Intersecting barriers to care: A scoping review on health behaviors and outcomes of transgender immigrants in the U.S.

Background Transgender immigrants in the United States encounter compounding barriers to health, stemming from gender and immigration-based stigma. Despite high risks for health disparities for both immigrant and transgender populations, research is extremely limited on unique health behaviors and outcomes of those who carry both identities.Aims Grounded in minority stress and intersectionality theories, this scoping review systematically maps and synthesizes existing literature on transgender immigrants’ health in the U.S.Methods The databases searched included PsycINFO, PubMed, Scopus, and Google Scholar, with a total of 970 records identified and 13 studies meeting the inclusion criteria for review.Results Thematic analysis identified key themes: intersecting sigma, gender- and immigration-based barriers, protective factors, and health outcomes. Barriers included transphobia, violence, racism, documentation, language, and detention. Protective factors identified were social support, self-acceptance, previous positive healthcare experiences, transitioning, and resettlement location. Health behaviors and outcomes highlighted were hesitancy to seek care, mental health issues, sexual health risks, substance use and dependency, and alternative and risky care.Conclusion These findings demonstrate the critical need for gender-affirming, immigrant-inclusive, and trauma-informed healthcare provision and policies. This scoping review reveals the urgent need for disaggregated research on transgender immigrants of varying ethnicities. Future research and policy must prioritize the unique healthcare needs of transgender immigrants to adequately address health disparities across all gender minorities and legal statuses.