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Healing, Strengthening, and Advancing the Lives of LGBTQ People Seeking Recovery

Transgender Sex Work: Why It Happens And How Rehab Centers Can Help

As much as 13% of the transgender community reports participating in sex work. At the same time, transgender individuals have high rates of alcohol use (estimates up to 72%), marijuana use (estimates up to 71%), hard drug use (estimates up to 34%), and prescription drug misuse (estimates up to 26.5%). 

What’s the connection between transgender sex work and substance abuse? And what can rehab centers do to better meet the needs of this group?

Read to learn why trans people get involved in this kind of labor. In addition, we’ll look at the role substances play in sex work. We’ll finish by looking at what rehab centers can do to improve access to treatment for trans sex workers. 

Why Transgender Sex Work Happens

Transgender people face discrimination on systemic, institutional, and interpersonal levels. As a result, studies have found that many transgender people (especially trans women) view sex work as their only viable career option. In fact, it’s one of the few vocations where supply and demand work in their favor. 

That being said, sex work tends to be riskier for trans people than for cis-gendered people. That’s because trans sex workers are more likely to work on the street, engage in unprotected sex, and use drugs with clients. Despite these added risks, trans sex workers earn less than other sex workers. As a result, many find themselves trapped in a cycle of homelessness, abuse, and drug use.  

Explanation Of Substance Abuse

Some of the same factors pushing trans people into sex work also explain their substance abuse. To put it simply, trans people deal with discrimination on a daily basis just for being who they are.

In fact, a study by the National Center for Transgender Equality explained that transgender individuals experience “devastating levels of discrimination in every aspect of life.” Notably, they experience high levels of homelessness, unemployment, and violence. 

Mental health challenges are also common in the transgender community. One study found that 44.1% of trans people suffer from clinical depression. Thirty-three percent experience anxiety. Another survey found that 42% of trans respondents had tried to commit suicide at least once. 

Homelessness, unemployment, violence, and mental health challenges touch most trans people, whether they engage in sex work or not. Read on to learn more about the specific aspects of sex work that contribute to substance abuse.

Trans Sex Work And Substance Abuse

Not all sex workers use drugs. And not all drug users turn to sex work to finance their habit. That being said, there’s usually some overlap between the two. Indeed, the U.S. Department of Justice noted that “street prostitution and street drug markets are often closely linked, supporting and reinforcing one another.”

This is especially true when it comes to trans sex workers. Keep reading to see why trans sex workers turn to substances. 

Substances As A Coping Mechanism

Using substances as a coping mechanism is common for many LGBTQ people. Especially in the case of trans sex workers. As an example, participants in a study of transgender sex workers in San Francisco reported using drugs and alcohol as emotional armor to get through the day.

Substance Use To Improve Job Performance

Many trans sex workers see a link between their substance use and their job performance. Participants in one study noted that their substance use (particularly cocaine and crystal meth) helped increase stamina. Another study found that some customers expect transgender sex workers to get high with them.

Substance Use Due To Fear of Violence 

In general, sex work is risky. It’s an industry where physical and sexual assault, robbery, and even murder are possible.

When it comes to transgender sex work, the risks are even greater. Compared to other sex workers, trans people are more likely to work as street-level prostitutes, something that exposes them to more violence. A study conducted in Washington, DC highlights this reality well. 

The study polled 100 female, male, and transgender inner-city street prostitutes in the city. Transgender respondents reported high levels of physical assault (65.4%). In addition, a high proportion had been threatened by a weapon (88%).

In another study, trans sex workers reported harassment and physical violence by the police due to their gender identity. Many also reported extortion (engaging in sexual favors to avoid arrest), rape, and beatings.

Given their terrifying daily realities, substance use is understandable. Indeed, a study about fear and drug use found that higher perceived levels of fear were correlated with higher rates of substance use.

Barriers to Medical Care 

Given the precarity and risk associated with trans sex work, one would hope for some understanding from the medical community. But that’s not quite the case.

Many trans people report insensitive behavior from health care providers. Such behaviors include misgendering, deadnaming (using a trans person’s given name rather than their chosen name), and even verbal or physical abuse at their doctor’s office.

These findings are terrible, but it gets worse. Most of the people who reported discrimination were “young, white, college-educated people with jobs and private health insurance.” Trans people with less privilege are even more likely to experience discrimination during treatment. 

This fear of mistreatment means that trans people, and especially those who feel stigmatized, delay seeking treatment for even minor medical issues. 

Stigma In Rehab

The same issues come up when trans people seek substance abuse treatment. That’s because the majority of treatment facilities don’t have the experience or the infrastructure to accommodate the needs of trans clients. 

Trans people are often excluded from these programs. If allowed entry, they’re usually grouped with lesbian, gay, and bisexual (LGB) clients. It’s certainly better than nothing, but mixing all LGBTQ people together isn’t the best solution. 

LGB people have distinct reasons for abusing substances. In many cases, they’re not the same reasons behind transgender substance abuse. As a result, trans people may not feel like their experiences are validated in treatment. This leads to feelings of isolation and exclusion during the recovery process.

These challenges mean poorer treatment outcomes. As an example, a study of 34 transgender people found that those who were subject to stigma and transphobia “left treatment prematurely after isolation and conflicts.”

Improving Access To Treatment 

With substance abuse rates as high as they are in the trans population, treatment centers should dedicate more resources to this group.

At the most basic level, transgender people require culturally competent providers. Clients should never have to train providers about healthcare needs. That’s even truer for a group as maligned as transgender people. 

To that end, here are steps to take in order to improve substance abuse treatment for transgender clients. 

  • Address Trans-Specific Issues Behind Substance Abuse –  Treatment must address the unique issues that put this group at a greater risk for substance abuse. Examples include family rejection, lack of social support, stigma, abuse/harassment, and minority stress. 

Only by acknowledging these challenges can trans people understand their substance abuse and learn healthier coping methods. 

  • Use Correct Language – When working with trans clients, providers should introduce themselves using their name and their pronouns. More importantly, providers should ask clients which pronouns they use.

Using the wrong pronouns with trans clients (a term called ‘misgendering’) is demeaning. What’s more, it can make trans people feel like their identity isn’t valid or respected. 

  • Improve Office Infrastructure – When working with trans clients, honor their self-identified gender when it comes to bathrooms and housing. Forcing clients to use facilities that align with their birth gender may add to the stigma they feel.  
  • Help Administer Hormones – During admission, always ask transgender clients about any hormone replacement therapy (HRT) they’re on. For many, continuing with HRT is an essential part of affirming their identity. As such, HRT should continue during treatment. 

La Fuente’s Commitment To The Trans Community

La Fuente is one of the nation’s only LGBTQ-affirmative substance abuse treatment centers. We’re dedicated to providing culturally competent care to all members of the LGBTQ community. 

More specifically, we understand that drug and alcohol addiction treatment for trans people begins by understanding and honoring their journey leading up to admission. 

We offer full-service care—detoxification, residential, outpatient, and sober living. Our clinical program uses evidence-based treatment including:

  • Motivational interviewing 
  • Dialectical behavioral therapy (DBT)
  • Cognitive behavioral therapy (CBT)
  • Therapeutic yoga
  • Relapse prevention therapy

In short, we work to stay on the cutting edge of LGBTQ-affirmative treatment so our clients achieve long-term sobriety. 

If you, or someone you love, is part of the transgender community and is struggling with substance abuse, fill out the contact form below. 

A member of our staff will respond in less than 24 hours and help you decide if our Los Angeles addiction treatment center is right for you. 

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