Transgender-related stigma and gender minority stress-related health disparities in Aotearoa New Zealand: hypercholesterolemia, hypertension, myocardial infarction, stroke, diabetes, and general health

BACKGROUND: Research has found that transgender-related enacted stigma—including discrimination, harassment, violence, cyberbullying, community rejection, and conversion efforts—is associated with negative mental health among transgender people. Transgender people also experience physical health disparities that could be due to chronic gender minority stress caused by stigma and prejudice. METHODS: We compared a large New Zealand national survey of transgender participants with the New Zealand Health Survey (NZHS) with age and ethnicity weightings on stress-related health conditions and indicators. We conducted multivariate logistic regression to test associations between transgender-related enacted stigma and physical health conditions and indicators, controlling for age, gender, ethnicity, gender affirming hormone use, and alcohol and tobacco use. FINDINGS: Transgender participants had a greater likelihood of ever having hypertension (63%, 95% CI 41%–89%), a myocardial infarction (98%, 6%–271%), a stroke (104%, 2%–311%), hypercholesteremia 148% (114%–188%), and current poor or fair general health (128%, 107%–151%). There were no significant differences for diabetes. Compared with those scoring at the 10th percentile on transgender-related enacted stigma, those at the 90th percentile were more likely to have had hypertension (81%, 36%–140%), hypercholesteremia (54%, 20%–98), and poor/fair health (75%, 45%–110%). INTERPRETATION: We found large disparities for stress-related physical health conditions and indicators, and transgender people who experienced higher transgender-related enacted stigma had a significantly increased prevalence of these negative outcomes. Our findings highlight the need for health professionals to consider gender minority stress and for interventions and policy/law reforms to address transgender-related stigma. FUNDING: The 10.13039/501100001505Health Research Council of New Zealand and Rule Foundation.