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ORIGINAL ARTICLE
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Demographic data of transgender population from a tertiary care center in South India


1 Department of Endocrinology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
2 Department of Urology, MS Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Submission06-Oct-2021
Date of Decision20-Nov-2021
Date of Acceptance06-Dec-2021

Correspondence Address:
Pramila Kalra,
Department of Endocrinology, MS Ramaiah Medical College, Mathikere, Bengaluru - 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_797_21

  Abstract 


Introduction: The transgender people face a lot of humiliation and injustice, leaving them socially, economically, and educationally backward in the community. In this study, we present our data on the demographics of the third gender living in our state. Methods: A cross-sectional study consisting of transgender people attending Endocrinology OPD was done and demographics were collected. Results: A total of 89 transgender people were included in the study, of which 43 were transgender female-to-male (FTM), and 46 were transgender male-to-female (MTF). The mean age was 26.98 ± 4.79 (mean ± standard deviation [SD]) years and 28.72 ± 5.56 (mean ± SD) years in the transgender FTMs and transgender MTF, respectively. Most of them in the transgender FTM group were graduates 24 (55.8%) and 16 (37.2%) completing <12th standard and very few 3 (7%) postgraduates whereas, in the transgender MTF group, most of them had <12th standard education 36 (78.3%) and only a few graduates 5 (10.8%) and postgraduates 4 (8.7%). Most of them in the transgender FTM group were graduates 24 (55.8%) while most of the transgender MTF group had education <12th standard education 36 (78.3%). Most of the transgender FTM (86%) had formal gainful employment, while most transgender MTFs (56.5%) depended on begging for their livelihood. Most transgender FTMs (83.7%) were on hormonal therapy, while only 41.3% of transgender MTFs were on hormonal therapy. Sixty-five percent of transgender FTM had not undergone sex reversal surgery, while 58.7% of transgender MTFs had undergone surgery. Addiction to alcohol and smoking was less in both the groups with no statistically significant difference. There was a lack of support by the family in both the groups. Conclusions: Our study helps to understand the demographic profile of the third gender living in our state. The policymakers need to use this data to target optimal health care delivery to them and draft policies for their overall well-being.

Keywords: Demographics, education, transgender female-to-male, transgender male-to-female



How to cite this URL:
Kumbar L, Bobba R, Nagaraj A, Kalra P. Demographic data of transgender population from a tertiary care center in South India. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=338029




  Introduction Top


Transgender is a term used to denote a person whose birth-assigned sex differs from their gender identity. Gender dysphoria is a term used to define the psychological distress experienced by transgender people because of the incongruence between the birth-assigned sex and one's gender identity.[1]

Most transgender people are abandoned by their family and society and face a lot of humiliation and injustice, leaving them socially, economically, and educationally backward in the community.[2]

As per the 2011 census, India's transgender population is around 4.88 lakh, with a literacy rate of 56.07%. In Karnataka, the total population of transgender is about 20,266, with a literacy rate of 58.82%.[3]

Because of lack of education, jobs in the private or government sector are less accessible to transgender people, which lead to inequality in social and economic status. This gender discrimination has led to the disempowerment of the transgender group in India. These factors have threatened them of livelihood and dependence on petty jobs for their livelihood.[3]

In this study, we present our data on the demographics of the transgender people in this region of South India. Our study may help find the inequalities the transgender population face and frame appropriate policies for their better living in this region of south India.


  Methods Top


This is a cross-sectional study consisting of transgender people consulting our Endocrinology OPD. A total of 89 transgender people were included in the study. The study was done in the Department of Endocrinology, Ramaiah Medical College, Bengaluru. The study was approved by the Institutional Ethics Review Board (Letter No. MEU-SS/EC/02/2108 dated January 10, 2018). Informed written consent was taken from the patients.

Statistical analysis

All the continuous variables such as age and number are expressed as mean and standard deviation (SD) Categorical variables are expressed as percentages, and associations are tested for statistical significance by Chi-square or Fischer's exact test.


  Results Top


A total of 89 transgender people were included in the study, of which 43 were transgender female-to-male (FTM), and 46 were transgender male-to-female (MTF). Baseline characteristics are mentioned in [Table 1] and [Table 2]. Age in the transgender FTM group was 26.98 ± 4.79 (mean ± SD) years and 28.72 ± 5.56 (mean ± SD) years in the transgender MTF group.
Table 1: Demographics of the transgender population

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Table 2: Treatment history of transgender population

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Transgender FTMs were more educated than transgender MTFs (P < 0.001). Most of them in the transgender FTM group were graduates 24 (55.8%) whereas in the transgender MTF group, most of them (78.3%) had <12th standard education

Transgender FTMs had a more formal gainful employment than transgender MTFs (P < 0.001). Most of the transgender FTM had a formal gainful employment 37 (86.1%), whereas, in the transgender MTF group, most of them (56.5%) depended on begging for their livelihood.

Most of the transgender FTMs (76.7%) belonged to the Hindu religion, similar to the transgender MTF group (84.8%).

Twenty-six (60.5%) of the transgender FTMs were from Bengaluru, 10 (23.3%) were residing outside Karnataka, and 7 (16.3%) were residing outside Bengaluru but within Karnataka. Thirty-eight (82.6%) of the transgender MTFs were from Bengaluru, 5 (10.9%) were from living outside Bengaluru but within Karnataka, and 3 (6.5%) were residing outside Karnataka.

Twenty-nine (67.4%) of the transgender FTM were from the urban region, while 14 (32.6%) were from a rural region. 38 (82.6%) of the transgender MTF were from the urban region, while 8 (17.4%) were from a rural region. There was no significant difference between the two groups (P = 0.09)

Thirty-six (83.2%) of transgender FTM were on hormonal therapy, whereas in transgender MTFs, most of them (58.7%) were not on hormonal therapy (P < 0.001).

Among the transgender FTM, who were on hormonal therapy, 23 (53.5%) were on treatment for more than 1 year, whereas among the transgender MTF, only 10 (21.7%) were on hormonal therapy for more than 1 year.

Most of the transgender FTM, 28 (65.1%) had not undergone sex reversal surgery, whereas, in the transgender MTF group, 27 (58.7%) had undergone genital surgery. There was no significant difference between the two groups regarding alcohol abuse or smoking (P = 0.36, P = 0.38 respectively). Most of the transgender FTM (62.8%) had no substance abuse with alcohol. Whereas, in the transgender MTF group, 33 (71.7%) had a history of substance abuse with alcohol. In the transgender FTM group, 33 (76.7%) had a history of smoking, similarly, 39 (84.8%) had a history of smoking in the transgender MTF group.

Both transgender FTMs and transgender MTFs had less family support (P = 0.10).


  Discussion Top


Our study included 89 transgender people, including 43 transgender FTM and 46 transgender MTF. As per the 2011 census, the transgender population in India is around 4.88 lakh. As per the data from the USA, transgender population made up 0.53% of the population, with more number of transgender MTFs (0.28%) than transgender FTMs (0.16%).[4]

Our study population's mean age was 26.98 ± 4.79 years in transgender FTMs and 28.72 ± 5.56 years in transgender MTFs. This was similar to the study done in South India,[5] where 42% of them were in the age group of 25–34 years and in a study by Virupaksha et al.,[6] where the mean age was 28.27 ± 6.804 years. Similarly, in a study done in West Bengal, most of the transgender population was 18–44 years.[7] The social system in India is such that the transgender only comes for the transition when they can support themselves financially as the family mostly refuses to support them when they go for the transition.

More than half of the transgender FTMs had completed graduation, while more than 3/4th of transgender MTFs had studied <12th standard schooling. Whereas in a study done by Madhavan et al.,[5] 33.5% of individuals had completed graduation. A lesser literacy rate was seen in studies by Naskar et al.[7] and Virupaksha et al.,[6] where only 2.8% and 3.3% had completed graduation, respectively. Our study population had a higher literacy rate than the national (56.07%) and state (58.82%) literacy rate.[3] This could be because more educated people become aware of the transgender policies and seek help from specialists for the transition, so skewed data showed a higher literacy rate in transgender.

More than three-fourths of the transgender FTMs had formal gainful employment, while more than half of the transgender MTFs were depended on begging for their livelihood in our study. A higher proportion of people were dependent on begging (71.6%) in a study by Virupaksha et al.[6] Similarly, in a study done by Madhavan et al.,[5] 35.5% depended on begging for their livelihood. A higher job opportunity in our region and a high literacy rate in our study population have provided jobs to most of the transgender, with only a few depending on begging. The other reason could be that people are more aware of transgender policies in metropolitan cities. They provide equal job opportunities to third gender compared to other genders.

Most of our study population belonged to the Hindu religion, which was similar to a study done by George et al.[8] in Bangalore. This contrasts with a study done in West Bengal,[7] where more than half (59.7%) belonged to the Muslim region. The acceptability for transition and supporting their kids has been seen in all religions in different studies. All this is attributable to the literacy level and knowledge about gender dysphoria in these areas.

Most of our study population resided in Bengaluru (transgender MTFs > transgender FTMs). In a study by Virupaksha et al.,[6] 50% of the study population were from Karnataka state. As per the 2011 census,[3] Karnataka has a transgender population of 20,266.

In our study population, most of them were from urban regions. In a study by Naskar et al.,[7] 56.9% were from the urban region. As per the data by Crissman et al.,[4] only 28.7% of the transgender population live in a rural area with more transgender MTF than transgender FTMs residing in rural areas; contrary to our study, more transgender FTMs living in rural areas than transgender MTF. With better education and job opportunities, the transgender population moves to urban areas.

Most transgender FTMs (83.7%) in our study were on hormonal therapy compared to 58.7% in transgender MTFs. Whereas in a study done in Eastern India,[9] a higher (74.5%) number of transgender MTFs were on hormonal therapy after excluding people of lost to follow-up. The higher cost of hormonal therapy might be why the lesser number of transgender MTFs on hormonal treatment, as transgender MTFs were less educated and less employed than transgender FTMs in our study. The other possible reason could be that the transgender MTFs mostly opted for testis removal, and after surgery, they got a testosterone deficient state and felt feminine. In contrast, transgender FTMs felt the need to take testosterone injections to see physical changes and masculine features as they mostly did not go for surgery. More than 1 year, more transgender FTMs were on hormonal therapy in 53.5% of transgender FTMs. In contrast, in transgender MTFs, only 21.7% were on hormonal therapy for more than 1 year, which again justifies the above statement. In the study done in Sanyal and Majumder,[10] the mean duration of follow-up in transgender MTFs was 25.5 and 13.1 months in transgender FTMs.

Regarding sex reversal surgery, more people underwent genital surgery in transgender MTFs (58.7%) than the transgender FTMs (4.7%) (P < 0.001). However, fewer transgender MTFs (25.5%) underwent genital surgery in a study done in Eastern India.[9] A higher percentage of sex reversal surgery (85%) was seen in a study done in Bengaluru of transgender people aged more than 40 years.[8] Fifteen (32.6%) of the transgender MTFs had undergone breast surgery in our study, which was almost similar to a study done in Eastern India by Majumder and Sanyal.[9] Some transgender people prefer only surgery, and some prefer only hormonal therapy, which accounts for the vast differences in different transgender people in other regions.

There was no difference in alcohol abuse among transgender FTMs and transgender MTFs (37.2% and 28.3%, respectively, P = 0.36). A lower percentage (13.3%) of the population had alcohol abuse in a study by Viruspaksha et al.[6] However, a higher number (64.5%) of transgender people consumed alcohol as per the study done in South India.[5] Binge drinking was seen in 18.8% of transgender FTMs and 12.9% transgender MTFs as per a study done in the USA,[11] which is less than our study. A higher number of transgender FTMs having an addiction to alcohol in our study may be due to transgender FTMs wanting to portray themselves as males in society.

There was also no significant difference in smoking history among transgender FTMs and transgender MTFs (23.3% and 15.2% respectively, P = 0.33). This is similar to the data by Azagba et al.,[11] where 20.5% of the transgender FTMs and 20.9% of the transgender MTFswere current smokers. Nevertheless, a lower percentage (12%) of smoking was seen in a study done in South India.[5] A higher percentage of smoking in our study might be because most of them lived in urban areas where smoking is common and is erroneously thought of as a sign of modernization.

Most transgender FTMs (83.3%) and transgender MTFs (90.7%) did not have any family support in our study, similar to the study done in Eastern India.[10] The lack of family support is probably because of the social stigma that hinders them from restraining from providing support in education or financially.


  Conclusions Top


Our study helps to understand the demographic profile of the third gender living in our state. The transgender population in our area though more literate but is similar to the population in other states in lacking family support and being more addicted to alcohol and smoking. The policymakers need to use these data to target optimal health care delivery to them and draft policies for their overall well-being.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Washington, DC: American Psychiatric Association; 2013.  Back to cited text no. 1
    
2.
Chandra S. Transgender Children's education and their reengagement in society. Int J Educ Res Stud 2017;2:875-90.  Back to cited text no. 2
    
3.
Mittra A. Educational inequality in India: A review paper for transgender population. Int J Trend Sci Res Dev 2017;2:1578-84.  Back to cited text no. 3
    
4.
Crissman HP, Berger MB, Graham LF, Dalton VK. Transgender demographics: A household probability sample of US adults, 2014. Am J Public Health 2017;107:213-5.  Back to cited text no. 4
    
5.
Madhavan M, Reddy MM, Chinnakali P, Kar SS, Lakshminarayanan S. High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India. J Family Med Prim Care 2020;9:1538-43.  Back to cited text no. 5
  [Full text]  
6.
Virupaksha HG, Muralidhar D. Resilience among transgender persons: Indian perspective. Indian J Soc Psychiatry 2018;34:111-5.  Back to cited text no. 6
  [Full text]  
7.
Naskar P, Roy S, Naskar S, Gupta I. An assessment of quality of life of transgender adults in an urban area of Burdwan district, West Bengal. Int J Community Med Public Health 2018;5:1089-95.  Back to cited text no. 7
    
8.
George A, Janardhana N, Muralidhar D. Quality of life of transgender older adults. Int J Humanit Soc Sci Invent 2015;4:07-11.  Back to cited text no. 8
    
9.
Majumder A, Sanyal D. Outcome and preferences in male-to-female subjects with gender dysphoria: Experience from Eastern India. Indian J Endocrinol Metab 2017;21:21-5.  Back to cited text no. 9
    
10.
Sanyal D, Majumder A. Presentation of gender dysphoria: A perspective from Eastern India. Indian J Endocrinol Metab 2016;20:129-33.  Back to cited text no. 10
    
11.
Azagba S, Latham K, Shan L. Cigarette, smokeless tobacco, and alcohol use among transgender adults in the United States. Int J Drug Policy 2019;73:163-9.  Back to cited text no. 11
    



 
 
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