identity continues to be a highly politicized topic of health and
science, with very real consequences for gender minorities (e.g.,
transgender, nonbinary and gender-fluid individuals). At the same time,
only a portion of American states have implemented policies aimed at
ensuring access to gender-affirming healthcare services, like hormone
therapy, reconstructive surgeries and mental health services.
services are considered as effective treatments for gender
dysphoria—the persistent, significant distress associated with
discordance between one’s gender identity and their assigned sex.
However, the battle for gender-minority rights is hard won and requires
evidence that such policies have a real-world, positive impact on
This was the goal of American researchers out of Boston, whose study on the association of nondiscrimination policies with mental health among gender minority individuals is published in JAMA Psychiatry.
The study included information from 28,980 unique gender minority,
pulled from the IBM MarketScan Commercial Database of deidentified
private health insurance claims and enrollment data.
authors looked at suicidality and hospitalization of gender-minority
individuals in each of the states where gender-affirming policies have
been implemented, including California, Illinois, Nevada, New York,
Washington, and Maryland, among others. The states were grouped based on
the year of implementation: 2013, 2014, 2015, and 2016.
results of the study are somewhat mixed for certain cohorts, but
globally, they tell a story of a moderate connection between
gender-affirming policies and more positive outcomes for gender-minority
example, the 2013, 2014 and 2016 cohorts all demonstrated significant
reductions in hospitalization in the year following policy
implementation. Likewise, in 2014, 2015 and 2016, nondiscrimination
policies were associated with significant reductions in suicidality in
the year following implementation.
are some limitations. The authors note, for example, that the
Difference-in-Difference statistical model they employ inherently
assumes that trajectories between groups (gender-minority vs control)
would remain stable if not for the implementation of policies.
there are a number of reasons why this may not be true, including
policy changes beyond healthcare and insurance, and social, political
and financial trends that may differentially impact gender-normative vs.
while the large sample size is decidedly advantageous, it is not
representative in that not all gender-minority individuals have a
diagnosis code related to this status. Indeed, in states where
experience and education lags behind policy, healthcare workers may
the data seems to suggest that in a majority of cases, the
implementation of gender-affirming healthcare policies in the United
States results in fewer hospitalizations and reduced suicide rates among
gender minorities. This is a crucial step towards eliminating gender
discrimination in the United States, and studies like the present are
necessary to ensure the importance of policy changes is widely