ArticleAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine2022
State-Level Policy Stigma and Non-Prescribed Hormones Use among Trans Populations in the United States: A Mediational Analysis of Insurance and Anticipated Stigma.
Article in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 31 citations in OpenAlex.
- "Stop playing politics with my kid:" Thematic analysis of a trans-exclusionary sports legislation hearing in Texas.International journal of transgender health · 2026Article
- A qualitative study of the ecology of stigma experiences - An application of the ecological model to stigma experiences of trans-women from Ghana. BSGH019.PLOS global public health · 2026Article
- What a boy wants: Transgender men's hidden tran/scripts about the nonprescription use of gender-affirming hormones in mainland China.Social science & medicine (1982) · 2025Article
- Demographic Differences in Responses to a Two-Step Gender Identity Measure.Sociological science · 2025Article
- Utilizing community engagement to define research and clinical priorities for gender-affirming hormone therapy.International journal of transgender health · 2025Article
- State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA.Nature human behaviour · 2024Article
- The Role of Stigma and Resilience in Healthcare Engagement Among Transgender Latinas in the U.S. South: Baseline Findings from the ChiCAS Study.Journal of immigrant and minority health · 2024Article
- Racial/ethnic differences in the association between transgender-related U.S. state policies and self-rated health of transgender women.BMC public health · 2024Article
- Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey.International journal of environmental research and public health · 2023Article
- Patients' Perceived Level of Clinician Knowledge of Transgender Health Care, Self-rated Health, and Psychological Distress Among Transgender Adults.JAMA network open · 2023Article
- US Black-White Differences in Mortality Risk Among Transgender and Cisgender People in Private Insurance, 2011-2019.American journal of public health · 2022Article
- Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance.Demography · 2022Article
- Improving "Life Chances": Surveying the Anti-Transgender Backlash, and Offering a Transgender Equity Impact Assessment Tool for Policy Analysis.The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · 2022Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundMedical gender affirmation (i.e., hormone use) is one-way transgender (trans) people affirm their gender and has been associated with health benefits. However, trans people face stigmatization when accessing gender-affirming healthcare, which leads some to use non-prescribed hormones (NPHs) that increase their risk for poor health. PURPOSE: We examined whether healthcare policy stigma, as measured by state-level trans-specific policies, was associated with NPHs use and tested mediational paths that might explain these associations. Because stigmatizing healthcare policies prevent trans people from participation in healthcare systems and allow for discrimination by healthcare providers, we hypothesized that healthcare policy stigma would be associated with NPHs use by operating through three main pathways: skipping care due to anticipated stigma in healthcare settings, skipping care due to cost, and being uninsured.
methodsWe conducted analyses using data from the 2015 U.S. Transgender Survey. The analytic sample included trans adults using hormones (N = 11,994). We fit a multinomial structural equation model to examine associations.
resultsAmong trans adults using hormones, we found that healthcare policy stigma was positively associated with NPHs use and operated through insurance coverage and anticipating stigma in healthcare settings. The effect sizes on key predictor variables varied significantly between those who use supplemental NPHs and those who only use NPHs suggesting the need to treat NPHs use as distinct from those who use supplemental NPHs.
conclusionsOur work highlights the importance of healthcare policy stigma in understanding health inequities among trans people in the USA, specifically NPHs use.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.