Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
Highlights
The term transgender describes individuals whose gender identity or expression differs from the sex they were assigned at birth
The results obtained regarding current tobacco use disorder, current substance use, and current substance use disorder were unreliable because we found so few studies examining these topics, we included them in the Supplementary Materials for informational purposes
Of note, when we considered tobacco use disorder in this current study, we found no differences between the transgender and cisgender groups, the small number of studies included in this analysis meant that our confidence in the reliability of this result was poor
Summary
The term transgender describes individuals whose gender identity or expression differs from the sex they were assigned at birth. Some people prefer to view these congenital conditions as a matter of diversity and use the terms intersex or intersexuality instead. This term includes people whose gender identity differs from the sex assigned at birth, and those whose reproductive organs do not conform to what is traditionally designated as male or female. These terms encourage the conception of gender from a non-binary perspective of it. Within gender minorities, there is people known as genderqueer, agender, non-binary, two-spirit, or gender fluid, which includes people whose gender identity and/or role does not conform to a binary understanding of gender as something limited to the categories of man or woman and masculine or feminine [1]
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