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Lancet. 2016 Jul 23;388(10042):390-400. doi: 10.1016/S0140-6736(16)00683-8. Epub 2016 Jun 17.

Transgender people: health at the margins of society.

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School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. Electronic address:
Pacific Center for Sex and Society, John A Burns School of Medicine, University of Hawai'i, Manoa, HI, USA.
California Institute of Integral Studies, San Francisco, CA, USA.
Department of Psychiatry, University of California and San Francisco, San Francisco, CA, USA.
Gender Identity Research and Education Society, Ashtead, UK.
School of Law, Manchester Metropolitan University, Manchester, UK.
Porterbrook Clinic and Royal Hallamshire Hospital, Sheffield, UK.


In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

[Indexed for MEDLINE]

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