Trans people more likely to get Long COVID

A friend asked me recently if COVID is still dangerous. I tried to make the case for why I wear a mask in grocery stores, trains, hospitals, etc. Unlike most people I know, I haven't gotten the flu this winter. Like, even if you aren't worried about COVID, it's nice to not be constantly ill?

But I have a personal and fact-based reason to avoid COVID as well.

A selfie of Rey wearing a mask on a cable car

I got COVID in summer 2024. I was ill with flu-like symptoms for about a week. I had asthma symptoms, breathing difficulties, and difficulty walking around for about four weeks. It's hard to explain, but it felt like walking to the bathroom was a massive endeavor. While my legs could physically do it, going anywhere took so much out of me.

We were camping in the van out in the wilderness at the time, so I didn't have reasonable access to my doctor, or Paxlovid, or anything other than drinking a lot of fluids and lying down all day.

I'm lucky that I had the opportunity to rest and recover for weeks. I had learned from experts in recovering from chronic illness that pacing, not overexerting, is crucial. I'm grateful that I recovered at all - I was wondering if I would be disabled in that way for years or perhaps the rest of my life. Some people I know personally are still experiencing serious symptoms from COVID infections years later.

While I hadn't had any vaccines shortly before falling ill, I suspect that without my five previous COVID vaccine shots, I would have felt much worse. If I had gotten COVID in 2020, I might not have recovered.

So yeah, that's why I still wear a mask in crowded public spaces. I'd prefer not to be sick for four or more weeks at a time, with a chance of never getting better.

A selfie of Rey wearing a mask in a bookstore, holding a copy of American Breakdown by Jennifer Lunden

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It's Long COVID Awareness Month!

March is Long COVID Awareness Month, and one thing I wanted to raise awareness about is that trans people are more likely to experience Long COVID symptoms.

Long COVID includes immune dysregulation and secondary conditions such as autoimmune disease, cognitive impairment, cardiovascular disease, ME/CFS, and more.

One survey by the CDC showed over 27% of transgender adults have experienced Long COVID, compared with over 13% of cisgender men and over 21% of cisgender women. That's around twice as many trans people as cis men with Long COVID!

However, a 2025 study found no evidence associating Long COVID with hormone replacement therapy, supporting prioritizing gender-affirming care.

Anecdotally, trans people have trouble accessing quality medical care because many providers don't want to treat "complicated" cases of people who are both trans and have chronic, poorly understood conditions.

Children are also affected by Long COVID, and as we support the health and safety of gender-diverse children, reducing COVID infections seems important as well. Air purifiers in classrooms can help.

A photo of Rey wearing a mask, sitting in an airplane seat, holding a small, cute rubber duck

Gender-affirming care and Long COVID

Being trans and accessing medical care can be challenging. Inclusive and gender-affirming healthcare providers are rare. It's even harder for people who are also disabled with chronic conditions, and for people who are marginalized by racism.

Long COVID and other chronic conditions can make it difficult to access gender-affirming care. A trans woman shared her experience on a survey:

“Long COVID made me so sick I couldn't do things like go to the doctor, and my [gender-affirming hormone therapy] was disrupted for a while.... It kind of hurts seeing people get back to life ‘as normal’ while my life has been trashed. It has also been a uniquely isolating experience as a trans woman... I have had more trouble with misgendering since being sick. I don't know, I guess I don't look as femme when I am haggard from illness and can't take care of my appearance.”

—survey response shared by Trans Health Research, a team within the Department of Medicine at the University of Melbourne

Wearing a mask to get sick less often

It's uncomfortable to wear a mask in the US. And I don't mean the physical experience of having a covering over nose and mouth.

When I wear a mask, often the first question is, "Are you sick?"

I've learned to defend myself by preemptively saying, "I'm not sick, just being careful."

Same with if I post a photo online of me wearing a mask. The comments come in, "Are you sick? Is everything okay?"

I used to find it offensive that people would assume I'd just go meet with them if I was sick, wearing a mask. I take more care than that. Now I'm just used to the assumption.

It's a strange feeling to look around an auditorium of 100 people and be the only person wearing a mask. This happened to me this week at a work event. A second person wearing a mask arrived later. I felt comforted.

It's not that different from the way I sometimes feel about being gender non-conforming. It's not like I'm doing something wrong by wearing a mask, or men's clothes, or cutting my hair short, but it kinda feels that way when I'm in public.

I feel lucky and grateful to be able to attend doctors appointments, travel, check out books in stores and libraries, and get together with friends. Wearing a mask in crowded social situations helps me maintain the life that I want to have.