Fenway Health, Brown, BU, and Rand Study Shows Significantly Higher Prevalence of Substance Use Disorder among U.S. Transgender Adults as Compared with Cisgender Peers

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It is believed to be the first national study to compare large, geographically-representative cohorts of transgender adults with their cisgender peers

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Research suggests that some transgender people misuse nicotine, alcohol, or other drugs such as cannabis, opioids, or cocaine to cope with the psychological toll of discrimination.

A new study published in JAMA Open Network found that the prevalence of nicotine, alcohol, cannabis, cocaine, opioid and polysubstance use disorder drug use was significantly higher among U.S. transgender adults than their cisgender peers. The study also showed that trans feminine adults (those who received feminizing hormones or procedures) had a higher prevalence of every substance use disorder diagnosis than trans masculine adults (those who received masculinizing hormones or procedures). The study was authored by researchers at The Fenway Institute, Brown University, Boston University, and the RAND Corporation and is believed to be the first national study to compare large, geographically-representative cohorts of transgender adults with their cisgender peers. It is also believed to be the first national study to document disparities in diagnosed substance use disorders among trans feminine and trans masculine adults.

A dearth of national surveillance data makes it difficult to capture the burden of substance use disorder among transgender adults. This study, titled “Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults,” capitalized on the use of de-identified medical claims data to explore the prevalence of diagnosed substance use disorders among 15,637 transgender adults and 46,911 cisgender adults with commercial insurance and Medicare Advantage. The researchers found that transgender adults were 3.6 times more likely to have been diagnosed with a substance use disorder than their cisgender peers, and four times more likely to have been diagnosed with multiple substance use disorders. The patterns persisted when transgender and cisgender groups were compared across age groups and geographic areas.

“Research suggests that some transgender people misuse nicotine, alcohol, or other drugs such as cannabis, opioids, or cocaine to cope with the psychological toll of discrimination. While the pathway to misuse is well understood, the extent to which substance misuse actually translates into diagnosed substance use disorders for transgender people is less understood,” said lead author Jaclyn White Hughto, PhD, MPH, an Assistant Professor at the Brown University School of Public Health and an Adjunct Investigator at The Fenway Institute. “By using insurance claims data, we were not only able to describe the prevalence of substance use disorders among a large, diverse sample of U.S. transgender adults but we were also able to document concerning disparities in the prevalence of substance use disorders among transgender adults relative to their cisgender counterparts. These findings underscore the urgent need for the development of and access to culturally-tailored, clinical interventions capable of effectively treating transgender people with substance use disorders.”

Findings from the study show the following:

  • Nicotine use was far more prevalent among transgender adults than cisgender adults: 16.6% versus 5.4%
  • Transgender individuals had four times the prevalence of cocaine use disorder as compared with cisgender people
  • Transgender individuals had three times the prevalence of opioid use disorder as compared with cisgender people
  • Trans feminine adults were nearly three times more likely to have received multiple diagnoses for substance use disorders than trans masculine adults

“The differences in diagnosed substance use disorders among trans feminine people relative to trans masculine people raise intriguing questions about the potential causes of these disparities. For example, do trans feminine people experience greater stressors or have fewer stress-management strategies leading to a greater reliance on substances as a way to cope with stress? Or is it that trans feminine people clinically present with substance use disorder symptoms at higher rates than trans masculine people?,” said Hughto. “Given that cisgender males in our study had higher rates of alcohol and drug disorder diagnoses than cisgender females, we also need to ask if there may be sex-related and developmental factors that lead individuals assigned a male birth at sex to engage in heavier substance use than individuals assigned a female birth sex. Additional research is needed to understand the drivers of the disparities in substance use disorder diagnoses we observed across transgender subgroups and relative to cisgender people in order to inform future clinical interventions for this population.”

“Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults” is available online.

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Christopher A Viveiros
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