About 44% of Americans say they know someone who is transgender, compared to 37% in 2017, and 20% report knowing someone who is nonbinary, according to the Pew Research Center. Numbers that high would have been unheard of a decade ago, much less several decades ago. That means much of the nation—including healthcare workers—has been on a steep learning curve in learning about and understanding a population of individuals who have been discriminated against and forced to hide for so long.

The best way to learn about a community is to hear from them directly, and that’s precisely what Pew Research did in a recent project to gain insights into the lives and experiences of trans, nonbinary, and gender-nonconforming Americans. The research organization surveyed Americans to find current statistics and then conducted focus groups with trans and nonbinary individuals. Some of the experiences focused specifically on gender transition medical care, and we’ll share those here. 

Definitions

Before we dive into the findings, let’s be sure we’re on the same page with terminology. 

• Transgender or trans refers to people whose gender is different than the one assigned at birth, such as a man who was called a “girl” when he was born. 

• Cisgender refers to people whose gender identity matches the sex they were assigned at birth. If a woman’s mother called her a girl at birth, that woman is cisgender. 

• Nonbinary individuals are those who are neither a man nor a woman nor who aren’t just one or the other. This concept can be challenging for cisgender people to understand at first, but it’s not as new as many think. The idea of a third gender, multiple genders, or other nonbinary concepts of gender has strong historical roots across the world going back centuries.

• Gender transition refers to the process by which an individual expresses their gender as different from what society expects based on the sex they were assigned at birth. 

• Social transitions refer to changes in name, pronouns (he/she/they), hairstyle, dress, etc. 

• Legal transitions involve legal name and gender changes on official documents, such as driver’s licenses, passports, and, depending on the state, medical records. 

• Medical transition refers to procedures such as laser hair removal, hormone therapy, or surgery.   

By the Numbers

Pew Research reported a range of statistics this month about who makes up the trans and nonbinary populations in the US and how many cisgender Americans know them. Here’s what they found: 

• 1.6% of US adults are trans or nonbinary, including 0.6% transgender and 1% nonbinary individuals. 

• 5.1% of US adults under age 30 are trans or nonbinary, including 2% trans and 3% nonbinary. 

• 0.3% of adults age 50 and older are trans or nonbinary (0.2% trans)

• More than half (52%) of young adults (ages 18-29) know someone trans, and 37% know someone nonbinary.

• A third (33%) of Americans age 65 and older know someone trans, though only 7% know someone nonbinary. 

• 27% of Americans have a trans friend, 13% work with one, and 10% have a trans family member.

• People across the political spectrum know trans folks, including 42% of Republicans (or Republican-leaning people) and 48% of Democrats (or Democrat-leaning people). Fewer Republicans (14%) than Democrats (25%) know someone nonbinary. 

Trans Perspectives on Medical Transitions

Not all trans/nonbinary individuals seek medical care as part of their transition. Still, many medical interventions are available for those who do, including hair removal and surgery. Most people have heard of top surgery—surgical changes to a person’s chest—or bottom surgery—surgical changes to a person’s genitals—but there are other forms of surgery as well, such as vocal cord surgery designed to affect the pitch of a person’s voice. Surgery also may be used to change aspects of a person’s face, to remove or add an Adam’s apple, or to increase, decrease or change the shape of a person’s hips or buttocks. 

Here’s what some trans people told Pew Research about their medical transition decisions. 

• “For me to really to live my truth and live my identity, I had to have the surgery, which is why I went through it. It doesn’t mean [that others] have to, or that it will make you more or less of a woman because you have it. But for me to be comfortable, that was a big part of it. And so, that’s why I felt I had to get it.” – Trans woman, early 40s

• “I’ve decided that the dysphoria of a second puberty … would just be too much for me, and I’m gender fluid enough where I’m happy, I guess.” – Nonbinary person, early 30s

• “Why do I need the permission of a therapist to say, ‘This person’s identity is valid,’ before I can get the health care that I need to be me, that is vital for myself and for my way of life?” – Nonbinary person, mid-40s

• “I guess it was hard for me to access hormones initially just because you had to jump through so many hoops, get letters, and then you had to find a provider that was willing to write it. And now it’s like people are getting it from their primary care doctor, which is great, but a very different experience than I had.” – Trans man, early 40s

• “I was flat-out turned down by the primary care physician who had to give the go-ahead to give me a referral to an endocrinologist; I was just shut down. That was it, end of the story.” – Nonbinary person, 50s

• “[My doctor] is basically the first person that actually embraced me and made me accept [who I am].” – Trans woman, late 20s

Read more at Pew Research.