That transgender individuals face an unique set of challenges and hardships is undeniable.

Quantifying these struggles, however, has proven to be difficult, since many are justifiably reluctant to expose their identity to society, lest they be the victim of discrimination or violence (even in health care). Now, for the first time, a team of researchers in the journal LGBT Health this past December have compiled a relatively large, if imperfect, analysis of the health issues that impact transgender veterans in the military, and the results are startling. Studying data taken from the Veterans Health Administration (VHA), the largest healthcare system in the U.S., they discovered that compared to a control group, these vets are overwhelmingly more likely to be at risk for a myriad of physical and mental health conditions, such as HIV, depression, and alcohol abuse.

“Transgender veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-transgender veterans,” the researchers, Dr. George Brown of the Mountain Home Veterans Affairs Medical Center in Johnson City, Tennessee and Dr. Kenneth Jones, a member of the VHA’s Office of Health Equity in D.C., concluded. “These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.”

In addition to its size, the VHA was an early adopter of electronic health records, enabling the researchers to track down subjects from 1996 to 2013. They classified people who were diagnosed with one of four conditions, including transsexualism and gender identity disorder, as being transgender. Ultimately, they ended up with a group of 5,135 such veterans. They then compared their medical records with a control group of non-transgendered veterans selected to match them in characteristics like age, race, and where they received medical care.

“Significant differences between groups were observed for a majority of illnesses analyzed after adjusting for marital status, religious affiliation, and priority group,” wrote the researchers. “TG veterans were significantly more likely to be diagnosed with all of the included psychiatric and medical conditions, except breast cancer and cirrhosis.”

In particular, the percentage of those who contracted HIV was nearly six times higher among transgender vets than with controls (2.90 percent vs .51 percent); nearly twice as high for alcohol abuse (32.19 percent vs 18.26 percent), and four times higher for major depression (47.73 percent vs 17.21 percent). In addition to the aforementioned conditions, there was a 10 percent or higher difference between the two groups found when it came to serious mental illness, post-traumatic stress disorder, suicidal ideation/attempts, obesity, and tobacco use. They were much more likely to face homelessness and military sexual trauma as well.

Overall, these results resoundingly validate prior research, which has unfortunately been limited to small samples or has had to rely on less rigorous means of data collection, such as internet surveys. While laudable though, even these findings aren’t perfect, since they can’t account for people who self-identify as transgender but for whatever reason, declined to disclose their status to medical providers. There’s also the matter that, post-2013, several of the diagnoses utilized by the researchers to determine transgender status were done away with and replaced by the more inclusive label of gender dysphoria. These and other factors mean their tally is likely underestimating the amount of people who would fall under the wide-ranging category of transgender.

Though they had available data on the gender these individuals identified themselves as, they were unable to determine their birth sex, making it difficult to figure out the precise proportion of “veterans who identify as transmen, transwomen, or another identity outside of the traditional binary.” These distinctions matter because, “[d]isparities and social determinants of health and well-being may well differ between transmen and transwomen,” the authors explained.

Still, the researchers are hopeful their study represents a step forward in better identifying the issues transgender vets have to contend with.  

“It is critical to meaningfully and sensitively collect self-identified gender identity information to develop facility-level, regional, and national treatment programs targeted to the needs of transgender patients and to build appropriate clinical capacity within the organization to meet those identified needs,” concluded the authors. “VHA has made some significant inroads over the past four years in developing training programs for VHA clinicians and providing improved access to care for TG veterans.”

They plan to further study transgender veterans, particularly to see if public health initiatives undertaken by the VHA in 2011 helped to close the gaps in health care now readily apparent.

Source: Brown G, Jones K. Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case–Control Study. LBGT Health . 2015.