Substance Abuse In Transmen and Transwomen—What’s Similar, What’s Different & What Can Be Done

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Despite growing awareness and acceptance of transgender people, substance abuse in transmen and transwomen is a huge problem. Learn why transgender people suffer more from substance abuse, how substance abuse differs between transmen and transwomen, and how La Fuente Hollywood Treatment is revolutionizing substance abuse treatment for the trans population. 

Rates Of Substance Abuse In Transmen and Transwomen

Recent studies have found that transgender individuals have high rates of alcohol use (estimates up to 72%), marijuana use (estimates up to 71%), hard drug use (estimates up to 34%), and prescription drug misuse (estimates up to 26.5%). What’s more, transgender people show greater misuse of these substances than those who are not transgender. 

These studies show just how problematic substance abuse is in the transgender community. But statistics don’t explain the cause of these alarming rates. Keep reading to learn what’s behind the data. 

Explanation Of Substance Abuse In Transmen and Transwomen

There are many overlapping explanations for the high rates of substance abuse in transmen and transwomen.

The first is that trans people deal with discrimination on a daily basis just for being who they are. In fact, a study by the National Center for Transgender Equality explained that transgender individuals experience “devastating levels of discrimination in every aspect of life.” 

In addition to widespread discrimination, trans people also experience high levels of…

  • Poverty- 29% of trans individuals in the U.S. fall below the poverty line, compared to 12% of the total U.S. population.
  • Unemployment – In 2020, transgender people were 11 percentage points less likely to be working compared to cisgender people. 
  • Homelessness – The number of adult transgender individuals experiencing homelessness increased 88% between 2016 and 2020.
  • Violence – 24% of trans people reported being physically attacked while in school (K-12), while 17% were sexually attacked.

In light of this data, several studies have looked at the association between trans-specific discrimination (transphobia and gender abuse), substance abuse, and mental health. The findings support the application of the Minority Stress Model to trans people. 

This model asserts that members of minority groups who experience prolonged exposure to prejudice and discrimination are more likely to experience psychological outcomes and risky behaviors, like substance abuse. 

On average, trans people have poorer mental health outcomes than their cisgender peers. One survey found that 44.1% of trans people reported suffering from clinical depression, while 33% experienced anxiety. 

Another survey about transgender mental health found that 42% of respondents have tried to commit suicide at least once. Indeed, one researcher noted that “in no other community is the link between rights and [mental] health so clearly visible as in the transgender community.” 

In the simplest terms, much of the substance abuse in the trans community comes as a response to the various stressors trans people face. Drugs and alcohol allow individuals to self-medicate and cope with their daily challenges. 

Substance Abuse In The Trans Community

Despite the high rates of substance abuse in transmen and transwomen, there are still a lot of unknowns. Specifically, not much is known about the similarities and differences in substance use by transmen and transwomen. Moreover, there’s a lack of consensus about best practices for substance abuse treatment in this population. 

Despite these shortcomings, we do know a few things about the similarities and differences in substance abuse between transmen (TM) and transwomen (TW). 

Similarities Between Transmen And Transwomen

Research has shown that transmen (TM) and transwomen (TW) suffering from addiction are likely to begin with alcohol abuse before graduating to other drugs.

What’s more, both TMs and TWs in substance abuse treatment are more likely to have co-occurring disorders (e.g. depression, anxiety, eating disorders) than heterosexuals or cisgendered individuals. 

The exact cause of these co-occurring disorders varies from person to person. However, it’s clear that these disorders complicate substance abuse treatment. That’s because the relationship between the disorders is complex. What’s more, treating only one disorder can have a negative effect on both disorders. 

Differences Between Transmen And Transwomen

Just as there are similarities between TM and TW in terms of substance abuse, there are also differences. While these differences are notable, it’s important to keep in mind the limited scope of the research on this subject. 

Differences In Substance Abuse Rates And The Causes

One major difference between the groups is that trans women appear to be at a greater risk for substance use. Again, there’s limited research on this topic, but one study found that 34% of TW had used intravenous drugs at one point or another during the course of their lives. For TM, this percentage was 18%.

Just as there’s not much data about the differences in drug use, there’s even less research into why TW suffer from substance abuse at twice the rate of TM. That being said, trans advocates do have some initial hypotheses. 

Transmen may fare better because of their “passing privilege.” For TM on a testosterone regime, the ability to eventually blend into society is often easier than it is for TW. Testosterone is an extremely effective masculinizing hormone, bringing a deeper voice, more facial and body hair, and even the squaring of facial features. 

On the other hand, estrogen and testosterone blockers don’t provide feminizing effects for TW as easily. In order to achieve a more feminine appearance, many TW undertake vocal training, hair removal, and even surgical procedures. But they may still struggle to “pass” even with these additional interventions, leading to ostracization, and in some cases, substance abuse. 

Another explanation for the discrepancy in substance abuse is that TM gain societal privilege as part of their transition. Indeed, several TM note that they gained more respect from colleagues, promotions, and higher salaries, just by virtue of being male. 

Conversely, TW may see their masculine privilege dry up as a result of their transition. Moreover, TW are more often portrayed as mentally unstable, disgusting, or ridiculous in television and movies. These representations can contribute to the transphobia TW feel. 

This is notable because researchers have found a link between transphobia and substance abuse. Transmen are mostly ignored in the media—which is damaging in and of itself—but the positive side is that they’re mostly spared from cruel, outdated tropes that may contribute to substance abuse behavior. 

Differences In Substance Abuse Treatment

In addition to the factors behind substance abuse in TM and TW, there are also important differences to consider as part of substance abuse treatment.

The first concerns TM. Transmen may use “street” or “black market” hormones. In addition, obtaining and using needles for testosterone injections may be relapse triggers for clients in early recovery. For these reasons, treatment providers should ensure TM are following only a medically-prescribed hormone replacement therapy. Preferably ones that uses transdermal testosterone instead of injectable testosterone. 

In terms of TW, treatment providers should note that many have sexual abuse histories. Some also have co-occurring eating disorders or depression. Others may not have experienced a sober relationship. These additional factors will impact substance abuse treatment and should be integrated into the treatment plan. 

How To Improve Treatment Outcomes

Despite the differences in substance abuse rates and treatment programs for TM and TW, there are several things providers can do to improve outcomes for both groups. Read on to learn how office infrastructure, language, and treatment approaches can improve treatment outcomes for trans patients. 

Office Infrastructure

  • Make all bathrooms gender-neutral. 
  • Allow clients to use dorm rooms of the gender they identify with or give them a private room.
  • Provide private shower stalls. If only group stalls are available, give trans clients a special time for showering.

Language

  • Leave a blank space after gender on intake forms or have a transgender option.
  • Use gender-inclusive language when asking about sexual or relationship history (e.g. “partner” instead of “boyfriend/girlfriend”).
  • Encourage staff members to introduce themselves using their name and their pronouns (he, she, they, or something else). Have clients do the same.

Treatment Approach 

  • Allow clients to self-identify and don’t judge them for their identity. 
  • Conduct a comprehensive biopsychosocial assessment during the intake process. This includes questions about sexuality, gender identity, and comfort with one’s sex role.
  • Acknowledge past negative experiences trans people have had with healthcare or other institutions. These experiences may cause trans clients to be distrustful of providers. As such, treat trans clients with respect and sensitivity. 
  • Support clients in maintaining a regular, legally prescribed hormone treatment program.
  • Consider using trauma-informed psychosocial interventions. This includes discussing the impact of societal and internalized transphobia, violence, discrimination, family issues, isolation, lack of education/job opportunities, access to healthcare, and self-esteem on substance abuse. 
  • Integrate the transgender theory approach. This approach looks at the relationship between a person’s physical self with their sexual and gender identity. Used correctly, this method can help individuals better understand themselves and their addiction.

La Fuente Is A Leader In Trans-Affirmative Substance Abuse Treatment

Just as the research about substance abuse and treatment for transgender people is lacking, so too is there a lack of trans-specific treatment programs. However, La Fuente Hollywood Treatment Center is working to change that. 

Located in Los Angeles, La Fuente is one of only a handful of substance abuse treatment centers specializing in LGBTQ-affirmative substance treatment. Our mission is to provide culturally-sensitive interventions and programs for all members of the LGBTQ community, including transmen and transwomen. 

So if you or a loved one is struggling with substance abuse and is looking for trans-affirmative treatment in Los Angeles, California, complete the form below. A member of our staff will contact you within 24 hours to help you determine if La Fuente is right for you. 

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