What This Means
This research synthesized data from 225 studies involving over 121,000 transgender and nonbinary (TNB) people to understand how different forms of stigma affect their health. The researchers looked at three levels of stigma: structural (laws and policies that discriminate), interpersonal (discrimination and mistreatment from others), and individual (internalized stigma, such as shame about one's gender identity). All three types were linked to worse health outcomes, with individual (internalized) stigma showing the strongest association. Stigma was connected to worse mental health, physical health, sexual health, suicidal thoughts, and substance use across the board.
A particularly important finding was a 'trickle-down effect': structural stigma — like discriminatory laws — didn't just harm health directly, but also contributed to interpersonal mistreatment, which in turn contributed to internalized stigma, each layer adding further harm to health. Somewhat surprisingly, the study found that resilience factors like community connectedness, gender affirmation, and gender identity pride did not appear to buffer or reduce stigma's negative health effects. Additionally, the stigma-health relationship appeared weaker for TNB people of color compared to TNB White people, a complex finding that may reflect differences in how stigma is measured or experienced across racial and ethnic groups.
This research suggests that addressing health disparities for transgender and nonbinary people requires tackling stigma at multiple levels simultaneously — not just helping individuals cope, but also changing discriminatory policies and reducing interpersonal discrimination. The finding that resilience factors alone do not protect against stigma's harms reinforces that the burden should not be placed on individuals to 'resilience their way out' of structural and social discrimination. Multilevel interventions — from policy change to community-level support — appear necessary to meaningfully improve health outcomes for TNB populations.