Jody Herman and ​Bianca D.M. Wilson, both at the Williams Institute, are co-authors of a policy brief about the newly released CHIS data on transgender adults in California.

In this brief interview, they discuss the high rates of suicidal thoughts and attempts among transgender adults, the need to enforce policies that protect the population, and the importance of CHIS accurately measuring gender orientation, and how its current and future data will inform better research and policies in the future.

Q: The prevalence of suicide ideation and attempts among transgender people seems quite high. What do you make of that?

​True, the suicide ideation rate among transgender people in this study is high and alarming. Unfortunately, it reflects what over a dozen surveys of transgender adults in the United States and other countries have also found.

Research shows that several factors appear to be related to suicide ideation and attempts among transgender people: stress related to experiences of anti-transgender bias, delaying health care due to discrimination, and not receiving medically necessary gender affirming health care. These factors are also interrelated.

These high rates of suicide ideation and attempts tell us that interventions are needed to help a severely marginalized group in the population. And the known factors associated with suicidality tell us that these interventions should focus on preventing violence and discrimination against transgender people and increasing access to culturally competent care and gender-affirming care.

These alarming data also tell us that we need to understand more about the lives of those who are not experiencing suicidal ideation or attempts. This would help us learn about existing sources for resiliency.

Q: California policies — including the new Gender Recognition Act― seem to help promote the health and well-being of transgender people. However, the study found significant health disparities in this population. Why do you think this is?

​California has put a number of protective public policies in place. Writing and passing good policies are a critical first step, but we then need to make sure those policies operate the way we expect.

These data point to a need to better understand how well the policies are being implemented and enforced to ensure these laws and regulations are bringing about positive effects. We also know that while public policies are one important piece of the puzzle to ending discrimination, more is needed.

We must develop interventions that target the ways families and communities treat transgender children, youth and adults to reduce anti-transgender rejection and violence.

Q: This is the first population-based data collected on transgender people in California. What do you hope to learn as the CHIS survey continues and larger samples are collected?

​This was the first time the commonly recommended two-step method for assessing gender identity was used in a state-wide representative survey. Our survey asked respondents for their sex assigned at birth and how they currently describe themselves (male, female or transgender). This two-step approach allowed us to include a larger range of transgender people in our analysis without needing them to self-identify as transgender. We expect that the success of using this approach in CHIS, the largest state health survey in the U.S., makes it more likely that other surveys conducted at national, state and county levels will also adopt this approach.

Using reliable and valid measures of gender identity that are inclusive of transgender people leads to more accurate information about the health and well-being of people in the U.S. This first round of data collection gave us representative information about the health and health care access of transgender adults in California. As more data are collected over the years, we will be able to examine whether transgender and cisgender people differ in other areas of health, such as insurance coverage, disease rates, and poverty.

Also important, a larger sample size will make it possible to assess whether there are important intragroup differences among transgender adults. For example, are their racial differences among transgender people that are relevant to discussions about health inequities? Do transgender people in Los Angeles and the Bay Area — counties known to have greater amounts of political, social and cultural resources for transgender people compared to some other parts of California — have different health outcomes and health access than those outside of these counties?

Answering questions like these will help health services and advocates consider how to best design and target future interventions, and use their resources more effectively.