How stigma hurts trans health

Robert-Paul Juster

Credit: Amélie Philibert, Université de Montréal

For transgender and nonbinary people, feeling connected to one's community may alleviate the adverse health effects of chronic exposure to stigma, the latest findings of a U.S.-Canada study suggests.

Done in collaboration with Université de Montréal assistant professor of psychiatry Robert-Paul Juster, the findings of the Trans Resilience & Health Study focus on variations in the human body’s production of cortisol, a key hormone in the stress response.

In their work published earlier this month in Hormones and Behavior, the researchers were able to demonstrate a link between higher exposure to gender-related stigma and a pattern of cortisol variation that was blunted, sluggish and flattened.

This implies a decreased ability to regulate the body’s stress response, the scientists say.

"Almost every cell and system in our body is influenced by cortisol," said Juster, who works at the UdeM-affiliated research centre of the Institut universitaire en santé mentale de Montréal.

"This is why chronic stress manifests itself in a plethora of pathologies linked to the cells in our heart, brain, stomach and kidneys … as well as to impairments in cognition and mental health."

The study show that trans and nonbinary people who feel more connected to their communities have a more dynamic pattern of cortisol function, suggesting they can recover better from stress.

Importantly, the results confirm other studies that transgender women and gender-diverse people who were assigned male at birth actually experience more overall stigma than the rest of the community.

The study's authors – led by by trans researchers Zachary DuBois at the University of Oregon and Jae Puckett at Michigan State University – interpret this as a function of sociocultural aspects of gender and social roles, not biology.

Besides this direct association between stigma and cortisol, DuBois and Juster also showed, in a 2022 study, that such stigma is associated with other markers of chronic stress (known as allostatic load) that represent an increased risk of disease and mortality.