Since 2022, the NIH has spent less than $150k studying medical transition

how the world's largest public funder of health research fails queer people

Source: Reddit

The United States National Institutes of Health (NIH) is the largest public funder of biomedical research in the world with an annual budget of $48 billion. Most of that money goes to funding health research in a variety of bioscience fields. Yet, since 2022 it has allocated only $131,247 to study medical gender transition, according to a public database of NIH funded research projects (RePORTER). This sum has funded a single project that seeks to understand how the vaginal microbiome changes during masculinizing hormone therapy.¹

This low figure is in spite of a Notice of Special Interest (NOSI) which calls for research on “the health of sexual and gender minority populations.” This jargon is biomedicine-speak for LGBTQIA2S+ folx. A NOSI functions to alert the research community to funding opportunities and easily identify applications that fall under its purview. The current NOSI on queer health was issued in 2022, replacing an expired notice on the same topic from 2019.

Importantly, this NOSI is broad, meaning that many possible projects would fit under its umbrella. A search of RePORTER for projects funded under the 2022 NOSI reveals that NIH has committed just over $12 million, including the $131,247 on transition-related health (~1% of the total funding thus far).

Of projects funded under the NOSI, the most money has been awarded to projects studying the behavioral health of queer people, particularly addiction. In fact, $3.8 million has been steered toward the Helping to End Addiction Long-term (HEAL) Initiative, an NIH-wide effort to address the ongoing opioid epidemic. Clearly, queer people are not the only population to suffer from high rates of addiction, but targeting interventions to queer folx is likely to have greater changes of long-term success. Notably, however, the specific HEAL projects funded under the queer health NOSI are not specifically targeted toward queer communities.

The second largest funding area under the queer health NOSI concerns training scientists (over $3.4 million in total funding spread across 19 projects). Specific support for queer scientists and other minoritized scientists is critical given broad systemic inequalities. Yet, once again, the training projects funded under this NOSI are not specifically targeting queer populations. To be clear, these projects are critical for ensuring that the bioscience workforce is diverse. However, the addiction and training projects (totaling over $7 million) raise critical questions about how effective the NOSI is in actually serving queer populations.

Importantly, the NIH is comprised of 27 independent institutes which individually handle funding applications. This means that different institutes will interpret a NOSI differently given their distinct funding priorities. This appears to be the case given that some institutes, like the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), have only funded training projects under the current queer health NOSI.

Further, the NIH only funds external projects that are formally proposed in a grant and then approved by peer reviewers. Therefore, the process itself may be the site of underfunding. For example, the dismal funding numbers could result from scientists being unwilling to propose research into queer populations and/or peer reviewers viewing investigations of queer health as unimportant (despite the NOSI).

The NIH does not provide data on projects that do not receive funding, so it is impossible to definitely identify the source of underfunding. However, a 2014 study on the rate of NIH funding for queer health projects found systemic underfunding which “contributes to the perpetuation of health inequities.”

NIH funding is critical to fund health research given its large budget. Academic researchers primarily rely on public funding to power their research. A single research study is incredibly expensive, and national governments (and a few private foundations) are some of the only entities with the resources and interest to foot the bill.

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Funding for queer and trans health research is paramount given our current political moment. A common refrain of anti-trans activists concerns a purported lack of evidence that gender affirming care is efficacious. This assertion is wrong on its face as it employs a logical fallacy — the absence of evidence is not evidence of absence. But, it also ignores the studies demonstrating improved outcomes that do exist² as well as the lived experiences of queer and trans people. These “concerns” around affirming care are bad faith expressions of transphobia and that no amount of evidence will satisfy the most hard-headed anti-trans activists.

However, understanding medical transition is also a critical research goal. Often, this research can overturn long-held assumptions about human biology which center chromosomal sex as the paramount site of gendered differences, such as in the functioning of the immune system. With these improved insights into physiology, all humans will benefit regardless of gender identity or sexuality.

Nature: Masculinizing testosterone therapy affirms more than meets the eye

Screen shot from the NIH RePORTER showing total funding for queer health from 2008-present. The data begins in 2015 when queer health was formally recognized as an area of NIH research interest.

Despite the imperfect NOSI, the NIH is funding more projects around queer health than ever before, doubling the funding amount since 2015. However, the increase has not been linear. In 2019 (under the first Trump administration), the NIH cut funding for queer health. It remains to be seen whether a similar drop in funding will occur under the second Trump administration and his chosen NIH director, Jay Bhattacharya.

1. Admittedly, this sounds really interesting, and I can’t wait to see the results when they are ready!

2. The 8th edition of the World Professional Association of Transgender Health Standards of Care has 68 pages of references.