Dynamics in Health and Employment Before and After Transgender Transitioning: Evidence from Dutch Administrative Data

Abstract

Transgender individuals on average have worse socioeconomic and health outcomes. This paper studies to what extent important socioeconomic and health outcomes change before and after gender transitioning. Using individual-level administrative panel data from the Netherlands over the period 2015-2022, we identify over 7,000 legal gender transitions through birth certificate gender marker changes. Data on health care utilization and employment are also drawn from administrative records. Using an event study approach with a sample of the general population serving as controls, we often find important differences between those transitioning female-to-male (FTM) versus male-to-female (MTF). For those transitioning FTM, we find large improvements in labor market outcomes afterwards, which we do not observe for those transitioning MTF. For both groups, antidepressant use increases in the years preceding a legal gender transition. However, after transitioning, antidepressant use decreases for FTM but not MTF. The results provide information about how important outcomes vary before and after legal transitions, and confirm that there can be meaningful differences between those transitioning FTM versus MTF. Joint work with John Cawley and Hans van Kippersluis.