Key Takeaways from the 2022 U.S. Transgender Survey

In 2022 The National Center for Transgender Equality (NCTE), a US trans rights organization, undertook an extensive survey of binary and non-binary transgender people in the USA and recently released preliminary results. This was an update to the 2015 U.S. Transgender Survey which had 28,000 participants from the transgender community. In 2022 the number of respondents tripled to over 90,000 people. It included people from every state and many US territories. Unlike the previous survey, which included only adults, the 2022 survey included 8,000 youth aged 16-17. Additionally, the number of available questions almost doubled to 624, allowing for more nuanced data collection.

The report details continued discrimination and mistreatment of people who are transgender. This includes experiencing poverty, unemployment, and job loss due to their gender identity and/or expression, mistreatment or bullying at school, and denial of restrooms that align with their gender identity.

Specific to healthcare, almost half of adult respondents reported at least one negative experience with a healthcare provider in the last year due to being transgender. This includes refusal of health care, using the wrong pronouns, and verbal and physical abuse during treatment. Nearly a quarter of people avoided seeking medical care when they needed it due to fear of mistreatment.

A key positive takeaway from the survey is that people have higher life satisfaction after gender transition. When combining those who were “a lot more satisfied” with those who were “a little more satisfied,” 94% reported increased life satisfaction when they lived at least some of the time with gender expression in line with their gender identity. Similarly, 98% of those getting hormone treatment and 97% of those who had at least one gender-affirming surgery reported increased life satisfaction.

The 2022 U.S. Transgender Survey highlights the need for further training for healthcare professionals and the significant positive impact gender-affirming healthcare has on the lives of people who are transgender. I’m proud of the rehab professionals I get to work with. In the seven-year interval of the survey a lot has changed in PT and OT involvement in transgender health. When I started working with people undergoing gender-affirming vaginoplasty (GAV). I could find nothing on pelvic therapy for GAV. There was not education aimed at rehab professionals and ways we could improve outcomes. Fast forward seven years, and now there are many rehab course offerings on many aspects of transgender health. Our original course included a broad overview of transgender care for the rehab professional. With all the offerings on care for people in the LGBTQIA2S community,  the course is now focused deeply on gender-affirming genital surgeries, including  of vulvo/vaginoplasty, metoidioplasty, and phalloplasty. Our gender affirming genital surgery course has more time devoted to multiple aspects of the recovery, rehabilitation, and improving outcomes of these surgeries. The full description is in this link: https://hermanwallace.com/continuing-education-courses/transgender-health-for-the-rehab-professional.

I enjoy teaching gender-affirming care and hope participants of our course, Transgender Health for the Rehab Professional, go on to help train their staff and team. Together we can help improve the health and lives of people who are transgender, join me in one of our upcoming courses scheduled for April 13th or August 17th. 

If you enjoyed this article and are looking for other course recommendations I recommend the following:

• Intersex Patients: Rehab and Inclusive Care with instructor Molly O'Brien-Horn, PT, DPT, CLT scheduled for May 4th
• Inclusive Care for Gender and Sexual Minorities with instructor Brianna Durand, PT, DPT - scheduled for June 8th and December 7th 
• Sexual Interviewing for Pelvic Health Therapists with instructor Mia Fine, PhD, LMFT-S, CST-S, CSE - dates to be announced

References:
James, S.E., Herman, J.L., Durso, L.E., & Heng-Lehtinen, R. (2024). Early Insights: A Report of the 2022 U.S. Transgender Survey. National Center for Transgender Equality, Washington, DC.

See publications from the course instructors:

Gallagher, S., Smigelski, C., Luikenaar, R., Dugi, D. (2022). Pelvic Physical Therapy for Gender-affirming Genital Vaginoplasty. In M. Van Trotsenburg, R. Luikenaar, R, & M. Meriggiola (Eds.), Context, Principles and Practice of TransGynecology: Managing Transgender Patients in ObGyn Practice. (pp 261-265). Cambridge: Cambridge University Press.

Jiang DD, Gallagher S, Burchill L, Berli J, Dugi D 3rd. Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstet Gynecol. 2019 May;133(5):1003-1011. doi: 10.1097/AOG.0000000000003236. PMID: 30969210.

Peters BR, Annen AA, Berli JU, Gallagher S, Smigelski C, Kahn LH, Skelton HE. Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol. Plast Reconstr Surg Glob Open. 2022 Oct 24;10(10):e4616. doi: 10.1097/GOX.0000000000004616. PMID: 36299822; PMCID: PMC9592297.

Smigelski, C. (2023). [Review of the book Understanding Trans Health: Discourse, Power and Possibility, by R. Pearce]. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy, Autumn 2023(133), 100-101.

Whitehead, D., Gallagher, S., & Condran, C (2023) Gender Affirmation Surgery. In West, A. M. (Ed.). The Transgender Athlete: A Guide for Sports Medicine Providers. (1st ed., p. 80). Elsevier. https://doi.org/eBook ISBN: 9780323916202

AUTHOR BIO:
Sandra Gallagher, PT, DPT, WCS

Sandi is a pelvic health physical therapist in Portland OR. Her practice includes providing evaluation and treatment of pelvic health conditions in adults and children of all gender identities. Dr. Gallagher received her primary physical therapy training in 1986 with a BS in Physical therapy from the University of Lowell in Massachusetts. She has pursued varied continuing education from manual therapy, Feldenkrais, biophysical agents, pelvic health, and pregnancy. She completed her Doctorate of Physical Therapy in June 2020.

Sandi has served on varied committees and boards at the state and national levels, most recently has the chair of the CAPP-OBC committee for the Academy of Pelvic Health of the APTA. She has presented on the role of PT in gender-affirming vaginoplasty at the UCSF Transgender Health Summit, the APTA Combined Sections Meeting, and at the 2018 international meeting of the World Professional Association for Transgender Health (WPATH). She is the recipient of the 2020 Elizabeth Noble Award from the Academy of Pelvic Health.