A new report that looks at health disparities between Americans who are cisgender and those who are transgender finds that trans Americans are feeling a lot less healthy.

Data-based insight into the lived experience of transgender Americans have only just begun to surface in recent years. Access to data is a core reason for this, as it is estimated that 0.6 percent of the population identifies as trans, meaning that random samples of the U.S. population often need to be fairly massive in order to reveal statistically significant findings. Additionally, major surveys such as the U.S. Census don’t yet include data on gender identity.

But it’s still a large group of Americans at 1.4 million, together making up a larger percentage of the country’s population than the sole population of 14 U.S. states. At present, the largest study of transgender Americans, conducted by the National Center for Transgender Equality last year, looks at data from under 28,000 respondents. This new report is based on data from the Behavioral Risk Factor Surveillance System, a survey sponsored by the Centers for Disease Control and Prevention that covered 1,443 people who did not identify as cisgender out of 315,893 people in total.

The report shows that health problems, ranging from concentration problems to weight troubles, affect transgender adults at a disproportionate rate. While the study does not delve into the reason for this, estrogen hormone therapy is known to cause weight gain for some people. Weight gain and concentration difficulties can also be the result of depression, which transgender Americans are also more likely to suffer from.

High depression rates among transgender individuals has been well-documented, often only after the situation has taken a tragic turn. According to the Williams Institute, the rate of suicide attempts for transgender Americans is more than eight times higher than in the general population.

Perhaps the most significant finding within the report is that the transgender adults surveyed were less likely to have health insurance. This is something likely tied to the disproportionately high rates of poverty and unemployment within the community, as the primary source of health insurance coverage for people in the U.S. is through individuals’ employers.

And for transgender Americans who are receiving health insurance, there are still issues they face in receiving health care. Past surveys have revealed they can have difficulty attaining even routine services, like physicals. Over 30 percent also reported having negative experiences with health care providers related to their gender identity.

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This issue could be exacerbated by the proposed American Health Care Act, which would not include the Obama-era protections banning sex discrimination. Those protections made it illegal for healthcare providers to deny patients treatments like hormone therapy. The National Center For Transgender Equality also notes its concern that gender dysphoria, which refers to a conflict between a person’s physical or assigned gender and their self-identified gender, could be considered a preexisting condition. Scientists recently found that dysphoria is not the result of a hormonal imbalance but rather is a psychological condition in its own right.