Disclosure of Gender Identity among Transgender Individuals to Healthcare Professionals in China: An Online Cross-sectional Study

PurposeCulture and stigma-relevant issues discourage transgender (TG) individuals in China from disclosing their gender identities. This limits their access to transgender competent health services. This study evaluates the factors associated with gender identity disclosure to health professionals among transgender individuals in China. MethodsA cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, HIV/STI testing, sexual behaviors, and access to medical and mental health services. ResultsOverall, 277 (85.5%) out of 324 transgender individuals were eligible to participate in the study. The mean age was 29{+/-}8 years old. Among them, 78% (192/277) had ever disclosed their gender identity to others, and 56% (155/277) had disclosed their gender identity to health professionals. 79.4% had ever tested for HIV (with an HIV prevalence of 9.1%), 47.3% had tested for other STIs, 42.6% had used hormone therapy, and 9.4% had undergone gender-affirming surgery. Results from the multivariable logistic regression demonstrated that compared to non-disclosers, disclosers were more likely to have tested for STIs (aOR=1.94, 95%CI: 1.12-3.39). Hormone intervention therapy (aOR=2.81, 95%CI: 1.56-5.05) and Pre-Exposure Prophylaxis (PrEP) use (aOR= 3.51, 95%CI: 1.12-10.97) were associated with gender identity disclosure to health professionals. ConclusionsLow rates of gender identity disclosure to health professionals among transgender people may reflect fear of stigma and outing, suggesting the need for more trans-inclusive environments. More research is needed to understand the importance of disclosure in improving transgender health services. SummaryA study among transgender individuals in nine cities across mainland China found that gender identity disclosers to health care professionals were more likely to test for STIs than nondisclosures.