A Quality of Life Study with Transgender, Gender Nonconforming, and Intersex (TGI) Adults in the City of Los Angeles

November 2023

Using data gathered from first-person accounts, this study examines the needs of transgender, non-binary, and intersex adults who live, work, or receive services in the City of Los Angeles.

Many participants had difficulty obtaining employment and were living with little to no financial resources.
Of all the measures of well-being discussed, housing was the most challenging for participants.
The need for transgender-competent resources and services in LA exceeds availability.
Data Points
of TGI participants were not employed

Transgender people in California experience discrimination and harassment in employment, housing, health care, schools, and other public places. More limited research has also documented that intersex people face employment discrimination and have poorer health compared to the general population. This study embraced a quality-of-life framework to gather first-person accounts from 55 transgender, non-binary, and intersex (TGI) adults to better understand the needs of TGI people who live, work, or receive services in the City of Los Angeles. Focus group topics included housing, employment, health care, and access to local services and resources. Overall, we found that while the TGI community continues to face many acute challenges, it has also developed expertise, relationships, and resources that will be critical to addressing these challenges in partnership with the City.

In this quality-of-life assessment, most (94.6%) focus group participants were transgender and 16.4% of participants identified as intersex. Nearly all participants were people of color, almost two-thirds were Latinx/Hispanic, and half were not born a U.S. citizen. A quarter of participants attended a focus group that was facilitated solely in Spanish.

Many participants had difficulty obtaining employment and were living with little to no financial resources. Specifically, over half (55.3%) were not employed while the rest worked one or more jobs. Almost a third of participants reported no income and over a third reported earning less than $15,000 per year. Only about one in ten (10.4%) participants reported a personal income of $50,000 or greater, even though more than a quarter of participants had a bachelor’s degree or more education.

Many participants reported barriers to finding work, including a lack of identity documentation, both for job applications and proof of legal residence, which matched their gender identity and expression. Other barriers included difficulty finding and applying for jobs and lack of English language fluency. For assistance in addressing these challenges, participants reported the most positive experiences with TGI-focused employment programs developed by TGI community-based organizations.

Out of all the dimensions of well-being discussed in the focus groups, housing was the area where participants expressed the most challenges, including: 1) landlord’s presumptions about their ability to pay rent because of their gender identity; 2) for transgender women, presumptions about their source of income, and stigma around sex work; 3) lack of safety in homeless shelters; and, 4) scarcity of emergency housing programs. A third of participants had used emergency shelters in Los Angeles, and most reported negative experiences and a lack of safety, except for those shelters designed for transgender and gender non-conforming people. However, several participants felt that there are too few emergency housing programs for TGI people in Los Angeles, and those that are available are in demand, have wait lists, and can only support short stays.

Participants also had trouble accessing health care due to the scarcity of providers who are knowledgeable about TGI people and their needs. Those who did not speak English fluently faced additional challenges accessing health care. However, participants described positive experiences related to a limited number of health care providers like Saint John’s Health Center, Kaiser, AltaMed, and the Los Angeles LGBT Center.

In terms of safety, some participants mentioned recent changes in the social climate, particularly anti-trans legislation that has been filed elsewhere in the country, as making them feel less safe. For some, primarily transgender women, longer-term safety concerns in Los Angeles persist. They reported feeling unsafe when using public transportation or walking around certain neighborhoods. Further, many described interactions with police officers that led to questioning the women about whether they were engaged in sex work.

While some transgender-competent resources and services do exist in Los Angeles, the current need appears to exceed availability and some TGI people face additional barriers. Services appeared to be more limited for TGI people who are not fluent in English. Black TGI people described experiences of racism in their efforts to obtain housing or shelter, as well as in relation to the police.

Findings from this focus group study, and the recent Los Angeles County Homeless Count, indicate a clear need to increase access to safe, TGI-competent homeless shelters. Given findings from this study, and published research on housing and employment discrimination, transgender-competent transitional housing programs with employment supports and other resources (e.g., mental health care, English language classes) are recommended. Similarly, given findings from this study, and published research on health care discrimination, efforts to increase the knowledge and skills of the local health care workforce are needed. All services must be linguistically competent and matched to the needs of the diverse population of Los Angeles.

City agencies, particularly those focused on housing, workforce development, health care quality, and public safety should develop performance goals and issue regular public reports on their activities to serve and engage TGI people. Compliance with nondiscrimination protections should also be assessed on an on-going basis—in both public and private spheres—and in relation to housing and employment.

One message came through consistently in this study: while the TGI community in Los Angeles faces significant challenges, the participants in this study demonstrated resilience and made use of resources developed by the local TGI community and other community-based organizations with a demonstrated commitment to serving TGI people. Whenever possible, TGI organizations should be funded directly to meet the needs of the TGI community identified in this report. This approach will be the most efficient, economical, and effective way to deliver services and overcome barriers. More broadly, all City initiatives to improve the quality and quantity of resources for TGI people should be conducted in partnership with TGI people and TGI-led organizations. Finally, on-going monitoring of the needs of TGI people in relation to housing, employment, health care, and safety is recommended to ensure that Los Angeles’ vibrant TGI community is thriving and enjoys the same quality of life as other Angelinos.

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A Quality of Life Study with Transgender, Gender Nonconforming, and Intersex (TGI) Adults in the City of Los Angeles