Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain

Arch Sex Behav. 2014 Nov;43(8):1503-14. doi: 10.1007/s10508-014-0314-2. Epub 2014 Jul 17.


Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54%; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Caribbean Region
  • Cross-Cultural Comparison
  • Cross-Sectional Studies
  • Female
  • Gender Identity*
  • HIV Infections / prevention & control
  • HIV Infections / psychology*
  • Health Status Indicators
  • Humans
  • Latin America
  • Male
  • Middle Aged
  • Population Surveillance
  • Portugal
  • Regression Analysis
  • Reproductive Health
  • Risk-Taking
  • Sexual Behavior
  • Socioeconomic Factors
  • Spain
  • Suicide
  • Transgender Persons / psychology*
  • Transsexualism / psychology*
  • Young Adult