Researchers in São Paulo have found clear differences in relationship status, sexual partnerships and sex work between trans women and trans men attending a specialist clinic. The findings matter because they point to wider effects of stigma, employment barriers and social exclusion, while also showing why transgender healthcare needs to be practical, inclusive and free from judgement.

Essential Takeaways

  • Small but significant study: Researchers reviewed records for 74 adults at a specialist transgender clinic in São Paulo.
  • Relationship gap: 76% of trans women were single, compared with 44.9% of trans men.
  • Different partnership patterns: Trans women were more likely to report either no partners or more than 15 partners in the previous year.
  • Sex work disparity: 21.7% of trans women reported sex work, compared with 6.3% of trans men.
  • Similar sexual debut: The groups showed no statistically meaningful difference in their average age at first intercourse.

The findings reveal more than dating patterns

The headline result is striking: trans women in this clinic were considerably more likely to be single than trans men. Four in five trans women were not married, cohabiting or dating, compared with just under half of trans men.

That doesn't mean gender identity determines someone's ability to find a partner. Rather, the researchers argue that relationships are shaped by social acceptance, discrimination and the opportunities available outside the clinic. The wider transgender population also faces barriers to healthcare, housing and employment, according to background research cited in the study.

There is an important human detail here. A relationship statistic can look clinical on paper, but behind it may sit loneliness, fear of rejection or the exhausting effort of navigating everyday prejudice.

Sexual behaviour showed a more divided picture

Most participants who answered the question reported between one and five sexual partners during the previous year. Yet the results became more uneven at the edges: 16.7% of trans women reported no partners, while 11.1% reported more than 15.

Among trans men, the comparable figures were 4.3% and 2.2%. The study found that this difference was statistically significant, although the sample was small and the figures shouldn't be treated as a portrait of every trans woman or trans man in Brazil.

Researchers suggest the pattern may reflect different experiences, including social isolation for some people and exposure to sexualised or economically driven situations for others. As the wider literature on transgender health makes clear, behaviour needs to be understood alongside safety, consent, income and access to supportive services.

Why employment may be part of the story

Sex work was reported by 21.7% of trans women in the study, compared with 6.3% of trans men. The authors stress that sex work itself isn't automatically harmful, but say it can become linked to vulnerability when discrimination limits other ways to earn a living.

That context is particularly important in Brazil, where employment insecurity has been repeatedly reported as a major concern for transgender people. Recent coverage and labour-market analysis have pointed to very low rates of formal employment, reinforcing the study's argument that economic policy belongs in conversations about sexual health.

Put simply, a sexual-health strategy that focuses only on testing and condoms misses part of the problem. Safer work conditions, anti-discrimination enforcement, housing support and accessible mental-health services can all influence health outcomes too.

What healthcare teams can learn from the research

The study was based on routine records from a specialist service between March 2020 and August 2023. Clinicians collected information about relationships, sexual history, income sources and other social circumstances during consultations, using those details to tailor care.

That approach offers a useful practical lesson. Sensitive questions work best when they're asked respectfully, explained clearly and treated as part of ordinary healthcare rather than as a test of someone's lifestyle. Patients should also be able to skip questions without feeling punished or judged.

For services, the findings support more targeted care for trans women, including confidential sexual-health screening, contraception and reproductive advice where relevant, mental-health support, and referrals for social or employment assistance. Inclusive care isn't just a friendly extra; it can determine whether someone returns for help.

The results are valuable, but not the final word

The research involved only 74 people from one clinic, and not every participant answered every question. It also excluded non-binary people and relied on retrospective medical records, so the results can't be applied automatically to Brazil's entire transgender population.

Still, the study provides a useful warning against treating transgender people as one uniform group. The differences between trans women and trans men were visible across relationships, partner numbers and sex work, while age at first intercourse was broadly similar.

Larger studies across multiple clinics will be needed to test the pattern. For now, the message is fairly clear: improving transgender sexual health means tackling the social and economic pressures that shape people's choices long before they enter a consulting room.

Better data can lead to better care, but only if it is collected with trust and used with compassion.

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