Few data are available on the number of transgender individuals in the United States; however, studies from the Netherlands estimate a prevalence of 1 in 11,900 males and 1 in 30,400 females.[49] Although no population-based studies have addressed transgender health care issues, small nonrandom surveys suggest that this group experiences significant health disparities especially in the areas of violence, HIV disease, and other STDs. Like other members of the LGBT community, people of transgender experience also face barriers to health care access due to stigma and discrimination, fewer options for health insurance and lack of knowledge by medical providers about their specific health concerns.

The National Coalition of Anti-Violence Programs (NCAVP) has reported a steady increase in the number of transgender individuals experiencing genderidentity-related bias crimes, including sexual assault and murder between 2007 and 2008.[50] Transgender individuals experience stigma in other areas of daily life and are not protected against work, housing, or education discrimination in most locales of the United States.

This social marginalization forces many transgender individuals to engage in survival sex work. In Texas, more than 50 percent of transgender women in one study had engaged in transactional sex for either money or drugs.[51] Similar high rates have been found among transgender youth.[52]

The CDC does not collect separate statistics on transgender individuals and classifies male-to-female transgender individuals as MWM for data-collection purposes. Several prevalence surveys and an incidence study have revealed HIV rates among transgender women that are among the highest in the United States. A cross-sectional survey conducted among 392 male-to-female transgender persons in California revealed that 35 percent were HIV-positive.[53] The prevalence among African American transgender women was even higher at 63 percent. Similarly high rates among transgender women have been found by other investigators, in particular those who are African American.[54, 55]

In 1997 the San Francisco Department of Health added male-to-female transgender as a gender category enabling further investigation of HIV outcomes in this community. The incidence among transgender women was found to be 7.8 per 100 person-years (95 percent Confidence Interval-CI,  4.6-12.3)  and 18.1 per 100 person-years (95 percent CI, 8.5-34.1) among African Americans.[54] The reasons for the high rates of HIV among transgender women has not been fully investigated, but so far appears to be related to substance use and transactional sex work.

Although many of the studies have been limited by small size and nonprobability sampling, all suggest that an HIV epidemic is currently under way in the maleto-female transgender community, which requires urgent attention by public health officials.  Unfortunately,  few HIV prevention programs in existence target this community.

Many, but not all, people of transgender experience use cross-gender hormone therapy or surgery to acquire the secondary sexual characteristics of the preferred gender. For transgender women, medical transition includes estrogen therapy and androgen blockers. Surgical treatment may include breast implants, facial feminization surgery, and genital surgery, such as orchiectomy, vaginoplasty, and labiaplasty. Transgender men may initiate testosterone therapy. Surgeries may involve chest masculinization (mastectomy) as well as genital surgery such as phalloplasty or metoidioplasty. Most public and private health insurance plans do not cover the costs of medical or surgical transition and many transgender individuals opt not to undergo expensive surgical interventions.