiroriginalbirthcertificate In additiontotransition-relatedcare, respondents the ageof34. between theagesof25and34,22%after procedure betweentheagesof18and24,40% of 18.Morethanone-third(35%)hadtheirfirst 3% hadtheirfirstprocedurebeforetheage undergone anyofthesesurgicalprocedures, birth certificaterespondentsandwhohad Among thosewhohadfemaleontheiroriginal 27 and1%hadundergonevoicesurgery 24 25 6%hadundergonefacial 8%hadaugmentation 26 4%hadatracheal 21,22 23 9% 9% Figure 7.14: Proceduresamongtransgenderwomen on theiroriginalbirthcertificate Table 7.5: Proceduresamongrespondentswithmale Augmentation Augmentation mammoplasty Voice therapy Voice surgery or electrolysis labiaplasty Vaginoplasty or (non-surgical) Voice therapy electrolysis Hair removalor not listed Other procedure Voice surgery injections Silicone Tracheal shave surgery feminization Facial Orchiectomy mammoplasty Augmentation (non-surgical) or labiaplasty procedure Type of Orchiectomy Vaginoplasty Hair removal Hair removal feminization feminization procedure procedure injections not listed Tracheal Silicone Silicone surgery shave Facial Facial Other Other 28

0% 1% 5% 3% 6% 7% 11% 12% 11% 14% 10% 18% had it Have 15% 20% 32% Do notwantthis Not sureiftheywantthis Want itsomeday Have hadit 41% 48% 10% 11% 6% 9% 5% 2% 8% 4% 1% 27% 15% 40% day some Want it 32% 43% 48% 40% 54% 47% 49% 29% 40% 46% 45% 39% 36% 16% 13% 9% 28% want this if they Not sure 60% 30% 29% 22% 64% 60% 29% 30% 24% 23% 32% 27% 17% 19% 15% 31% 5% 47% 49% 22% 80% this want Do not 35% 21% 21% 20% 19% 25% 22% 24% 24% 38% 67% 27% 61% 51% 12% 5% 3% 100% 2% HEALTH 103 30 58% of respondents had received counseling. half (54%) had received hormone Approximately including therapy and/or some form of surgery, 25% who had49% who had hormone therapy and surgery. undergone some form of transition-related Two percent (2%) of respondents with male (2%) of respondents percent Two had their first birth certificate on their original (not including procedure transition-related age of 18. Nearly therapy) before the hormone had their first procedure one-quarter (23%) of 18 and 24, 32% had their first between the ages the ages 25 and 34, and 43% procedure between after the age of 34. of Transition-Related Summary e. Health Care responses of all respondents,When examining the 91% reported that they had wanted counseling, for their genderhormones, and/or puberty blockers point, but onlyidentity or gender transition at some Overall,65% reported ever having any of them. 100% 18% 35% 80% 42% 47% 15% 51% 53% 59% 63% 70% 75% 60% 29% 36% 54% 40% 36% 33% 32% 29% 31% Have had it it some day Want Not sure if they want this Do not want this 34% 20% 16% 26% 21% 16% 15% 4% 14% 13% 11% Previous research has described substantial health disparities affecting transgender people Previous research has described substantial health disparities affecting 6% 4% 29 5% 1% 2% 1% 1% 1% 1% 0%

Thirty-nine percent (39%) of respondents were currently experiencing serious Thirty-nine percent (39%) of respondents were currently population (5%). psychological distress, nearly eight times the rate in the U.S. Twenty-two percent (22%) of respondents rated their health as “fair” or “poor,” their health as “fair” or “poor,” percent (22%) of respondents rated Twenty-two population. compared with 18% of the U.S. Other Facial shave surgery Silicone Tracheal Tracheal not listed injections procedure feminization

Hair removal Vaginoplasty Vaginoplasty Orchiectomy or labiaplasty (non-surgical)

or electrolysis Voice surgery Voice Voice therapy Voice mammoplasty Augmentation Figure 7.15: respondents among non-binary Procedures Figure 7.15: certificate on their original birth with male There is a well-documented link between experiences of discrimination and marginalization and poor There is a well-documented link between experiences of discrimination that face widespread stigma and discrimination are physical and mental health outcomes. Populations to report poor overall health and are more vulnerable to a variety of physical and mental health more likely conditions. have on these disparities. and the impact that experiences of discrimination, rejection, and violence B. OVERALL HEALTH AND PSYCHOLOGICAL AND PSYCHOLOGICAL HEALTH B. OVERALL DISTRESS KEY FINDINGS KEY 104 2015 U.S. TRANSGENDER SURVEY birth certificate(48%),transgender women(50%), non-binary peoplewithmale ontheiroriginal health comparedtotransgender men(47%), being lesslikely toreportexcellent orverygood with femaleontheiroriginalbirthcertificate(35%) gender identity, withnon-binaryrespondents Respondents’ self-reportedhealthvariedby Figure 7:17:Generalhealthrating Figure 7:16:Generalhealthrating 18% oftheU.S. generalpopulation(Figure7.17). it was“fair”or“poor”(Figure7.16), compared with said itwas“good.” Twenty-two percent(22%)said was “excellent” or“verygood”andone-third(33%) Nearly half(45%)ofrespondentssaidtheirhealth overall healthonascalefrom“excellent” to“poor.” Respondents wereasked toratetheircurrent I. CurrentHealth Poor 17% Fair 5% Poor 13% Fair 5%

Excellent

Excellent 12% 19% population % inUSTS

% inU.S.

(BRFSS)

Good 32% Good 33%

good Very 33% good Very 32%

31 CURRENT AGE (%) Figure 7:18:Reported overallhealth aged 25–44(48%)and18–24(39%)(Figure7.18). (60%) and45–64(53%),comparedwiththose respondents, suchasthoseaged65andolder report excellent orverygoodhealththanyounger by age, witholderrespondentsmorelikely to and crossdressers(57%).Reporting alsodiffered LEVEL OFFAMILY SUPPORT (%) Figure 7:19:Reported overallhealth or unsupportive(38%)(Figure7.19). (52%) thanthosewhosefamilieswereneutral(42%) more likely toreportexcellent orverygoodhealth family anddescribedtheirassupportivewere Respondents whowereouttotheirimmediate likelihood ofreportingexcellent orverygoodhealth. Family supportwasassociatedwithanincreased 20% 20% 25% 25% 30% 30% 40% 40% 35% 35% 10% 10% 15% 15% 0% 0% 5% 5% 12% 12%

Overall 33% Excellent Excellent

Overall 33% 33% 33% 17% 17% 5% 5% Very Good Very Good 18 to 24 9% 30% Supportive 35% 15% 20% 37% 6% 32% 13% 13% 3% 25 to 44 35% 32% 15% 5% 10%

Neutral 32% FairPoor FairPoor 35% 45 to 64 18% 18% 35% 5% 31% 13% 3% Unsupportive 65 and over 10% 22% 29% 38% 32% 27% 21% 11% 8% 2% HEALTH 105

35% Some

31% A little 22% Thirty-nine Some

26%

A little (NHIS) % in U.S. % in USTS Current serious psychological

population

12% A lot 36 29% A lot

all all 10% 35% Not at Not at is nearly eight times the rate reported in the U.S. is nearly eight times the rate reported in the U.S. population (5%). Non-binary distress varied by gender identity. to report respondents (49%) were more likely serious psychological distress than transgender men and women (35%) and crossdressers (18%). A variable was developed from the K6 current serious questions to reflect respondents’ psychological distress (serious psychological distress experienced in the 30 days prior to participating in the survey). percent (39%) of respondents reported currently experiencing serious psychological distress, which Figure 7:20: Interference of psychological distress with distress Interference of psychological Figure 7:20: of who reported feelings among those life or activities the past 30 days distress in distress with Figure 7:21: Interference of psychological feelings of life or activities among those who reported distress in the past 30 days 34

33 The K6 includes mental health screening The K6 includes mental health screening 32 psychological distress, a rate psychological times higher than nearly eight (5%). population in the U.S. Thirty-nine percent (39%) percent Thirty-nine reported of respondents serious currently experiencing past 30 days (Figure 7.20), in contrast to the 35% in contrast to the 35% past 30 days (Figure 7.20), population who reported no general in the U.S. interference with their lives (Figure 7.21). their life or activities. Among them, 27% reported 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 not interfere with their life or activities during the Respondents who reported experiencing feelings reported experiencing feelings who Respondents related to psychological distress at least “a little questions for one or more of the K6 of the time” with how much the feelings interfered were asked psychological distress—such as hopelessness or or psychological distress—such as hopelessness on a scale worthlessness—during the past month “a little of the that included “none of the time,” and “most of the time,” of the time,” “some time,” “all of the time.” (NHIS). people who questions and is designed to identify distress. are experiencing serious psychological respondents to rate how The K6 questions asked related to often they experienced several feelings Respondents were asked questions to assess questions to assess were asked Respondents in the past their level of psychological distress Psychological 30 days, based on the Kessler used Distress Scale (K6), a scale that is widely and is when assessing mental health outcomes Survey included in the National Health Interview II. Serious Psychological Distress 106 2015 U.S. TRANSGENDER SURVEY associate’s degree(32%)orhigher(Figure 7.23). distress thanrespondentswho hadcompletedan currently experiencingseriouspsychological education (48%)weremorelikely toreport a GEDonly(54%),andthosewithsomecollege (58%), thosewhohadcompletedhighschoolor Respondents whohadnotcompletedhighschool differed accordingtoeducationalattainment. Experiences withcurrentpsychologicaldistress CURRENT AGE (%) psychological distress Figure 7:22:Currentlyexperiencingserious distress asthoseaged65andolder(2%). likely toreportexperiencingseriouspsychological those aged18to25(10%)beingfivetimesas psychological distressintheU.S. population,with pattern emergedinreportingofcurrentserious were 65andolder(8%)(Figure7.22). times ashightherateamongrespondentswho psychological distress,whichwasmorethansix 18 to25reportedexperiencingcurrentserious three percent(53%)ofUSTS respondentsaged current seriouspsychologicaldistress.Fifty- survey respondentsweremorelikely toreport counterparts intheU.S. population,younger reported substantiallymoredistressthantheir While allagegroupsofUSTS respondents 60% 20% 50% 30% 40% 10% 0%

Overall 39%

18 to 25 5% 53% % inU.S. population(NSDUH) % inUSTS

26 to 29 10% 39%

30 to 34 7% 31%

35 to 39 5% 26%

40 to 44 5% 23% 5% 45 to 49 22%

50 to 54 5% 16% 5% 55 to 59 37 Asimilar 14% 4%

60 to 64 38

65 and over 10% 4% 8% 2% depression asadirectresultof “I hadsufferedfromanxietyand verge ofsuicide.” psychologically weak,andonthe away butitleftmephysicallyand could togetmytransnessgo destroy mylife. Idideverything certain thatcomingoutwould into depressionbecauseIwas “I spentdecadestorturingmyself Voices In OurOwn and happythanI’veeverbeen.” I feelsomuchmorecomfortable this isbecauseofmytransition. thought inmonths.Ifirmlybelieve and haven’t hadaserioussuicidal today I’vegotaplanforthefuture had dailysuicidalthoughts,and this. Ayearago, Ifelthopelessand and consideredsuicidebecauseof I’ve failedclasses,isolatedmyself, and anxietyeversincepuberty. “I havestruggledwithdepression member ofsociety.” so Icouldbecomeaproductive dealing withalloftheseissues Medicaid wasIfinallyabletostart on. Onlywhenmystateexpanded to functioninsocietyastimewent to becomemoreandunable gender dysphoria.Thiscausedme HEALTH 107

(31%) supportive as them to be (60%) were more likely 39 described and resign, denied a promotion, or not hired in resign, denied a promotion, or not hired the past year because they were transgender to report current serious (51%) were more likely did not psychological distress than those who year (36%). have those experiences in the past who were physically attacked Respondents to be in the past year (59%) were more likely currently experiencing serious psychological distress than those who were not physically in the past year (36%). attacked who were sexually assaulted in Respondents the past year currently experiencing serious psychological distress than those who were not sexually assaulted in the past year (37%). Respondents who were out to their immediate who were out to their Respondents families to report serious psychologicalwere less likely neutraldistress than those whose families were (42%) or unsupportive (50%). who were fired or forced to Respondents

• • Respondents who were living in poverty were living in poverty were who were Respondents serious to currently be experiencing more likely with People distress (52%). psychological twice as likely (59%) were nearly disabilities psychological distress to currently experience who did not identify as having compared to those a disability (31%). was associated with a Psychological distress of rejection, discrimination, variety of experiences and violence: • •

degree 18%

24% professional professional

Graduate or or Graduate

30% degree 10 years or more or years 10 Bachelor’s Bachelor’s

31%

32% degree

6 to 10 years 10 to 6 Associate’s Associate’s

48% 38%

2 to 5 years 5 to 2 Some college Some

54% school/GED

41%

Completed high high Completed 0 to 1 year 1 to 0

58% high school high

39%

Overall Did not complete complete not Did

39% Overall 0% 5% 0% 10% 15% 10% 70% 40% 30% 45% 35% 50% 20% 60% were currently experiencing serious psychological were currently experiencing serious who had distress, compared with 36% of those the survey. transitioned at any time prior to taking past year (41%) (Figure 7.24). While psychological past year (41%) (Figure 7.24). in their distress was higher among those early who have transition, it was higher yet among those (49%) Nearly half not transitioned but wanted to. wanted to of those who have not transitioned but Respondents who had transitioned ten or more Respondents (24%) years prior to participating in the survey to be currently were substantially less likely distress, in experiencing serious psychological within the contrast to those who had transitioned Figure 7.23: Currently experiencing serious experiencing Currently Figure 7.23: distress psychological (%) ATTAINMENT EDUCATIONAL 40% 30% 25% 20% TRANSITIONING (%) YEARS SINCE BEGAN Figure 7.24: Currently experiencing serious Currently experiencing serious Figure 7.24: psychological distress 108 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS living accordingtotheirgenderidentityatthetimeofsurvey. respondents de-transitioned,andmanyofthosewhodidde-transitionsoonlytemporarilywere overall demonstratedhighlevelsofresistancetosuchpressureandotherformsdiscrimination.Few transition orstopbeingtransgender. Experienceswithde-transitioningwerealsoexamined.Respondents as psychologists,counselors,andreligiousadvisors,includingpressurefromthoseprofessionalstode- The surveyexploredrespondents’ experiencesdiscussingtheirgenderidentitywithprofessionals,such may decidetotemporarilydelayorevenreversetheirtransitionasaresult. when theybegintransitioning,like losingtheirjobsorhomebeingrejectedbyfamilyfriends,and or employers,aswellreligiousadvisorshealthprofessionals.Othersfacesignificantdiscrimination avoid orputofftheirtransition,tode-transitionaftertheyhavestartedbyfamilymembers (“de-transition”) foravarietyofotherreasons.Forexample, sometransgenderpeoplearepressuredto hide theirgenderidentityortogobacklivingaccordingthetheywerethoughtbeatbirth abusive, identity orstopthemfrombeingtransgender(“conversiontherapy”)areineffective, harmful,andeven or religiousadvisors.However, despitethemedicalconsensusthateffortstochangesomeone’s gender Many transgenderpeoplediscusstheirgenderidentitywithprofessionals,suchashealthcareproviders PRESSURES TO DE-TRANSITION C. CONVERSIONTHERAPY ANDOTHER other familymembers(26%). having troublegettingajob(29%),orpressurefrom aparent (36%),spouse(18%),or facing toomuchharassmentordiscriminationafter theybegantransitioning(31%), Respondents whode-transitionedcitedanumberofreasonsfordoingso, including be atbirth. were currentlylivingfulltimeinagenderdifferent than the onetheywerethoughtto The majorityofrespondentswhode-transitioned didsoonlytemporarily, and62% be atbirthforaperiodoftime. some point,meaningthattheywentbacktolivingasthegenderwerethought Eight percent(8%)ofrespondentshadde-transitionedtemporarily orpermanentlyat being transgender. such asapsychologist,counselor, orreligiousadvisor, triedtostopthemfrom Thirteen percent(13%)ofrespondentsreportedthatoneormoreprofessionals, 40 someprofessionalsstillattempttodoso. Additionally, sometransgenderpeoplefeelpressureto HEALTH 109

19% White

21% Multiracial

32% Middle Eastern Middle

17% Latino/a

16% Black

14% Asian 27%

18% American Indian American Overall 5% 0%

15% 10%

35% 30% 25% 20% More than three-quarters (78%) of respondents were under the age of 25 when they had this and 28% 51% were 18 or younger, experience, were 15 or younger. The likelihood that a professional tried to stop aThe likelihood differed byrespondent from being transgender Eastern (32%) and While Middle race and ethnicity. most likelyAmerican Indian (27%) respondents were were lower for Black rates to have this experience, 7.26). (16%) and Asian (14%) respondents (Figure from Professional tried to stop them Figure 7.26: being transgender (%) RACE/ETHNICITY Nearly one in five (18%) one in five Nearly who discussedof those identity with atheir gender 13% of allprofessional—or thatrespondents—reported tried to stopthe professional being transgender. them from nearly one in ten and from being transgender, (9%) respondents saw a non-religious/spiritual counselor) professional (such as a therapist or a who tried to stop them from being transgender.

84% and men and Trans women women Trans

85% Trans men Trans Four percent 41

83% Trans women Trans

52% Non-binary

46% Crossdressers

72% Overall 0% 10% 70% 40% 30% 80% 50% 20% 60% 90% (4%) of all respondents saw a religious/spiritual counselor or advisor who tried to stop them Of all respondents who discussed their gender identity with a professional, nearly one in five (18%) reported that the professional tried to stop representing 13% them from being transgender, of all respondents in the sample. Figure 7.25: Ever discussed gender identity Ever discussed gender identity Figure 7.25: with a professional GENDER IDENTITY (%) Whether an individual discussed their gender Whether an individual discussed their with by gender, identity with a professional differed being more transgender men and women (84%) to do so than non-binary respondents (52%) likely and crossdressers (46%) (Figure 7.25). counselors, and religious advisors—with whom advisors—with whom counselors, and religious discussed their gender identity. respondents had of respondents (72%) Almost three-quarters gender reported that they had discussed their identity with such a professional. Professionals and Professionals Therapy Conversion a variety of experiences The survey examined as psychologists, with professionals—such I. Discussing I. Discussing with Identity Gender 110 2015 U.S. TRANSGENDER SURVEY • • • • • them frombeingtransgenderwere: Participants whohadaprofessionaltrytostop counselor oradvisor(Figure7.27). such anexperiencewithareligiousorspiritual Eastern (7%)respondentsweremorelikely tohave transgender, AmericanIndian(9%)andMiddle counselor oradvisortriedtostopthemfrombeing Of the4%whoreportedthatareligiousorspiritual RACE/ETHNICITY (%) from beingtransgender Figure 7.27: Religious counselortriedtostopthem 10% 0% 6% 9% 2% 5% 8% 3% 4% 7% 1% experience (11%). (18%) thanthosewhodidnothavethe More likely tohaveeverdonesexwork have theexperience(29%). homelessness (46%)thanthosewhodidnot More likely tohaveeverexperienced not havetheexperience(8%). away fromhome(22%)thanthosewhodid Nearly threetimesaslikely tohaverun experience (39%). (58%) thanthosewhodidnothavethe More likely tohaveattemptedsuicide those whodidnothavetheexperience(34%). serious psychologicaldistress(47%)than Far morelikely tocurrentlybeexperiencing Overall American Indian 4% 9%

Asian 3%

Black 5%

Latino/a

Middle Eastern 4% 7%

Multiracial 5%

White 4%

“When Iwas18,hadtoleave minute withoutthinkingofdeath.” so badlysuicidalthatIdidn’t goa there foroverthreeyears.Ibecame but nobodylistened.Iwassent that thedoctorwasnotworking, my parents.Itriedtotellfamily without tellinganyone, including and practicedconversiontherapy “The doctorfiguredoutIwastrans Voices In OurOwn accepted becauseIhad nochoice.” de-transition andliveasaman.I their homeontheconditionthatI family offeredtoletmereturn I had,andhadnowheretogo. My home. Iranoutofwhatlittlemoney “I waskicked outofmyparents’ three daysonbirthcontrol.” hospital onsuicidewatchafter in thepsychiatricwardofmylocal I wasawomanagain.endedup control pillsto‘fix’meintothinking “[An] OB/GYN forcedmeontobirth me more.” they usedthattohurtandcontrol was trans,butwhentheyfoundout, were abusivebeforetheyknewI therapy frommyfamily. Myparents physical violenceandconversion where Igrewupafterthreatsof HEALTH 111

3% 4% 2% 5% 5% 5% 17% 13% 31% 18% 33% 35% 29% 26% 36%

% of those who had ever de-transitioned

The most common reason cited for The most common 42 Reasons for de-transitioning Reasons Pressure from a religious counselor They realized that gender transition was not for them Initial transition did not reflect the complexity of their gender identity (write-in response) Financial reasons (write-in response) A reason not listed above Pressure from a parent was too hard for them Transitioning They faced too much harassment or discrimination as a transgender person They had trouble getting a job Pressure from other family members Pressure from a spouse or partner Pressure from an employer Pressure from friends Pressure from a mental health professional Medical reasons (write-in response) Respondents who had de-transitioned cited a cited who had de-transitioned Respondents 5% of those who reasons, though only range of that they had done reported had de-transitioned gender transition they realized that so because of the overall representing 0.4% was not for them, sample. pressure from a parent de-transitioning was reported that percent (26%) (36%). Twenty-six due to pressure from other they de-transitioned 18% reported that they de- family members, and of pressure from their spouse transitioned because facing Other common reasons included or partner. after they too much harassment or discrimination trouble began transitioning (31%), and having 7.6). getting a job (29%) (Table why respondents de-transitioned, Reasons 7.6: Table at least for a little while

8% White

10% Multiracial

Middle Eastern Middle

9% Latino/a

8% Black

10% Asian 14%

8% American Indian American Overall 4% 8% 2% 6% 0% 14% 12% 16% 10% transitioning (Figure 7.28). Ever de-transitioned Figure 7.28: (%) RACE/ETHNICITY having de-transitioned (11%), in contrast to having de-transitioned (11%), in contrast of de-transitioning transgender men (4%). Rates with American also differed by race and ethnicity, (10%) Indian (14%), Asian (10%), and multiracial of de- respondents reporting the highest levels did so only temporarily: 62% of those who had did so only temporarily: 62% of those currently de-transitioned reported that they were than the living full time in a gender different gender they were thought to be at birth. to report women were more likely Transgender “de-transitioned,” which was defined as having “de-transitioned,” as [their] sex assigned at “gone back to living Eight percent (8%) of while.” birth, at least for a at respondents reported having de-transitioned some point. Most of those who de-transitioned of the overall sample. II. De-Transitioning had ever whether they were asked Respondents Sixty-nine percent (69%) of respondents discussed respondents discussed percent (69%) of Sixty-nine a professional. Of orientation with their sexual tried to that a professional 14% reported those, 10% representing sexual orientation, change their 112 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS plans tokillthemselves inthepastyear, compared one-quarter (24%) ofrespondentsreported making to 4%oftheU.S. generalpopulation. themselves inthepasttwelve months,compared that theyhadseriouslythought aboutkilling Nearly half(48%)ofallrespondents reported Past Year and Behaviorsinthe I. SuicidalThoughts Health range ofsuicidalthoughtsandbehaviors.QuestionswerepatternedontheNationalSurveyDrugUse about, madeaplan,ortriedtokillthemselvesatanytimeintheirlivesthepasttwelvemonthsassess and intheyearpriortocompletingsurvey. Respondents wereasked whethertheyhadseriouslythought The surveyexploredsuicidalthoughtsandbehaviorsamongrespondentsbothoverthecourseoftheirlifetime care, employment,andhousing. including familysupport,experiencesofanti-transgenderdiscriminationandviolence, andaccesstohealth protective factorsthataffecttheratesofsuicidalthoughtsandbehaviorsamongtransgenderpeople, substantially higherthanthatintheU.S. generalpopulation.Previousstudiesidentifyavarietyofriskand The prevalenceofsuicideattemptsamongtransgenderpeopleisreportedintheliteratureasbeing D. SUICIDAL THOUGHTS ANDBEHAVIORS 44 andNationalComorbiditySurveyReplication reporting threeormoreattempts. so morethanonceintheirlifetime, with46%ofthosewhohaveattemptedsuicide More thantwo-thirds(71%)ofrespondentswhohaveattemptedsuicidedone 0.6% intheU.S. population. Seven percent(7%)ofrespondentsattemptedsuicideinthepastyear, comparedto year, comparedto1.1% oftheU.S. population. Nearly one-quarter(24%)ofrespondentsmadeplanstokillthemselvesinthepast had seriousthoughtsaboutkillingthemselvesatsomepointintheirlife. themselves inthepastyear, comparedto4%oftheU.S. population,and82%have Forty-eight percent(48%)ofrespondentshaveseriously thoughtaboutkilling compared to4.6% intheU.S. population. Forty percent(40%)ofrespondentshaveattemptedsuicideatsomepointintheirlife, 43 46 Nearly 45 toallowforcomparisontheU.S. population. people withdisabilities (12%). suicide inthe past yearwasalsohigher among respondents (Figure7.29). Therateofattempted multiracial (10%),Black(9%), andLatino/a (9%) people ofcolor, includingAmericanIndian (10%), suicide inthepastyearwas higheramong in thepastyear(0.6%). rate ofattemptedsuicideintheU.S. population suicide inthepastyear, nearly twelvetimesthe Seven percent(7%)ofallrespondentsattempted to 1.1% intheU.S. population. 48 Therateofattempted 47 HEALTH 113 50 0.2%

1% 65 and over over and 65 0.3%

2% 60 to 64 to 60 0.3%

2% 55 to 59 to 55 One in ten (10%) USTS respondents One in ten (10%) USTS 49 0.6%

3% 50 to 54 to 50 0.4%

3% Seven percent (7%) of all percent (7%) Seven in suicide attempted respondents nearly twelve times the past year, suicide inthe rate of attempted population (0.6%). the U.S. 49 to 45 their families as supportive (6%). year varied The rate of suicide attempt in the past being more with younger respondents by age, to have attempted suicide in the past year, likely general U.S. a similar pattern to that found in the population. in the past aged 18–25 have attempted suicide rate among those aged 65 and ten times the year, 18–25 those aged Similarly, older (1%) (Figure 7.31). were eight times more (1.6%) population in the U.S. to report having attempted suicide in the likely past year than those aged 65 and older (0.2%). Respondents whose current income came only came only whose current income Respondents such economy, from work in the underground sales, or other criminalized as sex work, drug in the work, had a higher rate of suicide attempts respondents who past year (27%). Additionally, (13%) described their families as unsupportive to have attempted were more than twice as likely described suicide in the past year as those who

0.5%

40 to 44 to 40 degree

3% White professional professional

0.4% Graduate or or Graduate 10% 5%

4% 35 to 39 to 35 degree

Multiracial Bachelor’s Bachelor’s 8% 0.6%

degree

30 to 34 to 30

Middle Eastern Middle

9% Associate’s Latino/a 9% 0.7%

Black

26 to 29 to 26 Some college Some 13%

1.6% 8% school/GED Asian

10%

18 to 25 to 18 Completed high high Completed 17%

10% high school high 0.6% % in USTS population (NSDUH) % in U.S.

Did not complete complete not Did

7% Overall

7% Overall American Indian American Overall 4% 4% 8% 8% 2% 2% 6% 6% 4% 0% 0% 8% 2% 6% 0% 14% 18% 12% 12% 16% 10% 10% 12% 10% Figure 7.31: Attempted suicide in the past year Attempted Figure 7.31: (%) CURRENT AGE (%) ATTAINMENT EDUCATIONAL Figure 7.30: Attempted suicide in the past year suicide in the Attempted Figure 7.30: sample to have attempted suicide in the past year, the past year, sample to have attempted suicide in or a GED and those who completed high school to have only (13%) were almost twice as likely (Figure 7.30). attempted suicide in that time period Respondents who did not complete high school Respondents as the overall (17%) were more than twice as likely Figure 7.29: Attempted suicide in the past year suicide Attempted Figure 7.29: (%) RACE/ETHNICITY 114 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) Figure 7.32: Everattemptedsuicide contrast towhite(37%)respondents(Figure7.32). and MiddleEastern(44%)respondents,in by multiracial(50%),Black(47%),Latino/a (45%), respondents reportingthehighestrates,followed people ofcolor, withAmericanIndian(57%) Lifetime suicideattemptswerealsohigheramong rate ofattemptedsuicideintheirlifetime(15%). and crossdressershadasubstantiallylower women (40%)andnon-binaryrespondents(39%), transgender men(45%)thanfor Lifetime suicideattemptrateswerehigherfor U.S. population(4.6%). is nearlyninetimesashightheprevalencein point intheirlife. Thislifetimesuicideattemptrate sample reportedhavingattemptedsuicideatsome point intheirlives,and40%ofrespondentsthe seriously thoughtaboutkillingthemselvesatsome Eighty-two percent(82%)ofallrespondentshad Thoughts andBehaviors II. LifetimeSuicidal the U.S. population. compared to41%ofthosewhoattemptedsuicidein suicide stayedinahospitalforatleastonenight, Thirty percent(30%)ofrespondentswhoattempted received medicalattentionintheU.S. population. compared to60%whoattemptedsuicideand 45% receivedmedicalattention Of thosewhoattemptedsuicideinthepastyear, 60% 20% 50% 30% 40% 10% 0%

Overall

American Indian 40% 57%

Asian 40% 53

54 Black 47%

Latino/a

Middle Eastern 45% 51 as a result, asaresult, 44%

Multiracial 50%

White 37% 52

higher (30%)(Figure7.33). among thosewithabachelor’s degree(34%)or complete highschool(52%),andthelowestrates with thehighestratesamongthosewhodidnot suicide attemptsalsovariedbylevelofeducation, more likely toreportattempting suicide. Lifetime People withdisabilities(54%)inthesamplewere the U.S. population(4.6%). nine timestheratereportedin suicide intheirlifetime, nearly respondents haveattempted Forty percent(40%)of sexually assaulted their jobforbeingtransgender (55%),orbeen homelessness (59%),done sexwork(57%),lost the pastyear(65%),orhave everexperienced respondents whowerephysically attacked in Lifetime suicideattemptswere alsohigherfor those withsupportivefamilies. suicide intheirlifetime, incontrastto37%of their familiesasunsupportivehadattempted support. Amajority(54%)ofthosewhodescribed suicide attemptsvariedsignificantlybyfamily immediate familytheygrewupwith,lifetime Among respondentswhowereouttothe EDUCATIONAL ATTAINMENT (%) Figure 7.33: Everattemptedsuicide 60% 20% 50% 30% 40% 10% 0%

Overall

Did not complete 40%

high school 52% Completed high

56 school/GED (54%). 49%

Some college 45%

Associate’s 55

degree 42%

Bachelor’s

degree 34%

Graduate or professional 30% degree HEALTH 115 to allow for 59 6% reported that their most recent 6% reported that 57 younger. Thirty-nine percent (39%) reported that reported that percent (39%) Thirty-nine younger. of 14 between the ages attempt occurred their first age it occurred between reported that 20% and 17, that their first attempt and 8% reported 18 and 24, was at age 25 or older. Attempt of Most Recent Age b. who reported a suicide Among respondents attempt, More at age 13 or younger. attempt happened reported the most recent than one-quarter (26%) between the ages of 14 and 17, attempt occurred the ages 41% reported that it happened between their most of 18 and 24, and 27% reported that recent attempt was at age 25 or older. The survey explored patterns in respondents’ The survey explored patterns in respondents’ 58 Overall, 29% of respondents reported illicit drug use, marijuana consumption, and/or Overall, 29% of respondents reported illicit drug use, times the rate in the nonmedical prescription drug use in the past month, nearly three population (10%). U.S. past month, compared to 2% of the U.S. population. past month, compared to 2% of the U.S. marijuana and Four percent (4%) of respondents used illicit drugs (not including have used them in nonmedical use of prescription drugs) in the past month, and 29% their lifetime. One-quarter (25%) of respondents used marijuana within the past month, compared to One-quarter (25%) of respondents used marijuana within the past population. 8% of the U.S. not prescribed Seven percent (7%) of respondents used prescription drugs that were in the drug use”) to them or used them not as prescribed (“nonmedical prescription

ever consumed certain substances, including alcohol, tobacco, marijuana, and other drugs, such as including alcohol, tobacco, ever consumed certain substances, received a who reported using such substances Respondents heroin, and methamphetamine. cocaine, the frequency and quantity of their substance use. series of follow-up questions about Substance use is an important indicator of mental health as well as physical wellbeing, and it may reflect Substance use is an important indicator of exposure to a variety of risk and protective factors, such as family acceptance, level an individual’s opportunity. and economic homelessness, violence, by the National Survey on Drug Use and Health substance use with questions informed had whether they were asked population. Respondents in the U.S. comparison to substance use trends reported that their first attempt was at age 13 or reported that their first attempt was USE E. SUBSTANCE a. Age of First Attempt a. Age of First suicide (once or who have attempted Respondents about the age of their multiple times) were asked (34%) first suicide attempt. More than one-third III. Age of Suicide Suicide III. Age of Attempts More than two-thirds (71%) of all respondents who two-thirds (71%) of More than did so more than once,attempted suicide had ever three or more attempts,46% who reported including or more attempts. reported five and 21% who KEY FINDINGS KEY 116 2015 U.S. TRANSGENDER SURVEY respondents reportedlower levels(Figure7.34). binge drinking,whilewhite (25%)andAsian(19%) (30%) respondentsweremore likely toreport Latino/a (32%),MiddleEastern (30%),andBlack drinking atleastonetimeinthepastmonth. overall sample, withnearlyhalf (49%)reportingbinge as likely toengageinbingedrinkingasthosethe sales, orothercriminalizedwork,werenearlytwice underground economy, such assexwork,drug Respondents whowerecurrentlyworkinginthe rate intheU.S. adultpopulationin2014(25%). drinking inthepastmonth,slightlyhigherthan percent (27%)ofthesamplereportedbinge each other(“bingedrinking”). at thesametimeorwithinacoupleofhours 5 ormoredrinksonthesameoccasion,meaning number ofdaysinthemonthwhentheyconsumed Current alcoholuserswerealsoasked forthe b. BingeandHeavyDrinking consumed alcoholon11ormoredays. used alcoholon6–10ofthepast30days,and23% days duringthepriormonth.Nineteenpercent(19%) on 1or2days,and28%hadusedalcohol3–5 past month.Twenty-nine percent(29%)usedalcohol asked howmanydaystheyhadusedalcoholinthe Respondents whowerecurrentlyusingalcohol Alcohol Use a. FrequencyofCurrent 56% oftheU.S. adultpopulation. days priortotakingthesurvey, comparedwith at leastonealcoholicbeveragewithinthe30 using alcohol,meaningthattheyhadconsumed percent (63%)ofrespondentswerecurrently to 86%intheU.S. adultpopulation. hard liquor, atanypointintheirlives,compared having adrinkofalcohol,suchasbeer, wine, or Ninety percent(90%)ofrespondentsreported I. AlcoholConsumption 62 Twenty-seven 61

60 Sixty-three

63 drinking on one day during the month and 10% drinking ononedayduringthemonthand10% Nine percent(9%)ofrespondentsreportedbinge current tobaccouse. tobacco withinthepastmonth, with51%reporting as likely astheoverallsampleto havesmoked underground economywere morethantwice Respondents whowerecurrentlyworkinginthe 21% oftheU.S. population. thirty daysoftakingthesurvey, whichcomparesto at leastonecigaretteorpartofawithin were currentsmokers, meaningthattheysmoked U.S. population(63%). any pointintheirlives,lowerthantherate that theyhadsmoked allorpartofacigaretteat Fifty-seven percent(57%)ofrespondentsreported Tobacco Use a. LifetimeandCurrent II. Tobacco Use the pastmonthasthoseinoverallsample. more thantwiceaslikely toreportheavydrinkingin working intheundergroundeconomy(19%)were population (7%). month (“heavydrinking”),thesamerateasU.S. reported bingedrinkingon5moredaysthat on 2–4days.Sevenpercent(7%)ofrespondents RACE/ETHNICITY (%) Figure 7.34: Reported bingedrinkinginthepastmonth 20% 25% 30% 35% 10% 15% 0% 5%

Overall

American Indian 27% 26% 64

Respondents whowerecurrently Asian 19% 65

Twenty-two percent(22%) Black 30% 66

Latino/a

Middle Eastern 32% 30%

Multiracial 25%

White 25% HEALTH 117 compared with 47% 68 69 Current marijuana use 70

marijuana on 1–2 days that month. Thirty percent 26% on marijuana on 3–12 days, (30%) smoked 13–28 days, and nearly one-quarter (23%) smoked marijuana on 29 or on all 30 of the past 30 days. Among those who were currently working in the one-third approximately underground economy, (34%) reported using marijuana on 29–30 days in Marijuana Use IV. reported Nearly two-thirds (64%) of respondents having ever used marijuana, of the general population. a. Current Marijuana Use current One-quarter (25%) of the sample reported marijuana within 30 meaning that they used use, 8% of the compared to days of taking the survey, general population. U.S. currently was elevated among those who were (60%) and working in the underground economy those who were living with HIV (48%). Frequency of Marijuana Use b. had used marijuana in the month who Respondents the number for before taking the survey were asked during marijuana of days in which they smoked that period. More than one in five (22%) smoked III. E-Cigarettes or III. E-Cigarettes Products Vaping (36%) of respondents had usedMore than one-third products at some point in theire-cigarettes or vaping these products was elevatedlives. Lifetime use of in the who have worked among respondents use. with 57% reporting past underground economy, of respondents who had everThirty percent (30%) vaping products used them withinused e-cigarettes or used An additional 40% survey. 30 days of taking the than a yearthem more than 30 days prior but less 29% had used them and before taking the survey, survey. more than 12 months before taking the 40% White

50%

65 and over and 65

27% Multiracial

54% 45 to 64 to 45

67 Middle Eastern* Middle

18% Latino/a

29% 25 to 44 to 25

14% Black

22%

19% Asian 18 to 24 to 18 44%

32%

Overall

32% Indian American Overall 5% 0% *Sample size too low to report 0% 15% 10% 10% 45% 35% 40% 30% 25% 40% 30% 20% 50% Figure 7.36: Daily smokers consuming one or more consuming one or more Daily smokers Figure 7.36: pack a day in the past month (%) RACE/ETHNICITY 20% 50% 60% packs a day in the past month (%) CURRENT AGE Figure 7.35: Daily smokers consuming one or more Daily smokers Figure 7.35: than one pack a day was more likely to be reportedthan one pack a day was more likely aged 45–64 (54%) and 65 andby daily smokers as well as American Indian over (50%) (Figure 7.35), 7.36). (44%) and white (40%) respondents (Figure the past month, compared to 59% of current the past month, compared population. in the U.S. smokers nearly one-third (32%)Among daily smokers, Smoking more one or more packs each day. smoked past month. Twenty-nine percent (29%) of current percent past month. Twenty-nine on 4 days or fewer in tobacco users smoked one-quarter (24%) smoked the past month, and days. More than one-third (38%) tobacco on 5–20 tobacco daily during smoked of current smokers b. Frequency of Tobacco Use of Tobacco Frequency b. Current Users Among of the number were also asked Current smokers tobacco in the had smoked days on which they 118 2015 U.S. TRANSGENDER SURVEY in theunderground economy. Rates ofnonmedical compared with26%ofthose whohadnoexperience reported nonmedicalprescription druguse, underground economy, almosttwo-thirds(63%) Among respondentswhohave worked inthe they werenotbeingtaken asprescribed. that thedrugswerenotprescribedtothemor Adderall, orAmbien,for“nonmedicaluse,” meaning taken prescriptiondrugs,suchasOxycontin,Xanax, Approximately one-third(34%)ofrespondentshave Prescription DrugUse VI. Nonmedical used illicitdrugswithinthepastmonth. working intheundergroundeconomy(3%)tohave times aslikely asthosewhowerenotcurrently underground economy(26%)werenearlynine Respondents whowerecurrentlyworkinginthe within 30daysoftakingthesurvey. marijuana), meaningtheyhadconsumedthem reported currentuseofillicitdrugs(notincluding Four percent(4%)ofrespondentsinthesample a. CurrentIllicitDrugUse or whohaveeverexperiencedhomelessness(42%). have lostajobbecauseofbeingtransgender(43%) illicit drugusewasalsohigheramongthosewho other thansexwork(suchasdrugsales)(75%).Past those whohavedoneundergroundeconomywork respondents whohavedonesexwork(56%)and Prior useofillicitdrugswasparticularlyhighamong poppers orwhippits(butnotincludingmarijuana). heroin, LSD, methamphetamine, orinhalantslike using illegalorillicitdrugs,suchascocaine, crack, Nearly one-third(29%)ofrespondentsreportedever V. IllicitDrugs on 29–30dayswithinthatmonth. HIV (34%)werealsomorelikely tousemarijuana the pastmonth.Respondents whowerelivingwith

nonmedical prescriptiondruguse, withthoseaged Younger respondentsweremorelikely toreport reporting nonmedicalprescriptiondruguse. other thansexwork,suchasdrugsales,with75% those whohaddoneundergroundeconomywork prescription drugusewereparticularlyhighamong 2% oftheU.S. population. represents 7%oftheoverall sample, comparedto drug usewithin30daysof taking thesurvey. This one infive(21%)reported nonmedical prescription that yearbutmorethanamonth earlier. Morethan taking thesurvey, and 28%haddonesowithin engaged insuchusemorethanayearbefore of prescriptiondrugs,overhalf(51%)hadlast Of respondentswhoreportednonmedicaluse Prescription DrugUse a. CurrentNonmedical CURRENT AGE (%) Figure 7.37: Nonmedicaluseofprescriptiondrugs prescription druguse(Figure7.37). and older(18%)beingtheleastlikely toreportsuch 25–44 (39%)beingmostlikely, andthoseaged65 20% 25% 30% 40% 35% 45% 10% 15% with 10%oftheU.S. population. use inthepastmonth,compared or nonmedicalprescriptiondrug use, marijuanaconsumption,and/ respondents reportedillicitdrug Almost one-third(29%)of 0% 5%

Overall 34%

18 to 24 31%

25 to 44 72 39%

45 to 64 27%

65 and over 18% HEALTH 119 73 10% 28%

68%

prescription drug use drug prescription

use, and/or nonmedical nonmedical and/or use,

N/A marijuana use, drug illicit Current 3% use) drug

26%

nonmedical prescription prescription nonmedical including marijuana or or marijuana including

they consumed them within 30 days of taking the 30 days of taking them within they consumed than three times higher This was nearly survey. (10%). general population the U.S. usage in (68%) of those currentlyMore than two-thirds economy reported illicitworking in the underground marijuana and prescription drugdrug use (including (Figure 7.38). use) in the past month Current illicit drug use (not (not use drug illicit Current 2% 6%

26%

prescription drug use drug prescription Current nonmedical nonmedical Current 8% 24%

60% Current marijuana use marijuana Current 27% 26%

49% in past month past in

% in USTS not currently working in underground not currently working % in USTS (NSDUH) population % in U.S. % in USTS currently working in underground economy currently working in % in USTS Binge drinking drinking Binge 0% 40% 20% 60% Figure 7:38: Substance use in the past month among respondents currently working in the underground economy currently working in the underground use in the past month among respondents Figure 7:38: Substance 80% Almost one-third (29%) of respondents in Almost one-third (29%) were currently using illicit the overall sample and/or prescription drugs not drugs, marijuana, or not as prescribed, meaning prescribed to them VI. Overall Current Current VI. Overall Use Drug 120 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS of colorandwhiterespondents (Figure7.39). more likely tohavebeentestedthanotherpeople and AmericanIndian(65%) respondentswere non-binary people(45%).Black respondents(70%) (58%) beingmorelikely tobetested,compared transgender women(62%)andmen population. HIV, incomparisonto34%oftheU.S. adult half (55%)ofrespondentshadbeentestedfor through theblooddonationprocess.Morethan been testedforHIV, asidefromtestingobtained Respondents wereasked whethertheyhadever I. HIVTesting Factor SurveillanceSystem (BRFSS), patterned onnationalsurveys,includingtheNationalHealthInterviewSurvey(NHIS) related toHIVtesting,care, andlivingwithHIV. Severalofthequestionsinthissectionsurveywere rates ofintimatepartnerviolence. access totransgender-competentcare, barrierstoaccessingeducation,employment,andhousing,high factors increasetransgenderpeople’s vulnerabilitytoHIV, includingsocialrejectionandstigma,inadequate than intheU.S. generalpopulation. The prevalenceofHIVandAIDShasbeenfoundinpriorresearchtobehigheramongtransgenderpeople F. HIVTESTING ANDCARE times aslikely tobelivingwithHIVastheoverallsample. American Indian(4.6%) andLatina (4.4%)transgenderwomenweremorethanthree Nearly oneinfive(19.0%) BlacktransgenderwomenwerelivingwithHIV, and overall sample. Transgender womenweremorethantwiceaslikely tobelivingwithHIV(3.4%)asthe substantially higherratethanintheU.S. population(0.3%). Respondents reportedthattheywerediagnosed withHIVatarateof1.4%, U.S. adultpopulation. More thanhalf(55%)ofthesamplehasbeentestedforHIV, comparedto34%ofthe 78 Thisvariedbygenderidentity, with 75 Respondents receivedaseriesofquestions toexamineexperiences 74 77 The Centers for Disease Prevention and Control found that a number of TheCentersforDiseasePreventionandControlfoundthatanumberof sothatanswerscouldbecomparedtotheU.S. population. RACE/ETHNICITY (%) Figure 7.39: EverbeentestedforHIV 60% 20% 50% 80% 30% 40% 70% 10% 0%

Overall

American Indian 55% 65%

Asian 49%

Black 70% 76

Latino/a andBehavioralRisk

Middle Eastern 54% 53%

Multiracial 59%

White 52% HEALTH 121 --- 1% 0% 0% 0% 0% <1% <1% 12% 86%

% of those who have not been tested in U.S. population (NHIS) 22% 2014 1% 1% 1% 1% 3% 2% 6% <1% <1%

86%

11% 2013

% of those who have not been tested in USTS 6% 2012

% of those 3% 2011 38% 2015

tested for HIV

who have been who have been

20% earlier 2010 or Reason they were HIV-positive They were worried their name would be sent to the government if they tested positive They were afraid of losing their friends, home, insurance, job, or family if people knew they were tested Some other reason No particular reason Unlikely they have been they have been Unlikely exposed to HIV Their doctor/health care provider never mentioned getting an HIV test They did not know where to get tested They did not want to think about HIV or being HIV-positive needles They did not like They were afraid to find out if Forty-five (45%) percent of respondents reported Forty-five (45%) percent of respondents Of those that they had not been tested for HIV. that who had not been tested, 86% reported was that the main reason for not being tested similarly to the exposure to HIV was unlikely, population (86%). general rate in the U.S. also reported a variety of additional Respondents 7.8). reasons for not being tested (Table for HIV Main reason for not being tested 7.8: Table Figure 7:40: Year of last HIV test Year Figure 7:40: Not Being Tested For c. Reason ------1% 1% 4% 2% 2% 9% 11% <1% 47% 23% % in U.S. population (BRFSS) --- 1% 1% 3% 2% 2% 9% 11% <1% <1% 45% 26% % in USTS and three times less likely to be tested as a and three times less likely 79 Location Private doctor or HMO office Clinic Counseling or testing site Somewhere else Military (write-in response) Hospital inpatient Emergency room Home Jail, prison, or other correctional facility Drug treatment facility Mobile clinic or testing site (write- in response) Do not know or not sure Table 7.7: Locations where last tested for HIV Locations 7.7: Table conducted), and more than two-thirds (71%) had last been tested in 2013 or later (Figure 7.40). b. Year of Last Test of Last Year b. 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 have been tested at a counseling or testing site have been tested at a counseling or general population (11%) than those in the U.S. (4%), 7.7). hospital inpatient (Table office, more than one-quarter (26%) at a clinic, more than one-quarter (26%) at a clinic, office, Testing or testing site. and 11% in a counseling a similar pattern in the U.S. locations followed USTS general population, with a few exceptions. to as likely respondents were almost three times a. Test Location a. Test for HIV received tests in Those who were tested with nearly one-half a wide range of locations, or HMO at their private doctor’s (45%) being tested People who were currently working in the working in the who were currently People and including sex work economy, underground been to have likely were also more drug sales, tested (78%). 122 2015 U.S. TRANSGENDER SURVEY respondents (Figure7.42). and incontrasttoAsian(0.5%) andwhite(0.4%) had higherratesofHIVcompared tothesample Indian (2.0%) andLatino/a (1.6%) participantsalso to beHIVpositiveorreactive(6.7%). American Black respondentsbeingalmostfivetimesaslikely The rateofHIVdifferedbyraceandethnicity, with GENDER IDENTITY(%) Figure 7.41: LivingwithHIV (0.4%) (Figure7.41). transgender men(0.3%) and non-binarypeople they werelivingwithHIV(3.4%),incontrastto transgender womenbeingmostlikely to report HIV statusvariedbygenderidentity, with the testdidnotdetermineiftheyhadHIV. received resultsthatwereunclear, whichmeant never receivedtheresultsandlessthan1%who tested butdidnotknowtheirstatusbecausethey HIV test.Thisincluded1%ofthosewhowere been testedordidnotknowtheresultsoftheir half (53%)wereHIVnegative, in theU.S. generalpopulation(0.3%). (1.4%) The rateofrespondentswhowerelivingwithHIV II. HIVStatus 2.5% 0.5% 3.5% 1.5% 0% 2% 3% 4% 1%

Overall 81,82 Non-binary people with male 1.4% Crossdressers wasmorethanfourtimesashighthat on their birth certificate Non-binary people with female 2.1%

on their birth certificate 1% 0.2% Non-binary (all) 0.4% 84

Trans women and46%hadnot 3.4% 83

Trans men Morethan 0.3% Trans women

and men 2%

testing because she said those testing becauseshesaidthose “The nurserefusedtogivemeHIV undetectably HIVpositive.” process astransgenderandbeing day isadoublecomingout because IamHIVpositive. Every 50–100% moreforthesurgery be toldtheywouldchargeme [for gendertransition]onlyto “I haveconsultedwithsurgeons Voices In OurOwn trans womenofcolor.” was socommonlyaccepted among It istrulybewilderingthat thisreality vulnerable transwomen like myself. one oftheharshrealities foryoung of fearandnecessity. Thisisjust participated inunprotectedsexout were somanytimesIwasinjailand HIV, wasthescariestofall.There the timeIbecameinfectedwith “My firsttimeinjail,andpossibly survival andmysuccess.” All thesefactorscontributetomy in genderissuesandtransitioning. a greattherapistwhoisanexpert related healthcare. Ihaveaccessto excellent trans-relatedandHIV- good healthinsuranceandget living withHIVfor25years.Ihave “I amatransmanwhohasbeen and justneededtoacceptreality.” man.’ ShetoldmeI was bornfemale have sexwithmenandI’m‘notareal funds werereservedformenwho

HEALTH 123 - 0.8%

1.6%

fessional degree fessional

65 and over and 65

Graduate or pro or Graduate

0.7% degree Bachelor’s Bachelor’s

3.3%

45 to 64 to 45

1.7% degree Associate’s Associate’s

1.6%

2.0%

25 to 44 to 25 Some college Some

1.8% school/GED

0.2%

18 to 24 to 18 Completed high high Completed 7.2%

high school high

1.4%

Overall

Did not complete complete not Did

1.4% Overall 1% 3% 2% 0% 1% 7% 4% 3% 8% 2% 5% 6% 0% 1.5% 3.5% 0.5% 2.5% Undocumented residents (15.0%) were more than were more Undocumented residents (15.0%) to report that they were livingten times as likely and documentedwith HIV as the overall sample, There were also more likely. non-citizens (3.6%) examiningwere also substantial differences when Those whorates of HIV by educational attainment. were more than did not complete high school (7.2%) to be living with HIV as those infive times as likely to the lower rates for in contrast the overall sample, or a graduate degree (0.7%) those with a bachelor’s (Figure 7.45). or professional degree (0.8%) Figure 7.45: Living with HIV (%) ATTAINMENT EDUCATIONAL The rate of HIV also differed by current age, with by current age, of HIV also differed The rate aged 45–64 (3.3%) among those it being highest age group (2.0%) higher for the 25–44 and also (Figure 7.44). Figure 7.44: Living with HIV (%) AGE

0.7%

White 0.4% White

0.8% 2.5%

Multiracial Multiracial

0% 0%

Middle Eastern Middle Middle Eastern Middle

1.6% 4.4%

Latina Latino/a

6.7% Black Black 19.0%

1.8% 0.5% Asian Asian

4.6% 2.0%

American Indian American

American Indian American 1.4% 1.4%

Overall

Overall (all (all Overall respondents) 1% 7% 4% 4% 3% 8% 8% 2% 2% 5% 6% 6% 0% 0% 14% 18% 12% 16% 10% 20% sample. American Indian (4.6%) and Latina (4.4%) and Latina American Indian (4.6%) sample. transgender women also reported substantially higher rates of HIV (Figure 7.43). women Living with HIV among transgender Figure 7.43: (%) RACE/ETHNICITY Nearly one in five (19.0%) Black transgender Nearly one in five (19.0%) a rate that is more women reported living with HIV, in the overall than thirteen times higher than that population (0.3%). population Living with HIV Figure 7.42: (%) RACE/ETHNICITY The rate of respondents living living of respondents The rate five nearly (1.4%) was with HIV than in the U.S. times higher 124 2015 U.S. TRANSGENDER SURVEY insurance, notbeingabletoaffordHIVcare, not a varietyofreasons,including nothavinghealth a doctorforHIVcare once peryear. HIV iswellcontrolledenoughtoonlyseeadoctor feeling sickenoughtolookforHIVcare, andtheir care forHIV, notbeingabletoaffordHIVcare, not reasons, includingnotbeingreadytofindhealth care Respondents whohadnotseenadoctorforHIV received HIVcareinthepast6months. for HIVcareinthepast12months,and87% with HIVhadseenadoctororhealthcareprovider Eighty-nine percent(89%)ofrespondentsliving emergency roomvisitorduringahospitalstay. past year, notincludingcarereceivedduringan had receivedHIV-specific healthcarewithinthe Most oftherespondentswhowerelivingwithHIV aspects oftheHIVcarecontinuum. to thesurvey, andwerealsoasked aboutother received HIV-related healthcareintheyearprior Respondents wereasked whethertheyhad therapy, andachievementofviralsuppression.” to care, retentionincare, receiptofantiretroviral care, including“diagnosisofHIVinfection,linkage care continuumdescribesstagesofHIVmedical continuum ortheHIVtreatmentcascade. TheHIV and managementofHIVintermsthecare advocates oftendescribeeffectivetreatment Medical providersandHIVhealthcare III. HIVHealthCare experienced homelessness(2.7%). (7.9%), andalmosttwiceashighforthosewhohave participated insexworkatanypointtheirlifetime (15.0%), five timeshigheramongthosewhohave income wasfromundergroundeconomywork for respondentswhosecurrentsolesourceof The rateofHIVwasmorethantentimeshigher inthepast6months 86 Similarly, thosewhohadnot seen inthepast12months offered a range of offeredarangeof offered offered 85

therapy (ART), whicharemedicationsthatcan with HIVhavebeenprescribedanti-retroviral Eighty-seven percent(87%)ofrespondentsliving load andCD4counts. and 7%hadneverabloodtestfortheirviral ago, 6%werelasttestedmorethanayearago, received suchtestingbetween6and12months past 6months.Fivepercent(5%)hadmostrecently determine theirviralloadandCD4countsinthe reported thattheyhadtheirbloodtestedto Of respondentswhowerelivingwithHIV, 82% unspecified reasons. finding outabouttheirHIVstatus,andother power orGodtohelpwiththeirHIV, onlyrecently enough tolookforhealthcare, relyingonahigher knowing wheretogoforHIVcare, notfeelingsick reasons notlistedinthequestion. weight gain,notwantingtotake ART, andother conflicts withothermedications,concernsabout not havinghealthinsurance, concernsabout including notbeingabletoaffordthemedication, they didnottake theirmedicationasprescribed, unweighted) reportedseveralreasonswhythat forgot totake it.Theremainingrespondents(n=23, taking itastheyweresupposedtowasthat never—reported thatthemainreasonfornot those whotookitmostofthetime, rarely, or their ART medicationallofthetime—including half (45%)ofrespondentswhowerenottaking took itregularlyandasprescribed.Approximately most ofthetime, 2%rarelytookit,and1%never prescribed allofthetime, one-third(33%)tookit thirds (64%)reportedtakingitregularlyandas who hadbeenprescribedART, almosttwo- currently takingtheirART medications.Ofthose of peoplelivingwithHIVreportedthattheywere general population. compared to94%ofthoselivingwithHIVinthe reduce theamountofHIVinbody. 89 87 Eighty-onepercent(81%) 88 Thisis HEALTH 125 2015 l?pid=ACS_15_1YR_ Available at: https://factfinder. Available 2015 American Community f/pages/productview.xhtm Available at: https://factfinder.census.gov/faces/ Available Q. 11.9 specified that “[h]ealth insurance marketplaces Q. sometimes called are part of the new health care law, where people can Care Act,’ or the ‘Affordable ‘Obamacare’ over such as through healthcare.gov, get insurance online, or in person.” the phone, “Insurer” here refers to insurers providing coverage under both private insurance plans (such as those purchased through an employer) and public plans (such as through Medicaid or Medicare). U.S. Census Bureau. (2015). U.S. Estimates: Private Health Insurance Coverage Survey 1-Year By Type. tableservices/js Census Bureau. (2015). U.S. S2703&prodType=table; Estimates: Public Health American Community Survey 1-Year Insurance Coverage by Type. census.gov/faces/tableservices/jsf/pages/productview. xhtml?pid=ACS_15_1YR_S2704&prodType=table. The estimate for the percentage of people who receive coverage through the Indian Health Service was calculated 2.2 million based on a 2015 statement that approximately American Indian and Alaska Native people were served by https://www.ihs.gov/newsroom/ the Indian Health Service. factsheets/quicklook/. 6 7 lack of family support. lack of family support. 4 5 income and economic instability and lack of access economic instability income and insurance. health insurance to adequate access insufficient also suggest that Results coverage contributed to to quality care and among respondents. poor health outcomes to more likely were substantially Respondents than the general population, be living with HIV rates among transgender with much higher were also more Respondents women of color. mental health outcomes, to report poor likely serious of substance use, including higher rates and suicide attempts. psychological distress, between Findings demonstrated an association of risk poor health outcomes and a number housing factors, such as economic instability, attainment, and lower educational instability,

943– The Social DC: National When Health Care Isn’t Caring: , 819–822; Poteat, T., German, T., , 819–822; Poteat, New York, NY: Lambda Legal. Lambda NY: New York, njustice at Every Turn: A Report of A Report njustice at Every Turn: , 22–29; Grant, et al. (2011). pp. | CHAPTER 7: HEALTH American Journal of Public Health, 103(5), Medical Care, 51(9) Medical Care, Lambda Legal’s Survey of Discrimination Against LGBT Survey of Discrimination Against LGBT Legal’s Lambda with HIV. and People People Census Bureau. (2015). 2015 American Community U.S. at: https://factfinder. Estimates. Available Survey 1-Year census.gov/faces/tableservices/jsf/pages/productview. xhtml?pid=ACS_15_1YR_S2701&prodType=table. Kosenko, K., Rintamaki, L., Raney, S., Maness, K. (2013). K., Rintamaki, L., Raney, Kosenko, patient perceptions of stigma in health care Transgender contexts. (2013). Managing uncertainty: A grounded D. & Kerrigan, D., theory of stigma in transgender health encounters. 84(1) Science & Medicine, (2010). Legal. 72–87; Lambda the National Transgender Discrimination Survey. (pp. 72–87). (pp. Discrimination Survey. the National Transgender Equality & National Gay DC: National Center for Transgender (2011). Force; Institute of Medicine. Task and Lesbian People: Bisexual, and Transgender Gay, Health of Lesbian, Building a Foundation for Better Understanding. Academy of Sciences. Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Romine, M. H., Swinburne Miner, O., Bockting, W. mental health,Hamilton, A., & Coleman, E. (2013). Stigma, and resilience in an online sample of the US transgender population. Herman, Harrison, J., J., M., Mottet, L. A., Tanis, 951; Grant, J. M. (2011). I L., & Keisling, J. 3 2 1 ENDNOTES ENDNOTES related to gender transition, such as counseling,related to gender transition, such as of surgical or a variety hormone therapy, received suchprocedures, a large number have not often due tohealth care despite wanting to do so, address their health needs, and lack of access toaddress their health who can administer healthhealth care providers with a sufficient knowledge care respectfully and of althoughneeds. Furthermore, transgender patients’ health caresome respondents were able to access related disparities, including access to qualityrelated disparities, reported Respondents care and health outcomes. to receiving the care that theysubstantial barriers constraints, lack of healthneed, such as financial that does not adequatelyinsurance or insurance Conclusion indicated thatthroughout the chapter Findings impacted by substantial health- respondents were 126 2015 U.S. TRANSGENDER SURVEY 17 16 15 14 13 12 11 10 9 8 reduction orreconstruction” inQ. 12.15. Respondents wereasked about having“top/chestsurgery the surgicalproceduresthatbestfit theirhealthcareneeds. a portionofthemmaynothavereceived questionsaboutall 2.7% ofrespondentsindicatedthattheywereintersex,and only questionsaboutmedicalprocedures availabletothem, 12.18. Although thevastmajorityofrespondentsreceived they hadmaleontheiroriginalbirthcertificatereceived Q. birth certificatereceived Q. 12.15, andrespondentswhosaid Respondents whosaidthattheyhadfemaleontheiroriginal about thesexlistedonrespondents’ originalbirthcertificate. procedures basedontheirresponsetoQ. 2.1, whichasked respondents receiveddifferentquestionsaboutsurgical (the gendertheywerethoughttobewhenborn), generally varybasedonindividuals’ sexassignedat birth Since theavailablesurgicalproceduresrelatedtotransition Service, andothertypesofinsurancenotlisted.SeeTable 7.1. TRICARE orothermilitarycoverage, VA, IndianHealth The “otherinsurance” categoryinFigure7.11 includes the povertylinecalculation. and EmploymentStatus who arelivingatornearthepovertyline. Seethe Respondents whoare“livinginpoverty”representthose and non-surgicalvoicetherapy. listed inTable 7.4 and7.5, withtheexception ofelectrolysis “Transition-related surgery”hereincludesallprocedures medication beforetheageof18. 27% ofrespondentswhoreportedtakingpuberty-blocking reported here(0.3% or“lessthan1%”)representsonlythe to adultsandolderadolescents.Therefore, thepercentage confused pubertyblockers withthehormonetherapygiven may havebeenmisinterpretedbysomerespondentswho so afterage18inQ.12.11. Thisindicatesthatthequestion having taken pubertyblockers inQ.12.9 reporteddoing therapy, alargemajority(73%)ofrespondentswhoreported youth ages9–16priortobeginninghormonereplacement used todelayphysicalchangesassociatedwithpubertyin medication. Whilepuberty-blockingmedicationsareusually on respondents’ reportedagesatthetimeoftakingthis here reflectsareductioninthereportedvaluebased taken puberty-blockingmedication,thepercentagereported Although 1.5%ofrespondentsinthesamplereportedhaving Service health care. Theseresultsarereportedinthe separately aboutwheretheyreceivedtransition-related Respondents onactivedutyinmilitaryservicewereasked identified asapersonwithdisabilityin Q. 2.20. “People withdisabilities” herereferstorespondentswho health caresetting(suchasahospital,office, clinic)”in Q.12.7. sexual contact(suchasfondling,assault,orrape)ina Respondents wereasked iftheyhad“experiencedunwanted of insurancenotlisted.SeeTable 7.1. military coverage, VA, IndianHealthService, andothertypes The “otherinsurance” categoryincludesTRICARE orother chapter. chapter for more information about chapter formoreinformationabout Military Income Income 22 21 20 19 18 30 29 28 27 26 25 24 23 Dataset_Documentation/NHIS/2015/samadult_freq.pdf Available at: National HealthInterviewSurvey:SampleAdultFile. Centers forDiseasePreventionandControl.(2016). UpdateSummaryFinal/cervical-cancer-screening. uspreventiveservicestaskforce.org/Page/Document/ Cervical Cancer:Screening. and 65.U.S. PreventiveServicesTask Force. (2012). who haveacervixandarebetweentheages21 recommends Pap smearseverythreeyearsforadults The U.S. PreventiveServicesTask Forcecurrently involving theconstructionofalargerphallus. (creation ofapenis)”inQ. 12.15. Thisisagenitalprocedure Respondents wereasked abouthavinga“phalloplasty genital proceduresthatseparatetheclitorisfromlabia. metoidioplasty/centurion procedure” inQ. 12.15. Theseare Respondents wereasked abouthavinga“clitoralrelease/ fallopian tubes,and/orcervix)”inQ. 12.15. “hysterectomy/‘hysto’ (removaloftheuterus,ovaries, Respondents wereasked abouthavinga women: A prospective study of vulnerability and resilience. women: Aprospective studyofvulnerabilityandresilience. Gender abuseand majordepressionamongtransgender A., Hwahng,S.,Mason,M.,Macri, &Becker, J. (2014). 105 transgender individuals. associated withpsychologicaldistress andresilienceamong P., Couch,M. (2015).Demographicandpsychosocialfactors See e.g., Bariola, E.Lyons, A.,Leonard, W., Pitts,M.,Badcock, Psychological Bulletin,135 discrimination andhealth:Ameta-analyticreview. See e.g., Pascoe, E.A.&Richman,L.S.(2009).Perceived substitute forsafertreatments. injections asalessexpensiveormoreeasilyaccessible affordable care, sometransgenderpeopleturntosilicone illegal intheUnitedStates. However, duetobarriers disfigurement, injury, andevendeath.Suchinjectionsare one’s appearance, theyareoftenrisky andcanleadto Although siliconeinjectionsaresometimesusedtomodify (Adam’s appleorthyroidcartilagereduction)”inQ. 12.18. Respondents wereasked abouthavinga“trachealshave the sizeofbreast. augmentation mammoplasty, whichreshapesorincreases augmentation/top surgery”inQ. 12.18. Thisreferstoan Respondents wereasked abouthaving“breast surgery (suchasnose, brow, chin,cheek)”inQ.12.18. Respondents wereasked abouthaving“facialfeminization “orchidectomy/‘orchy’/removal ofthetestes” inQ. 12.18. Respondents wereasked abouthavingan modification orconstructionofthelabia. a surgicalcreationofvagina.Alabiaplastyis labiaplasty/SRS/GRS/GCS” inQ. 12.18. Avaginoplastyis Respondents wereasked abouthavinga“vaginoplasty/ (10), 2108–2116;Nuttbrock,L.,Brockting, W., Rosenblum,

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/ American JournalofPublicHealth, (4), 531–554. Available at:http://www. 2015 2015

HEALTH 127 . (p. (5),

Suicide See note 36. Family Life and Faith Injustice at Every Turn: A Injustice at Every Turn: Available at: http://store.samhsa.gov/ Available Table 8.86B. section of the Archives of Sexual Behavior 42

chapter for a discussion about respondents (2), 69–92. International Journal of Methods in Psychiatric New York, NY & Los Angeles, CA; American Angeles, CA; NY & Los New York, Ending Conversion Therapy: Supporting and Suicidal Thoughts and Behaviors Among Adults: Results Suicidal Thoughts and Behaviors Among Adults: Results from the 2014 National Survey on Drug Use and Health. MD: Substance Abuse and Mental Health Services Rockville, Administration. Heeringa, O., Demler, T., Chiu, W. R. C., Berglund, P., Kessler, S., Hiripi, E., . . . Zheng, H. (2004). The US National (NCS-R): design and field Comorbidity Survey Replication procedures. 13 Research, Affirming LGBTQ Youth. LGBTQ Affirming shin/content//SMA15-4928/SMA15-4928.pdf. eleven percent (11%) of respondents in the Additionally, or sample said they were sent to a therapist, counselor, to stop themreligious advisor by immediate family members the “Sent to a Professional for See from being transgender. Being Transgender” Communities who were sent to a professional by their family. reported that gender of the overall sample Although 0.4% did identifytransition was not for them, these respondents criteria for inclusion in the survey meeting all as transgender, 1.10–1.18). (see Q. L. (2014). L., & Herman, J. P. Rodgers, Haas, A. P., and Gender Non-Conforming Among Transgender Attempts Adults. Foundation for Suicide Prevention & Williams Institute; C. & Smith, N. G. (2013). Suicide protective factors Moody, among trans adults. Harrison, J., J., M., Mottet, L. A., Tanis, 739–752; Grant, J. M. (2011). L., & Keisling, Herman, J. Discrimination Survey of the National Transgender Report Equality & National 82). DC: National Center for Transgender Force. Task Gay and Lesbian G. K. (2015). K., Kroutil, L. A., & Miller, Lipari, R., Piscopo, studies using population-based samples of transgender population-based samples studies using population is that the transgender adults, it is estimated attainment than the U.S. has lower educational younger and & Herman, N. T., T. Flores, A. R., Brown, adult population. Identify as Ethnicity of Adults who and (2016). Race L. J. Williams Angeles, CA: Los in the United States. Transgender S. G. S., & Landers, Scott, G., Stowell, Institute; Conron, K. J., from Results health in Massachusetts: (2012). Transgender J. sample of adults. American Journala household probability the finding of 118–122. Therefore, of Public Health, 102(1), psychological distress is39% for prevalence of serious standard weight only. reported here using the on Drug Use and from the 2015 National Survey Results Health: Detailed Tables. assaulted here for respondents who were sexually Results reflect those who reported that they had “experienced or analunwanted sexual contact (such as oral, genital, the pastcontact or penetration, forced fondling, rape)” in 18.3). year (see Q. Substance Abuse and Mental Health Services Administration. (2015). 45 41 42 43 44 38 39 40

2015 BRFSS (5), 943– 103

(11), 2191, 2198; The Health of Lesbian, Gay, Gay, The Health of Lesbian, Table 8.86B. Rockville, MD: 8.86B. Rockville, Table . Available at: http://www.cdc.gov/ . Available DC: National Academy of Sciences. DC: National Academy American Journal of Public Health, American Journal Results from the 2015 National Survey on Drug Use Results prevalence of serious psychological distress to adjust the sample to reflect the age and educational attainment of the adult population, the prevalence is reduced to 30%, U.S. adults. Based on six times the national prevalence for U.S. Serious psychological distress is related to age and general population. educational attainment in the U.S. (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 sample’s weight” is applied to the USTS “supplemental (2016). and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. at: http://www.samhsa.gov/data/sites/default/files/ Available NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH- DetTabs-2015.pdf. National Health Interview Survey: Sample Adult File. National Health Interview Survey: Sample Adult at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/ Available Dataset_Documentation/NHIS/2015/samadult_freq.pdf. psychological See note 33 for an explanation of how “serious is calculated based on the K6 scale. distress” Quality. and Center for Behavioral Health Statistics The K6 scale rates how often feelings are experienced onThe K6 scale rates how often feelings are experienced (1) a little of the time,the following scale: (0) none of the time, and (4) all of the (3) most of the time, (2) some of the time, 13 or above across all six 12.2. A total score of See Q. time. measures indicates serious psychological distress. Centers for Disease Prevention and Control. (2016). was an effort, or worthless. See Q. 12.2. See the National was an effort, or worthless. See aboutHealth Interview Survey for additional information measure ofthe K6 mental health screening instrument and at: http:// serious psychological distress in adults (available www.healthindicators.gov/Indicators/Serious-psychologicaldistress-adults-percent_50055/Profile). Prevalence & Trends Data Prevalence & Trends brfss/brfssprevalence. or K6, assesses Psychological Distress Scale, The Kessler past 30psychological distress based on how often in the cheer themdays respondents felt: so sad that nothing could everything hopeless, that or fidgety, nervous, restless up, Bisexual, and Transgender People: Building a Foundation for Building a Foundation People: Bisexual, and Transgender Better Understanding. population among adults in the U.S. The general health rating team using data fromwas calculated by the research (BRFSS). Surveillance System the Behavioral Risk Factor and Prevention. (2015). Centers for Disease Control American Journal of Public Health, 104 of Public Health, American Journal R. E., Romine, Swinburne M. H., Miner, O., Bockting, W. mental health, & Coleman, E. (2013). Stigma, Hamilton, A., the US transgender in an online sample of and resilience population. (2011). 951; Institute of Medicine. 37 35 36 33 34 32 31 128 2015 U.S. TRANSGENDER SURVEY 57 56 55 54 53 52 51 50 49 48 47 46 suicide attemptas reportedintheprevioussection. of themostrecentsuicideattemptis alsotheageoftheirfirst respondents whoreportedasingle suicideattempt,theage single attemptandthosewhoreported multipleattempts.For includes responsesfrombothrespondents whoreporteda The ageofthemostrecentsuicide attemptreportedhere lifetime (seeQ.18.1). contact orpenetration,forcedfondling,rape)”intheir unwanted sexualcontact(suchasoral,genital,oranal reflect thosewhoreportedthattheyhad“experienced Results forrespondentswhoweresexuallyassaultedhere a supportive, neutral,orunsupportivefamily. categories werecollapsedtocreateanewvariablereflecting scale from“verysupportive” to“veryunsupportive”. The to assesshowsupportivetheirfamilywasusingafive-point some oftheimmediatefamilytheygrewupwithwereasked Respondents whoreportedthattheywereouttoall,most,or attempts of1.9–8.7%). suicide plansof3.9%,alifetimeprevalencefor suicide ideationof5.6–14.3%, alifetimeprevalencefor Reviews, 30 & Lee, S.(2008).Suicideandsuicidalbehavior. Nock, M.K.,Borges,G.,Bromet,E.J., Cha,C.B.,Kessler, R.C., Survey Replication. suicidal behavior:Results fromtheNationalComorbidity & Kessler, R.C.(2010).Mentaldisorders, comorbidityand 617–626. Seealso Comorbidity Survey. of andriskfactorsforlifetimesuicideattemptsintheNational Kessler, R.C.,Borges,G.,&Walters, E.(1999).Prevalence Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand among USTS respondents. to usethismeasuregaugetheseverityofattempt “Experiences withHealthCareProviders”), itmaybedifficult mistreatment (see, forexample, theprevioussectionon report avoidingmedicalprofessionalsbecauseoffear of theattempt.However, becausemanytransgenderpeople a suicideattemptisoftenusedasmeasureoftheseverity Whether ornotapersonreceivesmedicalattentionfollowing Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand (1), 133–154

Nock, M. K., Hwang, I., Sampson, N. A., Nock, M.K.,Hwang,I.,Sampson,N.A., Molecular Psychiatry, 15 Archives ofGeneralPsychiatry,

(finding a lifetime prevalence of (finding alifetimeprevalenceof Table 8.70B. Seenote36. Table 8.77B. Seenote36. Table 8.77B. Seenote36. Table 8.70B. Table 8.70B. Seenote36. Table 8.70B. Seenote36. Table 8.69B. Seenote36. See note36. (8), 868–876; (8), 868–876; Epidemiologic Epidemiologic

56 (7), (7), 61 60 59 58 70 69 68 67 66 65 64 63 62 Results fromthe2014NationalSurveyonDrugUseand pdf. DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015. at: http://www.samhsa.gov/data/sites/default/files/NSDUH- Abuse andMentalHealthServicesAdministration.Available Health: DetailedTables. Results fromthe2014NationalSurveyonDrugUseand Center forBehavioralHealthStatistics andQuality. (2015). population-data-nsduh/reports?tab=39. Questionnaire. (2015). Center forBehavioralHealthStatistics andQuality. and ClinicalPsychology, 71 the NationalSurveyofAdolescents. substance abuse/dependence, andcomorbidity:Results from L. (2003).ViolenceandriskofPTSD, majordepression, K. J., Acierno, R.,Saunders,B.E.,Resnick, H.S.,&Best,C. Adolescent Health,43 factors insubstanceuseacrossadolescence. & Greenberg,M.T. (2008).Theroleofriskandprotective See e.g., Cleveland,M.J., Feinberg,M.E.,Bontempo, D. E., Health: Detailed Tables. Results fromthe2015National SurveyonDrugUseand Health: DetailedTables. Results from the2015NationalSurveyonDrugUseand on marijuanause. SeeQ. 15.1. “weed, joints,hashish,hash,orhash oil”whenreporting Respondents wereinstructedtoincludeproductssuchas Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2015NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2014NationalSurveyonDrugUseand Health: DetailedTables. Results fromthe2014NationalSurveyonDrugUseand NSDUH-FRR1-2014.pdf. www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/ Mental HealthServicesAdministration.Available at:http:// Drug UseandHealth. United States: Results from the2014NationalSurveyon P., &Kroutil,L.A.(2015). S. L.,Kennet, J., Lipari,R.,Medley, G.,Tice, P., Copello, E.A. report willbedrawnfromthe2014NSDUHdata.Hedden, population comparisonsforbingeandheavydrinkinginthis definition differsfromthe2015NSDUHdefinition,general occasion onatleast1dayinthepast30days.” Asthis is definedas“drinkingfiveormoredrinksonthesame and Health(NSDUH)definitionforbingedrinking,which This reportfollowsthe2014NationalSurveyonDrugUse Health: DetailedTables. 2015 National Survey on Drug Use and Health 2015 NationalSurveyonDrugUseandHealth Available at:http://www.samhsa.gov/data/ Rockville, MD:SubstanceAbuseand (2), 157–164;Kilpatrick,D. G.,Ruggiero, Table 2.6B. Rockville, MD:Substance Table 2.46B. Seenote60. Table 2.6B. Seenote60. Behavioral HealthTrends inthe Table 1.35B. Seenote36. Table 1.35B.Seenote36. Table 6.7B. Seenote36. Table 2.16B. Seenote36. Table 2.28B.Seenote36. Table 2.46B.Seenote60. (4), 692–700. Journal of Consulting Journal ofConsulting Journal of Journal of HEALTH 129 2015 . Available at: . Available Overview of HIV Treatments. Overview of HIV Treatments. HIV Care Continuum May 2014). HIV Surveillance Special Report 16. Available 16. Available May 2014). HIV Surveillance Special Report at: http://www.cdc.gov/hiv/pdf/statistics/systems/mmp/cdc- hiv-hssr-mmp-2013.pdf. U.S. population rate of those living with HIV, research team population rate of those living with HIV, U.S. 0.002% calculations estimated a difference of approximately not impact the rate of those living which would in the rate, population as reported here. with HIV in the U.S. tested for Ninety-seven percent (97%) of those who were HIV were HIV negative. (2015). AIDS.Gov. https://www.aids.gov/federal-resources/policies/care- continuum. response figures could not be Due to a low sample size, for HIV care reported for those who had not seen a doctor in the past 6 months. response figures could not be Due to a low sample size, reported for those who had not seen a doctor for HIV care in the past 12 months. (2015). See AIDS.Gov. at: https://www.aids.gov/hiv-aids-basics/just- Available diagnosed-with-hiv-aids/treatment-options/overview-of- hiv-treatments. Centers for Disease Control and Prevention. (2016). Behavioral and Clinical Characteristics of Persons Medical Care for HIV Infection–Medical Receiving 2013 Cycle (June 2013- Monitoring Project, United States, Centers for Disease Prevention and Control. (2016). Disease Prevention and Centers for Sample Adult File. Interview Survey: National Health at: https://www.cdc.gov/nchs/nhis/nhis_2015_ Available data_release.htm. with one related to HIV status are presented Percentages the section for more accurate decimal place throughout population figures. comparison with general living with HIV includes those The rate of respondents respondents Among or reactive. who were HIV-positive the rate of those who tested who had been tested, positive for HIV was 2.6%. and Prevention. (2015). HIVCenters for Disease Control at: 18a. Available 2014; vol. 26. Table Surveillance Report, The HIV http://www.cdc.gov/hiv/library/reports/surveillance/. provides data for those who were living Surveillance Report population in 2013. with diagnosed HIV infection in the U.S. population data includes those who are 15 years The U.S. those whoof age and older and does not include rate for theare under 18, so it was not possible to exactly match when population data. However, sample with the U.S. USTS in theestimating the impact of including 15–17 year olds 84 85 86 87 88 89 80 81 82 83 HIV BRFSS 2015 HIV and The Lancet (10042), 412–436. Table 1.30B. See 1.30B. Table Available at: http://www. Available Available at: http://www.cdc. Available Available at: http://www.cdc. Available Table 1.30B. See note 36. Table Table 1.22B. See note 36. 1.22B. Table (3), 214–222; Grant, J. M., Mottet, L.(3), 214–222; Grant, J. . (p. 80). DC: National Center for 80). DC: National . (p. Results from the 2015 National Survey Results Available at: http://www.cdc.gov/brfss/ Available Infectious Diseases, 388

Lancet

The Codebook Report. annual_data/2015/pdf/codebook15_llcp.pdf. Centers for Disease Control and Prevention. (2015). Data. Prevalence & Trends gov/brfss/brfssprevalence. Centers for Disease Control and Prevention. (2016). 2015 Behavioral Risk Factor Surveillance System: Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/ Available Dataset_Documentation/NHIS/2014/srvydesc.pdf . Centers for Disease Control and Prevention (2014). Questionnaire. Risk Factor Surveillance System Behavioral at: http://www.cdc.gov/brfss/questionnaires/pdf- Available ques/2015-brfss-questionnaire-12-29-14.pdf. review. review. (2016). Centers for Disease Control and Prevention. Communities. and Transgender cdc.gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf. Centers for Disease Control and Prevention (2015). National Health Interview Survey: Survey Description. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). L., & Keisling, Herman, J. Harrison, J., J., A., Tanis, of the National Transgender A Report Injustice at Every Turn: Discrimination Survey Force; Task Equality & National Gay and Lesbian Transgender Cabral, M. Mothopeng, T., J., Keatley, T., S. L., Poteat, Reisner, (2016). GlobalDunham, E., Holland, C. E., Max, R., Baral, S. D. ahealth burden and needs of transgender populations: Centers for Disease Control and Prevention. (2016). Centers for Disease Control and Prevention. (2016). Communities. Transgender Baral, S. gov/hiv/pdf/policies/cdc-hiv-transgender-brief.pdf; E., & Wirtz, A. L., Guadamuz, T. S., Strömdahl, T., Poteat, D., burden of HIV in transgender C. (2013). Worldwide Beyrer, women: a systematic review and meta-anaylsis. Infectious Diseases, 13 Results from the 2015 National Survey on Drug Use and from the 2015 National Survey Results Health: Detailed Tables. from the 2015 National Survey on Drug Use and Results Health: Detailed Tables. cocaine (including crack), heroin, hallucinogens, inhalants, orcocaine (including crack), methamphetamine.” Detailed Tables. on Drug Use and Health: between the two definitions,note 36. Due to the difference a for the overall use general population comparison to the U.S. marijuana or nonmedical use ofof illicit drugs (not including possible. prescription drugs) is not For the purposes of this report, “illicit drugs” include those drugs” of this report, “illicit For the purposes and methamphetamine, LSD, crack, heroin, such as cocaine, or nonmedical does not include marijuana inhalants, but differs from illicit This 15.1. drugs. See Q. use of prescription includes “the misuse in the NSDUH, which drugs as reported or the use of marijuana,of prescription psychotherapeutics 78 79 77 75 76 74 72 73 71 130 2015 U.S. TRANSGENDER SURVEY M Experiences atSchool CHAPTER 8 demographic andothercharacteristics arereported. and expulsion.Throughout thechapter, notabledifferencesinrespondents’ experiencesbasedon status, includingverbalharassment, physicalandsexualassault,leavingschoolbecause ofmistreatment, transgender wereasked additionalquestionsabout negativeexperiencesbasedontheirtransgender education institutions.Thosewhosaidthattheywere outastransgenderorthatothersthoughttheywere Survey respondentswereasked whethertheywereoutorperceivedastransgenderinK–12 andinhigher harassed orphysicallyattacked becauseoftheirtransgenderidentity. a collegeoruniversity).Otherstudieshaveshownthat manystudentsfeelunsafeandhavebeenverbally Kindergarten through12 some schoolscanbeunwelcomingandunsupportive fortransgenderstudents,whetherin any schoolsprovidesupportiveenvironmentsthatpromote learningandgrowth,while th grade(K–12), orintechnicalhighereducationinstitutions(suchas 1,2

EXPERIENCES AT SCHOOL 131 over

24% 65 and and 65

51% 45 to 64 to 45

76% 25 to 44 to 25

85% 18 to 24 to 18

75% Overall 0% 10% 70% 40% 30% 80% 50% 20% 90% 60% such as 18- to 24-year-olds (85%) in contrast to 45- such as 18- to 24-year-olds (85%) in to 64-year-olds (51%) (Figure 8.1). in K–12 as LGBQ Perceived Figure 8.1: (%) CURRENT AGE grade. th grade (K–12). Of grade (K–12). th Twenty-four percent (24%) of people who were out or perceived as transgender in (24%) of people who were out or perceived as transgender percent Twenty-four or sexually harassed. physically, verbally, college or vocational school were Fifty-four percent (54%) of people who were out or perceived as transgender in K–12 transgender in K–12 as perceived (54%) of people who were out or Fifty-four percent attacked. and 24% were physically were verbally harassed, left a as transgender who were out or perceived Seventeen percent (17%) of people bad, and 6% were expelled. school because the mistreatment was so K–12 More than three-quarters (77%) of respondents who were out or perceived as or were out (77%) of respondents who More than three-quarters verbally experiences, such as being had one or more negative transgender in K–12 or physically or their gender identity, from dressing according to harassed, prohibited sexually assaulted. Twelve percent (12%) of respondents were out as transgender at some point from at some point out as transgender respondents were percent (12%) of Twelve 12 through the Kindergarten

staff thought or knew they were LGBQ. Younger LGBQ. staff thought or knew they were to report that respondents were much more likely K–12 thought or classmates, teachers, or staff in than older respondents, knew they were LGBQ All respondents, including those who were out were also or perceived as transgender in K–12, or school whether classmates, teachers, asked staff thought or knew that they were lesbian, gay, Three-quarters in K–12. bisexual, or queer (LGBQ) (75%) believed that classmates, teachers, or school between Kindergarten and the 12 28% said those who were not out as transgender, or school that they believed classmates, teachers, staff thought they were transgender. I. Outness in K–12 percent (12%) of respondents reported Twelve some point that they were out as transgender at KEY FINDINGS KEY 132 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) transgender) in K–12 (ofthosewhowereoutorperceivedas Figure 8.2:Hadoneormorenegativeexperiences more negativeexperiences. disabilities (81%) respondents(Figure8.2)andpeoplewith (92%), MiddleEastern(84%),andmultiracial these experiences(Table 8.1). AmericanIndian experiences, whileonly23%didnothaveanyof as transgenderhadoneormoreofthesenegative Overall, 77%ofthosewhowereoutorperceived verbally harassed,physicallyattacked, orexpelled. about negativeexperiencesinK–12, suchasbeing were transgenderreceivedadditionalquestions K–12 orwhosaidthatothersthoughtthey Respondents whowereoutastransgender in II. Treatment inK–12 or physicallyattacked. such asbeingverballyharassed because theyweretransgender, negative experiencesatschool as transgenderhadoneormore those whowereoutorperceived More thanthree-quarters(77%)of 100% 90% 60% 20% 50% 80% 30% 40% 70% 10% 0%

Overall American Indian 77% 3 (82%)weremorelikely tohaveoneor 92%

Asian 73%

Black 74%

Latino/a

Middle Eastern 74% 84%

Multiracial 81%

White 79% Morelikely tocurrentlybeexperiencingserious • Morelikely tohaveexperiencedhomelessness • Morelikely tohaveattemptedsuicide(52%)than • this chapterwere: had oneormorenegativeexperiencesoutlinedin were outorperceivedastransgenderinK–12 and variety ofnegativeexperiences.Respondents who Poor treatmentinschoolwasassociatedwitha school staffthoughttheyweretransgender transgender inK–12 orbelievedclassmates,teachers, Table Morelikely tohaveeverworked inthe • One ormoreexperienceslisted Expelled fromschool thought theyweretransgender Sexually assaultedbecausepeople was sobad Left aschoolbecausethemistreatment thought theyweretransgender harshly becauseteachersorstaff Believe theyweredisciplinedmore thought theyweretransgender Physically attacked becausepeople bullies Disciplined forfightingbackagainst their genderidentityorexpression Not allowedtodressinawaythatfit thought theyweretransgender Verbally harassedbecausepeople Experiences out orperceivedastransgenderanddidnothave psychological distress(47%)thanthosewhowere experiences (22%). transgender anddidnothaveanyofthenegative (40%) thanthosewhowereoutorperceivedas experiences (37%). and didnothaveanyofthesenegative those whowereoutorperceivedastransgender any ofthenegativeexperiences(18%). out orperceivedastransgenderanddidnothave drug sales(28%),comparedwiththosewhowere underground economy, suchasinsexworkor any ofthenegativeexperiences(37%). 8.1: Experiencesofpeoplewhowereoutas % ofthosewhowere out orperceivedas transgender 20% 52% 54% 36% 24% 77% 13% 17% 6% EXPERIENCES AT SCHOOL 133

23% 28% White 31%

20% Multiracial

Trans women and men and women Trans Trans men Trans 36%

38%

Middle Eastern Middle

24%

Latino/a Trans women Trans

28%

16% Black Non-binary

17% Asian 26%

49% Crossdressers

24%

American Indian American Overall 24% Overall 5% 0% 0% 15% 10% 10% 35% 40% 30% 25% 20% 40% 30% 20% 50% 60% Figure 8.5: Physically attacked in K–12 because people in K–12 Figure 8.5: Physically attacked thought they were transgender (%) RACE/ETHNICITY Nearly one-quarter (24%) of (24%) of one-quarter Nearly out or perceived who were those in school were as transgender because of physically attacked being transgender. people because in K–12 attacked Figure 8.4: Physically thought they were transgender GENDER IDENTITY (%)

55% White

58% Multiracial

61%

Middle Eastern Middle

52% Latino/a

51% Black

53% Asian

69%

54% Indian American Overall 0% 10% 70% 40% 30% 80% 50% 20% 60% respondents were also more likely to have had respondents were also more likely (24%), white in contrast to Latino/a this experience, (23%), and Asian (17%) respondents (Figure 8.5). physically attacked than transgender men (20%) physically attacked and non-binary people (16%) (Figure 8.4). American Indian respondents (49%) were more than twice as and Middle to have been physically attacked, likely Eastern (36%), multiracial (31%), and Black (28%) b. Physical Attack b. Nearly one-quarter (24%) were physically attacked Transgender because of being transgender. to have been women (38%) were more likely Figure 8.3: Verbally harassed in K–12 because people harassed in K–12 Figure 8.3: Verbally thought they were transgender (%) RACE/ETHNICITY harassment differed among people of color, among people of color, harassment differed (69%) and Middle Eastern with American Indian have this to being more likely (61%) respondents Black (51%) (52%) and Latino/a and experience, 8.3). (Figure less likely respondents being a. Verbal Harassment a. Verbal or who were out half (54%) of people More than verbally were K–12 as transgender in perceived Verbal they were transgender. harassed because 134 2015 U.S. TRANSGENDER SURVEY CURRENT AGE (%) thought theyweretransgender Figure 8.7: SexuallyassaultedinK–12 becausepeople (Figure 8.7). respondents suchas25-to44-year-olds(16%) have beensexuallyassaulted(22%)thanyounger such as45-to64-year-oldsbeingmorelikely to in K–12 variedbyage, witholderrespondents Whether arespondentwassexuallyassaulted GENDER IDENTITY(%) thought theyweretransgender Figure 8.6: SexuallyassaultedinK–12 becausepeople non-binary people(10%)(Figure8.6). sexually assaultedthantransgendermen(9%)and crossdressers (18%)weremorelikely tohavebeen transgender. sexually assaultedinschoolbecausetheywere out orperceivedastransgenderinK–12 were Thirteen percent(13%)ofpeoplewhowere c. SexualAssault 20% 25% 20% 25% 10% 15% 10% 15% 0% 5% 0% 5%

Overall Overall 13% 13% Crossdressers 4 Transgender women(21%)and

18 to 24 18% 9% Non-binary 10%

25 to 44 Trans women 16% 21%

45 to 64 Trans men 22% Trans women and men 9%

65 and 23%

over 14% schools.” until Ifinallygaveuponpublic each timejustasbadthelast, change highschoolsthreetimes, continued, andIeventuallyhadto to intervene. Theharassment see ithappenandmake nomove classmates. Teachers wouldoften physically assaultedbymy “I wasconstantlybulliedand Voices In OurOwn gender.” students werebothered bymy out toeveryoneandnone ofthe uncomfortable, eventhough Iwas because I’dmake other students could notusethemen’s bathroom “In highschool,thestafftoldmeI happened tome.” has beenthebestthingtohave months. Gettingoutofthatschool twice overthecourseofthree It gotsobadthatItriedtokillmyself a lotmoreI’drathernotthinkabout. windows, insultedmeinclass,and shouted slursatmefromtheirdorm cars downtostareatme, they trans woman.People slowedtheir was harassedforbeingavisibly “Every singledayatcollege, I because Ididn’t feelsafe.” like busesandschoolbathrooms I hadtoavoidsocialinteractions Teachers weren’t thereordidn’t care. and paperairplanesofhatemail. “I’d gethitbysodacans,spitballs, EXPERIENCES AT SCHOOL 135 7%

Trans women and men and women Trans Trans men Trans

10% Trans women Trans

3% Non-binary

3% Crossdressers

6% Overall 4% 8% 2% 6% 0% 12% 10% underground economy (18%) were three times as underground economy (18%) were three to have been expelled from school. likely Expelled from school in K–12 Figure 8.10: GENDER IDENTITY (%) Seventeen percent (17%) percent Seventeen out or who were of people transgender in perceived as the left a school because K–12 was so bad. mistreatment from School Expelled e. people who were out or Six percent (6%) of from perceived as transgender were expelled nearly twice as women were school. Transgender to have been expelled, with one in ten (10%) likely Further, reporting that experience (Figure 8.10). in the respondents who were currently working

16% White 18%

21%

15% Multiracial

Trans women and men and women Trans

Trans men Trans

36%

22% Eastern Middle

16%

Latino/a Trans women Trans

22%

Black

15% Non-binary

11% Asian 12%

39% Crossdressers

17%

17% Indian American Overall Overall 5% 5% 0% 0% 15% 15% 10% 10% 45% 35% 25% 40% 30% 25% 20% 20% Figure 8.9: Left school due to mistreatment in K–12 Figure 8.9: Left (%) RACE/ETHNICITY respondents were more than twice as likely to as likely respondents were more than twice was have left a school because the mistreatment (21%) so bad, and Black (22%) and multiracial to have left a respondents were also more likely school for this reason (Figure 8.9). American Indian (39%) and Middle Eastern (36%) American Indian (39%) and Middle Eastern Figure 8.8: Left school due to mistreatment in K–12 school due to mistreatment in Figure 8.8: Left GENDER IDENTITY (%) women (22%) were more likely to have left a more likely women (22%) were mistreatment, in contrast to school because of (15%) and non-binary people transgender men (15%) (Figure 8.8). d. Left School Due to Harassment School Due d. Left or those who were out percent (17%) of Seventeen a school because as transgender left perceived so bad. Transgender the mistreatment was 136 2015 U.S. TRANSGENDER SURVEY transgender women(21%)were morelikely to who experiencedsomeform ofharassment, attended ahighereducation institution.Ofthose This represents2%ofallrespondents who school becausetheharassmentwassobad. of harassment,16%leftcollegeorvocational transgender andwhoexperiencedsomeform Of respondentswhowereoutorperceivedas RACE/ETHNICITY (%) college orvocationalschool Figure 8.11: Verbally, physically, orsexuallyharassedin were lesslikely (Figure8.11). (23%), Latino/a (23%),andAsian(22%)respondents likely tohavehadtheseexperiences,whilewhite and MiddleEastern(27%)respondentsweremore harassed. AmericanIndian(37%),Black(28%), transgender wereverbally, physically, orsexually or vocationalschoolthoughtknewtheywere that classmates,professors,orstaffatcollege one-quarter (24%)ofrespondentswhoindicated thought orknewtheyweretransgender. Nearly professors, orstaffatcollegevocationalschool vocational school,46%saidtheirclassmates, Of respondentswhohadattendedcollegeor or Vocational School Treatment inCollege III. Outnessand 20% 25% 30% 40% 35% 10% 15% 0% 5%

Overall

American Indian 24% 37%

Asian 22%

Black 28%

Latino/a 23% Middle Eastern 27%

Multiracial 25%

White 23% GENDER IDENTITY(%) harassment wassobad(ofthosewhowereharassed) Figure 8.12: Left collegeorvocationalschoolbecause report leavingschoolforthatreason(Figure8.13). multiracial (20%)respondentsweremorelikely to Indian (23%),Latino/a (23%),Black(21%),and of harassmentthanotherrespondents.American twice aslikely (31%)to have leftcollegebecause working intheundergroundeconomywerealmost people (12%)(Figure8.12). Respondents currently reason thantransgendermen(16%)andnon-binary have leftcollegeorvocationalschoolforthis other reasonsrelatedtobeing transgender. expelled orforcedout,and 5%leftbecauseof attended collegeorvocational schoolwere harassment wassobad,1% ofrespondentswho In additiontothe2%wholeftbecause *Sample sizetoolowtoreport RACE/ETHNICITY (%) harassment wassobad(ofthosewhowereharassed) Figure 8.13: Left collegeorvocationalschoolbecause 20% 25% 20% 25% 10% 15% 10% 15% 0% 5% 0% 5%

Overall American Indian 16% Overall 16%

Crossdressers 23% 8% Asian 9% Non-binary

Black 12% 21%

Trans women Latino/a Middle Eastern* 23% 21%

Trans men Multiracial Trans women and men 16% 20%

White 18% 13% EXPERIENCES AT SCHOOL 137

However, they also suggest that However, transgender. transgender. poor outcomes, such as higher rates of attempted poor outcomes, such as higher rates serious psychological homelessness, and suicide, were distress. Although negative experiences that older reported at all age groups, results found to have been out as individuals were less likely than younger respondents, transgender in K–12 to have but when out, they were more likely This experienced negative treatment in schools. improved indicates that school environments have though for transgender people over the years, even high rates of mistreatment were reported among younger respondents. results indicated that those who Additionally, attended college or another higher education institution were out or perceived as transgender at high rates. transgender students in such institutions are subject to harmful experiences that lead to negative outcomes, such as having to leave school to avoid being harassed because of being More than half (56%) of than half (56%) More least some who had at those who knew they classmates reported were transgender were that their classmates supportive. Conclusion indicated that the majority of those who Results in K–12 were out or perceived as transgender and that had one or more negative experiences, a variety of such experiences were correlated with

5 1% 4% 21% 35% 39% % of those who reported that all, most, or some of their classmates knew they were transgender Very unsupportive Very Very supportive Very Neither supportive nor unsupportive Unsupportive Level of support Level Supportive (Table 8.2). (Table level of support of them as a 8.2: Classmates’ Table transgender person supportive, neutral, or unsupportive classmates. supportive, classmates More than half (56%) reported that their 39% had classmates that were were supportive, and only 5% neither supportive nor unsupportive, reported that their classmates were unsupportive how supportive their classmates generally were of how supportive their classmates generally were them as a transgender person. Responses supportive” given on a five-point scale from “very The categories were to “very unsupportive.” collapsed to create a new variable reflecting (47%) said that none of their classmates knew that (47%) said that none of their classmates they were transgender. who currently had classmates and Respondents classmates reported that all, most, or some of their asked knew that they were transgender were knew that they were transgender. Of respondents transgender. knew that they were classmates, only 15% said who currently had knew that they were that all of their classmates 10% said that most of them knew, transgender, half and nearly 28% said that some of them knew, Classmates about being out to In addition to questions time while they were in school, classmates at any whether they currently asked respondents were whether those classmates had classmates, and IV. Current Outness Outness Current IV. of Support and 138 2015 U.S. TRANSGENDER SURVEY 2 1 ENDNOTES LGBT People Frazer, S.(2010). 17 lives ofgender-nonconformingyouth. Rankin, S.&Beemyn,G.(2012).Beyondabinary:The supports. outcomes forLGBT youthandtheroleofin-school The effectofnegativeschoolclimateonacademic J. G.,Palmer, N.A.,Kull, R.M.,&Greytak,E.A.(2013). NY: Gay, Lesbian &Straight EducationNetwork;Kosciw, Transgender Youth inOurNation’s Schools. The ExperiencesofLesbian, Gay, Bisexualand M. J. (2014). Kosciw, J. G.,Greytak,E.A.,Palmer, N.A.,&Boesen, (4), 2–10;Rankin, S.,Weber, G.,Blumenfeld,W., & Journal ofSchoolViolence, 12 |CHAPTER8:EXPERIENCESAT SCHOOL The 2013NationalSchoolClimateSurvey: . Charlotte, NC:CampusPride. 2010 State ofHigherEducationfor About Campus, (1), 45–63. New York, 5 4 3 4.12. collapsed intoasingle“unsupportive” category. SeeQ. unsupportive” and“unsupportive” categorieswere collapsed intoasingle“supportive” category. “Very “Very supportive” and“supportive” categorieswere were] trans.” unwanted sexualcontactbecausepeoplethought[they respondents wereasked iftheyhad“experienced This dataisderivedfromresponsestoQ. 26.4,where identified asapersonwithdisabilityin Q. 2.20. “People withdisabilities” here referstorespondentswho INCOME AND EMPLOYMENT STATUS 139 Notable differences in respondents’ experiences Notable differences in respondents’ 4 These disparities can lead to numerous negative outcomes 1 The questions were used to compare the income and employment experiences The questions were used to compare the income and employment experiences 2,3

igh rates of poverty, unemployment, and economic vulnerability among transgender people have unemployment, and economic vulnerability among transgender igh rates of poverty, been documented in prior research. employment The survey explored respondents’ in housing, health, and many other aspects of life.

in the United States. population. sample with those in the U.S. of the USTS the chapter. based on demographic and other characteristics are reported throughout status and income sources with questions that were patterned on the Current Population Survey (CPS), a Population status and income sources with questions that were patterned on the Current to assess economic indicators and the state of the labor force Statistics survey used by the Bureau of Labor Employment Status Income andIncome CHAPTER 9 CHAPTER H 140 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS contract. covered byaunionoremployee association of aunionorwerenotmembersbut workers intheU.S. populationwhoweremembers contract. Thiscomparesto12%ofwageandsalary covered byaunionoremployeeassociation an employerwerenotunionmembersbut while another2%ofthosewhowereworkingfor to aunion(representing6%ofthefullsample), a laborunionoranemployeeassociationsimilar part timeforanemployer, 13% weremembersof Of thosewhowereworkingeitherfulltimeor currently lookingforworkthatisnotcriminalized. income. Ofthese, 60%indicatedthattheywere other workintheundergroundeconomyfor employed doingsexwork,sellingdrugs,or Two percent(2%)ofrespondentswerecurrently which represents4%ofthewholesample. working morethanonefull-timeorpart-timejob, percent (9%)ofthosewhowereemployed employed, and11%werestudents(Table 9.1). Nine had atleastonepart-timejob, 15%wereself- one-third (35%)currentlyhadafull-timejob, 15% about theircurrentemploymentstatus.Morethan Respondents wereasked aseriesofquestions I. EmploymentStatus $9,999, threetimeshigherthantheU.S. adultpopulationinthisincomebracket (4%). One ineight(12%)respondentsreportedanannualhousehold incomebetween$1and the U.S. adultpopulation(12%). Nearly one-third(29%)ofrespondentswerelivinginpoverty, morethantwicetheratein unemployment rateatthetimeofsurvey(5%). The unemploymentrateamongrespondentswas15%,threetimeshigherthantheU.S. 6 5

Table the samemanner. Theunemployment rate for respondents reportedhere wascalculatedin comparison, theunemployment rateforUSTS to beoutofthelaborforce. Forthepurposesof not lookingforwork,sincetheyareconsidered It doesnotincludethosewhoareunemployedbut those whoareunemployedbutlookingforwork. This includespeoplewhoareemployedand only thosewhoarecurrently“inthelaborforce.” the BureauofLabor Statistics, iscalculatedoutof The nationalunemploymentrate, asreportedby Employment status Not listedabove criminalized drugs, orotherworkcurrently Work forpayfromsexwork,selling Homemaker orfull-timeparent looking forwork Unemployed andhavestopped Unemployed butlookingforwork Student Not employedduetodisability Retired (not includingundergroundeconomy) profession ortrade, oroperateafarm Self-employed inownbusiness, Work parttimeforanemployer Work fulltimeforanemployer 9.1: Currentemploymentstatus %ofrespondents (supplemental weight) 35% 15% 15% 14% 13% 11% 11% 5% 2% 4% 3% INCOME AND EMPLOYMENT STATUS 141 -- -- 1% 1% 1% 7% 3% 2% 2% 2% 13% 61% 67% 25% adult (CPS) % in U.S. population 1% 1% 7% 3% 4% 4% 2% 2% 9% 13% 18% 12% 57% 25% weight) % in USTS (supplemental

9.2: Current sources of income 9.2: TANF) or other public cash assistance TANF) program (not including SNAP or WIC) Unemployment benefits Child support or alimony compensation or other Workers’ disability Income not listed above Income source and/or partner’s from respondent’s Pay full-time or part-time job Self-employment income from own or farmbusiness, profession or trade, (not including underground economy) Social Security retirement, railroad or Social Securityretirement income, disability benefits (SSDI) Private pension, government employee pension, or other retirement income Income from dividends, estates or savings,trusts, royalties, rental income, or bonds Supplemental Security Income (SSI) contributions from people not Regular living in household disability benefits and other Veterans veterans benefits from sex work, selling drugs, or Pay other work currently criminalized Cash assistance from welfare (such as (ages 25 and older only) II. Sources of Income Income of II. Sources Assistance and about their income were asked Respondents reported a wide range of sources. sources, and they to the U.S. sample the USTS In order to compare presented data the USTS population in the CPS, is limited to respondents ages 25 and 9.2 in Table to findings from the CPS, Compared older only. the sources of income differed from respondents’ For instance, population in several categories. U.S. respondents aged 25 and older 57% of USTS spouse’s had income from their own and/or their aged 25 employment, compared to 67% of adults 9.2). population (Table and older in the U.S. Table

4% 7 10

12% White 9% (24%) 8 22%

9 Multiracial 35%

7% Middle Eastern* Middle

21% Latino/a

10% 20% Black

4% 10% Asian 12% 23% % in USTS (supplemental survey weight applied) % in USTS population (ACS) % in U.S.

5% American Indian American

15% Overall 5% 0% 15% 10% 35% 40% 30% 25% 20% *U.S. population data for Middle Eastern people alone is not available. See note 10. data for Middle Eastern people alone is not available. population *U.S. people in the U.S. population (Figure 9.1). population people in the U.S. rate Unemployment Figure 9.1: (%) RACE/ETHNICITY American Indian (23%), multiracial (22%), Latino/a Latino/a American Indian (23%), multiracial (22%), being more (21%), and Black (20%) respondents to be unemployed. Unemployment rates likely and Black USTS among Asian, multiracial, Latino/a, three times respondents were between two and and Black multiracial, higher than Asian, Latino/a, unemployment rate at the time of the survey (5%). unemployment rate of undocumented residents Nearly one-half (49%) The unemployment rate was were unemployed. also higher among people with disabilities with Middle Eastern (35%), and people of color, rate in the U.S. population. population. U.S. rate in the 15%, three times the U.S. respondents was USTS The unemployment rate for rate for The unemployment was 15%, respondents USTS the unemployment three times 142 2015 U.S. TRANSGENDER SURVEY the rateinU.S. population(4%). household income between$1and$9,999 peryear, threetimes One ineight(12%) respondentsreportedthatthey hada SNAP and/orWICassistance(Figure9.2). (18%) respondentswerealsomorelikely toreceive Black (23%),AmericanIndian(19%),andLatino/a WIC assistance. People with disabilities (29%),and respondents livingwithHIVreceivedSNAPand/or (SNAP) receiving assistancethroughfoodstamps Fifteen percent(15%)ofrespondentsreported multiple sources Table criminalized (Table 9.3). work, drugsales,orotherworkthatiscurrently from undergroundeconomywork,includingsex reported thattheirsolesourceofincomewas benefits orcashassistanceprograms,and1% 1% receivedtheironlyincomefromunemployment Supplemental SecurityIncome(SSI)ordisability, (9%) reportedthattheirsolesourceofincomewas or theirpartner’s employment.Nearlyoneinten source ofincomewasfromtheirownemployment Thirty-seven percent(37%)reportedthattheirsole reported havingmultiplesourcesofincome. sources. Nearlyone-half(45%)ofallrespondents respondents hadonesourceofincomeormultiple Responses wereexaminedtodeterminewhether Multiple sources assistance only Unemployment benefits/cash criminalized only or otherworkthatiscurrently Pay fromsexwork,sellingdrugs, Other sourcesonly Pension/retirement only SSI/disability only employment, orself-employment) employment, partner/spouse’s Employment only(fromtheirown Income source 9.3: Currentsourcesofincomebysingleand 11 and/orWIC. 12 Forty-onepercent(41%)of % ofrespondents (supplemental weight) 45% 37% 9% 3% 3% 1% 1% Household Income III. Individualand RACE/ETHNICITY (%) Figure 9.2: CurrentlyreceiveSNAPorWICassistance in theU.S. adultpopulation(Figure9.3). between $1and$9,999 peryear, compared to15% respondents reportedthattheyhadanincome adult population. individual income, comparedto10%intheU.S. 8% ofrespondentsreportedthattheyhadno When asked abouttheir a. IndividualIncome this chapterfocusesonhouseholdincome. poverty rates.Mostoftheanalysisandreportingin the U.S. populationasawhole, aswellhigher figures. Theyreportedlowerincomesoverallthan survey forwhichtheycouldprovideannualincome year 2014,whichwasthelastfullpriorto individual Respondents alsoreceivedquestionsabouttheir and Poverty 20% 25% 10% 15% 0% 5%

Overall

American Indian 15% 13 andhousehold 19%

15,16 Asian 5% Nearlyone-quarter(22%)of

Black 23% individual 14

incomesfromthe Latino/a

Middle Eastern 18% income, 8%

Multiracial 17 17%

White 13% INCOME AND EMPLOYMENT STATUS 143 could get it. I have over 20 years of experience in my field, yet I cannot even land a part-time retail position.” benefits because I know that I will benefits because I know that the be discriminated against. I’m on brink of being homeless and my even reached out own family hasn’t to help me.” “I have had to live my life with no safety net or resources, and hard. I’m constantly battling it’s homelessness, I rarely get hired and visibly because I’m mixed I end up having to rely and queer, on government assistance and friends with available couches.” “In the nearly seven years since I transitioned, I have been unemployed, surviving off the and charity of friends and family, government assistance when I In Our Own Own In Our Voices out as transgender “The day I came Since go. at work, I was let has been transitioning, employment a 95% reduction in difficult, with earnings.” “I quit after seven months of I unbearable working conditions. afloat have been struggling to keep I’m afraid of going to financially. apply for unemployment or SNAP 8%

9% 18% more or $100,000 15% income, income,

25% $50,000 to $99,999 to $50,000 21% household

24% $25,000 to $49,999 to $25,000 25% Respondents were nearly twice Respondents

15%

19 $10,000 to $24,999 to $10,000

22% $1 to $9,999 to $1 10% % in USTS (supplemental weight) % in USTS population (CPS) adult % in U.S. 8% Additionally, one in eight (12%) respondents Additionally,

18 No income No 5% 0% 15% 10% 30% 25% 20% Figure 9.3: Individual income in 2014 Individual Figure 9.3: $50,000 to $100,000 (23%) than those in the U.S. (23%) than those in the U.S. to $100,000 $50,000 adult population (31%). (4%) (Figure 9.4). of only to have a household income as likely to $24,999 (22%) as those in the U.S. $10,000 respondents adult population (12%). Furthermore, to have household incomes of were less likely those with no income in the U.S. adult population those with no income in the U.S. (12%). reported earning an annual household income which was three times as between $1 and $9,999, adult population many when compared to the U.S. b. Household Income b. 4% of respondents to household income, Turning reported that they had no which was four times higher than the rate of rate in the U.S. population (12%). population rate in the U.S. Nearly one-third (29%) of one-third Nearly living in were respondents than twice the more poverty, 144 2015 U.S. TRANSGENDER SURVEY (Figure 9.5). household incomebetween$1and$9,999 (16%) respondents,werealsomorelikely tohavea Black (19%),Latino/a (18%),andAmericanIndian living withHIV(19%)andpeopleofcolor, including twice aslikely astheoverallsample, andthose sample. People withdisabilities(21%)werenearly income, nearlythreetimestherateofoverall sources ofincomereportedthislowhousehold underground economyandalsohadadditional (31%) ofthosewhowerecurrentlyworkinginthe the rateinoverallsample. Nearlyone-third $1 and$9,999 peryear, morethanfourtimes economy hadahouseholdincomebetween source ofincomewasfromtheunderground More thanhalf(53%)ofrespondentswhosesole Figure 9.4: Householdincomein2014 20% 25% 30% 35% 10% 15% 0% 5%

No income 4% % inU.S. adultpopulation(CPS) % inUSTS (supplementalweight) 1% $1 to $9,999 12% $10,000 to $24,999 4% 22% $25,000 to $49,999 12% 24% $50,000 to $99,999 21% 23%

$100,000 or more 31%

15% 31% RACE/ETHNICITY (%) Figure 9.5: Householdincomefrom$1to$9,999 were mostlikely tobelivinginpoverty(Figure9.6). multiracial (40%),andBlack(38%)respondents of color, Latino/a (43%),AmericanIndian(41%), more likely tobelivinginpoverty. Amongpeople (51%) andpeoplewithdisabilities(45%)werealso were livinginpoverty. Respondents livingwithHIV currently workingintheundergroundeconomy residents andnearlytwo-thirds(62%)ofthose More thantwo-thirds(69%)ofundocumented time ofthesurvey(12%). living inpovertytheU.S. adultpopulationatthe in poverty, Nearly one-third(29%)ofrespondentswereliving c. Poverty 20% 10% 16% 12% 18% 14% 0% 6% 2% 8% 4%

Overall

American Indian 12% 20 morethantwicetherateofpeople 16%

Asian 15%

Black 21 19%

Latino/a

Middle Eastern 18% 8%

Multiracial 10%

White 9% INCOME AND EMPLOYMENT STATUS 145 chapter. Portrait of Portrait Available at: Available and Union Affiliation Union Affiliation The Employment Methodology at: http://www.bls.gov/news.

The Employment Situation— Available at: http://www.bls.gov/ Available chapters for more information about Available Therefore, the comparison to the USTS sample should be to the USTS the comparison Therefore, interpreted with caution. (2015). Statistics. Bureau of Labor 2015. Situation—August news.release/archives/empsit_09042015.pdf; Bureau (2015). Statistics. of Labor September 2015. The national release/archives/empsit_10022015.pdf. and September 2015, as unemployment rate for August includes those Statistics, published by the Bureau of Labor order to provide a more accurate comparison to the U.S. to the U.S. order to provide a more accurate comparison general population. See the Respondents USTS the supplemental survey weight. other Experiences of respondents with sex work and in the underground economy work are discussed further and Other Underground Economy Work Sex Work (2016). Statistics. Bureau of Labor by Selected Workers and Salary of Employed Wage Characteristics, 2014–2015 Annual Averages. http://www.bls.gov/news.release/union2.t01.htm#union_ who are The percentage of people in the U.S. a01.f.1. members of a union or covered by a union or employee population association contract includes those in the U.S. in contrast to the USTS who are 16 years of age and older, which includes respondents who are 18 and older. sample, Conclusion faced higher indicate that respondents The results and poverty compared to levels of unemployment three times adult population. They were the U.S. adult population to be than the U.S. more likely to be living than twice as likely unemployed, more to more than three times as likely and in poverty, income below $10,000. have an annual household people undocumented residents, of color, People respondents living with HIV with disabilities, and being unemployed, to report were more likely and having low incomes, which living in poverty, experienced indicate that these respondents have substantial economic instability. 7 5 6

24% White . (p. . (p. 40%

chapter. Multiracial Sex Work and Sex Work Military Service 34%

and Middle Eastern Middle

43% Latino/a

Available at: http://www.lgbtmap. Available 38% Black Injustice at Every Turn: A Report A Report Injustice at Every Turn:

32% Asian Employment and the Workplace

| CHAPTER 9: INCOME AND EMPLOYMENT STATUS | CHAPTER 9: INCOME AND EMPLOYMENT

41%

29% Indian American Overall income and employment have been weighted with a supplemental survey weight to reflect the age and population in addition educational attainment of the U.S. sample differs to the standard survey weight. The USTS population in regard to age and substantially from the U.S. this additional weight educational attainment. Therefore, is applied to all percentages reported in this chapter in fields of work are discussed further in the Other Underground Economy Work chapters. Experiences in employment settings, such being are discussed in more fired or harassed in the workplace, detail in the findings regarding respondents’ Throughout this chapter, Transgender in America. Transgender org/file/paying-an-unfair-price-transgender.pdf. (2015). Statistics. Census Bureau & Bureau of Labor U.S Survey (CPS). Current Population This chapter provides an overview of respondents’ income and employment status. Experiences in specific Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. Herman, J. Harrison, J., J., Mottet, L. A., Tanis, M., Grant, J. M. (2011). L., & Keisling, Discrimination Survey of the National Transgender & Equality 22). DC: National Center for Transgender Center for American Force; Task National Gay and Lesbian (2015). Progress & Movement Advancement Project. for Being an Unfair Price: The Financial Penalty Paying 5% 0% 15% 10% 45% 35% 40% 30% 25% 20% 50% Figure 9.6: Living in poverty Living Figure 9.6: (%) RACE/ETHNICITY 4 2 3 1 ENDNOTES ENDNOTES 146 2015 U.S. TRANSGENDER SURVEY 13 12 11 10 9 8 stamps (SNAP)orWICasincome.” received in2014.Donotincludeassistance fromfood payments, andothermoneyincome thatyoupersonally employment, pensions,dividends,interest,socialsecurity business, incomefromfarmsorrentals,self- includes moneyfromjobs,employment,netincome describing individualincome:“‘Individualincome’ See Q. 7.12. Respondents receivedthefollowing note healthy food.” WICbenefitsarenotconsideredincome. and childrenlessthanfiveyearsoldgethealthcare program tohelpwomenwhoarepregnantorbreastfeeding Program forWomen, Infants,andChildren. WICisafederal It’s theshortnameforSpecialSupplementalNutrition for WIC:“‘WIC’stands‘Women, Infants, andChildren.’ See Q. 7.10. Respondents receivedthefollowingdefinition considered income. buy food,usuallywithanEBT card.” SNAPbenefitsarenot program. Ithelpspeoplewhohavelowornoincometo Program (SNAP)issometimescalledtheFoodStamp for SNAP:“TheSupplementalNutritionAssistance See Q. 7.10. Respondents receivedthefollowingdefinition are includedintheCPSpercentageforthiscategory. therefore MiddleEasternrespondentsintheU.S. population and whitepeopleinasingle“white/Caucasian” category, CPS datacombinespeopleofMiddleEasterndescent comparisons shouldbeinterpretedaccordingly. have existedatthetimeofsurvey. Therefore, these smaller differencesintheunemploymentratethanwould by raceandethnicityasreportedherelikely reflects ethnicity totheunemploymentrateforUSTS respondents comparison ofthenationalunemploymentratebyraceand the highernationalunemploymentrateinMarch2015, at http://data.bls.gov/timeseries/LNS14000000). Given available throughtheBureauofLabor Statistics, available in thisreport(seetheunemploymentratetimeseriestable survey (5.1% inAugust andSeptember2015),asoutlined rate washigherthanthenationalattimeof rate was5.5%.ThisMarch2015nationalunemployment Supplement, inwhichtheoverallU.S. unemployment Current Population SurveyAnnualSocialandEconomic CPS Table CreatordatautilizesfromtheMarch2015 (http://www.census.gov/cps/data/cpstablecreator.html). team usingCPSdataavailableviatheTable Creator adults intheU.S. populationwascalculatedbytheresearch The unemploymentratebyraceandethnicityamong identified asapersonwithdisabilityin Q. 2.20. “People withdisabilities” herereferstorespondentswho sample shouldbeinterpretedwithcaution. unemployment rateandtheUSTS unemploymentrate older. Therefore, thecomparisonbetweennational The USTS sampleincludesrespondentswhoare18and in theU.S. populationwhoare16yearsofageandolder. 16 15 14 21 20 19 18 17 income earners. are generallypresentedseparatelyfromthoseoflow- the experiencesofthosewhoreportnohouseholdincome experiences byincomelevelarehighlightedinthisreport, to beoutofthelaborforce. Therefore, whendifferencesin between $1and$9,999. Forexample, theyaremorelikely low-income earners,suchasthosewhoearnanincome CPS areagroupwithcharacteristicsthatdistinctfrom Those whoreporthaving“noincome” intheUSTS and Current Population Survey(CPS). (SNAP) orWICasincome.” older in2014.Donotincludeassistancefromfoodstamps and membersofyourhouseholdwhoare15yearsageor payments, andanyothermoneyincomereceivedbyyou employment, pensions,dividends,interest,socialsecurity business, incomefromfarmsorrentals,self- includes moneyfromjobs,employment,netincome have livedwithyouduringthepast12monthsand includes youandallmembersofyourhouseholdwho describing householdincome:“‘Householdincome’ See Q. 7.14. Respondents receivedthefollowingnote team. 256.pdf. Calculationswerecompletedby theresearch content/dam/Census/library/publications/2016/demo/p60- Census Bureau.Available at:https://www.census.gov/ and Poverty intheUnitedStates: 2015 Proctor, B.D., Semega,J. L.,&Kollar, M.A.(2016). or nearthepovertyline. who are“livinginpoverty”representthoselivingat of comparisontotheU.S. adultpopulation.Respondents fell below125%oftheofficialpovertymeasureforpurposes respondents asinornearpovertyiftheirtotalfamilyincome The incomerangesintheUSTS allowedfordesignationof gov/hhes/www/poverty/about/overview/measure.html. Census Bureau,whichcanbefoundat:https://www.census. using theofficialpovertymeasure, asdefinedbythe U.S. The researchteamcalculatedtheUSTS povertymeasure Current Population Survey(CPS). Current Population Survey(CPS). Current Population Survey(CPS). See note2. See note2. See note2. See note2. . (p. 13).DC:U.S. Income Income EMPLOYMENT AND THE WORKPLACE 147

had to take had to take

In addition to being fired, forced 1

ccess to employment is critical to people’s ability to support themselves and their families. Prior ccess to employment is critical to people’s harassment, and research has shown that transgender people face pervasive mistreatment, discrimination in the workplace and during the hiring process.

A out of their jobs, or not hired for jobs because of their gender identity or expression, transgender people out of their jobs, or not hired for jobs because of their gender identity or as being verbally harassed, being are also often subject to additional forms of mistreatment at work, such at work. jobs, or being physically attacked their forced to present as the wrong gender in order to keep including whether they had been fired, denied a promotion, or not hired because of being transgender, because of being transgender, including whether they had been fired, denied a promotion, or not hired and whether they whether they had been harassed or faced other forms of mistreatment, transition. Throughout the chapter, actions to avoid mistreatment, such as quitting their job or delaying their and other characteristics are experiences based on demographic notable differences in respondents’ reported. Respondents were asked about being out in the workplace and the level of support they received from about being out in the workplace and the level of support they received asked were Respondents person, how they were treated in the workplace as a transgender They were also asked coworkers.

the Workplace CHAPTER 10 CHAPTER andEmployment 148 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS none oftheirbossesorsupervisors knewthatthey were transgender. Nearlyhalf(49%)reported that knew, and10%indicated thatsomeknewthey they weretransgender, 6%reported thatmost all oftheircurrentbossesorsupervisorsknew currently hadbossesorsupervisors,35%saidthat knew theyweretransgender. Of respondentswho bosses orsupervisorsandtheircurrentcoworkers Respondents wereasked whethertheircurrent Workplace Support inthe I. Outnessand In thepastyear, 27%ofthosewhoheldorappliedforajobreported beingfired,denied related totheirgenderidentityorexpression,suchasbeingharassedattacked. denied apromotion,orexperiencingsomeotherformofmistreatmentintheworkplace Thirty percent(30%)ofrespondentswhohadajobinthepastyearreportedbeingfired, least onejobbecauseoftheirgenderidentityorexpression. Sixteen percent(16%)ofrespondentswhohaveeverbeenemployedreportedlosingat transition orquittingtheirjob. steps toavoidmistreatmentintheworkplace, suchashidingordelayingtheirgender More thanthree-quarters(77%)ofrespondentswhohad ajobinthepastyeartook status withotherswithoutpermission. or havingemployerscoworkers shareprivateinformationabouttheirtransgender being toldbytheiremployertopresentasthewronggender inordertokeep theirjob of mistreatmentbasedontheirgenderidentityorexpression duringthatyear, such as Nearly one-quarter(23%)ofthosewhohadajobinthepast yearreportedotherforms gender identityorexpression. harassed, physicallyattacked, and/orsexuallyassaultedatworkbecauseoftheir Fifteen percent(15%)ofrespondentswhohadajobinthepastyearwereverbally expression. a promotion,ornothiredforjobtheyappliedbecauseoftheirgenderidentity were providedonafive-point scalefrom“very of themasatransgenderperson. how supportivetheircoworkers generallywere knew thattheyweretransgender wereasked reported thatall,most,orsomeoftheircoworkers Respondents whocurrentlyhadcoworkers and coworkers knewthattheyweretransgender. two percent(42%)indicatedthatnoneoftheir coworkers knewtheyweretransgender. Forty- coworkers knew, and24%saidthatsomeoftheir were transgender, 11%reportedthatmostoftheir reported thatalloftheircoworkers knewthey had coworkers, lessthanone-quarter(23%) were transgender. Ofrespondentswhocurrently 3 Responses EMPLOYMENT AND THE WORKPLACE 149

7% 7% 3% 4% 2%

6 53% White 16% 32% been

who have employed

56% % of those Multiracial 44% 7% 2% 5% 5% 13% 13% 61%

30%

Middle Eastern Middle lost job 50% Latino/a % of those

60% Black who have ever

38% Asian 66% (59%) were also more likely to have also more likely (59%) were

53% Indian American Overall reasons for losing a job Reported 10.1: 0% 10% for losing job Reason Age Disability Income level or education Gender identity or expression or ethnicity Race or spirituality Religion Sexual orientation None of the above 70% 40% 30% 20% 50% 60% One in six (16%) respondents who have been employed reported that they had lost a job because of their gender identity or expression. This represents 13% of the overall sample. Respondents who had lost a job at some point in Respondents what they believed the their lifetime were asked they selected reasons were for that treatment, and race as age, one or more reasons from a list, such and gender identity or expression or ethnicity, 10.1). (Table Table Indian (66%) and Black (60%) respondents (Figure respondents (Figure and Black (60%) Indian (66%) and people with women (66%), transgender 10.2), disabilities a job. ever lost Ever lost job for any reason Figure 10.2: (%) RACE/ETHNICITY

32% Very Very 1% supportive Very unsupportive Very

36%

Supportive said that all, transgender % of those who 2% their coworkers their coworkers knew they were most, or some of Unsupportive

Those respondents were asked whether Those respondents were asked 4 un- nor 29% Neither supportive supportive were living with HIV (78%) and those who have to have done sex work (73%) were more likely American lost a job at some point in their lifetime. believed this happened. Overall, more than half (53%) of respondents who had ever held a job experienced a loss of who employment for any reason. Respondents worked at a job or business at some point in their at a job or business at some point worked lifetime. they had ever experienced a loss of employment, being fired, being laid off, including losing a job, or being forced to resign, and the reasons they II. Loss of II. Loss Employment During Lifetime Eighty-one percent (81%) of respondents had unsupportive, and only 3% had unsupportive and unsupportive, (Figure 10.1). coworkers of support Level Figure 10.1: supportive” to “very unsupportive.” More than More unsupportive.” to “very supportive” reported (68%) of these respondents two-thirds 29% had were supportive, coworkers that their supportive nor who were neither coworkers 150 2015 U.S. TRANSGENDER SURVEY expression. or beingfiredduring thatyearbecauseoftheirgender identityor in thepastyearreported notbeinghired,denied apromotion, More thanone-quarter (27%)ofthosewhoheldorapplied forajob GENDER IDENTITY(%) Figure 10.4: Everlostjobbecauseofbeingtransgender RACE/ETHNICITY (%) Figure 10.3: Everlostjobbecauseofbeingtransgender gender identityorexpression(Figure10.4). people (7%)tohavelostajobbecauseoftheir likely thantransgendermen(14%)andnon-binary transgender. Transgender women(18%)weremore with HIV(26%)havelostajobbecauseofbeing done sexwork(27%)andrespondentsliving More thanone-quarterofrespondentswhohave their genderidentityorexpression(Figure10.3). the overallsampletohavelostajobbecauseof Black (17%)respondentsweremorelikely than American Indian(21%),multiracial(18%),and 20% 20% 25% 10% 16% 15% 12% 0% 0% 5% 8% 4%

Overall Overall

American Indian 13% 13%

Crossdressers 21% 3% Asian 8% Non-binary

7% Black 17%

Trans women Latino/a Middle Eastern 11% 18%

Trans men 14% Trans women and men

14% Multiracial 18%

16% White 12% Respondents currentlyworkingintheunderground applied for, and/ordeniedapromotion(Table 10.2). to resignfromajob, nothiredforajobthatthey past yearreportedthattheywerefiredorforced respondents whoheldorappliedforajobinthe Overall, approximately two-thirds(67%)of promotions inthepastyear. negative experiencesrelatedtofiring,hiring,and Those respondentswereasked iftheyhad held and/orappliedforajobinthepastyear. Seventy percent(70%)ofrespondentshad Past Year Promotions inthe III. Firing,Hiring,and any reasoninthepastyear Table 10.2: Fired,nothired,ordeniedapromotionfor (64%) respondents(Figure10.5). in contrasttowhite(63%)andAmericanIndian one ormoreoftheseexperiencesinthepastyear, respondents werealsomorelikely tohave had past year. Black(75%)andMiddleEastern(74%) have hadoneormoreoftheseexperiencesinthe people withdisabilities(75%)weremorelikely to work thatiscurrentlycriminalized(78%),and economy, suchassexwork,drugsales,orother listed One ormoreexperiences Fired orforcedtoresign Denied apromotion applied for Not hiredforajobthey Occurrence inthepastyear

% ofthosewhoheldor applied forjob 67% 61% 12% 13% EMPLOYMENT AND THE WORKPLACE 151 identity is respected consistently, identity is respected consistently, have to constantly where I don’t has fight for myself or hide myself, improved my quality of life more than any other aspect of my transition.” sent a mass email to everyone in the sent a mass email to everyone my trans office ‘warning’ them about bathroom status. I used the women’s the since starting, but a month in to I was called to my manager’s job, use office and told that I could not not bathroom. I did the women’s bathroom, so I feel safe in the men’s to city told the HR manager that due I could not be denied access to law, the bathroom matching my gender I was fired the next day for identity. no given reason.” “I changed jobs from a high-paying one where I was not comfortable being out as a trans person to a much lower-paying one where I felt that my identity would be respected. Having a job where my gender In Our Own Own In Our Voices gossip about would “Coworkers my trans status me as news about I was the workplace. spread through differently once treated significantly me being trans. people heard about had the right to felt they Coworkers the owners disrespect me because a spectacle in I became set the tone. my own workplace.” HR “The day before I started work, 2% 6% 6% 14% 15% 10% 40% 43% fired)

63% White being fired (% of those Reasons for Reasons 71%

3% 9% Multiracial 13% 14% 16% 16% 33% 49% 74% denied denied Reasons Reasons for being

promotion

promotion) (% of those

Middle Eastern Middle

72% Latino/a 1% 7% 11% 41% 21% 21% 10% 39%

75% Black being hired) for not Reasons Reasons those not hired (% of

68% Asian

64%

67% Indian American Overall being reasons for not being hired, Reported 10.3: 0% 10% Religion or Religion spirituality Sexual orientation None of the above Disability Income level or education Gender identity or expression or ethnicity Race Reported reasons Reported for negative experience in the past year Age 70% 40% 30% 80% 50% 20% 60% being fired from a job in the past year because of their being fired from a job in the past year gender identity or expression. Table past year denied a promotion, or being fired in the a job that they applied for, or were denied a promotion or a job that they applied for, identity or believed that it was due to their gender This means that 27% of all of 10.3). expression (Table in the past year (or those who held or applied for a job not being hired for 19% of the overall sample) reported denied a promotion, or being a job they applied for, Respondents who reported these experiences were who reported these experiences were Respondents what they believed the reasons were for that asked respondents who treatment. Forty-one percent (41%) of not hired for a job, were fired or forced to resign from Figure 10.5: Fired, not hired, or denied a promotion for hired, or denied Fired, not Figure 10.5: in the past year any reason (%) RACE/ETHNICITY 152 2015 U.S. TRANSGENDER SURVEY because oftheirgenderidentityorexpression Table nondiscrimination laws(Table 10.5). the agencythatenforcesfederalemployment Employment OpportunityCommission(EEOC), filed complaintsdidsowiththefederalEqual department. One-third(33%)ofrespondentswho their employer’s humanresourcesorpersonnel (53%) reportedthattheyfiledacomplaintwith were asked wherethey filedit.Morethanhalf (Table 10.4). Respondents whofiledacomplaint action inresponse, 14%filedanofficialcomplaint of theserespondentsdidnottake anyformal responded. Whilemorethantwo-thirds(69%) identity orexpressionwereasked howthey fired inthepastyearbecauseoftheirgender Respondents whoreportedthattheyhadbeen Transgender Status to FiringDue IV. Responses Not listedabove representative They contactedtheirunion group transgender, LGBT, orother They contacteda complaint (seeTable 10.5) They madeanofficial Table 10.6) They contactedalawyer(see They didnothing Response tobeingfired 10.4: Response tobeingfiredinthepastyear of theirgenderidentityor % ofthosefiredbecause expression 69% 10% 15% 14% 2% 7% These respondentswereasked whathappened expression respondedbycontactingalawyer. the pastyearbecauseoftheirgenderidentityor Fifteen percent(15%)ofthosewhowerefiredin official complaint Table contacted alawyer Table any action(10%)(Table 10.6). their employer(10%),oradvisedthemnottotake official complaint(14%),calledorwrotealetterto lawyer filedalawsuit(21%),helpedthemfilean the lawyer. Otherrespondentsreportedthatthe (29%) reportedthattheywerenotabletohire after theycontactedthelawyer. Nearlyone-third Not listedabove Supervisor ormanager commission Local orstatehumanrights Opportunity (EEO)office Employer’s EqualEmployment Commission (EEOC) Equal EmploymentOpportunity personnel department Employer’s humanresourcesor Place complaintwasfiled Not listedabove up (write-inresponse) Lawyer didnothingornotfollow action (write-inresponse) Lawyer advisedthemtotake no employer Lawyer calledorwrotealetterto official complaint Lawyer helpedthemtofilean Lawyer filedalawsuit lawyer They werenotabletohirethe Outcome ofcontactinglawyer 10.5: Location whererespondentmadean 10.6: Assistanceprovidedtothosewho % ofthosewhofiledan contacted alawyer official complaint % ofthosewho 26% 53% 33% 18% 17% 29% 9% 10% 10% 21% 14% 9% 7%

EMPLOYMENT AND THE WORKPLACE 153

that they were not allowed to use the restroom 10.7). consistent with their gender identity (Table in the Past Year in the Past boss, if their employer, were asked Respondents the took other negative actions in or coworkers status, past year because of their transgender wrong such as telling them to present as the them their jobs, removing gender in order to keep private from direct contact with clients, or sharing information. who Nearly one-quarter (23%) of respondents that they held a job in the past year reported in the experienced one or more of those actions past year because of their transgender status. One in six (16%) said that, because they were shared personal a boss or coworker transgender, information about them that should not have been shared. Six percent (6%) said that their boss gave them a negative review because they were 4% were told to present in the wrong transgender, and 4% said their job, gender in order to keep to be verbally harassed at work in the past year, in the past year, harassed at work to be verbally that others can with those who said compared they or never (10%) tell (19%) and rarely sometimes are transgender. respondents were physically One percent (1%) of the past year because they at work in attacked among with higher numbers were transgender, were currently working in the respondents who (4%). underground economy that they were sexually One percent (1%) reported in the past year because they assaulted at work Asian (4%) and American Indian were transgender. (2%) (2%) respondents and transgender women report this experience. were more likely Other Mistreatment b.

15% White

18% Multiracial

26%

15% Eastern Middle Latino/a

15% Black

13% Asian

28%

15% Indian American Overall 5% 0% 15% 10% 30% 25% 20% who said that others can always or usually tell that they are transgender (23%) were more likely Fourteen percent (14%) of those who held a job in the past year were verbally harassed at work Respondents because they were transgender. were more likely to report one or more of those to report one or more of those were more likely 10.6). experiences in the past year (Figure harassed, physically attacked, Verbally Figure 10.6: year or sexually assaulted at work in the past (%) RACE/ETHNICITY a job during that year were verbally harassed, a job during that year were verbally and/or sexually assaulted physically attacked, status. at work because of their transgender currently working in the underground Respondents economy (34%), American Indian respondents (26%) (28%), and Middle Eastern respondents a. Verbal Harassment, Physical Harassment, a. Verbal and Sexual Assault Attack, 15% of respondents who had held In the past year, in the Past Year in the Past past year were who held a job in the Respondents about other forms a series of questions asked the workplace that happened of mistreatment in transgender. because they were V. Other Forms Forms Other V. of Mistreatment 154 2015 U.S. TRANSGENDER SURVEY to avoiddiscrimination. their job, ortookotheractions gender identityatwork,quit a jobinthepastyearhidtheir (77%) ofrespondentswhohad More thanthree-quarters actions toavoiddiscrimination(Table 10.8). More thanthree-quarters(77%)tookoneormore delaying theirtransition,andquittingjob. past year, includinghidingtheirgenderidentity, took inordertoavoiddiscriminationatworkthe also asked aseriesofquestionsaboutactionsthey Respondents whoheldajobinthepastyearwere c. Effortsto Avoid Discrimination transgender inthepastyear Table One ormoreexperienceslisted at theirjob to adifferentpositionordepartment Employer/boss forcedthemtotransfer them acceptable restroomsituationwith Employer/boss couldnotworkoutan or patients direct contactwithclients,customers, Employer/boss removedthemfrom the wronggendertokeep theirjob Employer/boss toldthemtopresentin based ontheirgenderidentity use therestroomtheyshouldbeusing Employer/boss didnotallowthemto Employer/boss forcedthemtoresign job review Employer/boss gavethemanegative not have information aboutthemtheyshould Employer/boss orcoworkers shared transgender inthepastyear Mistreatment atworkduetobeing 10.7: Mistreatmentatworkduetobeing % ofthosewho had ajob 23% 16% 6% 2% 4% 4% 4% 3% 3% discrimination atworkinthepastyear Table avoid discrimination. that theywouldhavepreferredtoleaveinorder disabilities (30%)weremorelikely tostayatajob Latino/a (28%)respondentsandwith elsewhere. AmericanIndian(40%),Black(31%), and to leaveforfearofencounteringdiscrimination stayed atajobthattheywouldhavepreferred More thanone-quarter(26%)saidthatthey to transgendermenandwomen(34%). be referredtobytheircorrectpronounscompared (66%) werenearlytwiceaslikely toavoidasking of feardiscrimination.Non-binaryrespondents with correct pronouns (such as he, she, or they) out they didnotasktheiremployertoreferthem gender identityatwork. More thanhalf(53%)reportedhavingtohidetheir more ofthesestepstoavoiddiscrimination. disabilities (81%)weremorelikely totake oneor non-binary respondents(81%),andpeoplewith Respondents whowerelivinginpoverty One ormoreexperienceslisted or department They requestedtransfertoadifferentposition They didnotseekpromotionorraise They quittheirjob overqualified They kept ajobforwhichtheywere transitioned gender They hidthefactthattheyhadalready to leave They stayedinajobtheywouldhavepreferred They delayedtheirgendertransition they prefer(suchashe, she, orthey) They didnotaskemployertousepronouns They hadtohidetheirgenderidentity discrimination atworkinthepastyear Actions taken toavoidanti-transgender 10.8: Actionstaken toavoidanti-transgender 9 Nearlyhalf(47%)said 8 (82%), % ofthosewho had ajob 26% 26% 25% 53% 24% 77% 47% 15% 13% 6%

EMPLOYMENT AND THE WORKPLACE 155 This represents 16% of all 12 their gender identity or expression, including verbal harassment, physical and sexual assault, and breaches A large number of respondents felt of confidentiality. such actions to avoid discrimination, they had to take as quitting a job or hiding their transition, despite the potential impact on their wellbeing or financial stability. respondents. Conclusion reported high levels of workplace Respondents identity ordiscrimination based on their gender opportunities,expression, including losing employment facing otherbeing harassed, being assaulted, and transgender. forms of mistreatment because of being anti-transgenderMany reported losing their job due to to occurbias, with the experience being more likely people with underground among people of color, and people with disabilities.economy experience, 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. faced substantial levels of also Respondents harassment and mistreatment on the job because of VI. Overall Negative Negative VI. Overall in the Experiences Workplace respondents who held a job in Overall, 30% of all some form of workplace the past year experienced including being that year, discrimination during a promotion because of their fired or being denied expression, being harassed or gender identity or or experiencing one or more assaulted at work, of mistreatment discussed in of the other forms section V of this chapter. respondents who held 80% of respondents. Further, experiencing a job in the past year reported either steps to some form of discrimination and/or taking 41% of all avoid discrimination at work, representing

14% White 33%

17% Multiracial

36%

Trans women and men and women Trans Trans men Trans 17%

29%

17% Eastern Middle

Latino/a

Trans women Trans 19% Black

14% Non-binary

11% Asian 4%

23% Crossdressers

25%

15% Indian American Overall Overall 5% 5% 0% 0% 15% 15% 10% 10% 35% 40% 30% 25% 25% 20% 20% the past year (21%) were more likely to quit their job to avoid (21%) were more likely discrimination (Figure 10.8). discrimination in Quit job to avoid Figure 10.8: (%) RACE/ETHNICITY job in the past year reported that they quit their job job in the past year reported that they Those in order to avoid workplace discrimination. economy currently working in the underground (23%), Black (28%), American Indian respondents respondents (19%), and people with disabilities Fifteen percent (15%) of respondents who held a Fifteen percent (15%) of respondents in the workplace in order to avoid discrimination in the workplace in (Figure 10.7). to avoid discrimination Hid past transition Figure 10.7: in the past year GENDER IDENTITY (%) One-quarter (25%) of respondents reported that reported that (25%) of respondents One-quarter already transitioned. fact that they had they hid the (36%) of more than one-third year, In the past gender transition men hid their past transgender 156 2015 U.S. TRANSGENDER SURVEY 6 5 4 3 2 1 ENDNOTES collapsed forreportingas“genderidentityorexpression.” of thosewhoselectedoneorboththesereasonsare interchangeably orwithverysimilarmeanings,responses reasons, andbecausethesetermsarecommonlyused a substantialoverlapofrespondentswhoselectedboth best representedtheirexperience. Becausetherewas choices sothatrespondentscouldselectwhattheyfelt identity” and“genderexpression/appearance” asanswer The surveyincludedboth“transgenderstatus/gender identified asapersonwithdisabilityin Q. 2.20. “People withdisabilities” herereferstorespondentswho work thatiscurrentlyillegal. economy work,suchassexdrugsales,andother about jobsdoinglegalworkandexcluded underground Q. 21.1 andother questionsinthischapterasked only from theircurrentbossorsupervisor. Respondents werenotasked aboutthelevelofsupport Grant, etal.;Sears,al. FullReport_1.pdf. ohr/publication/attachments/QualifiedAndTransgender_ Available at:http://ohr.dc.gov/sites/default/files/dc/sites/ on GenderIdentity. of Resume Testing forEmploymentDiscriminationBased (2015). Discrimination-July-20111.pdf; Rainey, T. &Imse, E. law.ucla.edu/wp-content/uploads/Sears-Mallory- CA: WilliamsInstitute. Available at:http://williamsinstitute. Discrimination &ItsEffecton LGBT People. Mallory, C.(2011). & NationalGayandLesbian Task Force;Sears,B.& 50–71). DC:NationalCenterforTransgender Equality of theNationalTransgender DiscriminationSurvey L., &Keisling, M.(2011). Grant, J. M.,Mottet,L.A.,Tanis, J., Harrison,J., Herman,J. Qualified and Transgender: A Report on Results |CHAPTER10:EMPLOYMENT ANDTHEWORKPLACE Documented EvidenceofEmployment DC:DCOfficeofHumanRights. Injustice atEveryTurn: AReport Los Angeles, . (pp. 10 9 8 7 past year. of thosewhoappliedforajobbutdidnotworkinthe who hadajobonly. Italsodoesnotincludeexperiences adverse actionsintheworkplaceexperiencedbythose hired forajobinthepastyear, sincethisfigurerepresents This figuredoesnotincludetheexperienceofbeing avoid discrimination. about [their]genderidentityinthepastyear”orderto Respondents wereasked ifthey“hadtobeinthecloset poverty linecalculation. and Employment who arelivingatornearthepovertyline. Seethe Respondents whoare“livinginpoverty”representthose 22.3. or rape)”atworkbecausetheyweretransgenderinQ. unwanted sexualcontact(suchasfondling,assault, Respondents wereasked whethertheyhad“experienced chapter formoreinformationaboutthe Income SEX WORK AND OTHER UNDERGROUND ECONOMY WORK 157

2 igh They have also found h 3

4 Participation in the sex trade is often higher among those who Participation 1

any people participate in sex work, drug sales, and other activities that are currently criminalizedany people participate in sex work, drug sales, and other activities that are or other for food, a place to sleep, or in exchange (“underground economy”) to earn an income, street-basedgoods or services. The commercial sex trade exists in a variety of forms, including

economy work, and their interactions with law enforcement officers when they were doing sex work or economy work, and their interactions with law enforcement officers when experiences in respondents’ when police thought that they were doing sex work. Notable differences the chapter. based on demographic and other characteristics are reported throughout Previous studies have documented higher levels of participation in sex work among transgender people,Previous studies have documented higher levels of participation in sex work and in particular people of color and those facing homelessness or poverty. and experiences of violence amongrates of negative mental and physical health outcomes, police abuse, transgender people who have done sex work. underground a series of questions about their participation in sex work and other asked were Respondents sex work, pornography, and escort services. sex work, pornography, or unequal opportunities in employment, housing, and education. have faced family rejection, poverty, Economy Work Economy Sex Work and Sex Work Other Underground CHAPTER 11 CHAPTER M 158 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS Latina (30%)respondents (Figure11.1). (44%), AmericanIndian(41%), multiracial(38%),and underground economyfor income, including Black color werealsomorelikely toparticipateinthe underground economy. Transgender womenof (37%) weremorelikely tohaveparticipatedinthe job becauseoftheirgenderidentityorexpression residents (38%)andrespondentswhohavelosta income atsomepointintheirlives.Undocumented participated intheundergroundeconomyfor Overall, oneinfive(20%)respondentshad as undergroundeconomywork. criminalized, referredtothroughoutthisreport other formsofworkinareasthatarecurrently participation insexwork,drugsales,and Respondents wereasked abouttheir Economy Participation I. Overall Underground • • work, suchasformoney, food,oraplacetosleep. sleep. Overall,nearlyoneinfive(19%)respondentsreported doingsometypeofsex (6%) haveengagedinsexualactivityforfood,and8%donesoaplaceto One ineight(12%)respondentshaveparticipatedsexworkforincome. Sixpercent currently criminalizedwork,and9%didsointhepastyear. income atsomepointintheirlives,includingsexwork,drugsales,andother One infive(20%)respondentshaveparticipatedtheundergroundeconomyfor other workthatiscurrentlycriminalized(2%),than sexwork. One ineight(12%)respondentshaveearnedincomebysellingdrugs(11%)ordoing were doingsexworkorwhilepolicethoughtthatthey weredoingsexwork. Three percent(3%)ofallrespondentshaveinteractedwith thepoliceeitherwhilethey evidence ofsexwork. respondents whowerearrestedsaidthatpoliceusedcondomsintheirpossessionas 32% saidthatatleastoneofthoseinteractionsledtoanarrest.Nearlyhalf(44%) Of thosewhointeractedwiththepolicewhiledoingorthoughttobesexwork, being verballyharassed,physicallyattacked, orsexuallyassaultedbypolice. 86% reportedsomeformofpoliceharassment,abuse, ormistreatment,including Of thosewhointeractedwiththepolicewhiledoingorthoughttobesexwork, RACE/ETHNICITY (%) transgender women Figure 11.1: Undergroundeconomyexperienceamong 20% 50% 25% 30% 40% 35% 45% 10% 15% 0% 5%

respondents)Overall (all

American Indian 20% 41%

Asian 26%

Black 44%

Latina 30% Middle Eastern 19%

Multiracial 38%

White 20% SEX WORK AND OTHER UNDERGROUND ECONOMY WORK 159

11% White

27% 23%

Multiracial

19% men 9%

Trans Trans with female on their 7%

original birth certificate

Non-binary respondents Non-binary respondents Middle Eastern Middle

23% Latina

42% Black

on their original birth certificate Non-binary respondents with male 1%

sex work

who have 22% ever done Asian % of those Crossdressers 28%

50% Trans Trans Indian American

12% women

Overall (all (all Overall respondents) 5% 0% 15% 10% 45% 35% 40% 30% 25% 20% Figure 11.2: Income-based sex work in lifetime Figure 11.2: Income-based GENDER IDENTITY (%) Transgender women of color, including Black (42%), including Black women of color, Transgender LatinaAmerican Indian (28%), multiracial (27%), 11.3), were(23%), and Asian (22%) women (Figure to have participated in sex work thanmore likely residents (36%), Undocumented the overall sample. genderthose who have lost a job because of their identity or expression (25%), and those who have ever experienced homelessness (23%) were also more to have participated in sex work.likely Figure 11.3: Income-based sex work among transgender women (%) RACE/ETHNICITY important to recognize that non-binary people to recognize that important and birth certificates on their original with female of a large proportion men account for transgender done sex work. sample who have those in the 2% 11% 12% 20% % of respondents (in lifetime) 1% 4% 9% 5% % of respondents (past year) Type of work Type Income-based sex work Other criminalized work Drug sales Any underground economy work among those who have done sex work, it is also their original birth certificates represent nearly one- quarter (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 money or worked in the sex industry, such as in in the sex industry, money or worked erotic dancing, webcam work, or pornography. Of respondents who have done sex work for money transgender women representin their lifetime, one-half (50%), non-binary people with female on a. Income-Based Sex Work One in eight (12%) respondents have done sex work meaningfor income at some point in their lifetime, sex or sexual activity for that they have exchanged II. Sex Work been homeless in the past year (23%) were been homeless in the past year (23%) in the to have worked nearly three times as likely underground economy during that year. Income-based underground economy 11.1: Table experiences Nearly one in ten (9%) respondents have Nearly one in ten underground economy for participated in the Undocumented 11.1). year (Table income in the past times as residents (29%) were more than three economy in the underground to have worked likely respondents who have Further, in the past year. point in their lives and 9%point in their in the past year. participated One in five (20%) respondents five (20%) One in in thehave participated economy at someunderground 160 2015 U.S. TRANSGENDER SURVEY and 14%weretransgendermen(Figure11.4). people withfemaleontheiroriginalbirthcertificate, year weretransgenderwomen,22%non-binary those whodidincome-basedsexworkinthepast for incomeinthepastyear. Morethanhalf(55%)of Five percent(5%)ofallrespondentsdidsexwork • • • • experienced anumberofchallenges: work duringtheirlifetimeweremorelikely tohave Respondents whohavedoneincome-based sex in thepastyear. and 5%ofrespondentsdidso have donesexworkforincome, One ineight(12%)respondents than thoseintheoverallsample(1.4%). work (0.5%), andnearlysixtimesmorelikely HIV (7.9%) asthosewhohaveneverdonesex nearly sixteentimesaslikely tobeliving with Respondents withsexworkexperiencewere have notdonesexwork. violence, comparedwith51%ofthosewho experienced someformofintimatepartner who havedoneincome-basedsexwork More thanthree-quarters(77%)ofrespondents those whohavenotdonesexwork(44%). sexually assaultedintheirlifetime, incontrastto have doneincome-basedsexworkbeen Nearly three-quarters(72%)ofrespondentswho who havenotdonesexwork. living inpoverty, incontrastto26%ofthose done income-basedsexworkwerecurrently Nearly half(45%)ofrespondentswhohave

GENDER IDENTITY(%) Figure 11.4:Income-basedsexworkinpastyear RACE/ETHNICITY (%) among transgenderwomen Figure 11.5:Income-basedsexworkinpastyear in thepastyear(Figure11.5). five timesaslikely tohavedonesexworkforincome Black transgenderwomen(24%),whowerealmost of sexworkparticipationinthepastyear, particularly transgender womenofcolorreportedhigherrates participated insexworkthepastyear. Additionally, residents (29%)weresubstantiallymorelikely tohave who werelivingwithHIV(32%)andundocumented year comparedtotheoverallsample. Respondents likely tohaveparticipatedinsexworkduringthat the pastyear(17%)weremorethanthreetimesas Respondents whoexperiencedhomelessnessin 20% 25% 30% 10% 15% 0% 5%

respondents)Overall (all women

American Indian 5% Trans 55%

13% Crossdressers who didsex work inthe

Asian % ofthose past year 13% 1% Non-binary respondentswithmale

Black on theiroriginalbirthcertificate 24%

Latina Middle Eastern 13% Non-binary respondents original birthcertificate with femaleontheir 8% 9% Trans men 14%

Multiracial 22%

12%

White 5% SEX WORK AND OTHER UNDERGROUND ECONOMY WORK 161 I was at a street corner. It was I was at a street corner. roughly noon, I was holding a bag of food in my hand, and I was clearly waiting for the street light to change so I could cross the street.” their house, and sometimes I would and their house, sex meet people at a bar and have with them to really just sleep over and shower.” one find work. I watched “I couldn’t guy throw away my application it literally 30 seconds after turning the in. I resorted to escorting. It’s food in my belly only way to keep and a roof over my head.” to support “I became a sex worker myself and pay for my transition. I did not want to do sex work, but I have had worse jobs that paid less.” officer attempted to arrest me “An on prostitution charges because In Our Own Own In Our Voices of I ran away with no way 17, “At I turned to supporting myself. which allowed Internet prostitution, for myself that me to do things buy girl like [before], I couldn’t for my of pocket clothes, pay out put a and HRT, doctor to prescribe roof over my head.’’ “Sometimes I slept in my truck put me up at when friends couldn’t 7% 9% 11% 14%

21% 12%

24% 35% 36% 28% 18% 38% White

25% Multiracial

% of those who have ever done sex work

31% Eastern* Middle Latina

48% Black

29% Asian

50% American Indian American

21%

Overall (all (all Overall respondents) 0% Type of sex work Type Informal sex work through word of mouth, occasional hook ups with dates in my that networks, or things like 10% or newspapers Not listed above Pornography (picture or video) Pornography Fetish work sex work Street-based Phone sex Escort, call girl, or rent boy with an agency Erotic dancer or stripper Sex work advertised in magazines Sex work advertised online work Webcam 40% 30% 20% 50% 60% * Sample size too low to report Figure 11.6: Participation in street-based sex work Participation Figure 11.6: done sex work among transgender women who have (%) RACE/ETHNICITY (50%), Black (48%), and Latina (31%) women, being (31%) women, being and Latina (50%), Black (48%), participate in street- to likely substantially more 11.6). based sex work (Figure of income-based sex work 11.2: Type Table (21%) (Table 11.2). Among those who have done 11.2). Among those who have done (21%) (Table transgender women some type of sex work, with sex work than others (30%) were more likely done street-based sex work, experience to have Indian including American with women of color, Respondents who have done sex work for income done sex work for who have Respondents range of settings, working in a wide reported online (36%), sex work advertised including sex work work (35%), and street-based webcam 162 2015 U.S. TRANSGENDER SURVEY engaged insexualactivityforfood. (10%) respondentswerealsomorelikely tohave American Indian(15%),Black(12%),andmultiracial for food.Undocumentedresidents(17%)and as likely tohaveengagedinsexualactivity living withHIV(32%)weremorethanfivetimes engaged insexualactivityforfood.Respondents Six percent(6%)ofrespondentshaveever goods orservices Table 11.3:Engagedinsexualactivityexchange for exchange forsomethingelse(Table 11.3). for food,aplacetosleep, fordrugs,orin whether theyhadsexorengagedinsexualactivity not reportdoingsexworkforincome, wereasked All surveyrespondents,includingthosewhodid Services b. SexWork forGoodsor goods orservices. food, aplacetosleep, orother sex work,suchasformoney, respondents participatedin Nearly oneinfive(19%) listed above exchange forsomethingnot Engaged insexualactivity for drugs Engaged insexualactivity hotel room) bed, attheirhome, orintheir a placetosleep(insomeone's Engaged insexualactivityfor for food Engaged insexualactivity Type ofactivity

(past year) respondents % of 2% 2% 3% 1% (in lifetime) respondents % of 6% 5% 8% 7% they interacted with police while participating in sex they interactedwithpolicewhileparticipatinginsex work. Onepercent(1%)ofrespondentssaidthat work, orwhenpolicethoughttheyweredoingsex ever interactedwithpoliceeitherwhiledoingsex All surveyrespondentswereasked iftheyhad c. Police Interactions goods orservices. as formoney, food,aplacetosleep, orother Overall, 19%participatedinsexwork,such sexual activityforaplacetosleep. residents (17%)weremorelikely tohaveengagedin homelessness (20%),orwhowereundocumented living withHIV(28%),whohaveeverexperienced activity foraplacetosleep. Respondents whowere One intwelve(8%)respondentsengagedsexual RACE/ETHNICITY (%) were doingsexworkamongtransgenderwomen Figure 11.7: Interactedwithpolicewhothoughtthey (Figure 11.7). police who more likely thantheoverallsampletointeractwith multiracial (8%),andLatina (7%)women,were (15%), MiddleEastern(13%),AmericanIndian(12%), Transgender womenofcolor, includingBlack doing sexwork. doing sexworkorwhenpolicethoughttheywere 3% ofrespondentshaveinteractedwithpolicewhile police thoughttheyweredoingsexwork.Overall, work, andanadditional2%saidtheydidsowhen 10% 16% 12% 14% 0% 6% 2% 8% 4%

respondents)Overall (all

American Indian 2% thought 12%

Asian 4% theyweredoingsexwork

Black 15%

Latina

Middle Eastern 7% 13%

Multiracial 8%

White 3% SEX WORK AND OTHER UNDERGROUND ECONOMY WORK 163

19% 13% 2 times 3 times

16% 4–10 times

Number of times arrested

34% 1 time 19% times 11 or more prostitution.” Forty-four percent (44%) said that the prostitution.” police considered condoms in their possession to be evidence of prostitution (Figure 11.9). more times (Figure 11.8). doing or Figure 11.8: Number of times arrested while work when police thought they were doing sex were arrested while doing or who Respondents while police thought they were doing sex work items in whether police considered were also asked their possession, such as condoms, as “evidence of d. Arrest with police while who interacted Respondents police thought they in sex work or when engaging if they work were also asked were engaging in sex any of those interactions.were arrested during reported being arrestedAlmost one-third (32%) interaction. Black respondentsduring at least one women (40%) were more(50%) and transgender interaction with the police to report that their likely led to an arrest. arrested were who reported being Respondents how many times they were arrested while asked thought they were doing sex work or when police one- they were doing sex work. Approximately 32% were arrested third (34%) were arrested once, four or two or three times, and 35% were arrested 11% 14% 41% 18% 27% 65% 86% 69% % of those who interacted with police who thought they were doing sex work, or while doing sex work 27%) of respondents who Respondents who have ever Respondents 6 Type of interaction of Type kept using the wrongOfficers gender pronouns (such as he, or the wrong title or they) she, or Ms.) (such as Mr. Officers forced them to have sex or engage in sexual activity to avoid arrest Arrested for drugs in their possession when police stopped them for doing sex work One or more experiences listed Officers verbally harassed them questions about Officers asked their gender transition (such as hormones and surgical status) Officers sexually assaulted them them Officers physically attacked arrest. of sexual assault. experienced homelessness (34%) were more likely Fourteen to be sexually assaulted by an officer. percent (14%) also reported that they were forced to have sex or engage in sexual activity to avoid were verbally harassed by police. were verbally harassed by police. More than one-quarter ( had interacted with police in this context were including being sexually assaulted by an officer, fondled, raped, or experiencing another form More than two-thirds (69%) said that officers More than two-thirds (69%) said that repeatedly referred to them as the wrong among This experience was more likely gender. (65%) transgender women (74%). Nearly two-thirds six percent (86%) reported at least one negative six percent (86%) reported 11.4). the interaction (Table experience during with police while doing or 11.4: Interactions Table they were doing sex work when police thought Respondents who interacted with the police with the police who interacted Respondents police thought sex work or when while doing about asked doing sex work were they were Eighty- had with police. experiences they specific 164 2015 U.S. TRANSGENDER SURVEY while doingorsuspectedofsexwork) Figure 11.10: Outcomeofarrest(%thosearrested dropped onatleastoneoccasion(Figure11.10). nearly half(48%)reportedthatthechargeswere connection tooneormoreoftheirarrests,while respondents whowerearrestedpleadedguiltyin of theirarrests.Morethanhalf(55%)the Respondents wereasked abouttheoutcomes doing orsuspectedofsexwork) evidence whenarrested(%ofthosewhile Figure 11.9:Itemsinpossessionconsideredas 60% 60% 20% 50% 20% 50% 30% 30% 40% 40% 10% 10% 0% 0%

Pleaded guilty Condoms 44% 55%

wereThe dropped charges Sex toys 4% 48%

Went to trial and Another item

found guilty 27% 9%

Went to trial and Condoms, sex found not guilty toys, and/or another item 48% 15%

They did not Not listed 12% above 11% know sex workduringtheirlifetime. paid forundergroundeconomyworkapartfrom homelessness (21%)weremorelikely tohavebeen or expression(22%),haveeverexperienced have lostajobbecauseoftheirgenderidentity Respondents whowerelivingwithHIV(27%), who or otherworkthatiscurrentlycriminalized(2%). who hadparticipatedindrugsales(11%)and/ at somepointintheirlifetime. Thisincludedthose in theundergroundeconomyotherthansexwork One ineight(12%)respondentshavedonework Economy Work Other Underground III. DrugSalesand enforcement officers. physically attacked, orsexuallyassaultedbylaw by police, includingbeingverballyharassed, of doingsexworkreportedbeingmistreated police whiledoingsexworkorsuspected The vastmajorityofthosewhointeractedwiththe were doingsexwork,evenwhentheynot. color, alsoreportedthatpoliceoftenassumedthey respondents, especiallytransgenderwomenof those whohaveexperiencedhomelessness.Many living withHIV, undocumentedresidents,and economy work,particularlypeopleofcolor, those involvement insexworkandotherunderground Respondents reportedsubstantiallevelsof Conclusion sales orsexwork)(seeTable 11.1). other undergroundeconomywork(otherthandrug participated indrugsales,and1%have In thepastyear, 4%ofallrespondentshave 7

SEX WORK AND OTHER UNDERGROUND ECONOMY WORK 165 (sex work)

Fitzgerald, et al. See note 3. Fitzgerald, et they had “ever whether were asked Respondents activity for money engaged in sex or sexual (such as erotic dancing, in the sex industry or worked and whether they Q. 6.1 films)” in webcam work, or porn 6.2. This report the past year in Q. had done such work in to all work in the sex work” to refer uses the term “sex for of sexual activity exchange industry or involving the or other goods or services. food, a place to sleep, income, sex work are currently criminalized While many of forms of some of them are not. in the United States, they had “experienced whether were asked Respondents as fondling, unwanted sexual contact from an officer (such 6.6. sexual assault, or rape)” in Q. if they had “ever 6.11 in Q. were asked Respondents is currently been paid for selling drugs or other work that considered illegal.” 4 5 6 7 New DC & NY, DC & NY, Meaningful Work: Meaningful Work: Behind Closed Doors:Behind Closed Available at: https://www. Available Available at: https://www. Available Amnesty International Policy Policy Amnesty International Amnesty International Policy Amnesty International Policy | CHAPTER 11: SEX WORK AND OTHER UNDERGROUND ECONOMY WORK ECONOMY UNDERGROUND AND OTHER 11: SEX WORK | CHAPTER NY, New York: Sex Workers Project at the Urban Project at the Sex Workers New York: NY, amnesty.org/en/documents/pol30/4062/2016/en. amnesty.org/en/documents/pol30/4062/2016/en. New York: Best Practices Policy, National Center for Best Practices Policy, New York: Umbrella Project. Available & Red Equality, Transgender at: http://www.transequality.org/sites/default/files/ Meaningful%20Work-Full%20Report_FINAL_3.pdf; Amnesty International. (2016). Protect and Fulfill the Obligations to Respect, on State Human Rights of Sex Workers. Amnesty International. (2016). Amnesty International. Protect and Fulfill the to Respect, Obligations on State Human Rights of Sex Workers. amnesty.org/en/documents/pol30/4062/2016/en. D. Fitzgerald, E., Elspeth, S., & Hicky, Experiences in the Sex Trade. Transgender Available at: http://sexworkersproject.org/downloads/ Available (2003). J. M. & Thukral, Ditmore, BehindClosedDoors.pdf; Prostitution in Door: An Analysis of Street-Based Revolving New York. at: http://sexworkersproject.org/ Available Justice Center. downloads/RevolvingDoor.pdf. An Analysis of Indoor Sex Work in New York City. in New York of Indoor Sex Work An Analysis Project at the Urban Justice Center). Sex Workers NY: York, 2 3 ENDNOTES ENDNOTES (2011). J. M. & Thukral, 1 See Ditmore, 166 2015 U.S. TRANSGENDER SURVEY P Military Service CHAPTER 12 experiences basedondemographic andothercharacteristicsarereportedthroughout thechapter. experiences ofseparating from themilitaryandaccessinghealthcare. Notabledifferences inrespondents’ with leadershipandhealth care providersastransgenderpeople. Italsoexploresveterans’ unique This chapterexaminesthe experiences ofcurrentandformerservicemembers, including theirinteractions many ofthemopenlyandwiththesupporttheircolleagues andcommanders. the long-standingban,thousandsoftransgenderpeople haveservedandcontinuetoserveinthemilitary, of specificpoliciesrelatedtotransgenderservicemembers expectedtobecompletedin2017. Department ofDefenseannouncedthatitwasliftingthe banonJune30, 2016,withfullimplementation openly inthemilitary, andservicememberscouldbedischarged simplyforbeingtransgender. At thetimethatsurveydatawascollectedin2015,militarystillbarredtransgenderpeoplefromserving Veterans HealthAdministration. the military. Theywerealsoasked abouthealthcarethattheyreceived throughmilitaryprovidersandthe about theirservice, theirtreatmentastransgenderservicemembers,andseparationfrom general population. rior researchsuggeststhattransgenderpeopleserveinthemilitaryatahigherratethanU.S. 1 USTS respondents withmilitaryexperiencewereasked aseriesofquestions 2 3 The Despite MILITARY SERVICE 167

22% 52% plus 75 18%

40% 65 to 74 to 65 8%

25% 55 to 64 to 55 5%

15% 35 to 54 to 35 2% (Figure 12.1). (Figure 12.1). 8

3% 18 to 34 to 18 % in USTS (supplemental survey weight applied) % in USTS general population (ACS) % in U.S. 8%

15% Overall 0% 10% 40% 30% 20% 50% 60% Fifteen percent (15%) of respondents between the Fifteen percent (15%) of respondents was three ages of 35 and 54 were veterans, which in the U.S. times higher than the same age group population (5%) status Veteran Figure 12.1: (%) AGE

7 One-quarter 6 Fifteen percent (15%) of respondents Fifteen percent (15%) of respondents 4 5 status, and 19% left the military to avoid being mistreated or harassed as a transgender status, and 19% left the military to person. ten years said that they might or would return to the military if the ban on transgender the military if the ban on transgender they might or would return to ten years said that were lifted. service members ten the military more than who separated from Nearly one in five (19%) respondents partly or completely because of their transgender years ago said they were discharged Of current service members whose leadership or commanding officers knew or thought commanding officers knew or members whose leadership or Of current service to said that actions were taken nearly one-quarter (23%) they were transgender, discharge them. past from the military within the of service members who separated Sixty percent (60%) Nearly one in five (18%) respondents have served in the military, including veterans and veterans including military, served in the respondents have in five (18%) Nearly one duty. on active those currently

64 were veterans, more than three times higher population (8%). than that age group in the U.S. 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 population, respectively. in the U.S. (25%) of respondents between the ages of 55 and population. every age group were more likely in Respondents to be veterans than their counterparts in the U.S. population. More than half (52%) of respondents have served in the military, including respondents including respondents have served in the military, on active who were currently serving in the military on and those who were currently duty (0.5%), or National active duty for training in the Reserves Guard (2%). were veterans, compared with 8% in the U.S. I. Current and Past I. Current and Past Military Service in the sample Nearly one in five (18%) respondents KEY FINDINGS KEY 168 2015 U.S. TRANSGENDER SURVEY survey. with 5%onactivedutyatthetimetheytook the overallsampletocurrentlybeonactiveduty, Multiracial respondentsweretentimesaslikely as (7%) respondentswerelesslikely (Figure12.3). in themilitary, whileAsian(7%)andLatino/a respondents weremorelikely tohaveserved American Indian(20%),andMiddleEastern(20%) birth certificate(2%)(Figure12.2).White(21%), non-binary peoplewithfemaleontheiroriginal served, comparedwithtransgendermen(8%)and birth certificate(22%)weremorelikely tohave and non-binarypeoplewithmaleontheiroriginal crossdressers (33%),transgenderwomen(23%), Among thosewithpastorcurrentmilitaryservice, RACE/ETHNICITY (%) Figure 12.3:Past orcurrentmilitaryservice GENDER IDENTITY(%) Figure 12.2:Past orcurrentmilitaryservice 20% 20% 25% 25% 30% 35% 10% 10% 15% 15% 0% 0% 5% 5%

Overall Overall

American Indian 18% 18% Non-binary withNon-binary male on birthwithCrossdressers femalecertificate on 20% 33% birth certificate

Asian 7% 2%

Black 22% 15% Non-binary (all)

Latino/a 9% Middle Eastern 7% Trans women 20% 23%

Multiracial Trans womenTrans and men 18% 8%

White 19% 21% II. BranchofService years ago. separated frommilitaryservicemorethanten service withinthepasttenyears,and69% were nolongerservingseparatedfrommilitary still serving.Nearlyone-third(31%)ofthosewho Of thosewhoreportedmilitaryservice, 2%were population. compared with8%intheU.S. respondents wereveterans, Fifteen percent(15%)of Table Reserves ortheNationalGuard(Table 12.1). Guard. Nearlyone-quarter(24%)servedinthe in theMarineCorps,and1%servedCoast the Army, 22%intheNavy, 18%intheAirForce, 7% respondents currentlyormostrecentlyservedin of service. Twenty-eight percent(28%)ofthese to identifytheircurrentormostrecentbranch Current andformerservicememberswereasked Navy Reserve Navy Marine CorpsReserve Marine Corps Coast GuardReserve Coast Guard Army NationalGuard Army Reserve Army Air NationalGuard Air ForceReserve Air Force Branch ofservice 12 .1: Currentormostrecentbranchofservice % ofcurrentorformer service members 22% 28% 18% <1% 2% 2% 8% 8% 3% 7% 1% 1% MILITARY SERVICE 169 forcing respondents to present in a way that was forbidding inconsistent with their gender identity, them from discussing their transgender status passing them over for awards with anyone else, and duties, and subjecting them to administrative discipline. officer responded to their transgender status in officer responded to their transgender supporting a variety of positive ways, including their their name change (47%) and supporting (36%). Thirty transition-related medical treatment or percent (30%) reported that their leadership commanding officer ignored their transgender Approximately the other way. status or looked leadership one-quarter (23%) reported that their actions to or commanding officer had taken 12.2). discharge them (Table wrote in One-third (33%) of these respondents their responses describing additional actions leadership or commanding officers took because they thought or knew the respondent was Their write-in responses included transgender. several positive actions, such as supporting their social transition or their use of pronouns and uniforms that were consistent with their These respondents also offered gender identity. several additional negative actions, such as IV. Leadership Leadership IV. to Response Status Transgender members who said that Among current service most, or all others in the military some, a few, 48% were transgender, thought or knew they leadership or commanding indicated that their knew that they were officer thought or transgender. about the These respondents were asked ways in which their leadership or commanding officer responded to them being transgender, Many and they selected one or more response. reported that their leadership or commanding

52% None

11 were asked how many were asked 9

All 5% service 10 members

% of current

8% Most

23% A few .4: Number of people in the military who .4: Number of people in the military who 22% 12 Some Figure transgender thought or knew that respondent was members indicated that a few or some people members indicated that a few or some were in the military thought or knew that they and 13% indicated that most or all transgender, that they people in the military thought or knew were transgender (Figure 12.4). More than half (52%) of current service members More than half (52%) no one else they knew, said that, as far as thought or knew that they were transgender. one-third (34%) of current service Approximately Transgender Current service members other of (with the exception people in the military thought or knew that they transgender people) were transgender. III. Outness or III. Outness as Perceived Being thought or knew that they were transgender. More than half (52%) of current service members said that, as no one else far as they knew, 170 2015 U.S. TRANSGENDER SURVEY Table a varietyofothertypesdischarges(Table 12.3). honorably discharged,andtheremaining21%reported quarters (79%)oftheserespondentsreportedbeing the typeofdischargetheyreceived.Morethanthree- reasons fortheirseparationfromservice, including more thantenyearsago Respondents whoseparatedfrommilitaryservice a. Type of Discharge nature ofthemilitary. encountered duringtheirserviceandthechanging the typesofexperiencesaservicemembermayhave given distinctquestionsbasedonaconsiderationof years priortotakingthesurvey. Thetwogroupswere past tenyearsandthosewhoseparatedmorethan purposes ofanalysis:thosewhoseparatedwithinthe Veterans weredividedintotwogroupsforthe Military Service V. Separationfrom officer tobeingtransgender Table Not listedabove Dishonorable Retired Bad conduct Entry levelseparation Other-than-honorable Medical General Honorable Discharge Not listedabove Took actionstodischargethem Ignored orlooked theotherway Supported medicaltreatment Supported namechange officers’ response Leadership orcommanding 12 12 .2: Response ofleadershipand/orcommanding .3: Type ofdischarge 12 % ofveteranswhoseparatedmore 13 were asked about the wereasked aboutthe thought/knew theywere commanding officer % ofcurrentservice than 10yearsago members whose transgender 79% <1% 6% 2% 2% 3% 7% 1% 1% 30% 36% 23% 33% 47% workplace, andamcontinually “I amrepeatedlyharassedinmy private, thelowestrankinarmy.” I wasdemotedfromasergeantto was kept inunderpenalconditions. after returningfromdeployment,I didn’t sharemyenthusiasm.Ayear had beenbefore. Butthearmy woman. Iwashappierthanever “I begantoacceptmyselfasa Voices In OurOwn honorably discharged, while only 45% of those who honorably discharged,while only45%ofthosewho was notrelatedtotheirtransgender statuswere percent (86%)ofthosewho saidtheirdischarge to havebeenhonorablydischarged. Eighty-six was relatedtobeingtransgenderwerelesslikely Respondents whoindicatedthattheirdischarge (5%) tobeingtransgender. either partiallyrelated(14%)orcompletely transgender, 19%believedtheirdischargewas did notbelievetheirdischargewasrelatedtobeing service morethantenyearspriorreportedthatthey While 81%ofrespondentswhohadseparatedfrom Transgender Status b. DischargedBecauseof against harassmentinthemilitary.” individuals arenotprotected to helpbecausetransgender I wastoldthattheywereunable from theEqualOpportunityOffice, status. WhenIsoughtassistance required toconcealmytransgender MILITARY SERVICE 171 to the Department of Defense’s announcement to the Department of Defense’s of plans to allow transgender people to serve more than one-quarter (28%) of all current openly, service members reported taking hormones for their gender identity or gender transition at the Among these time they participated in the survey. VII. Health Care VII. Health Care from Treatment Military Providers who Current service members and veterans the ten years separated from military service within whether prior to taking the survey were asked to gender they had received health care related not including the transition from a military provider, percent Health Administration. Twelve Veterans (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 health treatment, such as hormone therapy or surgical from a military provider. care, Even though this survey was conducted prior VI. Name Change on Change VI. Name Papers Discharge military service who separated from Respondents if they earlier were also asked more than ten years name on their military dischargehad changed their percent (2%) the DD 214. Two papers, known as an updated DD 214applied for and received or they received a DD 215 (anwith a new name, to correct errors in a DD 214)alternative form used for Six percent (6%) applied with their new name. papers,a name change on their military discharge 92%but their request was denied. The remaining their militaryhad not tried to change their name on discharge papers. currently living in poverty and more than one-third of those who have done sex work (38%) also left the military to avoid mistreatment or harassment. Differences emerged by race, where Latino/a (28%) where Differences emerged by race, toand Black respondents (26%) were more likely have left to avoid mistreatment or harassment. one-third (32%) of those who were Approximately 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. distress (28%). or c. Separated to Transition Harassment Avoid who were currently living in poverty (29%) or who were currently living in poverty economy currently working in the underground to say that their discharge (34%) were more likely to their was completely or partially connected who transgender status, as were respondents psychological were currently experiencing serious than ten years ago, the experience of being than ten years ago, of one’s discharged partly or completely because a variety transgender status was associated with of negative outcomes affecting respondents Respondents at the time they took the survey. report that their transgender status was a factorreport that their transgender compared with white (16%)in their discharge, respondents. place more Even though these discharges took certificate (24%) were more likely to say that theirwere more likely certificate (24%) or completely related todischarge was partially than those with male on theirbeing transgender (28%) andLatino/a (17%). original birth certificate to were also more likely Black (24%) respondents said their discharge was partially related to being discharge was partially said their it who indicated that and 51% of those transgender honorably discharged. related were was completely original birth with female on their Respondents 172 2015 U.S. TRANSGENDER SURVEY VA. Ofthosewhoreceivedhealthcarethroughthe whom werecurrentlyreceiving carethroughthe have receivedhealthcarethrough theVA, 75%of Forty percent(40%)offormer servicemembers Veterans HealthAdministration(VA). experiences receivinghealthcarethroughthe than tenyearsagowereasked abouttheir Veterans whoseparatedfromthe militarymore Health Care VIII. Veterans discharge. said thattheirproviderrecommendedthemfor transgender statustotheircommander, and12% However, 8%saidthattheirproviderreported by militarymedicalormentalhealthproviders. transgender, service memberswhoseprovidersknewtheywere or recommendedthemfordischarge. Ofcurrent commanding officerthattheyweretransgender mental healthprovider, hadreportedtotheir a militarymedicalprovider, includingany Current servicesmemberswereasked whether Table off-post pharmacy(Table 12.4). medical doctor, and57%receivedthemthroughan received theirhormonesthroughanoff-post and/or pharmacy. Nearlythree-quarters(74%) their hormonesfromanon-postmedicaldoctor current servicemembers,28%reportedgetting On-post medicaldoctor non-licensed sources Friends, online, orother On-post pharmacy Off-post pharmacy Off-post medicaldoctor Source ofhormones 12 .4: Sourceofhormones 14 86%reportednoactionbeingtaken

% ofcurrentservice members whotake 15 hormones 57% 74% 15% 15% 13% Figure (Figure 12.5). 3% saidthattheywerenevertreatedrespectfully they weresometimestreatedrespectfully, and respectful care. Elevenpercent(11%)reportedthat person, and40%saidthattheyreceivedmostly were alwaystreatedrespectfullyasatransgender transgender, almosthalf(47%)reportedthatthey Of thosewhowereouttotheirVA providersas were outtotheirVA providersastransgender. Nearly three-quarters(72%)indicatedthatthey related togendertransition. VA atanypoint,morethanhalf(56%)receivedcare said thattheywouldfinish thetransitionthatthey would starttotransitionwhile stillserving,and18% openly. Nearlyone-quarter(24%)saidthatthey military allowedtransgender peopletoserve members wereasked whattheywoulddoifthe people serveopenly. Currentmilitaryservice had notyetannounceditwouldlettransgender At thetimesurveywastaken, themilitary Transgender Service Repealing Banon IX. Impactof 12 Always 47% .5: FrequencyofrespectfultreatmentattheVA

their VA provider who wereoutas transgender to % ofveterans Never Sometimes 3% 11%

Mostly 40%

MILITARY SERVICE 173 and implementing new policies could lead to a lead to a and implementing new policies could service substantial number of current and former military members continuing or resuming their service. Conclusion service members ban on transgender Despite a was administered, nearly at the time the survey reported having served one in five respondents and respondents were nearly in the military, veterans as the general U.S. to be twice as likely indicated that a majority population. The findings members were interested in of current service including transgender people, serving openly as transition during their military those who would indicated diverse also Responses service. of experiences of acceptance and rejection veteran transgender people in military and superiors, and settings by military officials, direct that health care providers. The results suggest members lifting the ban on transgender service 1% 3% 6% 6% 18% 21% 21% 24% service members % of current then return to service They would not finish the transition they already started and continue to serve Not listed above They would finish the transition they alreadyThey would finish the transition serve started and continue to to transition andThey would leave the military not return They do not want to transition They would leave the military to transition and What they would do if allowed to serve What they would do if openly while still serving They would start to transition They have already transitioned return to service. return, 30% said that they might return, and the return, 30% said that they might return, not return remaining 39% reported that they would men (42%) were Transgender to military service. and than transgender women (25%) more likely non-binary people (18%) to say that they would Veterans who separated from the military within Veterans whether they would the past ten years were asked people return to military service if transgender (30%) Nearly one-third were allowed to serve. they would of these respondents indicated that in the military was allowed for transgender people in the military was allowed had already started while continuing to serve. to serve. started while continuing had already that they had already 21% reported Additionally, 12.5). (Table transitioned respondent would do if open service 12.5: What Table 174 2015 U.S. TRANSGENDER SURVEY 9 8 7 6 5 4 3 2 1 ENDNOTES serving inthemilitary. SeeQ. 2.17. longer onactivedutybuthadbeen inthepastandwerestill for trainingintheReserves orNationalGuard,(3)no (1) currentlyservingonactiveduty, (2)onlyonactiveduty “Current servicemembers” includesindividualswhowere U.S. Census Bureau.Seenote5. U.S. CensusBureau.Seenote5. U.S. CensusBureau.Seenote5. S2101&prodType=table. jsf/pages/productview.xhtml?pid=ACS_15_1YR_ at: https://factfinder.census.gov/faces/tableservices/ Survey 1-Year Estimates:Veteran status U.S. CensusBureau.(2015). supplemental surveyweight. chapters formoreinformationabouttheapplicationof See the forces, asreportedintheAmericanCommunitySurvey. the percentageofU.S. adultswhohaveservedinthearmed is appliedinorder to provideamore accurate comparison to educational attainment,andtherefore, thisadditionalweight substantially fromtheU.S. populationinregardtoageand to thestandardsurveyweight.TheUSTS samplediffers and educational attainment of the U.S. population in addition U.S. ArmedForceshavebeenweightedtoreflecttheage respondents whohaveservedorarecurrentlyservinginthe In thissectionofchapter, thepercentagesof com/2016/07/01/us/transgender-military.html New York Times. people willbeallowedtoserveopenlyinmilitary. See e.g., Rosenberg, M.(2016,June30).Transgender here asrelatingtoopenserviceatransgenderperson. their identitytodoso. Therefore, thebanisbeingdescribed serve inthemilitarydespiteban,andmanyhadtohide clear thattensofthousandstransgenderpeoplechoseto not theywereopenaboutbeingtransgender. However, itis transgender peoplefromserving,regardlessofwhetheror in themilitary,” inactuality, thebancategoricallybarred that prevented“transgenderpeoplefromservingopenly Although thebanisdescribedinthischapterasbeingone 78–87. utilization. Male-to-female transgenderveteransandVA healthcare Shipherd, J. C.,Mizock,L.,Maguen,S.,&Green,K.E.(2012). American JournalofPublicHealth,103 veterans utilizingVeterans HealthAdministrationcare. identity disorderandsuicideriskamongtransgender Piegari, R.I.,&Bossarte, R.M.(2013).Prevalenceofgender pdf; Blosnich,J. R.,Brown,G.Shipherd,J. C.,Kauth, M., wp-content/uploads/Transgender-Military-Service-May-2014. Institute. Available at:http://williamsinstitute.law.ucla.edu/ Service intheUnitedStates. Gates, G.J. &Herman,J. L.(2014). Methodology International JournalofSexualHealth,24 |CHAPTER12:MILITARY SERVICE Available at: and Portrait ofUSTS Respondents American Community Los Angeles,CA: Williams

http://www.nytimes. Transgender Military (10), e27–e32; . Available . The (1), 12 11 10 15 14 13 the researchteamconsultedwithindividualsandgroups During thedevelopmentofsurveyquestionnaire, identity withoutdisclosingtheirpasttransition. others inthemilitarywerelivingaccordingtotheirgender substantial numberofrespondentswhowerenotoutto that theywerelivingfull-timeinQ. 1.12, suggestingthata thought orknewtheyweretransgenderalsoreported of servicememberswhosaidthatnooneinthemilitary fact thattheyhadpreviouslytransitioned.However, 47% according totheirgenderidentitybutdidnotdisclosethe identity, andthosewhowerealreadylivingfulltime because theywerenotlivingaccordingtotheirgender members whowerenotoutorperceivedastransgender This question(Q. 8.9)didnotdistinguishbetweenservice knew thattheyweretransgender. determining ifothernon-transgenderpeoplethoughtor many peoplewereoutastransgenderinthemilitaryby in thissection,questionwasintendedtoassesshow trans) believeyouaretrans?” Inthecontextofquestions Q. 8.9asked, “Howmanypeopleinthemilitary(whoaren’t error. Seenote 13. years didnotreceive thisquestionduetoaprogramming Veterans whoseparated fromthemilitarywithinpastten knew theyweretransgender. while 63%indicatedthatatleastone militaryhealthprovider military healthprovidersknewthat theyweretransgender, that thequestiondidnotapplyto them, asnoneoftheir Thirty-seven percent(37%)ofcurrent servicememberssaid underestimated certainexperiencesreportedinthissection. of thosewhoseparatedmorethantenyearspriorandlikely addressed veterans’ issuesonlyreflected theexperiences these questions.Therefore, resultsofquestionsthat who separatedwithinthepasttenyearsdidnotreceive survey. However, duetoaprogrammingerror, respondents separated morethantenyearspriortoparticipatinginthe differences inexperiencesbetweenthemandthosewho health care, andmilitarydischargepapers)toevaluatethe reasons forseparationandthenatureoftheirdischarge, VA have receivedquestions8.12–8.21 (whichcoveredthe Those whoseparatedwithinthepasttenyearsshould two groupsweredirectedtospecificquestionsaccordingly. related healthcare, andeligibilitytoreturn toservice. The receiving medicalcarefortransition-andnon-transition- may havealsohaddifferentexperienceswithtransitioning, may havehaddifferentexperiencesasaresult.Thisgroup not transgender)servicememberstoserveopenly—and Ask, Don’t Tell,” permittinglesbian,gay, andbisexual(but military cultureandpolicies—includingtherepealof“Don’t ten yearswereservinginatimeofchangingsocietaland that thosewhohadseparatedfromservicewithinthepast on theirtimeofserviceandseparation.Itwasdetermined the experiencesthateachgroupmighthavehadbased had separatedfromserviceintotwogroupstoevaluate consultation, theresearchteamchosetodividethosewho general, andtransgendermilitaryserviceinparticular. After with subject-matterexpertiseinLGBT militaryservice in HOUSING, HOMELESSNESS, AND SHELTER ACCESS 175 For transgender people 1 2

have faced discrimination when seeking housing, and are vulnerable to actions such as eviction have faced discrimination when seeking housing, and are vulnerable to family rejection and other because of their transgender status. Such discrimination, in addition to ousing is one of the most vital needs all people share. However, many transgender people However, ousing is one of the most vital needs all people share.

including access to shelters and the treatment they received in those shelters as transgender people. as transgender people. including access to shelters and the treatment they received in those shelters based on demographic and other characteristics are experiences Notable differences in respondents’ reported throughout the chapter. gender identity, or require them to stay in facilities that are inappropriate for their gender, often putting often or require them to stay in facilities that are inappropriate for their gender, gender identity, them at further risk of violence and harassment. living arrangements and their experiences with homelessness, current This chapter explores respondents’ in the past year because as well as with specific forms of housing discrimination and instability occurring experiences with homelessness in the past year, of their transgender status. It also examines respondents’ risk factors, can lead to housing instability and higher rates of homelessness. often are unsafe environments. who experience homelessness, shelters present additional problems and away because of their Previous studies have found that shelters frequently turn transgender people Shelter Access Shelter Housing, andHomelessness, CHAPTER 13 CHAPTER H 176 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS One-quarter(25%)decidedtodressorpresentasthewronggenderin ordertofeel • Nearlyoneinten(9%)respondentswerethrownoutoncetheshelterstafffound out • Morethanhalf(52%)ofthosewhostayedatashelterinthepastyearwere • discrimination inthepastyear, suchasbeingevictedfromtheirhomeordenieda Nearly one-quarter(23%)ofrespondentsexperiencedsomeformhousing being transgender. in theirlives.Oneeight(12%)experiencedhomelessness inthepastyearbecauseof Nearly one-third(30%)ofrespondentshaveexperienced homelessnessatsomepoint Only 16%ofrespondentsownedtheirhomes,incontrastto63%theU.S. population. form ofmistreatmentbecausebeingtransgender. Seventy percent(70%)ofthosewhostayedinashelterthepastyearreportedsome including 4%whoweredeniedaccessduetobeingtransgender. as atransgenderperson.Additionally, sixpercent(6%)weredeniedaccesstoashelter, avoided stayinginhomelesssheltersbecausetheyfearedwouldbemistreated More thanone-quarter(26%)ofrespondentswhowerehomeless inthepastyear or apartmentbecauseofbeingtransgender. the wronggenderinordertostayatshelter. safe inashelter, and14%saidthattheshelterstaffforcedthemtodressorpresentas treatment orunsafeconditions. that theyweretransgender, and44%decidedtoleavetheshelterbecauseofpoor transgender. verbally harassed,physicallyattacked, and/or sexuallyassaultedbecauseofbeing HOUSING, HOMELESSNESS, AND SHELTER ACCESS 177 78%

69% 65 and over and 65 4 75%

58% 55 to 64 to 55 68%

43% 45 to 54 to 45 USTS respondents respondents USTS 3 56%

28% 35 to 44 to 35 37%

11% 25 to 34 to 25

13% 5 1%

% in USTS % in USTS (ACS) population % in U.S. Under 25 Under 63%

16% Overall 0% 10% 70% 40% 30% 80% 20% 50% 60% Figure 13.1: Homeownership rate Figure 13.1: (%) CURRENT AGE adults in the U.S. population (0.18%), as reported population (0.18%), adults in the U.S. by the Department of Housing and Urban Development. Respondents also reported substantial housing Respondents Nearly one in ten (9%) respondents instability. were living temporarily with friends or family because they could not afford their own housing. of half of one percent (0.53%) Approximately respondents were homeless at the time they including those who participated in the survey, were living in a shelter (other than a domestic violence shelter), or on the street. This was three times the rate of current homelessness among In contrast to the 63% homeownership rate in the rate in to the 63% homeownership In contrast the time of the survey, at U.S. a home, to own likely four times less were nearly in a they were living 16% reporting that with only A or condo that they owned. apartment, house, the rate of homeownership was large difference in age groups (Figure 13.1). consistent across 7% 2% 5% 9% <1% <1% <1% <1% <1% <1% <1% <1% 17% 16% 44% % of respondents Not listed above Living in military barracks Living in a nursing home or other adult care facility Living in a foster group home or other foster care Living in a hospital domestic violence, or other type ofdomestic violence, emergency shelter) or in a hotel or motel with an emergency shelter voucher Living in transitional housing or a halfway house Living in a hotel or motel that they pay for Living in campus or university housing or other person spouse, Living with a partner, who pays for the housing in an abandoned Living on the street, in a car, a building, in a park, or a place that is NOT or other housing shelter, apartment, house, Living in a shelter (including homeless, with because they have not yet left home or condo they apartment, Living in house, own (alone or with others) Living temporarily with friends or family because they cannot afford their own housing Current living arrangements or condo they apartment, Living in house, rent (alone or with others) Living with parents or family they grew up commonly reported living arrangement. Seventeen commonly reported not yet left home and were living percent (17%) had or the family they grew up with with their parents 13.1). (Table Current living arrangements 13.1: Table Respondents were asked what their current living what their current were asked Respondents at the time they participated in arrangements were half (44%) of respondents were Nearly the survey. apartment, or condo they rented, living in a house, others, which was the most either alone or with I. Current Living Living I. Current Arrangements 178 2015 U.S. TRANSGENDER SURVEY 13.2). especially highratesofhomelessness(Figure Middle Eastern(49%)women,alsoexperienced Indian (59%),Black(51%),multiracialand Transgender womenofcolor, includingAmerican of theirgenderidentityorexpression(55%). as respondentswhohavelosttheirjobbecause work (59%)andthoselivingwithHIV(59%),aswell high amongrespondentswhohavedonesex The homelessnessratewasalsonearlytwiceas these respondentsexperiencinghomelessness. the house, withnearlythree-quarters(74%)of whose immediatefamilyhadkicked themoutof was substantiallyhigheramongrespondents could notaffordhousing.Thehomelessnessrate temporarily withfamilyorfriendsbecausethey lived onthestreet,outofacar, orstayed including thosewhohavestayedinashelter, experienced homelessnessduringtheirlifetime, Nearly one-third(30%)ofrespondentshave During One’s Lifetime II. Homelessness RACE/ETHNICITY (%) transgender women Figure 13.2:Lifetimehomelessnessrateamong 60% 20% 50% 30% 40% 70% 10% 0%

respondents)Overall (all

American Indian 30% 59%

Asian 25%

Black 51%

Latina Middle Eastern 35% 49%

Multiracial 51%

White 31% being transgender(Figure 13.3). report beinghomelessinthe pastyearbecauseof (18%) women,weresubstantially morelikely to American Indian(27%),multiracial(18%),andLatina Transgender womenofcolor, includingBlack(31%), the pastyearbecausetheyweretransgender. likely toreportexperiencinghomelessnessin (32%), andthoselivingwithHIV(27%)weremore criminalized) (37%),undocumentedresidents work, drugsales,andotherworkthatiscurrently working intheundergroundeconomy(suchassex a resultofanti-transgenderbias.Thosecurrently experiencing homelessnessinthepastyearas One ineight(12%)respondentsreported past yearbecauseofbeingtransgender Table 13.2:Housingsituationsthatoccurredinthe (Table 13.2). being homeless,becausetheyweretransgender instability inthepastyear, suchasbeingevictedor experiences withhousingdiscriminationand Respondents wereasked aboutspecific Past Year Homelessness inthe Discrimination and III. Housing One or more experiences listed One ormoreexperienceslisted or apartment They wereevictedfromahome Housing situation apartment They weredeniedahomeor They experiencedhomelessness expensive homeorapartment They hadtomoveintoaless a friend’s couch) short periodsoftime(suchason They sleptindifferentplacesfor family membersorfriends They hadtomovebackinwith 6 % ofpeopletowhom situation applied

30% 20% 15% 12% 13% 6% 5% HOUSING, HOMELESSNESS, AND SHELTER ACCESS 179 sexual violence. And when I turned sexual violence. shelters, I was too to the women’s the women masculine to make comfortable.” “When I was 18, I ran away from “When I was 18, I ran away from my abusive parents who had been my violent toward me because of sexuality and gender expression. I became homeless for several years, traveling all over the country, stealing food and sleeping in abandoned buildings.” “When I go to shelters, I am admonished and told that I should order in return to ‘being a woman’ to use the shelter system.” ones “I’ve tried shelters. The men’s safe for trans men: if those aren’t you’re men find out who you are, opening yourself up to physical and In Our Own Own In Our Voices my apartment “I was ejected from of town after my while I was out home.’’ I was trans. landlord discovered was empty when I The apartment returned as “I lost my job after I came out I became homeless transgender. I never stayed for about year. in a shelter because I feared harassment.”

12% White White

18% 15%

Multiracial

Middle Eastern* Middle 11% 18%

Middle Eastern* Middle

Latina Latina

17% 31%

Black Black

13% 10% Asian Asian

27% 10%

12% Indian American 6% American Indian American

Overall (all (all Overall

respondents) Overall (all (all Overall respondents) 5% 4% 0% 8% 2% 6% 0% 15% 14% 10% 18% 12% 16% 10% 35% 30% 25% 20% Figure 13.3: Homelessness in the past year because of the past year because Homelessness in Figure 13.3: women among transgender being transgender (%) RACE/ETHNICITY *Sample size too low to report (%) RACE/ETHNICITY were transgender, with transgender women of were transgender, Black (17%), multiracial (15%), and including color, to have this being more likely (11%) women, Latina experience (Figure 13.4). in the past year Figure 13.4: Denial of home/apartment women due to being transgender among transgender *Sample size too low to report denied a Six percent (6%) of respondents were because they home or apartment in the past year 180 2015 U.S. TRANSGENDER SURVEY *Sample size toolowtoreport women (Figure13.5). (39%), AmericanIndianandLatina (37%) experiences, includingBlack(49%),multiracial also morelikely havehadoneormoreofthese (50%) andtransgenderwomenofcolorwere of theseexperiences.Undocumentedresidents were nearlytwiceaslikely toreportone or more their livesbecausetheyweretransgender(59%) out ofthehousebytheirfamilyatsomepointin economy (59%)andthosewhohadbeenkicked who werecurrentlyworkingintheunderground year becausetheyweretransgender. Respondents of housingdiscriminationorinstabilityinthepast all respondents—experiencedoneormoreforms whom thesehousingsituationsapplied—23%of Overall, nearlyone-third(30%)ofrespondentsto were morelikely toreport thisexperience. American Indian(9%)andBlackrespondents, disabilities undocumented residents(18%),peoplewith emerged bydemographiccharacteristics,where because ofanti-transgenderbias.Differences from theirhomeorapartmentinthepastyear Five percent(5%)ofrespondentswereevicted transgender bias. the pastyearbecauseofanti- were evictedfromtheirhomein Five percent(5%)ofrespondents RACE/ETHNICITY (%) among transgenderwomen instability inpastyearduetobeingtransgender Figure 13.5:Anyhousingdiscriminationand/or 60% 20% 50% 30% 40% 10% 0%

respondents)Overall (all

American Indian 30% 7 (8%),andpeopleofcolor, including 39%

Asian 33%

Black 49%

Latina Middle Eastern* 37%

Multiracial 39%

White 27% past year Table 13.3:Experienceswithhomelesssheltersinthe shelter duringthatyear(Table 13.3). were asked whetherthey hadgonetoahomeless the pastyearbecauseoftheirtransgenderstatus Respondents whoexperiencedhomelessness in a. AccesstoShelters IV. Shelters avoid seekingshelterforfearofbeingmistreated. for beingtransgender(35%)weremorelikely to whose familieshadkicked themoutofthehouse underground economy(36%),andrespondents (Figure 13.6). Respondents currentlyworkinginthe as Black(25%)andLatino/a (22%)respondents reason, incontrasttootherpeopleofcolor, such more likely toreportavoidingashelterforthis and AmericanIndian(37%)respondentswere transgender personinthepastyear. Asian(43%) because theyfearedbeingmistreatedasa More thanone-quarter(26%)didnotseekshelter Indian (23%)andBlack(15%)respondents. respondents livingwithHIV(22%)andAmerican year. Higherpercentageswerenotedamong and stayedatoneormoresheltersinthepast One inten(10%)respondentssoughtshelter because they feared because theyfeared They didnotseekshelter, shelters denied accesstooneormore They soughtshelterandwere at oneormoreshelters They soughtshelterandstayed shelters Experiences withhomeless person mistreatment asatransgender other reasons They didnotseekshelterfor % ofpeoplewhowere homeless 59% 26% 10% 6% HOUSING, HOMELESSNESS, AND SHELTER ACCESS 181 7% 4% 4% 8% 5% 17% 19% 74% access to shelter % of those denied Reason for denial Reason Age Disability Income level or education Gender identity or expression or ethnicity Race Religion or spirituality Religion Sexual orientation None of the above Seven out of ten (70%) respondents respondents out of ten (70%) Seven in the at a shelter who stayed form of faced some past year such as being forced mistreatment, because or attacked out, harassed, of being transgender. being denied access reasons for 13.4: Reported Table to one or more shelters conditions, even though they had no other place to One-quarter (25%) of respondents decided to go. dress or present as the wrong gender in order to and 14% said that the shelter feel safe in a shelter, staff forced them to dress or present as the wrong 13.5). gender in order to stay at the shelter (Table in Shelters Treatment b. who stayed at one or more shelters Respondents about how in the past year received questions a transgender they were treated at the shelter(s) as at person. Seventy percent (70%) encountered on their least one negative experience based such as being transgender status in the past year, because they forced out, harassed, or attacked were transgender. Nearly one in ten (9%) respondents who stayed at a 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 the shelter because of poor treatment or unsafe

26% White

22% Multiracial This represents

22% Eastern* Middle Latino/a

25% Black

43% Asian

37%

26% Indian American Overall 5% 0% 15% 10% 45% 35% 40% 30% 25% 50% 20% *Sample size too low to report were denied access to a shelter because of their gender identity or expression. 4% of those who were homeless in the past year 13.4). (Table more shelters in the past year were asked what more shelters in the past year were asked they believed the reasons were for that treatment, and they selected one or more reasons from a list, and gender identity. race or ethnicity, such as age, Nearly three-quarters (74%) believed that they being more than twice as likely. Those who were being more than twice as likely. economy currently working in the underground to be denied access to (13%) were also more likely a shelter. were denied access to one or who Respondents Six percent (6%) of respondents were denied Six percent (6%) of respondents were Transgender access to a shelter in the past year. to be denied women of color were more likely with multiracial women (30%) access to a shelter, and Black women (13%) being five times as likely, Figure 13.6: Did not seek shelter for fear of shelter for fear Did not seek Figure 13.6: year person in the past as a transgender mistreatment (%) RACE/ETHNICITY 182 2015 U.S. TRANSGENDER SURVEY because theyweretransgender sexual assaultinhomelesssheltersthepastyear Table shelter becausetheyweretransgender(Table 13.6). attacked, and17%weresexuallyassaultedatthe transgender. Nearlyone-fifth(19%)werephysically they wereverballyharassedbecause were transgender. Nearlyhalf(49%)reportedthat sexually assaulted were verballyharassed,physicallyattacked, or in thepastyearwerealsoasked whetherthey Respondents whostayedatahomelessshelter shelters inthepastyear Table 13.5:Experienceswhilestayinginhomeless One or more experiences listed One ormoreexperienceslisted Sexually assaulted Physically attacked Verbally harassed homeless shelters Experiences whilestayingin One ormoreexperienceslisted learned theyweretransgender They werethrownoutaftershelterstaff present asthewronggender The shelterrequiredthemtodressor wrong gendertofeelsafeinshelter They decidedtodressorpresentasthe had nowhereelsetogo unsafe conditions,eventhoughthey They leftbecauseofpoortreatmentor homeless shelters Experiences whilestayingin 13 .6: Verbal harassment,physicalattack,and 9 at the shelter because they attheshelterbecausethey stayed inashelter stayed inashelter % ofpeoplewho % ofpeoplewho 58% 52% 25% 49% 44% 19% 14% 17% 9%

use ashelterinthepastyearfacedhighratesof as atransgenderperson,andthosewhodid a shelterbecausetheyfearedbeingmistreated in thepastyearreportedthattheyavoidedusing Many ofthosewhoexperiencedhomelessness currently workingintheundergroundeconomy. their homesbyfamilies,andrespondents with HIV, peoplewhohavebeenkicked outof among transgenderwomenofcolor, peopleliving on theirtransgenderstatus,withhigherrates and housinginstabilityinthepastyearbased respondents experiencedhousingdiscrimination results alsoindicatedthatasubstantialnumberof both intheirlifetimeandthepastyear. The Respondents reportedhighratesofhomelessness Conclusion assaulted. verbally harassed,physicallyattacked, orsexually such asbeingkicked outoftheshelter, being mistreatment basedontheirtransgenderstatus, HOUSING, HOMELESSNESS, AND SHELTER ACCESS 183 Available Available 2015 Annual Homelessness 2015 Annual “People with disabilities” here refers to respondents who here refers to respondents who with disabilities” “People Q. 2.20. identified as a person with a disability in The survey included both “transgender status/gender as answer identity” and “gender expression/appearance” they felt choices so that respondents could select what Because there was best represented their experience. both a substantial overlap of respondents who selected used reasons, and because these terms are commonly responses interchangeably or with very similar meanings, are of those who selected one or both of these reasons expression.” collapsed for reporting as “gender identity or if they had experienced were asked Respondents sexual “unwanted sexual contact (such as fondling, 24.4. assault, or rape)” in Q. The homelessness point-in-time estimate is based on point-in-time estimate The homelessness Housing and Urban data. Department of January 2015 (2015). Development. (AHAR) to Congress. Assessment Report at: https://www.hudexchange.info/resources/ is based on Calculation documents/2015-AHAR-Part-1.pdf. the age of 18 who were homeless the 436,921 people over and the January 2015 estimated on a given night in 2015 adult population (247,492,492). of answering “yes,” were given the choice Respondents scenario for each housing or “does not apply to me” “no,” to select “does 23.2. They were instructed listed in Q. housing situation could not have if the not apply to me” those example, For past year. happened to them in the not have who did not rent a home in the past year could not been evicted, and were instructed to select “does for that question. The results reported in this apply to me” not section do not include those who answered “does for each of the housing situations. apply to me” 7 8 9 5 6

, . (p. 112). . (p. Serving Our Youth: Serving Our Youth: . DC: Center for American American Community American Community Injustice at Every Turn: A Report of A Report Injustice at Every Turn: The ACS homeownership rate include homeownership rate include The ACS In Focus: A Quarterly Research Review Review Quarterly Research In Focus: A The ACS homeownership rate for the “under The ACS | CHAPTER 13: HOUSING, HOMELESSNESS, AND SHELTER ACCESS AND SHELTER HOMELESSNESS, 13: HOUSING, | CHAPTER . Los Angeles, CA: Williams Institute. Available Available Williams Institute. Angeles, CA: . Los (1). Available at: http://www.nhchc.org/wp-content/ at: (1). Available 25” age group includes those who are 15–24 years of age, 25” age group includes those who are 15–24 years of age, which includes respondents rate, in contrast to the USTS See note 3. who are 18–24 years of age. comparison to the USTS sample could not be made. sample could not be made. comparison to the USTS this comparison should be interpreted with Therefore, caution. Census Bureau. (2015). U.S. by Age of Estimates: Homeownership Rate Survey 1-Year Householder. U.S. Census Bureau. (2015). U.S. by Age Estimates: Homeownership Rate Survey 1-Year of Householder. which rate, in contrast to the USTS ages 15 and older, Because includes respondents who are 18 and older. an exact years of age, includes people under 18 the ACS Grant, et al.; Rooney, C., Durso, L. E., & Gruberg, S. (2016). L. E., & Gruberg, S. (2016). C., Durso, Grant, et al.; Rooney, Seeking Women Discrimination Against Transgender Access to Homeless Shelters at: https://www.americanprogress. Progress. Available org/issues/lgbt/report/2016/01/07/128323/discrimination- against-transgender-women-seeking-access-to-homeless- shelters/. at: http://williamsinstitute.law.ucla.edu/wp-content/uploads/ Durso-Gates-LGBT-Homeless-Youth-Survey-July-2012.pdf; Herman, J. Harrison, J., J., M., Mottet, L. A., Tanis, Grant, J. M. (2011). L., & Keisling, Discrimination Survey the National Transgender Equality & National DC: National Center for Transgender Force. Task Gay and Lesbian 3 uploads/2014/10/in-focus_transgender_sep2014_final. (2012). L. E. & Gates, G. J. pdf; Durso, Survey of Service Providers Findings from a National Bisexual, and Transgender Gay, Lesbian, with Working are Homeless or at Risk of Becoming who Youth Homeless See e.g., Davidson, C. (2014). Gender minority and Gender minority and Davidson, C. (2014). See e.g., homelessness. Homeless Council Health Care for the of the National 4 3 2 ENDNOTES ENDNOTES 1 184 2015 U.S. TRANSGENDER SURVEY T Immigration Detention Police, Prisons, and CHAPTER 14 experiences basedondemographic andothercharacteristicsarereportedthroughout thechapter. or JuvenileDetention,and (C) ExperiencesinImmigrationDetention.Notabledifferences inrespondents’ presented inthreesections: (A)InteractionswithLaw EnforcementOfficers,(B)IncarcerationinJail, Prison, section weremodeledonthe BureauofJusticeStatistics’ National InmateSurvey. Results inthischapterare sexual assaultduringinteractionswithlawenforcement andwhileincarcerated.Manyofthequestionsinthis prison, orjuveniledetentioncenters,andinimmigration detention,includingexperiencesofphysicaland This chapterexploresrespondents’ experienceswithpoliceand other lawenforcementofficers,injail, them vulnerabletophysicalandsexualabuse, denialofmedicaltreatment,andother dangerousconditions. facilities thatdonotmatchtheirgenderidentityorface extendedperiodsofsolitaryconfinement,leaving immigration detentioncenters.Whileindetention, transgenderpeopleareoftenplacedin those whoareseekingasylumbasedontheirgender identity, facetheprospectofbeingplacedintounsafe Furthermore, whennavigatingtheUnitedStates immigrationsystem,manytransgenderpeople, including rates ofpolicemistreatment, interactions withlawenforcementofficersandthecriminaljusticesystem.Thisincludeshigher ransgender people, particularlytransgenderpeopleofcolor, faceelevatedlevelsofnegative 1 incarceration, 2 andphysicalsexualassaultinjailsprisons. 3

4 POLICE, PRISONS, AND IMMIGRATION DETENTION 185

with 4 3 % Always treated respect past year

interacted with % of those who 14%

transgender in the or knew they were officers who thought with respect Never treated 43% treated Sometimes with respect Respondents who were currently working in the who Respondents to underground economy (80%) were more likely Respondents who said that some or all of the law Respondents they were enforcement officers thought or knew whether they were transgender were then asked More treated with respect during the interactions. said that than half of these respondents (57%) treated with they were never or only sometimes were always respect, and 43% reported that they treated with respect (Figure 14.2). by police Figure 14.2: Frequency of respectful treatment the past year or other law enforcement officers in

23% Some

All 12% past year who interacted with police in the % of respondents

22% believed they were arrested because they were transgender. because they were transgender. 22% believed they were arrested More than half (57%) of respondents said they were either somewhat or very somewhat either of respondents said they were More than half (57%) the police for help. uncomfortable asking and of those arrested, of respondents were arrested in the past year, percent (2%) Two Of respondents who interacted with police or law enforcement officers who thought enforcement officers who thought who interacted with police or law Of respondents never or only 57% said they were transgender in the past year, or knew they were mistreatment, such 58% reported some form of Further, respectfully. sometimes treated or physical or verbally harassed, referred to as the wrong gender, as being repeatedly sexually assaulted. 65% None

knew they were transgender (Figure 14.1). Interaction with officers Figure 14.1: who thought or knew respondents were transgender they interacted with the police or other law they interacted with the police or other Of those, enforcement officers in the past year. the officers 65% said that they believed none of and 35% thought or knew they were transgender, said that some or all of the officers thought or I. Law Enforcement Enforcement I. Law Interactions in the Year Past said that Forty percent (40%) of respondents A. INTERACTIONS WITH LAW LAW WITH A. INTERACTIONS OFFICERS ENFORCEMENT KEY FINDINGS KEY 186 2015 U.S. TRANSGENDER SURVEY *Sample sizetoolowtoreport RACE/ETHNICITY (%) respect bylawenforcementofficersinthepastyear Figure 14.4:Neveroronlysometimestreatedwith GENDER IDENTITY(%) respect bylawenforcementofficersinthepastyear Figure 14.3:Neveroronlysometimestreatedwith Black (70%)respondents(Figure14.4). respect, particularlyAmericanIndian(72%)and report neveroronlysometimesbeingtreatedwith 14.3). People ofcolorwerealsomorelikely to respect thantransgenderwomen(51%)(Figure having neveroronlysometimesbeentreatedwith transgender men(62%)weremorelikely toreport poverty respect, aswerethosewhocurrentlylivingin report neveroronlysometimesbeingtreatedwith 60% 20% 50% 80% 30% 40% 60% 20% 50% 80% 70% 30% 40% 70%

10% 10% 0% 0%

Overall

American Indian 57% Overall 57% 5 (69%).Non-binaryrespondents(70%)and Crossdressers 72% 20%

Asian 57% Non-binary 70%

Black 70%

Trans women Latino/a

Middle Eastern* 62% 51%

Trans men Trans women and men

Multiracial 62% 66%

White 55% 52% enforcement officersinthepastyear Table more formsofmistreatment(Table 14.1). respondents reportedhavingexperiencedoneor physically attacked. More thanhalf(58%)ofthese to asthewronggender, verballyharassed,or the pastyear, suchasbeingrepeatedlyreferred their interactionswithlawenforcementofficersin experienced specificformsofmistreatmentin were transgenderalsoasked whetherthey officers theyinteractedwiththoughtorknew Respondents whosaidthatsomeorallofthe of theseexperiences. (68%) werealsomorelikely toreportoneormore unemployed (75%),andpeople withdisabilities in thepastyear(78%),those whowerecurrently (Figure 14.5).Respondents whowerehomeless experienced oneormoreformsofmistreatment (61%) respondents,weremorelikely tohave (74%), multiracial(71%),Latino/a (66%), and Black People ofcolor, includingAmericanIndian gender pronouns(suchashe/ Officers keptusingthewrong past year mistreatment inthe Experiences of listed One ormoreexperiences arrest in sexualactivitytoavoid Forced byofficerstoengage Sexually assaultedbyofficers Physically attacked byofficers sex workers Officers assumedtheywere surgical status) (such asabouthormonesor about gendertransition Officers asked questions Verbally harassedbyofficers (such asMr. orMs.) him orshe/her)wrongtitle 14.1: Mistreatmentbypoliceorotherlaw

knew theyweretransgender with officerswhothoughtor % ofthosewhointeracted in thepastyear 58% 20% 49% 19% 11% 4% 3% 1% 6

POLICE, PRISONS, AND IMMIGRATION DETENTION 187

11% White

30%

Multiracial Middle Eastern* Middle

25% Latina

33% Black

and/or forced to engage

20% Asian 7

23%

11% American Indian American

Overall (all (all Overall respondents) 5% 0% 15% 10% 35% 30% 25% 20% (%) RACE/ETHNICITY Figure 14.6: Law enforcement officer assumed Law Figure 14.6: in the past year among they were a sex worker transgender women *Sample size too low to report of these respondents were physically attacked, of these respondents were physically attacked, sexually assaulted, in sexual activity to avoid arrest by an officer. were currently working in the who Respondents underground economy (27%) and those who were homeless in the past year (17%) were more interacted with law enforcement who Respondents officers who thought or knew they were transgender in the past year also reported being physically or sexually assaulted. Six percent (6%) be verbally harassed by an officer (40%), and those officer (40%), and harassed by an be verbally in the underground currently working who were to be as likely were more than twice economy (51%). verbally harassed more than one in ten (11%) In the past year, interacted with law enforcement respondents who or knew they were officers who thought that an officer assumed transgender reported women Transgender workers. that they were sex that an officer to report likely of color were more including Black sex workers, assumed they were (25%), American Latina (33%), multiracial (30%), (Figure 14.6). Indian (23%), and Asian (20%) women

55% White

71%

Multiracial Middle Eastern* Middle

66% Latino/a

61%

Black 60% Asian

74%

58% Indian American Overall 0% 10% 70% 40% 30% 80% 50% 20% 60% five (20%) of these respondents reported verbal Those who had been harassment by an officer. to homeless in the past year were twice as likely Verbal harassment was frequently reported by Verbal respondents who interacted with police or other law enforcement officers who thought or knew one in In the past year, they were transgender. *Sample size too low to report Figure 14.5: Experienced one or more forms of Figure 14.5: Experienced one or more forms in the mistreatment by law enforcement officers past year (%) RACE/ETHNICITY physically or sexuallyphysically inassaulted, or mistreated year. another way in the past with a law enforcementwith a law thought or knewofficer who transgenderthat they were harassed,were verbally More than half (58%) of than half (58%) More interacted who respondents 188 2015 U.S. TRANSGENDER SURVEY help fromthepolice(Figure14.8). uncomfortable orveryaskingfor (57%) ofthesamplesaidthattheyweresomewhat police, and15%saidtheywere neutral.Amajority somewhat comfortableaskingforhelpfromthe that theywouldeitherbeverycomfortableor needed it.Twenty-nine percent(29%)reported would feelaskingforhelpfromthepoliceifthey All respondentswereasked howcomfortablethey Officers with Law Enforcement II. ComfortInteracting *Sample sizetoolowtoreport RACE/ETHNICITY (%) arrest inthepastyearamongtransgenderwomen and/or forcedtoengageinsexualactivityavoid Figure 14.7: Physicallyattacked, sexuallyassaulted, of theseexperiences(Figure14.7). women, werealsomorelikely toreportoneormore Indian (20%),Black(17%),andmultiracial(16%) Transgender womenofcolor, includingAmerican likely toreportoneormoreoftheseexperiences. 20% 25% 10% 15% 0% 5%

respondents)Overall (all

American Indian 6% 20%

Asian 10%

Black 17%

Latina

Middle Eastern* 8%

Multiracial 16%

White 3% me Isoundedfemale. Nextthing told himIwasmale, andhetold asked meaboutmygender. I “While Iwasinsolitary, acop and accusedofbeingasexworker.” harassed, threatenedwitharrest, of themaswellbeingverbally and forcedtostripinpublicfront gender, Iwasstoppedbypolice “When Ibegantoliveinmycorrect Voices In OurOwn full timeas male.” female colorseventhough Ipass calling me‘miss,’ andgaveme solitary confinementcell, kept booking meintoanall-female laughed aboutit.They endedup nonprofessional mannerand about mygenitaliainavery asked veryintrusivequestions “When Iwasbooked, theofficers transgender.” because theymocked meforbeing and theguardswereofnohelp being different.Ifearedformylife towards mewhilemockingfor inmates whomadesexualadvances strip downandshowerwithmale shower areawhereIwasforcedto booked, Iwasescortedtothe with maledetainees.Uponbeing for12dayshoused “I wasin[jail] humiliating.” have himconfirmmygender. Itwas jail doctortospreadmylegsand I knew, Iwasbeingtaken tothe POLICE, PRISONS, AND IMMIGRATION DETENTION 189

2% White

3% Multiracial

Middle Eastern Middle

2% Latina

6% Black

2% Asian 6%

2% American Indian American

Overall (all (all Overall respondents) 4% 2% 6% 0% Figure 14.10: Arrested in the past year for any reason Figure 14.10: among transgender women (%) RACE/ETHNICITY Respondents who were homeless in the past year who were homeless in the past year Respondents to be arrested during that (6%) were more likely Black including women of color, Transgender year. (3%) (6%), American Indian (6%), and multiracial to be arrested in the women, were also more likely past year (Figure 14.10). A majority (57%) of respondents of respondents (57%) A majority be somewhat would said they asking or very uncomfortable the police if they for help from needed it. III. Arrest respondents reported percent (2%) of all Two Almost having been arrested in the past year. arrested one-quarter (22%) of those who were they believed that they were arrested because were transgender.

53% White

67%

Multiracial

17% able what Some- comfort- 70% 15% Neutral

Middle Eastern Middle

59% 12% Latino/a Very Very

comfortable

67% Black

% of

26%

58% Asian respondents Somewhat uncomfortable

59%

31% able Very Very

57% Indian American Overall uncomfort- 0% 10% 70% 40% 30% 80% 50% 20% 60% (%) RACE/ETHNICITY were living in poverty (67%) were also more likely more likely were living in poverty (67%) were also asking for to be somewhat or very uncomfortable help from the police. Figure 14.9: Somewhat or very uncomfortable asking the police for help Middle Eastern (70%), Black (67%), and multiracial Middle Eastern (70%), Black (67%), and to say that (67%) respondents were more likely they were either somewhat or very uncomfortable 14.9). asking for help from the police (Figure with disabilities (70%) and those who Respondents Figure 14.8: Comfort asking the police for help Comfort asking the Figure 14.8: 190 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS year (7%). respondents whohadbeenhomelessinthepast incarcerated inthepastyear(Figure14.11), aswere (6%) women,weremorelikely tohavebeen including Black(9%)andAmericanIndian in thepastyear. Transgender womenofcolor, of undocumentedrespondentswereincarcerated detention) inthepastyear. Twelve percent(12%) incarcerated (heldinjail,prison,orjuvenile Two percent(2%)ofrespondentswere Incarceration Rates I. Overall OR JUVENILEDETENTION B. INCARCERATION INJAIL, PRISON, RACE/ETHNICITY (%) transgender women Figure 14.11: Incarceratedin the pastyearamong 10% 0% 6% 2% 8% 4%

respondents)Overall (all

American Indian 2% while incarcerated. hormones beforetheirincarcerationwerepreventedfrom takingtheirhormones During thepastyear, morethanone-third(37%)ofrespondentswhoweretaking sexually assaultedbyfacilitystaffand/oranotherinmateinthepastyear. Nearly one-third(30%)ofrespondentswhowereincarceratedphysicallyand/or past year. Two percent(2%)ofrespondentswereheldinjail,prison,orjuveniledetentionthe 6%

Asian 1%

Black 9%

Latina

Middle Eastern 3% 0%

Multiracial 2%

White 2% 60% 20% 50% 30% 40% 70% Respondents whowereincarceratedinthepast Figure 14.12: Types ofincarcerationfacilities and/or heldinaholdingcell(58%)(Figure14.12). respondents wereincarceratedinalocaljail(64%) made oneormoreselections.Mostofthese juvenile detentionfacilitytheywerein,and year wereasked whattypeofjail,prison,or 10% 0%

Local jail 64%

Holding cell 58%

State prison

State juvenile system 6% 2% Locally or privatelyFederal operated prison

1% juvenile facilities Other correctional facility 1% 5% POLICE, PRISONS, AND IMMIGRATION DETENTION 191 -

20% facility staff facility

sexual assault by by assault sexual Physical and/or and/or Physical 53% Once

11%

by facility staff facility by Sexual assault assault Sexual staff

assaulted by % of those who were physically 19% 18% times 12% Twice

8 or more

by facility staff facility by Physical assault assault Physical 3–7 16% times 5% 0% 15% 10% 25% 20% Almost one in five (18%) respondents who were Almost one in five (18%) respondents incarcerated in the past year were physically time in assaulted by facility staff during their jail, prison, or juvenile detention. Respondents staff who were physically assaulted by facility how many times it in the past year were asked that they happened. More than half (53%) reported reported 12% had been physically assaulted once, 16% said that it happened that it happened twice, nearly one in between three and seven times, and five (19%) reported that it happened eight or more times (Figure 14.15). assaults Number of physical Figure 14.15: by facility staff a. Physical and Sexual Assault Assault and Sexual a. Physical Staff by Facility who were incarcer (20%) respondents One in five or juvenile detention in the pastated in jail, prison, and/or sexually assaulted byyear were physically that time (Figure 14.14). facility staff during Physical and sexual assault by facility Figure 14.14: year staff during the past

30%

staff or inmates or staff

sexual assault by by assault sexual

Physical and/or and/or Physical Overall, 30% were inmates

20% 10 by staff or or staff by Nearly one-quarter (23%)

9 by facility staff or other by facility staff or assault Sexual

8 inmate

23%

by staff or or staff by Physical assault assault Physical 5% 0% 15% 10% 35% 30% Figure 14.13: Physical and sexual assault by staff or Figure 14.13: inmates in the past year during incarceration 25% 20% sexual assault by staff or other inmates is explored sexual assault by staff or other inmates separately in the following sections. by the U.S. incarcerated population in prisons incarcerated by the U.S. (4%) and in jails (3.2%). were physically assaulted. in the past physically and/or sexually assaulted Physical and year while incarcerated (Figure 14.13). inmates during that time period. One in five (20%) inmates during that being sexually assaulted respondents reported other inmates. This rate was by facility staff or of sexual five to six times higher than the rates reported assault by facility staff or other inmates Incarceration in jail, who were incarcerated Respondents detention in the past year prison, or juvenile had been physically whether they were asked or sexually assaulted II. Physical and and II. Physical During Assault Sexual 192 2015 U.S. TRANSGENDER SURVEY inmates duringthattime(Figure14.17). physically and/orsexuallyassaultedbyother detention inthepastyearreportedthattheywere were incarceratedinjail,prison,orjuvenile Twenty-two percent(22%)ofrespondentswho Other Inmates b. PhysicalandSexualAssaultby facility staff Figure 14.16: Numberofsexualassaultsby eight ormoretimes(Figure14.16). almost one-quarter(23%)saidthatithappened it happenedbetweenthreeandseventimes, once, 9%reportedthatithappenedtwice, 19%said happened. Nearlyhalf(49%)saidthatithappened the pastyearwereasked howmanytimesit who weresexuallyassaultedbyfacilitystaffin prisons (2.4%)andinjails(1.8%). reported bytheU.S. incarceratedpopulationin than theratesofsexualassaultbyfacilitystaff USTS respondentswasfivetosixtimeshigher jail, prison,orjuveniledetention.Therateamong facility staffinthepastyearduringtheirtime Eleven percent(11%)weresexuallyassaultedby 8 ormore 3–7 times times 23% 19%

assaulted by Twice % ofthose who were 9% sexually staff

11 Respondents Once 49%

assaulted byanotherinmate. times morelikely tobesexually facility staff, andninetoten to besexuallyassaultedby general incarceratedpopulation times morelikely thanthe incarcerated werefivetosix Respondents whowere jail, prison,orjuveniledetention.Respondents assaulted byanotherinmateduringtheirtimein incarcerated inthepastyearwerephysically One insix(16%)respondentswhowere more times(Figure14.18). one inten(10%)saidthatithappenedeightor happened betweenthreeandseventimes, were physicallyassaultedtwice, 34%saidthatit respondents werephysicallyassaultedonce, 13% it happened.Fewerthanhalf(43%)ofthose in thepastyearwereasked howmanytimes who werephysicallyassaultedbyanotherinmate 20% 25% inmates duringthepastyear Figure 14.17: Physicalandsexualassaultbyother 10% 15% 0% 5%

Physical assault by other inmates 16%

by otherSexual inmates assault 17%

sexualPhysical assault and/or by

other inmates 22% POLICE, PRISONS, AND IMMIGRATION DETENTION 193

43% Once

16% Twice assaulted by were sexually

% of those who another inmate 23% times

8 or more 3–7 18% times hormones while in jail, prison, or juvenile detention. III. Hormone Therapy III. Hormone Therapy During Incarceration were Over half (58%) of respondents who taking incarcerated in the past year had been hormones before their time in jail, prison, a 82% had or juvenile detention. Of those, than prescription for those hormones. More had been one-third (37%) of respondents who were taking hormones before their incarceration in the past prohibited from taking their hormones year while in jail, prison, or juvenile detention. more than In the past year, one-third (37%) of respondents who had been taking hormones before being incarcerated were prohibited from taking those Figure 14.19: Number of sexual assaults by of sexual assaults Number Figure 14.19: another inmate

43% Once

13% Twice

10% times assaulted by % of those who another inmate 8 or more were physically

3-7 34% times (23%) said that it happened eight or more times (Figure 14.19). another inmate in the past year were asked how asked another inmate in the past year were percent (43%) many times it happened. Forty-three assaulted of those respondents were sexually assaulted twice. and 16% were sexually once, between Nearly one in five (18%) said it happened three and seven times, and nearly one-quarter times higher than the rates of sexual assault by times higher than the rates of sexual incarcerated other inmates reported by the U.S. (1.6%). population in prisons (2%) and in jails who were sexually assaulted by Respondents Seventeen percent (17%) of respondents who were Seventeen percent (17%) of respondents that they incarcerated in the past year reported inmate during were sexually assaulted by another The their time in jail, prison, or juvenile detention. respondents was nine to ten rate among USTS Figure 14.18: Number of physical assaults by of physical assaults Number Figure 14.18: another inmate 194 2015 U.S. TRANSGENDER SURVEY

lesbian, gay, orbisexual(LGB). thought orknewthattheyweretransgender detention saidthatstaff, guards,orothers (69%) ofthosewhowereheldinimmigration immigration detention.Morethantwo-thirds (4%) (n=30, unweighted) immigration courtproceedings. (ICE) detentioncenteroralocaljailjustfor in anImmigrationandCustomsEnforcement in immigrationdetention,suchasbeingheld birth wereasked iftheyhadeverbeenheld Respondents whowerenotU.S. citizensby Detention in Immigration I. Placement KEY FINDINGS DETENTION C. EXPERIENCESINIMMIGRATION assaulted orbeingdeniedaccesstohormones. experienced someformofmistreatment,suchasbeingphysicallyorsexually Forty-five percent(45%)ofrespondentswhowereinimmigrationdetention confinement. segregated fromotherpeopleindetention,including42%whowereheldsolitary More thanhalf(52%)ofrespondentswhowereheldinimmigrationdetention in immigrationdetentionatsomepointtheirlives. Four percent(4%)ofrespondentswhowerenotU.S. citizens bybirthhadbeenheld 14 hadbeenheldin 13 Fourpercent months (Figure14.20). 14% wereheldinsolitaryconfinementforoversix quarter (28%)wereheldfor1–3months,while days orless(uptotwoweeks).Morethanone- confinement, fortypercent(40%)wereheldfor14 Of theninerespondentswhohadbeeninsolitary asked howlongtheywereheldinconfinement. Those whowereheldinsolitaryconfinement confinement. area. Forty-twopercent(42%)wereheldinsolitary people, suchasapod,unit,tank,orotherhousing in aseparateareafortransgenderand/orLGB more ways.Seventeenpercent(17%)wereheld than half(52%)reportedbeingisolatedinoneor respondents whoansweredthisquestion,more others whowerealsoindetention.Ofthethirty whether theyhadbeensegregatedfrom Respondents whoweredetainedasked Solitary Confinement II. Isolationand POLICE, PRISONS, AND IMMIGRATION DETENTION 195 15% 19% 23% 22% 29% 45% detained % of those 14.2: Mistreatment and assault in immigration and assault 14.2: Mistreatment Form of mistreatment or assault unweighted) (n=29, Denied access to hormones Physically assaulted clothing Denied gender-appropriate assault Threatened with sexual Sexually assaulted listed One or more experiences systems, as well as high rates of mistreatment systems, as well as high rates of mistreatment physical and sexual abuse in jails and by police, while prisons, and denial of medical treatment incarcerated. Experiences with law enforcement transgender varied by demographic groups, with those who have experienced people of color, and low- homelessness, people with disabilities, higher income transgender people reporting by rates of discomfort with and mistreatment Results police and other law enforcement officers. also indicated substantial levels of mistreatment detention and abuse in jail, prisons, and juvenile the experiences of centers. Additionally, respondents who were placed in immigration detention included harmful conditions and mistreatment, such as lengthy periods of solitary confinement and physical and sexual assault by detention staff and other detainees. Table Table detention with these findings should be interpreted size, * Due to the small sample caution. Conclusion reported frequent contact with Respondents the law enforcement and criminal justice

3% 40% or less 14 days 15–30 days

% of those 28% confinement 14% held in solitary 1–3 months to a year Six months Six months

3–6 14% months staff or detention officers or by other detainees or inmates, while 19% were threatened with sexual assault. Nearly one-third (29%) were denied access 14.2). to hormone treatment (Table respondents who answered these questions, 45% reported one or more of these experiences from their time in immigration detention. one-quarter (23%) were physically Approximately assaulted and 15% were sexually assaulted by were asked about any mistreatment they faced about any mistreatment they faced were asked such as being physically while they were there, sexual or sexually assaulted, threatened with or assault, or denied access to hormones twenty-nine gender-appropriate clothing. Of the Assault in Immigration Assault Detention detention Those who were placed in immigration * Due to the small sample size, these findings should be interpreted with * Due to the small sample size, caution. and III. Mistreatment Figure 14.20: Duration of solitary confinement unweighted) (n=9, 196 2015 U.S. TRANSGENDER SURVEY 7 6 5 4 3 2 1 ENDNOTES officer (suchasfondling,sexualassault,orrape).” 28.5: “Iexperiencedunwantedsexualcontactfroman Respondents receivedthefollowinganswerchoiceinQ. who identifiedasapersonwithdisabilityin Q. 2.20. “Respondents withdisabilities” herereferstorespondents about thepovertylinecalculation. and EmploymentStatus who arelivingatornearthepovertyline. Seethe Respondents whoare“livinginpoverty”representthose default/files/docs/resources/OurMoment_CIR_en.pdf. Equality. Available at:http://www.transequality.org/sites/ Transgender People. H. J. (2013). files/report_pdf/us0316_web.pdf; Jeanty, J. & Tobin, Watch. Available at:https://www.hrw.org/sites/default/ US ImmigrationDetention. Suffering Here?”: AbuseAgainst Transgender Women in Human RightsWatch. (2016). at: https://www.bjs.gov/content/pub/pdf/svpjri1112_st.pdf. Adult Inmates. Prevalence ofSexualVictimizationAmongTransgender Jails Reported byInmates Beck, A.J. (2014). Concrete-Closets.-Black-and-Pink.-October-21-2015..pdf. blackandpink.org/wp-content/upLoads/Coming-Out-of- Pink’s NationalLGBTQ Survey. Coming outofConcreteClosets:AReport onBlack& lgbtmap.org/file/lgbt-criminal-justice.pdf; Lydon, J. (2015). System FailsLGBT People. Project. (2016). Center forAmericanProgress&MovementAdvancement lgbtmap.org/file/lgbt-criminal-justice.pdf. System FailsLGBT People. Project. (2016). Center forAmericanProgress&MovementAdvancement |CHAPTER14:POLICE,PRISONS,ANDIMMIGRATION DETENTION Our MomentforReform: Immigration and DC: BureauofJusticeStatistics. Available Unjust: HowtheBroken CriminalJustice Unjust: HowtheBroken CriminalJustice Sexual VictimizationinPrisonsand DC: NationalCenterforTransgender chapter formoreinformation , Available at:http://www. Available at:http://www. NY, NewYork: HumanRights 2011–12: SupplementalTables: “Do You SeeHowMuchI’m Available at:http://www.

Income 9 8 14 13 12 11 10 detention. Therefore, datafromtheU.S. incarcerated of thosewhowereincarceratedinjail,prison,andjuvenile detention facilities.USTS dataincludestheexperiences but theydonotpresentdataforthoseheldinjuvenile state andfederalprisonspeopleincarceratedinjails, (BJS) presentsdataseparatelyforpeopleincarceratedin Beck etal.Seenote8.TheBureauofJusticeStatistics pdf/svpjri1112.pdf. Statistics. Available at:https://www.bjs.gov/content/pub/ Jails Reported byInmates2011–12 R., &Krebs,C.(2013). incarcerated population.Beck,A.J., Berzofsky, M.,Caspar, Inmate Surveytoallowforcomparisonwiththegeneral the languageusedbyBureauofJustice’s National staff orwithanotherinmate. Thisquestionwasbasedon that [they]hadtohavesexorsexualcontact”withfacility they were“physicallyforced,pressured,ormadetofeel Respondents wereasked inQ. 28.10 andQ. 28.12 whether small samplesize. section shouldbeinterpretedwithcautionduetothe experiences inthisreport,thefindingspresented of respondents.Whileitisimportanttopresentthese percentages reflecttheexperiencesofasmallnumber weighted percentagesinthissectiontobeclearthatthe size, unweightedfrequenciesarepresentedalongside experiences inthisreport.Duetothesmallsample detention facility, itwasimportanttohighlighttheir (n=30, unweighted)hadbeenheldinanimmigration Although asmallnumberofrespondentsinthesample USTS Respondents with applicationsforasylum,isprovidedinthe citizenship andimmigrationstatus,includingexperiences held inimmigrationdetention.Generalinformationabout This sectiondiscussesthespecificexperiencesofthose Beck etal.Seenote8. Beck etal.Seenote8. assault thatdoesnotinvolvesexualviolence. The NationalInmateSurveydoesnotaskaboutphysical interpreted withcaution. experiences amongUSTS respondentsandshouldbe population inthissectionisprovidedasabenchmarkfor chapter. Sexual VictimizationinPrisonsand . DC:BureauofJustice Portrait of HARASSMENT AND VIOLENCE 197

4 chapter), 3

They also received questions about experiences with 5 Transgender people also face high rates of violence, people also face high rates of violence, Transgender 2 Places of Public Accommodation and Airport Security Transgender people, however, are often vulnerable to mistreatment in public spaces, resulting however, people, Transgender 1

been shown to have wide-ranging impacts on health, economic stability, and other key aspects of and other key been shown to have wide-ranging impacts on health, economic stability, life. he freedom to participate in public life without fear of discrimination, harassment, and violence has he freedom to participate in public life

the National Crime Victimization Survey and the National Intimate Partner and Sexual Violence Survey. the National Crime Victimization Survey and the National Intimate Partner based on demographic and other characteristics are experiences Notable differences in respondents’ reported throughout the chapter. in businesses, government agencies, and other public places (more broadly than just in public in businesses, government agencies, and other public places (more broadly accommodations, which are covered in the as well their experiences with verbal harassment. about they were asked or sexually assaulted in a variety of settings. Finally, being physically attacked were informed by several national surveys, including Questions experiences with intimate partner violence. in barriers to civic and economic participation. including physical attacks, sexual assault, and intimate partner violence. service about their experiences in the past year with unequal treatment or asked were Respondents and Violence Harassment CHAPTER 15 CHAPTER T 198 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS past year, andisfollowedbyseparate sections examine respondents’ overall experiencesinthe were transgender. Thissectionofthechapterwill regardless ofwhetherithappenedbecausethey physically attacked inthepastyearforanyreason, equal treatmentorservice, verballyharassed,or Respondents wereasked iftheyhadbeendenied Physical Attack Harassment, and of UnequalTreatment, I. OverallExperiences Morethanone-third(35%)experiencedphysicalviolencebyanintimatepartner, • Nearlyoneinten(9%)respondentsreportedthattheywerephysicallyattacked inthe • Nearlyhalf(46%)ofrespondentsreportedthattheywereverballyharassedinthe • Oneinseven(14%)respondentsreportedthattheyweredeniedequaltreatmentor • being transgender. treatment, verballyharassed,and/orphysicallyattacked inthepastyearbecauseof Nearly half(48%)ofallrespondentsinthesamplereported beingdeniedequal violence. More thanhalf(54%)ofrespondentsexperiencedsomeform ofintimatepartner One inten(10%)respondentsthesurveyweresexuallyassaultedpastyear. lifetime. Nearly half(47%)ofrespondentshavebeensexuallyassaultedatsomepointintheir past yearbecauseofbeingtransgender. service inapublicplacethepastyearbecauseofbeingtransgender. U.S. population. severe physicalviolencebyacurrentorformerpartner, comparedwith18%of the compared to30%oftheU.S. adultpopulation.Nearlyone-quarter(24%)experienced past yearbecauseofbeingtransgender. more oftheseexperiences (Figure15.1). respondents werealsomore likely toreportoneor (70%), multiracialandAmericanIndian(69%) or moreoftheseexperiences.MiddleEastern disabilities is currentlycriminalized(82%),andpeoplewith such assexwork,drugsales,orotherworkthat currently workingintheundergroundeconomy, past yearforanyreason.Respondents whowere verbally harassed,and/orphysicallyattacked inthe they weredeniedequaltreatmentorservice, Fifty-eight percent(58%)ofrespondentssaidthat harassment, andphysicalattacksingreaterdetail. examining denialofequaltreatment,verbal 7 (69%)weremorelikely toreportone HARASSMENT AND VIOLENCE 199 39% 59%

66%

One or more more or One experiences listed experiences 6%

11% transgender

15%

due to being being to due Physically attacked attacked Physically 36%

56% transgender

63% due to being being to due Verbally harassed harassed Verbally 10% 18%

24%

being transgender being Denied equal equal Denied treatment due to to due treatment % of those who said others could always or usually tell they were transgender % of those who said others could sometimes tell they were transgender % of those who said others could rarely or never tell they were transgender 0% 10% 70% 40% 30% 20% 50% 60% Almost three-quarters (73%) of respondents who were currently working in the underground economy reported being denied equal treatment, verbally in the past year harassed, and/or physically attacked because of being transgender (Figure 15.3). Figure 15.2: Denial of equal treatment, verbal Figure 15.2: Denial of equal treatment, past year harassment, and physical attack in the (%) PERCEPTION OF TRANSGENDER STATUS OTHERS’ Nearly half (48%) of respondents of respondents half (48%) Nearly were denied that they reported service, treatment or equal and/or verbally harassed, because of physically attacked in the past year. being transgender others could usually or alwaysThose who said that transgender (66%) were more likelytell that they were experiencesto report having one or more of these in contrast to those because of being transgender, tell thatwho said that others could rarely or never 15.2). they were transgender (39%) (Figure % 9%

14% 57% White 46% 48 70%

respondents) Multiracial Had experience

because of being

transgender (% of 70% Middle Eastern Middle

% 57% Latino/a 13% 16% 54% 58

58% Black

Had experience of respondents) 58% Asian for any reason (%

69%

58% Indian American Overall 0% Physically attacked One or more experiences listed Experience Denied equal treatment Verbally harassed 10% 70% 40% 30% 80% 50% 20% 60%

because of being transgender in the past year because of being transgender in the 15.1). (Table Denial of equal treatment, verbal 15.1: Table past year harassment, and physical attack in the percent (84%) believed that it happened because percent (84%) believed that it happened This means of their gender identity or expression. reported that 48% of all respondents in the survey or service, that they were denied equal treatment attacked verbally harassed, and/or physically Respondents who had one or more of these Respondents what they believed experiences were then asked Eighty-four the reasons were for that treatment. Figure 15.1: Unequal treatment, verbal treatment, verbal Unequal Figure 15.1: attack for any and/or physical harassment, the past year reason in (%) RACE/ETHNICITY 200 2015 U.S. TRANSGENDER SURVEY citizens (16%). in contrasttodocumented non-citizens (20%)and treatment orserviceasthose intheoverallsample, than twiceaslikely tohavebeendeniedequal 15.4). Undocumentedresidents(39%)weremore respondents alsoreportedhigherrates(Figure Eastern (23%),multiracial(22%),andBlack(20%) service atapublicplaceinthepastyear. Middle reported beingdeniedequaltreatmentor one-third (30%)ofAmericanIndianrespondents experienced unequaltreatmentorservice. Almost People ofcolorweremorelikely tohave being transgender. reason, regardlessofwhetheritwasrelatedto government agency, orotherpublicplace, forany taking thesurvey, suchasataplaceofbusiness, equal treatmentorserviceintheyearbefore Sixteen percent(16%)ofrespondentsweredenied or Service II. UnequalTreatment ECONOMY (%) CURRENT PARTICIPATION INTHEUNDERGROUND physical attackinthepastyear Figure 15.3:Unequaltreatment,harassment,and 60% 20% 50% 80% 30% 40% 70% 10% 0% the undergroundeconomy % ofthosewhoarenotcurrentlyworkingin underground economy % ofthosewhoarecurrentlyworkinginthe beingtreatment transgenderDenied due equal to 33% 13%

Verbally harassed

due to being

transgender 70% 45%

Physically attacked

due to being

transgender 29% 8%

experiences listed One or more 73% 48% reasons wereforthattreatment,andtheyselected service wereasked whattheybelievedthe Respondents whoweredeniedequaltreatmentor Asian (9%), and multiracial (8%) respondents were Asian (9%),andmultiracial(8%) respondentswere race orethnicity. Amongpeopleofcolor, Black(15%), denied equaltreatmentorservice becauseoftheir Respondents also reportedthattheyhadbeen expression. in thepastyearbecauseoftheirgenderidentityor they hadbeendeniedequaltreatmentorservice Fourteen percent(14%)ofallrespondentssaid treatment orservice Table (Table 15.2). or ethnicity, andgenderidentityorexpression one ormorereasonsfromalist,suchasage, race 20% RACE/ETHNICITY (%) for anyreasoninthepastyear Figure 15.4:Denialofequaltreatmentorservice 25% 30% 35% 10% 15% None oftheabove Sexual orientation Religion orspirituality Gender identityorexpression Income leveloreducation Disability Age Reason forexperience Race orethnicity 0% 5%

Overall 15

American Indian 16% .2: Reported reasonsfordenialofequal 9 30%

Asian 18% 8

Black 20%

Latino/a

Middle Eastern 17% % ofthose treatment 23% denied equal 88% 36% 24% 14% 14% 13% Multiracial 5% 2% 22% sample whole % of 14%

<1% White 14% 6% 2% 2% 2% 4% 1% HARASSMENT AND VIOLENCE 201

emotionally and physically abusing me.” “My trans status was used as a tool to me] stay with my former partner. [make She would say things such as ‘no one else would ever love you.’” stalked. The university didn’t do The university didn’t stalked. Instead, it anything to help me. I lived in threatened to punish me. campus. terror the entire time I was on I I was denied a rape kit because were was transgender and the police completely uninterested.” “I was found in a ditch after being was brutally raped for three days. I to an ER. There I met an taken it for officer who told me I deserved attempting to be a woman and should a have died. He also refused to take report.” “I was a victim of spousal abuse for over ten years. This grew worse when I transitioned, as [my transition] became an easy justification for verbally, In Our Own Own In Our Voices have tried to grope me “When people have verbally harassed in the street or usually either because they it’s me, target or because see me as a sexual I am a figure out whether they can’t and they think or a ‘woman’ ‘man’ to demand an they have the right explanation.” “I was sexually assaulted at my and I was also attacked university.

<1% White 54% White

8% 66%

Multiracial Multiracial

67%

Middle Eastern Middle

6% Eastern Middle 53%

Latino/a Latino/a

53% 15% Black Black

56% Asian Asian 7% 65%

American Indian American 54% Indian American

Overall Overall 0% 4% 8% 2% 6% 0% 10% 14% 12% 16% 10% 70% 40% 30% 80% 50% 20% 60% (%) RACE/ETHNICITY Figure 15.5: Denial of equal treatment or service or service Denial of equal treatment Figure 15.5: of race or ethnicity in the past year because harassed in the past year (Figure 15.6). harassment for any reason Verbal Figure 15.6: in the past year (%) RACE/ETHNICITY who were currently working in the underground who were currently working in the underground to experience verbal economy (77%) were more likely Middle Eastern harassment. Among people of color, Indian (65%) (67%), multiracial (66%), and American to have been verbally respondents were more likely Respondents were asked if anyone had verbally were asked Respondents reason, harassed them in the past year for any to being regardless of whether it was related More than half (54%) reported that transgender. Those they had experienced verbal harassment. III. Verbal Harassment III. Verbal most likely to report being denied equal treatment or equal treatment to report being denied most likely 15.5). or ethnicity (Figure of their race service because 202 2015 U.S. TRANSGENDER SURVEY all respondentsreportedhaving thisexperiencein transgender inthepastyear. harassed inpublic Respondents were asked iftheyhadbeen verbally (Figure 15.7). verbally harassed because oftheirraceorethnicity respondents weremostlikely toreportbeing Middle Eastern(25%),andmultiracial(18%) Among peopleofcolor, Black(29%),Asian(27%), the pastyearbecauseofbeingtransgender. sample reportedtheywereverballyharassedin Nearly half(46%)ofrespondentsintheoverall Table that treatment(Table 15.3). asked whattheybelievedthereasonswerefor Respondents whowereverballyharassed were 20% 25% RACE/ETHNICITY (%) because ofraceorethnicity Figure 15.7: Verbal harassmentinthepastyear 30% 35% 10% 15% None oftheabove Sexual orientation Religion orspirituality Race orethnicity Gender identityorexpression Income leveloreducation Disability Age Reason forexperience 0% 5%

Overall American Indian 15 9% .3: Reported reasonsforverbalharassment 16%

Asian 27% by strangers

Black 29%

Latino/a % ofthose 10 harassed 13% One-third(33%)of

Middle Eastern verbally becauseofbeing 84% 42% 10% 10% 16% 5% 8% 7% 25%

Multiracial % ofwhole 18% sample

46% White 23% 9% 5% 5% 4% 4% 3% 1% RACE/ETHNICITY (%) the pastyearamongtransgenderwomen Figure 15.8:Verbal harassmentinpublicbystrangers transgender (22%). people couldrarelyornevertellthattheywere strangers, incontrasttothosewhosaidthat more likely tohavebeen verballyharassedby even withoutbeingtold(55%),weresubstantially always orusuallytellthattheyweretransgender, (Figure 15.8).Thosewhosaidthatotherscould multiracial (51%)andAmericanIndian(47%)women of theirgenderidentityorexpression,particularly more likely tobeharassed bystrangersbecause the pastyear. Transgender womenofcolorwere Indian (25%),MiddleEastern (25%),andmultiracial also variedbyraceandethnicity, with American physically attacked. Experiencesofphysicalattack were almosttwiceaslikely toreportbeing in thepastyear. Undocumentedresidents(24%) times aslikely toreportbeingphysicallyattacked underground economy(41%)weremorethanthree Those whowerecurrentlyworkinginthe weapon againstthemforanyreason. something atthem,punchingorusinga past year, such asbygrabbingthem,throwing someone hadphysicallyattacked theminthe Thirteen percent(13%)ofrespondentssaidthat IV. PhysicalAttack 60% 20% 50% 30% 40% 10% 0%

respondents)Overall (all

American Indian 33% 47%

Asian 39%

Black 38%

Latina 38% Middle Eastern 37%

Multiracial 51%

White 34% HARASSMENT AND VIOLENCE 203

8% <1% White White by

3% 12%

Multiracial Multiracial

6% 14%

Middle Eastern Middle Middle Eastern Middle

2% 9%

Latino/a Latino/a

4% 9%

Black Black

3% 11%

Asian Asian 4% 19% because of being transgender.

1% American Indian American 9% Indian American

Overall Overall 1% 7% 4% 3% 5% 2% 4% 6% 0% 8% 2% 6% 0% 14% 18% 12% 16% 10% 20% currently working in the underground economy to report this (20%) were four times more likely Transgender experience than the overall sample. to report women of color were also more likely particularly American Indian (19%), this experience, Middle Eastern (12%), and multiracial (11%) women (6%), American Indian (4%), Black (4%), and Asian (6%), American Indian (4%), Black (4%), to report being (4%) respondents were most likely because of their race or physically attacked ethnicity (Figure 15.11). Physical attack in the past year Figure 15.11: because of race or ethnicity (%) RACE/ETHNICITY Five percent (5%) of respondents in the overall in public sample were physically attacked strangers Undocumented residents (20%) and respondents Figure 15.10: Physical attack in the past year attack in the past Physical Figure 15.10: being transgender because of (%) RACE/ETHNICITY also reported that they had been Respondents because of their race or physically attacked Middle Eastern Among people of color, ethnicity. 1% 1% 1% 1% 3% 4% 9%

<1%

% of 12% White whole sample

19% American

Multiracial 7% 3% 8% 5% 11% 32% 25% 66% 25% attacked

physically

% of those Middle Eastern Middle

14% Latino/a

14% Black

14% Asian

25%

13% Indian American Overall 5% 0% Religion or spirituality Religion Sexual orientation None of the above Age Disability Income level or education Gender identity or expression or ethnicity Race Reason for experience Reason 15% 10% 30% 25% 20% of being transgender (Figure 15.10), as were of being transgender (Figure 15.10), undocumented residents (23%). sample reported being physically attacked in the sample reported being physically attacked past year because of being transgender. Indian (19%), Middle Eastern (14%), multiracial respondents (12%), and Asian respondents (11%) because to report being attacked were more likely Nearly one in ten (9%) respondents in the overall Table 15.4: Reported reasons for physical attack 15.4: Reported Table Those who had been physically attacked in the Those who had been physically attacked what they believed the past year were asked 15.4). reasons were for that attack (Table (%) RACE/ETHNICITY (19%) respondents being more likely to report a to report a likely being more (19%) respondents year (Figure 15.9). attack in the past physically any reason in the Physical attack for Figure 15.9: past year 204 2015 U.S. TRANSGENDER SURVEY them, like arockorbottle. Nearlyone-third (29%) (29%) reportedthatsomeone threwanobjectat punched, orchoked them.Twenty-nine percent past yearreportedthatsomeonehadgrabbed, (73%) ofthosewhowerephysicallyattacked inthe how theywereattacked. Nearlythree-quarters These respondentswerealsoasked tospecify past year Figure 15.13: Numberofphysicalattacksinthe or moretimesthatyear(Figure15.13). attacked threetimes,and16%wereattacked four were attacked twice. Thirteenpercent(13%)were (45%) wereattacked oncethatyear, and25% times theyhadbeenattacked. Forty-five percent any reasoninthepastyearwereasked howmany Respondents whowerephysicallyattacked for RACE/ETHNICITY (%) the pastyearamongtransgenderwomen Figure 15.12: Physicalattackinpublicbystrangers 20% 10% 16% 12% 18% 14% 0% 6% 2% 8% 4% respondents)Overall (all Three times American Indian 5% 13% Four ormore

19% times 16% Twice 25% % ofthose

physically Asian

attacked 9%

Black 9%

Latina 8% Middle Eastern 12% Once 45% Multiracial

11%

White 6% physically attacked reported being attacked with a physically attacked reportedbeingattacked witha Three percent(3%)ofrespondentswhowere Table 15.5:Meansofphysicalattackinthepastyear were sexuallyassaulted. of thosewhoreportedbeingphysicallyattacked *Sample sizetoolowtoreport RACE/ETHNICITY (%) women whowerephysicallyattacked inthepastyear Figure 15.14: Attacked withagunamongtransgender have beenattacked withagun. work (16%)weremorethanfivetimesaslikely to source ofincomewasfromundergroundeconomy been attacked withagun,andthosewhoseonly (10%) weremorethanthreetimesaslikely tohave currently workingintheundergroundeconomy attacked withagun(Figure15.14). Respondents nearly fourtimesaslikely toreportthattheywere particularly Black(11%)andLatina (11%)women,were gun inthepastyear. Transgender womenof color, 10% 12% Not listedabove With agun With aknife frying pan,scissors,orstick) With anotherweapon(like abaseballbat, By beingsexuallyassaulted as arockorbottle) By havingsomethingthrownatthem(such By beinggrabbed,punched,orchoked Type ofphysicalattack 0% 6% 2% 8% 4%

respondents)Overall (all

American Indian 3% 7%

Asian 3%

Black 11% 12 (Table 15.5). Latino/a

Middle Eastern* 11%

Multiracial % ofthose physically attacked 4% 29% 29% 73% 9% 5% 3% White 7% 3% HARASSMENT AND VIOLENCE 205

44% 52%

45% White White

51%

58% 59%

Trans men Trans Trans women and men and women Trans Multiracial Multiracial

37%

67% 58%

Trans women Trans

Middle Eastern Middle

Middle Eastern Middle 55% 48% 48%

Latino

Latino/a Non-binary (all) Non-binary

41%

51%

53% Black Black birth certificate birth

58% 41%

42% Asian

Asian

Non-binary with male on on male with Non-binary

on birth certificate birth on 71% 19%

65%

Non-binary with female female with Non-binary

Crossdressers

47% Indian American

47%

47% Indian American

Overall Overall

Overall (all (all Overall respondents) 0% 0% 0% 10% 10% 10% 70% 40% 30% Figure 15.16: Lifetime sexual assault Figure 15.16: GENDER IDENTITY (%) 20% 50% 60% 70% 70% 40% 40% 30% 30% 80% 20% 20% 50% 50% 60% 60% Figure 15.17: Lifetime sexual assault among Lifetime sexual Figure 15.17: transgender men (%) RACE/ETHNICITY Figure 15.15: Lifetime sexual assault Lifetime Figure 15.15: (%) RACE/ETHNICITY

13 15,16 14 American Indian, Middle Eastern, and multiracial & Figure 15.18). people (Figure 15.17 binary people with male on their original birth Among transgender certificate (41%) (Figure 15.16). men and non-binary people with female on their original birth certificates, rates of sexual assault particularly were higher among people of color, been sexually assaulted in their lifetime (Figure with gender, Experiences also varied across 15.15). transgender men (51%) and non-binary people with female on their original birth certificate (58%) being to have been sexually assaulted, in more likely contrast to transgender women (37%) and non- (65%), and people with disabilities (61%) were more (65%), and people with disabilities (61%) to have been sexually assaulted in their likely American Indian Among people of color, lifetime. (58%), and (65%), multiracial (59%), Middle Eastern to have likely Black (53%) respondents were most sexual contact, such as oral, genital, or anal sexual contact, such as oral, genital, or rape.” contact, penetration, forced fondling, who have participated in sex work Respondents homelessness (72%), those who have experienced informed by questions from the National Intimate informed by questions from the National Survey (NISVS). and Sexual Violence Partner been Nearly half (47%) of respondents have their lifetime. sexually assaulted at some point in “unwanted This included any experiences with In addition to questions about being physically In addition to questions respondents were asked year, in the past attacked sexual questions about their experiences with past year, assault during their lifetime and in the point in their lifetime. point in their Sexual Assault V. Nearly half (47%) of half (47%) Nearly been have respondents at some sexually assaulted 206 2015 U.S. TRANSGENDER SURVEY Table committed theassault(Table 15.6). of sexualassaultsurvivorsreportedthatastranger relative wastheperpetrator. Nearlyone-third(30%) (25%) ofsexualassaultsurvivorsreportedthata partner hadsexuallyassaultedthem.One-quarter sexually assaultedsaidthatacurrentorformer Approximately one-third(34%)ofthosewhowere then asked whohadcommittedthesexualassault. Respondents whoreportedthisexperiencewere RACE/ETHNICITY (%) people withfemaleontheiroriginalbirthcertificate Figure 15.18: Lifetimesexualassaultamongnon-binary 60% 20% 50% 80% 30% 40% 70% 10% A personnotlistedabove A bossorsupervisor A lawenforcementofficer A teacherorschoolstaffmember A healthcareproviderordoctor A coworker A relative A stranger A partnerorex-partner A friendoracquaintance assault Person whocommittedsexual 0%

respondents)Overall (all 15

American Indian 47% .6: Person whocommittedsexualassault 74%

Asian 47%

Black 65%

Latino/a

Middle Eastern 55% sexually assaulted 62% % ofrespondents

who havebeen Multiracial 67%

White 59% 25% 30% 34% 47% 12% 5% 2% 2% 4% 3% VI. IntimatePartner to havebeensexuallyassaultedinthepastyear. economy (36%)weremorethanthreetimesaslikely who werecurrentlyworkingintheunderground sexually assaultedinthepastyear. One inten(10%)respondentsthesurveywere the pastyear. were sexuallyassaultedin respondents inthesurvey One inten(10%) more likely toreportthisexperience(Figure15.19). and MiddleEastern(62%)respondents, werealso including AmericanIndian(73%), multiracial(62%), people withdisabilities(61%),andofcolor, partner violence. Undocumentedresidents(68%), have beenhomelessexperiencedintimate and nearlythree-quarters(72%)ofthosewho (77%) ofrespondentswhohavedonesexwork violence intheirlifetime. Overthree-quarters experienced someformofintimatepartner Overall, morethanhalf(54%)ofallrespondents survey aredefinedas“intimatepartnerviolence.” (NISVS). Intimate Partner andSexualViolenceSurvey which werebasedonquestionsintheNational physical, emotional,orfinancialharm,manyof a currentorformerintimatepartner, including about theirexperienceswithharminvolving romantic orsexualpartnerreceivedquestions Respondents whoreportedeverhavinghada Violence a. OverallIntimatePartner Violence 19 Suchactsofharmasdescribedinthe 17,18 Respondents 20 HARASSMENT AND VIOLENCE 207 1% 3% 3% 9% 9% 6% 11% 11% 15% 16% 23% 27% 25% % of 44% respondents

.7: Intimate partner violence involving coercive involving coercive partner violence Intimate .7: 15 Would not let them have their hormones Would not let them have other medications Would Threatened to use their immigration status against them One or more experiences listed One or more experiences related to being transgender listed Type of intimate partner violence of intimate Type involving coercive control them that they were not a “real” woman Told or man talking to them from seeing or to keep Tried family or friends Stalked from leaving the house when they them Kept wanted to go on them Threatened to call the police Threatened to “out” them for their own them from having money Kept use Hurt someone they love Threatened to hurt a pet or threatened to a pet away take in the Overall, nearly half (44%) of respondents sample experienced some form of intimate control, partner violence involving coercive financial including intimidation, emotional, and harm. Experience with this type of intimate partner with American Indian violence differed by race, (66%), Middle Eastern (56%), and multiracial (51%) respondents reporting higher rates of these who experiences (Figure 15.20). Respondents have done sex work (66%), have experienced homelessness (62%), or were undocumented to have experienced (60%) were also more likely intimate partner violence of this form. Table Table emotional and financial intimidation, control, including physical harm to others harm, and

54% White

62% Multiracial

62% Middle Eastern Middle 54% One in four (25%)

21 Latino/a

56% Black 43% Asian

73%

54% Indian American

Overall (all (all Overall respondents) 0% 10% 70% 40% 30% 80% 50% 20% 60% lifetime. respondents experienced some form of intimate partner violence in their seeing or talking to family or friends, and 15% were wanted to from leaving the house when they kept 15.7). go (Table More than half (54%) of all respondents. Sixteen percent (16%) of respondents respondents. Sixteen percent (16%) compared reported that they had been stalked, population. to 6% in the U.S. not a “real” respondents were told that they were from 23% were kept woman or man by a partner, covering a range of experiences with intimate covering a range of experiences with set of questions involved The first partner violence. experiences with coercive control, including harm, and intimidation, emotional and financial to physical harm to others who were important b. Intimidation, Emotional, and b. Financial Harm received two sets of questions Respondents Figure 15.19: Intimate partner violence Intimate Figure 15.19: (%) RACE/ETHNICITY 208 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) transgender statusamongwomen Figure 15.21:Intimatepartnerviolencerelatedto related totheirtransgenderstatus(Figure15.21). women, weremorelikely toreportactsof harm American Indian(57%)andmultiracial(39%) hormones. Transgender womenofcolor, including transgender status,orpreventedfromtakingtheir threatened withbeing“outed”byrevealingtheir told thattheywerenota“real”womanorman, related totheirtransgenderstatus,includingbeing respondents reportedactsofcoercivecontrol Furthermore, morethanaquarter(27%)ofsurvey RACE/ETHNICITY (%) intimidation, emotional,andfinancialharm Figure 15.20:Intimatepartnerviolenceinvolving 60% 60% 20% 50% 20% 50% 30% 30% 40% 40% 70% 10% 10% 0% 0%

Overall Overall 27% American Indian American Indian 44% 57% 66% 35%

Asian 28% Asian

Black 36% Black 44%

Latino/a Latina 36% Middle Eastern Middle Eastern 44% 56% 37%

Multiracial Multiracial 39% 51%

White White 44% 34% physical harm Table physical harminflictedonthem(Table 15.8). experiences ofintimatepartnerviolenceinvolving Respondents receivedadditionalquestions about Involving PhysicalHarm c. IntimatePartner Violence Middle Eastern(49%)respondents (Figure15.22). (59%), AmericanIndian(61%),multiracial(54%),and involving physicalharm,aswereundocumented more likely toreportintimatepartnerviolence who haveexperiencedhomelessness(61%)were Respondents whohavedonesexwork(67%)or threat ofphysicalviolence, overtheirlifetime. violence involvingphysicalharm,includingthe experiencing someformofintimatepartner Overall, 42%ofallsurveyrespondentsreported something hard Hit themwithafistor sexual activity Forced themtoengagein them Made threatstophysicallyharm Slapped Pushed orshoved violence Type ofintimatepartner listed One ormoreexperiences Any severephysicalviolence Any physicalviolence Burned themonpurpose them Used aknifeorgunagainst Beat them suffocating them Tried tohurtthembychokingor Kicked Hurt thembypullingtheirhair something Slammed themagainst 15 .8: Intimatepartnerviolenceinvolving respondents % ofUSTS 42% 24% 35% 20% 30% 24% 10% 16% 19% 14% 11% 6% 2% 3% 7% population % inU.S.

(NISVS) 30% 23% 18% 19% 12% 6% 9% 6% 6% 9% 3% 1% ------HARASSMENT AND VIOLENCE 209

Employment , chapter. Places of Public chapters. Health Experiences at School , and harassment in specific settings are discussed in other chapters, such as the and the Workplace This chapter discusses general experiences with which unequal treatment in public places in the past year, includes both public accommodations as well as other public spaces. For findings related to unequal treatment in specific public places, such as stores, restaurants, and government agencies, see the Accommodation and Airport Security This chapter discusses overall experiences with verbal Findings related to verbal harassment in the past year. 4 5 economy or who have experienced homelessness. economy or who have experienced Conclusion respondents faced indicated that The findings treatment, harassment, and high levels of unequal with higher rates the past year, physical attacks in reported among people of these experiences in the respondents currently working of color, and those who reported underground economy, that they are transgender. that others can tell rates of also experienced high Respondents lifetime and in the past year, sexual assault in their to population the U.S. than and were more likely violence. experience physical intimate partner residents of color and undocumented People to report experiences of sexual were more likely as were assault and intimate partner violence, in the underground respondents who have worked

42% White

54% Multiracial Perspectives Perspectives New York, NY: NY: New York, 49%

Injustice at Every Turn: Injustice at Every Turn: Middle Eastern Middle

Socio-Emotional Impact of 43% Latino/a at: http://pps. 521. Available Moreover, nearly one- Moreover, compared to 30% of (8) 23

44% Black 30% Asian DC: Bureau of Justice Statistics. Available Available DC: Bureau of Justice Statistics. | CHAPTER 15: HARASSMENT AND VIOLENCE | CHAPTER 15: HARASSMENT 61%

. (pp. 124–135). DC: National Center for Transgender 124–135). DC: National Center for Transgender . (pp. The Lives of Transgender People. The Lives of Transgender American Indian American 42%

See e.g., Grant et al., 100, 127; Beemyn, G. & Rankin, S. 127; Beemyn, G. & Rankin, Grant et al., 100, See e.g., (2011). Columbia University Press. sagepub.com/content/8/5/521.full.pdf+html. sagepub.com/content/8/5/521.full.pdf+html. Harrison, J., J., M., Mottet, L. A., Tanis, Grant, J. See e.g., M. (2011). L., & Keisling, Herman, J. Discrimination of the National Transgender A Report Survey Force. Task Equality & National Gay and Lesbian Langton, L. & Truman, J. (2014). J. L. & Truman, Langton, Violent Crime. Lick, D. at: http://www.bjs.gov/content/pub/pdf/sivc.pdf; L. E., & Johnson, K. L. (2013). Minority stress and Durso, J., physical health among sexual minorities. on Psychological Science,

Overall (all (all Overall respondents) 0% 10% 70% 40% 30% 3 2 1 50% 20% ENDNOTES ENDNOTES 60% quarter (24%) of respondents reported having quarter (24%) of respondents reported from a experienced severe physical violence population. compared to 18% in the U.S. partner, More than one-third (35%) experienced some More than one-third (35%) experienced partner, form of physical violence by an intimate Partner and as defined by the National Intimate Sexual Violence Survey, adult population. the U.S. Figure 15.22: Intimate partner violence involving violence involving Intimate partner Figure 15.22: physical harm (%) RACE/ETHNICITY 210 2015 U.S. TRANSGENDER SURVEY 15 14 13 12 11 10 9 8 7 6 note 16. Intimate Partner andSexualViolenceSurvey(NISVS).See categories ofsexualviolenceasoutlined intheNational This definitionofsexualassaultencompassedseveral contact, penetration,forcedfondling,orrape” inQ. 18.1. unwanted sexualcontact,suchasoral,genital,oranal Respondents wereasked iftheyhadever“experienced Breiding etal.Seenote6. contact, penetration,forcedfondling,orrape.” unwanted sexualcontact,suchasoral,genital,oranal Q.18.1 asked ifrespondentshadever“experienced attempted rape, beingforcedtopenetrate).” attacked with“unwantedsexualcontact(suchasrape, In Q. 17.8, respondentswereasked iftheywerephysically Results arereportedoutofthefullsample. your transstatus,genderidentity, orgenderexpression?” did strangersphysicallyattackyouinpublicbecauseof this question(Q. 17.10), whichasked: “Inthepastyear, identity, genderexpression,orappearancereceived attacked becauseoftheirtransgenderstatus,gender Only respondentswhoreportedthattheywerephysically Results arereportedoutofthefullsample. trans status,genderidentity, orgenderexpression?” strangers verballyharassyouinpublicbecauseofyour this question(Q. 17.6), whichasked: “Inthepastyear, did identity, genderexpression,orappearancereceived harassed becauseoftheirtransgenderstatus,gender Only respondentswhoreportedthattheywereverbally collapsed forreportingas“genderidentityorexpression.” of thosewhoselectedoneorboththesereasonsare interchangeably orwithverysimilarmeanings,responses reasons, andbecausethesetermsarecommonlyused a substantialoverlapofrespondentswhoselectedboth best representedtheirexperience. Becausetherewas choices sothatrespondentscouldselectwhattheyfelt identity” and“genderexpression/appearance” asanswer The surveyincludedboth“transgenderstatus/gender applied totheirexperience. Respondents wereasked toselectallthereasonsthat identified asapersonwithdisabilityin Q. 2.20. “People withdisabilities” here referstorespondentswho Available at:http://www.cdc.gov/mmwr/pdf/ss/ss6308.pdf. Violence Survey, UnitedStates, 2011. victimization—National IntimatePartner andSexual sexual violence, stalking,andintimatepartner violence Merrick, M.T. (2014).Prevalenceandcharacteristicsof Smith, S.G.,Basile, K.C.,Walters, M.L.,Chen,J., & 2015. Truman, J. L.&Morgan,R.E.(2016). DC: BureauofJusticeStatistics; Breiding,M.J., Criminal Victimization, MMWR, 63 (8). 16 17 sexual violencetomatchthebroaderUSTS categoryof of NISVSrespondentswhoexperienced and therefore, wereunabletocombinethepercentages who reportedmorethanoneexperienceintheNISVS, team wasunabletoavoiddoublecountingrespondents in severalcategoriesofsexualviolence. Theresearch NISVS respondent’s experiencescouldbereflected experiences withmultipleformsofsexualviolence, an Disease Control.SinceNISVSrespondentscouldreport 2011 datafromtheNISVS,asreportedbyCentersfor percentage fortheexperiencesofmenandwomenusing calculated bytheresearchteamtopresentacombined violence duringone’s lifetime in theU.S. populationwere al. Seenote6.Thefiguresfortheprevalenceofsexual and 4%wereforcedtopenetratesomeone. Breidinget sexual contact,10%haveexperiencedcoercion, raped intheirlifetime, 19%haveexperiencedunwanted estimated 11%ofadultsintheU.S. populationhavebeen with sexualassault,NISVSfindingsindicatethatan However, ascontextforUSTS respondents’ experience to theU.S. populationwasnotfeasibleforthisreport. questions aboutsexualviolence, adirectcomparison Due todifferencesbetween Q. 18.1 andtheNISVS rape, attemptedrape, beingforced topenetrate”). definition ofunwantedsexualcontactin Q. 17.8 (“such as penetration, forcedfondling,orrape”), incontrast tothe provided inQ. 18.3(“such asoral,genital,oranalcontact, more inclusiveexamplesofunwantedsexualcontact the differenceinreportingmaypartlyresultfrom not reportedanotherformofphysicalattack.Additionally, question regardingthemethodofattack,iftheyhad of physicalattackwouldnothavereceivedthefollow-up their experienceofunwantedsexualcontactasaform sexual contact.” Thoserespondentswhodidnotidentify (Q. 17.8), whichincluded ananswerchoiceof“unwanted up questionaskinghowtheywerephysicallyattacked had beenphysicallyattacked inQ. 17.3, receivedafollow- answer toQ. 17.3. Respondents whoindicatedthatthey number ofrespondentsreceivedQ. 17.8 basedontheir respondents inthesamplereceivedQ. 18.3,alimited each questionbasedonskip-logicpatterns.Whileall the numberofrespondentsinsamplewhoreceived was basedonQ. 17.8. Thisdifferenceislikely dueto the “PhysicalAttack” sectionofthischapter(4%),which the rateofsexualassaultinpastyearreported in thissectionwasbasedonQ. 18.3.Thisdiffersfrom The 10%rateofsexualassaultinthepastyearreported should beinterpretedwithcaution. comparisons betweentheNISVSandUSTS findings being forcedtopenetratearepresentedseparately, and rape, unwantedsexualcontact,coercion,and Therefore, findingsforthe U.S. populationinregardto “unwanted sexualcontact,” andmake adirectcomparison. any form of HARASSMENT AND VIOLENCE 211 form of sexual violence to match the broader USTS USTS form of sexual violence to match the broader something, choked or suffocated, beaten, burned, or something, choked with a knife or gun. attacked experiences of men and women using 2011 data from the NISVS, as reported by the Centers for Disease Control and Prevention. See Breiding et al. See note 6. physical violence” According to the NISVS, “severe hair pulled, being hit includes being hurt by having one’s slammed against with a fist or something hard, kicked, The NISVS measure for “any physical violence” includes The NISVS measure for “any physical violence” for forced 15.8, except all of the actions listed in Table sexual activity and threats of physical violence. The figures for the prevalence of intimate partner violence involving physical violence and/or severe physical population was calculated by the violence in the U.S. research team to present a combined percentage for the Breiding et al. See note 6. for a list of acts described as forms 19.3 and Q. 19.2 See Q. of intimate partner violence. Breiding et al. See note 6. category of “unwanted sexual contact,” and make a direct and make category of “unwanted sexual contact,” U.S. population in findings for the comparison. Therefore, unwanted sexual contact, sexual coercion, regard to rape, separately, and being forced to penetrate are presented findings and comparisons between the NISVS and USTS should be interpreted with caution. of sexual violence, an NISVS respondent’s experiences an NISVS respondent’s of sexual violence, violence. sexual of categories in several reflected be could counting The research team was unable to avoid double in respondents who reported more than one experience were unable to combine the the NISVS, and therefore, percentages of NISVS respondents who experienced any men who reported being raped in the past year, a reliable raped in the past year, men who reported being for men. An estimated 1.7% estimate was not available penetrate a perpetrator in the of men were forced to forced while the number of women who were past year, a to penetrate a perpetrator was too low to produce Breiding et al. See note 6. Since NISVS reliable estimate. forms respondents could report experiences with multiple U.S. population experienced unwanted sexual contact in population experienced unwanted U.S. sexual experienced 1.7% the past year and an estimated were calculated These figures coercion in the past year. present a combined percentage by the research team to men and women using 2011 data for the experiences of of women an estimated 1.6% from the NISVS. Additionally, number of Due to the small year. were raped in the past Due to differences between Q. 18.3 (sexual assault in Q. 18.3 (sexual between Due to differences about sexual and the NISVS questions the past year) population was to the U.S. a direct comparison violence, USTS as context for for this report. However, not feasible with sexual assault, NISVS experience respondents’ an estimated 1.9% of adults in the findings indicate that 24 22 23 19 20 21 18 212 2015 U.S. TRANSGENDER SURVEY P reported throughoutthechapter. Notable differencesinrespondents’ experiences basedondemographicandothercharacteristics are vulnerable toharassmentand discriminatorytreatmentbyTSA officersandbystanders. related clothingoritemsfor additionalscreening,whichcanleadtounnecessary searchesandmake them security screening. scrutiny andsearchesbyTransportation SecurityAdministration(TSA) officerswhengoingthroughairport or expressioninthepastyear, givennumerousreportsoftransgenderpeoplebeingsubjectedtoexcessive Respondents werealsoasked questionsabouttheirexperiencesinairportsrelatedtogenderidentity these locations. that respondentsweredeniedequaltreatment,verbally harassed,andphysicallyattacked inseveralof explored respondents’ experiences inspecifictypesofpublicaccommodationsthepastyearandfound people mayfaceunequaltreatmentorharassmentin public settingssuchasretailstores. public accommodationarepotentiallyunwelcomingorunsafe. Priorresearchhasfoundthattransgender and AirportSecurity Accommodation Places ofPublic CHAPTER 16 including governmentagencies,retailstores,andrestaurants. which provideessentialservicesthatallowpeopletomeetbasicneedsandparticipateinciviclife, ublic accommodationsareplacesofbusinessorotherlocationsgenerallyopentothepublic, 3 Widelyusedbodyscannersoftenflagtransgenderpeople’s bodies andgender- 1 Fortransgenderpeople, placesof

2 Thesurvey PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 213

Nearly one-third (31%) of those who said that staff or employees knew or thought they were transgender experienced negative treatment in at least one of the locations, including being denied verbally harassed, or equal treatment or service, 16.1). (Table physically attacked they had been denied equal treatment, verbally they had been denied equal treatment, at the selected harassed, or physically attacked transgender. type of location because they were Nearly all respondents in the sample (96%) had visited or used services in at least one of the places of public accommodation outlined in this Of those who had visited chapter in the past year. or used services, 50% reported that they thought the staff or employees knew or thought they were transgender at one or more of the locations. center where employees thought or knew they were transgender. center where employees thought experiences in the past year when using public transportation where employees past year when using public transportation experiences in the they were transgender. thought or knew or a rape crisis violence shelter or program the past year when visiting a domestic or employees thought or knew that they were transgender, 31% were denied equal 31% were denied or knew that they were transgender, or employees thought there. harassed, and/or physically attacked treatment, verbally Additionally, 43% of respondents who went through airport security in the past year 43% of respondents who went through Additionally, or such as being patted down being transgender, experienced a problem related to item, having the name or gender on their ID searched because of a gender-related questioned, or being detained. One in five (20%) respondents did not use one or more places of public accommodation One in five (20%) respondents did they would be mistreated as a transgender in the past year because they thought person. treatment or service (14%), verbally harassed (24%), and/or physically attacked (2%) in (2%) attacked physically and/or (14%), verbally harassed (24%), treatment or service the past year. Of respondents who said that staff or employees at a place of public accommodation of public accommodation at a place that staff or employees who said Of respondents (31%) nearly one-third transgender, that they were thought or knew they visited equal being denied including experience, type of negative at least one experienced • one or more of these negative (34%) of respondents had one-third Approximately • of respondents had one or more of these experiences in Nearly one-quarter (22%) • theater and said that staff restaurant, hotel, or those who visited a retail store, Among

they had visited in the past year, respondents respondents they had visited in the past year, whether they thought that staff or were asked employees at the location knew or thought they whether They were also asked were transgender. agencies in the past year. They were first asked They were first asked agencies in the past year. whether they had visited or used services in specific kinds of public accommodations, and they then received follow-up questions based on their responses. For each type of location that Accommodation questions about their received Respondents experiences in places of public accommodation, such as hotels, restaurants, or government I. Overall Experiences I. Overall Experiences in Places of Public KEY FINDINGS KEY 214 2015 U.S. TRANSGENDER SURVEY being transgender public accommodationinthepastyearbecauseof Table 16.2:Negativeexperiencesinplacesof a transgenderperson. because theythoughtwouldbemistreatedas use servicesatoneormoreoftheselocations in five(20%)reportedthattheydidnotvisitor mistreated asatransgenderperson.Overall,one at thatplacebecausetheywereafraidofbeing asked whethertheydidnotvisitoruseservices a specifictypeofpublicaccommodationwere chapter (Table 16.2).Thosewhohadnotvisited past yeararedescribedindetailthroughoutthe public accommodationvisitedorusedinthe Respondents’ experiencesineachtypeof being transgender public accommodationinthepastyearbecauseof Table 16.1: Overallexperiencesinanyplaceof clinic, orlegalprofessional Legal servicesfromanattorney, Social Securityoffice Court orcourthouse facility Nursing homeorextendedcare Vehicles) DMV (DepartmentofMotor benefit office Public assistanceorgovernment Gym orhealthclub program orrapecrisiscenter Domestic violenceshelteror Drug oralcoholtreatmentprogram theater Retail store, restaurant,hotel,or Public transportation Location visited listed One ormoreexperiences Physically attacked Verbally harassed service Denied equaltreatmentor public accommodation Experience ataplaceof transgender knew orthoughttheywere % ofthosewhobelievestaff they weretransgender staff kneworthought % ofthosewhobelieve 22% 22% 24% 34% 31% 18% 14% 14% 14% 13% 31% 17% 11% 6% 2% while usingpublictransportation(Table 16.3). physically attacked becauseofbeingtransgender equal treatmentorservice, verballyharassed,or transgender. Ofthose, 34%reportedbeingdenied that theemployeeskneworthoughttheywere of thosewhousedpublictransportationbelieved transgender person. in thepastyearforfearofmistreatmentasa respondents didnotusepublictransportation a bus,train,subway, ortaxi.Two percent(2%)of transportation servicesinthepastyear, suchas Two-thirds (66%)ofthesampleusedpublic Transportation II. Public report suchanexperience. living inpoverty(39%)werealsomorelikely to currently criminalized)(49%)andthosewhowere (such assexwork,drugsales,orotherworkthatis currently workingintheundergroundeconomy experience (Figure16.2).Thosewhowere respondents beingmorelikely tohaveanegative Indian (48%),multiracial(45%),andAsian(39%) also variedbyraceandethnicity, withAmerican transportation (Figure16.1). men andwomen(32%)whenusingpublic experienced negativetreatmentthantransgender Non-binary people(39%)weremorelikely tohave the pastyearbecauseofbeingtransgender Table 16.3:Experiencesonpublictransportationin One ormoreexperienceslisted Physically attacked Verbally harassed Denied equaltreatmentorservice Experience inlocation

Twenty-four percent(24%)

These experiences they weretransgender staff kneworthought % ofthosewhobelieve 34% 32% 4% 3% PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 215 1% 11% 31% 24% One percent

% of those who believe staff knew or thought they were transgender (39%) were also more likely to have (39%) were also more likely 5 Those who were currently working in the

Denied equal treatment or service harassed Verbally Physically attacked Experience in location One or more experiences listed such experiences in these locations. because of being transgender (Table 16.4). because of being transgender (Table restaurant, 16.4: Experiences in a retail store, Table of being hotel, or theater in the past year because transgender American Indian (49%), multiracial (41%), Black (36%), and Asian (36%) respondents were more to have a negative experience (Figure likely 16.3). underground economy (52%), those who were living in poverty level (37%), and people with disabilities III. Retail Store, Store, III. Retail or Hotel, Restaurant, Theater (91%) of respondents visited Ninety-one percent restaurant, a retail store, or used services in the past year. hotel, or theater in reported not visiting a retail (1%) of respondents year hotel, or theater in the past restaurant, store, afraid of mistreatment as a because they were one-third (34%) Approximately transgender person. at these of those who visited or used services employees locations believed that the staff or Of those, knew or thought they were transgender. or 31% reported being denied equal treatment or physically attacked verbally harassed, service,

32%

33% White 45%

27%

Multiracial Trans women and men and women Trans Trans men Trans

35%

35% Eastern* Middle

Latino/a Trans women Trans

31%

39% Black Non-binary

39% Asian 12%

48% Crossdressers

34%

34% Indian American Overall Overall *Sample size too low to report 5% 0% 0% 15% 10% 10% mistreated because of their gender identity or expression. restaurant, hotel, or theater where the staff knew or thought they were transgender were Nearly one-third (31%) of respondents who visited a store, 45% 35% 40% 40% 30% 30% 25% 20% 50% 20% 60% Figure 16.2: Negative experience on public Figure 16.2: Negative experience on public transportation in the past year (%) RACE/ETHNICITY Figure 16.1: Negative experiences on public experiences on public Negative Figure 16.1: in the past year transportation (%) GENDER IDENTITY 216 2015 U.S. TRANSGENDER SURVEY being transgender treatment programinthepastyearbecauseof Table 16.5:Experiencesinadrugoralcohol (Table 16.5). physically attacked becauseofbeingtransgender equal treatmentorservice, verballyharassed,or transgender. Ofthose, 22%reportedbeingdenied staff oremployeesknewthoughttheywere at atreatmentprogram, person. because offearmistreatmentasatransgender did notgotoatreatmentcenterinthepastyear in thepastyear. services atadrugoralcoholtreatmentprogram Two percent(2%)ofthesamplevisitedorused Treatment Program IV. DrugorAlcohol RACE/ETHNICITY (%) because ofbeingtransgender restaurant, hotel,ortheaterinthepastyear Figure 16.3:Experiencesinaretailstore, 60% 20% 50% 30% 40% 10% listed One ormoreexperiences Physically attacked Verbally harassed service Denied equaltreatmentor Experience inlocation 0%

Overall American Indian 31%

Of thosewhovisitedorusedservices 49%

One percent(1%)ofrespondents Asian 36%

Black

36% 58% believedthatthe

transgender knew orthoughttheywere % ofthosewhobelievestaff Latino/a

Middle Eastern 29% 34%

Multiracial 41%

White 22% 29% 13% 11% 1% updated toreflectmynewnameand “A yearagoIhadmySocialSecurity the DMValsobegantolaugh.” talked soloudthatotherpatronsat fun ofmeandstartedlaughing manager oftheDMVlocationmade I washarassed.Inoneincident,the denied threetimes.Alltimes gender marker onmystateID, Iwas “When Iattemptedtochangemy Voices In OurOwn humiliated.” prove Iwasthesameperson. Iwas laugh. Ihadtoremovemywig and calledoverfriendstolook bag, pulledoutmyintimateitems, screening whiletheysearchedmy “I wassubjectedtoalongerTSA being toldthatIwasnotaman.” I stoodmygroundafterrepeatedly woman wouldbemoreappropriate. pat downandIwasinformedthata a maleemployeeneededtodothe surgery. IhadtoarguewithTSA that their securityscreenfollowingtop ‘it’ whenIcouldn’t walkthrough “A TSA officerreferredtomeas on mycopyofthedocumentation.” ‘congratulations’ anddrewaheart in theSocialSecurityofficewrote at alltimes.Thewomanworking gender. Iwastreatedwithrespect PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 217 24%

21%

Trans women and men and women Trans Trans men Trans

28% Trans women Trans

19%

Non-binary Crossdressers*

22% Overall 5% 0% 15% 10% 30% 25% 20% *Sample size too low to report person. Of those respondents who had visited a 28% believed that the staff or gym or health club, employees knew or thought they were transgender. 18% reported being denied equal treatment Of those, verbally harassed, or physically attacked or service, 16.7). because of being transgender (Table VI. Gym or Health Club More than one-third (35%) of the sample had visited or used services at a gym or health club in the past Fourteen percent (14%) of respondents did not year. go to a gym or health club in the past year because they were afraid of mistreatment as a transgender Nearly one in four (22%) one in four Nearly to a who went respondents shelter or violence domestic crisis center program or rape knew or thought they where staff experienced were transgender of some kind. mistreatment experiences in domestic Figure 16.4: Negative violence shelter in the past year GENDER IDENTITY (%) 2% 11% 16% 22% % of those who believe staff knew or thought they were transgender Physically attacked Denied equal treatment or service harassed Verbally One or more experiences listed Experience in location Transgender women (28%) were more likely to women (28%) were more likely Transgender shelter, report having a negative experience at a DV program, or rape crisis center (Figure 16.4). DV equal treatment or service, verbally harassed, or verbally harassed, equal treatment or service, because of being transgender physically attacked 16.6). (Table DV shelter, a DV Experiences in 16.6: Table program, or rape crisis center in the past year because of being transgender past year because they were afraid they would past year because they were afraid Of those be mistreated as a transgender person. more than who went to one of these locations, employees half (59%) believed that the staff or Of those, knew or thought they were transgender. denied nearly one-quarter (22%) reported being One percent (1%) of the sample visited or used One percent (1%) of the sample visited DV shelter, services at a domestic violence (DV) past year. program, or rape crisis center in the go to a percent (2%) of respondents did not Two or rape crisis center in the shelter or program DV Shelter, Domestic Domestic Shelter, Program, or Violence Crisis Center Rape treatment program. treatment program. Domestic Violence V. Those who were currently working in the were currently Those who were and those who economy (34%) underground to report more likely (27%) were living in poverty in a drug or alcohol negative experience having a 218 2015 U.S. TRANSGENDER SURVEY transgender (Table 16.8). or beingverballyharassedbecauseof reported beingdeniedequaltreatmentorservice thought theyweretransgender. Ofthose, 17% believed thatthestafforemployeesknew who visitedorusedservicesattheselocations transgender person.Overone-third(36%)ofthose past yearbecausetheyfearedmistreatmentasa respondents didnotgotosuchanagencyinthe and Children(WIC)benefits. Two percent(2%)of Program (SNAPorfoodstamps)Women, Infants, as forreceivingSupplementalNutritionAssistance government benefitsofficeinthepastyear, such or usedservicesatapublicassistance Twelve percent(12%)ofthesamplehadvisited Benefits Office or Government VII. PublicAssistance health club(35%). to reporthavinganegativeexperienceingymor underground economywerenearlytwiceaslikely Respondents whowerecurrentlyworkingin the the pastyearbecauseofbeingtransgender Table 16.7: Experiencesinagymorhealthclub listed One ormoreexperiences Physically attacked Verbally harassed service Denied equaltreatmentor Experience inlocation transgender knew orthoughttheywere % ofthosewhobelievestaff 18% 13% 7% 1%

working intheundergroundeconomy(24%) disabilities (21%)andthosewhowerecurrently of whiterespondents(Figure16.5).People with higher ratesofmistreatment,incontrastto15% (20%), andLatino/a (20%)respondentsreported American Indian(25%),multiracial(22%),Black RACE/ETHNICITY (%) or governmentbenefitsofficeinthepastyear Figure 16.5:Negativeexperiencesinapublicassistance benefits office. experience inapublicassistanceorgovernment were alsomorelikely toreporthavinganegative because orbeingtransgender or governmentbenefitsofficeinthepastyear Table 16.8:Experiencesinapublicassistance 20% 25% 30% 10% 15% listed One ormoreexperiences Verbally harassed service Denied equaltreatmentor Experience inlocation 0% 5% *Sample sizetoolowtoreport

Overall

American Indian 17% 25%

Asian*

Black 20% transgender knew orthoughttheywere % ofthosewhobelievestaff Latino/a

Middle Eastern* 20%

Multiracial 22%

White 15% 17% 11% 9% PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 219

1% 6% 11% 14% Two percent (2%) of Two

% of those who believe staff knew or thought they were transgender Experience in location Denied equal treatment or service harassed Verbally Physically attacked One or more experiences listed of being transgender (Table 16.11). 16.11). of being transgender (Table X. Court or Courthouse in one in four (22%) respondents Approximately at a court or the sample visited or used services courthouse in the past year. respondents did not go to a court or courthouse in 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 13% those, Of thought they were transgender. reported being denied equal treatment or service, because verbally harassed, or physically attacked Nearly one in five (18%) one in five Nearly went to a who respondents club where gym or health or thought they staff knew experienced were transgender of some kind. mistreatment or Experiences in a nursing home 16.10: Table in the past year because of extended care facility being transgender 7% 9% 14% % of those who believe staff knew or thought they were transgender One percent (1%) of

Experience in location harassed Verbally One or more experiences listed Denied equal treatment or service Table 16.9: Experiences in a DMV in the past year 16.9: Experiences in a DMV in Table because of being transgender harassed, or physically attacked because of being harassed, or physically attacked 16.10). transgender (Table person. Twenty-two percent (22%) of those who person. Twenty-two visited or used services in this location believed that the staff or employees knew or thought 14% reported Of those, they were transgender. verbally being denied equal treatment or service, Four percent (4%) of the sample visited or used services at a nursing home or extended care facility in the past year. respondents did not go to a nursing home or extended care facility in the past year because they were afraid of mistreatment as a transgender IX. Nursing Home IX. Nursing Home or Extended Care Facility or thought they were transgender. Of those, 14% Of those, transgender. or thought they were equal treatment or service reported being denied because of being or being verbally harassed 16.9). transgender (Table in the past year. Three percent (3%) of respondents Three percent (3%) of respondents in the past year. in the past year because of did not go to a DMV as a transgender person. fear of mistreatment (36%) of those who visited this More than one-third that the staff or employees knew location believed VIII. DMV VIII. visited or used (44%) of the sample Nearly half (Department of Motor Vehicles) services at a DMV 220 2015 U.S. TRANSGENDER SURVEY because ofbeingtransgender(Table 16.12). service, verballyharassed,or physicallyattacked 11% reportedbeingdeniedequaltreatmentor knew orthoughttheyweretransgender. Ofthose, Security officebelievedthatthestafforemployees seven percent(57%)ofthosewhowenttoaSocial of mistreatmentasatransgenderperson.Fifty- a SocialSecurityofficeinthepastyearforfear Four percent(4%)ofrespondentsdidnotgoto Social Securitycard,oraccessingpublicbenefits. gender ontheirrecords,receivingorchanginga past year, suchasforupdatingthenameor used servicesataSocialSecurityofficeinthe Nearly oneinfourrespondents(19%)visitedor Office XI. SocialSecurity higher amongpeoplewithdisabilities(19%). in courtoracourthouse, andtheratewasalso more likely toreporthavinganegativeexperience underground economy(37%)weresubstantially Those whowerecurrentlyworkinginthe the pastyearbecauseofbeingtransgender Table 16.11: Experiencesincourtoracourthouse listed One ormoreexperiences Physically attacked Verbally harassed service Denied equaltreatmentor Experience inlocation transgender knew orthoughttheywere % ofthosewhobelievestaff 13% <1% 8% 8% people withdisabilities(16%)werealsomorelikely working intheundergroundeconomy(36%)and (Figure 16.6). Respondents whowerecurrently a negativeexperienceinSocialSecurityoffice respondents weremorelikely toreporthaving Asian (15%),BlackandLatino/a (14%) in thepastyearbecauseofbeingtransgender Table 16.12: ExperiencesinaSocialSecurityoffice RACE/ETHNICITY (%) Security officeinthepastyear Figure 16.6: NegativeexperienceinaSocial to havesuchanexperience. 10% 16% 12% 14% listed One ormoreexperiences Physically attacked Verbally harassed service Denied equaltreatmentor Experience inlocation 0% 6% 2% 8% 4% *Sample sizetoolowtoreport

Overall American Indian* 11%

Asian 15%

Black 15% transgender knew orthoughttheywere % ofthosewhobelievestaff Latino/a

Middle Eastern* 14%

Multiracial 13%

White 9% 11% <1% 5% 8% PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 221 5%

Trans women and men and women Trans Trans men Trans

6% Trans women Trans

12%

Non-binary Crossdressers*

6% Overall 4% 8% 2% 6% 0% 14% 12% 10% year experienced at least one problem related to their gender identity or expression. XIV. Experiences with XIV. Airport Security In addition to the questions regarding mistreatment in and avoidance of public about asked accommodations, respondents were airport security their experiences traveling through More than past year. in the in the United States gone half (53%) of respondents reported having period. through airport security during that time about specific These respondents were asked experiences and interactions with Transportation officers during the Security Administration (TSA) security screening process. Forty-three percent (43%) of those who went through airport security in the past Figure 16.7: Negative experiences with legal Negative experiences Figure 16.7: clinic, or legal an attorney, services from in the past year professional (%) GENDER IDENTITY *Sample size too low to report 3% 4% 6% Two percent (2%) Two

% of those who believe staff knew or thought they were transgender Experience in location Denied equal treatment or service harassed Verbally One or more experiences listed to transgender men and women (5%) (Figure working in the Those who were currently 16.7). underground economy (23%) were almost four as to report a negative experience times as likely the overall sample. Non-binary respondents (12%) were more than to report having a negativetwice as likely experience when seeking legal services, in contrast Table 16.13: Experiences with legal services from 16.13: Table professional in the past clinic, or legal an attorney, year because of being transgender legal clinic, or legal professional believed that the legal clinic, or legal professional believed they were staff or employees knew or thought Of those respondents, 6% reported transgender. verbally being denied equal treatment or service, because of being harassed, or physically attacked 16.13). transgender (Table professional in the past year. professional in the not visit or use such services of respondents did to fear of mistreatment as a in the past year due (57%) transgender person. Fifty-seven percent attorney, of those who sought services from an Clinic, or Legal Legal Clinic, or Professional of the sample visited or used percent (12%) Twelve clinic, or legal an attorney, legal services from XII. Legal Services Services XII. Legal an Attorney, from 222 2015 U.S. TRANSGENDER SURVEY security inthepastyearreported oneormoreof multiracial respondentswho wentthroughairport More thanhalf(56%)ofMiddle Easternand50%of security inthepastyear Table 16.14: Issueswhengoingthroughairport gender-related item,ordetainingthem(Table 16.14). searching theirbodiesorbelongingsbecauseofa using thewrongpronounortitletoreferthem, gender identityorexpression,suchasTSA officers experienced atleastoneissuerelatedtotheir through airportsecurityinthepastyear Forty-three percent(43%)ofthosewhowent One ormoreexperienceslisted They werenotallowedtofly attacked byTSA officers They werephysicallyattacked them TSA officerscalledthepoliceabout screening They missedtheirflightdueto They weredetainedforoveranhour TSA officers) contact (beyondtypicalpatdownby They experiencedunwantedsexual officers They wereverballyharassedbyTSA for questioningorexamination They weretaken toaseparateroom or othersensitivearea clothing toshowbinder, undergarment, They wereasked toremoveorlift or packer) gender-related item(suchasabinder Their bagwassearchedduetoa sensitive items(e.g., binder, packer) questioned theirgender, bodyparts,or TSAor officersloudlyannounced gender onID TSAor officersquestionedthename officers ofthewronggender They werepatteddownbyTSA or packer) related clothing/items(suchasabinder They werepatteddownduetogender- as Mr. orMs.) (such ashe, she, orthey)title(such TSA officersusedthewrongpronouns security issue Airport airport security had gonethrough % ofthosewho 43% 29% 14% 17% <1% <1% <1% 11% 6% 5% 2% 4% 4% 1% 1% 1% gender identity. experiences inairportsecurityrelatedtotheir were alsomorelikely to reportnegative reflect thenameand/orgendertheyprefer(51%) Respondents whosaidthatnoneoftheirIDs these experiencesthantransgenderwomen(31%). (52%) beingmorelikely toreportoneormoreof also differedbygender, withtransgendermen transgender withoutbeingtold(35%).Experiences others canrarelyornevertellthattheyare experiences, incomparisontothosewhosaidthat were morelikely toreport oneormoreofthese sometimes (53%)tellthattheyaretransgender said thatotherscanalwaysorusually(61%) these experiences(Figure16.8).Respondents who A substantialnumberofrespondents alsodid economy weremorelikely toreportmistreatment. respondents currentlyworking intheunderground one ormoreofthelocations.People ofcolorand verbally harassed,and/orphysicallyattacked in including beingdeniedequaltreatmentorservice, mistreatment inplacesofpublicaccommodation, Responses indicatedthatmanyrespondentsfaced Conclusion RACE/ETHNICITY (%) in thepastyear Figure 16.8:Negativeexperienceinairportsecurity 60% 20% 50% 30% 40% 10% 0%

Overall

American Indian 43% 49%

Asian 45%

Black 43%

Latino/a

Middle Eastern 44% 56%

Multiracial 50%

White 43% PLACES OF PUBLIC ACCOMMODATION

AND AIRPORT SECURITY 223 AND AIRPORT SECURITY AND AIRPORT TSA body scanners examine each passenger’s body each passenger’s body scanners examine TSA the passenger based on the gender the officer perceives body parts, or people’s As a result, transgender to be. items such as chest binders (compression garments) and and breast forms), may get prosthetics (such as packers flagged. This often causes transgender passengers to See be outed or to face additional searches and scrutiny. note 3. here refers to respondents who with disabilities” “People Q. 2.20. identified as a person with a disability in 4 5 related to their gender identity when passing when passing their gender identity related to as a result, were security and, through airport traveling through potential harm while at risk of airports.

Available Available Available at: Available Room for Room Available at: http://www. Available The Advocate. The Advocate. New York Times. New York The Advocate. The Advocate. | CHAPTER 16: PLACES OF PUBLIC ACCOMMODATION OF PUBLIC ACCOMMODATION | CHAPTER 16: PLACES . DC: Equal Rights Center. Available at: http:// Available . DC: Equal Rights Center. transgender air traveler. transgender air traveler. http://www.nytimes.com/2015/09/23/us/shadi-petosky-tsa- transgender.html. is not an anomaly. is not an anomaly. advocate.com/commentary/2015/10/01/dear-tsa-my-body- while (2015, October 21). Traveling not-anomaly; Ennis, D. share their stories. trans: Women at: http://www.advocate.com/transgender/2015/10/21/ traveling-while-trans-women-share-their-stories; Rogers, defends treatment of K. (2015, September 22). T.S.A. government agencies. (2016). Equal Rights Center. See e.g., Change www.equalrightscenter.org/site/DocServer/Contents. pdf?docID=2681. my body Dear TSA, Charles, C. (2015, October 1). See e.g., The legal definitions of public accommodations vary The legal definitions of public accommodations and federal laws, but frequently according to local, state, include places open to the public, such as restaurants, stores, hotels, places of public transportation, and 2 3 1 transgender people experienced mistreatment transgender people not visit or use services in places of public use services in places not visit or because of fear altogether accommodation person. as a transgender of being mistreated many that findings demonstrated Additionally, ENDNOTES ENDNOTES 224 2015 U.S. TRANSGENDER SURVEY S Restrooms Experiences in CHAPTER 17 with potentiallyhighernumbers ofrespondentsreportingnegativeexperiences in publicrestrooms. public restrooms.Asaresult, datacollectedafterMarch2016wouldlikely differfromUSTS survey results, experiences oftransgender peopleinrestroomsandtheirperceptionsofsafety when accessingandusing restroom access.Widespread anecdotalevidencesuggeststhatthisclimatehad anadverseeffectonthe 2016. people’s restroom access,andbeforesimilarlegislationwasintroducedinatleast23otherstates than sixmonthsbeforethestateofNorthCarolinapassed alawinMarch2016restrictingtransgender It isimportanttonotethatthesurveywasconductedbetween August andSeptember2015,more characteristics arereportedthroughoutthechapter. public restrooms.Notabledifferencesinrespondents’ experiencesbasedondemographic andother including experienceswithdenialofaccess,harassment, andviolence, aswellavoidanceof This chapterexploresrespondents’ experiencesinrestrooms public places,atwork,andschool, health, includinghigherlevelsofsuicidalthoughtsandbehaviors. to restroomsconsistentwiththeirgenderidentityarevulnerableharassment,violence, andpoormental urinary tractinfections,andstress-relatedconditions. or staff. 5 Thislegislationpromptedsubstantialmediacoverage andpublicscrutinyoftransgenderpeople’s 2 violence whenseekingtousepublicrestrooms,ortheyareexcluded fromrestroomsbypolicies in civiclife, theworkplace, andschool. afe accesstopublicrestroomsisabasicnecessityandessentialformostpeople’s participation Lack ofsaferestroomaccesshasbeenlinked tomedicalproblemssuchaskidneyinfections, 1 Manytransgenderpeople, however, faceharassmentand 3 Transgender peoplewhoaredeniedequalaccess 4

EXPERIENCES IN RESTROOMS 225

8% White

11% Multiracial

12%

10% Eastern Middle Latino/a

9% Black

13% Asian 18%

American Indian American Overall 4% 8% 2% 6% 0% 14% 18% 12% 16% 10% 20% Figure 17.1: Denied access to a restroom in the Figure 17.1: past year (%) RACE/ETHNICITY restroom in the past year. kidney infection, or a urinary tract infection, Eight percent (8%) reported having in the past year as a result of avoiding restrooms. another kidney-related problem More than half (59%) avoided using a public restroom in the past year because they in the past year because they avoided using a public restroom More than half (59%) problems. were afraid of having to avoid using the amount they ate or drank Nearly one-third (32%) limited the Nearly one in ten (9%) respondents reported that someone denied them access to a someone denied them access to (9%) respondents reported that Nearly one in ten year. restroom in the past or physically attacked, respondents were verbally harassed, One in eight (12%) in the past year. when accessing or using a restroom sexually assaulted Nearly one-quarter (24%) of respondents said that someone had questioned or had questioned said that someone of respondents (24%) Nearly one-quarter in the past year. in a restroom their presence challenged

currently working in the underground economy, currently working in the underground economy, such as sex work, drug sales, and other work that is currently criminalized (20%), were more than to be denied access to restrooms twice as likely than those in the overall sample. Asian (13%), and Middle Eastern (12%) respondents to report that someone stopped were more likely them from entering or denied them access to a restroom in the past year (Figure 17.1). Undocumented residents (23%) and respondents someone told them or asked them if they were someone told them or asked and year, using the wrong restroom in the past stopped nearly one in ten (9%) said that someone access to a them from entering or denied them American Indian (18%), restroom in the past year. I. Access to Restrooms said that Nearly one-quarter (24%) of respondents KEY FINDINGS KEY 226 2015 U.S. TRANSGENDER SURVEY RACE/ETHNICITY (%) sexual assaultinarestroomthepastyear Figure 17.2: Verbal harassment,physicalattack,and/or 20% 25% 30% (16%) respondents(Figure17.2). (25%), andAmericanIndian(24%)multiracial currently workingintheundergroundeconomy undocumented residents(34%),respondents experiences weremorefrequentlyreportedby while usingarestroominthepastyear. These and/or sexualassaulted being verballyharassed,physicallyattacked, Twelve percent(12%)ofrespondentsreported Sexual Assault Physical Attack, and II. Verbal Harassment, restroom inthepastyear. or deniedthemaccesstoa stopped themfromentering respondents saidthatsomeone Nearly oneinten(9%) 10% 15% 0% 5%

Overall

American Indian 12% 24%

Asian 12%

Black 10% 6 whenaccessingor

Latino/a 12% Middle Eastern 13%

Multiracial 16%

White 12% in pastyear Table 17.1: Location ofverbalharassmentinrestroom in aschoolrestroom(Table 17.1). or movietheater, and20%wereverballyharassed public place, suchasarestaurant,shoppingmall, (89%) wereverballyharassedinarestroomat harassment hadoccurred.Eighty-ninepercent restrooms wereasked fortheplaceswhere Respondents whowereverballyharassed in harassed inarestroomthepastyear. One outofeight(12%)respondentswereverbally a. Verbal Harassment past year Table 17.2: Location of physicalattackinrestroom attacked inarestroomatschool(Table 17.2). over one-quarter(27%)saidtheywerephysically a restaurant,shoppingmall,ormovietheater, and attacked inarestroomatpublicplace, suchas attack. Eighty-sixpercent(86%)werephysically asked wheretheyhadexperiencedthephysical Respondents whowerephysicallyattacked were likely tobephysicallyattacked inarestroom. and AmericanIndianrespondents(3%)weremore in thepastyear. Undocumentedresidents(4%) unweighted) wasphysicallyattacked ina restroom One percent(1%)ofthesample(228respondents, b. PhysicalAttack movie theater) restaurant, shoppingmall,or Public place(suchasa Restroom location Another location Workplace School movie theater) restaurant, shoppingmall,or Public place(suchasa Restroom location Another location Workplace School verbally harassed % ofrespondentswhowere physically attacked % ofrespondentswhowere 20% 86% 89% 27% 14% 14% 9% 5% EXPERIENCES IN RESTROOMS 227

25% White

32% Multiracial

29% Middle Eastern Middle

28% Latino/a

27% Black

29% Asian

36%

26% Indian American Overall 5% 0% 15% 10% 35% 40% 30% 25% 20% Figure 17.4: Any reported problem in a restroom Any reported problem in a restroom Figure 17.4: in the past year (%) RACE/ETHNICITY transgender without being told (45%) or sometimes transgender without being told (45%) more likely tell they were transgender (38%) were in to report one or more of these experiences, could rarely contrast to those who said that others (16%). or never tell that they were transgender III. Overall Access Access III. Overall in Treatment to and Restrooms prior to taking the survey, Overall, in the year were denied access to 26% of all respondents presence in a restroom restrooms, had their were verbally harassed, questioned, and/or assaulted in or sexually physically attacked, nearly twice as high for a restroom. This was (50%) and was also undocumented residents in the higher for respondents currently working also higher underground economy (39%). It was (32%) among American Indian (36%) and multiracial who said Respondents respondents (Figure 17.4). they were that others could always or usually tell

14% 18%

19% 78% 0.5% White

2.4% Multiracial

3.2%

0.9% Eastern Middle Latino/a % of respondents who were sexually assaulted

0.8% Black

3.2% Asian 2.8%

0.6%

American Indian American Overall 1% 3% 2% 0% Workplace Another location Restroom location Restroom Public place (such as a restaurant, shopping mall, or movie theater) School 1.5% 3.5% 0.5% 2.5% sexual assault occurred in a restroom at a public and 19% were sexually assaulted at a school place, 17.3). restroom (Table of sexual assault in restroom in Location 17.3: Table past year More than three-quarters (78%) of respondents More than three-quarters (78%) of respondents that the who were sexually assaulted reported women were more likely to have been sexually likely women were more in the past year (Figure 17.3). assaulted in a restroom past Sexual assault in a restroom in the Figure 17.3: year among transgender women (%) RACE/ETHNICITY Those currently working in the undergroundThose currently working to have had this likely economy were more transgender women experience (4%). Additionally, Eastern including Asian (3.2%), Middle of color, (2.8%), and multiracial (2.4%)(3.2%), American Indian c. Sexual Assault c. Sexual sample of the one percent (0.6%) Approximately reported being unweighted) (139 respondents, in a restroom in the past year. sexually assaulted 228 2015 U.S. TRANSGENDER SURVEY GENDER IDENTITY(%) in thepastyear Figure 17.5: Sometimesoralwaysavoidedbathrooms tell thattheyaretransgender. of thosewhosaidthatotherscanrarelyornever avoiding usingpublicrestroom,incontrastto48% can sometimestelltheyaretransgenderreported transgender and72%ofthosewhosaidthatothers others couldalwaysorusuallytellthattheywere Eighty percent(80%)ofrespondentswhosaidthat using apublicrestroominthepastyear(72%). likely toreportsometimesoralwaysavoiding 17.5). Undocumentedresidentswerealsomore (53%) andnon-binaryrespondents(Figure public restroom,incontrasttotransgenderwomen report sometimesoralwaysavoidingusinga Transgender men(75%)werefarmorelikely to confrontations orotherproblems. at work,orschool,becausetheywereafraidof (11%) avoidedusingarestroom,suchasinpublic, past yeartheyhadeithersometimes(48%)oralways in 2016,59%ofrespondentsreportedthatthe country aboutanti-transgenderbathroomlegislation conversations inNorthCarolinaandacrossthe Even priortotheincreasedpublicscrutinyand Public Restrooms IV. Avoidance of 60% 20% 50% 80% 30% 40% 70% 10% 0%

Overall 59%

Crossdressers 36%

Non-binary 53%

Trans women 53%

Trans men 75%

Trans women

and men 64%

apparently thoughtitwasokaytogo came outonlytofindonepersonwho a manandall.Iwasusingstall, “I wentintothemen’s bathroom,being attempting to.” confronted multipletimeswhen the femalerestroomandhavebeen public place. I’mnotallowedtouse down anduseamalerestroomin “I eitherhaveto‘holdit’orbreak I’m transgender.” dignified placeforme simplybecause like awalkofshame, like therewas no Going tothenurse’s officealwaysfelt bathroom sinceIwasliving asaboy. would happenifIwentintothegirls’ get reprimanded,andthesame used theboys’ bathroom, Iwould the nurse’s bathroom,becauseifI “I spenthighschoolhavingtouse disgusted lookandlefttheroom.” a pants down.Theofficershotme The menrespondedbyrippingmy and triedtoprotesttheirharassment. police officerwalked intotherestroom pushed mearoundbetweenthem.A me asItriedtoexittherestroomand me. Heandhisbuddiescircledaround This time, though,someonerecognized like Ihaddonesomanytimesbefore. “I walked intoastalltodomybusiness passed outduetotheblow.” and thenwentformyvagina.Inearly when hefirstpunchedmeintheback after me. Iwasjustwashingmyhands Voices In OurOwn EXPERIENCES IN RESTROOMS 229 related problems. Conclusion in using restrooms suggest that Responses or at school presents public places, at work, for transgender people. serious challenges barriers and faced numerous Respondents to use a public problems when attempting being verbally harassed, restroom, including sexually assaulted, or physically attacked, the restroom altogether. denied access to these experiences were In many instances, by people of color. more frequently reported A majority of people had avoided using to fear public restrooms in the past year due other of encountering confrontations and health issues, problems, which led to a range of kidney- including urinary tract infections and 1% 1% 1% 8% 8% 32% 55% % of all respondents 2% 2% 2% 13% 12% 89% 52% % of respondents who avoided using restrooms A problem not listed Kidney infection Other kidney- related problems Kidney-related problem and/ or a urinary tract infection Did not use the restroom when needed to (“held it”) drinking Avoided or eating Urinary tract infection Physical problem Table 17.4: Physical problems due to avoiding public public Physical problems due to avoiding 17.4: Table restrooms in the past year avoided drinking or eating so that they would not avoided drinking or eating so that they having need to use the restroom, and 8% reported medical a urinary tract infection or kidney-related in the problem as a result of avoiding restrooms 17.4). past year (Table Respondents were also asked if they had were also asked Respondents as a result of experienced any physical problems at work, or avoiding restrooms in public places, the sample at school. Nearly one-third (32%) of related medical problem as a problem as a related medical restrooms result of avoiding in the past year. need to use the restroom, and the restroom, and need to use having a urinary 8% reported or kidney- tract infection Nearly one-third (32%) of the (32%) of the one-third Nearly drinking or avoided sample they would not eating so that 230 2015 U.S. TRANSGENDER SURVEY 4 3 2 1 ENDNOTES suicidality. college bathroomsandhousingtherelationshipto Seelman, K.L.(2016).Transgender adults’ accessto Herman, J. L.Seenote2. & SocialPolicy, 19 transgender people’s lives. stress: Thepublicregulationofgenderanditsimpacton Herman, J. L.(2013).Genderedrestroomsandminority https://www.osha.gov/Publications/OSHA3795.pdf. Restroom AccessforTransgender Workers. Administration. (2015). Department ofLabor &OccupationalSafetyandHealth Journal ofHomosexuality, 63 |CHAPTER17:EXPERIENCESINRESTROOMS (1), 65–85. Best Practices:AGuideto Journal of Public Management Journal ofPublicManagement (10), 1378–1399. Available at: 7 6 5

Movement AdvancementProjectetal.Seenote5. a bathroominQ. 20.3 andQ. 20.6. “unwanted sexualcontact”whenaccessingorwhileusing Respondents wereasked iftheyhadexperienced bathroom-ban-laws.pdf. Ban Laws. Safety, NondiscriminationLaws, andBathroom for Transgender Equality. (2016). Institute, FreedomforAllAmericans,&NationalCenter Movement AdvancementProject,EqualityFederation Available at:http://www.lgbtmap.org/file/ The Facts:Bathroom CIVIC PARTICIPATION AND POLICY PRIORITIES 231

to assess 1

oting and other forms of participation in the political process are important methods by which oting and other forms of participation in the political process are important governance at the local, people involve themselves in their communities and can have a voice in and federal levels. They are also significant avenues by which individuals and groups can state,

V about their political engagement, political party affiliation, and policy priorities as they relate to issues that about their political engagement, political party affiliation, and policy priorities Notable Poll. Daily Tracking some of which were patterned on the Gallup U.S. impact transgender people, other characteristics are reported experiences based on demographic and differences in respondents’ throughout the chapter. Respondents received questions about voting in the previous national election (November 2014) received Respondents barriers to voting such as levels of voting and determine reasons for not participating, including potential Registration Voting and Relevant questions were patterned on the November 2014 voter identification laws. questions respondents were asked Survey (CPS). Additionally, Supplement of the Current Population affect change and influence the policies and procedures that impact their lives. affect change and influence the policies and procedures that impact their

and Policy Priorities and Policy CHAPTER 18 CHAPTER Civic Participation 232 2015 U.S. TRANSGENDER SURVEY

KEY FINDINGS (76%) ofU.S. citizensinthesurvey samplewho proximity tothesurvey. Morethanthree-quarters which wasthenationalelection heldinclosest relation totheNovember4, 2014midtermelection, Survey respondentswereasked aboutvotingin a. Voter Registration and Voting I. Voter Registration U.S. population. voted intheelection,comparedto42%ofthosewhoreportedtheyhad More thanhalf(54%)ofU.S. citizensofvotingageinthesamplereportedthattheyhad of individualsintheU.S. populationwhoreportedthattheywereregistered. they wereregisteredtovoteintheNovember2014midtermelection,compared65% More thanthree-quarters(76%)ofU.S. citizensofvotingageinthesamplereportedthat top priorities. transgender people(25%),healthinsurancecoverage(15%), andracism(11%)astheir transgender people, respondentsmostoftenidentifiedaddressingviolenceagainst When asked aboutwhattheybelievedthemostimportantpolicyprioritieswerefor because theyweretransgender. that themainreasonwastheywantedtoavoidharassmentbyelectionofficials Three percent(3%)ofthosewhoreported interested intheelection,comparedto16%ofthoseU.S. population. vote saidthattheythoughttheirwouldnotmake adifference ortheywerenot Nineteen percent(19%)ofthosewhoreportedtheywereregistered butdidnot they weretransgender. main reasonwasthattheywantedtoavoidharassmentbyelectionofficialsbecause Three percent(3%)ofthosewhosaidtheywere politics. that themainreasonwastheywerenotinterestedin theelectionornotinvolvedin Over one-quarter(27%)ofthosewhosaidtheyhadnotbeenregisteredtovote being registeredtovote (79%) respondents(Figure 18.1). than AmericanIndian(77%), white(78%),andBlack respondents beinglesslikely toberegistered Eastern (71%),Latino/a (70%),andAsian(65%) voters differedbyraceorethnicity, withMiddle population. compared to65%ofthoseindividualsintheU.S. reported thattheywereregisteredtovote, were ofvotingageatthetimeelection not registeredtovote 3 Thenumberofreportedregistered

but notvoting reportedthatthe said 2

CIVIC PARTICIPATION AND POLICY PRIORITIES 233

5 were not registered to vote because they wanted to avoid anti-transgender harassment by election officials. eight (12%) felt that their vote would not make a make eight (12%) felt that their vote would not (Table difference and therefore did not register 18.1). respondents reported not being Additionally, to avoid registered to vote because they wanted officials anti-transgender harassment by election current (3%), because they did not have their card (2%), name updated on their Social Security voter and because they thought their state’s voting identification law would stop them from anti-transgender harassment by (1%). Avoiding reason election officials was a more common for transgender men and women (5%) than for crossdressers (2%) and non-binary respondents Three percent (3%) of respondents who were citizens and of voting age at the time of the 2014 midterm election b. Reasons for Not Registering for Not Registering Reasons b. to Vote they were not registered who said Respondents 4, 2014 election wereto vote in the November main reason why they were to identify the asked on categories outlined in thenot registered based Survey (CPS) and additional Current Population have had as a transgenderexperiences they might one-quarter (27%) of those in theperson. More than that they were not registeredsample who reported were not interested in theto vote said that they in politics, which was theelection or not involved beingmost frequently selected reason for not not knowregistered. Sixteen percent (16%) did and 15% indicated that where or how to register, One inthey did not meet registration deadlines.

61%

78%

White No income No 79% 75%

(65%)

4 Multiracial

66% Multiple sources Multiple 71%

65%

Other source only source Other Middle Eastern Middle

70%

cash assistance cash Latino/a 75%

79%

SSI/disability Black Unemployment benefits/ benefits/ Unemployment 81%

65% Asian

76%

Pension/retirement only Pension/retirement only 77%

48%

Employment only Employment

76% Indian American 76%

Overall Overall Underground economy economy Underground 0% 0% 10% 10% 70% 70% 40% 40% 30% 30% 80% 80% 50% 20% 50% 20% 60% 90% 60% Figure 18.1: Registered to vote Registered Figure 18.1: (%) RACE/ETHNICITY Figure 18.2: Registered to vote Figure 18.2: Registered SOURCES OF INCOME (%) registered. Respondents whose only source of registered. Respondents or otherincome was from unemployment benefits cash assistance programs such as TANF to be registered (Figure 18.2).were also less likely in voting registration based on respondents’ in voting registration based on respondents’ 48% of those whose with only sources of income, sole source of income was from the underground sales, and othereconomy—including sex work, drug beingwork that is currently criminalized—reporting Naturalized citizens (69%) were less likely to report to likely Naturalized citizens (69%) were less born in thebeing registered than citizens who were (76%). There were also differences United States 234 2015 U.S. TRANSGENDER SURVEY vote onNovember4,2014 Table 18.1: Mainreasonfornotbeingregisteredto harassment byelectionofficials(Figure18.4). that theydidnotregistertovoteinorderavoid respondents (7%)werealsomorelikely toreport were transgenderwithoutbeingtold(3%).Black who saidpeoplecouldrarelyornevertellthey likely toreportthisreason(8%),incontrastthose even withoutbeingtoldweremorethantwiceas could alwaysorusuallytelltheyweretransgender (1%) (Figure18.3).Thosewhoreportedthatpeople Other reasons(including): Difficulty withEnglish Permanent illnessordisability reason) to criminal/felonyconvictionorother They werenoteligibletovote(due requirements enough ormeetresidency They didnotliveinplacelong difference They felttheirvotewouldnotmake a deadlines They didnotmeetregistration register They didnotknowwhereorhowto election ornotinvolvedinpolitics They werenotinterestedinthe registered tovote Reasons fornotbeing (write-in response) Protest orphilosophicalreasons would stopthemfromvoting They thoughttheirstate’s voterIDlaw name ontheirSocialSecuritycard Their currentnamedidnotmatchthe needed onetoregister document (ID)andthoughtthey They didnothaveanidentity transgender election officialsbecausetheywere They wantedtoavoidharassmentby

not registered to vote not registeredtovote % ofUSTS citizens 27%

19% 16% 15% 12% <1%

5% 2% 3% 2% 2% 3% 1% 1% RACE/ETHNICITY (%) anti-transgender harassment Figure 18.4:Notregisteredduetoavoiding the U.S. population. election, compared to42%in reported thatthey votedinthe of the2014midtermelection and ofvotingageatthetime respondents whowerecitizens More thanhalf(54%)of likely toreportvoting(Figure18.5). (48%) andBlack(50%)respondentswerealsoless least likely toreporthavingvoted,andLatino/a people ofcolor, Asianrespondents(44%)were to 42%ofthoseintheU.S. population. reported thattheyvotedintheelection,compared who wereofvotingageatthetimeelection More thanhalf(54%)ofU.S. citizensinthesample c. Voting inthe 2014Election GENDER IDENTITY(%) anti-transgender harassment Figure 18.3:Notregisteredduetoavoiding 0% 6% 2% 0% 4% 6% 2% 8% 4%

Overall American Indian Overall 3% 3%

Crossdressers 0% 2% Asian

2% Non-binary

Black 1% 7% Trans women Latino/a

Middle Eastern 3% 6%

0% Trans men Trans women and men 6

Multiracial 4% Among 4%

White 5% 3% CIVIC PARTICIPATION AND POLICY PRIORITIES 235 sure I had the best candidates who would protect my rights.” “When changing my name on my voter registration, the DMV put in the wrong name. know how to fix it and I don’t I’m scared that if I try to vote (something I really want to do!) be able to because I won’t the voter registration has the wrong name.” “I had to try twice to get my county to change my name in the voter registration, which is extremely embarrassing as people are essentially shouting that you’re trans in a public Some accused me of place. attempting voter fraud when all I wanted to do was try to make In Our Own Own In Our Voices pushed through “Lawmakers in my state, voter ID reforms voter to present requiring every a gender a photo ID with Since I was unable marker. of ‘de I was a victim to do so, disenfranchisement and facto’ voter intimidation tactics that all too unfortunately, are now, common.”

56% White 53%

(41%)

7 Multiracial

53% Middle Eastern Middle

48% Latino/a

50% Black were also Respondents 8

44% Asian

56%

54% Indian American Overall 0% 10% 40% 30% 50% 20% 60% of respondents reported that they wanted to avoid harassment by election officials because they men and women Transgender were transgender. current location (5%), than registered voters in the 18.2). (2%) (Table general population U.S. Among those who provided additional reasons for not voting that were not included in the CPS, 3% make a difference, compared to 16% of such voters a difference, make population. in the U.S. to report not voting due more than twice as likely to registration problems, such as not receiving an absentee ballot or not being registered in the did not vote, based on categories outlined in did not vote, they might the CPS and additional experiences one in have had as a transgender person. Nearly they were five (19%) respondents who reported that they registered but did not vote reported were not interested or felt their vote would not d. Reasons for Not Voting for d. Reasons who reported being registered but Respondents election did not vote in the November 4, 2014 they to identify the main reason why were asked were also less likely to say they had voted, as to say they had voted, were also less likely in the were those who were currently working (42%), underground economy (40%), unemployed or out of the labor force (50%). Respondents who were living in poverty Respondents Figure 18.5: Voted in election in Voted Figure 18.5: (%) RACE/ETHNICITY 236 2015 U.S. TRANSGENDER SURVEY Table did notvotesaidthatthemainreasonwas (<1%) (Figure18.6). Two percent(2%)ofthosewho an electionofficialthannon-binaryrespondents vote becausetheywantedtoavoidharassmentby (4%) weremorelikely to reportthattheydidnot official becausetheyweretransgender They werenotallowedbyapoll worker orelection Protest orphilosophicalreasons(write-inresponse) know aboutthecandidates(write-inresponse) They didnotknowtheprocessforvotingor They didnothavetheIDtheyneededtovote Name orgenderonIDdidnotmatchvoterregistration they hadanoldphoto Their IDdidnotmatchtheircurrentnameorgender, or because theyweretransgender They wantedtoavoidharassmentbyelectionofficials Additional reasonsnotincludedintheCPS: Other reasons Bad weatherconditions Transportation problems long Inconvenient hours,pollingplace, orhourslinestoo Illness ordisability(ownfamily’s) current location) absentee ballotortheywerenotregisteredintheir Registration problems(e.g., theydidnotreceivean They didnotlike thecandidatesorcampaignissues They wereoutoftownorawayfromhome schedule They weretoobusyorhadaconflictingworkschool They forgottovoteorsendinanabsenteeballot make adifference They werenotinterestedorfelttheirvotewould Population Survey(CPS): Reasons includedintheCurrent 18 .2: MainreasonfornotvotingonNovember4,2014

did notvote who wereregisteredbut % ofUSTS respondents

voter registration. current nameorgenderthatdidnotmatchtheir and 1%saidthatthemainreasonwastheir or thattheirphotodidnotmatchappearance, their IDdidnotmatchcurrentnameorgender 10% 16% 19% 19% 12% <1% <1% 5% 5% 2% 8% 3% 3% 3% 1% 1% 1% 1% but didnotvote(CPS) who wereregistered % inU.S. population

28% 10% 16% <1% 11% 9% 2% 2% 2% 8% 8% ------CIVIC PARTICIPATION AND POLICY PRIORITIES 237

19% Agree

13% agree 24% Strongly nor disagree Neither agree

“Someone decisions.” government like me can’t me can’t like really influence 16% Strongly disagree

Respondents who did not identify Respondents 9

28% Disagree asked whether they lean more to the Democratic whether they lean more to the asked Overall, 79% in Party. or the Republican Party the sample reported that they were Democrats 4% were or lean towards the Democratic Party, Party, lean towards the Republican or Republicans Respondents were also asked about their were also asked Respondents that were political party affiliation with questions Poll, Daily Tracking patterned on the Gallup U.S. a including whether they consider themselves Democrat, or Independent. Half (50%) Republican, 48% of respondents identified as Democrats, identified identified as Independents, and 2% compared to 27%, 43%, and as Republicans, population, respectively general 27% in the U.S (Figure 18.8). wrote in several as Democrats or Republicans political parties and political movements, including socialist or democratic socialist (4%), Green Party (2%), Libertarian (1%), and anarchist (1%). For Poll, comparison with the Gallup Daily Tracking these respondents are included as Independents in Figure 18.8. Those who identified as Independents were also have some influence on government decisions decisions influence on government have some could not influence who believed they than those decisions. government ability to of Perception Figure 18.7: decisions influence government 4%

Trans women and men and women Trans Trans men Trans

5% Trans women Trans

<1% Non-binary

0% Crossdressers

3% Overall 4% 2% 6% 0% 27%, 43%, and 27% in the general population, U.S. respectively. identified as Independents, and 2% identified as compared to Republicans, Half (50%) of respondents identified as Democrats, 48% more respondents who thought that they could following statement: “Someone like me can’t me can’t following statement: “Someone like Nearly really influence government decisions.” or strongly half (44%) of respondents disagreed disagreed with the statement, and approximately with the one-third (32%) agreed or strongly agreed This means that there were statement (Figure 18.7). affairs to examine how much of an influence affairs to examine how much of an influence they believed they could have on government to rate they were asked decisions. Specifically, to “strongly agree” on five-point scale from what they thought about the disagree” “strong Engagement and Engagement and Affiliation Party received a question about political Respondents II. Political II. Political Figure 18.6: Did not vote due to avoiding due to avoiding Did not vote Figure 18.6: harassment anti-transgender (%) GENDER IDENTITY 238 2015 U.S. TRANSGENDER SURVEY Democrat, orIndependent Figure 18.8:ConsiderthemselvesaRepublican, 1% describedthemselvesas“veryconservative.” “moderate,” 2%selected“conservative,” andonly “very liberal,” 27%selected“liberal,” 15%selected half (55%)ofthesampledescribedthemselvesas When asked abouttheirpoliticalviews,morethan and donotleantowardseitherparty(Figure18.9). Republican Party, and11%whoareIndependents 45% whoareRepublicans orleantowardsthe Democrats orleantowardstheDemocraticParty, compares to44%intheU.S. populationwhoare towards theDemocraticorRepublican parties.This and 17%wereIndependentswhodonotlean Indepen- 48% dent Republican

27% Political party Political party population Independent % inU.S. % USTS (Gallup) 43% Republican 2% Democrat 27% Democrat 50% 10 mistreatment oftransgender people(88%),and for transgender-relatedhealth care(90%),police very importantissue(94%). Insurancecoverage people wasmostwidelyselected asbeinga very important.” Violenceagainsttransgender to beranked from“veryimportant”to“not people intheU.S. andasked for thoseissues most importantpolicyprioritiesfortransgender The surveyexploredrespondents’ opinionson the III. Policy Priorities affiliation andleaning Figure 18.9:DemocraticorRepublican party lean Republican Republican or 4% Independent Independent Republican orlean Independent Independent (no lean) (no lean) 17% Republican 11% Political party Political party and leaning and leaning 45% population % inU.S. % USTS (Gallup)

Democrat Democrat Democrat Democrat or lean or lean or lean or lean 44% 79% CIVIC PARTICIPATION AND POLICY PRIORITIES 239 1% 1% 1% 1% 1% 1% 7% 7% 4% 2% 5% 5% 5% 6% 11% 15% 25% % of respondents

Respondents’ most most Respondents’ important priority transgenderViolence against people Insurance coverage for care transgender-related health Racism Employment Mistreatment in prisons or jails HIV/AIDS Conversion therapy Military (open service for transgender people) Immigration reform and adoption rights Parenting Marriage recognition Identity documents Poverty inBullying and discrimination schools health care providers Training about transgender health mistreatment of Police transgender people Housing and homelessness Table 18.4: Top policy priorities policy Top 18.4: Table and day-to-day needs can be expressed. The results indicate that while a majority of eligible respondents had registered to vote in the most recent national election, only half had engaged in the process by voting, providing reasons such as difference or a not believing their vote would make Conclusion in the political process through Participation activities such as voting is a vital component of influencing policies that impact lives and and national levels communities at the local, state, the process may be However, throughout the U.S. inaccessible at times or may otherwise present a difficult avenue through which policy priorities 1% 1% 1% 1% 1% 1% 1% 1% 1% 3% 3% 4% 2% 13% 18% 10% 10% Not very important 5% 9% 11% 13% 13% 14% 15% 15% 15% 16% 33% 32% 28% 30% 22% 29% 20% Important 87% 79% 83% 84% 84% 49% 94% 88% 82% 85% 68% 68% 68% 86% 55% 60% 90% Very Very important .3: Respondents’ policy priorities .3: Respondents’ 18 recognition Military (open service for transgender people) Parenting and Parenting adoption rights Conversion therapy Immigration reform Marriage schools Racism Mistreatment in prisons or jails Identity documents HIV/AIDS transgender health Housing and homelessness Poverty Bullying and discrimination in Police mistreatment Police of transgender people Employment health care Training providers about Issue Violence against transgender people Insurance coverage for transgender- related health care coverage was the most important priority for them, and 11% reported that racism was the most 18.4). important policy priority for them (Table policy 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 Respondents were also asked for their top three also asked were Respondents employment (87%) were also commonly selected commonly selected (87%) were also employment 18.3). (Table priorities as very important Table 240 2015 U.S. TRANSGENDER SURVEY 6 5 4 3 2 1 ENDNOTES that respondentsidentifiedasmostimportantare Party thanotherpoliticalparties.Policy priorities Democratic Party orleantowardstheDemocratic were substantiallymorelikely toidentifywiththe officials asatransgenderperson. Respondents wanting toavoidpotentialharassmentbyelection (2014, November). represents 65%ofregisteredvoters. U.S. Census Bureau. voters aged18andoldervotedin the2014election,which in theelection.AccordingtoCPS, 42%ofcitizen 70% ofthoseinthesamplewhowere registeredtovote The numberofUSTS respondentswhovotedrepresents available atthetimeofthisreport. 4, 2014,U.S. populationdataforthatquestionwasnot the mainreasonfornotregisteringtovoteonNovember Although theCurrentPopulation Surveyasked about program) isafederalcashassistanceprogram. TANF (theTemporary AssistanceforNeedyFamilies 577.html. data/tables/time-series/demo/voting-and-registration/p20- November 2014 and Registration, bySexandSingleYears ofAge: November). citizens aged18andover. U.S. CensusBureau,(2014, Reported voterregistrationintheU.S. isamongU.S. in theU.S. population. Current Population Surveydataonregistrationandvoting election toprovidethemostappropriatecomparison the samplewhowereaged18orolderattimeof chapter arebasedontheresponsesofU.S. citizensin Voter registrationandvotingresultsreportedinthis level offices.” See Q. 29.1 and 29.2. 2014 toelectmembersoftheU.S. Congressandstate- the explanationthat“[t]hiswaselectioninNovember Tuesday, November4,2014,andrespondentsreceived Questions referredtothemidtermelectionsheldon |CHAPTER18:CIVICPARTICIPATION ANDPOLICY PRIORITIES Current Population Survey:Reported Voting . Available at:https://www.census.gov/ Current Population Survey . Reported 10 9 8 7 racism, employment,andhousing. care, policetreatmentoftransgenderpeople, transgender people, healthinsuranceand of transgenderpeople, includingviolenceagainst those directlyrelatedtothesafetyandwellbeing affiliation.aspx. Available at:http://www.gallup.com/poll/15370/party- Gallup Poll. (2015,September9–13). poll/15370/party-affiliation.aspx. 9–13). survey wasinthefield.Gallup Poll. (2015,September 9–13, 2015,thepollinclosestproximity towhenthe This dataisbasedonGallupPoll resultsfromSeptember 577.html. data/tables/time-series/demo/voting-and-registration/p20- November 2014 Survey U.S. CensusBureau.(2014,November). about thepovertylinecalculation. and EmploymentStatus who arelivingatornearthepovertyline. Seethe Respondents whoare“livinginpoverty”representthose publications/2015/demo/p20-577.pdf. https://www.census.gov/content/dam/Census/library/ 1978-2014. Congressional ElectionsandtheAmericanElectorate: p20-577.html. SeealsoFile, T. (2015). data/tables/time-series/demo/voting-and-registration/ November 2014. Voting andRegistration, bySexandSingleYears ofAge: Party Affiliation. . Voting andRegistration intheElectionof (p. 2).DC:U.S. CensusBureau.Available at: . Available at:https://www.census.gov/ Available at:https://www.census.gov/ Available at:http://www.gallup.com/ chapter formoreinformation Party Affiliation. Who Votes? Current Population Income ABOUT THE AUTHORS 241

The The in 2010 and an , based on the National He has worked on numerousHe has worked LGBTQ Policy Journal at the Harvard Kennedy Journal at the Harvard Kennedy Policy LGBTQ Injustice at Every Turn The Lives of Transgender People The Lives of Transgender and the and in 2011. In addition to serving as a consultant for the National

Sandy received a J.D and M.A in American Government from Georgetown University, where he from Georgetown University, and M.A in American Government Sandy received a J.D

to improve the campus climate for under-served communities. Her recent publications include to improve the campus climate for under-served communities. Her recent People for LGBT of Higher Education State Climate Study Student-Athlete NCAA Discrimination Survey in 2011, she has collaborated with over 170 institutions in Transgender justice issues.implementing assessments and developing strategic plans regarding social State University in 2013 after 36 years, where she most recently served as an Associate Professor University in 2013 State of Higher Education. Sue earned her B.S. of Education, and Associate in the Center for the Study University. State from the Pennsylvania University in 1978, and an M.S. and Ph.D. from Montclair State and heterosexism inShe has presented and published widely on the impact of sexism, racism, on the assessment ofthe academy and in intercollegiate athletics. Her current research focuses with recommended strategiesinstitutional climate and providing program planners and policymakers expression. Sue Rankin Consulting. She retired from the Pennsylvania & Associates is the principal of Rankin Sue Rankin non-profit research, advocacy, and direct-service organizations in the United States and Mexico. She States and Mexico. and direct-service organizations in the United non-profit research, advocacy, report served as a co-author on the groundbreaking Force and Task and Lesbian Discrimination Survey conducted by the National Gay Transgender at the Williams Institute focuses on the research Equality. Her the National Center for Transgender on gender identity orprevalence and impact of interpersonal and structural discrimination based holds a Ph.D. in Public Policy and Public Administration in the field of Gender and Social Policy from the and Social and Public Administration in the field of Gender in Public Policy holds a Ph.D. with a concentration Policy where she also earned her M.A. in Public University, George Washington focused on the problems transgender and gender Her doctoral dissertation Studies. in Women’s public restrooms and the development of anti-discriminationnon-conforming people face when using based on gender identity and expression. She has workedprotections in public accommodations and anti-discrimination policy development with rights, voting rights, women’s on issues of poverty, is also currently pursuing his Ph.D. is also currently pursuing his Ph.D. Jody L. Herman She at the Williams Institute at the UCLA School of Law. Policy Jody L. Herman is a Scholar of Public focused on law, research, and policy to advance transgender rights. research, and policy to advance transgender focused on law, work with data and research, including extensive trans-related legislation, policy, projects involving has been published in Sandy Discrimination Survey. National Transgender from the 2008–09 the Law Georgetown Journal of Gender and School. Sandy E. James Sandy led the research Equality, Manager at the National Center for Transgender As Survey Project After a Transgender Survey. U.S. the 2015 fielding, analyzing, and presenting team in developing, a new career as a civil rights advocate Sandy launched as a forensic toxicologist, decade-long career About the Authors the About 242 2015 U.S. TRANSGENDER SURVEY person, Ma’ayan istheco-leaderofDCchapterAutistic Self-Advocacy Network. from HarvardLaw SchoolandaB.A.fromtheUniversityofToronto. AnAutistic andnon-binary transgender federal nondiscriminationlawsinhealthcare, employment,education,andhousing.Ma’ayan obtainedaJ.D. communities, withafocusoneffortstodefeatanti-transgender statelegislationandtheimplementationof team, Ma’ayan hasworked tostrengthenandpreservenondiscrimination protectionsfortransgender Ma’ayan Anafiisa Policy CounselattheNational Centerfor Transgender Equality. As part oftheNCTE Ma’ayan Anafi Law Centerin2001. graduated fromtheUniversityofWashington in1998andreceivedherJ.D. fromtheGeorgetownUniversity Transitioning OurShelters:AGuidetoMakingHomelessSheltersSafeforTransgender People Making LGBT OrganizationsFullyTransgender-Inclusive were recordedinthe2008publication, law in2009, andtotheEmploymentNon-DiscriminationAct.Herthoughtsguidanceontrans-inclusion “gender identity”totheMatthewShepardandJamesByrd,Jr. HateCrimesPreventionAct,whichbecame trans-inclusion intheLGBT movement and,whileattheTask at EveryTurn team fortheNationalTransgender DiscriminationSurvey, andco-authoredthereportofitsfindings, National GayandLesbian Task Force),wheresheservedfor12years,wasamemberoftheresearch position asDirectoroftheTransgender CivilRightsProjectatthe federal policyadvocacy, whilealsohelpingtooverseecommunicationsanddevelopment. Inherprevious helping togrowNCTEfrom5staffnow15staff. Shehelpsguidetheorganization’s local,state, and Lisa MottetjoinedtheNationalCenterforTransgender EqualityastheDeputyExecutive Directorin2013, Lisa Mottet University. from Pennsylvania State Universityandconducted hergraduatestudiesinAmericanGovernmentatHarvard Transgender DiscriminationSurvey lives oftransgenderpeople. Marawasaco-authorof policy. Underherleadership, NCTEhaswonwellover100federalpolicychangesthathaveimprovedthe won significantadvancesintransgenderequalitythroughoutthecountry, especiallyinfederallawand foremost authoritiesontransgender a 25-yearcareerinsurvey the nation’s leadingsocialjusticeorganizationswinninglife-savingchangefortransgenderpeople. After Mara Keisling isthefoundingExecutive DirectoroftheNationalCenterforTransgender Equality, oneof Mara Keisling (2011).Asalong-timeallytothetransgenderco research, MarahelpedfoundNCTEandquicklybecameoneofthenation’s . Anativeof issues. Opening theDoortoTransgender Inclusion:TheNineKeys to Mara has led organizational and coalition efforts that have Mara hasledorganizationalandcoalitioneffortsthathave Pennsylvania andatransgenderwoman,Mara Injustice atEveryTurn: TheReport oftheNational . AlsowhileattheTask Force, Lisaco-authored Force, shehelpedengineertheadditionof mmunity, Lisawasamajorfigureinpromoting National LGBTQ Task Force(formerlythe holds a B.A. holds aB.A. . Lisa . Lisa Injustice Injustice APPENDIX A 243 chapter and

Methodology for a description of the weights used in this report.

hroughout the report, findings were presented with the standard or supplemental survey hroughout the report, findings were presented with the standard or supplemental U.S. population in regard to weight applied. These weights adjusted the sample to reflect the for disproportionate representation and educational attainment and also adjusted race, age,

other variables are presented to provide a description of the sample before weights were applied. other variables are presented to provide a description of the sample before This includes recoded variables, which are indicated as such. See the Appendix C: Detailed Methodology of 18-year-olds in the sample. In this appendix, unweighted tabulations of selected demographic and In this appendix, unweighted tabulations of selected of 18-year-olds in the sample. Demographic Description and Demographic Description and Sample Other Characteristics of the Appendix AAppendix T 244 2015 U.S. TRANSGENDER SURVEY Oklahoma Ohio North Dakota North Carolina New York New Mexico New Jersey New Hampshire Nevada Nebraska Montana Missouri Mississippi Minnesota Michigan Massachusetts Maryland Maine Louisiana Kentucky Kansas Iowa Indiana Illinois Idaho Hawai‘i Guam Georgia Florida District ofColumbia Delaware Connecticut Colorado California Arkansas Arizona American Samoa Alaska Alabama of theU.S. U.S. militarybaseoutside live in? territory doyoucurrently Q1.4. WhatU.S. stateor

Unweighted Unweighted frequency 3453 1099 1082 1779 1195 509 550 206 669 662 225 222 686 228 452 894 670 537 274 274 165 155 219 215 182 941 614 319 214 213 197 69 82 46 32 84 84 72 2 2 Unweighted Unweighted 12.5% 2.5% 2.2% 0.2% 2.0% 0.0% 0.0% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 6.4% 3.9% 2.4% 2.4% 2.4% 3.2% 0.6% 0.6% 4.0% 0.3% 0.3% 0.3% 0.3% 0.3% 3.4% 4.3% 0.7% 0.7% 0.7% 1.9% 1.2% 1.0% 1.0% 1.8% 1.6% 0.1% % Utah Texas South Carolina Rhode Island Total Wyoming Wisconsin West Virginia Virginia Vermont Tennessee South Dakota Puerto Rico Pennsylvania Oregon in? territory doyoucurrentlylive Q1.4. WhatU.S. stateor Total Yes No assigned toyouatbirth? is differentfromtheone full-time inagenderthat Q1.12. Doyoucurrentlylive Total Yes No no gender? more thanonegenderoras Q1.11. Doyouidentifyas Total Yes No yourself astransgender? Q1.10. Doyouthinkof Total West South Midwest Northeast Census regions) residence (recodebasedon Q1.4. U.S. regionofcurrent Washington (continued) Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted frequency frequency frequency frequency frequency 27652 24445 16580 27715 27715 27715 14362 13353 7599 5759 5703 3270 27715 11135 8591 1490 1667 1152 270 233 723 1171 416 541 163 119 83 44 43 27 Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted 100% 100% 100% 100% 100% 60% 52% 40% 6.0% 0.2% 0.2% 2.0% 0.8% 5.4% 2.6% 48% 4.2% 4.2% 0.6% 0.4% 88% 0.3% 27% 1.5% 1.0% 12% 21% 21% 0.1% 31% % % % % % APPENDIX A 245 % % % % %* 3% 4% 4% 2% 2% 11% 21% 15% 16% 10% 37% 27% 33% 33% 34% 44% 23% 36% 36% 64% 30% 29% 20% 100% 100% 100% 100% Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted 549 466 830 3116 1162 7413 8271 5721 9418 4129 9139 9981 5619 1095 9769 6346 4305 8986 17188 2629 8026 10138 12189 27715 27677 27649 26957 frequency frequency frequency frequency frequency Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted

trans even if I don’t tell trans even if I don’t them. Always Most of the time Sometimes Rarely Never Total He, his He, hers She, their They, hir Ze, No pronouns. I ask people only to use my name. ask people to useI don’t specific pronouns. Pronouns not listed above 100%. *Multiple choices were allowed, so percentages do not add to What gender do you Q2.6. currently live in on a day-to-day basis? Man Woman Neither man nor woman/ Genderqueer/Non-binary time one gender/part Part time another gender Total can tell I am People Q2.7. Q2.1 & Q2.3. Gender & Q2.3. Gender Q2.1 (collapsed categories recode) women men and Transgender people Non-binary Total Q2.4. How comfortable are you with the word to “transgender” being used describe you? comfortable Very Somewhat comfortable Neutral Somewhat uncomfortable uncomfortable Very Total Q2.5. What gender pronouns do you ask people to use to refer to you? % % % % % % 7% 7% 3% 9% 31% 91% 57% 67% 33% 33% 43% 35% 28% 58% 29% 69% 100% 100% 100% 100% 100% 100% Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted 251 519 770 758 770 1925 7844 6497 7950 3862 9238 2490 8652 11857 11129 15858 19063 27715 27715 27715 27715 25225 frequency frequency frequency frequency frequency frequency Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted Unweighted gender that is different fromgender that is different atthe one assigned to you birth (transitioning gender)?* Not sure Total to Q1.12. responded “No” of those who *Asked Have you seriously Q1.16. athought about living in Q1.14. Someday do you want Someday Q1.14. in a genderto live full time from the onethat is different you at birth?* assigned to No Yes Q2.1 & Q2.3. Gender Q2.1 categories used for analysis (recode) Crossdressers women Transgender Q2.1. What sex were you Q2.1. assigned at birth, on your original birth certificate? Female Male Total gender? No Yes Total Yes Total Do you live part of Q1.18. the time in one gender and part of the time in another *Asked of those who responded “No” to Q1.12 and Q1.14. to Q1.12 of those who responded “No” *Asked Do you consider Q1.17. yourself to be a crossdresser? No No Yes Total Transgender men Transgender assignedNon-binary people, female at birth assignedNon-binary people, male at birth Total 246 2015 U.S. TRANSGENDER SURVEY 45 to64 25 to44 18 to24 Q2.13. Ageranges(recode) Total Religious/spiritual Not religious/spiritual identity (recode) Q2.12. Religious/spiritual Total listed above A racial/ethnicidentitynot Total 65 andover Demisexual* Queer alone White/European American Islander alone Native Hawaiian/Pacific alone Middle Eastern/NorthAfrican Latino/a/Hispanic alone Black/African Americanalone Biracial/Multiracial Asian/Asian Americanalone American Indianalone Alaska Nativealone (recode) Q2.9-Q2.11. Race/ethnicity *Added totheresponselistfromwrite-inresponses. Total above A sexualorientationnotlisted Pansexual Same-gender loving Lesbian Heterosexual/Straight Gay Bisexual Asexual orientation? your currentsexual Q2.8. Whatbestdescribes Unweighted Unweighted Unweighted Unweighted frequency frequency frequency frequency 27655 22658 10460 27715 27715 27715 10987 11840 5056 17195 4085 2984 5706 3363 3037 4129 1573 1473 1316 1513 302 803 264 796 287 132 721 62 41 17 Unweighted Unweighted Unweighted Unweighted 81.8% 100% 100% 100% 100% 5.5% 2.9% 0.5% 0.2% 0.2% 2.6% 5.3% 62% 40% 38% 43% 0.1% 15% 15% 21% 12% 18% 1.1% 11% 11% 6% 5% 3% 1% 1% % % % % Widowed partnership Registered domestic Legally recognizedcivilunion Married legal maritalstatus? Q2.16. Whatisyourcurrent *Added totheresponselistfromwrite-inresponses. Total Single, widowed* Single, divorced* Poly* Open relationship* Aromantic/not active/platonic* Not listedabove Single Partnered, notlivingtogether Partnered, livingtogether relationship status? Q2.15. Whatisyourcurrent Total Undocumented resident of removalstatus Currently undera withholding mentioned above Other documentedstatusnot Refugee status Parental Accountability) DAPA (DeferredActionfor Childhood Arrival) DACA (DeferredActionfor H1-B, andU) A visaholder(suchasF-1,J-1, Permanent Resident U.S. citizen,naturalized U.S. citizen,birth status intheU.S.? citizenship orimmigration Q2.18. Whatisyour Total not now On activedutyinthepast,but Now onactiveduty Guard in theReserves orNational Only activedutyfortraining Never servedinthemilitary National Guard? Armed Forces,Reserves, or on activedutyintheU.S. Q2.17. Haveyoueverserved Total Single, nevermarried Separated Divorced frequency Unweighted Unweighted Unweighted Unweighted frequency frequency frequency 27666 27649 27709 25263 26684 27715 19463 13219 4630 2538 8762 1976 4671 555 298 456 535 249 404 238 216 129 115 40 28 46 53 67 67 16 11 6 3 1 Unweighted Unweighted Unweighted Unweighted 96.3% 70.4% 16.9% 91.3% 100% 100% 100% 100% 31.6% 47.7% 16.7% 0.9% 0.9% 0.5% 0.2% 2.0% 0.2% 0.2% 0.2% 0.0% 0.0% 0.0% 0.0% 0.8% 9.2% 0.4% 1.9% 1.5% 0.1% 0.1% 0.1% 1.7% 7.1% 1.1% % % % % APPENDIX A 247 % % 3.1% 0.1% 0.1% 1.8% 1.9% 2.4% 5.3% 9.2% 19.1% 8.0% 0.0% 0.0% 0.0% 0.0% 0.2% 0.2% 10.1% 6.0% 5.2% 2.9% 17.0% 100% 18.6% 41.5% 37.8% 6.65% Unweighted Unweighted Unweighted 2 9 6 31 10 37 48 54 514 661 804 858 504 1821 1475 1443 5149 5291 1652 4697 2229 2562 2806 11507 10486 27715 frequency frequency Unweighted Unweighted Unweighted Living in a nursing home or other adult care facility Living in a hospital Living in military barracks Living in a hotel or motel that I pay for myself Living in a hotel or motel with an emergency shelter voucher Professional degree (e.g., Professional degree (e.g., JD) MD, Total Q2.23. What are your arrangements? living current Living in house/apartment/ alone or with condo I OWN others (with a mortgage or that you own free and clear) Living in house/apartment/ condo I RENT alone or with others spouse, Living with a partner, or other person who pays for the 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 home Living in a foster group home or other foster care Living in campus/university housing Q2.22. What is the highest What is the Q2.22. degree school or level of you have completed? than 8th grade Less 8th grade diplomano school, high Some or GED GED High school graduate no degreeSome college, (including currently in college) Associate degree in college— Occupational/vocational program Associate degree in college— Academic program degree Bachelor’s Some graduate work, no graduate degree degree (M.A, M.S., Master’s MBA) Ph.D., Doctoral degree (e.g., Ed.D.) % % %* 3% 4% 2% 6% 31% 100 1.0% 23% 28% 40% 60% 8.9% 100% 90.1% Unweighted Unweighted Unweighted Unweighted 679 924 285 8471 1729 1072 2461 7764 6200 10913 16305 27218 27704 24958 frequency frequency frequency Unweighted Unweighted Unweighted Unweighted a doctor’s office or shopping? a doctor’s walking or climbing stairs? Do you have difficulty dressing or bathing? Because of a physical, mental, or emotional condition, do you have difficulty doing as visiting such errands alone, wearing glasses? Because of a physical mental door emotional condition, you have serious difficulty concentrating, remembering, or making decisions? Do you have serious difficulty Community Survey, with Survey, Community last of the the exception question) or have seriousAre you deaf hearing? difficulty or have seriousAre you blind whendifficulty seeing even Q2.20. Disability (questions (questions Disability Q2.20. on American based Language(s) other than Language(s) English English and other language(s) Total Total Q2.21. What is the main language that people speak in your home? English only (recode) (based on American Community not Survey questions only, including self-identification) No Yes Do YOU identify as a person Do YOU with a disability? 100%. *Multiple choices were allowed, so percentages do not add to Any disability Q2.20. 248 2015 U.S. TRANSGENDER SURVEY Total Don’t know/nottested HIV negative HIV positive (recode) Q14.1 &Q14.2HIVstatus Total Yes No phone? Q2.24. Doyouhaveacell Total Yes No phone? working andisnotacell your homethatiscurrently one telephoneINSIDE Q2.24. Isthereatleast *Added totheresponselistfromwrite-inresponses. Total Commune/co-op/collective* Nomadic* reasons* At home/withfamilyforother facility* A grouphomeortreatment someone else* A placeowned/rentedby etc.)* Mobile housing(RV, camper, listed above A livingarrangementnot violence shelter homeless shelterordomestic Living inashelterthatisnot shelter Living inadomesticviolence Living inahomelessshelter other housing house, apartment,shelter, or park, oraplacethatisNOT a an abandonedbuilding,ina Living onthestreet,inacar, in halfway house Living intransitionalhousing/ (continued) current living arrangements? Q2.23. Whatareyour

frequency Unweighted Unweighted Unweighted Unweighted frequency frequency frequency 27568 27626 27654 26744 27710 13606 18255 13869 9313 882 126 186 179 176 40 28 36 48 16 91 13 6 3 % Unweighted Unweighted Unweighted Unweighted 50.2% 49.2% 100% 100% 100% 100% 0.5% 0.2% 0.0% 0.0% 0.6% 0.3% 0.7% 0.7% 66% 34% 97% 0.1% 0.1% 0.1% 0.1% 0.1% 3% % % % Student disability Not employeddueto stopped lookingforwork Unemployed andhave work Unemployed butlookingfor currently consideredillegal) drugs, orotherworkthatis including sexwork,selling trade, oroperateafarm(not business, professionor Self-employed inyourown employer Work part-timeforan Work full-timeforanemployer is currentlyconsideredillegal selling drugs,orotherworkthat Work forpayfromsexwork, Q7.7 Employmentstatus Total Yes No food stamps(SNAP)orWIC? receive assistancefrom Q7.10. Doyoucurrently Total Yes No union contract(recode) a unionmemberorunder Q7.8 &Q7.9. Respondent is Total Yes No member ofaunion(recode) Q7.8. Respondent is *Multiple choiceswereallowed,sopercentagesdonotaddto100%. Internship* Volunteer* part-time work* Seasonal work/oddjobs/other Not listedabove parent Homemaker orfull-time Retired Unweighted Unweighted Unweighted Unweighted frequency frequency frequency frequency 25060 27666 27688 27705 25623 25997 9560 2606 2082 2255 8639 3868 6735 1240 3991 1247 1691 1107 549 516 136 66 76 Unweighted Unweighted Unweighted Unweighted 34.5% 24.3% 31.2% 14.0% 100% 100% 100% 14.4% 0.5% 0.2% 2.0% 4.5% 4.5% 4.0% 0.3% 92% 1.9% 94% 8.1% 91% 9% 6% 8% %* % % % APPENDIX A 249 % % % 31% 7.1% 7.1% 69% 7.4% 50% 50% 5.7% 3.4% 4.4% 3.6% 9.3% 9.6% 8.3% 4.8% 4.8% 3.2% 3.9% 5.4% 2.9% 2.9% 6.2% 100% 100% 100% Unweighted Unweighted Unweighted Unweighted 811 897 725 725 869 996 1571 1109 1797 1367 1433 1872 2418 1224 1806 1220 8468 2360 2096 19215 13846 13805 27651 27683 25296 frequency frequency frequency Unweighted Unweighted Unweighted Unweighted $75,000 to $99,999 $75,000 to $149,999 $100,000 or more $150,000 Total to Registered & Q29.2 Q29.1 vote on November 4, 2014 (recode) No Yes Total Did you vote in the Q29.1. election held on Tuesday, November 4, 2014? No Yes Total Q7.12 - Q7.14 Household Household - Q7.14 Q7.12 (recode) income in 2014 No income $1 to $5,000 to $7,499 $5,000 to $9,999 $7,500 to $12,499 $10,000 $12,500 to $14,999 to $17,499 $15,000 to $19,999 $17,500 to $24,999 $20,000 to $29,999 $25,000 to $34,999 $30,000 to $39,999 $35,000 to $49,999 $40,000 to $59,999 $50,000 to $74,999 $60,000 % % 3.1% 4.1% 6.1% 3.7% 17.1% 3.3% 4.3% 4.4% 4.0% 0.6% 2.3% 5.3% 3.5% 3.9% 3.9% 4.5% 2.6% 6.4% 0.8% 5.8% 5.0% 0.9% 2.9% 14.4% 100% 100% 40.4% 46.8% Unweighted Unweighted Unweighted 143 1118 772 227 843 207 636 664 888 903 998 1071 1184 1163 1165 1743 1444 3913 1355 1070 1049 1568 1665 4647 12183 10519 26011 27127 frequency frequency Unweighted Unweighted Unweighted $100,000 to $149,999 $100,000 or more $150,000 Total $35,000 to $39,999 $35,000 to $49,999 $40,000 to $59,999 $50,000 to $74,999 $60,000 to $99,999 $75,000 $15,000 to $17,499 $15,000 to $19,999 $17,500 to $24,999 $20,000 to $29,999 $25,000 to $34,999 $30,000 $1 to $5,000 to $7,499 $5,000 to $9,999 $7,500 to $12,499 $10,000 $12,500 to $14,999 Q7.12. Individual income in Individual Q7.12. 2014 (includes all income food stamps sources except (SNAP) or WIC) No income cash assistance only Other income source only Multiple income sources No income Total only only from employment Pay or from pension Pay retirement only only SSI or disability income orUnemployment benefits Q7.11. Current sources of Q7.11. income (recode) sex work, selling from Pay work that isdrugs, or other currently considered illegal 250 2015 U.S. TRANSGENDER SURVEY Survey Instrument(Questionnaire) Appendix B APPENDIX B 251 from 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 NCTE will not provide to the have participated in the survey. research team any information that could be used to identify you will remain anonymous Therefore, you, such as your name. to the research team. a list of resources, including hotlines, provided at the end of the a list of resources, including hotlines, provided survey. IF I PARTICIPATE? ARE THERE ANY BENEFITS benefit of The results of the research will be used for the and the research the trans community in the United States will not directly benefit from your participation You community. in the research. FOR MY PARTICIPATION? WILL I BE PAID will have will receive no payment for your participation. You You one of three the option to voluntarily enter a drawing to win of $250. cash prizes: one prize of $500 and two prizes AND MY ABOUT ME WILL INFORMATION HOW BE KEPT CONFIDENTIAL? PARTICIPATION so no information survey response will be anonymous, Your that can be used to identify you will be collected unless you voluntarily provide it. Any information that is obtained in connection 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 maintain your confidentiality by taking precautions to minimize any risk to your privacy from participating in this survey. the end of the survey to be will be given the option at You directed to a separate page on a secure website if you wish to provide your contact information to receive survey results WHAT WILL HAPPEN IF I TAKE PART IN THIS RESEARCH IN THIS PART HAPPEN IF I TAKE WILL WHAT STUDY? ask the researchers study, to participate in this If you volunteer of the The purpose in an online survey. that you participate you and your experiences gather information about survey is to will be one of over You United States. as a trans person in the part in this survey, take possible participants who may 700,000 estimate of the total number of trans- which is the current best States. United identified adults in the RESEARCH STUDY? WILL I BE IN THE LONG HOW between 30 and 60 minutes. study will take in the Participation I CAN THAT OR DISCOMFORTS ARE THERE ANY RISKS EXPECT FROM THIS STUDY? in this study poses no risks that are not ordinarily Participating Any information you provide in the encountered in daily life. of you asked survey will be confidential. Some of the questions You uncomfortable. you feel as part of this survey may make by skipping the may refuse to answer questions posed to you participation in this study at any may stop your question. You Should you need them, there will be time by exiting the survey.

WHY IS THIS STUDY BEING DONE? WHY IS THIS STUDY This study is being conducted to better understand the demographics, health, and experiences of trans people in the will be used for the The findings of this study United States. benefit of the trans community and the research community. This study has been commissioned by the National Center for Equality (NCTE). A research team made up of Jody Transgender are conducting this Ph.D. and Susan Rankin, L. Herman, Ph.D. participation in this study is voluntary. Your study. UNIVERSITY OF CALIFORNIA UNIVERSITY OF CALIFORNIA ANGELES LOS information sheet Study Survey Trans 2015 U.S. appreciate yours. Sincerely, Equality Survey Team Transgender The National Center for QUESTIONNAIRE: Equality welcomes you Transgender The National Center for the follow up to the National Survey, Trans to the 2015 U.S. Every Turn. Injustice At Discrimination Survey: Transgender Every voice for participating in this survey. thank you We and better understanding the lives counts in documenting and we people in the United States, and experiences of trans The survey was offered online only. The questionnaire has The questionnaire was offered online only. The survey saw what respondents here to best reflect been reproduced notes are indicated Programming the survey. when completing in italics. 252 2015 U.S. TRANSGENDER SURVEY disqualification page#2. Respondents whoselected“donotagree” weresenta I donotagreetoparticipateinthisstudy. ☐ I agreeandgivemyconsenttoparticipateinthisstudy. ☐ above, pleaseclickonthe“ If youdonotagreetotake partinthisstudy, asdescribed participate inthisstudy. on the“ above, pleaseclickonthe“ If youagreetotake partinthisstudy, asdescribedindetail 951694, Los Angeles, CA 90095-1694. or U.S. mail:UCLAOHRPP, 11000KinrossAve., Suite102,Box you maycontacttheUCLAOHRPPbyphone:(310)825-7122 talk tosomeoneotherthantheresearchersaboutstudy, study, oryouhaveconcernssuggestionsandwantto If youhavequestionsaboutyourrightswhiletakingpartinthis (OHRPP): UCLA OfficeoftheHuman ResearchProtectionProgram the researchoryourparticipationinthisstudy. Rankin at(814)625-2780withanyquestionsorconcernsabout You maycontactJodyL.Hermanat(310)267-4382orSusan The Research Team: STUDY? WHO CAN ICONTACT IFIHAVE QUESTIONS ABOUTTHIS Ifyoudecideatanypointtostopparticipatinginthisstudy, • Ifyoudecidetotake partinthestudy, youhavetherightto • You havearighttoallofyourquestionsanswered • there willbenopenaltytoyou. or notyouwanttoparticipate. Whateverdecisionyoumake, Taking partinthisstudyisyourchoice. You canchoosewhether WHAT AREMYRIGHTS IFITAKE PART INTHISSTUDY? study. the survey, yourresponseswillnotberecordedorusedinthe remove yourselffromthestudybyexitingsurvey. Ifyouexit The researcherswillnotremoveyoufromthestudy. You may CAN THERESEARCHERSREMOVE MEFROMTHISSTUDY? will beremoved. and anycontentofquotesthatcouldbeusedtoidentifyyou instead ofyournameifquotingyoudirectlyinanypublication written response, adifferentnamewillbecreated andused choose toself-identifyanywhereonthesurveyandprovidea form willnotnameyouoridentifyasaparticipant.If Results ofthisresearchstudythatarereportedinpublished I DONOT AGREE I AGREE the survey. you havetherighttoexitstudyatanytimebyexiting exit thestudyatanytimebyexitingsurvey. before decidingwhethertotake partinthestudy. I AGREE

” button,youwillindicateyourconsentto

1 I DONOT AGREE I AGREE ” buttonbelow. Byclicking ” buttonbelow. could beusedtoidentifyyou,suchasyournameorcontact In thesurvey, pleasedonotprovideanyinformationthat before thosethreepageswouldstaythesame. answers onthosethreepageswillbeerased.Responses For instance, ifyouclickbackthreepages inthesurvey, your entered foreachpageyouclicked backonwillbeerased. to returnapreviousquestion,theresponsesyouhave WARNING: Ifyouusethebackbuttononyourbrowser on yourbrowser. In ordertocleararesponsechoice, pleaseusethebackbutton information willbeoffered. click onthosewordsorphrasesandadefinitionadditional see awordorphrasethatisunderlinedandbolded.You can There willbeseveralplacesinthesurveywhereyou take between30-60minutestocomplete. You maydeclinetoanswerspecificquestions.Thesurveywill your previousresponsewillbeerased. oval ofyournewanswerand/oredittheappropriateblank,and appropriate blank.Ifyouwanttochangeananswer, clickonthe answer, clickontheappropriateovaland/orfillin Please readandanswereachquestioncarefully. Foreach Survey Instructions 1.3 survey before? this surveymorethanonce. Haveyoualreadycompletedthis be enteredintotheprizedrawingonce, evenifyoucomplete time sothatwecangatheraccurateinformation.You willonly 1.2 your lastnameis“Smith”, enter“S”. Enter thefirstletterofyourpreferredlastname. Forexample, if example, ifyourfirstnameis“Robert”, enter“RT”. Enter thefirstandlastletterofyourpreferredname. For the IDfortheiranalysis.Itwillnotbeusedtoidentifyyou. 1.1 Section 1 survey foryourresponsestobeincludedinthefinalanalyses. You musthitthe“submit” buttononthelastpageof used againstyou. information. Allofyouranswersareconfidentialandcannotbe Please make anIDinquestion1.1. Theresearchteamwilluse Are you18yearsofageorolder? It isimportantthatpeopleonlycompletethissurveyone Yes No Yes No [Text box] [Text box] [Senttodisqualificationpage#2] [Senttodisqualificationpage#1] [Must answertocontinue.] [Mustanswertocontinue.]

2 3

APPENDIX B 253 [Respondents [Respondents [Must answer to

[Must answer to [Must answer to [Only respondents who selected “Yes” or [Only respondents who selected “Yes” [Skip to 1.14] [Skip to 1.16] 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. No Yes and “100 [Drop-down list of all ages from “1” through “99,” as final response choice] and above” No Yes Not sure 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. No Yes No Yes Do you think of yourself as transgender? Do you think of yourself What are the main reasons that you don’t live full-time in a What are the main reasons that you don’t Do you currently live full-time in a gender that is different Do you currently live full-time in a gender that Someday do you want to live full-time in a gender that is Someday do you want to live full-time in a gender How old were you when you started to live full-time in a How old were you when you started to live full-time Do you identify as more than one gender or as no gender Do you identify as more 1.13 1.13 to you at birth? gender that is different from the one assigned in response to 1.12 [Only respondents who selected “Yes” received this question.] 1.14 different from the one assigned to you at birth? to continue.] must answer in response to 1.12 who selected “No” 1.15 gender that is different from the one assigned to you at birth? (Mark all that apply.) this question.] received in response to 1.14 “Not sure” PLEASE READ AND RESPOND CAREFULLY TO THE TO CAREFULLY READ AND RESPOND PLEASE QUESTIONS. FOLLOWING trans, or non- transgender, for people who are This is a survey gender or if matter if you have transitioned It doesn’t binary. the is for you, please answer see if this survey To you plan to. following questions. 1.10 continue.] 1.11 or non-binary)? (such as genderqueer continue.] 1.12 from the one assigned to you at birth? continue.] [Must

) [Sent to (Mark all that apply.) 4 Mark all that apply. How would you answer?

[Respondents could not select “No” in combination could not select “No” [Respondents I would answer No I would answer Yes I would not answer the question No with any other option.] the internet Yes, email Yes, On a friend’s or family member’s mobile phone, tablet, or mobile phone, or family member’s On a friend’s computer Not listed above (please specify) ______On my home computer/laptop On my work computer lab or library) On a public computer (such as in a computer On my mobile phone or tablet No Yes I was told about it in person (at an organization, event, or I was told about it in person support group) Flier or print advertisement (e-mail from a friend, a friend told you of mouth Word about it) Not listed above (please specify) ______Email from an organization (listserv, e-newsletter) (listserv, Email from an organization (such as Facebook) Social networking site as NCTE) Organization website (such [Drop-down list of all U.S. states and territories.] list of all U.S. [Drop-down or territory. state in a U.S. I do not live page #1] disqualification If a national survey company, like Gallup, asked you the asked Gallup, like If a national survey company, How did you hear about this survey? How did you hear about Not including for this survey, do you use the internet or Not including for this survey, What U.S. state or territory do you currently live in? do you currently live state or territory What U.S. Are you taking this survey at a survey event or meeting, Are you taking this survey at a survey event or How are you taking this survey? following question: “We are asking only for statistical purposes: are asking only for statistical purposes: following question: “We bisexual, or identify as lesbian, gay, Do you, personally, transgender?” 1.9 1.8 ( email, at least occasionally? 1.7 1.7 1.6 organization or or Trans such as one hosted by an LGBTQ meeting? 1.5 1.4 answer to continue.] 254 2015 U.S. TRANSGENDER SURVEY apply.) 2.2 certificate? 2.1 Section 2 and 1.18 weresenttodisqualificationpage#1.] [Respondents whoanswered“No” to1.10, 1.11, 1.12, 1.14, 1.16, 1.17, time inanothergender? 1.18 answer tocontinue.] 1.17 must answertocontinue.] gender)? is differentfromtheoneassignedtoyouatbirth(transitioning 1.16 What sexwereyouassignedatbirth,onyouroriginalbirth Whichofthesetermsdoyouidentifywith? Do youconsideryourselftobeacross-dresser? Do youlivepartofthetimeinonegenderand Have youseriouslythoughtaboutlivinginagenderthat Non-binary Multi-gender Mahu Intersex Gender fluid/fluid Genderqueer Gender non-conformingorgendervariant Fa’afafine Drag performer(king/queen) Cross dresser Bulldagger Butch Bi-gender Androgynous Agender A.G. oraggressive Male Female Yes No Yes No Yes No (please specify)______A reasonnotlistedabove I amnotreadytotransition. I mightfaceviolence. [Respondents whoselected“No” inresponseto1.13 [Must answertocontinue.] [Must answertocontinue.]

5 (Mark allthat [Must only oneanswer.) best describesyourcurrentgenderidentity? 2.3 question.] “Non-binary/Genderqueer” inresponseto2.3receivedthis woman), howdoyourespond? other thannon-binary/genderqueer(suchasamanor 2.3_2 response to2.3receivedthisquestion.] [Only respondentswhoselected“Non-binary/Genderqueer”in binary/genderqueer, whatgenderdotheyusuallythinkyou are? 2.3_1 If youhadtochooseonlyoneofthefollowingterms,which Trans woman(MTF) Man Woman Cross-dresser (please specify)______A gendernotlistedabove Two-spirit Travesti Trans woman(MTF, maletofemale) Transsexual Trans man(FTM,femaletomale) Trans Transgender Stud Third gender whatever wordsIuse) I (or whateverwordsIuse) I I It varies They can’t tell Non-Binary/Genderqueer Trans Woman Trans Man Woman Man answer receivedquestions2.3_1,2.3_2,and2.3_3.] Non-binary/Genderqueer Trans man(FTM) Forpeopleinyourlifewhodon’t knowthatyou’renon- Whenpeopleinyourlifeassumeyouaresomething always sometimes usually tellthemIidentifyasnon-binary/genderqueer(or letthemassumeIamamanorwoman tellthemIidentifyasnon-binary/genderqueer [Skip to2.4.] [Respondents whoselectedthis [Only respondentswhoselected

(Please choose APPENDIX B 255

[required] principal corporation: or [required] [respondents received follow-up [respondents received follow-up question (Please choose only one answer.) Enter your enrolled ______Enter your enrolled or principal tribe: ______White/European American A racial/ethnic identity not listed above (please specify) ______2.11] Lesbian Same-gender loving Pansexual Queer A sexual orientation not listed above (please specify)______Alaska Native American Indian Asian/Asian American Biracial/Multiracial question 2.10] American Black/African Latino/a/Hispanic Middle Eastern/North African Islander Native Hawaiian/Pacific Man Woman nor woman/Genderqueer/Non-binary Neither man time another gender time one gender/part Part Always Most of the time Sometimes Rarely Never Asexual Bisexual Gay Heterosexual/Straight Although the choices listed below may not represent your Although the choices listed below may not represent What best describes your current sexual orientation? What best describes your current sexual orientation? What gender do you currently live in on a day-to-day basis? do you currently live What gender People can tell I am trans even if I don’t tell them. can tell I am trans even if I don’t People 2.9 for this survey full identity or use the language you prefer, describes your please select the choice that most accurately racial/ethnic identity. 2.6 2.6 2.7 2.8

We (Mark all that apply). (Mark all that

What are the main reasons that you don’t tell people tell people don’t main reasons that you What are the [Respondents could mark all answers that applied.] [Respondents Pronouns not listed above (please specify) ______She, hers She, their They, hir Ze, No pronouns. I ask people only to use my name. ask people to use specific pronouns. I don’t He, his He, Somewhat uncomfortable uncomfortable Very Very comfortable Very Somewhat comfortable Neutral I might become homeless. My church or faith community might reject me. I might face violence. A reason not listed above (please specify) ______genderqueer. be able to get a job. I might lose my job or not at school. I might face mistreatment My friends might reject me. I might not get the medical care I need. I might be hurt financially. Most people don’t understand so I don’t try to explain it. so I don’t understand Most people don’t as not being a real identity or a Most people dismiss it “phase.” anything. It is just easier not to say I identify as non-binary/ I am not ready to tell people What gender pronouns do you ask people to use to refer to How comfortable are you with the word “transgender” How comfortable are you with the word “transgender” refer to all trans and non-binary identities. Because of this in this survey to refer to all trans we will use the word “trans” and non-binary identities. 2.5 you? [All respondents received the following message.] [All respondents received the following message.] the word know that not everyone is comfortable with we must use one word to for this survey, but “transgender,” 2.4 being used to describe you? question.] 2.3_3 as non-binary/genderqueer? you identify in who selected “Non-binary/Genderqueer” [Only respondents “I usually let them assume 2.3 and either selected response to as tell them I identify or a woman” or “I sometimes I am a man this to 2.3_2 received genderqueer” in response non/binary 256 2015 U.S. TRANSGENDER SURVEY that apply.) 2.12 listed above” in2.9receivedthisquestion.] [Only respondentswhoselected“A racial/ethnicidentitynot describe you. listed above. Pleasechoosetheracial/ethnicidentitiesthatbest 2.11 received thisquestion.] [Only respondentswhoselected“Biracial/Multiracial”in2.9 apply.) the racial/ethnicidentitiesthatbestdescribeyou. 2.10 You saidthatyouhadaracial/ethnicidentitywasnot What isyourcurrentreligiousorspiritualidentity? You saidthatyouarebiracialormultiracial.Pleasechoose received thefollowingdrop-down list.] Christian (Pleaseclickheretospecify) Buddhist Baha’i Atheist Agnostic White/European American Native Hawaiian/Pacific Islander Middle Eastern/NorthAfrican Latino/a/Hispanic Black/African American Asian/Asian American American Indian Alaska Native (please specify)______A racial/ethnicidentitynotlistedabove White/European American Native Hawaiian/Pacific Islander Middle Eastern/NorthAfrican Latino/a/Hispanic Black/African American Asian/Asian American American Indian Alaska Native Assembly ofGod African MethodistEpiscopalZion African MethodistEpiscopal ______Enter yourenrolledorprincipaltribe: ______Enter yourenrolledorprincipalcorporation: ______Enter yourenrolledorprincipaltribe: ______Enter yourenrolledorprincipalcorporation: (Mark allthatapply.) [required] [required] [required] [required] [Respondents

(Mark allthat (Mark all Pagan Native AmericanTraditional PractitionerorCeremonial received thefollowingdrop-downlist.] Muslim (Pleaseclickheretospecify) received thefollowingdrop-downlist.] Jewish (Pleaseclickheretospecify) Jehovah’s Witness Jain Hindu Druid Confucianist Protestant Reformed Church(PR) Protestant Presbyterian Pentecostal Nondenominational Christian Moravian Mennonite Lutheran Greek Orthodox Evangelical Episcopalian Christian Reformed Church(CRC) Christian MethodistEpiscopal Christian Orthodox Church ofGodinChrist Church ofChrist Catholic/Roman Catholic Baptist Sunni Sufi Shi’ite Ahmadi Reform Orthodox Conservative (please specify)______A Christianaffiliationnotlistedabove United ChurchofChrist Unitarian Universalist United Methodist The ChurchofJesusChristLatter-day Saints Seventh DayAdventist Russian Orthodox Reformed ChurchofAmerica(RCA) Quaker [Respondents [Respondents

APPENDIX B 257 O O O O O O O Yes [Only O O O O O O O No Please provide an - [Respondents directed to 2.19] directed to [Respondents ) Armenian Chinese French German Greek identify as a person with a disability?

Please answer each question below. ( Please answer each question below. Language(s) other than English Language(s) response choices. Respondents who selected “New York” who selected “New York” response choices. Respondents “New York received an additional drop-down choice for City.”] English only U.S. citizen, birth U.S. citizen, naturalized U.S. Resident Permanent F-1, J-1, H1-B, and U) A visa holder (such as (Deferred Action for Childhood Arrival) DACA Accountability) (Deferred Action for Parental DAPA status Refugee not mentioned above Other documented status of removal status Currently under a withholding Undocumented resident state or territory. I was not born in a U.S. states and territories for other [Drop-down list for all U.S. What is the main language that people speak in your In what U.S. state or territory were you born? state or territory were you born? In what U.S. What is your citizenship or immigration status in the U.S.? status in the U.S.? citizenship or immigration What is your YOU Are you deaf or have serious difficulty hearing? Are you blind or have serious difficulty seeing even when wearing glasses? Because of a physical mental or emotional condition, do you have serious difficulty concen trating, remembering, or making decisions? Do you have serious difficulty walking or climbing stairs? Do you have difficulty dressing or bathing? Because of a physical, mental, or emotional condition, do you have difficulty doing errands office or such as visiting a doctor’s alone, shopping? Do 2.20 answer in each row. 2.21 home? 2.18 2.18 cannot be are confidential and your answers As a reminder, you. used against 2.19 received citizen, birth” in 2.18 respondents who selected “U.S. this question.]

As a reminder, your As a reminder,

6 active duty [Drop-down list of all months] [Drop-down list with years 1997–1915, and earlier as [Drop-down list with years 1997–1915, and earlier On active duty in the past, but not now Never served in the military National or Only on active duty for training in the Reserves Guard Now on Widowed Divorced Separated never married Single, Married recognized civil union Legally domestic partnership Registered Partnered, living together Partnered, not living together Partnered, Single Not listed above (please specify) ______Month Year final response choice] A religious affiliation or spiritual identity not listed above A religious affiliation (please specify) ______and “99,” [Drop-down list of all ages from “18” through as final response choice] “100 and above” Sikh Taoist Tenrikyo Wiccan affiliation Spiritual, but no religious No affiliation Rastafarian Scientologist Secular Humanist Shinto What is your current legal marital status? What is your current relationship status? What month and year were you born? What is your current age? What is your current age? Have you ever served on active duty in the U.S. Armed Armed Have you ever served on active duty in the U.S. Forces, Reserves, or National Guard? Forces, Reserves, answers are confidential and cannot be used against you. 2.17 2.17 2.16 2.16 2.15 2.15 2.14 2.14 2.13 2.13 258 2015 U.S. TRANSGENDER SURVEY completed? 2.22 Bachelor’s degree Associate degreeincollege–Academic program program Associate degreeincollege–Occupational/vocational Some college, nodegree(includingcurrentlyincollege) High schoolgraduate GED Some highschool,nodiplomaorGED 8 Less than8 English andotherlanguage(s) What isthehighestlevelofschoolordegreeyouhave th grade (______) A languagenotlistedabove Yiddish Vietnamese Tagalog Spanish orCreole Serbo-Croatian Russian Portuguese orPortuguese Creole Polish Persian Korean Japanese Italian Greek German French Chinese Armenian (______) A languagenotlistedabove Yiddish Vietnamese Tagalog Spanish orCreole Serbo-Croatian Russian Portuguese orPortuguese Creole Polish Persian Korean Japanese Italian th grade

2.23 live? ______2.26 2.25 currently workingandisnotacellphone? 2.24 Living inanursinghomeorotheradultcarefacility Living incampus/universityhousing Living inafostergrouphomeorothercare not yetlefthome Living withparentsorfamilyIgrewupbecausehave afford myownhousing Living temporarilywithfriendsorfamilybecauseIcan’t the housing Living withapartner, spouse, orotherpersonwhopaysfor others Living inhouse/apartment/condoIRENTaloneorwith others (withamortgageorthatyouownfreeandclear) Living inhouse/apartment/condoIOWN aloneorwith Professional degree(e.g., MD, JD) Doctoral degree(e.g., Ph.D., Ed.D.) Master’s degree(M.A,M.S.,MBA) Some graduatework,nodegree Yes No Yes No (please specify)______A livingarrangementnotlistedabove domestic violenceshelter Living inashelterthatisnothomelessor Living inadomesticviolenceshelter Living inahomelessshelter other housing park, oraplacethatisNOT ahouse, apartment,shelter, or Living onthestreet,inacar, inanabandonedbuilding, a Living intransitionalhousing/halfwayhouse voucher Living inahotelormotelwithanemergencyshelter Living inahotelormotelthatIpayformyself Living inmilitarybarracks Living inahospital What areyourcurrentlivingarrangements? Is thereatleastonetelephoneINSIDEyourhomethatis What isthezipcodewhereyoucurrently Do youhaveacellphone? [Skip to2.25] [Skip to2.25] [Skip to2.25] [Skip to2.25]

APPENDIX B 259 O O O O O O O O that I am trans None know O O O O O O O O that I am trans know Some ) O O O O O O O O that I am Most trans know (Mark all that apply.) (Mark all that apply.) O O O O O O O O All that I am trans know O O O O O O O O life have no this in my I currently people like people like - -

Please provide an answer in each row. Please provide an answer [Skip to 4.5] Stopped speaking to you for a long time or ended your speaking to you for a long time Stopped relationship violent towards you Were you out of the house Kicked Very supportive Very Supportive Neither supportive nor unsupportive Unsupportive unsupportive Very No Yes No Yes How many people in each group below currently know you How many people in each Have any of your children ever stopped speaking to you or speaking to you your children ever stopped Have any of You said some or all of your immediate family you grew up You Did any of your immediate family members you grew up ual, or trans (LGBT) ual, or trans (LGBT) friends non-trans Straight, friends (non-LGBT) Current boss/ manager/supervisor Current coworkers Current classmates Current health care providers Immediate family you grew up with sis father, (mother, ters, brothers, etc.) Extended family (aunts, uncles, cousins, etc.) bisex gay, Lesbian, [Only respondents who said in response to 4.5 that some, most, some, that 4.5 to response in said who respondents [Only or all of their immediate family members knew they were trans received this question.] 4.6 4.6 sisters, brothers, etc.) know that you are father, with (mother, how supportive are they of you being trans? trans. On average, most, some, that 4.5 to response in said who respondents [Only they were trans or all of their immediate family members knew received this question.] 4.7 sisters, brothers, etc.) do any of these father, with (mother, things to you because you are trans? 4.4 because you are trans? spending time with you 4.5 ( are trans? (Mark all [Respondents [Respondents [Respondents could not [Respondents (Mark all that apply). [Skip to 4.5] [Only respondents who indicated that [Respondents could not select this answer in [Respondents [Drop-down list of ages for other responses] [Drop-down list of ages [Drop-down list of ages] [Drop-down list of ages] [Drop-down Yes, because I was trans and other reasons. because I was trans and other Yes, I do not have any children No only because I was trans. Yes, No combination with any other option. Skip to 4.3 if selected.] knows I am trans my current spouse/partner Yes, spouses or partners knew I at least one of my former Yes, was trans I have never had a spouse/partner option. select this answer in combination with any other Skip to 4.3 if selected.] option.] Not listed above (please specify) ______In political activism Socializing in person Socializing on-line (such as Facebook or Twitter) In support groups socialize with other trans people I don’t any other could not select this answer in combination with I have not told others that I am trans. I have not told others that Have any of your spouses/partners ended your relationship At about what age did you start to think you were trans about what At Do any of your children know you are trans? Do any of your children know you are trans? How do you socialize with other trans people? How do you socialize with other trans people? At about what age did you first start to tell others that you age did you first start to tell others that you about what At Have any of your spouses/partners known that you are trans Have any of your spouses/partners known that At about what age did you begin to feel that your gender begin to feel that your about what age did you At 4.3 4.2 because you are trans? at least one of their past or current spouses knew they were received this question.] trans in 4.1 whether they know you are trans. 4.1 during your relationship with them? Section 4 life and These are questions about the people in your 3.4 that apply.) 3.2 the word for it)? (even if you did not know 3.3 did not use that word)? were trans (even if you Section 3 Section 3.1 birth sex? from your assigned was “different” 260 2015 U.S. TRANSGENDER SURVEY received thisquestion.] that some, most,oralloftheircoworkers knewtheyweretrans being trans? 4.11 this question.] trans? 4.10 received thisquestion.] or alloftheirimmediatefamilymembersknewtheyweretrans [Only respondents who said in response to 4.5 that some, most, 4.9 question.] immediate familymembersknewtheyweretransreceivedthis who saidinresponseto4.5thatsome, most,oralloftheir things to with (mother, father, sisters,brothers,etc.)doanyofthese 4.8 Did anyofyourimmediatefamilymembersyougrewup Did youeverrunawayfromhomebecausearetrans? On average, howsupportiveareyourco-workers withyou At whatagedidyourunawayfromhome becauseyouare Very unsupportive Unsupportive Neither supportivenorunsupportive Supportive Very supportive Yes No answer incombinationwithanyotheroption.] None oftheabove specify)______Supported youinanotherwaynotlistedabove(please Stood upformewithfamily, friends,orothers conference) reading books,usingonlineinformation,orattendinga Did researchtolearnhowbestsupportyou(suchas court) doing thingslike fillingoutpapersorgoingwithyouto identity documents(ID),like yourdriver’s license(suchas Helped youchangeyournameand/orgenderon transition Gave youmoneytohelpwithanypartofyourgender Used yourcorrectpronouns(suchashe/she/they) Used yourpreferredname Told youthattheyrespectand/orsupport answer incombinationwithanyotheroption.] None oftheabove stop youfrombeingtrans Sent youtoatherapist,counselor, orreligiousadvisorto gender Did notallowyoutoweartheclothesthatmatchedyour [Only respondentswhoselected“Yes” in4.9received [Drop-down listofages] [Skip to4.11] support [Only respondentswhosaidinresponseto4.5 you? (Mark allthatapply.) [Respondents couldnotselectthis [Respondents couldnotselectthis

[Only respondents community)? (such asachurch,synagogue, mosque, orotherfaith 5.1 church, synagogue, mosque, orotherfaithcommunity. These questionsareaboutyourexperienceswith Section 5 trans receivedthisquestion.] 4.5 thatsome, most,oralloftheirclassmates knew theywere you beingtrans? 4.12 spiritual/religious communitythinkorknowyouweretrans? 5.6 Inthepastyear of aspiritual/religiouscommunity? 5.5 Nowjustthinkingaboutthepastyear, question.] [Only respondentswhoselected“Yes” in5.4receivedthis religious communitythatwelcomedyouasatransperson? 5.4 because they 5.3 are atransperson? because you 5.2 Have youeverbeenpartofaspiritual/religiouscommunity Have youeverleftyourspiritual/religiouscommunity After youstoppedattending,didfindaspiritual/ Have youeverleftyourspiritual/religiouscommunity On average, howsupportiveareyourclassmates with Yes No Very unsupportive Unsupportive Neither supportivenorunsupportive Supportive Very supportive Yes No Yes No Yes No Yes No Yes No [Skip to6.1] [Skip to6.1] [Skip to6.1] [Skip to5.5] were afraid did reject [Only respondentswhosaidinresponseto

, didanyleadersorothermembersofyour youbecauseareatransperson? theymightrejectyoubecause

haveyoubeenpart APPENDIX B 261 O O O O O O O O O O O when Yes ) Yes, but more Yes, than a year ago [Only respondents O O O O O O O O O O O No Yes, within Yes, the past year Please provide an answer in O O O O you were doing sex work? No

Please mark all that apply in each row. Please mark all that apply you were doing sex work? .) [Skip to 6.11] when police thought No while I was doing sex work. Yes, when police thought I was doing sex work. Yes, Erotic dancer/stripper switch) sub, (Domme, Fetish work (please specify) ______Not listed above Did you ever interact with the police while doing sex Did you ever interact with the police while doing Have you engaged in sex or sexual activity for any of Have you engaged in sex When you interacted with police while doing sex work When you interacted with police while doing Have you ever been arrested for doing sex work or when police stopped me for doing sex work. Officers kept calling me by the wrong Officers gender pronouns (such as he/him or she/ or Ms.). her) or the wrong title (such as Mr. me questions about my Officers asked gender transition (such as hormones and surgical status). me. Officers verbally harassed me. Officers physically attacked Officers forced me to have sex or sexual activity to avoid arrest. I experienced unwanted sexual contact from an officer (such as fondling, sexual assault, or rape). I was arrested for drugs in my possession I engaged in sex or sexual activity for food I engaged in sex or sexual activity for a place to sleep bed, at their in someone’s or in their hotel room home, I engaged in sex or sexual activity for drugs For something not listed above (please specify) ______recorded as “No” [Response if text left blank.] 6.7 6.7 police thought while I was doing sex work” and/or “Yes, who selected “Yes, when police thought I was doing sex work” in 6.5 received this 6.5 work or could select multiple answer choices, but could [Respondents in combination with any other option.] not select “No” 6.6 did you or when police thought you were doing sex work, ( experience any of the following? each row 6.4 ( the following? with any in combination could not select “No” [Respondents other option.]

O O O O O O O times Many for money O O O O O O O times A few , have you engaged O O O O O O O twice Once or [Only respondents who Please provide an answer Please provide ). O O O O O O O Never [Only respondents who selected “Yes” in [Only respondents who selected “Yes” -

, how often did leaders or other members of did leaders or other members , how often Mark all that apply ( ? ) done [Skip to 6.4] Pornography/picture or video Pornography/picture Phone sex work Webcam Street-based sex work Street-based Sex work advertised online Sex work advertised in magazines or newspapers Informal sex work through word of mouth, occasional hook that ups with dates in my networks, or things like Escort/call girl/rent boy with an agency No Yes Yes No What type of sex work or work in the sex industry have ever Have you ever engaged in sex or sexual activity Have you ever engaged in sex or sexual activity Ask you to stop coming to services or faith community functions? sin or that your religion does not sin or that your religion does not approve of your being trans? Ask you to meet with spiritual/ religious leaders to stop you from being trans? Ask you to seek medical/psy chological help to stop you from being trans? Make you feel welcome as a Make trans person attending services/ faith community functions? a Accept you for who you are as trans person? you that your religion/faith Tell accepts you as a trans person? is a you that your being trans Tell In the past year… 6.3 you received this question.] in 6.1 selected “Yes” 6.2 Now just thinking about the past year in the or worked in sex or sexual activity for money (sex work) work, or porn sex industry (such as erotic dancing, webcam films) in the past year? received this question.] 6.1 and sex work. As a reminder, your answers are confidential and sex work. As a reminder, and cannot be used against you. 6.1 as erotic dancing, in the sex industry (such (sex work) or worked webcam work, or porn films)? Section 6 sex industry These are questions about work for pay in the 5.7 In the past year 5.7 ( community… your spiritual/religious in each row. 262 2015 U.S. TRANSGENDER SURVEY with anyotheroption.] question. Respondents couldnotselect“No” incombination who selectedananswerchoiceotherthan“No” receivedthis in thepastyear? selling drugsorotherworkthatiscurrentlyconsideredillegal 6.12 Nowjustthinkingaboutthepastyear, other option.] [Respondents couldnotselect“No” incombinationwithany that iscurrentlyconsideredillegal? 6.11 (Mark allthatapply.) 6.10 choices.] of prostitution”? your possessionsuchascondomsorsextoys“evidence 6.9 work orwhenpolicethoughtyouweredoingsexwork? 6.8 but couldnotselect“No” incombinationwithany other option.] question. Respondents couldselectmultipleanswerchoices How manytimeshaveyoubeenarrestedfordoingsex When policearrestedyou,didtheyconsiderthingsin Didanyofthesethingshappenwhenyouwerearrested? Have youeverbeenpaidforsellingdrugsorotherwork Yes, otherwork(pleasespecify) ______Yes, sellingdrugs No Yes, otherwork(pleasespecify)______Yes, sellingdrugs No Something notlistedabove(pleasespecify)______I wenttotrialandwasfoundguilty. I wenttotrialandwasfoundnotguilty. I pledguilty. The chargesweredropped. I don’t know ______Yes, itemsnotlistedabove(pleasespecify) Yes, sextoys Yes, condoms No Yes, whenthepolicethoughtIwasdoingsexwork Yes, whileIwasdoingsexwork No [Drop-down listof1–10and“11ormore”] [Skip to7.1] [Skip to6.11] [Respondents couldselectmultipleanswer (Mark allthatapply.) (Mark allthatapply.) [Only respondents wereyoupaidfor more information,clickon live withyouinyourhouse, apartment,orsinglehousingunit.)For (Donotincludeneighborsorotherswhodo including yourself? 7.1 surveys thatwewillusetocomparewiththeU.S. population. cannot beusedagainstyou. your currentjob. Asareminder, youranswersareconfidentialand These questionsareaboutyourhousehold,income, and Section 7 We willaskaboutthemlater. who aren’t legallymarriedtoyouoradultswhoaren’t relatedtoyou. (blood relatives),adoption,orlegalmarriage? Don’t includepartners 7.3 household relatedtoyou? 7.2 How manyadults(age18orolder)liveinyour How manyadultsinyourhouseholdare How aretheotheradults(age18orolder)wholiveinyour 9 ormore 8 7 6 5 4 3 2 1 9 ormore 8 7 6 5 4 3 2 1 0 Not listedabove(pleasespecify)______Other non-relative(s) Roomer(s)/Boarder(s) Housemate(s)/Roommate(s) Foster childorfosterchildren Other relative(s)(Aunt, Cousin,Nephew, Mother-in-law, etc.) Brother(s)/Sister(s)/Step-Brother(s)/Step-Sister(s) Parent(s) (Mother/Father/Step-Parent(s)) Grandchild orgrandchildren Child orchildren Partner (notlegallymarried) Spouse (legallymarried) [Skip to7.5] [Skip to7.5] household (Mark allthatapply).

These questionsarebasedonnational above. related toyou household 8 bybirth , 7

APPENDIX B 263 [Only Mark all that 13 Do you have more Do you have [Respondents could not [Respondents ) 14,15 [Skip to 7.10] [Skip to 7.10] Mark all that apply. current sources of income? ( current sources of income?

? ( 12 WIC or [Respondents who selected this answer choice who selected [Respondents following question.] received the job? than one part-time No Yes for work Unemployed but looking stopped looking for work Unemployed and have Not employed due to disability Student Retired or full-time parent Homemaker Not listed above (please specify) ______[Only respondents who selected “Work full-time for [Only respondents who selected “Work 11 ) Pay from sex work, selling drugs, or other work that is from sex work, selling drugs, or other Pay currently considered illegal from your full-time or part-time job Pay full-time or part-time job from your partner’s/spouse’s Pay No in a part-time job Yes in a full-time job Yes No in a part-time job Yes in a full-time job Yes No (SNAP) assistance from food stamps Yes, assistance from WIC Yes, Work part-time for an employer Work own business, profession or trade, Self-employed in your including sex work, selling drugs, or or operate a farm (not considered illegal) other work that is currently Do you currently receive assistance from FOOD STAMPS Do you currently receive assistance from FOOD STAMPS What are your On any of your full-time or part-time jobs, are you On any of your full-time or part-time jobs, are On any of your full-time or part-time jobs, are you a member On any of your full-time or part-time jobs, are 7.11 7.11 apply. an employer” and/or “Work part-time for an employer” in 7.7 part-time for an employer” in 7.7 an employer” and/or “Work could select multiple received this question. Respondents with in combination answer choices but could not select “No” any other option.] 7.9 contract? covered by a union or employee association full-time for an employer” respondents who selected “Work AND selected in 7.7 part-time for an employer” and/or “Work could received this question. Respondents in 7.8 “No” in select “No” select multiple answer choices but could not combination with any other option.] 7.10 (SNAP) with any other option.] in combination select “No” 7.8 7.8 similar to a of a labor union or of an employee association union? (Mark all that Are you actively Do you have more named on the lease, lease, named on the by birth (blood relatives) or 10 for your household? for your household? 9 related to you than one full-time job? No Yes or other work that is currently considered illegal No Yes who selected this answer choice [Respondents received the following question.] [Respondents who selected this answer choice [Respondents received the following question.] looking for legal work outside sex work, selling drugs , [Skip to 7.7] Work full-time for an employer Work Work for pay from sex work, selling drugs, or other work Work that is currently considered illegal 6 7 8 9 or more 0 1 2 3 4 5 9 or more 3 4 5 6 7 8 0 1 2 No Yes How many babies and other children under age 18 live in How many babies and Is any person aged 65 or older Is any person How many of the children under age 18 who live in your How many of the children under age 18 who What is your current employment status? What is your current employment status? 7.7 apply.) 7.6 household are related to you by children who aren’t include Don’t adoption? ask about them later. will birth or legal adoption. We 7.5 7.5 your household? 7.4 7.4 or deed mortgage, 264 2015 U.S. TRANSGENDER SURVEY or adoptionandwhohavelivedwith youduringthelast12 members whoarerelatedtoyouby legalmarriage, birth, taxes) 7.13 stamps (SNAP)orWIC. taxes) 7.12 What wasyourtotalcombined What wasyourtotalcombined 150,000 ormore 100,000 to149,999 75,000 to99,999 60,000 to74,999 50,000 to59,999 40,000 to49,999 35,000 to39,999 30,000 to34,999 25,000 to29,999 20,000 to24,999 17,500 to19,999 15,000 to17,499 12,500 to14,999 10,000 to12,499 7,500 to9,999 5,000 to7,499 1 to5,000 No income (please specify)______Income notlistedabove, household Regular contributionsfrompeoplewhodon’t liveinthe Veteran’s disabilitybenefitsandother Veteran’s benefits Workers’ comporotherdisability Supplemental securityincome(SSI) Social securitydisabilitybenefits(SSDI) Other retirementincome Private pensionorgovernmentemployee Social securityretirementorrailroadincome Child supportoralimony Unemployment benefits stamps (SNAP)orWIC) public cashassistanceprogram(DONOT includefood Cash assistancefromwelfare(suchasTANF) orother Interest income(onsavingsorbonds) rental income Income fromdividends,estatesortrusts,royalties, economy) profession ortrade, orfarm(notincludingunderground Self-employment incomefromyourownbusiness, in 2014 in 2014 ? Thisincludesallincomesources ? Thisincludesallincomefrom family

Family Income Individual Income except 17 (before 16 (before food received thisquestion.] choice otherthan“0”in7.6 (relatedchildreninhousehold) in 7.3 (relatedadultsinhousehold)and/orselected ananswer respondents whoselectedananswerchoiceotherthan“0” months. response to7.6 thaninresponseto7.5).] selected “1”ormorein7.5 andselectedahighernumberin that theyhadnon-relatedchildreninthehousehold(they in responseto7.3 thaninresponseto7.1) and/ortheyindicated (they selected“2”ormorein7.1 andselectedahighernumber indicated thattheyhadnon-relatedadultsintheirhousehold this question.Respondents received thisquestionifthey adults and/ornon-relatedchildrenintheirhouseholdreceived stamps (SNAP)orWIC. all membersofyourhouseholdfromsources INCOME 7.14 How muchwasyourtotalcombined 50,000 to59,999 40,000 to49,999 35,000 to39,999 30,000 to34,999 25,000 to29,999 20,000 to24,999 17,500 to19,999 15,000 to17,499 12,500 to14,999 10,000 to12,499 7,500 to9,999 5,000 to7,499 1 to5,000 No income 50,000 to 59,999 40,000 to 49,999 35,000 to39,999 30,000 to 34,999 25,000 to29,999 20,000 to24,999 17,500 to19,999 15,000 to17,499 12,500 to14,999 10,000 to12,499 7,500 to9,999 5,000 to7,499 1 to5,000 No income 150,000 ormore 100,000 to149,999 75,000 to99,999 60,000 to74,999 Don’t include 18 (beforetaxes) foodstamps(SNAP)orWIC. [Only respondentswithnon-related in 2014 ? Thisincludesincomefrom HOUSEHOLD except [Only food APPENDIX B 265 medical [Only respondents who [Only respondents who [Only respondents who selected “Yes” in 8.2 [Only respondents who selected “Yes” [Only respondents who selected “Yes” in 8.2 “Yes” who selected [Only respondents (Mark all that apply.) (Mark all that apply.) [Only respondents would selected “Yes” in 8.2 received [Only respondents would selected “Yes” [Skip to 9.1] [Only respondents who selected “Yes” in 8.3 received this [Only respondents who selected “Yes” A few Some Most All I would start to transition while still serving started while I would finish the transition that I have already still serving started I would not finish the transition that I have already while still serving and I would leave military service so that I could transition, not return. then I would leave military service so that I could transition, return to service after transition I do not want to transition I have already transitioned None of the options listed above Yes No Maybe None No Yes No that I was trans reported Yes, me for discharge recommended Yes, none of these providers knew that I Does not apply to me, was trans How many people in the military (who aren’t trans) believe you How many people in the military (who aren’t While serving in the military, have you ever received have in the military, While serving If trans people were allowed to serve openly, I would return to If trans people were allowed to serve openly, Has any military medical or mental health provider reported Has any military medical If trans people were allowed to serve openly, which of these If trans people were allowed to serve openly, 8.8 service: question.] 8.9 are trans? this question.] 8.5 from a military provider to a gender transition treatment related VA)? (do not include question.] in 8.3 received this “Yes” or selected 8.6 that you are trans or recommended to your commanding officer you for discharge? could in 8.2 received this question. Respondents selected “Yes” other option.] in combination with any not select “No” 8.7 would apply to you? received this question.] mental [Only respondents [Only respondents who selected [Skip to 8.4] [Skip to 8.12] [Only respondents who selected “on active duty in the treatment related to a gender transition from a military No Yes Yes No No Yes Navy Navy Reserve Army National Guard Coast Guard Coast Guard Reserve Marine Corps Marine Corps Reserve Air Force Air Force Reserve Air National Guard Army Army Reserve 60,000 to 74,999 60,000 to 99,999 75,000 to 149,999 100,000 or more 150,000 Are you still serving in the military? Are you still serving in the military? While serving in the military, have you ever received While serving in the military, Did you separate from military service within the last 10 What is your current or most recent branch of service? What is your current or most recent branch of 8.4 health provider (do not include VA)? in 8.3 received this question.] in 8.2 or selected “Yes” “Yes” 8.3 years? received this question.] past, but not now” in 2.17 8.2 not now” in 2.17 who selected “on active duty in the past, but received this question.] 8.1 8.1 You said earlier that you currently serve or have served on earlier that you currently serve or have served said You or National Reserves, Armed Forces, active duty in U.S. As a about your military service. Guard. These are questions are confidential and cannot be used your answers reminder, against you. Section 8 selected an answer choice other than [Only respondents who in this received question in 2.17 “never served in the military” section.] 266 2015 U.S. TRANSGENDER SURVEY “No” incombinationwith any otheroption.] discharge? your commanderthatyouaretrans orrecommendyoufor 8.16 harassment? 8.15 8.14 8.13 8.12 respondents whoselected“Yes” in8.10 receivedthisquestion.] both) reactedtoyoubeingtrans? 8.11 this question.] in 8.2andananswerchoiceotherthan“None” in8.9received or knowyouaretrans? 8.10 Doyoubelieveyourdischargewasrelatedtobeingtrans? How hasyourleadershiporcommandingofficer(or Did youleavetheserviceinordertotransition? What wasyourcharacterofdischarge? Did anymilitarymedicalormentalhealthprovidertell Did youleavetheservicetoavoidmistreatment/ Does yourleadershiporcommandingofficer(orboth)think Yes, reportedthatIwastrans. No Yes No Yes No Yes, completely Yes, partially No (please specify)______None oftheoptionslistedabove Dishonorable Bad Conduct Other-than-honorable Medical General Honorable Entry Level Separation 8.3 receivedquestions8.12–8.21] [Only respondentswhoselected“No” in8.2and“No” in Not listedabove(pleasespecify)______Took actionstodischargeme Ignored itorlooked theotherway Supported mymedicaltreatment Supported mynamechange Yes No [Skip to9.1] (Mark allthatapply.) [Only respondentswhoselected“Yes” [Respondents couldnotselect (Mark allthatapply.)

[Only 8.20 VA? 8.19 through theVA? 8.18 8.17 proceedings)? (ICE) detentioncenterorlocaljail just forimmigrationcourt as beingheldinanImmigrationandCustomsEnforcement 9.1 be usedagainstyou. had. Asareminder, youranswersareconfidential andcannot are questionsaboutimmigrationexperiencesyoumayhave You saidearlierthat youarenotaU.S. citizen bybirth.These “U.S. citizen,birth”in2.18 receivedquestionsinthissection.] [Only respondentswhoselectedanyanswerchoiceotherthan Section 9 discharge papers? 8.21 the VA? Have youeverbeenheldinimmigrationdetention(such HaveyouchangedyournameonDD214military Did youevergetanytypeofhealthcarethroughtheVA? Did youevergethealthcarerelatedtoagendertransition Do youcurrentlygetanytypeofhealthcarethroughthe Yes No Yes No Yes No I wastrans. Does notapplytome, noneoftheseproviders knewthat Yes, recommendedmefordischarge. Yes No No, Inevertried. No, Iwasdenied. Yes, IreceivedaDD215(amended)withnewname. Yes, IreceivedanupdatedDD214withnewname. Does notapplytome, theVA staffdonotknowI’mtrans Always Mostly Sometimes Never As atransperson,haveyoureceivedrespectfulcareat [Skip to8.21] [Skip to9.6] APPENDIX B 267 [Skip [Skip to [Only [Only respondents who [Only respondents who

[Skip to 10.13] complete the process to get a legal OR

[Skip to 10.1] [Skip to 10.12] [Skip to 9.8] [Skip to 9.9] With a court order During the immigration/naturalization process 10.13] By another method (Please tell us what method) ______I was afraid to apply. I believed I was past the 1 year deadline. A reason not listed above (please specify) ______I was past the 1 year deadline. face danger in The immigration official decided that I didn’t my country. A reason not listed above (please specify) ______No Yes No or LGB because I am trans Yes, another reason for Yes, Yes No status. but I received a “withholding of removal” No, to 10.1] know how to apply. I didn’t I have access to other legal statuses. want to apply. I didn’t How did you try to change your name? Did you ever try Why didn’t you receive asylum? you receive asylum? Why didn’t Why didn’t you apply for asylum? you apply for asylum? Why didn’t Have you ever applied for asylum in the United States? in the United States? applied for asylum Have you ever Did you receive asylum in the United States? in the United States? Did you receive asylum 10.2 10.2 9.9 9.9 received this question.] in 9.7 selected “No” Section 10 These are questions about legal name change and your current identification documents, such as your birth license. certificate or driver’s 10.1 name change to match your gender identity? 9.6 but could multiple answer choices could select [Respondents choice.] with any other answer in combination not select “No” 9.7 or trans or LGB” because I am “Yes, respondents who selected another reason” received this question.] for “Yes, 9.8 question.] received this in 9.6 selected “No” ) [Skip to [Respondents [Respondents [Skip to 9.5] Were you sexually Were you threatened Were Were you physically Were Mark all that apply. Mark all that apply.) Mark all that apply.) [Skip to 9.5] Other detainees or inmates Other detainees or inmates who selected this answer choice [Respondents received the following question.] with sexual assault by: or detention officers Staff Other detainees or inmates who selected this answer choice [Respondents received the following question.] assaulted by: or detention officers Staff [Respondents who selected this answer choice [Respondents received the following question.] assaulted by: or detention officers Staff I was denied access to hormones that I use. I was denied gender-appropriate clothing. None of these things happened to me. I was threatened with sexual assault I was sexually assaulted. I was physically assaulted. 91 days to 180 days (3-6 months) to a year) 181 days to one year (more than 6 months up More than 1 year Up to 14 days (up to two weeks) 15 days to 30 days (three or four weeks) 31 days to 90 days (1-3 months) Yes, in solitary confinement in solitary Yes, people (such as a separate area for trans or LGB in a Yes, housing area) pod, unit, tank, or other specify) ______Not listed above (please 9.5] No No Yes When you were in immigration detention, did any of these When you were in immigration detention, did While you were in immigration detention, do you believe do you believe in immigration detention, While you were In total, how long were you held in solitary confinement? In total, how long were you held in solitary confinement? When you were in immigration detention, separated from When you were in immigration

could not select “None of these things happened to me” in to me” could not select “None of these things happened combination with any other option.] 9.5 9.5 ( things happen to you? 9.4 9.4 in solitary confinement” [Only respondents who selected “Yes, received this question.] 9.3 9.3 ( detention? others who were also in with any in combination could not choose “No” [Respondents other option.] 9.2 9.2 trans or or knew you were guards, or others thought staff, or bisexual (LGB)? lesbian, gay, 268 2015 U.S. TRANSGENDER SURVEY court order”in10.2 receivedthisquestion.] legal namechange? 10.9 change” in10.7 receivedthisquestion.] respondents whoselected“No, thecourtdeniedmyname 10.8 question.] who selected“Withacourtorder”in10.2 receivedthis 10.7 received thisquestion.] in eachrow. experience anyofthefollowing? ( 10.6 10.4 receivedthisquestion.] treated withrespect? 10.5 selected “Yes” in10.3 receivedthisquestion.] with thoughtorknewyouweretrans? 10.4 order” in10.2 receivedthisquestion.] or courtstaff? 10.3 (such ashormonesandsurgicalstatus). I wasasked questionsaboutmygendertransition title (Mr. orMs.). pronouns (suchashe/himorshe/her)awrong They kept callingmebythewronggender I receivedunequaltreatment/service. I wasverballyharassed. Did thecourtgrantyournamechange? For yourlegalnamechange, didyouinteractwithjudges When youinteractedwithjudgesorcourtstaff, didyou Do youbelievethejudgesorcourtstaffinteracted to 10.9] Not listedabove(pleasespecify)______ordered namechange. Not sureyet.Iamstillintheprocessofgettingmycourt No, Igaveup. 10.9] No, Iranoutofmoneytocompletetheprocess. No, thecourtdeniedmynamechange. Yes, thecourtgrantedmynamechange. I wasalwaystreatedwithrespect I wassometimestreatedwithrespect I wasnevertreatedwithrespect Yes No Yes No Why didthecourtdenyyournamechange? How oldwereyouwhenwent tocourtgetyour When youinteractedwithjudgesorcourtstaff, wereyou [Drop-down listof ages] [Text box]

[Skip to10.7] [Skip to10.7] ) [Only respondentswhoselected“Yes” in10.4 [Only respondentswhoselected“Withacourt [Skip to10.9] [Onlyrespondentswhoselected “With a [Only respondentswhoselected“Yes” in [Skip to10.9]

Please provideananswer [Only respondentswho [Only respondents No O O O O [Skip to10.9] [Only [Skip to Yes O O O O [Skip granted mynamechange” in10.7 receivedthisquestion.] publication, etc. include thecostoflegalhelp, courtfees,newspaper 10.11 this question.] respondents whoselected“Withacourtorder”in10.2 received 10.10 name Iprefer”in10.13 received thisquestion.] list thenameIprefer”or“Someof myIDsandrecordslistthe [Only respondentswhoselected“All ofmyIDsandrecords preferred 10.14 most true? driver’s license, passport, etc.Whichofthestatementsbelowis and recordsthatlistyourname, suchasyourbirthcertificate, 10.13 received thisquestion.] (Mark allthatapply.) 10.12 Howmuchdidyourlegalnamechangecost?Please $750 -$999 $500 -$749 $250 -$499 $100 -$249 $1 -$99 $0 Yes, Igothelpfromsomeothersource. Yes, Igothelpfromafriend. organization. Yes, Igothelpforfreefromalegalclinicornon-profit Yes, Igotlegalhelpfromapaidattorney. No 10.15] None ofmyIDsandrecordslistthenameIprefer. Some ofmyIDsandrecordslistthenameIprefer. All ofmyIDsandrecordslistthenameIprefer. A reasonnotlistedabove(pleasespecify)______I amworriedthatchangingmynamewouldoutme. criminal record,immigrationstatus,orresidency). I believeamnotallowed(forexample, becauseofmy I don’t knowhow. I cannotaffordit. I amnotready. or expression. I feellike mynamedoesn’t conflictwithmygenderidentity I donotrememberthecostofmylegalnamechange. More than$2,000 $1,000 -$2,000 Thinking abouthowyour Which oftheseIDs/recordshaveyou changedtolistyour Why youhavenottriedtolegallychangeyourname? Did yougetlegalhelptochangeyourname? NAME [All respondentsreceivedthisquestion.] [Only respondentswhoselected“Yes, thecourt ? ( Please provideananswerineach row.) [Only thosewhoselected“No” in10.1 NAME islistedonallofyourIDs [Only [Skip to APPENDIX B 269 (Mark all that apply). [Only respondents who [Only respondents (Mark all that apply.) apply.) (Mark all that (Mark all that apply.) [Skip to 11.4] When I have shown IDs with my name or gender that When I have shown IDs with my name or gender No Yes Insurance through my current or former employer or union current or former Insurance through someone else’s employer or union Insurance I or someone else purchased through specify)______I have been verbally harassed. I have been assaulted/attacked. to leave. I have been asked I have been denied services or benefits. I have had none of the above problems. I have only shown IDs that This does not apply to me. match. The gender options that are available (male or female) do The gender options that not fit my gender identity. I have not tried yet. My request was denied. I am not ready. I cannot afford it. I do not know how. I have not had the (For example, I believe I am not allowed. Or to change my gender on ID. medical treatment needed that is needed to letter or other letter get a doctor’s I can’t update the gender.) I might not be I am worried that if I change my gender, might include able to get some benefits or services. These employment, etc. medical, insurance, out me. I am worried that changing my gender would A reason not listed above (please You said that none of your IDs or records list the gender of your IDs or records said that none You What type of health insurance or health coverage plan do Are you currently covered by any health insurance or health 11.2 you have? 10.18 10.18 do not match the gender I present as… could [All respondents received this question. Respondents or “This not select “I have had none of the above problems” I have only shown IDs that match” in does not apply to me. combination with any other option.] Section 11 These are questions about your current health insurance health care providers, and the health your coverage, (such as healthcare.gov). insurance marketplace 11.1 coverage plan? 10.17 your gender on your you changed Why haven’t you prefer. IDs or records? list the gender I prefer” of my IDs and records selected “None this question.] received in 10.15 to to O O O O O O O O O O O ID/ my my do not do not NAME record on this record change want I change want I GENDER on this ID/

[Skip to to O O O O O O my not have but I O O O O O I my record this ID/ tried change want to NAME on tried change have not I want to GENDER I on this ID/ record but

- -

- in of O O O O O O ing O O O O O I am in the on this cord process ID/re I am ing my on this chang cess of chang ID/record my NAME the pro is listed on all of GENDER

a -

O O O O O O O O O O O ID/ cord I was I was ID/re record on this denied on this [All respondents received this change change a NAME GENDER denied GENDER

O O O O O O O O O O O my on this changed record Please provide an answer in each row.) Please provide an answer in each row.) changed ID/record I my NAME GENDER I on this ID/ ? (

O O O O O O do O O O O O ID/ not this I have do not have record record this ID/ I GENDER

- Which of these IDs/records have you changed to list your Which of these IDs/records have you changed Thinking about how your

None of my IDs and records list the gender I prefer. prefer. None of my IDs and records list the gender I to 10.17] All of my IDs and records list the gender I prefer. All of my IDs and records list the gender I prefer. prefer. Some of my IDs and records list the gender I Social Security records Passport Student records (current or last school attended) Birth certificate Driver’s license and/or state issued non-driv er ID Student Student records (current or last school attended) ID Work issued non-driver ID Social Security records Passport Birth certificate Driver’s license and/ or state gender I prefer” in 10.15 received this question.] gender I prefer” in 10.15 10.16 10.16 preferred of my IDs and records list [Only respondents who selected “All the gender I prefer” or “Some of my IDs and records list the your IDs and records that list your gender, such as your your IDs and records that list your gender, etc. Which of the passport, license, driver’s birth certificate, statements below is most true? question.] 10.15 10.15 270 2015 U.S. TRANSGENDER SURVEY people? much dotheyknowaboutprovidinghealthcarefortrans trans-related 11.4 this.”) tried tochangeyourrecords,choose“Ihavenotasked for row. health insurancecompany? 11.3 Inthepastyear, care becauseIamtrans. denied meotherroutinehealth My healthinsurancecompany am trans. mammogram, etc.)becauseI smears, prostateexams, health care(suchasPap denied megender-specific My healthinsurancecompany their network. but hasnosurgeryprovidersin covers surgeryfortransition, My healthinsurancecompany transition. surgical careIneedformy covers onlysomeofthe My healthinsurancecompany transition. pany deniedmesurgeryfor My healthinsurancecom for transition. denied mehormonetherapy My healthinsurancecompany list mycurrentnameorgender. wouldn’t changemyrecordsto My healthinsurancecompany In thepastyear… Thinking aboutthedoctororprovideryougotoforyour I amnotsure They knowalmostnothingabout trans healthcare They knowsomethingsabouttrans healthcare They knowmostthingsabouttrans healthcare They knowalmosteverythingabout transhealthcare right now I don’t haveatrans-relateddoctororhealthcareprovider (please specify)______Any othertypeofhealthinsuranceorcoverageplan Indian HealthService health care) VA (includingthosewhohaveeverusedorenrolledforVA TRICARE orothermilitaryhealthcare incomes oradisability) Medicaid (government-assistanceplanforthosewithlow disabilities) Medicare (forpeople65andolder, orpeoplewith certain insurance company Insurance Iorsomeoneelsepurchaseddirectlyfroman (sometimes called“Obamacare”) HealthCare.Gov oraHealthInsuranceMarketplace If youdidn’t trytogetthekindofcarelistedorifyounever healthcare(suchashormonetreatment),how [Skip to11.7] - did anyofthesethingshappenwithyour

( Please provideananswerineach Yes O O O O O O O No O O O O O O O I havenot asked for this O O O O O O O care fortranspeople? you seeforphysicals,flu,diabetes,etc.)knowabouthealth 11.7 for yourroutinehealthcare, like physicals,flu,diabetes,etc.? 11.6 provider? 11.5 respondents who selected“Yes” in11.9received thisquestion.] program throughahealthinsurance marketplace? 11.10 healthcare.gov, overthephone, orinperson.) where peoplecangetinsuranceonline, suchasthrough sometimes called“Obamacare” orthe“Affordable CareAct,” insurance marketplaces arepartofthenewhealthcarelaw, a stateorfederalhealthinsurancemarketplace? (Health 11.9 Inthepastyear received thisquestion.] doctor orhealthcareproviderformyroutinehealthcare” provider? 11.8 healthcare” receivedthisquestion.] see adifferentdoctororhealthcareproviderformyroutine Howfardoyoutraveltoseeyourroutinehealthcare How muchdoesyour Do youalsogotoyour How fardoyoutraveltoseeyourtrans-relatedhealthcare Didyoubuyinsuranceorenrollin astateMedicaid No, Idonotgetanyroutinehealthcare routine healthcare No, Iseeadifferentdoctororhealthcareproviderformy health care Yes, Iseemytranshealthcareproviderforroutine Over 100miles 75-100 miles 50-75 miles 25-50 miles 10-25 miles Less than10miles Yes No Yes No Over 100miles 75-100 miles 50-75 miles 25-50 miles 10-25 miles Less than10miles I amnotsure They knowalmostnothing They knowsomethings They knowmostthings They knowalmosteverythingabouttranshealthcare I don’t havearoutinehealthcareprovider [Skip to12.1] [Skip to12.1] [Onlyrespondentswhoselected“No, Iseeadifferent [Skip to11.9] , didyoulookforhealthinsurancefrom [Only respondentswhoselected“No, I routine healthcare trans-related healthcareprovider [Skip to11.9] provider(who [Skip to11.9] [Only APPENDIX B 271 O O O O O O O O O

Yes [Only ) O O O O O O O O O No when you needed when you needed (Mark all that apply.) (Mark all that apply.) (Mark all that apply.) past 12 months any of the health care listed below for any of the health care listed below for , have you seen a doctor or health care , have you seen a doctor , did you have any of these things happen to , did you have any of these Please provide an answer in each row. Please provide an answer ever had ever wanted [Skip to 12.8] Have you Was there a time in the there a time in the Was Have you Counseling/Therapy Hormone Treatment/HRT Puberty Blocking Hormones (usually used by youth ages 9-16) None of the above Counseling/Therapy Hormone Treatment/HRT Puberty Blocking Hormones (usually used by youth ages 9-16) None of the above No Yes No Yes A doctor or other health care provider refused to give me other A doctor or other health care provider refused to give me other physicals, flu, diabetes). health care (such as for like questions about my me unnecessary/invasive My doctor asked trans status that were not related to the reason for my visit. A doctor or other health care provider used harsh or abusive language when treating me. or A doctor or other health care provider was physically rough abusive when treating me. I was verbally harassed in a health care setting (such as a clinic). hospital, office, my visit in a health by someone during I was physically attacked clinic). care setting (such as a hospital, office, I experienced unwanted sexual contact (such as fondling, sexual assault, or rape) in a health care setting (such as a hospital, clinic). office, In the past year… My doctor knew I was trans and treated me with respect. I had to teach my doctor or other health care provider about trans people so that I could get appropriate care. A doctor or other health care provider refused to give me trans-related care. with any other option.] 12.8 your gender identity or gender transition? in combination could not select “None of the above” [Respondents with any other option.] 12.9 your gender identity or gender transition? in combination could not select “None of the above” [Respondents 12.5 be you thought you would but did not because to see a doctor person? or mistreated as a trans disrespected In the past year 12.6 provider? In the past year 12.7 when you went to see a doctor or health you, as a trans person, care provider? ( received this question.] in 12.6 “Yes” respondents who selected O O O O O O time None of the during [Only O O O O O O time of the A little when you needed O O O O O O time Some of the ) [Only respondents who O O O O O O time Most of the . For each row, please select . For each row, O O O O O O the time All of in the past 12 months . Altogether, how MUCH did these feelings . Altogether,

during the past 30 days No Yes A lot Some A little Not at all Good Fair Poor Excellent Excellent good Very Coverage through a private plan without a subsidy Coverage through a private specify) ______Not listed above (please Coverage through a state Medicaid program a state Medicaid Coverage through I pay a so a subsidy, a private plan with Coverage through because of my income lower price The following questions ask about how you have been The following questions ask about how you have Was there a time Was We just asked about a number of feelings you had just asked We What type of insurance coverage did you buy? did you buy? insurance coverage What type of Would you say that in general your health is… you say that in general your Would …nervous? …restless or fidgety? …hopeless? was an everything …that effort? …worthless? During the past 30 days, how often did you feel… …so sad that nothing could cheer you up? Please provide an answer in each row. to see a doctor but could not because of cost? 12.4 12.3 the past 30 days interfere with your life or activities? in selected an answer choice other than “None of the time” 12.2 received this question.] the column that best describes how often you had this feeling. the column that best describes how often you ( 12.2 feeling These are questions about your health, experiences with These are questions about providers, and health care. doctors or health care 12.1 Section 12 11.11 11.11 this question.] received in 11.10 who selected “Yes” respondents 272 2015 U.S. TRANSGENDER SURVEY this question.] row.) below forgendertransition? 12.15 selected “Nowonactiveduty”in2.17 receivedthisquestion.] that apply.) 12.14 “Now onactiveduty”in2.17 receivedthisquestion.] respondents whoselected“Yes” in12.12 anddidnotselect 12.13 identity orgendertransition? 12.12 Hormones” in12.9receivedthisquestion.] Hormones? 12.11 Therapy/HRT” in12.9receivedthisquestion.] treatment? 12.10 ______Other procedurenotlisted: Phalloplasty (creationofapenis) centurion procedure Clitoral release/metoidioplasty/ tubes, and/orcervix) of theuterus,ovaries,fallopian Hysterectomy/“hysto” (removal reconstruction Top/chest surgeryreductionor (please specify)______Another sourcenotlistedabove through adoctorormedicalprovider) Through friends,online, orothernon-licensed sources(not Off-post pharmacy On-post pharmacy Off-post medicaldoctor On-post medicaldoctor licensed sources I ONLY gethormonesfromfriends,online, orothernon- from friends,online, orothernon-licensedsources In additiontolicensedprofessionals,Ialsogethormones hormones I onlygotolicensedprofessionals(like adoctor)for Yes No [Drop-down listofages] [Drop-down listofages] At whatagedidyoubegintakingPubertyBlocking Where doyoucurrentlygetyourhormones? Where doyoucurrentlygetyourhormones? ( Are youcurrentlytakinghormonesforyourgender Have youhadordowantanyofthehealthcarelisted At whatagedidyoubeginhormonetreatment/HRT [Only respondentswhoselected“Female” in 2.1 received [Skip to12.15] [Only respondentswhoselected“Hormone [Onlyrespondentswhoselected“PubertyBlocking [Only respondentswhoselected“Yes” in12.12 and (Pleasegiveananswerineach had it Have O O O O O

Want it some day O O O O O sure if I want this Not [Only O O O O O Mark all Do not want this O O O O O received thisquestion.] in eachrow.) listed belowforgendertransition? 12.18 question.] [Only respondentswhoselected“Female” in2.1 receivedthis 12.17 question.] selected “Havehadit”atleastoncein12.15 receivedthis procedure (otherthanhormones)? your gendertransition.At whatagedidyouhaveyourfirst 12.16 apply.) go backtolivingasyoursexassigned atbirth? 12.21 for awhile? ever gonebacktolivingasyoursexassignedatbirth,least 12.20 “voice therapy(non-surgical)”in12.15 receivedthisquestion.] selected “Havehadit”atleastonceforaprocedureotherthan procedure (otherthanhormones)? your gendertransition.At whatagedidyouhaveyourfirst 12.19 Breast augmentation/topsurgery Hair removal/electrolysis ______Other procedurenotlisted: Voice surgery Voice therapy(non-surgical) nose, brow, chin,cheek) Facial feminizationsurgery(suchas cartilage reduction) Trachea shave(Adam’s appleorthyroid Vaginoplasty/labiaplasty/SRS/GRS/GCS testes Orchidectomy /“orchy”removalof Silicone injections Yes No Pressure fromaparent Pressure fromspouseorpartner Yes No I havenevertransitioned. Haveyouhadordowantanyofthehealthcare Have youhadaPap smearorPap testinthepastyear? You saidthatyouhadatleastoneprocedurefor You saidthatyouhadatleastoneprocedurefor Why didyoude-transition? Inotherwords,whydidyou Have youeverde-transitioned?Inotherwords,have [Drop-down listofages] [Drop-down listofages] [Skip to13.1] [Only respondentswhoselected“Male” in2.1 [Skip to13.1] (Pleaseprovideananswer had it Have [Only respondentswho [Only respondentswho O O O O O O O O O O some day Want it O O O O O O O O O O (Mark allthat Not sure if Iwant this O O O O O O O O O O Do not want this O O O O O O O O O O APPENDIX B 273 [Only [Skip to 14.4] [Skip to 14.4] [Skip to 14.4] [Only respondents who [Skip to 14.4] [Only respondents who selected “Yes” in 13.5 who selected “Yes” [Only respondents [Skip to 14.3] [Only respondents who selected “No” in 14.1 received in 14.1 [Only respondents who selected “No” Where were you last tested? No particular reason Private doctor or HMO office Counseling and testing site Emergency room Hospital inpatient HIV negative, meaning I do not have HIV. meaning I do not have HIV. HIV negative, meaning the test could not HIV test results were unclear, determine if I have HIV. I never received the results. know. I don’t I’ve been exposed to HIV. unlikely It’s you had I was afraid to find out if I was HIV positive (that HIV). want to think about HIV or about being HIV I didn’t positive. I was worried my name would be sent to the government if I tested positive. know where to get tested. I didn’t needles. like I don’t friends, or home, insurance, I was afraid of losing my job, family if people knew I was tested for AIDS infection. My doctor/health care provider never mentioned getting an HIV test. Some other reason No Yes No Yes meaning I have HIV. HIV positive or reactive, What was the result of your most recent HIV test? What was the result of your most recent HIV Here is a list of reasons why some people have not been Here is a list of reasons why some people have This question is about the test for HIV, the virus that causes the virus that causes the test for HIV, This question is about 14.4_1 received this question.] in 14.1 selected “Yes” 14.3 one of these tested for HIV (the virus that causes AIDS). Which not been would you say is the MAIN reason why you have tested? this question.] or who you are attracted to (such as try to make you straight/ as try to make are attracted to (such or who you heterosexual)? question.] received this Section 14 HIV testing and care. These are questions about 14.1 for tests you may have had as part of blood AIDS. Except been tested for HIV? donations, have you ever 14.2 received this question.] in 14.1 those who selected “Yes”

with any sexual orientation [Only respondents who sexual orientation [Skip to 14.1] [Skip to 13.5] [Skip to 13.5] [Drop-down list of ages] Yes Yes No No Yes Yes No No Pressure from a mental health professional Pressure from a mental job. I had trouble getting a was not for me. I realized that gender transition I faced too much harassment/discrimination. me. It was just too hard for specify)______Not listed above (please Pressure from other family members Pressure from friends Pressure from my employer Pressure from a religious counselor Pressure from Did you ever discuss your Did any professional (such as a psychologist, counselor, counselor, Did any professional (such as a psychologist, Was this person a religious or spiritual counselor/advisor? Was Did any professional (such as a psychologist, counselor, Did any professional (such as a psychologist, counselor, How old were you the first time a professional tried to How old were you the first time a professional Did you ever discuss your gender identity or trans identity Did you ever discuss your gender identity or 13.6 13.6 religious advisor) ever try to change your 13.5 religious professional (such as a psychologist, counselor, advisor)? 13.4 in 13.2 received this [Only respondents who selected “Yes” question.] 13.3 at birth (in other you identify only with your sex assigned make words, try to stop you being trans)? in 13.2 received this question.] selected “Yes” 13.2 only with your sex you identify religious advisor) try to make being trans)? assigned at birth (in other words, try to stop you religious advisors. 13.1 religious with a professional (such as a psychologist, counselor, advisor)? Section 13 may have had These are questions about experiences you counselors, with some professionals, such as psychologists, 274 2015 U.S. TRANSGENDER SURVEY health careproviderforHIV in thepast6months? 14.8 question.] [Only respondentswhoselected“Yes” in14.5receivedthis during emergencyroomvisitsorwhilestayinginthehospital. care providerforHIVcare? Don’t includecareyoureceived 14.7 respondents whoselected“No” in14.5received thisquestion.] health careproviderforHIVinthepast12months? 14.6 during emergencyroomvisitsorwhilestayinginthehospital. care providerforHIVcare? Don’t include careyoureceived 14.5 meaning IhaveHIV”in14.2receivedquestions14.5–14.13.] [Only respondentswhoselected“HIVpositiveorreactive, in 14.1 receivedthisquestion.] was yourlastHIVtest? 14.4_2 In thepast6MONTHS,haveyouseenadoctororhealth What isthemainreasonyouhaven’t seenadoctoror Yes No (please specify)______A reasonnotlistedabove I relyonahigherpower/GodtohelpmyHIV. I believedthatwouldbemistreatedbecauseamtrans. My familyorpartnerwouldfindoutIhaveHIV. I didn’t feelsickenoughtolookforhealthcare. I wasn’t readytolookforhealthcareHIV. I didn’t knowwheretogoforHIVcare. care. I haveneededothertypesofmedicalormentalhealth I onlyrecentlyfoundouthaveHIV. I havenohealthinsurance. I couldn’t affordit. Yes No 1984” asafinaloption] Year Month (please specify)______A placenotlistedabove Somewhere else At home Drug treatmentfacility Jail orprison(orothercorrectionalfacility) Clinic What isthemainreasonthatyou haven’t seenadoctoror In thepast12MONTHS,haveyouseenadoctororhealth Not includingblooddonations,inwhatmonthandyear [Skip to14.7] [Skip to14.9] [Drop-down listwithyears2015–1984and“before [Drop-down listofallmonths] [Onlyrespondentswhoselected“Yes”

[Only [Only and CD4counts? 14.9 respondents whoselected“No” in14.7 receivedthisquestion.] “Rarely,” or“Most of thetime” in14.12 receivedthisquestion.] [Only respondentswhoselected“No” in14.11 or“Never,” regularly takinganti-retroviraltherapy(ART) allofthetime? 14.13 supposed to(regularlyandasprescribed)? 14.12 14.11 (often calledART)? which arethepillsthatreduceamountofHIVinyourbody 14.10 Whenwasyourlastbloodtesttodetermineviralload More thanayearago Within thepastyear Within thepast6months (please specify)______A reasonnotlistedabove I relyonahigherpower/GodtohelpmyHIV. I believedthatwouldbemistreatedbecauseamtrans. My familyorpartnerwouldfindoutIhaveHIV. I didn’t feelsickenoughtolookforhealthcare. I wasn’t readytolookforhealthcareHIV. I didn’t knowwheretogoforHIVcare. care. I haveneededothertypesofmedicalormentalhealth I havenohealthinsurance. I couldn’t affordit. I wouldgainweight. I amafraiditwouldconflictwith my othermedications. I amafraiditwouldconflictwith my hormones. My doctororhealthcareprovider saidIdidn’t needit. I onlyrecentlyfoundouthaveHIV. I havenohealthinsurance. I can’t affordit. All ofthetime Most ofthetime Rarely Never Yes No Yes No count. I haveneverhadabloodtestformyviralloadandCD4 Are youcurrentlytakinganti-retroviraltherapy(ART)? What isthemainreasonthatareyounottakingor Do youtake youranti-retroviraltherapy(ART) like you’re Have youeverbeenprescribedanti-retroviraltherapy, [Skip to14.13] [Skip to15.1]

APPENDIX B 275 used marijuana last [Only respondents who [Only respondents who [Only respondents who selected “Within [Only respondents who selected “Yes” [Only respondents who selected “Yes” [Only respondents who selected “Yes” under [Only respondents who selected “Yes” [Only respondents who selected “Yes” under [Only respondents who selected “Yes” [Drop-down list of numbers 1–30] [Drop-down list of numbers 1–30] [Drop-down list of numbers During the past 30 days, on how many days did you use How long has it been since you last used any illegal/illicit How long has it been since you How long has it been since you last used E-Cigarettes or How long has it been since you last used E-Cigarettes Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago 16 to 25 cigarettes per day (about 1 pack) 26 to 35 cigarettes per day (about 1 ½ packs) or more) More than 35 cigarettes per day (about 2 packs Within the past 30 days months More than 30 days ago but within the past 12 More than 12 months ago Within the past 30 days More than 30 days ago but within the past 12 months More than 12 months ago Within the past 30 days Within the past the past 12 months days ago but within More than 30 More than 12 months ago than one cigarette per day Less 1 cigarette per day 2 to 5 cigarettes per day 6 to 15 cigarettes per day (about ½ pack) During the past 30 days, on how many days did you During the past 30 days, On the days you smoked cigarettes during the past 30 On the days you smoked How long has it been since you last smoked part or all of part smoked it been since you last How long has 15.11 15.11 meth, inhalants like crack, heroin, LSD, drug (such as cocaine, poppers or whippits)? crack, heroin, under “Illegal or illicit drugs (such as cocaine, received poppers or whippits)” in 15.1 meth, inhalants like LSD, this question.] 15.8 vaping products? received this question.] in 15.1 “E-cigarettes or vaping products” 15.9 or hashish? hash, hash oil)” in “Marijuana or hashish (such as weed, joints, received this question.] 15.1 15.10 marijuana or hashish? in 15.9 received this question.] the past 30 days” 15.5 a cigarette? 15.6 part or all of a cigarette? smoke in 15.5 received this 30 days” selected “Within the past question.] 15.7 on average? per day, did you smoke days, how many cigarettes in selected “Within the past 30 days” [Only respondents who 15.5 received this question.] O O O O O O Yes [Only ) O O O O O O No drank an alcoholic last d.

of any type of alcoholic beverage, 19 of an alcoholic beverage? of an alcoholic beverage? 22 27 had a drink weren’t prescribed to weren’t

on the same occasion? By ‘occasion,’ we By ‘occasion,’ on the same occasion? (such as weed, joints, (such as cocaine, crack, (such as cocaine, 23 28 24 (such as Oxycontin, Xanax, that 25 ) ever Please provide an answer in each row. ? drinks (tobacco only) 26 21 (such as beer, wine, or hard liquor) or hard wine, (such as beer, [Drop-down list of numbers 1–30] [Drop-down list of numbers 1–30] 20 [Only respondents who selected “Within the past 30 How long has it been since you During the past 30 days, on how many days did you have 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. I rely on a higher power/God A reason not listed above (please specify) ______I don’t know where to get it. know where I don’t (ART). anti-retroviral therapy take want to I don’t therapy anti-retroviral enough to take feel sick I don’t (ART). would find out I have HIV. or friends partner, My family, During the past 30 days, on how many days did you Have you hash, hash oil) Illegal or illicit drugs or poppers meth, inhalants like heroin, LSD, whippits) Prescription drugs Adderall, Ambien as prescribe take you, or that you didn’t Alcohol Cigarettes E-Cigarettes or vaping products Marijuana or hashish other. other. in 15.2 received this question.] days” under “Cigarettes [Only respondents who selected “Yes” received questions 15.5–15.7] (tobacco only)” in 15.1 respondents who selected “Within the past 30 days” in 15.2 respondents who selected “Within the past 30 days” received this question.] 15.4 5 or more mean at the same time or within a couple of hours of each 15.3 drink one or more drinks (such as under “Alcohol [Only respondents who selected “Yes” received questions 15.2–15.4] or hard liquor)” in 15.1 wine, beer, 15.2 beverage substances? ( substances? Section 15 your use of alcohol, tobacco, These are questions about marijuana, or other drugs. 15.1 or used any of the other following part or all of a cigarette, smoked 276 2015 U.S. TRANSGENDER SURVEY 16.4 receivedthisquestion.] tried tokillyourself? 16.5 in 16.3receivedthisquestion.] attempt tokillyourself? from adoctororotherhealthprofessionalasresultofan 16.4 question.] [Only respondentswhoselected“Yes” in16.1 receivedthis 16.3 this question.] yourself? 16.2 trying tokillyourself any timeinthepast12months 16.1 anonymous helplineslistedattheendofsection. to gethelpfromsomeoneyoutrustorcalloneofthe emotions becauseofthesequestionsweencourageyou brings updifficultemotions.Ifyouexperienceany Talking aboutsuicidalthoughtsorbehaviorssometimes These arequestionsaboutsuicidalthoughtsandbehaviors. Section 16 received thisquestion.] prescribed toyou,orthatyoudidn’ttake asprescribed”in15.1 (such asOxycontin,Xanax,Adderall,Ambien)thatweren’t respondents whoselected“Yes” under“Prescriptiondrugs drugs notasprescribedortoyou? 15.12 The nextfewquestionsareaboutthoughtsofsuicide. During thepast12months,didyou Yes No Yes No Yes No Yes No Yes No More than12monthsago More than30daysagobutwithinthepast12months Within thepast30days During thepast12months,didyougetmedicalattention During thepast12months,didyou Did youstayinahospitalovernightorlongerbecause How longhasitbeensinceyoulastusedanyprescription [Skip to16.9] [Skip to16.9] [Skip to16.8] [Skip to16.6] [Skip to16.9] [Only respondentswhoselected“Yes” in16.1 received [Only respondentswhoselected“Yes” in ? [Only respondentswhoselected“Yes” did you try make anyplans seriously thinkabout to killyourself? [Only tokill

At At to 16.8receivedthisquestion.] lifetime? 16.9 respondents whosaid“Yes” in16.6 receivedthisquestion.] 16.8 received thisquestion.] yourself? 16.7 16.1 receivedthisquestion.] trying tokillyourself? 16.6 At anytimeinyourlife http://www.thetrevorproject.org/section/get-help 1-866-488-7386 Project willspeakorchatwithpeople ofallages. LGBTQ people. Forthoseparticipatinginthissurvey, TheTrevor The Trevor Projectisaphoneandinternetchathotlinefor The Trevor Project http://veteranscrisisline.net/ 1-800-273-8255 andPress1 families) Veterans CrisisLine http://www.suicidepreventionlifeline.org/ 1-800-273-8255 National SuicidePreventionHelpline contact oneoftheanonymousresourcesbelow: these questionsandwouldlike totalksomeone, please If youareexperiencinganydifficultemotionsafteranswering 16.12 received thisquestion.] [Only respondentswhoselectedavalueotherthan“1”in16.9 16.11 respondents whoselected“1”in16.9receivedthisquestion.] 16.10 At anytimeinyourlife, didyou At anytimeinyourlife, didyou Yes No Yes No Yes No How manytimeshaveyoutriedtokillyourselfinyour How oldwereyouthe How oldwereyouthe How old were you when you tried to kill yourself? How oldwereyouwhentriedtokillyourself? [Drop-down listofages] [Drop-down listofages] [Drop-down listofages] last option] [Drop-down listofnumbers1–25and“morethan25”as

[Skip to17.1] [Skip to17.1] [Only respondentswhoselected“Yes” in16.3“or“Yes” [Only respondentswhoselected“Yes” in16.6

(for veterans,militarypersonnel,andtheir [Only respondentswhoselected“No” in first time

, haveyou last time make anyplans try you tried to kill yourself? youtriedtokillyourself? you tried to kill yourself? youtriedtokillyourself?

seriously thought to kill yourself? tokillyourself?

tokill [Only [Only about APPENDIX B 277 do in the past year, (Mark all that apply.) [Respondents could not select “None of [Respondents , did strangers verbally harass you in verbally harass you , did strangers , how many times were you physically ). [Only respondents who selected “Trans status/ [Only respondents who selected “Trans [Only respondents who selected “Trans status/ selected “Trans [Only respondents who [Drop-down list of numbers] In the past year, did strangers physically attack you in In the past year, No Yes With a knife frying pan, a baseball bat, With another weapon (like scissors, or stick) By something thrown (such as a rock or bottle) you By someone grabbing, punching, or choking attempted rape, Unwanted sexual contact (such as rape, being forced to penetrate) Not listed above Age Disability Income level or education identity status/gender Trans Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation None of the above Sexual orientation Sexual orientation above None of the No Yes With a gun How were you physically attacked? How were you physically attacked? In the past year In the past When you were physically attacked When you were physically attacked

Mark all that apply 17.10 17.10 or gender public because of your trans status, gender identity, expression? in 17.9 expression/appearance” gender identity” or “Gender received this question.] 17.9 of your… you believe any of those experiences were because ( in combination with any other option.] the above” 17.6 or gender trans status, gender identity, public because of your expression? in 17.5 expression/appearance” gender identity” or “Gender received this question.] received 17.3 in selected “Yes” [Only respondents who questions 17.7–17.10.] In the past year 17.7 ______attacked? 17.8 in the past [Only respondents who ) [Only respondents who selected ) did anyone physically attack you (such as did anyone verbally harass you for any did anyone verbally harass have you been denied equal treatment or have you been denied Mark all that apply. Do you believe any of those experiences were Do you believe any of those experiences were Mark all that apply. Do you believe any of those experiences were because Gender expression/appearance Race/ethnicity Religion/spirituality Age Disability Income level or education identity status/gender Trans None of the above Income level or education status/gender identity Trans Gender expression/appearance Race/ethnicity Religion/spirituality Sexual orientation Age Disability No Yes No Yes No Yes You said that you were denied equal treatment or service You You said that you have been verbally harassed said that you have been verbally You select “None of the above” in combination with any other select “None of the above” option.] 17.5 year. ( of your… could not received this question. Respondents in 17.2 “Yes” because of your… ( because of your… could this question. Respondents received in 17.1 selected “Yes” with any other in combination not select “None of the above” option.] for any reason? for any reason? 17.4 in the past year. reason? In the past year, 17.3 use a weapon) grab you, throw something at you, punch you, 17.1 In the past year, In the past year, 17.1 or agency, such as at a place of business, government service, public place for any reason? In the past year, 17.2 Section 17 Section harassed, treated unequally, about being These are questions attacked. or physically 278 2015 U.S. TRANSGENDER SURVEY https://ohl.rainn.org/online/ 800-656-HOPE (4673) National SexualAssaultHotline resources http://forge-forward.org/anti-violence/for-survivors/ tolistof 414-559-2123 FORGE Transgender SexualViolenceProject http://veteranscrisisline.net/ 1-800-273-8255 andPress1 families) Veterans CrisisLine contact oneoftheanonymousresourcesbelow: these questionsandwouldlike totalksomeone, please If youareexperiencinganydifficultemotionsafteranswering anal contactorpenetration,forcedfondling,rape)? experienced unwantedsexualcontact(suchasoral,genital,or 18.3 18.2 rape)? as oral,genital,oranalcontactpenetration,forcedfondling, 18.1 listed attheendofsection. someone youtrustorcalloneoftheanonymoushelplines of thesequestionsweencourageyoutogethelpfrom population. Ifyouexperienceanydifficultemotionsbecause on nationalsurveysthatwewillusetocomparewiththeU.S. supervisor, orafamilymember. Thesequestionsarebased romantic orsexualpartner, afriend,teacher, acoworker, a ask for. Itcouldcomefromsomeonetheyknowwell-a people getsexualattentionthattheydon’t wantanddon’t These arequestionsaboutunwantedsexualcontact.Some Section 18 Have youeverexperiencedunwantedsexualcontact(such Now justthinkingabout Yes No A personnotlistedabove A teacherorschoolstaffmember A co-worker A bossorsupervisor A stranger A healthcareprovider/doctor A lawenforcementofficer A friend/acquaintance A relative A partner/ex-partner Yes No Who didthistoyou?

[Skip to19.1]

(for veterans,militarypersonnel,andtheir

(Mark allthatapply.)

thepastyear

, haveyou

( 19.2 19.1 physical, emotional,orfinancialharm. or formerromanticsexualpartner. Thiscouldinclude These arequestionsaboutanyharmcausedbyacurrent Section 19 ( 19.3 Please provideananswerineachrow. Please provideananswerineachrow. away fromyou Threatened tohurtapetorthreatenedtake apet Hurt someoneyoulove to go Kept youfromleavingthehousewhenwanted Kept youfromhavingmoneyforyourownuse or friends Tried tokeep youfromseeingortalkingtoyourfamily Used aknifeorgunonyou Burned youonpurpose Beaten you Tried tohurtyoubychokingorsuffocating you Forced youtoengageinsexualactivity Slammed youagainstsomething Hurt youbypullingyourhair Kicked you Hit youwithafistorsomethinghard Pushed orshovedyou Slapped you Made threatstophysicallyharmyou Threatened touseyourimmigrationstatusagainstyou Stalked you Told youthatweren’t a“real”womanorman Threatened to“out”you Threatened tocallthepoliceonyou Wouldn’t letyouhaveothermedications Wouldn’t letyouhaveyourhormones Have youeverhadaromanticorsexualpartner? Have anyofyourromanticorsexualpartnersever...? Have anyofyourromanticorsexualpartnersever...? Yes No [Skip to20.1] ) ) No O O O O O O O O O O O O No O O O O O O O O O O O O Yes Yes O O O O O O O O O O O O O O O O O O O O O O O O APPENDIX B 279 [Only respondents who

[Skip to 21.1] [Only respondents who selected , did you avoid going to the bathroom , did you avoid going to (Mark all that apply.) (Mark all that apply.) [Skip to 21.6] [Skip to 21.4] (Mark all that apply.) (Mark all that apply.) Did you experience any of the following because you Did you experience any of the following because Yes Yes 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) ______No Yes No A bathroom in a public place (such as a restaurant, in a public place (such A bathroom etc.) movie theater, shopping mall, at my workplace A bathroom at my school A bathroom location A bathroom at another (please specify) ______I have never avoided them them I have sometimes avoided them I have always avoided specify) ______Not listed above (please Have you ever lost a job or been laid off? Do you believe that you were ever laid off or lost a job Have you ever worked at a job or business? Do not at a job or business? Have you ever worked 21.3 because of your… this question. Respondents in 21.2 received selected “Yes” in combination with any could not select “None of the above” other option.] Section 21 have happened These are questions about things that might were looking for to you at your job or business, or while you work. 21.1 include sex work, selling drugs, or other work that is currently considered illegal. 21.2 20.7 In the past year 20.7 This of having problems using them? because you were afraid in public, at work, or at school. would include bathrooms 20.8 work, or at avoided using bathrooms in public places, at school? them” in an answer choice other than “I have never avoided received this question.] 20.8

in a bathroom in a bathroom (Mark all that apply.) (Mark all that apply.) (Mark all that apply.) (Mark all that apply.) (Mark all that apply.) (Mark all that apply.)

physically attacked verbally harassed experienced unwanted sexual contact did anyone tell or ask you if you were did anyone tell or ask you [Only respondents who selected “Yes, [Only respondents who selected “Yes, , did anyone stop you from entering or , did anyone stop you from , were you verbally harassed, physically [Skip to 20.7] You said that you were You You said that you were You You said that you You A bathroom at my workplace A bathroom at my school A bathroom at another location (please specify) ______A bathroom in a public place (such as a restaurant, etc.) shopping mall, movie theater, shopping mall, movie theater, etc.) shopping mall, movie theater, A bathroom at my workplace A bathroom at my school A bathroom at another location (please specify) ______A bathroom in a public place (such as a restaurant, A bathroom in a public place (such as a restaurant, No verbally harassed Yes, physically attacked Yes, experienced unwanted sexual contact Yes, No Yes No Yes in a bathroom in the past year. Where did this happen? in a bathroom in the past year. (Mark all that apply.) received this experienced unwanted sexual contact” in 20.3 question.] 20.6 20.5 20.5 Where did this happen? in the past year. in physically attacked” [Only respondents who selected “Yes, received this question.] 20.3 20.4 20.4 Where did this happen? in the past year. verbally harassed” in [Only respondents who selected “Yes, received this question.] 20.3 [Respondents could not select “No” in combination with any could not select “No” [Respondents other option.] 20.3 In the past year 20.3 when or experience unwanted sexual contact attacked, accessing or while using a bathroom? 20.1 In the past year, In the past year, 20.1 using the wrong bathroom? In the past year 20.2 deny you access to a bathroom? Section 20 Section experiences with bathrooms about your These are questions at school. places, at work, or while in public 280 2015 U.S. TRANSGENDER SURVEY provide ananswerineachrow. 21.7 Inthepastyear combination withanyotheroption.] (Mark allthatapply.) selling drugs,orotherworkthatiscurrentlyconsideredillegal. job and/orworkataorbusiness? Donotincludesexwork, 21.6 Nowjustthinkingaboutthepast other option.] could notselect“Noneoftheabove” incombinationwithany selected “Yes” in21.4receivedthisquestion.Respondents because ofyour… 21.5 21.4 resign fromajob Fired orforcedto applied for you Not hiredforajob at ajob Denied apromotion In thepastyear

Have youeverbeenfiredorforcedtoresignfromajob? Yes, Iworked atjobor business Yes, Iappliedforajob No None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age Yes No None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age Do youbelievethatwereeverfiredorforcedtoresign [Skip to22.1] [Skip to21.6] … (Mark allthatapply.) times , howmanytimeshaveyoubeen…( [Respondents couldnotselect“No” in O O O 0 time O O O 1 ) times O O O 2

year [Only respondentswho times O O O 3 , didyouapplyfora times O O O 4 times more 5 or Please O O O

a valueotherthan“0”under“Nothiredforjobyouapplied of your… hired forajobyouapplied 21.8_2 “None oftheabove” incombinationwithanyotheroption.] in 21.7 receivedthisquestion.Respondents couldnotselect a valueotherthan“0”under“Deniedpromotionatjob” your… denied apromotionatjob 21.8_1 option.] select “Noneoftheabove” incombinationwithanyother a job” in21.7 receivedthisquestion.Respondents couldnot a valueotherthan“0”under“Firedorforcedtoresignfrom of your… or forcedtoresignfromajob 21.8_3 “None oftheabove” incombinationwithanyotheroption.] for” in21.7 receivedthisquestion.Respondents couldnotselect None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age (Mark allthatapply.) Do youbelievethatanyofthetimeswere Do youbelievethatanyofthetimeswere Do youbelievethatanyofthetimeswere (Mark allthatapply.) (Mark allthatapply.) [Only respondentswhoselected in thepastyearwerebecauseof [Only respondentswhoselected [Only respondentswhoselected in thepastyearwerebecause in thepastyearwerebecause fired not APPENDIX B 281 O O O O O O O O O O O O O O O O O Yes Yes O O O O O O O O O O O O O O O O O No No (Please provide an (Mark all that apply.) (Mark all that apply.) trans discrimination at work… trans discrimination at avoid , did any of these things happen to you , did any of these things happen to , to I was physically attacked I experienced unwanted sexual contact (such as fondling, sexual assault, or rape) None of the above I was verbally harassed My employer/boss forced me to resign in the past year. My employer/boss forced me to transfer to a different position/department at my job in the past year. My employer/boss removed me from direct contact with clients, customers, or patients in the past year. My employer/boss told me to present in the wrong gender my job in the past year. in order to keep My employer/boss gave me a negative job review in the past year. My employer/boss and I could not work out an acceptable bathroom situation in the past year. My employer/boss did not let me use the bathroom I should be using based on my gender identity in the past year. shared information about My employer/boss or coworkers me that they should not have in the past year. I asked for a transfer to a different position/department at for a transfer to a different I asked my job in the past year in the past year I stayed in a job I’d prefer to leave in the past year seek a promotion or a raise I didn’t I quit my job in the past year over-qualified (in the past I had/have a job for which I am year) my gender identity in the I had to be in the closet about past year I delayed my gender transition in the past year I did not ask my employer to use the pronouns I prefer in or they) she, the past year (such as he, I hid the fact that I have transitioned gender already in the past year 22.2 In the past year because of trans discrimination at work? answer in each row.) 22.3 In the past year you at work because you are trans? in could not select “None of the above” [Respondents combination with any other option.] Section 22 Section or at a job I worked who selected “Yes, [Only respondents 22.1–22.3.] received questions in 21.6 business” In the past year 22.1 in each row.) (Please provide an answer [Skip fired or forced to fired or forced in the past year. in the past year. Mark all that [Skip to 22.1] in the past year. What did in the past year. [Only respondents who selected “I [Skip to 22.1] because of your gender identity, trans status, trans status, identity, because of your gender (Mark all that apply.) fired or forced to resign from a job [Only respondents who selected “I made an official [Only respondents who selected “I made an ) You said that you contacted a lawyer in response to being You You said that you made an official complaint in response You Equal Employment Opportunity (EEO) office of the employer Not listed above (please specify) ______EEOC (Equal Employment Opportunity Commission Human Rights Commission Local/State department of the or Personnel The Human Resources employer The lawyer filed a lawsuit for me. Not listed above (please specify) ______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. I contacted my union representative. I contacted my union representative. I made an official complaint. specify) ______Not listed above (please [Skip to 22.1] I did nothing I contacted a lawyer. group. or other non-profit I contacted a trans, LGBT, to 22.1] Now just thinking about when you were about when you Now just thinking apply. complaint” in 21.9 received this question.] 21.11 21.11 to being the official complaint? ( Where did you make 21.10 21.10 fired or forced to resign from a job the lawyer do to help you? contacted a lawyer” in 21.9 received this question.] resign from a job please describe in the past year, and/or gender expression your response. [Only respondents who selected “Trans status/gender identity” status/gender identity” who selected “Trans [Only respondents in 21.8_3 received expression/appearance” or “gender questions 21.9–21.11.] 21.9 282 2015 U.S. TRANSGENDER SURVEY combination withanyotheroption.] question. Respondents couldnotselect“Noneoftheabove” in denied accesstooneormoreshelters” in24.1 receivedthis that apply.) homeless shelterinthepastyear because ofyour… 24.2 with a“Yes” answer.] [Respondents couldnotselecta“No” answerincombination you seekshelterinahomelessshelter? 24.1 in 23.2receivedquestions24.1–24.4.] [Only respondentswhoselected“Iexperiencedhomelessness” Section 24 have beenevicted. not applytome” tothefirstquestionbecauseyoucouldnot didn’t rentahomeinthepastyear, youwouldanswer“Does had thathousingsituationinthepastyear. Forexample, ifyou Please choose“Doesnotapplytome” ifyoucouldnothave provide ananswerineachrow.) of thesehousingsituations 23.2 Nowjustthinkingaboutthepastyear family orfriendsbecauseyoucan’t affordhousing. on thestreet,livingoutofacar, orstayingtemporarily with homelessness includessuchthingsasstayinginashelter, living 23.1 with housing. These arequestionsaboutexperiencesyoumayhavehad Section 23 time, such asonafriend’s couch. I sleptindifferentplacesforshortperiodsof apartment. I hadtomoveintoalessexpensivehome/ friends. I hadtomovebackinwithfamilymembersor I experienced I wasdeniedahome/apartment. I wasevictedfrommyhome/apartment. In thepastyear... Have youeverexperiencedhomelessness? Experiencing When youexperiencedhomelessness No, forotherreasons person No, becauseIfearedwouldbemistreatedasatrans Yes, butIwasdeniedaccess tooneormoreshelters. Yes, andIstayedatoneor moreshelters. Yes No Do youbelievethatweredeniedaccesstoa homelessness [Only respondentswhoselected“Yes, but Iwas [Skip to25.1] . 29 [Skip to25.2] becauseyouaretrans? (Please (Mark allthatapply.) Yes O O O O O O this pastyear , haveyouhadany [Skip to24.3] No O O O O O O (Mark all Does not apply to , did me O O O O O O more shelters” in24.1 receivedthisquestion.] [Only respondentswhoselected“Yes, andIstayedatoneor the homelessshelter?( 24.3 Inthepastyear places” incombinationwithanyotheroption.] not select“Ihavevisitedorusedservicesinanyofthese of theseplaces? 25.1 Inthepastyear, government agencies. public accommodations,suchashotels,restaurants,or These arequestionsaboutyourexperiencesinplacesof Section 25 combination withanyotheroption.] Respondents couldnotselect“Noneoftheabove” in at oneormoreshelters” in24.1 receivedthisquestion. apply.) in ahomelessshelterbecauseyouaretrans? 24.4 Inthepastyear the shelter. They requiredmetodress/presentasthewronggenderin in ashelter. I decidedtodress/presentasthewronggenderfeelsafe I wasthrownoutaftertheylearnedtrans. unsafe conditions,eventhoughIhadnoplacetogo. I decidedtoleaveashelterbecauseofpoortreatmentor None oftheabove Sexual orientation Religion/spirituality Race/ethnicity Gender expression/appearance Trans status/genderidentity Income leveloreducation Disability Age Social Securitycard,publicbenefits) Social Securityoffice(suchasfor nameorgenderchange, DMV orRMV(DepartmentRegistry ofMotorVehicles) Drug/alcohol treatmentprogram Domestic violenceshelter/DV program/Rape crisiscenter None oftheabove sexual assault,orrape) I experiencedunwantedsexualcontact(suchasfondling, I wasphysicallyattacked I wasverballyharassed [Only respondentswhoselected“Yes, andIstayed (Mark allthatapply.) , didanyofthesethingshappentoyouin , didanyofthesethingshappentoyou have youvisitedorusedservicesinany Please provideananswerineachrow. [Respondents could (Markallthat No O O O O Yes O O O O )

APPENDIX B 283 O O O O O O O O YES O O O O O O O NO O O O O O O O O NO O O O O O O O YES - Please provide an Please provide an [Only respondents who selected “No” [Only respondents who selected “No” [Only respondents who selected “Yes” in selected “Yes” [Only respondents who ) ) Did any of these happen to you while in K-12? (If any of Did any of these happen to you while in K-12? Did any of these happen to you while in K-12? (If any of to you while in K-12? Did any of these happen Do you believe that any of your classmates, teachers or teachers or that any of your classmates, Do you believe No Yes No Yes I left a school because the mistreatment was so bad. I was expelled from school. I wasn’t allowed to dress in the way that fit my gender I wasn’t identity/expression. I was disciplined for fighting back against bullies. I believe I was disciplined more harshly because teach ers/staff thought I was trans. I left a school because the mistreatment was so bad. I was expelled from school. I was verbally harassed because people thought I was LGBQ. because people I was physically attacked thought I was LGBQ. I experienced unwanted sexual contact because people thought I was LGBQ. allowed to dress in a way that fit my I wasn’t gender identity/expression. I was disciplined for fighting back against bullies. I was verbally harassed because people thought I was trans. I was because people thought I was physically attacked trans. I experienced unwanted sexual contact because people thought I was trans [Only respondents who selected a level of educational in 2.22 received attainment higher than “high school graduate” questions 26.6–26.9.] 26.5 teachers, by classmates, these things were done to you in K-12 ( please answer “yes.”) or school staff, answer in each row. in 26.3 received this in 26.2, AND “Yes” AND “No” in 26.1, question.] 26.3 or knew you were lesbian, gay, K-12 thought school staff in bisexual, or queer (LGBQ)? 26.4 by classmates, teachers, to you in K-12 these things were done ( please answer “yes.”) or school staff, answer in each row. in 26.2 received this question.] or “Yes” 26.1

O of the thought O None of these Yes O things happened to me at this place each of the locations of the locations O O each each Yes (I did NOT visit because I (I did NOT Yes No grade (K-12) grade (K-12) attacked thought I would be mistreated) Physically th visit or use services at visit or use services at O No O NOT Verbally Verbally harassed (Please give an answer for each , did you , when you visited or used services at , when you visited or used services at selected in 25.1.] (Please give an answer for each place.) for each place.) (Please give an answer

O [Only respondents who selected “No” in 26.1 in 26.1 [Only respondents who selected “No” service (Please provide an answer for each location.) (Please provide an answer for each location.) treatment or Denied equal [Skip to 26.3] [Respondents received this question for [Respondents Do you believe that any of your classmates, teachers, or No Yes Nursing home/extended care facility Nursing home/extended taxi) as bus, train, subway, Public transportation (such restaurant, hotel, theater store, Retail services in any of these places. I have not visited or used Public assistance/government benefits office (such as benefits Public assistance/government WIC) SNAP, club Gym/health professional clinic, or legal attorney, services from an Legal Court/court house Were you out as trans in school at any time between Were 25.1] [Location [Location selected in [Location selected in 25.1] selected [Location [Location not selected in 25.1] not [Location 26.2 school staff in Kindergarten through 12 you were trans? received this question.] 26.1 26.1 Kindergarten and 12th grade? Section 26 These are questions about experiences you may have had in school. you are trans? received this question for [Respondents that they selected in 25.1.] 25.4 In the past year to you because these places, did any of these things happen 25.3 In the past year knew or these places, do you think the staff or employees thought you were trans? place.) locations that they 25.2 In the past year you thought you would be mistreated these places because as a trans person? for received this question [Respondents that they did not select in 25.1.] 284 2015 U.S. TRANSGENDER SURVEY combination withanyotheroption.] Respondents couldnotselect“Noneoftheabove” in all thatapply.) year, did aTSA officerdoanyofthesethingstoyou? 27.2 the UnitedStates? 27.1 Inthepastyear you whengoingthroughairportsecurity. These arequestionsaboutthingsthatmayhavehappenedto Section 27 other option.] [Respondents couldnotselect“No” incombinationwithany vocational schoolbecauseyouaretrans? 26.9 selected “Yes” in26.7 receivedthisquestion.] because theharassmentwassobad? 26.8 received thisquestion.] you weretrans? college orvocationalschoolbecausepeoplethoughtknew 26.7 were trans? your collegeorvocationalschool,didtheythinkknowyou 26.6 as binder, packer). They searchedmybagduetoagender-related item(such I waspatteddownbyaTSA officerofthewronggender. items (suchasabinder, packer). They pattedmedownduetogender-related clothingor her) orwrongtitle(Mr. orMs.) They usedthewrongpronounswithme(he/himorshe/ They questionedthenameorgenderonmyID. Yes No Yes, Ileftforothertrans-relatedreasons. Yes, Iwasexpelledorforcedout. Yes, Ileftschoolbecausethemistreatmentwassobad. No Yes No Yes No Yes No When youwentthroughairportsecurityinthepast Were youharassed(verbally, physically, orsexually)at Now justthinkingaboutclassmates,professors,orstaffat Did youhavetoleaveyourcollegeorvocationalschool Did youleaveorwereforcedtoacollege [Skip to28.1] [Skip to26.9] [Skip to26.9] [List wasrandomizedforeachrespondent. [Only respondentswhoselected“Yes” in26.6 , haveyougonethroughairportsecurityin [Onlyrespondentswho (Mark allthatapply.) (Mark These arequestionsaboutthingsthathappenedtoyouwith Section 28 law enforcementofficers,wereyoutreatedwithrespect? 28.4 Inthepastyear were trans? enforcement officersyouinteractedwiththoughtorknew 28.3 Inthepastyear law enforcementofficers? 28.2 Inthepastyear you feelaskingthemforhelp? 28.1 police, injail,prison,orajuveniledetention center. If youneededhelpfromthepolice, howcomfortablewould None oftheabove pat downbyaTSA officer) I experiencedunwantedsexualcontact(beyondatypical They physicallyattacked me. They verballyharassedme. They detainedmeforoveranhour. I wasnotallowedtofly. I missedmyflightduetoscreening. They calledthepoliceaboutme. parts, orsensitiveitems(suchasabinder, packer). They announcedorquestionedloudlymygender, body examination. They tookmetoaseparateroomforquestioning/ undergarment, orothersensitivearea. They asked metoremoveorliftclothingshowabinder, I wasalwaystreatedwithrespect. I wassometimestreatedwithrespect. I wasnevertreatedwithrespect. All officersthoughtorknewIwastrans. Some officersthoughtorknewIwastrans,somedidnot. 28.6] None oftheofficersthoughtorknewIwastrans. Yes No Very uncomfortable Somewhat uncomfortable Neutral Somewhat comfortable Very comfortable [Skip to28.8] , doyoubelievethepoliceorotherlaw , whenyouinteractedwithpoliceorother , didyouinteractwiththepoliceorother [Skip to APPENDIX B 285

assaulted or attacked by assaulted or attacked assaulted or attacked by assaulted or attacked physically physically , how many times did this happen to you? , during your time in jail, prison or juvenile , during your time in jail, prison or juvenile , during your time in jail, , during your time in jail, prison or juvenile , how many times did this happen to you? happen to you? , how many times did this , how many times did this happen to you? , how many times did this happen to you? to you? times did this happen , how many ? ? ? [Skip to 28.18] [Skip to 29.1] [Skip to 28.14] [Skip to 28.16] [Drop-down list of numbers 1–10 and “11 or more”] [Drop-down list of numbers 1–10 and “11 or more”] [Drop-down list of numbers 1–10 and “11 or more”] list of numbers 1–10 and [Drop-down [Drop-down list of numbers 1–10 and “11 or more”] Did you have a prescription for the hormones you were Before your time in jail, prison, or juvenile detention, were No Yes Yes No Yes No Yes No Yes No 28.19 28.19 taking? 28.15 In the past year 28.15 received this in 28.14 [Only respondents who selected “Yes” question.] In the past year 28.16 detention facility were you another inmate In the past year 28.17 received this in 28.16 [Only respondents who selected “Yes” question.] 28.18 you taking hormones? 28.11 In the past year In the past 28.11 received this in 28.10 who selected “Yes” [Only respondents question.] In the past year 28.12 or were you physically forced, pressured, detention facility, to have sex or sexual contact with made to feel that you had another inmate In the past year 28.13 received this 28.12 in selected “Yes” [Only respondents who question.] In the past year 28.14 detention facility were you facility staff O O O O O O O Yes O O O O O O O No

(Mark all that apply.) , during your time in jail, prison or juvenile

, what types of jail, prison or juvenile , when you interacted with police or other interacted with police , when you , at any time were you held in jail, prison, , were you arrested for any reason? , do you believe that you were arrested ? [Skip to 28.12] [Skip to 29.1] [Skip to 28.8] In the past year

(Please give an answer in each row.) (Please give No Yes Locally or privately-operated juvenile facilities Locally Other correctional facility (please specify) ______Federal prison prison State jail Local Holding cell juvenile system State Yes No Yes Yes No No facility staff Officers forced me to engage in sexual activity to Officers forced me to engage avoid arrest contact from an I experienced unwanted sexual assault, or rape) officer (such as fondling, sexual pronouns (such as he/him or she/her) or wrong title pronouns (such as he/him or she/her) or Ms.) (Mr. me questions about my gender Officers asked surgical status). transition (such as hormones and worker. Officers assumed I was a sex me. Officers verbally harassed me. Officers physically attacked In the past year… me by the wrong gender kept called Officers any 28.10 detention facility were you physically forced, pressured, or made to feel that you had to have sex or sexual contact with [Only respondents who selected “Yes” in 28.8 received [Only respondents who selected “Yes” questions 28.9–28.20.] 28.9 In the past year detention facility were you in? 28.8 In the past year or juvenile detention? 28.7 In the past year 28.7 because you were trans? 28.6 In the past year 28.6 28.5 In the past year 28.5 In the to of these things happen officers, did any law enforcement you? 286 2015 U.S. TRANSGENDER SURVEY “Yes” in29.2 receivedthisquestion.] choose onlyoneresponse.) 29.4 respondents whoselected“No” in29.2 receivedthisquestion.] registered tovote? 29.3 received thisquestion.] election 29.2 November 4,2014 not wanttovote. Didyouvoteintheelectionheld on they aresickorbusyhavesomeotherreason,andothersdo 29.1 Now wehavesomequestionsaboutvotingandregistration. Section 29 hormones? or juveniledetention,wereyounotallowedtotake your 28.20 In anyelection,somepeoplearenotabletovotebecause Were youregisteredtovoteinthe (please specify)______A reasonnotlistedabove felony conviction. Not eligibletovoteforareasonotherthancriminal/ conviction. Not eligibletovotebecauseofacriminal/felony My votewouldnotmake adifference. Not interestedintheelectionornotinvolvedpolitics. Difficulty withEnglish Permanent illnessordisability requirements. Did notliveherelongenough/didmeetresidency Did notknowwhereorhowtoregister Did notmeetregistrationdeadlines. I don’t haveIDandthoughtIwouldneedonetoregister. voting. I thoughtmystate’s voterIDlawcould stop mefrom My currentnamedoesnotmatchsocialsecuritycard. because Iamtrans. I wantedtoavoidbeingharassedbyelectionofficials Not eligibletovotebecauseIamnotaU.S. citizen. Yes No Yes No Yes No Which ofthefollowingwasMAINreasonyouwerenot What wastheMAINreasonyoudid notvote?

In thepastyear 31 [Skip to29.4] [Skip to30.1] ? [Only respondentswhoselected“No” in29.1 30 (Please chooseonlyoneresponse.) ? , duringyourtimeinjail,prison, [Only respondentswhoselected

November 4,2014 (Please Tuesday, [Only following order.] keeping thefirsttwoandlastgroupedtogetherin an answerineachrow. the last 30.2 Someone like mecan’t reallyinfluencegovernmentdecisions. about politicalaffairsinthiscountry? 30.1 These arequestionsaboutcivicandpoliticalactivities. Section 30 cause Give moneytoanotherpoliticalcandidate, issue, or Give moneytoaPresidentialcampaign issue, orcause Volunteer orworkforanotherpoliticalcandidate, Volunteer orworkforaPresidentialcampaign In thelastPresidentialelectionin2012didyou… Do youagreeordisagreewiththefollowingstatement not matchmyvoterregistration. My gender/nameonmyidentificationdocument(ID)does name, gender, orhaveanoldphoto. My identificationdocuments(ID)donotmatchmycurrent vote. I didn’t havetheidentificationdocuments(ID)Ineededto long Inconvenient hours,pollingplace, orhourslinestoo Bad weatherconditions absentee ballotorwasn’t registeredincurrentlocation) Registration problems(forexample, Ididn’t receivean Didn’t like candidatesorcampaignissues. Transportation problems Too busy, conflictingworkorschoolschedule Not interested,feltmyvotewouldn’t make adifference Forgot tovote(orsendinabsenteeballot) Out oftownorawayfromhome Illness ordisability(ownfamily’s) because Iamtrans. I wantedtoavoidbeingharassedbyelectionofficials Strongly disagree Disagree Neither agreenordisagree Agree Strongly agree (please specify)______A reasonnotlistedabove official becauseIamtrans. I wasnotallowedtovotebyapollworker orelection People maybeinvolvedincivicandpoliticalactivities.In Presidential electionin2012 ) [Response choiceswererandomized,

32 didyou…( No Please provide Yes APPENDIX B 287 O O O O O O O O O O O O O O O O O Not very important ) O O O O O O O O O O O O O O O O O Important

O O O O O O O O O O O O O O O O O [Only respondents Very Very important Please provide an answer in each row. Please provide an answer [Drop-down list of issues listed in 31.1] [Drop-down list of issues listed in 31.1] [Drop-down list of issues listed in 31.1] [Responses were submitted and respondents were directed [Responses [Text box] [Text SUBMIT Please tell us anything else that you would like to tell us about Please tell us anything else that you would like Issue#1 Issue#2 Issue#3 No hosted by NCTE.] Page to the Thank You Yes Of these issues, please select your top 3 most important issues. Of these issues, please select your top 3 most Is there anything else that you would like to tell us about your Is there anything else that you would like For each issue below that affects trans people in the U.S., please affects trans people in the For each issue below that Employment Housing and homelessness Violence against trans people and adoption rights Parenting Marriage recognition Conversion Therapy Racism Poverty HIV/AIDS name and gender) Identity documents (ID) (updating Bullying/discrimination in schools mistreatment of trans people Police Mistreatment in prisons/jails Immigration reform Military (ability to be openly trans) health health care providers about trans Training Insurance coverage for trans-related health care your experiences of acceptance or discrimination so we can better understand your experiences. Please do not provide any information that could be used to identify you, such as your name or contact response will be anonymous. information. Your received this question.] in 32.1 who selected “Yes” Please enter your survey responses by clicking on the submit button below: 31.2 Section 32 32.1 experiences of acceptance or discrimination so we can better understand your experiences? 32.2 Section 31 Section policy on the most important asks for your opinion This question States. trans people in the United priorities for question: This is a two-part 31.1 is. ( mark how important it could select up to Respondents choices were randomized. [Response the last column.] 3 response choices in Yes No Please provide an Please provide have you… ( have you… [Only respondents who selected [Response choices were randomized.] [Response

) [Skip to 30.6] [Skip to 30.6] As of today, do you lean more to the Democratic Party more to the Democratic Party do you lean As of today, In politics, as of today, do you consider yourself a do you consider yourself In politics, as of today, Conservative Moderate Liberal liberal Very Democratic Republican Neither/Other conservative Very Independent ______specify) (please party Other Republican Republican Democrat How would you describe your political views? Held a publicly elected office Worked with others in your community to solve a Worked problem Served on a community board a “letter to the editor” Written a message board or Commented about politics on Internet site In the past 12 months, have you… In the past 12 months, protest or rally a political Attended Contacted a government official 30.6 30.5 30.5 Party? or the Republican received this question.] party” in 30.4 “Independent” or “Other 30.4 30.4 a Democrat, or an Independent? Republican, 30.3 In the past 12 months 30.3 row. answer in each 288 2015 U.S. TRANSGENDER SURVEY 2 1 SUBMIT responses. This informationwillnotbeconnectedtoyoursurvey Give usyourinfohere. Want towinoneofthecashprizes? Want tobeoneofthefirstgetsurveyresults? YOUR SURVEY HAS BEENSUBMITTED THANK YOU FORMAKINGYOUR VOICE HEARD Thank You Page were directedtotheThankYou Page hostedbyNCTE.] [Once completed,responsesweresubmittedandrespondents ENDNOTES

one prizeof$500andtwoprizes$250! [ ]Entermeinthedrawingforoneofthreecashprizes: them! [ ]Sendmetheresultsofsurveywhenyourelease Phone (optional) Zip Code(required) Email address Preferred name identify you,suchasyournameorcontactinformation. do not more, pleaserespondtothefollowingquestions.Please your identityandexperiences.Ifyouwouldlike totellus survey responses.We’re interested tolearnmoreabout received thefollowingmessage:“Thankyouforyour Respondents whoweresenttodisqualificationpage#1 website: http://www.ustranssruvey.org.” information aboutthisprojectpleasevisittheNCTE for yourinterestinparticipatingthisstudy. Formore you arenoteligibletocompletethissurvey. Thankyou received thefollowingmessage:“Basedonyouranswers, Respondents whoweresenttodisqualificationpage#2 identity orexpression. Tell usaboutyourexperiencesrelatedto your gender box.] Tell usaboutyourgenderidentityorexpression. provide anyinformationthatcouldbeusedto |APPENDIXB [Text box.] ” [Text http://www.thetrevorproject.org/section/get-help 1-866-488-7386 Project willspeakorchatwithpeopleofallages. LGBTQ people. Forthoseparticipatinginthissurvey, TheTrevor The Trevor Projectisaphoneandinternetchathotlinefor The Trevor Project http://veteranscrisisline.net/ 1-800-273-8255 andPress1 families) Veterans CrisisLine resources http://forge-forward.org/anti-violence/for-survivors/ tolistof 414-559-2123 FORGE Transgender SexualViolenceProject http://www.suicidepreventionlifeline.org/ 1-800-273-8255 National SuicidePreventionHelpline below: to someone, pleasecontactoneoftheanonymous resources emotions afteransweringthequestionsandwouldlike totalk survey mayhavebeenhard.Ifyouareexperiencinganydifficult We recognizethatansweringsomeofthequestionsonthis RESOURCES 6 5 4 3 https://ohl.rainn.org/online/ 800-656-HOPE (4673) National SexualAssaultHotline been calledupforactiveduty, mobilized,ordeployed.For Reserves or NationalGuard”box ifthepersonhasnever Guard, markthe“Only onactive dutyfortraininginthe person withserviceinthemilitary Reserves orNational the fiveUnited States MilitaryServiceAcademies.Fora also appliestoapersonwhoiscadetattendingoneof Environmental ScienceServiceAdministration.Activeduty or itspredecessors,theCoastandGeodeticSurvey the NationalOceanicandAtmospheric Administration, a commissionedofficerofthePublicHealthServiceor Army, Navy, AirForce, MarineCorps,CoastGuard,oras other thanactivedutyfortrainingasamemberofthe for “activeduty”:“Active duty meansfull-timeservice, Respondents receivedthefollowinghyperlinked definition See note2. See note2. See note1.

(for veterans,militarypersonnel,andtheir

APPENDIX B 289 Respondents received the following hyperlinked definition received the following hyperlinked Respondents “Marijuana is also called pot or for “marijuana or hashish”: either in cigarettes, grass. Marijuana is usually smoked, in food. It is sometimes cooked called joints, or in a pipe. Hashish is a form of marijuana that is also called ‘hash.’ Another form of hashish is in a pipe. It is usually smoked hash oil.” Respondents received the following hyperlinked definition received the following hyperlinked Respondents includes “‘Household income’ for “Household Income”: have lived you and all members of your household who money with you during the past 12 months and includes income from jobs, employment, net income from business, from farms or rentals, income from self-employment, payments, pensions, dividends, interest, social security and and any other money income received by you of age or members of your household who are 15 years food stamps older in 2014. Do not include assistance from (SNAP) or WIC as income.” note received the following hyperlinked Respondents not include regarding the term “had a drink”: “Please do a drink.” any time when you only had a sip or two from definition received the following hyperlinked Respondents wine, beverages, such as beer, for “alcohol”: “Alcoholic drinks.” and mixed brandy, definition received the following hyperlinked Respondents Do not made of tobacco. “Cigarettes for “cigarettes”: include electronic cigarettes (E-cigs).” definition received the following hyperlinked Respondents “This includes for “e-cigarettes or vaping products”: electronic cigarettes (e-cigs or e-cigarettes), personal vaporizer (PV), or electronic nicotine delivery system (ENDS), all of which are battery-powered vaporizers that feel similar to tobacco smoking.” about income, don’t include assistance from food stamps from food stamps include assistance don’t about income, as income.” (SNAP) or WIC following hyperlinked received the Respondents “Individual income” “Individual Income”: definition for net income from from jobs, employment, includes money farms or rentals, income from self- business, income from dividends, interest, social security employment, pensions, income that you personally payments, and other money include assistance from food received in 2014. Do not as income.” stamps (SNAP) or WIC definition hyperlinked received the following Respondents includes you and “‘Family income’ for “Family Income”: related by legally-recognized members of your family have lived with by birth, or by adoption who marriage, and includes money from you during the last 12 months income from business, income from jobs, employment, net pensions, farms or rentals, income from self-employment, and any dividends, interest, social security payments, members other money income received by you and family older in in your household who are 15 years of age or (SNAP) 2014. Do not include assistance from food stamps or WIC as income.” 23 18 19 20 21 22 16 17 includes all the adults A household Respondents who selected multiple answer choices in this Respondents “OK” question received the following message and clicked to proceed: “Please note that for upcoming questions the message and clicked “OK” to proceed: “Please note “OK” the message and clicked include don’t that for upcoming questions about income, food stamps (SNAP) as income.” who selected this answer choice received Respondents to proceed: “For upcoming “OK” the message and clicked include assistance from don’t questions about income, WIC as income.” for “WIC”: “‘WIC’ stands for ‘Women, Infants, and Children.’ Infants, and Children.’ for “WIC”: “‘WIC’ stands for ‘Women, the short name for the Special Supplemental Nutrition It’s Children. WIC is a Infants, and Program for Women, federal program to help women who are pregnant or breastfeeding and children less than five years old get health care and healthy food.” who selected this answer choice received Respondents Respondents received the following hyperlinked definition received the following hyperlinked Respondents for “SNAP”: “The Supplemental Nutrition Assistance Stamp Program (SNAP) is sometimes called the Food income to program. It helps people who have low or no card.” buy food, usually with an EBT definition received the following hyperlinked Respondents Respondents received the following hyperlinked note received the following hyperlinked Respondents include regarding the term “related to you”: “Do not by legal children that are not related to you by birth or children your unmarried partner’s adoption. For instance, legally would not be included here unless you have ask about these members of your adopted them. We household elsewhere in the survey.” Respondents received the following hyperlinked note received the following hyperlinked Respondents or mortgage, regarding the term “named on the lease, the lease, deed”: “This includes people who are listed on If your home is not or deed for your home. mortgage, include owned or rented by anyone who lives with you, roomers, boarders, or paid any adult in the home except employees.” Respondents received the following hyperlinked note hyperlinked received the following Respondents to you”: “Include only adults regarding the term “related legal adoption, or legal you’re related to by blood, government. Do by the U.S. marriage that is recognized adults. not include your unmarried partner or unrelated we will ask about the people not included here.” Later Respondents received the following hyperlinked definition hyperlinked received the following Respondents for “household”: “ apartment, group same house, who live with you in the If you live in is used as one home. of rooms, or room that yourself only include a dormitory, group housing, such as who live with you. and your adult family members a person whose only service was as a civilian employee as a civilian employee only service was a person whose Public Health USO, Cross, for the Red or civilian volunteer mark the ‘Never or Defense Department, or War Service, Marine service, For Merchant military’ box. served in the duty II as active War service during World count only the service.” and no other period of 15 14 13 11 12 10 9 8 7 290 2015 U.S. TRANSGENDER SURVEY 32 31 30 28 27 26 29 25 24 2012 betweenMittRomney andBarackObama.” regarding thisterm:“Thiswasthepresidentialelectionin Respondents receivedthefollowinghyperlinked note members oftheU.S. Congressandstate-leveloffices.” “This wastheelectioninNovember2014toelect Respondents receivedthefollowinghyperlinked note: members oftheU.S. Congressandstate-leveloffices.” “This wastheelectioninNovember2014toelect Respondents receivedthefollowinghyperlinked note: or twofromadrink.” it. We arenotaskingabouttimeswhenyouonlyhadasip wine cooler, ashotofliquor, oramixed drinkwithliquorin term “drinks”: “A canorbottleofbeer, aglassofwineor Respondents receivedthefollowingnoteregarding you onlyhadasiportwofromdrink.” drink withliquorinit.We arenotaskingabouttimeswhen glass ofwineoracooler, ashotofliquor, oramixed term “drinkoneormoredrinks”: “A canorbottleofbeer, a Respondents receivedthefollowingnoteregarding when youonlyhadasiportwofromdrink.” mixed drinkwithliquorinit.We arenotaskingabout times beer, aglassofwineorcooler, ashotofliquor, ora term “drankanalcoholicbeverage”: “A canorbottleof Respondents receivedthefollowingnoteregarding friends becauseyoucan’t affordhousing.” living outofacar, orstayingtemporarilywithfamily such thingsasstayinginashelter, livingonthestreet, for “homelessness”: “Experiencinghomelessnessincludes Respondents receivedthefollowinghyperlinked definition • Usingitinanyotherwayadoctordidnotdirectyouto • Usingitingreateramounts,moreoften,orlongerthan • Usingitwithoutaprescriptionofyourown you touseit,including: the prescriptiondruginanywayadoctordidnotdirect answer thisquestion,pleasethinkonlyaboutyouruseof way adoctordidnotdirectyoutousethem.When for “prescriptiondrugs”: “Useofprescriptiondrugsinany Respondents receivedthefollowinghyperlinked definition cleaning anoven,orfillingacarwithgasoline.” inhaled asubstanceaccidentally—suchaswhenpainting, or whippits.We arenotinterestedintimeswhenyou inhale togethighormake themfeelgood,like poppers Inhalants areliquids,sprays,andgasesthatpeoplesniffor heroin, LSD, andmeththatareconsideredtobeillegal. for “illegalorillicitdrugs”: “Drugslike cocaine, crack, Respondents receivedthefollowinghyperlinked definition use it” you weretoldtotake it APPENDIX C 291 while gathering information about disparities that often exist between transgender people and while gathering information about disparities that often exist between transgender hen developing the survey instrument, the research team focused on creating a questionnaire hen developing the survey instrument, the research team focused on creating transgender people that could provide data to address both current and emerging needs of

such as measures related to income and health. Questions in the USTS survey instrument were drawn from survey instrument were drawn from such as measures related to income and health. Questions in the USTS as they appeared in the source federally administered national population-based surveys, either exactly survey or with modifications, as follows: non-transgender people throughout the United States. To achieve this, questions were included that would To non-transgender people throughout the United States. sample and known benchmarks for the Survey (USTS) Transgender allow comparisons between the U.S. questions were selected to best Consequently, as a whole or populations within the U.S. population U.S. in federal government or other national surveys on a number of measures, match those previously asked Survey Sources Detailed Methodology Appendix CAppendix W 292 2015 U.S. TRANSGENDER SURVEY identities—or meetothercriteria relatedtotheir to identifyastransgender—including non-binary military base. Additionally, respondentsneeded and resideintheU.S., aU.S. territory, oronaU.S. to take thesurvey, beatleast18yearsofage, criteria forthesurvey. Respondents hadtoconsent from individualswhodidnotmeetbasiceligibility The firststepwastoremovesurveyresponses (4) flaggingandremovalofillogicalresponses. flagging andremovalofduplicateresponses, flagging andremovalofincompleteresponses,(3) respondents noteligibletotake thesurvey, (2) in thefollowingsteps:(1)flaggingandremovalof sample. CleaningoftheUSTS dataproceeded responses) inordertoimprovethequalityof responses, incompleteillogical removing somesurveyresponses(e.g., duplicate Data cleaningistheprocessofdetectingand Data Cleaning 30.4–30.6 29.1–29.4 28.10–28.17 18.1–18.3; 19.2 &19.3 17.7 &17.8 16.6–16.12 12.2 &12.3;14.1; 14.3 12.1; 12.4;12.6; 12.17; 14.4 7.1–7.14 16.1–16.5 2.24 &2.25;15.1–15.12; 2.16–2.22; 11.1 &11.2 USTS Questions Source Survey Daily Tracking) (U.S. Political andEconomic Gallup DailyTracking Poll Supplement (CPS) 2014November Current Population Survey National InmateSurvey(NIS) (NISVS) and SexualViolenceSurvey National IntimatePartner Survey (NCVS) National CrimeVictimization Replication (NCS-R) National ComorbiditySurvey Survey (NHIS) National HealthInterview Surveillance System (BRFSS) CDC’s BehavioralRiskFactor (CPS) Current Population Survey and Health(NSDUH) National SurveyonDrugUse (ACS) American CommunitySurvey and transitionstatusinSections12ofthe analyses ofresponsesrelatedtogenderidentity flagged andremovedfromthedataset.Additional under 18atthetimetheytooksurveywere month andyearofbirththatindicatedtheywere respondents. Respondents whoprovideda the datasetwerecompletedtoremoveineligible and hadtoberemoved.Additionalanalysesof their responseswereincludedintheinitialdataset eligibility criteriatoadisqualificationpage, but send respondentswhodidnotmeetthesebasic survey. Skiplogicwasaddedtothesurvey survey beforewerealsoineligibletotake the who indicatedthattheyhadcompletedthe completed thissurveybefore. Respondents respondents wereasked iftheyhadalready gender identityorexpression.Additionally, incomplete surveyresponses. dataset. Inall515respondents wereremovedfor willing toacceptforarespondent toremaininthe survey “completeness” theresearchteamwas questions wereusedtosetaminimallevelof questions usedtodetermineeligibility, andthese key informationaboutrespondents,including determined thatthesequestionswouldprovide or 2.14, 2.15, 2.18, 2.19, 2.22,2.23,and2.26.Itwas were asfollows:2.1, 2.3,2.6, 2.8,2.9, either2.13 questions. TherequiredSection2questions allowed providedrespondentscompletedthese the questionnaire. Missingdatawasotherwise specific demographicquestionsinSection2of respondents minimallycompleteSection1and from thesamplebasedonarequirementthat Incomplete responseswerethenremoved due tobeingineligibletake thesurvey. responses wereremovedfromtheinitialdataset detailed descriptionofthisprocess.Inall,10,304 Recoding Process” sectionbelowforamore transgender communities.Pleaseseethe“Variable gender-related experiencesassociatedwith identify astransgenderorwitharangeofother respondents, whichincludedthosewhodidnot survey werecompletedtoflagadditionalineligible APPENDIX C 293 The research team conducted an analysis The research team 2 (Q. 14.4: “Not including blood donations, in what 14.4: “Not (Q. item may month was your last HIV test?”). This have had relatively higher item non-response more likely because respondents may have been which was to recall the year of their last HIV test, 14.4, than the month. Question also requested in Q. of income had sources regarding respondents’ 7.11 “What are your current 7.11: 6.2% missing data (Q. may reflect a general This sources of income?”). that is reluctance to provide financial information to income- routinely found in item non-response surveys. related questions in population-based The research team determined that due to the low amount of missing data, including minimal missing data on questions that routinely have high item non-response in population-based surveys individual and household income), missing (e.g., data imputation was not necessary for this report. Future researchers are encouraged to investigate the impact of data imputation when using this dataset. Missing Data and Data Missing Imputation missing of has substantial amounts When a dataset 5% missing data, researchers data, such as over to impute the missing should consider techniques data. missing data should be to determine whether The percentage dataset. imputed in the USTS to item non-response (not of missing data due missing data due to skip including intentionally (not logic) on any original quantitative variable variables) including recoded variables or “write-in” of two was less than 5%, with the exception month of variables. Question 14.4 regarding the last HIV test had 5.9% missing data respondents’ 53 515 223 329 1,072 6,168 1,052 1, 789 11,201 27,715 38,916 1 Illogical responses Not eligible: had already taken survey Not eligible: had already taken or territory, Not eligible: did not live in U.S., military base Not eligible: gender identity or expression did not meet minimum criteria Duplicate responses Incomplete responses Did not consent to take survey Did not consent to take Not eligible: under 18 years of age Final sample: Total initial sample: Total cases removed: Total from the final dataset. research team considered a respondent having research team considered a respondent evidence that more than one illogical response as taking the the respondent may not have been had more survey in earnest. In all, 53 respondents removed than one illogical response and were than their current age. An illogical response could An illogical response than their current age. the part of the be due to an accidental miscode on filled out a respondent, meaning they accidentally that a or could be evidence question incorrectly, in earnest. The respondent is not taking the survey age, age they first disclosed to others they are age they first disclosed age, age of suicide attempts, and ages of transgender, example of other milestones or experiences. An who an illogical response would be a respondent age older reported they attempted suicide at an from the final dataset. An illogical response is from the final dataset. information that contradicts one that provides provided by a respondent. For other information questions survey included 16 the USTS instance, including current age, related to respondents’ determining whether a response was a duplicate. a response was a duplicate. determining whether were considered duplicates In all, 329 responses from the final dataset. and were removed who provided more than one respondents Finally, were flagged and removed illogical response Duplicate survey responses were then flagged and were then flagged survey responses Duplicate on determined based Duplicates were removed. Qualitative the survey. responses in all quantitative when were not considered responses (“write-in”) 294 2015 U.S. TRANSGENDER SURVEY could berecodedintoexisting answeroptions.If write-in responseswerereviewed toseeifthey where onlyoneansweroption wasallowed, In thecaseofaquestionwith write-inresponses and Q. 21.11 (70%)). below 80%agreement(Q. 1.7 (79%),Q. 9.3 (67%), agreement between80%and90%,threefell had 90%orhigheragreement,twovariables recoded, thecodingteamandreview rater reliability. Fornearlyallvariablesthatwere agreement scorewascalculatedtoassessinter- of disagreementwereflagged.Asimplepercent was reviewedbyanothercodingteamandareas coding teamsthatconductedinitialcoding,which recoding. Therecodingprocessincludedtwo approximately 80,000 write-inresponsesfor ended question.Theresearchteamreviewed in auniqueresponseorrespondingtoanopen- answer suchas“noneoftheabove” and writing to writeinresponsesquestionsbyselectingan Respondents tothesurveyhadmanyopportunities presented inthisreport. 2,000 recodesusedtogeneratethefindings recode. Inall,theresearchteamproducedover and thevariablewasthenconsideredafinal The primaryresearchercompletedanycorrections primary researcherinordertomake corrections. were foundinthereviewsubmittedto another researcher. Anyerrorsinthesyntaxthat and thesyntaxforthatrecodewasreviewedby were completedbyoneprimaryresearcher a respondentwasabouttheirtransgenderidentity, such asforcreatingvariablestoreflecthow“out” recoding foruseinthestudy. Quantitativerecodes, variables requiredquantitativeorqualitative could havereceivedinthesurvey. Mostofthese variables basedon324itemsrespondents The initialfinaldatasetcontained1,140 unique Process Variable Recoding should beviewedasasubsetofthe“none questions thatallowedmultipleanswerchoices Therefore, newansweroptionsbasedonwrite-in also remainedinthe“noneofabove” category. to describethoseresponses,respondents answer optionandanewvariablewascreated number ofresponsescouldbegroupedintoanew process tookplace. However, ifasubstantial question thatallowedmultiplechoices,asimilar category asauniqueresponse. Inthecaseofa response remainedinthe“noneofabove” with otherstocreateanewansweroption,the into anexistingansweroptionortobecombined If itwasnotfeasibleforaresponsetoberecoded added tothequestionreflectthoseresponses. same response, anewansweroptioncouldbe substantial numbersofrespondentswroteinthe to helpmake thesedeterminations.Members team reliedonquestionsin Sections1,2,and12 non-binary people, or crossdressers.Theresearch them astransgendermen, transgender women, criteria forthesurvey, andifso, tocategorize in ordertodetermineiftheymettheeligibility additional analysisoftheirsurveyresponses and maninQ. 2.3.Theserespondentsrequired and womaninQ. 2.3orselectedmaleinQ. 2.1 (n=439), arespondentselectedfemaleinQ. 2.1 in Q. 2.3asatransgenderwoman.Infewcases male atbirthinQ. 2.1 whoidentifiesasawoman man andwouldcategorizesomeoneassigned identifies asamanin Q. 2.3asatransgender someone assignedfemaleatbirthinQ. 2.1 who For instance, theresearcherswouldcategorize identify transgendermenandwomen. Q. 2.3,whichwascross-tabulatedwith Q. 2.1 to respondents’ self-selectedgendercategoryin on genderidentity, theresearchteamreliedon crossdressers. transgender men,non-binarypeople, and identity categories:transgenderwomen, order torecoderespondentsintofourgender A differentrecodingprocesswasestablishedin above” category. To categorizerespondents based APPENDIX C 295 The USTS sample has sample has The USTS 5 Studies have found no difference found no difference have Studies 4 weight applied to all findings in this report. While this may still over-represent white respondents of the transgender adult relative to the makeup population, this weighting procedure brings the sample closer to what is believed to be the true population distribution for race and ethnicity for attainment, or income. However, there is sufficient However, attainment, or income. ethnicity of evidence to indicate that the race and sample does not reflect the racial and the USTS population transgender of the U.S. ethnic makeup as a whole. is a common statistical technique “Weighting” of a used to adjust data drawn from a sample of the population to be more representative drawn. population from which the sample was in a survey sample of the U.S. For example, aged population, the proportion of respondents of that 18–24 may differ from the proportion in population as a whole, age group in the U.S. which case weights are commonly applied to adjust the sample to be more representative of help correct for sampling To population. the U.S. sample in regard to race and bias in the USTS population weights based on U.S. ethnicity, the American Community Survey for race and ethnicity were created as part of the standard population. lower educational attainment or in educational lower incomes and have found attainment as compared to people among transgender non-transgender people. young, and more of white, a higher percentage general than the U.S. highly educated respondents at least in part, to may be due, population, which is the younger age However, internet survey bias. transgender population being due to the also likely also has higher sample USTS younger overall. The as compared to the U.S. incidence of low incomes typical internet population, which goes against the about survey bias. Based on the existing research not adequate the transgender population, there is for information available to attempt to correct educational bias in the sample based on age, In order to address these biases, at least In order to address these biases, at 3 to race and ethnicity and age, with those that to race and ethnicity and age, to be identify as transgender being more likely people of color and younger than the general based samples of the U.S. population. based samples of the U.S. Prior research using probability samples of transgender adults have found that transgender adults differ from the general population in regard in part, the research team created and utilized sample in certain weights to adjust the USTS ways in order to better represent what is believed to be the actual population characteristics of and in order to transgender people in the U.S. population- more accurate comparisons with make surveys have a known bias, particularly in regard surveys have a known bias, particularly samples to demographic representation. Online white, tend to over-represent those who are higher young, more highly educated, and with incomes. As a non-probability sample, generalizability is generalizability As a non-probability sample, the findings limited, meaning it is unclear whether true for the presented in this report would hold as a whole. transgender population of the U.S. that online In addition, prior research has found Weights sample was a purposive sample that The USTS was created using direct outreach, modified sampling. venue-based sampling, and “snowball” 250 respondents were determined to be ineligible 250 respondents on this recoding and review for the survey based removed from the final dataset. process and were initial recodes were reviewed by other members initial recodes were When initial recoders and of the research team. the in agreement on a recode, reviewers were not the disagreements and made team met to discuss In all, the recode as a group. a final decision on of the research team completed initial recoding initial recoding team completed of the research whether they to indicate of these respondents of in which and if so, for the survey, were eligible be included. These they should these categories 296 2015 U.S. TRANSGENDER SURVEY the compositionof19-year-olds. composition of18-year-olds shouldstronglymatch they tookthesurvey. Thiswouldimplythatthe randomly distributedaroundthedateinwhich adjustment isthataperson’s year ofbirthislikely other demographics.Therationalebehindthis 19-year-old respondentsinbothsamplesizeand reporting thatageappearedmorelike the the 18-year-oldsinsamplesothatrespondents it, theresearchteamcreatedaweighttoadjust of thisbinningentirely, butinordertocorrectfor sample. Itisimpossibletodeterminethesource compared to19-year-oldscomprising6%ofthe in 18-year-oldscomprising9%ofthesample, than 18atthetimeofsurvey. Thisresulted prevalence ofrespondentswhowereyounger attributable tomultiplefactors,includingahigher that theincreasedbinningof18-year-oldsmaybe birth date, were17yearsold. years old,andrespondentswho, basedontheir respondents whoindicatedthattheiragewas18 above, theUSTS hadahighvolumeof In additiontothepotentialbiasesdescribed Appendix A for theseandothervariablescanbefoundin Unweighted frequenciesandpercentages in the for theseandothervariablescanbefound the “supplemental weight.” Weighted percentages household income, andarenotedaccordinglyas educational attainment,suchasindividualand population foritemsthataresensitivetoageand when comparingtheUSTS sampletotheU.S. were appliedinadditiontothestandardweight age andeducationalattainment. and nationaldatasources,includingweightsfor purposes ofcomparabilitywithfederalgovernment Additional surveyweightswerecreatedforthe old category, describedinmoredetailbelow. weight alsoincludesanadjustmenttothe18-year- transgender peopleintheU.S. Thestandard Portrait ofUSTS Respondents

(Characteristics oftheSample) 7 Itwassuspected 6 Theseweights chapter. . sample comprises6%,whichisthesameas size. After weighting,thesizeof18-year-old the datasuchthattwogroupsareofequivalent reflect 19-year-olds. olds tomake theirdemographic composition reduces observabledifferencesamong18-year- in onegroupovertheother. Theformerprocess accounting fortheconditionalprobabilityofbeing covariates usedinthemodelwhilesimultaneously procedure thentriestoachievebalanceon as abaseline“controlgroup.” olds asa“treatmentgroup” and19-year-olds Propensity Score(CBPS),whichtreatsthe18-year- process isdonebyusingtheCovariateBalance respondents to19-year-oldrespondents.This used tobalancethecompositionof18-year-old A samplematchingandweightingprocedurewas in thisreport. the standardsurveyweightappliedtoallfindings This adjustmentfor18-year-oldswasincludedin minimizing theinfluenceofthatgrouponfindings. respondents astheydivergefrom19-year-olds, The weightingprocessdown-weights18-year-old from 19-year-oldsasthatagegapincreases. be expectedthattheirresponseswoulddiverge are reallyyoungerthan18yearsofage, itwould respondents whowerebinnedat18yearsofage less likely toactuallybe18yearsold.Thisway, if olds) andtodown-weightrespondentswhoare to theagecohortclosestthem(i.e., 19-year- old bymakingthemobservationallyequivalent weight respondentswhoaremostlikely 18years The goalofthisweightingprocessistoup- significance. minimized, andmanyfailedtoreachstatistical differences between18-and19-year-oldswere 19-year-old sample. Anyobserveddemographic 9 Thelatterprocessweights 8 Theestimation 10

APPENDIX C 297 Journal of the Royal Statistical Society, Society, Statistical Royal Journal of the (1), 243–263. 76

commonality with 17-year-olds. Imai, K. & Ratkovic, M. (2014). Covariate balancing Covariate balancing M. (2014). Imai, K. & Ratkovic, score. propensity Series B, the used for covariate balance were based on Variables Q. 1.14; Q. 1.12; Q. 1.11; Q. 1.10; 1.4; Q. following questions: Q. Q. 2.6; 2.5; Q. 2.4; Q. 2.3; Q. Q. 2.1; Q. 1.18; Q. 1.17; Q. 1.16; 2.23; 2.22; Q. Q. 2.19; Q. 2.18; Q. 2.17; Q. 2.16; 2.9; Q. Q. 2.7; Q. 7.7; Q. 6.1; 4.5; Q. 4.3; Q. Q. 4.1; 3.3; Q. 3.2; Q. Q. 3.1; Q. Q. 12.8; Q. 12.1; Q. 11.2; Q. 11.1; Q. 10.1; Q. 7.14; Q. 7.13; Q. 7.12; 16.3; Q. 15.9; Q. 15.2; Q. Q. 14.1; Q. 13.1; 12.20; Q. Q. 12.12; 17.9; Q. 17.3; Q. 17.6; Q. 17.5; Q. 17.4; Q. 17.2; Q. 17.1; 16.8; Q. Q. 21.1; Q. 20.7; Q. 20.2; Q. 20.1; Q. 19.1; 18.3; Q. Q. 18.1; Q. Q. 27.1; Q. 26.6; Q. 26.1; 23.2; Q. Q. 23.1; Q. 21.7; 21.2; Q. 30.6. and Q. 30.4; Q. 29.2; Q. 29.1; 28.2; Q. Q. 28.1; of Prior to weighing, the demographic characteristics who were 18-year-olds were more similar to respondents similarity identified as being 17 years of age and had less weighting, there are many more to 19-year-olds. After far less similarities between 18- and 19-year-olds and 8 9 10 . African African . DC: Working Working (4th ed.). , 222. 2 (1), 118–122; , 102 , . (accepted); Harris, . Los Angeles, CA: Angeles, CA: . Los SpringerPlus Internet, Phone, Mail, and Mixed- Internet, Phone, Likely Transgender Individuals in U.S. Federal Individuals in U.S. Transgender Likely | APPENDIX C | APPENDIX Internet Access and Voter Registration Internet Access and Voter Race and Ethnicity of Adults who Identify as Race the study. The weights for race, age, and educational attainment age, The weights for race, 2014 were created based on the Census Bureau’s American Community Survey (ACS). who are younger than 18 were removed Respondents from all are excluded from the final dataset and, therefore, reporting because they were not eligible to participate in Administrative Records and the 2010 Census, Administrative Records Records #2015-03. DC: Center for Administrative Paper Available Papers. and Applications Working Research at: https://www.census.gov/srd/carra/15_03_Likely_ Transgender_Individuals_in_ARs_and_2010Census.pdf. See note 4. American Journal of Public Health S. L., L., Reisner, Herman, J. N. T., I. H., Brown, T. Meyer, (in press). Demographic characteristics O. & Bockting, W. in select and health outcomes among transgender adults System. regions in the Behavioral Risk Factor Surveillance American Journal of Public Health B.C. (2015). See e.g., Flores, A. R., Brown, T. N. T., & Herman, J. L. & Herman, J. N. T., Flores, A. R., Brown, T. See e.g., (2016). in the United States Transgender G. S., & Scott, G., Stowell, Williams Institute; Conron, K. J., health in Massachusetts: (2012). Transgender S. J. Landers, from a household probability sample of adults. Results Christian, L. M. (2014). Design Method Mode Surveys: The Tailored NJ: John Wiley & Sons; Smith, A. (2014). Hoboken, Use: A Demographic Portrait Americans and Technology L. & Hess, D. Center; Herman, J. Research DC: The Pew R. (2009). Project Vote. other variables are often presented in ranges, which also other variables are often of outliers. helps to mitigate any influence (2013). Principled missing data J. C. Y. & Pang, Dong, Y. methods for researchers. differences Online survey bias is related to demographic & D., A., Smyth, J. Dillman, D. in internet access. See e.g., types of responses were only considered to be illogical types of responses were other responses. In the responses if they contradicted they were considered unlikely, case of responses that in the dataset. These outliers were were allowed to remain findings in that only a handful of negligible in the overall given variable and, therefore, outliers are found in any findings. Findings based on age and the they do not skew Respondents sometimes provided responses that provided responses that sometimes Respondents away from home for instance running seemed unlikely, as two years old. These such age, at a very young 6 7 5 4 2 3 1 ENDNOTES ENDNOTES Updated December 2017

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