Exploring Life Outcomes and Early Experiences Among Transgender Adults in the United States: A Mixed Methods Study

Transgender individuals experience notable disparities in life outcomes relative to their cisgender counterparts. This explanatory mixed-methods study aimed to explore the relationships between early experiences and gender identity to identify factors contributing to different life outcomes among the transgender community. Quantitative data were analyzed from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) survey of the Centers for Disease Control and Prevention (CDC), including 284,929 transgender and cisgender adults in the United States. Online qualitative interviews were conducted among 21 transgender individuals to expand upon the quantitative findings. In the quantitative component, transgender respondents reported significantly more adverse childhood experiences (ACEs) and worse outcomes in mental health, education, and income than cisgender respondents. Key factors such as lack of support, exposure to mental health and substances, household incarceration, and neglect significantly interacted with gender to predict poor life outcomes. In the qualitative component, five themes emerged from the thematic analysis, relating to participant experiences: the impact of family dysfunction, body discomfort before and after transitioning, relatedness and belonging, the importance of social support, and community and healthcare dilemmas. These findings highlight the importance of support systems at the familial, community, and healthcare levels. Transgender individuals who reported positive family functioning, strong support networks, and access to care were found to have better life outcomes. Future research endeavors should examine the perspectives of family members, friends, school faculty, and healthcare professionals to gain a more comprehensive understanding of factors contributing to social inequities within the transgender community.