Introduction

Transgender people experience their gender as incongruent with the sex assigned at birth. They might identify as a binary gender or outside of the gender binary. People who are non-binary might experience their gender as moving between male and female or as situated beyond the gender binary. Some reject the concept of sex and gender at all, either on a personal, or a general level. Transgender health care primarily focusses on medical measures to support the person’s transition to live their gender both physically and socially. This may include hormone therapy, gender-affirming surgery, and a variety of additional interventions. For treatment-seeking transgender people these interventions positively affect mental health and quality of life and are thus considered state-of-the-art treatments. However, not all transgender people want to undergo any of these medical interventions, or might have access to it.

Transgender communities all around the world are highly diverse, depending on cultural background, socioeconomic factors, legal circumstances, and many more influences. Therefore, there is no universal narrative that could be assumed to represent transgender communities globally. However, transgender people have been considered to be a vulnerable social group in much of the world, many of whom have experienced discrimination and marginalization by society, and health care systems in particular. Access to transgender health care is often restricted due to legal requirements, financial barriers, and ‘gatekeeping’ health care providers in countries all over the world. These elements can lead to a negative impact on transgender individuals health and quality of life.

During to the COVID-19 pandemic access to medical care was, and in some areas globally still is, restricted for nearly all non-acute medical conditions. State health care, as well as private practice, were mainly focusing on COVID-19. Since transgender individuals often need access to medical treatments such as hormone therapy, these restrictions are likely to have increased psychological distress. Due to both their status as a vulnerable social group and their need for transition-related treatments, this impact may be particularly severe for transgender people.

Even though some authors have already addressed the impact of the COVID-19 pandemic on transgender people, there remains a dearth of evidence. Perez-Brumer and Silva-Santisteban discussed the disparities transgender people face in Peru due to binary-based policies as a response to the COVID-19 pandemic and how this increasing discrimination impacts physical and mental health. Van der Miesen and colleagues summarized the intersections between health care, human rights, and socioeconomic stress for transgender individuals during the COVID-19 pandemic. They state the need for a joint strategy of policy makers, transgender advocates, health care providers, and governments. Wang and colleagues refer to the barriers of care for transgender people in times of COVID-19 in light of evidence from their clinic in Beijing, China. The restricted access to hormone treatment was associated with high levels of depression and anxiety due to the challenge of continuing presenting and socially living as their sex assigned at birth. All the authors state the need for collaborative strategies between relevant stakeholders to actively consider the difficulties faced by the transgender population during the COVID-19 pandemic and the need for high-quality evidence to base strategies upon.

The current study investigates the impact of the COVID-19 pandemic on the health and health care of transgender individuals, acknowledging the diversity of transgender communities in different geographical regions and countries and the variety of societal, legal, and medical circumstances. As an ad hoc collaboration between researchers, community members and clinicians from several countries, the study aims to generate an impression of the situation of transgender health care during the COVID-19 pandemic in as many countries as possible. The study aimed to contribute empirical evidence on the situation of transgender individuals in times of COVID-19 and, therefore, help to develop and implement measures addressing the obstacles that affect transgender individuals during the pandemic.