Among these single subgroup studies, the majority focused specifically on the TW community, with only a few studies that were dedicated exclusively to TM populations. Interestingly, in the studies that did compare addiction prevalence rates between TGD subgroups, there was more evidence to suggest that TM were at a higher risk for most forms of addiction than TWs. While it is undeniable that TW face unique obstacles that intersect with their substance use , future research should also investigate the distinctive reasons that underlie substance abuse among TM. After all, establishing a deeper understanding of a subgroup’sunique predispositions has clinically important implications for screening at-risk patients and tailoring treatments. Our review also included numerous studies that examined addiction rates among nonbinary individuals, a large portion of the TGD population that remains largely understudied.
While we identifified studies suggesting that nonbinary and GNC individuals may be at a higher risk for certain addictions relative to their transgender counterparts , the majority of current research suggests that their addiction rates do not significantly differ from TW and TM. In fact, some studies even indicated that nonbinary and GNC individuals may be at a lower risk for certain addictions compared to the other TGD subgroups . However, it should be noted that the number of studies that stratified participants into separate nonbinary or GNC subgroups was sparse, and as a result, it is difficult to draw any overarching conclusions. As in our previous review of SM subgroups, there was substantially less research that investigated behavioral addictions as a function of gender identity . However, despite a limited number of published studies, there is compelling evidence to suggest that prevalence rates may vary significantly between individual GM subgroups. For instance, we found one study indicating that a random sample of TM reported levels of body dysmorphia comparable to those with a diagnosed eating disorder.A similar study concluded that TM, as a result of their elevated rates of muscle dysmorphia, were more likely to engage in compulsive exercise.
We also located a study that indicated that nonbinary and GNC individuals had higher rates of binge eating, and therefore, were at a higher risk of food addiction relative to both TM and TF. While there is a clear need for more studies that characterize behavioral addictions among the TGD community, there are also a number of unique concerns that make this area of research particularly challenging. After all, PG is currently the only behavioral addiction with diagnostic criteria included in the DSM-V. Of the remaining behavioral addictions, researchers utilized differing sets of diagnostic criteria that may not measure the same addiction outcome. As a result, this absence of a single, uniform set of diagnostic criteria makes it particularly challenging to compare results from one study to another. It has also been purported that stigmatization of transgender populations may result in provider bias that ultimately impacts prevalence estimates. In fact, one study suggested that transgender individuals, when compared to cisgender populations, are less likely to receive a diagnosis of sex addiction as a result of the general perception of sex positivity among the LGBTQ community . While future studies are likely to provide further insight into the susceptibility of TGD subgroups to behavioral addictions, it is also important that future researchers acknowledge and account for the inherent challenges associated with this area of study. Through our analysis of TGD addiction rates, we also identified several important yet overlooked areas of research that deserve additional investigation.
For instance, while we only identified a limited number of studies that examined co-occurring addictions as a function of gender identity, it became apparent that substantial differences existed between various addiction subtypes. For example, two studies, which examined the co-occurrence of non-medical prescription opioid use with other substances, concluded that TGD individuals with a history of NMPO use were over twice as likely to report both cannabis and nicotine use; however, rates of alcohol use remained unchanged as a function of NMPO use . Several studies also investigated whether HIV status was significantly associated with a transgender individual’s risk of abusing a particular substance. As demonstrated in the co-occurring addictions example, associations differed markedly based on which addiction subtype was being analyzed. For example, TW who were HIV+ were more likely to use methamphetamine, while those who were HIV- were more likely to use alcohol; additionally, cannabis use remained unchanged regardless of one’s HIV status. Through understanding the degree to which certain addictions co-occur with other addictions or disease states, clinicians may be more effective in their efforts to screen at-risk GM patients and provide appropriate interventions.In addition to investigating co-occurring addictions, future studies should also consider additional methods of stratification when analyzing TGD populations.