While society begins to realise that gender is not binary, many of the world’s 25 million transgender people still experience stigma, prejudice and abuse.

Australian experts have contributed to an international assessment of the health of transgender people.

The study points to major gaps in our understanding of transgender health, due to failure to recognise gender diversity in public health efforts.

The authors say there is enough information about this marginalised group to act now.

The world’s estimated 25 million transgender people are routinely denied rights, and they often face stigma, discrimination and abuse leading to marginalisation which has further damaging effects on their physical and mental health.

As a result of this social and legal context, transgender people have high rates of depression (reported up to 60 per cent).

Transgender people are often excluded from families or the workplace, and are at greater risk of engaging in risky behaviour (sex work or drug use for instance). Leading to studies that show transgender people are at almost 50 times greater risk of HIV than the general population.

Violence against transgender people is widespread.

Between 2008 and 2016, there were 2115 documented killings of transgender people across the world, with many other murders likely going unreported or misreported.

“Many of the health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition. In no other community is the link between rights and health so clearly visible as in the transgender community,” says researcher Associate Professor Sam Winter from Curtin University.

The research team is calling for action, including:

  • Revisions to the WHO’s diagnostic manual, due in 2018, to remove the diagnoses for transgender people from the chapter relating to “mental and behavioural disorders” to “conditions related to sexual health”. A mental health diagnosis is widely regarded as inappropriate and potentially harmful by reinforcing stigma. The authors say this move would be ‘truly historic’
  • WHO should reconsider the highly controversial diagnosis of “gender incongruence in childhood” for children below the age of puberty, and instead focus efforts on providing children with access to better support and information to understand and express their gender identity
  • Health care for transgender people, including access to feminising and masculinising hormones, should be funded on the same basis as other health care
  • Physicians should be trained to understand the health needs of transgender people, especially in delivering general health care such as mental and reproductive health
  • Governments worldwide must put an end to gender reparative therapies for children, adolescents and adults, widely condemned as unethical
  • It is imperative that anti-discrimination laws are inclusive of transgender people – where anti-discrimination law is absent, the practical result is often that discrimination is legal
  • Schools must be more inclusive of gender diversity and all teachers should be trained to work with, and teach about, transgender people and gender diversity
  • While gender diversity is a global phenomenon, much research to date has been in high-income countries and parts of Asia. The needs of transgender people in much of Africa, the Middle East, Central Asia and the former Soviet republics are vastly understudied, yet they face significant discrimination in these regions

The latest report in the WHO’s series on transgender health is available here.