Menu Close

State Policies and Healthcare Use among Transgender People in the U.S.


Goldenberg, Tamar; Reisner, Sari L.; Harper, Gary W.; Gamarel, Kristi E.; & Stephenson, Rob (2020). State Policies and Healthcare Use among Transgender People in the U.S.. American Journal of Preventive Medicine, 59(2), 247-259. PMCID: PMC7384261


Introduction: The introduction and passing of restrictive and protective transgender-specific state policies has increased over the past decade. These policies are critical for the health of transgender and other gender diverse (TGGD) people; however, little is known about the relationship between these policies and healthcare use, and the role that race/ethnicity plays in this relationship.
Methods: Analysis was conducted in 2018-2019 using multilevel modeling and data from the 2015 U.S. Trans Survey (conducted by the National Center for Transgender Equality among nearly 28,000 TGGD people across the United States) to explore associations between transgender-specific state policies and healthcare avoidance due to fears of mistreatment. State policies included those related to experiences of discrimination, health insurance coverage, and changing legal documents. Restrictive and protective policies were measured individually and as a composite index. The relationship between race/ethnicity and healthcare use was also examined to determine if there were differences in the association between race/ethnicity and healthcare avoidance by state.
Results: None of the individual policies were associated with healthcare use, but the composite policy index was significant, such that living in states with more protective policies was associated with reduced odds of avoiding healthcare due to fears of mistreatment. The relationship between race/ethnicity and healthcare also varied across states.
Conclusions: Findings suggest the importance of advocating for more protective transgender-specific policies to improve healthcare access for TGGD people in the United States, particularly for TGGD people of color.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

American Journal of Preventive Medicine


Goldenberg, Tamar
Reisner, Sari L.
Harper, Gary W.
Gamarel, Kristi E.
Stephenson, Rob



Data Set/Study

2015 U.S. Trans Survey


United States of America