Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Epidemiology and Biostatistics


Greta Bauer


The purpose of this dissertation was to develop an understanding of, and draw attention to, the health and service access issues faced by trans (transgender, transsexual, or transitioned) Ontarians. This thesis is based on the Trans PULSE Project, a community-based research (CBR) initiative whose goal is to improve the health of trans people. Data collection was carried out between May 2009 and April 2010 using a quantitative survey. Trans participants were recruited through respondent-driven sampling (RDS), a network-based sampling method developed for the recruitment of hidden populations. Weighted prevalence estimates and 95% confidence intervals were calculated for all variables of interest using methods that compensate for non-random recruitment patterns. The first manuscript outlines the lessons learned from doing participatory doctoral research, and provides a guide for students in the form of key recommendations. The second manuscript assessed the prevalence of and risk factors for depression among male-to-female (MTF) and female-to-male (FTM) Ontarians. Our findings indicate that depression is widespread among MTFs and FTMs. Furthermore, multivariable regression analyses revealed that the risk factors associated with depression varied between MTFs and FTMs in Ontario. This research is a first step in understanding the complex mental health issues of a highly marginalized community.

The third manuscript characterized and examined the extent of “do-it-yourself” transitions among trans people in Ontario. While self-performed surgeries and current use of non-prescribed hormones were uncommon, this study indicates that trans people’s experiences with providers may have played a role in their willingness to seek hormones from non-medical sources. Lastly, the fourth manuscript explored the long-term positive and adverse health effects associated with hormone use and SRS. We found no evidence that hormone use among MTF and FTM people in Ontario conferred negative effects on health. While some conditions were relatively common (sleep apnea, high cholesterol, and hypertension), almost all other outcomes were rare. These results are informative and may provide health care providers with the knowledge to make more informed treatment and screening decisions. More specifically, our findings show that the fear of “doing harm” by prescribing hormones to trans people is likely unfounded.

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