How stigma hurts trans health

Researchers demonstrate a link between transgender people’s exposure to gender-related stigma and cortisol, a key hormone in the stress response.

For transgender and nonbinary people, feeling connected to one’s community may alleviate the adverse health effects of chronic exposure to stigma, the latest findings of a U.S.-Canada study suggests.

Done in collaboration with Université de Montréal assistant professor of psychiatry Robert-Paul Juster , the findings of the Trans Resilience & Health Study focus on variations in the human body’s production of cortisol, a key hormone in the stress response.

In their work published earlier this month in Hormones and Behavior, the researchers were able to demonstrate a link between higher exposure to gender-related stigma and a pattern of cortisol variation that was blunted, sluggish and flattened.

This implies a decreased ability to regulate the body’s stress response, the scientists say.

"Almost every cell and system in our body is influenced by cortisol," said Juster, who works at the UdeM-affiliated research centre of the Institut universitaire en santé mentale de Montréal.

"This is why chronic stress manifests itself in a plethora of pathologies linked to the cells in our heart, brain, stomach and kidneys... as well as to impairments in cognition and mental health."

The study show that trans and nonbinary people who feel more connected to their communities have a more dynamic pattern of cortisol function, suggesting they can recover better from stress.

Importantly, the results confirm other studies that transgender women and gender-diverse people who were assigned male at birth actually experience more overall stigma than the rest of the community.

The study’s authors - led by by trans researchers Zachary DuBois at the University of Oregon and Jae Puckett at Michigan State University - interpret this as a function of sociocultural aspects of gender and social roles, not biology.

Besides this direct association between stigma and cortisol, DuBois and Juster also showed, in a 2022 study, that such stigma is associated with other markers of chronic stress (known as allostatic load) that represent an increased risk of disease and mortality.

’Bridging the gap’

"Community-based studies like ours are bridging the gap between what marginalized people know intimately and what is understood scientifically," said Gaïa Guenoun, a research coordinator in Juster’s laboratory.

"We worked with trans and non-binary people in Michigan, Nebraska, Oregon and Tennessee to broaden knowledge about stigma and resilience in our communities,"added DuBois.

The researchers enrolled 124 participants in the study, following them for one year between the fall of 2019 and summer of 2020.

The findings are being published against the backdrop of what the researchers call the worst year in legal history for transgender and gender-diverse people. In 2023, over 500 pieces of anti-trans legislation were introduced in the U.S, the highest number ever recorded.

Until recently, trans and nonbinary people have been excluded as participants in scientific research in part due to a rigid conception of sex and gender as immutable and binary, creating a bias in the literature, the scientists say.

About this study

"Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States," by L. Zachary DuBois, Jae Puckett, Robert-Paul Juster et al., was published online Jan. 7, 2024 in a special issue of Hormones and Behavior titled "Sex/Gender Diversity."