Archives of Sexual Behavior

, Volume 47, Issue 4, pp 953–962 | Cite as

Structural Inequities and Social Networks Impact Hormone Use and Misuse Among Transgender Women in Los Angeles County

  • Kirsty Clark
  • Jesse B. Fletcher
  • Ian W. Holloway
  • Cathy J. Reback
Original Paper


In order to reduce gender dysphoria and combat stigma, transgender women often affirm their gender through social and medical transition, which may include cross-sex hormone therapy. This study examined associations between medically monitored hormone use and hormone misuse (non-prescribed hormone use including “fillers”), structural inequities (access to housing, health insurance, and income), and social network dynamics among 271 transgender women in Los Angeles. Hormone use status was coded trichotomously (hormone use, hormone misuse, no hormone use), and robust multinomial logistic regression as well as novel social network analysis was conducted to examine associations. Results demonstrated that younger, African-American/Black transgender women were most likely to engage in hormone misuse compared to transgender women who were older or non-African-American/Black. One-third of the sample reported sex work as a main source of income, and this group was more likely to misuse hormones than those with another primary source of income. Transgender women with access to stable housing and health insurance were most likely to engage in medically monitored hormone use. Social network analysis revealed that transgender women with a greater number of hormone-using network alters were most likely to misuse hormones, but that using the Internet to find transgender friends mitigated this association. Results demonstrate the multifaceted risk profile of transgender women who use and misuse hormones, including that social networks play an important role in hormone usage among transgender women.


Transgender women Hormone use Social network Structural inequality 



This study was supported by the National Institute on Drug Abuse, Grant #R21DA037816. Dr. Reback acknowledges additional support from the National Institute of Mental Health (P30 MH58107). Ms. Clark acknowledges funding support from the Graduate Division, UCLA Fielding School of Public Health (Fellowship in Epidemiology, #104733842). Dr. Holloway acknowledges funding support from the California HIV/AIDS Research Program (RP15-LA-007).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kirsty Clark
    • 1
  • Jesse B. Fletcher
    • 2
  • Ian W. Holloway
    • 3
  • Cathy J. Reback
    • 2
    • 4
  1. 1.Department of Epidemiology, Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Friends Research Institute, Inc.Los AngelesUSA
  3. 3.Department of Social Welfare, Luskin School of Public AffairsUniversity of California, Los AngelesLos AngelesUSA
  4. 4.David Geffen School of Medicine, Semel Institute of Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesUSA

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