The sample included 65 individuals self-declared as TRANS. Of these, 42 were TRANS men, 11 were TRANS women, and 11 were non-binary. The CIS group included 78 individuals who self-declared as CIS, among whom22 were CIS men and 56 were CIS women. The median age in the TRANS group was 24 years (18-44) and in the CIS group, 23.5 years (19-55) (p>0.05). The total income of the TRANS group was lower than that of the CIS group – 2200 BRL(300-10000) and 5000 BRL(1100-30000) (p<0.001), respectively. A significant difference was still observed between the groups regarding schooling, in which the CIS group showed a predominance of people who had completed higher education when compared with the TRANS group (p=0.002) (Table 1).
Table 1. Sociodemographic characteristics of transgender and cisgender population of a southeastern Brazilian state.
Variables
|
All
N=143
(%)
|
Transgender
N=65 (45.5%)
|
Cisgender
N=78
(54.5%)
|
p
|
Agea,c
Biological sex
|
24
(18 – 57)
|
24.0
(18 – 44)
|
23.5
(19 – 57)
|
0.852d
0.360
|
Male
|
36 (25.2)
|
14 (21.5)
|
22 (28.2)
|
|
Female
|
107 (74.8)
|
51 (78.5)
|
56 (71.8)
|
|
Race
|
|
|
|
0.353
|
White
Black
|
63 (44.0)
20 (14.0)
|
28 (43.0)
12 (18.5)
|
35 (44.9)
8 (10.3)
|
|
Brown
|
60 (42.0)
|
25 (38.5)
|
35 (44.9)
|
|
Occupation
|
|
|
|
0.012
|
Student
Employee
|
59(41.3)
77(53.8)
|
25 (38.5)
33 (50.8)
|
34 (43.6)
44 (56.4)
|
|
Unemployed
|
7 (4.9)
|
7 (10.8)
|
0
|
|
Incomeb,c
|
3300 (300 – 30000)
|
2200 (300 – 10000)
|
5000 (1100 – 30000)
|
<0.001d
|
Schooling
|
|
|
|
0.002
|
Complete elementary School
|
6 (4.2)
|
6 (9.2)
|
0
|
|
Complete high School
Complete higher education
Complete post-graduation
|
89(62.2)
41 (28.7)
7 (4.9)
|
46 (70.8)
11 (16.9)
2 (3.1)
|
43 (55.1)
30 (38.5)
5 (6.4)
|
|
Marital Status
|
|
|
|
0.574
|
Single
|
113 (79.0)
|
50 (76.9)
|
63 (80.8)
|
|
Stableunion
|
30(21.0)
|
15 (23.1)
|
15 (19.2)
|
|
Place of residencea
|
|
|
|
0.279
|
State’s capital
|
100(70.4)
|
48 (75.0)
|
52 (66.7)
|
|
Countryside
|
42(29.6)
|
16 (25.0)
|
26 (33.3)
|
|
aN=142. bN=126. cMedian (minimume maximum). Chi-square test(X2). dU of Mann-Whitney test. Values in bold are less than 0.05
The TRANS group reported having had a greater number of medical follow-ups or with other health professionals in the Brazilian National Health System – SUS (p<0.001) when compared with CIS individuals (Table 2). As for the data on the follow-up with other health professionals besides the physician, we observed a higher number of TRANS people within this category than CIS individuals(p≤0.001), which reflects the care with a psychologist and/or psychiatrist in the TRANS group (p≤0.001). In addition, the CIS group had fewer comorbidities when compared with the TRANS group (p≤0.001) (Table 2). Regarding the prejudice suffered, the TRANS group was more affected when compared with the CIS group (p<0.001). There was also a difference between the groups regarding smoking, with a higher number of smokers in the TRANS group (p≤0.001) (Table 2).
Table 2. Health characteristics of thetransgender and cisgender population of a southeastern Brazilian state.
Variables
|
All
N=143 (%)
|
Transgender
N=65
(45.5%)
|
Cisgender
N=78
(54.5%)
|
p
|
Comorbidities
|
|
|
|
0.001
|
Yes
|
25 (17.5)
|
19 (29.2)
|
6 (7.7)
|
|
No
|
118 (82.5)
|
46 (70.8)
|
72 (92.3)
|
|
Medical follow-up
|
|
|
|
0.424
|
Yes
|
80 (55.9)
|
34 (52.3)
|
46 (59.0)
|
|
No
|
63 (44.1)
|
31 (47.7)
|
32 (41.0)
|
|
Professional health follow-upa
|
|
|
|
<0.001
|
Psychologist/Psychiatrist
|
33 (24.3)
|
21 (35.0)
|
12 (15.8)
|
|
Nutritionist
|
7 (5.1)
|
3 (5.0)
|
4 (5.3)
|
|
Speech therapist
|
2 (1.5)
|
1 (1.7)
|
1 (1.3)
|
|
Others
|
10 (7.4)
|
3 (5.0)
|
7 (9.2)
|
|
With more thanone professional
|
22 (16.2)
|
17 (28.3)
|
5 (6.6)
|
|
None
|
62 (45.6)
|
15 (25.0)
|
47 (61.8)
|
|
Professional follow-upb
|
|
|
|
<0.001
|
Sim
|
73 (54.1)
|
44 (74.6)
|
29 (38.2)
|
|
Não
|
62 (45.9)
|
15 (25.4)
|
47 (61.8)
|
|
Follow-up systemc
|
|
|
|
<0.001
|
Public
|
45 (31.9)
|
31 (49.2)
|
14 (17.9)
|
|
Private
|
52 (36.9)
|
17 (27.0)
|
35 (44.9)
|
|
Both
|
44 (31.2)
|
15 (23.8)
|
29 (37.2)
|
|
Medicationd
|
|
|
|
0.040
|
Psychiatricmedications
|
16 (11.3)
|
11 (16.9)
|
5 (6.5)
|
|
None
|
96 (67.6)
|
45 (69.2)
|
51 (66.2)
|
|
Others
|
30 (21.1)
|
9 (13.8)
|
21 (27.3)
|
|
Smoking
|
|
|
|
<0.001
|
Yes
|
24 (16.8)
|
20 (30.8)
|
4 (5.1)
|
|
No
|
100 69.9)
|
30 (46.2)
|
70 (89.7)
|
|
Recently stopped
|
19 (13.3)
|
15 (23.1)
|
4 (5.1)
|
|
Prejudice
|
|
|
|
<0.001
|
Yes
|
93 (65.0)
|
58 (89.2)
|
35 (44.9)
|
|
No
|
50 (35.0)
|
7 (10.8)
|
43 (55.1)
|
|
Situations faced in the health environment
|
|
|
|
0.004
|
Stigma/prejudice
|
17 (11.9)
|
12 (18.5)
|
5 (6.4)
|
|
Shortage of qualified professionals
|
82 (57.3)
|
41 (63.1)
|
41 (52.6)
|
|
None
|
44 (30.8)
|
12 (18.5)
|
32 (41.0)
|
|
Health demandse
|
|
|
|
0.001
|
Surgical need
|
4 (6.5)
|
4 (8.5)
|
0
|
|
Hormone therapy
|
8 (12.9)
|
8 (17.0)
|
0
|
|
Specialized care
|
46 (74.1)
|
35 (74.5)
|
11 (73.3)
|
|
None
|
4 (6.5)
|
0
|
4 (26.7)
|
|
Nutrition statusf
Low weight
|
9 (6.4)
|
6 (9.5)
|
3 (3.9)
|
0.321
|
Eutrophy
|
71 (50.7)
|
29 (46.0)
|
42 (54.5)
|
|
Overweight
|
60 (42.9)
|
28 (44.4)
|
32 (41.6)
|
|
aN=136; bN=135; cN=141; dN=142; eN=62; fN=140. Chi-square test(X2). Values in bold are less than 0.05
Regarding the health characteristics of the TRANS population, we observed that 61.9% (n=26) of the TRANS men and 75% (n=9) of the TRANS women use hormone therapy (Table 3). When TRANS men, TRANS women, and non-binary individuals are compared regarding over-the-counter hormone therapy, a significant difference was observed between groups (p=0.048). TRANS men make more use of over-the-counter hormone therapy (n=15) than the other groups (Table 3).
Table 3. Characteristics of health conditions of the transgender of population of a southeastern Brazilian state.
Variables
|
All
N=65 (%)
|
Trans MAN
N=42
(64.6%)
|
Trans WOMAN
N=12
(18.5%)
|
Non-binary
N=11 (16.9%)
|
P
|
Hormonetherapy
|
|
|
|
|
0.002
|
Yes
|
36 (55.4)
|
26 (61.9)
|
9 (75.0)
|
1 (9.1)
|
|
No
|
29 (44.6)
|
16 (38.1)
|
3(25.0)
|
10 (90.9)
|
|
Time of use of hormone therapya
|
|
|
|
|
0.001
|
< 6 months
|
2 (5.6)
|
1 (3.8)
|
0
|
1 (100)
|
|
Between 6 months to 2 years
|
15 (41.7)
|
12 (46.2)
|
3 (33.3)
|
0
|
|
> 2 years
|
19 (52.8)
|
13 (50.0)
|
6 (66.7)
|
0
|
|
Type of hormone therapyb
|
|
|
|
|
<0.001
|
Estrogen
|
2 (6.1)
|
0
|
2 (33.3)
|
0
|
|
Antiandrogen
|
4 (12.1)
|
0
|
4 (66.7)
|
0
|
|
Testosterone
|
27 (81.8)
|
26 (100)
|
0
|
1 (100)
|
|
Hormone therapy with out a prescription
|
|
|
|
|
0.048
|
Yes
|
23 (35.4)
|
15 (35.7)
|
7 (58.3)
|
1 (9.1)
|
|
No
|
42 (64.6)
|
27 (64.3)
|
5 (41.7)
|
10 (90.9)
|
|
Time of use of hormone therapyb
|
33.5
(4 – 276)
|
25.5
(4 – 96)
|
36
(12 – 276)
|
-
|
0.166e
|
Surgical procedurec
|
|
|
|
|
0.419
|
Yes
|
8 (12.5)
|
6 (41.3)
|
2 (16.7)
|
0
|
|
No
|
56 (87.5)
|
36 (85.7)
|
10 (83.3)
|
10 (100)
|
|
Nutritional Statusd
Lowweight
|
6 (9.5)
|
3 (7.4)
|
1 (9.0)
|
2 (18.1)
|
0.865
|
Eutrophy
|
29 (46.0)
|
19 (46.3)
|
5 (45.5)
|
5 (45.5)
|
|
Overweight
|
28 (44.4)
|
19 (46.3)
|
5 (45.5)
|
4 (36.4)
|
|
aN=36; bN=35; cN=64; dN=63. Chi-square test(X2). eU of Mann-Whitney test. Values in bold are less than 0.05
When assessing QoL, we observed that the CIS group showed better QoL when compared with the TRANS group (p=0.014). When assessing QoL by dimension, a significant difference between groups was detected for all dimensions: functional capacity (p<0.001), global limitation (p=0.007), social aspects (p≤0.001), pain (p<0.001), mental health (p<0.001), and vitality (p=0.023) (table 4).
Table 4. Quality of life score (SF-6D) and quality of life dimension scores for transgender and cisgender populations.
Variables
|
Cis
|
Trans
|
|
|
Median
(Min - Max)
|
Median
(Min – Max)
|
p
|
Score of QoL
|
0.834
(0.721 – 1.00)
|
0.749
(0.627 – 0.929)
|
0.014
|
Dimensions
|
|
|
|
Functional capacity
|
0.00
(-0.05 – 0.00)
|
-0.51
(-0.05 – 0.00)
|
<0.001
|
Global limitation
|
0.00
(-0.05 – 0.00)
|
-0.48
(-0.05 – 0.00)
|
0.007
|
Social aspects
|
-0.03
(-0.06 – 0.00)
|
-0.04
(-0.07 – 0.00)
|
<0.001
|
Pain
|
-0.06
(-0.06 – 0.00)
|
-0.06
(-0.09 – 0.00)
|
<0.001
|
Mental health
|
-0.47
(-0.07 – 0.00)
|
-0.47
(-0.07 – 0.00)
|
<0.001
|
Vitality
|
-0.03
(-0.05 – 0.00)
|
-0.03
(-0.05 – -0.03)
|
0.023
|
QoL= quality of life. Chi-square test(X2). Values in bold are less than 0.05
The sociodemographic and health data distributed according to the median QoL score are presented in Supplementary Table 1 (TS1). The median QoL scores were 0.834 (0.721-1.00) for the TRANS group and 0.749 (0.627-0.929) for the CIS group (TS1). CIS participants scored better on QoL and had lower age (24.2±4.3 years; p≤0.05), body weight (63.7±13.4 kg; p≤0.05), and BMI (22.9±3.2 kg/m²; p≤0.001) than TRANS individuals. When checking the data for the TRANS population, we found that those with higher QoL scores had an income ≥3 MW (n=17; 77.3%) (p≤0.05), no comorbidities (n=27; 58.7%) (p≤0.05), lived in the countryside (n=13; 81.3%) (p≤0.05), and did not suffer prejudice (n=6; 85.7%) (p≤0.05) (TS1).
From the multivariate logistic regression analysis of the data of the TRANS population adjusted for prejudice and gender identity, we observed that having an income of 1 to 3 MW reduces the chances of having a better QoL by 94.6% (OR=0.054, CI=0.004-0.707, p=0.026) when compared with those with income above 3 MW. Similarly, living in the state’s capital reduces by 96.2% (OR=0.038, CI=0.004-0.387, p=0.006) the chances of having a better QoL when compared with those who live in the countryside (Table 5).
Table 5: Logistic regression models for quality of life in the transgender population.
Variables
|
OR raw (CI95%)
|
p valor
|
OR Model 1(CI95%)a
|
p valor
|
OR Model 2
(CI95%)b
|
p valor
|
Income
|
|
|
|
|
|
|
≥3 MW
|
1
|
|
1
|
|
1
|
|
<1 MW
|
0.171
(0.040 – 0.737)
|
0.018
|
0.195
(0.044 – 0.868)
|
0.032
|
0.054
(0.004 – 0.707)
|
0.026
|
Comorbidities
|
|
|
|
|
|
|
No
|
1
|
|
1
|
|
1
|
|
Yes
|
0.297
(0.059 – 1.487)
|
0.140
|
0.394
(0.075 – 2.052)
|
0.268
|
0.128
(0.015 – 1.072)
|
0.058
|
City
|
|
|
|
|
|
|
Countryside
|
1
|
|
1
|
|
1
|
1
|
State’s capital
|
0.057
(0.006 – 0.532)
|
0.012
|
0.053
(0.006 – 0.494)
|
0.010
|
0.038
(0.004 – 0.387)
|
0.006
|
aModel 1: Adjusted for prejudice; bModel 2: Adjusted for prejudice and gender identity; OR: odds ratio; CI: confidence intervals; MW: minimum wage. Values in bold are less than 0.05