News Release

COVID-19 pandemic linked to reduced access to gender-affirming care in 76 countries

Reduced access was associated with poorer mental health for transgender and nonbinary people

Peer-Reviewed Publication


A survey offered to transgender and nonbinary people across six continents and in thirteen languages shows that during the first months of the COVID-19 pandemic, many faced reduced access to gender-affirming resources, and this reduction was linked to poorer mental health. Brooke Jarrett of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues present the findings in the open-access journal PLOS ONE on July 9.

Gender-affirming resources, which can include health care such as surgery and/or hormone therapy as well as gender affirming services and products --are well-known to significantly boost mental health and quality of life for transgender and nonbinary people. However, factors such as transphobia, lack of proper clinician training, and individual economic insecurity can hamper access to such resources.

Meanwhile, mounting evidence suggests that measures to reduce the spread of COVID-19 exacerbated these challenges. For instance, people may have had to cancel gender-affirming surgeries that were perceived to be elective. Or they may have had to move in with unsupportive relatives and spend more time living according to their sex assigned at birth instead of their actual gender.

To better understand the worldwide impact of the COVID-19 crisis on transgender and nonbinary people, Jarrett and colleagues surveyed 964 adults residing in 76 countries via the social networking apps Hornet and Her. The survey, conducted between April and August 2020, asked participants questions about how the pandemic had affected their access to gender-affirming resources, mental health, and financial stability.

Statistical analyses of the survey responses showed that about half of the participants faced reduced access to gender-affirming resources during the study period. Nearly 40 percent said that the pandemic reduced their ability to live according to their gender. Many also reported anticipating financial hardships, such as possible reduced income and possible loss of health insurance. Those who reported reduced access to gender-affirming resources also had increased prevalence of depressive symptoms, anxiety, and suicidal ideation.

The researchers say that their findings highlight a need to increase and secure access to gender-affirming resources in order to improve the health of transgender and nonbinary people, during and beyond the COVID-19 pandemic.

The authors add: "Transgender communities, who already face a myriad of health inequities, experienced even further health burdens due to restrictions imposed during COVID, like reduced access to gender-affirming treatments and mental health resources. To move forward, we need to support trans communities with policies that make gender-affirming healthcare affordable, accessible, and recognized as essential."


Citation: Jarrett BA, Peitzmeier SM, Restar A, Adamson T, Howell S, Baral S, et al. (2021) Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people. PLoS ONE 16(7): e0254215.

Funding: BAJ, SWB, and SDB were supported by the National Institute of Mental Health (F31MH121128, K01MH114715, R01MH110358 respectively). SWB also receives funding from Viiv Healthcare. AJR was supported by the National Institute of Allergy and Infectious Diseases (grant T32AI102623). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

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