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Empowering Trans Adults

Rice University study advocates for wellness reforms to support trans adults, who disproportionately suffer from disabilities.

Madeline Smith- Johnson
Madeline Smith- Johnson (Courtesy photo)

Transgender Awareness Week and the Transgender Day of Remembrance are annual November observances that memorialize victims of anti-trans violence and educate people on trans issues— including, for example, what it’s like to be trans and disabled.

Trans adults are more likely to report suffering from a disability, compared to cisgender men and women, according to a new study by Rice University researcher Madeline Smith-Johnson. The study determined that trans adults have a 27 percent chance of having at least one disability at age 20, and a 39 percent chance at age 55—nearly twice the rate of their cis counterparts at both ages.

The disabilities in the study were defined as having serious difficulty walking, climbing stairs, dressing, bathing, running errands alone, concentrating, remembering, or making decisions.

Smith-Johnson, the nonbinary researcher who helmed the study, was interested in the experiences of LGBTQ elders because they provide insight into the LGBTQ community’s future.

“I’m hopeful that by exposing health disparities associated with being queer, across the lifespan, we can learn more about how to build longevity, well-being, and resilience in this community,” says Smith-Johnson, who uses they/them pronouns.

Learn more about Smith-Johnson’s study in the Q&A below.

Why did you conduct this study?

I’m interested in the link between a person’s social environment and their health. We know that lifelong experiences of stress and victimization can have long-lasting impacts on a person’s body. But we also know that social support and community, or “finding your people,” can act as a buffer against some of the most pervasive hate and discrimination. It took me most of my young adulthood to find my people. I’m hopeful that by exposing health disparities associated with being queer, across the lifespan, we can learn more about how to build longevity, well-being, and resilience in this community. But I can’t continue to study these topics unless we have inclusive questions about gender identity and sexual orientation in national surveys.


How did your own experiences contribute to the article?
As a queer person, I know the daily wear-and-tear of living in a society that penalizes anyone who is not heterosexual or cisgender. As a researcher, I’m tired of LGBTQ+ lives and stories being invisible in many of the conversations around health and well-being happening in the United States. More and more population health data are finding health disparities among trans people, especially nonbinary folks. We don’t really know why. As a nonbinary person, I’m committed to documenting these health disparities. Even though it’s difficult and depressing, I believe that we hold systems of oppression to account by sounding the alarm about the harm done to our community, while also building queer joy in the face of that harm. This article sounds the alarm. But it’s up to individual communities to continue building change.

I understand you used data from the Behavioral Risk Factor Surveillance System (BRFSS). Could you tell me how you used that data to determine your findings?
BRFSS is one of the largest health surveys in the United States. In 2014, the Centers for Disease Control and Prevention introduced a set of questions about sexual orientation and gender identity, but left it up to individual states to [decide about] asking these questions. Since 2014, 43 states have asked about sexual orientation and gender identity. I take all these survey responses and pool them together to get a “snapshot” of health in the trans community in these particular states. I predict a person’s likelihood of reporting at least one disability.

Now, we know that on average in the US, trans people tend to have higher rates of poverty, lower rates of employment and higher education, and are more likely to be current smokers. All these things can impact the likelihood of disability in a population. If we held race, marital status, socioeconomic status, and health behaviors like smoking constant [for transgender and cisgender people], we still see higher rates of disability among transgender adults, compared to cisgender men and women.

What were your most interesting findings?
The most interesting finding is that there is no evidence that transgender disadvantage is leveling out in older age groups. And there’s no evidence that transgender disadvantage is simply about the wear-and-tear of getting old. Even though cisgender men and women also experience increasing rates of disability at older ages, the levels of disability in the transgender population continue to outpace them—both in young and older groups.

Could you expand on how age is important to this study?
I wanted to investigate these two possibilities: do we see disparities in disability among younger trans groups, or among older trans people? I did not expect to find disparities at all ages. This tells us that there are probably multiple mechanisms driving disparities in disability by gender identity. The trans population starts off young adulthood with already-elevated levels of disability—higher than cisgender men and women. As the population moves through middle adulthood and older adult- hood, the gap only widens. This is incredibly concerning!

What other findings stood out to you?
I also think these findings are significant because of the particular kind of disability captured in the data. These functional limitations—having difficulty dressing, bathing, running errands, etc.—don’t tell us everything we need to know about how a per- son is really doing. For example, a transgender person who is well connected in their community, with a large social network to rely on, might be able to overcome these limitations with the help of others. By contrast, a trans- gender person with the same self-reported disability, but without these connections, is likely much more limited in their day-to-day life because of the lack of assistance from others. We need more studies and more community engagement to begin to examine what kinds of support folks need in their day-to-day lives.

What are the social implications of the study?
There are implications at every level of society. First, we need LGBTQ+ competent care in all healthcare systems in the United States. There are high levels of healthcare avoidance in the transgender community. Experiences of discrimination from medical professionals can lead trans people to avoid healthcare. At the same time, medical schools offer almost no training in how to competently care for LGBTQ+ populations. We need to see the healthcare system begin to train individual professionals in how to reach out to and care for transgender adults.

Second, we need legislation at the federal level that includes gender identity as a protected identity class. This means that service providers would not be able to discriminate against transgender people in healthcare, housing, employment, social services, etc., based on their gender identity. Note that this includes eliminating religious-refusal exemptions in [the current] nondiscrimination laws. It might seem like housing, income, and employment are separate from someone’s disability status. Actually, decades of social-science research has found that the most fundamental factors impacting health are not [the access to] healthcare, but actually having the resources to live well. This means that providing access to education, employment, and a safe place to live are the most fundamental changes a society can make to try to begin to shift health disparities.

Third, we need communities to organize on behalf of their trans neighbors. Social isolation is detrimental to health. Social support is key to continuing to flourish despite functional limitations.

Read Madeline Smith-Johnson’s full study at



Lillian Hoang is a staff reporter for OutSmart Magazine. She graduated from the University of Houston with a degree in journalism and minor in Asian American studies. She works as a College of Education communication assistant and hopes to become an editor-in-chief.
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