Intersectionality and trans people: when discriminations compound

In 2024, 88% of trans people killed worldwide — monitored by TGEU in its Trans Murder Monitoring — were people of color [8]. Ninety percent were trans women or transfeminine individuals [8]. This is not a coincidence. It is not a statistical fluke. It is the result of what happens when multiple forms of marginalization converge on the same person: racism, transphobia, sexism, poverty. These forces do not add up arithmetically. They intertwine, amplify each other, and produce something different from the simple juxtaposition of their parts.

To describe this phenomenon, there is a precise concept: intersectionality. And for trans people, it is not an abstract theory. It is the difference between living in difficulty and living in danger.

What is intersectionality

The origins of the concept

The term “intersectionality” was coined in 1989 by jurist and academic Kimberle Crenshaw in an essay published in the University of Chicago Legal Forum: Demarginalizing the Intersection of Race and Sex [1]. Crenshaw was not constructing an abstract theory: she was analyzing concrete court cases in which Black women had sued for discrimination and the courts had dismissed the claims because they did not fall into either the “racial discrimination” or “sexual discrimination” category [1].

The problem was structural: the legal system was designed to recognize only one axis of oppression at a time. If a company hired women (white ones) and men (Black ones), it could claim it discriminated neither on the basis of sex nor race — even though it hired no Black women. The specific experience of Black women fell into a crack between categories.

Two years later, in 1991, Crenshaw deepened the concept in Mapping the Margins, analyzing how violence against women of color is systematically undervalued by both feminist movements (which tend to center the experience of white women) and antiracist movements (which tend to center the experience of Black men) [2].

Beyond the sum of the parts

The central insight of intersectionality is that identities do not add up like numbers [1]. A Black, disabled trans woman does not experience “transphobia + racism + ableism”: she experiences a specific form of oppression that arises from the intersection of all these factors and cannot be understood by decomposing it into its parts. It is like the difference between looking at individual ingredients and tasting the dish: the result is qualitatively different from the list of components.

This means that responses — legal, healthcare, social — must be designed taking these intersections into account, not isolated categories. An anti-discrimination policy that protects “trans people” in the abstract, without considering that a migrant trans woman faces radically different barriers than a trans man with citizenship and a degree, risks working only for those who already have the least need for protection.

Being trans and belonging to an ethnic minority

The data: a disparity within disparity

The most comprehensive data on intersections between trans identity and ethnic belonging come from the U.S. Transgender Survey (USTS). The 2015 study, with over 27,000 participants, and the 2022 study have documented profound differences within the same trans community [3][4].

In the 2015 survey, the poverty rate among trans people overall was three times that of the general U.S. population (29% versus 12%) [3]. But when disaggregated by ethnicity, the picture worsened radically: 42% of trans people of color lived in poverty, compared to 23% of white trans people [3]. For Black trans women, the figure rose even higher. Unemployment followed the same pattern: 20% overall among trans people, but up to 35% among Native American trans people [3].

In healthcare, 33% of Black trans people interviewed had foregone medical care in the previous year for fear of discrimination, compared to 23% of white trans people [3]. Forty-one percent had experienced mistreatment in healthcare settings, compared to 29% [3].

Disparities in mental health follow the same pattern. The minority stress model — theorized by Ilan Meyer and confirmed by a 2023 European systematic review [7] — predicts that cumulative exposure to multiple sources of stigma produces a mental health impact that exceeds the sum of individual exposures. Trans people of color, simultaneously exposed to transphobia and racism, show higher rates of depression, anxiety, and suicidal ideation compared to both white trans people and cisgender people of the same ethnic minority [13].

Violence: who gets killed

Data on lethal violence against trans people is where intersectionality stops being an academic concept and becomes a matter of life and death.

The Trans Murder Monitoring by TGEU, the most systematic monitoring of trans murders globally, documents year after year a constant pattern: victims are overwhelmingly trans women, of color, young, often in poverty or involved in sex work [8]. In the 2025 report, 88% of victims whose ethnic background was known belonged to minorities [8]. Ninety percent were trans women or transfeminine individuals [8]. The median age was under 30.

These numbers do not describe a generic “at-risk community.” They describe a specific profile: the trans person most vulnerable to lethal violence is young, of color, poor, and often without regular documentation. Each additional factor of marginalization does not add a risk: it multiplies the existing one.

The history of the trans movement is marked by this reality. Marsha P. Johnson and Sylvia Rivera — central figures in the 1969 Stonewall riots — were both people of color from lower socioeconomic backgrounds. The people most exposed to violence have often also been the most determined in fighting for everyone’s rights.

Being trans and having a disability

Double invisibility

Trans people with disabilities face what researchers call “double invisibility”: invisible within the trans community, where discourse tends to center the experiences of able-bodied people, and invisible within the disability community, where heteronormativity and cisnormativity are often taken for granted.

This invisibility has practical consequences. Gender identity centers — in Italy and elsewhere — are often physically inaccessible for people with mobility disabilities, or lack staff trained to communicate with deaf people or people with cognitive disabilities. Standard procedures for gender affirmation pathways presuppose an ability to navigate the healthcare and bureaucratic system that does not account for the additional barriers a disabled person must face.

The 2015 USTS found that 39% of trans people with disabilities lived in poverty, compared to 24% of trans people without disabilities [3]. Trans disabled people were also significantly more likely to have experienced physical violence (18% versus 9% in the year preceding the survey) and to have attempted suicide (54% over their lifetime, compared to 38% of trans people without disabilities) [3].

Access to gender affirmation pathways

For trans people with disabilities, access to transition pathways presents specific obstacles. In Italy, where waiting lists at gender identity centers can exceed 18 months, a person with a mobility disability might have to travel hundreds of kilometers to specialized centers that are not equipped to accommodate them. A person with an intellectual disability might be denied access to hormone therapy because the protocol requires informed consent that the system is unable to adapt to their needs.

The WPATH Standards of Care version 8 (2022) explicitly recognize the need for individualized approaches for trans people with disabilities, recommending that physical, sensory, and cognitive barriers not be used as grounds for exclusion from care pathways, but be addressed with reasonable accommodations [9]. The gap between this recommendation and everyday clinical practice, however, remains wide.

Being trans and poor

Social class as a determinant

Social class is perhaps the most underestimated axis of intersectionality in the discourse on trans rights. The transition pathway in Italy is formally free through the NHS. In practice, real costs are often significant.

Public service waiting lists — documented in detail in the article on the situation of trans people in Italy — push those who can afford it toward the private sector: endocrinologists, psychologists, surgeons. The costs of hormone therapy followed privately, while variable, amount to several hundred euros per year. Surgical procedures not covered or partially covered by the NHS can reach five-figure sums. For trans people living in poverty, these figures represent an insurmountable wall.

But the problem is not just the cost of transition. It is the vicious cycle between employment discrimination and poverty. As documented by the ISTAT-UNAR 2023 survey, one in two trans people in Italy has experienced discrimination in job searching [6]. 46.4% gave up applying for a job they were qualified for [6]. The unemployment rate for trans people is estimated at up to five times the national average.

Employment discrimination produces poverty. Poverty prevents access to private care when public care is unavailable. The inability to complete transition prevents document rectification. Incongruent documents fuel employment discrimination. The spiral closes.

Sex work as an outcome of economic marginalization

A 2013 study published in PubMed systematically analyzed how systemic, institutional, and interpersonal discrimination pushes some trans women — particularly those of color and from lower socioeconomic backgrounds — toward sex work as a survival strategy [10]. It is not an identity choice: it is the consequence of the progressive closure of all economic alternatives.

In Italy, this dynamic has deep historical roots. In the 1970s and 1980s, for many trans women, prostitution was one of the few available means of livelihood. Today, alternatives are formally broader, but structural barriers — employment discrimination, lack of consistent documents, family rejection — continue to produce economic vulnerability, and this vulnerability is not distributed evenly: it disproportionately affects trans people who also belong to other minorities.

Being trans and a migrant

The specific condition of trans migrants

Trans migrants face a stratification of vulnerabilities that places them among the most exposed to violence and marginalization. In many countries of origin, being trans is criminalized or socially unsustainable: migration is often, before being a choice, an escape. But the destination country is not necessarily a safe harbor.

In Italy, a trans migrant person must simultaneously navigate the asylum system (with its slowness and uncertainties), the healthcare system (where access to gender affirmation pathways for people without citizenship or residency permits is often de facto impossible), and a social context where racism and transphobia intertwine.

Law 164/1982 allows legal sex rectification, but the process requires a lengthy and complex judicial procedure that presupposes a stable residence, a lawyer, and often a medico-legal evaluation — conditions that a person awaiting asylum or with a precarious residency permit rarely meets. The result is a documentary limbo that renders invisible the specific needs of trans migrants and exposes them to further discrimination.

Casa Caterina and existing resources

MIT (Movimento Identita Trans) in Bologna opened Casa Caterina in 2018, the first protected shelter in Europe specifically dedicated to trans refugees and asylum seekers [12]. The facility offers residential accommodation, legal support for asylum procedures, healthcare accompaniment, and employment integration. It is an internationally recognized best practice, but remains an exception: a single facility in a single territory for a need that spans the entire country.

Some local Arcigay chapters and the National Trans Network offer orientation services for trans migrants, but territorial coverage is fragmented. In southern regions and the islands, where a significant portion of migratory arrivals are concentrated, dedicated resources are virtually absent.

The UNAR National LGBT+ Strategy 2022-2025 mentions the need for specific interventions for LGBTIQ+ migrants, but without dedicated funding and with largely insufficient implementation [11].

The Italian context: North, South, and internal inequalities

The geography of transition

In Italy, the concrete possibility of living one’s gender identity depends significantly on where one is born and where one lives. The main gender identity centers — CIDIGEM in Turin, the C.A.R.E. Project in Florence, SAIFIP in Rome — are concentrated in the Center-North. For a trans teenager living in Calabria or Sardinia, accessing a gender affirmation pathway often means traveling hundreds of kilometers, with travel and accommodation costs entirely at their own expense.

This territorial disparity is not just a healthcare issue. It is a class issue. Families with economic resources can afford the travel, private appointments, and reduced waiting times of the private sector. Families without these resources — who are proportionally more numerous in the South — are trapped in waiting lists that can last years, with consequences on mental health, school and work life, and the very possibility of living authentically.

The Italian National Institute of Health, in its 2022 press release on gender health in the transgender population, highlighted a low level of healthcare prevention among trans people in Italy [15]. The figure is national, but regional disparities suggest the problem is particularly acute in areas with fewer dedicated services.

Transphobia and cultural context

The third FRA survey on LGBTIQ+ people (2024) placed Italy below the European average on several inclusion indicators [5]. Thirty-eight percent of Italian LGBTIQ+ people had experienced discrimination in at least one area of life in the year preceding the survey [5]. But the national figure hides significant regional differences.

The cultural context of the country’s more conservative areas — not necessarily coinciding only with the South, but often correlated with smaller centers and less exposure to diversity — produces a climate where coming out as a trans person carries greater social risks: family rejection, community isolation, violence. For trans people living in these contexts who also belong to other minorities (migrants, disabled, lower socioeconomic class), risks multiply.

Italian policy on trans rights reflects these tensions. The defeat of the DDL Zan in 2021 left the country without a specific law against hate crimes based on gender identity, making even more vulnerable the trans people who already face discrimination on other fronts [14].

Age as an intersectional factor

Trans adolescents

For trans adolescents, intersectionality manifests through dependence on the family unit. A trans adolescent living in an accepting, economically stable family in a large northern city has access to radically different resources than a peer living in a hostile family, in precarious economic conditions, in a small southern town.

International data are eloquent. The Family Acceptance Project demonstrated that LGBT youth with high family rejection are 8.4 times more at risk of suicide attempt. For trans adolescents who also belong to ethnic minorities or live in poverty, family rejection is statistically more frequent and support services less accessible.

In Italy, school represents a critical context: 66.1% of trans people whose identity was visible during their studies experienced discrimination, according to the ISTAT-UNAR 2023 survey [6]. For trans students who are also migrants or disabled, the school experience can become a trap from which it is difficult to escape without external support.

Trans elderly people

At the other end of the age spectrum, trans elderly people face a specific form of invisibility. Many lived most of their lives before coming out was socially possible and built relationships, families, and careers hiding their identity. Others undertook transition in eras when discrimination was even more pervasive and protections nonexistent.

Trans elderly people who need long-term care — in residential facilities, nursing homes, or through home services — often find themselves in environments where staff are not trained on gender identity and where the pressure to conform to the gender assigned at birth is strong. For trans elderly people who are also alone, poor, or disabled, the risk of a forced return to the abandoned identity is concrete.

Why the intersectional approach is necessary

The limits of the single-issue approach

An approach to trans rights protection that does not consider intersections with other forms of marginalization risks producing policies that work only for part of the community — typically the already less vulnerable part.

A concrete example: the alias career in the workplace, described in the article on employment discrimination, is a good practice that allows trans employees to use their chosen name in internal company contexts. But for a trans person who does not have a job — because they are a migrant without a permit, because they are disabled and lack targeted placement, because they live in an area with very high unemployment — the alias career is irrelevant. Their problem is upstream: accessing the labor market.

Similarly, an awareness campaign against transphobia that exclusively uses images and stories of white, young, able-bodied trans people communicates — implicitly — that trans people of color, elderly, or disabled people do not exist or do not matter. Not out of bad faith, but due to a deficiency of perspective that intersectionality allows to correct.

How intersectionality improves services

The WPATH Standards of Care version 8 (2022) explicitly integrate an intersectional perspective, recognizing that barriers to accessing gender-affirming care are unequally distributed and that treatment protocols must be adapted to each person’s specific conditions, including their position with respect to race, class, disability, and immigration status [9].

In practice, an intersectional approach to services for trans people means:

Collecting disaggregated data. It is not enough to know how many trans people experience discrimination. It is necessary to know who, among trans people, experiences more discrimination, and why. The ISTAT-UNAR 2023 survey represents an important step forward [6], but it does not disaggregate data by ethnicity, disability, or immigration status. Without these data, policies fly blind.

Designing accessible services. Gender identity centers must be physically accessible, culturally competent, and linguistically equipped. This means ramps and elevators, but also interpreters, cultural mediators, and staff trained on the specificities of trans migrants or disabled people.

Decentralizing the offering. The concentration of services in the Center-North systematically penalizes trans people residing in the South and islands, who also tend to have fewer economic resources for travel. Creating local outposts — even light ones, even in collaboration with associations — is a necessity, not a luxury.

Ensuring representation. The trans people who design services, who lead campaigns, who speak in the media should reflect the internal diversity of the community. Not because representation is an end in itself, but because those who do not see themselves represented tend not to access services.

Intersectionality in the Italian trans movement

Associations and the intersectional perspective

The Italian trans movement has begun to integrate an intersectional perspective, but the process is still underway. MIT in Bologna, with the opening of Casa Caterina for trans refugees, provided a concrete response to a specific intersectional need [12]. Arcigay’s National Trans Network, which in 2024 supported 899 people, includes legal accompaniment for asylum procedures and support for trans parenthood among its services, recognizing that trans people’s needs are not exhausted by medical transition.

Italian intersectional feminism, embodied by movements like Non Una Di Meno, has explicitly included trans women in its political platform, recognizing that the fight against patriarchy and the fight against transphobia are inseparable.

However, significant challenges remain. Associations operate with limited resources and often rely on volunteering. Specific training on intersectional issues — racism, ableism, classism within the trans community — is still not widespread. And the Italian public debate tends to treat “trans rights” as a monolithic block, without recognizing the enormous differences in conditions within the community.

What remains to be done

The picture that emerges from this analysis is clear: trans people are not a homogeneous group, and the policies that concern them cannot treat them as such. A Nigerian trans woman seeking asylum in Catania faces a radically different reality than a Milanese trans man with Italian citizenship and stable employment. Both are trans. Their needs, vulnerabilities, and accessible resources are incomparable.

Intersectionality is not an optional addition to the discourse on trans rights. It is the necessary condition for that discourse to be honest. Recognizing that the trans community is traversed by the same inequalities that traverse society as a whole — racism, ableism, classism, xenophobia — does not weaken the fight for trans rights. It makes it more lucid, more effective, and more just.

The available data — from the USTS [3][4] to the FRA surveys [5], from TGEU monitoring [8] to ISTAT-UNAR reports [6] — consistently document that intersections between trans identity and other forms of marginalization produce specific, measurable, and predictable vulnerabilities. This means they are also addressable, provided we are willing to see them.

Collect disaggregated data. Design accessible services. Listen to the voices of those living at the intersection. This is not idealism: it is the minimum requirement for policies that work for everyone, not just for those who already need the least help.